Progress in Transplantation最新文献_第4页

Impact of Renal Replacement Therapy on Rejection among Liver Transplant Recipients. 肾替代治疗对肝移植受者排斥反应的影响。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-12-01 Epub Date: 2023-11-19 DOI: 10.1177/15269248231212915

Sara Farghaly, Tracy Sparkes, Brian Masters, Abdolreza Haririan, Neha Jakhete, Daniel Maluf, Rolf N Barth, Sari Freedman

{"title":"Impact of Renal Replacement Therapy on Rejection among Liver Transplant Recipients.","authors":"Sara Farghaly, Tracy Sparkes, Brian Masters, Abdolreza Haririan, Neha Jakhete, Daniel Maluf, Rolf N Barth, Sari Freedman","doi":"10.1177/15269248231212915","DOIUrl":"10.1177/15269248231212915","url":null,"abstract":"Introduction: Renal dysfunction in liver transplant recipients is associated with an increased risk of morbidity and mortality, with an even higher risk among patients requiring renal replacement therapy. There is limited data evaluating rejection outcomes in patients requiring renal replacement therapy after liver transplant. Program evaluation aims: To evaluate the incidence of biopsy-proven acute rejection, recipient and graft survival, infection, renal dysfunction, and immunosuppression practices. Design: This was a single-center, retrospective, cohort study. To be eligible, patients were deceased donor liver transplant recipients ≥18 year of age transplanted between January 2017 and August 2019 who received steroid-only induction and tacrolimus as part of their initial immunosuppression regimen. Results: Recipients that required renal replacement therapy (N = 86) were compared to those who received no renal replacement therapy (N = 158). Biopsy-proven acute rejection at 1-year posttransplant was significantly higher among those requiring renal replacement therapy (36% vs 13%, P < .001). Patient survival at 12 months was 77% for those requiring renal replacement therapy and 94% for those not requiring renal replacement therapy (P < .001). Infection (HR 3.8, 95% CI 1.6-8.8; P < .001), but not rejection (HR 0.7, 95% CI 0.3-1.7; P = .5) was an independent predictor of mortality. The use of renal replacement therapy after liver transplant necessitated careful titration of immunosuppression to balance the detrimental risks of infection versus rejection in this high-risk population.","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138047821","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}

引用次数: 0

Deceased Organ Donor Management and Organ Distribution From Organ Procurement Organization-Based Recovery Facilities Versus Acute-Care Hospitals. 基于器官采购组织的康复机构与急性护理医院的已故器官捐献者管理和器官分配。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-12-01 Epub Date: 2023-11-09 DOI: 10.1177/15269248231212918

Emily A Vail, Douglas E Schaubel, Vishnu S Potluri, Peter L Abt, Niels D Martin, Peter P Reese, Mark D Neuman

{"title":"Deceased Organ Donor Management and Organ Distribution From Organ Procurement Organization-Based Recovery Facilities Versus Acute-Care Hospitals.","authors":"Emily A Vail, Douglas E Schaubel, Vishnu S Potluri, Peter L Abt, Niels D Martin, Peter P Reese, Mark D Neuman","doi":"10.1177/15269248231212918","DOIUrl":"10.1177/15269248231212918","url":null,"abstract":"Introduction: Organ recovery facilities address the logistical challenges of hospital-based deceased organ donor management. While more organs are transplanted from donors in facilities, differences in donor management and donation processes are not fully characterized. Research Question: Does deceased donor management and organ transport distance differ between organ procurement organization (OPO)-based recovery facilities versus hospitals? Design: Retrospective analysis of Organ Procurement and Transplant Network data, including adults after brain death in 10 procurement regions (April 2017-June 2021). The primary outcomes were ischemic times of transplanted hearts, kidneys, livers, and lungs. Secondary outcomes included transport distances (between the facility or hospital and the transplant program) for each transplanted organ. Results: Among 5010 deceased donors, 51.7% underwent recovery in an OPO-based recovery facility. After adjustment for recipient and system factors, mean differences in ischemic times of any transplanted organ were not significantly different between donors in facilities and hospitals. Transplanted hearts recovered from donors in facilities were transported further than hearts from hospital donors (median 255 mi [IQR 27, 475] versus 174 [IQR 42, 365], P = .002); transport distances for livers and kidneys were significantly shorter (P < .001 for both). Conclusion: Organ recovery procedures performed in OPO-based recovery facilities were not associated with differences in ischemic times in transplanted organs from organs recovered in hospitals, but differences in organ transport distances exist. Further work is needed to determine whether other observed differences in donor management and organ distribution meaningfully impact donation and transplantation outcomes.","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10691289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71522475","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}

