世界移植杂志(英文版)最新文献

{"title":"Effects of an active lifestyle on the physical frailty of liver transplant candidates.","authors":"Ilias Marios Oikonomou,&nbsp;Emmanouil Sinakos,&nbsp;Nikolaos Antoniadis,&nbsp;Ioannis Goulis,&nbsp;Olga Giouleme,&nbsp;Maria Anifanti,&nbsp;Georgios Katsanos,&nbsp;Konstantina-Eleni Karakasi,&nbsp;Georgios Tsoulfas,&nbsp;Evangelia Kouidi","doi":"10.5500/wjt.v12.i11.365","DOIUrl":"https://doi.org/10.5500/wjt.v12.i11.365","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation is the most important therapeutic intervention for end-stage liver disease (ELD). The prioritization of these patients is based on the model for end-stage liver disease (MELD), which can successfully predict short-term mortality. However, despite its great validity and value, it cannot fully incor porate several comorbidities of liver disease, such as sarcopenia and physical frailty, variables that can sufficiently influence the survival of such patients. Subsequently, there is growing interest in the importance of physical frailty in regard to mortality in liver transplant candidates and recipients, as well as its role in improving their survival rates.</p><p><strong>Aim: </strong>To evaluate the effects of an active lifestyle on physical frailty on liver transplant candidates.</p><p><strong>Methods: </strong>An observational study was performed within the facilities of the Department of Transplant Surgery of Aristotle University of Thessaloniki. Twenty liver tran splant candidate patients from the waiting list of the department were included in the study. Patients that were bedridden, had recent cardiovascular incidents, or had required inpatient treatment for more than 5 d in the last 6 mo were excluded from the study. The following variables were evaluated: Activity level <i>via</i> the International Physical Activity Questionnaire (IPAQ); functional capacity <i>via</i> the 6-min walking test (6MWT) and cardiopulmonary exercise testing; and physical frailty <i>via</i> the Liver Frailty Index (LFI).</p><p><strong>Results: </strong>According to their responses in the IPAQ, patients were divided into the following two groups based on their activity level: Active group (A, 10 patients); and sedentary group (S, 10 patients). Comparing mean values of the recorded variables showed the following results: MELD (A: 12.05 ± 5.63 <i>vs</i> S: 13.99 ± 3.60; <i>P</i> > 0.05); peak oxygen uptake (A: 29.78 ± 6.07 mL/kg/min <i>vs</i> S: 18.11 ± 3.39 mL/kg/min; <i>P</i> < 0.001); anaerobic threshold (A: 16.71 ± 2.17 mL/kg/min <i>vs</i> S: 13.96 ± 1.45 mL/kg/min; <i>P</i> < 0.01); 6MWT (A: 458.2 ± 57.5 m <i>vs</i> S: 324.7 ± 55.8 m; <i>P</i> < 0.001); and LFI (A: 3.75 ± 0.31 <i>vs</i> S: 4.42 ± 0.32; <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>An active lifestyle can be associated with better musculoskeletal and functional capacity, while simultaneously preventing the evolution of physical frailty in liver transplant candidates. This effect appears to be independent of the liver disease severity.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 11","pages":"365-377"},"PeriodicalIF":0.0,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9b/7c/WJT-12-365.PMC9693895.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40512813","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":"Role of immunotherapy in downsizing hepatocellular carcinoma prior to liver transplantation.","authors":"Konstantinos Ouranos,&nbsp;Anthi Chatziioannou,&nbsp;Ioannis Goulis,&nbsp;Emmanouil Sinakos","doi":"10.5500/wjt.v12.i11.331","DOIUrl":"https://doi.org/10.5500/wjt.v12.i11.331","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is an aggressive primary liver neoplasm that, according to tumor stage, can be treated with resection, transplantation, locoregional treatment options, or systemic therapy. Although interventions only in early-stage disease can offer complete tumor regression, systemic therapy in advanced disease can significantly prolong overall survival, according to pub lished clinical trials. The emergence of immunotherapy in the field of cancer therapy has had a positive impact on patients with HCC, resulting in atezolizumab-bevacizumab currently being the first-line option for treatment of advanced HCC. In light of this, application of immunotherapy in the preoperative process could increase the number of patients fulfilling the criteria for liver transplantation (LT). Implementation of this approach is faced with challenges regarding the safety of immunotherapy and the possibly increased risk of re jection in the perioperative period. Case reports and clinical trials assessing the safety profile and effectiveness of neoadjuvant immunotherapy, highlight important aspects regarding this newly evolving approach to HCC management. More studies need to be conducted in order to reach a consensus regarding the optimal way to administer immunotherapy prior to LT. In this review, we sum marize the role, safety profile and future considerations regarding the use of neoadjuvant immunotherapy prior to LT in patients with HCC.