Transplant InternationalPub Date : 2025-01-03eCollection Date: 2024-01-01DOI: 10.3389/ti.2024.13646
Quirin Bachmann, Carlos Torrez, Maike Büttner-Herold, Bernhard Haller, Flora Haberfellner, Renate Hausinger, Volker Assfalg, Lutz Renders, Kerstin Amann, Uwe Heemann, Christoph Schmaderer, Stephan Kemmner
{"title":"Only IF/TA in the Histological Evaluation of Post-Reperfusion Baseline Biopsies Correlates With Kidney Transplant Outcome.","authors":"Quirin Bachmann, Carlos Torrez, Maike Büttner-Herold, Bernhard Haller, Flora Haberfellner, Renate Hausinger, Volker Assfalg, Lutz Renders, Kerstin Amann, Uwe Heemann, Christoph Schmaderer, Stephan Kemmner","doi":"10.3389/ti.2024.13646","DOIUrl":"10.3389/ti.2024.13646","url":null,"abstract":"<p><p>Here, we retrospectively evaluated the informational yield of 338 post-reperfusion kidney transplant biopsies (including 95 living donations) assessed according to BANFF for the histological characteristics interstitial fibrosis and tubular atrophy (IF/TA), glomerulosclerosis, arteriosclerosis, and acute tubular injury (ATI). Associations with delayed graft function (DGF) and death-censored graft survival were explored through Cox-regression analyses. The maximum follow-up time was 11.4 years, with DGF observed in 108 (32%) cases. After deceased donation there was no association between DGF and histologic parameters. Univariable Cox-regression unveiled an association of IF/TA and glomerulosclerosis with long-term death-censored graft survival (HR per 10% increase: IF/TA 1.63; 95% CI 1.17-2.28; <i>p</i> = 0.003; glomerulosclerosis 1.19; 95% CI 1.01-1.39; <i>p</i> = 0.031). In multivariable Cox regression analyses, adjusted for recognized clinical risk variables like expanded criteria donor-status, donor age, history of diabetes, and HLA-mismatches, only IF/TA maintained association over the total observation period in deceased donations and in the total cohort. Arteriosclerosis and ATI were not associated with clinical outcome after deceased donation. Especially ATI did not affect delayed graft function if only deceased donations were considered. Our data underlines the role of organ quality for transplant outcome prior to acute lesions such as ATI during the transplantation process.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13646"},"PeriodicalIF":2.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transplant InternationalPub Date : 2025-01-03eCollection Date: 2024-01-01DOI: 10.3389/ti.2024.14040
Serkan Sucu, Yucel Yankol, Luis A Fernandez, Burcin Ekser
{"title":"Liver Xenotransplantation: A Path to Clinical Reality.","authors":"Serkan Sucu, Yucel Yankol, Luis A Fernandez, Burcin Ekser","doi":"10.3389/ti.2024.14040","DOIUrl":"10.3389/ti.2024.14040","url":null,"abstract":"<p><p>Liver xenotransplantation has emerged as a potential solution to the shortage of deceased human donor organs and is now becoming a reality due to recent developments in genetic engineering and immunosuppressive therapy. Early efforts using non-human primates and genetically modified pigs faced significant challenges such as thrombocytopenia and graft rejection. Understanding the mechanism behind those challenges and using novel genetically engineered pigs enabled researchers to overcome some of the hurdles, but more research is needed. However, new advances might allow pig liver xenotransplantation to potentially serve as a bridge to liver allotransplantation or allow native liver regeneration in the near future.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"14040"},"PeriodicalIF":2.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11738628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transplant InternationalPub Date : 2025-01-03eCollection Date: 2024-01-01DOI: 10.3389/ti.2024.13484
Liesbeth Daniëls, Hanne Beeckmans, Andrea Zajacova, Pieterjan Kerckhof, Saskia Bos, Maarten Naesens, Bart Vanaudenaerde, Frans Claas, Robin Vos
{"title":"The Clinical Significance of HLA Compatibility Scores in Lung Transplantation.","authors":"Liesbeth Daniëls, Hanne Beeckmans, Andrea Zajacova, Pieterjan Kerckhof, Saskia Bos, Maarten Naesens, Bart Vanaudenaerde, Frans Claas, Robin Vos","doi":"10.3389/ti.2024.13484","DOIUrl":"10.3389/ti.2024.13484","url":null,"abstract":"<p><p>Lung transplantation is a life-saving therapeutic option for many chronic end-stage pulmonary diseases, but long-term survival may be limited by rejection of the transplanted organ. Since HLA disparity between donor and recipient plays a major role in rejection, we performed a single center, retrospective observational cohort analysis in our lung transplant cohort (n = 128) in which we calculated HLA compatibility scores for