Clinical Transplantation最新文献

{"title":"Ultrasound Utilization in Hospitalized Kidney Transplant Recipients: Useful or Overused?","authors":"Jason T. Bau,&nbsp;Jennifer Park,&nbsp;Yanhong Li,&nbsp;Christie Rampersad,&nbsp;S. Joseph Kim","doi":"10.1111/ctr.70048","DOIUrl":"https://doi.org/10.1111/ctr.70048","url":null,"abstract":"<p>Kidney transplant ultrasonography is an important diagnostic tool in the care of transplant recipients. This modality of nonradiation-based imaging allows for precise and expedient reporting of allograft architecture, which can inform clinical decision-making. However, as with any diagnostic tool, overuse may lead to unnecessary interventions and costs on the healthcare system. To better understand the use of ultrasonography in hospitalized kidney transplant recipients and outcomes of subsequent interventions, we conducted a single-center retrospective study at a large transplant program in Ontario, Canada. We noted that over 30% of admissions resulted in a ultrasonographic survey within the first 24 h of presentation; however, most of these did not change clinical management or lead to a subsequent procedural intervention. Using multivariable logistic regression, we identified predictors for receiving an ultrasound, including time from transplantation, elevated serum creatinine and infectious diagnosis. Procedural interventions (e.g., drain or biopsy) resulted from less than 20% of all ultrasound investigations, with patients closer to the time of index transplant or with elevated serum creatinine values more likely to receive an intervention. In conducting a cost analysis, we estimated that approximately $80 000 CAD per year could be saved with more selective decisions on ultrasound requisitions. Overall, our results indicate that despite being an informative tool, the broad use of ultrasonography in the kidney transplant population may not yield significant changes to transplant care.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes Toward Use of an APOL1 Genetic Testing Chatbot in Living Kidney Donor Evaluation: A Focus Group Study","authors":"James L. Rogers,&nbsp;Jessica Gacki-Smith,&nbsp;Rochell Yacat,&nbsp;Catherine Wicklund,&nbsp;Debra Duquette,&nbsp;John Friedewald,&nbsp;Matthew Cooper,&nbsp;Alexander Gilbert,&nbsp;Akansha Agrawal,&nbsp;Elisa J. Gordon","doi":"10.1111/ctr.70026","DOIUrl":"https://doi.org/10.1111/ctr.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Living kidney donor (LKD) candidates of African ancestry are increasingly asked to undergo <i>Apolipoprotein</i> L1 (<i>APOL1</i>) genetic testing during the donor evaluation process to better understand their risk of kidney disease. LKD candidates’ attitudes about using a clinical chatbot on <i>APOL1</i> remain unknown. This study builds on prior work to culturally adapt the Gia (Genetic Information Assistant) chatbot on <i>APOL1</i> by assessing donor, recipient, and community member attitudes about the Gia chatbot for enhancing the integration of <i>APOL1</i> testing into the LKD clinical evaluation workflow.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study involved focus groups and a post-focus group survey in two US cities about the <i>APOL1</i> Gia chatbot. Qualitative data were analyzed via thematic analysis, and descriptive statistics were used for demographic data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We conducted 10 focus groups including 54 participants (25 LKDs, 23 community members, and 6 living donor kidney transplant recipients of African ancestry). Five themes emerged: (1) participants supported LKD candidates using the Gia chatbot before the nephrologist clinic visit, (2) participants were interested in undergoing <i>APOL1</i> testing after using Gia, (3) <i>APOL1</i> testing costs may influence LKD candidates’ willingness to get tested, (4) patients of African ancestry may hold varying preferences for using chatbots in the healthcare setting, and (5) individual-level barriers may limit the use of Gia in the healthcare setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individuals of African ancestry were highly receptive to integrating the <i>APOL1</i> chatbot into LKD candidate clinical evaluation, which bodes well for integrating chatbots into the <i>APOL1</i> clinical genetic testing process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family Planning Counseling and Practices in Kidney Transplant Recipients","authors":"Swathi Rajagopal,&nbsp;Julia Ritchie,&nbsp;Dominika Seidman,&nbsp;Emily R. Perito,&nbsp;Deborah Adey,&nbsp;Monika Sarkar","doi":"10.1111/ctr.70047","DOIUrl":"https://doi.org/10.1111/ctr.