Clinical transplantation and research最新文献

{"title":"Impact of liver disease severity on postoperative pain after living donor liver transplantation: a prospective observational study.","authors":"Priyanka Chuttani, Gaurav Sindwani, Viniyendra Pamecha, Nihar Mohapatra, Mahesh Kumar Arora","doi":"10.4285/ctr.24.0054","DOIUrl":"10.4285/ctr.24.0054","url":null,"abstract":"<p><strong>Background: </strong>Managing pain after liver transplantation presents unique challenges. The severity of this pain may correspond to elevated endogenous opioid peptide levels, which in turn depend on the severity of liver disease, as represented by the Model for End-Stage Liver Disease (MELD) score. Hence, this study aimed to assess the difference in fentanyl consumption after liver transplantation between patients with high and low MELD scores.</p><p><strong>Methods: </strong>Patients meeting the inclusion criteria and scheduled for living donor liver transplantation were prospectively recruited. A standard anesthesia protocol was followed for intraoperative management. Postoperatively, intravenous patient-controlled analgesia was initiated. Visual analogue scores, fentanyl consumption, sedation levels, and complications such as pruritus, nausea, and vomiting were recorded.</p><p><strong>Results: </strong>A total of 40 patients were included. The patients were divided into low-MELD (<25) and high-MELD (≥25) groups, with 20 patients in each. Fentanyl consumption was significantly higher in the low-MELD group on both postoperative day (POD) 1 (118.00±11.16 vs. 62.25±11.16 μg, P=0.001) and POD 2 (59.00±7.41 vs. 18.00±7.41 μg, P<0.001). Similarly, pain at rest was significantly higher in the low-MELD group on POD 1 (39.29±1.01 vs. 35.70±1.01, P=0.019) and POD 2 (28.21±1.01 vs. 22.78±1.00, P=0.001).</p><p><strong>Conclusions: </strong>Among patients with chronic liver disease undergoing living donor liver transplantation, postoperative fentanyl consumption and pain scores were significantly lower in those with a high MELD score compared to patients with a low MELD score.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"142-149"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775256","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":"A novel INDEL-based next-generation sequencing assay for monitoring donor-derived cell-free DNA in renal transplant recipients-from bedside to results: a UK pilot study.","authors":"George E Nita, Fotini Partheniou, Dan Ridgway, Sanjay Mehra, Matthew Howse, Abdul Hammad, Andrew R Jones, Petra M Goldsmith","doi":"10.4285/ctr.25.0004","DOIUrl":"10.4285/ctr.25.0004","url":null,"abstract":"<p><strong>Background: </strong>Monitoring donor-derived cell-free DNA (dd-cfDNA) is a promising noninvasive method for assessing allograft health in renal transplant recipients. This UK pilot study evaluated a novel insertion and deletion (INDEL)-based next-generation sequencing (NGS) assay for detecting dd-cfDNA and explored its association with potentially injurious concomitant pathologies, including donor-specific antibodies. Current methods are limited to first and only transplant recipients, as other assays cannot distinguish graft injury in the context of transplantation from multiple donors.</p><p><strong>Methods: </strong>Fourteen high-risk renal transplant recipients (level IV human leukocyte antigen mismatch, calculated reaction frequency >20%, retransplant) were recruited between October 2023 and July 2024 at Liverpool University Hospitals. Plasma samples were collected 6 months posttransplant, and cfDNA was extracted using QIAsymphony DSP Circulating DNA Kit (Qiagen). dd-cfDNA was quantified using the Devyser Accept cfDNA assay (Devyser), and NGS was performed using MiSeq (Illumina).</p><p><strong>Results: </strong>We present preliminary observations from the first 14 patients included in this proof-of-concept arm of the study. A dd-cfDNA level ≤0.5% correlated with stable graft function (n=11). Patients with dd-cfDNA ≥1.0% had supratherapeutic tacrolimus levels (n=2). Intermediate dd-cfDNA levels (0.5%-1.0%) were found in the setting of <i>de novo</i> donor-specific antibody emergence (n=1). We were able to identify informative markers and derive interpretable results in a multitransplant recipient setting.</p><p><strong>Conclusions: </strong>The INDEL-based NGS assay is a promising novel tool for detecting and monitoring dd-cfDNA in renal transplant recipients with an easy-to-implement workflow. These preliminary results support its clinical utility in a high-immunological-risk setting. These findings are consistent with emergent literature; however, longitudinal data and further validation in a larger cohort of patients are required.