Transplantation Direct最新文献

{"title":"International Travel for Organ Transplantation: Provider and Patient Perspectives.","authors":"Ann B Nguyen, Hannah F Roth, Bow Chung, Daniel Rodgers, Kevin J Clerkin, Gabriel Sayer, Gene Kim, Valluvan Jeevanandam, Mark Siegler, Nir Uriel, Andrew Aronsohn","doi":"10.1097/TXD.0000000000001686","DOIUrl":"10.1097/TXD.0000000000001686","url":null,"abstract":"<p><strong>Background: </strong>Organ allocation in the United States to non-US citizen, non-US residents who travel for transplant (NC/NRTx) is controversial. Current policies may not be informed by stakeholder opinions, as limited data exist assessing the knowledge or opinions of providers or patients on this issue.</p><p><strong>Methods: </strong>A cross-sectional, hospital-based pilot survey was distributed to providers and patients from December 2019 to June 2020 at a single large urban transplant institute. Providers were members of the departments of surgery and medicine and included both transplant and nontransplant providers. Surveys included 10 questions on eligibility, prioritization, and limitations for deceased donor transplantation and 12 demographic questions.</p><p><strong>Results: </strong>A total of 209 providers responded (61% women, median age 40) and 119 patients responded (62% women, median age 54). Awareness of eligibility for transplantation of US citizens, non-US citizens residing in the United States (NC/R), and NC/NRTx was high in both groups, though providers and patients lacked awareness of the eligibility of nonlegal NC/R (those who live in the United States who are not citizens and are not legal residents) to donate and receive organs. Overall, 79.3% of patients stated that NC/NRTx should be eligible for transplant in the United States compared with only 60.7% of providers (<i>P</i> = 0.001). Providers were more likely than patients to prioritize transplant to legal NC/NR over NC/NRTx (58.2% versus 35.1%, <i>P</i> < 000.1) and reported that families should be able to limit donations to NC/NRTx (34.9% versus 23.2%, <i>P</i> = 0.03).</p><p><strong>Conclusions: </strong>Surveyed patients and providers generally support transplant in non-US citizens; however, the strength of support varied considerably based on the legal status of the patient and the occupation of those surveyed. Larger studies are necessary to develop data-informed policy.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 8","pages":"e1686"},"PeriodicalIF":1.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11259398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735066","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":"Comparison of COVID-19 Hospitalization and Death Between Solid Organ Transplant Recipients and the General Population in Canada, 2020-2022.","authors":"Kyla L Naylor, Gregory A Knoll, Darin Treleaven, Yuguang Kang, Amit X Garg, Kathryn Stirling, S Joseph Kim","doi":"10.1097/TXD.0000000000001670","DOIUrl":"10.1097/TXD.0000000000001670","url":null,"abstract":"<p><strong>Background: </strong>Solid organ transplant recipients have a high risk of severe outcomes from SARS-CoV-2 infection. A comprehensive understanding of the impact of the COVID-19 pandemic across multiple waves in the solid organ transplant population and how this compares to the general population is limited. We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada to answer this question.</p><p><strong>Methods: </strong>We included 15 306 solid organ transplant recipients and 12 160 904 individuals from the general population. Our primary outcome was the rate (per 100 person-years) of severe COVID-19 (ie, hospitalization or death with a positive SARS-CoV-2 test) occurring between January 25, 2020, and November 30, 2022.</p><p><strong>Results: </strong>Compared with the general population, solid organ transplant recipients had almost a 6 times higher rate of severe COVID-19 (20.39 versus 3.44 per 100 person-years), with almost 5.5 times as high a rate of death alone (4.19 versus 0.77 per 100 person-years). Transplant recipients with severe COVID-19 were substantially younger (60.1 versus 66.5 y) and had more comorbidities. The rate of severe COVID-19 declined over time in the solid organ transplant population, with an incidence rate of 41.25 per 100 person-years in the first wave (January 25, 2020, to August 31, 2020) and 18.41 in the seventh wave (June 19, 2022, to November 30, 2022, Omicron era).</p><p><strong>Conclusions: </strong>Solid organ transplant recipients remain at high risk of severe outcomes when they are infected with SARS-CoV-2. Resources and strategies to mitigate the impact of SARS-CoV-2 exposure are needed in this vulnerable patient population.