Transplant International最新文献_第3页

European Society for Organ Transplantation (ESOT) Consensus Statement on the Use of Non-invasive Biomarkers for Cardiothoracic Transplant Rejection Surveillance 欧洲器官移植学会 (ESOT) 关于使用非侵入性生物标志物监测心胸移植排斥反应的共识声明

Transplant International Pub Date : 2024-06-11 DOI: 10.3389/ti.2024.12445

Andriana Nikolova, Sean Agbor-Enoh, S. Bos, Marisa Crespo-Leiro, Stephan Ensminger, Marta Jimenez-Blanco, Annamaria Minervini, Michael Perch, Javier Segovia, Robin Vos, Kiran Khush, Luciano Potena

{"title":"European Society for Organ Transplantation (ESOT) Consensus Statement on the Use of Non-invasive Biomarkers for Cardiothoracic Transplant Rejection Surveillance","authors":"Andriana Nikolova, Sean Agbor-Enoh, S. Bos, Marisa Crespo-Leiro, Stephan Ensminger, Marta Jimenez-Blanco, Annamaria Minervini, Michael Perch, Javier Segovia, Robin Vos, Kiran Khush, Luciano Potena","doi":"10.3389/ti.2024.12445","DOIUrl":"https://doi.org/10.3389/ti.2024.12445","url":null,"abstract":"While allograft rejection (AR) continues to threaten the success of cardiothoracic transplantation, lack of accurate and repeatable surveillance tools to diagnose AR is a major unmet need in the clinical management of cardiothoracic transplant recipients. Endomyocardial biopsy (EMB) and transbronchial biopsy (TBBx) have been the cornerstone of rejection monitoring since the field’s incipience, but both suffer from significant limitations, including poor concordance of biopsy interpretation among pathologists. In recent years, novel molecular tools for AR monitoring have emerged and their performance characteristics have been evaluated in multiple studies. An international working group convened by ESOT has reviewed the existing literature and provides a series of recommendations to guide the use of these biomarkers in clinical practice. While acknowledging some caveats, the group recognized that Gene-expression profiling and donor-derived cell-free DNA (dd-cfDNA) may be used to rule out rejection in heart transplant recipients, but they are not recommended for cardiac allograft vasculopathy screening. Other traditional biomarkers (NT-proBNP, BNP or troponin) do not have sufficient evidence to support their use to diagnose AR. Regarding lung transplant, dd-cfDNA could be used to rule out clinical rejection and infection, but its use to monitor treatment response is not recommended.","PeriodicalId":506324,"journal":{"name":"Transplant International","volume":"25 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141357575","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}

引用次数: 0

Ten Years of Quality Monitoring of Abdominal Organ Procurement in the Netherlands and Its Impact on Transplant Outcome 荷兰腹部器官采购质量监测十年及其对移植结果的影响

Transplant International Pub Date : 2024-06-11 DOI: 10.3389/ti.2024.12989

K. A. Chotkan, I. Alwayn, A. Hemke, A. Baranski, W. Nijboer, R. A. Pol, A. Braat

{"title":"Ten Years of Quality Monitoring of Abdominal Organ Procurement in the Netherlands and Its Impact on Transplant Outcome","authors":"K. A. Chotkan, I. Alwayn, A. Hemke, A. Baranski, W. Nijboer, R. A. Pol, A. Braat","doi":"10.3389/ti.2024.12989","DOIUrl":"https://doi.org/10.3389/ti.2024.12989","url":null,"abstract":"In this study, 10 years of procurement quality monitoring data were analyzed to identify potential risk factors associated with procurement-related injury and their association with long-term graft survival. All deceased kidney, liver, and pancreas donors from 2012 to 2022 and their corresponding recipients in the Netherlands were retrospectively included. The incidence of procurement-related injuries and potential risk factors were analyzed. Of all abdominal organs procured, 23% exhibited procurement-related injuries, with a discard rate of 4.0%. In kidneys and livers, 23% of the grafts had procurement-related injury, with 2.5% and 4% of organs with procurement-related injury being discarded, respectively. In pancreas procurement, this was 27%, with a discard rate of 24%. Male donor gender and donor BMI >25 were significant risk factors for procurement-related injury in all three abdominal organs, whereas aberrant vascularization was significant only for the kidney and liver. In the multivariable Cox regression analyses, procurement-related injury was not a significant predictor for graft failure (kidney; HR 0.99, 95% CI 0.75–1.33, p = 0.99, liver; HR 0.92, 95% CI 0.66–1.28, p = 0.61, pancreas: HR 1.16; 95% CI 0.16–8.68, p = 0.88). The findings of this study suggest that transplant surgeons exhibited good decision-making skills in determining the acceptability and repairability of procurement-related injuries.","PeriodicalId":506324,"journal":{"name":"Transplant International","volume":"54 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141358359","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}

