Clinical Transplantation最新文献

{"title":"Evaluating the Relationship Between Medication Adherence, Dietary Practices, and Physical Activity in Heart Transplant Recipients","authors":"Eda Ayten Kankaya,&nbsp;Yaprak Sarıgol Ordin,&nbsp;Derya Kayıhan,&nbsp;Çağatay Engin,&nbsp;Ümit Kahraman","doi":"10.1111/ctr.70125","DOIUrl":"https://doi.org/10.1111/ctr.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Medication adherence is critical to improve quality of life, reduce transplant-related complications, and increase survival. Nonadherent health behaviors after heart transplantation lead to increased morbidity and mortality, decreased quality of life, increased medical costs, and overuse of healthcare services in heart transplant patients (HTR).</p>\u0000 \u0000 <p>This study examined the relationship between heart transplant recipients' medication adherence, dietary practices, and physical activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study was conducted at a university hospital's Heart and Lung Transplant Outpatient Clinic. The sample included adult HTR who had undergone transplantation at least 6 months prior. Data were collected using the Basel Assessment of Adherence to Immunosuppressive Medication Scale, a Nutritional Behaviors Questionnaire, and the International Physical Activity Questionnaire Short Form Statistical analyses using SPSS 24.0, with significance set at <i>p</i> &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 70 participants, 42.85% were non-adherent to immunosuppressive medications. Factors influencing adherence included age and time since transplantation. Dietary assessments revealed that while most patients practiced washing fruits and vegetables, adherence to other food safety measures was low. Physical activity levels indicated that 50% of participants were physically inactive, with high body mass index significantly correlating with lower activity levels. Patients with medication adherence had higher physical activity levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study highlights the critical need for targeted interventions to improve medication adherence, dietary practices, and physical activity among HTR. Addressing these factors is essential for enhancing patient outcomes, reducing morbidity and mortality, and improving quality of life posttransplant. Further research is warranted to explore the barriers and facilitators influencing these health behaviors in diverse populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530319","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":"Comparing Mid-Term Outcomes of Donation After Brain Death and Donation After Circulatory Death Orthotopic Heart Transplant Recipients–A Single-Center Retrospective UK Study","authors":"Mansimran Singh Dulay,&nbsp;Amira Bhaiji,&nbsp;Nahal Raza,&nbsp;Ramey Assaf,&nbsp;Diana Garcia Saez,&nbsp;Espeed Khoshbin,&nbsp;Owais Dar","doi":"10.1111/ctr.70121","DOIUrl":"https://doi.org/10.1111/ctr.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The number of patients on heart transplant waitlists is growing globally, with an insufficient number of organ offers to meet this growing demand. To help improve patient outcomes, in the United Kingdom (UK), orthotopic cardiac transplantation (OCTx) can occur using hearts donated following donor brain death (DBD) or donor circulatory death (DCD). The aim of this paper was to compare outcomes between groups of DBD and DCD OCTx patients at Harefield Hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>44 DCD patients (transplanted between 2012 and 2023) were matched (with outcomes blinded, by age and gender) with 33 DBD patients (transplanted between 2015 and 2023). Short-term outcomes (up until 1-year posttransplants, including outcomes such as primary graft dysfunction [PGD] and length of intensive care unit [ICU] stay) and midterm outcomes (up until 5 years posttransplant, including outcomes such as all-cause-mortality, episodes of rejection and graft left ventricular function) were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, no significant differences were noted with regard to baseline characteristics, and outcome measures (both short and mid-term outcomes) between the matched DCD and DBD cohorts. Event-free survival with regard to all-cause mortality also remained not significantly different between both groups (log-rank <i>p</i> &lt; 0.756).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, our single-center UK data did not demonstrate any differences in outcomes between DCD and DBD OCTx patients. We add to growing literature that would support DCD organ use in heart transplantation, in an effort to reduce growing organ demand worldwide.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513546","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":"Heart Transplantation Utilizing Brain-Dead Donors Procured From Extended Distances Under the 2018 New Allocation Policy","authors":"Rintaro Kinjo,&nbsp;Sooyun Caroline Tavolacci,&nbsp;Shazli Khan,&nbsp;Kenji Okumura,&nbsp;Junichi Shimamura,&nbsp;David Spielvogel,&nbsp;Suguru Ohira","doi":"10.1111/ctr.70122","DOIUrl":"https://doi.org/10.1111/ctr.70122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>There are limited data regarding outcomes of a new heart allocation policy on recovering brain-death donors (DBD) from extended distances.