Transplantation Direct最新文献

{"title":"Measurement Matters: A Metrological Approach to Renal Preimplantation Biopsy Evaluation to Address Uncertainty in Organ Selection.","authors":"John O O Ayorinde, Xavier Loizeau, Victoria Bardsley, Spencer Angus Thomas, Marina Romanchikova, Alex Samoshkin, Gavin J Pettigrew","doi":"10.1097/TXD.0000000000001708","DOIUrl":"10.1097/TXD.0000000000001708","url":null,"abstract":"<p><strong>Background: </strong>Preimplantation biopsy combines measurements of injury into a composite index to inform organ acceptance. The uncertainty in these measurements remains poorly characterized, raising concerns variability may contribute to inappropriate clinical decisions.</p><p><strong>Methods: </strong>We adopted a metrological approach to evaluate biopsy score reliability. Variability was assessed by performing repeat biopsies (n = 293) on discarded allografts (n = 16) using 3 methods (core, punch, and wedge). Uncertainty was quantified using a bootstrapping analysis. Observer effects were controlled by semi-blinded scoring, and the findings were validated by comparison with standard glass evaluation.</p><p><strong>Results: </strong>The surgical method strongly determined the size (core biopsy area 9.04 mm², wedge 37.9 mm²) and, therefore, yield (glomerular yield <i>r</i> = 0.94, arterial <i>r</i> = 0.62) of each biopsy. Core biopsies yielded inadequate slides most frequently. Repeat biopsy of the same kidney led to marked variation in biopsy scores. In 10 of 16 cases, scores were contradictory, crossing at least 1 decision boundary (ie, to transplant or to discard). Bootstrapping demonstrated significant uncertainty associated with single-slide assessment; however, scores were similar for paired kidneys from the same donor.</p><p><strong>Conclusions: </strong>Our investigation highlights the risks of relying on single-slide assessment to quantify organ injury. Biopsy evaluation is subject to uncertainty, meaning each slide is better conceptualized as providing an estimate of the kidney's condition rather than a definitive result. Pooling multiple assessments could improve the reliability of biopsy analysis, enhancing confidence. Where histological quantification is necessary, clinicians should seek to develop new protocols using more tissue and consider automated methods to assist pathologists in delivering analysis within clinical time frames.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 11","pages":"e1708"},"PeriodicalIF":1.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475591","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":"Nova Scotia's Deemed Consent for Deceased Organ Donation: Family Member Perspectives and Experiences in the ICU Setting.","authors":"Aimee J Sarti, Stephanie Sutherland, Matthew J Weiss, Alain Landry, Heather Hemming, Jade Dirk, Ken Lotherington, Stephen Beed","doi":"10.1097/TXD.0000000000001713","DOIUrl":"10.1097/TXD.0000000000001713","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to explore the experience of family members of potential organ donors in the intensive care unit following the change to deemed consent legislation in Nova Scotia.</p><p><strong>Methods: </strong>This was a qualitative study with semistructured, in-depth interviews with 17 family members who were asked to make an organ donation decision on behalf of patients admitted to the intensive care unit in Nova Scotia. We analyzed themes using a descriptive approach. Participants were recruited from the organ donation organization in Nova Scotia, Canada.</p><p><strong>Results: </strong>Participant awareness and knowledge of the Human Organ and Tissue Donation Act legislation varied from individuals having no awareness and knowledge of the bill to those who had awareness and optimism that the legislation would be beneficial for increasing organ donation rates in the province. Other themes emerging from the interviews included (1) COVID context, (2) quality of healthcare professional care, (3) family support, and (4) barriers to donation (waiting, consent questionnaire, and patient transfers).</p><p><strong>Conclusions: </strong>The Human Organ and Tissue Donation Act legislation included enhanced support, which was viewed positively by family members. There is a need for continued evaluation as most participants felt it was too early to see the tangible impacts of the newly implemented legislation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 11","pages":"e1713"},"PeriodicalIF":1.