Clinical Transplantation最新文献

{"title":"Sex Differences in Incidence and Outcomes of New-Onset Post-Transplant Diabetes Mellitus After Heart Transplantation","authors":"Alice Chung,&nbsp;Heidi Hartman,&nbsp;Ersilia M. DeFilippis,&nbsp;Eleanor Keller,&nbsp;Stephanie Golob,&nbsp;Daniella Concha,&nbsp;Jaya Batra,&nbsp;Gabriel Sayer,&nbsp;Farhana Latif,&nbsp;Melana Yuzefpolskaya,&nbsp;Jayant Raikhelkar,&nbsp;Justin Fried,&nbsp;Koji Takeda,&nbsp;Nir Uriel,&nbsp;Kevin Clerkin","doi":"10.1111/ctr.70143","DOIUrl":"https://doi.org/10.1111/ctr.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Post-transplant diabetes mellitus (PTDM) is a common complication following heart transplantation (HT). The purpose of this study was to investigate sex differences in risk factors for the development of PTDM after HT, as well as in PTDM-related post-transplant outcomes, including acute cellular rejection (ACR), antibody-mediated rejection (AMR), cardiac allograft vasculopathy (CAV), and death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review of patients who underwent HT at a large-volume center between January 1, 2010 and December 31, 2019 was performed. PTDM was defined as hemoglobin A1C ≥ 6.5% or a random glucose &gt;200 after HT among patients with no prior history of DM. Predictors of PTDM and post-HT outcomes were analyzed by sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 533 patients were transplanted during the study period and screened for inclusion. Among the 317 HT patients without pre-transplant DM, 71 (22.4%) developed PTDM: 24 women (33.7%), 47 men (66.2%). Baseline hypertension (OR 2.9, [1.3, 6.7], <i>p</i> = 0.009) and mean steroid dose over the first 2 years post-transplant (OR 1.2, [1.0, 1.3], <i>p</i> = 0.006) were predictors of PTDM in women but not in men, and mean tacrolimus dose was a predictor in men (OR 1.1, [1.0, 1.2], <i>p</i> = 0.001) but not in women while mean tacrolimus level was a predictor in women (OR 1.2, [1.0, 1.2], <i>p</i> = 0.034) but not in men. Post-transplant outcomes, including ACR, AMR, CAV, and death, did not differ between men with and without PTDM. However, women with PTDM had a higher rate of AMR (38% vs. 18%, <i>p</i> = 0.04) as compared to women without PTDM. There were no significant differences in rates of ACR, CAV, infection requiring hospitalization, or death among women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PTDM is a common complication of HT. Our study suggests that risk factors for PTDM and outcomes among HT patients differ by sex.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831254","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":"Efficacy, Tolerability, and Safety of Glucagon-Like Peptide 1 Receptor Agonists (GLP1-RA) in Kidney Transplant Recipients With Diabetes","authors":"Henry Zelada,&nbsp;Mario Campana,&nbsp;Kosuke Kawai,&nbsp;David Redden,&nbsp;Gaurav Agarwal,&nbsp;Orlando M. Gutierrez,&nbsp;Vineeta Kumar","doi":"10.1111/ctr.70144","DOIUrl":"https://doi.org/10.1111/ctr.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Uncontrolled diabetes after solid-organ transplantation has been associated with weight gain, high cardiovascular mortality, and transplant rejection. The current standard of care for uncontrolled diabetes after KT is insulin. Recently GLP1-RA have been proposed as an adjuvant medication for those with obesity, but there are concerns for side effects and safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults (<i>n</i> = 50) with diabetes who underwent KT from at a single academic medical center were included. This is a retrospective study of 25 recipients on insulin ± oral antidiabetic medications who initiated GLP1-RA, and 25 recipients on insulin ± oral agents. Metabolic issues and safety were evaluated before starting GLP1RA, and 6 and 12 months after. The linear mixed effects model was used to evaluate the mean difference in the change in the outcome between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>KT participants were on average 56 years of age, 64% male, with T2D. The primary outcome of change in weight 12 months after initiation of GLP1-RA on an average was −10.1 pounds in the GLP1-RA group, compared to +6.0 pounds in the non-GLP1-RA group (<i>p</i> &lt; 0.01), the change