引用次数: 0

Subtle Changes in Tacrolimus Levels Have an Impact on Early Donor-Specific Antibodies in Kidney Transplantation. 他克莫司水平的细微变化对肾移植早期供体特异性抗体有影响。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-12-01 Epub Date: 2023-11-09 DOI: 10.1177/15269248231212923

Megan Henderson, Linda Awdishu, Gerald P Morris, Kassandra Fabbri, Mita Shah, Adnan Khan, Janice Kerr

{"title":"Subtle Changes in Tacrolimus Levels Have an Impact on Early Donor-Specific Antibodies in Kidney Transplantation.","authors":"Megan Henderson, Linda Awdishu, Gerald P Morris, Kassandra Fabbri, Mita Shah, Adnan Khan, Janice Kerr","doi":"10.1177/15269248231212923","DOIUrl":"10.1177/15269248231212923","url":null,"abstract":"Introduction: The impact of each immunosuppressive agent on de novo donor-specific antibodies in kidney transplant recipients varies among extant literature. Project aims: Patterns in immunosuppression and the effects on incidence of de novo donor-specific antibodies were evaluated. Design: Adult kidney transplant recipients from 2017 to 2019 without preformed antibodies were sampled. Allograft function, de novo donor-specific antibodies, tacrolimus concentrations, duration of goal-dose antiproliferatives, and steroid doses were recorded. Outcomes included incidence of de novo donor-specific antibodies, and their relation to tacrolimus concentrations, time at goal-dose antiproliferatives, and steroid doses. Results: Recipients (N = 153) were followed for 1 year; all were crossmatch negative and received rabbit antithymocyte globulin induction. Sixteen (10%) recipients developed de novo donor-specific antibodies in a median of 31 days [interquartile range, IQR: 12-67 days], most were Class II antibodies (87.5%). Incidence of de novo donor-specific antibodies did not differ based on induction dosing. Tacrolimus levels in the first month were lower for patients with de novo donor-specific antibodies (8.8 ng/mL vs 10.4 ng/mL, P < .01). There was no difference in time on goal antiproliferative doses, but higher steroid doses (0.4 vs 0.3 mg/kg/d; P = .02) were noted in patients with antibodies. Steroid dosing was likely impacted by baseline risk factors. Conclusion: A significant association was found between lower tacrolimus concentrations early post-transplant and incidence of de novo donor-specific antibodies. This highlighted the importance of clinician attention to subtle changes in tacrolimus and the impact it can have on antibody risk in the early post-transplant period.","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71522477","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}

引用次数: 0

Report From a Multidisciplinary Symposium on the Future of Living Kidney Donor Transplantation. 活体肾供体移植未来多学科研讨会报告。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-12-01 Epub Date: 2023-11-15 DOI: 10.1177/15269248231212911

Thomas G Peters, John J Fung, Janet Radcliffe-Richards, Sally Satel, Alvin E Roth, Frank McCormick, Martha Gershun, Arthur J Matas, John P Roberts, Josh Morrison, Glenn M Chertow, Laurie D Lee, Philip J Held, Akinlolu Ojo

{"title":"Report From a Multidisciplinary Symposium on the Future of Living Kidney Donor Transplantation.","authors":"Thomas G Peters, John J Fung, Janet Radcliffe-Richards, Sally Satel, Alvin E Roth, Frank McCormick, Martha Gershun, Arthur J Matas, John P Roberts, Josh Morrison, Glenn M Chertow, Laurie D Lee, Philip J Held, Akinlolu Ojo","doi":"10.1177/15269248231212911","DOIUrl":"10.1177/15269248231212911","url":null,"abstract":"Virtually all clinicians agree that living donor renal transplantation is the optimal treatment for permanent loss of kidney function. Yet, living donor kidney transplantation has not grown in the United States for more than 2 decades. A virtual symposium gathered experts to examine this shortcoming and to stimulate and clarify issues salient to improving living donation. The ethical principles of rewarding kidney donors and the limits of altruism as the exclusive compelling stimulus for donation were emphasized. Concepts that donor incentives could save up to 40 000 lives annually and considerable taxpayer dollars were examined, and survey data confirmed voter support for donor compensation. Objections to rewarding donors were also presented. Living donor kidney exchanges and limited numbers of deceased donor kidneys were reviewed. Discussants found consensus that attempts to increase living donation should include removing artificial barriers in donor evaluation, expansion of living donor chains, affirming the safety of live kidney donation, and assurance that donors incur no expense. If the current legal and practice standards persist, living kidney donation will fail to achieve its true potential to save lives.","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134649573","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}

引用次数: 0

Messaging White and Black Next of Kin in Advance to Promote Authorization for Tissue Donation. 提前向白人和黑人近亲发送信息，以促进组织捐赠授权。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-11-09 DOI: 10.1177/15269248231212922

