Clinical Transplantation最新文献

{"title":"Longitudinal Study on Psychological Distress Trajectory and Influencing Factors of Kidney Transplant Patients: A Potential Category Analysis Study","authors":"Xiaoting Zheng,&nbsp;Xingwang Yao","doi":"10.1111/ctr.70296","DOIUrl":"https://doi.org/10.1111/ctr.70296","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although kidney transplantation confers substantial benefits, patients also exhibit varying levels of psychological distress attributable to multiple factors, with significant heterogeneity observed in their trajectories of change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study investigates latent heterogeneous trajectories of psychological distress in kidney transplant recipients (KTRs) from pre-transplantation to 6 months postoperatively. It tests the core hypothesis that high Neuroticism (N) and Psychoticism (P) scores serve as key distinguishing predictors of these trajectory classes. The analysis also explores the influence of sociodemographic and clinical factors on class membership. By elucidating distress patterns and their underlying drivers, this research aims to facilitate early identification of high-risk patients and inform the development of personalized psychological interventions, ultimately improving treatment adherence and long-term quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A convenience sampling method was used to select 326 kidney transplant patients from the kidney transplant department of a tertiary hospital in Changsha, Hunan Province, from September 2022 to August 2024 as the research subjects. We conducted a cross-sectional survey design by using three standardized instruments: Sociodemographic variables, Eysenck Personality Questionnaire Short Scale-Chinese, and Psychological Distress Thermometer (DT) were collected at four time points: preoperative (T₀), postoperative 1 week (T₁), 1 month (T₂), and 6 months (T₃). Using a latent variable growth model to identify the developmental trajectory of psychological distress and explore its influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three heterogeneous psychological distress trajectory classes were identified. Membership in these classes was significantly associated with the clinical course of illness, household income, and personality traits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Psychological distress in KTRs exhibits significant population heterogeneity. Clinicians can utilize patients' distress trajectory patterns and temperament characteristics to implement personalized care protocols, thereby reducing distress levels.</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":"144927590","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":"Exercise Performance in Transplant Recipients of Hearts From Donation After Circulatory Death and Donation After Brain Death","authors":"Lorenzo D'Angelo,&nbsp;Christiana Gjelaj,&nbsp;Enklajd Marsela,&nbsp;Julio A. Ovalle-Ramos,&nbsp;Carles Díez-López,&nbsp;Kalil Salkey,&nbsp;Marie Galvao,&nbsp;Jeanne Hickey,&nbsp;Yogita Rochlani,&nbsp;Sandhya Murthy,&nbsp;Shivank Madan,&nbsp;Daniel B. Sims,&nbsp;Julia J. Shin,&nbsp;Daniel J. Goldstein,&nbsp;Stephen J. Forest,&nbsp;Snehal R. Patel,&nbsp;Ulrich P. Jorde,&nbsp;Omar Saeed","doi":"10.1111/ctr.70300","DOIUrl":"https://doi.org/10.1111/ctr.70300","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart transplantation (HT) following donation after circulatory death (DCD) has grown substantially in recent years. However, the effects of functional ischemic injury during procurement on exercise capacity remain unknown. We compared exercise performance parameters between DCD and donation after brain death (DBD) recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center, retrospective, case–control study of adults with isolated HT between January 2022 and April 2024 and completed a treadmill cardiopulmonary exercise test (CPET) post-transplant. DCD-HT recipients (cases) were matched to DBD-HT recipients (controls) based on major demographics and CPET timing. The primary outcome was peak oxygen consumption (pVO₂). Secondary outcomes included additional exercise capacity parameters and echocardiographic indices at peak exercise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cases (DCD-HT: <i>n</i> = 10, 20% female) and controls (DBD-HT: <i>n</i> = 10, 20% female) had