American Journal of Transplantation最新文献_第6页

Racial disparities across multiple stages of the deceased organ donation process 已故器官捐献过程多个阶段的种族差异。

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2023.12.024

{"title":"Racial disparities across multiple stages of the deceased organ donation process","authors":"","doi":"10.1016/j.ajt.2023.12.024","DOIUrl":"10.1016/j.ajt.2023.12.024","url":null,"abstract":"<div><div>Pervasive structural violence causes higher organ failure rates among Black Americans and excess Black potential deceased organ donors. Underuse of Black donors would exacerbate organ shortages that disproportionately harm Black transplant candidates. This study investigates racial differences in transit between distinct donation steps among 132 968 potential donors across 557 hospitals and 6 Organ Procurement<span> Organizations (OPOs) from 2015 through 2021. Multilevel multistate modeling with patient covariates and OPO random effects shows adjusted likelihoods (95% confidence interval [CI]) of non-Black versus Black patients transitioning from OPO referral to approach: odds ratio (OR) 1.23 (95% CI 1.18, 1.27), approach to authorization: OR 1.64 (95% CI 1.56, 1.72), authorization to procurement: OR 1.08 (95% CI 1.02, 1.14), and procurement to transplant: OR 0.99 (95% CI 0.93, 1.04). Overall organ utilization rates for Black, Latino, White, and other OPO referrals were 5.88%, 8.17%, 6.78%, and 5.24%, respectively. Adjusting for patient covariates and hospital and OPO random effects, multilevel logistic models estimated that compared with Black patients, Latino, White, and other patients had ORs of organ utilization of 1.82 (95% CI 1.61, 2.04), 3.19 (95% CI 2.91, 3.50), and 1.25 (95% CI 1.06, 1.47), respectively. Nationwide in 2022, donor conversion disparities likely lost more than 1800 donors—70% of whom would have been Black. Achieving racial equity for transplant candidates will require reducing racial disparities in organ donation.</span></div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"24 11","pages":"Pages 2034-2044"},"PeriodicalIF":8.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139424358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intraoperative blood pressure management during kidney transplantation: Grafts under pressure 肾移植手术中的术中血压管理：压力下的移植物。

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.06.017

引用次数: 0

Corrigendum to ‘A novel scoring system to predict short-term mortality after living donor liver transplantation for acute liver failure’ [American Journal of Transplantation 24 (2024): 1857–1867] 预测急性肝功能衰竭活体肝移植术后短期死亡率的新型评分系统 "的更正，《美国移植杂志》，2024 年 4 月 29 日在线出版，校正稿。

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.08.001

Keita Shimata , Young-In Yoon , Taizo Hibi , Jun Morinaga , Anila Kutty Narayanan , Takeo Toshima , Takashi Ito , Nobuhisa Akamatsu , Yoshihito Kotera , Suk Kyun Hong , Yasushi Hasegawa , Yuzo Umeda , Mettu Srinivas Reddy , Aldwin De Leon Ong , Saraswathy Sivaprasadan , Joy Varghese , Yasuhiko Sugawara , Chao-Long Chen , Nobuaki Nakayama , Satoshi Mochida , Sung-Gyu Lee

引用次数: 0

Robotic living donor hepatectomy is associated with superior outcomes for both the donor and the recipient compared with laparoscopic or open - A single-center prospective registry study of 3448 cases 与腹腔镜或开腹手术相比，机器人活体肝切除术对供体和受体都有更好的疗效 - 一项对 3,448 例病例进行的单中心前瞻性登记研究。