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From May 6, 2014, to March 31, 2023, the United Network for Organ Sharing database was queried where 1885 cases (8.3%) out of 22 806 isolated heart transplants received donor hearts from extended distances (ED) greater than 500 miles. Patients were divided into groups based on the transplanted date before or after the policy change (October 18, 2018): old (<i>N</i> = 443) versus new (<i>N</i> = 1383). A total of 439 pairs were matched utilizing propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The utilization of hearts from ED in the new system increased 2.7 times. Before matching, characteristics that differed included new group recipients with higher usage of temporary mechanical circulatory support devices and donors with more anoxia as the cause of death (new, 47% vs. old, 37%; <i>p</i> &lt; 0.001). In the matched cohort, the incidences of dialysis (14% vs. 11%, <i>p</i> = 0.18), stroke (3.9% vs. 2.7%, <i>p</i> = 0.44), or pacemaker implantation (3.0% vs. 2.5%, <i>p</i> = 0.83) were similar. Both groups showed similar 1-year recipient survival (90.9% vs. 90.4%, <i>p</i> = 0.79) and graft survival (90.7% vs. 90.2%, <i>p</i> = 0.8).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In the new allocation policy, the utilization of hearts from ED has increased approximately three-fold compared to the period before the policy change without affecting transplant outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513772","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":"The Impact of Epstein–Barr Virus Serostatus Mismatch in Adult Kidney Transplant Recipients: An Analysis of the 2012–2022 OPTN Database","authors":"Namrata Parikh,&nbsp;Rose Mary Attieh,&nbsp;Hani M. Wadei,&nbsp;Michael A. Mao,&nbsp;Shennen A. Mao,&nbsp;Cemal Burcin Taner,&nbsp;Tambi Jarmi,&nbsp;Wisit Cheungpasitporn,&nbsp;Napat Leeaphorn","doi":"10.1111/ctr.70117","DOIUrl":"https://doi.org/10.1111/ctr.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>One strategy to minimize the risk of posttransplant lymphoproliferative disorder (PTLD) is to avoid an Epstein–Barr Virus (EBV) mismatch through kidney paired donation. We aimed to estimate the incidence of PTLD in EBV-negative kidney transplant recipients with EBV-positive donors (D+/R−) and evaluate the excess risk of death following the occurrence of PTLD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included adult patients in OPTN database who underwent kidney transplants between 2012 and 2022. Cox regression analysis was employed to evaluate the impact of EBV serostatus on the development of PTLD, and to assess mortality following PTLD diagnosis in D+/R− individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 179 068 patients were included, with 92.8% in the R+, 6.4% in the D+/R−, and 0.8% in the D−/R− group. D+/R− exhibited a significantly higher risk of PTLD compared to R+ and D−/R− groups. D+/R− had a greater risk of PTLD when compared to D−/R− recipients (aHR: 3.82; <i>p</i> &lt; 0.001). Among D+/R− recipients, those who developed PTLD had a significantly higher risk of mortality (aHR: 2.28; <i>p</i> &lt; 0.001 in deceased donor kidney transplant [DDKT] and aHR: 5.22; <i>p </i>&lt; 0.001 in living donor kidney transplant [LDKT]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>D+/R− recipients have nearly a fourfold higher risk of PTLD compared to D−/R− recipients, suggesting that choosing an EBV D−/R− transplant could reduce the PTLD risk by about 73%. This data is crucial for counseling EBV-negative patients considering kidney paired donation to avoid an EBV serostatus mismatch.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513771","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":"Myocardial Perfusion Scintigraphy Provides Incremental Prognostic Value in Patients on the Kidney Transplant Waiting List","authors":"Stefan Reuter,&nbsp;Stefanie Reiermann,&nbsp;Jörg Stypmann,&nbsp;Joachim Bautz,&nbsp;Katharina Schütte-Nütgen,&nbsp;Hermann Pavenstädt,&nbsp;Viola Malyar,&nbsp;Holger Reinecke,&nbsp;Marc-Andre Kurosinski,&nbsp;Dennis Görlich,&nbsp;Hans-Werner Hense,&nbsp;Barbara Suwelack,&nbsp;Michael Schäfers","doi":"10.1111/ctr.70114","DOIUrl":"https://doi.org/10.1111/ctr.70114","url":null,"abstract":"<p>The approach to cardiovascular risk assessment before renal transplantation is still controversial. Therefore, we evaluated and compared the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) who are candidates for kidney transplantation (KTx). Methods: We prospectively enrolled 356 ESRD clinical transplantations for review, only patients (NCT01064674) admitted to our transplant center between August 2009 and July 2012. Cardiovascular risk assessment at the time of listing was based on the Münster Cardiovascular Risk Stratification Score (MCRSS), additionally including evaluation by