Transplantation Direct最新文献

{"title":"Impact of Therapeutic Plasma Exchange and Rituximab for Prevention of Idiopathic Focal Segmental Glomerulosclerosis Recurrence Post-Kidney Transplantation.","authors":"Allison N Yun, Alex W Rogers, Jill C Krisl, Anna Kagan, Horacio E Adrogue, Abdul J Khan, Pascale Khairallah, Stephanie G Yi, Mark J Hobeika, Lillian Gaber, Luan Truong, Hemangshu Podder, Ahmed O Gaber, Richard J Knight","doi":"10.1097/TXD.0000000000001769","DOIUrl":"10.1097/TXD.0000000000001769","url":null,"abstract":"<p><strong>Background: </strong>Focal segmental glomerulosclerosis (FSGS) recurs after kidney transplantation (KT) in 30%-50% of recipients. Recurrence is associated with early graft loss in up to 60% of cases. This study aimed to assess the efficacy of therapeutic plasma exchange (TPE) combined with rituximab (RTX) in preventing early FSGS recurrence within 1 y post-KT.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study included patients receiving KT for idiopathic FSGS between June 2013 and August 2021. In May 2016, a preventative FSGS protocol was implemented where KT recipients with idiopathic FSGS received perioperative sessions of TPE followed by a dose of RTX with or without IVIG. The incidence of recurrent FSGS within the first year posttransplantation was assessed between the FSGS protocol cohort versus the historical group of patients who did not undergo prophylactic treatment.</p><p><strong>Results: </strong>A total of 65 patients received KT for idiopathic FSGS during the study period. Forty patients were included in the FSGS protocol cohort and 25 in the control cohort. When assessing clinical recurrence with proteinuria, there were significantly fewer cases in the FSGS protocol cohort versus the control cohort, 1 versus 5 patients (3% versus 20%, <i>P</i> = 0.03). There were no instances of death-censored graft loss at 1 y in the protocol cohort versus 2 cases in the control cohort (0% versus 8%, <i>P</i> = 0.14).</p><p><strong>Conclusions: </strong>TPE combined with RTX may prevent early FSGS recurrence without significant rates of infection.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 3","pages":"e1769"},"PeriodicalIF":1.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542975","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":"Thoracoabdominal Normothermic Regional Perfusion: Real-world Experience and Outcomes of DCD Liver Transplantation.","authors":"Yanik J Bababekov, Anna H Ha, Trevor L Nydam, Carlos Goncalves, Rashikh Choudhury, JoLynn Shinsako, Maria Baimas-George, David M Reynolds, Cassidy Yoshida, Caroline A Racke, Han Grewal, Sophia Pomposelli, Ivan E Rodriguez, Jordan R H Hoffman, Jesse D Schold, Bruce Kaplan, Elizabeth A Pomfret, James J Pomposelli","doi":"10.1097/TXD.0000000000001767","DOIUrl":"10.1097/TXD.0000000000001767","url":null,"abstract":"<p><strong>Background: </strong>Donation after circulatory death liver transplantation (DCD LT) is underused given historical outcomes fraught with ischemic cholangiopathy (IC). We aimed to assess 6-mo IC in LT from DCD via normothermic regional perfusion (NRP) compared with DCD via static cold storage (SCS).</p><p><strong>Methods: </strong>A retrospective review of adult Maastricht-III DCD liver donors and recipients at the University of Colorado Hospital from January 1, 2017, to August 27, 2024, was performed. The 6-mo IC rate was compared between NRP and SCS. Secondary outcomes included biochemical assessments of accepted versus declined NRP liver allografts and allograft and patient survival for NRP and SCS groups.</p><p><strong>Results: </strong>One hundred sixty-two DCD LTs (SCS = 79; NRP = 97) were performed and 150 recipients (SCS = 74; NRP = 86) reached 6-mo follow-up. Six-month IC was lower for NRP compared with SCS (1.2% versus 9.5%, <i>P</i> = 0.03). The Donor Risk Index (2.44 [2.02-2.82] versus 2.17 [1.97-2.30], <i>P</i> = 0.002) and UK DCD Risk Score (4.2 ± 2.9 versus 3.2 ± 2.3, <i>P</i> = 0.008) were higher for NRP versus SCS. The Liver Graft assessment Following Transplantation score was less for NRP compared with SCS (-3.3 versus -3.1, <i>P</i> < 0.05). There were several differences in median biochemical parameters during NRP between accepted and declined livers, including higher terminal biliary bicarbonate (22.7 [20.9-29.1] versus 10.8 [7.6-13.1] mEq/L, <i>P</i> = 0.004). There were no significant differences in 12-mo allograft or patient survival for NRP versus SCS.</p><p><strong>Conclusions: </strong>NRP is a disruptive innovation that improves the utilization of DCD livers. Despite higher-risk donor-recipient pairing for NRP compared with SCS, we demonstrate a decrease in IC for NRP. These data facilitate benchmarking of thoracoabdominal NRP DCD LT and support further protocol development.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 3","pages":"e1767"},"PeriodicalIF":1.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543342","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":"Outcomes of Kidney Transplantation From Donors on Renal Replacement Therapy.","authors":"Naeem Goussous, Karima Alghannam, Peter A Than, Aileen X Wang, Ling-Xin Chen, Sophoclis P Alexopoulos, Junichiro Sageshima, Richard V Perez","doi":"10.1097/TXD.0000000000001771","DOIUrl":"10.1097/TXD.0000000000001771","url":null,"abstract":"<p><strong>Background: </strong>The increasing demand for organs has pushed transplant providers to expand kidney acceptance criteria. The use of kidneys from donors with AKI has been shown to provide good long-term graft survival. We aim to evaluate and compare the outcomes of deceased donor kidney transplantation from donors with acute kidney injury (AKI), either with or without renal replacement therapy (AKI-RRT) before donation.</p><p><strong>Methods: </strong>A single-center retrospective review of all patients who underwent deceased donor kidney transplantation from AKI donors between 2009 and 2020 was performed. AKI donors were defined on the basis of donor terminal creatinine ≥2.0 mg/dL or use of RRT before donation. We compared the outcomes of recipients receiving a kidney from a donor with AKI versus AKI-RRT. Data are presented as medians (interquartile ranges) and numbers (percentages).</p><p><strong>Results: </strong>Four hundred ninety-six patients were identified, of whom 300 (60.4%) were men with a median age of 57 y at transplantation. Thirty-nine patients received an AKI-RRT, whereas 457 received an AKI kidney. Donors in the AKI-RRT group were younger (28 versus 40), had less incidence of hypertension (15.3% versus 31.9%), and were more likely to be imported (94.9% versus 76.8%). There was a higher incidence of delayed graft function (72% versus 44%, <i>P</i> < 0.001) in the AKI-RRT group. Recipients in both groups had similar 90-d (100% versus 95.2%) and 1-y (100% versus 91.9%) graft survival. With a median follow-up of 5 y, there was no difference in death-censored graft survival in both groups (<i>P</i> = 0.83).</p><p><strong>Conclusions: </strong>Careful selection of kidneys from donors with AKI on RRT can be safely used for kidney transplantation with favorable clinical outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 3","pages":"e1771"},"PeriodicalIF":1.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543133","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":"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}