Journal of Transplantation最新文献

{"title":"Banff 2016 Global Assessment and Quantitative Scoring for T Cell-Mediated Liver Transplant Rejection are Interchangeable.","authors":"Maryam Eghtedari,&nbsp;Catriona McKenzie,&nbsp;Lauren C Y Tang,&nbsp;Avik Majumdar,&nbsp;James G Kench","doi":"10.1155/2023/3103335","DOIUrl":"https://doi.org/10.1155/2023/3103335","url":null,"abstract":"<p><strong>Introduction: </strong>Histopathological assessment of liver biopsies is the current \"gold standard\" for diagnosing graft dysfunction after liver transplantation (LT), as graft dysfunction can have nonspecific clinical presentations and inconsistent patterns of liver biochemical dysfunction. Most commonly, post-LT, graft dysfunction within the first year, is due to acute T-cell mediated rejection (TCMR) which is characterised histologically by the degree of portal inflammation (PI), bile duct damage (BDD), and venous endothelial inflammation (VEI). This study aimed to establish the relationship between global assessment, which is the global grading of rejection using a \"gestalt\" approach, and the rejection activity index (RAI) of each component of TCMR as described in revised Banff 2016 guidelines.</p><p><strong>Methods: </strong>Liver biopsies (<i>n</i> = 90) taken from patients who underwent LT in 2015 and 2016 at the Australian National Liver Transplant Unit were identified from the electronic medical records. All biopsy slides were microscopically graded by at least two assessors independently using the revised 2016 Banff criteria. Data were analysed using IBM SPSS v21. A Fisher-Freeman-Halton test was performed to assess the correlation between the global assessment and the RAI scores for each TCMR biopsy.</p><p><strong>Results: </strong>Within the cohort, 60 (37%, <i>n</i> = 164) patients underwent at least 1 biopsy within 12 months after LT. The most common biopsy outcome (total <i>n</i> = 90) was acute TCMR (64, 71.1%). Global assessment of TCMR slides strongly positively correlated with PI (<i>p</i> value <0.001), BDD (<i>p</i> value <0.001), VEI (<i>p</i> value <0.001), and total RAI (<i>p</i> value <0.001). Liver biochemistry of patients with TCMR significantly improved within 4 to 6 weeks post-biopsy compared to the day of the biopsy.</p><p><strong>Conclusion: </strong>In acute TCMR, global assessment and total RAI are strongly correlated and can be used interchangeably to describe the severity of TCMR.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2023 ","pages":"3103335"},"PeriodicalIF":2.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10070025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9250926","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":"Risk Factors for Symptomatic Pericardial Effusions Posthematopoietic Stem Cell Transplant.","authors":"Kelly Lyons,&nbsp;Niti Dham,&nbsp;Bryanna Schwartz,&nbsp;Blachy J Dávila Saldaña","doi":"10.1155/2023/7455756","DOIUrl":"https://doi.org/10.1155/2023/7455756","url":null,"abstract":"<p><strong>Background: </strong>Pericardial effusions are a known complication posthematopoietic stem cell transplant (HSCT), causing significant morbidity. We aimed to evaluate the risk factors associated with the development of high-grade effusions requiring interventions. <i>Procedure</i>. A retrospective chart review of all HSCT patients over a period of 7 years (2013-2019) in a single institution in the Northeastern United States is conducted. All patients who developed an effusion requiring intervention were included. Patient's clinical characteristics were compared with all others transplanted during the same time period. Echocardiogram findings of the affected patients were compared to a case-control cohort of unaffected patients with similar age and diagnosis. Chi-square and paired <i>t</i>-tests were utilized to ascertain statistical differences between the groups.