Clinical Transplantation最新文献

{"title":"Hepatitis C Nucleic Acid Test Positive (NAT+) Solid Organ Consent Rates Are Highest in Patients Listed for Liver Transplant and With an English Language Preference","authors":"Sachiko M. Oshima,&nbsp;Alice Parish,&nbsp;Jacqueline B. Henson,&nbsp;Mariya Samoylova,&nbsp;Donna Niedzwiecki,&nbsp;Lisa McElroy,&nbsp;Lindsay King,&nbsp;Julius M. Wilder,&nbsp;Kara Wegermann","doi":"10.1111/ctr.70186","DOIUrl":"https://doi.org/10.1111/ctr.70186","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transplantation of hepatitis C virus (HCV) nucleic acid (NAT) positive organs is associated with shorter time to transplant and decreased risk of death on the waiting list. Treatment for HCV post-transplant is well-tolerated, successful, and leads to similar transplant outcomes to patients transplanted with HCV NAT− organs. Despite these outcomes, not all patients consent to receive HCV NAT+ organs, and factors associated with consent are not well-known.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective single-center study of adult patients listed for heart, liver, lung, and kidney transplant aimed to determine whether sociodemographic and organ-specific disparities exist in consent for HCV NAT+ donor organs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 2788 transplant candidates, 44% (<i>N</i> = 1229) consented to receive an HCV NAT+ organ. Patients who designated English as their preferred language were more likely to consent compared to a non-English preference (45% vs. 19%, <i>p</i> &lt; 0.001). Consent rates were highest amongst patients listed for liver transplantation compared to kidney, heart, and lung transplants (67%, <i>N</i> = 319 vs. 42%, <i>N</i> = 602 vs. 38%, <i>N</i> = 159 vs. 32%, <i>N</i> = 149; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Overall, more efforts are needed to ensure that all patients who may benefit from consenting for HCV NAT+ organs are appropriately educated in their language of choice on the risks and benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244662","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":"Increased Donor-Derived Cell-Free DNA as a Predictor for the Early Detection of Antibody-Mediated Rejection Following Heart Transplantation","authors":"Dana Dlouha,&nbsp;Sarka Chytilova,&nbsp;Jevgenija Vymetalova,&nbsp;Eva Rohlova,&nbsp;Marianna Lukasova,&nbsp;Sarka Novakova,&nbsp;Jaroslav Alois Hubacek","doi":"10.1111/ctr.70209","DOIUrl":"https://doi.org/10.1111/ctr.70209","url":null,"abstract":"<div>\u0000 \u0000 <p>Plasma circulating donor-derived cell-free DNA (ddcfDNA) can be used to noninvasively monitor acute rejection of heart transplants (HTx). This study utilized digital droplet PCR to analyze ddcfDNA concentrations (measured in copies per milliliter) and the fractional abundance (%ddcfDNA) to differentiate between donor and recipient DNA on the basis of single nucleotide polymorphism (SNP) homozygosity. Seventy-seven patients participated in a study, providing 300 plasma samples. Both markers, mean ddcfDNA (cp/mL) and %ddcfDNA, showed similar decreasing trends following the HTx, (<i>R</i>² &lt; 0.2; <i>p</i> &lt; 0.001). Significantly higher levels of ddcfDNA (cp/mL) and %ddcfDNA were observed during episodes of acute rejection (AR) compared to non-rejection samples (<i>p</i> &lt; 0.001). Additionally, antibody-mediated rejection (AMR) was associated with increased %ddcfDNA levels compared to non-rejection and to acute cellular rejection samples (<i>p</i> &lt; 0.001 and <i>p</i> &lt; 0.01). A logistic regression model identified %ddcfDNA as an early predictor of AMR risk 10–19 days post-heart transplant (odds ratio 158, <i>p</i> &lt; 0.02). Performance analysis established an optimal %ddcfDNA threshold of 0.125% for AMR detection, correctly identifying all patients without subsequent AMR. These findings suggest that early %ddcfDNA measurements post-HTx can accurately identify individuals unlikely to develop AMR during the first posttransplant year.