Clinical Transplantation最新文献

{"title":"Psychiatric Disorders and Associated Factors in Left Ventricular Assist Device Implantation and Heart Transplant Candidates","authors":"Selvi Ceran,&nbsp;Esra Emekli,&nbsp;Gonca Aşut,&nbsp;Atilla Sezgin","doi":"10.1111/ctr.70052","DOIUrl":"10.1111/ctr.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>End-stage heart failure (ESHF) remains a significant challenge despite optimal treatment, with heart transplantation (HTx) being the gold standard of care. Mechanical circulatory support (MCS) devices such as left ventricular assist devices (LVADs) are increasingly used for temporary or permanent treatment. Psychiatric comorbidities are common in patients with ESHF and may affect treatment outcomes, but the relationship between sociodemographic, clinical, and psychiatric characteristics remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A medical record based, descriptive cross-sectional study was conducted on 94 ESHF patients scheduled for HTx or LVAD therapy. Sociodemographic, clinical, and psychiatric data, including psychiatric diagnoses and systemic inflammatory markers, were collected from medical records. Univariate analyses compared patients with (PD) and without psychiatric disorders (No-PD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the participants, 37% had active psychopathology, with major depressive disorder (MDD) and generalized anxiety disorder (GAD) being prevalent. Approximately half of those diagnosed received their first psychiatric diagnosis at the time of assessment. Sociodemographic factors did not differ significantly between the PD and No-PD groups. While no significant difference was observed in ejection fraction (%) and inflammatory markers such as C-reactive protein (CRP), lymphocyte count was higher in the PD group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preoperative psychiatric assessment is crucial to identify psychiatric comorbidities in ESHF patients undergoing HTx or LVAD therapy. Despite limitations, this study sheds light on previously unexplored aspects, such as the relationship between ejection fraction and psychiatric comorbidities and the relationship between depressive symptoms and inflammatory markers obtained from complete blood count. Furthermore, the fact that almost half of the patients with psychiatric comorbidity were first diagnosed during the pre-treatment psychiatric assessment underlines the importance of pre-LVAD and pre-HTX psychiatric evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945826","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":"Tricuspid Regurgitation after Orthotopic Heart Transplantation: Trajectories and Association With Mortality","authors":"Kiran Belani,&nbsp;Vincent Brinker,&nbsp;Matthew Fuller,&nbsp;Mary Cooter,&nbsp;Jacob N. Schroder,&nbsp;Negmeldeen Mamoun,&nbsp;Adam DeVore,&nbsp;Madhav Swaminathan,&nbsp;Alina Nicoara,&nbsp;Sharon L. McCartney","doi":"10.1111/ctr.70062","DOIUrl":"10.1111/ctr.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tricuspid regurgitation (TR) is common immediately after orthotopic heart transplantation (OHT), though the expected outcomes of TR over time remain undefined. In this study, we examined the natural trajectory of TR in the first 120 days post-transplantation. We observed the clinical phenotypes of trajectories of TR after OHT, and assessed trajectory correlation with 1-year mortality and degree of right ventricular (RV) dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients who underwent OHT at a single institution from January 2009 to July 2019 were included, unless death occurred during the index hospitalization. TR and RV dysfunction on follow-up transthoracic echocardiograms were tracked on 4-point scales and latent-class mixed modeling (LCMM) identified classes of TR trajectories. Fisher's exact test was used to compare 1-year mortalities between classes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Based on LCMM, four distinct classes of TR trajectories emerged, characterized as sustained (<i>n</i> = 40), variable (<i>n</i> = 172), stable (<i>n</i> = 175), and recovered (<i>n</i> = 189) TR. Significant differences in mortality rates were found amongst classes at 10.0%, 8.1%, 4.0%, and 2.6%, respectively (<i>p</i> = 0.025). The degree of RV dysfunction mirrored TR severity in all subsets except the sustained TR group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The trajectory of TR in the first 120 days post-OHT is associated with 1-year mortality. In many subsets, there is a close association with TR grade and RV function improvement. However, in the sustained TR group, RV function improved without subsequent improvement in TR severity. These findings could identify patients with higher mortality risk for whom more frequent follow-up or intervention is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945844","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":"Risk of Post-Transplant Malignancy After Isolated Heart Transplant Among Adult Patients With Congenital Heart Disease","authors":"Orly Leiva,&nbsp;Stephanie Golob,&nbsp;Alex Reyentovich,&nbsp;Jose Alvarez-Cardona,&nbsp;Michelle Bloom,&nbsp;Dan Halpern,&nbsp;Adam Small","doi":"10.1111/ctr.70077","DOIUrl":"10.1111/ctr.