Transplantation Direct最新文献

{"title":"A Clinical Model to Predict the Occurrence of Select High-risk Infections in the First Year Following Heart Transplantation.","authors":"Whitney A Perry, Jennifer K Chow, Jason Nelson, David M Kent, David R Snydman","doi":"10.1097/TXD.0000000000001542","DOIUrl":"10.1097/TXD.0000000000001542","url":null,"abstract":"<p><strong>Background: </strong>Invasive infection remains a dangerous complication of heart transplantation (HT). No objectively defined set of clinical risk factors has been established to reliably predict infection in HT. The aim of this study was to develop a clinical prediction model for use at 1 mo post-HT to predict serious infection by 1 y.</p><p><strong>Methods: </strong>A retrospective cohort study of HT recipients (2000-2018) was performed. The composite endpoint included cytomegalovirus (CMV), herpes simplex or varicella zoster virus infection, blood stream infection, invasive fungal, or nocardial infection occurring 1 mo to 1 y post-HT. A least absolute shrinkage and selection operator regression model was constructed using 10 candidate variables. A concordance statistic, calibration curve, and mean calibration error were calculated. A scoring system was derived for ease of clinical application.</p><p><strong>Results: </strong>Three hundred seventy-five patients were analyzed; 93 patients experienced an outcome event. All variables remained in the final model: aged 55 y or above, history of diabetes, need for renal replacement therapy in first month, CMV risk derived from donor and recipient serology, use of induction and/or early lymphodepleting therapy in the first month, use of trimethoprim-sulfamethoxazole prophylaxis at 1 mo, lymphocyte count under 0.75 × 10³cells/µL at 1 mo, and inpatient status at 1 mo. Good discrimination (C-index 0.80) and calibration (mean absolute calibration error 3.6%) were demonstrated.</p><p><strong>Conclusion: </strong>This model synthesizes multiple highly relevant clinical parameters, available at 1 mo post-HT, into a unified, objective, and clinically useful prediction tool for occurrence of serious infection by 1 y post-HT.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 12","pages":"e1542"},"PeriodicalIF":2.3,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486493","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":"Evolving Trends in Kidney Transplant Outcomes Among Older Adults: A Comparative Analysis Before and During the COVID-19 Pandemic.","authors":"Yiting Li, Gayathri Menon, Wenbo Wu, Amrusha Musunuru, Yusi Chen, Evelien E Quint, Maya N Clark-Cutaia, Laura B Zeiser, Dorry L Segev, Mara A McAdams-DeMarco","doi":"10.1097/TXD.0000000000001520","DOIUrl":"10.1097/TXD.0000000000001520","url":null,"abstract":"<p><strong>Background: </strong>Advancements in medical technology, healthcare delivery, and organ allocation resulted in improved patient/graft survival for older (age ≥65) kidney transplant (KT) recipients. However, the recent trends in these post-KT outcomes are uncertain in light of the mounting burden of cardiovascular disease, changing kidney allocation policies, heterogeneity in candidates' risk profile, and the coronavirus disease 2019 pandemic. Thus, we examined secular trends in post-KT outcomes among older and younger KT recipients over the last 3 decades.</p><p><strong>Methods: </strong>We identified 73 078 older and 378 800 younger adult (aged 18-64) recipients using Scientific Registry of Transplant Recipients (1990-2022). KTs were grouped into 6 prepandemic eras and 1 postpandemic-onset era. Kaplan-Meier and Cox proportional hazards models were used to examine temporal trends in post-KT mortality and death-censored graft failure.</p><p><strong>Results: </strong>From 1990 to 2022, a 19-fold increase in the proportion of older KT recipients was observed compared to a 2-fold increase in younger adults despite a slight decline in the absolute number of older recipients in 2020. The mortality risk for older recipients between 2015 and March 14, 2020, was 39% (adjusted hazard ratio [aHR] = 0.61, 95% confidence interval [CI], 0.50-0.75) lower compared to 1990-1994, whereas that for younger adults was 47% lower (aHR = 0.53, 95% CI, 0.48-0.59). However, mortality risk during the pandemic was 25% lower (aHR = 0.75, 95% CI, 0.61-0.93) in older adults and 37% lower in younger adults (aHR = 0.63, 95% CI, 0.56-0.70) relative to 1990-1994. For both populations, the risk of graft failure declined over time and was unaffected during the pandemic relative to the preceding period.