Frontiers in transplantation最新文献

{"title":"Clinical outcomes of COVID-19 infection in liver transplant recipients based on vaccination status.","authors":"Vinathi Polamraju, Neeta Vachharajani, Brian F Gage, Jeffrey S Crippin, William C Chapman","doi":"10.3389/frtra.2024.1515964","DOIUrl":"10.3389/frtra.2024.1515964","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 disease burden has been mitigated by vaccination; however, concerns persist regarding weakened immune responses in liver transplant (LT) recipients. This study investigates COVID-19 outcomes in LT recipients based on vaccination status.</p><p><strong>Methods: </strong>This single-center retrospective study identified LT recipients with PCR-confirmed COVID-19 infection from 03/01/2020 to 07/31/2023. Logistic regression analyses were conducted, adjusting for age, race, co-morbidities, number of immunosuppressive agents, and infection date.</p><p><strong>Results: </strong>Of 1,787 registered LT recipients, 361 had confirmed COVID-19 infection. Of those, 136 were unvaccinated and 225 were vaccinated. 13% had 1 vaccine dose, 31% had 2 vaccine doses, and 56% had 3 vaccine doses prior to infection. Logistic regression found higher mortality (<i>p</i> = 0.001) and hospitalization (<i>p</i> = 0.016) rates for older recipients, while those with 3 or more vaccine doses had lower mortality (<i>p</i> = 0.039) and hospitalization (<i>p</i> = 0.008) rates. Chronic kidney disease (CKD) increased risk of hospitalization (<i>p</i> < 0.001). Adjusting for the date when the Omicron variant became locally predominant, the protective effect from 3 or more vaccine doses declined to an OR (95% CI) of 0.58 (0.15-2.23), <i>p</i> = 0.39.</p><p><strong>Conclusions: </strong>Three or more COVID-19 vaccine doses could decrease mortality for LT recipients, particularly older recipients and those with CKD. These individuals may benefit from vaccination and other interventions.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1515964"},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030682","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":"Diagnosis and management of <i>de novo</i> inflammatory bowel disease after solid organ transplantation in the era of biologic therapy: a case series.","authors":"Willie Mohammed Johnson, Byron P Vaughn, Nicholas Lim","doi":"10.3389/frtra.2024.1483943","DOIUrl":"10.3389/frtra.2024.1483943","url":null,"abstract":"<p><strong>Introduction: </strong>The clinical characteristics of <i>de novo</i> inflammatory bowel disease (dnIBD) diagnosed after solid organ transplant (SOT) are not well-described, particularly since the advent of biologic therapy for treatment of IBD.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective review of SOT recipients between 2010 and 2022 at the University of Minnesota Medical Center who were diagnosed with IBD after transplant.</p><p><strong>Results: </strong>Of 89 patients at our center with IBD and a history of SOT, five (5.6%) patients were diagnosed with IBD post-transplant (three liver, one kidney, and one simultaneous liver and kidney): three patients were female and four were Caucasian. Mean age at transplant and IBD diagnosis were 46.7 and 49.4 years respectively. Indication for transplant were alcohol-related cirrhosis (<i>n</i> = 2), idiopathic fulminant hepatic failure (<i>n</i> = 1), metabolic dysfunction-associated steatotic liver disease (<i>n</i> = 1), and IgA nephropathy (<i>n</i> = 1). Four patients were diagnosed with ulcerative colitis (UC) and one with Crohn's disease (CD). Three patients (all with UC) required escalation to a biologic therapy. Four patients were in clinical remission from IBD at last follow-up, one patient required IBD surgery, while there was no rejection and no deaths following IBD diagnosis.</p><p><strong>Conclusion: </strong>dnIBD post-SOT is uncommon, while newer IBD therapies may be safe and effective. Further study is required to better understand the natural history and IBD outcomes of this population relative to non-SOT patients.