Clinical Transplantation最新文献

{"title":"Type A Aortic Dissection Following Abdominal Solid Organ Transplantation: Population-Level Outcomes in the United States","authors":"Yunda Wang,&nbsp;Joy Mohnot,&nbsp;Kanhua Yin,&nbsp;Nikola Dobrilovic,&nbsp;Yong Zhan","doi":"10.1111/ctr.70130","DOIUrl":"https://doi.org/10.1111/ctr.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aims to analyze the patient characteristics, clinical outcomes, and contemporary trends concerning type A aortic dissection (TAAD) in previous recipients of abdominal solid organ transplantation (ASOT) in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The National Inpatient Sample was queried to identify all patients aged ≥18 with TAAD and a history of ASOT (TAAD-ASOT) between 2002 and 2015Q3 using ICD-9 diagnosis and procedure codes. Baseline characteristics and in-hospital outcomes were compared between TAAD-ASOT patients and TAAD patients without a history of ASOT (TAAD-non-ASOT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified a weighted total of 71 061 TAAD patients. Among them, 346 (0.49%) were ASOT recipients; of these, 318 (91.9%) were kidney transplant recipients, and 28 (8.1%) were liver transplant recipients. There is an increasing trend in the incidence of TAAD among ASOT recipients over the study period (p-trend &lt; 0.001). Compared to TAAD-non-ASOT patients, TAAD-ASOT patients were younger (54.7 vs. 60.7 years, <i>p</i> &lt; 0.001), less likely to be White (53.8% vs. 69.1%, <i>p</i> = 0.008), and associated with a higher Charlson Comorbidity Index (3.79 vs. 2.26, <i>p</i> &lt; 0.001). TAAD-ASOT patients also exhibited significantly higher in-hospital mortality (27.4% vs. 17.8%, <i>p</i> = 0.03) and a greater risk of renal complications (53.5% vs. 29.7%, <i>p</i> &lt; 0.001). Multivariable analysis indicated that a history of ASOT was independently associated with an increased in-hospital mortality rate in TAAD patients (adjusted odds ratio = 1.83, 95% CI = 1.01–3.31, <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TAAD-ASOT patients were younger but presented a higher comorbidity burden, an elevated in-hospital mortality rate, and an increased risk of postoperative complications compared to TAAD-non-ASOT patients. The rising incidence and unfavorable outcomes emphasize the need for future preventative measures and enhancements in surgical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143602451","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":"Safety and Efficacy of Belatacept in Pancreas Transplantation: A Case Series","authors":"Quentin Perrier,&nbsp;Alexandra Rose Monetti,&nbsp;Natalia Vladimirovn Sakhovskaya,&nbsp;Alejandra N. Mena Gutierrez,&nbsp;Amber Reeves-Daniel,&nbsp;William Doares,&nbsp;Christopher J. Webb,&nbsp;Robert J. Stratta,&nbsp;Giuseppe Orlando","doi":"10.1111/ctr.70131","DOIUrl":"https://doi.org/10.1111/ctr.70131","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581607","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":"Exploring the Viability of Matching Marginal Donors With Low Renal Function Recipients in Liver Transplantation","authors":"Miho Akabane,&nbsp;Yuki Imaoka,&nbsp;Toshihiro Nakayama,&nbsp;Carlos O. Esquivel,&nbsp;Kazunari Sasaki","doi":"10.1111/ctr.70123","DOIUrl":"https://doi.org/10.1111/ctr.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Renal function varies among liver transplantation (LT) candidates with the same Model for End-Stage Liver Disease (MELD)3.0 score. The impact of marginal grafts on post-LT renal function and prognosis varies based on the pre-LT renal function. We explored the effects of matching recipients with low renal function to marginal donors on graft survival (GS) and post-LT kidney function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the Scientific Registry of Transplant Recipients (SRTR), categorizing pre-LT renal function by estimated glomerular filtration rate (eGFR) into low (&lt;30 mL/min/1.73 m²) and high (≥30 mL/min/1.73 m²). Marginal donors were defined by criteria including donation after cardiac death, age ≥ 65, severe macrosteatosis (≥30%), or body mass index ≥ 40 kg/m². The primary outcome was to compare 3-year post-LT GS between patients with low and high pre-LT renal function. Additionally, we