</p><p><strong>Results: </strong>A total of 15 patients out of 201 (7.5%) transplanted at our institution developed a moderate or large pericardial effusion requiring pericardiocentesis or a pericardial window. Of this cohort, 13 (87%) underwent a myeloablative preparative regimen, 13 (87%) had cyclophosphamide as part of their regimen, 13 (87%) had recent treatment for viral reactivation, 6 (40%) had an underlying hemoglobinopathy diagnosis, and only 4 (27%) had an active diagnosis of GVHD. A myeloablative preparative regimen had a higher rate of effusion requiring intervention, although it was not statistically significant, and concurrent GVHD was not predictive of effusion development. However, exposure to cyclophosphamide, recent treatment for viral reactivation, and a diagnosis of transplant-associated thrombotic microangiopathy (Ta-TMA) were highly associated with effusions. The latter was associated with increased mortality. The duration of pericardial effusion correlated with the pretransplant echocardiogram left ventricle end diastolic diameter z-score and apical 4-chamber left ventricular peak average strain measurement.</p><p><strong>Conclusions: </strong>Potential risk factors for pericardial effusions post-HSCT include a diagnosis of Ta-TMA, active viral infection, exposure to cyclophosphamide, and a higher left ventricle end diastolic diameter <i>z</i>-score. This information may help guide management for these patients, including identifying high-risk subjects, determining the frequency of echocardiograms, and determining specific echocardiogram measures to follow over time.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2023 ","pages":"7455756"},"PeriodicalIF":2.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10772736","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":"Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung Transplantation","authors":"D. Razia, S. Tokman, Sharjeel Israr, H. Mohamed, H. Abdelrazek, B. Buddhdev, A. Arjuna, K. Mcanally, S. Hashimi, Michael A. Smith, R. Bremner, R. Walia, A. Omar","doi":"10.1155/2022/3308939","DOIUrl":"https://doi.org/10.1155/2022/3308939","url":null,"abstract":"Background Persistent orthostatic hypotension (OH) is a lesser-known complication of lung transplantation (LTx). In this retrospective case series, we describe the clinical manifestations, complications, and treatment of persistent OH in 13 LTx recipients. Methods We identified LTx recipients who underwent transplantation between March 1, 2018, and March 31, 2020, with persistent symptomatic OH and retrospectively queried the records for clinical information. Results Thirteen patients were included in the analysis, 9 (69%) had underlying pulmonary fibrosis, and 12 (92%) were male. The median age, height, and body mass index at LTx were 68 years, 70 inches, and 27 kg/m2, respectively. Six (46%) patients were deceased at the time of chart abstraction with a median (IQR) posttransplant survival of 12.6 months (6, 21); the 7 remaining living patients were a median of 19.6 months (18, 32) posttransplant. Signs and symptoms of OH developed a median of 60 (7, 75) days after transplant. Patients were treated with pharmacological agents and underwent extensive physical therapy. Most patients required inpatient rehabilitation (n = 10, 77%), and patients commonly developed comorbid conditions including weight loss, renal insufficiency with eGFR <50 (n = 13, 100%), gastroparesis (n = 7, 54%), and tachycardia-bradycardia syndrome (n = 2, 15%). Falls were common (n = 10, 77%). The incidence of OH in LTx recipients at our center during the study period was 5.6% (13/234). Conclusions Persistent OH is a lesser-known complication of LTx that impacts posttransplant rehabilitation and may lead to comorbidities and shortened survival. In addition, most LTx recipients with OH at our center were tall, thin men with underlying pulmonary fibrosis, which may offer an opportunity to instate pretransplant OH screening of at-risk patients.