Transplantation proceedings最新文献

{"title":"A Case of ABO-Incompatible Kidney Transplantation for a False-Positive T and B-Cell Crossmatch Test Due to Anti-A Antibodies","authors":"Masahiro Ikeda ,&nbsp;Masayuki Tasaki ,&nbsp;Hiroki Hashiguchi ,&nbsp;Hitomi Kanamoto ,&nbsp;Tsutomu Anraku ,&nbsp;Kaede Hiruma ,&nbsp;Tatsuro Sanami ,&nbsp;Kazuhide Saito ,&nbsp;Yoshihiko Tomita","doi":"10.1016/j.transproceed.2025.02.013","DOIUrl":"10.1016/j.transproceed.2025.02.013","url":null,"abstract":"<div><div>The recipient was a 50-year-old man with blood type O who was referred to our department for a pre-emptive ABO-incompatible kidney transplantation (KTx), with his wife as the donor whose blood was type A. However, both of the T and B cell complement-dependent crossmatch and flow cytometric crossmatch tests showed positive results. Even though donor-specific antibodies were negative by Luminex, we did not recommend transplantation and he had received dialysis therapy for 3 years. We conducted a re-evaluation of crossmatch tests. IgM and anti-B antibody were eliminated from the recipient's sera by the processing with dithiothreitol and the absorption mixing type B red blood cells. However, crossmatch tests still showed positive. Then, we eliminated anti-A antibody by the absorption mixing type A red blood cells. T- and B-cell crossmatch tests turned to negative, suggesting anti-A antibody in the recipient's sera binds to type A substance onto the donor's T and B lymphocytes. The recipient received an ABO-incompatible KTx with our standard desensitization therapy. Immediate graft function was achieved without any rejection</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 438-441"},"PeriodicalIF":0.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517707","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":"Case Report of an ABO-Matched Post-Hematopoietic Stem Cell Transplant-Associated Autoimmune Hemolytic Anemia: A Diagnostic and Therapeutic Challenge","authors":"Owen Dan Luo ,&nbsp;Angelo Rizzolo ,&nbsp;Patricia Pelletier ,&nbsp;Gizelle Popradi","doi":"10.1016/j.transproceed.2025.02.003","DOIUrl":"10.1016/j.transproceed.2025.02.003","url":null,"abstract":"<div><div>Autoimmune hemolytic anemia (AIHA) is a rare complication of ABO-matched hematopoietic stem cell transplantation (HSCT). Post-HSCT AIHA is diagnosed by a positive hemolysis laboratory work-up and positive direct antiglobulin testing with usually a pan-reactive antibody in indirect antiglobulin testing. In this case report, we describe the diagnosis of post-HSCT AIHA in a 62-year-old male patient and its management with combined immunosuppressive therapy with steroids, rituximab, and intravenous immunoglobulin to achieve transfusion independence and disease remission. Post-HSCT AIHA is generally refractory to treatment but this case highlights the role of combination immunosuppressive therapies to maximize the likelihood of transfusion independence.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 498-501"},"PeriodicalIF":0.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525613","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":"Delayed Chest Closure in Adult Living-donor Lobar Lung Transplantation—A Case Report","authors":"Marina Nakatsuka ,&nbsp;Tatsuaki Watanabe ,&nbsp;Chikara Sakai ,&nbsp;Yuki Shundo ,&nbsp;Yui Watanabe ,&nbsp;Hirotsugu Notsuda ,&nbsp;Takaya Suzuki ,&nbsp;Takashi Hirama ,&nbsp;Hisashi Oishi ,&nbsp;Hiromichi Niikawa ,&nbsp;Masafumi Noda ,&nbsp;Yoshinori Okada","doi":"10.1016/j.transproceed.2025.02.002","DOIUrl":"10.1016/j.transproceed.2025.02.002","url":null,"abstract":"<div><div>Delayed chest closure (DCC) is a useful technique in cases with oversized lung grafts, pulmonary edema, and hemodynamic instability. Anatomically oversized lung grafts are potentially problematic in pediatric living-donor lobar lung transplantation (LDLLT), but rarely in an adult LDLLT. We experienced a case of anatomically oversized grafts in the adult LDLLT requiring DCC, although the grafts provided only 57.2% of the recipient's predicted forced vital capacity. Through 3-dimensional computed tomography volumetry, the volume of the donor's right lower lobe was illustrated as 108% of that of the recipient's right hemithorax, the volume of the donor left lower lobe was 143% of that of the recipient's left hemithorax. Her chest was closed without volume reduction 5 days after transplantation. Our experience illustrates the importance of anatomical size-matching even in an adult LDLLT and the usefulness of DCC as a perioperative management modality.