Transplantation Direct最新文献

{"title":"Multiple-target Therapy for Posttransplant Focal Segmental Glomerulosclerosis.","authors":"Juliana Mansur, Domingo Chang-Dávila, Marcela Giraldes Simões, Marina Pontello Cristelli, Suelen Bianca Stopa Martins, Henrique Machado de Sousa Proença, Laila Almeida Viana, Alexandra Nicolau Ferreira, Marisa Petrucelli Doher, José Medina-Pestana, Gianna Mastroianni Kirsztajn, Helio Tedesco-Silva","doi":"10.1097/TXD.0000000000001651","DOIUrl":"10.1097/TXD.0000000000001651","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on the ideal strategy to treat posttransplant focal segmental glomerulosclerosis. The multiple-target therapy, which consisted of high-dose intravenous cyclosporine, prednisone, and plasmapheresis, showed favorable results.</p><p><strong>Methods: </strong>This single-center, prospective study sought to evaluate the multiple-target therapy in an independent cohort of patients.</p><p><strong>Results: </strong>Thirteen patients with posttransplant focal segmental glomerulosclerosis received multiple-target therapy. Complete remission was achieved in 2 patients (15.4%), and partial remission in another 2 patients (15.4%). Four patients (30.7%) did not show remission, and 5 patients (38%) lost the graft because of posttransplant focal segmental glomerulosclerosis during the 12-mo follow-up. Premature discontinuation of treatment occurred in 10 patients (77%), all associated with infectious adverse events. Cytomegalovirus was the most common complication, and preemptive therapy was used instead of prophylaxis.</p><p><strong>Conclusions: </strong>In this cohort of patients, the efficacy of the multiple-target therapy was poor and limited by the high incidence of infectious adverse events.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 6","pages":"e1651"},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180756","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":"Variation in DCD Liver Transplant Protocols Among Transplant Centers in the United States.","authors":"Sai Rithin Punjala, April Logan, Jing Han, Ayato Obana, Ashley J Limkemann, Austin D Schenk, William K Washburn","doi":"10.1097/TXD.0000000000001650","DOIUrl":"10.1097/TXD.0000000000001650","url":null,"abstract":"<p><strong>Background: </strong>Variation in donation after circulatory death (DCD) organ recovery and liver transplant practices exist among transplant centers. This study aimed to evaluate these practices among centers in the United States.</p><p><strong>Methods: </strong>Scientific Registry of Transplant Recipients data were accessed to identify centers that performed liver transplantation in 2021 and 2022. Surveys were sent to transplant centers that consistently performed ≥5 DCD liver transplants per year.</p><p><strong>Results: </strong>DCD liver transplants were performed by 95 centers (65.1%) of the 146 liver transplant centers in the United States. Survey results were recorded from 42 centers that consistently performed ≥5 DCD liver transplants per year, with a 59.5% response rate. Withdrawal-to-asystole and agonal time were used to define donor warm ischemia time (WIT) in 16% and 84% centers, respectively. Fifty-six percent of the centers did not use oxygen saturation to define donor WIT. Systolic blood pressure cutoffs used to define agonal time varied between 50 and 80 mm Hg, donor age cutoffs ranged between 55 and 75 y, and cold ischemia times varied between 4 and 10 h. Seventy-six percent of centers used normothermic machine perfusion for DCD liver transplantation.</p><p><strong>Conclusions: </strong>This study highlights the wide variation in use, recovery, and definition of donor WIT. Using national data to rigorously define best practices will encourage greater utilization of this important donor resource.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 6","pages":"e1650"},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180777","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":"Deceased Donors With HIV in the Era of the HOPE Act: Referrals and Procurement.","authors":"Tao Liang, Jordan H Salas, Mary G Bowring, Oyinkan Kusemiju, Brittany Barnaba, Matthew Wingler, Deborah McRann, Alghidak Salama, R Patrick Wood, Allan Massie, William Werbel, Aaron A R Tobian, Dorry L Segev, Christine M Durand","doi":"10.1097/TXD.0000000000001641","DOIUrl":"10.1097/TXD.0000000000001641","url":null,"abstract":"<p><strong>Background: </strong>The HIV Organ Policy Equity Act legalizes organ procurement from donors with HIV (HIV D+). A prior survey of Organ Procurement Organizations (OPOs) estimated >2000 HIV D+ referrals/year; however, only 30-35 HIV D+/year have had organs procured. Given this gap, we sought to understand HIV D+ referrals and procurements in practice.