Clinical Transplantation最新文献

{"title":"Effects of Nighttime Procurement and Transplantation on Outcomes Following Heart Transplantation","authors":"Yeahwa Hong,&nbsp;Nicholas R. Hess,&nbsp;Ander Dorken-Gallastegi,&nbsp;Mohamed Abdullah,&nbsp;Nidhi Iyanna,&nbsp;Umar Nasim,&nbsp;Ibrahim Sultan,&nbsp;Gavin W. Hickey,&nbsp;Mary E. Keebler,&nbsp;David J. Kaczorowski","doi":"10.1111/ctr.70093","DOIUrl":"10.1111/ctr.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study evaluates the effects of nighttime procurement and transplantation on outcomes following heart transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The UNOS registry was queried to analyze adult recipients who underwent isolated orthotopic heart transplantation between January 1, 2010, and September 30, 2022. The cohort was stratified into daytime (4 am–8 pm) and nighttime (8 pm–4 am) transplant groups. The primary outcome was 1-year survival. Propensity score-matching was performed. Risk adjustment was performed using multivariable Cox regression. Restricted cubic spline was used to model the association between the time of transplantation and the likelihood of 1-year mortality. Sub-analysis was performed to evaluate the impact of nighttime procurement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 30 426 recipients were analyzed, where 10 807 recipients (35.5%) underwent nighttime transplantation. The nighttime recipients had reduced 1-year post-transplant survival compared to the daytime recipients (90.6% vs. 91.5%, <i>p</i> = 0.019), and this lower survival persisted in the propensity score-matched comparison. After adjusting for established predictors for post-transplant mortality, nighttime transplantation continued to have a significantly increased risk of 1-year mortality (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.03–1.21, <i>p</i> = 0.005). The spline model demonstrated increased odds of 1-year mortality between 5 pm and 4 am, with the highest odds at 11 pm (odds ratio [OR] 1.25, 95% CI 1.07–1.47), compared to the reference transplantation time of 7 am. When assessing the impact of procurement timing, nighttime procurement negatively impacted 1-year post-transplant survival among the daytime recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates the adverse impact of nighttime heart procurement and transplantation on early post-transplant survival. With emerging organ perfusion and thermal protection systems, additional studies are warranted to assess the safety of extending the heart preservation period to optimize the timing of transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063904","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":"SherpaPak Cardiac Transport System: Experience in Pediatric Heart Transplantation","authors":"Anna Sather,&nbsp;Molly Marshall,&nbsp;Raghav Murthy,&nbsp;Jacqueline M. Lamour,&nbsp;Christyn Chase,&nbsp;Neha Bansal","doi":"10.1111/ctr.70095","DOIUrl":"10.1111/ctr.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The present study aimed to assess the clinical outcomes of pediatric heart transplant patients whose donor hearts were preserved with the SherpaPakCardiac Transport System.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All pediatric patients undergoing heart transplantation at our center between January 2020 and June 2024 were included and described. Vasoactive inotropic score (VIS) was calculated. The cohort was divided into two groups by recipient diagnoses (cardiomyopathy vs. congenital heart disease [CHD]). They were compared based on demographics, operative details, and postoperative outcomes. The <i>χ</i>2 and Fisher exact tests were used for categorical variables and the Mann–Whitney <i>U</i> test or <i>t</i>-test for continuous variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 18 patients were included. The median recipient age was 11.9 years (IQR: 2.5, 13.9). Half had cardiomyopathy, median total ischemic time was 236 min (IQR: 211.5, 283.5). Upon comparing the two groups, there were no significant differences observed in VIS or primary graft dysfunction (PGD) even though the median circulatory arrest time and bypass times were significantly longer in the CHD group (<i>p</i> &lt; 0.05). Three patients experienced early rejection (all with CHD), but there was no mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The SherpaPak Cardiac Transport System provides safe outcomes for pediatric heart transplant patients, including those with complex CHD. Further multi-institutional and registry studies are needed to evaluate this method for pediatric heart transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063908","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":"Assessing the Quality of Life in Adult Lung Transplant Recipients Quality of Life Post-Lung Transplant","authors":"Bashayer M. Al-Shweeman,&nbsp;Gamal Mohamed,&nbsp;Atheer Alawwad","doi":"10.1111/ctr.70098","DOIUrl":"10.1111/ctr.70098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Significant limitations in daily life characterize end-stage lung diseases (ESLD) due to symptoms such as dyspnea, recurrent infections, side effects of immunosuppressive medication, and frequent need for hospitalizations. In addition to physical symptoms, ESLD is associated with emotional and social sources of distress such as depression, anxiety, fear of dying, financial concerns, and regular need for relocation. A