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 11","pages":"331-346"},"PeriodicalIF":0.0,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0d/4b/WJT-12-331.PMC9693898.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40512814","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":"COVID-19 in a pregnant kidney transplant recipient - what we need to know: A case report.","authors":"Roberta Angelico,&nbsp;Maria Luisa Framarino-Dei-Malatesta,&nbsp;Giuseppe Iaria","doi":"10.5500/wjt.v12.i10.325","DOIUrl":"https://doi.org/10.5500/wjt.v12.i10.325","url":null,"abstract":"<p><strong>Background: </strong>In the era of the coronavirus disease 2019 (COVID-19) pandemic, kidney tran splant recipients are more susceptible to severe acute respiratory syndrome co ronavirus (SARS-CoV-2) infection, developing severe morbidity and graft im pairment. Pregnant women are also more likely to develop severe COVID-19 di sease, causing pregnancy complications such as preterm births and acute kidney injury.</p><p><strong>Case summary: </strong>Herein, we report the case of a pregnant woman with a third kidney tran splantation who developed COVID-19 disease. The reduction of immunosuppressive drugs and strict monitoring of trough blood levels were needed to avoid severe SARS-CoV-2-related complications, and permitted to continue a healthy pregnancy and maintain good graft function. In such a complex scenario, the con comitance of COVID-19-related morbidity, the risk of acute rejection in the hype rimmune recipient, graft dysfunction and pregnancy complications make the management of immunosuppression a very difficult task and clinicians must be aware.</p><p><strong>Conclusion: </strong>Tailoring the immunosuppressive regimen is a key factor affecting both the graft outcome and pregnancy safety.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 10","pages":"325-330"},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/52/24/WJT-12-325.PMC9614586.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40438564","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":"Effect of panel reactive antibodies on T cell immunity reinstatement following renal transplantation.","authors":"Lampros Vagiotas,&nbsp;Maria Stangou,&nbsp;Efstratios Kasimatis,&nbsp;Aliki Xochelli,&nbsp;Grigorios Myserlis,&nbsp;Georgios Lioulios,&nbsp;Vasiliki Nikolaidou,&nbsp;Manolis Panteli,&nbsp;Konstantinos Ouranos,&nbsp;Nikolaos Antoniadis,&nbsp;Daoudaki Maria,&nbsp;Aikaterini Papagianni,&nbsp;Georgios Tsoulfas,&nbsp;Asimina Fylaktou","doi":"10.5500/wjt.v12.i10.313","DOIUrl":"https://doi.org/10.5500/wjt.v12.i10.313","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease is associated with immunological disorders, presented as phenotypic alterations of T lymphocytes. These changes are expected to be restored after a successful renal transplantation; however, additional parameters may contribute to this process.</p><p><strong>Aim: </strong>To evaluate the impact of positive panel reactive antibodies (PRAs) on the restoration of T cell phenotype, after renal transplantation.</p><p><strong>Methods: </strong>CD4CD28null, CD8CD28null, natural killer cells (NKs), and regulatory T cells (Tregs) were estimated by flow cytometry at T0, T3, and T6 which were the time of transplantation, and 3- and 6-mo follow-up, respectively. Changes were esti mated regarding the presence or absence of PRAs.</p><p><strong>Results: </strong>Patients were classified in two groups: PRA(-) (<i>n</i> = 43) and PRA(+) (<i>n</i> = 28) groups. Lymphocyte and their subtypes were similar between the two groups at T0, whereas their percentage was increased at T3 in PRA(-) compared to PRA(+) [23 (10.9-47.9) <i>vs</i> 16.4 (7.5-36.8 μ/L, respectively; <i>P</i> = 0.03]. Lymphocyte changes in PRA(-) patients included a significant increase in CD4 cells (<i>P</i> < 0.0001), CD8 cells (<i>P</i> < 0.0001), and Tregs (<i>P</i> < 0.0001), and a reduction of NKs (<i>P</i> < 0.0001). PRA(+) patients showed an increase in CD4 (<i>P</i> = 0.008) and CD8 (<i>P</i> = 0.0001), and a reduction in NKs (<i>P</i> = 0.07). CD4CD28null and CD8CD28null cells, although initially reduced in both groups, were stabilized thereafter.