</p><p><strong>Conclusions: </strong>The steady improvements in 5-y mortality and graft survival were disrupted during the pandemic, particularly among older adults. Specifically, mortality among older adults reflected rates seen 20 y prior.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 12","pages":"e1520"},"PeriodicalIF":2.3,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486503","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":"Sodium Hydrosulfide Treatment During Porcine Kidney Ex Vivo Perfusion and Transplantation.","authors":"Thomas Agius,&nbsp;Julien Songeon,&nbsp;Arnaud Lyon,&nbsp;Justine Longchamp,&nbsp;Raphael Ruttimann,&nbsp;Florent Allagnat,&nbsp;Sébastien Déglise,&nbsp;Jean-Marc Corpataux,&nbsp;Déla Golshayan,&nbsp;Léo Buhler,&nbsp;Raphael Meier,&nbsp;Heidi Yeh,&nbsp;James F Markmann,&nbsp;Korkut Uygun,&nbsp;Christian Toso,&nbsp;Antoine Klauser,&nbsp;Francois Lazeyras,&nbsp;Alban Longchamp","doi":"10.1097/TXD.0000000000001508","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001508","url":null,"abstract":"<p><strong>Background: </strong>In rodents, hydrogen sulfide (H₂S) reduces ischemia-reperfusion injury and improves renal graft function after transplantation. Here, we hypothesized that the benefits of H₂S are conserved in pigs, a more clinically relevant model.</p><p><strong>Methods: </strong>Adult porcine kidneys retrieved immediately or after 60 min of warm ischemia (WI) were exposed to 100 µM sodium hydrosulfide (NaHS) (1) during the hypothermic ex vivo perfusion only, (2) during WI only, and (3) during both WI and ex vivo perfusion. Kidney perfusion was evaluated with dynamic contrast-enhanced MRI. MRI spectroscopy was further employed to assess energy metabolites including ATP. Renal biopsies were collected at various time points for histopathological analysis.</p><p><strong>Results: </strong>Perfusion for 4 h pig kidneys with Belzer MPS UW + NaHS resulted in similar renal perfusion and ATP levels than perfusion with UW alone. Similarly, no difference was observed when NaHS was administered in the renal artery before ischemia. After autotransplantation, no improvement in histologic lesions or cortical/medullary kidney perfusion was observed upon H₂S administration. In addition, AMP and ATP levels were identical in both groups.</p><p><strong>Conclusions: </strong>In conclusion, treatment of porcine kidney grafts using NaHS did not result in a significant reduction of ischemia-reperfusion injury or improvement of kidney metabolism. Future studies will need to define the benefits of H₂S in human, possibly using other molecules as H₂S donors.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1508"},"PeriodicalIF":2.3,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427117","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":"Renal Transplantation in Patients With Tuberculosis: A Single-center Experience From an Endemic Region.","authors":"Ashwini B Gadde,&nbsp;Pranaw Kumar Jha,&nbsp;Shyam B Bansal,&nbsp;Abhyudaysingh Rana,&nbsp;Manish Jain,&nbsp;Dinesh Bansal,&nbsp;Dinesh Kumar Yadav,&nbsp;Amit Kumar Mahapatra,&nbsp;Sidharth Kumar Sethi,&nbsp;Vijay Kher","doi":"10.1097/TXD.0000000000001541","DOIUrl":"10.1097/TXD.0000000000001541","url":null,"abstract":"<p><strong>Background: </strong>Despite being a common infection in end-stage kidney disease patients, there are no evidence-based guidelines to suggest the ideal time of transplantation in patients on antitubercular therapy (ATT). This study aimed to examine the outcome of transplantation in patients while on ATT compared with those without tuberculosis (TB).</p><p><strong>Methods: </strong>This was a retrospective study. Renal transplant recipients transplanted while on ATT were compared with a 1:1 matched group (for age, sex, diabetic status, and type of induction agent) of patients without TB at the time of transplant. Patient outcomes included relapse of TB and graft and patient survival.