Clinical Transplantation最新文献

{"title":"Participation and Progression of Hybrid Rehabilitation following Lung Transplantation","authors":"Rachel Carson,&nbsp;Carina Cordi,&nbsp;Emma Campisi,&nbsp;Skyler Moss,&nbsp;Alyssa Trask,&nbsp;Kevin Zhu,&nbsp;Chaya Gottesman,&nbsp;Manoela Ferreira,&nbsp;Tamires Mori,&nbsp;Lisa Wickerson","doi":"10.1111/ctr.70185","DOIUrl":"https://doi.org/10.1111/ctr.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Exercise training is recommended to improve physical recovery following lung transplantation (LTx). Since the COVID-19 pandemic, hybrid rehabilitation has emerged utilizing both in-person and home-based exercise. Little is known about exercise participation, progression and intensity with this delivery model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single center retrospective chart review of adult LTx recipients who undertook outpatient rehabilitation within the first 3 months after LTx between December 1, 2022 and February 29, 2024, was conducted. High participation was defined as ≥3 exercise sessions/week for at least 50% of the rehabilitation period. Progression of exercise volumes was examined and walking intensity (Borg leg fatigue scale) was compared between in-person and home rehabilitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 166 LTx recipients were included (70% male, 64 [14] years, 71% interstitial lung disease). High rehabilitation participation was observed in 48% of participants over a mean of 8 ± 2 weeks. The median walking distance, biceps and quadriceps resistance training volumes increased between the first and last recorded rehabilitation sessions during both in-person (536 [538] vs. 1073 [650] m, 40 [20] vs. 60 [55] repxlbs, and 20 [10] vs. 40 [30] repxlbs) and home rehabilitation (968 [991] vs. 1556 [1019] m, 50 [70] vs. 100 [70] repxlbs, and 30 [32] vs. 40 [70] repxlbs), all <i>p</i> &lt; 0.05. Leg fatigue was higher during in-person walking compared to home (3 [3–4] vs. 3 [2–3]), <i>p</i> &lt; 0.001.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Half of LTx recipients had low participation in outpatient and home rehabilitation early after transplantation. Understanding barriers to home exercise participation and reporting will enhance hybrid rehabilitation delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085093","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":"Establishing a Normothermic Machine Perfusion Program for Liver Transplantation: Lessons Learned and Early Outcomes in the United States","authors":"Yuzuru Sambommatsu,&nbsp;Daisuke Imai,&nbsp;Kush Savsani,&nbsp;Mallika Datta,&nbsp;Junpei Tarashi,&nbsp;Jacob Hallesy,&nbsp;Samuel Wolfe,&nbsp;Aamir A. Khan,&nbsp;Seung Duk Lee,&nbsp;Amit Sharma,&nbsp;Muhammad Saeed,&nbsp;Vinay Kumaran,&nbsp;Adrian H. Cotterell,&nbsp;Marlon F. Levy,&nbsp;David A. Bruno","doi":"10.1111/ctr.70170","DOIUrl":"https://doi.org/10.1111/ctr.70170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Normothermic machine perfusion (NMP) has emerged as a promising technology in liver transplantation, but limited data exist regarding real-world implementation in the United States following FDA approval. We report our experience establishing an NMP program and share insights from our first 100 cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 100 consecutive liver NMP cases performed between July 2023 and May 2024 using the OrganOx Metra device. Program establishment required assembling a dedicated team, comprehensive training, establishing a dedicated perfusion facility, coordinating with multiple departments including laboratory, blood bank, electronic medical record vendors, and billing services, and developing institutional viability criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 100 NMP cases, 92 proceeded to transplantation while eight were declined. Early allograft dysfunction occurred in 19 cases (20.7%) with no instances of primary non-function, and 90-day graft survival was 94.6%. No graft losses were directly attributable to NMP. Six grafts showed delayed lactate clearance but achieved successful outcomes with extended perfusion time. We systematically refined our protocols and developed standardized troubleshooting approaches to address various