Transplantation proceedings最新文献

{"title":"Transplantation for Peri-Hilar and Intrahepatic Cholangiocarcinoma With mTOR Immunosuppression","authors":"Samar Semaan ,&nbsp;Ashton A. Connor ,&nbsp;Ashish Saharia ,&nbsp;Sudha Kodali ,&nbsp;Ahmed Elaileh ,&nbsp;Khush Patel ,&nbsp;Nadine Soliman ,&nbsp;Tamneet Basra ,&nbsp;David W. Victor III ,&nbsp;Caroline J. Simon ,&nbsp;Yee Lee Cheah ,&nbsp;Mark J. Hobeika ,&nbsp;Constance M. Mobley ,&nbsp;Sadhna Dhingra ,&nbsp;Mary R. Schwartz ,&nbsp;Anaum Maqsood ,&nbsp;Kirk Heyne ,&nbsp;Maen Abdelrahim ,&nbsp;Xian C. Li ,&nbsp;Milind Javle ,&nbsp;R. Mark Ghobrial","doi":"10.1016/j.transproceed.2025.02.001","DOIUrl":"10.1016/j.transproceed.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Cholangiocarcinoma (CCA) has rising incidence and mortality rates. Outcomes from combination systemic, loco-regional therapy (LRT) and liver transplantation (LT) are improving, but more granular data are needed to inform evidence-based management, including patient selection and immunosuppression.</div></div><div><h3>Methods</h3><div>Patients with peri-hilar (PH) and intrahepatic (IH) CCA who underwent LT at a single center between January 2008 and February 2023 were reviewed retrospectively. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS) with significance determined by Cox proportional hazards model.</div></div><div><h3>Results</h3><div>During the study period, 53 patients underwent LT for either PH (n = 27), or IH (26). Cohort had mean age 58.5 years old (IQR, 47.0-63.0), body mass index (BMI) 25.9 (IQR, 22.9-30.0) kg/m², and mean biologic MELD 9 (IQR, 7-17). Most frequent etiology was PSC (n = 12, 22.6%). Forty-nine patients (92.5%) received neoadjuvant therapy, including systemic (n = 48, 90.6%) and locoregional therapy (LRT) (n = 22, 41.5%), to which PH tumors were both most and least responsive (<em>P</em> = .03). On explant pathology, tumor were a median size of 3.5 cm and lympho-vascular invasion (LVI) was present in 13 (24.5%) cases. Median follow-up post-transplant was 910 days (IQR, 407-1509). Probabilities of OS and RFS at 3-years post-LT were 69.2% (95% CI, 56.9%-84.2%) and 57.4% (95% CI, 43.7%-75.4%). In multivariable analysis, OS was associated with tumor type and LVI, and RFS with age, BMI, PSC and LRT. After a median post-LT period of 38 days (IQR, 27-79.5), 39 (71.7%) patients started mTOR inhibition with lowered tacrolimus goal. Cox proportional hazard model showed significant association of OS with mTOR inhibition, though this was not validated by a time-dependent co-variate approach.</div></div><div><h3>Conclusions</h3><div>In this single center cohort of CCA, post-LT outcomes were significantly greater for patients with IH tumors and no LVI. Immunosuppression with mTOR inhibition was not consistently associated with outcomes.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 255-263"},"PeriodicalIF":0.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distribution, Drug Resistance, and Risk Factors of Infection in Liver Transplant Recipients With Liver Failure","authors":"Wenjing Wang ,&nbsp;Bo Wang ,&nbsp;Ting Lin ,&nbsp;Yi Zhang ,&nbsp;Xiaogang Zhang","doi":"10.1016/j.transproceed.2025.01.003","DOIUrl":"10.1016/j.transproceed.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to explore strategies for postoperative infection prevention and treatment, and how they might help to improve the prognosis in liver transplant recipients with liver failure.</div></div><div><h3>Methods</h3><div>We retrospectively investigated 98 recipients with liver failure in the Surgical Intensive Care Unit of The First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to December 2023, and the pathogens distribution, drug resistance, and risk factors of infection after liver transplantation were analyzed.