Clinical Transplantation最新文献

{"title":"Travel Practices and Associated Risks in Adult Thoracic Transplant Recipients: A Monocentric Survey","authors":"Benoît Henry,&nbsp;Aurélie Garraffo,&nbsp;Paul-Henri Consigny,&nbsp;Claire Rouzaud,&nbsp;Fanny Lanternier,&nbsp;Pierre Frange,&nbsp;Ngoc-Tram To,&nbsp;Pierre Buffet,&nbsp;Benoît Pilmis,&nbsp;Shahid Husain,&nbsp;Elie Fadel,&nbsp;Jérôme Le Pavec,&nbsp;Olivier Lortholary","doi":"10.1111/ctr.70206","DOIUrl":"https://doi.org/10.1111/ctr.70206","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Little is known regarding the travel practices of thoracic organ transplant recipients and their potential associated morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A questionnaire was distributed to thoracic organ transplant recipients to capture demographics, risk perception, knowledge regarding vaccination, history of travel outside metropolitan France, pre-travel advice, health issues during travel outside Europe, and travel intentions in the following year. Comparisons were performed between travelers and non-travelers through univariable then multivariable logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>134 patients completed the survey (72% lung, 11% heart, and 17% heart–lung transplant recipients). Twenty-four percent considered themselves at moderately to significantly increased risk of travel-related health issues. Sixty-two patients (47%) had traveled outside metropolitan France. Among 29 subjects who had traveled outside Europe, 22 had received pre-travel advice. Among 62 respondents who had traveled outside metropolitan France, 6 (10%) experienced health issues (all outside Europe), which led to consultation in three cases and hospitalization in one case. Among 117 respondents, 68 (58%) intended to travel within the following year, and 57 (84%) to seek medical advice before departure, predominantly from their transplant physician. In multivariable analysis, being a lung transplant recipient and higher education level were associated with travel outside Europe. The time post-transplantation was longer for all types of travel, when compared to non-travelers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Almost half of adult thoracic transplant recipients had traveled outside metropolitan France, 22% outside Europe, and 10% of travelers experienced health issues. The suboptimal preparation of these patients underlines the potential benefits of closer interaction between travel medicine specialists and transplant physicians.</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":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891677","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":"Altered Immune Profiles in Non-Failing Heart Donors With Induced Long QT Syndrome: A Potential Risk Factor for Cardiac Allograft Vasculopathy","authors":"Zhi Wen,&nbsp;Shuai Shao,&nbsp;Yu Feng,&nbsp;Zheng Wang,&nbsp;Jianqiang Wu,&nbsp;Changxue Wu,&nbsp;Mingwu Tian","doi":"10.1111/ctr.70286","DOIUrl":"https://doi.org/10.1111/ctr.70286","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cardiac allograft vasculopathy (CAV) develops more aggressively in recipients of hearts from brain-dead (BD) donors with induced long QT syndrome (iLQTS), yet the underlying mechanisms remain poorly understood. In this study, we employ a multi-omics and experimental framework to explore the role of neuro-immune interactions in non-failing donor hearts affected by iLQTS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-nuclei RNA sequencing (snRNA-seq) compared four iLQTS and four non-arrhythmic non-failing donor hearts. Pathway enrichment and cell-cell communication were assessed. Plasma proteome data from BD donors and neuronal differentially expressed (DE) genes were integrated via Omicsnet. Human BD donor transcriptomes data were analyzed for immune correlation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ILQTS hearts showed elevated T/mast cells and upregulated leukocyte migration/focal adhesion pathways. Neuronal signaling (NGF, HSPG) and adhesion molecules (ITGB1, LAMININ) drove immune trafficking. Integrative proteomics identified ITGB1 as a central hub linking neuronal DE genes to BD-associated plasma proteins. Human validation linked activated CD4⁺ T cells/Th2 enrichment to prolonged QT intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Neuro-immune dysregulation and integrin signaling related T cell activation underlie iLQTS-related heart donors. Targeting neuronal-integrin crosstalk may reduce CAV progression and improve transplant outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891715","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":"Trajectories of Immunosuppressive Medication Adherence Among Kidney Transplant Recipients: A 2-Year Prospective Cohort Study","authors":"Lei Dong,&nbsp;Keke Lin,&nbsp;Shan Liu,&nbsp;Hongxia Liu,&nbsp;Jia