Clinical Transplantation最新文献

{"title":"Increased Infectious Risk Donor Status and Equity-Relevant Predictors of Organ Donation Organization Approach and Caregiver Consent for Deceased Organ Donation in a Canadian Province (2015–2021)","authors":"Murdoch Leeies,&nbsp;Karen Doucette,&nbsp;Brenden Dufault,&nbsp;Tricia Carta,&nbsp;Owen Mooney,&nbsp;Carmen Hrymak,&nbsp;Nicolette Balzer,&nbsp;Ben Borys,&nbsp;Yasmine El-Salakawy,&nbsp;Mirna Ragheb,&nbsp;Davie Xie,&nbsp;Emily Christie,&nbsp;David Collister,&nbsp;Matthew J. Weiss,&nbsp;Sonny Dhanani,&nbsp;Julie Ho","doi":"10.1111/ctr.70058","DOIUrl":"https://doi.org/10.1111/ctr.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Current donor risk assessments to identify risk of infectious transmission through transplantation have been criticized as unnecessarily discriminatory for sexual and gender minorities. Little is known about how increased infectious risk donor (IIRD) patients transition through the deceased donation system. We sought to evaluate how IIRD status and other equity-relevant identities impacted the likelihood of a caregiver of a deceased donor being approached for organ donation and the likelihood of caregiver consent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective, observational cohort study of potential deceased donors referred to a Canadian provincial organ donation organization (ODO) from 2015 to 2021. Our primary outcome is the difference in the likelihood of being approached by the ODO for organ donation for IIRDs compared to baseline risk donors, amongst referred potential deceased organ donors. Secondary outcomes include the difference in caregiver consent for donation for IIRDs compared to baseline risk donors, amongst approached deceased organ donors. We built multivariable logistic regression models to evaluate these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Amongst all referred potential deceased organ donors, IIRD status did not impact the likelihood of being approached by our ODO for deceased organ donation compared to baseline risk donors (OR 1.695, 95% CI 0.902–3.197). Amongst approached deceased organ donors, there was no significant difference in caregiver consent for donation between IIRD and baseline risk donors (OR 1.854, 95% CI 0.902–3.929). Approached eligible IIRDs were younger with fewer comorbidities, lower KDPI scores, were more likely to have died from anoxic brain injuries and have death determined by neurologic criteria, and more likely to have non-medical injection drug use than baseline risk donors. There were no cases of donor-derived human immunodeficiency virus (HIV), hepatitis C virus (HCV), or hepatitis B virus (HBV) reported for any donors included, regardless of IIRD status, during the study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found no significant difference in the likelihood of ODO approach in IIRDs compared to baseline risk donors. There was no difference in caregiver consent for donation in IIRDs compared to baseline risk donors. A greater proportion of IIRDs became successful donors compared to baseline risk donors.</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":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868811","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":"Recovery and Stabilization of Kidney Allograft Function Following Post-Implantation Cholesterol Crystal Embolization","authors":"Subrahmanian Sathiavageesan","doi":"10.1111/ctr.70068","DOIUrl":"https://doi.org/10.1111/ctr.70068","url":null,"abstract":"","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":"142867966","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":"Response to “Postoperative Cognitive Dysfunction in Heart Transplantation Recipients”","authors":"Tao Zheng","doi":"10.1111/ctr.70057","DOIUrl":"10.1111/ctr.70057","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834376","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":"The Use of Long-Term Monthly Basiliximab Infusions as Rescue Maintenance Immunosuppression in Pancreas Transplant Recipients","authors":"Jeanne M. Chen,&nbsp;Richard S. Mangus,&nbsp;Asif A. Sharfuddin,&nbsp;John A. Powelson,&nbsp;Muhammad S. Yaqub,&nbsp;Oluwafisayo O. Adebiyi,&nbsp;Muhammad Y. Jan,&nbsp;Andrew J. Lutz,&nbsp;Jonathan A. Fridell","doi":"10.1111/ctr.70050","DOIUrl":"10.1111/ctr.70050","url":null,"abstract":"<p>This single-center retrospective study was designed to evaluate the use of basiliximab as an alternative rescue maintenance immunosuppression in situations where standard maintenance immunosuppression is not tolerated after a pancreas transplant. All pancreas transplants performed between January 11, 2006, and January 6, 2022, were reviewed. All recipients received rabbit antithymocyte globulin (rATG) induction with tacrolimus + sirolimus maintenance for simultaneous pancreas and kidney (SPK) and additional low-dose mycophenolic acid for pancreas transplant alone (PTA). Basiliximab 40mg IV q 4 weeks was either added to or in replacement of adjunct immunosuppression in cases of medication intolerance. All recipients who received ≥3 months of basiliximab with ≥1 year follow-up were included. 