Progress in Transplantation最新文献

{"title":"Long-term Care of Living Kidney Donors Needs a Better Model of Healthcare Delivery.","authors":"Katya Loban,&nbsp;Jorane-Tiana Robert,&nbsp;Ahsan Alam,&nbsp;Shaifali Sandal","doi":"10.1177/15269248231189879","DOIUrl":"10.1177/15269248231189879","url":null,"abstract":"<p><p>Every year, over 30,000 healthy individuals globally donate a kidney to a patient with kidney failure. These living kidney donors are at higher risk of some medical complications post-donation when compared with matched controls. Although the absolute risk of these complications is low, appropriate long-term care is essential to allow early detection and timely interventions. Some transplant centers follow living donors long-term, but many recommend that donors regularly see a primary care practitioner post-donation. However, primary care is currently not integrated with transplant centers, and the two often work in silos with little to no channels of communication with each other. As this model of care is suboptimal, existing evidence suggests that post-donation care and follow-up are inadequate. We argue for an integrated model of living donor care with stronger continuity and coordination between primary care and transplant centers that are developed with the input of all relevant stakeholders.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 3","pages":"242-246"},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10466930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10128755","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":"Changes in Functional Outcomes After an Inpatient Rehabilitation Program for Solid-Organ Transplant Recipients.","authors":"Matheus de Paiva Azevedo,&nbsp;Patrícia Angelica de Miranda Silva Nogueira,&nbsp;Lorna D'Souza,&nbsp;Betty Cheung,&nbsp;Karen Uy,&nbsp;John Patcai,&nbsp;Sunita Mathur,&nbsp;Tania Janaudis-Ferreira","doi":"10.1177/15269248231189861","DOIUrl":"10.1177/15269248231189861","url":null,"abstract":"<p><p><b>Introduction:</b> Outpatient exercise training has been shown to be beneficial for solid organ transplant recipients. Little is known about the effects of inpatient rehabilitation programs for recipients with a more complicated postoperative course. <b>Research Question:</b> This study was designed to (1) describe the changes in functional outcomes after an inpatient rehabilitation program, and (2) determine whether the changes in lower body strength and quadriceps strength are associated with changes in functional exercise capacity. <b>Design:</b> This was a single-arm prospective longitudinal study. The recipients participated in an inpatient rehabilitation program twice a day, 7 days a week for 3 to 4 weeks. <b>Outcome Measures Included:</b> 2-Minute Walking Test, Timed Up and Go, Berg Balance Scale, 30-Second Sit to Stand, biceps and quadriceps strength, Functional Independence Measure, SF-36, and Canadian Occupational Performance Measure. <b>Results:</b> Twenty-eight patients (54% female, mean age = 55 [11]) completed the study. Participants were mostly liver (42%) and lung recipients (35%). There were statistically significant improvements in all outcomes after the intervention. There was no relationship between changes in functional exercise capacity and quadriceps strength or lower body strength. <b>Conclusion:</b> An inpatient rehabilitation program may improve several functional outcomes and health-related quality of life in transplant recipients with a complicated postoperative course.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 3","pages":"201-207"},"PeriodicalIF":0.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10466989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10128770","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":"A Nominal Group Technique Study of Patients Who Identify as Black or African American and Access to Renal Transplantation.","authors":"Camilla W Nonterah,&nbsp;Shawn O Utsey,&nbsp;Gaurav Gupta,&nbsp;Sawyer Wilkins,&nbsp;Heather M Gardiner","doi":"10.1177/15269248231164164","DOIUrl":"https://doi.org/10.1177/15269248231164164","url":null,"abstract":"<p><p><b>Introduction:</b> Completion of the renal transplant evaluation has been associated with several barriers for patients who identify as Black or African American. This study sought to prioritize barriers to and motivators of completing the renal transplant evaluation. <b>Methods/Approach:</b> Semi-structured