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46574015","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":"Mammalian Target of Rapamycin Inhibitors and Wound Healing Complications in Kidney Transplantation: Old Myths and New Realities","authors":"Muhammad Abdul Mabood Khalil, S. Al-Ghamdi, U. Dawood, Said Sayed Ahmed Khamis, H. Ishida, V. Chong, Jackson Tan","doi":"10.1155/2022/6255339","DOIUrl":"https://doi.org/10.1155/2022/6255339","url":null,"abstract":"Mammalian target of rapamycin inhibitors (mTOR-I) lacks nephrotoxicity, has antineoplastic effects, and reduces viral infections in kidney transplant recipients. Earlier studies reported a significant incidence of wound healing complications and lymphocele. This resulted in the uncomfortable willingness of transplant clinicians to use these agents in the immediate posttransplant period. As evidence and experience evolved over time, much useful information became available about the optimal use of these agents. Understandably, mTOR-I effects wound healing through their antiproliferative properties. However, there are a lot of other immunological and nonimmunological factors which can also contribute to wound healing complications. These risk factors include obesity, uremia, increasing age, diabetes, smoking, alcoholism, and protein-energy malnutrition. Except for age, the rest of all these risk factors are modifiable. At the same time, mycophenolic acid derivatives, steroids, and antithymocyte globulin (ATG) have also been implicated in wound healing complications. A lot has been learnt about the optimal dose of mTOR-I and their trough levels, its combinations with other immunosuppressive medications, and patients' profile, enabling clinicians to use these agents appropriately for maximum benefits. Recent randomized control trials have further increased the confidence of clinicians to use these agents in immediate posttransplant periods.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2022 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44259626","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":"Living-Donor Liver Transplant in Oman: A Quantitative Cross-Sectional Study of Donors' Experiences and Challenges.","authors":"Mudhar Al Adawi,&nbsp;Hasina Al Harthi,&nbsp;Raja Al Hinai,&nbsp;Suad Al Haddabi,&nbsp;Iqbal Al Busaidi,&nbsp;Omar Al Siyabi,&nbsp;Salah Thabit Al Awaidy","doi":"10.1155/2021/4251814","DOIUrl":"https://doi.org/10.1155/2021/4251814","url":null,"abstract":"<p><strong>Background: </strong>In Oman, the first liver transplant was performed at the Royal Hospital (RH) in September 2017. Since then, thirteen cases have been operated on at the RH. All of these cases were living-donor liver transplants (LDLT), and the remaining cases were treated in India with a total of approximately 193 recipients. To provide an in-depth overview of donor experiences, challenges, and perceptions, a cross-sectional study was conducted.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at one tertiary hospital in 2019. The survey was designed to collect data composed of closed and open-ended questions to reveal a thorough knowledge of the topic.</p><p><strong>Results: </strong>A total of 50 of 120 donors responded to the survey with male dominance in the sample (68%) and 64% were aged 28 to 38 years. 66% of the respondents came to know about the donation through hospital staff. Interestingly, respondents (<i>n</i> = 8/12) who reported that fear of operation is the cause that prevents people from donating are among the male gender, while more men believe that the main cause is lack of knowledge. 90% of the respondents felt satisfied after donation. More men reported ambiguous feelings before donation. Moreover, married donors reported ambiguous feelings before donation (<i>p</i> = 0.008). The younger age group reported anxiety and doubt as a challenge through their donation experience.</p><p><strong>Conclusion: </strong>This study revealed that donors have a positive feeling after donating as they have saved a life, as well as being empowered by family and community. The donors encourage individuals to donate a portion of their liver. Some crucial questions arose, such as anxiety before surgery, ambiguous feelings before surgery, and fatigue after surgery. These findings underscore the importance of a holistic approach that would enable donors to be well informed prior to surgery.