Journal of Transplantation最新文献

{"title":"Pneumatosis Intestinalis and Pneumoperitoneum After Lung Transplantation: Single-Center Experience and Systematic Review.","authors":"Hiroshi Kagawa, Masashi Furukawa, Ernest Chan, Matthew Morrell, Pablo G Sanchez","doi":"10.1155/2024/8867932","DOIUrl":"10.1155/2024/8867932","url":null,"abstract":"<p><p><b>Background:</b> Pneumatosis intestinalis (PI) and pneumoperitoneum are some of the complications after lung transplantation (LT). But only limited reports are published. The purpose of this study is to review our experience and perform a systematic review to discuss the possible causes, risk factors, and management. <b>Methods:</b> We reviewed the characteristics, management, and outcome of the patients who developed PI or pneumoperitoneum after LT in our institution from 2013 to 2022. We also performed a systematic review to discuss the management and outcome. <b>Results:</b> PI and pneumoperitoneum were found in 15 out of 729 patients (2.06%) in our institution. We also found 50 patients in the systematic review. Tracheostomy was performed in 40% and gastrointestinal procedures were performed in 55.6%. Laparotomy was performed in 23.4%. A total of 44.6% of patients had benign physical exams or no symptoms. Rejection was seen in 42.9%. A total of 28.6% of patients died during follow-up periods. <b>Conclusions:</b> This report has the largest number of patients so far with PI and pneumoperitoneum after LT. These conditions have a high rejection and high mortality rate. Mechanical ventilation, tracheostomy, gastrointestinal procedure, CMV infection, <i>Clostridium difficile (C. difficile)</i> infection, and immunosuppression can be the risk factors, and the management includes laparotomy or conservative management. It is generally recommended to proceed with laparotomy if patients have portal venous gas, elevated white blood cell count, elevated lactic acid level, decreased bicarbonate level, elevated amylase level, metabolic acidosis, abdominal tenderness, or abdominal distension. Otherwise, most of the patients recover with conservative management with nil per os (NPO), metronidazole, ganciclovir, antibiotics, high-flow oxygen, and holding mycophenolate mofetil (MMF).</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Duct Division During Robotic Living Donor Hepatectomy: A Comparison Between the Novel Triple C (Clip-Clamp-Cut) and the Cut-Suture Techniques.","authors":"Arvinder S Soin, Kamal S Yadav, Fysal Valappil, Nikhitha Shetty, Raghav Bansal, Suchet Chaudhary, Ankur Gupta, Amit Rastogi, Prashant Bhangui","doi":"10.1155/2024/8955970","DOIUrl":"https://doi.org/10.1155/2024/8955970","url":null,"abstract":"<p><p><b>Background:</b> In robotic donor hepatectomy (RDH), hepatic duct division (HDD) and its stump closure technique are of paramount importance in avoiding postoperative biliary complications in both donors and recipients. We describe our novel triple C (\"clip-clamp-cut\") technique of HDD. <b>Methods:</b> Out of 4016 living donor liver transplant (LDLT) (2004-October 2023), we have performed 208 RDH cases since December 2019. This study is a retrospective analysis of the first 160 RDH cases. After excluding the first 20 RDH cases (learning curve) and 3 left-sided RDH cases, 137 cases with no exclusion criteria were included. We divided these 137 donors into the \"cut and suture\" (CS) group (<i>n</i> = 33) and the \"triple C\" technique group (<i>n</i> = 104). We compared intraoperative details and postoperative outcomes. <b>Results:</b> All 137 robotic donors and 128/137 recipients are currently well. Donor biliary leak rate was significantly lower among the triple C group (<i>n</i> = 3, 2.9%) compared to the CS group (<i>n</i> = 5, 15.2%) (<i>p</i>=0.009). No other differences in postdonation morbidity were observed among the two groups. Recipient biliary complication rate was lower in the triple C group than in the CS group although not statistically significant (10.6% vs. 15.1%; <i>p</i>=0.537), despite more multiple biliary anastomoses in the former. No significant differences in post-transplant recipient morbidity and mortality were observed. <b>Conclusions:</b> Our simple yet novel triple C technique enables clean, precise, bloodless HDD resulting in lower donor and potentially recipient biliary complication rates. The ease and reproducibility make it ideal for widespread adoption.