similar baseline characteristics. Total ischemic time was longer in the DCD group (6.9 [interquartile range (IQR): 6.4–7.1] vs. 4.6 [IQR: 3.94.8] h; <i>p</i> = 0.002). Time from HT to CPET did not differ. DCD and DBD-HT recipients had similar pVO₂ (17.1 [IQR: 15.2–19.7] vs. 19.7 [IQR: 13.3–21.2] mL/kg/min; <i>p</i> = 0.545). Respiratory exchange ratio (RER) was slightly lower in the DCD group (1.1 [IQR: 1.0–1.2] vs. 1.2 [IQR: 1.21.3]; <i>p</i> = 0.031). Ventilatory efficiency (VE/VCO₂) at anaerobic threshold, left ventricular ejection fraction, and <i>E</i>/<i>e</i>′ at peak exercise were comparable between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DCD and DBD heart transplant recipients demonstrate similar exercise performance. Overall, exercise capacity remains limited after HT, highlighting the need for further studies to identify underlying mechanisms and potential therapeutic interventions.</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":"144927592","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":"Hypothermic Oxygenated Perfusion Versus Static Cold Storage in Transplantation of Extended Criteria Liver Grafts: A Systematic Review and Meta-Analysis","authors":"Valberto Sanha,&nbsp;Bruna Oliveira Trindade,&nbsp;Sangeeta Satish,&nbsp;Laura Batista de Oliveira,&nbsp;Omer Faruk Karakaya,&nbsp;Chunbao Jiao,&nbsp;Keyue Sun,&nbsp;Muhammad Ahmad Nadeem,&nbsp;Charles Miller,&nbsp;Koji Hashimoto,&nbsp;Chase J. Wehrle,&nbsp;Andrea Schlegel","doi":"10.1111/ctr.70291","DOIUrl":"https://doi.org/10.1111/ctr.70291","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of extended criteria donor livers (ECD) is becoming more routine in many transplant centers. These organs have higher risks for complications; however, hypothermic-oxygenated perfusion (HOPE) was found to improve outcomes, including graft survival. We aim to assess the effect of HOPE on different types of ECD liver grafts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted of PubMed, EMBASE, and Cochrane databases to identify studies that compared HOPE versus static cold storage (SCS) for ECD. Subgroup analysis on ECD from brain death (DBD-ECD) and circulatory death (DCD) donors, and of randomized controlled trials (RCT) were conducted. Primary endpoints were primary non-function (PNF), early allograft dysfunction (EAD), length of ICU/hospital stay, vascular/biliary complications, retransplantation, and graft survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve studies were identified comprising 1833 transplant patients (29% receiving HOPE and 71% SCS). Pooled analysis showed a significant reduction of EAD, 1-year graft failure rate, retransplantation rate, non-anastomotic biliary strictures and Clavien-Dindo Grade ≥ 3 complications favoring HOPE. Subgroup analysis on DBD-ECD grafts yielded lower EAD and shorter length of the hospital stay with HOPE. Further subgroup analysis on DCD grafts demonstrated lower EAD rates, superior 1-year graft survival rates, and reduced NAS in the HOPE group. Finally, analysis including RCTs revealed decreased EAD and retransplantation rates in the HOPE group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Reported outcomes after ECD liver transplantation were significantly improved with HOPE compared to SCS alone. This effect was even more pronounced in DCD grafts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923326","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":"Adrenal Dysfunction in Cirrhosis Does Not Affect Liver Transplantation-Related Outcomes","authors":"Ari J. Esrig,&nbsp;Brian J. Wentworth","doi":"10.1111/ctr.70298","DOIUrl":"https://doi.org/10.1111/ctr.70298","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144918769","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":"Understanding Racial Disparities in Lung Transplant Outcomes: A Comparative Study of White and Hispanic Patients","authors":"Jason Cory Brunson,&nbsp;Johnny F. Jaber,&nbsp;Sravanthi Nandavaram,&nbsp;Amir Emtiazjoo,&nbsp;Borna Mehrad,&nbsp;Divya C. Patel,&nbsp;Diana Gomez-Manjarres","doi":"10.1111/ctr.70290","DOIUrl":"https://doi.org/10.1111/ctr.70290","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hispanic/Latino individuals are the fastest growing subset of the US population. Although racial and ethnic differences in outcomes following lung transplantation have been recognized, they