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Half of all female kidney transplant (KT) recipients are reproductive-aged, though data on reproductive practices and counseling are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional survey evaluated patient experiences, practices, and preferences surrounding contraception and pregnancy in female KT patients (listed or post-transplant) ages 14–45 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 152/682 eligible participants (22%; 50 pre- and 102 post-KT) completed the survey with 26% unaware at the time of KT that future pregnancy was possible. The majority (72%) of sexually active patients used contraception during the first year post-KT, though 24% exclusively used high failure-rate methods. Less than half (48%) felt their pre-KT reproductive counseling was adequate to guide decision-making, although 63% reported satisfaction with post-KT counseling. Discussions with transplant providers were the single most favored counseling modality at 74%. Misconceptions of intrauterine device safety and efficacy were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Reproductive counseling commonly occurred, although information was inadequate for guiding pregnancy and contraceptive decisions in most pre-KT patients. Misconceptions about pregnancy potential and contraceptive efficacy and safety were common, as well as patient reliance on high-failure contraceptive methods. Improving patient knowledge and access to contraception and pregnancy planning is essential for honoring patients’ reproductive wishes while lowering obstetric, graft, and perinatal risks in post-KT pregnancies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762356","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":"Successful Multiorgan Transplantation in Highly Sensitized Patients With Positive Crossmatch Donor","authors":"Benjamin Louis Thomae,&nbsp;Taisuke Kaihou,&nbsp;David F. Pinelli,&nbsp;John J. Friedewald,&nbsp;Juan C. Caicedo-Ramirez,&nbsp;Ankit Bharat,&nbsp;Satish Nadig,&nbsp;Chitaru Kurihara","doi":"10.1111/ctr.70040","DOIUrl":"https://doi.org/10.1111/ctr.70040","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762080","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":"Randomized Controlled Trial to Evaluate a New Tool to Support Patient Decision-making on Transplant Centers","authors":"Warren T. McKinney,&nbsp;Kareena Israni,&nbsp;Cory R. Schaffhausen,&nbsp;David P. Schladt,&nbsp;Grace R. Lyden,&nbsp;Arthur Matas,&nbsp;Jack Wolf,&nbsp;Sandra Japuntich,&nbsp;Ajay K. Israni","doi":"10.1111/ctr.70043","DOIUrl":"https://doi.org/10.1111/ctr.70043","url":null,"abstract":"<div>\u0000 \u0000 <p>Patients are not always aware of listing criteria and offer acceptance across transplant programs. Factors such as age and body mass index can impact access to transplants as centers have different candidate criteria. Therefore, we created a transplant center search tool (transplantcentersearch.org) (TCST) to help patients find comparative information on transplant programs. We conducted a cross-over randomized controlled trial (RCT) to assess whether the TCST improved comprehension compared to the existing Scientific Registry of Transplant Recipients website among adults seeking kidney transplants at two centers. To assess comprehension participants were asked to use the TCST and the SRTR website to identify which transplant program within a prespecified area had the most recipients over 70 years of age; and which programs had the most recipients with BMI &gt;40. Participants were asked to provide qualitative feedback on using both websites. Sixty-eight candidates participated in the RCT. Participants were more likely to identify the correct program when using the TCST compared to the existing SRTR website (OR 8.13, 95% CI 1.87–35.33). Participants stated they preferred the TCST over the SRTR website (52.9% vs. 25.0%, respectively, <i>p</i> = 0.009). With increased comprehension, patients would be better equipped to identify programs that transplant patients like them.