Frontiers in transplantation最新文献

{"title":"Mitigating the risk of inflammatory type primary graft dysfunction by applying an integrated approach to assess, modify and match risk factors in lung transplantation.","authors":"Sue A Braithwaite, Elize M Berg, Linda M de Heer, Jitte Jennekens, Arne Neyrinck, Elise van Hooijdonk, Bart Luijk, Wolfgang F F A Buhre, Niels P van der Kaaij","doi":"10.3389/frtra.2024.1422088","DOIUrl":"10.3389/frtra.2024.1422088","url":null,"abstract":"<p><p>Long-term outcome following lung transplantation remains one of the poorest of all solid organ transplants with a 1- and 5-year survival of 85% and 59% respectively for adult lung transplant recipients and with 50% of patients developing chronic lung allograft dysfunction (CLAD) in the first 5 years following transplant. Reducing the risk of inflammatory type primary graft dysfunction (PGD) is vital for improving both short-term survival following lung transplantation and long-term outcome due to the association of early inflammatory-mediated damage to the allograft and the risk of CLAD. PGD has a multifactorial aetiology and high-grade inflammatory-type PGD is the result of cumulative insults that may be incurred in one or more of the three variables of the transplantation continuum: the donor lungs, the recipient and intraoperative process. We set out a conceptual framework which uses a fully integrated approach to this transplant continuum to attempt to identify and, where possible, modify specific donor, recipient and intraoperative PGD risk with the goal of reducing inflammatory-type PGD risk for an individual recipient. We also consider the concept and risk-benefit of matching lung allografts and recipients on the basis of donor and recipient PGD-risk compatibility. The use of ex vivo lung perfusion (EVLP) and the extended preservation of lung allografts on EVLP will be explored as safe, non-injurious EVLP may enable extensive inflammatory testing of specific donor lungs and has the potential to provide a platform for targeted therapeutic interventions on lung allografts.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142128147","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":"Predictors for postoperative dysphagia in liver transplant recipients.","authors":"Marian Isdahl, Lily Katz, Michaela Johnson, Glen Leverson, David Al-Adra, Susan Thibeault","doi":"10.3389/frtra.2024.1415141","DOIUrl":"10.3389/frtra.2024.1415141","url":null,"abstract":"<p><strong>Introduction: </strong>Liver transplant recipients are at a heightened risk for oropharyngeal dysphagia; identification of those who are at high risk for postoperative dysphagia could reduce hospital costs and length of stay. We sought to identify predictors of dysphagia, in a large cohort of patients who underwent liver transplantation.</p><p><strong>Methods: </strong>Electronic medical records were queried for patients undergoing liver transplantation, who underwent instrumental swallowing evaluations. Demographics, functional outcomes, and interventions were collected. Logistic regression analyses were performed to identify predictors of dysphagia.</p><p><strong>Results: </strong>Seven hundred and ninety-five patients met inclusionary criteria. Multivariate analyses found ethnic group (<i>p</i> = .0191), MELD Score (<i>p</i> < 0001), cold ischemia time (<i>p</i> = .0123), and length of intubation (<i>p</i> < .0001) to be predictors of post-operative development of dysphagia. Pre-transplant dialysis (<i>p</i> < .0001), dysphagia related to end stage liver disease (<i>p</i> < .0001), Karnofsky Performance Status Scale (<i>p</i> < .0001), wait time to transplant (<i>p</i> = 0.0173), surgery time (<i>p</i> = 0.0095), tracheostomy (<i>p</i> < 0.0001), and transfusion of intraoperative RBC (<i>p</i> < .0001), intraoperative platelets (<i>p</i> = 0.0018), intraoperative FFP (<i>p</i> = 0.0495), perioperative FFP (<i>p</i> = 0.0002), perioperative platelets (<i>p</i> = 0.0151) and perioperative RBC (<i>p</i> = 0.0002) were variables of significance associated with the development of postoperative dysphagia from univariate analysis.</p><p><strong>Conclusions: </strong>Our results propose a set of predictors that should be considered when identifying post-operative critically ill patients at risk for dysphagia.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116900","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":"An analysis of the UK national pancreas allocation scheme.","authors":"Jeevan Prakash Gopal, Sean P Gavan, Kerry Burke, Stephen Birch, Titus Augustine","doi":"10.3389/frtra.2024.1408838","DOIUrl":"https://doi.org/10.3389/frtra.2024.1408838","url":null,"abstract":"","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116899","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":"Changing landscape of liver transplant in the United States-<i>time for a new innovative way to define and utilize the \"non-standard liver allograft\"-a proposal</i>.","authors":"Rashmi Seth, Kenneth A Andreoni","doi":"10.3389/frtra.2024.1449407","DOIUrl":"10.3389/frtra.2024.1449407","url":null,"abstract":"<p><p>Since the first liver transplant was performed over six decades ago, the landscape of liver transplantation in the US has seen dramatic evolution. Numerous advancements in perioperative and operative techniques have resulted in major improvements in graft and patient survival rates. Despite the increase in transplants performed over the years, the waitlist mortality rate continues to remain high. The obesity epidemic and the resultant metabolic sequelae continue to result in more marginal donors and challenging recipients. In this review, we aim to highlight the changing characteristics of liver transplant recipients and liver allograft donors. We focus on issues relevant in successfully transplanting a high model for end stage liver disease recipient. We provide insights into the current use of terms and definitions utilized to discuss marginal allografts, discuss the need to look into more consistent ways to describe these organs and propose two new concepts we coin as \"Liver Allograft Variables\" (LAV) and \"Liver Allograft Composite Score\" (LACS) for this. We discuss the development of spectrum of risk indexes as a dynamic tool to characterize an allograft in real time. We believe that this concept has the potential to optimize the way we allocate, utilize and transplant livers across the US.