世界移植杂志最新文献

{"title":"SIMAP500: A novel risk score to identify recipients at higher risk of hepatocellular carcinoma recurrence following liver transplantation.","authors":"Amr Alnagar, Nekisa Zakeri, Konstantinos Koilias, Rosemary E Faulkes, Rachel Brown, Owen Cain, M Thamara P R Perera, Keith J Roberts, Rebeca Sanabria-Mateos, David C Bartlett, Yuk Ting Ma, Shivan Sivakumar, Shishir Shetty, Tahir Shah, Bobby V M Dasari","doi":"10.5500/wjt.v14.i3.95849","DOIUrl":"https://doi.org/10.5500/wjt.v14.i3.95849","url":null,"abstract":"<p><strong>Background: </strong>Recurrence of hepatocellular carcinoma (HCC) following liver transplantation (LT) has a devastating influence on recipients' survival; however, the risk of recurrence is not routinely stratified. Risk stratification is vital with a long LT waiting time, as that could influence the recurrence despite strict listing criteria.</p><p><strong>Aim: </strong>This study aims to identify predictors of recurrence and develop a novel risk prediction score to forecast HCC recurrence following LT.</p><p><strong>Methods: </strong>A retrospective review of LT for HCC recipients at University Hospitals Birmingham between July 2011 and February 2020. Univariate and multivariate analyses were performed to identify recurrence predictors, based on which the novel SIMAP500 (satellite nodules, increase in size, microvascular invasion, AFP > 500, poor differentiation) risk score was proposed.</p><p><strong>Results: </strong>234 LTs for HCC were performed with a median follow-up of 5.3 years. Recurrence developed in 25 patients (10.7%). On univariate analyses, RETREAT score > 3, α-fetoprotein (AFP) at listing 100-500 and > 500, bridging, increased tumour size between imaging at the listing time and explant histology, increase in the size of viable tumour between listing and explant, presence of satellite nodules, micro- and macrovascular invasion on explant and poor differentiation of tumours were significantly associated with recurrence, based on which, the SIMAP500 risk score is proposed. The SIMAP500 demonstrated an excellent predictive ability (c-index = 0.803) and outperformed the RETREAT score (c-index = 0.73). SIMAP500 is indicative of the time to disease recurrence.</p><p><strong>Conclusion: </strong>SIMAP500 risk score identifies the LT recipients at risk of HCC recurrence. Risk stratification allows patient-centric post-transplant surveillance programs. Further validation of the score is recommended.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"14 3","pages":"95849"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302180","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":"Dosing strategies for <i>de novo</i> once-daily extended release tacrolimus in kidney transplant recipients based on <i>CYP3A5</i> genotype.","authors":"Adam Diamond, Sunil Karhadkar, Kenneth Chavin, Serban Constantinescu, Kwan N Lau, Oscar Perez-Leal, Kerry Mohrien, Nicole Sifontis, Antonio Di Carlo","doi":"10.5500/wjt.v13.i6.368","DOIUrl":"10.5500/wjt.v13.i6.368","url":null,"abstract":"<p><strong>Background: </strong>Tacrolimus extended-release tablets have been Food and Drug Administration-approved for use in the <i>de novo</i> kidney transplant population. Dosing requi rements often vary for tacrolimus based on several factors including variation in metabolism based on <i>CYP3A5</i> expression. Patients who express <i>CYP3A5</i> often require higher dosing of immediate-release tacrolimus, but this has not been established for tacrolimus extended-release tablets in the <i>de novo</i> setting.</p><p><strong>Aim: </strong>To obtain target trough concentrations of extended-release tacrolimus in <i>de novo</i> kidney transplant recipients according to <i>CYP3A5</i> genotype.</p><p><strong>Methods: </strong>Single-arm, prospective, single-center, open-label, observational study (ClinicalTrials.gov: NCT037 13645). Life cycle pharma tacrolimus (LCPT) orally once daily at a starting dose of 0.13 mg/kg/day based on actual body weight. If weight is more than 120% of ideal body weight, an adjusted body weight was used. LCPT dose was adjusted to maintain tacrolimus trough concentrations of 8-10 ng/mL. Pharmacogenetic analysis of <i>CYP3A5</i> genotype was performed at study conclusion.