examined post-LT eGFR 1–3 months post-LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 13 279 LT recipients, 12 851 had high pre-LT eGFR and 428 had low pre-LT eGFR. Kaplan–Meier survival analysis showed that recipients with low pre-LT eGFR had significantly lower 3-year GS compared to those with high eGFR (<i>p</i> &lt; 0.01). Recipients of organs from marginal donors also exhibited a significant reduction in 3-year GS (<i>p</i> &lt; 0.01). This adverse effect persisted within the same MELD3.0 category. Additionally, lower pre-LT eGFR was associated with an increased risk of post-LT kidney function deterioration, especially among those receiving grafts from marginal donors. Multivariable logistic regression identified recipient age &gt; 65 as a significant risk factor for post-LT kidney function decline (OR 3.34 [1.05–10.7]; <i>p</i> = 0.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>GS was notably worse in recipients with low pre-LT eGFR, particularly when matched with marginal donors. A recipient age &gt; 65 is a risk indicator for post-LT kidney function deterioration with marginal donors, underscoring the importance of careful donor-recipient matching, especially with compromised pre-LT kidney function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581608","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":"Strategic Development of a Larynx and Trachea Transplantation Program: The Mayo Clinic Arizona Experience","authors":"Stephanie R. C. Zacharias,&nbsp;Danielle Grandjean,&nbsp;Elizabeth Stearns,&nbsp;Girish Mour,&nbsp;David G. Lott","doi":"10.1111/ctr.70126","DOIUrl":"https://doi.org/10.1111/ctr.70126","url":null,"abstract":"<div>\u0000 \u0000 <p>Medical advances have enabled the realization of vascularized composite allografts and to date have demonstrated reasonably successful graft survival rates. Larynx and Trachea Transplantation (LT) has long been contemplated as a therapeutic option for severe laryngeal trauma and patients following total laryngectomy. Progress has been limited most likely due to lack of awareness as an option, technical and surgical expertise, limited transplant centers worldwide, need for multidisciplinary engagement from hospital leadership, Otolaryngology, and transplant medicine to build a successful program. As one of the first programs to exist in the United States, we have had to create new pathways, develop new workflows, work with numerous regulatory bodies, educate many people about the need for an LT, and learn many lessons along the way. The objectives of this paper are to help others navigate the complexities of creating a new LT transplant program so that this important treatment option may become more available to patients worldwide. We will provide a checklist for developing an LT program and discuss our experiences with the strategic development of an LT transplant program in an academic medical institution.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581604","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 Retransplantation in the Elderly: Are the Benefits Worth the Risks?","authors":"Syed S. Mujtahedi,&nbsp;Colleen L. Jay,&nbsp;Natalia Sakhovskaya,&nbsp;Amber Reeves-Daniel,&nbsp;Alejandra Mena-Gutierrez,&nbsp;Christopher J. Webb,&nbsp;Emily K. E. McCracken,&nbsp;Alan C. Farney,&nbsp;Giuseppe Orlando,&nbsp;Jigish Vyas,&nbsp;Arianna Cabrales,&nbsp;Robert J. Stratta","doi":"10.1111/ctr.70129","DOIUrl":"https://doi.org/10.1111/ctr.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>An increasing number of elderly patients are undergoing either primary kidney transplantation (PrKT) or retransplantation (ReKT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-center retrospective cohort study of all deceased donor KTs (DDKTs) performed in elderly patients (age ≥65 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From December 2004 through August 2022, we performed 668 DDKTs in elderly patients including 39 ReKTs and 629 PrKTs. Mean donor age was lower in the ReKT group (44 ± 17 ReKT vs. 54 ± 13 years PrKT), as was KDPI (58 ± 24 vs. 74 ± 21% PrKT, both <i>p</i> &lt; 0.05). A total of 44% of ReKT patients had a cPRA level above 50% compared to 10.3% PrKT (<i>p</i> &lt; 0.0001). Rates were comparable between groups for primary nonfunction (2.6% ReKT vs. 3.7% PrKT) and delayed graft function (23% ReKT vs. 32% PrKT, <i>p</i> = 0.29). Five-year patient (55.2% ReKT vs. 74.3% PrKT, <i>p</i> = 0.03) and graft survival rates (GSRs, 55.2% ReKT vs. 64.7% PrKT, <i>p</i> = 0.32) were higher in the PrKT group. Death with functioning graft (DWFG) occurred in 59% of ReKT versus 37.4% of PrKT patients (<i>p</i> = 0.01) and accounted for 79.3% ReKT and 65.3% PrKT graft losses. Death-censored GSRs were not different (62.5% ReKT vs. 68.3% PrKT, <i>p</i> = 0.6).