Transplantation Direct最新文献

{"title":"Psychosocial Determinants and Outcomes of Expedited Liver Transplant Evaluations: Insights From a Retrospective Cohort Analysis.","authors":"Katherine M Cooper, Padmavathi Srivoleti, Alessandro Colletta, Doris Tripp, Savant Mehta, Babak Movahedi, Deepika Devuni","doi":"10.1097/TXD.0000000000001745","DOIUrl":"10.1097/TXD.0000000000001745","url":null,"abstract":"<p><strong>Background: </strong>As the burden of chronic liver disease and the demand for liver transplants (LT) grows, understanding the interplay between access to care and patient outcomes is increasingly important. In this study, we explored patient characteristics and transplant outcomes in patients undergoing LT evaluations, with a focus on identifying risk factors for expedited LT evaluation.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included patients who underwent LT evaluation for deceased donor LT between October 2017 and July 2021. Patients were categorized by context: expedited (inpatient) and routine (outpatient) LT evaluation groups. The outcome measures included waitlist status, pre-LT mortality, and post-LT complications.</p><p><strong>Results: </strong>Of 602 patients, 26% underwent expedited LT evaluation. Patients who underwent expedited evaluation were more likely to have a history of ascites (<i>P</i> < 0.001), hepatic encephalopathy (<i>P</i> < 0.001), and spontaneous bacterial peritonitis (<i>P</i> < 0.001) and had a higher model for end-stage liver disease sodium scores (<i>P</i> < 0.001). Both mortality (35% versus 17%, <i>P</i> < 0.001) and LT (39% versus 22%, <i>P</i> < 0.001) were more common in the expedited group; post-LT mortality was similar up to 2 y. Perceived financial concerns and social security disability income were risk factors for expedited LT evaluation. In addition, greater proximity to the LT center (95% confidence interval, 1.1-6.3; <i>P</i> = 0.025) and speaking a primary language other than English (95% confidence interval, 1.0-10.7; <i>P</i> = 0.042) were risk factors for expedited LT evaluation in women but not in men.</p><p><strong>Conclusions: </strong>Expedited LT evaluations were associated with more severe illness and higher pre-LT mortality; however, post-LT outcomes were comparable with those of routine evaluations. Identifying psychosocial risk factors may enhance equity and access to LT evaluations, particularly for women who face unique challenges in this context.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 2","pages":"e1745"},"PeriodicalIF":1.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of a Liver Allocation Policy Change With Domestic Travel for Liver Transplantation.","authors":"Katie Ross-Driscoll, Chandrashekhar Kubal, Arrey-Takor Ayuk-Arrey, Jonathan Fridell, David Axelrod","doi":"10.1097/TXD.0000000000001749","DOIUrl":"10.1097/TXD.0000000000001749","url":null,"abstract":"<p><strong>Background: </strong>In 2020, liver allocation policy in the United States was changed to allow for broader organ sharing, which was hypothesized to reduce patient incentives to travel for transplant. Our objective was to describe patterns of travel for domestic liver transplant pre- and post-acuity circle (AC) implementation.</p><p><strong>Methods: </strong>Incident adult liver transplant listings between August 16, 2016, and February 3, 2020 (pre-AC) or June 13, 2020, and December 3, 2023 (post-AC) were obtained from the Scientific Registry of Transplant Recipients. We used previously defined geographic catchment areas to classify patients as (1) no travel, (2) travel to a neighboring region, and (3) travel beyond a neighboring region. We used multinomial logistic regression to identify characteristics associated with travel and cause-specific hazards modeling to estimate the association between travel and time to deceased donor transplant, stratified by model for end-stage liver disease (MELD) score and AC era.