Liu","doi":"10.1111/ctr.70280","DOIUrl":"https://doi.org/10.1111/ctr.70280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Immunosuppressive medication (IM) adherence, a dynamic and time-dependent behavior, is typically suboptimal among kidney transplant recipients (KTRs) and severely impacts their prognosis. Longitudinal data regarding the temporal trajectories of medication adherence are important for devising targeted intervention strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify the trajectories of IM adherence in KTRs over the 2 years post transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two hundred and twenty-two KTRs were recruited from a tertiary care hospital in China between May 2020 and February 2022. Data were collected at 3-, 6-, 12-, and 24-month post kidney transplantation. IM adherence was defined according to the BAASIS scale. A group-based trajectory model was used to depict and identify distinct trajectories. Univariate analysis and multinomial logistic regression were conducted to evaluate the association between baseline factors and membership in different trajectory groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of medication non-adherence at 3, 6, 12, and 24 months after transplantation was 10.8%, 9.9%, 11.7%, and 22.1%, respectively. Three adherence trajectories were identified, including the “consistent adherence” (65.5%), “high start and decreasing adherence” (28.0%), and “increasing adherence” (6.6%) trajectory group. The critical transition point, as the 6-month time point after transplantation, in adherence dynamics was identified. Recipients experiencing decreasing adherence trajectories were possibly younger, received a technical/high school education, and lived alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Distinct trajectories of medication adherence among KTRs were identified during the 2-year post-transplantation period. A previously unrecognized adherence trajectory-the “increasing adherence” trajectory and the critical transition point in adherence dynamics was identified, particularly highlighting the 6-month post transplantation period as a pivotal intervention window.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891594","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":"Pleural Effusions Requiring Thoracocentesis Are Associated With Baseline Lung Allograft Dysfunction and Mortality in Lung Transplant Recipients","authors":"Michael Gerckens,&nbsp;Nicole Weiss,&nbsp;Daria Khmelovska,&nbsp;Alexander Richard,&nbsp;Mathias Klemm,&nbsp;Philipp Plohmann,&nbsp;Paola Arnold,&nbsp;Tobias Veit,&nbsp;Jürgen Barton,&nbsp;Teresa Kauke,&nbsp;Christian Schneider,&nbsp;Sebastian Michel,&nbsp;Michael Irlbeck,&nbsp;Ali Önder Yildirim,&nbsp;Jürgen Behr,&nbsp;Nikolaus Kneidinger,&nbsp;Carlo Mümmler","doi":"10.1111/ctr.70234","DOIUrl":"https://doi.org/10.1111/ctr.70234","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pleural effusions of unknown etiology have been demonstrated to be associated with poor prognosis in lung allograft recipients. We aimed to identify novel risk factors for pleural effusions after lung transplantation (LTX) and to shed light on their association with allograft function and survival, differentiating early and late pleural effusions after LTX.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective study of all LTX recipients transplanted at the LMU Klinikum Munich from 2013 to 2018. We recorded all pleural effusions requiring thoracocentesis and analyzed the corresponding clinical data. A total of 426 pleural effusions in 369 lung allograft recipients with a median follow-up time of 6.9 years were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both early (&lt;90 days after LTX) and late pleural effusions (&gt;90 days after LTX) were associated with increased mortality, with a strong mortality risk for late pleural effusions (HR 4.0). Increased mortality in patients with early pleural effusions might be mediated by a higher risk for baseline lung allograft dysfunction (BLAD). Early pleural effusions were associated with underlying obstructive disease, relative donor organ undersizing and clamshell thoracotomy. Notably, (partial) resection of the parietal pleura during LTX was not associated with pleural effusions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study underlines the importance of pleural effusions after LTX. All pleural effusions were associated with increased mortality, while only early pleural effusions were associated with BLAD. The mechanisms linking pleural effusions to BLAD and to higher mortality remain unknown and will be investigated in future, prospective cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891672","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":"Heart Allograft Utilization Rates Following Donation After Circulatory Death Compared to Donation After Brain Death in the Ideal Heart Donor","authors":"Nayeem Nasher,&nbsp;Daler Rahimov,&nbsp;T. Reese Macmillan,&nbsp;Faizaan