</p>\u0000 <p><b>Trial Registration</b>: ClinicalTrials.gov identifier: NCT03610555</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759852","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":"Influence of Acuity Circles on Hepatocellular Carcinoma and the Interaction of Gender and Race in Liver Transplantation","authors":"Ahila Manivannan,&nbsp;Anjana Pillai,&nbsp;AnnMarie Liapakis,&nbsp;Neehar D. Parikh,&nbsp;Vineeta Kumar,&nbsp;Elizabeth C. Verna,&nbsp;Reena Salgia,&nbsp;Trueman Wu,&nbsp;Mei Lu,&nbsp;Michelle T. Jesse","doi":"10.1111/ctr.70045","DOIUrl":"https://doi.org/10.1111/ctr.70045","url":null,"abstract":"<div>\u0000 \u0000 <p>The impact of liver transplant allocation policy using acuity circles (ACs) on interactions between race and gender on waitlist mortality or receipt of deceased donor liver transplant (DDLT) is unknown. Using data from the United Network for Organ Sharing (UNOS), we examined adults listed for DDLT from April 3, 2017, to October 4, 2022 (30 months pre- and post-AC). Fine-Gray sub-distribution hazard model explored AC indicators by race and gender interactions and their effect on receipt of DDLT or waitlist mortality. Also explored was AC's impact on hepatocellular carcinoma (HCC) diagnosis and receipt of DDLT or waitlist mortality. 59 592 patients (30 202 pre-AC, 29 390 post-AC) included. For both receipt of DDLT and waitlist mortality, there were no 3-way (AC by race by gender) interactions, indicating that the effects of race and gender on DDLT or waitlist mortality were consistent pre- and post-AC. Irrespective of AC implementation, Black and Hispanic women were less likely to receive DDLT and had an increased risk of waitlist mortality compared to White women. White, Black, and Hispanic men had lower waitlist mortality risk and greater likelihood of receiving DDLT compared to their female race/ethnic counterparts. Patients with HCC had a significantly greater chance for DDLT than non-HCC, although post-AC this effect was attenuated. Patients with HCC were also at greater risk of waitlist mortality pre- and post-AC compared to those without HCC however, the waitlist mortality post-AC was attenuated only for those patients without HCC. To our knowledge, this is the first study to show the interaction of gender and race on waitlist mortality and access to transplantation since the implementation of AC, showing continued disparate outcomes for women both within and across racial groups.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762531","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":"Outcomes of Lung Transplantation in Coal Workers Pneumoconiosis: Analysis of UNOS Database","authors":"Sravanthi Nandavaram,&nbsp;Xiaonan Mei,&nbsp;Tahir Khan,&nbsp;Muhammad Asad Faruqi,&nbsp;Zachary Fyffe,&nbsp;Suresh Keshavamurthy,&nbsp;Satish Chandrashekaran","doi":"10.1111/ctr.70042","DOIUrl":"https://doi.org/10.1111/ctr.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coal worker's pneumoconiosis (CWP) poses a significant burden on affected individuals and is associated with increased morbidity and mortality. Lung transplantation (LT) is the only effective treatment for this progressive and fatal lung disease. This study aims to evaluate the outcomes of patients who have undergone LT for primary diagnosis of CWP. </p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Scientific Registry of Transplant Recipients (SRTR) data from the United Network of Organ Sharing (UNOS) was queried to identify recipients who underwent lung transplantation (LT) between May 2005 and June 2021 in the lung allocation score (LAS) era across all transplant centers reporting to SRTR. A comparison was conducted between baseline characteristics, perioperative variables, and post-transplant outcomes of patients who underwent LT for CWP and those who received LT for other indications. Kaplan–Meier survival analysis and multivariable Cox regression analysis were performed to assess graft and patient survival post LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May 2005 and June 2021, 158 patients underwent LT for CWP. Overall graft survival (Log-rank <i>p</i> = 