</div></div><div><h3>Results</h3><div>The incidence of infection was 48.0%, with common infection sites including the respiratory tract, abdominal cavity, biliary tract, and bloodstream. A total of 145 pathogens were isolated, 110 (75.9%) of which were Gram-negative bacteria, 30 (20.7%) were Gram-positive bacteria, and 5 (3.4%) were fungi. The most common pathogenic bacteria were <em>Klebsiella pneumoniae, Acinetobacter baumannii, Enterococcus faecalis, Pseudomonas aeruginosa</em>, and <em>Stenotrophomonas maltophilia</em>. Drug sensitivity data showed that <em>Klebsiella pneumoniae</em> showed a high resistance rate (over 70%) to all tested antibiotics except for tigecycline, colistin, and ceftazidime avibactam. <em>Acinetobacter baumannii</em> was highly sensitive to colistin and tigecycline, with a sensitivity of over 50% to minocycline and aminoglycosides, and a resistance rate of over 70% to other tested antibiotics. No Gram-positive strain was resistant to tigecycline, linezolid, vancomycin, and teicoplanin. Risk factor analysis suggested that preoperative infection within 2 months was an independent risk factor for infection after liver transplantation in recipients with liver failure.</div></div><div><h3>Conclusions</h3><div>The incidence of postoperative infection in liver failure recipients was high, and the respiratory tract and abdomen were the most common sites. The pathogenic bacteria were mainly Gram-negative bacteria, which showed an extensive and high drug resistance. Patients with liver failure who underwent liver transplantation with a preoperative infection within 2 months of the transplantation were more likely to develop an infection after surgery.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 305-311"},"PeriodicalIF":0.8,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Long-term Kidney Allograft Survival: A Contemporary Analysis of the UNOS Database","authors":"Muhammad Hasnain Mankani ,&nbsp;Omar Mahmud ,&nbsp;Muhammad Saad Hafeez ,&nbsp;Muhammad Abdullah Javed ,&nbsp;Muhammad Abdullah Arain ,&nbsp;Muneeb Ul-Haq ,&nbsp;Abbas A. Rana","doi":"10.1016/j.transproceed.2025.01.006","DOIUrl":"10.1016/j.transproceed.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>Various clinicopathologic markers, such as 1-year serum creatinine (Cr), have been used to prognosticate kidney allografts after transplantation. However, a contemporary analysis of their relationship with long-term graft survival is lacking. This study aimed to analyze recent data on the association of prognostic factors with kidney allograft survival in patients who underwent transplantation in the modern era.</div></div><div><h3>Methods</h3><div>Adult kidney-transplant recipients in the UNOS database (2008-2020) were identified. Living and deceased donor allografts were analyzed separately and stratified by 1-year serum Cr level: ≤1.0, 1.0 to 1.5, 1.5 to 2.0, and &gt;2.0 mg/dL. Time-to-event analysis was performed with long-term death-censored graft survival as the primary outcome. In addition, factors associated with raised 1-year serum Cr and with long-term allograft failure were identified.</div></div><div><h3>Results</h3><div>174,547 patients were included. Ten-year survival decreased with increasing 1-year creatinine, and these trends persisted on adjusted analysis for both living donor (Cr ≤ 1.0 mg/dL: reference; Cr 1.0-1.5 mg/dL aHR = 1.77 [1.59-1.96]; Cr 1.5-2.0 mg/dL aHR = 3.24 [2.89-3.64] and; Cr &gt; 2.0 mg/dL aHR = 9.78, [8.64-11.07], <em>P &lt;</em> .01) as well as deceased donor allografts (Cr ≤ 1.0 mg/dL: reference; Cr 1.0-1.5 mg/dL aHR = 1.74 [1.63-1.86]; Cr 1.5-2.0 mg/dL aHR = 3.06 [2.84-3.30] and; Cr &gt; 2.0 mg/dL aHR = 8.51, [7.89-9.18], <em>P &lt;</em> .01).</div></div><div><h3>Conclusion</h3><div>These results characterize the association between 1-year serum creatinine levels and other clinicopathologic factors with long-term kidney allograft survival. We demonstrate the ability of prognostic factors to stratify patients by risk of graft failure in a contemporary patient cohort that is representative of current practice and outcomes.