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 7","pages":"e1670"},"PeriodicalIF":1.9,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477528","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":"Randomized Controlled Trial of Enhanced Recovery After Surgery Protocols in Live Kidney Donors: ERASKT Study.","authors":"Jacob Saks, Uzung Yoon, Natalie Neiswinter, Eric S Schwenk, Stephen Goldberg, Linh Nguyen, Marc C Torjman, Elia Elia, Ashesh Shah","doi":"10.1097/TXD.0000000000001663","DOIUrl":"10.1097/TXD.0000000000001663","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) pathways represent a comprehensive approach to optimizing perioperative management and reducing hospital stay and cost. In living donor kidney transplantation, key impediments to postoperative discharge include pain, and opioid associated complications such as nausea, vomiting, and the return of gastrointestinal function.</p><p><strong>Methods: </strong>In this randomized controlled trial, living kidney transplantation donors were assigned to either the ERAS or control group. The ERAS group patients received 15 preoperative, 17 intraoperative, 19 postoperative element intervention. The control group received standard care. The ERAS group received a multimodal opioid sparing pain management including an intraoperative transverse abdominis plane block. Our primary outcome measure was postoperative opioid consumption. The secondary outcome measures were postoperative pain scores, first oral intake, and hospital length of stay.</p><p><strong>Results: </strong>There were no significant differences in demographics between the 2 groups. The ERAS group had a statistically significant reduction in total postoperative opioid consumption calculated in intravenous morphine equivalents (24.2 ± 20.2 versus 71 ± 39.5 mg, <i>P</i> < 0.01). Postoperative pain scores were significantly lower (<i>P</i> < 0.001) from 1 h postoperatively to 48 h. Surgical time was 45 min shorter (<i>P</i> = 0.037). Intraoperative PlasmaLyte administration was lower (PlasmaLyte: 1444 ± 907 versus 2168 ± 1347 mL, <i>P</i> = 0.049). Time to tolerating regular diet was shorter by 2 h (<i>P</i> < 0.008), and length of hospital stay was decreased by 10.1 h.</p><p><strong>Conclusions: </strong>The ERAS group experienced superior postoperative analgesia and a shorter length of hospital stay compared with controls.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 7","pages":"e1663"},"PeriodicalIF":1.9,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477529","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":"The Risk of Microbial Transmission in Recipients of Donor Livers That Underwent Hypothermic or Normothermic Machine Perfusion.","authors":"Chikako Endo, Bianca Lascaris, Isabel M A Brüggenwirth, Jan Roggeveld, Hans Blokzijl, Vincent E de Meijer, M H Edwina Doting, Robert J Porte","doi":"10.1097/TXD.0000000000001664","DOIUrl":"10.1097/TXD.0000000000001664","url":null,"abstract":"<p><strong>Background: </strong>Ex situ machine perfusion is increasingly used to preserve and assess donor livers before transplantation. Compared with traditional static cold storage (SCS), machine perfusion exposes livers to an additional risk of microbial contamination. However, information on the risk of microbial transmission during machine perfusion is lacking.</p><p><strong>Methods: </strong>All livers that underwent either hypothermic oxygenated machine perfusion (HOPE) or normothermic machine perfusion (NMP) in our center between September 2021 and September 2023, and during which samples were taken from SCS fluid and/or machine perfusion solution for microbiological examination, were included in this retrospective, observational clinical study. Microbial transmission was examined from SCS fluid to machine perfusion solution fluid and, subsequently, to recipients of these livers.</p><p><strong>Results: </strong>A total of 90 cases of liver machine perfusion were included: 59 HOPE and 31 NMP. SCS preservation fluid cultures before HOPE or NMP were positive for at least 1 microorganism in 52% of the cases. After HOPE, there were no cases of positive machine perfusion fluid or evidence of microbial transmission to the recipients. After NMP, in 1 (3%) patient <i>Escherichia coli</i> was grown from abdominal drain fluid, the same bacterial strain that was also grown from the SCS preservation fluid before NMP. This <i>E coli</i> was resistant to the antibiotics that are routinely added to the NMP perfusion fluid.</p><p><strong>Conclusions: </strong>The risk of microbial transmission after machine perfusion is very low but not absent. We recommend routine sampling of machine perfusion fluid at the end of the procedure for microbiological analysis.