0.889) and patient survival (Log-rank <i>p</i> = 0.910) were not significantly different between the two groups. CWP group was noted to have higher mean pulmonary artery pressures, LAS, need for prolonged intubation and extracorporeal membrane oxygenation (ECMO) at 72 h and the need for dialysis at the time of discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients who underwent LT for coal workers' pneumoconiosis (CWP) had comparable post-transplant outcomes to those with other diagnoses. Therefore, LT for CWP can be safely performed. It is crucial to recognize the severity of the illness and be aware of the potential challenges in the perioperative transplant course to effectively manage this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759705","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":"What Makes Non-Directed Living Kidney Donors Tick? Actionable Items to Increase Non-Directed Live Organ Donation","authors":"Amy S. Wang,&nbsp;Kasi McCune,&nbsp;Ilona Wiener,&nbsp;Brian Runge,&nbsp;Daniela Pasantes,&nbsp;Eric Johnson,&nbsp;Lloyd E. Ratner","doi":"10.1111/ctr.70044","DOIUrl":"https://doi.org/10.1111/ctr.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Non-directed donors (NDDs), individuals who donate their organs with no intended recipient, in the United States increased 90-fold from 1999 to 2019. There is a paucity of studies investigating the motivations of NDDs. The objective of our study is to identify actionable items to increase NDDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A survey of kidney NDDs at CUIMC from 2009 to 2021 was conducted. The survey was conducted via Qualtrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy individuals met the study criteria. Forty-seven (67.1%) individuals completed the survey. A total of 98% of respondents reported participating in other altruistic activities prior to donation. A total of 70% donors identified as religious, and 57% reported religion/spirituality positively affected the decision to donate. The three most common factors that got respondents interested in NDD included: (1) hearing about an individual in need of a transplant, (2) knowing someone who had donated an organ, and (3) as a next step in altruistic behavior. A total of 85% said that donating a kidney met or exceeded expectations. A total of 44% and 31% of NDDs were interested in being either liver or uterus NDDs, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We identified six potential action items: (1) Identify pools of receptive individuals who participated in other altruistic behaviors and/or identify as religious. (2) Outreach to individuals who came forward as directed donors, but whose intended recipient was successfully transplanted with a kidney from another donor. (3) Promote stories of those who need organ transplants or whose lives have been changed by transplantation. (4) Promote NDDs as resources for potential NDDs. (5) Educate interested kidney NDDs about liver and uterus transplant programs. (6) Decrease financial barriers to donation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749224","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 Letermovir for Cytomegalovirus Primary Prophylaxis on Myelosuppression and Immunosuppression in Lung Transplant Recipients","authors":"Hanna L. Kleiboeker,&nbsp;Alyson Prom,&nbsp;Krista Paplaczyk,&nbsp;Jacob Wang,&nbsp;Nicole Borkowski,&nbsp;Brad Miner,&nbsp;Jennifer Wright,&nbsp;Mrinalini Venkata Subramani,&nbsp;Ambalavanan Arunachalam,&nbsp;Alan D. Betensley,&nbsp;Rade Tomic,&nbsp;Catherine N. Myers","doi":"10.1111/ctr.70033","DOIUrl":"10.1111/ctr.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cytomegalovirus (CMV) is associated with detrimental outcomes after lung transplantation (LTX); primary prophylaxis (PPX) with valganciclovir (VGC) is guideline-recommended. VGC is associated with myelosuppression, spurring interest in letermovir (LTV).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults undergoing LTX between January 1, 2021, and July 30, 2022 at our institution who were converted from VGC to LTV for PPX were evaluated. Outcomes included antimetabolite dosing during PPX, the incidence and frequency of myelosuppressive events, and the time to the first myelosuppressive event.