</p><p><strong>Results: </strong>Among 83 033 liver candidates, 76% were listed in their home region. Black race, lower educational attainment, increased neighborhood social deprivation, and Medicaid were significantly associated with decreased odds of traveling beyond a neighboring region. After AC, traveling beyond a neighboring region was associated with an increased hazard of transplant for patients with a MELD score <15 (cause-specific hazard ratio [csHR]: 1.25; 95% confidence interval [CI], 1.11-1.40), MELD score 15-24 (csHR: 1.19; 95% CI, 1.07-1.31), and MELD score 25-34 (csHR: 1.15; 95% CI, 1.01-1.32).</p><p><strong>Conclusions: </strong>Travel frequency, geographic patterns of travel, and characteristics associated with travel were largely unchanged after AC. Changes to allocation policy alone may not equalize patient means or desire to travel for transplant care.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 2","pages":"e1749"},"PeriodicalIF":1.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic, Pretransplant Screening by Aortoiliac CT Angiography: Impact on Surgical Decision-making and Clinical Outcomes.","authors":"Marie B Nielsen, Jacob Budtz-Lilly, Jonathan N Dahl, Anna K Keller, Bente Jespersen, Per R Ivarsen, Simon Winther, Henrik Birn","doi":"10.1097/TXD.0000000000001750","DOIUrl":"10.1097/TXD.0000000000001750","url":null,"abstract":"<p><strong>Background: </strong>Aortoiliac screening before kidney transplantation is suggested by some guidelines to select patients for transplantation and to assist surgical planning. We investigated the clinical outcomes of systematic screening for aortoiliac disease in potential kidney transplant candidates.</p><p><strong>Methods: </strong>In this observational study, 470 potential kidney transplant candidates underwent aortoiliac computed tomography angiography. Patients were characterized by the presence of peripheral artery disease and calcification of iliac arteries and aortoiliac arteries. The risk of graft loss and graft function at 1 y posttransplant were examined and clinical decisions based on the vascular findings were assessed.</p><p><strong>Results: </strong>Clinically diagnosed peripheral artery disease was present in 66 patients (14%), circular calcifications in 101 patients (21%), and aortoiliac stenosis in 77 patients (16%). In 326 patients undergoing kidney transplantation, circular calcification or aortoiliac stenosis was not associated with an increased risk of graft loss (<i>P</i> = 0.45 and <i>P</i> = 0.28) or estimated glomerular filtration rate (<i>P</i> = 0.23 and <i>P</i> = 0.76) at 1 y posttransplant. When evaluated for transplantability, clinical decision-making based on vascular findings was recorded in 67 of 429 patients (16%), including rejection for transplantation in 7 patients (2%) and laterality for surgical implantation in 52 patients (12%).</p><p><strong>Conclusions: </strong>Systematic screening by aortoiliac computed tomography angiography may assist in surgical planning but seems of limited clinical value in assessing the risk of future graft loss and graft function in patients undergoing kidney transplantation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 2","pages":"e1750"},"PeriodicalIF":1.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic Inequities in Preemptive Kidney Transplantation and Graft Survival: An Innovative Approach to Identifying Disparities in Kidney Transplantation.","authors":"Sarah Kizilbash, Chung-Ii Wi, Madison Roy, Euijung Ryu, Arthur Matas, Vesna Garovic, Samy Riad, Carrie Schinstock, Young Juhn","doi":"10.1097/TXD.0000000000001734","DOIUrl":"10.1097/TXD.0000000000001734","url":null,"abstract":"<p><strong>Background: </strong>The limitations of conventional measures of socioeconomic status (SES) limit our ability to elucidate the role of SES as a key element of social determinants of health in kidney transplantation. This study's objective was to use an innovative SES measure, the HOUsing-based SES measure (HOUSES) index, to examine the effects of social determinants of health on access to and outcomes of kidney transplantation.