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 194-207"},"PeriodicalIF":0.8,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Recipient Insurance on the Outcome of Simultaneous Pancreas and Kidney Transplantation","authors":"Raza Ali Zaidi ,&nbsp;Elizabeth Hubin ,&nbsp;Ahmed Agha ,&nbsp;Suhant Takande","doi":"10.1016/j.transproceed.2025.01.005","DOIUrl":"10.1016/j.transproceed.2025.01.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Simultaneous pancreas–kidney (SPK) transplantation is an established treatment for insulin-requiring diabetics with advanced chronic or end-stage kidney disease. Outcomes of SPK transplantation may vary according to socioeconomic factors such as funding sources. The aim of this study was to assess the association between insurance payer of transplant recipients and outcomes of SPK transplantation in the United States.</div></div><div><h3>Methods</h3><div>All adult primary SPK transplants performed in the United States between January 1, 1988, and December 31, 2017 were included, using data from the national Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients database. A total of 19,849 adult SPK transplant recipients were included in the study, after excluding patients who had insurance sources other than Medicaid, Medicare, or private; dual insurance; or were lost at 90-day follow-up. Post-transplant outcomes were analyzed in terms of allograft and recipient survival.</div></div><div><h3>Results</h3><div>Recipients with private insurance had significantly lower risks of late kidney graft loss (hazard ratio [HR], 0.74), late pancreas graft loss (HR, 0.77), and late death (HR, 0.73) compared with those with Medicaid. Recipients with Medicare had a higher risk of late death (HR, 1.05). Private insurance recipients had better 10-year and 15-year kidney, pancreas, and patient graft survival rates across most racial/ethnic groups.</div></div><div><h3>Conclusions</h3><div>Recipient insurance status significantly influenced long-term outcomes after SPK transplantation. Transplant programs should consider publicly sponsored insurance status as a marker of poorer post-transplant survival to implement changes in both pre- and post-transplant strategies.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 371-379"},"PeriodicalIF":0.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Priority Should be Given to Centers that Split En Bloc Pediatric Kidneys to Maximize Transplantation: A Single Center Experience","authors":"Daniel Barbash ,&nbsp;Miriam Steinberger ,&nbsp;Julia Torabi ,&nbsp;Hillary Yaffe ,&nbsp;Maria Ajaimy ,&nbsp;Enver Akalin ,&nbsp;Luz E. Liriano ,&nbsp;Yorg Azzi ,&nbsp;Swati Jain ,&nbsp;Cindy Pynadath ,&nbsp;Nidal Muhdi ,&nbsp;Marie Le ,&nbsp;Jay A. Graham","doi":"10.1016/j.transproceed.2025.01.004","DOIUrl":"10.1016/j.transproceed.2025.01.004","url":null,"abstract":"<div><div>The foundation for OPTN policy 8.5.B that allows for en bloc kidney utilization from pediatric donors under &lt;18 kg is unclear. Naturally, kidneys recovered from these donors can be split and transplanted into 2 adult recipients as opposed to only 1 (OPTN policy 8.5.C). Our center universally splits all pediatric donor kidneys. We showed that early eGFR is lower in recipients that receive a kidney from a donor &lt;18 kg (3-month eGFR; 36.3 vs 49.7 mL/min/1.73 m², <em>P</em> = .01), but quickly rebounds with no significant differences thereafter. As such, efforts should be made to revisit the practice of en bloc kidney transplantation from small pediatric donors. Given similar complication rates and outcomes seen at our center between the 2 groups, “splitting first” should be the policy to ensure maximalization of transplant recipients.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 250-254"},"PeriodicalIF":0.