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients with congenital heart disease (CHD) are at increased risk of cancer. In patients with CHD and advanced heart failure, isolated heart transplantation (HT) can be considered. In the overall HT population, immunosuppression after HT increases the risk of post-transplant malignancy (PTM). However, cancer outcomes among adult HT patients with CHD have not been investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged ≥ 18 years who received HT between January 1, 2010 and December 31, 2021 were identified using the United Network for Organ Sharing (UNOS) registry. Patients with CHD were compared to those without. T primary outcome was a composite outcome of PTM or death due to malignancy. Multivariable Fine-Gray competing-risk regression was used to estimate the subhazard ratio (SHR) of primary and secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the total of 29717 patients with HT were included, 1017 (3.4%) had CHD. Patients with CHD were younger, more likely to be female, and have had prior cardiac surgery. After multivariable competing-risk regression, CHD was associated with a higher risk of the primary outcome (SHR 1.43, 95% CI 1.15–1.80). Among patients who developed PTM, the median time to diagnosis of first PTM (median 36 vs. 46 months, <i>p</i> = 0.027) was shorter in patients with CHD. Among patients with CHD, survival after PTM was significantly lower compared with patients without malignancy (HR 3.32, 95% CI 2.03–5.43).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among adult patients with HT, CHD was associated with an increased risk of PTM. Further investigation is warranted to identify risk factors and screening strategies for malignancy in this patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945828","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":"Increased Mortality in Kidney Transplant Recipients During the Delta/Omicron Era of the COVID-19 Pandemic Despite Widespread Vaccination","authors":"Byron Smith,&nbsp;Sumi Nair,&nbsp;Hani Wadei,&nbsp;Martin Mai,&nbsp;Hasan Khamash,&nbsp;Carrie Schinstock,&nbsp;Yun Liang,&nbsp;Ahmed Abdelrheem,&nbsp;Walter Park,&nbsp;Andrew Badley,&nbsp;Mark D. Stegall","doi":"10.1111/ctr.70071","DOIUrl":"10.1111/ctr.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The incidence of mortality late in the pandemic, particularly after widespread vaccine availability, is not well understood. Herein, we elucidate the effect of this impact of the COVID pandemic as well as risk factors for mortality during it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The primary end point was death with a functioning graft with secondary endpoints of mortality rates in subgroups and at different time intervals during the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Despite widespread vaccination, mortality rates for kidney transplant (KTx) recipients almost doubled during the COVID-19 era (6.40 deaths per 100 person years vs. 3.54 pre-COVID). Mortality increased in all racial/ethnic groups but increased more in Native Americans, Hispanics, and African Americans compared to non-Hispanic Caucasians. The highest mortality rate occurred during the Delta and Omicron time frames. In contrast to the general population, mortality was more evenly spread across age groups in KTx recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mortality rates during the COVID-19 era were extremely high, more than doubling in some racial/ethnic groups. We conclude that the KTx population was a particularly vulnerable group during the COVID-19 era and suggests the need for further research into the management of variants in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945820","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":"Second Time Around: Increased Rate of Living Donation From Repeat Organ Donors","authors":"Carolyn N. Sidoti,&nbsp;Kelly Terlizzi,&nbsp;Conor Donnelly,&nbsp;Ian S. Jaffe,&nbsp;Jennifer D. Motter,&nbsp;Benjamin Philosophe,&nbsp;Reed T. Jenkins,&nbsp;Sarah Hussain,&nbsp;Pedro Colon,&nbsp;Amit D. Tevar,&nbsp;Bonnie E. Lonze,&nbsp;Babak J. Orandi,&nbsp;Macey L. Levan,&nbsp;Dorry L. Segev,&nbsp;Allan B. Massie","doi":"10.1111/ctr.70049","DOIUrl":"https://doi.org/10.1111/ctr.