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"4251814"},"PeriodicalIF":2.5,"publicationDate":"2021-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656637","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":"Natural Antibodies and Alloreactive T Cells Long after Kidney Transplantation.","authors":"Nicole M van Besouw,&nbsp;Aleixandra Mendoza Rojas,&nbsp;Sarah B See,&nbsp;Ronella de Kuiper,&nbsp;Marjolein Dieterich,&nbsp;Dave L Roelen,&nbsp;Marian C Clahsen-van Groningen,&nbsp;Dennis A Hesselink,&nbsp;Emmanuel Zorn,&nbsp;Carla C Baan","doi":"10.1155/2021/7005080","DOIUrl":"https://doi.org/10.1155/2021/7005080","url":null,"abstract":"<p><strong>Background: </strong>The relationship between circulating effector memory T and B cells long after transplantation and their susceptibility to immunosuppression are unknown. To investigate the impact of antirejection therapy on T cell-B cell coordinated immune responses, we assessed IFN-<i>γ</i>-producing memory cells and natural antibodies (nAbs) that potentially bind to autoantigens on the graft.</p><p><strong>Methods: </strong>Plasma levels of IgG nAbs to malondialdehyde (MDA) were measured in 145 kidney transplant recipients at 5-7 years after transplantation. In 54 of these patients, the number of donor-reactive IFN-<i>γ</i>-producing cells was determined. 35/145 patients experienced rejection, 18 of which occurred within 1 year after transplantation.</p><p><strong>Results: </strong>The number of donor-reactive IFN-<i>γ</i>-producing cells and the levels of nAbs were comparable between rejectors and nonrejectors. The nAbs levels were positively correlated with the number of donor-reactive IFN-<i>γ</i>-producing cells (<i>r</i> _s = 0.39, <i>p</i>=0.004). The positive correlation was only observed in rejectors (<i>r</i> _s = 0.53, <i>p</i>=0.003; nonrejectors: <i>r</i> _s = 0.24, <i>p</i>=0.23). Moreover, we observed that intravenous immune globulin treatment affected the level of nAbs and this effect was found in patients who experienced a late ca-ABMR compared to nonrejectors (<i>p</i>=0.008).</p><p><strong>Conclusion: </strong>The positive correlation found between alloreactive T cells and nAbs in rejectors suggests an intricate role for both components of the immune response in the rejection process. Treatment with intravenous immune globulin impacted nAbs.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"7005080"},"PeriodicalIF":2.5,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39504549","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":"Waitlist Mortality and Posttransplant Outcomes in African Americans with Autoimmune Liver Diseases.","authors":"John Paul Nsubuga,&nbsp;Daniela Goyes,&nbsp;Hirsh D Trivedi,&nbsp;Esli Medina-Morales,&nbsp;Vilas Patwardhan,&nbsp;Alan Bonder","doi":"10.1155/2021/6692049","DOIUrl":"https://doi.org/10.1155/2021/6692049","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation is indicated in end-stage liver disease due to autoimmune diseases. The liver allocation system can be affected by disparities such as decreased liver transplant referrals for racial minorities, especially African Americans that negatively impact the pre- and posttransplant outcomes.</p><p><strong>Aim: </strong>To determine differences in waitlist survival and posttransplant graft survival rates between African American and Caucasian patients with autoimmune liver diseases. <i>Study</i>. The United Network for Organ Sharing database was used to identify all patients with autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis who underwent liver transplant from 1988 to 2019. We compared waitlist survival and posttransplant graft survival between Caucasians and African Americans using Kaplan-Meier curves and Cox regression models. We also evaluated the cumulative incidence of death or delisting for deterioration and posttransplant incidence of death and retransplantation using competing risk analysis.</p><p><strong>Results: </strong>African Americans were more likely to be removed from the waitlist for death or clinical deterioration (subdistribution hazard ratio (SHR) 1.26, 95% CI 1-1.58, <i>P</i>=0.046) using competing risk analysis. On multivariate Cox regression analysis, there was no difference in posttransplant graft survival among the two groups (hazard ratio (HR) 1.10, 95% CI 0.98-1.23, <i>P</i>=0.081).</p><p><strong>Conclusions: </strong>Despite the current efforts to reduce racial disparities, we found that African Americans are more likely to die on the waitlist for liver transplant and are less likely to be transplanted, with no differences in graft survival rates. The persistence of healthcare disparities continues to negatively impact African Americans.