transplant can significantly affect the recipients’ life domains, from physical and emotional well-being to social relationships and roles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to assess the quality of life of adult lung transplant recipients in Saudi Arabia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A cross-sectional quantitative design was employed using the self-administered World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, a sociodemographic and clinical questionnaire, and a medical chart review. The study was conducted in a tertiary care center in Saudi Arabia. Data were collected from November 2023 to April 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred fifty-seven individuals with a mean age of 45 years had completed the questionnaire, and there was no participant refusal (Response rate = 100%). Males accounted for 61.1%, and most participants were married (63.7%). About half (44.6%) had at least one comorbidity outside ESLD. Only 26.7% were working post-transplant. Overall, the data strongly suggests that as individuals adjust and recover post-transplant, they tend to feel increasingly positive with time. Most rated their quality of life and health satisfaction as high. The lowest score was for the <i>physical domain</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study's findings showed that the quality was good overall across various domains, with moderate scores, with the lowest score on the <i>physical domain</i>. Improving rehabilitation strategies would help transplanted patients live more fulfilling lives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063903","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":"Intraoperative Hemodynamic Monitoring and Prediction of Early Allograft Dysfunction Following Living Donor Liver Transplantation: A Systematic Review","authors":"Audrey E. Brown,&nbsp;John Roberts","doi":"10.1111/ctr.70074","DOIUrl":"10.1111/ctr.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Multiple intraoperative hemodynamic parameters are associated with an increased risk of early allograft dysfunction (EAD) following living donor liver transplantation (LDLT); however, there is significant center-to-center variability in terms of which parameters are used. We sought to determine which intraoperative hemodynamic parameters are most predictive of EAD following LDLT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a systematic review following PRISMA guidelines (PROSPERO ID: CRD42023409711). Receiver operating characteristic (ROC) analyses were used to compare predictive parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4399 articles were identified from 3 large, international databases (PubMed, Embase, and Web of Science). Eighteen articles fit the inclusion criteria. The most commonly evaluated hemodynamic parameter was the postreperfusion portal venous pressure (PVP). A postreperfusion PVP of &lt;15–20 mmHg was consistently associated with lower rates of EAD and, in some cases, improvements in patient survival. Other hemodynamic parameters evaluated included portal venous flow, hepatic arterial flow, portal venous velocities, and the hyperperfusion index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hemodynamic measurements indicative of portal hyperperfusion, especially elevated PVP, have been consistently associated with the development of EAD. Intraoperative hemodynamics should be monitored on all LDLT recipients, with portal inflow modulation procedures indicated if portal hyperperfusion is present.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058297","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":"Sarcopenia As a Predictor of Survival and Complications of Patients With Cirrhosis After Liver Transplantation: A Systematic Review and Meta-Analysis","authors":"George E. Markakis,&nbsp;Jennifer C. Lai,&nbsp;Nikolaos D. Karakousis,&nbsp;George V. Papatheodoridis,&nbsp;Theodora Psaltopoulou,&nbsp;Manuela Merli,&nbsp;Theodoros N. Sergentanis,&nbsp;Evangelos Cholongitas","doi":"10.1111/ctr.70088","DOIUrl":"10.1111/ctr.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This systematic review/meta-analysis evaluated the impact of sarcopenia in patients with cirrhosis before liver transplantation (LT) on outcomes after LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted in six medical databases until February 2022. The primary outcome was overall mortality after LT, while several secondary outcomes including liver graft survival and rejection, the need for transfusions, the length of the intensive care unit (ICU) and hospital stay, and surgical complications were evaluated. Sub-group analyses and meta-regression analyses were also performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-three studies were evaluated in the systematic review, of which 30, including 5875 patients, were included in the meta-analysis. All studies included were cohort studies of good/high quality on the Newcastle-Ottawa scale (NOS), while in our analysis no publication bias was found, although there was substantial heterogeneity between the studies. Muscle mass was assessed using skeletal muscle index (SMI) in 14 studies, psoas muscle area (PMA) in seven studies, and psoas muscle index (PMI) in four studies. The prevalence of pre-LT sarcopenia ranged from 14.7% to 88.3%. Pre-LT sarcopenia was significantly associated with post-LT mortality (Relative Risk [RR] = 1.84, 95% CI:1.41,2.39), as well as with a high risk of infections post-LT, surgical complications, fresh frozen plasma (FFP) transfusions, and ICU length of stay (LOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pre-LT sarcopenia in patients with cirrhosis is a strong risk factor for clinically meaningful adverse outcomes after LT. Assessment may help identify patients at the highest risk for poor outcomes who may benefit from targeted interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Outcomes of Invasive Candida Infections in Heart Transplant Recipients: A Case-Control Study","authors":"Majd Alsoubani,&nbsp;Gabriela Andujar Vazquez,&nbsp;Andrew Strand,&nbsp;Shira Doron,&nbsp;Jennifer Chow","doi":"10.1111/ctr.70091","DOIUrl":"10.1111/ctr.