in BMI 12 months after initiation of GLP1-RA on an average was −1.7 kg/m² in the GLP1-RA group compared to +1.1 kg/m² in the non-GLP1-RA group (<i>p</i> &lt; 0.01), and the change in creatinine 12 months after starting GLP1-RA was on average −0.2 mg/dL in the GLP1-RA group and on average +0.3 mg/dL in the non-GLP1-RA group (<i>p</i> &lt; 0.01). The change in proteinuria 12 months after starting GLP1-RA was on average −128.4 in the GLP1-RA and on average +15.4 mg/dL in the controls (<i>p</i> &lt; 0.01). The rate of GLP1-RA discontinuation was 0%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Well-selected post-kidney transplant participants demonstrated good tolerance for GLP-1RA. Participants who took GLP1-RA had better glycemic control, more weight loss, a decrease in daily insulin requirements, better preservation of kidney function, and reduced proteinuria 7 12 months after initiation of GLP1-RA compared to those who did not. GLP1-RA did not alter tacrolimus levels or doses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831252","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":"Twelve-Month Clinical and Cost Outcomes of Removal of Cytomegalovirus Intravenous Immune Globulin From Heart Transplantation Protocol","authors":"Madhumita Rao,&nbsp;Robert L. Page II,&nbsp;Emily Sartain","doi":"10.1111/ctr.70147","DOIUrl":"https://doi.org/10.1111/ctr.70147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cytomegalovirus (CMV) is a common opportunistic infection in solid organ transplant patients. Intravenous CMV immunoglobulin (CMV-IVIG) is a pharmacotherapy option with limited data within heart transplantation. At UCHealth, CMV-IVIG was removed from the heart transplant CMV prophylaxis protocol in July 2022. This study evaluated the efficacy and cost outcomes of CMV-IVIG removal from the protocol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-center, retrospective cohort study of heart transplant recipients transplanted at UCHealth between October 2020 and March 2023. Patients were included if seronegative for CMV, and excluded if they died or were lost to follow-up within 12 months of transplantation. Patients included were compared after being separated into pre- and post-protocol cohorts if transplanted prior to July 1, 2022 when CMV-IVIG was removed from the protocol and afterward, respectively. Standard universal prophylaxis with valganciclovir was used in both cohorts. The primary outcome was CMV DNAemia within 12 months of heart transplant, and secondary outcomes included cost avoidance and CMV DNAemia within 18 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-two patients were included in this study. There was no significant difference in CMV DNAemia between pre- and post-protocol groups at 12 months (9.5% vs. 4.8%, <i>p</i> = 0.55) or 18 months (28.6% vs. 19%, <i>p</i> = 0.53). Median cost avoidance for removing CMV-IVIG from the protocol per patient was $30 652.13–$40 331.75.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Removing CMV-IVIG from a heart transplant protocol was associated with cost avoidance without worsened outcomes in CMV DNAemia. CMV-IVIG likely does not have significant benefits for preventing CMV DNAemia with concomitant universal antiviral prophylaxis in heart transplant recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836024","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":"Center-Level Variability in Use of Normothermic Machine Perfusion and the Association With Recipient Insurance","authors":"Chawin Lopimpisuth,&nbsp;David S. Goldberg","doi":"10.1111/ctr.70140","DOIUrl":"https://doi.org/10.1111/ctr.70140","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The rapid implementation of normothermic machine perfusion (NMP), since the FDA-approved NMP devices, has resulted in a paradigm shift in the ability to use marginal livers and allow for daytime operations. A major rate-limiting factor is costs which could lead to disparities among recipients. We aim to evaluate center-level variability in utilization of NMP, and to determine whether recipient insurance type was associated with NMP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated deceased donor liver transplants in high-volume NMP centers between January 2022 and