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232336","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":"Kidney Donors' Perceived and Measured Stress Levels Before and After Donation, a Longitudinal Cohort Study","authors":"Jenny Stenberg,&nbsp;Annette Lennerling,&nbsp;Helen Andersson,&nbsp;Maria K. Svensson","doi":"10.1111/ctr.70208","DOIUrl":"https://doi.org/10.1111/ctr.70208","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Transplantation with a kidney from a living donor has superior long-term patient and graft survival compared to a kidney from a deceased donor. For a kidney donor, feelings of stress may exist at different stages of the donation process. The aim of the study was to evaluate living kidney donors’ perceived and measured stress levels before and after donation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective observational cohort study with longitudinal follow-up, kidney donors were invited to answer three self-rating questionnaires targeting stress, vital exhaustion, and depressive symptoms the day before and two and six months after kidney donation. At the same time points, blood and saliva samples of insulin, glucose, and cortisol were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analyses were based on data from seventy-five individuals, with a mean age 46.5 (11) years, 60% women. The kidney donors scored low in self-rating stress, exhaustion and depression both pre- and two and six months post-donation, and no correlations were established between self-reported measures and metabolic stress biomarkers. Post-donation, however, a gender difference emerged, with women reporting decreased vitality scores 32.1 (9.3) and 30.7 (11.6) at two and six months versus men reporting increased scores 35.8 (6.9) and 36.9 (7.1). Six months post-donation, women also reported more symptoms of depression than men, 12.2 (12.5) versus 6.4 (8.2) (<i>p</i> = 0.058).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Kidney donors’ self-reported and measured stress levels and depressive symptoms were low and did not change from pre-donation up to six months after donation. The low levels of subjective and objective stress reported by the donors support the limited risks associated with living kidney donation. However, six months post-donation, women reported more feelings of exhaustion and depression than did men. Practitioner points: (1) The low levels of subjective and objective stress reported by kidney donors support the limited risks associated with living kidney donation. (2) Because most kidney donors are women, the gender difference in perceived stress levels presented in this study is of clinical relevance. (3) A more structured psychosocial follow-up could enable the identification of individuals in need of more psychological follow-up post-donation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220008","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":"Comparison of Sarcopenia Assessment in Liver Transplant Recipients by Computed Tomography Freehand Region-of-Interest versus an Automated Deep Learning System","authors":"William Miller,&nbsp;Kassandra Fate,&nbsp;Jessica Fisher,&nbsp;Jessica Thul,&nbsp;Yousun Ko,&nbsp;Kyung Won Kim,&nbsp;Timothy Pruett,&nbsp;Levi Teigen","doi":"10.1111/ctr.70201","DOIUrl":"https://doi.org/10.1111/ctr.70201","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Sarcopenia, or the loss of muscle quality and quantity, has been associated with poor clinical outcomes in liver transplantation such as infection, increased length of stay, and increased patient mortality. Abdominal computed tomography (CT) scans are utilized to measure patient core musculature as a measurement of sarcopenia. Methods to extract information on core body musculature can be through either freehand region-of-interest (ROI) or machine learning algorithms to quantitate total body muscle within a given area. This study directly compares these two collection methods leveraging length of stay (LOS) outcomes previously found to be associated with freehand ROI measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 50 individuals were included who underwent liver transplantation from our single center between January 1, 2016, and May 30, 2021, and had a non-contrast abdominal CT scan within 6-months of surgery. CT-derived skeletal muscle measures at the third lumbar vertebrae were obtained using freehand ROI and an automated deep learning system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Correlation analysis of freehand psoas muscle measures, psoas area index (PAI) and mean Hounsfield units (mHU), were significantly correlated to the automated deep learning system's total skeletal muscle measures at the level of the L3, skeletal muscle index (SMI) and skeletal muscle density (SMD), respectively (R² = 0.4221; <i>p</i> value &lt; 0.0001; R² = 0.6297; <i>p</i> value &lt; 0.0001). The automated deep learning model's SMI predicted ∼20% of the variability (R² = 0.2013; hospital length of stay) while the PAI variable only predicted about 10% of the variability (R² = 0.0919; total healthcare length of stay) of the length of stay variables. In contrast, both the freehand ROI mHU and the automated deep learning model's muscle density variables were associated with ∼20% of the variability in the inpatient length of stay (R² = 0.2383 and 0.1810, respectively) and total healthcare length of stay variables (R² = 0.2190 and 0.1947, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Sarcopenia measurements represent an important risk stratification tool for liver transplantation outcomes. For muscle sarcopenia assessment association with LOS, freehand measures of sarcopenia perform similarly to automated deep learning system measurements.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213822","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":"Experience With 117 Donation After Circulatory Death Expanded Criteria Donor Kidney Transplants: What Are the Limits of Acceptability?","authors":"David I. Harriman,&nbsp;Christopher J. Webb,&nbsp;Colleen L. Jay,&nbsp;Joseph Criscitiello,&nbsp;Jigish Vyas,&nbsp;Alan C. Farney,&nbsp;Giuseppe Orlando,&nbsp;Emily McCracken,&nbsp;Amber Reeves-Daniel,&nbsp;Alejandra Mena-Gutierrez,&nbsp;Natalia Sakhovskaya,&nbsp;Bobby Stratta,&nbsp;Robert J. Stratta","doi":"10.1111/ctr.70203","DOIUrl":"https://doi.org/10.1111/ctr.70203","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Nonuse of expanded criteria donor (ECD) kidneys from donation after cardiocirculatory death (DCD) donors remains high. The study purpose was to analyze our experience with kidney transplantation (KT) from DCD donors stratified by ECD versus non-ECD (standard criteria donor [SCD]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single center retrospective cohort study of all primary DCD KT recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From April 2003 to January 2024, we performed 671 primary DCD KTs (554 from DCD/SCDs and 117 from DCD/ECDs). Mean donor and recipient ages were 38.3 ± 14.6 DCD/SCD versus 59.4 ± 4.5 years DCD/ECD and 54.0 ± 13.1 DCD/SCD versus 63.0 ± 7.7 years DCD/ECD, respectively (both <i>p</i> &lt; 0.05). Mean Kidney Donor Profile Index (KDPI) values were 53 ± 23% DCD/SCD versus 85 ± 9% DCD/ECD (<i>p</i> &lt; 0.05). With a mean follow-up of 71 months DCD/SCD and 58 months DCD/ECD, patient (76.2% DCD/SCD vs. 72.6% DCD/ECD) and graft survival (61.6% DCD/SCD vs. 61.5% DCD/ECD) rates were comparable. Rates of primary nonfunction/thrombosis and delayed graft function were 3.4% for both DCD/SCD and DCD/ECD and 49% DCD/SCD versus 56% DCD/ECD, respectively (both <i>p</i> = NS). The presence of DGF did not influence survival outcomes in DCD/ECD KTs whereas inferior graft survival was noted in DCD/SCD KTs with DGF. However, DGF did have a negative effect on renal function in all groups. DCD/ECD KTs with or without DGF had comparable outcomes to DCD/SCD KTs with DGF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DCD/ECD KTs are associated with inferior functional but similar mid-term survival outcomes compared to DCD/SCD KTs with DGF. The presence of DGF appears to have a differential effect on survival outcomes in these two groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206557","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":"Skin Elasticity: A Potential Surrogate Marker for Facial Allograft Skin Fibrosis—A Case Series","authors":"Viola A. Stögner,&nbsp;Sam Boroumand,&nbsp;Aliyar Zahedi Vafa,&nbsp;Lioba Huelsboemer,&nbsp;Martin Kauke-Navarro,&nbsp;Richard Formica,&nbsp;David Leffell,&nbsp;Siba Haykal,&nbsp;Bohdan Pomahac","doi":"10.1111/ctr.70175","DOIUrl":"https://doi.org/10.1111/ctr.70175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Rejection represents a major and common complication in vascularized composite allotransplantation (VCA). Over time, recurrent acute or chronic rejection can lead to vascular and dermal fibrosis and potentially graft loss. To date, a non-invasive monitoring tool to capture chronic graft changes among VCA recipients has not been established. This pilot study aims to assess the potential value of noninvasive skin elasticity measurements for surveillance of