are not entirely understood. We compared long-term post–lung transplant outcomes in Hispanic/Latino and White non-Hispanic recipients and aimed to determine whether any differences are attributable to a specific racial–ethnic effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study of first-time lung transplant recipients using UNOS/OPTN data from June 2005 through September 2020. We compared all-cause mortality post-transplantation in Hispanic/Latino and White non-Hispanic recipients using Kaplan–Meier curves, matched comparisons, and semiparametric (Cox) proportional hazards models, which were adjusted for relevant covariates and extended to account for time-varying effects and center random effects, and modeled graft failure against the competing risk of other-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 18 915 transplant recipients for whom all study variables were available, 93% self-reported as White non-Hispanic, and 7.3% as Hispanic/Latino. Hispanics had similar short- and long-term survival compared to White non-Hispanics (1-year: 90% vs. 88%, <i>p</i> = 0.121; 5-year: 61% vs. 58%, <i>p</i> = 0.190; 10-year: 37% vs. 32%, <i>p</i> = 0.543). Nevertheless, overall survival curves (<i>p</i> = 0.037) and the fully adjusted model (aHR = 0.90, <i>p</i> = 0.047) suggested better outcomes among Hispanic/Latino recipients (<i>p</i> = 0.037).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite several pre-transplantation indicators of worse health, Hispanic/Latino lung transplant recipients have similar long-term post–lung transplantation outcomes when compared to White non-Hispanic recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144918768","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":"Effectiveness and Safety of Switching to Ravulizumab From Eculizumab in Kidney Transplant Recipients With Atypical Hemolytic Uremic Syndrome: A Global aHUS Registry Analysis","authors":"Anja Gaeckler,&nbsp;Imad Al-Dakkak,&nbsp;Nuria Saval,&nbsp;Hans Herman Dieperink,&nbsp;Margriet Eygenraam,&nbsp;Larry A. Greenbaum,&nbsp;Nicole Isbel,&nbsp;Johan Vande Walle","doi":"10.1111/ctr.70278","DOIUrl":"https://doi.org/10.1111/ctr.70278","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atypical hemolytic uremic syndrome (aHUS) is a disease of complement dysregulation that may lead to kidney failure. Ravulizumab and eculizumab are complement C5 inhibitors approved for the treatment of aHUS. This study assessed the real-world effectiveness and safety of switching to ravulizumab from eculizumab in kidney transplant recipients with aHUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Global aHUS Registry is a multicenter study enrolling patients with aHUS since 2012. Effectiveness and safety outcomes were assessed in kidney transplant recipients with aHUS who switched to ravulizumab from eculizumab up to September 2, 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 38 patients received a kidney transplant before ravulizumab initiation; 27 patients with ≥3 months of ravulizumab treatment were included in the patient characteristics and effectiveness analyses. Median (range) time on eculizumab and ravulizumab treatment was 66.1 (3.7, 158.3) and 24.1 (4.2, 49.3) months, respectively (<i>n</i> = 27); time from last kidney transplantation to ravulizumab initiation was 65.9 (3.7, 184.0) months. Following ravulizumab initiation, laboratory parameters remained stable, and no kidney transplant rejections/graft failures were reported. In the safety analysis (<i>n</i> = 38), 23 adverse events were reported in 19 patients (50.0%) at or after ravulizumab initiation, and none were considered treatment-related. No new events of thrombotic microangiopathy or kidney impairment and no meningococcal infections or deaths were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This analysis from the Global aHUS Registry provides real-world evidence to demonstrate that the transition to ravulizumab from eculizumab in kidney transplant recipients with aHUS is successful, with stable graft function with no treatment-related safety concerns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT01522183</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915167","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":"Outcomes of Patients With Severe and Very Severe Hepatopulmonary Syndrome After Liver Transplantation at