Laura A Siminoff, Maureen Wilson-Genderson, Sharon M West, Richard D Hasz, Lawrence Suplee, John Clarke, K Laura Barker, Patricia A Mulvania

{"title":"Messaging White and Black Next of Kin in Advance to Promote Authorization for Tissue Donation.","authors":"Laura A Siminoff, Maureen Wilson-Genderson, Sharon M West, Richard D Hasz, Lawrence Suplee, John Clarke, K Laura Barker, Patricia A Mulvania","doi":"10.1177/15269248231212922","DOIUrl":"https://doi.org/10.1177/15269248231212922","url":null,"abstract":"Introduction: Organ Procurement Organizations seek authorization for tissue donation from next-of-kin of deceased patients. Best practices for achieving contact and authorization are unknown, notably, authorization rates are lower for Black compared to White patients. Research Questions: Can next-of-kin (NOK) contact and authorization rates be improved if they are texted prior to telephone contact? Is a text message containing an infographic more effective, and does an infographic culturally tailored to Black families improve contact and authorization rates in the Black population? Design: This three-armed randomized trial compared (1) telephonic contact initiation (control condition); (2) generic text messaging prior to telephonic contact; and (3) text messaging one of two versions of an infographic prior to telephonic contact: (a) a generic infographic or (b) a culturally tailored infographic (sent to Black NOK only) at one Northeastern Organ Procurement Organization. Results: Tissue Donation Professionals (N = 47) and 2399 White and 745 Black NOK were included, of which 35.6% were registered donors. Authorization rates were much higher for White than Black (40.1% v 16.3%, P < 0.0001). The generic infographic resulted in significantly lower rates of contact for White NOK compared to the control condition 83.5% v 89.5%, P = 0.002), but study arm assignments were not otherwise associated with differences in contact or authorization rates. Conclusion: Although the analysis did not find a benefit for text messaging, it is possible that training for staff making requests and refining the content of the messaging could be more effective.","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72015204","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}

引用次数: 0

Inferior Vena Cava Thrombectomy and Stenting as Bridge to Liver Transplantation After Radiotherapy-Induced Thrombosis. 下腔静脉血栓切除术和支架作为肝移植术后放疗诱导血栓形成的桥梁。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-11-09 DOI: 10.1177/15269248231212914

Raphael Ph Meier, Shani Kamberi, Josue Alvarez-Casas, Barton F Lane, Chandra S Bhati, Saad Malik, William Twaddell, Kirti Shetty, Adam Fang, Hyun S Kim, Daniel G Maluf

引用次数: 0

A Rapid Scoping Review of the Dual Advocacy Model for Donation Conversations. 捐赠对话的双重倡导模式的快速范围审查。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-09-01 Epub Date: 2023-08-07 DOI: 10.1177/15269248231189866

Diana C Litsas, Patricia A Mulvania, Stephanie Roth, Laura A Siminoff

{"title":"A Rapid Scoping Review of the Dual Advocacy Model for Donation Conversations.","authors":"Diana C Litsas, Patricia A Mulvania, Stephanie Roth, Laura A Siminoff","doi":"10.1177/15269248231189866","DOIUrl":"10.1177/15269248231189866","url":null,"abstract":"Introduction: Increasing family authorization for donation is critical to address the shortage of organs for transplantation, yet there is no standardized method for leading conversations with families about donation.Objective: The aim of this rapid scoping review is to identify research assessing the components of dual advocacy, a model to discuss organ donation with grieving families.Methods: PubMed, Web of Science, and grey literature were searched for studies published from 2012 to the present. Data representing the various dual advocacy components that were empirically tested were extracted. Outcomes of interest were authorization for organ donation or family satisfaction with the donation conversation.Results: Twenty-two articles were identified that tested at least one component of dual advocacy. The most commonly tested component was effective communication about donation (N = 9), including explaining brain death and the donation process. The primary outcome for the majority of studies was donation authorization or conversion rates. Studies that tested all components of dual advocacy (N = 9) had overall positive results while studies that tested a single component had mixed results.Discussion: Although family authorization to donation is critical to addressing the national organ shortage, there has yet to be a standardized method for leading families in the organ donation conversation. Despite the need for organ transplantation in the United States and worldwide, few large-scale studies have rigorously tested the most effective ways to engage families of donor-eligible patients about the organ donation opportunity. There is an urgent need for further research to establish a standard of evidence-based practice.","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10069688","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}

引用次数: 0

Safety and Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Solid Organ Transplant Recipients. 钠-葡萄糖协同转运蛋白-2抑制剂在实体器官移植受者中的安全性和有效性。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.1177/15269248231189880