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine LTX recipients met the inclusion criteria. Most patients received non-lymphocyte-depleting induction (96.6%) and had moderate risk CMV serostatus (D+/R+, 48.3%). Patients transitioned from VGC to LTV 177 days (IQR 102 days) post-transplant. After conversion to LTV, patients tolerated higher daily doses of mycophenolate (721 mg vs. 1000 mg, <i>p</i> = 0.008) or azathioprine (33.3 mg vs. 62.5 mg, <i>p</i> = 0.478). The incidence of myelosuppressive events was reduced (100.0% vs. 62.1%, <i>p</i> &lt; 0.001) including leukopenia (96.6% vs. 58.6%, <i>p</i> = 0.001), severe leukopenia (82.8% vs 31.0%, <i>p</i> &lt; 0.001) and neutropenia requiring GCSF (96.6% vs. 48.3%, <i>p</i> &lt; 0.001) while on VGC compared to LTV. While on LTV, patients had a reduced rate of myelosuppressive events compared to VGC (1 event per 6.2 patient days vs. 1 event per 14.7 patient days, <i>p</i> &lt; 0.001). While on LTV, one patient had breakthrough viremia (3.4%) that was treated with (val)ganciclovir.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this single-center study, patients tolerated higher doses of antimetabolite immunosuppression, and the incidence and frequency of myelosuppressive events were reduced while on LTV compared to VGC. This evidence expands upon the current literature demonstrating improved tolerability of LTV in LTX recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726508","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":"Outcomes of Hematopoietic Stem Cell Transplantation in Patients With Thalassemia Major: How Do Anti-HLA Antibodies Impact?","authors":"Gizem Zengin Ersoy,&nbsp;Basak Adakli Aksoy,&nbsp;Melek Erdem,&nbsp;Lokman Karataş,&nbsp;Selime Aydoğdu,&nbsp;Özlem Başoğlu Öner,&nbsp;Gürcan Dikme,&nbsp;Ceyhun Bozkurt,&nbsp;Tunç Fışgın","doi":"10.1111/ctr.70035","DOIUrl":"10.1111/ctr.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate the effects of anti-human Leucocyte Antigen (HLA) antibody positivity on early hematopoietic stem cell transplantation (HSCT) results in patients with thalassemia major (TM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred and twenty-four HLA-matched HSCTs were performed in patients with TM between 2015 and 2022. Ninety-one patients were screened for anti-HLA antibodies by testing panel reactive antigens (PRA). Demographic and transplantation characteristics of patients were recorded. The presence of PRA was tested with the Antibody Testing Assay (Luminex LIFECODES HLA Antibody Identification System).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The number of PRA-positive patients was 54. There was no relationship between acute graft versus host disease (GVHD), chronic GVHD, grade of GVHD, and viral reactivation of the patients. However, platelet engraftment took around 3 days longer in the PRA-positive group (<i>p</i> = 0.05). The median number of erythrocyte transfusions was significantly higher in PRA-positive patients in the post-transplant period (<i>p</i> = 0.003), as was the median number of platelet transfusions (<i>p</i> = 0.003). Treosulfan conditioning increased the stable mixed chimerism (MC) rate by 3.8-fold (<i>p</i> = 0.011). In contrast, reduced rates of MC were found in patients who received matched unrelated donor cells or peripherally derived stem cells (<i>p</i> = 0.011 and <i>p</i> = 0.039, respectively) in the posttransplantation period in TM patients. PRA-positivity did not affect MC (<i>p</i> = 0.478). However, 80% of patients who had primary graft failure (<i>n</i> = 5; <i>p</i> = 0.59) and 75% of patients who died (<i>n</i> = 4) were PRA positive (<i>p</i> = 0.64), but these results were statistically insignificant due to the low number of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Anti-HLA antibodies primarily delayed platelet engraftment in TM patients and increased the erythrocyte and thrombocyte transfusion requirements. Although PRA positivity was more common in patients with primary graft failure or who died, there was no statistically significant impact of PRA positivity on chimerism, acute or chronic GVHD, viral activation, or mortality rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726534","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}