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Invasive Candida infections (ICI) are the most common invasive fungal infections in solid organ transplant recipients. There are limited contemporary data on the risk factors for infection in heart transplant (HT) recipients especially since the expansion of temporary mechanical circulatory support (MCS) use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a case-control study conducted at a tertiary care academic hospital of HT recipients from January 2022 to January 2024. All patients who developed ICI by the detection of Candida species from a normally sterile site were included as cases. Four controls who underwent HT, two before the case and two after the case, were selected. ​Fisher's exact or Mann-U-Whitney tests were used for the analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 12 cases and 48 controls out of a total of 117 transplants during the study period​. The proportion of ICI was 10.6%. The median time to ICI from transplant was 16 days (IQR 10, 83). The most common organisms isolated were <i>Candida parapsilosis</i> and <i>Candida albicans</i>. The majority of infections were mediastinitis. Risk factors for ICI included receipt of antibiotics for more than 7 days within 1 month prior to transplant (58.3% vs. 22.9%, <i>p</i> = 0.03), tracheostomy (41.7% vs. 10.4%, <i>p</i> = 0.02), prolonged chest tube placement (13 vs. 9 days, <i>p</i> = 0.02), and temporary MCS (<i>p</i> = 0.042). Patients who developed ICI had increased 90-day all-cause mortality compared to controls (33.3% vs. 4.2%, <i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified several risk factors for ICI following HT. Further research is essential to develop interventions that mitigate these risk factors in this patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058299","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":"Impact of Ex Vivo Lung Perfusion on Inpatient Cost: A Propensity Score-Matched Analysis of the US Nationwide Healthcare Cost and Utilization Project Database","authors":"Victoria Yin,&nbsp;Scott M. Atay,&nbsp;John C. S. Rodman,&nbsp;Sean C. Wightman,&nbsp;Graeme M. Rosenberg,&nbsp;Brooks V. Udelsman,&nbsp;Anthony W. Kim,&nbsp;Takashi Harano","doi":"10.1111/ctr.70096","DOIUrl":"10.1111/ctr.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The goal of this study was to investigate the association between ex vivo lung perfusion (EVLP) use and inpatient hospitalization cost for lung transplantation in a nationwide sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Lung transplantation patients in 2018–2020 Nationwide Readmissions Database (NRD) were grouped based on use of EVLP. The primary outcome was total inpatient hospitalization cost. 1:2 propensity score matching by EVLP status was performed followed by multivariable linear regression to determine the association between inpatient cost and EVLP while adjusting for pre-transplant hospital days, high volume EVLP center status, and propensity score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 3902 lung transplants and 118 (3%) were recipients of EVLP lungs. Among EVLP patients, the median cost was $871 468 (IQR: $608 671–1 274 392), compared to $846 516 (IQR: $531 462–1 439 267, <i>p</i> = 0.871) among the total non-EVLP cohort. After 1:2 propensity score-matched cohort, recipients of EVLP lungs had longer median hospital length of stay (<i>p</i> = 0.046). In the multivariable model using the matched sample, increased cost was not associated with EVLP use (<i>p</i> = 0.783); however, high volume EVLP centers were associated with decreased cost (<i>p</i> = 0.018).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EVLP use was not associated with greater inpatient costs and may be favorable at high volume centers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058295","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":"Advancement of Heart Transplantation in Thai Recipients: Survival Trends and Pharmacogenetic Insights","authors":"Siwaporn Manomaisantiphap,&nbsp;Pasawat Boon-yasidhi,&nbsp;Napatsanan Tanathitiphuwarat,&nbsp;Kanokwan Thammanatsakul,&nbsp;Sarinya Puwanant,&nbsp;Akekarach Ariyachaipanich,&nbsp;Supanee Sinphurmsukskul,&nbsp;Monvasi Pachinburavan,&nbsp;Pajaree Chariyavilaskul,&nbsp;Sarawut Siwamogsatham,&nbsp;Pat Ongcharit","doi":"10.1111/ctr.70092","DOIUrl":"10.1111/ctr.70092","url":null,"abstract":"<div>\u0000 \u0000 <p>Since 1987, King Chulalongkorn Memorial Hospital (KCMH) has performed a substantial number of heart transplants as a specific therapy for advanced-stage heart failure. This descriptive study