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475592","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":"Early Complications in Kidney Donors and Course of Health-related Quality of Life 12 mo After Donation: An Analysis of the Swiss Organ Living-Donor Health Registry.","authors":"Charlotte Brügger, Zoé Hunkeler, Matthias Diebold, Joana Krättli, Irene Geiger, Caroline Wehmeier, Thomas Wolff, Bruno Vogt, Federico Storni, Dela Golshayan, Tobias Zingg, Sophie de Seigneux, Fadi Haidar, Isabelle Binet, Aurelia Schnyder, Kerstin Hübel, Thomas Müller, Fabian Rössler, Jürg Steiger, Patricia Hirt-Minkowski","doi":"10.1097/TXD.0000000000001716","DOIUrl":"10.1097/TXD.0000000000001716","url":null,"abstract":"<p><strong>Background: </strong>Since 1998, the Swiss Organ Living-Donor Health Registry (SOL-DHR) has recorded peri- and postoperative complications of living kidney (LK) donors, as reported by all Swiss transplant centers and has collected follow-up data prospectively.</p><p><strong>Methods: </strong>We analyzed the early complications of 2379 consecutive individuals who donated a kidney between January 1998 and June 2022 and assessed their health-related quality of life (HRQoL) 1 y after donation.</p><p><strong>Results: </strong>In total, 447 early complications in 404/2379 LK donors (17.0%) were reported to the SOL-DHR. The frequency of donors with major complications (ie, Dindo-Clavien classification 3/4) was 2.4%. In total, 31 donors needed reoperation, and in 13/31 (42%), donors reoperation was necessary because of bleeding complications. Independent risk factors for major early complications were older donor age (<i>P</i> = 0.005) and type of surgical approach (ie, the laparoscopic retroperitoneal compared with laparoscopic transabdominal surgery; <i>P</i> = 0.01), but not sex. We observed a <i>U</i>-shaped association of body mass index, where very low/high body mass indexes had higher odds of major early complications, without reaching statistical significance. Although HRQoL was affected by kidney donation, 96.5% of donors indicated that they would donate their kidney again. The only independent risk factor for low HRQoL based on mental health scores was worsening EB after living kidney donation (<i>P</i> < 0.0001).</p><p><strong>Conclusions: </strong>Overall, living kidney donation is a safe procedure, however, donor age and type of surgical approach affect the risk of complications. A decline in emotional bonding with the recipient after donation may worsen the quality of life of the donor.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 11","pages":"e1716"},"PeriodicalIF":1.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475590","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":"Beyond 75: Graft Allocation and Organ Utility Implications in Liver Transplantation.","authors":"Miho Akabane, Allison Kwong, Yuki Imaoka, Carlos O Esquivel, W Ray Kim, Marc L Melcher, Kazunari Sasaki","doi":"10.1097/TXD.0000000000001661","DOIUrl":"10.1097/TXD.0000000000001661","url":null,"abstract":"<p><strong>Background: </strong>The global surge in aging has intensified debates on liver transplantation (LT) for candidates aged 75 y and older, given the prevalent donor scarcity. This study examined both the survival benefits and organ utility of LT for this age group.</p><p><strong>Methods: </strong>A total of 178 469 adult LT candidates from the United Network for Organ Sharing database (2003-2022) were analyzed, with 112 266 undergoing LT. Post-LT survival outcomes and waitlist dropout rates were monitored across varying age brackets. Multivariable Cox regression analysis determined prognostic indicators. The 5-y survival benefit was assessed by comparing LT recipients to waitlist candidates using hazard ratios. Organ utility was evaluated through a simulation model across various donor classifications.</p><p><strong>Results: </strong>Among candidates aged 75 y and older, 343 received LT. The 90-d graft and patient survival rates for these patients were comparable with those in other age categories; however, differences emerged at 1 and 3 y. Age of 75 y or older was identified as a significant negative prognostic indicator for 3-y graft survival (hazard ratio: 1.72 [1.20-2.42], <i>P</i> < 0.01). Dropout rates for the 75 y and older age category were 12.0%, 24.1%, and 35.1% at 90 d, 1 y, and 3 y, respectively. The survival benefit of LT for the 75 y and older cohort was clear when comparing outcomes between LT recipients and those on waitlists. However, organ utility considerations did not favor allocating livers to this age group, regardless of donor type. Comparing 3-y patient survival between LT using donors aged 60 y and younger and older than 60 y showed no significant difference (<i>P</i> = 0.50) in the 75 y or older cohort.</p><p><strong>Conclusions: </strong>Although LT offers survival benefits to individuals aged 75 y and older, the system may need rethinking to optimize the use of scarce donor livers, perhaps by matching older donors with older recipients.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 10","pages":"e1661"},"PeriodicalIF":1.