DSE and MPS in all ESRD patients. Coronary angiography was conducted in patients at high risk according to the MCRSS and in those where noninvasive stress testing revealed stress-induced ischemia or wall motion abnormalities. Results: During long-term follow-up until October 2020, 2.43 cardiovascular events/100 person-years (nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) occurred, and the overall patient survival was 71.9%. Mild perfusion deficits identified by MPS, unlike wall motion abnormalities detected by DSE, showed incremental prognostic value for event-free survival in patients with low MCRSS risk. Conclusion: We therefore propose a modified MCRSS-based approach including MPS as a reasonable risk stratification approach for cardiovascular risk assessment of ESRD patients applying for KTx.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143455768","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":"Impact of Immunosuppressive Drug Concentrations on Microvascular Inflammation, Negative Donor-Specific Antibodies, and C4d-Negative Status in Kidney Transplant Recipients","authors":"Yoichi Kakuta,&nbsp;Yoko Maegawa-Higa,&nbsp;Soichi Matsumura,&nbsp;Shota Fukae,&nbsp;Ryo Tanaka,&nbsp;Hiroaki Yonishi,&nbsp;Shigeaki Nakazawa,&nbsp;Tomoko Namba-Hamano,&nbsp;Yoshitaka Isaka,&nbsp;Norio Nonomura","doi":"10.1111/ctr.70112","DOIUrl":"https://doi.org/10.1111/ctr.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study investigated the impact of immunosuppressive drug concentrations on microvascular inflammation (MVI) in kidney transplant recipients with negative donor-specific antibodies (DSA) against human leukocyte antigen (HLA) and negative C4d deposition in peritubular capillaries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from 268 living kidney transplant recipients at the Department of Urology, University of Osaka, Japan. Patients received immunosuppressive therapy comprising extended-release tacrolimus, mycophenolate mofetil (MMF), and/or everolimus, with or without steroids. Graft biopsies were routinely performed at 3, 12, 36 and 60 months post-surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences were observed between the MVI+DSA-C4d- and MVI-DSAC4d groups regarding graft survival rates (95.5% vs. 96.6%, <i>p</i> = 0.772) or patient survival rates (95.7% vs. 95.9%, <i>p</i> = 0.735). Lower tacrolimus and everolimus concentrations were significantly associated with an increased risk of MVI+DSA-C4d- (tacrolimus: OR, 0.169; 95% CI, 0.055–0.515; <i>p</i> = 0.002; everolimus: OR, 0.386; 95% CI, 0.171–0.874; <i>p</i> = 0.022). In contrast, MPA concentration was not significantly associated with MVI+DSA-C4d- (OR, 0.994; 95% CI, 0.554–1.780; <i>p</i> = 0.984). Steroid discontinuation did not significantly impact the risk of MVI+DSA-C4d- (OR, 1.980; 95% CI, 0.318–12.000; <i>p</i> = 0.470).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lower trough levels of tacrolimus and everolimus correlated with a higher incidence of antibody-independent MVI, supporting the need for tailored immunosuppressive regimens in kidney transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143455769","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":"Liver Transplant Fast-Track With an Emphasis on Reduced Delirium: A Multidisciplinary Approach to Reducing Length of Stay","authors":"David M. Salerno,&nbsp;Mia Genovese,&nbsp;Arun Jesudian,&nbsp;Erica Roman,&nbsp;Mashal Khan,&nbsp;Benjamin Samstein,&nbsp;Danielle Brandman","doi":"10.1111/ctr.70111","DOIUrl":"https://doi.org/10.1111/ctr.70111","url":null,"abstract":"<div>\u0000 \u0000 <p>Enhanced recovery after surgery protocols have been shown to reduce length of stay in transplant patients. The purpose of our study was to evaluate the impact of a standardized protocol in liver transplant recipients (LTR) on length of stay (LOS) and delirium during the index hospitalization post-LT. Elements of the protocol included reduced intraoperative corticosteroids (from methylprednisolone 1000 to 250 mg), conversion of steroid taper to be administered once-daily instead of BID, optimal end-of-case intraoperative extubation, multimodal analgesia, early removal of surgical drains, implementation of dietary and physical therapy plans and education for multidisciplinary providers and patients about expected LOS. The primary outcome was post-LT LOS. Secondary outcomes included incidence of delirium, ICU LOS, rejection at 60 days and readmission within 30 days of discharge. A total of 125 LTRs were included. Baseline characteristics were similar between groups. The median LOS was 12 days (IQR, 9–19) and 10 days (IQR, 8–15) in the pre- and post-implementation groups, respectively (<i>p</i> = 0.025). ICU LOS was 2.9 (IQR, 2.1–4) and 2.7 (IQR, 1.9–3.7) in the pre- and post-implementation groups, respectively (<i>p</i> = 0.525). In the pre- and post-implementation groups, the incidence of delirium was 17 (25.8%) and 5 (8.6%), respectively (<i>p</i> = 0.013). The incidence of treated rejection at 60 days was 3% (0.0–10.1) and 5.2% (2.9–15.2) in the pre- and post-implementation groups, respectively (<i>p</i> = 0.550). Implementation of a Fast Track protocol in a high acuity LTR was feasible and safe and was associated with a reduction in LOS.