interviews and focus groups with a nominal group technique were used to generate priority scores. Transplant professionals (N = 23) were recruited from 9 transplant centers in the Mid-Atlantic, Mid-Western, and Southeastern parts of the United States. Black or African American identifying renal patients (N = 30) diagnosed with end-stage kidney disease were recruited from 1 transplant center in the Mid-Atlantic region. <b>Findings:</b> Priority scores were created to assess the quantitative data of participant rankings of top barriers and motivators. The most significant barriers identified by both patients and transplant professionals comprised financial constraints, insurance issues, difficulty navigating the healthcare system, transportation difficulties, and multiple health problems. Facilitators consisted of family/social support, transplant education, patient navigators, comprehensive insurance, and physician repertoire and investment. A qualitative description of the ranked factors resulted in themes classified as intrapersonal, health, socioeconomic, transplant-specific healthcare, and general healthcare. <b>Conclusion:</b> These findings provided vital information to transplant centers nationwide about assessing the influences of renal transplant evaluation completion. Achieving equity in access to transplantation for Black or African American renal patients requires multilayered approaches.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 2","pages":"141-149"},"PeriodicalIF":0.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9501135","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":"Testing the Differential Access Hypothesis That Black Kidney Transplant Candidates Perceive Social Network Access to Fewer Potential Living Donors Than White Candidates.","authors":"Jonathan Daw,&nbsp;Mary Roberts,&nbsp;Avrum Gillespie,&nbsp;Ashton M Verdery,&nbsp;Tanjala S Purnell","doi":"10.1177/15269248231164174","DOIUrl":"https://doi.org/10.1177/15269248231164174","url":null,"abstract":"<p><strong>Introduction: </strong>Many studies of Black-White disparities in living donor kidney transplantation hypothesize that they were partially due to Black-White differences in candidate social network access to healthy, willing donors. This differential access hypothesis has not been tested using directly measured social network data.</p><p><strong>Research questions: </strong>Do black kidney transplant candidates have perceived lower social network access to health and/or willing living donors than white candidates?</p><p><strong>Design: </strong>A cross-sectional survey that measured the social network members was collected in 2015. Black-White differences in patient counts of perceived healthy and/or willing potential donors in social networks, and individual network members' probability of being perceived healthy and/or willing, were compared using logistic and negative binomial regression models.</p><p><strong>Results: </strong>The survey included 66 kidney transplant candidates reporting on 1474 social network members at a large Southeastern US transplant center in 2015. Black and White patients had similar access to perceived healthy, likely potential donors (86% vs 87% had 1 or more, <i>P</i> = .92; 5.91 vs 4.13 mean counts, <i>P</i> = .20) and perceived healthy, agreed potential donors (56% vs 48%, <i>P</i> = .54; 1.77 vs 1.74, <i>P</i> = .97). Black patients' network members were individually more likely to be perceived healthy and likely potential donors (26% vs 21%, <i>P</i> = .04), and White patients' network members were more likely to have agreed (13% vs 9%, <i>P</i> = .03), but these differences were statistically insignificant in demographically adjusted models.</p><p><strong>Conclusion: </strong>Black and White transplant candidates perceived access to similar numbers of potential donors in their social networks. This result does not support the differential access hypothesis.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 2","pages":"130-140"},"PeriodicalIF":0.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/1c/10.1177_15269248231164174.PMC10150261.