Transplant International最新文献_第6页

Normothermic Regional Perfusion in Controlled Donation After Circulatory Death Liver Transplantation: A Systematic Review and Meta-Analysis. 常温区域灌注在循环死亡肝移植后控制性捐献中的应用：系统回顾与元分析》。

IF 2.7 3区医学

Transplant International Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI: 10.3389/ti.2024.13263

Carly Mastrovangelis, Charles Frost, Amy Hort, Jerome Laurence, Tony Pang, Henry Pleass

{"title":"Normothermic Regional Perfusion in Controlled Donation After Circulatory Death Liver Transplantation: A Systematic Review and Meta-Analysis.","authors":"Carly Mastrovangelis, Charles Frost, Amy Hort, Jerome Laurence, Tony Pang, Henry Pleass","doi":"10.3389/ti.2024.13263","DOIUrl":"10.3389/ti.2024.13263","url":null,"abstract":"Liver grafts from controlled donation after circulatory death (cDCD) donors have lower utilization rates due to inferior graft and patient survival rates, largely attributable to the increased incidence of ischemic cholangiopathy, when compared with grafts from brain dead donors (DBD). Normothermic regional perfusion (NRP) may improve the quality of cDCD livers to allow for expansion of the donor pool, helping to alleviate the shortage of transplantable grafts. A systematic review and metanalysis was conducted comparing NRP cDCD livers with both non-NRP cDCD livers and DBD livers. In comparison to non-NRP cDCD outcomes, NRP cDCD grafts had lower rates of ischemic cholangiopathy [RR = 0.23, 95% CI (0.11, 0.49), p = 0.0002], primary non-function [RR = 0.51, 95% CI (0.27, 0.97), p = 0.04], and recipient death [HR = 0.5, 95% CI (0.36, 0.69), p < 0.0001]. There was no difference in outcomes between NRP cDCD donation compared to DBD liver donation. In conclusion, NRP improved the quality of cDCD livers compared to their non-NRP counterparts. NRP cDCD livers had similar outcomes to DBD grafts. This provides further evidence supporting the continued use of NRP in cDCD liver transplantation and offers weight to proposals for its more widespread adoption.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13263"},"PeriodicalIF":2.7,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154992","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}

引用次数: 0

Benefits of Living Over Deceased Donor Kidney Transplantation in Elderly Recipients. A Propensity Score Matched Analysis of a Large European Registry Cohort. 老年受者接受活体肾移植比接受死体肾移植的益处。对欧洲大型登记队列的倾向得分匹配分析。

IF 3.1 3区医学

Transplant International Pub Date : 2024-08-23 DOI: 10.3389/ti.2024.13452

Néstor Toapanta,Jordi Comas,Ignacio Revuelta,Anna Manonelles,Carme Facundo,María José Pérez-Saez,Anna Vila,Emma Arcos,Jaume Tort,Magali Giral,Maarten Naesens,Dirk Kuypers,Anders Asberg,Francesc Moreso,Oriol Bestard,