</p><p><strong>Methods: </strong>Our study included residents of Minnesota (age older than 18 y) who underwent kidney transplantation at a single center between 2010 and 2020. SES was determined using the HOUSES index, categorized into quartiles (Q1 for lower, Q2-Q4 for higher SES). We used mixed-effects multivariable logistic and Cox models to examine the effects of HOUSES on preemptive transplants, pretransplant dialysis duration, and death-censored graft loss, adjusting for covariates.</p><p><strong>Results: </strong>Among 1975 eligible patients, 29.4% received preemptive transplants, 34.9% underwent pretransplant dialysis for >3 y, and 15.1% experienced death-censored graft loss for a median follow-up of 7.15 (interquartile range, 4.25-11.38) y. Lower SES recipients (Q1) demonstrated decreased preemptive transplant likelihood (adjusted odds ratio [aOR]: 0.74; 95% confidence interval [CI], 0.57-0.97; <i>P</i> = 0.03), longer dialysis duration (>3 y; aOR: 1.43; 95% CI, 1.01-2.03; <i>P</i> = 0.046), and higher death-censored graft loss (adjusted hazard ratio 1.36; 95% CI, 1.02-1.12; <i>P</i> = 0.036) versus higher SES recipients (Q2-Q4).</p><p><strong>Conclusions: </strong>We observed significant socioeconomic disparities in kidney transplant access, dialysis duration, and graft survival. The HOUSES index may be a promising tool for individual-based targeted interventions as it identifies SES on an individual rather than an area-level basis.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 1","pages":"e1734"},"PeriodicalIF":1.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States.","authors":"Peter J Altshuler, Adam S Bodzin, Kenneth A Andreoni, Pooja Singh, Anju Yadav, Jaime M Glorioso, Ashesh P Shah, Carlo Gerado B Ramirez, Warren R Maley, Adam M Frank","doi":"10.1097/TXD.0000000000001744","DOIUrl":"10.1097/TXD.0000000000001744","url":null,"abstract":"<p><strong>Background: </strong>Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients.</p><p><strong>Methods: </strong>We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased donor kidney transplants. Recipients were classified as kidney transplant alone (KTA) (n = 62,252) or MOTs pancreas-kidney, simultaneous pancreas-kidney (n = 3,976), liver-kidney, simultaneous liver-kidney (n = 3,212), heart-kidney, simultaneous heart-kidney (n = 808), and \"other\"-kidney, simultaneous \"other\" kidney (n = 73).</p><p><strong>Results: </strong>Liver, heart, and lung-alone transplants were at least 7 times more frequent than their MOT correlate, whereas the inverse was true with pancreas transplantation with SPKs being by far the most common pancreas transplant type. On average, KTA recipients waited between 2.8 and 21.4 times longer than MOTs, with SPKs waiting the longest of the MOT types. Predialysis initiation transplants were less frequent in KTAs compared with MOTs. Use of high-quality grafts according to Kidney Donor Profile Index < 35% was frequent among MOTs, but uncommon in KTAs who had an Estimated Post Transplant Survival score (EPTS) of >20%. For recipients older than 65, SPKs and SOKs were rare, but SLKs and SHKs had a higher fraction of recipients than KTAs and were much more likely to use a Kidney Donor Profile Index <35% kidney. SPKs and KTAs with an EPTS ≤20% had the best kidney graft survival. KTAs with an EPTS ≤80% had better kidney graft survival than SLKs, SHKs, and SOKs.</p><p><strong>Conclusions: </strong>This study highlights disparities in access to deceased donor kidneys for kidney-alone candidates versus MOTs and suggests opportunities to improve allocation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 1","pages":"e1744"},"PeriodicalIF":1.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balanced Electrolyte Solutions Versus 0.9% Saline for Kidney Transplantation: An Updated Systematic Review and Meta-analysis.","authors":"Susan S Wan, Kate Wyburn, Steven J Chadban, Michael G Collins","doi":"10.1097/TXD.0000000000001687","DOIUrl":"10.1097/TXD.0000000000001687","url":null,"abstract":"<p><strong>Background: </strong>Perioperative intravenous fluids are administered to kidney transplant recipients to maintain hemodynamic stability and graft perfusion; however, the ideal fluid remains uncertain. Although 0.9% saline (saline) is commonly used, its high chloride content causes hyperchloremic metabolic acidosis and may increase the risks of delayed graft function (DGF) and hyperkalemia. Balanced electrolyte solutions (BES) have a more physiological chloride concentration and may reduce these risks. Previous meta-analyses found insufficient evidence to compare BES with saline for these outcomes; however, new studies have recently been published. In this updated review, we compared the effects of BES with saline on the risk of DGF and hyperkalemia in kidney transplantation.