technical challenges including graft bleeding, arterial flow monitoring issues, persistent acidosis, and bile duct drainage issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Successful implementation of an NMP program requires careful preparation, dedicated staffing, and interdepartmental coordination. Although various challenges are expected in the initial phase of the program, these can be successfully managed with a systematic approach. Our experience provides practical guidance for centers planning to establish NMP programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091768","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":"Trends, Clinical Characteristics, and Outcomes of Percutaneous Coronary Intervention in Liver Transplant Recipients","authors":"Song Peng Ang,&nbsp;Jia Ee Chia,&nbsp;Jose Iglesias,&nbsp;Chayakrit Krittanawong","doi":"10.1111/ctr.70181","DOIUrl":"https://doi.org/10.1111/ctr.70181","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Coronary artery disease (CAD) poses a significant challenge for liver transplant recipients (LTRs) who face higher cardiovascular risks due to immunosuppressive therapies and metabolic changes. While extensive research has focused on CAD management in patients awaiting liver transplantation, data on the outcomes of percutaneous coronary intervention (PCI) in the post-transplant population remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used the National Inpatient Sample database (2016–2021) to evaluate PCI hospitalizations involving LTR and non-transplant patients. Propensity score matching (1:3) was applied to balance the covariates between the LTRs and non-transplant patients. The primary outcome was in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 2 681 545 PCI hospitalizations, LTRs accounted for 0.1% (<i>n</i> = 2675). LTRs were more likely to have diabetes (60.56% vs. 41.36%) and chronic kidney disease (60.93% vs. 21.06%) but less likely to have hyperlipidemia (58.32% vs. 72.65%; all <i>p</i> &lt; 0.001). The crude rates of AKI (32.34% vs. 16.07%; <i>p</i> &lt; 0.001) and blood transfusion (5.61% vs. 2.76%; <i>p</i> = 0.0001) were higher in the LTRs. After matching, the LTRs were associated with lower odds of in-hospital mortality (OR, 0.55; 95% CI, 0.30–1.00; <i>p</i> = 0.05) and cardiogenic shock (OR, 0.46; 95% CI, 0.29–0.74; <i>p</i> = 0.001). PCI hospitalizations among LTRs increased over time, peaking in 2019 (116.6/100 000).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite higher comorbidities and complication rates, LTRs undergoing PCI exhibited lower in-hospital mortality than non-transplant patients, likely reflecting survivor bias, rigorous pre- and post-transplant care, and specialized management. These preliminary findings highlight the need for further studies with detailed clinical data to validate the current findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144074492","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 Left Ventricular-Vascular Interaction on Long-Term Outcome After Heart Transplantation","authors":"Mattia Corianò,&nbsp;Nicola Pradegan,&nbsp;Andrea Golfetto,&nbsp;Vincenzo Tarzia,&nbsp;Annalisa Angelini,&nbsp;Antonio Gambino,&nbsp;Chiara Tessari,&nbsp;Marny Fedrigo,&nbsp;Giuseppe Toscano,&nbsp;Gino Gerosa,&nbsp;Francesco Tona","doi":"10.1111/ctr.70178","DOIUrl":"https://doi.org/10.1111/ctr.70178","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aim</h3>\u0000 \u0000 <p>To compare pressure-volume (PV) derivative variables between HT patients and healthy controls and to assess their impact on long-term outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-center retrospective study, HT patients surviving their first post-HT year with left ventricular ejection fraction (LVEF) ≥50%, absence of allograft vasculopathy, and rejection were enrolled. PV variable surrogates were measured by transthoracic echocardiography and compared with healthy controls. The endpoint was cardiovascular mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1985 to 2015, 345 patients were enrolled. Arterial elastance (Ea) and left ventricular end-systolic elastance (Ees) were higher in HT recipients than in healthy controls (4.03 vs. 1.65, <i>p</i> &lt; 0.0001 and 6.75 