Siddique,&nbsp;J. Eduardo Rame,&nbsp;Howard J. Eisen,&nbsp;Rene J. Alvarez,&nbsp;Keshava Rajagopal,&nbsp;John W. Entwistle,&nbsp;Vakhtang Tchantchaleishvili","doi":"10.1111/ctr.70266","DOIUrl":"https://doi.org/10.1111/ctr.70266","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The number of heart allografts obtained from donation after circulatory death (DCD) remains low, especially compared to donation after brain death (DBD). Our study aimed to identify factors associated with the underutilization of hearts in ideal donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patient-level data were obtained from the United Network for Organ Sharing (UNOS) database for all adult deceased donors who underwent organ procurement and subsequent transplantation between January 2020 and December 2023. “Ideal” DCD donors were analyzed as a separate subset and compared with ideal DBD donors. Transplantation rates, along with associated factors, were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The rate of heart allograft utilization was 6.9% in DCD donors compared to 35.4% among DBD donors (<i>p</i> &lt; 0.001). Subgroup analysis of ideal donors demonstrated that 41% of DCD donors were utilized for heart transplantation compared to 85% of DBD donors (<i>p</i> &lt; 0.001). Multivariable logistic regression analysis for heart utilization demonstrated that interventions, including extracorporeal life support (odds ratio [OR] 7.48, 95% CI 4.72–12.35) and coronary angiography (OR 2.77, 95% CI 1.76–4.39), were independent predictors of utilization. There was no significant association with hypertension (OR 0.75, 95% CI 0.52–1.06), tobacco use (OR 0.71, 95% CI 0.47–1.06), or BMI (OR 0.99, 95% CI 0.97–1.01) in the ideal DCD donor. Regional variation in donor heart utilization rates was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There remains a significant portion of ideal DCD donors whose hearts remain unutilized. Identifying and addressing factors related to underutilization may improve organ yield.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891569","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":"Five-Aminolevulinic Acid as a Potential Biomarker for Renal Insufficiency After Heart Transplantation","authors":"Xiao Huang,&nbsp;Linhua Chen,&nbsp;Li Liu,&nbsp;Ying Zhou,&nbsp;Hong Zhou,&nbsp;Yu Zhang","doi":"10.1111/ctr.70284","DOIUrl":"https://doi.org/10.1111/ctr.70284","url":null,"abstract":"<div>\u0000 \u0000 <p>Renal complications are common following heart transplantation and lead to increased morbidity and mortality. The incidence of renal insufficiency is 10%–40% at 3–7 years after transplantation. This study aims to conduct metabolic profiling of serum samples from heart transplantation recipients to uncover differential metabolites related to renal insufficiency and potential pathogenic mechanisms. A total of 101 heart transplantation recipients were included and categorized into three groups according to their estimated glomerular filtration rate. The demographic and clinical data were collected at the time of sample collection. Plasma samples were collected and analyzed using liquid chromatography-tandem mass spectrometry. The untargeted metabolomics revealed that during the progression of renal injury, 35 metabolites were upregulated and 1 metabolite was downregulated. Among them, the univariate analysis demonstrated that 13 differential metabolites had AUC ≥ 0.80 in both Stage 3 versus Stage 1 and Stage 3 versus Stage 2. Furthermore, enriched pathway analysis revealed that the differential metabolites among the three groups are mainly associated with ascorbate and aldarate metabolism, glycine, serine, and threonine metabolism, protein digestion and absorption, and biosynthesis of amino acids. Our findings indicate a strong association between creatinine and 5-aminolevulinic acid with the occurrence and progression of renal insufficiency following heart transplantation. These results offer valuable insights into the underlying mechanisms contributing to renal dysfunction in heart transplantation recipients from a metabolomics perspective, thereby supporting improved prediction and treatment strategies for renal insufficiency posttransplantation.