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1483943"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026185","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":"Vascularized composite allograft deceased donation in the United States.","authors":"Wida S Cherikh, Samantha M Noreen, Alexandra Lewis, Sarah E Booker, Jesse Howell, Erin M Schnellinger, Jennifer L Wainright, Christopher C Curran","doi":"10.3389/frtra.2024.1520970","DOIUrl":"10.3389/frtra.2024.1520970","url":null,"abstract":"<p><p>Vascularized composite allograft (VCA) transplantation represents a significant advancement in reconstructive surgery and offers hope to individuals who experienced congenital disorders or severe tissue injuries to restore physical appearance, function, and enhance quality of life. VCA recovery introduces complexities to conventional solid organ recovery, and there remain concerns regarding the potential impact of VCA recovery on non-VCA organs for transplant. The current retrospective study examines deceased donor characteristics and observed-to-expected (O/E) organ yield ratios for 51 VCA donors recovered in the US between July 4, 2014 and March 31, 2024, compared with a contemporary cohort of non-VCA donors recovered in 2023. Among the VCA donors, 17 donated a uterus, 15 each donated head and neck and upper limbs, 4 were abdominal wall donors, and 2 donated external male genitalia. The findings indicate that VCA donors tended to be younger (18-34 years old), predominantly White, non-Hispanic, and had no history of diabetes, along with lower weight, lower kidney donor profile index, and lower ejection fraction. The analysis revealed that VCA donors had higher observed overall organ yield than expected (O/E: 1.24, 95% CI: 1.16-1.33), with better-than-expected organ yields across VCA types. The number of deceased VCA donors in the US is still relatively small compared to the overall donor population. As the field continues to evolve and more data becomes available, further analyses need to be conducted to understand the demographics of VCA donors and the potential impact of VCA donation within the donation and transplant system.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1520970"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019937","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 carbon footprint and energy consumption of liver transplantation.","authors":"Paolo De Simone, Quirino Lai, Juri Ducci, Daniela Campani, Giandomenico Biancofiore","doi":"10.3389/frtra.2024.1441928","DOIUrl":"10.3389/frtra.2024.1441928","url":null,"abstract":"<p><strong>Background and aims: </strong>There is growing interest in the environmental impact of surgical procedures, yet more information is needed specifically regarding liver transplantation. This study aims to quantify the total greenhouse gas emissions, or carbon footprint, associated with adult whole-size liver transplantation from donors after brain death, including the relevant back-table graft preparation.</p><p><strong>Methods: </strong>The carbon footprint was calculated retrospectively using a bottom-up approach. This approach sums the volumes of energy consumption (kWh), volatile anesthetics (ml), solid waste (kg), and units of blood products transfused for each transplant. These consumption values were converted using validated conversion factors to the equivalent mass of carbon dioxide released into the environment (kg CO2e).</p><p><strong>Results: </strong>A total of 147 patients with a mean age of 55 years (male, 78.9%) who underwent liver transplants between 2021 and 2022 were analyzed, resulting in 45.5 tons CO2e. The mean (SD) carbon footprint for each procedure was 309.8 (33.2) kg CO2e [95% CI: 304.4; 315.3]. Total energy power consumption was 96.5 MW, contributing 65.4% of greenhouse emissions (29.8 tons CO2e), while volatile anesthetics, solid waste, and blood product transfusions contributed 8.0% (3.64 tons CO2e), 5.9% (2.7 tons CO2e), and 20.6% (9.4 tons CO2e), respectively. The duration of surgery (<i>t</i> = 29.0; <i>p</i> < 0.001), transfused red blood cells (<i>t</i> = 13.1; <i>p</i> < 0.001), fresh frozen plasma (<i>t</i> = 11.1; <i>p</i> < 0.001), platelets (<i>t</i> = 8.9; <i>p</i> < 0.001), and the use of an extracorporeal pump machine (<i>t</i> = 3.6; <i>p</i> < 0.001) had the greatest effects on greenhouse gas emissions.</p><p><strong>Conclusions: </strong>Liver transplantation requires significant energy and is associated with considerable greenhouse gas emissions, particularly during longer procedures. Transplant clinicians, hospital administrators, policymakers, and patients should be aware of the environmental impact of liver transplantation and collaborate to adopt sustainable energy practices.