Transplantation Direct最新文献

{"title":"Pediatric Liver and Kidney Transplant Recipients Demonstrate Greater Serological Response to SARS-CoV-2 Vaccination Than Adults.","authors":"Tobias Laue, Maria Pilar Ballester, Lily Meoli, Carl Grabitz, Eva Uson, Lorenzo D Antiga, Valerie McLin, Montserrat Pujadas, Ângela Carvalho-Gomes, Ivan Sahuco, Ariadna Bono, Federico D'Amico, Raffaela Viganò, Elena Diago, Beatriz Tormo Lanseros, Elvira Inglese, Dani Martinez Vazquez, Annelotte Broekhoven, Marjolein Kikkert, Shessy P Torres Morales, Sebenzile K Myeni, Mar Riveiro-Barciela, Adriana Palom, Nicola Zeni, Alessandra Brocca, Annarosa Cussigh, Sara Cmet, Maria Desamparados Escudero-García, Matteo Stocco, Leonardo Antonio Natola, Donatella Ieluzzi, Veronica Paon, Angelo Sangiovanni, Elisa Farina, Clara Dibenedetto, Yolanda Sánchez-Torrijos, Ana Lucena-Varela, Eva Román, Elisabet Sánchez, Rubén Sánchez-Aldehuelo, Julia López-Cardona, Dhaarica Jeyanesan, Alejandro Esquivel Morocho, Itzel Canas-Perez, Christine Eastgate, Simone Di Cola, Lucia Lapenna, Giacomo Zaccherini, Deborah Bongiovanni, Antonio Riva, Rajni Sharma, Hio Lam Phoebe Tsou, Nicola Harris, Paola Zanaga, Katia Sayaf, Sabir Hossain, Javier Crespo, Mercedes Robles-Díaz, Antonio Madejón, Helena Degroote, Marko Korenjak, Xavier Verhelst, Javier García-Samaniego, Raúl J Andrade, Paula Iruzubieta, Gavin Wright, Paolo Caraceni, Manuela Merli, Vishal C Patel, Amir Gander, Agustín Albillos, Germán Soriano, Maria Francesca Donato, David Sacerdoti, Pierluigi Toniutto, Maria Buti, Christophe Duvoux, Paolo Antonio Grossi, Thomas Berg, Wojciech G Polak, Massimo Puoti, Anna Bosch-Comas, Luca S Belli, Patrizia Burra, Francesco Paolo Russo, Minneke Coenraad, José Luis Calleja, Giovanni Perricone, Shilpa Chokshi, Marina Berenguer, Joan Clària, Richard Moreau, Javier Fernández, Vicente Arroyo, Paolo Angeli, Cristina Sánchez-Garrido, Javier Ampuero, Salvatore Piano, Emanuele Nicastro, Nathalie Rock, Debbie Shawcross, Lindsey Edwards, Frauke Mutschler, Anette Melk, Gautam Mehta, Ulrich Baumann, Rajiv Jalan","doi":"10.1097/TXD.0000000000001787","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001787","url":null,"abstract":"<p><strong>Background: </strong>Adult solid organ transplant recipients (SOTRs) have decreased responsiveness to severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) vaccination and higher incidence of infection, but there are few data on the serological response in pediatric SOTR. The aim of this study was to determine serological response to SARS-CoV-2 vaccination in pediatric liver (LT) and kidney transplant (KT) recipients and compare it with adult SOTR.</p><p><strong>Methods: </strong>A European, prospective, multicenter study was performed. Samples were taken at 7 and 32 wk following COVID-19 vaccination and serological endpoints were measured by ELISA.</p><p><strong>Results: </strong>A total of 42 pediatric (16 post-LT and 26 post-KT) and 117 adult (all post-LT) were included. All pediatric participants and 94% adult participants received mRNA vaccines. Paediatric SOTR patients had significantly higher anti-Spike IgG levels than adult participants at week 7 (114 220.7 [59 285.92-220 058.55] versus 8756.7 [5643.69-13 586.71], <i>P</i> < 0.0001) and week 32 (46 113.2 [10 992.91-193 436.14] versus 8207.0 [3561.20-18 913.43], <i>P</i> = 0.0032). No significant difference in week 7 anti-Spike IgG response was found between pediatric LT and KT (129 434.4 [51 888.64-322 869.69] versus 105 304.5 [39 910.20-277 849.50], <i>P</i> = 0.9854). No differences were seen between children and adults in the rate of decline of anti-Spike IgG between weeks 7 and 32 (<i>P</i> = 0.8000). Male sex and hemolytic-uremic syndrome or postischemic kidney disease were associated with lower anti-Spike IgG levels at week 7 in pediatric SOTR.</p><p><strong>Conclusions: </strong>Paediatric SOTR demonstrate greater SARS-CoV-2 vaccine responses than comparable adult SOTR patients. These data support efficacy and safety of SARS-CoV-2 vaccination in child SOTR and may alleviate vaccine hesitancy in this patient group.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1787"},"PeriodicalIF":1.