29/557 (5.2%) recipients (5 SPK and 24 PTA) were identified. Median time to switch was 13 months. When compared 1:2 to matched controls on standard immunosuppression, there was no difference in pancreas rejection, allograft loss, or mortality. Eleven recipients had 13 episodes of pancreas rejection at a median of 28 months post conversion. Eight pancreas allografts failed at a median of 28 months post conversion, and there were five deaths—all occurring in PTA, 4/5 occurring ≥1 year after discontinuation of basiliximab. Renal allograft rejection occurred in one SPK and there was one renal allograft loss. Five PTA developed renal failure. Ten remain on basiliximab (2/5 SPK, 8/24 PTA) at a median of 44 months with good pancreas and kidney function; 4 pts &gt; 4 years. Basiliximab can be considered an alternative rescue maintenance strategy in pancreas transplant recipients who failed other conventional agents.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834380","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":"Evaluating Readability and Reliability of Online Information Provided by Pancreas Transplant Centers in the United States","authors":"Vincenzo Villani,&nbsp;Kumaran Shanmugarajah","doi":"10.1111/ctr.70055","DOIUrl":"10.1111/ctr.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The decision of proceeding with a pancreas transplant (PTx) is a complex one, and patient education is important to allow transplant candidates to make an informed and autonomous decision. In this study, we assessed the readability and reliability of online information provided by PTx centers in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Websites of PTx centers active between 2022 and 2023 were searched for patient information on pancreas transplantation. Readability was assessed using eight validated formulas. Reliability was assessed using the Journal of the American Medical Association criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 117 PTx centers, 57 provided online information material. High-volume centers were more likely to provide patient information compared to medium- and low-volume centers (76.6%, 45.6%, 34.6%, respectively). Average readability was at the 11^th grade and beyond, with no difference among the three groups (11.9, 11.4, 11.4). Reliability was low, with two centers providing information on the material sources. Only one center provided information in a language other than English.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Readability of online material on PTx provided by US transplant centers is low, well above the recommended 6^thgrade-level. Transplant centers, national societies and patient advocacy groups should collaborate in developing information material that is evidence-based, easy to read, and available in multiple languages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817484","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":"Bilateral Lung Transplantation in Patients With Severe Chest Asymmetry: A Case Series From a Single Center","authors":"Paolo Mendogni,&nbsp;Alessandro Palleschi,&nbsp;Giacomo Grisorio,&nbsp;Alessandra Mazzucco,&nbsp;Cristina Diotti,&nbsp;Letizia Corinna Morlacchi,&nbsp;Valeria Rosetti,&nbsp;Gianluca Bonitta,&nbsp;Mario Nosotti,&nbsp;Lorenzo Rosso","doi":"10.1111/ctr.70054","DOIUrl":"10.1111/ctr.70054","url":null,"abstract":"<p>Suppurative lung diseases leading to end-stage respiratory failure are typical indications for bilateral lung transplantation (LuTx). Some cases may present severe chest asymmetry because of recurrent infections or previous surgical procedures, and the most used surgical options are single LuTx and contralateral pneumonectomy or bilateral transplantation with graft downsizing. Our purpose is to evaluate our treatment protocols for these patients and review surgical strategies reported by others.</p><p>We prospectively collected clinical data of patients with significant pleural cavity asymmetry who underwent bilateral LuTx at our center from 2017 to 2022. Clinical reports of all patients who underwent LuTx for end-stage suppurative disease in the same period were reviewed as the control group.</p><p>During the study period, 74 patients underwent bilateral LuTx for suppurative disease; seven of them presented with severe thoracic asymmetry, and all of them were extubated by the second postoperative day. The mean intensive care unit stay was 4 days. The postoperative radiological evaluation did not show clustering or atelectasis of the graft implanted in the smaller hemithorax. No perioperative major complications were recorded, and the average length of stay was 23 days. The perioperative course appeared remarkably good, and both the short- and long-term follow-up were similar to that of the control group.