</p><p><strong>Methods: </strong>MEDLINE, Embase, and CENTRAL were searched for randomized controlled trials comparing BES with saline in kidney transplantation. The primary outcomes were DGF and hyperkalemia. Eligible studies were assessed for risk of bias and data were pooled for analysis. The Grading of Recommendations Assessment, Development, and Evaluation framework was used to assess the quality of evidence.</p><p><strong>Results: </strong>Ten studies involving 1532 participants were included. The quality of evidence was high for deceased donor transplantation and very low for living donor transplantation. The relative risk (RR) of DGF associated with BES compared with saline was 0.83 (95% confidence interval [CI], 0.71-0.96; <i>P</i> = 0.01) in deceased donor transplantation. There was no difference in DGF in living donor transplantation (RR 0.79; 95% CI, 0.26-2.41; <i>P</i> = 0.68). There was no difference in hyperkalemia between groups (RR 0.87; 95% CI, 0.59-1.27; <i>P</i> = 0.46).</p><p><strong>Conclusions: </strong>Compared with saline, BES reduces the risk of DGF in deceased donor kidney transplantation without increasing hyperkalemia.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 1","pages":"e1687"},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11649268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcriptomic Signatures of Antibody-mediated Rejection in Early Biopsies With Negative Histology in HLA-incompatible Kidney Transplantation.","authors":"Petra Hruba, Jiri Klema, Petra Mrazova, Eva Girmanova, Katerina Jaklova, Ludek Voska, Martin Kment, Martina Mackova, Klara Osickova, Vladimir Hanzal, Philip F Halloran, Ondrej Viklicky","doi":"10.1097/TXD.0000000000001741","DOIUrl":"10.1097/TXD.0000000000001741","url":null,"abstract":"<p><strong>Background: </strong>Presensitized patients with circulating donor-specific antibodies (DSAs) before transplantation are at risk for antibody-mediated rejection (AMR). Peritransplant desensitization mitigates but does not eliminate the alloimmune response. We examined the possibility that subthreshold AMR activity undetected by histology could be operating in some early biopsies.</p><p><strong>Methods: </strong>Transcriptome of kidney allograft biopsies performed within the first month in presensitized patients (DSA⁺) who had received desensitization and did not develop active/probable AMR by histology (R^-) was compared with biopsies showing active/probable AMR (R⁺/DSA⁺). As negative controls, biopsies without rejection by histology in patients without DSA at transplantation were used (R^-/DSA^-). RNA sequencing from biopsies selected from the biobank was used in cohort 1 (n = 32) and microarray, including the molecular microscope (Molecular Microscope Diagnostic System [MMDx]) algorithm, in recent cohort 2 (n = 30).</p><p><strong>Results: </strong>The transcriptome of R^-/DSA⁺ was similar to R⁺/DSA⁺ as these groups differed in 14 transcripts only. Contrarily, large differences were found between both DSA⁺ groups and negative controls. Fast gene set enrichment analyses showed upregulation of the immune system in both DSA⁺ groups (gene ontology terms: adaptive immune response, humoral immune response, antigen receptor-mediated signaling, and B-cell receptor signaling or complement activation) when compared with negative controls. MMDx assessment in cohort 2 classified 50% of R^-/DSA⁺ samples as AMR and found no differences in AMR molecular scores between R⁺ and R^- DSA⁺ groups. In imlifidase desensitization, MMDx series showed a gradual increase in AMR scores over time.