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055233","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":"Radial Forearm Free Flap: A Modified Technique for Procurement as a Sentinel Skin Flap.","authors":"Floris P C Kroezen, Sanne Molenkamp, Marijn A Huijing, Robert A Pol, Llewellyn Thomas, Leela Sayed, Paul M N Werker, Henk Giele","doi":"10.1097/TXD.0000000000001798","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001798","url":null,"abstract":"<p><strong>Background: </strong>Organ rejection after solid organ transplantation remains a major challenge. The sentinel skin flap (SSF), a vascularized skin flap procured from the donor and transplanted alongside solid organs, has shown promise for early detection of rejection. The radial forearm free flap (RFFF) has a long history of use in reconstructive surgery and offers distinct advantages as SSF in organ donation procedures (ODPs). Until now, the SSF has been procured using the traditional RFFF way. However, an easier, quicker, and safer way is beneficial for logistical and financial reasons. This study presents a modified RFFF procurement technique for ODPs that is simple, quick, and reproducible and can be executed by surgeons who are not familiar with the original RFFF.</p><p><strong>Methods: </strong>The traditional RFFF procurement technique was modified using deceased donor models, leading to the development of an SSF technique tailored for application during ODPs.</p><p><strong>Results: </strong>A modified technique was developed and presented, enabling SSF procurement to be completed within 40 min. During the procedure, the donor's arm was positioned above the head or at a 90-degree angle, allowing the creation of a sterile field without interfering with the anesthesiology or organ procurement team. Donor-site closure was achieved using running sutures, ensuring an optimal cosmetic outcome.</p><p><strong>Conclusions: </strong>We present a modified RFFF procurement technique, designed to obtain an SSF during ODPs, that we believe can also be executed by surgeons not familiar with this flap, ensuring that the procedure does not interfere with or impede the organ procurement procedure.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1798"},"PeriodicalIF":1.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12037097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062158","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":"Kidney Delayed Graft Function in Simultaneous Pancreas-Kidney Transplant Recipients Is Associated With Inferior Outcomes.","authors":"Sofia Nehring Firmino, Ekaterina Fedorova, Eman A Alshaikh, Dixon Kaufman, Jon Odorico, Didier Mandelbrot, Brad C Astor, Sandesh Parajuli","doi":"10.1097/TXD.0000000000001797","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001797","url":null,"abstract":"<p><strong>Background: </strong>Kidney delayed graft function (K-DGF) is associated with worse outcomes in simultaneous pancreas-kidney (SPK) recipients. However, its potential association with specific infections, rejection, and early complications remains unclear.</p><p><strong>Methods: </strong>We compared recipients with K-DGF to those without K-DGF among all adult SPK recipients transplanted at our center between January 2000 and December 2022 who had >2 wk of pancreas graft survival. Outcomes of interest included common posttransplant infections, including urinary tract infection (UTI), pneumonia, cytomegalovirus, BK, surgical wound infection, infected intra-abdominal fluid collection, graft rejection, and death-censored graft failure (DCGF) within the first year of transplant. We also looked for the need for early laparotomy within 90 d.</p><p><strong>Results: </strong>Seven hundred sixty-five SPK recipients were included, of whom 85 (11.1%) developed K-DGF. In Cox regression analysis, after adjustment for multiple key variables, K-DGF was associated/related with increased risk for UTI (adjusted hazard ratio [aHR], 1.76; 95% confidence interval [CI], 1.06-0.94; <i>P</i> = 0.03), infected intra-abdominal fluid collection (aHR, 2.14; 95% CI, 1.13-4.04; <i>P</i> = 0.02), and need for relaparotomy within 90 d (aHR, 2.07; 95% CI, 1.27-3.37; <i>P</i> = 0.003). K-DGF was also associated with increased risk for pancreas DCGF (aHR, 4.88; 95% CI, 1.90-12.51; <i>P</i> < 0.001). K-DGF was not associated with risk for other common infections of interest or graft rejection.</p><p><strong>Conclusions: </strong>K-DGF among SPK recipients is associated with an increased risk of UTI, infected intra-abdominal fluid collection, and the need for early relaparotomy, along with pancreas DCGF. Close monitoring and appropriate management are warranted in this higher-risk patient population.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1797"},"PeriodicalIF":1.