Clinical Transplantation最新文献

{"title":"The Number of CD34 Cells Employed in Autologous Hematopoietic Stem Cell Transplantation for Persons With Multiple Sclerosis Is Not Related to the Neurological Outcome of the Procedure","authors":"Michelle Lavoignet-Cisneros, Olivia Lira-Lara, Miguel Ángel Viveros- Lugo, Sofía Chávez-Martínez, Monica Daniela Salgado-Cabrera, Lidia Joanna Alberto-López, Gabriela Lizeth Flores-Vargas, Juan Carlos Olivares-Gazca, Max Robles-Nasta, Guillermo José Ruiz-Delgado, Guillermo José Ruiz-Argüelles","doi":"10.1111/ctr.70311","DOIUrl":"https://doi.org/10.1111/ctr.70311","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Outcomes Associated With Immediate Versus Delayed Presentation of Severe Primary Graft Dysfunction After Heart Transplantation: Does Timing Matter?","authors":"Yosef Manla,&nbsp;David H. Chang,&nbsp;Peter Deckerman,&nbsp;Michelle Kittleson,&nbsp;Fardad Esmailian,&nbsp;Avani Kanungo,&nbsp;Evan P. Kransdorf,&nbsp;Jillian Max,&nbsp;Andriana Nikolova,&nbsp;Lawrence S. Czer,&nbsp;Lily Stern,&nbsp;Jon A. Kobashigawa","doi":"10.1111/ctr.70305","DOIUrl":"https://doi.org/10.1111/ctr.70305","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Severe left ventricular/biventricular primary graft dysfunction (PGD-LV) continues to be a major contributor to 30-day mortality post-heart transplantation (HTx). In patients with severe PGD-LV, two distinctive presentation phenotypes are encountered: an “immediate PGD” (IP), where patients fail to wean from cardiopulmonary bypass (CPB), or a “delayed PGD” (DP) following successful weaning from CPB and/or transfer from the operating room. Data on these phenotypes' incidence, associated characteristics, and outcomes remain limited. Therefore, we assessed patient characteristics and 1-year post-HTx outcomes associated with IP versus DP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2010 and 2022, we included 47 HTx patients with severe PGD-LV. Patients were divided into those with IP (<i>n</i> = 16) and those with DP (<i>n</i> = 31). Endpoints included 30-day and 1-year survival, as well as 1-year freedom from any-treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR), biopsy-negative rejection (BNR), cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events (NF-MACE), and freedom from left ventricular dysfunction (LVD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to patients with DP, those with IP had a higher prevalence of pre-HTx sensitization (56.3% vs. 19.4%, <i>p</i> = 0.01) and tended to receive hearts from older donors (47.5 vs. 34 years, <i>p</i> = 0.055). They had decreased survival rates at 30 days (50% vs. 77.4%, <i>p</i> = 0.043) and 1-year post-HTx (31.2% vs. 61.1%, <i>p</i> = 0.029). No significant differences were recorded in 1-year freedom from CAV, ATR, ACR, AMR, BNR, NF-MACE, or LVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Immediate presentation of severe PGD-LV appeared to be associated with pre-HTx sensitization and use of older donor hearts and conferred a worse post-HTx survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929786","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":"Correction to “Risk Factors for Renal Dysfunction After Isolated Intestinal Transplantation”","authors":"","doi":"10.1111/ctr.70302","DOIUrl":"https://doi.org/10.1111/ctr.70302","url":null,"abstract":"<p>Von Ahrens D, Santeusanio AD, Weinberg AD, Moon J, Iyer KR. Risk factors for renal dysfunction after isolated intestinal transplantation. Clin Transplant. 2024 Jan;38(1):e15228. https://doi.org/10.1111/ctr.15228. PMID: 38289880.</p><p>An author, Natalie F. Berger, was not included in the authors of this paper. The authors should be: “Dagny von Ahrens, Andrew D. Santeusanio, Alan D. Weinberg, Natalie F. Berger, Jang Moon, and Kishore R. Iyer.”</p><p>We apologize for this error.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929785","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":"Hepatitis B Boosters Using a Different Product vs. the Same Product for Kidney Transplant Recipients: A Retrospective Study With Bayesian Inference","authors":"Kentaro Iwata,&nbsp;Shunkichi Ikegaki,&nbsp;Yoji Hyodo,&nbsp;Hideaki Miyake","doi":"10.1111/ctr.70307","DOIUrl":"https://doi.org/10.1111/ctr.70307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Hepatitis B vaccination is recommended for those receiving kidney transplants. When hepatitis B surface antibody (HBsAb) levels remain low, the booster dose of the vaccine should be considered. Some consider that the use of a different product as a booster might be beneficial to the patients, but the effectiveness of such a strategy has not been evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The kidney transplant recipients (KTR) who received hepatitis B vaccines (Bimmugen or Heptavax-II), and failed to develop