{"title":"Benefits of Living Over Deceased Donor Kidney Transplantation in Elderly Recipients. A Propensity Score Matched Analysis of a Large European Registry Cohort.","authors":"Néstor Toapanta,Jordi Comas,Ignacio Revuelta,Anna Manonelles,Carme Facundo,María José Pérez-Saez,Anna Vila,Emma Arcos,Jaume Tort,Magali Giral,Maarten Naesens,Dirk Kuypers,Anders Asberg,Francesc Moreso,Oriol Bestard,","doi":"10.3389/ti.2024.13452","DOIUrl":"https://doi.org/10.3389/ti.2024.13452","url":null,"abstract":"Although kidney transplantation from living donors (LD) offers better long-term results than from deceased donors (DD), elderly recipients are less likely to receive LD transplants than younger ones. We analyzed renal transplant outcomes from LD versus DD in elderly recipients with a propensity-matched score. This retrospective, observational study included the first single kidney transplants in recipients aged ≥65 years from two European registry cohorts (2013-2020, n = 4,257). Recipients of LD (n = 408), brain death donors (BDD, n = 3,072), and controlled cardiocirculatory death donors (cDCD, n = 777) were matched for donor and recipient age, sex, dialysis time and recipient diabetes. Major graft and patient outcomes were investigated. Unmatched analyses showed that LD recipients were more likely to be transplanted preemptively and had shorter dialysis times than any DD type. The propensity score matched Cox's regression analysis between LD and BDD (387-pairs) and LD and cDCD (259-pairs) revealing a higher hazard ratio for graft failure with BDD (2.19 [95% CI: 1.16-4.15], p = 0.016) and cDCD (3.38 [95% CI: 1.79-6.39], p < 0.001). One-year eGFR was higher in LD transplants than in BDD and cDCD recipients. In elderly recipients, LD transplantation offers superior graft survival and renal function compared to BDD or cDCD. This strategy should be further promoted to improve transplant outcomes.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"29 1","pages":"13452"},"PeriodicalIF":3.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Activation and Regulation of Indirect Alloresponses in Transplanted Patients With Donor Specific Antibodies and Chronic Rejection. 伴有供体特异性抗体和慢性排斥反应的移植患者间接异体反应的激活与调节

IF 2.7 3区医学

Transplant International Pub Date : 2024-08-20 eCollection Date: 2024-01-01 DOI: 10.3389/ti.2024.13196

Sumoyee Basu, Caroline Dudreuilh, Sapna Shah, Alberto Sanchez-Fueyo, Giovanna Lombardi, Anthony Dorling

{"title":"Activation and Regulation of Indirect Alloresponses in Transplanted Patients With Donor Specific Antibodies and Chronic Rejection.","authors":"Sumoyee Basu, Caroline Dudreuilh, Sapna Shah, Alberto Sanchez-Fueyo, Giovanna Lombardi, Anthony Dorling","doi":"10.3389/ti.2024.13196","DOIUrl":"10.3389/ti.2024.13196","url":null,"abstract":"Following transplantation, human CD4+T cells can respond to alloantigen using three distinct pathways. Direct and semi-direct responses are considered potent, but brief, so contribute mostly to acute rejection. Indirect responses are persistent and prolonged, involve B cells as critical antigen presenting cells, and are an absolute requirement for development of donor specific antibody, so more often mediate chronic rejection. Novel in vitro techniques have furthered our understanding by mimicking in vivo germinal centre processes, including B cell antigen presentation to CD4+ T cells and effector cytokine responses following challenge with donor specific peptides. In this review we outline recent data detailing the contribution of CD4+ T follicular helper cells and antigen presenting B cells to donor specific antibody formation and antibody mediated rejection. Furthermore, multi-parametric flow cytometry analyses have revealed specific endogenous regulatory T and B subsets each capable of suppressing distinct aspects of the indirect response, including CD4+ T cell cytokine production, B cell maturation into plasmablasts and antibody production, and germinal centre maturation. These data underpin novel opportunities to control these aberrant processes either by targeting molecules critical to indirect alloresponses or potentiating suppression via exogenous regulatory cell therapy.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13196"},"PeriodicalIF":2.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126809","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}

引用次数: 0

Post-Kidney Transplant Cancer: A Real-World Retrospective Analysis From a Single Italian Center. 肾移植后癌症：来自意大利单个中心的真实世界回顾性分析

IF 2.7 3区医学

Transplant International Pub Date : 2024-08-20 eCollection Date: 2024-01-01 DOI: 10.3389/ti.2024.13220

Giulia Vanessa Re Sartò, Carlo Alfieri, Laura Cosmai, Emilietta Brigati, Mariarosaria Campise, Anna Regalia, Simona Verdesca, Paolo Molinari, Anna Maria Pisacreta, Marta Pirovano, Luca Nardelli, Maurizio Gallieni, Giuseppe Castellano