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the Perioperative Practices for Immunological Assessment and Immunosuppression Strategies for Patients Undergoing Intestinal Transplantation at American Transplant Centers","authors":"Mohammed Abusuliman ,&nbsp;Syed-Mohammed Jafri ,&nbsp;Bryant B. Summers ,&nbsp;Thiago Beduschi ,&nbsp;Justin Boike ,&nbsp;Douglas G. Farmer ,&nbsp;Simon Horslen ,&nbsp;Kishore Lyer ,&nbsp;Alan N. Langnas ,&nbsp;Richard S. Mangus ,&nbsp;Cal S. Matsumoto ,&nbsp;Alisha M. Mavis ,&nbsp;George V. Mazariegos ,&nbsp;Shunji Nagai ,&nbsp;Jacqueline O'Leary ,&nbsp;Thomas D. Schiano ,&nbsp;Debra L. Sudan ,&nbsp;Amr Abusuliman ,&nbsp;Nimisha Sulejmani ,&nbsp;Maria Cristina Segovia","doi":"10.1016/j.transproceed.2025.01.002","DOIUrl":"10.1016/j.transproceed.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Intestinal transplantation (IT) is a complex procedure that requires nuanced immunosuppressive strategies to optimize patient outcomes. Despite advancements, significant variability remains in immunosuppressive protocols across transplant centers due to a lack of consensus on the optimal approaches for induction, maintenance, and clinical testing. This variability complicates standardization and identification of best practices for IT recipients.</div></div><div><h3>Methods</h3><div>A descriptive survey study was conducted to characterize immunosuppressive and testing strategies in IT at major transplant centers in the United States. Ten centers known to have performed over 10 ITs since 2015 were selected from the Scientific Registry of Transplant Recipients database. A 22-question survey was distributed to surgical directors, collecting data on pre-, peri-, and post-transplant immunological testing, desensitization strategies, immunosuppressive regimens, and management of antibody-mediated rejection (AMR) and acute cellular rejection (ACR).</div></div><div><h3>Results</h3><div>Nine centers (90%) responded. All centers conducted pretransplant human leukocyte antigen (HLA) and donor-specific antibody (DSA) testing, with varying frequencies and methodologies. Desensitization was reported by 44% of centers for isolated IT and by 22% for multivisceral transplants. Induction therapy predominantly involved antithymocyte globulin (89%) and rituximab (44%). Tacrolimus was universally used for maintenance, with varying trough level targets across centers. Post-transplant DSA testing was performed by all centers, and protocol-driven endoscopic bowel biopsies were routine at 67% of centers. AMR was diagnosed at 89% of centers, with plasmapheresis and IVIG being the most common treatments. Variability was noted in desensitization practices and AMR management.</div></div><div><h3>Conclusion</h3><div>This survey highlights considerable consistency in pre- and post-transplant testing and immunosuppressive regimens for IT recipients, while significant variability exists in desensitization strategies and AMR management. Further research is needed to standardize these practices to improve patient outcomes across transplant centers</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 380-389"},"PeriodicalIF":0.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life in Pediatric CKD Patients on Dialysis vs Renal Transplantation: A Comparative Study of the Perspectives of Parents and Children","authors":"Maisan Alaskar ,&nbsp;Fatima AlQattan ,&nbsp;Sara Al-Shami ,&nbsp;Ammar Hamed ,&nbsp;Alanoud Alshami","doi":"10.1016/j.transproceed.2024.12.023","DOIUrl":"10.1016/j.transproceed.2024.12.023","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) is a burden on children and their caregivers, especially in advanced stages requiring different renal replacement modalities (peritoneal/hemodialysis and renal transplant). The aim of the study is to measure the health-related quality of life (HRQOL) of children and their caregivers for each renal replacement modality, specifically dialysis and transplant.</div></div><div><h3>Methods</h3><div>This study is a single-center cross-sectional study that was carried out at King Fahad Specialist Hospital in Dammam (KFSH-D). A total of 57 participants ranging from 5 to 18 years of age were included in the study, comprised of 42 patients and their parents in the transplant arm and 15 patients and their parents in the end-stage renal disease (ESRD) arm. The HRQOL was measured using the Pediatric Quality of Life Inventory (PedsQL) version 3.0 ESRD and transplant modules, respectively.