enough antibody titer and those who received additional vaccines, were enrolled in the study. Those who received a different product were compared with those who received the same product as the booster. The outcome is the seroconversion of hepatitis B surface antibody level ≧ 10 IU/mL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 26 patients were non-responders after a receipt of three-dose hepatitis B vaccines. Among those, 15 received additional hepatitis B vaccine of the different product (crossover group), and 11 received the same product (non-crossover group). Only five patients (19.2%) had seroconversion after the booster doses, three in the crossover group (20%) and two in the non-crossover group (18.2%) (<i>p</i> = 1.0). In the Bayesian analysis, the medial posterior probability of the seroconversion rate of the crossover group was 23% (95% CrI: 7%–47%), whereas that of the non-crossover group was 14% (95% CrI: 2%–40%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The crossover strategy hepatitis B vaccines did not appear to lead to seroconversion of much significance among KTR. Other options to augment the protection should be investigated to protect these populations against the infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Assessment of Plasma CXCL9 and CXCL10 in Improving Clinical Prediction Models for Kidney Allograft Rejection","authors":"Alvaro Assis de Souza,&nbsp;Dennis A. Hesselink,&nbsp;Carolien C. H. M. Maas,&nbsp;Andrew P. Stubbs,&nbsp;Marian Clahsen-van Groningen,&nbsp;Carla C. Baan,&nbsp;David van Klaveren,&nbsp;Karin Boer","doi":"10.1111/ctr.70299","DOIUrl":"https://doi.org/10.1111/ctr.70299","url":null,"abstract":"<p>Chemokine levels may predict kidney graft rejection. This study evaluated whether adding early plasma chemokines C-X-C motif ligand 9 (CXCL9) or chemokines C-X-C motif ligand 10 (CXCL10) measurements to a standard-of-care model improves the prediction of the need for antirejection treatment and helps guide biopsy decisions. The benchmark model used recipient and donor age, human leukocyte antigen mismatches, and dialysis need in the first 3 days after transplantation. Plasma CXCL9 or CXCL10 was added, and the extended models were evaluated using likelihood ratio tests (LRTs), area under the receiver operating characteristic curve (ROC-AUC), flexible calibration curves, and net benefit analysis. Model internal validation was performed through bootstrapping. Among 163 consecutively transplanted recipients on standard immunosuppression, 43 (26.4%) required antirejection therapy between Days 3 and 21 posttransplant. The chemokine-extended models outperformed the benchmark (LRT <i>p</i> &lt; 0.01), increasing discriminative ability (delta ROC-AUC of 0.02) and improving calibration. Across the range of risk thresholds for biopsy, the extended models provided better clinical utility, resulting in up to 17 fewer unnecessary biopsies per 100 patients. These findings suggest that adding plasma CXCL9 or CXCL10 to a benchmark model can improve patient care by reducing the number of biopsies in individuals unlikely to require antirejection therapy.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70299","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927591","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":"Accuracy, Clarity, and Comprehensiveness of ChatGPT Outputs for Commonly Asked Questions About Living Kidney Donation","authors":"Ria Singla,&nbsp;Sumiya Lodhi,&nbsp;Taddele Kibret,&nbsp;Januvi Jegatheswaran,&nbsp;Tamara Glavinovic,&nbsp;David Massicotte-Azarniouch,&nbsp;Jolanta Karpinski,&nbsp;Rinu Powell,&nbsp;Kevin Burns,&nbsp;Manish M. Sood,&nbsp;Ann Bugeja","doi":"10.1111/ctr.70303","DOIUrl":"https://doi.org/10.1111/ctr.70303","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The effectiveness of ChatGPT responses to common living kidney donation (LKD) queries remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We surveyed nephrologists and living kidney donors/candidates to evaluate ChatGPT-3.5's accuracy, comprehensiveness, and clarity in answering common donation questions in English and French. Ratings used a 5-point Likert scale, with percentage agreement and modified Fleiss’ Kappa measuring inter-rater consistency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The evaluation of ChatGPT-3.5's responses varied between nephrologists and kidney donors/candidates. Nephrologists showed moderate percentage agreement for English responses (50%–59%) and poor agreement for French responses (9%–45%). Kidney donors/candidates exhibited high agreement for English (90%–100%) but low for French (0%–77%). Inter-rater agreement among nephrologists was moderate for both English (Kappa 0.74, 95% CI: 0.67, 0.79, <i>p</i> &lt; 0.0001) and French (Kappa 0.70, 95% CI: 0.64, 0.77, <i>p</i> &lt; 0.0001). In contrast, inter-rater agreement was poor among donors/candidates for both English (Kappa −0.10, 95% CI: −0.14, −0.07, <i>p</i> = 0.99) and French (Kappa −0.03, 95% CI: −0.07, 0, <i>p</i> = 0.81).