longitudinal fibrosis of facial allografts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Viscoelasticity was non-invasively assessed via triplicate measurements of the transplanted facial skin on bilateral cheeks and native skin on bilateral upper arms in six face transplant recipients using the well-established Cutometer Dual MPA 580. Data were statistically compared with recipient/donor age, post-transplant years (PTYs), and cumulative rejection burden (CRB), smoking status, ethnicities, and immunosuppressive regimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A significant (<i>p</i> &lt; 0.05) negative linear relationship between CRB and the Cutometer parameters R2 (gross elasticity), R5 (net elasticity), and R7 (elasticity recovery) was found, which was not observed in control measurements of native skin of VCA recipients. Results were ranked into a three-level severity scale. Comparison with PTYs further revealed a significant negative linear relationship with R2 and R5 values. No statistically significant correlation was detected across R values when evaluated against recipient/donor age, smoking status, ethnicity, or immunosuppressive regimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although diagnosis and monitoring of rejection-associated degenerative skin changes currently still rely on biopsies, this exploratory study identifies skin elasticity as a promising surrogate marker for facial allograft fibrosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206555","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":"Postoperative Outcomes Following Liver Transplantation for Wilson's Disease: A Systematic Review and Meta-Analysis","authors":"Austine Wang,&nbsp;Noor Bakir,&nbsp;Clarissa Ngo,&nbsp;Justin Kang,&nbsp;Felipe Rodriguez,&nbsp;Tyler McKechnie,&nbsp;Cagla Eskicioglu,&nbsp;Maja Segedi,&nbsp;Pablo E. Serrano","doi":"10.1111/ctr.70155","DOIUrl":"https://doi.org/10.1111/ctr.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liver transplant is indicated in patients with Wilson's disease for acute hepatic failure, advanced cirrhosis, and disease refractory to chelation therapy. This study aims to systematically review data about overall morbidity, hepatic, neuropsychiatric, and survival outcomes following liver transplantation for Wilson disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>MEDLINE, Embase, and Central were searched from inception until July 2023. Peer-reviewed articles and published abstracts evaluating patients diagnosed with Wilson's disease and undergoing any type of liver transplant as a result of the disease were eligible for inclusion. A restricted maximum likelihood random effects model was used to generate the pooled proportion of each outcome. The risk of bias for each included observational study was assessed using the Methodological Index for Non-Randomized Studies tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 39 studies met all inclusion criteria. All studies were observational. Specific indications for liver transplant were most commonly acute liver failure (36.73%), chronic liver failure (45.02%), and acute-on-chronic liver failure (8.35%). The pooled proportions of mortality at 30 days, 1, and 5 years were 0.10 (95% CI 0.08, 0.13; <i>I</i>² = 16%), 0.11 (95% CI 0.09, 0.14; <i>I</i>² = 37%), and 0.15 (95% CI 0.11, 0.20; <i>I</i>² = 81%), respectively. The postoperative complication with the greatest prevalence was biopsy-proven acute rejection with a pooled proportion of 0.20 (95% CI 0.12, 0.31; <i>I</i>² = 84%). The mean MINORS score for risk of bias for all studies was 8.19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Overall, reporting quality and consistency of outcomes included in the studies was poor as assessed using the MINORS score. Pooled proportions for 30-day, 1- and 5-year mortality are similar, suggesting most postoperative deaths are acute in nature. Future research should incorporate objective measures and the reporting of standardized parameters to allow more robust comparisons between studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190674","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":"Defining Targets for Continuous Glucose Monitoring After Total Pancreatectomy With Islet Autotransplantation","authors":"Zaynab Somani,&nbsp;James S. Hodges,&nbsp;Srinath Chinnakotla,&nbsp;David Martin,&nbsp;Karthik Ramanathan,&nbsp;Gregory