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431394","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":"Flying Kidneys or Flying Donors: What Do Prior Canadian Living Kidney Donors Think?","authors":"Katya Loban,&nbsp;Kathleen Gaudio,&nbsp;Shaifali Sandal","doi":"10.1111/ctr.70115","DOIUrl":"https://doi.org/10.1111/ctr.70115","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431340","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":"Individual Association of Predicted Left and Right Ventricular Mass Ratios With Survival After Heart Transplantation: A UNOS Database Analysis","authors":"Amiti Jain,&nbsp;Christopher Pritting,&nbsp;Andrew Brodie,&nbsp;Daler Rahimov,&nbsp;Danial Ahmad,&nbsp;J. Eduardo Rame,&nbsp;Rene Alvarez,&nbsp;Keshava Rajagopal,&nbsp;John W. Entwistle,&nbsp;Vakhtang Tchantchaleishvili","doi":"10.1111/ctr.70113","DOIUrl":"https://doi.org/10.1111/ctr.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Predicted heart mass (PHM) ratio is a commonly used metric for donor-to-recipient size matching that has been associated with survival after heart transplantation (HTx). PHM represents a sum of two separate statistical models for predicted left ventricular mass (PLVM) and predicted right ventricular mass (PRVM); however, their individual contributions have not been sufficiently studied. We sought to assess the association of donor-to-recipient PLVM (PLVMR) and PRVM ratios (PRVMR) with overall posttransplant survival individually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult heart transplant recipients from 2005 to 2021 were queried from the UNOS database. A three-dimensional tensor product spline model assessed the association of PLVMR and PRVMR with survival simultaneously on a continuous distribution. Subsequently, PLVMR and PRVMR were explored individually using individual restricted cubic spline models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 25 549 patients were analyzed. Of these, female recipients comprised 26.7% (<i>n</i> = 6818), and the median age was 56 [IQR 46–63] years. In the three-dimensional restricted cubic spline (3D-RCS) model, PLVMR and PRVMR were significantly associated with survival (<i>p</i> value: overall = 0.002, PLVMR = 0.0006, PRVMR = 0.0006, PLVMR*PRVMR = 0.0002). When analyzed with two-dimensional restricted cubic spline (2D-RCS) models, PLVMR was not associated with survival (<i>p</i> = 0.59), while PRVMR retained its significant association (<i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While both PLVMR and PRVMR appear to be associated with posttransplant survival, the effect of PRVMR might be disproportionately high as PRVM makes up a much smaller fraction of PHM than PLVM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431393","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":"Is Survival Impacted by One or Several Successive Cancers After Liver Transplantation? A French National Study","authors":"Anaïs R. Briant,&nbsp;Rémy Morello,&nbsp;Olivier Sérée,&nbsp;Nicolas Vigneron,&nbsp;Sarah Wilson,&nbsp;Camille Besch,&nbsp;Pauline Houssel-Debry,&nbsp;Georges-Philippe Pageaux,&nbsp;Audrey Coilly,&nbsp;Jérôme Dumortier,&nbsp;Mario Altieri","doi":"10.1111/ctr.70109","DOIUrl":"https://doi.org/10.1111/ctr.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>De novo cancers after liver transplantation (LT) are major causes of complications and mortality after LT. No report was found in the literature on several successive cancers (SSC). The aim of this study was to see if the survival of one or more cancers was different and to study the survival prognostic factors of patients with one cancer or SSC after LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from the French national database, 114 French patients who underwent LT between 1993 and 2012 were followed up until their death or until June 2016. The Cox model performed to analyze potential risk factors (cancer characteristics, immunosuppressive therapy (IT), smoking, and alcohol use).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After an average follow-up of 9.8 ± 5.1 years, 52 patients developed 1 cancer, 49 had 2 cancers, and 13 had 3 cancers. The reduction in survival time was significantly and independently associated with the metastatic stage (hazard ratio (HR) = 3.98, 95% confidence interval (95% CI) = [1.45–10.93], <i>p</i> &lt; 0.001), ENT (otolaryngology), and respiratory cancer versus genitourinary (HR = 8.28, 95% CI = [3.12–22.02], <i>p</i> &lt; 0.001), and SSC (HR = 2.54, 95% CI = [1.39–4.65], <i>p</i> = 0.014).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The patients with ENT, respiratory cancers have a shorter survival. The stage of cancer and SSC reduces median survival at 10 years. The earliness of the first cancer should be taken as a warning signal of risk of SSC and impaired survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397177","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}