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 487-490"},"PeriodicalIF":0.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525556","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":"Donor-Derived Aspergillosis Following Kidney Transplantation: A Case Report","authors":"Michael A. Deal,&nbsp;John J. Nunnery,&nbsp;Stephen Patrick,&nbsp;Santosh Nagaraju,&nbsp;Joseph Scalea","doi":"10.1016/j.transproceed.2025.02.012","DOIUrl":"10.1016/j.transproceed.2025.02.012","url":null,"abstract":"<div><h3>Introduction</h3><div>While kidney transplantation can improve both quality and quantity of life in patients with renal disease, there are well-described possible surgical and medical complications. Of these complications, donor-derived infections represent a source of morbidity and mortality. Donor-derived aspergillosis is a rare source of these infections. Given the limited number of reported cases of donor-derived aspergillosis, we present a case that resulted in multisystem organ failure, graft loss, and death.</div></div><div><h3>Case Presentation</h3><div>A 72-year-old male underwent renal transplantation. Two months later, the patient presented with fevers, chills, weakness, and right lower quadrant pain. His early hospital course was notable for blood and urine cultures positive for <em>Enterococcus faecalis</em>, which was treated with broad spectrum antibiotics. Despite appropriate treatment, the patient ultimately required ICU admission, intubation, and initiation of vasopressors. After additional diagnostic imaging revealed multifocal pyelonephritis, the patient underwent transplant nephrectomy with intraoperative cultures revealing aspergillosis. Shortly following transplant nephrectomy, we were notified by the Organ Procurement Organization (OPO) that this likely represented a donor-derived infection. Our patient was initiated on appropriate antifungal coverage, though had continued respiratory and hemodynamic compromise and was ultimately transitioned to comfort care. He expired shortly thereafter.</div></div><div><h3>Conclusion</h3><div>In reporting this rare case, we hope to increase awareness of the significant illness severity and associated complications with donor-derived aspergillosis. Additionally, we highlight the need for improved screening for rare organisms in donors and for decreased communication delays between the OPO and transplant centers.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 460-463"},"PeriodicalIF":0.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517720","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":"Silent Threat: Fatal Consequences of Occult Hepatitis C Viral Infection in a Kidney Transplant Recipient: A Case Report and Literature Review","authors":"Hany M. El Hennawy ,&nbsp;Abelaziz A. Abdelaziz ,&nbsp;Yasser Mansour ,&nbsp;Mohammad F. Zaitoun ,&nbsp;Ibrahim Tawhari ,&nbsp;Omar Safar ,&nbsp;Rafaat M. Chakik ,&nbsp;Mosa A. Fagih ,&nbsp;Abdullah S. Al Faifi","doi":"10.1016/j.transproceed.2025.02.006","DOIUrl":"10.1016/j.transproceed.2025.02.006","url":null,"abstract":"<div><div>We present the case of a 54-year-old female patient with a history of treated hepatitis B who underwent living-related kidney transplantation from her son. The timing of the transplantation and immediate postoperative period was uneventful, with no significant complications. However, within 3 months, she was repeatedly hospitalized because of persistent jaundice, abdominal pain, and diarrhea, and liver function tests indicated considerable liver injury. Extensive investigations have revealed an occult hepatitis C virus infection that occurred before transplantation. The patient subsequently developed acute fulminant liver failure accompanied by severe gastrointestinal bleeding. Despite aggressive medical management, her condition deteriorated rapidly, leading to death. This case underscores the importance of comprehensive viral screening in transplant recipients, particularly those with risk factors or symptoms of hepatitis C virus infection, to prevent potentially life-threatening complications following transplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 445-449"},"PeriodicalIF":0.