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1441928"},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019930","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":"Gene expression profiling in PBMCs for acute rejection in lung transplant recipients reveals myeloid responses.","authors":"Siqi Liu, Johanna Westra, Shixian Hu, Erik A M Verschuuren, Léon C van Kempen, Debbie van Baarle, Nico A Bos","doi":"10.3389/frtra.2024.1508419","DOIUrl":"10.3389/frtra.2024.1508419","url":null,"abstract":"<p><p>The acute rejection (AR) diagnosis depends on transbronchial biopsy, which is semi-invasive and not easily performed<b>.</b> Our study used the Nanostring gene expression technology on PBMCs obtained from lung transplant recipients (LTRs) to search for biomarkers. We identified distinct differential gene profiles between patients with stable status (STA) and AR. Subsequently, we independently evaluated monocyte compositions in PBMCs using flow cytometry and assessed the levels of 7 chemokines in serum using Luminex. The 48 top differentially expressed genes (DEGs) were identified, utilizing a criterion of at least a 1.5-fold change between two groups, with a false discovery rate (FDR) <i>p</i>-Adj < 0.05. Of these 48 genes, the top 10 genes with the highest fold changes and significant <i>p</i>-values were selected for qPCR validation. CD68, ANXA1, ITGB, and IFI30 can be confirmed among the validated genes. A significantly lower percentage of CD14 + CD16- classical monocytes was observed in AR than in STA patients, which aligns with downregulated DEGs. Many of the DEGs were related to monocytes-macrophages and chemokines. Although these results still need to be confirmed in larger cohorts, they suggest that gene profiling of PBMC can help to identify markers related to AR in LTRs.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1508419"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916815","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":"Immunoproteasome inhibition reduces donor specific antibody production and cardiac allograft vasculopathy in a mouse heart transplantation model.","authors":"Allison M Schwalb, Imran Anwar, Isabel DeLaura, Joseph M Ladowski, Janghoon Yoon, Rafaela Belloni, Mingqing Song, Carolyn Glass, Jun Wang, Stuart Knechtle, Jean Kwun","doi":"10.3389/frtra.2024.1494455","DOIUrl":"10.3389/frtra.2024.1494455","url":null,"abstract":"<p><strong>Objective: </strong>Cardiac Allograft Vasculopathy (CAV), a process of vascular damage accelerated by antibody-mediated rejection (AMR), is one of the leading causes of cardiac transplant failure. Proteasome inhibitors (PIs) are utilized to treat AMR, however PI-associated toxicity limits their therapeutic utility. Novel immunoproteasome inhibitors (IPIs) have higher specificity for immune cells and have not been investigated for AMR in cardiac transplant patients. We sought to evaluate IPI effect on AMR in a murine cardiac transplant model.</p><p><strong>Methods: </strong>Fully MHC mismatched C57BL/6 to huCD52Tg heterotopic heart transplantations were performed. Recipients were treated with alemtuzumab (10 µg, IP) on days -2, -1, 2, and 4 and anti-CD25mAb (PC61, 100 µg, IP) on day 7 to accelerate AMR with or without IPI (ONX-0914,15 mg/kg, SQ), administered on transplant day and three times a week thereafter.</p><p><strong>Results: </strong>Animals without IPI gradually developed post-transplant donor-specific antibody (DSA) and showed a significantly elevated DSA level compared to animals receiving IPI. (TFXM 48.86 vs. 14.17; <i>p</i> = 0.0291, BFXM 43.53 vs. 6.114; <i>p</i> = 0.0031). Accordingly, H&E staining of allograft showed reduced evidence of AMR with IPI compared to controls (<i>P</i> = 0.0410). Notably, increased mortality was observed in the IPI treated group.</p><p><strong>Conclusion: </strong>This study demonstrated the ability of ONYX-0914, an IPI, to control post-transplant DSA production and the AMR development in a heart transplant model. However, IPI-resistant DSA production was also observed and increased mortality with IPI therapy raises concerns about potential toxicity. Further investigation is warranted to assess the utility and potential risk associated with the use of IPI as a post-transplant maintenance immunosuppression.