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.04.020

{"title":"Robotic living donor hepatectomy is associated with superior outcomes for both the donor and the recipient compared with laparoscopic or open - A single-center prospective registry study of 3448 cases","authors":"","doi":"10.1016/j.ajt.2024.04.020","DOIUrl":"10.1016/j.ajt.2024.04.020","url":null,"abstract":"<div><div><span><span>Minimally invasive donor hepatectomy is an emerging surgical technique in living donor </span>liver transplantation (LDLT). We examined outcomes across open, laparoscopic, and robotic LDLT using a prospective registry. We analyzed 3448 cases (1724 donor-recipient pairs) from January 2011 to March 2023 (NCT06062706). Among donors, 520 (30%) were female. Adult-to-adult LDLT comprised 1061 (62%) cases. A total of 646 (37%) of the donors underwent open, 165 (10%) laparoscopic, and 913 (53%) robotic hepatectomies. Primary outcomes: donor overall morbidity was 4% (35/903) for robotic, 8% (13/165) laparoscopic, and 16% (106/646) open (</span><em>P</em><span> < .001) procedures. Pediatric and adult recipient mortality was similar among the 3 donor hepatectomy approaches: robotic 1.5% and 7.0%, compared with 2.3% and 8.3% laparoscopic, and 1.6% and 5.5% for open donor surgery, respectively (</span><em>P =</em> .802, <em>P =</em><span> .564). Secondary outcomes: pediatric and adult recipients major morbidity after robotic hepatectomy was 15% and 23%, compared with 25% and 44% for laparoscopic surgery and 19% and 31% for open surgery, respectively (</span><em>P =</em> .033, <em>P <</em><span> .001). Graft and recipient 5-year survival were 90% and 93% for pediatrics and 79% and 80% for adults, respectively. In conclusion, robotic LDLT was associated with superior outcomes when compared with the laparoscopic and open approaches. Both donors and, for the first time reported, recipients benefitted from lower morbidity rates in robotic surgery, emphasizing its potential for further advancing this field.</span></div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"24 11","pages":"Pages 2080-2091"},"PeriodicalIF":8.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Invasive aspergillosis in liver transplant recipients in the current era 当今时代肝移植受者的侵袭性曲霉菌病

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.05.016

{"title":"Invasive aspergillosis in liver transplant recipients in the current era","authors":"","doi":"10.1016/j.ajt.2024.05.016","DOIUrl":"10.1016/j.ajt.2024.05.016","url":null,"abstract":"<div><div>Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multicenter 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in 8 cases (13%). Twelve-week all-cause mortality of IA was 37%. In multivariate analyses, systemic antibiotic usage (adjusted odds ratio [aOR], 4.74; <em>P</em> = .03) and history of pneumonia (aOR, 48.7; <em>P</em> = .01) were identified as independent risk factors associated with the occurrence of IA. Moreover, reoperation (aOR, 5.99; <em>P</em> = .01), systemic antibiotic usage (aOR, 5.03; <em>P</em> = .04), and antimold prophylaxis (aOR, 11.9; <em>P</em> = .02) were identified as independent risk factors associated with the occurrence of early IA. Among IA cases, <em>Aspergillus</em> colonization (adjusted hazard ratio [aHR], 86.9; <em>P</em> < .001), intensive care unit stay (aHR, 3.67; <em>P</em> = .02), disseminated IA (aHR, 8.98; <em>P</em> < .001), and dialysis (aHR, 2.93; <em>P</em> = .001) were identified as independent risk factors associated with 12-week all-cause mortality, while recent receipt of tacrolimus (aHR, 0.11; <em>P</em> = .001) was protective. Mortality among LiTRs with IA remains high in the current era. The identified risk factors and protective factors may be useful for establishing robust targeted antimold prophylactic and appropriate treatment strategies against IA.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"24 11","pages":"Pages 2092-2107"},"PeriodicalIF":8.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development of an improved Scientific Registry of Transplant Recipients deceased donor heart yield model using donor critical care data from the Donor Management Goal Registry cohort 利用捐献者管理目标登记队列中的捐献者危重症护理数据，开发改进的移植受者科学登记处已故捐献者心脏产量模型。

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.07.001

Elizabeth A. Swanson , Shaina Kian , Samantha Noreen , Gaya Shivega , Virginia McBride , Paul Lange , Mitchell B. Sally , Darren J. Malinoski