引用次数: 0

SGLT2 Inhibitors Correct Fluid Overload in Adult Kidney Transplant Recipients—A Prospective Observational Study SGLT2 抑制剂可纠正成人肾移植受者的体液超负荷--一项前瞻性观察研究

Transplant International Pub Date : 2024-06-10 DOI: 10.3389/ti.2024.12879

Anja Schork, Marie-Luise Eberbach, Ferruh Artunc, Bernhard N. Bohnert, Felix Eisinger, David J. Heister, Dorothea Vosseler, Silvio Nadalin, A. Birkenfeld, Nils Heyne, Martina Guthoff

{"title":"SGLT2 Inhibitors Correct Fluid Overload in Adult Kidney Transplant Recipients—A Prospective Observational Study","authors":"Anja Schork, Marie-Luise Eberbach, Ferruh Artunc, Bernhard N. Bohnert, Felix Eisinger, David J. Heister, Dorothea Vosseler, Silvio Nadalin, A. Birkenfeld, Nils Heyne, Martina Guthoff","doi":"10.3389/ti.2024.12879","DOIUrl":"https://doi.org/10.3389/ti.2024.12879","url":null,"abstract":"In this longitudinal observational study, we measured urinary glucose concentration, body composition and volume status (bioimpedance spectroscopy) and plasma renin and aldosterone concentrations in n = 22 kidney transplant recipients (KTRs) initiating on SGLT2I at baseline (BL), and after 1 week and 1, 3, and 6 months. Estimated glomerular filtration rate (eGFR) decreased by −2 mL/min/1.73 m2 (IQR −10–0) after 1 week and remained stable thereafter. Urinary glucose concentration was 10 (3–24) g/g creatinine after 1 week and correlated with eGFR (r2 = 0.273; p = 0.057). SGLT2I did not affect HbA1c, fasting blood glucose, body weight, fat or lean mass. SGLT2I decreased fluid overload dependent on baseline overhydration (OH, r2 = 0.54, p = 0.0003) without occurrence of dehydration. Plasma aldosterone increased at day 7, while plasma renin did not change significantly. In conclusion, SGLT2I corrected fluid overload in patients with elevated overhydration at baseline, while in euvolemic KTRs fluid status remained stable without reduction of body water below the reference range, thus promoting the safety of SGLT2I therapy in patients following kidney transplantation. Glucosuria, together with effects of SGLT2I on blood glucose control and body weight, is attenuated in KTRs dependent on eGFR.","PeriodicalId":506324,"journal":{"name":"Transplant International","volume":" November","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364400","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}

引用次数: 0

HOPE Mitigates Ischemia-Reperfusion Injury in Ex-Situ Split Grafts: A Comparative Study With Living Donation in Pediatric Liver Transplantation HOPE 可减轻原位分割移植物的缺血再灌注损伤：小儿肝移植中活体捐献的比较研究

Transplant International Pub Date : 2024-06-07 DOI: 10.3389/ti.2024.12686

G. Rossignol, Xavier Muller, M. Ruiz, S. Collardeau-Frachon, Natacha Boulanger, C. Depaulis, Térésa Antonini, R. Dubois, K. Mohkam, J. Mabrut

