Clinical Transplantation最新文献

{"title":"Association of Functional, Academic, Motor, and Cognitive Deficits in Graft Failure in Pediatric Liver Transplantation","authors":"Conor Donnelly,&nbsp;Suhani S. Patel,&nbsp;Ian S. Jaffe,&nbsp;Daniyar Akizhanov,&nbsp;Teresa Po-Yu Chiang,&nbsp;Jane J. Long,&nbsp;Luckmini Liyanage,&nbsp;Adam Griesemer,&nbsp;Dorry L. Segev,&nbsp;Allan B. Massie","doi":"10.1111/ctr.70132","DOIUrl":"https://doi.org/10.1111/ctr.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Predicting graft failure risk in pediatric liver transplantation (LT) recipients could identify areas for improving management. Persistent cognitive, motor, academic, and functional deficits are common in recipients and their impact on graft survival following LT helps inform risk prediction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using SRTR data 2008–2023, we evaluated the cognitive, motor, academic, and functional deficits of LT recipients at time of transplant to 14 years post-LT. We compared all cause graft failure (ACGF) among patients with versus without pre-LT and 1-year post-LT deficits using Cox regression, adjusting for recipient characteristics. We calculated an individual risk score for ACGF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 8062 pediatric LT recipients median age 3 (IQR: 1, 10), 28.0%, 29.5%, 35.0%, and 79.8% of recipients had pre-LT deficits in cognition, motor, academic activity, and functional status respectively. This decreased to 23.0%, 18.1%, 14.2%, and 38.7% 1-year post-LT. Increased hazard of ACGF was noted in recipients with pre-LT decreased functional status (aHR = 1.13 (per 10% decrease), 95% CI: 1.10–1.15, <i>p</i> &lt; 0.001), definite motor delay (aHR = 1.60, 95% CI: 1.21–2.10, <i>p</i> &lt; 0.001), and inability to participate in academics (aHR = 1.49, 95% CI: 1.08–1.89, <i>p</i> = 0.01), but not delays in cognition (aHR = 0.91, 95% CI: 0.69–1.21, <i>p</i> = 0.19). Our risk score predicting ACGF demonstrated improved predictive performance compared to clinical parameters alone (C-statistic = 0.70 (0.67, 0.72) vs. 0.66 (0.64, 0.69), <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pediatric LT recipients with pre- or post-LT motor, academic, and functional deficits are at higher risk for ACGF. Care should be taken to assess deficits to identify patients who may benefit from functional intervention to potentially reduce ACGF risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143726846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Utilization Rate in Solid Organ Donors ≥80 Years: The 7-Year Tuscany Experience","authors":"Chiara Lazzeri,&nbsp;Davide Ghinolfi,&nbsp;Lara Entani Santini,&nbsp;Arianna Precisi o Procissi,&nbsp;Daniele Cultrera,&nbsp;Adriano Peris","doi":"10.1111/ctr.70142","DOIUrl":"https://doi.org/10.1111/ctr.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Tuscany Region has a quite high annual number of donors per million population (100 donors/pmp (annually)). Considering the increasing donor age and organ shortage, the donation and transplantation community needs to expand procurement and transplants from elderly donors. We assessed the utilization rate in donors aged ≥80 years during the study period (2018–2024) in Tuscany.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our retrospective observational study comprised 809 donors aged ≥80 years. We compared Period 1 (from 2018 to 2020, before the COVID pandemic) to Period 2 (from 2021 to 2024, after the COVID pandemic).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>cDCD donors significantly increased in Period 2 (0.0001). The utilization rate increased from Period 1 to Period 2 (81.5% vs. 91.7%). In the study period (2018–2024), 377 liver transplants were performed. Overall graft and patient survival at 1, 3, and 5 years when an octogenarian graft was used was 89.4%, 85.0%, 81.8% and 92.5%, 88.7%, 85.5%, respectively. EAD (early allograft dysfunction) was observed in 2.9% of the cases, and IC (ischemic cholangiopathy) developed in 6.3% of the cases. Forty kidneys were transplanted into 22 patients, including 18 dual kidney transplants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>During the 7-year study period, donors aged ≥80 years represented a consistent subgroup, since they accounted for one-third of the overall donor population. The increase in utilization rate observed during the study period may be related to several factors, both in the procurement and the transplant phase.</p>\u0000 \u0000 <p><b>Trial Registration</b>: Clinicaltrial.gov: #NCT04744389</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Mobile Health System on Compliance With 2-Year Living Kidney Donor Follow-Up in the United States","authors":"Alvin G. Thomas,&nbsp;Sarah Hussain,&nbsp;Samantha B. Klitenic,&nbsp;Carolyn N. Sidoti,&nbsp;Madeleine M. Waldram,&nbsp;Amy Chang,&nbsp;Jennifer D. Motter,&nbsp;Kelly Terlizzi,&nbsp;Allan B. Massie,&nbsp;Mary Schofield,&nbsp;Karol Barstow,&nbsp;Adam Bingaman,&nbsp;Dorry L. Segev,&nbsp;Macey L. Levan","doi":"10.1111/ctr.70139","DOIUrl":"https://doi.org/10.1111/ctr.