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9512726","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":"A Randomized Control Trial Testing a Medication Safety Dashboard in Veteran Transplant Recipients.","authors":"David J Taber,&nbsp;Sherry Milfred-LaForest,&nbsp;Kelsey Rife,&nbsp;Rebecca Felkner,&nbsp;Danielle Cooney,&nbsp;Nicholas Super,&nbsp;Samantha McClelland,&nbsp;Casey Buchanan","doi":"10.1177/15269248231164177","DOIUrl":"https://doi.org/10.1177/15269248231164177","url":null,"abstract":"<p><strong>Introduction: </strong>Medication errors, adverse events, and nonadherence in organ transplant recipients are common and can lead to suboptimal outcomes. A medication safety dashboard was developed to identify issues in medication therapy.</p><p><strong>Research questions: </strong>Can a multicenter bioinformatics dashboard accurately identify clinically relevant medication safety issues in US military Veteran transplant recipients?</p><p><strong>Design: </strong>The dashboard was tested through a 24-month, prospective, cluster-randomized controlled multicenter study. Pharmacists used the dashboard to identify and address potential medication safety issues, which was compared with usual care.</p><p><strong>Results: </strong>Across the 10 sites (5 control sites and 5 intervention sites), 2012 patients were enrolled (1197 intervention vs 831 control). The mean age was 65 (10) years, 95% male, and 27% Black. The dashboard produced 18 132 alerts at a rate of 0.61(0.32) alerts per patient-month, ranging from 0.44 to 0.72 across the 5 intervention sites. Lab-based issues were most common (83.4%), followed by nonadherence (9.4%) and transitions in care (6.4%); 56% of alerts were addressed, taking an average of 43 (29) days. Common responses to alerts included those already resolved by another provider (N = 4431, 44%), the alert not clinically relevant (N = 3131, 31%), scheduling of follow-up labs (N = 591, 6%), and providing medication reconciliation/education (N = 99, 1%). Inaccurate flags significantly decreased over the study by a mean of -0.6% per month (95% CI -0.1 to -1.0; <i>P</i> = .0265), starting at 13.4% and ending at 2.6%.</p><p><strong>Conclusion: </strong>This multicenter cluster-randomized controlled trial demonstrated that a medication safety dashboard was feasibly deployable across the VA healthcare system, creating valid alerts.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 2","pages":"121-129"},"PeriodicalIF":0.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9513206","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":"Comparison of Transplant Pharmacist Treatment Decisions Between Telehealth and Clinic Visits.","authors":"Jiashan Xu-Stettner,&nbsp;Amy N Thompson,&nbsp;Linda J Fitzgerald,&nbsp;Tracy Licari,&nbsp;Katie A McMurry,&nbsp;Sarah Tischer","doi":"10.1177/15269248231164161","DOIUrl":"https://doi.org/10.1177/15269248231164161","url":null,"abstract":"<p><p><b>Introduction:</b> Implementation of telehealth in high-risk patient populations provides opportunities for continuous interactions and has previously been shown to positively impact practice. However, there is a paucity of studies focused on telehealth in the liver transplant population specific to pharmacist care. <b>Project Aim:</b> Describe the importance of transplant pharmacist treatment decisions between telehealth, in-clinic, and asynchronous (eg chart review and electronic message support) visit types. <b>Design:</b> This was a single-center comparative evaluation of adult liver transplant recipients transplanted between May 1, 2020 and October 31, 2020 with a transplant pharmacist visit between May 1, 2020 and November 30, 2020. The primary outcome was the average number of treatment decisions per encounter and the average number of important treatment decisions per encounter. The importance of these treatment decisions was determined by a panel of three clinicians. <b>Results:</b> Twenty-eight patients met the inclusion criteria with 85 in-clinic, 42 telehealth, and 55 asynchronous visits. For all treatment decisions, there was no statistical difference in average number of treatment decisions per encounter between telehealth visits and in-clinic visits with an odds ratio (OR) of 0.822 (95% CI, 0.674-1.000; <i>P</i> = 0.051). Similarly, for important treatment decisions, there was no statistical difference between telehealth visits and in-clinic visits (OR 0.847; 95% CI, 0.642-1.116; <i>P</i> = 0.238). <b>Conclusion:</b> Transplant pharmacists can deliver recommendations with similar importance via telehealth compared to in-clinic visits based on the number of total and important treatment decisions.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 2","pages":"156-161"},"PeriodicalIF":0.