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028717","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":"Incidental Cold Agglutinins in Lung Transplant Recipients.","authors":"Isabelle Moneke, Axel Semmelmann, David Schibilsky, Torsten Loop, Elke Weinig, Ömer Senbaklavaci, Johannes Kalbhenn, Florian Emmerich","doi":"10.1097/TXD.0000000000001795","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001795","url":null,"abstract":"<p><strong>Background: </strong>The relevance of cold agglutinins in lung transplantation (LTx) recipients is unclear. While there is typically no intentionally induced hypothermia, the cold preservation of organs could potentially lead to microvascular injury and vascular occlusion after implantation and reperfusion in the presence of cold agglutinins. This study aims to analyze the impact of cold agglutinins in lung transplant recipients on short- and long-term outcomes after LTx.</p><p><strong>Methods: </strong>We retrospectively analyzed the medical records of 251 patients who underwent LTx at our institution between March 2003 and June 2023. One hundred seventy-three patients were included in the study. Statistical analysis was performed using SPSS and GraphPad software.</p><p><strong>Results: </strong>One hundred seventy-three of 251 (69%) of the lung transplant recipients were tested for cold agglutinins, which were positive in 78 of 173 (45%) patients. Most had a temperature amplitude of 4 °C; a broader temperature amplitude was detected in 9 of 78 (12%) patients. While there was no effect on overall long-term survival, cold agglutinins were associated with an increased incidence of reperfusion edema (<i>P</i> = 0.0002), severe primary graft dysfunction grade 2/3 (PGD2/3; <i>P</i> = 0.001), and early postoperative thromboembolism (<i>P</i> = 0.04). Multivariate analysis revealed PGD2/3 and thromboembolism as independent predictors of reduced long-term survival (<i>P</i> = 0.003 and <i>P</i> = 0.003, respectively). Plasmapheresis shortly before LTx in selected patients with a high cold agglutinin titer and broad temperature amplitude removed the cold agglutinins for at least 2 mo with good patient outcomes.</p><p><strong>Conclusions: </strong>Cold agglutinins are associated with an increased incidence of reperfusion edema, PGD2/3, and early postoperative thromboembolism after LTx. Further studies are warranted to evaluate the benefits of regular screening.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1795"},"PeriodicalIF":1.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999231","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 Kidney Graft Long-term Outcome With Recipient Cystathionine Gamma-lyase Polymorphisms and Hydrogen Sulfide Levels: A Cohort Study.","authors":"Matthieu Halfon, Raffaella Emsley, Thomas Agius, Arnaud Lyon, Sébastien Déglise, Manuel Pascual, Korkut Uygun, Heidi Yeh, Leonardo V Riella, James F Markmann, Pierre-Yves Bochud, Dela Golshayan, Alban Longchamp","doi":"10.1097/TXD.0000000000001779","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001779","url":null,"abstract":"<p><strong>Background: </strong>Hydrogen sulfide (H₂S) produced endogenously by the <i>CTH</i> gene-encoded cystathionine gamma-lyase protects from renal ischemia-reperfusion injury in preclinical models. Here, we hypothesized that <i>CTH</i> gene polymorphisms (single nucleotide polymorphism [SNP]) and recipient H₂S serum levels influence kidney graft outcomes after transplantation.</p><p><strong>Methods: </strong>We included all consecutive recipients of a first kidney transplant in the Swiss Transplant Cohort Study and with available genotyping. In addition, 192 deceased-donor kidney transplant recipients were randomly selected to measure baseline serum H₂S levels. The primary endpoint was graft loss during follow-up.</p><p><strong>Results: </strong><i>CTH</i> SNPs were identified in up to 50% of the patients. During median follow-up (6.4 y, interquartile range: 3.9-9.8), graft loss was observed in 247 (9.8%) of 2518 patients. The incidence of graft loss was associated with the presence or absence of <i>CTH</i> SNPs. Specifically, rs672203 and rs10458561, increased the risk of graft loss (hazard ratio [HR]: 1.36, 95% confidence interval [CI]: 1.04-1.78, <i>P</i> = 0.02; and HR: 1.29, 95% CI: 1.0-1.66, <i>P</i> = 0.05; respectively), whereas rs113285275 was protective (HR: 0.78, 95% CI: 0.6-1.01, <i>P</i> = 0.05). Interestingly, rs672203 was associated with an increased risk of acute rejection (<i>P</i> = 0.05), whereas rs113285275 was associated with a lower risk of acute rejection (<i>P</i> = 0.01). Finally, in patients with delayed graft function, serum H₂S levels correlated with lower graft dysfunction (defined as estimated glomerular filtration rate <30 mL/min/1.73 m²) (<i>P</i> = 0.05).