Transplantation Direct最新文献

{"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}

{"title":"A Comprehensive Review of Liver Allograft Fibrosis and Steatosis: From Cause to Diagnosis.","authors":"Madhumitha Rabindranath,&nbsp;Rita Zaya,&nbsp;Khairunnadiya Prayitno,&nbsp;Ani Orchanian-Cheff,&nbsp;Keyur Patel,&nbsp;Elmar Jaeckel,&nbsp;Mamatha Bhat","doi":"10.1097/TXD.0000000000001547","DOIUrl":"10.1097/TXD.0000000000001547","url":null,"abstract":"<p><p>Despite advances in posttransplant care, long-term outcomes for liver transplant recipients remain unchanged. Approximately 25% of recipients will advance to graft cirrhosis and require retransplantation. Graft fibrosis progresses in the context of de novo or recurrent disease. Recurrent hepatitis C virus infection was previously the most important cause of graft failure but is now curable in the majority of patients. However, with an increasing prevalence of obesity and diabetes and nonalcoholic fatty liver disease as the most rapidly increasing indication for liver transplantation, metabolic dysfunction-associated liver injury is anticipated to become an important cause of graft fibrosis alongside alloimmune hepatitis and alcoholic liver disease. To better understand the landscape of the graft fibrosis literature, we summarize the associated epidemiology, cause, potential mechanisms, diagnosis, and complications. We additionally highlight the need for better noninvasive methods to ameliorate the management of graft fibrosis. Some examples include leveraging the microbiome, genetic, and machine learning methods to address these limitations. Overall, graft fibrosis is routinely seen by transplant clinicians, but it requires a better understanding of its underlying biology and contributors that can help inform diagnostic and therapeutic practices.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1547"},"PeriodicalIF":2.3,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/72/41/txd-9-e1547.PMC10581596.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49682696","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":"Putting Guidelines Into Practice: Is Frailty Measurement at the Time of Kidney Transplant Eligibility Assessment Valid, Feasible, and Acceptable to Patients?","authors":"Shavini Weerasekera,&nbsp;Natasha Reid,&nbsp;Adrienne Young,&nbsp;Ryan Homes,&nbsp;Aaron Sia,&nbsp;Fiona Giddens,&nbsp;Ross S Francis,&nbsp;Ruth E Hubbard,&nbsp;Emily H Gordon","doi":"10.1097/TXD.0000000000001548","DOIUrl":"10.1097/TXD.0000000000001548","url":null,"abstract":"<p><strong>Background: </strong>Clinical Practice Guidelines suggest that frailty be measured during kidney transplant eligibility assessments. Yet it is not known how frailty is best assessed in this setting or whether its assessment is acceptable to patients. We aimed to examine the construct validity and feasibility of Frailty Index (FI) assessment among patients attending a kidney transplant assessment clinic and to explore patients' perspectives on frailty and the acceptability of its routine assessment.</p><p><strong>Methods: </strong>A 58-item FI was calculated for 147 clinic patients. Semistructured interviews were conducted with a subgroup of 29 patients. The FI was validated against normative FI characteristics (mean, distribution, limit), age, and the Estimated Post-Transplant Survival Score. Feasibility was assessed using descriptive statistics. Qualitative data were analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>The mean FI was 0.23 (±0.10, normal distribution, limit 0.53). FI increased with age and Estimated Post-Transplant Survival score. The FI was completed for 62.8% of eligible patients (147/234). The median completion time was 10 min, and completion rate (with no missing data) was 100%. Four themes were identified: perceptions of frailty, acceptability, perceived benefits, and risks of frailty measurement. Patients linked frailty with age and adverse outcomes, and most did not consider themselves frail. Patients reported that the FI was quick, simple, and efficient. They felt that frailty assessment is relevant to transplant eligibility and should be used to address potentially reversible factors.</p><p><strong>Conclusions: </strong>The FI demonstrated construct validity and was feasible and acceptable in this clinic setting. The challenge is ensuring that routine assessments lead to better care.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1548"},"PeriodicalIF":2.3,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3b/df/txd-9-e1548.PMC10581598.