a High-Volume Transplant Center: A Case Series Hepatopulmonary Syndrome Post-Transplant","authors":"Natalia M. Linares,&nbsp;Isabella R. Reitz,&nbsp;Karen Swanson,&nbsp;Elizabeth J. Carey","doi":"10.1111/ctr.70293","DOIUrl":"https://doi.org/10.1111/ctr.70293","url":null,"abstract":"<div>\u0000 \u0000 <p>Hepatopulmonary syndrome (HPS) affects up to one-third of patients with advanced chronic liver disease (ACLD) and is an independent risk factor for increased mortality. While HPS often improves following liver transplantation, patients with severe or very severe HPS—classified by partial pressure of arterial oxygen (PaO₂) &lt;60 mmHg—face higher post-transplant complications and mortality. However, evidence suggests that even patients with severe HPS may benefit from liver transplantation when performed at high-volume centers. To assess post-transplant outcomes in this population, we conducted a retrospective chart review of 20 patients diagnosed with severe or very severe HPS who underwent liver transplantation at Mayo Clinic Hospital in Arizona between 2014 and 2024. The most common post-transplant complication was persistent hypoxemia, managed on a case-by-case basis with various treatments, though no single approach proved consistently superior. All patients who received transplants demonstrated improvement; 84% of patients ultimately discontinued supplemental oxygen, with a mean time of 250 days (range: 0–1113 days). Time was the key factor in recovery. Notably, no deaths in our cohort were directly attributed to HPS. These findings support liver transplantation as a viable treatment option for HPS, even in severe cases, and underscore the importance of experienced transplant centers in optimizing patient outcomes.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915177","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":"Adult Left Liver Transplantation With Mesocaval Shunt With Porto-Mesenteric Disconnection: Long-Term Outcome","authors":"Jérôme Dumortier,&nbsp;Sophie Chopinet,&nbsp;Romain L'Huillier,&nbsp;Serban Puia-Negulescu,&nbsp;Mustapha Adham,&nbsp;Laurent Milot,&nbsp;Olivier Boillot","doi":"10.1111/ctr.70292","DOIUrl":"https://doi.org/10.1111/ctr.70292","url":null,"abstract":"<p>Aiming to decrease portal venous pressure and to minimize the risk of small-for-size syndrome when using a partial liver graft for liver transplantation (LT), surgical techniques modulating venous portal inflow have been proposed. We report here our experience on the long-term outcome after adult left split LT with mesocaval shunt (MCS) with porto-mesenteric disconnection (PMD). Between March 1996 and March 2010, 33 adult patients underwent LT from a full-right/full-left SLT for two adult recipients; portal vein inflow modulation through a MCS with PMD was realized in 10 cases. The study population consisted of 13 left liver and 15 right liver recipients who survived more than 1 year without retransplantation. The technique of mesenterico-portal disconnection with MCS which allowed to decrease the mean portal vein pressure to 14.2 mm Hg, was applied in six recipients who survived more than 1 year without retransplantation: five males and one female, with a mean age of 60 years (range: 53–66) who all received a left split graft, with a mean weight and GRWR of 562 g (range: 430–740) and 0.79% (range: 0.61–0.98), respectively. During follow-up, four patients with MCS (4/6) experienced hyperammonemic encephalopathy, after a mean delay of 9.1 ± 7.9 years after LT (ranging 2.6–20.1). The outcome was favorable with symptomatic treatment with lactulose ± rifaximin in all cases except one, who underwent surgical closure of the shunt. In conclusion, our results emphasize that portal vein inflow modulation through MCS during LT can be complicated by late occurrence of hyperammonemic encephalopathy.