Clinical Transplantation最新文献

{"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}

{"title":"Hybrid Telemedicine and In-Person Care for Kidney Transplant Follow-Up: A Qualitative Study","authors":"Suad Esayed,&nbsp;Ellie Kim,&nbsp;Hannah C. Sung,&nbsp;Abdula Al-Seraji,&nbsp;Simeon Adeyemo,&nbsp;Hayden Troutt,&nbsp;Ekamol Tantisattamoa,&nbsp;Antoney Ferrey,&nbsp;Uttam G. Reddy,&nbsp;Fatima T. Malik,&nbsp;Robert R. Redfield III,&nbsp;Hirohito Ichii,&nbsp;Abimereki D. Muzaale,&nbsp;Divyanshu Malhotra,&nbsp;Fawaz Al Ammary","doi":"10.1111/ctr.70106","DOIUrl":"https://doi.org/10.1111/ctr.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Kidney transplant recipients are immunocompromised and require lifelong follow-up. Recipients face geographic, socioeconomic, and logistical challenges when seeking follow-up that can be alleviated using telemedicine. We aimed to understand patient experiences and preferences regarding telemedicine video visits and highlight insights to advance adopting hybrid telemedicine/in-person transplant care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted qualitative in-depth, semi-structured interviews with kidney transplant recipients between November 18, 2022, and January 11, 2023. Participants had follow-up at ≥12 months post-transplant via telemedicine at a tertiary transplant center. Study enrollment continued until data saturation was reached (<i>n</i> = 20 participants) when no new information emerged from additional interviews. Transcripts were analyzed using inductive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants median age was 58 years (IQR, 52–72), and 50% were female, 45% were White, 30% were Black, 15% were Asian, 10% were Hispanic/Other persons, and 30% were out-of-state residents. We identified the following seven themes: (1) reducing travel time, (2) minimizing financial burden (decreasing travel-related expenses and lost wages), (3) engaging patients within their comfort space, (4) establishing rapport with patients, (5) limitations of the virtual physical exam, (6) enhancing access to transplant providers (maximizing adherence to follow-up), and (7) lowering risk of communicable diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrating telemedicine with in-person visits enhances post-transplant follow-up care. A hybrid model should leverage the strengths of both modalities, ensuring patient access to care and being patient-centered and flexible. Efforts are needed to advance technological tools in physical examination and human connection, and assess patient outcomes. Policymakers and healthcare systems need to incentivize the adoption and expansion of telemedicine in transplant care.</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":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397176","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":"Clinical Practice Recommendations on the Effect of COVID-19 Vaccination Strategies on Outcomes in Solid Organ Transplant Recipients","authors":"Farid Foroutan,&nbsp;Daniel G Rayner,&nbsp;Shelly Oss,&nbsp;Marco Straccia,&nbsp;Rienk de Vries,&nbsp;Shilpa Raju,&nbsp;Farhin Ahmed,&nbsp;Jennifer Kingdon,&nbsp;Sai Bhagra,&nbsp;Shafrina Tarani,&nbsp;Sabina Herrera,&nbsp;Rahima Bhanji,&nbsp;Heather Ross,&nbsp;Timothy Pruett,&nbsp;Sandy Feng,&nbsp;Marcus Pereira,&nbsp;Coleman Rotstein,&nbsp;Gordon Guyatt,&nbsp;Natasha Aleksova","doi":"10.1111/ctr.70100","DOIUrl":"https://doi.org/10.1111/ctr.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Solid organ transplant (SOT) recipients were excluded from clinical trials evaluating the efficacy of COVID-19 vaccines. There is uncertainty about the number of doses required to prevent life-threatening infection, as well as uncertainty in the optimal vaccine type and their durability. Our objectives were to provide recommendations on the number of COVID-19 vaccination doses, type of vaccine, dose of vaccine administered, and timing of vaccination in SOT recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We commissioned a systematic review on COVID-19 vaccination in SOT, focusing on patient-important outcomes. We recruited an international, multidisciplinary panel of 18 stakeholders, including patient partners to summarize our findings using the GRADE (grading of recommendation, assessment, development, and evaluation) framework, rate certainty in the evidence, and develop recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our panel recommends the routine provision of additional COVID-19 doses after the primary series to SOT recipients with variant-appropriate vaccines (strong recommendation, low certainty evidence). We suggest using any available WHO-approved vaccine rather than selectively choosing a specific type and receiving a single dose rather than a double dose of any COVID-19 vaccine booster (weak recommendation, low certainty evidence). Lastly, we suggest vaccination before transplantation when possible (weak recommendation, low certainty evidence).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The evidence used to guide these recommendations is limited by the paucity of robust randomized trials evaluating COVID-19 vaccination strategies and clinical outcomes in the SOT population. The provision of higher-quality evidence of the overall effects of COVID-19 vaccination in SOT to inform clinical practice will require large, randomized trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389281","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":"Optimizing Anesthesia Management in Liver Transplantation With Use of Real Time Frontal Electroencephalogram","authors":"Gabriel Rice,&nbsp;Nicholas Douville,&nbsp;Sathish Kumar,&nbsp;Patricia Bloom","doi":"10.1111/ctr.70110","DOIUrl":"https://doi.org/10.1111/ctr.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Frontal electroencephalogram (fEEG) is a novel tool to monitor intraoperative sedation and may reduce anesthetic requirements. The utility of fEEG during liver transplantation has not been studied. The primary aim was to determine the association of fEEG with anesthetic requirement. Secondary aims included the effect of fEEG on intraoperative hemodynamics and postoperative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a single-center retrospective cohort study of first-time, liver-alone transplant patients. Anesthetic requirement was measured by the mean minimum alveolar concentration of inhaled anesthetic. Hemodynamics were assessed by mean arterial pressure and total norepinephrine equivalents. Postoperative outcomes included time to extubation, mean postoperative sedation score, and incidence of delirium within five days of transplant. Both univariable and multivariable analysis was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 37 fEEG-guided and 40 standard-of-care patients included in analysis. fEEG was associated with a 15% decrease of mean minimum alveolar concentration compared to standard-of-care (<i>p</i> &lt; 0.01). There was no association between fEEG and mean arterial pressure or total norepinephrine equivalents. fEEG-guided and standard-of-care patients had similar time-to-extubation (10 h vs. 10 h, <i>p</i> = 0.98) and incidence of post-operative delirium (19% vs. 10%, <i>p</i> = 0.43). fEEG was associated with a lower average postoperative sedation score (Beta = −0.2, <i>p</i> = 0.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study demonstrated an association of fEEG with a reduced anesthetic requirement while maintaining adequate sedation. Patients monitored with fEEG had lower postoperative sedation scores, but no changes in other postoperative outcomes. Future prospective studies are needed to better elucidate the role of fEEG in liver transplantation, its impact on patient outcomes, and its implications for healthcare costs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389282","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}