{"title":"Post-Kidney Transplant Cancer: A Real-World Retrospective Analysis From a Single Italian Center.","authors":"Giulia Vanessa Re Sartò, Carlo Alfieri, Laura Cosmai, Emilietta Brigati, Mariarosaria Campise, Anna Regalia, Simona Verdesca, Paolo Molinari, Anna Maria Pisacreta, Marta Pirovano, Luca Nardelli, Maurizio Gallieni, Giuseppe Castellano","doi":"10.3389/ti.2024.13220","DOIUrl":"10.3389/ti.2024.13220","url":null,"abstract":"We describe the epidemiology of cancer after kidney transplantation (KTx), investigating its risk factors and impact on therapeutic management and survival in KTx recipients (KTRs). The association between modification of immunosuppressive (IS) therapy after cancer and survival outcomes was analyzed. We collected data from 930 KTRs followed for 7 [1-19] years. The majority of KTRs received KTx from a deceased donor (84%). In total, 74% of patients received induction therapy with basiliximab and 26% with ATG. Maintenance therapy included steroids, calcineurin inhibitors, and mycophenolate. Patients with at least one cancer (CA+) amounted to 19%. NMSC was the most common tumor (55%). CA+ were older and had a higher BMI. Vasculitis and ADPKD were more prevalent in CA+. ATG was independently associated with CA+ and was related to earlier cancer development in survival and competing risk analyses (p = 0.01 and <0.0001; basiliximab 89 ± 4 vs. ATG 40 ± 4 months). After cancer diagnosis, a significant prognostic impact was derived from the shift to mTOR inhibitors compared to a definitive IS drug suspension (p = 0.004). Our data confirm the relevance of cancer as a complication in KTRs with ATG as an independent risk factor. An individualized choice of IS to be proposed at the time of KTx is crucial in the prevention of neoplastic risk. Finally, switching to mTORi could represent an important strategy to improve patient survival.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13220"},"PeriodicalIF":2.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126818","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}

引用次数: 0

Antibiotic Prophylaxis in Patients Undergoing Lung Transplant: Single-Center Cohort Study. 肺移植患者的抗生素预防：单中心队列研究

IF 2.7 3区医学

Transplant International Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.3389/ti.2024.13245

Renato Pascale, Beatrice Tazza, Armando Amicucci, Elena Salvaterra, Giampiero Dolci, Filippo Antonacci, Massimo Baiocchi, Saverio Pastore, Simone Ambretti, Maddalena Peghin, Pierluigi Viale, Maddalena Giannella

{"title":"Antibiotic Prophylaxis in Patients Undergoing Lung Transplant: Single-Center Cohort Study.","authors":"Renato Pascale, Beatrice Tazza, Armando Amicucci, Elena Salvaterra, Giampiero Dolci, Filippo Antonacci, Massimo Baiocchi, Saverio Pastore, Simone Ambretti, Maddalena Peghin, Pierluigi Viale, Maddalena Giannella","doi":"10.3389/ti.2024.13245","DOIUrl":"10.3389/ti.2024.13245","url":null,"abstract":"Perioperative antibiotic prophylaxis (PAP) in lung transplant recipients (LuTRs) has high heterogeneity between centers. Our aim was to investigate retrospectively the approach to PAP in our center over a 20-year period (2002-2023), and its impact on early post-operative infections (EPOIs) after lung transplantation (LuT). Primary endpoint was diagnosis of EPOI, defined as any bacterial infection including donor-derived events diagnosed within 30 days from LuT. Main exposure variables were type of PAP (combination vs. monotherapy) and PAP duration. We enrolled 111 LuTRs. PAP consisted of single-agent or combination regimens in 26 (25.2%) and 85 (74.8%) LuTR. Median PAP duration was 10 days (IQR 6-13) days. Piperacillin/tazobactam was the most common agent used either as monotherapy (n = 21, 80.7%) or as combination with levofloxacin (n = 79, 92.9%). EPOIs were diagnosed in 30 (27%) patients. At multivariable analysis no advantages were found for combination regimens compared to single-agent PAP in preventing EPOI (OR: 1.57, 95% CI: 0.488-5.068, p:0.448). The impact of PAP duration on EPOIs development was investigated including duration of PAP ≤6 days as main exposure variables, without finding a significantly impact (OR:2.165, 95% CI: 0.596-7.863, p: 0.240). Our results suggest no advantages for combination regimens PAP in preventing EPOI in LuTR.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13245"},"PeriodicalIF":2.7,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11361928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112415","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}