Helen Sweiss, Leah Selznick, Jillian Contreras, Christina Long, Reed Hall, Suverta Bhayana, Rupal Patel, Kelsey Klein

{"title":"Safety and Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Solid Organ Transplant Recipients.","authors":"Helen Sweiss, Leah Selznick, Jillian Contreras, Christina Long, Reed Hall, Suverta Bhayana, Rupal Patel, Kelsey Klein","doi":"10.1177/15269248231189880","DOIUrl":"10.1177/15269248231189880","url":null,"abstract":"Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) may be effective in reducing body weight and hemoglobin A1c (HbA1c) post-kidney transplantation. Limited literature exists on use of these agents outside of kidney transplant. The purpose of this program evaluation was to evaluate the safety and efficacy of SGLT2i in kidney, liver, and lung transplant recipients. Methods: This was a retrospective program evaluation of adult kidney, liver, and lung transplant recipients between August 31, 2016 and July 31, 2021. Patients initiated on SGLT2i for diabetes for a minimum of 90 days with at least 1 follow-up appointment were screened for inclusion. Outcomes were compared between SGLT2i initiation to nadir values 3-12-months post-initiation. Outcomes included change in hemoglobin A1c, fasting blood glucose, actual body weight, and body mass index. Safety outcomes included adverse effects, cardiovascular events, death-censored graft loss, and all-cause mortality. Results: Forty-nine patients met inclusion criteria, (26 liver, 18 kidney, 4 lung, and 1 simultaneous liver-kidney recipient). The median time from transplant to SGLT2i initiation was 1216 days (IQR 524-2256). Glycemic and weight loss outcomes showed a statistically significant benefit from SGLT2i use. Total safety outcome incidence was minimal at 12 months. No patient experienced myocardial infarctions, graft loss, or mortality at 3-12 months. One incidence of urinary tract infection and stroke occurred each. The most common adverse effects included hypotension and hypoglycemia. Conclusion: This program evaluation demonstrated that SGLT2i can be used safely in solid organ transplant recipients. These agents can provide an additional non-insulin agent for post-transplant diabetes mellitus management in solid organ transplant.","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10126017","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}

引用次数: 0

A Case Study of a Transplant Candidate With Stress-Induced Takotsubo Cardiomyopathy. 一例移植候选者应激性Takotsubo心肌病的病例研究。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.1177/15269248231189871

Haley Hoy, Nilsa M Black, Anil J Trindade

引用次数: 0

Pancreatic Exocrine Secretion and Weight Gain After Pancreas Transplantation. 胰腺移植后胰腺外分泌与体重增加。

IF 0.8 4区医学

Progress in Transplantation Pub Date : 2023-09-01 Epub Date: 2023-07-30 DOI: 10.1177/15269248231189877

Amanda Van Jacobs, Michael D Williams, Oliver G Ralph, Adan Z Becerra, Edie Y Chan, Oyedolamu Olaitan

{"title":"Pancreatic Exocrine Secretion and Weight Gain After Pancreas Transplantation.","authors":"Amanda Van Jacobs, Michael D Williams, Oliver G Ralph, Adan Z Becerra, Edie Y Chan, Oyedolamu Olaitan","doi":"10.1177/15269248231189877","DOIUrl":"10.1177/15269248231189877","url":null,"abstract":"Introduction: Weight gain after pancreas transplant is a poorly understood phenomenon thought to be related to increased posttransplant insulin production, immunosuppressive medications, and appetite changes. No study has investigated the effect of increased exocrine secretion posttransplant.Aims and hypothesis: We hypothesized that exocrine function, measured by fecal elastase-1 (FE-1), was normal posttransplant and not correlated with weight gain. Our primary aim was to investigate changes in FE-1 levels with pancreas transplantation and to correlate this with weight gain. Establishing weight trends and identifying additional correlating factors were secondary aims.Design: Forty-two patients that underwent simultaneous pancreas and kidney or pancreas after kidney transplant at a single center between 2013 and 2021 were included. Fecal elastase was measured prospectively in each patient at a single time point, with >500 µg/g categorized as high. Weight and C-peptide values were obtained. All the patients were on steroid-free immunosuppression.Results: Nineteen patients (45%) had fecal elastase levels >500 µg/g, with a maximum of 3910 µg/g; 43% had levels greater than twice the upper limit of normal. The biggest increase in weight occurred between years 1 and 2, which continued to a median weight gain of 14% at 3 years. There was no correlation between weight gain and FE-1, pretransplant C-peptide levels, or duration of diabetes.Conclusion: This study demonstrated supranormal fecal elastase levels and weight gain posttransplant; however, there was no correlation. Future study with serial FE-1 before and after transplant is needed to better assess its correlation with weight gain.","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10082429","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}

引用次数: 0