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"6692049"},"PeriodicalIF":2.5,"publicationDate":"2021-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8357471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39313458","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":"Is Bigger Better? Living Donor Kidney Volume as Measured by the Donor CT Angiogram in Predicting Donor and Recipient eGFR after Living Donor Kidney Transplantation.","authors":"Chaudhry Adeel Ebad, David Brennan, Julio Chevarria, Mohammad Bin Hussein, Donal Sexton, Douglas Mulholland, Ciaran Doyle, Patrick O'Kelly, Yvonne Williams, Ruth Dunne, Conall O'Seaghdha, Dilly Little, Martina Morrin, Peter J Conlon","doi":"10.1155/2021/8885354","DOIUrl":"10.1155/2021/8885354","url":null,"abstract":"<p><strong>Background: </strong>The role of kidney volume measurement in predicting the donor and recipient kidney function is not clear.</p><p><strong>Methods: </strong>We measured kidney volume bilaterally in living kidney donors using CT angiography and assessed the association with the donor remaining kidney and recipient kidney (donated kidney) function at 1 year after kidney transplantation. Donor volume was categorized into tertiles based on lowest, middle, and highest volume.</p><p><strong>Results: </strong>There were 166 living donor and recipient pairs. The mean donor age was 44.8 years (SD ± 10.8), and donor mean BMI was 25.5 (SD ± 2.9). The recipients of living donor kidneys were 64% male and had a mean age of 43.5 years (SD ± 13.3). Six percent of patients experienced an episode of cellular rejection and were maintained on dialysis for a mean of 18 months (13-32) prior to transplant. Kidney volume was divided into tertiles based on lowest, middle, and highest volume. Kidney volume median (range) in tertiles 1, 2, and 3 was 124 (89-135 ml), 155 (136-164 ml), and 184 (165-240 ml) with donor eGFR ml/min (adjusted for body surface area expressed as ml/min/1.73 m²) at the time of donation in each tertile, 109 (93-129), 110 (92-132), and 101 ml/min (84-117). The median (IQR) eGFR in tertiles 1 to 3 in kidney recipients at 1 year after donation was 54 (44-67), 62 (50-75), and 63 ml/min (58-79), respectively. The median (IQR) eGFR in tertiles 1 to 3 in the remaining kidney of donors at 1 year after donation was 59 (53-66), 65 (57-72), and 65 ml/min (56-73), respectively.</p><p><strong>Conclusion: </strong>Bigger kidney volume was associated with better eGFR at 1 year after transplant in the recipient and marginally in the donor remaining kidney.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"8885354"},"PeriodicalIF":2.5,"publicationDate":"2021-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39265841","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 Impact of Timing of Stent Removal on the Incidence of UTI, Recurrence, Symptomatology, Resistance, and Hospitalization in Renal Transplant Recipients.","authors":"Ziad Arabi,&nbsp;Khalefa Al Thiab,&nbsp;Abdulrahman Altheaby,&nbsp;Mohammed Tawhari,&nbsp;Ghaleb Aboalsamh,&nbsp;Mohamad Almarastani,&nbsp;Samy Kashkoush,&nbsp;Mohammed F Shaheen,&nbsp;Abdulrahman Altamimi,&nbsp;Lina Alnajjar,&nbsp;Rawan Alhussein,&nbsp;Raghad Almuhiteb,&nbsp;Bashayr Alqahtani,&nbsp;Rayana Alotaibi,&nbsp;Marah Alqahtani,&nbsp;Yahya Ghazwani,&nbsp;Wael O'Hali,&nbsp;Khalid Bin Saad","doi":"10.1155/2021/3428260","DOIUrl":"https://doi.org/10.1155/2021/3428260","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent removal on urinary tract infections (UTIs) post renal transplantation.</p><p><strong>Methods: </strong>A retrospective study was performed including all adult renal transplants who were transplanted between January 2017 and May 2020 with a minimum of 6-month follow-up at King Abdulaziz Medical City, Riyadh, Saudi Arabia.