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ChatGPT 3.5's responses to common LKD queries demonstrated limited agreement among nephrologists and kidney donors/donor candidates, highlighting its lack of reliability as a supplement to existing educational materials for living kidney donor programs in English and French.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927593","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 Donor and Recipient Sex-Mismatch in Donation After Circulatory Death Heart Transplant","authors":"Kavya Rajesh,&nbsp;Iris Feng,&nbsp;Farhana Latif,&nbsp;Gabriel Sayer,&nbsp;Nir Uriel,&nbsp;Yuji Kaku,&nbsp;Yoshifumi Naka,&nbsp;Paul Kurlansky,&nbsp;Koji Takeda","doi":"10.1111/ctr.70285","DOIUrl":"https://doi.org/10.1111/ctr.70285","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Prior studies have demonstrated an association between donor/recipient sex mismatch and worse outcomes in donation after brain death (DBD) heart transplant. This study aims to determine the impact of donor/recipient sex mismatch on outcomes in donation after circulatory death (DCD) transplant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study cohort consisted of 1260 patients from the United Network for Organ Sharing (UNOS) dataset who underwent DCD heart transplant between 12/2019 and 12/2023. Transplants were stratified into four groups: female donor/female recipient (FD/FR), female donor/male recipient (FD/MR), male donor/male recipient (MD/MR), and male donor/female recipient (MD/FR). The primary outcomes were acute rejection and post-operative complications, while the secondary outcome was mortality. Multivariable logistic regression was used to analyze factors associated with rejection, while Kaplan–Meier (KM) survival analyses were compared using the log-rank test with post-hoc binary comparisons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Female recipients who received DCD transplant had higher rates of acute rejection compared to male recipients (FD/FR: 26 (20%), MD/FR: 28 (22.2%), MD/MR 110 (11.8%), FD/MR 6 (9%), <i>p</i> = 0.001) while rates of stroke, dialysis, and pacemaker implantation were similar. Among male recipients, weight, height, and left ventricular assist device (LVAD) were associated with acute rejection. However, neither weight nor height was associated with acute rejection in female recipients. The KM curve showed no difference in long-term mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Female recipients who receive DCD hearts from male and female donors have an increased risk of acute rejection compared to their male counterparts. Height and weight are associated with acute rejection in male patients. Male and female recipients have similar long-term mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927453","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":"Potential Role of SGLT-2 Inhibitors in Improving Allograft Function and Reducing Rejection in Kidney Transplantation","authors":"Mehmet Emin Demir,&nbsp;Özant Helvacı,&nbsp;Tolga Yıldırım,&nbsp;Özgür Merhametsiz,&nbsp;Siren Sezer","doi":"10.1111/ctr.70233","DOIUrl":"https://doi.org/10.1111/ctr.70233","url":null,"abstract":"<p>Sodium–glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated renoprotective and cardioprotective benefits beyond their antiglycemic effects. Their potential utility in kidney transplant recipients (KTRs) for preserving graft function and reducing rejection risk is currently under active investigation. Preliminary studies indicate that SGLT-2i therapy stabilizes estimated glomerular filtration rate (eGFR), decreases glomerular hyperfiltration, and improves metabolic outcomes in KTRs. Emerging clinical evidence also suggests that SGLT-2i may be associated with reduced rates of acute rejection, although direct immunosuppressive actions remain unclear. Experimental findings further suggest that SGLT-2i modulates gene regulation pathways involved in inflammation, oxidative stress, and fibrosis, contributing to improved allograft outcomes. Current safety data in KTRs are reassuring, without significant increases in urinary tract infections or adverse graft events. Nevertheless, long-term prospective studies specific to transplant populations are lacking. This review summarizes available evidence regarding the mechanisms of action, clinical efficacy, and safety profile of SGLT-2i in kidney transplantation, emphasizing their metabolic, hemodynamic, inflammatory, and immunomodulatory effects.