</p><p><strong>Conclusions: </strong>Presensitized kidney transplant recipients exhibited frequent molecular calls of AMR in biopsy-based transcript diagnostics despite desensitization therapy and negative histology.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 1","pages":"e1741"},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11649270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Hypothermic Perfusion on Immune Responses and Sterile Inflammation in a Preclinical Model of Pancreatic Transplantation.","authors":"Benoit Mesnard, Sarah Bruneau, Stéphanie Le Bas-Bernardet, Etohan Ogbemudia, Delphine Kervella, Christophe Masset, Mélanie Neel, M David Minault, M Jeremy Hervouet, Diego Cantarovich, Jérôme Rigaud, Lionel Badet, Peter Friend, Rutger Ploeg, Gilles Blancho, James Hunter, Thomas Prudhomme, Julien Branchereau","doi":"10.1097/TXD.0000000000001743","DOIUrl":"10.1097/TXD.0000000000001743","url":null,"abstract":"<p><strong>Background: </strong>In organ transplantation, cold ischemia is associated with sterile inflammation that subsequently conditions adaptive immunity directed against the grafts during revascularization. This inflammation is responsible for venous thrombosis, which is the main postoperative complication affecting graft function. Our aim was to investigate the modulation of immune responses and endothelial function of pancreatic grafts during cold ischemia using different preservation modalities.</p><p><strong>Methods: </strong>According to a preclinical porcine model of controlled donation after circulatory death, pancreatic grafts were preserved under hypothermic conditions for 24 h according to 4 modalities: static cold storage, hypothermic machine perfusion, hypothermic oxygenated perfusion at 21%, and 100%. Biopsies of the head and tail of the pancreas were performed during preservation. The first step involved a broad screening of the gene expression profile (84 genes) during preservation on a limited number of grafts. In the second step, a confirmation test was performed in all 4 groups.</p><p><strong>Results: </strong>Vascular endothelial growth factor gene expression showed a decrease during preservation in the hypothermic oxygenated perfusion 21% and 100% groups compared with the static cold storage group. In contrast, thrombomodulin gene expression showed an increase during preservation in the hypothermic oxygenated perfusion 21% and 100% groups compared with the static cold storage and hypothermic machine perfusion groups.</p><p><strong>Conclusions: </strong>We demonstrated that compared with static cold storage, hypothermic oxygenated perfusion is an effective modality for modulating endothelial function by increasing thrombomodulin expression and decreasing ischemia and vascular endothelial growth factor expression.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 1","pages":"e1743"},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11649271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifaceted Control Interventions for Healthcare-associated Infections in a Kidney Transplant Intensive Care Unit: Clinical Outcome Improvement and Bundle Adherence.","authors":"Luana Oliveira Calegari, Maria Bethânia Peruzzo, Renato Demarchi Foresto, Helio Tedesco-Silva, José Medina Pestana, Lúcio R Requião-Moura","doi":"10.1097/TXD.0000000000001718","DOIUrl":"10.1097/TXD.0000000000001718","url":null,"abstract":"<p><strong>Background: </strong>Healthcare-associated infections (HAIs) are preventable complications that overwhelm the healthcare system. The implementation of multifaceted control intervention actions in the intensive care setting modifies clinical outcomes, but its effectiveness has not been specifically investigated for high-risk patients, such as kidney transplant recipients (KTRs).</p><p><strong>Methods: </strong>This observational retrospective natural experiment evaluated the effectiveness of multifaceted control interventions (bundles) in reducing HAIs in a KTR intensive care unit. We also measured the bundle adherence rate during 16 mo in the after era.