</p><p><strong>Results: </strong>There were 71 patients in each group. The mean duration for which ATT was given pretransplant was 3.8 ± 2.47 mo. The average total duration of ATT received was 12.27 ± 1.25 mo. Mortality in both the groups was similar (8.4% in the TB group versus 4.5% in the non-TB group; <i>P</i> = 0.49). None of the surviving patients had recurrence of TB during the follow-up. Death-censored graft survival (98.5% in the TB group versus 97% in the non-TB group; <i>P</i> = 1) and biopsy-proven acute rejection rates (9.86% in the TB group versus 8.45% in the non-TB group; <i>P</i> = 1) were also similar in both the groups.</p><p><strong>Conclusions: </strong>Successful transplantation in patients with end-stage kidney disease on ATT is possible without any deleterious effect on patient and graft survival and no risk of disease recurrence. Multicentric prospective studies are needed.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1541"},"PeriodicalIF":2.3,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427116","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":"Idiopathic Ileal Ulceration After Intestinal Transplantation.","authors":"Elsadig Hussan,&nbsp;Alexander Kroemer,&nbsp;Ahmed M Elsabbagh,&nbsp;Khalid M Khan,&nbsp;Nada A Yazigi,&nbsp;Udeme D Ekong,&nbsp;Sukanya Subramanian,&nbsp;Shahira S Ghobrial,&nbsp;Juan-Francisco Guerra,&nbsp;Thomas M Fishbein,&nbsp;Cal S Matsumoto,&nbsp;Stuart S Kaufman","doi":"10.1097/TXD.0000000000001529","DOIUrl":"10.1097/TXD.0000000000001529","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic ileal ulceration after intestinal transplantation (ITx) has been discussed infrequently and has an uncertain natural history and relation to graft rejection. Herein, we review our experience with this pathology.</p><p><strong>Methods: </strong>We retrospectively reviewed 225 ITx in 217 patients with minimum 1 y graft survival. Routine graft endoscopy was conducted up to twice weekly within the first 90 d after ITx, gradually decreasing to once yearly. Risks for ulceration over time were evaluated using Cox regression.</p><p><strong>Results: </strong>Of 93 (41%) patients with ulcers, 50 were found within 90 d after ITx mostly via ileoscopy; delayed healing after biopsy appeared causal in the majority. Of the remaining 43 patients with ulcers found >90 d after ITx, 36 were after ileostomy closure. Multivariable modeling demonstrated within 90-d ulcer associations with increasing patient age (hazard ratio [HR], 1.027; <i>P</i> < 0.001) and loop ileostomy (versus Santulli ileostomy; HR, 0.271; <i>P</i> < 0.001). For ulcers appearing after ileostomy closure, their sole association was with absence of graft colon (HR, 7.232; <i>P</i> < 0.001). For ulcers requiring extended anti-microbial and anti-inflammatory therapy, associations included de novo donor-specific antibodies (HR, 3.222; <i>P</i> < 0.007) and nucleotide oligomerization domain mutations (HR, 2.772; <i>P</i> < 0.016). Whole-cohort post-ITx ulceration was not associated with either graft rejection (<i>P</i> = 0.161) or graft failure (<i>P</i> = 0.410).</p><p><strong>Conclusions: </strong>Idiopathic ulceration after ITx is relatively common but has little independent influence on outcome; risks include ileostomy construction, colon-free ITx, immunologic mutation, and donor sensitization.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1529"},"PeriodicalIF":2.3,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10602531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414011","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":"Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation.","authors":"José Sampaio-Neto,&nbsp;João E L Nicoluzzi,&nbsp;Larissa Luvison Gomes da Silva,&nbsp;Leandro Billó,&nbsp;Antônio de Pádua Peppe-Neto,&nbsp;Luíza Dall Asta,&nbsp;Thyago P de Moraes,&nbsp;Gabrielle R Fragoso","doi":"10.1097/TXD.0000000000001540","DOIUrl":"10.1097/TXD.0000000000001540","url":null,"abstract":"<p><strong>Background: </strong>The main challenge of liver transplantation is the discrepancy in demand and availability. Marginal grafts or full organs from donors with expansion criteria have been considered to reduce the shortage and assist a greater number of patients. Nonalcoholic fatty liver disease (NAFLD) is one of the most important defining criteria for expanded criteria organs. The present study proposes that an organized visual analysis method could correctly identify and classify NAFLD and organ viability without the need for liver biopsy and its logistical concerns.