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Organ Procurement and Transplantation Network (OPTN) policy requires 2 years of follow-up for living kidney donors (LKDs); however, many transplant hospitals struggle to meet this requirement. We developed and tested a mobile health (mHealth) system for LKD follow-up in a pilot randomized-controlled trial (RCT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>LKDs were randomly assigned to either the intervention (mHealth + standard of care) or control arm (standard of care). We assessed OPTN policy-defined completeness and timeliness of 6-month, 1-year, and 2-year follow-ups. Four hundred LKDs were enrolled in the study (June 2018 to February 2021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 6-month follow-up, a higher proportion of the intervention arm participants completed composite visits (97.5% vs. 91.5%, <i>p</i> = 0.01). Both arms had similar compliance rates at 1- and 2-year follow-up (92.0% vs. 89.5%, <i>p</i> = 0.49, and 66.5% vs. 65.0%, <i>p</i> = 0.83). Intervention arm participants completed 6-month follow-up 11 days earlier than their counterparts (<i>p</i> = 0.009).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>mHealth technologies improved 6-month follow-up, but did not impact 1- and 2-year LKD follow-up in this single-center RCT. Other strategies, such as providing services beyond data collection, may be necessary to improve donor engagement and support LDK's long-term follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated CT Image Processing for the Diagnosis, Prediction, and Differentiation of Phenotypes in Chronic Lung Allograft Dysfunction After Lung Transplantation","authors":"Stefan Kuhnert,&nbsp;Nermin Halim,&nbsp;Janine Sommerlad,&nbsp;Henning Gall,&nbsp;Athiththan Yogeswaran,&nbsp;Fritz C. Roller,&nbsp;Gabriele Krombach,&nbsp;Martin Reichert,&nbsp;Ingolf Askevold,&nbsp;Andreas Hecker,&nbsp;Christian Koch,&nbsp;Werner Seeger,&nbsp;Konstantin Mayer,&nbsp;Oliver Weinheimer,&nbsp;Matthias Hecker","doi":"10.1111/ctr.70137","DOIUrl":"https://doi.org/10.1111/ctr.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic lung allograft dysfunction (CLAD) after lung transplantation is a common complication with a poor prognosis. We assessed the utility of quantitative computed tomography (CT) for the diagnosis, prediction, and discrimination of CLAD phenotypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed routine inspiratory and expiratory CT scans from 78 patients at different time points after lung transplantation. Mean lung density (MLD), parametric response mapping (PRM), percentage of air trapping, and airway wall morphology parameters were calculated using the image processing software YACTA. Diagnostic and predictive utility was determined by receiver operating characteristic analysis and Pearson correlation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Markers of air trapping showed promise for the diagnosis and prediction of bronchiolitis obliterans syndrome (BOS); for example, expiratory MLD showed areas under the curve (AUCs) of 0.905 for diagnosis and 0.729 for 1-year prediction. For diagnosis of CLAD with mixed phenotype, peripheral measurements (e.g., PRM of peripheral functional small airway disease: AUC 0.893) were most suitable. Markers of airway thickening (e.g., expiratory wall thickness at an inner perimeter of 10 mm: AUC 0.767) gave good diagnostic values for the undefined phenotype. CT biomarkers differed significantly among CLAD phenotypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Different CT biomarkers are suitable for the diagnosis of CLAD phenotypes, prediction of BOS, and differentiation of CLAD phenotypes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Dynapenia on Short-Term Changes in Handgrip Strength Among Japanese Kidney Transplant Recipients: A Cross-Sectional Study","authors":"Masatoshi Matsunami,&nbsp;Tomo Suzuki,&nbsp;Yayoi Takanashi,&nbsp;Teruaki Koshiba,&nbsp;Atsuhiko Ochi,&nbsp;Hiroshi Kuji,&nbsp;Jun Yashima","doi":"10.1111/ctr.70138","DOIUrl":"10.1111/ctr.70138","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Utility of the GAP Score in Interstitial Lung Disease Patients Evaluated for Lung Transplantation: A Single-Center Study","authors":"Víctor M. Mora-Cuesta,&nbsp;Javier Zuazaga-Fuentes,&nbsp;David Iturbe-Fernández,&nbsp;Sandra Tello-Mena,&nbsp;Sheila Izquierdo-Cuervo,&nbsp;Pilar Alonso-Lecue,&nbsp;José M. Cifrián-Martínez","doi":"10.1111/ctr.70136","DOIUrl":"10.1111/ctr.