aimed to analyze post-transplant survival in the recent era compared to earlier periods and examine the pharmacogenetics of related immunosuppressants. Data from all recipients who underwent heart transplants from 1987 to 2021 were retrospectively retrieved from the electronic medical record. The genotypes of relevant pharmacogenes were analyzed in recipients who were alive during the enrollment period. Kaplan–Meier analysis revealed improved overall survival rates in the recent era compared to the past. Dilated cardiomyopathy was identified as the most common pretransplant diagnosis, while infection remained the leading cause of mortality. In conclusion, the findings demonstrate significant advancements in the quality of heart transplantation in Thailand. Future studies are warranted to explore the correlation between pharmacogenetic variations identified in this study and subsequent clinical outcomes, with a focus on genetic-guided treatment to optimize patient care.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058328","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":"Long Term Outcomes of Transplant Recipients Comparing Belatacept vs. Tacrolimus: A UNOS Database Analysis","authors":"Stalin Canizares,&nbsp;Adriana Montalvan,&nbsp;Devin Eckhoff,&nbsp;Kalathil K. Sureshkumar,&nbsp;Bhavna Chopra","doi":"10.1111/ctr.70075","DOIUrl":"10.1111/ctr.70075","url":null,"abstract":"<div>\u0000 \u0000 <p>Calcineurin inhibitors have been the choice for maintenance immunosuppression (IS) in kidney transplant recipients (KTR), but they are associated with nephrotoxicity and metabolic side effects. We aim to compare the long-term outcomes of KTR on belatacept (bela) versus tacrolimus (tac) IS, in all KTRs and various subgroups. Using the UNOS-STAR files, we identified adult first-KTR from 2010 to 2022. Patients were categorized based on maintenance-IS at index transplant admission by creating a propensity score matched cohort at 1:5 rate using several clinical characteristics. Primary outcomes included patient death, graft failure (GF), and death-censored graft failure (DCGF). Secondary outcomes included delayed graft function (DGF), acute-rejections (AR) within a year, and serum creatinine (Cr) at 1-year. The propensity-matched cohort included KTRs on bela (<i>N</i> = 2612) and tac (<i>N</i> = 12760). There was no significant difference in the hazard ratio of death (1.03 [0.92, 1.14]), GF (1.07 [0.97, 1.17]), or DCGF (1.11 [0.98, 1.25]). A sensitivity analysis comparing a propensity-matched cohort of bela + tac (<i>n</i> = 2033) versus tac (<i>n</i> = 9004); demonstrated significantly reduced risks of death (0.87 [0.76–1.00], <i>p</i> = 0.043) and GF (0.73 [0.64–0.83] <i>p</i> &lt; 0.001) compared to those on Tac alone. In conclusion, bela + tac seems to be a nephron-sparing and rejection-lowering IS regimen with overall improved graft and patient outcomes when compared to the current standard of tacrolimus. Larger Randomized Controlled studies are needed.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045832","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":"Factor V Serves as an Early Biomarker for Graft Loss After Liver Transplant: A Prospective Evaluation","authors":"Annabel K. Gravely,&nbsp;Marco P. A. W. Claasen,&nbsp;Tommy Ivanics,&nbsp;Erin Winter,&nbsp;Peregrina Peralta,&nbsp;Markus Selzner,&nbsp;Gonzalo Sapisochin","doi":"10.1111/ctr.70086","DOIUrl":"10.1111/ctr.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low post-operative day (POD) 1 Factor V has been retrospectively associated with graft loss after liver transplantation when stratified by a cutoff of 0.36 U/mL. We aimed to validate this prospectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients transplanted at Toronto General Hospital were recruited (May 2018–March 2021). Factor V measurements were obtained on POD1-3, 5, and 7. Graft and patient survival at 3, 6, and 12 months were primary and secondary outcomes, respectively. We identified an optimal cutoff through receiver operating characteristic (ROC) analysis and the Youden index. Kaplan–Meier method and Log-rank tests were used to assess/compare survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and twenty-nine patients were included. One hundred and eight had Factor V &gt;0.36 and 21 had ≤0.36 U/mL. This cutoff was predictive of 6- and 12-month graft survival and 12-month patient survival. With an optimal cutoff of 0.46 U/mL on POD1, 87 patients had Factor V &gt;0.46 and 42 had ≤0.46 U/mL. Three-, 6-, and 12-month graft survival rates were 100%, 98.8%, and 98.8%, for patients with Factor V &gt;0.46 U/mL, and 92.9%, 87.7%, and 87.7% for Factor V ≤0.46 U/mL. Similarly, 3-, 6-, and 12-month patient survival rates were 98.8%, 96.4%, and 95.0% for patients with Factor V &gt;0.46 U/mL, and 92.9%, 88.0%, and 82.9% for Factor V ≤0.46 U/mL. Stratification below the novel cutoff was associated with decreased graft survival at months 3 (<i>p</i> = 0.012), 6 (<i>p</i> = 0.006), and 12 (<i>p</i> = 0.006), and decreased patient survival at 12 months (<i>p</i> = 0.022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Factor V serves as an early biomarker for graft loss, with an optimal predictive cutoff of 0.46 U/mL in this prospective population. Validation of this new cutoff is necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051937","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}