Transplantation proceedings最新文献

{"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}

{"title":"Calcitriol Treated Mesenchymal Stem Cells Modulated Immune Response in Collagen-Induced Rheumatoid Arthritis in BALB/c Mice","authors":"Alireza Rafati ,&nbsp;Reihaneh Ramezani ,&nbsp;Hadi Esmaeili Gouvarchin Ghaleh ,&nbsp;Shabnam Bahrami ,&nbsp;Akbar Ghorbani Alvanegh ,&nbsp;Mahmood Reza Masoudi","doi":"10.1016/j.transproceed.2024.12.020","DOIUrl":"10.1016/j.transproceed.2024.12.020","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Rheumatoid arthritis (RA) is a chronic inflammatory disease that primarily involves synovial joints. During the past decade, disease-modifying antirheumatic drugs and biologic agents have been introduced for the treatment of RA. However, they have limitations, including incomplete treatment response, adverse effects requiring drug withdrawal, fall off in efficacy over time, high cost of biologic agents, and refractory cases. Consequently, there is a need to establish safe and effective advanced therapeutic modalities for RA to overcome the shortcomings of current treatments.</div></div><div><h3>Methods</h3><div>MSCs after isolation were exposed to 200 nM calcitriol. Rheumatoid arthritis was induced in BALB/c mice using collagen and Freund's complete adjuvant. One week after immunization, the mice were divided into 3 groups including without treatment, groups treated with untreated and treated MSCs. One week after the last injection, mice sacrificed and samples were taken and the desired evaluations were done.</div></div><div><h3>Results</h3><div>Our results revealed that the respiratory burst capacity, neutrophil phagocytosis, and nitric oxide production in the population of splenocytes were higher in the positive control group compared to the treatment groups. Also, the level of production of IL-4, IL-10 and TGF-β cytokines and INF-γ and IL-17 cytokines showed a significant increase and decrease, respectively, compared to the positive control group.</div></div><div><h3>Conclusion</h3><div>Treatment of MSCs with calcitriol leads to an improvement in regulatory function and inhibitory effects on inflammatory mediators of innate immune cells, particularly splenocytes, in a rheumatoid arthritis model compared to untreated mesenchymal stem cells.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 355-363"},"PeriodicalIF":0.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019314","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":"Experimental Study on Myocardial Protective Effect of Xuebijing Injection on Extracorporeal Membrane Oxygenation Perfused Isolated Heart: Based on Autophagy and NLRP3 Inflammatory Pathway","authors":"Shijie Yin ,&nbsp;Chunhua Wang ,&nbsp;Xiao Yue ,&nbsp;Qiangxin Huang ,&nbsp;Wei Wu ,&nbsp;Guanbin Qin ,&nbsp;Lan Luo ,&nbsp;Huabei Wu","doi":"10.1016/j.transproceed.2024.12.022","DOIUrl":"10.1016/j.transproceed.2024.12.022","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to investigate the myocardial protective effect of Xuebijing (XBJ) injection in isolated donor heart preservation based on autophagy and NLRP3 inflammatory pathway, and to provide clues for improving the quality of donor heart preservation in the clinic.</div></div><div><h3>Methods</h3><div>Fourteen Guangxi Bama miniature pigs were randomly divided into two groups to establish the isolated heart perfusion model of extracorporeal membrane oxygenation (ECMO): (1) normal saline group (NS group): 50 mL normal saline was added to the perfusion solution; and (2) Xuebijing injection group (XBJ group): 10 mL of XBJ was added to the perfusate. Both groups were continuously pumped with 5 mL/h for 8 hours. Hemodynamic changes, inflammatory reaction, and myocardial enzyme levels were observed at five different time points. Western blot and real-time quantitative polymerase chain reaction (RT-qPCR) were used to detect the expression of autophagy markers and the NLRP3 signaling pathway related factors mRNA in myocardial tissue. Hematoxylin and eosin (H&amp;E) staining and transmission electron microscopy were used to observe the pathomorphology and ultrastructure of the myocardium.</div></div><div><h3>Results</h3><div>There was no significant difference in perfusion pressure, heart rate, perfusion flow, and PH value between the two groups. The degree of myocardial tissue injury in the XBJ group was lighter, and the levels of myocardial enzymes, serum inflammatory factors were lower. The mRNA expression levels of beclin-1 and LC3 in the XBJ group were higher than those in the saline group, and the mRNA expression levels of NLRP3, Caspase-1, and ASC were lower.</div></div><div><h3>Conclusions</h3><div>Xuebijing injection can effectively improve the level of autophagy, reduce the activation and release of NLRP3 inflammasome, and slow down the inflammatory response, which has a certain myocardial protection effect.