</p><p><strong>Results: </strong>Mean time to therapeutic tacrolimus trough concentration was longer in <i>CYP3A5</i> intermediate and extensive metabolizers <i>vs CYP3A5</i> non-expressers (6 d <i>vs</i> 13.5 d <i>vs</i> 4.5 d; <i>P</i> = 0.025). Mean tacrolimus doses and weight-based doses to achieve therapeutic concentration were higher in <i>CYP3A5</i> intermediate and extensive metabolizers <i>vs CYP3A5</i> non-expressers (16 mg <i>vs</i> 16 mg <i>vs</i> 12 mg; <i>P</i> = 0.010) (0.20 mg/kg <i>vs</i> 0.19 mg/kg <i>vs</i> 0.13 mg/kg; <i>P</i> = 0.018). <i>CYP3A5</i> extensive metabolizers experienced lower mean tacrolimus trough concentrations throughout the study period compared to <i>CYP3A5</i> intermediate metabolizers and non-expressers (7.98 ng/mL <i>vs</i> 9.18 ng/mL <i>vs</i> 10.78 ng/mL; <i>P</i> = 0 0.008). No differences were identified with regards to kidney graft function at 30-d post-transplant. Serious adverse events were reported for 13 (36%) patients.</p><p><strong>Conclusion: </strong>Expression of <i>CYP3A5</i> leads to higher starting doses and incremental dosage titration of extended-release tacro limus to achieve target trough concentrations. We suggest a higher starting dose of 0.2 mg/kg/d for <i>CYP3A5</i> expressers.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"13 6","pages":"368-378"},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10758687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089540","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":"Outcomes of early hospital readmission after kidney transplantation: Perspectives from a Canadian transplant centre.","authors":"Olusegun Famure, Esther D Kim, Yanhong Li, Johnny W Huang, Roman Zyla, Magdalene Au, Pei Xuan Chen, Heebah Sultan, Monika Ashwin, Michelle Minkovich, S Joseph Kim","doi":"10.5500/wjt.v13.i6.357","DOIUrl":"10.5500/wjt.v13.i6.357","url":null,"abstract":"<p><strong>Background: </strong>Early hospital readmissions (EHRs) after kidney transplantation range in incidence from 18%-47% and are important and substantial healthcare quality indicators. EHR can adversely impact clinical outcomes such as graft function and patient mortality as well as healthcare costs. EHRs have been extensively studied in American healthcare systems, but these associations have not been explored within a Canadian setting. Due to significant differences in the delivery of healthcare and patient outcomes, results from American studies cannot be readily applicable to Canadian populations. A better understanding of EHR can facilitate improved discharge planning and long-term outpatient management post kidney transplant.</p><p><strong>Aim: </strong>To explore the burden of EHR on kidney transplant recipients (KTRs) and the Canadian healthcare system in a large transplant centre.</p><p><strong>Methods: </strong>This single centre cohort study included 1564 KTRs recruited from January 1, 2009 to December 31, 2017, with a 1-year follow-up. We defined EHR as hospitalizations within 30 d or 90 d of transplant discharge, excluding elective procedures. Multivariable Cox and linear regression models were used to examine EHR, late hospital readmissions (defined as hospitalizations within 31-365 d for 30-d EHR and within 91-365 d for 90-d EHR), and outcomes including graft function and patient mortality.</p><p><strong>Results: </strong>In this study, 307 (22.4%) and 394 (29.6%) KTRs had 30-d and 90-d EHRs, respectively. Factors such as having previous cases of rejection, being transplanted in more recent years, having a longer duration of dialysis pretransplant, and having an expanded criteria donor were associated with EHR post-transplant. The cumulative probability of death censored graft failure, as well as total graft failure, was higher among the 90-d EHR group as compared to patients with no EHR. While multivariable models found no significant association between EHR and patient mortality, patients with EHR were at an increased risk of late hospital readmissions, poorer kidney function throughout the 1^st year post-transplant, and higher hospital-based care costs within the 1^st year of follow-up.</p><p><strong>Conclusion: </strong>EHRs are associated with suboptimal outcomes after kidney transplant and increased financial burden on the healthcare system. The results warrant the need for effective strategies to reduce post-transplant EHR.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"13 6","pages":"357-367"},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10758685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089541","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":"Unveiling transplantation research productivity of United States: A bibliometric analysis.","authors":"Badi Rawashdeh, Saif Aldeen AlRyalat, Mohammad Abuassi, Raj Prasad, Matthew Cooper","doi":"10.5500/wjt.v13.i6.391","DOIUrl":"10.5500/wjt.v13.i6.391","url":null,"abstract":"<p><strong>Background: </strong>The United States has witnessed significant advancements in the field of organ transplantation over the course of the last five decades, as demonstrated by a notable increase in the quantity of academic research. The presence of a highly dynamic research environment necessitates continuous evaluations to maintain the integrity and progress of the field.