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11640198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817470","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":"Influence of Donor Transfusion on Heart Transplantation Outcomes: A United Network for Organ Sharing Registry Analysis","authors":"Sooyun Caroline Tavolacci,&nbsp;Vasiliki Gregory,&nbsp;Kenji Okumura,&nbsp;Ameesh Isath,&nbsp;Junichi Shimamura,&nbsp;David Spielvogel,&nbsp;Suguru Ohira","doi":"10.1111/ctr.70053","DOIUrl":"10.1111/ctr.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is a lack of evidence regarding the impact of donor blood transfusion on heart transplant (HT) outcomes. We sought to elucidate the influence of donor transfusion on HT outcomes using the national database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From January 2004 to March 2023, donor transfusion information was available for 40 538 recipients for HT in the United Network for Organ Sharing (UNOS) database. We used the UNOS 4-level designation of transfusion (no blood [<i>N</i> = 18 575], 1–5 units [<i>N</i> = 14 098], 6–10 units [<i>N</i> = 4766], and massive transfusion of &gt; 10 units [<i>N</i> = 3099]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among this cohort, 53.2% of donors (<i>N</i> = 20 220) received a blood transfusion during the same admission. Donors who required blood transfusion commonly had head trauma as a cause of death (no-blood, 22% vs. 1–5 units, 61%, 6–10 units, 88%, massive, 89%, <i>p</i> &lt; 0.001). An increased amount of donor blood transfusion did not affect rates of acute rejection (no-blood, 18% vs. 1–5 units, 19%, 6–10 units, 17%, massive, 19%, <i>p</i> = 0.13). The number of units transfused also did not affect 1-year survival rates. The Cox hazard model showed no effect of massive transfusion on mortality following transplant (no-blood, reference vs. 1–5 units; HR, 1.02 [<i>p</i> = 0.35], 6–10 units; HR, 1.10 [<i>p</i> = 0.01], massive transfusion; HR 1.04 [<i>p</i> = 0.3]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Massive transfusion in donors was not associated with increased recipient mortality. Additionally, the amount of donor blood transfusion did not affect rejection rates following HT. The present study suggests that a history of donor blood transfusion, as well as the amount of transfusion, should not preclude donor heart utilization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799719","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":"Multicenter, Real-World Clinical Evaluation of Alemtuzumab and Anti-Thymocyte Globulin for Severe Acute T Cell-Mediated Kidney Transplant Rejection","authors":"Lukas K. van Vugt,&nbsp;Erzsi Tegzess,&nbsp;Marieke van der Zwan,&nbsp;Marian C. Clahsen-van Groningen,&nbsp;Brenda C. M. de Winter,&nbsp;Priya Vart,&nbsp;Marlies E. J. Reinders,&nbsp;Jan Stephan F. Sanders,&nbsp;Stefan P. Berger,&nbsp;Dennis A. Hesselink","doi":"10.1111/ctr.70046","DOIUrl":"10.1111/ctr.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Alemtuzumab can be an alternative to rabbit anti-thymocyte globulin (rATG) to treat severe or glucocorticoid-resistant acute T cell-mediated kidney transplant rejection (TCMR). Yet, there are few reports in which these two treatments are evaluated let alone, compared. This study describes the real-world clinical experience of both therapies and compares their efficacy and toxicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Kidney transplant recipients of two Dutch transplant centers who received lymphocyte-depleting antibody therapy for severe or glucocorticoid-resistant TCMR were retrospectively evaluated. In the first, alemtuzumab was the standard treatment for this indication, in the second, it was rATG. Patient survival, graft survival and function, and the occurrence of infections and malignancies were reported and compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and forty-three patients treated with alemtuzumab and 57 patients with rATG were evaluated. Patient survival was not significantly different during follow-up (<i>p</i> = 0.55), and 5-year survival rates were 71.0% (95% confidence interval [CI]: 63.0–79.9) after alemtuzumab and 70.7% (95% CI: 58.3–85.7) after rATG. Graft survival was not significantly different during follow-up either (<i>p</i> = 0.24), and 5-year graft loss rates were 32.3% (95% CI: 24.2–40.5) after alemtuzumab and 29.2% (95% CI: 16.0–42.4) after rATG. The occurrence of infections and malignancies did not differ between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mostly, severe TCMRs have good long-term graft survival and function after either alemtuzumab or rATG therapy. No significant differences between the two therapies were found in this real-world clinical experience. Alemtuzumab is an effective alternative to rATG for the treatment of severe TCMR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11620281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Cold Ischemia Time and Donor Age on Donation After Circulatory Death Kidney Transplant Outcomes: A UNOS Mate-Kidney Analysis","authors":"Gabriel Cojuc-Konigsberg,&nbsp;Belen Rivera,&nbsp;Stalin Cañizares,&nbsp;Martha Pavlakis,&nbsp;Devin Eckhoff,&nbsp;Bhavna Chopra","doi":"10.1111/ctr.70051","DOIUrl":"10.1111/ctr.