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 416-423"},"PeriodicalIF":0.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019356","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 Impacting Early Adverse Outcomes in Simultaneous Heart-Kidney Transplantation","authors":"Bernard John DuBray ,&nbsp;Saed Shawar ,&nbsp;Sandip Zalawadiya ,&nbsp;Kelly Schlendorf ,&nbsp;Bonnie Ann Sarrell ,&nbsp;Beatrice P. Concepcion ,&nbsp;Scott A. Rega ,&nbsp;Irene D. Feurer ,&nbsp;David Shaffer ,&nbsp;Rachel C. Forbes","doi":"10.1016/j.transproceed.2024.11.037","DOIUrl":"10.1016/j.transproceed.2024.11.037","url":null,"abstract":"<div><h3>Background</h3><div>Over the last decade, the number of simultaneous heart-kidney transplants (SHKTs) has increased dramatically. There are few reports of renal allograft outcomes in these high acuity patients. The goal of the present study was to identify variables that were related to early adverse outcomes (EAOs), including delayed graft function (DGF), primary non-function (PNF), and renal allograft futility (RAF) after SHKTs.</div></div><div><h3>Methods</h3><div>We performed a single center retrospective review of all adults undergoing SHKTs from October 2011 to August 2021. Multivariable logistic regression models with backward elimination were used to test the relationships between recipient (pre-transplant dialysis, intra-aortic balloon pump, serum lactate, norepinephrine use, and re-do sternotomy) and operative (cold ischemia time [CIT]) variables and the likelihood of DGF, PNF, and RAF.</div></div><div><h3>Results</h3><div>Sixty-eight patients underwent SHKT during the study period. Overall, patient survival was 87%, 83%, and 80% at 6 months, 1 year, and 3 years, respectively. Twenty-four patients (35%) experienced DGF, whereas 4 patients (6%) had PNF, and 12 patients (18%) had RAF (Table 1). Pre-transplant dialysis, serum lactate, and CIT were significantly associated with an increased likelihood of DGF. Norepinephrine (NE) and CIT were associated with increased likelihood of RAF (Table 2).</div></div><div><h3>Conclusions</h3><div>Pre-transplant dialysis is related to an increased likelihood of EAO following SHKT, with CIT and NE contributing to increased likelihood of RAF. Given that SHKT recipients are at risk of remaining on dialysis following SHKT, strategies that allow for expedited kidney transplantation after heart transplantation may mitigate the hemodynamic and ischemic constraints of SHKT that contribute to early adverse outcomes.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 390-393"},"PeriodicalIF":0.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking Rural Live-Kidney Donation Through Insights From a Decade-Long Analysis at a Single Center in the Northern Great Plains","authors":"Kaleb Dobbs ,&nbsp;Els Reuvekamp ,&nbsp;Benjamin Limburg ,&nbsp;Sujit Vijay Sakpal","doi":"10.1016/j.transproceed.2024.12.018","DOIUrl":"10.1016/j.transproceed.2024.12.018","url":null,"abstract":"<div><h3>Background</h3><div>Data on barriers to live-kidney donation in the rural United States is limited despite its widespread adoption across the country.</div></div><div><h3>Methods</h3><div>A retrospective review of 1776 self-referrals for live-kidney donation between June 1, 2012, and May 31, 2022, was conducted. Multivariate analyses evaluated independent factors which may have potentially influenced donation at different stages in its process.</div></div><div><h3>Results</h3><div>Of the 1776 self-referrals, 398 (22.4%) individuals underwent evaluation and 121 (6.8%) of those became live-kidney donors. Middle-aged people (average age = 43 years), Whites (91.7%), and women (70.2%) were the most likely to donate. One thousand, one hundred, eighteen individuals (63.0%) dropped out after completing the intake form and the primary reasons included lost to follow-up (32.1%) and donor retraction (24.6%). Concerns related to personal health and compatibility were the predominant subjective factors for retraction. Following in-person evaluation, the most common reasons were medical comorbidities (34.9%) and inoperable renal anatomy (26.5%). Of the 1655 people that did not donate, 178 (10.8%) individuals discovered a new diagnosis during their evaluation process.</div></div><div><h3>Conclusions</h3><div>Only a fraction of those who begin the process proceed to donate a kidney, and most withdraw voluntarily before reaching the in-person evaluation phase. Focused approaches aimed at concerns regarding personal health and donor-recipient compatibility in otherwise healthy, motivated candidates in the early phases of donation hold potential for improving retention rates and subsequent donations.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 180-186"},"PeriodicalIF":0.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025783","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}