vs. 2.47, <i>p</i> &lt; 0.0001, respectively), while ventricular arterial coupling (VAC) was similar between the two groups (0.66 vs. 0.59, <i>p</i> = 0.105). After a median of 11.3-year follow-up, 59 (17%) HT recipients died. VAC was not significantly associated with cardiac mortality (<i>p</i> = 0.074). Survival was lower in HT recipients with Ea &gt; 4 mmHg/mL/m² and Ees ≤ 6.75 mmHg/mL/m², and both were independently associated with mortality risk after adjustment (Ea &gt; 4 mmHg/mL/m²: HR 2.25 [95% CI 1.38–3.66], <i>p</i> = 0.013; Ees ≤ 6.75 mmHg/mL/m²: HR 3.70 [95% CI 1.95–7.06], <i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In HT recipients surviving the first year after transplantation with normal LVEF, high Ea, and low Ees values were independently associated with poorer outcomes in long-term follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70178","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944720","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":"Secular Trends in Development of End-Stage Renal Disease Following Liver Transplantation","authors":"Jessica M. Ruck,&nbsp;Maria A. Parra,&nbsp;Laura B. Zeiser,&nbsp;Goutham Nair,&nbsp;Sam Kant,&nbsp;Benjamin Philosophe,&nbsp;Shane E. Ottmann,&nbsp;Andrew M. Cameron,&nbsp;Russell N. Wesson,&nbsp;Allan B. Massie,&nbsp;Dorry L. Segev,&nbsp;Elizabeth A. King","doi":"10.1111/ctr.70141","DOIUrl":"https://doi.org/10.1111/ctr.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Renal dysfunction is common among liver transplant candidates and can resolve, persist, or develop de novo following liver transplantation (LT). In light of the 2017 policy changes to simultaneous liver-kidney transplant and the post-LT kidney transplant safety net eligibility, we evaluated risk factors for and change in the incidence of post-LT renal dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using SRTR data for adult deceased-donor liver-only transplant recipients 2010–2022, we evaluated secular trends in and risk factors for the development of post-LT ESRD at 1 year and overall using multivariable logistic and Cox regression. We compared observed versus expected incidence of ESRD at 1-year post-LT using weighting by odds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 77 565 LT recipients, 6032 (7.8%) developed ESRD during the study period, of whom 2354 (39.0%) developed ESRD within the first year after LT. In a multivariable model, diabetes (aOR 1.63, 95% CI 1.48–1.79, <i>p</i> &lt; 0.001), pre-LT eGFR (aOR 0.97 per unit, 95% CI 0.97–0.97, <i>p</i> &lt; 0.001), and MELD category remained independently associated with ESRD within 1-year post-LT. Odds of ESRD by 1 year post-LT were 47% higher than expected post-2017 after accounting for changes in donor and recipient characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The rising 1-year post-LT ESRD risk highlights the need to reassess safety net eligibility beyond 1 year and prioritize counseling on risk minimization, including post-transplant diabetes management and potential adjustments to immunosuppression protocols to improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938939","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":"Hyperfibrinolysis Detection During Liver Transplantation Using Viscoelastometry","authors":"Sarah Thaler,&nbsp;Anna Zorn,&nbsp;Isabell Aster,&nbsp;Dionysios Koliogiannis,&nbsp;Bernhard W. Renz,&nbsp;Markus Guba,&nbsp;Philipp Groene","doi":"10.1111/ctr.70179","DOIUrl":"https://doi.org/10.1111/ctr.70179","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>End-stage liver disease induces a precarious hemostatic equilibrium, named rebalanced hemostasis. Liver transplantation additionally causes profound disturbances in the hemostatic balance. Hyperfibrinolysis poses a relevant impairment to the coagulation process during liver transplantation. During surgery, the hemostatic management is guided by viscoelastic monitoring systems. The aim of this prospective, observational study was to evaluate the incidence of hyperfibrinolysis during liver transplantation using different viscoelastic assays, namely an ecarin-based test and a tissue factor-based test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Blood sampling was done at