</p><p><strong>Aim: </strong>To evaluate the total output and thematic emphasis of transplant research conducted in the United States.</p><p><strong>Methods: </strong>On January 10, 2023, we conducted a bibliometric search of United States research output in transplantation journals from the Web of Science database's Science Citation Index Expanded. We excluded editorials, meeting abstracts, and other non-article types. We analyzed annual trends, authors, institutions, articles, keywords, and countries collaborating with the United States, using VOSviewer 1.6.18 to create figures and tables.</p><p><strong>Results: </strong>The United States published 25956 papers (3078 reviews and 22878 articles) representing 37.7% of the world's scientific output. Canada emerged as the top collaborator with the United States, co-authoring 1263 articles. Leading institutions in United States transplantation research were the University of Pittsburgh (1749 articles), Mayo Clinic (1605 articles), Harvard Medical School (1549 articles), and Johns Hopkins University (1280 articles). The top three keywords with over 2000 occurrences were \"recipients,\" \"survival,\" and \"outcomes,\" indicating a focus on graft and recipient outcome markers by United States researchers.</p><p><strong>Conclusion: </strong>Our findings demonstrate the United States leadership in organ transplantation research, contributing significantly to the global scientific output in this field. However, opportunities exist for fostering expansive partnerships, particularly with developing countries. This study provides valuable insights into the transplantation research landscape in the United States, emphasizing the importance of ongoing evaluations to maintain and propel advancements in this critical medical discipline. The results may facilitate future collaborations, knowledge exchange, and the pursuit of innovative solutions in the realm of organ transplantation.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"13 6","pages":"391-402"},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10758679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089543","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":"Pathophysiology of acute graft-versus-host disease from the perspective of hemodynamics determined by dielectric analysis.","authors":"Masayuki Nagasawa","doi":"10.5500/wjt.v13.i6.379","DOIUrl":"10.5500/wjt.v13.i6.379","url":null,"abstract":"<p><strong>Background: </strong>Numerous reports have demonstrated that the pathophysiology of graft-versus-host disease (GVHD) during hematopoietic stem cell transplantation (HSCT) is closely related to vascular endothelial disorders and coagulation abnormalities. We previously presented the discovery of a principle and the development of a novel instrument for measuring whole blood coagulation. This was achieved by assessing the variations in the dielectric properties of whole blood.</p><p><strong>Aim: </strong>To investigate how GVHD affects the changes of dielectric properties of whole blood in patients with HSCT.</p><p><strong>Methods: </strong>We examined the changes of dielectric properties of whole blood and erythrocyte proteins by sodium dodecyl sulfate-polyacrylamide gel electrophoresis sequentially in patients with HSCT and compared it with clinical symptoms and inflammatory parameters of GVHD.</p><p><strong>Results: </strong>During severe GVHD, the dielectric relaxation strength markedly increased and expression of band3 decreased. The dielectric relaxation strength normalized with the improvement of GVHD. <i>In vitro</i> analysis confirmed that the increase of relaxation strength was associated with severe erythrocyte aggregates, but not with decreased expression of band3.</p><p><strong>Conclusion: </strong>Severe erythrocyte aggregates observed in GVHD may cause coagulation abnor malities and circulatory failure, which, together with the irreversible erythrocyte dysfunction we recently reported, could lead to organ failure.</p>","PeriodicalId":65557,"journal":{"name":"世界移植杂志","volume":"13 6","pages":"379-390"},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10758686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089542","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}