B-cell epitopes (HLAMatchmaker, HLA-EMMA), T-cell epitopes (PIRCHE-II) and missing self-induced NK cell activation (KIR Ligand Calculator). Adjusted Cox proportional hazards model was used to investigate the association between mismatched scores and time to development of donor-specific antibodies (DSA) post-transplant, time to first biopsy-proven acute rejection episode, freedom from CLAD, graft survival and overall survival. For time to first DSA, HLA-EMMA DQB1 scores and PIRCHE-II DQB1 scores were significantly associated with more rapidly developing anti-HLA-DQ antibodies. HLA-EMMA DQB1 score was significantly associated with worse survival. KIR ligand Host-versus-Graft (HvG) mismatches was significantly associated with worse graft survival (CLAD or death) and shorter time to first biopsy-proven rejection when 2 mismatches were present. We demonstrated that HLA-DQB1 compatibility scores and KIR ligand HvG 2 mismatches may allow for identification of recipients at risk of poor long-term outcomes after lung transplantation.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13484"},"PeriodicalIF":2.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11738610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transplant InternationalPub Date : 2024-12-18eCollection Date: 2024-01-01DOI: 10.3389/ti.2024.13440
Iulia Minciuna, Jeroen De Jonge, Caroline Den Hoed, Raoel Maan, Wojciech G Polak, Robert J Porte, Harry L A Janssen, Bogdan Procopet, Sarwa Darwish Murad
{"title":"Antiplatelet Prophylaxis Reduces the Risk of Early Hepatic Artery Thrombosis Following Liver Transplantation in High-Risk Patients.","authors":"Iulia Minciuna, Jeroen De Jonge, Caroline Den Hoed, Raoel Maan, Wojciech G Polak, Robert J Porte, Harry L A Janssen, Bogdan Procopet, Sarwa Darwish Murad","doi":"10.3389/ti.2024.13440","DOIUrl":"10.3389/ti.2024.13440","url":null,"abstract":"<p><p>The prevention of hepatic artery thrombosis (HAT) is pivotal for graft survival immediately after liver transplantation (LT). This study aimed to identify risk factors (RF) for early HAT (eHAT) and assess the benefit of antiplatelet prophylaxis (AP). This retrospective single-center study included 836 adult patients who underwent LT between 2007 and 2022. AP was administered for 3 months in N = 127 patients for surgical reasons. In total, 836 patients underwent LT, of whom 5.5% developed eHAT. In multivariable analysis, arterial anastomotic redo (aHR = 4.33), arterial reconstruction (aHR = 3.72) and cryptogenic liver cirrhosis (aHR = 4.25) were independent RFs for eHAT and AP appeared to be protective (aHR = 0.18). Indeed, in patients with at least one RF who received AP (RF+AP+, n = 94), the eHAT rate was significantly lower (3.2% vs. 21.3%, <i>p</i> < 0.001) than in those with RF who did not receive AP (RF+AP-, n = 89). The effect was even more pronounced when focusing on surgical RF alone (i.e., redo and/or reconstruction) with an additional improvement in 1 year graft survival of 85.3% vs. 70.4%, <i>p</i> = 0.02. AP did not pose an increased risk of bleeding. In conclusion, the main RFs for eHAT include arterial anastomotic redo, arterial reconstruction and cryptogenic liver cirrhosis as LT indications. Our results suggest that AP may protect against eHAT development in these high-risk patients.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13440"},"PeriodicalIF":2.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11692146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transplant InternationalPub Date : 2024-12-18eCollection Date: 2024-01-01DOI: 10.3389/ti.2024.13720
Francesca Raineri, Lukas Frischknecht, Jakob Nilsson, Fabian Rössler, Claudia Cavelti-Weder, Seraina von Moos, Thomas Schachtner
{"title":"Assessing the Predictive Power of PIRCHE-II Scores for the Development of <i>De Novo</i> Donor-Specific Antibodies After Simultaneous Pancreas-Kidney Transplantation.","authors":"Francesca Raineri, Lukas Frischknecht, Jakob Nilsson, Fabian Rössler, Claudia Cavelti-Weder, Seraina von Moos, Thomas Schachtner","doi":"10.3389/ti.2024.13720","DOIUrl":"10.3389/ti.2024.13720","url":null,"abstract":"<p><p>The molecular HLA epitope mismatch is an advanced measure for developing <i>de novo</i> donor-specific antibodies (dnDSA) after kidney transplantation. Its relevance in simultaneous pancreas/kidney transplant recipients (SPKTRs) remains unclear. We investigated dnDSA development in 72 SPKTRs and 383 kidney transplant recipients (KTRs) and used the Predicted Indirectly Recognizable HLA-Epitopes (PIRCHE-II) algorithm to calculate the mismatch load of HLA-derived epitopes in total, per HLA-class, and per HLA-locus. At 1 year post-transplant, SPKTRs exhibited