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial Trauma History Negatively Impacts Liver Transplant Access in Women with Chronic Liver Disease.","authors":"Katherine M Cooper, Alessandro Colletta, Dhruval Amin, Darya M Herscovici, Deepika Devuni","doi":"10.1155/2024/2455942","DOIUrl":"10.1155/2024/2455942","url":null,"abstract":"<p><strong>Introduction: </strong>Few studies have evaluated the impact of psychological trauma (mental, emotional, or physical) on liver transplant (LT) candidacy and outcomes.</p><p><strong>Methods: </strong>We performed a single center retrospective analysis of patients who completed routine LT evaluation between October 2017 and June 2021. We identified the prevalence of psychological trauma history in men and women LT candidates and evaluated the association between trauma history and LT access. The primary outcome measure was listing for LT.</p><p><strong>Results: </strong>A total of 463 patients completed LT evaluation, of which 17% (<i>n</i> = 79) reported a history of trauma: 49 of 159 women and 30 of 304 men. Trauma history was significantly more common in women than in men (31% vs. 10%, <i>p</i> < 0.001). Women with trauma history were less likely to be listed for LT (80% vs. 93%, <i>p</i> = 0.016). Women with trauma history were also more likely to be removed from the LT waitlist (26% vs. 12%, <i>p</i> = 0.045); this persists when excluding patients removed for transfer to another center or for medical improvement (22% vs. 7%, <i>p</i> = 0.020). In contrast, listing for LT (87% vs. 86%, <i>p</i> = 0.973) and waitlist removal (12% vs. 10%, <i>p</i> = 0.766) did not differ in men with and without trauma history. In those that received a LT (<i>n</i> = 107), post-LT relapse, rejection, readmissions, and death did not differ in patients with (n=13)and without (n=94) trauma history.</p><p><strong>Conclusions: </strong>Trauma history is associated with reduced access to LT in women but not men with chronic liver disease. Further studies are needed to understand the impact of psychological trauma on LT access and post-LT outcomes.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of Recipients of Liver Transplants from Living Donors Treated with a Very Low-Calorie Diet.","authors":"Hannah Wozniak, Sara Naimimohasses, Toru Goto, Gonzalo Sapisochin, Blayne Sayed, Anand Ghanekar, Mark Cattral, Nazia Selzner","doi":"10.1155/2024/9024204","DOIUrl":"10.1155/2024/9024204","url":null,"abstract":"<p><p>The increasing prevalence of steatotic liver disease (SLD) in potential living donors is concerning, as it limits donor's availability amid rising demand. OPTIFAST very low-calorie diet (VLCD), a meal replacement product, effectively reduces weight and hepatic steatosis before transplantation. However, data on the outcomes of recipients of VLCD-treated donors are lacking. We conducted a single-center, retrospective study on 199 living donor liver transplant recipients at Toronto General Hospital, Canada, between January 2015 and January 2020. We compared the 1-year posttransplant outcomes between recipients who received organs from donors treated with VLCD (<i>N</i> = 34) for either weight loss or steatosis reduction, with those who did not require treatment (<i>N</i> = 165). Our analysis revealed no statistically significant differences in the rates of postoperative complications (23% vs 32.4%, <i>p</i>=0.3) or intensive care unit stays (70.9% vs 70.6%, <i>p</i>=1) between recipients of non-VLCD and VLCD grafts. Following adjusted multivariate logistic regression, receipt of VLCD grafts was not associated with increased hospital length of stay. In addition, one-year mortality did not differ between the two groups (4.2% non-VLCD recipients vs 2.9% VLCD recipients, <i>p</i>=0.6). OPTIFAST VLCD treatment for liver donors demonstrates positive and safe outcomes in recipients, expanding the pool of potential living donors for increased organ availability.