Transplantation最新文献

{"title":"Development of a Survival Predictive Model After Pediatric Liver Transplantation: A Single-center Retrospective Cohort Study.","authors":"Yuan Liu, Qi Pan, Bingran Wang, Aiwei Zhou, Tao Zhou, Yongbo Liu, Yi Luo, Qiang Xia","doi":"10.1097/TP.0000000000005299","DOIUrl":"https://doi.org/10.1097/TP.0000000000005299","url":null,"abstract":"<p><strong>Background: </strong>Current prognostic models for liver transplantation (LT) recipients are not applicable for long-term survival prediction, especially for pediatric living donor LT recipients. In this retrospective prognostic study, we aimed to develop and validate a survival predictive model for pediatric LT recipients, the Survival Predictive Model After Pediatric Liver Transplantation (SPPLT) model.</p><p><strong>Methods: </strong>A total of 2964 pediatric recipients from Renji Hospital were enrolled and randomly assigned to the training and validation cohort by a ratio of 1:1. Logistic analysis was performed to identify risk factors for posttransplant mortality and least absolute shrinkage and selection operator Cox regression was used to establish the SPPLT model.</p><p><strong>Results: </strong>Univariate analysis identified 19 risk factors that were associated with post-LT mortality, including graft-recipient compatibility, pre-LT hepatorenal function, blood loss and transfusion during the operation, post-LT infection and surgical complications. Using the least absolute shrinkage and selection operator multivariable Cox regression, we established the prognostic SPPLT model which included 7 clinical easily approached factors (pre-LT creatinine level, blood loss during operation, days of intensive care unit and hospital stay after transplantation, sputum culture positivity, post-LT abdominal hemorrhage, and intestinal perforation). The accuracy of predicting 1-, 3-, and 5-y post-LT survival rates in the training and validation cohort reached 0.802, 0.828, 0.811, and 0.803, 0.784, 0.778, respectively. Furthermore, the SPPLT model efficiently stratified all pediatric LT recipients into high-risk and low-risk groups, which were associated with totally different long-term outcomes (hazard ratio = 0.27, 95% confidence interval (0.120-0.620), P < 0.01).</p><p><strong>Conclusions: </strong>SPPLT is the first prognostic model to accurately predict long-term survival rate after pediatric LT. Recipients with high mortality risk should receive intense monitoring after transplantation.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future of Transplantation: Not a Privilege, but a Fundamental Right: Presidential Address at the 30th International Congress of The Transplantation Society, Istanbul, Turkey, September 22-25, 2024.","authors":"Elmi Muller","doi":"10.1097/TP.0000000000005340","DOIUrl":"https://doi.org/10.1097/TP.0000000000005340","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"As Good as it Gets. Using National Databases to Identify Opportunities in Ex Vivo Lung Perfusion.","authors":"Amer Alzahrani, Kentaro Noda, Pablo G Sanchez","doi":"10.1097/TP.0000000000005338","DOIUrl":"https://doi.org/10.1097/TP.0000000000005338","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Feasibility of Early Extubation in Liver Transplantation: Experience in 1555 Patients.","authors":"Conrad Lacom, Rishi P Kothari, Nicholas V Mendez, Alessandro Galli, Garrett R Roll, Michael P Bokoch, Matthieu Legrand, Dieter Adelmann","doi":"10.1097/TP.0000000000005356","DOIUrl":"https://doi.org/10.1097/TP.0000000000005356","url":null,"abstract":"<p><strong>Background: </strong>Early extubation after liver transplantation can decrease cost and intensive care unit lengths of stay, but its adoption remains limited because of safety concerns. We assessed the feasibility and safety of early extubation at a liver transplant center with a high early extubation rate. We analyzed subgroups of high-risk patients, including high model for end-stage liver disease-sodium (MELD-Na) score, high intraoperative blood loss, and patients undergoing simultaneous liver-kidney transplantation.</p><p><strong>Methods: </strong>We included all adult liver transplantations performed at a single center between June 2012 and July 2022. Patients were divided into 2 groups: (1) those extubated early (ie, in the operating room or within the first hour of intensive care unit admission) and (2) those who underwent delayed extubation. The primary outcome was reintubation within 48 h after early extubation. Rates of early extubation were analyzed separately for quartiles of MELD-Na score and intraoperative blood loss.