Transplantation Direct最新文献

{"title":"Exploring Caregiver Support as a Potential Mediator of Neighborhood Socioeconomic Disadvantage and Reduced Likelihood of Liver Transplant Waitlisting.","authors":"Anna M Morenz, Jordan Nichols, Andrew Snyder, James Perkins, David K Prince, Omri Ganzarski, Zakariya Hussein, Nicole J Kim, Andre Dick, Yue-Harn Ng","doi":"10.1097/TXD.0000000000001782","DOIUrl":"10.1097/TXD.0000000000001782","url":null,"abstract":"<p><strong>Background: </strong>Individuals from socioeconomically disadvantaged neighborhoods may be at risk of inequitable access to the liver transplant (LT) waitlisting (WL), but mechanisms mediating this relationship are not well understood. We assessed whether area deprivation index (ADI), a measure of neighborhood socioeconomic deprivation, was associated with LT WL and assessed whether caregiver support, a potentially modifiable factor, mediated this relationship.</p><p><strong>Methods: </strong>We performed a single-center retrospective cohort study of adults referred for LT evaluation from January 2015 to December 2021. First, we assessed the association between ADI and LT WL using univariate and multivariable logistic regression analyses. Second, we analyzed caregiver support as a potential mediator through mediation analysis.</p><p><strong>Results: </strong>During the study period, 2574 patients were referred for LT, 2057 patients initiated evaluation, and 622 patients were waitlisted. Residence in the highest ADI quartile was associated with lower probability of WL (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.52-0.99) after adjusting for individual medical and sociodemographic factors, and distance from the transplant center. In adjusted mediation analysis, caregiver support did not mediate the relationship between ADI and LT WL (OR, 0.90; 95% CI, 0.80-1.01), and highest ADI quartile also did not have significant direct effects on LT WL (OR, 0.95; 95% CI, 0.72-1.26).</p><p><strong>Conclusions: </strong>ADI may be useful as a screening tool to identify candidates who could benefit from early intervention in the LT process when individual social needs information is not available. Caregiver support did not mediate the ADI and LT WL association. Additional work is needed to understand which modifiable factors may mediate this association to inform potential interventions for this population.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 4","pages":"e1782"},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754775","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":"Machine Learning Prediction Model of Waitlist Outcomes in Patients with Primary Sclerosing Cholangitis.","authors":"Xun Zhao, Maryam Naghibzadeh, Yingji Sun, Arya Rahmani, Leslie Lilly, Nazia Selzner, Cynthia Tsien, Elmar Jaeckel, Mary Pressley Vyas, Rahul Krishnan, Gideon Hirschfield, Mamatha Bhat","doi":"10.1097/TXD.0000000000001774","DOIUrl":"10.1097/TXD.0000000000001774","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation is essential for many people with primary sclerosing cholangitis (PSC). People with PSC are less likely to receive a deceased donor liver transplant compared with other causes of chronic liver disease. This disparity may stem from the inaccuracy of the model for end-stage liver disease (MELD) in predicting waitlist mortality or dropout for PSC. The broad applicability of MELD across many causes comes at the expense of accuracy in prediction for certain causes that involve unique comorbidities. We aimed to develop a model that could more accurately predict dynamic changes in waitlist outcomes among patients with PSC while including complex clinical variables.</p><p><strong>Methods: </strong>We developed 3 machine learning architectures using data from 4666 patients with PSC in the Scientific Registry of Transplant Recipients (SRTR) and tested our models on our institutional data set of 144 patients at the University Health Network (UHN). We evaluated their time-dependent concordance index (C-index) for mortality prediction and compared it against MELD-sodium and MELD 3.0.</p><p><strong>Results: </strong>Random survival forest (RSF), a decision tree-based survival model, outperformed MELD-sodium and MELD 3.0 in both the SRTR and the UHN test data set using the same bloodwork variables and readily available demographic data. It achieved a C-index of 0.868 (SD 0.020) and 0.771 (SD 0.085) on the SRTR and UHN test data, respectively. Training a separate RSF model using the UHN data with PSC-specific achieved a C-index of 0.91. In addition to high MELD score, increased white blood cells, time on the waiting list, platelet count, presence of Autoimmune hepatitis-PSC overlap, aspartate aminotransferase, female sex, age, history of stricture dilation, and extremes of body weight were the top-ranked features predictive of the outcomes.</p><p><strong>Conclusions: </strong>Our RSF model offers more accurate waitlist outcome prediction in PSC. The significant performance improvement with the inclusion of PSC-specific variables highlights the importance of disease-specific variables for predicting trajectories of clinically distinct presentations.