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891673","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":"Treating Donation After Circulatory Death Liver Grafts With Alteplase During Ex Situ Normothermic Machine Perfusion","authors":"Rachel Todd,&nbsp;Leonie van Leeuwen,&nbsp;Andrew Rosowicz,&nbsp;Aritz Irizar,&nbsp;Antonios Arvelakis,&nbsp;Joseph DiNorcia,&nbsp;Marcelo Facciuto,&nbsp;Jang Moon,&nbsp;Chiara Rocha,&nbsp;Parissa Tabrizian,&nbsp;Leona Kim-Schluger,&nbsp;Sander S. Florman,&nbsp;M. Zeeshan Akhtar","doi":"10.1111/ctr.70282","DOIUrl":"https://doi.org/10.1111/ctr.70282","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Normothermic machine perfusion (NMP) is increasing the safe utilization of donation after circulatory death livers. Historically, tissue plasminogen activator (tPA) has been administered intraoperatively to DCD graft recipients to reduce non-anastomotic biliary complications (NAS). Treating the liver during NMP offers a potentially safer administration, preventing systemic treatment of the recipient. In this retrospective study, we explore our center's experience of giving tPA with FFP during NMP and its effects on clinical chemistries during perfusion, intraoperative transfusions, and post-operative outcomes and clinical chemistries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred and twenty-seven livers were perfused using the OrganOx <i>metra</i>, including 56 DCD livers (tPA + NMP-DCD) that received a bolus of 10 mg tPA followed by a 90-min infusion of 40 mg. Sixty-five livers from donation after brain death donors underwent NMP without tPA (NMP-DBD). A historical, propensity-matched cohort of 78 livers from non-NMP DCD donor livers (<i>n</i> = 51) were an additional comparator group (tPA-DCD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Intraoperative transfusions, 30-day and 3-month patient survival, and 30-day and 3-month graft survival were not statistically different between the tPA-NMP-DCD and NMP-DBD groups, except for cell saver volumes (<i>p</i> = 0.0034). Less platelets and cryoprecipitate transfusions were observed in the tPA-NMP-DCD livers compared to historical tPA-DCD livers (<i>p </i>= 0.0021 and 0.0046, respectively). One incidence of primary non-function occurred in the tPA-DCD group, and the tPA-NMP-DCD arm had one case of ischemic cholangiopathy required re-transplant. There was a higher reoperation rate for hematoma evacuation in the NMP-DBD cohort. Minimum follow-up time was 5 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results continue to lend support to NMP providing a platform for administering tPA to donor livers, curtailing a potential risk to the recipient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>Administration of tissue plasminogen activator (tPA) can be safely administered during normothermic machine perfusion. For centers who traditionally deploy tPA in recipients for DCD donor livers, delivering during NMP is an alternative safer option sparing the reciepient from exposure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869910","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":"Association of Community Distress With Lung Transplant Waitlist Acceptance","authors":"William M. Brandon,&nbsp;Alan Jacob,&nbsp;Colin Dunn,&nbsp;Song Zhang,&nbsp;Ang Gao,&nbsp;Fernando Torres,&nbsp;Adrian Lawrence,&nbsp;Irina Timofte,&nbsp;Srinivas Bollineni,&nbsp;Manish Mohanka,&nbsp;Juan Deleija-Lujano,&nbsp;Adnan Khan,&nbsp;Joseph Crossno,&nbsp;Michael Wait,&nbsp;Matthias Peltz,&nbsp;Christopher Heid,&nbsp;Lynn Huffman,&nbsp;Steve Ring,&nbsp;John Murala,&nbsp;Suresh Keshavamurthy,&nbsp;Alex Jaye Weston,&nbsp;Vaidehi Kaza","doi":"10.1111/ctr.70289","DOIUrl":"https://doi.org/10.1111/ctr.70289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Access to transplantation is not entirely equitable with several studies demonstrating racial and socioeconomic disparities affecting the transplant process and thereby outcomes. Notably, few studies have focused on disparities prior to waitlisting. This study aimed to characterize the impact of community socioeconomic factors as measured by the Distressed Community Index (DCI) on acceptance for lung transplant waitlisting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was performed on 463 patients evaluated for lung transplant waitlisting at our institution between 2016 and 2020. Community distress was calculated using the DCI, which yields a composite Distress Index (cDI) and includes data on various community characteristics. Statistical analysis was done using descriptive statistics and logistic regression methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 463 patients included, 333 (71.9%) were accepted and 130 (28.1%) were denied for waitlisting. The mean cDI was 42.5 (±30.0) and 44.8 (±30.8) (<i>p</i> = 0.45) for the accepted and declined groups, respectively, indicating mid-tier distress for both groups by DCI metrics. The cDI was not found to be associated with odds of waitlist acceptance (OR 0.997, CI 0.99–1.004, <i>p</i> = 0.455). Furthermore, there was no association between sex, race, ethnicity, public insurance coverage, or any of the subcomponents of the DCI and the odds of successful waitlisting at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This single-center retrospective evaluation found that cDI, as calculated by the DCI, and the DCI subcomponents were not associated with transplant waitlist acceptance. Future studies should be done evaluating community-level socioeconomic disparities and the utility of community disadvantage indexing tools in the lung transplant waitlisting process, with the intentions