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"150-160"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056635","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":"Thirty-year survival following living donor liver transplantation: a case report.","authors":"Kyung Mo Kim, Sung-Gyu Lee","doi":"10.4285/ctr.25.0006","DOIUrl":"10.4285/ctr.25.0006","url":null,"abstract":"","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"181-182"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057023","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":"Comparing drug combinations for graft-versus-host disease prophylaxis using the U.S. Food and Drug Administration Adverse Event Reporting System.","authors":"Toru Ogura, Chihiro Shiraishi, Aiko Urawa","doi":"10.4285/ctr.24.0049","DOIUrl":"10.4285/ctr.24.0049","url":null,"abstract":"<p><strong>Background: </strong>Graft-versus-host disease (GVHD) is a severe complication for transplant patients, particularly those undergoing allogeneic hematopoietic stem cell transplantation. Although various GVHD prophylaxis drug combinations are administered in clinical settings, previous studies have primarily focused on monotherapies or limited drug combinations.</p><p><strong>Methods: </strong>We analyzed data from the U.S. Food and Drug Administration Adverse Event Reporting System for patients receiving GVHD prophylaxis drugs between January 2004 and March 2024. Efficacy was evaluated based on the recorded occurrence or nonoccurrence of GVHD following the administration of prophylactic drugs. Drug combinations were compared using the reporting odds ratio (ROR) and adjusted ROR (aROR), which were calculated through univariate and multivariate binomial logistic regression analyses, respectively. The aROR controlled for differences in patient backgrounds.</p><p><strong>Results: </strong>This study identified 10 GVHD prophylaxis drug combinations with aROR values significantly less than 1, indicating high effectiveness, and 13 combinations with aROR values significantly greater than 1, representing low effectiveness.</p><p><strong>Conclusions: </strong>The results demonstrated that certain GVHD prophylaxis drug combinations, particularly those including cyclosporine, may be relatively ineffective. However, avoiding cyclosporine is not always feasible in clinical settings, where treatment plans must be tailored to each patient. To address this issue, the study also identified cyclosporine-containing drug combinations that exhibit high efficacy. These findings could help inform the development of personalized treatment strategies for GVHD prophylaxis and thus improve outcomes in patients undergoing allogeneic hematopoietic stem cell transplantation.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"131-141"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035611","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":"Interventional management of graft hepatic artery dissection in a donor right hepatectomy: a case report.","authors":"Oğuzhan Şal, Cihan Karataş, Altan Alim, Barış Demir, Levent Oğuzkurt, Turan Kanmaz","doi":"10.4285/ctr.24.0052","DOIUrl":"10.4285/ctr.24.0052","url":null,"abstract":"<p><p>Graft hepatic artery dissection (GHAD) is a rare but serious complication in liver transplantation, often leading to graft loss and retransplantation. Treatment typically involves re-establishing arterial flow through primary repair and reanastomosis. We present the case of an 11-year-old female with a history of biliary atresia admitted for decompensation. During back-table preparation following a donor right hepatectomy, GHAD was identified. The dissected segment was excised, but the dissection extended toward the graft. The intima was sutured circumferentially, and anastomosis was completed. Intraoperative ultrasound revealed inadequate arterial flow, prompting perioperative angiography, which identified a narrowed segment at the anastomosis site. An expendable coronary stent was deployed, significantly improving arterial flow. The patient required no further interventions and was discharged on postoperative day 25, with aspirin as the sole antiplatelet agent. This case highlights the effectiveness of stent placement in managing GHAD through an endovascular approach.