Experimental and Clinical Transplantation最新文献

{"title":"Validated Score for Prediction of Neurological Complications After Living Donor Liver Transplant.","authors":"John S Christian, Akila Rajakumar, Amal F Sam, Susan Paulin, Ashwin Rammohan, Mohamed Rela","doi":"10.6002/ect.2025.0062","DOIUrl":"https://doi.org/10.6002/ect.2025.0062","url":null,"abstract":"<p><strong>Objectives: </strong>Neurological complications after liver transplant greatly increase patient mortality and morbidity. Our study aimed to assess the prevalence and risk factors associated with neurological complications after liver transplant and to investigate the possibility of creating a predictive model to identify patients more likely to develop these complications.</p><p><strong>Materials and methods: </strong>After Institutional Ethics Committee approval, researchers prospectively gathered data on patients who received living donor liver transplant at the Dr. Rela Institute and Medical Centre in Chennai, India, from January 2019 to September 2022. We examined perioperative factors to identify risk factors and evaluated outcomes of interventions in cases involving neurological complications.</p><p><strong>Results: </strong>Among 569 liver transplant recipients, 42 (7.4%) developed neurological complications. Complications included altered sensorium, convulsions, localized neurological deficits, posterior reversible encephalopathy syndrome, and intracranial hemorrhage. Using logistic regression analysis, we identified several independent factors that predicted neurological complications afterlivertransplant.These factors (odds ratio; 95% CI) were preoperative Model for End-Stage LiverDisease score (1.76; 95% CI, 1.05-2.93), preexisting hepatic encephalopathy (2.49; 95% CI, 1.16-5.33), requirement for vasopressor support for >24 hour from end of surgery (3.08; 95% CI, 1.25-7.58), postoperative sepsis (3.55; 95% CI, 1.51-8.34), early allograft dysfunction (5.37; 95% CI, 2.23-12.93), and duration of intensive care unit stay >6 days (3.55; 95% CI, 1.63-7.75). Utilizing regression coefficients, we created a risk index, named Neurological Complications Post-Liver Transplant score (NC-PoLT). A score ≥4 predicted neurological complications after liver transplant (area under the receiver operating curve of 0.87).</p><p><strong>Conclusions: </strong>The NC-PoLT scoring index can serve as a tool to identify patients who may be at risk of developing neurological complications after living donor liver transplant. This internally validated metric aids in predicting outcomes and recognizing target groups for preventive strategies. However, an external validation of this score has not yet been conducted.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 5","pages":"362-370"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Outcomes of Neutropenia Following Pediatric Liver Transplant.","authors":"Pamir Işık, Burcu Belen Apak, Lale Olcay, Figen Özçay, Oya Balcı Sezer, Emre Karakaya, Adem Şafak, Ayşe Yavuz Derman, Mehmet Haberal","doi":"10.6002/ect.2024.0266","DOIUrl":"https://doi.org/10.6002/ect.2024.0266","url":null,"abstract":"<p><strong>Objectives: </strong>Solid-organ transplant is an ideal treatment option for patients with end-organ dysfunction, and post-transplant neutropenia in recipients causes higher rates of infection, rejection, and mortality. We aimed to determine the incidence rates, risk factors, and clinical outcomes of neutropenia during the first year after pediatric liver transplant.</p><p><strong>Materials and methods: </strong>We conducted a retrospective evaluation of data from 60 pediatric liver recipients who had developed post-transplant neutropenia within the first year at the Baskent University Ankara Hospital Solid Organ Transplantation Center. Patient data were collected from computer records from September 2013 to September 2023.</p><p><strong>Results: </strong>Mean age of liver recipients (58.3% male) who developed posttransplant neutropenia was 4.82 ± 4.93 years (minimum-maximum, 4.5 months to 17.5 years). Immunity to cytomegalovirus pretransplant was shown by 75% of recipients and 94.5% of donors. During the neutropenia period, 40% of recipients were diagnosed with sepsis as etiology of neutropenia. Other etiologies were 28.33% immunosuppressive drug use, 11.6% cholangitis, 8.3% bacterial pneumonia, and 6.6% cytomegalovirus disease. After the neutropenia period, complications developed: invasive fungal infection in 13.3% of the patients and sepsis in 20%. However, 81.3% of patients recovered completely from neutropenia. Within the first year, acute graft rejection developed in 16.9% of patients and chronic graft rejection in 6.7% of patients; mortality rate due to all causes, including infection, was 11.8%. Hospitalization events were significantly higher in the neutropenic roup than in the control group within the first posttransplant year (P = .003). Mortality rates were higher in the neutropenia group (11.86%) versus the control group (5%), but this difference was not significant (P > .05).