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Some living organ donors will decide to donate again at a later date. Evidence has indicated that this practice may have increased in recent years. We evaluated the incidence and outcomes of this practice to inform counseling of potential repeat donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using SRTR data from 1994 to 2023, we identified 220 repeat living donors and their 415 recipients. We constructed donor comparison groups using weighting by the odds. We described clinical and lab results at 6 months, 1 year, and 2 years post-donation separately for kidney-second donors and liver-second donors. We compared all-cause graft failure for their recipients with those of comparison donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The annual count of repeat living donors increased from 5 in 2018 to 25 in 2019 (<i>p</i> &lt; 0.001). Of 220 donors, 159 were liver-second donors (72.3%) and 55 were kidney-second donors (25.0). The percentage of nondirected donations increased from 30.5% at first donation to 53.2% at second donation (<i>p</i> &lt; 0.001). Liver-second donors had one death approximately 2.5 years post-donation. Seventeen were re-admitted and 20 experienced complications requiring an interventional procedure or re-operation. Among kidney-second donors, no deaths, re-admissions, or post-donation complications were reported. Post-donation outcomes in both groups were comparable when evaluated against organ-specific comparison donors. Recipients of repeat living donors experienced graft survival similar to recipients of comparison donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Repeat living donation may be a safe practice for carefully selected living donors in the short term; however, long term safety is unknown. Outcomes for recipients are similar to recipients of comparison donors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143112655","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":"Pretransplant Minimal Pleural and Peritoneal Effusion Is a Potential Poor Prognostic Indicator in Allogeneic Hematopoietic Stem Cell Transplantation","authors":"Takashi Oyama,&nbsp;Akira Honda,&nbsp;Yasutaka Masuda,&nbsp;Ken Morita,&nbsp;Hiroaki Maki,&nbsp;Yosuke Masamoto,&nbsp;Mineo Kurokawa","doi":"10.1111/ctr.70072","DOIUrl":"10.1111/ctr.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pleural effusion and ascites developing after allogeneic hematopoietic stem cell transplantation (allo-SCT) are generally associated with inferior overall survival (OS); however, the prognostic value of pretransplant effusion on transplant outcomes remained unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated minimal pleural effusion and ascites detected by computed tomography in 248 consecutive adult patients who underwent their first allo-SCT from January 2007 to December 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-eight patients demonstrated minimal pleural effusion or ascites within 100 days before transplantation (Effusion group) and the other 200 had no effusion (No effusion group). Serum albumin level was significantly lower in the Effusion group than in the No effusion group (median 3.8 vs. 3.4 g/dL, <i>p</i> &lt; 0.001). Performance status (PS) was significantly inferior and refined disease risk index tended to be higher in the Effusion group. The 2-year OS rate after transplantation was significantly worse in the Effusion group (57.1% vs. 36.7%, <i>p</i> &lt; 0.001). The Effusion group had a significantly lower cumulative incidence of neutrophil and platelet engraftment and higher hepatic veno-occlusive disease. Moreover, a tendency toward higher cumulative incidence of relapse and non-relapse mortality was shown in the Effusion group. In multivariate analysis, the Effusion group had a significantly inferior OS with a hazard ratio of 1.848 (95% confidence interval 1.231–2.774), even after adjustment for disease risk, serum albumin level, PS, and Hematopoietic Cell Transplant-Comorbidity Index points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Reflecting high disease activity and impaired general condition, pretransplant effusion can be a complementary indicator for poor prognosis in allo-SCT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945824","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":"Has Sex-Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study","authors":"Miho Akabane,&nbsp;Yuki Imaoka,&nbsp;Carlos O. Esquivel,&nbsp;Kazunari Sasaki","doi":"10.1111/ctr.70064","DOIUrl":"10.1111/ctr.