December 2023, using the national registry. The primary outcome was whether the DDLT was performed using NMP. To explore center-level and factors associated with NMP, we evaluated variables related to donor quality and insurance. We fit multivariable logistic regression models to evaluate these factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 142 liver transplant centers, 72 had ≥1 DDLT using NMP, and 28 were high-volume NMP centers. There was marked center-level variability in the proportion of donation after brain death (DCD) versus donation after brain death (DBD) allografts that underwent NMP. In logistic regression, liver allografts procured using NMP were more likely to occur during the nighttime (OR 1.26, <i>p</i> &lt; 0.001), more likely to be used for DCD allografts (OR 13.2, <i>p</i> &lt; 0.001), and less likely to occur in recipients insured by Medicaid, Medicare, or the Veterans Health Administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study demonstrates center-level variability in the use of NMP, and factors associated with these differences. Although the change in practice may help to increase DCD utilization, and shift the timing of transplants, the disparity based on insurance is alarming.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831253","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":"Clinical Features and Treatment of Antibody-Mediated Rejection After Liver Transplantation: A Largest Single Center Experience in China","authors":"Li-Na Wu,&nbsp;Jing-Yi Liu,&nbsp;Xin-Yan Zhao,&nbsp;Zhi-Jun Zhu,&nbsp;Lin Wei,&nbsp;Wei Qu,&nbsp;Zhi-Gui Zeng,&nbsp;Li-Ying Sun","doi":"10.1111/ctr.70149","DOIUrl":"https://doi.org/10.1111/ctr.70149","url":null,"abstract":"<div>\u0000 \u0000 <p>Antibody-mediated rejection (AMR) is frequently observed in renal transplantation but remains rare and less understood in liver transplantation (LT). This study summarizes the clinical features of AMR in liver transplant patients at our center from August 2020 to October 2023. Thirteen patients were identified as having AMR, including 11 pediatric cases with a median age of 16.2 months. The median interval from transplantation to AMR diagnosis was 54.13 months. Most patients exhibited mild elevation in liver function. A notable decrease in CD4+ T cells was found in acute AMR patients, alongside reduced complement C3 in chronic cases. PRA was positive in 92.31% of patients, all of whom had elevated class II DSA. Additionally, many patients experienced infections with non-hepatotropic viruses. Following intensified immunosuppression and other therapies, 92.31% of patients achieved normal liver function, including five chronic AMR cases with characteristic histological features and seven acute AMR cases that showed no inflammation or centrilobular fibrosis on biopsy. These findings indicate that AMR patients may not exhibit significant liver function abnormalities, emphasizing the critical role of PRA and DSA in diagnosis. The observed reduction in CD4+ T cells and complement C3 may provide valuable insights into the pathogenesis of AMR.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831264","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":"Multivariable Predictors of Poorer Renal Function Among 1119 Deceased Donor Kidney Transplant Recipients During the First Year Post-Transplant, With a Particular Focus on the Influence of Individual KDRI Components and Donor AKI","authors":"Giselle Guerra,&nbsp;Luke Preczewski,&nbsp;Jeffrey J. Gaynor,&nbsp;Mahmoud Morsi,&nbsp;Marina M. Tabbara,&nbsp;Adela Mattiazzi,&nbsp;Rodrigo Vianna,&nbsp;Gaetano Ciancio","doi":"10.1111/ctr.70080","DOIUrl":"https://doi.org/10.1111/ctr.70080","url":null,"abstract":"<p>Given our desire to reduce kidney transplant waiting times by utilizing more difficult-to-place (“higher-risk”) DD kidneys, we wanted to better understand post-transplant renal function among 1119 adult DD recipients consecutively transplanted during 2016–2019. Stepwise linear regression of eGFR (CKD-EPI formula) at 3-, 6-, and 12-months post-transplant (considered as biomarkers for longer-term outcomes), respectively, was performed to determine the significant multivariable baseline predictors, using a type I error ≤ 0.01 to avoid spurious/weak