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11338891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038651","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":"Experience of a novel lung transplant program in Mexico","authors":"Mariana N. Zavala-Gómez, Patricia Rodríguez-de la Garza, Uriel Chavarría-Martínez, Manuel Wong-Jaen, Adrián Camacho-Ortiz, Lilia Rizo-Topete, A. López-Romo, Vicente Fuentes-Puga, S. Sanchez-Salazar","doi":"10.3389/frtra.2024.1347603","DOIUrl":"https://doi.org/10.3389/frtra.2024.1347603","url":null,"abstract":"Lung transplantation is the gold standard therapy for patients in the end stages of pulmonary disease. However, in numerous countries, candidates for lung transplants often die on the waiting list due to a shortage of donors and limited access to transplant centers. This article delves into the experience of our hospital, Christus Muguerza in Monterrey, Mexico, as the sole active lung transplant program in the country, having conducted 35 transplants from August 2017 to March 2023. We discuss the actual situation of lung transplantation in Mexico and the challenges we have faced over time, such as late patient referrals for evaluation and eventual transplantation. In addition, we outline the challenges we anticipate as more transplant programs emerge in the country.","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810678","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":"The role of the purposeful shared decision making model in vascularized composite allotransplantation.","authors":"Ian G Hargraves, Kasey R Boehmer, Hatem Amer, Cassie C Kennedy, Joan M Griffin, Dawn M Finnie, Victor M Montori, Fantley Clay Smither, Samir Mardini, Steven Moran, Sheila Jowsey-Gregoire","doi":"10.3389/frtra.2024.1421154","DOIUrl":"10.3389/frtra.2024.1421154","url":null,"abstract":"<p><p>For some patients who have lost the lower part of an arm, hand transplant offers the possibility of receiving a new limb with varying degrees of sensation and function. This procedure, Vascularized Composite Allotransplantation (VCA), is demanding for patients and their care community and comes with significant risks. As a high-stakes decision, patients interested in VCA are subject to extensive clinical evaluation and eligibility decision making. Patients and their care community must also decide if hand transplant (versus other approaches including rehabilitative therapies with or without prosthesis) is right for them. This decision making is often confusing and practically and emotionally fraught. It is complicated in four ways: by the numerous beneficial and harmful potential effects of hand transplant or other options, the number of people affected by VCA and the diverse or conflicting positions that they may hold, the practical demands and limitations of the patient's life situation, and the existential significance of limb loss and transplant for the patient's being. Patients need support in working through these treatment determining issues. Evaluation does not provide this support. Shared decision making (SDM) is a method of care that helps patients think, talk, and feel their way through to the right course of action for them. However, traditional models of SDM that focus on weighing possible beneficial and harmful effects of treatments are ill-equipped to tackle the heterogeneous issues of VCA. A recent model, Purposeful SDM extends the range of troubling issues that SDM can help support beyond opposing effects, to include conflicting positions, life situations, and existential being. In this paper we explore the pertinence of these issues in VCA, methods of SDM that each require of clinicians, the benefits of supporting patients with the breadth of issues in their unique problematic situations, implications for outcomes and practice, and extend the theory of the Purposeful SDM model itself based on the issues present in hand transplant decision making.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11235292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592593","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":"Remdesivir and molnupiravir had comparable efficacy in lung transplant recipients with mild-to-moderate COVID-19: a single center experience.","authors":"Deepika Razia, Devika Sindu, Lauren Cherrier, Katherine Grief, Rajat Walia, Sofya Tokman","doi":"10.3389/frtra.2024.1408289","DOIUrl":"10.3389/frtra.2024.1408289","url":null,"abstract":"<p><strong>Introduction: </strong>Remdesivir (REM) and molnupiravir (MOL) are commonly used to treat lung transplant recipients (LTRs) with COVID-19; however, the clinical efficacy of these medications is yet to be compared. In this retrospective cohort study, we compared the clinical outcomes between LTRs with mild-to-moderate COVID-19 treated with REM and those treated with MOL.