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9501656","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":"Apixaban for Treatment of Atrial Fibrillation and Venous Thromboembolism After Lung Transplantation.","authors":"Anne Nikodem,&nbsp;Ashwini Arjuna,&nbsp;Chengcheng Hu,&nbsp;Aasya Nasar,&nbsp;Jade C Lam,&nbsp;Lauren Cherrier","doi":"10.1177/15269248231164173","DOIUrl":"https://doi.org/10.1177/15269248231164173","url":null,"abstract":"<p><strong>Introduction: </strong>Guidelines recommend the use of direct oral anticoagulation therapy over warfarin for the treatment of venous thromboembolism and atrial fibrillation. However, there is uncertainty and a lack of data supporting the safety and efficacy of anticoagulation therapy in lung transplant recipients. Additionally, there are unique considerations for this population, such as labile renal function and drug interactions.</p><p><strong>Project aims: </strong>The objective of this program evaluation was to evaluate the safety and efficacy of apixaban therapy for atrial fibrillation and venous thromboembolism in lung transplant recipients.</p><p><strong>Design: </strong>Medical records of all adult lung transplant recipients who received apixaban for atrial fibrillation or venous thromboembolism treatment between January 1, 2018, and August 31, 2020 were retrospectively reviewed. Safety was evaluated by the incidence of bleeding. Efficacy was evaluated by the recurrence of blood clots or the incidence of stroke.</p><p><strong>Results: </strong>A total of 134 recipients were included in the review. Thromboembolisms occurred in 14 recipients (10%), and none experienced a stroke. Bleeding occurred in 12 recipients (9%).</p><p><strong>Conclusions: </strong>The results of this evaluation were similar to those seen in smaller studies of the safety and efficacy of direct oral anticoagulation therapy for the treatment of atrial fibrillation or venous thromboembolism in lung transplant recipients, especially in recipients taking interacting azole antifungals. Prospective, comparative studies are needed to confirm these findings.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 2","pages":"175-181"},"PeriodicalIF":0.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9512724","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":"One Editor's Tip on Publishing Outcomes of a Performance Improvement Project.","authors":"Rebecca P Winsett","doi":"10.1177/15269248231165328","DOIUrl":"https://doi.org/10.1177/15269248231165328","url":null,"abstract":"","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 2","pages":"107-109"},"PeriodicalIF":0.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9862810","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":"Perspectives on Donor-Derived Cell-Free DNA in Kidney Transplant Recipients with Systemic Lupus Erythematosus.","authors":"Michael D Williams,&nbsp;Vineet Gupta,&nbsp;Edie Y Chan,&nbsp;Oyedolamu Olaitan","doi":"10.1177/15269248231164175","DOIUrl":"https://doi.org/10.1177/15269248231164175","url":null,"abstract":"Many kidney transplant recipients undergo graft surveillance with AlloSure® donor-deived cell-free DNA (dd-cfDNA) (CareDx Inc.). Published data show that 75% of patients with stable grafts have dd-cfDNA less than 0.4%. In our experience, patients with systemic lupus erythematosus (SLE) have higher levels of dd-cfDNA, with fluctuations that cannot be explained by graft injury. We retrospectively evaluated 19 patients with SLE who underwent kidney transplantation (68% female, median age 40 years). Seventy-five dd-cfDNA values were obtained over a 3-year period; median= 0.39% (interquartile range: 0.21%-0.95%). Six allograft biopsies were performed during the study period (Table 1). Five showed no rejection, associated dd-cfDNA levels= 0.24%, 0.26%, 0.43%, 2.9%, 6.9%. One biopsy revealed antibody-mediated rejection (AMR), dd-cfDNA= 0.85%. The published median for AMR is 1.8%, and values less than 1% have a negative predictive value of 96%. Variations in dd-cfDNA can be used to detect rejection; relative change value (RCV) of &gt;61% has been associated with high probability of graft injury. Two patients demonstrated significant variation in dd-cfDNA (Figure 1). The First patient increased from 0.5% to 2.9% (RCV= 480%) and the second patient rose from 0.31% to 6.9% (RCV= 2125%). Both patients had normal biopsies at the time of peak dd-cfDNA. Cell-free DNA (cfDNA) has been described in the pathophysiology of SLE and other inflammatory diseases. Elevations in cfDNA have been associated with SLE and have been proposed as a diagnostic biomarker. Systemic inflammation results in the release of cfDNA into circulation; fluctuations in dd-cfDNA may be related to lupus flares, or other SLE-related physiology, however, this does not appear to be the reason based on review of the patients’ charts. Published data doesn’t show clear correlation between disease flares and cfDNA levels in SLE. Because AlloSure is measured as a fraction (donor-derived/total circulating cfDNA), we investigated that changes in the total circulating cfDNA may lead to inappropriately high or low values in the setting of SLE. The total cfDNA values for our patients had no correlation between total cfDNA and the reported AlloSure values. Patients with large fluctuations in AlloSure had consistently low total cfDNA, suggesting that the source was the allograft. This requires attention since false positive values can lead to unnecessary biopsies. This small cohort of 6 biopsies could be outliers by chance, or by other factors not related to SLE. However, given the relationship between SLE and cfDNA, it is worth further investigation. Elevations in cfDNA are a hallmark of SLE, where both hematopoietic and nonhematopoietic cells contribute to cfDNA levels. Levels of cfDNA in circulation are affected by genetic and systemic factors. DNAse family of enzymes naturally degrade cfDNA and are essential for regulating the levels in circulation. Patients with single-nucleotide polymorphisms (SNPs) in nu","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 2","pages":"182-183"},"PeriodicalIF":0.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9862825","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":"Reassessing Geographic, Logistical, and Cold Ischemia Cutoffs in Liver Transplantation.","authors":"Stephanie Ohara,&nbsp;Blanca Lizaola-Mayo,&nbsp;Elizabeth Macdonough,&nbsp;Paige Morgan,&nbsp;Devika Das,&nbsp;Lena Egbert,&nbsp;Abigail Brooks,&nbsp;Amit K Mathur,&nbsp;Bashar Aqel,&nbsp;Kunam S Reddy,&nbsp;Caroline C Jadlowiec","doi":"10.1177/15269248231164169","DOIUrl":"https://doi.org/10.1177/15269248231164169","url":null,"abstract":"<p><strong>Introduction: </strong>Liver acceptance patterns vary significantly between transplant centers. Data pertaining to outcomes of livers declined by local and regional centers and allocated nationally remains limited.</p><p><strong>Project aim: </strong>The objective was to compare post-liver transplant outcomes between liver allografts transplanted as a result of national and local-regional allocation.</p><p><strong>Design: </strong>This was a retrospective evaluation of 109 nationally allocated liver allografts used for transplant by a single center. Outcomes of nationally allocated grafts were compared to standard allocation grafts (N  =  505) during the same period.</p><p><strong>Results: </strong>Recipients of nationally allocated grafts had lower model for end stage liver disease scores (17 vs 22, <i>P</i>  =  .001). Nationally allocated grafts were more likely to be post-cross clamp offers (29.4% vs 13.4%, <i>P</i>  =  .001) and have longer cold ischemia times (median hours 7.8 vs 5.5, <i>P</i>  =  .001). Early allograft dysfunction was common (54.1% vs 52.5%, <i>P</i>  =  .75) and did not impact hospital length of stay (median 5 vs 6 days, <i>P</i>  =  .89). There were no differences in biliary complications (<i>P</i>  =  .11). There were no differences in patient (<i>P</i>  =  .88) or graft survival (<i>P</i>  =  .35). In a multivariate model, after accounting for differences in cold ischemia time and posttransplant biliary complications, nationally allocated grafts were not associated with increased risk for graft loss (HR 0.9, 95% CI 0.4-1.8). Abnormal liver biopsy findings (33.0%) followed by donor donation after circulatory death status (22.9%) were the most common reasons for decline by local-regional centers.</p><p><strong>Conclusion: </strong>Despite longer cold ischemia times, patient and graft survival outcomes remain excellent and comparable to those seen from standard allocation grafts.</p>","PeriodicalId":20671,"journal":{"name":"Progress in Transplantation","volume":"33 2","pages":"168-174"},"PeriodicalIF":0.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9863321","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}