an increased dnDSA incidence (11.2% vs. 3.1%, <i>p</i> = 0.011); but not at 10 years post-transplant. In SPKTRs, preformed DSA (HR 2.872, <i>p</i> = 0.039) and younger donor age (HR 0.943, <i>p</i> = 0.017) were independent risk factors for developing dnDSA. PIRCHE-II scores for HLA-DQ correlated with dnDSA development upon univariate analysis (<i>p</i> = 0.044). Among 455 KTRs/SPKTRs, multivariate analysis identified PIRCHE-II scores for HLA-DQ (HR 1.023, <i>p</i> = 0.025) and ciclosporine use (HR 2.440, <i>p</i> = 0.001) as independent predictors of dnDSA development. Simultaneous pancreas/kidney transplantation (SPK) was an independent risk factor in case of preformed DSA only (HR 2.782, <i>p</i> = 0.037). High PIRCHE-II scores for HLA-DQ are crucial for dnDSA development in both SPKTRs and KTRs. The lack of an independent association of total PIRCHE-II scores urges caution in implementing it in post-transplantation risk assessment.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13720"},"PeriodicalIF":2.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transplant InternationalPub Date : 2024-12-18eCollection Date: 2024-01-01DOI: 10.3389/ti.2024.12981
Lorenzo Giovannico, Giuseppe Fischetti, Domenico Parigino, Luca Savino, Nicola Di Bari, Aldo Domenico Milano, Massimo Padalino, Tomaso Bottio
{"title":"Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support in New Era of Heart Transplant.","authors":"Lorenzo Giovannico, Giuseppe Fischetti, Domenico Parigino, Luca Savino, Nicola Di Bari, Aldo Domenico Milano, Massimo Padalino, Tomaso Bottio","doi":"10.3389/ti.2024.12981","DOIUrl":"10.3389/ti.2024.12981","url":null,"abstract":"<p><p>Heart failure is a serious and challenging medical condition characterized by the inability of the heart to pump blood effectively, leading to reduced blood flow to organs and tissues. Several underlying causes may be linked to this, including coronary artery disease, hypertension, or previous heart attacks. Therefore, it is a chronic condition that requires ongoing management and medical attention. HF affects >64 million individuals worldwide. Heart transplantation remains the gold standard of treatment for patients with end-stage cardiomyopathy. The recruitment of marginal donors may be considered an asset at the age of cardiac donor organ shortage. Primary graft dysfunction (PGD) is becoming increasingly common in the new era of heart transplantations. PGD is the most common cause of death within 30 days of cardiac transplantation. Mechanical Circulatory Support (MCS), particularly venoarterial extracorporeal membrane oxygenation (V-A ECMO), is the only effective treatment for severe PGD. VA-ECMO support ensures organ perfusion and provides the transplanted heart with adequate rest and recovery. In the new era of heart transplantation, early use allows for increased patient survival and careful management reduces complications.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"12981"},"PeriodicalIF":2.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transplant InternationalPub Date : 2024-12-18eCollection Date: 2024-01-01DOI: 10.3389/ti.2024.13954
Nizar I Mourad, Pierre Gianello
{"title":"Enhanced Insulin Production From Porcine Islets: More Insulin, Less Islets.","authors":"Nizar I Mourad, Pierre Gianello","doi":"10.3389/ti.2024.13954","DOIUrl":"10.3389/ti.2024.13954","url":null,"abstract":"<p><p>Clinical pancreatic islet xenotransplantation will most probably rely on genetically modified pigs as donors. Several lines of transgenic pigs carrying one and more often, multiple modifications already exist. The vast majority of these modifications aim to mitigate the host immune response by suppressing major xeno-antigens, or expressing immunomodulatory molecules that act locally at the graft site. While these modifications are essential and have proven beneficial in preclinical trials, ensuring good intrinsic islet secretory function is equally important to achieve normoglycemia in recipients. Neonatal and even adult porcine islets are known for their low secretory response to physiological stimulation, a shortcoming that is often overcome by implanting extremely large numbers of such islets to compensate for insulin requirement incompatibilities between donor pigs and rodent, non-human primate or human recipients. Recent studies have revealed the existence of secretory amplifying pathways in porcine beta-cells previously identified in murine and human cells. Building upon these findings, a new line of transgenic pigs where these pathways are activated specifically in beta-cells has been created. Compared to their wild-type counterparts, islets from these transgenic pigs have proven to be better insulin secretors in their native pancreas environment, <i>in vitro</i> after isolation and most importantly <i>in vivo</i> after transplantation to diabetic mice.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13954"},"PeriodicalIF":2.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transplant InternationalPub Date : 2024-12-17eCollection Date: 2024-01-01DOI: 10.3389/ti.2024.13919