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lung transplantation (LT) is a critical option for patients with advanced respiratory diseases, especially interstitial lung diseases (ILD). The GAP score (Gender, Age, Physiology) has shown prognostic value in idiopathic pulmonary fibrosis (IPF), but its utility in other progressive fibrotic diseases and LT candidates is less well-studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included ILD patients evaluated as LT candidates between January 2017 and December 2023 at a single center. The GAP score was calculated for each patient, and patients were classified into GAP stages I, II, or III. Outcomes evaluated included LT waiting list inclusion, LT performed, death, and active follow-up without waiting list inclusion. The prognostic utility was analyzed using survival analysis, including Cox regression and Kaplan–Meier methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 413 ILD patients, 119 were included on the LT waiting list. GAP stage III was an independent predictor of transplant-free survival (HR = 2.720; <i>p</i> = 0.011). Patients in stage II showed a transplant-free survival of 51.3% at 2 years, while stage III had 49.2% survival at 1 year. GAP stages significantly predicted transplant outcomes and survival rates (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The GAP score is a reliable prognostic tool for ILD patients being evaluated for LT, aiding in decision-making regarding referral and waiting list inclusion. It may serve as a useful marker for early referral and prioritization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor App Increases Awareness and Overall Living Kidney Organ Donation","authors":"Tayseer Shamaa,&nbsp;Iman Bajjoka,&nbsp;Rohini Prashar,&nbsp;Matthew Callaghan,&nbsp;Salvatore Serra,&nbsp;Marwan Abouljoud,&nbsp;Jason Denny","doi":"10.1111/ctr.70118","DOIUrl":"https://doi.org/10.1111/ctr.70118","url":null,"abstract":"<div>\u0000 \u0000 <p>Thirty-seven million adult Americans have chronic kidney disease with African Americans are significantly more likely to develop end-stage renal disease (ESRD) compared to other racial groups. Donor App was designed to help kidney transplant candidates (KTCs) identify potential living donors (LDs) by creating social media postings about their need for transplant. The purpose of this study is to evaluate the feasibility of using Donor App in improving awareness about living organ donation and rates of living donor kidney transplantation (LDKT). LD inquiries and transplant outcomes were compared between KTCs who used the Donor App with 1:3 matched historic controls from our center's waitlist. Forty-nine KTCs posted their stories using Donor App. The total views on all platforms and patients were 11 881. Ninety-three potential LD inquiries came on behalf of 26/49 KTCs (53%). KTCs with at least one potential LD inquiry were likely to have at least one donor champion (<i>p</i> = 0.01), used multiple social media outlets (<i>p</i> = 0.003), and had significantly higher median views versus candidates without inquiries (263 [interquartile range (IQR): 117–624] vs. 42 [IQR: 15–96], respectively; <i>p</i> &lt; 0.001). To date, three underwent transplants (two LDKTs and one deceased direct donation). None of the matched controls had any potential LD inquiries (<i>p</i> = 0.01). The Donor App can significantly increase awareness and rate of living organ donation.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Normothermic Regional Perfusion in Circulatory Death Donors for Lung Transplantation in the United States","authors":"Jonathan E. Williams,&nbsp;John M. Trahanas,&nbsp;Jacob A. Klapper,&nbsp;Caitlin Demarest,&nbsp;Kiran H. Lagisetty,&nbsp;Andrew C. Chang,&nbsp;Dennis M. Lyu,&nbsp;David D. Odell,&nbsp;Matthew D. Bacchetta,&nbsp;Aaron M. Williams","doi":"10.1111/ctr.70135","DOIUrl":"https://doi.org/10.1111/ctr.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Use of normothermic regional perfusion (NRP) to recover donation after circulatory death (DCD) organs demonstrates increased heart utilization with favorable outcomes. Conversely, DCD lung allograft use when NRP was employed remains controversial. This is a contemporary analysis of DCD lung recipient outcomes in which NRP was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Utilizing the STAR-OPTN database, all adult DCD lung recipients in the United States between January 1, 2020, and June 30, 2024 were identified. NRP use was defined if the time between donor death and aortic clamp time was greater than 30 min. Recipient outcomes, including 30-, 60-, and 90-day mortality, grade-3 primary graft dysfunction (PGD), and postoperative length of stay were compared using multivariable logistic regression controlling for donor and recipient covariates. Survival analysis was performed using Cox proportional hazard modeling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 987 DCD lung transplants, 92 (9.4%) utilized NRP. There were no differences in recipient characteristics between direct recovery and NRP cohorts. No difference in 30-, 60-, or 90-day mortality, grade-3 PGD, or length of stay was found between cohorts. 