</p><p><strong>Conclusion: </strong>Our study described important differences in the immune response between PRA(+) and PRA(-) patients with changes in lymphocytes and lymphocyte subpopulations. PRA(+) patients seemed to have a worse immune profile after 6 mo follow-up, regardless of renal function.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 10","pages":"313-324"},"PeriodicalIF":0.0,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/69/WJT-12-313.PMC9614585.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40438565","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":"Simultaneous kidney transplantation and ipsilateral native nephrectomy in patients with autosomal dominant polycystic kidney disease.","authors":"Rabea Ahmed Gadelkareem,&nbsp;Amr Mostafa Abdelgawad,&nbsp;Nasreldin Mohammed","doi":"10.5500/wjt.v12.i9.310","DOIUrl":"https://doi.org/10.5500/wjt.v12.i9.310","url":null,"abstract":"<p><p>The simultaneous kidney transplantation and ipsilateral native nephrectomy for autosomal dominant polycystic kidney disease does not seem to be associated with increased rates of comorbidity and complications. This outcome can efficiently be achieved when the indication and surgical approach of native nephrectomy are properly justified.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 9","pages":"310-312"},"PeriodicalIF":0.0,"publicationDate":"2022-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/5e/WJT-12-310.PMC9516487.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390919","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":"Growing challenge of post-liver transplantation non-alcoholic fatty liver disease.","authors":"Maria Styliani Kalogirou,&nbsp;Olga Giouleme","doi":"10.5500/wjt.v12.i9.281","DOIUrl":"https://doi.org/10.5500/wjt.v12.i9.281","url":null,"abstract":"Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma worldwide, with an estimated prevalence of 25%. Post-liver transplantation (LT) recurrent or de novo hepatic steatosis is a common complication in recipients, irrespective of transplantation indication. Risk factors for graft steatosis mainly include obesity, immunosuppression, donor steatosis, and genetic factors. Liver transplant recipients are at high risk of developing insulin resistance, new-onset diabetes, and post-transplantation metabolic syndrome that is highly associated with immunosuppressive treatment. Post-LT NAFLD is often underdiagnosed due to the poor sensitivity of most routine imaging methods. The gold standard for the diagnosis of hepatic steatosis is liver biopsy, which is, however, limited to more complex cases due to its invasive nature. There is no approved pharmacotherapy in NAFLD. Lifestyle modification remains the cornerstone in NAFLD treatment. Other treatment strategies in post-LT NAFLD include lifestyle modifications, pharmacotherapy, bariatric surgery, and tailored immunosuppression. However, these approaches originate from recommendations in the general population, as there is scarce data regarding the safety and efficacy of current management strategies for NAFLD in liver transplant patients. Future prospective studies are required to achieve tailored treatment for these patients.","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 9","pages":"281-287"},"PeriodicalIF":0.0,"publicationDate":"2022-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/30/WJT-12-281.PMC9516490.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390917","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":"Liver transplantation during COVID-19: Adaptive measures with future significance.","authors":"Argyrios Gyftopoulos, Ioannis A Ziogas, Martin I Montenovo","doi":"10.5500/wjt.v12.i9.288","DOIUrl":"10.5500/wjt.v12.i9.288","url":null,"abstract":"<p><p>Following the outbreak of coronavirus disease 2019 (COVID-19), a disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the field of liver transplantation, along with many other aspects of healthcare, underwent drastic changes. Despite an initial increase in waitlist mortality and a decrease in both living and deceased donor liver transplantation rates, through the implementation of a series of new measures, the transplant community was able to recover by the summer of 2020. Changes in waitlist prioritization, the gradual implementation of telehealth, and immunosuppressive regimen alterations amidst concerns regarding more severe disease in immunocompromised patients, were among the changes implemented in an attempt by the transplant community to adapt to the pandemic. More recently, with the advent of the Pfizer BNT162b2 vaccine, a powerful new preventative tool against infection, the pandemic is slowly beginning to subside. The pandemic has certainly brought transplant centers around the world to their limits. Despite the unspeakable tragedy, COVID-19 constitutes a valuable lesson for health systems to be more prepared for potential future health crises and for life-saving transplantation not to fall behind.