Clinical Transplantation最新文献

{"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}

{"title":"Do Factors Influencing Acceptance of Kidney Stone Formers as Donors Predict Subsequent Stone Events?","authors":"Mira T. Keddis,&nbsp;Matthew R. Howard,&nbsp;Nan Zhang,&nbsp;Jaxon K. Quillen,&nbsp;Matthew R. D'Costa,&nbsp;Hasan A. Khamash,&nbsp;Carrie C. Jadlowiec,&nbsp;Hani M. Wadei,&nbsp;Ivan E. Porter,&nbsp;Karen L. Stern,&nbsp;Andrew D. Rule","doi":"10.1111/ctr.70069","DOIUrl":"10.1111/ctr.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to assess whether kidney stone burden and risk factors at the time of kidney donor evaluation were associated with a symptomatic stone event post-donor evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified adults evaluated at Mayo Clinic (two sites) (2000–2011) for living kidney donation and had either a personal history or radiological evidence of kidney stone disease. We analyzed demographics, stone risk factors, stone number/size, and the committee's donation decision and reasons. A follow-up survey (2022–2023) assessed post-evaluation symptomatic kidney stones and related morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 412 potential donors with kidney stone disease, 258 donated, 75 did not donate due to kidney stones, and 79 did not donate for other reasons. Multivariable analysis showed that candidates not donating due to stones had higher body mass index (BMI), prior symptomatic kidney stones, multiple stones on imaging, bilateral kidney stones, and diameter of largest stone ≥3 mm. Of 147 who completed the survey, 26 (18%) had a symptomatic kidney stone post-donor evaluation. Younger age (<i>p</i> = 0.031) and multiple stones on imaging (<i>p</i> = 0.02) were significant predictors of post-evaluation symptomatic stones regardless of donation status (<i>p</i> = 0.41).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Stone burden on imaging and prior symptomatic stone events were associated with not donating. Younger age and stone burden on imaging were the primary risk factors for a symptomatic kidney stone event after donor evaluation.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906798","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":"Evolving Impact of COVID-19 on Intestinal Transplant Recipients: A Single-Center Experience","authors":"Colin Powers,&nbsp;Brielle Corrente,&nbsp;Jennifer Joyce,&nbsp;William Stein,&nbsp;Shelly Polydor,&nbsp;Vikraman Gunabushanam,&nbsp;Ajai Khanna,&nbsp;Fernanda P. Silveira,&nbsp;Ruy J. Cruz Jr.","doi":"10.1111/ctr.70065","DOIUrl":"10.1111/ctr.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There has been significant concern about coronavirus disease 2019 (COVID-19) among transplant recipients, particularly those who are highly immunosuppressed. Several studies have analyzed the impact of COVID-19 on different solid organ transplant patients. However, few isolated case reports of COVID-19 in intestinal and multivisceral transplant (ITx and MVTx) recipients are available in the literature. We report the first single-center study evaluating the clinical course and outcome of COVID-19 in ITx/MVTx recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients (age ≥ 18 years) with confirmed cases of COVID-19 between February 2020 and February 2024 were included in this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve of the 67 (17.9%) ITx/MVTx recipients followed at our center had COVID-19. Seven patients (58%) were female, and the median age at diagnosis was 47 years (range: 31–68 years). The average time from transplantation to COVID-19 was 89 months (range: 14–215 months). Nine patients (75%) required hospitalization; three of them were admitted to the intensive care unit (ICU) and required ventilator support. One patient had COVID-19 on two different occasions. Treatment modalities consisted of monoclonal antibody treatment (<i>n</i> = 5), of antiviral therapy (<i>n</i> = 4), and steroid monotherapy (<i>n</i> = 1). Three patients received combination therapy. Three patients (25%) developed irreversible respiratory failure and died after prolonged ventilator use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our data suggested a possible increase in the incidence of COVID-19 in ITx and MVTx recipients with an unchanged mortality rate despite the use of vaccines and new therapeutic modalities. Further multicenter studies are needed to analyze the real impact of COVID-19 on this unique population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909434","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":"Mechanical Circulatory Support for Right Ventricular Primary Graft Dysfunction After Heart Transplant: A Review","authors":"Einar A. Hart,&nbsp;S. A. Braithwaite,&nbsp;J. A. J. Hermens,&nbsp;A. O. Kraaijeveld,&nbsp;F. Ramjankhan,&nbsp;L. W. van Laake,&nbsp;M. I. F. J. Oerlemans,&nbsp;M. K. Szymanski","doi":"10.1111/ctr.70066","DOIUrl":"10.1111/ctr.70066","url":null,"abstract":"<p>Primary graft dysfunction (PGD) is the most common cause of early mortality following heart transplantation. Although PGD can affect both ventricles, isolated right ventricular dysfunction (RV-PGD) is observed in nearly half of PGD patients. RV-PGD requires specific medical management to support the preload, afterload, and function of the failing RV; however, the use of mechanical circulatory support of the RV (RV-MCS) might be required when optimal medical therapy is insufficient in preventing forward failure and retrograde venous congestion. While RV-MCS options provide the opportunity to prevent or to recover from circulatory shock states, MCS is associated with a significant risk of complications. As a result of recent developments in short-term mechanical support devices, less invasive, percutaneous options for RV-MCS are available. In this review, we discuss the available devices, their advantages and disadvantages, and reported outcomes in RV-PGD.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909437","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 Five-Year Prospective, Randomized, Open-Label Study of Standard-Dose Versus Low-Dose Prolonged-Release Tacrolimus With or Without Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Post Kidney Transplantation","authors":"Patricia M. Campbell,&nbsp;Marcelo Cantarovich,&nbsp;Azim Gangji,&nbsp;Isabelle Houde,&nbsp;Anthony M. Jevnikar,&nbsp;Felix-Mauricio Monroy-Cuadros,&nbsp;Peter W. Nickerson,&nbsp;Michel R. Pâquet,&nbsp;G. V. Ramesh Prasad,&nbsp;Lynne Senécal,&nbsp;Jean-Luc Wolff,&nbsp;Jason J. Schwartz,&nbsp;David N. Rush","doi":"10.1111/ctr.70067","DOIUrl":"10.1111/ctr.