</p><p><strong>Conclusions: </strong>Graft outcome after kidney transplantation was associated with <i>CTH</i> genotype and, to some extent, H₂S serum levels. Further research is needed to define the underlying protective mechanisms.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1779"},"PeriodicalIF":1.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039424","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":"Challenges and Solutions for Transplantation in Northeast India: Proceedings of the National Organ and Tissue Organization Session at the India Society of Organ Transplantation 2023 Meeting in Kolkata.","authors":"Vivek B Kute, Anil Kumar, Awadhesh Kumar Yadav, Shiny Suman Pradhan, Sumana Arora, Avinash Sunthlia, Indakiewlin Kharbuli, Guliver Potsangbam, Manjuri Sharma, Malsawmkima Chhakchhuak, Samaresh Paul, Sourabh Sharma, Abhisek Gautam, Manong Chohwanglim, Naloh Mibang, Vishal Golay, Arpita Ray Chaudhury, Manish Balwani, Aneesh Srivastava, Georgi Abraham, Hari Shankar Meshram, Pranjal Modi, Anup Kumar Barman, Atul Goel","doi":"10.1097/TXD.0000000000001786","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001786","url":null,"abstract":"<p><strong>Background: </strong>India is the third highest in terms of the total number of organ transplants in a year worldwide mainly based on living donor transplants. The number of deceased donor transplants has been limited in India ranking only at the 68th position of 94 countries that reported data to Global Observatory on Organ Donation and Transplantation during the year 2022.</p><p><strong>Methods: </strong>Representatives of National Organ and Tissue Transplant Organisation in addition to local transplant experts from Northeast India and Indian Society of Organ Transplantation discussed challenges and potential solutions for organ transplantation in Northeast India at the National Organ and Tissue Transplant Organisation session during the India Society of Organ Transplantation 2023 annual conference held at Kolkata.</p><p><strong>Results: </strong>Here, we summarize deliberations on the opportunities for the care of patients with end-stage-organ failure in India with a focus on the Northeast part of the country. States in the Northeast face many problems for establishing organ transplant programs including but not limited to difficult terrain, lack of skilled healthcare providers (qualified doctors, nursing staff, and technicians) needed for dialysis and organ transplants, financial constraints, administrative issues, limited infrastructure in both government and private hospitals and, in addition, history of lacking support by professional societies. Discussions focused on establishing organ retrieval centers, minimal criteria for starting an organ transplant center, guidelines on how to start a new State Organ and Tissue Transplant Organization, establishing retrieval and transplant centers with support from National Organ Transplant Program, recent reforms in organ donation and transplantation, in addition to overcoming medical, surgical, immunological, administrative, sociocultural, geographic/regional challenges for organ transplantation in Northeast India.</p><p><strong>Conclusions: </strong>Overall, deliberations aimed at providing a basis for policy makers to start and expand organ transplantation in low and low- to-middle income and infrastructurally poor states.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1786"},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024849","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":"Elderly Ages in Liver Transplantation: Are Older Donors Really Higher Risk?","authors":"Sangeeta Satish, Chase J Wehrle, Mingyi Zhang, Mazhar Khalil, Chunbao Jiao, Keyue Sun, Jiro Kusakabe, Antonio D Pinna, Masato Fujiki, Charles Miller, Koji Hashimoto, Andrea Schlegel","doi":"10.1097/TXD.0000000000001789","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001789","url":null,"abstract":"<p><strong>Background: </strong>There is currently a supply and demand mismatch in liver transplantation, with more patients needing transplants than grafts available. The use of older donors is one potential way of expanding access to viable grafts. No national study has yet reported on outcomes of liver transplants with donors ≥70 y.