</p><p><strong>Methods: </strong>We prospectively collected data on all OPO-reported HIV D+ referrals, including reasons for nonprocurement. We evaluated trends and compared HIV D+ characteristics by procurement status using regression, chi-squared tests, and Wilcoxon rank-sum tests.</p><p><strong>Results: </strong>From December 23, 2015 to May 31, 2021, there were 710 HIV D+ referrals from 49 OPOs, of which 171 (24%) had organs procured. HIV D+ referrals increased from 7 to 15 per month (<i>P</i> < 0.001), and the procurement rate increased from 10% to 39% (<i>P</i> < 0.001). Compared with HIV D+ without procurement, HIV D+ with procurement were younger (median age 36 versus 50 y), more commonly White (46% versus 36%), and more often had trauma-related deaths (29% versus 8%) (all <i>P</i> < 0.001). Nonprocurement was attributed to medical reasons in 63% of cases, of which 36% were AIDS-defining infections and 64% were HIV-unrelated, commonly due to organ failure (36%), high neurologic function (31%), and cancer (14%). Nonprocurement was attributed to nonmedical reasons in 26% of cases, commonly due to no authorization (42%), no waitlist candidates (21%), or no transplant center interest (20%).</p><p><strong>Conclusions: </strong>In the early years of the HIV Organ Policy Equity Act, actual HIV D+ referrals were much lower than prior estimates; however, the numbers and procurement rates increased over time. Nonprocurement was attributed to both medical and nonmedical issues, and addressing these issues could increase organ availability.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 6","pages":"e1641"},"PeriodicalIF":2.3,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11104717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141069686","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":"Differential Effects of Ascites and Hepatic Encephalopathy on Waitlist Mortality in Liver Transplantation by MELD 3.0.","authors":"Brian T Lee, Nathan T Chen, Tse-Ling Fong, Jennifer L Dodge","doi":"10.1097/TXD.0000000000001625","DOIUrl":"10.1097/TXD.0000000000001625","url":null,"abstract":"<p><strong>Background: </strong>MELD 3.0 introduces changes to address waitlist disparities for liver transplant (LT) candidates. Ascites and hepatic encephalopathy (HE) are important milestones in the natural history of cirrhosis regardless of the Model for End-Stage Liver Disease (MELD) score. We aim to assess the impact of ascites and HE and its interaction with MELD 3.0 on waitlist mortality.</p><p><strong>Methods: </strong>This is a retrospective study of patients listed for LT in the Organ Procurement and Transplantation Network database from 2016 to 2021. The primary outcome was waitlist mortality (death/delisting for too sick to LT). Ascites/HE were classified as moderate ascites without moderate HE (mAscites), moderate HE without moderate ascites (mHE), both moderate ascites/HE (mBoth), and neither. MELD 3.0 scores were categorized as <20, 20-29, 30-39, and ≥40.</p><p><strong>Results: </strong>Of 39 025 candidates, 29% had mAscites, 3% mHE, and 8% mBoth. One-year waitlist mortality was 30%, 38%, and 47%, respectively, compared with 17% (all <i>P</i> < 0.001) for those with neither. In multivariable Cox regression, the adjusted risk of waitlist mortality associated with mAscites (versus neither) was a hazard ratio (HR) of 1.76 (95% confidence interval [CI], 1.55-2.00) when the MELD 3.0 score was <20, significantly higher than when the MELD 3.0 score was 20-29 (HR 1.40; 95% CI, 1.27-1.54), 30-39 (HR 1.19; 95% CI, 1.04-1.35), and ≥40 (HR 1.14; 95% CI, 0.91-1.43, interaction <i>P</i> < 0.05 for all). A similar pattern was observed by MELD 3.0 for both moderate ascites/HE.</p><p><strong>Conclusions: </strong>The presence of moderate ascites alone, or combined with moderate HE, not only increases the risk of waitlist mortality but also has a differential effect by MELD 3.0, especially at lower MELD scores. Earlier strategies addressing this group and improving treatment plans or access to LT regardless of MELD remain needed.