</p><p><strong>Conclusions: </strong>This study identified thatinfection, as well as the use of immunosuppressive drugs inherent to the liver transplant process, was the most important etiological factors in the development of posttransplant neutropenia.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 5","pages":"354-361"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking Acute Rejection in Heart Transplant Recipients by Using Donor-Derived Cell-Free DNA: A Promising Approach.","authors":"Yan Qiu, Jianming Xia, Xiaoqi Wang","doi":"10.6002/ect.2024.0300","DOIUrl":"10.6002/ect.2024.0300","url":null,"abstract":"<p><p>Biomarkers play a crucial role in posttransplant monitoring as they enable early detection of graft dysfunction and rejection, thereby facilitating personalized therapeutic interventions. Although recent studies have demonstrated the potential of donor-derived cell-free DNA in monitoring acute rejection episodes in heart transplant recipients, further investigations are required to enhance its diagnostic accuracy and clinical applicability. Comprehensive clinical trials are warranted to establish standardized threshold values and evaluate the diagnostic utility of donor-derived cell-free DNA in identifying various patterns of allograft injury. A thorough investigation into the molecular mechanisms, clinical applications, and quantification methods of donor-derived cell-free DNA could substantially enhance posttransplant management and patient outcomes.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 4","pages":"241-246"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuation of the Transplant Program in Montenegro After 2019: The First Kidney Transplant From a Living Donor in 2025 After 5 Years.","authors":"Damir Pelicic","doi":"10.6002/ect.2025.0057","DOIUrl":"https://doi.org/10.6002/ect.2025.0057","url":null,"abstract":"<p><p></p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 4","pages":"315-316"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oro-Dental Findings in Pediatric Liver and Kidney Transplant Recipients.","authors":"Nur Sena Önder, Simge Polat, Güler Burcu Senirkentli, Resmiye Ebru Tireli, Mehmet Haberal","doi":"10.6002/ect.2025.0015","DOIUrl":"10.6002/ect.2025.0015","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the effects of transplant, as well as the immunosuppressive agents used in liver transplant and kidney transplant recipients, on the incidence of dental caries, tooth and bone anomalies, and dental age.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed the medical records of 175 pediatric patients who underwent liver transplant and kidney transplant at Baskent University between 2011 and 2023. We included 92 patients whose data were available. We examined patient demographic characteristics, their immunosuppressive agents, and their orthopanto-mographies. We calculated patient dental ages with the Demirjian method and determined values for permanent teeth and primary teeth (total number of teeth extracted and filled due to caries, caries). We used the Mann-Whitney U test and X2 test for analysis.</p><p><strong>Results: </strong>Of 92 included patients, 71% underwent liver transplant and 29% underwent kidney transplant. We observed no differences between dental ages for permanent and primary teeth according to transplant type (P > .05). Dental caries were more common in liver transplant recipients (P = .006). No significant relationship was found between dental age and transplanted organ type (P > .05). In terms of odon-togenic and jaw anomalies, more tubercle deformities were observed in kidney transplant recipients (P = .033). Patients with tooth and jaw anomalies used more mycophenolate mofetil daily (P = .008).</p><p><strong>Conclusions: </strong>Dental caries were shown to be more prevalent among patients undergoing long-term immunosuppression, irrespective of the specific immunosuppressive agent or its dosage. Furthermore, the dosage of mycophenolate mofetil appeared to influence the occurrence of dental and jaw anomalies. These findings underscore the necessity for enhanced monitoring of transplant recipients in clinical practice.