</p><p><strong>Methods: </strong>The US Scientific Registry of Transplant Recipients registry was queried for deceased donor LT (1988-2021). Balance-of-risk (BAR) score was calculated for each patient. The primary outcome was graft survival. Cubic spline curves were used to evaluate the full spectrum of donor ages.</p><p><strong>Results: </strong>A total of 148 960 livers met inclusion criteria: 5414 (3.6%) from donors ≥70 y and 4291 (2.9%) recipients ≥70 y. Within the overall cohort, graft survival decreased with increased donor and recipient age. Median graft survival within donors ≥70 y improved over time from 2.2 y (interquartile range [IQR] 0.2-9.8 y) in 1987-1999 to 9.6 y (IQR 3.2-11.6 y) in 2010-2019 (<i>P</i> < 0.0001). Elderly donors had equivalent outcomes to donors <70 y when transplanted in elderly recipients (≥70 y). Outcomes for young recipients that received grafts from elderly donor improved with time, with median survival of 10.1 y (IQR 3.9-11.5 y) in 2010-2019. BAR and survival outcomes following liver transplant (SOFT) scores predicted improved graft survival on time-to-event analysis in all donors aged >70 y. In low-risk recipients, evidenced by preallocation SOFT score <5, elderly donors had comparable outcomes to young (<40 y) and middle-aged donors (40-69 y). Increasing donor age was not associated with worse graft survival in transplants performed between 2010 and 2019.</p><p><strong>Conclusions: </strong>Donors aged ≥70 y may be more comfortably considered for deceased donor liver transplantation, especially within low-risk recipients. The BAR and SOFT scores may be a useful guide for safely expanding the use of these theoretically riskier liver grafts.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1789"},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000873","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 Gastroparesis on Outcomes After Pancreas Transplantation.","authors":"Jonathan A Fridell, Jeanne M Chen, Emily A Kerby, William A Marshall, Andrew J Lutz, John A Powelson, Richard S Mangus","doi":"10.1097/TXD.0000000000001788","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001788","url":null,"abstract":"<p><strong>Background: </strong>Gastroparesis (GP) is a chronic disorder of the stomach characterized by delayed gastric emptying and frequently associated with longstanding diabetes. This is a single-center retrospective analysis designed to establish the prevalence and assess the impact on posttransplant outcomes of GP among pancreas transplant recipients.</p><p><strong>Methods: </strong>Medical records for all recipients of pancreas transplants performed between January 2003 and December 2023 were reviewed. GP was defined by abnormal gastric-emptying scintigraphy or other motility study or a history of symptoms. Primary outcomes included graft loss and patient death. Clinical outcomes included length of stay after transplant and readmissions, including specifically for GP symptoms.</p><p><strong>Results: </strong>Of 731 recipients, 156 (21%) were diagnosed with GP before transplant. Patients with GP were younger and more likely to be female individuals. Posttransplant, there was no difference in length of stay, graft survival, or patient survival. Patients with GP were more likely to be readmitted and to be specifically admitted for GP symptoms. Requirement for interventions was more common in patients with GP.</p><p><strong>Conclusions: </strong>GP is identified with increased frequency among the specific patient population referred for pancreas transplant, and although it does not seem to affect allograft or patient survival, it does seem to have an impact on readmissions and the need for interventions.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1788"},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000426","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":"Recipient 3-Hepatic Vein Technique with Graft Venoplasty to Maximize Venous Outflow in Left Lobe Living Donor Liver Transplantation.","authors":"Yuki Miyazaki, Masato Fujiki, Munkhbold Tuul, Mazhar Khalil, Alejandro Pita, Jaekeun Kim, Andrea Schlegel, Choon H D Kwon, Federico Aucejo, Antonio D Pinna, Charles Miller, Koji Hashimoto","doi":"10.1097/TXD.0000000000001778","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001778","url":null,"abstract":"<p><strong>Background: </strong>Augmentation of hepatic venous outflow is crucial in living donor liver