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elderly recipients of deceased donor ReKTs have a higher risk of DWFG, but death-censored outcomes are comparable to age-matched PrKT recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581606","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":"Early Post-Transplant Renal Recovery Trajectory and Trajectory Velocity Functions Are Predictors of Estimated GFR at 1 Year: A Functional Data Analysis Approach","authors":"Wairimu Magua,&nbsp;Octav Cristea,&nbsp;Emily M. Eichenberger,&nbsp;Geeta M. Karadkhele,&nbsp;Alanna A. Morris,&nbsp;Kenneth Newell,&nbsp;Joseph B. Rickert,&nbsp;Christian P. Larsen","doi":"10.1111/ctr.70119","DOIUrl":"https://doi.org/10.1111/ctr.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Kidney function at 1-year post-transplant is an indicator of long-term graft function. Using functional data analysis (FDA), we evaluate the relationship between early renal recovery trajectories and kidney function at 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 1748 adults who underwent deceased-donor kidney transplantation between 2010 and 2021. Renal recovery trajectory functions were derived from longitudinal inverse creatinine values. Functional linear regression models were used to evaluate how well early (&lt;90 days) renal recovery trajectory functions, and their rate of change explained 1-year eGFR. The explanatory power of the functional regression models was compared to results from ordinary least squares models, which used cross-sectional inverse creatinine values and linear slopes. Models were adjusted for age, sex, kidney donor profile index (KDPI), delayed graft function (DGF), race, body mass index (BMI), rejection, diabetes, hypertension, cytomegalovirus (CMV) serostatus risk, index admission length of stay, and immunosuppression agent. The <i>R</i>² coefficient quantified the 1-year eGFR variation explained by model variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adjusted functional linear models with renal recovery trajectory and trajectory velocity functions as independent variables explained 68% (65, 71), 70% (67, 74), 70% (66, 74), 70% (66, 75), and 73% (69, 79) of the variation in 1-year eGFR by 7, 14, 30, 60, and 90 days, respectively. By comparison, the ordinary least squares linear models explained a maximum of 69% of the variation in 1-year eGFR at 90 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Renal recovery patterns captured as continuous functions as early as 14 days are predictive of renal function at 1 year and may enable early personalized care of recipients at increased risk of poor graft function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554364","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 Coronary Artery Bypass Grafting for Asymptomatic Patients Referred for Renal Transplant","authors":"Enoch J. Wong,&nbsp;Connor M. McDonald,&nbsp;Elizabeth Thomas,&nbsp;Ali Zarrinpar,&nbsp;Lawrence Lee,&nbsp;Karen M. Kim,&nbsp;Thomas M. Beaver,&nbsp;Raja Al-Bahou,&nbsp;Jonathan Gelfond AL,&nbsp;John H. Calhoon,&nbsp;Dawn S. Hui","doi":"10.1111/ctr.70128","DOIUrl":"https://doi.org/10.1111/ctr.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The optimal management of incidental coronary artery disease (CAD) for renal transplant candidates is not well-defined. This study examined transplant and survival outcomes in patients undergoing coronary artery bypass grafting (CABG) for asymptomatic CAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review of patients undergoing CABG solely to facilitate renal transplant was conducted at four tertiary centers. Exclusion criteria were symptoms or acute coronary syndrome (ACS). The primary outcomes were successful renal transplant and survival analyzed using Kaplan-Meier curves with log-rank testing, compared to US Renal Data System (USRDS)-predicted life expectancy matched for age and gender.