</div></div><div><h3>Results</h3><div>The mean scores for HRQOL for children receiving dialysis were found to be 60.2 ± 22.6, which was significantly lower than the scores for children who had undergone transplantation (84.1 ± 14.7, <em>P</em> = .001). Additionally, the scores for the parents providing proxy reports for children on dialysis (52.5 ± 25.7) were also significantly lower compared with those for parents of children who had undergone transplantation (83.8 ± 13.9, <em>P</em> ≤ .001).</div></div><div><h3>Conclusions</h3><div>This research demonstrated that HRQOL of both children who had undergone transplants and their caregivers was notably superior to that of individuals with ESRD. Which reinforces the importance of timely kidney transplantation in children and its positive impact on both physical and psychosocial well-being.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 241-249"},"PeriodicalIF":0.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Variation of Plasma Copeptin and Its Association With Vasopressor Need During Liver Transplantation","authors":"Ceren Gunt ,&nbsp;Nedim Çekmen","doi":"10.1016/j.transproceed.2024.11.035","DOIUrl":"10.1016/j.transproceed.2024.11.035","url":null,"abstract":"<div><h3>Background</h3><div>Vasopressor usage during liver transplant is related to decreased hepatic flow, graft failure, and mortality. We measured plasma Copeptin levels in liver transplant patients based on vasopressor requirements. We hypothesize that preoperative plasma copeptin measurement helps predict the vasopressor infusion requirement during liver transplantation in preoperative evaluation.</div></div><div><h3>Methods</h3><div>The plasma Copeptin of 40 patients was measured 5 times: before the operation, 15 minutes before and after reperfusion, and postoperative 12^th and 24^th hours. Patients were categorized into 2 groups based on vasopressor infusion for comparison.</div></div><div><h3>Results</h3><div>There was a statistically significant rise in median serum Copeptin concentration between the preoperative phase and before reperfusion (11.2 [7.3-20.9] vs 178.5 [121.5-243.0], <em>P &lt; .</em>001), as well as a statistically substantial decline between after reperfusion and postoperative 12^th hours (190.6 [127-276.3] vs 74.7 [42.0-124.9], <em>P &lt; .</em>001). The vasopressor-taking group had significantly higher plasma copeptin at postoperative 12^th hours (96.6 [71.4-191.7] vs 55.0 [31.8-82.5], <em>P</em> = .030) and 24^th (133.7 [72.2-175.5] vs 51.1 [24.8-85.8], <em>P</em> = .037). A tendency above 11.85 pmol/L of plasma Copeptine level was observed between increasing preoperative plasma Copeptin and the odds of vasopressor use.</div></div><div><h3>Conclusion</h3><div>High preoperative plasma Copeptin levels may be an indicator of vasopressor need during liver transplantation. Further studies with more samples, including a higher range of preoperative plasma Copeptin levels, are required to provide more generalizable findings and to determine thresholds applicable to LT candidates.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 277-283"},"PeriodicalIF":0.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Clinical Outcomes Between Two Types of Dipeptidyl Peptidase-4 Inhibitors in Posttransplant Diabetes Mellitus in Kidney Transplantation Recipients: A Nationwide Population-Based Cohort Study in Korea","authors":"Keun young Lee ,&nbsp;Ga young Song ,&nbsp;Min jun Seo ,&nbsp;Sung hwa Kim ,&nbsp;Dae Ryong Kang ,&nbsp;Keunryul Park ,&nbsp;Ji Teck Kim ,&nbsp;Sang Wook Park ,&nbsp;Jun Young Lee","doi":"10.1016/j.transproceed.2024.12.014","DOIUrl":"10.1016/j.transproceed.2024.