five measurement time points during liver transplantation (T1 induction of general anesthesia, T2 start of anhepatic phase, T3 end of anhepatic phase, T4 10 min after reperfusion, T5 end of surgery). Viscoelastic testing included ClotPro assays EX-test, FIB-test, AP-test, and ECA-test. Hyperfibrinolysis was defined as a maximum lysis of at least 15%. Lysis detection time (LDT) served as an indicator for the velocity of lysis, marking the time point when less than 85% of the clot are extant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty transplantation surgeries were included. A total of 150 viscoelastic measurements have been performed. The ECA-test detected hyperfibrinolysis significantly more often (31 [21%] vs. 22 [15%] out of 150, <i>p</i> = 0.039) and in a higher number of patients than the EX-test. The ECA-test revealed hyperfibrinolysis significantly earlier compared to the EX-test (median LDT 2100 s [1500/2900] vs. 3300 s [2400/3800], <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates higher sensitivity of the ecarin-test than the tissue-factor-test in monitoring hyperfibrinolysis, with more frequent and earlier detection of this coagulopathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>German Clinical Trials Register: DRKS00032827</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932291","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":"Effect of Renal Transplantation on Left Ventricular Ejection Fraction in Patients on Dialysis with Ischemic and Nonischemic Cardiomyopathy","authors":"Jose Jayme G. De Lima,&nbsp;Luis Henrique W. Gowdak,&nbsp;José Otto Reusing Jr,&nbsp;Elias David-Neto,&nbsp;Luiz A. Bortolotto","doi":"10.1111/ctr.70176","DOIUrl":"https://doi.org/10.1111/ctr.70176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transplant centers exclude patients from the waiting list with reduced left ventricular ejection fraction (LVEF). It is unclear whether renal transplantation (RT) is safe, will have different impacts on patients with ischemic/nonischemic reduced LVEF, and whether myocardial revascularization will influence prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Four hundred and sixty RT patients assessed for coronary artery disease (CAD) and with LVEF determined before and after RT were divided into four groups (Group 1: No CAD and normal LVEF [reference]; Group 2: CAD and normal LVEF; Group 3: No CAD and reduced LVEF [nonischemic cardiomyopathy]; Group 4: CAD and reduced LVEF [ischemic cardiomyopathy]) and followed until death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>RT was associated with increased LVEF in patients with cardiomyopathy. Patients with ischemic cardiomyopathy had a reduced survival rate; coronary intervention and medical treatment had comparable effects on outcomes. However, LVEF or CAD did not influence outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RT can be performed safely in patients with ischemic and nonischemic reduced LVEF and is associated with substantial improvement in LVEF. Although the long-term outcomes were poorer in patients with ischemic disease, LVEF and CAD were not independent predictors of events or death after adjustments. Therefore, reduced LVEF, even in patients with CAD, should not hamper the indication for RT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939077","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":"Dual-Energy X-Ray Absorptiometry-Derived Advanced Hip Analysis and the Trabecular Bone Score Are Associated With the Diagnosis of Fracture Following Kidney and Simultaneous Pancreas-Kidney Transplantation","authors":"Tahira Scott,&nbsp;Jasna Aleksova,&nbsp;Carmel Hawley,&nbsp;Mina Khair,&nbsp;Harpreet Kaur,&nbsp;Christopher Schultz,&nbsp;Ryan Gately,&nbsp;Mirna Vucak-Dzumhur,&nbsp;James Elhindi,&nbsp;Grahame J. Elder","doi":"10.1111/ctr.70177","DOIUrl":"https://doi.org/10.1111/ctr.70177","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with kidney failure have elevated fracture risk that remains high following kidney transplantation. This study aimed to assess whether dual-energy x-ray absorptiometry-derived advanced hip analysis (AHA) and the trabecular bone score (TBS) improve bone mineral density (BMD)-based post-transplant fracture