associations. Three unfavorable characteristics were selected as highly significant in all three models: Older DonorAge (yr) (<i>p</i> &lt; 0.000001), Longer StaticColdStorage Time (hr) (<i>p</i> &lt; 0.000001), and Higher RecipientBMI (<i>p</i> ≤ 0.00003). Other significantly unfavorable characteristics included: Shorter DonorHeight (cm) (<i>p</i> ≤ 0.00001), Higher Natural Logarithm {Initial DonorCreatinine} (<i>p</i> ≤ 0.001), Longer MachinePerfusion Time (<i>p</i> ≤ 0.003), Greater DR Mismatches (<i>p</i> = 0.01), DonorHypertension (<i>p</i> ≤ 0.004), Recipient HIV+ (<i>p</i> ≤ 0.006), DCD Kidney (<i>p</i> = 0.002), Cerebrovascular DonorDeath (<i>p</i> = 0.01), and DonorDiabetes (<i>p</i> = 0.01). Variables not selected into any model included DonorAKI Stage (<i>p</i> ≥ 0.24), Any DonorAKI (<i>p</i> ≥ 0.04), and five KDRI components: two DonorAge splines at 18 years (<i>p</i> ≥ 0.52) and 50 years (<i>p</i> ≥ 0.28), BlackDonor (<i>p</i> ≥ 0.08), DonorHCV+ (<i>p</i> ≥ 0.06), and DonorWeight spline at 80 kg (<i>p</i> ≥ 0.03), indicating that DonorAKI and the weaker KDRI components have little, if any, prognostic impact on renal function during the first 12 months post-transplant. Additionally, biochemical determinations with skewed distributions such as DonorCreatinine are more accurately represented by natural logarithmic transformed values. In conclusion, one practical takeaway is that donor AKI may be ignored when evaluating DD risk.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827072","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":"A Simple One-Item Nursing Falls Assessment Predicts Outcomes for Patients With Stage D Heart Failure Undergoing Surgical Advanced Therapies","authors":"Vincent D. Salvador,&nbsp;Jaime Abraham Perez,&nbsp;Paige W. Hudec,&nbsp;Eiran Z. Gorodeski,&nbsp;Thomas JosephO'Neill IV","doi":"10.1111/ctr.70146","DOIUrl":"https://doi.org/10.1111/ctr.70146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Frailty portends worse outcomes for patients with advanced heart failure (HF) undergoing surgical advanced therapies. Falls are characteristic of frailty, but it is unknown if the history of falls predicts post-operative risk. We hypothesized that a one-item fall screening is associated with worse outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study of all patients undergoing orthotopic heart transplantation (OHT) or left ventricular assist device (LVAD) implantation at our institution between 2020 and 2023. Our primary exposure of interest was falls, as assessed by a nursing questionnaire within 12 months or less prior to surgery. We tracked hospital- and ICU-length of stay, duration of mechanical ventilator use, renal replacement therapy (RRT), and survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>History of falls was associated with prolonged mechanical support (mean difference: +1.5 days, <i>p</i> = 0.002), prolonged ICU stay (mean difference: +13 days, <i>p</i> = 0.03), and prolonged hospital stay (mean difference: +17 days, <i>p</i> = 0.03). Patients with a history of falls also had a higher rate of needing RRT in the 90 days following surgery (adjusted HR: 4.7, 95% CI 1.1–20, <i>p</i> = 0.035). There were no differences in survival between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among patients with advanced HF undergoing OHT or LVAD, a simple one-item nursing falls assessment is associated with clinically relevant worse outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827073","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":"Performance of Five Estimated Glomerular Filtration Rate Equations in Vietnamese Kidney Transplant Recipients: A Cross-Sectional Study","authors":"Tam Thai Thanh Tran,&nbsp;Tho Kieu Anh Pham,&nbsp;Nghia Nhu Nguyen,&nbsp;Thao Minh Truong,&nbsp;Hoang Nguyen Huy Ho,&nbsp;Chuan Khac Hoang,&nbsp;Sam Minh Thai,&nbsp;An Bao Huynh","doi":"10.1111/ctr.70145","DOIUrl":"https://doi.org/10.1111/ctr.