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In July 2023, the OPTN adopted MELD3.0 to address sex-based disparities in liver transplantation (LT) opportunity and waitlist mortality. No studies have proven that MELD3.0 alleviated them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated sex-based disparities in LT opportunities and waitlist mortality, utilizing the UNOS data (August 2022–March 2024), comparing pre- and post-MELD3.0 eras.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 11 795 LT candidates (pre-MELD3.0: 7263; post-MELD3.0: 4532), the proportion of females increased from 38.8% to 42.6% post-MELD3.0. In the transplanted population, females increased from 37.7% to 41.6% post-MELD3.0. The median MELD score difference (“MELD3.0–MELD-Na”) at listing was -0.26 [-2.13, 0.80] for females and -0.86 [-2.92, 0.00] for males (<i>p</i> &lt; 0.01). Compared to females, males consistently showed a larger drop in points from MELD-Na to MELD3.0. In the pre-MELD3.0 era, females had lower LT opportunity (sub-hazard ratio [sHR]: 0.88 [0.83–0.93], <i>p</i> &lt; 0.01) and higher waitlist mortality (sHR: 1.39 [1.20–1.62], <i>p</i> &lt; 0.01). In the post-MELD3.0 era, there were no significant differences in LT opportunity (sHR: 0.93 [0.87–1.00], <i>p</i> = 0.07) and waitlist mortality (sHR: 1.25 [0.98–1.57], <i>p</i> = 0.26). Subgroup analyses based on MELD-Na groups showed that significant differences in LT opportunity and waitlist mortality in the pre-MELD3.0 era became insignificant in the post-MELD3.0 era. Multivariable competing-risk analysis showed that, in the pre-MELD3.0 era, female sex was a significant risk factor for LT opportunity (sHR: 0.90 [0.84–0.96], <i>p</i> &lt; 0.01) and waitlist mortality (sHR: 1.19 [1.01–1.38], <i>p</i> = 0.03), but in the post-MELD3.0 era, it was not significant (sHR: 0.94 [0.86–1.02], <i>p</i> = 0.11 for LT opportunity/sHR: 1.08 [0.83–1.40], <i>p</i> = 0.57 for waitlist mortality).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our preliminary findings suggest that MELD3.0 has the potential to reduce sex-based disparities in LT opportunities and waitlist mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906799","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":"Predicting Sarcopenia and Frailty Risk in Patients Post Heart Transplantation","authors":"Trinidad Sentandreu-Mañó,&nbsp;Elena Marques-Sule,&nbsp;Luis Almenar-Bonet,&nbsp;José M. Tomás,&nbsp;Dominique Hansen,&nbsp;Pallav Deka,&nbsp;Raquel López-Vilella,&nbsp;Leonie Klompstra,&nbsp;Felipe V. C. Machado","doi":"10.1111/ctr.70027","DOIUrl":"10.1111/ctr.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Currently, there is little evidence on the prevalence and factors associated with sarcopenia risk or frailty risk in patients post heart transplantation (HTx). The objective of this study was to analyze the influence of sociodemographic, lifestyle, physical, and psychological factors on sarcopenia and frailty risk in patients post-HTx.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>133 patients post-HTx (59.4% men, mean age 56.5 ± 12.7 years) participated in this cross-sectional study. The main outcomes were sarcopenia and frailty risk, and potential related predictors were comorbidities, time from transplantation, body mass index, sociodemographic factors, musculoskeletal pain, functional capacity, kinesiophobia, sleep problems, depression, physical activity, and diet quality. Multiple regression models were performed with all predictors, including polynomial regressions for predictors with a nonlinear relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The predictor variables explained 73.93% of frailty's variance. Functional capacity (with a nonlinear relationship) and diet quality were significant predictors of frailty risk, while diabetes and physical activity were marginally significant. In addition, the predictors explained 73.52% of sarcopenia's variance. Diabetes, functional capacity (with a nonlinear relationship), and kinesiophobia were significant predictors of sarcopenia risk, while pain intensity and diet quality were marginally significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Multivariate analysis conducted on patients post-HTx revealed that functional capacity was associated with both sarcopenia and frailty risk. Additionally, diet quality was a predictive factor of frailty, while diabetes and kinesiophobia were predictors of sarcopenia. These findings emphasize the importance of proper management to prevent frailty and sarcopenia, which share common associated factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906801","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":"Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D−/R−): Time to Reexamine Donor CMV Serostatus","authors":"Madeleine R. Heldman,&nbsp;Julia A. Messina,&nbsp;Annette J. Schlueter,&nbsp;Mark J. Lee,&nbsp;Jennifer L. Saullo,&nbsp;Rachel A. Miller","doi":"10.1111/ctr.70073","DOIUrl":"10.1111/ctr.