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Dipeptidyl peptidase-4 inhibitors (DPP-4i) are antidiabetic drugs known for their minimal side effects and limited drug interaction witih immunosuppressants, making them suitable for patients with diabetes and kidney transplant recipients. However, there is limited real-world information regarding the use of DPP-4 inhibitors in patients with post transplant diabetes mellitus (PTDM).</div></div><div><h3>Method</h3><div>We performed a retrospective observational cohort study of 13,828 kidney transplant recipients form Janary 1, 2002, through December 21, 2018, using the Korean National Health Information Database. We extracted PTDM patients, and divided the patients into 2 groups baased on whether they received DPP4-inhibitor which needs dose adjustement (group A) or not (Group B) according to estimaged glomerular filtration rate.</div></div><div><h3>Results</h3><div>Out of 3154 patients who developed PTDM after transplantation, 738 patients prescribed DPP-4 inhibitors. Among these, 490 patients prescribed Group B DPP-4 inhibitors and 238 patients prescribed Group A DPP-4 inhibitors. Multivariate-adjusted Cox regression analysis showed that compared Group B, Group A DPP-4 inhibitors was associated with higher incidence rate of genital tract infection (hazard ratio (HR) 1.87, 95% Confidence Interval (CI) 1.18-2.99), and emergency department visit (HR 3.12, 95% CI 1.89-5.16). However, there was no significantly difference in death (any cause), admission, graft failure, infection, or hypoglycemia between the 2 groups.</div></div><div><h3>Conclusions</h3><div>In patients with PTDM, some kinds of DPP-4 inhibitors, which need dose adjustment according to renal function, were associated with an increased rate of emergency department visit and genital tract infection.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 208-213"},"PeriodicalIF":0.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonlinear Relationship Between Body Mass Index and Liver Transplant Outcomes: A Dose-Response Meta-Analysis","authors":"Chengze Liang ,&nbsp;Saifu Yin ,&nbsp;Turun Song ,&nbsp;Tao Lin","doi":"10.1016/j.transproceed.2024.12.019","DOIUrl":"10.1016/j.transproceed.2024.12.019","url":null,"abstract":"<div><h3>Background</h3><div>Weight management was recommended to have more access to transplantation and improve transplant outcomes after liver transplantation (LT). However, the dose-response relationship between body mass index (BMI) and transplant outcomes has not been clearly defined.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Web of Science, and Cochrane Library databases were searched up to October 20th, 2019. Dose-response meta-analyses was conducted to establish the dose-response relationship pattern.</div></div><div><h3>Results</h3><div>Twenty-three observational studies were eligible. In the pair-wise analysis, compared with normal BMI, HRs in underweight, overweight, obesity-I, obesity-II, and obesity-III were 2.13, 0.96, 1.06, 1.36, and 1.97 for patient death, and 3.08, 1.02, 1.25, 1.58, and 2.90, for graft loss. In the dose-response analysis, U-shaped relationships were observed between BMI and both patient and graft survival (<em>P &lt; .</em>001, <em>P &lt; .</em>001). Referring to 17.5kg/m², the patient death risk decreased to 0.72 (95% CI: 0.62-0.84) in 27kg/m² and then increased to 1.44 (95% CI:1.09-1.90) in 28.7-42kg/m². Comparing to 17.5kg/m², individuals in 26.7-28.0kg/m² had the least risk of graft loss with HR of 0.62 (95% CI:0.48-0.80) and increased to 1.64 (95% CI:1.03-2.61) in 42kg/m². Subgroup analyses by age, sex, sample size, duration of follow-up, location, publication year, and study type presented similar results.</div></div><div><h3>Conclusion</h3><div>Underweight and severe obesity are associated with a significantly increased risk of graft loss and patient death after liver transplantation. Overweight, especially BMI of 26-28 kg/m², may have extra survival benefit. Weight management before liver transplantation may be necessary.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 312-323"},"PeriodicalIF":0.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}