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 7","pages":"e1664"},"PeriodicalIF":1.9,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477530","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":"Baseline Lung Allograft Dysfunction After Bilateral Lung Transplantation Is Associated With an Increased Risk of Death: Results From a Multicenter Cohort Study.","authors":"Michael B Keller, Junfeng Sun, Muhtadi Alnababteh, Lucia Ponor, Pali D Shah, Joby Mathew, Hyesik Kong, Ananth Charya, Helen Luikart, Shambhu Aryal, Steven D Nathan, Jonathan B Orens, Kiran K Khush, Moon Kyoo Jang, Sean Agbor-Enoh","doi":"10.1097/TXD.0000000000001669","DOIUrl":"10.1097/TXD.0000000000001669","url":null,"abstract":"<p><strong>Background: </strong>A prior single-center, retrospective cohort study identified baseline lung allograft dysfunction (BLAD) as a risk factor for death in bilateral lung transplant recipients. In this multicenter prospective cohort study, we test the association of BLAD with death in bilateral lung transplant recipients, identify clinical risk factors for BLAD, and assess its association with allograft injury on the molecular level.</p><p><strong>Methods: </strong>This multicenter, prospective cohort study included 173 bilateral lung transplant recipients that underwent serial pulmonary function testing and plasma collection for donor-derived cell-free DNA at prespecified time points. BLAD was defined as failure to achieve ≥80% predicted for both forced expiratory volume in 1 s and forced vital capacity after lung transplant, on 2 consecutive measurements at least 3 mo apart.</p><p><strong>Results: </strong>BLAD was associated with increased risk of death (hazard ratio, 1.97; 95% confidence interval [CI], 1.05-3.69; <i>P</i> = 0.03) but not chronic lung allograft dysfunction alone (hazard ratio, 1.60; 95% CI, 0.87-2.95; <i>P</i> = 0.13). Recipient obesity (odds ratio, 1.69; 95% CI, 1.15-2.80; <i>P</i> = 0.04) and donor age (odds ratio, 1.03; 95% CI, 1.02-1.05; <i>P</i> = 0.004) increased the risk of developing BLAD. Patients with BLAD did not demonstrate higher log₁₀(donor-derived cell-free DNA) levels compared with no BLAD (slope [SE]: -0.0095 [0.0007] versus -0.0109 [0.0007]; <i>P</i> = 0.15).</p><p><strong>Conclusions: </strong>BLAD is associated with an increased risk of death following lung transplantation, representing an important posttransplant outcome with valuable prognostic significance; however, early allograft specific injury on the molecular level does not increase the risk of BLAD, supporting further mechanistic insight into disease pathophysiology.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 7","pages":"e1669"},"PeriodicalIF":1.9,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477527","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":"Sex-based Disparities in Liver Transplantation for Hepatocellular Carcinoma and the Impact of the Growing Burden of NASH.","authors":"Jia Hong Koh, Douglas Chee, Cheng Han Ng, Karn Wijarnpreecha, Mark Muthiah, Darren Jun Hao Tan, Wen Hui Lim, Rebecca Wenling Zeng, Benjamin Koh, Eunice Tan Xiang Xuan, Glenn Bonney, Shridhar Iyer, Dan Yock Young, Toru Nakamura, Hirokazu Takahashi, Mazen Noureddin, Mohammad Shadab Siddiqui, Tracey G Simon, Rohit Loomba, Daniel Q Huang","doi":"10.1097/TXD.0000000000001642","DOIUrl":"10.1097/TXD.0000000000001642","url":null,"abstract":"<p><strong>Background: </strong>The cause of liver disease is changing, but its impact on liver transplantation (LT) for hepatocellular carcinoma (HCC) in women and men is unclear. We performed a nationwide study to assess the prevalence and posttransplant survival outcomes of the various causes of liver disease in women and men with HCC.</p><p><strong>Methods: </strong>Data were obtained from the United Network for Organ Sharing database from 2000 to 2022. Data related to the listing, transplant, waitlist mortality, and posttransplant mortality for HCC were extracted. The proportion of HCC related to the various causes of liver disease among LT candidates and recipients and posttransplant survival were compared between women and men.