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915208","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":"Naples Prognostic Score May Be Associated With Acute Rejection in Kidney Transplant Patients: A Single Center Experience","authors":"Ramazan Danis,&nbsp;Eren Eynel,&nbsp;Jehat Kilic,&nbsp;Nurettin Ay","doi":"10.1111/ctr.70294","DOIUrl":"https://doi.org/10.1111/ctr.70294","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Naples Prognostic Score (NPS) is a comprehensive measure of patients' inflammatory and nutritional status. In this study, we compared the preoperative NPS of kidney transplant recipients who experienced acute rejection (AR) with those who did not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This retrospective study included 294 patients who underwent kidney transplantation and were followed up at our hospital between January 2012 and January 2024. NPS was calculated based on laboratory values obtained 1 day before the transplantation surgery. Patients were divided into two groups according to the occurrence of biopsy-proven acute rejection (AR): Group A consisted of patients who developed AR, and Group B comprised those without AR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our analysis revealed a significant difference between Group A and Group B regarding donor type (living or cadaveric) (<i>p</i> = 0.016). Furthermore, a significant difference was observed in the comparison of the Naples Prognostic Score (<i>p</i> = 0.014). The subsequent multivariate analysis showed that cadaveric donor status significantly increased the risk of acute rejection (HR = 2.935 [95% CI, 1.250–6.893], <i>p</i> = 0.013). Additionally, patients with a Naples score of 3–4 had a higher risk of acute rejection compared to those with a score of 0–2 (HR = 2.142 [95% CI, 1.160–3.955], <i>p</i> = 0.015).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preoperative Naples Prognostic Score, may influence the risk of acute rejection in the postoperative period. A higher NPS is associated with an increased risk of acute rejection, which may subsequently lead to graft dysfunction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915209","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":"Pre- and Post-Kidney Transplant Abdominal Computed Tomography-Based Muscle Measurements and Post-KT Outcomes","authors":"Yi Liu,&nbsp;Harris Z. Whiteson,&nbsp;Jingyao Hong,&nbsp;Nidhi Ghildayal,&nbsp;Omid Shafaat,&nbsp;Clifford R. Weiss,&nbsp;Robert A. Pol,&nbsp;Aarti Mathur,&nbsp;Babak J. Orandi,&nbsp;Dorry L. Segev,&nbsp;Mara A. McAdams-DeMarco","doi":"10.1111/ctr.70281","DOIUrl":"https://doi.org/10.1111/ctr.70281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Early post-kidney transplant (KT) changes likely impact body composition, resulting in adverse post-KT outcomes. We estimated post-KT trajectories of computed tomography (CT)-based muscle quantity/quality and tested whether they were associated with mortality and death-censored graft loss (DCGL) among frail and nonfrail recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We leveraged a cohort of 294 adult KT recipients (December 2008–February 2020) with CT measurements (muscle quantity: skeletal muscle index; muscle quality: skeletal muscle radiation attenuation). We used mixed linear regression models to estimate 3-year post-KT muscle quantity/quality trajectories. Cox proportional hazard models quantified the association between time-varying pre-/post-KT muscle mass measurements and post-KT mortality and DCGL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Muscle quantity (−2.4 cm²/m²/year) and quality (−1.3 HU/year) decreased during the first 2 years post-KT and then remained constant in the third year post-KT. Change in muscle quantity (<i>p</i>_interaction &lt; 0.01) and quality (<i>p</i>_interaction = 0.01) differed by frailty in the first 2 years post-KT; change in muscle quality (<i>p</i>_interaction &lt; 0.01) differed by lower extremity impairment in the third year post-KT. Among frail recipients, lower muscle quantity (per 10 cm²/m²) was associated with elevated mortality risk (aHR: 2.00, 95% CI: 1.08–3.70), but not among nonfrail recipients. Among older (≥65 years) recipients, lower muscle quantity was associated with increased DCGL risk (aHR: 2.70, 95% CI: 1.04–7.04), but not among younger recipients. Lower muscle quality (per 10 HU) was associated with elevated mortality (aHR: 2.23, 95% CI: 1.61–3.08) and DCGL (aHR: 1.90, 95% CI: 1.16–3.12) risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lower pre-/post-KT muscle quantity/quality were associated with higher risks of post-KT adverse outcomes. Pre-/post-KT rehabilitation to improve muscle quantity/quality may be an effective clinical intervention to minimize risks of adverse post-KT outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891584","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}