of conceptually expanding our understanding of the link between transplant outcomes and biopsychosocial candidacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869912","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 Characteristics and Outcomes of Influenza-Associated Late-Onset Severe Pneumonia After Allogeneic Hematopoietic Stem Cell Transplantation","authors":"Yuewen Wang,&nbsp;Leqing Cao,&nbsp;Xiaohui Zhang,&nbsp;Lanping Xu,&nbsp;Yu Wang,&nbsp;Chenhua Yan,&nbsp;Huan Chen,&nbsp;Yuhong Chen,&nbsp;Wei Han,&nbsp;Fengrong Wang,&nbsp;Jingzhi Wang,&nbsp;Xiaojun Huang,&nbsp;Xiaodong Mo","doi":"10.1111/ctr.70287","DOIUrl":"https://doi.org/10.1111/ctr.70287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Late-onset severe pneumonia (LOSP) is one of the most important causes of mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The influenza virus is a frequent viral pathogen in patients receiving allo-HSCT, accounting for at least 30% of all respiratory viral infections. We aimed to identify the clinical characteristics and outcomes of influenza-associated LOSP after allo-HSCT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study enrolled 23 patients who underwent allo-HSCT at the Peking University Institute of Hematology and were subsequently diagnosed with influenza-associated LOSP. Survival analysis was conducted via the Kaplan‒Meier method. Potential risk factors for survival and mortality following influenza-associated LOSP were evaluated through univariate and multivariate Cox regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the patients, 39.1% (<i>n</i> = 9) died following influenza-associated LOSP. The median time from allo-HSCT to influenza infection was 269 days (range 100–3979 days), and the median time from the onset of influenza symptoms to influenza-associated LOSP was 5 days (range 0–38 days). The most common clinical manifestations were fever (95.7%), cough (56.5%), and expectoration (34.8%). After antiviral therapy, the median time for the influenza virus to turn negative was 11 days (range, 4–34 days). The 100-day cumulative incidence of influenza-associated LOSP-related mortality was 30.9% (95% CI 11.3%–50.5%). The probability of overall survival at 100 days after influenza-associated LOSP was 59.1% (95% CI 41.5%–84.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study presents the first comprehensive analysis of the clinical characteristics and outcomes associated with influenza-related LOSP following allo-HSCT. Additionally, our findings highlight the treatment strategies and prognostic factors associated with influenza-associated LOSP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869911","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":"UNOS 2018 Heart Allocation Policy: Evaluation of Status 1 and 2 Extensions on Heart Transplant Outcomes","authors":"Toyokazu Endo,&nbsp;Priyadarshini Chandrashekhar,&nbsp;Michele Gallo,&nbsp;Erin M. Schumer,&nbsp;Siddharth Pahwa,&nbsp;Mark S. Slaughter,&nbsp;Jaimin R. Trivedi","doi":"10.1111/ctr.70283","DOIUrl":"https://doi.org/10.1111/ctr.70283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The new United Network of Organ Sharing (UNOS) allocation policy emphasizes those supported by mechanical circulatory support devices (MCSD). We evaluated the outcomes based on temporary mechanical circulatory support (TMCS) devices that have a timeline restriction (Status 1: Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) and Status 2: Intra-Aortic Balloon Pump (IABP) and Impella) and extension status among Status 1 and 2 patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The UNOS database was used to identify adult patients (age &gt; 17) listed for heart transplants as Status 1 or 2 at any point during their listing from October 2018 to June 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among Status 1 patients, extensions have stayed steady throughout the years but with significant regional variations across the UNOS region (0%–30.2%). Those extensions granted had worse waitlist outcomes but comparable post-transplant survival. Among Status 2 patients, the use of IABP and Impella has significantly increased over the years, with the use of extensions increased during our study period. The majority of the patients were supported on IABP. Again, regional variations existed with the UNOS region that ranged from 12% to 25% use of the extension. Those who were extended had better waitlist survival, with comparable post-transplant outcomes (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The timeline restriction for Status 1 and 2 patients with TMCS are not seen in practice with more patients remaining in their respective status through extensions. Extension criteria as well as timeline restriction should be revisited in the UNOS heart allocation policy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869431","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}