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 4","pages":"285-291"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Injury From BK Virus After Second Transplant Resulted in Rapid Graft Loss: A Case Report.","authors":"Zipei Wang, Yuanyuan Zhao, Hui Guo, Jipin Jiang, Ping Zhou, Dunfeng Du","doi":"10.6002/ect.2024.0273","DOIUrl":"10.6002/ect.2024.0273","url":null,"abstract":"<p><p>The BK virus has become a substantial threat to transplanted kidneys. Yet, the present understanding of the clinical course and postoperative management of BK virus infections remains inadequate. Here, we report a case of a male transplant recipient with rapid graft loss due to BK virus-associated nephropathy after the second renal transplant, who had previously experienced failure of his first kidney allograft for the same reason. The posttransplant period was uneventful until serum creatinine rose to 2.30 mg/dL on postoperative day 59. Puncture biopsy was postponed because of swelling in the transplanted kidney, and acute rejection was considered as a source of the swelling because the repetitive results of blood BK virus DNA tests were negative. Methylprednisolone 500 mg was administered empirically for 3 days, followed by a 5-day course of anti-thymocyte globulin 100 mg. On postoperative day 83, SV40 T-antigen antibody immunostaining confirmed the diagnosis of BK virus nephropathy. However, it took only 28 days for this patient to progress from abnormal kidney function to the loss of the secondary transplanted kidney, and dialysis was initiated on postoperative day 87. To our knowledge, this is the first report of BK virus resulting in acute failure of a transplanted kidney. An early biopsy is crucial, and a negative test for viremia is not sufficient to exclude the recurrence of BK virus.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 4","pages":"310-314"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Kidney Donor Profile Index and the Kidney Transplant Function in a Serbian Cohort.","authors":"Milica Kravljaca, Marija Milinkovic, Voin Brkovic, Ivona Krivokapic, Ivan Soldatovic, Milan Radovic, Mirjana Lausevic","doi":"10.6002/ect.2025.0028","DOIUrl":"10.6002/ect.2025.0028","url":null,"abstract":"<p><strong>Objectives: </strong>Our objective was to investigate the average Kidney Donor Profile Index in the Serbian kidney donor population and its influence on kidney transplant function.</p><p><strong>Materials and methods: </strong>We conducted a noninterventional retrospective study that included brain dead donors with data between 2010 and 2016. We analyzed the following donor data: sex, age, body mass, body height, race, hypertension and diabetes mellitus, cause of death, terminal creatinine level, hepatitis C positivity, existence of circulatory death before donation, and calculated Kidney Donor Profile Index. We analyzed the following recipient data: sex, age, primary kidney disease, HLA mismatches, cold ischemia time, delayed graft function, acute rejection, surgical complications, and infections after transplant. We used descriptive and analytical statistical methods and used SPSS version 29.0 for all analyses.</p><p><strong>Results: </strong>Our study included 61 organ donors (27 men and 34 women) of mean age 50.93 ± 13.29 years. The average Kidney Donor Profile Index of our donors was 53.98 ± 27.41%. We did not find that Kidney Donor Profile Index influenced the occurrence of delayed graft function. Kidney transplant recipients who received kidneys with Kidney Donor Profile Index ≤20% had significantly lower serum creatinine level and higher creatinine clearance at 1 year and 3 years after kidney transplant and had lower proteinuria at 1 year posttransplant compared with recipients who received kidneys with higher Kidney Donor Profile Index. Multivariate regression analysis showed that Kidney Donor Profile Index ≤20% was a significant independent predictor of transplanted kidney function at 1 and 3 years posttransplant.</p><p><strong>Conclusions: </strong>Kidney Donor Profile Index was significantly associated with allograft function at 1 and 3 years after kidney transplant in our Serbian cohort. Kidney Donor Profile Index ≤20% was shown as an independent predictor of transplanted kidney function.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 4","pages":"252-258"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Cases of Maribavir Treatment of Refractory/Resistant Cytomegalovirus Infection in Solid-Organ Transplant Recipients: Time for a New Paradigm?","authors":"Biagio Pinchera, Rosa Carrano, Giuseppe Gigliotti, Fabrizio Salemi, Alessia D'Agostino, Francesco Vitiello, Amerigo Piccione, Ivan Gentile","doi":"10.6002/ect.2025.0035","DOIUrl":"10.6002/ect.2025.0035","url":null,"abstract":"<p><p>Refractory and resistant cytomegalovirus infections remain significant challenges in solid-organ transplant recipients. In this context, maribavir is a valuable therapeutic option for management of cytomegalovirus infection. Although the clinical efficacy and safety of maribavir are well established, the optimal approach for assessment of viremic response, which is defined as the clearance of viremia, still requires further clarification. Notably, some patients treated with maribavir do not achieve full viremia clearance, despite clinical improvement and a significant reduction in viral load. In this report, we shared our exploration of the potential for a new paradigm for management of the viremic response during maribavir therapy. Our experience suggested that the goal to achieve complete viremia clearance may not always be necessary if clinical resolution and stable viremic responses (ie, viral load <1000 IU/mL) are achieved. In such cases, discontinuation of therapy with close monitoring may be a viable option.