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The association between prolonged cold ischemia times (CIT), donor age, and outcomes in kidney transplant recipients (KTRs) from donors after circulatory death (DCD) remains uncertain. We aimed to compare allograft outcomes in DCD-donor KTRs according to CIT and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>UNOS database study (2010–2024) of DCD-donor KTRs on tacrolimus maintenance. We developed a mate-kidney analysis, comparing outcomes where one mate kidney had CIT &gt;24 and the other ≤24 h. We evaluated patient death, all-cause allograft failure, and death-censored graft failure (DCGF) using multivariable stratified Cox proportional hazards models. We compared outcomes across age groups (≥50 or &lt;50 years) and 6-h-period CIT deltas between mate kidneys. We assessed delayed graft function (DGF) occurrence with multivariable conditional logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 4092 DCD-donor mate-kidney pairs. There were no differences between CIT &gt;24 versus ≤24 h in patient death (aHR 1.12, 95% CI 0.97–1.30), all-cause allograft failure (aHR 1.10, 95% CI 0.98–1.24), or DCGF (aHR 1.07, 95% CI 0.90–1.27). Similar results were observed when comparing outcomes by age group and 6-h-period CIT deltas between mate kidneys. Compared to shorter CITs, CITs &gt;24 h were associated with increased DGF likelihood (aOR 1.42, 95% CI 1.25–1.60), as were increasing CIT deltas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CITs &gt;24 h in DCD-donor KTRs were not associated with adverse allograft outcomes, irrespective of age group. However, prolonged CITs were associated with increased DGF likelihood. Increasing the acceptance of both mate kidney from DCD donors should be considered despite projected CITs &gt;24 h.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784309","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":"Myosteatosis Is Associated With Frailty and Poor Physical Function in Patients Undergoing Liver Transplant Evaluation: A Cohort Study","authors":"Heidi E. Johnston,&nbsp;Melita Andelkovic,&nbsp;Hannah L. Mayr,&nbsp;Yanyan Chen,&nbsp;Aaron P. Thrift,&nbsp;Graeme A. Macdonald,&nbsp;Ingrid J. Hickman","doi":"10.1111/ctr.70034","DOIUrl":"https://doi.org/10.1111/ctr.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Myosteatosis is fat infiltration within skeletal muscle. The impact of myosteatosis on physical function and clinical outcomes in patients referred for liver transplantation (LT) is unclear. We explored associations between myosteatosis and sarcopenia, frailty, physical function, and pre- and early post-LT outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Myosteatosis was assessed by computed tomography (CT) in 237 patients referred for LT (March 2018 to September 2022). Chi-square/Fishers exact tests and multivariable regression compared myosteatosis and sarcopenia, frailty (liver frailty index), physical function (short physical performance battery, SPPB); and associations with pre-LT unplanned hospitalizations, post-LT surgical complications (Clavien–Dindo grade ≥ 3), and LT admission length of stay (LOS). Kaplan–Meier and Cox-proportional hazards models explored myosteatosis and time to LT and unplanned admission. Fine–Gray model evaluated the competing risks of receiving an LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Myosteatosis was present in 74 (31%) patients. Patients with myosteatosis were 2.5 times (95% confidence interval [CI] 1.1–5.7, <i>p</i> = 0.03) more likely to be frail, and 3.0 times (95% CI 1.6–5.6, <i>p</i> &lt; 0.001) more likely to have a poor physical function (SPPB ≤ 9/12) than those without myosteatosis. Patients with myosteatosis versus those without were more likely to have a pre-LT unplanned hospitalization (51% vs. 36%, <i>p</i> = 0.03), but significance was lost after adjusting for age, sex, Model for End-stage Liver Disease (MELD), and the presence of hepatocellular carcinoma. Myosteatosis did not impact the likelihood of receiving an LT (<i>p</i> = 0.39), post-LT complications (<i>p</i> = 0.93), or LOS in intensive care unit (ICU) (<i>p</i> = 0.66) or hospital (<i>p</i> = 0.34).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Myosteatosis is prevalent in patients referred for LT and is associated with impaired physical function. Using existing CTs to assess myosteatosis in practice may help identify physically compromised patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762355","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}