</p><p><strong>Results: </strong>Of 1555 patients, 969 (62%) were extubated early. Of these, 31 patients (3.2%) required mechanical ventilation within 48 h postoperatively: 11 patients (1.1%) were reintubated for respiratory failure and 20 (2.1%) remained intubated after reoperation. There was no difference in postoperative pneumonia between the groups (P = 0.059). Early extubation rates inversely correlated with the quartiles of MELD-Na score and estimated blood loss. In the highest quartile for MELD-Na (>34) and estimated blood loss (>5 L), 34% of patients were extubated early.</p><p><strong>Conclusions: </strong>Early extubation of properly selected patients after liver transplantation is safe and associated with a low rate of reintubation, even among select groups of high-risk patients.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of HLA Epitope Matching on Outcomes in Haploidentical HSCT With Distinct GVHD Prophylaxes.","authors":"Makoto Iwasaki, Junya Kanda, Hidenori Tanaka, Kazuhiro Ikegame, Takero Shindo, Takakazu Kawase, Satoshi Yoshihara, Noriko Doki, Hirohisa Nakamae, Tetsuya Eto, Takashi Tanaka, Takahide Ara, Nobuhiro Hiramoto, Yukio Kondo, Ken-Ichi Matsuoka, Toshihiko Ando, Katsuhiro Shono, Koji Nagafuji, Takahiro Fukuda, Tatsuo Ichinohe, Yoshiko Atsuta, Makoto Murata, Satoko Morishima","doi":"10.1097/TP.0000000000005347","DOIUrl":"https://doi.org/10.1097/TP.0000000000005347","url":null,"abstract":"<p><strong>Background: </strong>The introduction of posttransplant cyclophosphamide (PTCy) for prophylaxis against graft-versus-host disease (GVHD) has led to an increase in the number of transplants from haploidentical donors. Accordingly, we aimed to understand the impact of HLA epitope mismatch on the outcomes of haploidentical hematopoietic stem cell transplantation (HSCT) with prophylaxis against GVHD.</p><p><strong>Methods: </strong>This retrospective study included 1037 patients who underwent their first HSCT for hematologic malignancies from haploidentical peripheral blood donors in a Japanese registry between 2011 and 2019. In total, 542 patients received PTCy and 495 received antithymocyte globulin-based GVHD prophylaxis.</p><p><strong>Results: </strong>In patients with high-risk disease who received PTCy, higher class I Predicted Indirectly ReCognizable HLA Epitopes (PIRCHE-I) scores were associated with a significantly lower risk of relapse, leading to a higher overall survival (OS: high PIRCHE-I patients compared with low PIRCHE-I patients: relapse: hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.46-0.98; P = 0.040; mortality: HR, 0.69; 95% CI, 0.46-0.99; P = 0.042). In patients with standard-risk disease who received antithymocyte globulin, a significant association between class II PIRCHE (PIRCHE-II) and a lower incidence of nonrelapse mortality (NRM) leading to higher OS was observed (high PIRCHE-II patients compared with low PIRCHE-II patients, NRM: HR, 0.41; 95% CI, 0.19-0.86; P = 0.019; OS: HR, 0.55; 95% CI, 0.32-0.94; P = 0.030).</p><p><strong>Conclusions: </strong>These findings suggest the differential effects of T-cell epitope matching based on GVHD prophylaxis after haploidentical HSCT. Pretransplant disease status may also be important for understanding the graft-versus-leukemia effect of mismatched HLA in haploidentical HSCT using PTCy.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ Transplantation in India: INDEED, for the Common Good!","authors":"Mohamed Rela, Ashwin Rammohan, Vivek Kute, Manish R Balwani, Arpita Ray Chaudhury","doi":"10.1097/TP.0000000000005349","DOIUrl":"https://doi.org/10.1097/TP.0000000000005349","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photoacoustic Tomography Assessments During Ex Vivo Normothermic Perfusion. A Novel and Noninvasive Modality to Evaluate Endothelial Integrity.","authors":"Benoit Mesnard, Julien Branchereau, Thomas Prudhomme","doi":"10.1097/TP.0000000000005342","DOIUrl":"https://doi.org/10.1097/TP.0000000000005342","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All Cloak and No Dagger? Immunosuppression-free Lung Transplantation by Sustained Knockdown of Major Histocompatibility Complex Expression in the Graft.","authors":"Stephen Juvet, Marcelo