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 4","pages":"306-309"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep Anxiety and Influencing Factors in Patients After Kidney Transplant: A Latent Profile Analysis.","authors":"Xiaoting Zheng, Marija Milinkovic, Voin Brkovic, Ivona Krivokapic, Ivan Soldatovic, Milan Radovic, Mirjana Lausevic","doi":"10.6002/ect.2024.0313","DOIUrl":"10.6002/ect.2024.0313","url":null,"abstract":"<p><strong>Objectives: </strong>Our objective was to investigate the average Kidney Donor Profile Index in the Serbian kidney donor population and its influence on kidney transplant function.</p><p><strong>Materials and methods: </strong>We conducted a noninterventional retrospective study that included brain dead donors with data between 2010 and 2016. We analyzed the following donor data: sex, age, body mass, body height, race, hypertension and diabetes mellitus, cause of death, terminal creatinine level, hepatitis C positivity, existence of circulatory death before donation, and calculated Kidney Donor Profile Index. We analyzed the following recipient data: sex, age, primary kidney disease, HLA mismatches, cold ischemia time, delayed graft function, acute rejection, surgical complications, and infections after transplant. We used descriptive and analytical statistical methods and used SPSS version 29.0 for all analyses.</p><p><strong>Results: </strong>Our study included 61 organ donors (27 men and 34 women) of mean age 50.93 ± 13.29 years. The average Kidney Donor Profile Index of our donors was 53.98 ± 27.41%. We did not find that Kidney Donor Profile Index influenced the occurrence of delayed graft function. Kidney transplant recipients who received kidneys with Kidney Donor Profile Index ≤20% had significantly lower serum creatinine level and higher creatinine clearance at 1 year and 3 years after kidney transplant and had lower proteinuria at 1 year posttransplant compared with recipients who received kidneys with higher Kidney Donor Profile Index. Multivariate regression analysis showed that Kidney Donor Profile Index ≤20% was a significant independent predictor of transplanted kidney function at 1 and 3 years posttransplant.</p><p><strong>Conclusions: </strong>Kidney Donor Profile Index was significantly associated with allograft function at 1 and 3 years after kidney transplant in our Serbian cohort. Kidney Donor Profile Index ≤20% was shown as an independent predictor of transplanted kidney function.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 4","pages":"259-268"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Functional Performance and Quality of Life with Pulmonary Rehabilitation in Patients Before Lung Transplant: A Quasi-Experimental Study.","authors":"Rasha Alghofaily, Monira I Aldhahi, Mohammed Takroni, Hana Al Khabbaz, Ehab Abufarhaneh, Rakan Nazer, Dieter Broering, Ali Albarrati","doi":"10.6002/ect.2024.0329","DOIUrl":"10.6002/ect.2024.0329","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence supports the positive effect of pulmonary rehabilitation as a secondary preventive option in patients who have undergone lung transplant. However, evidence of the effects of a pulmonary rehabilitation program on candidates before lung transplant is scarce. In this study, we assessed the effects of pulmonary rehabilitation before lung transplant on exercise capacity, functional mobility, and quality of life in patients with end-stage pulmonary disease.</p><p><strong>Materials and methods: </strong>This was a prospective cohort quasi-experimental study. Patients diagnosed with end-stage pulmonary disease and listed for lung transplant were recruited. All patients received pulmonary rehabilitation for 8 weeks. All patients underwent the 6-minute walk test and the timed up and go test and completed the 8 questions of the SF-36 Short Form Health Survey questionnaire.</p><p><strong>Results: </strong>Sixty-five patients completed the pulmonary rehabilitation program (mean age of 40 ± 13 years). Significant improvements were shown in the distance covered in the 6-minute walk test, which increased by 57 ± 17 m, and the timed up and go test result decreased by 1.58 seconds. The total SF-36 score increased by 17.9%.</p><p><strong>Conclusions: </strong>Pulmonary rehabilitation before lung transplant has a positive effect on the exercise capacity, functional mobility, and quality of life of patients listed for lung transplant.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"23 4","pages":"292-298"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}