{"title":"Development of an improved Scientific Registry of Transplant Recipients deceased donor heart yield model using donor critical care data from the Donor Management Goal Registry cohort","authors":"Elizabeth A. Swanson , Shaina Kian , Samantha Noreen , Gaya Shivega , Virginia McBride , Paul Lange , Mitchell B. Sally , Darren J. Malinoski","doi":"10.1016/j.ajt.2024.07.001","DOIUrl":"10.1016/j.ajt.2024.07.001","url":null,"abstract":"<div><div>Organ procurement organizations (OPOs) face increasing regulatory scrutiny, and the performance of predictive models used to assess OPO performance is critical. We sought to determine whether adding deceased donor physiological and critical care data to the existing Scientific Registry of Transplant Recipients (SRTR) heart yield model would improve the model’s performance. Donor data and heart transplanted (yes/no), the outcome of interest, were obtained from the United Network for Organ Sharing Donor Management Goal (DMG) Registry for 19 141 donors after brain death, from 25 OPOs. The data were split into training and testing portions. Multivariable LASSO regression was used to develop a statistical model incorporating DMG data elements with the existing components of the SRTR model. The DMG + SRTR and SRTR models were applied to the test data to compare the predictive performance of the models. The sensitivity (84%-86%) and specificity (84%-86%) were higher for the DMG + SRTR model compared to the SRTR model (71%-75% and 76%-77%, respectively). For the DMG + SRTR model, the C-statistic was 0.92 to 0.93 compared to 0.80 to 0.81 for the SRTR model. DMG data elements improve the predictive performance of the heart yield model. The addition of DMG data elements to the Organ Procurement and Transplantation Network data collection requirements should be considered.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"24 11","pages":"Pages 2108-2120"},"PeriodicalIF":8.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

From prognostication to therapeutics: Four key questions to accelerate the development of therapeutics for patients with acute-on-chronic liver failure 从诊断到治疗：加速 ACLF 患者治疗药物开发的四个关键问题。

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.06.007

Jennifer C. Lai , S.K. Sarin , Pere Gines

{"title":"From prognostication to therapeutics: Four key questions to accelerate the development of therapeutics for patients with acute-on-chronic liver failure","authors":"Jennifer C. Lai , S.K. Sarin , Pere Gines","doi":"10.1016/j.ajt.2024.06.007","DOIUrl":"10.1016/j.ajt.2024.06.007","url":null,"abstract":"<div><div>Acute-on-chronic liver failure (ACLF) has come a long way as a clinical concept within the hepatology and liver transplant communities. Though the term was proposed in 1995, the first recognition of the entity along with a consensus definition emerged in 2009. Subsequently, the entity has sparked great interest, inspired several consensus conferences, and inspired national societies to form professional ACLF affinity groups (eg, special interest group). Multicenter consortia have been established all over the world to study this condition, including the North American Consortium for the Study of End-Stage Liver Disease, Chronic Liver Failure consortium, Asian Pacific Association for the Study of Liver Diseases ACLF Research Consortium, Chronic Liver disease Evolution And Registry for Events and Decompensation, and the LiverHope Consortium. Collectively, these consortia have enrolled tens of thousands of patients with or at risk for ACLF across dozens of countries and characterized in detail the predictors, pathogenesis, and progression of patients with ACLF. Perhaps most importantly, they have produced essential data characterizing the excess morbidity and mortality that patients with ACLF face, making a compelling case for the urgent need for therapeutic strategies for this condition.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"24 11","pages":"Pages 1963-1967"},"PeriodicalIF":8.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141755884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation for genetic disease in kidney transplant candidates: A practice resource. 肾移植候选者遗传病评估：实践资源。

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-10-31 DOI: 10.1016/j.ajt.2024.10.019

Elizabeth G Ames, Prince M Anand, Mir Reza Bekheirnia, Mona D Doshi, Mireille El Ters, Margaret E Freese, Rasheed A Gbadegesin, Lisa M Guay-Woodford, Anuja Java, Daniel Ranch, Nancy M Rodig, Xiangling Wang, Christie P Thomas

{"title":"Evaluation for genetic disease in kidney transplant candidates: A practice resource.","authors":"Elizabeth G Ames, Prince M Anand, Mir Reza Bekheirnia, Mona D Doshi, Mireille El Ters, Margaret E Freese, Rasheed A Gbadegesin, Lisa M Guay-Woodford, Anuja Java, Daniel Ranch, Nancy M Rodig, Xiangling Wang, Christie P Thomas","doi":"10.1016/j.ajt.2024.10.019","DOIUrl":"10.1016/j.ajt.2024.10.019","url":null,"abstract":"<p><p>The increasing availability of clinically approved genetic tests for kidney disease has spurred the growth in the use of these tests in kidney transplant practice. Neither the testing options nor the patient population where this should be deployed has been defined, and its value in kidney transplant evaluation has not been demonstrated. Transplant providers may not always be aware of the limitations of genetic testing and may need guidance on comprehending test results and providing counsel, as many centers do not have easy access to a renal genetic counselor or a clinical geneticist. In this practice resource, a working group of nephrologists, geneticists, and a genetic counselor provide a pragmatic, tailored approach to genetic testing, advocating for its use only where the genetic diagnosis or its exclusion can impact the choices available for transplantation or posttransplant management or the workup of living donor candidates at increased risk for heritable disease.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Blocking donor liver Pannexin 1 channels facilitates mitochondria protection during liver transplantation（3966）. 阻断供体肝脏Pannexin 1通道有利于肝移植过程中的线粒体保护（3966）。