</p><p><strong>Results: </strong>We included 1257 KTRs, 684 before and 573 in the postintervention period. After the bundle implementation, the incidence density of device-associated HAIs decreased from 8.5 to 3.9 per 1000 patient-days (relative risk [RR] = 0.46; 95% confidence interval [CI], 0.25-0.85; <i>P</i> = 0.01), primarily because of the reduction in central line-associated bloodstream infection from 8.0 to 3.4 events per 1000 catheter-days (RR = 0.43; 95% CI, 0.22-0.83; <i>P</i> = 0.012). Reductions in catheter-associated urinary tract infection (2.5 versus 0.6 per 1000 catheter-days; RR = 0.22; 95% CI, 0.03-1.92; <i>P</i> = 0.17) and ventilator-associated pneumonia (3.4 versus 1.0 per 1000 ventilator-days; RR = 0.29; 95% CI, 0.03-2.63; <i>P</i> = 0.27) were not significant. Central venous (<i>P</i> = 0.53) and urinary catheter (<i>P</i> = 0.47) insertion adherence were stable during 16 mo, whereas central venous (<i>P</i> < 0.001) and urinary catheter (<i>P</i> = 0.004) maintenance gradually increased. Finally, ventilator-associated pneumonia prevention bundle adherence slightly decreased over time (<i>P</i> = 0.06).</p><p><strong>Conclusions: </strong>The implementation of comprehensive multifaceted control intervention actions in an intensive care unit dedicated to KTR care was effective in significantly reducing device-associated infections. The impact was in line with the reductions observed in populations that have not undergone transplantation, underscoring the effectiveness of these interventions across different patient groups.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 11","pages":"e1718"},"PeriodicalIF":1.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Post-transplant Lymphoproliferative Disorders-Metagenomic Shotgun Microbial Sequencing (PTLD-MSMS) Study Methods and Protocol.","authors":"Vikas R Dharnidharka, Kristine M Wylie, Todd N Wylie, Marianna B Ruzinova, Charles W Goss, Gregory A Storch, Neha Mehta-Shah, Derek Byers, Leslie Walther, Lujain Jaza, Hongjie Gu, Mansi Agarwal, Michael Green, Erika Moore, Steven H Swerdlow, Fernanda Silveira, Lianna J Marks, Dita Gratzinger, Adam Bagg, Soi Cheng Law, Maher Gandhi","doi":"10.1097/TXD.0000000000001723","DOIUrl":"10.1097/TXD.0000000000001723","url":null,"abstract":"<p><p>Post-transplant lymphoproliferative disorders (PTLDs) remain a feared complication of transplantation, with significant morbidity and mortality. The oncogenic Epstein-Barr virus (EBV) is a key pathogenic driver in 50%-80% of cases. Numerous prognostic indices, comprising multiple clinical, epidemiological and tumor characteristics, including EBV tumor positivity, do not consistently associate with worse patient survival, suggesting a potential role for EBV genome variants in determining outcome. However, the precision medicine tools for determining if a viral genome variant is pathogenic are very limited compared with human genome variants. Further, targeted studies have not implicated a specific viral etiological agent in EBV-negative PTLD. Using novel cutting-edge technologies, we are extracting viral nucleic acids from formalin-fixed, paraffin-embedded archived, or frozen PTLD tissues or plasma, to test for all vertebrate viruses simultaneously in an unbiased fashion, using metagenomic shotgun sequencing (MSS). We are collecting such samples from multiple transplant centers to address the following specific aims and close the following knowledge gaps: (1) Validate our novel observation that PTLD tissue positivity by MSS for anellovirus (and confirmed by PCR) serves as a biomarker for higher transplant recipient mortality after the diagnosis of PTLD; (2) determine the role of other oncogenic viruses in EBV-negative PTLD by unbiased MSS of multiple viral groupings, confirmed by other techniques; and (3) develop the necessary computational, algorithmic and software analytic tools required to determine association of EBV genome variants with worse presentations or outcomes in PTLD. Study completion will contribute to better patient care and may provide avenues for novel therapies.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 11","pages":"e1723"},"PeriodicalIF":1.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}