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Older Primary Kidney Transplant Recipients by Induction Agent and High-risk Viral Discordance Status in the United States.","authors":"Randi J Ryan, Andrew J Bentall, Naim Issa, Patrick G Dean, Byron H Smith, Mark D Stegall, Samy M Riad","doi":"10.1097/TXD.0000000000001698","DOIUrl":"10.1097/TXD.0000000000001698","url":null,"abstract":"<p><strong>Background: </strong>The impact of induction type or high-risk viral discordance on older kidney transplant recipients is unclear. Herein, we analyzed the association between induction type, viral discordance, and outcomes for older recipients.</p><p><strong>Methods: </strong>We analyzed the Scientific Registry of Transplant Recipients standard analysis file for all primary kidney transplant recipients older than 55 y who were transplanted between 2005 and 2022. All transplants were crossmatch negative and ABO-compatible. Recipients were discharged on tacrolimus and mycophenolate ± steroids. Recipients were categorized into 3 groups by induction received: rabbit antithymocyte globulin (r-ATG; N = 51 079), interleukin-2 receptor antagonist (IL-2RA; N = 22 752), and alemtuzumab (N = 13 465). Kaplan-Meier curves were generated for recipient and graft survival, and follow-up was censored at 10 y. Mixed-effect Cox proportional hazard models examined the association between induction type, high-risk viral discordance, and outcomes of interest. Models were adjusted for pertinent recipient and donor characteristics.</p><p><strong>Results: </strong>Induction type did not predict recipient survival in the multivariable model, whereas Epstein-Barr virus high-risk discordance predicted 14% higher mortality (1.14 [1.07-1.21], <i>P</i> < 0.01). In the multivariable model for death-censored graft survival, alemtuzumab, but not IL-2RA, was associated with an increased risk of graft loss (1.18 [1.06-1.29], <i>P</i> < 0.01) compared with r-ATG. High-risk cytomegalovirus discordance predicted 10% lower death-censored graft survival (1.10 [1.01-1.19], <i>P</i> < 0.02). Live donor and preemptive transplantation were favorable predictors of survival.</p><p><strong>Conclusions: </strong>In this large cohort of older transplant recipients, alemtuzumab, but not IL-2RA, induction was associated with an increased risk of graft loss compared with r-ATG. Cytomegalovirus and Epstein-Barr virus high-risk viral discordance portended poor graft and recipient survival, respectively.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 10","pages":"e1698"},"PeriodicalIF":1.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354504","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":"Making Living-donor Liver Transplantation a Viable Option for Patients With Portopulmonary Hypertension.","authors":"Kristen Burton, Andrew Gold, Peter Abt, Nolan Machado, Kristen Rock, Dmitri Bezinover","doi":"10.1097/TXD.0000000000001710","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001710","url":null,"abstract":"<p><p>Liver transplantation (LT) in patients with significant portopulmonary hypertension (PoPH) is associated with an increased risk of several complications, including graft failure. Graft loss is one of the major reasons. Living donor LT (LDLT) is not routinely performed in the United States in this patient population. In addition, ethical considerations often preclude donation from healthy donors in the setting of a procedure associated with an elevated risk of recipient morbidity and mortality. However, LDLT allows LT to be performed electively, using a superior graft with an improved probability of a good outcome. The key to success in managing these patients is establishing a multidisciplinary team that follows an institutional protocol with clear evaluation and management criteria. These criteria include screening and early diagnosis as well as treatment of PoPH with the goal of optimizing pulmonary arterial hemodynamics and maintaining right ventricular function. Any protocol should include admitting the patient to the hospital a day before surgery for placement of a pulmonary artery catheter to measure and derive relevant hemodynamic variables. A multidisciplinary team should determine the fitness for a transplant a after a careful review of the most up-to-date clinical information. Finally, the team prescribes and executes a plan for optimization and safe perioperative management of the patient. In this report, we discuss our approach to the perioperative management of a patient with significant PoPH who safely underwent LDLT with an excellent postoperative outcome.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 10","pages":"e1710"},"PeriodicalIF":1.