引用次数: 0

Clinical Outcomes and Quality of Life of Patients Receiving Multi-Solid-Organ Transplants in Childhood Are Excellent: Results From a 20-Year Cohort Study. 儿童期接受多实体器官移植患者的临床疗效和生活质量非常好：一项为期 20 年的队列研究结果。

IF 2.7 3区医学

Transplant International Pub Date : 2024-08-14 eCollection Date: 2024-01-01 DOI: 10.3389/ti.2024.13372

Alicia Paessler, Hannah Maple, Miriam Cortes, Jacob Simmonds, Yincent Tse, Maduri Raja, Mordi Muorah, Nicos Kessaris, Jelena Stojanovic

{"title":"Clinical Outcomes and Quality of Life of Patients Receiving Multi-Solid-Organ Transplants in Childhood Are Excellent: Results From a 20-Year Cohort Study.","authors":"Alicia Paessler, Hannah Maple, Miriam Cortes, Jacob Simmonds, Yincent Tse, Maduri Raja, Mordi Muorah, Nicos Kessaris, Jelena Stojanovic","doi":"10.3389/ti.2024.13372","DOIUrl":"https://doi.org/10.3389/ti.2024.13372","url":null,"abstract":"Advances in medicine allow children with previously fatal conditions to survive longer and present as transplant candidates; some requiring multiple solid-organ transplants (MSOT). There is limited data on clinical outcomes and no data on quality of life (QoL). In this mixed methods cohort study clinical outcomes from the NHSBT registry were analysed for all patients who received a kidney and one other solid-organ transplant as a child between 2000 and 2021 in the UK. QoL was measured using the PedsQL 3.0 Transplant Module questionnaire. 92 children met the inclusion criteria: heart/heart-lung and kidney (n = 15), liver and kidney (n = 72), pancreas and kidney (n = 4) and multivisceral (n = 1). Results showed excellent patient and graft survival, comparable to single-organ transplants. Allograft survival and rejection were significantly better in patients with combined liver and kidney transplants compared to patients with sequential liver and kidney transplants. QoL was excellent with a mean score of 74%. Key findings included a significant improvement in QoL post-transplant. This is the first study to look at clinical and QoL outcomes in MSOT recipients. The results indicate excellent long-term outcomes. All children born with conditions leading to end-stage disease in multiple solid-organs should be assessed as transplant candidates.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13372"},"PeriodicalIF":2.7,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116956","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}

引用次数: 0

Incidence, Nature and Natural History of Additional Histological Findings in Preimplantation and Implantation Kidney Transplant Biopsies. 移植前和移植后肾移植活检中其他组织学发现的发生率、性质和自然史。

IF 2.7 3区医学

Transplant International Pub Date : 2024-08-14 eCollection Date: 2024-01-01 DOI: 10.3389/ti.2024.12997