Alexandre Loupy, Anaïs Certain, Narin S Tangprasertchai, Maud Racapé, Cindy Ursule-Dufait, Kawthar Benbadi, Marc Raynaud, Evgeniya Vaskova, Corina Marchis, Sílvia Casas, Tim Hague, Oriol Bestard, Delphine Kervella, Carmen Lefaucheur, Thierry Viard, Olivier Aubert
{"title":"Evaluation of a Decentralized Donor-Derived Cell-Free DNA Assay for Kidney Allograft Rejection Monitoring.","authors":"Alexandre Loupy, Anaïs Certain, Narin S Tangprasertchai, Maud Racapé, Cindy Ursule-Dufait, Kawthar Benbadi, Marc Raynaud, Evgeniya Vaskova, Corina Marchis, Sílvia Casas, Tim Hague, Oriol Bestard, Delphine Kervella, Carmen Lefaucheur, Thierry Viard, Olivier Aubert","doi":"10.3389/ti.2024.13919","DOIUrl":"10.3389/ti.2024.13919","url":null,"abstract":"<p><p>Donor-derived cell-free DNA (dd-cfDNA) is an emerging non-invasive biomarker for allograft injury detection. This study aimed to evaluate a new, decentralized dd-cfDNA testing kit against a centralized dd-cfDNA testing service broadly utilized in the United States. Kidney transplant recipients with decentralized and centralized dd-cfDNA measurements and concomitant kidney allograft biopsies were included in the study. 580 kidney allograft recipients from 3 referral centers were included for 603 total evaluations. Correlation between assays was evaluated using r-squared (<i>r</i> <sup>2</sup>) and Spearman's rank correlation test, and associations with rejection using logistic regression analyses and discrimination using area under the curve. Mean dd-cfDNA levels from decentralized and centralized tests were 0.51% ± 0.81% and 0.43% ± 0.78%, respectively. The assays were highly correlated, with <i>r</i> <sup>2</sup> = 0.95 and Spearman's rank correlation 0.88 (<i>p</i> < 0.0001). Both tests showed significant association with allograft rejection (<i>p</i> < 0.0001) and good and similar discriminations to predict rejection (AUC: 0.758 for the decentralized and AUC: 0.760 for the centralized dd-cfDNA; <i>p</i> = 0.8466). Consistency between the assays was also confirmed across clinical scenarios including post-transplant timepoint, allograft stability, and allograft rejection subcategories. This decentralized dd-cfDNA assessment demonstrates high accuracy and value to non-invasively monitor kidney recipients.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13919"},"PeriodicalIF":2.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transplant InternationalPub Date : 2024-12-13eCollection Date: 2024-01-01DOI: 10.3389/ti.2024.13557
Min Xu, Salamah M Alwahsh, Myung-Ho Kim, Otto Kollmar
{"title":"A Multidrug Donor Preconditioning Improves Steatotic Rat Liver Allograft Function and Recipient Survival After Transplantation.","authors":"Min Xu, Salamah M Alwahsh, Myung-Ho Kim, Otto Kollmar","doi":"10.3389/ti.2024.13557","DOIUrl":"10.3389/ti.2024.13557","url":null,"abstract":"<p><p>The scarcity of donors has prompted the growing utilization of steatotic livers, which are susceptible to injuries following orthotopic liver transplantation (OLT). This study aims to assess the efficacy of multidrug donor preconditioning (MDDP) in alleviating injuries of steatotic grafts following rat OLT. Lean rats were subjected to a Western-style diet with high-fat (HF) and high-fructose (HFr) for 30 days to induce steatosis. Both lean and steatotic livers were implanted into lean recipients fed with a chow diet after OLT. The HF + HFr diet effectively elevated blood triglyceride and cholesterol levels and induced fat accumulation in rat livers. Our results demonstrated a significant decrease in alanine aminotransferase levels (<i>p</i> = 0.003), aspartate aminotransferase levels (<i>p</i> = 0.021), and hepatic Suzuki scores (<i>p</i> = 0.045) in the steatotic rat liver allograft group following MDDP treatment on post-operation day (POD) 7. Furthermore, the survival rates of steatotic rat liver allografts with MDDP (19/21, 90.5%) were significantly higher than those in the steatotic control (12/21, 57.1%, *<i>p</i> = 0.019). These findings indicate that MDDP treatment improves steatotic rat liver allograft function and recipient survival following OLT.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13557"},"PeriodicalIF":2.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}