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354503","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":"Clinical Translation and Implementation of a Bioartificial Pancreas Therapy: A Qualitative Study Exploring the Perspectives of People With Type 1 Diabetes.","authors":"Dide de Jongh, Silke Lapré, Behiye Özcan, Robert Zietse, Eline M Bunnik, Emma K Massey","doi":"10.1097/TXD.0000000000001711","DOIUrl":"10.1097/TXD.0000000000001711","url":null,"abstract":"<p><strong>Background: </strong>The development of a hybrid beta-cell replacement approach, referred to as a personalized, transplantable bioartificial pancreas (BAP), holds promise to treat type 1 diabetes (T1D). This interview study aimed to explore patients' expectations, needs, concerns, and considerations when considering to undergo a BAP transplantation.</p><p><strong>Research design and methods: </strong>Semistructured interviews were conducted with 24 participants diagnosed with T1D. Data collection stopped once data saturation was reached. Audio recordings of the interviews were transcribed verbatim. The interviews were independently analyzed by 2 researchers. A qualitative content analysis using an inductive approach was used.</p><p><strong>Results: </strong>Three main themes emerged as follow: (1) hoped-for benefits, (2) concerns and decision-making considerations, and (3) procedural aspects. First, the participants expected benefits across medical, psychological, and social domains. Over these 3 domains, 9 subthemes were identified, including improved clinical outcomes, a cure for diabetes, more headspace, emotional relief, a shift in responsibility, protection of privacy, improved flexibility in daily life, less visible diseases, and improved relationships with others. Second, concerns and considerations about undergoing a BAP transplant comprised adverse events, the functionality of the BAP, the surgery procedure, the biological materials used, the transplant location, and the intrusiveness associated with follow-up care. Finally, procedural considerations included equitable access, patient prioritization, and trust and control.</p><p><strong>Conclusions: </strong>Incorporating insights from this study into the clinical development and implementation of the BAP is crucial to ensure alignment of the product and procedures with the needs and expectations of people with T1D.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 10","pages":"e1711"},"PeriodicalIF":1.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354502","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":"Performance of the New CKD-EPI Creatinine-and Cystatin C-based Glomerular Filtration Rate Estimation Equation in Living Kidney Donor Candidate.","authors":"Yoichi Kakuta, Yoko Maegawa-Higa, Soichi Matsumura, Shota Fukae, Ryo Tanaka, Hiroaki Yonishi, Shigeaki Nakazawa, Kazuaki Yamanaka, Yoshitaka Isaka, Norio Nonomura","doi":"10.1097/TXD.0000000000001712","DOIUrl":"10.1097/TXD.0000000000001712","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative evaluation of renal function in living kidney donor candidates (LKDCs) is crucial to prevent kidney failure after nephrectomy. We examined the performance of various estimated glomerular filtration rate (eGFR) equations, including the new chronic kidney disease epidemiology collaboration (CKD-EPI) equation in LKDCs.</p><p><strong>Methods: </strong>We analyzed 752 LKDCs who were assessed for measured GFR by inulin clearance as part of routine pretransplant examination from 2006 to 2020. CKD-EPI2012 from cystatin C (CKD-EPI12cys), CKD-EPI2021 from creatinine (CKD-EPI21cr), CKD-EPI21cr-cys, Japanese modified (JPN) eGFRcr, and JPN eGFRcys were compared in determining the suitability for LKDCs.</p><p><strong>Results: </strong>CKD-EPI12cys had the lowest absolute and relative biases, with higher P₃₀ and P₁₀, followed by JPN eGFRcys, CKD-EPI21cr, and CKD-EPI21cr-cys. The root mean square error was least for CKD-EPI12cys, then JPN eGFRcys, CKD-EPI21cr-cys, CKD-EPI21cr, and JPN eGFRcr. CKD-EPI21cr, CKD-EPI12cys, and CKD-EPI21cr-cys estimated GFR higher, whereas JPN eGFRcr estimated GFR lower. At the threshold of 90 mL/min/1.73 m², CKD-EPI21cr had the highest percentage of misclassification at 37.37%, whereas JPN eGFRcr had the lowest percentage of misclassification at 6.91%. Using the age-adapted approach, JPN eGFRcr had the lowest percentage of misclassification into overestimation at 7.31%. All eGFR had >5.0%, and CKD-EPI21cr had the highest percentage of misclassification at 21.94%. Conversely, CKD-EPI21cr-cys had the lowest percentage of misclassification into underestimation at 3.19%, both at the threshold of 90 mL/min/1.73 m² and the age-adapted approach. JPN eGFRcr had the highest percentage at 33.38% and 40.69%, respectively.