</p><p><strong>Methods: </strong>Pictures from the grafts were taken at a standardized method (same distance, light conditions, and register device) before and after the perfusion. The visual liver score (VLS) was applied by transplant surgeons; biopsies of the grafts were analyzed by a pathologist in a double-blind design. Score performance and interobserver agreement for NAFLD detection and grading, as graft viability evaluation, were calculated.</p><p><strong>Results: </strong>Fifty-seven grafts were analyzed. At least 1 previous expansion criterion was presented by 59.64% of donors. The prevalence of NAFLD was 94.73%, with 31.57% borderline nonalcoholic steatohepatitis and 5.26% nonalcoholic steatohepatitis. Steatosis was identified with 48.68% (preperfusion) and 64.03% (postperfusion) accuracy. NAFLD stratification was performed with 49.53% (preperfusion) and 46.29% (postperfusion) accuracy. Viability related to NAFLD was identified with 51.96% (preperfusion) and 48.52% (postperfusion) accuracy. Interobserver agreement was moderate for total VLS and poor for individual components of VLS.</p><p><strong>Conclusions: </strong>Although a standardized method was not reliable enough for visual evaluation of NALFD compared with pathology, efforts should be made to expand access to biopsy. Further studies are needed to understand whether the VLS needs to be adapted or even excluded in the liver transplant scenario, to assess the importance of ectoscopy related to posttransplant clinical outcomes, and to determine its role in graft selection.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1540"},"PeriodicalIF":2.3,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10602502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414012","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":"Preserved 2-y Liver Transplant Outcomes Following Simultaneous Thoracoabdominal DCD Organ Procurement Despite Effects on Liver Utilization Rate.","authors":"Steven A Wisel, Justin A Steggerda, Carrie Thiessen, Garrett R Roll, Qiudong Chen, Jason Thomas, Bhupinder Kaur, Pedro Catarino, Joanna Chikwe, Irene K Kim","doi":"10.1097/TXD.0000000000001528","DOIUrl":"10.1097/TXD.0000000000001528","url":null,"abstract":"<p><strong>Background: </strong>Current techniques for donation after circulatory determination of death (DCD) heart procurement, through either direct procurement and machine perfusion or thoracoabdominal normothermic regional perfusion (NRP), have demonstrated excellent heart transplant outcomes. However, the impact of thoracoabdominal DCD (TA-DCD) heart procurement on liver allograft outcomes and utilization is poorly understood.</p><p><strong>Methods: </strong>One hundred sixty simultaneous heart and liver DCD donors were identified using the United Network for Organ Sharing/Organ Procurement and Transplantation Network database between December 2019 and July 2021. Liver outcomes from TA-DCD donors were stratified by heart procurement technique and evaluated for organ utilization, graft survival, and patient survival. Results were compared with abdominal-only DCD (A-DCD; n = 1332) and donation after brain death (DBD; n = 12 891) liver transplants during the study interval. Kaplan-Meier methods with log-rank testing were used to evaluate patient and graft survival.</p><p><strong>Results: </strong>One hundred thirty-three of 160 livers procured from TA-DCD donors proceeded to transplant. TA-DCD donors were younger (mean 28.26 y; <i>P</i> < 0.0001) with lower body mass index (mean 26.61; <i>P</i> < 0.0001) than A-DCD and DBD donors. TA-DCD livers had equivalent patient survival ( <i>P</i> = 0.893) and superior graft survival (<i>P</i> = 0.009) compared with A-DCD. TA-DCD livers had higher rates of organ discard for long warm ischemia time (37.0%) than A-DCD (20.5%) and DBD (0.5%; <i>P</i> < 0.0001), with direct procurement and machine perfusion procurements leading to a higher discard rate (18.5%) than NRP procurements (7.4%).</p><p><strong>Conclusions: </strong>Liver transplants after TA-DCD donation demonstrated equivalent patient outcomes and excellent graft outcomes. NRP procurements resulted in the lowest rate of organ discard after DCD donation and may represent an optimal strategy to maximize organ utilization.