</p><p><strong>Methods and results: </strong>Between March 2020 and August 2022, 195 LTRs developed COVID-19 at our center. After excluding 82 who presented with severe disease requiring hospitalization, the remaining 113 were included in the analysis: 54 did not receive antiviral treatment, 30 were treated with REM, and 29 were treated with MOL. Adjusted multivariable logistic regression analysis showed similar rates of hospitalization (adjusted odds ratio (aOR) 1.169, [95% confidence interval (95% CI) 0.105-12.997, <i>p</i> = 0.899], ICU admission (aOR 0.822, 95% CI 0.042-16.220, <i>p</i> = 0.898), mechanical ventilation (aOR 0.903, 95% CI 0.015-55.124, <i>p</i> = 0.961), and COVID-19-related mortality (aOR 0.822, 95% CI 0.042-16.220, <i>p</i> = 0.898) between LTRs treated with REM and those treated with MOL for mild-to-moderate COVID-19, irrespective of SARS-CoV-2 strain.</p><p><strong>Conclusion: </strong>MOL may be a suitable alternative to REM to treat LTRs with mild-to-moderate COVID-19, and the choice of antiviral therapy can be driven by practical considerations such as route of administration and drug availability.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11235218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592591","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":"Gradual rewarming with a hemoglobin-based oxygen carrier improves viability of donation after circulatory death in rat livers.","authors":"Paria Mahboub, Mohamed Aburawi, O Sila Ozgur, Casie Pendexter, Stephanie Cronin, Florence Min Lin, Rohil Jain, Murat N Karabacak, Negin Karimian, Shannon N Tessier, James F Markmann, Heidi Yeh, Korkut Uygun","doi":"10.3389/frtra.2024.1353124","DOIUrl":"10.3389/frtra.2024.1353124","url":null,"abstract":"<p><strong>Background: </strong>Donation after circulatory death (DCD) grafts are vital for increasing available donor organs. Gradual rewarming during machine perfusion has proven effective in mitigating reperfusion injury and enhancing graft quality. Limited data exist on artificial oxygen carriers as an effective solution to meet the increasing metabolic demand with temperature changes. The aim of the present study was to assess the efficacy and safety of utilizing a hemoglobin-based oxygen carrier (HBOC) during the gradual rewarming of DCD rat livers.</p><p><strong>Methods: </strong>Liver grafts were procured after 30 min of warm ischemia. The effect of 90 min of oxygenated rewarming perfusion from ice cold temperatures (4 °C) to 37 °C with HBOC after cold storage was evaluated and the results were compared with cold storage alone. Reperfusion at 37 °C was performed to assess the post-preservation recovery.</p><p><strong>Results: </strong>Gradual rewarming with HBOC significantly enhanced recovery, demonstrated by markedly lower lactate levels and reduced vascular resistance compared to cold-stored liver grafts. Increased bile production in the HBOC group was noted, indicating improved liver function and bile synthesis capacity. Histological examination showed reduced cellular damage and better tissue preservation in the HBOC-treated livers compared to those subjected to cold storage alone.</p><p><strong>Conclusion: </strong>This study suggests the safety of using HBOC during rewarming perfusion of rat livers as no harmful effect was detected. Furthermore, the viability assessment indicated improvement in graft function.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11235298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592588","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":"Development of a checklist framework for kidney transplantation.","authors":"Ramona Nicolau-Raducu, Gaetano Ciancio, Yehuda Raveh","doi":"10.3389/frtra.2024.1412391","DOIUrl":"10.3389/frtra.2024.1412391","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is the therapy of choice for end-stage kidney disease, and a fast-growing transplant procedure worldwide. Diverse clinical practices for recipients and donors' selection and management between transplant centers hinder the creation and dissemination of an anesthesia-surgical checklist.</p><p><strong>Methods: </strong>Components of the anesthesia-surgical checklist were selected after a review of the English literature using PubMed search for donor, recipient and graft protocols and outcomes of existing practices in the field of kidney transplantation. Key elements of the most relevant articles were combined with our own center's experience and formulated into the proposed checklist. The checklist is intended to be used perioperatively, once patient receives an offer.</p><p><strong>Results: </strong>The perioperative checklist centers primarily on the following donor and recipient's factors: (i) Review of the pretransplant candidate workup; (ii) Assessment of donor/graft status; (iii) Hypothermic machine perfusion parameters; (iv) Operating room management; (v) Sign out. The proposed kidney transplant checklist was designed to ensure consistency and completeness of diverse tasks and facilitates team communication and coordination.</p><p><strong>Conclusion: </strong>We present a novel standardized combined anesthesia-surgical checklist framework for kidney transplant aimed at increasing perioperative safety and streamline the perioperative care of recipients. Future validation studies will determine its clinical feasibility and post-implementation efficacy.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11235342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592586","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":"Donor-specific graft injury in solid organ transplantation: potential mechanisms and therapeutic strategies.","authors":"Chengliang Yang, Casey P Shannon, Hedi Zhao, Scott J Tebbutt","doi":"10.3389/frtra.2024.1427106","DOIUrl":"10.3389/frtra.2024.1427106","url":null,"abstract":"","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11235368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592587","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}