</p><p><strong>Conclusions: </strong>In evaluating the renal function of Japanese LKDCs, the new CKD-EPI equation had a lower rate of underestimation but a relatively high rate of overestimation. New GFR estimation formulas are needed to be tailored to each ethnic group to enhance the accuracy and reliability of donor selection processes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 10","pages":"e1712"},"PeriodicalIF":1.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296288","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":"Molecular Signature Associated With Acute Rejection in Vascularized Composite Allotransplantation.","authors":"Michael F Cassidy, Nicole A Doudican, Nicholas Frazzette, Piul S Rabbani, John A Carucci, Bruce E Gelb, Eduardo D Rodriguez, Catherine P Lu, Daniel J Ceradini","doi":"10.1097/TXD.0000000000001714","DOIUrl":"10.1097/TXD.0000000000001714","url":null,"abstract":"<p><strong>Background: </strong>A deeper understanding of acute rejection in vascularized composite allotransplantation is paramount for expanding its utility and longevity. There remains a need to develop more precise and accurate tools for diagnosis and prognosis of these allografts, as well as alternatives to traditional immunosuppressive regimens.</p><p><strong>Methods: </strong>Twenty-seven skin biopsies collected from 3 vascularized composite allotransplantation recipients, consisting of face and hand transplants, were evaluated by histology, immunohistochemistry staining, and gene expression profiling.</p><p><strong>Results: </strong>Biopsies with clinical signs and symptoms of rejection, irrespective of histopathological grading, were significantly enriched for genes contributing to the adaptive immune response, innate immune response, and lymphocyte activation. Inflammation episodes exhibited significant fold change correlations between the face and hands, as well as across patients. Immune checkpoint genes were upregulated during periods of inflammation that necessitated treatment. A gene signature consisting of <i>CCL5</i>, <i>CD8A</i>, <i>KLRK1</i>, and <i>IFNγ</i> significantly predicted inflammation specific to vascularized composite allografts that required therapeutic intervention.</p><p><strong>Conclusions: </strong>The mechanism of vascularized composite allograft-specific inflammation and rejection appears to be conserved across different patients and skin on different anatomical sites. A concise gene signature can be utilized to ascertain graft status along with a continuous scale, providing valuable diagnostic and prognostic information to supplement current gold standards of graft evaluation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 10","pages":"e1714"},"PeriodicalIF":1.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296287","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":"Textbook Outcomes in Solid Transplantation: A Systematic Review.","authors":"Alessandro Martinino, Joseph Matthew Ladowski, Davide Schilirò, Matthew G Hartwig, Dimitrios Moris, Andrew S Barbas","doi":"10.1097/TXD.0000000000001694","DOIUrl":"10.1097/TXD.0000000000001694","url":null,"abstract":"<p><strong>Background: </strong>The concept of TO is expanding across various surgical disciplines to establish a standardized, comprehensive quality benchmark. Traditional metrics such as 1-y patient and graft survival have been key for evaluating transplant program performance but are now deemed inadequate because of significant field advancements. This systematic review aims to provide a comprehensive understanding of the applicability and validity of textbook outcome (TO) in the setting of solid organ transplantation.</p><p><strong>Methods: </strong>A structured search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted across PubMed, Embase, and Scopus databases on March 10, 2024.</p><p><strong>Results: </strong>Fourteen articles were identified for inclusion in this review. Of these, 2 studies addressed TO in heart transplantation, 3 in lung transplantation, 2 in kidney transplantation, and 7 in liver transplantation. A subgroup analysis was conducted to categorize the different definitions of TOs and identify the most common reasons for TO failure.</p><p><strong>Conclusions: </strong>Our systematic review highlights the ongoing efforts in the field of solid organ transplantation to define TO and emphasizes the importance of developing a universally recognized set of TO criteria for each type of transplant. TO provides a valuable framework for transplant centers to benchmark their performance against similar institutions on a risk-adjusted basis and to pinpoint specific areas for enhancing patient outcomes. Even the most successful programs may discover aspects within the composite outcome with scope for improvement.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 10","pages":"e1694"},"PeriodicalIF":1.9,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296289","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}