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49682697","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":"Scandiatransplant Exchange Program (STEP): Development and Results From an International Kidney Exchange Program.","authors":"Ilse Duus Weinreich,&nbsp;Tommy Andersson,&nbsp;Margrét Birna Andrésdóttir,&nbsp;Mats Bengtsson,&nbsp;Alireza Biglarnia,&nbsp;Claus Bistrup,&nbsp;Line Boulland,&nbsp;Helle Bruunsgaard,&nbsp;Ilkka Helanterä,&nbsp;Kulli Kölvald,&nbsp;Jouni Lauronen,&nbsp;Jørn Petter Lindahl,&nbsp;Karin Skov,&nbsp;Søren Schwarz Sørensen,&nbsp;Lars Wennberg,&nbsp;Per Lindner","doi":"10.1097/TXD.0000000000001549","DOIUrl":"10.1097/TXD.0000000000001549","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplant candidates may be incompatible with their intended living donors because of the presence of antibodies against HLA and/or ABO. To increase the possibility of finding an acceptable kidney donor for these patients, the Scandiatransplant Exchange Program (STEP) program within Scandiatransplant was launched in 2019.</p><p><strong>Methods: </strong>This is a retrospective review of our experiences from the first 4 y of the STEP program, including details about the match runs, performed transplantations, and recipient outcomes within the program.</p><p><strong>Results: </strong>During 2019-2022, 11 match runs and 4 reruns were performed. In total, 114 pairs and 6 anonymous donors participated in these match runs. Fifty-one pairs (45%) participated in 1 match run, 31 pairs (27%) participated in 2 match runs, and 32 pairs (29%) participated in ≥3 match runs. Seventy-two individuals (63%) participated because of HLA incompatibility, 19 (17%) because of ABO incompatibility, and 7 (6%) because of both HLA and ABO incompatibility.Forty percent of the patients enrolled in the program underwent transplantation. In total, 49 transplantations have so far been performed within the program, and 46 (94%) of the recipients had a functioning kidney graft at follow-up in February 2023.</p><p><strong>Conclusions: </strong>The STEP program offers sensitized patients an enlarged pool of living donors and a chance of a compatible international living donor, resulting in an increased number of total transplantations. Currently, STEP is one of the largest transnational kidney exchange programs and has improved the situation for patients waiting for kidney transplantation in Scandiatransplant.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1549"},"PeriodicalIF":2.3,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/a0/txd-9-e1549.PMC10581625.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49682698","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":"Assessing Kidney Transplantation Using ECMO-Supported Donors Within a KDPI-Based Allocation System.","authors":"Peter J Altshuler,&nbsp;Devon J Pace,&nbsp;William A Preston,&nbsp;Sage A Vincent,&nbsp;Ashesh P Shah,&nbsp;Jaime M Glorioso,&nbsp;Warren R Maley,&nbsp;Adam M Frank,&nbsp;Carlo B Ramirez,&nbsp;Sharon West,&nbsp;Richard Hasz,&nbsp;Adam S Bodzin","doi":"10.1097/TXD.0000000000001521","DOIUrl":"10.1097/TXD.0000000000001521","url":null,"abstract":"<p><strong>Background: </strong>Organ donors supported by extracorporeal membrane oxygenation (ECMO) have historically been considered high-risk and are judiciously utilized. This study examines transplant outcomes using renal allografts from donors supported on ECMO for nondonation purposes.</p><p><strong>Methods: </strong>Retrospective review of the Gift of Life (Pennsylvania, New Jersey, Delaware) organ procurement organization database, cross-referenced to the Organ Procurement and Transplantation Network database, assessed kidney transplants using donors supported on venoarterial (VA) and venovenous (VV) ECMO for nondonation purposes. Transplants using VA- and VV-ECMO donors were compared with Kidney Donor Profile Index (KDPI)-stratified non-ECMO donors. Regression modeling of the entire ECMO and non-ECMO populations assessed ECMO as predictive of graft survival. Additional regression of the ECMO population alone assessed for donor features associated with graft survival.</p><p><strong>Results: </strong>Seventy-eight ECMO donors yielded 128 kidney transplants (VA: 80, VV: 48). Comparing outcomes using these donors to kidney transplants using organs from KDPI-stratified non-ECMO donors, VA- and VV-ECMO donor grafts conferred similar rates of delayed graft function and posttransplant renal function to KDPI-matched non-ECMO counterparts. VA-ECMO kidneys demonstrated superior graft survival compared with the lowest-quality (KDPI 86%-100%) non-ECMO kidneys and similar graft survival to KDPI <85% non-ECMO kidneys. VV-ECMO showed inferior graft survival to all but the lowest-quality (KDPI 86%-100%) non-ECMO kidneys. VV-ECMO, but not VA-ECMO, was associated with increased risk of graft loss on multivariable regression (hazard ratios-VA: 1.02, VV: 2.18). Higher KDPI, advanced age, increased body mass index, hypertension, and diabetes were identified as high-risk features of ECMO donors.</p><p><strong>Conclusions: </strong>Kidney transplantation using appropriately selected ECMO donors can safely expand the donor pool. Ongoing studies are necessary to determine best practice patterns using kidneys from these donors.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"9 11","pages":"e1521"},"PeriodicalIF":2.3,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/cb/txd-9-e1521.PMC10566806.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41214004","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}