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 9","pages":"288-298"},"PeriodicalIF":0.0,"publicationDate":"2022-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ff/03/WJT-12-288.PMC9516488.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390916","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":"Vitamin D deficiency may predispose patients to increased risk of kidney transplant rejection.","authors":"Semih Buyukdemirci,&nbsp;Ebru Gok Oguz,&nbsp;Sanem Guler Cimen,&nbsp;Hatice Sahin,&nbsp;Sertac Cimen,&nbsp;Mehmet Deniz Ayli","doi":"10.5500/wjt.v12.i9.299","DOIUrl":"https://doi.org/10.5500/wjt.v12.i9.299","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D deficiency occurs in more than 80% of kidney transplant recipients. Its immunomodulatory effects can predispose transplant recipients to rejection and chronic allograft nephropathy (CAN). This study determined the association between serum 25 (OH) vitamin D, biopsy-proven allograft rejection, and CAN rates.</p><p><strong>Aim: </strong>To determine the relationship between serum 25 (OH) vitamin D level and biopsy-proven allograft rejection and CAN rate in renal transplant recipients.</p><p><strong>Methods: </strong>Adult renal transplant recipients followed at the clinic between January 2013 and 2018 were included. Recipients requiring graft biopsy due to declined function, hematuria, and proteinuria were reviewed. The two groups were compared regarding collected data, including the biopsy results, immunologic parameters, vitamin D, parathyroid hormone (PTH), phosphorus, albumin levels, and graft function tests.</p><p><strong>Results: </strong>Fifty-two recipients who underwent graft biopsy met the inclusion criteria. In all, 14 recipients had a vitamin D level > 15 ng/mL (group 1) <i>vs</i> ≤ 15 ng/mL (group 2) in 38. In total, 27 patients had biopsy-proven rejection, and 19 had CAN. There was only 1 recipient with biopsy-proven rejection in group 1, whereas there were 24 patients with rejection in group 2. The rejection rate was significantly higher in group 2 than in group 1 (<i>P</i> < 0.001). Four patients were diagnosed with CAN in group 1 <i>vs</i> fifteen in group 2. There was no significant difference in the CAN rate between the two groups. PTH was higher at the time of graft biopsy (<i>P</i> = 0.009, <i>P</i> = 0.022) in group 1 with a mean of 268 pg/mL. Donor-specific antibodies were detected in 14 (56.0%) of the recipients with rejection. Vitamin D level was 9.7 ± 3.4 ng/mL in the rejection group <i>vs</i> 14.7 ± 7.2 in the non-rejection group; this difference was statistically significant (<i>P</i> = 0.003). The albumin levels were significantly lower in patients with rejection than in those without rejection (<i>P</i> = 0.001). In univariate regression analysis of risk factors affecting rejection, sex, serum vitamin D, phosphorus and albumin were found to have an impact (<i>P</i> = 0.027, <i>P</i> = 0.007, <i>P</i> = 0.023, <i>P</i> = 0.008). In multivariate regression analysis, the same factors did not affect rejection.</p><p><strong>Conclusion: </strong>The serum 25 (OH) vitamin D level in kidney transplant recipients remained low. Although low serum vitamin D level emerged as a risk factor for rejection in univariate analysis, this finding was not confirmed by multivariate analysis. Prospective studies are required to determine the effect of serum vitamin D levels on allograft rejection.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 9","pages":"299-309"},"PeriodicalIF":0.0,"publicationDate":"2022-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/33/WJT-12-299.PMC9516489.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390918","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":"Kidney disease in non-kidney solid organ transplantation.","authors":"Kurtis J Swanson","doi":"10.5500/wjt.v12.i8.231","DOIUrl":"https://doi.org/10.5500/wjt.v12.i8.231","url":null,"abstract":"<p><p>Kidney disease after non-kidney solid organ transplantation (NKSOT) is a common post-transplant complication associated with deleterious outcomes. Kidney disease, both acute kidney injury and chronic kidney disease (CKD) alike, emanates from multifactorial, summative pre-, peri- and post-transplant events. Several factors leading to kidney disease are shared amongst solid organ transplantation in addition to distinct mechanisms unique to individual transplant types. The aim of this review is to summarize the current literature describing