A L Paterson, V Broecker, M Gray, A Chalisey, G J Pettigrew, D M Summers

{"title":"Incidence, Nature and Natural History of Additional Histological Findings in Preimplantation and Implantation Kidney Transplant Biopsies.","authors":"A L Paterson, V Broecker, M Gray, A Chalisey, G J Pettigrew, D M Summers","doi":"10.3389/ti.2024.12997","DOIUrl":"https://doi.org/10.3389/ti.2024.12997","url":null,"abstract":"The quality assurance provided by preimplantation biopsy quantification of chronic damage may allow greater use of kidneys from expanded criteria donors, and thereby expand the deceased donor pool. Preimplantation biopsy may, however, identify additional acute or chronic pathologies not considered in the scoring of chronic damage, and these may influence the decision to implant or discard the kidney. This single-centre retrospective cohort study of a contemporary UK donor population systematically characterised the nature of additional findings in 1,046 preimplantation and implantation biopsies over an eight-year period. A diverse range of findings were identified in 111/1,046 (11%) organs; most frequently diabetic glomerulopathy, focal segmental glomerulosclerosis, (micro)thrombi, neutrophil casts, and immunoglobulin/complement staining. Seventy (63%) of these were transplanted, with subsequent biopsy in 41 (58%) cases confirming that 80% of the initial acute changes had spontaneously resolved, while there was no progression of diabetic glomerulopathy, and the lesions of focal segmental glomerulosclerosis were not identified. Over 75% of assessable grafts with additional histological findings at the time of transplant showed adequate function at one-year following transplant. In conclusion, most histological abnormalities that may be identified in addition to chronic scarring in preimplantation kidney biopsies would not preclude transplantation nor predict poor graft function.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"12997"},"PeriodicalIF":2.7,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112416","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}

引用次数: 0

The Impact of Early Brain-Dead Donor Detection in the Emergency Department on the Organ Donation Process in Iran. 伊朗急诊科早期发现脑死亡捐献者对器官捐献过程的影响。

IF 2.7 3区医学

Transplant International Pub Date : 2024-08-13 eCollection Date: 2024-01-01 DOI: 10.3389/ti.2024.11903

Arman Hasanzade, Seyed Mohammad Reza Nejatollahi, Mojtaba Mokhber Dezfouli, Mahdieh Hazrati, Soheil Sheikholeslami, Masoud Imani, Bardia Mohseni, Fariba Ghorbani

{"title":"The Impact of Early Brain-Dead Donor Detection in the Emergency Department on the Organ Donation Process in Iran.","authors":"Arman Hasanzade, Seyed Mohammad Reza Nejatollahi, Mojtaba Mokhber Dezfouli, Mahdieh Hazrati, Soheil Sheikholeslami, Masoud Imani, Bardia Mohseni, Fariba Ghorbani","doi":"10.3389/ti.2024.11903","DOIUrl":"10.3389/ti.2024.11903","url":null,"abstract":"We aimed to assess the impact of hospital characteristics on the outcomes of detected possible brain-dead donors, in our organ procurement network in Iran. Data was collected through twice-daily calls with 57 hospitals' intensive care units and emergency departments over 1 year. The donation team got involved when there was suspicion of brain death before the hospital officially declared it. The data was categorized by hospital size, presence of neurosurgery/trauma departments, ownership, and referral site. Out of 813 possible donors, 315 were declared brain dead, and 203 were eligible for donation. After conducting family interviews (consent rate: 62.2%), 102 eligible donors became actual donors (conversion rate: 50.2%). While hospital ownership and the presence of trauma/neurosurgery care did not affect donation, early referral from the emergency department had a positive effect. Therefore, we strongly recommend prioritizing possible donor identification in emergency rooms and involving the organ donation team as early as possible. The use of twice-daily calls for donor identification likely contributed to the consistency in donation rates across hospitals, as this approach involves the donation team earlier and mitigates the impact of hospital characteristics. Early detection of possible donors from the emergency department is crucial in improving donation rates.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"11903"},"PeriodicalIF":2.7,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081770","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}

引用次数: 0

Perspective for Donor-Derived Cell-Free DNA in Antibody-Mediated Rejection After Kidney Transplantation: Defining Context of Use and Clinical Implications. 透视肾移植后抗体介导的排斥反应中的供体来源无细胞 DNA：确定使用背景和临床意义。

IF 2.7 3区医学

Transplant International Pub Date : 2024-08-12 eCollection Date: 2024-01-01 DOI: 10.3389/ti.2024.13239