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1494455"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908170","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 derived cell free DNA in lung transplant recipients rises in setting of allograft instability.","authors":"Joshua B Smith, Ryan A Peterson, Raymond Pomponio, Mark Steele, Alice L Gray","doi":"10.3389/frtra.2024.1497374","DOIUrl":"10.3389/frtra.2024.1497374","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to evaluate the correlation between longitudinal monitoring of donor-derived cell free DNA (dd-cfDNA) in lung transplant recipients and a \"gold standard\" of existing tools (pulmonary function testing, radiographic imaging, laboratory and bronchoscopy data, clinical judgment) to assess allograft function.</p><p><strong>Methods: </strong>24 consecutive transplant recipients were prospectively enrolled in this study measuring dd-cfDNA levels monthly in the first year after bilateral lung transplant. Blinded clinical adjudications were performed at the same timepoints to categorize allograft function as stable (FEV1 within 10% of prior value or when compared to best two averaged post-transplant values) or unstable. When deemed unstable, etiology of unstable graft function was elicited based on available clinical data. We then evaluated the association between dd-cfDNA and the clinical impression of allograft function using linear mixed models which adjusted for patient-level covariates and time since transplant.</p><p><strong>Results: </strong>Unstable allografts were associated with 54.4% higher measures of dd-cfDNA, controlling for time since transplant and demographic covariates [<i>adjusted mean ratio (aMR)</i> = 1.54, 95% CI: 1.25-1.91]. Females tended to have higher measures of dd-cfDNA (<i>aMR</i> = 1.90 95%CI: 1.14-3.16). A two-fold increase in dd-cfDNA was associated with declines in FEV1 and FVC of 0.047 and 0.066 L, respectively, controlling for time since transplant and demographic covariates (<i>slope:</i> -0.047 95%CI: -0.076 to -0.019, and <i>slope:</i> -0.066 95%CI: -0.097 to -0.035, respectively). Discussion: Donor derived cell free DNA presents a potential additional minimally invasive clinical tool in lung transplant allograft monitoring within the first year of transplant, with unstable allografts correlating with higher dd-cfDNA values.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1497374"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908169","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":"Cord blood T regulatory cells synergize with ruxolitinib to improve GVHD outcomes.","authors":"Ke Zeng, Hongbing Ma, Meixian Huang, Mi-Ae Lyu, Tara Sadeghi, Christopher R Flowers, Simrit Parmar","doi":"10.3389/frtra.2024.1448650","DOIUrl":"10.3389/frtra.2024.1448650","url":null,"abstract":"<p><strong>Background: </strong>Adoptive therapy with umbilical cord blood (UCB) T-regulatory (Treg) cells can prevent graft vs. host disease (GVHD). We hypothesize that UCB Tregs can treat GVHD and synergize with ruxolitinib, Jak2 inhibitor, to improve outcomes.</p><p><strong>Methods: </strong>UCB Treg potency and efficacy was examined using cell suppression assay and xenogeneic GVHD model, respectively. Ruxolitinib was fed continuously in presence or absence of CellTraceViolet tagged UCB Tregs on days +4, +7, +11, +18. Mice were followed for survival, GVHD score, hematology parameters and inflammation.</p><p><strong>Results: </strong>Addition of ruxolitinib to UCB Tregs exerted synergistic suppressor function <i>in vitro</i> and improved persistence of UCB Tregs <i>in vivo</i>. Lower GVHD score, improved survival, increased hemoglobin level and platelet count, decreased inflammatory cytokines and decrease in CD3⁺ T cell lung infiltrate was observed in UCB Tregs+ruxolitinib recipients.</p><p><strong>Conclusion: </strong>UCB Treg+Ruxolitinib combination improves outcomes in xenogeneic GVHD and should be explored in a clinical setting.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1448650"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11668690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901586","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":"Autologous porcine VRAM flap model for VCA research.","authors":"Caitlin M Blades, Zari P Dumanian, Yong Wang, Zhaohui Wang, Bing Li, Kia M Washington, Julia B Slade, Conor L Evans, Paula Arrowsmith, Evan A Farkash, Jason W Yu, Mark A Greyson, Christene A Huang, Nalu Navarro-Alvarez, David W Mathes","doi":"10.3389/frtra.2024.1504959","DOIUrl":"10.3389/frtra.2024.1504959","url":null,"abstract":"<p><strong>Introduction: </strong>As research advances in vascularized composite allotransplantation (VCA), large animal models are essential for translational studies related to immune rejection and graft survival. However, procurement of large flaps can cause significant defects, complicating wound closure and increasing postoperative risks. This study details the surgical techniques and outcomes of autologous vertical rectus abdominis myocutaneous (VRAM) flap transplantation and neck flap isolation with induced ischemia in a swine model. The purpose of this study was to identify the most effective control procedure for use in future VRAM flap allotransplantation research.