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70233","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929763","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":"Sirolimus Plus Low-Exposure Calcineurin Inhibitors as an Alternative Graft-Versus-Host Disease Prophylaxis in Calcineurin Inhibitor-Intolerant Recipients: A Retrospective Study","authors":"Yanfei Lu,&nbsp;Min Wu,&nbsp;Zhenbin Wei,&nbsp;Lingling Shi,&nbsp;Yongrong Lai,&nbsp;Rongrong Liu","doi":"10.1111/ctr.70306","DOIUrl":"https://doi.org/10.1111/ctr.70306","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Graft-versus-host disease (GvHD) remains a major barrier to long-term survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although calcineurin inhibitors (CNIs) are the cornerstone of GvHD prophylaxis, some patients cannot tolerate them, creating a critical need for alternative strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the efficacy and safety of sirolimus plus low-exposure CNIs as an alternative GvHD prophylaxis in CNI-intolerant recipients undergoing allo-HSCT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 16 allo-HSCT recipients who received alternative GvHD prophylaxis due to CNI intolerance, evaluating GvHD incidence, survival and relapse outcomes, infectious complications, and immune reconstitution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median time to regimen initiation was 27.5 days (range, −2 to 114 days), and the median treatment duration was 53 days (range, 14–319 days). Only one patient (6.3%) experienced grade 2 acute GvHD, and none developed grade 3–4 acute GvHD. No cases of chronic GvHD were observed in the 15 evaluable patients. Over a median follow-up of 271 days (range, 58–505 days), one non-relapse mortality and three relapses (18.7%) occurred, with no relapse-related deaths. The alternative regimen was well-tolerated with manageable infections and, importantly, did not impair early T, B, or NK cell reconstitution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For allo-HSCT recipients with CNI intolerance, this study provides the first evaluation of sirolimus combined with low-exposure CNIs as a GvHD prophylaxis. Our findings suggest this regimen is a promising and feasible alternative, although validation in larger, prospective studies is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927454","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":"Ultrasound-Guided Modified Thoracoabdominal Nerve Block Through Perichondrial Approach for Postoperative Analgesia Management in Living Liver Donors: A Randomized, Prospective, Controlled Study","authors":"Hande Gungor,&nbsp;Ayşe Ince,&nbsp;Bahadir Ciftci,&nbsp;Birzat Emre Gölboyu,&nbsp;Mert Asici,&nbsp;Pelin Karaaslan,&nbsp;Tumay Uludag Yanaral","doi":"10.1111/ctr.70224","DOIUrl":"https://doi.org/10.1111/ctr.70224","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Optimal postoperative pain management in living donor hepatectomy remains challenging, with conventional methods showing limitations. This study evaluated the efficacy and safety of ultrasound-guided modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) compared to conventional pain management in living donor hepatectomy patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective, randomized, controlled, single-blind study conducted between April 2024 and January 2025, 50 ASA I-II patients undergoing living donor right hepatectomy were randomly allocated to either the M-TAPA group (<i>n</i> = 25, receiving ultrasound-guided M-TAPA block plus standard analgesia) or the Control group (<i>n</i> = 25, receiving conventional pain management only). The primary outcome was postoperative opioid consumption during the first 48 h. Secondary outcomes included pain scores, rescue analgesia requirements, and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The M-TAPA group showed significantly lower median total fentanyl consumption (<i>p</i> = 0.002) and reduced need for rescue analgesia (<i>p</i> = 0.011) compared to the Control group. Both static and dynamic Numeric Rating Scale pain scores were significantly lower in the M-TAPA group across all time points (<i>p</i> &lt; 0.001). Although the M-TAPA group showed a trend toward reduced nausea incidence (<i>p</i> = 0.066), other side effects were comparable between groups. No M-TAPA block–related complications were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ultrasound-guided M-TAPA block provides effective postoperative pain management in living donor hepatectomy, demonstrating significant reductions in opioid consumption and pain scores without increasing complications. These findings suggest MTAPA could be a valuable component of enhanced recovery protocols in living donor liver transplantation programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT06300372</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929773","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}