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11081753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Kidney Transplant Shortage: The Potential of Kidney Paired Exchanges in Jordan","authors":"Mohammad H. Al-Thnaibat, Mohammad Balaw, Mohammed K. Al-Aquily, Reem A. Ghannam, Omar B. Mohd, Firas Alabidi, S. Alabidi, Fadi Hussein, Badi Rawashdeh","doi":"10.1155/2024/4538034","DOIUrl":"https://doi.org/10.1155/2024/4538034","url":null,"abstract":"Jordan performed the Middle East's first living-donor kidney transplant in 1972. In 1977, the country became one of the first Arab countries to regulate organ donation and transplantation. Despite these early advances in living donor transplantation, Jordan's organ donation after brain death program remains inactive, making it challenging to meet organ demand and placing many patients on long transplant waiting lists. As of 2020, only 14.2% of the patients with end-stage kidney disease have access to a living donor. The scarcity of compatible living donors exacerbates Jordan's organ shortage, leaving patients with extended waits and uncertain transplant prospects. Due to the lack of living donors and the inactive brain death donation program, additional options are needed to meet organ demand. Kidney paired exchange (KPE), emerges as a potential solution to the problem of donor shortage and donor-recipient incompatibility. By allowing living donors to direct their donated organs to different compatible recipients, KPE offers the promise of expanding transplant opportunities for patients without suitable living donors. However, the current Jordanian law restricting living kidney donation to fifth-degree relatives further limits the pool of potential donors, aggravating the organ shortage situation. This article explores the feasibility of implementing KPE in Jordan and proposes an approach to implementing KPE in Jordan, considering ethical and legal aspects to substantially increase kidney transplants.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Early Rejection Treatment on Infection Development in Kidney Transplant Recipients: A Propensity Analysis","authors":"Simran Gupta, Juan Gea-Banacloche, R. Heilman, Reena N. Yaman, H. Me, Nan Zhang, H. Vikram, L. Kodali","doi":"10.1155/2024/6663086","DOIUrl":"https://doi.org/10.1155/2024/6663086","url":null,"abstract":"Introduction The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature. Methods We conducted a retrospective cohort study of 185 rejection (case) and 185 nonrejection (control) kidney transplant patients treated at our institution from 2014 to 2020 to understand the impact of rejection on infection development. Propensity scoring was used to match cohorts. We collected data for infections within 6 months of rejection for the cases and 18 months posttransplant for controls. Results In 370 patients, we identified 466 infections, 297 in the controls, and 169 in the cases. Urinary tract infections (38.9%) and cytomegalovirus viremia (13.7%) were most common. Cumulative incidence of infection between the case and controls was 2.17 (CI 1.54–3.05); p < 0.001. There was no difference in overall survival (HR 0.90, CI 0.49–1.66) or graft survival (HR 1.27, CI 0.74–2.20) between the groups. There was a significant difference in overall survival (HR 2.28, CI 1.14–4.55; p = 0.019) and graft survival (HR 1.98, CI 1.10–3.56; p = 0.023) when patients with infection were compared to those without. Conclusions As previously understood, rejection treatment is a risk factor for subsequent infection development. Our data have defined this relationship more clearly. This study is unique, however, in that we found that infections, but not rejection, negatively impacted both overall patient survival and allograft survival, likely due to our institution's robust post-rejection protocols. Clinicians should monitor patients closely for infections in the post-rejection period and have a low threshold to treat these infections while also restarting appropriate prophylaxis.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140092877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Center Outcomes of Epstein-Barr Virus DNAemia in Adult Solid Organ Transplant Recipients.","authors":"Sara W Dong, Barbra M Blair, Carolyn D Alonso","doi":"10.1155/2024/5598324","DOIUrl":"10.1155/2024/5598324","url":null,"abstract":"<p><strong>Background: </strong>Immunosuppression in solid organ transplantation (SOT) increases the risk of Epstein-Barr virus (EBV) DNAemia, which may herald development of posttransplant lymphoproliferative disease (PTLD). Few studies have characterized the incidence, risk factors, and clinical impact of EBV DNAemia in adult SOT recipients (SOTR).