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>86 patients (59.0 [IQR 51.0,65.0] years, 88% male) were identified. At follow-up of 4.41 (2.74,6.04) years, 19.8% (<i>n</i> = 17) had successful renal transplant; 29.1% (<i>n</i> = 25) were never listed, 44.2% (<i>n</i> = 38) listed but removed (29 permanently, 9 temporarily), 7.0% (<i>n</i> = 6) awaiting transplant. Pre- and intraoperative characteristics were similar between those transplanted and not. For the entire cohort, CABG was associated with worse 1-year survival, similar 5-year survival, and better 8-year survival compared to USRDS-predicted life expectancy (log-rank <i>p</i> = 0.027).  Considering those not transplanted, 8-year survival was similar to USRDS (log-rank <i>p</i> = 0.94).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with Stage V CKD and asymptomatic CAD, renal transplant rates are low. Whether surgical revascularization offers survival benefit due to successful renal transplant or due to revascularization remains an area of future study. Longer follow-up, study of patient/procedural factors, and multidisciplinary efforts may improve patient selection and transplantation rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554214","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":"Soluble ST2 as a Predictive Biomarker for Acute Graft-Versus-Host Disease Post -Allogeneic Stem Cell Transplantation","authors":"Ken Huang,&nbsp;Mengxin Yang,&nbsp;Jinfang Huang,&nbsp;Yaxuan Cao,&nbsp;Yuhang Zhou,&nbsp;Guanxiu Pang,&nbsp;Jie Zhao,&nbsp;Jianming Luo","doi":"10.1111/ctr.70108","DOIUrl":"https://doi.org/10.1111/ctr.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute graft-versus-host disease (aGVHD) remains a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Identifying reliable biomarkers for early prediction of aGVHD could enable timely interventions and improve patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to assess whether levels of specific cytokines can serve as predictive markers for the onset and severity of aGVHD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Plasma levels of IL-6, IFN-γ, TNF-α, sST2, CD25, and REG3α were measured via ELISA in 50 allo-HSCT patients (20 with aGVHD and 30 without aGVHD) on Days +7, +14, and +21 post - transplantation. Receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were used to assess the predictive performance of these biomarkers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the six biomarkers analyzed, sST2 demonstrated the highest predictive accuracy for aGVHD. Elevated sST2 levels at Days +14 and +21 posttransplantation significantly correlated with aGVHD occurrence (AUC = 0.7092 at Day +21) and gastrointestinal aGVHD (AUC = 0.8007 at Day +14). sST2 also showed strong predictive performance for severe aGVHD (Grade II-IV), with AUC values of 0.8125 at Day +7 and 0.8021 at Day +14. Other biomarkers, including IL-6, REG3α, CD25, and TNF-α, exhibited dynamic changes but lacked robust predictive value for aGVHD onset or severity. These findings support sST2 as a promising biomarker for early risk stratification of aGVHD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SST2 is a promising biomarker for the early prediction of aGVHD, offering potential for guiding proactive therapeutic strategies in allo-HSCT patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535793","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":"Characterizing Survival for Patients Supported With Inotropes After the 2018 Donor Allocation Restructuring: A UNOS Database Analysis","authors":"Christopher Pritting,&nbsp;Joshua Chen,&nbsp;Abdulmojeed Ekiyoyo,&nbsp;Eric Warner,&nbsp;Yevgeniy Brailovsky,&nbsp;Vakhtang Tchantchaleishvili,&nbsp;Indranee Rajapreyar","doi":"10.1111/ctr.70105","DOIUrl":"https://doi.org/10.1111/ctr.