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"169-173"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627043","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":"Back-to-base normothermic perfusion for livers with severe steatosis: a call for caution.","authors":"Marc Antoine Allard, Nassiba Beghdadi, Olivier Scatton, Mickael Lesurtel, Safi Dokmak, Claire Goumard, René Adam","doi":"10.4285/ctr.25.0005","DOIUrl":"https://doi.org/10.4285/ctr.25.0005","url":null,"abstract":"","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176497","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":"Bowel complications requiring surgical intervention in kidney transplant recipients: clinical characteristics and risk factors.","authors":"Jin-Myung Kim, Tuan Thanh Nguyen, Hye Eun Kwon, Youngmin Ko, Joo Hee Jung, Hyunwook Kwon, Young Hoon Kim, Sung Shin","doi":"10.4285/ctr.24.0071","DOIUrl":"https://doi.org/10.4285/ctr.24.0071","url":null,"abstract":"<p><strong>Background: </strong>Bowel complications following kidney transplantation (KT) are rare but life-threatening, often necessitating bowel resection. These complications are associated with immunosuppressive therapy, comorbidities, and viral infections. This study aimed to analyze the characteristics and risk factors of patients who underwent bowel resection after KT.</p><p><strong>Methods: </strong>A retrospective review was conducted of 31 KT recipients who underwent bowel resection between 1990 and 2020 at a single center. Patient data, including demographics, comorbidities, transplant-related factors, cytomegalovirus (CMV)/Epstein-Barr virus (EBV) infections, and surgical outcomes, were analyzed.</p><p><strong>Results: </strong>Bowel resection was necessary in under 0.5% of KT recipients, primarily for perforation (48.4%), ischemia, posttransplant lymphoproliferative disorder, and obstruction. Bowel inflammation was the most common cause of perforation, followed by fungal infection (e.g., aspergillosis, mucormycosis) and Kayexalate ileitis. The mean patient age was 53.6±14.2 years, and 54.8% were male. Notable characteristics of those undergoing bowel resection included ABO incompatibility (25.8%), cardiac comorbidities (29.0%), diabetes mellitus (41.9%), and history of retransplantation (19.4%). Bowel resection was performed at an average of 54.3 months post-KT (standard deviation, 77.2 months). All patients were CMV immunoglobulin G (IgG) positive and 91.3% were EBV IgG positive, indicating prior viral infections.</p><p><strong>Conclusions: </strong>Although infrequent, bowel complications represent a serious concern for KT recipients. Identifying contributing factors-including viral infections, comorbidities, and immunosuppressive therapies-could aid in recognizing patients at high risk. Implementing preventive strategies and closely monitoring KT recipients may help reduce the incidence of these complications and improve posttransplant outcomes.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083145","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":"Early ureteral stent removal reduces urinary tract infection risk without increasing complications in living donor kidney transplantation: a systematic review and meta-analysis.","authors":"Muhammad Halim Hanindya Kusuma, Tanaya Ghinorawa, Indrawarman Soero Hardjo","doi":"10.4285/ctr.24.0069","DOIUrl":"https://doi.org/10.4285/ctr.24.0069","url":null,"abstract":"<p><strong>Background: </strong>Ureteral stenting is commonly performed after ureteral neoimplantation during kidney transplantation to reduce major urological complications (MUCs). However, the optimal duration of ureteral stent removal remains unclear, as longer stenting is associated with increased risk of urinary tract infection (UTI). This study compared UTI and MUC incidence between early (≤3 weeks) and late (>3 weeks) stent removal following living donor kidney transplantation (LDKT).</p><p><strong>Methods: </strong>We systematically searched the PubMed/MEDLINE, Science Direct, Cochrane, and EMBASE databases through January 2024 for randomized and observational studies comparing early (≤3 weeks) and late (>3 weeks) ureteral stent removal in LDKT recipients. The following Medical Subject Headings were used for the search: \"kidney transplantation,\" \"renal transplantation,\" and \"ureteral stent\" or \"stent\". Stenting duration, UTI incidence, and MUCs (obstruction and urinary leakage) were recorded, and a meta-analysis was performed to pool odds ratios (ORs).