kidney disease in NKSOT. We conducted a narrative review of pertinent studies on the subject, limiting our search to full text studies in the English language. Kidney disease after NKSOT is prevalent, particularly in intestinal and lung transplantation. Management strategies in the peri-operative and post-transplant periods including proteinuria management, calcineurin-inhibitor minimization/ sparing approaches, and nephrology referral can counteract CKD progression and/or aid in subsequent kidney after solid organ transplantation. Kidney disease after NKSOT is an important consideration in organ allocation practices, ethics of transplantation. Kidney disease after SOT is an incipient condition demanding further inquiry. While some truths have been revealed about this chronic disease, as we have aimed to describe in this review, continued multidisciplinary efforts are needed more than ever to combat this threat to patient and allograft survival.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 8","pages":"231-249"},"PeriodicalIF":0.0,"publicationDate":"2022-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/8f/WJT-12-231.PMC9453292.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33485217","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":"Trends and outcomes of liver transplantation among older recipients in the United States.","authors":"Kenji Okumura,&nbsp;Joon Sub Lee,&nbsp;Abhay Dhand,&nbsp;Hiroshi Sogawa,&nbsp;Gregory Veillette,&nbsp;Devon John,&nbsp;Ryosuke Misawa,&nbsp;Roxana Bodin,&nbsp;David C Wolf,&nbsp;Thomas Diflo,&nbsp;Seigo Nishida","doi":"10.5500/wjt.v12.i8.259","DOIUrl":"https://doi.org/10.5500/wjt.v12.i8.259","url":null,"abstract":"<p><strong>Background: </strong>The average age of recipients and donors of liver transplantation (LT) is increasing. Although there has been a change in the indications for LT over the years, data regarding the trends and outcomes of LT in the older population is limited.</p><p><strong>Aim: </strong>To assess the clinical characteristics, age-related trends, and outcomes of LT among the older population in the United States.</p><p><strong>Methods: </strong>We analyzed data from the United Network for Organ Sharing database between 1987-2019. The sample was split into younger group (18-64 years old) and older group (≥ 65 years old).</p><p><strong>Results: </strong>Between 1987-2019, 155758 LT were performed in the United States. During this period there was a rise in median age of the recipients and percentage of LT recipients who were older than 65 years increased (<i>P</i> < 0.05) with the highest incidence of LT among older population seen in 2019 (1920, 23%). Common primary etiologies of liver disease leading to LT in older patients when compared to the younger group, were non-alcoholic steatohepatitis (16.4% <i>vs</i> 5.9%), hepatocellular carcinoma (14.9% <i>vs</i> 6.9%), acute liver failure (2.5% <i>vs</i> 5.2%), hepatitis C cirrhosis (HCV) (19.2 % <i>vs</i> 25.6%) and acute alcoholic hepatitis (0.13% <i>vs</i> 0.35%). In older recipient group female sex and Asian race were higher, while model for end-stage liver disease (MELD) score and rates of preoperative mechanical ventilation were lower (<i>P</i> < 0.01). Median age of donor, female sex, body mass index (BMI), donor HCV positive status, and donor risk index (DRI) were significantly higher in older group (<i>P</i> < 0.01). In univariable analysis, there was no difference in post-transplant length of hospitalization, one-year, three-year and five-year graft survivals between the two groups. In multivariable Cox-Hazard regression analysis, older group had an increased risk of graft failure during the five-year post-transplant period (hazard ratio: 1.27, <i>P</i> < 0.001). Other risk factors for graft failure among recipients were male sex, African American race, re-transplantation, presence of diabetes, mechanical ventilation at the time of LT, higher MELD score, presence of portal vein thrombosis, HCV positive status, and higher DRI.</p><p><strong>Conclusion: </strong>While there is a higher risk of graft failure in older recipient population, age alone should not be a contraindication for LT. Careful selection of donors and recipients along with optimal management of risk factors during the postoperative period are necessary to maximize the transplant outcomes in this population.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"12 8","pages":"259-267"},"PeriodicalIF":0.0,"publicationDate":"2022-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/bb/WJT-12-259.PMC9453296.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33485216","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}