</p><p><strong>Methods: </strong>We performed two left heterotopic autologous VRAM flap transplants and two right anterolateral neck flap isolations using female Yucatan pigs. Postoperatively, animals were monitored for complications and flap healing, with punch biopsies taken on POD1, 5, and at the end of the study for histological analysis. Transcutaneous oxygen and temperature were also recorded.</p><p><strong>Results: </strong>Both autologous flaps survived after vessel anastomosis, with effective closure of abdominal defects using suturable mesh, and no postoperative complications were observed. Histology revealed mild dermal edema and perivascular inflammation on POD5. In the neck flap group, both flaps survived temporary ischemia, however, postoperative complications included dorsal flap necrosis and wound dehiscence, requiring reoperation. No gross inflammation or edema was observed following surgery and histologically there was only mild dermal edema on POD5.</p><p><strong>Discussion: </strong>We have developed a low-risk, technically feasible porcine autologous VRAM flap transplantation model and our findings support its use in future VCA studies.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1504959"},"PeriodicalIF":0.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879545","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":"Vascular reconstructions in living donor kidney transplantation: a single-center experience over the last 17 years.","authors":"Nadina Roth, Manfred Kalteis, Axel Krause, Christiane Sophie Rösch, Jürgen Huber, Wolfgang Enkner, Maria Haller, Daniel Cejka, Reinhold Függer, Matthias Biebl","doi":"10.3389/frtra.2024.1488277","DOIUrl":"10.3389/frtra.2024.1488277","url":null,"abstract":"<p><strong>Introduction: </strong>In living donor kidney transplantation (LDKT), vascular anastomosis is more difficult due to missing arterial patches and shorter renal veins. The surgical challenge is even more demanding in kidneys with multiple arteries. Although renal transplantation is feasible in most cases of complex donor vascular anatomy and similar results compared with standard LDKT are reported, the discussion on potentially increased complication rates and graft function continues. This prompted us to review our results of LDKT with multiple renal artery (MRA) grafts with a special concentration on complications and long-term function.</p><p><strong>Patients and methods: </strong>We reviewed the records of all LDKT in our center from the beginning of the program in 2005 until 2022 for arterial vascular reconstructions. The cohort was divided into two groups: transplantation with vascular reconstruction (VR) and standard transplantation. These groups were compared for operative parameters and short- and long-term results.</p><p><strong>Results: </strong>From 2005 to 2022, 211 LDKT were completed in our unit. In 32 (15.2%), a VR was performed, including single ostium side-to-side anastomosis, end-to-side anastomosis, patch reconstruction, and vein interposition. There was no significant difference in operative time (169 min vs. 180 min; <i>p</i> = 0.118) and time for anastomosis (28 min vs. 26 min; <i>p</i> = 0.59) between both groups. Postoperative complications (5.7% vs. 7.4%; <i>p</i> = 0.72) were not significantly different. During the follow-up period (110 months, range 10-204), the risk of organ loss was comparable after VR (13.625% vs. 11.56% <i>p</i> = 0.69).</p><p><strong>Conclusion: </strong>In LDKT, arterial vascular reconstructions for kidneys with MRA provide similar results compared to grafts with a single renal artery (SRA). Short- and long-term results are comparable with standard procedures.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"3 ","pages":"1488277"},"PeriodicalIF":0.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879559","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}