12-month survival was equivalent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Outcomes between NRP lung recipients were equivalent to DCD direct recovery recipients. Thus, donor lungs may be considered for transplantation following NRP donation procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative Trajectory Analysis Reveals Dynamics and Risk Factors of Post-Kidney Transplant Diabetes Mellitus in a French Cohort","authors":"Julie Olabe,&nbsp;Cyril Garrouste,&nbsp;Bruno Pereira,&nbsp;Charlotte Colosio,&nbsp;Antoine Thierry,&nbsp;Jean-Philippe Rerolle,&nbsp;Dominique Bertrand,&nbsp;Maïté Jaureguy,&nbsp;Léonard Goblin,&nbsp;Mathias Buchler,&nbsp;Yannick Le Meur,&nbsp;Valerie Chatelet,&nbsp;Jean-François Augusto,&nbsp;Igor Tauveron,&nbsp;Marie Batisse-Lignier,&nbsp;Anne Elizabeth Heng,&nbsp;ASTRE Study group","doi":"10.1111/ctr.70116","DOIUrl":"https://doi.org/10.1111/ctr.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Hypothesis</h3>\u0000 \u0000 <p>Post-transplant diabetes mellitus (PTDM) is a common, dynamic complication after kidney transplantation (KT) that may resolve over time. To better understand and prevent PTDM, we analyzed its prevalence, evolution, and influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the French national ASTRE database at different post-transplantation periods (P) were analyzed. PTDM was defined by fasting blood glucose (FBG) ≥1.26 g/L, HbA1c ≥ 6.5%, or the use of hypoglycemic medications in kidney transplant recipients without diabetes. Patient trajectories were identified using group-based trajectory models (GBTM), and associated factors were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2898 patients, PTDM prevalence was 27.3% at P1 (&gt;M2, ≤M6), 21.3% at P2 (&gt;M6, ≤M18), 19.8% at P3 (&gt;M18, ≤M30), and 19.9% at P4 (&gt;M30, ≤M42). Analysis of 1825 patients identified four trajectories: no PTDM (67%), late-onset PTDM (6%), remission after P1 (10%), and early, persistent PTDM (17%). Late-onset PTDM was linked to history of cardiovascular disease, higher BMI at transplantation, HCV positive status, and weight gain. Early, persistent PTDM was associated with older age, higher BMI, HVC positive status, history of cardiovascular disease, and tacrolimus use. PTDM remission was linked to lower BMI. Corticosteroids contributed to both late-onset and persistent PTDM, while switching between tacrolimus and cyclosporine did not significantly affect progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study confirmed the high prevalence and dynamic nature of PTDM after transplantation, emphasizing the critical role of pretransplant cardiovascular disease, BMI, and early post-transplant weight gain in the onset or remission of PTDM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normothermic Machine Perfusion Improves Outcomes for Donation After Cardiac Death Allografts With Extended Donor Warm Ischemia Time","authors":"Xingjie Li,&nbsp;Yu-Hui Chang,&nbsp;Stephanie Y. Ohara,&nbsp;Kunam S. Reddy,&nbsp;Caroline C. Jadlowiec,&nbsp;Amit K. Mathur,&nbsp;Michelle C. Nguyen","doi":"10.1111/ctr.70133","DOIUrl":"https://doi.org/10.1111/ctr.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Donation after circulatory death (DCD) allografts are underutilized in liver transplantation (LT) due to increased risk of complications. These risks stem from ischemic injury sustained during the total donor warm ischemia time (tDWIT), historically limited to 30 min. Normothermic machine perfusion (NMP) can mitigate these risks and facilitate LT of DCD grafts with extended tDWIT. We aimed to compare outcomes of DCD allografts with extended tDWIT preserved on NMP versus static cold storage (SCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center study included adult DCD LT with tDWIT ≥ 30 from 2019 to 2023. Outcomes of NMP and SCS were compared including EAD, IC, graft survival, and patient survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 68 DCD LT with tDWIT ≥ 30, 64.7% (<i>n</i> = 44) were preserved with NMP and 35.3% (<i>n</i> = 24) with SCS. No differences in donor or recipient demographics were observed. The median tDWIT was 33 min for NMP and 30.5 min for SCS (<i>p</i> &lt; 0.01). Despite longer tDWIT, the NMP group had lower rates of EAD (4.5% vs. 66.7%, <i>p</i> &lt; 0.01) and IC (2.3% vs. 29.2%, <i>p</i> &lt; 0.01). One-year graft survival was higher in NMP (<i>p</i> &lt; 0.01), and 1-year patient survival was comparable between groups (<i>p</i> = 0.18).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NMP challenges traditional tDWIT constraints and can increase the pool of viable DCD allografts for transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}