</p><p><strong>Results: </strong>Eight studies (five randomized controlled trials and three cohort studies) comprising 2,148 LDKT recipients were included. Early removal significantly reduced the incidence of UTIs compared with late removal (OR, 0.53; 95% confidence interval [CI], 0.32-0.87). Six studies assessed MUC incidence, revealing no significant difference between early and late removal (OR, 0.69; 95% CI, 0.28-1.65). Subgroup analysis demonstrated that early stent removal does not increase the risk of obstruction (OR, 0.76; 95% CI, 0.22-2.66) or urinary leakage (OR, 0.62; 95% CI, 0.18-2.14) compared with late removal.</p><p><strong>Conclusions: </strong>Performing ureteral stent removal less than 3 weeks after LDKT reduces UTI risk without increasing MUCs relative to later removal.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056978","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":"Kaposi sarcoma of a liver graft in living donor liver transplantation: a rare case report.","authors":"Umid Salimov, Palat Balachandran, Konstantin Semash","doi":"10.4285/ctr.24.0030","DOIUrl":"10.4285/ctr.24.0030","url":null,"abstract":"<p><p>Kaposi sarcoma following solid organ transplantation is a rare and underreported complication, with few cases documented globally concerning its origin from liver grafts. This case report describes an Asian woman who developed Kaposi sarcoma in a liver graft following living donor liver transplantation for end-stage liver disease resulting from hepatitis D virus. In accordance with current guidelines, standard immunosuppression was discontinued, and mammalian target of rapamycin (mTOR) inhibitors were initiated. The use of mTOR inhibitors led to the complete resolution of the liver graft lesions within 9 months. However, subsequent follow-up revealed several complications, including late anastomotic biliary stricture, extensively drug-resistant <i>Klebsiella pneumoniae</i> infection, and subtotal hydrothorax. These complications required intensive care unit admission, biliary stenting, oxygen therapy, and pleural drainage. Despite the severity of her condition, the patient fully recovered and showed no signs of recurrence throughout the 64-month follow-up period. To our knowledge, this is the first reported case of Kaposi sarcoma in a liver graft with such an extended follow-up.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"77-83"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191677","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 neutrophil-to-lymphocyte ratio for acute allograft rejection and delayed graft function prediction in kidney transplant recipients: a meta-analysis.","authors":"Ryuu Damara Parisudha, Tanaya Ghinorawa, Indrawarman Soero Hardjo","doi":"10.4285/ctr.24.0041","DOIUrl":"10.4285/ctr.24.0041","url":null,"abstract":"<p><strong>Background: </strong>The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been the focus of several observational studies investigating their roles in acute allograft rejection (AR) and delayed graft function (DGF) among kidney transplant (KT) recipients. This meta-analysis evaluated the impact of the NLR and PLR on the incidence of AR and DGF in KT recipients.</p><p><strong>Methods: </strong>We searched PubMed, MEDLINE and Science Direct from their inception through October 2023. Random effects models were used. To investigate potential sources of heterogeneity, we performed subgroup and meta-regression analyses. The Comprehensive Meta-Analysis ver. 3 software package was used.</p><p><strong>Results: </strong>Seven studies (247 KT recipients with AR or DGF and 475 controls) were analyzed. Our pooled analysis showed a significantly higher NLR in KT recipients with AR (weighted mean difference [WMD], 2.292; 95% confidence interval [CI], 1.449-3.135; P<0.001) than in controls. The preoperative NLR was insignificantly higher in patients with DGF (WMD, 0.871; 95% CI, -0.103 to 1.846; P=0.08). The PLR was insignificantly higher in KT recipients with AR than in controls (WMD, 32.125; 95% CI, -19.978 to 84.228; P=0.227). The PLR was not significantly different between KT recipients with DGF and controls. Region, publication year, sample size, donor type, biopsy type, AR type and Newcastle-Ottawa Scale score did not affect the outcomes of the meta-analysis. Meta-regression showed that publication year and donor type might be sources of heterogeneity.</p><p><strong>Conclusions: </strong>This study revealed a significantly higher NLR in patients with AR. This suggests that NLR may be utilized as a noninvasive marker for AR in KT recipients.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"36-45"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191678","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}