Progress in Transplantation最新文献

{"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":"<p><p><b>Introduction:</b> The impact of each immunosuppressive agent on de novo donor-specific antibodies in kidney transplant recipients varies among extant literature. <b>Project aims:</b> Patterns in immunosuppression and the effects on incidence of de novo donor-specific antibodies were evaluated. <b>Design:</b> 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. <b>Results:</b> 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, <i>P</i> < .01). There was no difference in time on goal antiproliferative doses, but higher steroid doses (0.4 vs 0.3 mg/kg/d; <i>P</i> = .02) were noted in patients with antibodies. Steroid dosing was likely impacted by baseline risk factors. <b>Conclusion:</b> 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.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":" ","pages":"335-340"},"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}

{"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":"<p><p>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.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":" ","pages":"363-371"},"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}

{"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":"<p><p><b>Introduction:</b> 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. <b>Research Questions:</b> 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? <b>Design:</b> 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. <b>Results:</b> 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%, <i>P</i> < 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%, <i>P</i> = 0.002), but study arm assignments were not otherwise associated with differences in contact or authorization rates. <b>Conclusion:</b> 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.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":" ","pages":"15269248231212922"},"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}

{"title":"Inferior Vena Cava Thrombectomy and Stenting as Bridge to Liver Transplantation After Radiotherapy-Induced Thrombosis.","authors":"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","doi":"10.1177/15269248231212914","DOIUrl":"https://doi.org/10.1177/15269248231212914","url":null,"abstract":"","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":" ","pages":"15269248231212914"},"PeriodicalIF":0.8,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71522476","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":"A Rapid Scoping Review of the Dual Advocacy Model for Donation Conversations.","authors":"Diana C Litsas,&nbsp;Patricia A Mulvania,&nbsp;Stephanie Roth,&nbsp;Laura A Siminoff","doi":"10.1177/15269248231189866","DOIUrl":"10.1177/15269248231189866","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Twenty-two articles were identified that tested at least one component of dual advocacy. The most commonly tested component was effective communication about donation (<i>N</i> = 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 (<i>N</i> = 9) had overall positive results while studies that tested a single component had mixed results.</p><p><strong>Discussion: </strong>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.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 3","pages":"247-255"},"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}

{"title":"Safety and Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Solid Organ Transplant Recipients.","authors":"Helen Sweiss,&nbsp;Leah Selznick,&nbsp;Jillian Contreras,&nbsp;Christina Long,&nbsp;Reed Hall,&nbsp;Suverta Bhayana,&nbsp;Rupal Patel,&nbsp;Kelsey Klein","doi":"10.1177/15269248231189880","DOIUrl":"10.1177/15269248231189880","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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. <b>Conclusion:</b> 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.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 3","pages":"261-265"},"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}

{"title":"A Case Study of a Transplant Candidate With Stress-Induced Takotsubo Cardiomyopathy.","authors":"Haley Hoy, Nilsa M Black, Anil J Trindade","doi":"10.1177/15269248231189871","DOIUrl":"10.1177/15269248231189871","url":null,"abstract":"","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 3","pages":"266-267"},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10710735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10134331","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":"Pancreatic Exocrine Secretion and Weight Gain After Pancreas Transplantation.","authors":"Amanda Van Jacobs,&nbsp;Michael D Williams,&nbsp;Oliver G Ralph,&nbsp;Adan Z Becerra,&nbsp;Edie Y Chan,&nbsp;Oyedolamu Olaitan","doi":"10.1177/15269248231189877","DOIUrl":"10.1177/15269248231189877","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Aims and hypothesis: </strong>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.</p><p><strong>Design: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 3","pages":"236-241"},"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}

{"title":"Developing a Healthy Lifestyle Program for Recent Kidney Transplant Recipients.","authors":"Cheryl A Gibson,&nbsp;Aditi Gupta,&nbsp;Abhijit Naik,&nbsp;Debra K Sullivan,&nbsp;Mona Doshi,&nbsp;Jim Backes,&nbsp;Susan Harvey,&nbsp;Jaehoon Lee,&nbsp;Rebecca Mount,&nbsp;Heather Valentine,&nbsp;Kelly Shaffer","doi":"10.1177/15269248231189878","DOIUrl":"10.1177/15269248231189878","url":null,"abstract":"<p><strong>Introduction: </strong>Many kidney transplant recipients experience weight gain in the first year after transplantation.</p><p><strong>Research question: </strong>The objective of this research study was to assess the desires of recent kidney transplant patients about the design features of a healthy lifestyle program to counter unnecessary weight gain.</p><p><strong>Design: </strong>In this descriptive study, recent recipients at 2 transplant centers were invited to participate in an online survey. Survey items included sociodemographic information, current medications, health conditions, weight change posttransplant, diet behaviors, physical activity participation, and desired features of a lifestyle program.</p><p><strong>Results: </strong>Fifty-three participants, mean age 60.5 (11.2) years, primarily males, completed surveys. Forty percent gained weight posttransplantation with many indicating struggling with their diet. Physical activity levels stayed the same (17%) or decreased (40%) posttransplantation. Eighty-seven percent of participants indicated they would participate in an online lifestyle program and 76% wanted online physical activity and nutrition sessions to meet at least once weekly. Suggestions about the type of information and activities, included eating strategies (eg, how to eat healthfully at restaurants, grocery shopping tips, and recipes), resources for at-home physical activities, access to cooking classes, and apps to track both activity and food intake.</p><p><strong>Conclusion: </strong>Recent kidney transplant recipients would benefit from and desired to join a lifestyle program featuring tailored nutrition education and physical activity coaching. Gathered information will be used to inform and tailor a lifestyle program. Identifying features for the prevention of unnecessary weight gain with patients' input is essential for promoting and sustaining healthy behaviors.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 3","pages":"193-200"},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10069166","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":"A Description of Resource Utilization and Costs in Acute on Chronic Liver Failure.","authors":"Pei Xue,&nbsp;Erin Zisman,&nbsp;Preet Patel,&nbsp;Neha Jakhete,&nbsp;Sasan Sakiani,&nbsp;T Joseph Mattingly,&nbsp;Kirti Shetty","doi":"10.1177/15269248231189876","DOIUrl":"10.1177/15269248231189876","url":null,"abstract":"Liver transplantation offers a life-saving option for those with liver cirrhosis, but it is associated with signi fi cant healthcare costs with some","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 3","pages":"272-274"},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10134327","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}