</p><p><strong>Results: </strong>A total of 279 kidney recipients included in the study were stratified into 114 in the early stent removal group (ESR) and 165 in the late stent removal group (LSR). Mean age was 43.4 ± 15.8; women: <i>n</i>: 114, 40.90%; and deceased donor transplant: <i>n</i>: 55, 19.70%. Mean stent removal time was 35.3 ± 28.0 days posttransplant (14.1 ± 4.6 days in the ESR versus 49.9 ± 28.1 days in LSR, <i>p</i> < 0.001). Seventy-four UTIs were diagnosed while the stents were in vivo or up to two weeks after the stent removal \"UTIs related to the stent\" (<i>n</i> = 20, 17.5% in ESR versus <i>n</i> = 54, 32.7% in LSR; <i>p</i>=0.006). By six months after transplantation, there were 97 UTIs (<i>n</i> = 36, 31.6% UTIs in ESR versus <i>n</i> = 61, 37% in LSR; <i>p</i>=0.373). Compared with UTIs diagnosed after stent removal, UTIs diagnosed while the stent was still in vivo tended to be complicated (17.9% versus 4.9%, <i>p</i>: 0.019), recurrent (66.1% versus 46.3%; <i>p</i>: 0.063), associated with bacteremia (10.7% versus 0%; <i>p</i>: 0.019), and requiring hospitalization (61% versus 24%, <i>p</i>: 0.024). Early stent removal decreased the need for expedited stent removal due to UTI reasons (rate of UTIs before stent removal) (<i>n</i> = 11, 9% in the early group versus <i>n</i> = 45, 27% in the late group; <i>p</i>=0.001). The effect on the rate of multidrug-resistant organisms (MDRO) was less clear (33% versus 47%, <i>p</i>: 0.205). Early stent removal was associated with a statistically significant reduction in the incidence of UTIs related to the stent (HR = 0.505, 95% CI: 0.302-0.844, <i>p</i>=0.009) without increasing the incidence of urological complications. Removing the stent before 21 days posttransplantation decreased UTIs related to stent (aOR: 0.403, CI: 0.218-0.744). Removing the stent before 14 days may even further decrease the risk of UTIs (aOR: 0.311, CI: 0.035- 2.726).</p><p><strong>Conclusion: </strong>Early ureteric stent removal defined as less than 21 days post renal transplantation reduced the incidence of UTIs related to stent without increasing the incidence of urological complications. UTIs occurring while the ureteric stent still in vivo were notably associated with bacteremia and hospitalization. A randomized trial will be required to further determine the best timing for stent removal.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"3428260"},"PeriodicalIF":2.5,"publicationDate":"2021-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39219637","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 Living-Related Kidney Transplant Program in Brunei Darussalam: Lessons Learnt from a Nascent National Program in a Small, Muslim, and Asian Country.","authors":"Jackson Tan,&nbsp;Muhammad Abdul Mabood Khalil,&nbsp;Dalinatul Ahmed,&nbsp;Jayakrishnan Pisharam,&nbsp;Chiao Yuen Lim,&nbsp;Hock Beng Chua,&nbsp;William Chong,&nbsp;Kim Khee Tan","doi":"10.1155/2021/8828145","DOIUrl":"https://doi.org/10.1155/2021/8828145","url":null,"abstract":"<p><p>Brunei Darussalam commenced its living-related renal transplant program in 2013, with subsequent attainment of independent local capacity and proficiency in 2019. The preliminary outcome from the program has already begun to shape the national nephrology landscape with a 36% increment in transplant rate and mitigation of commercialized transplantations. The blueprint for the program was first laid out in 2010 and thereupon executed in four phases. The first phase involved the gathering of evidence to support the establishment of the national program, through researches investigating feasibility, public opinion, quality of life, graft survival, and cost-effectiveness. The second phase focused on laying the foundation of the program through grooming of local expertise, implementation of legal-ethical frameworks, religious legitimization, and propagation of awareness. The third phase worked on facilitating experiential exposure and strengthening local infrastructure through the upgrading of facilities and the introduction of subsidiary services. The fourth phase was implemented in Brunei in 2013 when foreign personnel worked together with the local team to perform the transplants. Between 2013 and 2019, ten kidney transplants were performed, with two being done in 2018 and three in 2019. We hope to inspire other similar countries to develop their own self-sustainable and independent local program.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"8828145"},"PeriodicalIF":2.5,"publicationDate":"2021-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38895930","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}