J. Beilman,&nbsp;Melena D. Bellin","doi":"10.1111/ctr.70202","DOIUrl":"https://doi.org/10.1111/ctr.70202","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Targets for continuous glucose monitoring (CGM) are well established for type 1 and type 2 diabetes. In total pancreatectomy with islet autotransplantation (TPIAT), stricter glycemic targets are needed to avoid metabolic stress on transplanted islets, but no guidelines exist for CGM targets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We aimed to determine CGM targets for TPIAT clinical management by associating CGM metrics with goal hemoglobin A1c (HbA1c) ≤ 6.5%. Targets for time in range (TIR) 70–140, TIR 70–180, mean CGM glucose, and time in hyperglycemia (&gt;140, &gt;180, &gt;250 mg/dL) were chosen to give good sensitivity and specificity for identifying HbA1c ≤6.5%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 256 pairs of 14-day CGM metrics with a concurrent HbA1c value (<i>n</i> = 82 patients, age 35 [IQR 19–46] years at surgery, 70% female) who were ≥0.5 years post TPIAT (median 4.1 years) and wearing Dexcom G6. Most patients had more than one HbA1c and corresponding CGM available (median 2 [IQR 1–4] per patient).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found that TIR 70–140 ≥ 50% and TIR 70–180 mg/dL ≥ 75% may be reasonable minimum targets for patients and providers using CGM data to manage diabetes long-term after TPIAT. Failure to meet these targets should prompt starting or adjusting insulin therapy, especially if hypoglycemia is not a concern.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190676","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":"Transplants of Grafts With Constitutional/Germline Chromosome Abnormalities","authors":"Chenghua Cui,&nbsp;Yanan Chang,&nbsp;Xuping Liu,&nbsp;Xiaojin Cai,&nbsp;Chengwen Li,&nbsp;Qi Sun,&nbsp;Erlie Jiang,&nbsp;Robert Peter Gale,&nbsp;Zhijian Xiao","doi":"10.1111/ctr.70207","DOIUrl":"https://doi.org/10.1111/ctr.70207","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190677","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":"Economic Impact of Dementia After Kidney Transplantation: A Matched Cohort Analysis","authors":"Krista L. Lentine,&nbsp;Melissa L. Swee,&nbsp;Wisit Cheungpasitporn,&nbsp;Huiling Xiao,&nbsp;Yasar Caliskan,&nbsp;Mara McAdams-DeMarco,&nbsp;Yusi Chen,&nbsp;Sunjae Bae,&nbsp;Dorry Segev,&nbsp;David Axelrod,&nbsp;Mark Schnitzler","doi":"10.1111/ctr.70189","DOIUrl":"https://doi.org/10.1111/ctr.70189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Kidney disease significantly increases the risk of dementia, including among kidney transplant (KTx) recipients. To date, the cost implications of dementia after KTx are not well described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study of US Renal Data System (USRDS) data (2006–2020) to estimate cost of care for ≥65-year-old Medicare insured KTx recipients (2006–2020) with newly diagnosed dementia (<i>n</i> = 3285), compared to propensity-matched controls without dementia (<i>n</i> = 6570). KTx recipients age 65+ years with post-KTx dementia were identified by diagnosis codes, and costs were computed based on payments on Medicare claims. Average costs per month, marginal costs per month, and cumulative costs were compared after dementia diagnosis versus after the equivalent time post-KTx in controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Dementia was diagnosed at a mean of 5.1 ± 3.4 years post-KTx. Patients' characteristics were well matched in cases versus controls, including age (mean: 70.1 vs. 69.9 years), sex (38.4% vs. 37.9% women), race (23.7% vs. 22.2% African American), and cause of ESKD (45.4% vs. 43.7% diabetes). Over 4 years post-KTx, dementia was associated with reduced survival (27% vs. 68%) along with $66 145 (95% CI $51 560-$78 489) higher Medicare spending. Average monthly costs in dementia patients reached a maximum of $12 713 and exceeded the cost of unaffected patients by up to $9789 per month.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Post-KTx dementia dramatically increased resource utilization and reduced post-KTx surivival. These findings highlight the need for care pathways that better integrate cognitive health assessment and management into the care of KTx candidates and recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190675","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}