</p><p><strong>Results: </strong>A total of 51 721 individuals (39 465 men, 12 256 women) with HCC were included. From 2000 to 2022, nonalcoholic steatohepatitis (NASH) was the fastest-growing cause of liver disease among female LT candidates with HCC (<i>P</i> < 0.01), followed by alcohol-associated liver disease. NASH overtook chronic hepatitis C as the leading cause of liver disease in 2020 and 2022 among waitlisted women and men with HCC, respectively. Female patients with HCC spent a significantly longer time on the LT waitlist compared with male patients (β: 8.73; 95% confidence interval [CI], 2.91-14.54). Female patients with HCC from alcohol-associated liver disease also have a lower probability of receiving LT (subdistribution hazard ratio: 0.90; 95% CI, 0.82-0.99). Among transplant recipients with NASH HCC, female sex was associated with lower posttransplant mortality compared with male sex (hazard ratio: 0.79; 95% CI, 0.70-0.89; <i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>Women have a significantly longer waitlist duration compared with men. NASH is now the leading cause of liver disease among both female and male LT candidates and recipients with HCC.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 7","pages":"e1642"},"PeriodicalIF":1.9,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443367","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":"HLA Genotype Imputation Results in Largely Accurate Epitope Mismatch Risk Categorization Across Racial Groups.","authors":"Gregory S Cohen, Alison J Gareau, Melissa A Kallarakal, Tayyiaba Farooq, Maria P Bettinotti, H Cliff Sullivan, Abeer Madbouly, Scott M Krummey","doi":"10.1097/TXD.0000000000001639","DOIUrl":"10.1097/TXD.0000000000001639","url":null,"abstract":"<p><strong>Background: </strong>Biomarkers that predict posttransplant alloimmunity could lead to improved long-term graft survival. Evaluation of the number of mismatched epitopes between donor and recipient HLA proteins, termed molecular mismatch analysis, has emerged as an approach to classify transplant recipients as having high, intermediate, or low risk of graft rejection. When high-resolution genotypes are unavailable, molecular mismatch analysis requires algorithmic assignment, or imputation, of a high-resolution genotyping. Although imputation introduces inaccuracies in molecular mismatch analyses, it is unclear whether these inaccuracies would impact the clinical risk assessment for graft rejection.</p><p><strong>Methods: </strong>Using renal transplant patients and donors from our center, we constructed cohorts of surrogate donor-recipient pairs with high-resolution and low-resolution HLA genotyping that were racially concordant or discordant. We systemically assessed the impact of imputation on molecular mismatch analysis for cohorts of 180-200 donor-recipient pairs for each of 4 major racial groups. We also evaluated the effect of imputation for a racially diverse validation cohort of 35 real-world renal transplant pairs.</p><p><strong>Results: </strong>In the surrogate donor-recipient cohorts, imputation preserved the molecular mismatch risk category for 90.5%-99.6% of racially concordant donor-recipient pairs and 92.5%-100% of racially discordant pairs. In the validation cohort, which comprised 72% racially discordant pairs, we found that imputation preserved the molecular mismatch risk category for 97.1% of pairs.</p><p><strong>Conclusions: </strong>Overall, these data demonstrate that imputation preserves the molecular mismatch risk assessment in the vast majority of cases and provides evidence supporting imputation in the performance of molecular mismatch analysis for clinical assessment.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 7","pages":"e1639"},"PeriodicalIF":1.9,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443364","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":"Immunologic Benefits of 0-antigen Mismatched Transplants: No Added Boost for Racial and Ethnic Minorities.","authors":"Jillian S Caldwell, Gomathy Parvathinathan, Margaret R Stedman, Patrick Ahearn, Jane C Tan, Xingxing S Cheng","doi":"10.1097/TXD.0000000000001653","DOIUrl":"10.1097/TXD.0000000000001653","url":null,"abstract":"<p><strong>Background: </strong>Systemic barriers to posttransplant care, including access to immunosuppressant medications, contribute to higher rates of kidney transplant failure in racial minorities. Matching donor and recipient HLA alleles reduce allorecognition, easing reliance on immunosuppression. We hypothesize that 0-antigen mismatch transplants may provide stronger protection against graft loss in racial minorities.</p><p><strong>Methods: </strong>We compared adult, single-organ, deceased-donor kidney transplants in the United States from 2007 to 2016 by degree of HLA mismatch (0- versus ≥1-antigen mismatch). We examined time-to-allograft failure, with death as a competing event, using multivariable Weibull models, stratified by recipient race (White versus non-White), and evaluated the interaction between mismatch and recipient race. We used Kaplan-Meier imputation to account for competing risk of death.