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Novel approaches to improve long-term outcomes in kidney transplant recipients are required. Here<b>, </b>we present the 5-year data from a multicenter, prospective, Phase 3b trial evaluating treatment outcomes with standard (STD) or low (LOW) dose prolonged-release tacrolimus (TAC) combined with ACEi/ARB or other antihypertensive therapy (OAHT) in Canadian kidney transplant recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult <i>de novo</i> kidney transplant recipients were randomized 2 × 2 to STD or LOW dose TAC and ACEi/ARB or OAHT. Patients had received a first or second transplant from a living or deceased donor and had ≥ 1 human leukocyte antigen mismatch with their donor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 281 patients from 13 sites across Canada. Overall patient survival was 95.7% and was comparable between groups. Graft survival at study end was 89.7% in the LOW+OAHT group and 94.4%–97.1% in the other groups and BPAR, and Class II <i>de novo </i>donor-specific antibodies (<i>dn</i>DSA) were higher in the LOW+OAHT group than in the other groups. However, these differences were not statistically significant. Graft function, blood pressure (BP), and proteinuria were similar between the groups; however, between 2 and 5 years there was a 2-fold or greater increase in the use of ACEi/ARB in patients randomized initially to OAHT, mostly because of hypertension and proteinuria. There were no unexpected safety findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients randomized to LOW TAC with renin-angiotensin system (RAS) blockade had similar outcomes at 5 years as patients treated with STD TAC with or without RAS blockade, whereas those randomized to LOW TAC without RAS blockade showed a non-significant trend towards more rejections and <i>dn</i>DSA</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration:</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT00933231</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909429","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 Acute Kidney Injury After Pediatric Liver Transplantation: A 1-Year Follow-Up","authors":"Jiemei Ji,&nbsp;Shengfeng Liang,&nbsp;Jian Lai,&nbsp;Zhongxuan Mao,&nbsp;Yunan Lin,&nbsp;Yuyan Lan,&nbsp;Jingchen Liu","doi":"10.1111/ctr.70063","DOIUrl":"10.1111/ctr.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) following pediatric liver transplantation (PLT) have not been comprehensively studied. This study aimed to evaluate the correlation between AKI and both 1-year CKD and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 132 children aged between 3 months and 12 years who underwent PLT between 2017 and 2021. Postoperative AKI and CKD after 1 year were assessed according to KDIGO criteria. AKI was classified as mild, moderate, or severe based on severity as well as transient (≤2 days) and persistent (&gt;2 days) based on duration. CKD occurrence was the primary outcome, whereas all-cause mortality was the secondary outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AKI developed in 45.4% of children, with 40.7% mild, 37.1% moderate, and 22.2% severe. Half of the children with AKI subsequently developed CKD within 1 year, compared to 23.1% without AKI. Multivariate analysis indicated that moderate AKI, severe AKI, and persistent AKI were risk factors for CKD development (moderate AKI, OR = 3.8, 95% CI = 1.2–12.3; severe AKI, OR = 7.4, 95% CI = 1.4–38.3; persistent AKI, OR = 9.7, 95% CI = 2.3–36.4). The overall mortality rate within 1 year after surgery was 9.8%. Children with severe AKI and AKI lasting longer than 2 days exhibited a higher mortality rate than those without AKI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The development of postoperative AKI is relatively common after PLT, and the severity and duration of AKI are associated with CKD and mortality within 1 year.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892610","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":"Intraoperative Cardiac Arrests in Asian Recipients of Liver Transplantation—Second Report After Learning Curve","authors":"Jisun Choi,&nbsp;SangHyun Lee,&nbsp;Justin Sangwook Ko,&nbsp;Mi Sook Gwak,&nbsp;Gaab Soo Kim","doi":"10.1111/ctr.70038","DOIUrl":"https://doi.org/10.1111/ctr.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although surgical competency and anesthesia for liver transplantation (LT) have evolved significantly in the past decades, intraoperative cardiac arrest (ICA) is still an event that brings a poor prognosis to the recipient. We report a second-decade experience of ICA as a follow-up study of our first report at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective observational study of the medical records and the Liver Transplant Program database of our institution. LT from January 2011 to June 2023 were included. Of the 1735 LT cases, a total of 1730 cases were included, excluding three non-Asian and two simultaneous heart and liver transplants (1598 adult LT, 132 pediatric LT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ICA incidence during adult LT was 0.7% (11/1598) which is significantly lower compared to our first report (1.5%; 14/919) (<i>p</i> = 0.042). ICA occurred only in adult recipients. Post-reperfusion syndrome (PRS, six cases) and bleeding (four cases) were the primary causes in most cases and most ICA occurred after reperfusion (10/11). The mortality rates within 24 h, 30 days, and 1 year were 27.3%, 45.5%, and 54.5%, respectively. The survival curve did not show a significant difference from our first report (<i>p</i> = 0.570), and the survival rate of the ICA group was significantly lower compared to the non-ICA group. (<i>p</i> = 0.000)</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The incidence of ICA has decreased, but the main causes of ICA as PRS and bleeding after reperfusion have not changed. Additionally, there was no significant difference in the survival curves from the first report. Because ICA is still fatal, efforts to reduce its incidence should be continued.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868810","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}