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506739","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":"Do We Need a Predischarge Psychosocial Evaluation? A Case Report on Peri-Allograft Abscess in a Noncompliant Elderly Kidney Transplant Patient","authors":"Hany El Hennawy ,&nbsp;Ahmed Khattab ,&nbsp;Eisa Al Atta ,&nbsp;Amal Awadh ,&nbsp;Omar Safar ,&nbsp;Manea Al Qarni ,&nbsp;Mohammad F. Zaitoun ,&nbsp;Tayseer Ghalyoob ,&nbsp;Mohamed F. Bazeed ,&nbsp;Abdullah S. Al Faifi","doi":"10.1016/j.transproceed.2025.02.018","DOIUrl":"10.1016/j.transproceed.2025.02.018","url":null,"abstract":"<div><div>Although postrenal transplant surgical site infections are relatively uncommon, we present the case of a 72-year-old diabetic and hypertensive male patient who developed a delayed peri-graft abscess and severe surgical site infection due to a closed drain exit site infection 1 month following a living-related kidney transplant. While the transplant itself was successful and the patient had passed the pretransplant psychosocial evaluation, their post-transplant noncompliance and unresolved social barriers—such as missed outpatient follow-up appointments—significantly contributed to these complications. This case highlights the limitations of relying solely on pretransplant evaluations and, therefore, emphasizes the critical need for a comprehensive predischarge psychosocial assessment. Such an assessment is particularly vital, especially in elderly patients, as it helps identify and address risks for noncompliance and barriers to follow-up care. To address these challenges, we propose implementing a predischarge psychosocial scoring system that evaluates psychological well-being, social support, cognitive function, understanding of the care plan, and potential obstacles. By identifying high-risk patients, this tool can, in turn, guide tailored interventions to improve adherence. Consequently, a structured predischarge assessment system becomes essential for optimizing post-transplant care, enhancing outcomes, and reducing complications.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 453-456"},"PeriodicalIF":0.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517711","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":"First Use of Maribavir in Poland to Treat Refractory CMV Disease in a Patient After Kidney Transplantation","authors":"Anna Pawłowska,&nbsp;Norbert Kwella,&nbsp;Justyna Zbrzeźniak-Suszczewicz,&nbsp;Monika Knysak,&nbsp;Tomasz Stompór","doi":"10.1016/j.transproceed.2025.02.008","DOIUrl":"10.1016/j.transproceed.2025.02.008","url":null,"abstract":"<div><div>Cytomegalovirus (CMV) is one of the most common opportunistic infections affecting solid organ transplant recipients (SOTRs). In this article, we presented the case of a 39-year-old patient with end-stage renal disease after kidney transplantation with refractory CMV infection, who was successfully treated with maribavir for the first time in Poland. The use of maribavir resulted in a significant reduction of CMV viremia in ganciclovir/valganciclovir-resistant CMV infection and resolution of CMV disease symptoms in the absence of drug-related adverse events.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 427-429"},"PeriodicalIF":0.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506738","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":"Case Report: Intravascular Lithotripsy of Calcified Iliac Artery Disease to Facilitate Kidney Transplantation","authors":"Diana A. Wu ,&nbsp;Peter Douglas ,&nbsp;Trijntje J.W. Rennie ,&nbsp;Victoria Banwell ,&nbsp;Avinash Sewpaul ,&nbsp;Colin Geddes ,&nbsp;Karen Stevenson ,&nbsp;Martin Hennessy ,&nbsp;Keith Hussey ,&nbsp;David B. Kingsmore","doi":"10.1016/j.transproceed.2025.02.004","DOIUrl":"10.1016/j.transproceed.2025.02.004","url":null,"abstract":"<div><div>Intravascular lithotripsy is a novel technique that treats calcified atherosclerotic disease using shock waves to disrupt the rigid plaque. It is an evolving technique with high reported success rates and minimal complications. Calcified plaque in the aorto-iliac arteries is highly prevalent in patients with renal impairment and is a major barrier to kidney transplantation. This case report is the first known successful application of intravascular lithotripsy for severe calcified iliac artery disease in a patient with end-stage renal disease (ESRD), in order to facilitate listing for kidney transplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 3","pages":"Pages 435-437"},"PeriodicalIF":0.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506737","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":"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}