Cypel","doi":"10.1097/TP.0000000000005351","DOIUrl":"https://doi.org/10.1097/TP.0000000000005351","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Graft-versus-host Disease, Part 2: Clinical Success and Roadmap to the Future.","authors":"Najla El Jurdi, Bruce R Blazar, Steven Z Pavletic","doi":"10.1097/TP.0000000000005345","DOIUrl":"https://doi.org/10.1097/TP.0000000000005345","url":null,"abstract":"<p><p>Chronic graft-versus-host disease (cGVHD) is an immune-mediated, heterogeneous, multiorgan complication affecting allogeneic hematopoietic cell transplantation recipients, leading to increased morbidity, mortality, and decline in health-related quality-of-life. Advances in understanding the complex disease pathophysiology, and collaborative efforts lead by the National Institutes of Health to standardize criteria for clinical trials, led to bench-to-bedside efforts resulting in the development of 4 US Food and Drug Administration-approved agents for the treatment steroids-refractory cGVHD since 2017. Despite the remarkable advances in the field of hematopoietic cell transplantation in prevention of cGVHD, and more treatment options, the outcome of patients with moderate-severe cGVHD remains suboptimal. Essential to successful cGVHD management is to recognize the disease at early stages before the onset of irreversible damage, allowing for personalized multidisciplinary specialized interventions that include pharmacologic therapies and additional supportive care measures. The aim of this review is to summarize key areas of active clinical research and new developments in cGVHD therapeutic approaches, with focus on (1) preemptive therapy, (2) upfront therapy beyond corticosteroids, (3) treatment refractory cGVHD novel agents, role of combination therapies, and organ-specific approaches, and (4) challenges, gaps, and future directions.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Aberrantly Expressed Nuclear Factor (Erythroid-derived 2)-Like 2 Participates in aGVHD by Modulating the Activation and Differentiation of CD4+ T Lymphocytes.","authors":"Xu Chen, Yue Zhang, Yan Chen, Wei Qin, Tingting Cheng, Shiyu Wang, Yajing Xu","doi":"10.1097/TP.0000000000005289","DOIUrl":"https://doi.org/10.1097/TP.0000000000005289","url":null,"abstract":"<p><strong>Background: </strong>Current investigation indicates that nuclear factor (erythroid-derived 2)-like 2 (NRF2) possesses both proinflammatory and anti-inflammatory capabilities in T cells, yet its exact function in acute graft-versus-host disease (aGVHD) CD4+ T cells remains unexplored.</p><p><strong>Methods: </strong>This study aims to determine NRF2 levels within CD4+ T cells of patients with or without aGVHD and analyze the correlation between T-cell receptor activation and NRF2 expression. RNA sequencing was used to detect changes in the expression profile of CD4+ T cells after overexpression of NRF2, and functional enrichment analysis was performed on the sequencing results. Finally, after treating aGVHD CD4+ T cells with NRF2 inhibitor, the expression of related pathway molecules was detected.</p><p><strong>Results: </strong>Our findings demonstrated a significant upregulation of NRF2 expression in CD4+ T cells from patients in the aGVHD group compared with patients in the non-aGVHD group, and its expression level is correlated with the severity of aGVHD. Additionally, T-cell receptor activation in CD4+ T cells elevates NRF2 expression. Postactivation of NRF2-inhibited CD4+ T cells, the expression levels of T-cell activation markers were notably lower than those in non-NRF2-inhibited CD4+ T cells. Sequencing analysis identified 904 genes that changed after NRF2 overexpression. These genes were categorized into 288 gene subsets, encompassing pathways such as T-cell receptor signaling transduction, Janus kinase 1/signal transducer and activator of transcription 1 (JAK1-STAT1) signaling, T helper cell 17 (Th17) cell differentiation, etc. Ultimately, treating CD4+ T cells of aGVHD patients with an NRF2 inhibitor led to a significant downregulation of JAK1-STAT1 signaling and Th17 cells.</p><p><strong>Conclusions: </strong>Elevated NRF2 expression in CD4+ T cells of patients with aGVHD initiates and exacerbates aGVHD by potentiating T-cell activation, amplifying JAK1/STAT1 signaling, and instigating Th17/regulatory T-cell ratio imbalance.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}