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We sought to characterize adaptive changes to the revised UNOS donor heart allocation policy in 2018 and estimate long-term survival trends for heart transplant (HTx) recipients with respect to inotropic support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients listed for HTx between July 18, 2014, and July 18, 2016 (prepolicy revision) and between October 18, 2018, and October 18, 2020 (postpolicy revision) were identified from the UNOS database. Sub-analyses examined trends in device progression where patients listed on inotropes were later transplanted on inotropes and/or on extracorporeal membranous oxygenator (ECMO), durable left ventricular assist device (LVAD), temporary mechanical circulatory support (tMCS), or intra-aortic balloon pump (IABP). Survival data post-HTx were calculated and plotted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 3,189 patients were waitlisted (pre: 1,408; post: 1,781). Patient demographics differed only by cardiac output, mean PCWP, cigarette use, ventilatory support, and time on the waitlist. Policy revisions were associated with an increase in patients transplanted while supported with IABP (<i>p</i> &lt; 0.01), tMCS (<i>p</i> &lt; 0.01), and ECMO (<i>p</i> &lt; 0.01). In contrast, postpolicy, fewer patients were transplanted while on inotropes (<i>p</i> &lt; 0.01) or an LVAD (<i>p</i> &lt; 0.01), and 57.4% patients progressed from inotropes to another form of support (27.4% prepolicy, <i>p</i> &lt; 0.01). Additionally, waitlisted patients in the postpolicy period were more likely to be transplanted (pre: 78.9% vs. post: 89.8%, <i>p</i> &lt; 0.01) and more likely to survive (mortality, pre: 26.9% vs. post: 19.1, <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Allocation policy revisions have contributed to increased utilization of temporary support (ECMO, tMCS, and IABP) and decreased utilization of others such as durable LVADs. Additionally, revisions have led to improved survival and increased transplantation for patients waitlisted on inotropes, yet similar survival for each individual form of temporary support.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535926","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 Restrictive Cardiac Allograft Physiology on Heart Re-Transplantation Outcomes","authors":"Masaki Tsuji,&nbsp;Jignesh K. Patel,&nbsp;Michelle M. Kittleson,&nbsp;David H. Chang,&nbsp;Evan P. Kransdorf,&nbsp;Andriana P. Nikolova,&nbsp;Lily K. Stern,&nbsp;Mason Lee,&nbsp;Jon A. Kobashigawa","doi":"10.1111/ctr.70124","DOIUrl":"https://doi.org/10.1111/ctr.70124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart re-transplantation (re-HT) is the last treatment option for end-stage graft failure, with cases due to severe cardiac allograft vasculopathy (CAV) showing a better prognosis compared to other indications. However, the effects of restrictive cardiac allograft physiology (RCP), classified as severe CAV, on re-HT outcomes remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We assessed patients with severe CAV who underwent re-HT between 2010 and 2024. RCP was defined as symptomatic heart failure with restrictive echocardiographic values (E-to-A velocity ratio &gt;2 and deceleration time &lt;150 ms) or hemodynamic values (mean right atrial pressure &gt;12 mmHg, pulmonary capillary wedge pressure &gt;25 mmHg, and cardiac index &lt;2.0 L/min/m²). The primary outcome was death or third re-HT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 86 patients; 34 patients were complicated with RCP and 52 patients were without RCP. During the follow-up period, two patients underwent a third re-HT, and 16 died. The most frequent cause of death among those with and without RCP was malignancy and cardiovascular death, respectively. The probability of survival from all-cause death or third re-HT was significantly worse for those with RCP than for those without RCP (<i>p</i> = 0.021). Additionally, RCP was independently associated with an increased risk of death or third re-HT (hazard ratio: 3.36; 95% confidence interval: 1.16–9.75; <i>p</i> = 0.026).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among patients with severe CAV, those with RCP appear to have a worse prognosis after re-HT compared to those without RCP. This finding might be considered in the candidate selection for re-HT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554213","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}