Aylin Akifova, Klemens Budde, Michael Oellerich, Julia Beck, Kirsten Bornemann-Kolatzki, Ekkehard Schütz, Bilgin Osmanodja

{"title":"Perspective for Donor-Derived Cell-Free DNA in Antibody-Mediated Rejection After Kidney Transplantation: Defining Context of Use and Clinical Implications.","authors":"Aylin Akifova, Klemens Budde, Michael Oellerich, Julia Beck, Kirsten Bornemann-Kolatzki, Ekkehard Schütz, Bilgin Osmanodja","doi":"10.3389/ti.2024.13239","DOIUrl":"10.3389/ti.2024.13239","url":null,"abstract":"Antibody-mediated rejection (AMR) is a major cause of graft failure limiting long-term graft survival after kidney transplantation. Current diagnostic strategy to detect AMR is suboptimal and requires further improvement. Previously suggested treatment regimens for AMR could not demonstrate efficacy, however novel therapeutic agents are currently under investigation. Donor-derived cell-free DNA (dd-cfDNA) is a novel non-invasive biomarker for allograft injury, that has been mainly studied in the context of rejection. Its short-half-life in circulation and injury-dependent release are its key advantages that contribute to its superior diagnostic accuracy, compared to traditional biomarkers. Moreover, previous studies showed that dd-cfDNA-release is well-linked to histological and molecular features of AMR, and thus able to reflect real-time injury. Further observations suggest that dd-cfDNA can be used as a suitable screening tool for early detection of AMR in patients with donor-specific-anti-HLA-antibodies (DSA), as well as for monitoring AMR activity after anti-rejection treatment. The weight of evidence suggests that the integration of dd-cfDNA in the graft surveillance of patients with AMR, or those suspicious of AMR (e.g., due to the presence of donor-specific anti-HLA-antibodies) has an added value and might have a positive impact on outcomes in this specific cohort.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"13239"},"PeriodicalIF":2.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073891","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}

引用次数: 0

Management of Arteriovenous Fistula After Successful Kidney Transplantation in Long-Term Follow-Up. 成功肾移植后动静脉瘘的长期随访管理。

IF 2.7 3区医学

Transplant International Pub Date : 2024-08-12 eCollection Date: 2024-01-01 DOI: 10.3389/ti.2024.12841

Jana Janeckova, Petr Bachleda, Petr Utikal, Jirir Orsag

{"title":"Management of Arteriovenous Fistula After Successful Kidney Transplantation in Long-Term Follow-Up.","authors":"Jana Janeckova, Petr Bachleda, Petr Utikal, Jirir Orsag","doi":"10.3389/ti.2024.12841","DOIUrl":"10.3389/ti.2024.12841","url":null,"abstract":"Arteriovenous fistula (AVF) is the best method of vascular access for hemodialysis. This approach can lead to several complications, such as hyperkinetic heart failure due to a hyperfunctional AVF or dilatation of the feeding artery. These are late complications, especially in patients after a successful kidney transplantation. An observational study was performed focusing on patients more than 12 months after kidney transplantation. The AVF was evaluated by ultrasound and, if the outflow exceeded 1.5 L/min, an echocardiogram was performed. Surgical management was indicated if the cardiac index was higher than 3.9 L/min/m2 or upon finding a brachial artery aneurysm. A total of 208 post- kidney transplantation patients were examined over a 3-year period, of which 46 subjects (22.11%) had hyperfunctional AVF and 34 cases (16.34%) of feeding artery dilatation were determined. In total, 40 AVF flow reduction and 6 AVF ligation procedures were performed. The median AVF flow before and after the reduction was 2955 mL/min and 1060 mL/min, respectively. Primary patency after flow reduction was 88.3% at 12 months. Late AVF complications in patients following kidney transplantation are quite common. It is necessary to create a screening program to monitor AVFs in these patients.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"37 ","pages":"12841"},"PeriodicalIF":2.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11346416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073890","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}

引用次数: 0