{"title":"HOPE Mitigates Ischemia-Reperfusion Injury in Ex-Situ Split Grafts: A Comparative Study With Living Donation in Pediatric Liver Transplantation","authors":"G. Rossignol, Xavier Muller, M. Ruiz, S. Collardeau-Frachon, Natacha Boulanger, C. Depaulis, Térésa Antonini, R. Dubois, K. Mohkam, J. Mabrut","doi":"10.3389/ti.2024.12686","DOIUrl":"https://doi.org/10.3389/ti.2024.12686","url":null,"abstract":"Optimizing graft preservation is key for ex-situ split grafts in pediatric liver transplantation (PSLT). Hypothermic Oxygenated Perfusion (HOPE) improves ischemia-reperfusion injury (IRI) and post-operative outcomes in adult LT. This study compares the use of HOPE in ex-situ partial grafts to static cold storage ex-situ partial grafts (SCS-Split) and to the gold standard living donor liver transplantation (LDLT). All consecutive HOPE-Split, SCS-Split and LDLT performed between 2018–2023 for pediatric recipients were included. Post‐reperfusion syndrome (PRS, drop ≥30% in systolic arterial pressure) and reperfusion biopsies served as early indicators of IRI. We included 47 pediatric recipients (15 HOPE-Split, 17 SCS-Split, and 15 LDLT). In comparison to SCS-Split, HOPE-Split had a significantly shorter cold ischemia time (CIT) (470min vs. 538 min; p =0.02), lower PRS rates (13.3% vs. 47.1%; p = 0.04) and a lower IRI score (3 vs. 4; p = 0.03). The overall IRI score (3 vs. 3; p = 0.28) and PRS (13.3% vs. 13.3%; p = 1) after HOPE-Split were comparable to LDLT, despite a longer CIT (470 min vs. 117 min; p < 0.001). Surgical complications, one-year graft, and recipient survival did not differ among the groups. In conclusion, HOPE-Split mitigates early IRI in pediatric recipients in comparison to SCS-Split, approaching the gold standard of LDLT.","PeriodicalId":506324,"journal":{"name":"Transplant International","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141371315","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}

引用次数: 0

Prevalence of Musculoskeletal and Metabolic Disorders in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis 肾移植受者肌肉骨骼和代谢紊乱的患病率：系统回顾与元分析

Transplant International Pub Date : 2024-04-24 DOI: 10.3389/ti.2024.12312

Álvaro Herreros-Carretero, Carlos Berlanga-Macías, V. Martínez-Vizcaíno, A. Torres-Costoso, C. Pascual-Morena, L. E. Hernández-Castillejo, I. Sequí-Domínguez, Miriam Garrido-Miguel

{"title":"Prevalence of Musculoskeletal and Metabolic Disorders in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis","authors":"Álvaro Herreros-Carretero, Carlos Berlanga-Macías, V. Martínez-Vizcaíno, A. Torres-Costoso, C. Pascual-Morena, L. E. Hernández-Castillejo, I. Sequí-Domínguez, Miriam Garrido-Miguel","doi":"10.3389/ti.2024.12312","DOIUrl":"https://doi.org/10.3389/ti.2024.12312","url":null,"abstract":"Musculoskeletal disorders could be associated with metabolic disorders that are common after kidney transplantation, which could reduce the quality of life of patients. The aim of this study was to assess the prevalence of both musculoskeletal and metabolic disorders in kidney transplant patients.MEDLINE, CINAHL, Cochrane Library, EMBASE and Web of Science were searched from their inception up to June 2023. DerSimonian and Laird random-effects method was used to calculate pooled prevalence estimates and their 95% confidence intervals (CIs).21,879 kidney transplant recipients from 38 studies were analysed. The overall proportion of kidney transplant patients with musculoskeletal disorders was 27.2% (95% CI: 18.4–36.0), with low muscle strength (64.5%; 95% CI: 43.1–81.3) being the most common disorder. Otherwise, the overall proportion of kidney transplant patients with metabolic disorders was 37.6% (95% CI: 21.9–53.2), with hypovitaminosis D (81.8%; 95% CI: 67.2–90.8) being the most prevalent disorder.The most common musculoskeletal disorders were low muscle strength, femoral osteopenia, and low muscle mass. Hypovitaminosis D, hyperparathyroidism, and hyperuricemia were also the most common metabolic disorders. These disorders could be associated with poorer quality of life in kidney transplant recipients.https://www.crd.york.ac.uk/prospero/, identifier [CRD42023449171].","PeriodicalId":506324,"journal":{"name":"Transplant International","volume":"52 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140664430","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}

引用次数: 0

How to Treat T Cell Mediated Rejection? -A Call for Action 如何治疗 T 细胞介导的排斥反应？-行动呼吁

Transplant International Pub Date : 2024-04-18 DOI: 10.3389/ti.2024.12621

Klemens Budde

引用次数: 0

Interactions of the Immune System with Human Kidney Organoids 免疫系统与人体肾脏器官组织的相互作用

Transplant International Pub Date : 2024-04-18 DOI: 10.3389/ti.2024.12468

Anusha S Shankar, H. Tejeda-Mora, Z. Du, Q. Nlandu, Virginia Palomares-Cabeza, T. P. P. van den Bosch, S. Korevaar, Fabiany da Costa Gonçalves, E. M. Bindels, R. Kramann, M. Reinders, M. C. Clahsen‐van Groningen, E. Hoorn, J. Gribnau, Carla C. Baan, M. Hoogduijn