transplantation (LDLT) to maximize functional graft size and prevent venous complications. We present details of our outflow augmentation technique for left lobe grafts (LLG) in adult LDLTs, which uses all recipient 3 hepatic veins and venoplasty of graft left and middle hepatic veins. This study examines the effectiveness of our technique in preventing outflow complications and the correlation between anatomical variations of the graft hepatic veins and surgical outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed 88 patients who underwent LLG-LDLT between 2012 and 2023. The patients were classified into 3 groups based on the graft hepatic vein anatomy and usage of venoplasty: group 1 (n = 10, common trunk without venoplasty), group 2 (n = 62, common trunk with venoplasty), and group 3 (n = 16, no common trunk with venoplasty).</p><p><strong>Results: </strong>No patient developed clinically significant venous outflow complications or graft loss related to venous outflow. There were no significant differences in complication rates or ascites production among the groups. Five-year graft survival was comparable among the groups (<i>P</i> = 0.43). Multiple regression analysis revealed that the model for end-stage liver disease score was the only independent risk factor for increased ascites after transplant (standardized beta, 0.546; <i>t</i> value,4.20; <i>P</i> < 0.001; 95% confidence interval, 0.287-0.804), but anatomical variations of the graft hepatic veins did not influence ascites output.</p><p><strong>Conclusions: </strong>The recipient 3 hepatic vein outflow augmentation technique with graft venoplasty can be applied to various graft hepatic venous anatomy and effectively prevents outflow-related graft loss in LLG-LDLT.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1778"},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011773","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 Evaluation of Prospective Living Kidney Donors in Qatar: A Profile of Prospective Donors, Process, and Outcomes.","authors":"Riadh A S Fadhil, Asma Al Abdulghani, Majid Alabdulla, Nighat A Ajmal, Nicoleta R Stanciu, Sabera I Baqi, Pratibha Ratheesh, Dominique E Martin","doi":"10.1097/TXD.0000000000001785","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001785","url":null,"abstract":"<p><strong>Background: </strong>In Qatar, the Committee for Oversight of Living Donation (COLD) was established at Hamad Medical Corporation in 2014 to provide standardized, multidisciplinary psychosocial evaluation (PE) for prospective living kidney donors (PLKDs) and ensure appropriate care throughout evaluation, donation, and postdonation follow-up, consistent with legal and ethical standards. We describe the COLD protocol and report PE outcomes of PLKDs in Qatar.</p><p><strong>Methods: </strong>A retrospective observational cross-sectional study was conducted using case file data of PLKDs assessed at Hamad Medical Corporation between August 2014 and December 2022. Descriptive statistics analyzed demographics and outcomes of COLD evaluation.</p><p><strong>Results: </strong>Eight hundred ninety-eight PLKDs (54% men) were enlisted for 545 transplant candidates. Four hundred forty-seven PLKDs (49.8%) were Qatari; the remainder were noncitizen residents representing 43 nationalities. Most 680 PLKDs (76%) claimed a genetic relationship with recipients; 20% were emotionally related and 4.34% were unrelated. Of those who proceeded with evaluation, 88% (n = 788) were accepted, 7.5% were declined, and 4.8% dropped out. Of those who were declined (n = 67), 81% were noncitizen residents; 42% claimed an emotional relationship with the intended recipient, whereas 34% were unrelated and 24% were genetically related. The main reasons for declining a PLKD were insufficient socioeconomic support, psychological unfitness, and coercion by employers or family.</p><p><strong>Conclusions: </strong>Standardized structured PE has been effective in identifying and addressing risk factors across various PLKD demographics in Qatar. This study highlights the importance of comprehensive evaluation for all PLKDs, regardless of nationality or relationships with recipients. The COLD protocol could serve as a valuable tool for PE of PLKDs in other countries.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1785"},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11984761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035994","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}