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early posttransplant cytomegalovirus (CMV) infections in CMV seronegative solid organ transplant recipients (SOTR) with CMV seronegative donors (D−/R−) are often attributed transfusion-transmitted CMV. The prevalence of false-negative donor CMV serology in D−/R− SOTR with early CMV infections has not been explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We determined the frequency and characteristics of CMV DNAemia that occurred within 90 days of transplant among adult SOTR classified as D−/R− who underwent a first SOT at a single center between February 25, 2014 and February 25, 2024. Repeat donor CMV antibody testing was performed on stored donor sera if possible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen of 737 (1.8%) D−/R− SOTR from 12 donors developed CMV DNAemia within 90 days of transplant (median time to DNAemia: 28 days, interquartile range 23–42 days). Five (38%) recipients experienced CMV disease either before (<i>n</i> = 2) or after (<i>n</i> = 3) CMV DNAemia was identified, and five (38%) developed CMV antiviral resistance mutations during their course. Repeat CMV antibody testing was performed on sera from four donors to five recipients and was positive in three (75%) tested donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early CMV infections in D−/R− SOTR are uncommon but associated with high morbidity. CMV transmission from organ donors with false negative CMV serology is an important source of early CMV infections in D−/R− SOTR. Clinicians should suspect and promptly report early CMV infections in D−/R− SOTR as potential donor-derived processes, regardless of donor and/or recipient transfusion histories. Reporting such cases is essential to promote broader investigations that may identify suboptimal donor CMV screening assays.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906797","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":"Implementation of a Comprehensive Protocol for Enhanced Recovery After Surgery (ERAS) in Kidney Transplant Recipients Improves Patient and Graft Outcomes","authors":"Mohamed Eltemamy,&nbsp;Paul J. Oh,&nbsp;Hafiz Umair Siddiqui,&nbsp;Yi-Chia Lin,&nbsp;M. Cecilia Lansang,&nbsp;Emilio Poggio,&nbsp;David Goldfarb,&nbsp;Venkatesh Krishnamurthi,&nbsp;Alvin Wee","doi":"10.1111/ctr.70056","DOIUrl":"10.1111/ctr.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Enhanced recovery after surgery (ERAS) protocols have gained widespread acceptance as a means to enhance surgical outcomes. However, the intricate care required for kidney transplant recipients has not yet led to the establishment of a universally recognized and dependable ERAS protocol for kidney transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We devised a customized ERAS protocol to determine its effectiveness in improving surgical and postoperative outcomes among kidney transplant recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, Setting, and Participants</h3>\u0000 \u0000 <p>This was a retrospective, single-center study performed at our tertiary care institution. Three hundred and fifty-six patients in the conventional group (from January 1, 2015 to December 31, 2017) and 442 patients from the ERAS group (from January 1, 2018 to June 1, 2020) were compared. Patients were followed for 1 year postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>Changes were made in the preoperative, operative, postoperative, and outpatient follow-up settings after transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcome Measurements and Statistical Analysis</h3>\u0000 \u0000 <p>Primary endpoints were hospital length of stay (LOS) and 30-day readmission rates. We also measured surgical outcomes, graft performance, and patient survival. Wilcoxon rank-sum, Pearson's Chi-squared, or Fisher's exact tests were used to compare groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our ERAS protocol was associated with a decrease in hospital LOS from 5 to 3 days (<i>p</i> &lt; 0.001) and 57.1% lower odds of hospital readmissions within 30 days compared to the conventional group (<i>p</i> &lt; 0.001, 95% CI 0.26–0.7). Decreases in operative estimated blood loss, blood transfusion rates, and delayed graft function were also associated with the ERAS protocol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our multi-layered ERAS protocol is effective in improving outcomes for kidney transplant recipients. A future multi-institutional study with healthcare savings analysis may suggest that widespread benefits are yet to be realized by the greater implementation of such enhanced recovery protocols.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906800","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}