Clinical Transplantation最新文献

{"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}

{"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}