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 6","pages":"e1625"},"PeriodicalIF":2.3,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956554","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":"Pretransplant Malnutrition, Particularly With Muscle Depletion Is Associated With Adverse Outcomes After Kidney Transplantation.","authors":"Heather Lorden, Jessa Engelken, Katrina Sprang, Megan Rolfson, Didier Mandelbrot, Sandesh Parajuli","doi":"10.1097/TXD.0000000000001619","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001619","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplant centers lack consistent diagnostic malnutrition tools. The Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition Adult Malnutrition Criteria (AMC) is the widely accepted and utilized tool by Registered Dietitian Nutritionists (RDNs) to diagnose malnutrition.</p><p><strong>Methods: </strong>In this single-center, retrospective observational study, we evaluated the outcomes of prekidney transplant malnutrition based on Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition AMC, as well as the individual components of the AMC, on posttransplant outcomes including length of stay, delayed graft function (DGF), early readmission, cardiovascular events, acute rejection, death-censored graft failure, and death. Bivariable and multivariable logistic regression models were used to assess the association of malnutrition or its components with outcomes of interest.</p><p><strong>Results: </strong>A total of 367 recipients were included, of whom 36 (10%) were malnourished (23 moderately and 13 severely) at pretransplant evaluation. In adjusted models, pretransplant malnutrition was significantly associated with increased risk for early readmission (adjusted odds ratio 2.86; 95% confidence interval: 1.14-7.21; <i>P</i> = 0.03) and with DGF (adjusted odds ratio 8.33; 95% confidence interval: 1.07-64.6; <i>P</i> = 0.04). Muscle depletion was also associated with an increased risk for readmission and with DGF. Fat depletion and reduced functionality in the adjusted model were only associated with increased risk for readmission.</p><p><strong>Conclusions: </strong>Malnutrition could be an important consideration for selecting kidney transplant recipients because it was associated with poor clinical outcomes. A multidisciplinary approach with the involvement of RDNs to outline a nutrition intervention plan may help mitigate some of the poor outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 5","pages":"e1619"},"PeriodicalIF":2.3,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860441","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":"Use of Donor-derived Cell-free DNA to Inform Tapering of Immunosuppression Therapy in Kidney Transplant Recipients: An Observational Study.","authors":"George Osuchukwu, Alexa Trevino, Sarah McCormick, Navchetan Kaur, Brittany Prigmore, Nour Al Haj Baddar, Michelle S Bloom, Zachary Demko, Philippe Gauthier","doi":"10.1097/TXD.0000000000001610","DOIUrl":"10.1097/TXD.0000000000001610","url":null,"abstract":"<p><strong>Background: </strong>Immunosuppression therapy (IST) is required for allograft survival but can cause significant adverse effects. Donor-derived cell-free DNA (dd-cfDNA) is a validated noninvasive biomarker for active rejection in kidney transplant (KTx). Evidence supporting dd-cfDNA testing use in IST management is limited.</p><p><strong>Methods: </strong>In this single-center observational study, dd-cfDNA testing was performed in 21 KTx patients considered good candidates for mycophenolic acid (MPA) reduction. Patients with dd-cfDNA <1% at the first visit (enrollment) had their MPA dosage reduced; those with dd-cfDNA ≥1% had their MPA dosage maintained. Patients were monitored with dd-cfDNA for 6 additional visits.</p><p><strong>Results: </strong>Of 21 patients enrolled in the study, 17 were considered low risk for rejection by dd-cfDNA and underwent MPA reduction; 4 patients were considered high risk for rejection by dd-cfDNA and had their initial MPA dosage maintained. Of the 4 patients considered high risk for rejection by dd-cfDNA, 1 experienced chronic allograft nephropathy and graft loss, and another received an indication biopsy that showed no evidence of rejection. Of the 17 patients considered low risk for rejection by dd-cfDNA, none experienced allograft rejection. dd-cfDNA was used for surveillance in a 6-mo period following MPA reduction; no untoward results were noted.