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 4","pages":"e1774"},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754024","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":"Feasibility and Safety of Ex Vivo Delivery of Rituximab to Lung Allografts in Transplant Recipients at High Risk for Epstein-Barr Virus-associated Posttransplant Lymphoproliferative Disorder.","authors":"Victor H Ferreira, Rafaela V P Ribeiro, Faranak Mavandadnejad, Matthew Ierullo, Beata Majchrzak-Kita, Aizhou Wang, Lianne Singer, Shaf Keshavjee, Marcelo Cypel, Deepali Kumar, Atul Humar","doi":"10.1097/TXD.0000000000001784","DOIUrl":"10.1097/TXD.0000000000001784","url":null,"abstract":"<p><strong>Background: </strong>Ex vivo lung perfusion (EVLP) offers a novel platform for delivering targeted therapies directly to donor lungs before transplantation, potentially reducing systemic side effects. Our study evaluated the feasibility and safety of rituximab delivery to donor lungs from Epstein-Barr virus (EBV)-seropositive donors for transplantation into EBV-seronegative recipients (D⁺/R^-) to reduce the risk of EBV-associated posttransplant lymphoproliferative disorder (PTLD), which remains a major obstacle in the transplant setting.</p><p><strong>Methods: </strong>A pilot study was conducted involving 5 EBV-seronegative lung transplant recipients. Donor lungs were perfused with 500 mg rituximab during EVLP for 3-4 h. Primary outcomes included safety and feasibility, assessed by monitoring lung function during perfusion, posttransplant complications, and graft dysfunction. Secondary outcomes included EBV DNAemia, PTLD incidence, peripheral B-cell frequencies, EBV blood transcripts, and rituximab serum levels.</p><p><strong>Results: </strong>Rituximab delivery via EVLP was feasible and safe, with no significant deviations in lung function or adverse events linked to treatment. One patient experienced primary graft dysfunction. Peripheral B-cell counts were reduced immediately posttransplant and remained low in some patients, whereas others rebounded over the weeks posttransplant, and serum rituximab levels were undetectable after 2 wk. Three patients developed EBV DNAemia and 2 developed PTLD within 2 y, although PTLD lesions were not observed in transplanted lungs.</p><p><strong>Conclusions: </strong>EVLP-based rituximab delivery is a feasible and promising strategy for targeting donor-transmitted EBV with minimal systemic exposure. Although the findings suggest potential clinical benefit, the development of PTLD in extrathoracic sites underscores the need for further optimization and larger studies to evaluate efficacy and refine the intervention.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 4","pages":"e1784"},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753830","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":"Liver Transplant Provider Perspectives on Posttransplant Management of Alcohol Use Disorder.","authors":"Maria P Cote, Daniel Cloonan, Sienna Li, Shahaan Razak, Ruby Singh, Taylor Coe, Paula C Zimbrean, Sarah Andrews, Ana Ivkovic, Stephen Bartels, Ryan Chadha, Emily Bethea, Heidi Yeh, Nicholas Lim, Leigh Anne Dageforde","doi":"10.1097/TXD.0000000000001766","DOIUrl":"10.1097/TXD.0000000000001766","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation (LT) is the standard treatment for liver failure secondary to alcohol-associated liver disease, but limited literature and best practices exist for post-LT treatment of alcohol use disorder (AUD). This study explores current AUD management practices and providers' perceived barriers to effective post-LT AUD management.</p><p><strong>Methods: </strong>A 45-item survey on post-LT AUD treatment practices was distributed to members of the American Society of Transplant Surgeons, the Association of Consult/Liaison Psychiatry Transplant Special Interest Group, and both the American Society of Transplantation's Liver and Intestine Community of Practice and Psychosocial and Ethics Community of Practice discussion boards, between December 2021 and April 2022. Univariate analysis of categorical variables was performed using the chi-square test. Data were analyzed using center volume tertiles, country region, and provider professional activity.</p><p><strong>Results: </strong>Two hundred thirty-two respondents from 70 LT centers across all 11 United Network for Organ Sharing regions completed the survey. Half of the them were attending physicians and 16.4% were nurse coordinators. Most centers (84%) aimed for alcohol abstinence for all post-LT patients. Perceived barriers to AUD treatment efficacy included ongoing desire to drink (18%), denial about alcohol misuse (14.9%), and lack of posttransplant support (14%). Additionally, 62.1% of centers had no policy for prescribing medication-assisted therapy to treat AUD, and 32.7% of centers reported no center-level changes in AUD care. Providers identified primary needs as hiring additional mental health professionals (30.8%), dedicating specific staff to AUD care (24.7%), and standardizing psychiatric/psychological care in transplant clinics (17.2%).</p><p><strong>Conclusions: </strong>Despite the increasing volume of LT for alcohol-associated liver disease, significant perceived barriers to effective AUD treatment remain.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 4","pages":"e1766"},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11896101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617249","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 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}