</p><p><strong>Methods: </strong>A single-center, retrospective review of adult (≥18 years) SOTR between 01 January 2015 and 31 December 2019 was conducted. Patients were stratified by the primary study endpoint of development of EBV DNAemia (whole blood EBV DNA PCR > 200 copies/mL). Secondary endpoints included development of PTLD, reduction in immunosuppression (RIS), use of pre-emptive therapy, and all-cause mortality.</p><p><strong>Results: </strong>Among 442 adult SOTR, the predominant transplant organs were the kidney (258, 58%) and liver (141, 31.9%). EBV serostatus in most subjects (430, 97%) was classified as intermediate risk (R+). Eight subjects (2%) were high risk (donor (D+/R-), and 4 (1%) were low risk (D-/R-). The overall incidence of EBV DNAemia was 4.1% (18/442) with a median time to detection of 14 months (range 3-60). The highest proportion of DNAemia was observed in D+/R- subjects (37.5%; <i>p</i> < 0.001). Development of PTLD was significantly associated with EBV DNAemia and occurred in 3/18 patients with DNAemia (16.7%) vs. 3/424 (0.7%) without DNAemia (<i>p</i> < 0.001). All patients with PTLD were managed with RIS and rituximab.</p><p><strong>Conclusion: </strong>We observed that EBV D+/R- serostatus and development of sustained EBV DNAemia were high risk features associated with subsequent development of PTLD in our cohort of adult SOTR.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10810690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Haematopoietic Stem Cell Transplant Trends in Pakistan: Activity Survey from Pakistan Bone Marrow Transplant Group.","authors":"Natasha Ali,&nbsp;Raheel Iftikhar,&nbsp;Muhammad Ayaz Mir,&nbsp;Syed Waqas Bokhari,&nbsp;Jehanzeb Ur Rehman,&nbsp;Uzma Zaidi,&nbsp;Shahzad Nasir,&nbsp;Salman Naseem Adil,&nbsp;Tariq Satti,&nbsp;Qamar Un Nisa Chaudhry,&nbsp;Muhammad Farhan,&nbsp;Tasneem Farzana,&nbsp;Tariq Ghafoor,&nbsp;Bushra Ahsan,&nbsp;Azhar S Khan,&nbsp;Farrukh Ali Khan,&nbsp;Syeda Itrat Fatima,&nbsp;Shafaq Abdul Samad,&nbsp;Aliya Batool,&nbsp;Hafiz Muhammad Nadeem,&nbsp;Syed Nasir Abbas Bukhari,&nbsp;Saqib Hussain Ansari,&nbsp;Parvez Ahmed","doi":"10.1155/2023/8865364","DOIUrl":"10.1155/2023/8865364","url":null,"abstract":"<p><p>Pakistan is the fifth most populous country with a population of 225 million and has health expenditure accounting for only 2.8 percent of gross domestic product (GDP). Accordingly, there are a limited number of haematology-oncology and transplant centers in the country. The Pakistan Blood and Marrow Transplant (PBMT) group was established in 2020, and this report is the first activity survey from January 2021 to December 2022 focusing on the trends of matched-related donor, haploidentical, and autologous transplants in a developing country. A total of 12 transplant centers contributed data on the modified PBMT survey form retrospectively and 806 haematopoietic stem cell transplants (HSCTs) were carried out during the study duration. Allogeneic HSCT constituted 595 (73.8%) of all the transplants; this is in stark contrast to Western data, where autologous HSCT accounts for the majority of transplants. <i>ß</i>-thalassemia major and aplastic anemia were the commonest indications for allogeneic HSCT, in contrast to Western data, where acute leukemia is the leading transplant indication. Autologous transplants were more frequently performed for Hodgkin's lymphoma as compared to non-Hodgkin's lymphoma and multiple myeloma. The use of peripheral and bone marrow stem cells was comparable. A myeloablative conditioning regimen was routinely used in patients with acute leukemia. This report provides an insight of HSCT trends in Pakistan which are different from those of Western centers contributing to transplant data from South Asia.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10555501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41178777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Leading Transplantation Journals: A Trend Analysis, 2011-2021.","authors":"Badi Rawashdeh,&nbsp;Saif Aldeen Alryalat,&nbsp;Joohyun Kim,&nbsp;Calvin Eriksen,&nbsp;Mohammad Abu Assi,&nbsp;Raj Prasad,&nbsp;Matthew Cooper","doi":"10.1155/2023/8858320","DOIUrl":"10.1155/2023/8858320","url":null,"abstract":"<p><strong>Background: </strong>As the field of transplantation has expanded, so have the quantity and variety of articles published on the topic. Evaluation of publications and journals is crucial to the expansion of transplant research. This study investigated the research output and journal metrics of the leading solid organ transplant journals published between 2011 and 2021 based on estimations of the trends in the category CiteScore from the Scopus database.