</p><p><strong>Results: </strong>We analyzed 102 114 transplants (median follow-up, 5.6 y; 16 862 graft losses, 18 994 deaths). Zero-antigen mismatch was associated with improved allograft survival (adjusted subdistribution hazard ratio [sHR] 0.80; 95% confidence interval [CI], 0.75-0.85). When stratified by recipient race, the effect of 0-antigen mismatch was more pronounced in White (unadjusted sHR 0.78; 95% CI, 0.72-0.83) versus non-White recipients (sHR 0.88; 95% CI, 0.79-0.99; interaction <i>P</i> = 0.04). The differential effect was attenuated after adjusting for covariates (sHR 0.78; 95% CI, 0.73-0.84 versus sHR 0.87; 95% CI, 0.77-0.98; interaction <i>P</i> = 0.10).</p><p><strong>Conclusions: </strong>Zero-antigen mismatch transplants conferred a 20% risk reduction in allograft loss, which was similar between non-White and White recipients. This may reflect an increased degree of mismatch at other HLA alleles and non-HLA alleles in non-White recipients or because of the extent of systemic barriers to healthcare borne by minority recipients.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 7","pages":"e1653"},"PeriodicalIF":1.9,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11177818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331841","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":"Less Is More? Two Cases of Cryptococcosis Treated Using Single-dose Liposomal Amphotericin B as Part of Induction Therapy in Solid Organ Transplant Recipients.","authors":"Carson K L Lo, Christie Rampersad, Justin Barr, Shahid Husain","doi":"10.1097/TXD.0000000000001648","DOIUrl":"10.1097/TXD.0000000000001648","url":null,"abstract":"","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 6","pages":"e1648"},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180754","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":"Prophylactic Anticoagulation Reduces the Risk of Kidney Graft Venous Thrombosis in Recipients From Uncontrolled Donation After Circulatory Death Donors With High Renal Resistive Index.","authors":"Maria Molina, Mario Fernández-Ruiz, Esther Gonzalez, Jimena Cabrera, Manuel Praga, Alfredo Rodriguez, Angel Tejido-Sánchez, Jose Medina-Polo, Alonso Mateos, Carlos Rubio-Chacón, Angel Sanchez, Ana Pla, Amado Andrés","doi":"10.1097/TXD.0000000000001649","DOIUrl":"10.1097/TXD.0000000000001649","url":null,"abstract":"<p><strong>Background: </strong>Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplantation (KT) at the expense of a higher risk of primary graft nonfunction (PNF). At least half of the cases of PNF are secondary to graft venous thrombosis. The potential benefit from prophylactic anticoagulation in this scenario remains unclear.</p><p><strong>Methods: </strong>In this single-center retrospective study we compared 2 consecutive cohorts of KT from uDCD with increased (≥0.8) renal resistive index (RRI) in the Doppler ultrasound examination performed within the first 24-72 h after transplantation: 36 patients did not receive anticoagulation (\"nonanticoagulation group\") and 71 patients underwent prophylactic anticoagulation until normalization of RRI in follow-up Doppler examinations (\"anticoagulation group\").</p><p><strong>Results: </strong>Anticoagulation was initiated at a median of 2 d (interquartile range, 2-3) after transplantation and maintained for a median of 12 d (interquartile range, 7-18). In 4 patients (5.6%), anticoagulation had to be prematurely stopped because of the development of a hemorrhagic complication. In comparison with the nonanticoagulation group, recipients in the anticoagulation group had a lower 2-wk cumulative incidence of graft venous thrombosis (19.4% versus 0.0%; <i>P</i> < 0.001) and PNF (19.4% versus 2.8%; <i>P</i> = 0.006). The competing risk analysis with nonthrombotic causes of PNF as the competitive event confirmed the higher risk of graft thrombosis in the nonanticoagulation group <i>(P</i> = 0.0001). The anticoagulation group had a higher incidence of macroscopic hematuria (21.1% versus 5.6%; <i>P</i> = 0.049) and blood transfusion requirements (39.4% versus 19.4%; <i>P</i> = 0.050) compared with the nonanticoagulation group. No graft losses or deaths were attributable to complications potentially associated with anticoagulation.</p><p><strong>Conclusions: </strong>Early initiation of prophylactic anticoagulation in selected KT recipients from uDCD with an early Doppler ultrasound RRI of ≥0.8 within the first 24-72 h may reduce the incidence of graft venous thrombosis as a cause of PNF.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 6","pages":"e1649"},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180757","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}