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the critical role of glomerular filtration rate (GFR) assessment in monitoring kidney transplants, the most accurate estimate remains uncertain. This study aimed to evaluate the performance of established estimated GFR (eGFR) equations in the Vietnamese population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study involving 299 Vietnamese kidney transplant recipients (KTRs) compared measured GFR (mGFR), determined using technetium-99m-diethylenetriaminepentaacetate (^99mTc-DTPA) renal dynamic scintigraphy, with five eGFR equations (Modification of Diet in Renal Disease [MDRD], Asian modified Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI], CKD-EPI SCysC 2012, CKD-EPI SCr 2021, and CKD-EPI SCr–SCysC 2021). The performances of the five eGFR equations were compared based on bias, P₃₀ accuracy, absolute accuracy, precision, root mean square error (RMSE), concordance correlation coefficient (CCC), and Pearson's correlation coefficient (<i>r</i>), along with their 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CKD-EPI SCr–SCysC 2021 showed the best performance. The values for median bias, P₃₀ accuracy, absolute accuracy, precision, RMSE, CCC, and <i>r</i> were: 2.57 [1.22; 3.55] mL/min/1.73 m², 87.6% [83.3; 90.6], 10.0% [8.3; 11.7], 11.29 [9.57; 13.40] mL/min/1.73 m², 11.54 [10.42; 12.92], 0.787 [0.737; 0.828], and 0.810 [0.759; 0.850], respectively. The MDRD equation did not show significantly lower precision and accuracy than the CKD-EPI SCr–SCysC 2021 equation. All five equations demonstrated improved accuracy in the mGFR ≥ 60 mL/min/1.73 m² subgroup compared to the mGFR &lt; 60 mL/min/1.73 m² subgroup.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CKD-EPI SCr–SCysC 2021 is the most accurate eGFR equation for Vietnamese KTRs. Further studies with larger cohorts and comparisons with gold-standard methods are needed to confirm these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826731","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":"Association of Functional, Academic, Motor, and Cognitive Deficits in Graft Failure in Pediatric Liver Transplantation","authors":"Conor Donnelly,&nbsp;Suhani S. Patel,&nbsp;Ian S. Jaffe,&nbsp;Daniyar Akizhanov,&nbsp;Teresa Po-Yu Chiang,&nbsp;Jane J. Long,&nbsp;Luckmini Liyanage,&nbsp;Adam Griesemer,&nbsp;Dorry L. Segev,&nbsp;Allan B. Massie","doi":"10.1111/ctr.70132","DOIUrl":"10.1111/ctr.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Predicting graft failure risk in pediatric liver transplantation (LT) recipients could identify areas for improving management. Persistent cognitive, motor, academic, and functional deficits are common in recipients and their impact on graft survival following LT helps inform risk prediction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using SRTR data 2008–2023, we evaluated the cognitive, motor, academic, and functional deficits of LT recipients at time of transplant to 14 years post-LT. We compared all cause graft failure (ACGF) among patients with versus without pre-LT and 1-year post-LT deficits using Cox regression, adjusting for recipient characteristics. We calculated an individual risk score for ACGF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 8062 pediatric LT recipients median age 3 (IQR: 1, 10), 28.0%, 29.5%, 35.0%, and 79.8% of recipients had pre-LT deficits in cognition, motor, academic activity, and functional status respectively. This decreased to 23.0%, 18.1%, 14.2%, and 38.7% 1-year post-LT. Increased hazard of ACGF was noted in recipients with pre-LT decreased functional status (aHR = 1.13 (per 10% decrease), 95% CI: 1.10–1.15, <i>p</i> &lt; 0.001), definite motor delay (aHR = 1.60, 95% CI: 1.21–2.10, <i>p</i> &lt; 0.001), and inability to participate in academics (aHR = 1.49, 95% CI: 1.08–1.89, <i>p</i> = 0.01), but not delays in cognition (aHR = 0.91, 95% CI: 0.69–1.21, <i>p</i> = 0.19). Our risk score predicting ACGF demonstrated improved predictive performance compared to clinical parameters alone (C-statistic = 0.70 (0.67, 0.72) vs. 0.66 (0.64, 0.69), <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pediatric LT recipients with pre- or post-LT motor, academic, and functional deficits are at higher risk for ACGF. Care should be taken to assess deficits to identify patients who may benefit from functional intervention to potentially reduce ACGF risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143726846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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