</p><p><strong>Materials and methods: </strong>We obtained data on the listed journals from the Scopus Source List. We then filtered the list for \"Transplantation\" journals. Only the top quartiles or quartile 1 (Q1) journals were placed in this category. This study focused specifically on transplantation journals and did not include other journals related to diseases of transplanted organs such as the kidney, liver, heart, and lungs.</p><p><strong>Results: </strong>The number of transplantation journals increased by 42.8% in the last ten years, from 28 in 2011 to 40 in 2021. Between 2011 and 2021, nine transplantation journals ranked in the highest quartile (Q1). The American Journal of Transplantation was the top journal in both years, with a 150% increase in citations and an 11.2% increase in articles published. Open access (OA) transplant journals rose from 3 in 2011 to 10 in 2021. In 2021, OA journals earned 8,555 citations, a 125% increase from 2011. Despite this increase, non-OA journals received more citations than OA in 2021 (<i>p</i> value 0.026).</p><p><strong>Conclusion: </strong>Solid organ transplantation advances lead to more publications and citations. Regular journals and publications evaluation benefits academics and policymakers by promoting the growth of research. This study examined solid organ transplantation journals and gave a global perspective on transplant journal rankings and compared their status in 2011 and 2021.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41173686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Medication Adherence with the Use of Extended-Release Tacrolimus in Liver Transplant Recipients: A Pilot Randomized Controlled Trial.","authors":"Manisha Verma,&nbsp;Radi Zaki,&nbsp;Johnathan Sadeh,&nbsp;John P Knorr,&nbsp;Mark Gallagher,&nbsp;Afshin Parsikia,&nbsp;Victor Navarro","doi":"10.1155/2023/7915781","DOIUrl":"https://doi.org/10.1155/2023/7915781","url":null,"abstract":"<p><strong>Background: </strong>Nonadherence to immunosuppression in liver transplant recipients (LTRs) leads to deterioration in health outcomes. Once-dailyextended-release tacrolimus (TAC-ER) may improve adherence when compared to twice-dailyimmediate-release tacrolimus (TAC-IR).</p><p><strong>Methods: </strong>We conducted a randomized controlled study to evaluate medication adherence, clinical efficacy, and safety of TAC-ER in stable LTR. All patients >18 years who underwent liver transplantation before 6 months were eligible. Patients were randomized 1 : 1 to continued TAC-IR or conversion to TAC-ER. The primary outcome was change in medication adherence from baseline to 9 months, assessed using BAASIS. Secondary outcomes were tacrolimus trough levels, safety, and quality of life.</p><p><strong>Results: </strong>Thirty-one patients were consented and randomized to either of the two groups: conversion to TAC-ER (<i>n</i> = 15) or continued TAC-IR (<i>n</i> = 16). Six patients in the TAC-ER group withdrew after randomization due to apprehension about switching medication (<i>n</i> = 2), unwillingness to travel (<i>n</i> = 2), and increased liver tests after conversion (<i>n</i> = 2, both were acute rejections despite therapeutic tacrolimus levels and were considered unrelated to TAC-ER). We compared the results of nine patients in the TAC-ER group that completed the study with those of sixteen in the TAC-IR group. At baseline, there was no difference in tacrolimus trough levels between groups. Improved adherence was observed in the TAC-ER group as 100% of patients reported at least one period of full adherence during the study period (100% vs. 62.6%, <i>p</i> = 0.035). Tacrolimus trough levels and liver tests were comparable between groups throughout the study. There were no differences in eGFR, HbA1c, or QoL between the groups.</p><p><strong>Conclusion: </strong>TAC-ER improved medication adherence while maintaining comparable trough levels, liver function, and QoL as TAC-IR in LTR.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9833930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10535388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}