{"title":"Interactions of the Immune System with Human Kidney Organoids","authors":"Anusha S Shankar, H. Tejeda-Mora, Z. Du, Q. Nlandu, Virginia Palomares-Cabeza, T. P. P. van den Bosch, S. Korevaar, Fabiany da Costa Gonçalves, E. M. Bindels, R. Kramann, M. Reinders, M. C. Clahsen‐van Groningen, E. Hoorn, J. Gribnau, Carla C. Baan, M. Hoogduijn","doi":"10.3389/ti.2024.12468","DOIUrl":"https://doi.org/10.3389/ti.2024.12468","url":null,"abstract":"Kidney organoids are an innovative tool in transplantation research. The aim of the present study was to investigate whether kidney organoids are susceptible for allo-immune attack and whether they can be used as a model to study allo-immunity in kidney transplantation. Human induced pluripotent stem cell-derived kidney organoids were co-cultured with human peripheral blood mononuclear cells (PBMC), which resulted in invasion of allogeneic T-cells around nephron structures and macrophages in the stromal cell compartment of the organoids. This process was associated with the induction of fibrosis. Subcutaneous implantation of kidney organoids in immune-deficient mice followed by adoptive transfer of human PBMC led to the invasion of diverse T-cell subsets. Single cell transcriptomic analysis revealed that stromal cells in the organoids upregulated expression of immune response genes upon immune cell invasion. Moreover, immune regulatory PD-L1 protein was elevated in epithelial cells while genes related to nephron differentiation and function were downregulated. This study characterized the interaction between immune cells and kidney organoids, which will advance the use of kidney organoids for transplantation research.","PeriodicalId":506324,"journal":{"name":"Transplant International","volume":" 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140688273","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}

引用次数: 0

European Survey on Clinical Practice of Detecting and Treating T-Cell Mediated Kidney Transplant Rejection 关于检测和治疗 T 细胞介导的肾移植排斥反应临床实践的欧洲调查

Transplant International Pub Date : 2024-04-18 DOI: 10.3389/ti.2024.12283

Priyanka Koshy, L. Furian, Peter Nickerson, G. Zaza, Maria C Haller, Aiko P. J. de Vries, Martin Naesens

{"title":"European Survey on Clinical Practice of Detecting and Treating T-Cell Mediated Kidney Transplant Rejection","authors":"Priyanka Koshy, L. Furian, Peter Nickerson, G. Zaza, Maria C Haller, Aiko P. J. de Vries, Martin Naesens","doi":"10.3389/ti.2024.12283","DOIUrl":"https://doi.org/10.3389/ti.2024.12283","url":null,"abstract":"The KDIGO guideline for acute rejection treatment recommends use of corticosteroids and suggests using lymphocyte-depleting agents as second line treatment. Aim of the study was to determine the current practices of detection and treatment of TCMR of kidney allografts amongst European kidney transplant centres. An invitation was sent through ESOT/EKITA newsletters and through social media to transplant professionals in Europe for taking part in the survey. A total of 129 transplant professionals responded to the survey. There was equal representation of small and large sized transplant centres. The majority of centres treat borderline changes (BL) and TCMR (Grade IA-B, IIA-B) in indication biopsies and protocol biopsies with corticosteroids as first line treatment. Thymoglobulin is used mainly as second line treatment for TCMR Grade IA-B (80%) and TCMR IIA-B (85%). Treatment success is most often evaluated within one month of therapy. There were no differences observed between the large and small centres for the management of TCMR. This survey highlights the common practices and diversity in clinics for the management of TCMR in Europe. Testing new therapies for TCMR should be in comparison to the current standard of care in Europe. Better consensus on treatment success is crucial for robust study designs.","PeriodicalId":506324,"journal":{"name":"Transplant International","volume":" 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140687553","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}

引用次数: 1

Controlled Hypothermic Storage for Lung Preservation: Leaving the Ice Age Behind 用于肺部保存的受控低温储存：告别冰河时代

Transplant International Pub Date : 2024-04-17 DOI: 10.3389/ti.2024.12601

I. Cenik, J. Van Slambrouck, An-Lies Provoost, Annalisa Barbarossa, C. Vanluyten, Caroline Boelhouwer, B. Vanaudenaerde, R. Vos, Jacques Pirenne, Dirk E. Van Raemdonck, L. Ceulemans