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-10-29 DOI: 10.1016/j.ajt.2024.10.021

Shiquan Xu, Hao Li, Yuxue Gao, Yaohui Wang, Bo Zhu, He Shi, Jie Wang, Xia Wu, Ying Wang, Baojie Shi, Zhaojie Su, Yang Zhang, Zhihai Peng, Xiaoyu Yu

{"title":"Blocking donor liver Pannexin 1 channels facilitates mitochondria protection during liver transplantation（3966）.","authors":"Shiquan Xu, Hao Li, Yuxue Gao, Yaohui Wang, Bo Zhu, He Shi, Jie Wang, Xia Wu, Ying Wang, Baojie Shi, Zhaojie Su, Yang Zhang, Zhihai Peng, Xiaoyu Yu","doi":"10.1016/j.ajt.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.ajt.2024.10.021","url":null,"abstract":"<p><p>Static cold storage (SCS) is the standard technique for organ preservation during transplantation, resulting in cold ischemic injury. Hypoxia can induce Panx1 channels open, leading to release of ATP. However, it is unknown whether Panx1 play a role in SCS. Our research demonstrates that livers from Panx1<sup>-/-</sup> mice exhibited reduced ATP release, resulting in protected hepatocytes during preservation. The donor liver damage is decreased during SCS with blocking Panx1. Transmission electron microscopy revealed a decreased mitochondria-associated ER membranes (MAMs) and an improved mitochondria morphology. Mechanistically, Panx1 blockade upregulated the PI3K-AKT pathway and increased Bcl2 level to combat apoptosis during liver preservation. The data indicate that blocking Panx1 during preservation of the donor liver can effectively improve mitochondrial function, reducing cellular stress damage. Then cold ischemia and reperfusion-related injuries are obviously decreased in liver transplantation.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Navigating challenges in recipient selection for end-chain kidneys. 个人观点：驾驭终末链肾受体选择的挑战。

IF 8.9 2区医学

American Journal of Transplantation Pub Date : 2024-10-28 DOI: 10.1016/j.ajt.2024.10.018

Neetika Garg, Carrie Thiessen, Jacqueline Garonzik-Wang, Joshua Mezrich, Didier A Mandelbrot

{"title":"Navigating challenges in recipient selection for end-chain kidneys.","authors":"Neetika Garg, Carrie Thiessen, Jacqueline Garonzik-Wang, Joshua Mezrich, Didier A Mandelbrot","doi":"10.1016/j.ajt.2024.10.018","DOIUrl":"10.1016/j.ajt.2024.10.018","url":null,"abstract":"<p><p>As a result of the increasing number of transplants being facilitated by kidney paired donation and newer initiatives such as voucher donation, end-chain (EC) kidneys now constitute a considerable proportion of kidney paired donation transplants in the United States. Data on EC kidneys are limited. They may be lower in quality compared with non-EC living donor kidneys. However, they can provide unique opportunities for recipient candidates without living donors. There are no data or algorithms available to guide recipient selection for EC kidneys accepted by a transplant center. Considering the ethical principles of utility, justice, and respect for persons that underlie organ allocation, we discuss 3 potential approaches for recipient selection: (1) adherence to the kidney allocation system, (2) utility maximization; and (3) priority to high-risk candidates, along with examples from our own center's experience. Similar considerations are also relevant to selection of recipients for nondirected donor organs and to out-of-sequence allocation for deceased organ donors. Because EC kidneys represent an increasing proportion of kidney paired donation-facilitated living kidney donor transplantation in the United States and will likely get more medically and surgically complex over time, ongoing research on their utilization and outcomes is needed.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0