</p><p><strong>Conclusions: </strong>This proof-of-concept study reports the use of dd-cfDNA to directly inform IST management in a cohort of KTx who were candidates for IST reduction.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 4","pages":"e1610"},"PeriodicalIF":1.9,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10936987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120647","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":"Diagnosis and Management of Esophageal Fistulas After Lung Transplantation: A Case Series.","authors":"Stijn Vanstraelen, Robin Vos, Marie Dausy, Jan Van Slambrouck, Cedric Vanluyten, Paul De Leyn, Willy Coosemans, Herbert Decaluwé, Hans Van Veer, Lieven Depypere, Raf Bisschops, Ingrid Demedts, Michael P Casaer, Yves Debaveye, Greet De Vlieger, Laurent Godinas, Geert Verleden, Dirk Van Raemdonck, Philippe Nafteux, Laurens J Ceulemans","doi":"10.1097/TXD.0000000000001593","DOIUrl":"10.1097/TXD.0000000000001593","url":null,"abstract":"<p><strong>Background: </strong>Lung transplantations are highly complex procedures, often conducted in frail patients. Through the addition of immunosuppressants, healing can be compromised, primarily leading to the development of bronchopleural fistulas. Although esophageal fistulas (EFs) after lung transplantation remain rare, they are associated with significant morbidity. We aimed to investigate the clinical presentation, diagnostic approaches, and treatment strategies of EF after lung transplantation.</p><p><strong>Methods: </strong>All patients who developed EF after lung transplantation at the University Hospitals Leuven between January 2019 and March 2022 were retrospectively reviewed and the clinical presentations, diagnostic approaches, and treatment strategies were summarized.</p><p><strong>Results: </strong>Among 212 lung transplantation patients, 5 patients (2.4%) developed EF. Three patients were male and median age was 39 y (range, 34-63). Intraoperative circulatory support was required in 3 patients, with 2 needing continued support postoperatively. Bipolar energy devices were consistently used for mediastinal hemostasis. All EFs were right-sided. Median time to diagnosis was 28 d (range, 12-48) and 80% of EFs presented as recurrent respiratory infections or empyema. Diagnosis was made through computed tomography (n = 3) or esophagogastroscopy (n = 2). Surgical repair with muscle flap covering achieved an 80% success rate. All patients achieved complete resolution, with only 1 patient experiencing a fatal outcome during a complicated EF-related recovery.</p><p><strong>Conclusion: </strong>Although EF after lung transplantation remains rare, vigilance is crucial, particularly in cases of right-sided intrathoracic infection. Moreover, caution must be exercised when applying thermal energy in the mediastinal area to prevent EF development and mitigate the risk of major morbidity. Timely diagnosis and surgical intervention can yield favorable outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 3","pages":"e1593"},"PeriodicalIF":2.3,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983905","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":"Enhanced Donor Antigen Presentation by B Cells Predicts Acute Cellular Rejection and Late Outcomes After Transplantation.","authors":"Chethan Ashokkumar, Mylarappa Ningappa, Vikram Raghu, George Mazariegos, Brandon W Higgs, Paul Morgan, Lisa Remaley, Tamara Fazzolare Martin, Pamela Holzer, Kevin Trostle, Qingyong Xu, Adriana Zeevi, James Squires, Kyle Soltys, Simon Horslen, Ajai Khanna, Armando Ganoza, Rakesh Sindhi","doi":"10.1097/TXD.0000000000001589","DOIUrl":"10.1097/TXD.0000000000001589","url":null,"abstract":"<p><strong>Background: </strong>Enhanced B-cell presentation of donor alloantigen relative to presentation of HLA-mismatched reference alloantigen is associated with acute cellular rejection (ACR), when expressed as a ratio called the antigen presenting index (API) in an exploratory cohort of liver and intestine transplant (LT and IT) recipients.</p><p><strong>Methods: </strong>To test clinical performance, we measured the API using the previously described 6-h assay in 84 LT and 54 IT recipients with median age 3.3 y (0.05-23.96). Recipients experiencing ACR within 60 d after testing were termed rejectors.