{"title":"Controlled Hypothermic Storage for Lung Preservation: Leaving the Ice Age Behind","authors":"I. Cenik, J. Van Slambrouck, An-Lies Provoost, Annalisa Barbarossa, C. Vanluyten, Caroline Boelhouwer, B. Vanaudenaerde, R. Vos, Jacques Pirenne, Dirk E. Van Raemdonck, L. Ceulemans","doi":"10.3389/ti.2024.12601","DOIUrl":"https://doi.org/10.3389/ti.2024.12601","url":null,"abstract":"Controlled hypothermic storage (CHS) is a recent advance in lung transplantation (LTx) allowing preservation at temperatures higher than those achieved with traditional ice storage. The mechanisms explaining the benefits of CHS compared to conventional static ice storage (SIS) remain unclear and clinical data on safety and feasibility of lung CHS are limited. Therefore, we aimed to provide a focus review on animal experiments, molecular mechanisms, CHS devices, current clinical experience, and potential future benefits of CHS. Rabbit, canine and porcine experiments showed superior lung physiology after prolonged storage at 10°C vs. ≤4°C. In recent molecular analyses of lung CHS, better protection of mitochondrial health and higher levels of antioxidative metabolites were observed. The acquired insights into the underlying mechanisms and development of CHS devices allowed clinical application and research using CHS for lung preservation. The initial findings are promising; however, further data collection and analysis are required to draw more robust conclusions. Extended lung preservation with CHS may provide benefits to both recipients and healthcare personnel. Reduced time pressure between procurement and transplantation introduces flexibility allowing better decision-making and overnight bridging by delaying transplantation to daytime without compromising outcome.","PeriodicalId":506324,"journal":{"name":"Transplant International","volume":"20 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692982","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}

引用次数: 0

Tacrolimus’s Time Below Therapeutic Range Is Associated With Acute Pancreatic Graft Rejection and the Development of De Novo Donor-specific Antibodies 他克莫司低于治疗范围的时间与急性胰腺移植物排斥反应和新的捐献者特异性抗体的产生有关

Transplant International Pub Date : 2024-04-17 DOI: 10.3389/ti.2024.12591

D. Rodríguez-Espinosa, J. Broseta, Enrique Montagud-Marrahi, Carolt Arana, Joana Ferrer, Miriam Cuatrecasas, Ángeles García-Criado, A. Amor, Fritz Diekmann, P. Ventura-Aguiar

{"title":"Tacrolimus’s Time Below Therapeutic Range Is Associated With Acute Pancreatic Graft Rejection and the Development of De Novo Donor-specific Antibodies","authors":"D. Rodríguez-Espinosa, J. Broseta, Enrique Montagud-Marrahi, Carolt Arana, Joana Ferrer, Miriam Cuatrecasas, Ángeles García-Criado, A. Amor, Fritz Diekmann, P. Ventura-Aguiar","doi":"10.3389/ti.2024.12591","DOIUrl":"https://doi.org/10.3389/ti.2024.12591","url":null,"abstract":"Tacrolimus is pivotal in pancreas transplants but poses challenges in maintaining optimal levels due to recipient differences. This study aimed to explore the utility of time spent below the therapeutic range and intrapatient variability in predicting rejection and de novo donor-specific antibody (dnDSA) development in pancreas graft recipients. This retrospective unicentric study included adult pancreas transplant recipients between January 2006 and July 2020. Recorded variables included demographics, immunosuppression details, HLA matching, biopsy results, dnDSA development, and clinical parameters. Statistical analysis included ROC curves, sensitivity, specificity, and predictive values. A total of 131 patients were included. Those with biopsy-proven acute rejection (BPAR, 12.2%) had more time (39.9% ± 24% vs. 25.72% ± 21.57%, p = 0.016) and tests (41.95% ± 13.57% vs. 29.96% ± 17.33%, p = 0.009) below therapeutic range. Specific cutoffs of 31.5% for time and 34% for tests below the therapeutic range showed a high negative predictive value for BPAR (93.98% and 93.1%, respectively). Similarly, patients with more than 34% of tests below the therapeutic range were associated with dnDSA appearance (38.9% vs. 9.4%, p = 0.012; OR 6.135, 1.346–27.78). In pancreas transplantation, maintaining optimal tacrolimus levels is crucial. Suboptimal test percentages below the therapeutic range prove valuable in identifying acute graft rejection risk.","PeriodicalId":506324,"journal":{"name":"Transplant International","volume":"68 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693973","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}

引用次数: 0