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1528"},"PeriodicalIF":2.3,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10593259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50158854","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":"Effects of Adding Congested Segment IV to the Left Lateral Graft on Short-term Outcomes in Pediatric Living-donor Liver-transplant Recipients.","authors":"Hikaru Aoki,&nbsp;Takashi Ito,&nbsp;Masaaki Hirata,&nbsp;Masashi Kadohisa,&nbsp;Miki Yamamoto,&nbsp;Elena Yukie Uebayashi,&nbsp;Hisaya Shirai,&nbsp;Shinya Okumura,&nbsp;Yuki Masano,&nbsp;Eri Ogawa,&nbsp;Tatsuya Okamoto,&nbsp;Hideaki Okajima,&nbsp;Etsuro Hatano","doi":"10.1097/TXD.0000000000001551","DOIUrl":"10.1097/TXD.0000000000001551","url":null,"abstract":"<p><strong>Background: </strong>In some pediatric patients undergoing living-donor liver transplantation, segment IV without the middle hepatic vein can be added to a left lateral segment graft to obtain larger graft volume. Because no clear consensus on this technique exists, this study investigated the effects of congested areas on postoperative outcomes in pediatric patients with biliary atresia undergoing living-donor liver transplantation.</p><p><strong>Methods: </strong>We retrospectively reviewed data of recipients with biliary atresia aged ≤15 y who had undergone living-donor liver transplantation at Kyoto University Hospital between 2006 and 2021 and with graft-to-recipient weight ratios (GRWR) of ≤2%. Based on the percentage of congested area in the graft, patients were classified into the noncongestion (n = 40; ≤10%) and congestion (n = 13; >10%) groups. To compare the differences between groups with similar nooncongestive GRWRs and investigate the effect of adding congested areas, patients in the noncongestion group with GRWRs of ≤1.5% were categorized into the small noncongestion group (n = 24).</p><p><strong>Results: </strong>GRWRs and backgrounds were similar between the noncongestion and congestion groups; however, patients in the congestion group demonstrated significantly longer prothrombin times, higher ascites volumes, and longer hospitalization. Further, compared with the small noncongestion group, the congestion group had significantly greater GRWR and similar noncongestive GRWR; however, the congestion group had significantly longer prothrombin time recovery (<i>P</i> = 0.020, postoperative d 14), higher volume of ascites (<i>P</i> < 0.05, consistently), and longer hospitalization (<i>P</i> = 0.045), requiring significantly higher albumin and gamma-globulin transfusion volumes than the small noncongestion group (<i>P</i> = 0.027 and <i>P</i> = 0.0083, respectively). Reoperation for wound dehiscence was significantly more frequent in the congestion group (<i>P</i> = 0.048).</p><p><strong>Conclusions: </strong>In pediatric liver-transplant recipients, adding a congested segment IV to the left lateral segment to obtain larger graft volume may negatively impact short-term postoperative outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1551"},"PeriodicalIF":2.3,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/de/txd-9-e1551.PMC10593261.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50158852","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":"Immune Features of Disparate Liver Transplant Outcomes in Female Hispanics With Nonalcoholic Steatohepatitis.","authors":"Rebecca A Sosa, Allyson Q Terry, Takahiro Ito, Bita V Naini, Ying Zheng, Harry Pickering, Jessica Nevarez-Mejia, Ronald W Busuttil, David W Gjertson, Jerzy W Kupiec-Weglinski, Elaine F Reed, Fady M Kaldas","doi":"10.1097/TXD.0000000000001550","DOIUrl":"10.1097/TXD.0000000000001550","url":null,"abstract":"<p><strong>Background: </strong>Nonalcoholic steatohepatitis (NASH) is a severe immune-mediated stage of nonalcoholic fatty liver disease that is rapidly becoming the most common etiology requiring liver transplantation (LT), with Hispanics bearing a disproportionate burden. This study aimed to uncover the underlying immune mechanisms of the disparities experienced by Hispanic patients undergoing LT for NASH.