</p><p><strong>Results: </strong>We first confirmed that B-cell uptake and presentation of alloantigen induced and thus reflected the alloresponse of T-helper cells, which were incubated without and with cytochalasin and primaquine to inhibit antigen uptake and presentation, respectively. Transplant recipients included 76 males and 62 females. Rejectors were tested at median 3.6 d before diagnosis. The API was higher among rejectors compared with nonrejectors (2.2 ± 0.2 versus 0.6 ± 0.04, <i>P</i> value = 1.7E-09). In logistic regression and receiver-operating-characteristic analysis, API ≥1.1 achieved sensitivity, specificity, and positive and negative predictive values for predicting ACR in 99 training set samples. Corresponding metrics ranged from 80% to 88% in 32 independent posttransplant samples, and 73% to 100% in 20 independent pretransplant samples. In time-to-event analysis, API ≥1.1 predicted higher incidence of late donor-specific anti-HLA antibodies after API measurements in LT recipients (<i>P</i> = 0.011) and graft loss in IT recipients (<i>P</i> = 0.008), compared with recipients with API <1.1, respectively.</p><p><strong>Conclusions: </strong>Enhanced donor antigen presentation by circulating B cells predicts rejection after liver or intestine transplantation as well as higher incidence of DSA and graft loss late after transplantation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 3","pages":"e1589"},"PeriodicalIF":2.3,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983907","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":"CAR T-Cell Therapy for Refractory Posttransplantation Lymphoproliferative Disorder in a Kidney Transplant Patient.","authors":"Pierre Guy, Olivier Marion, Lucie Oberic, Amandine Darres, Olivier Cointault, Arnaud Del Bello, Nassim Kamar","doi":"10.1097/TXD.0000000000001584","DOIUrl":"10.1097/TXD.0000000000001584","url":null,"abstract":"","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 3","pages":"e1584"},"PeriodicalIF":2.3,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983904","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":"Disparities Persist Among Hispanic Patients: Completing Evaluation, Waitlisting, and Receiving a Kidney Transplant.","authors":"Elisa J Gordon, Jungwha Lee, Raymond Kang, Jefferson Uriarte, Juan Carlos Caicedo","doi":"10.1097/TXD.0000000000001595","DOIUrl":"10.1097/TXD.0000000000001595","url":null,"abstract":"<p><strong>Background: </strong>Hispanic patients receive disproportionately fewer kidney transplants (KT) than non-Hispanic White (NHW) patients. In this observational study, we evaluated disparities in completing evaluation steps to KT among Hispanic patients.</p><p><strong>Methods: </strong>Using medical records of Hispanic and NHW patients initiating evaluation at 4 transplant centers from January 2011 to March 2020, we performed sequential Cox models to compare Hispanic versus NHW patients reaching each step of the evaluation process until receiving a KT.</p><p><strong>Results: </strong>Among all 5197 patients (Hispanic n = 2473; NHW n = 2724) initiating evaluation, Hispanic patients had 8% lower risk to be approved by the kidney pancreas (KP) committee than NHW patients (adjusted hazard ratio [aHR], 0.92; 95% confidence intervals (CI), 0.86-0.98; <i>P</i> = 0.015). Among 3492 patients approved by the KP committee, Hispanic patients had 13% lower risk to be waitlisted than NHW patients (aHR, 0.87; 95% CI, 0.81-0.94; <i>P</i> = 0.004). Among 3382 patients who were waitlisted, Hispanic patients had 11% lower risk than NHW patients to receive KT (aHR, 0.89; 95% CI, 0.81-0.97; <i>P</i> = 0.011). Among all patients initiating evaluation, Hispanic patients had a 16% lower risk than NHW patients to reach KT (aHR, 0.84; 95% CI, 0.76-0.92; <i>P</i> = 0.0002).</p><p><strong>Conclusions: </strong>Our study found that disproportionately fewer Hispanic patients were approved by the KP committee, were waitlisted, and received a KT, particularly a living donor kidney transplant, than NHW patients. Closer oversight of the evaluation process may help patients overcome challenges in access to KT.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"10 3","pages":"e1595"},"PeriodicalIF":1.9,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983906","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}