prediction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients receiving kidney-only or simultaneous pancreas-kidney (SPK) transplants underwent immediate post-transplant dual-energy x-ray absorptiometry to provide BMD, the TBS, and AHA parameters; femoral neck, calcar, and shaft cortical thickness (CTh), and femoral neck buckling ratio (BR), an index of structural instability. Patients received treatment to reduce post-transplant BMD loss, using an established risk algorithm. Hazard ratios were determined using Kaplan–Meier and Cox proportional hazard models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 357 transplant recipients, 289 (83%) received a kidney-only transplant. There were 83 incident fractures over a median of 4.4 years (IQR: 2.5–5.5). Fracture was associated with type 1 diabetes mellitus (<i>p</i> &lt; 0.001), former smoking (<i>p</i> = 0.006), lower 25-hydroxyvitamin D (<i>p</i> = 0.003), BMD at total proximal femur and neck of femur (<i>p</i> &lt; 0.001) and spine (<i>p</i> = 0.008), lower CTh at the calcar (<i>p</i> = 0.005) and shaft (<i>p</i> = 0.023), higher BR (<i>p</i> = 0.016) and lower TBS (<i>p</i> = 0.047). Following multivariable adjustment, type 1 diabetes mellitus, 25-hydroxyvitamin D, smoking, and femoral neck BMD remained significant. Using the BMD-based risk algorithm, inclusion of the BR improved the model fit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>BMD, the TBS, and AHA parameters are associated with incident fracture in kidney-only and SPK transplant recipients. Pre-transplant smoking, lower 25-hydroxyvitamin D and BMD are potentially modifiable factors that could reduce post-transplant fracture risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932290","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":"Cover Image, Volume 39, Issue 5","authors":"Ruth Sapir-Pichhadze,&nbsp;Medhat Askar,&nbsp;Matthew Cooper,&nbsp;Lynn D. Cornell,&nbsp;Emanuele Cozzi,&nbsp;Darshana M. Dadhania,&nbsp;Fritz Diekmann,&nbsp;Aiko P. J. de Vries,&nbsp;Carrie A. Schinstock,&nbsp;Robert P. Carroll,&nbsp;Ahmad Abdelrehim,&nbsp;Geliang Gan,&nbsp;Yanhong Deng,&nbsp;Sami Alasfar,&nbsp;Serena M. Bagnasco,&nbsp;Ibrahim Batal,&nbsp;Klemens Budde,&nbsp;Marian C. Clahsen-van Groningen,&nbsp;Vanderlene L. Kung,&nbsp;Fritz Lower,&nbsp;Mariana Seija,&nbsp;Edward Kraus,&nbsp;Maarten Naesens,&nbsp;Laurine M. Bow,&nbsp;the Banff Antibody-Mediated Injury Working Group","doi":"10.1111/ctr.70184","DOIUrl":"https://doi.org/10.1111/ctr.70184","url":null,"abstract":"<p>The cover image is based on the article <i>Rethinking the Diagnosis and Management of Antibody-Mediated Rejection in Multidisciplinary Transplant Meetings: A Global Survey and Banff Working Group Recommendations</i> by Ruth Sapir-Pichhadze et al., https://doi.org/10.1111/ctr.70167.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926165","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":"Pulse Wave Velocity in Pediatric Heart Transplant Recipients–A Marker of Vascular Health","authors":"John-Anthony Coppola,&nbsp;Dipankar Gupta,&nbsp;Dalia Lopez-Colon,&nbsp;Michael Killian,&nbsp;Himesh Vyas","doi":"10.1111/ctr.70173","DOIUrl":"https://doi.org/10.1111/ctr.70173","url":null,"abstract":"<div>\u0000 \u0000 <p>Elevated arterial stiffness is associated with an increased risk of comorbidities such as stroke, heart attack, and kidney disease. Pediatric heart transplant patients are known to have arterial hypertension and elevated aortic stiffness. Limited data on pulse wave velocity (PWV), a surrogate for arterial stiffness, is available in pediatric patients. We performed an observational, prospective study assessing arterial stiffness, utilizing PWV, in pediatric heart transplant recipients. Hemodynamic tracings were obtained via pigtail catheter pullback from ascending to descending aorta during surveillance cardiac catheterization. We found that PWV was abnormal ≥4m/s in patients early and late post-heart transplantation. Cholesterol levels were negatively correlated with PWV. A serial longitudinal assessment of PWV is required to further correlate abnormal PWV with clinical complications.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926093","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}