</p><p><strong>Methods: </strong>We enrolled 164 LT recipients in our institutional review board-approved study, 33 of whom presented with NASH as the primary etiology of LT (20%), with 16 self-reported as Hispanic (48%). We investigated the histopathology of prereperfusion and postreperfusion biopsies, clinical liver function tests, longitudinal soluble cytokines via 38-plex Luminex, and immune cell phenotypes generated by prereperfusion and postreperfusion blood using 14-color flow cytometry and enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Hispanic LT recipients transplanted for NASH were disproportionately female (81%) and disproportionately suffered poor outcomes in the first year posttransplant, including rejection (26%) and death (38%). Clinically, we observed increased pro-inflammatory and apoptotic histopathological features in biopsies, increased AST/international normalized ratio early posttransplantation, and a higher incidence of presensitization to mismatched HLA antigens expressed by the donor allograft. Experimental investigations revealed that blood from female Hispanic NASH patients showed significantly increased levels of leukocyte-attracting chemokines, innate-to-adaptive switching cytokines and growth factors, HMGB1 release, and TLR4/TLR8/TLR9/NOD1 activation, and produced a pro-inflammatory, pro-apoptotic macrophage phenotype with reduced CD14/CD68/CD66a/TIM-3 and increased CD16/CD11b/HLA-DR/CD80.</p><p><strong>Conclusions: </strong>A personalized approach to reducing immunological risk factors is urgently needed for this endotype in Hispanics with NASH requiring LT, particularly in females.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1550"},"PeriodicalIF":2.3,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2c/8c/txd-9-e1550.PMC10593264.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50158853","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":"Development of the Nova Scotia Potential Donor Audit (PDA) Tool and 2020 Historic Performance Database: Lessons Learned From the First 1000 Medical Record Reviews.","authors":"Kristina Krmpotic,&nbsp;Jade Dirk,&nbsp;Julien Gallant,&nbsp;Jennifer Hancock,&nbsp;Cynthia Isenor,&nbsp;Lee James,&nbsp;Alain Landry,&nbsp;Amy Laybolt,&nbsp;Karthik Tennankore,&nbsp;Matthew-John Weiss,&nbsp;Stephen Beed","doi":"10.1097/TXD.0000000000001545","DOIUrl":"10.1097/TXD.0000000000001545","url":null,"abstract":"<p><strong>Background: </strong>Legislation and accountability frameworks are key components of high-performing deceased-donation systems. In 2021, Nova Scotia (NS), Canada, became the first jurisdiction in North America to enact deemed consent legislation and concurrently implemented mandatory referral legislation similar to that found in other Canadian provinces. Frontline financial resources were provided by the government to support the development of program infrastructure, including implementation of means to evaluate system performance.</p><p><strong>Methods: </strong>The Organ Donation Program (ODP), in collaboration with other stakeholders, developed a Potential Donor Audit (PDA) tool and database for referral intake and manual performance audits. Medical record reviews of deaths in the year before legislative change were conducted to pilot and revise the PDA and evaluate missed donation opportunities.</p><p><strong>Results: </strong>The NS PDA was piloted on 1028 patient deaths. Of 518 patients (50.4%) who met clinical triggers for referral to the ODP, 72 (13.9%) were referred (86.1% missed referral rate). One hundred sixty-three patients met the NS definition of a potential donor; 53 (32.5%) were referred (110 missed potential donors). Referral consent rates reached 71.7% (n = 38 of 53 approaches). The actualized donation rate reported by Canadian Blood Services was 29.9 donors per million population (n = 34 donors).</p><p><strong>Discussion: </strong>We documented high rates of missed referrals and missed potential donors before the enactment of mandatory referral and deemed consent legislation.</p><p><strong>Conclusions: </strong>The ODP has intentionally broadened clinical criteria for referral to shift the responsibility of identifying medically suitable potential donors from bedside clinicians to organ donation specialists. Lessons learned from our experience developing a PDA include the importance of early involvement of multiple stakeholders and ongoing modification of fields and workflow based on data availability and utility for clinical, educational, research, and reporting purposes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1545"},"PeriodicalIF":2.3,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/68/30/txd-9-e1545.PMC10593262.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50158851","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}