OBM transplantation最新文献

{"title":"Duration of Hospitalization is Associated with the Gut Microbiome in Patients Undergoing Hematopoietic Stem Cell Transplantation: Early Results from a Randomized Trial of Home Versus Hospital Transplantation.","authors":"Tessa M Andermann, Ke Zeng, Sayal Guirales-Medrano, Adam Groth, Bhanu C Ramachandran, Shan Sun, Alicia A Sorgen, Lauren Hill, Amy T Bush, Hongwei Liu, Corbin Jones, Jeffrey Roach, Brian P Conlon, Gauri Rao, Nelson J Chao, Anthony A Fodor, Anthony D Sung","doi":"10.21926/obm.transplant.2503255","DOIUrl":"10.21926/obm.transplant.2503255","url":null,"abstract":"<p><p>Home-based hematopoietic stem cell transplantation (HCT) is an innovative care model with growing interest, but its impact on the gut microbiome remains unexplored in a randomized setting. We present interim results from the first randomized controlled trials (RCT) evaluating the effect of HCT location-home versus hospital-on gut microbial diversity and antimicrobial resistance (AMR) gene carriage. We hypothesize that patients randomized to undergo home HCT would have higher gut taxonomic diversity and lower AMR gene abundance compared to those undergoing standard hospital HCT. We analyzed stool samples from the first 28 patients enrolled in ongoing Phase II RCTs comparing home (n = 16) and hospital (n = 12) HCT at Duke University using shotgun metagenomic sequencing to compare taxa and AMR gene composition between groups. We also performed a secondary analysis comparing patients who received transplants at outpatient infusion clinics versus inpatient standard HCT to evaluate the influence of hospitalization duration. In the primary RCT analysis, taxonomic and AMR gene α- and β-diversity were comparable between home and hospital groups, reflecting similar durations of hospitalization despite group allocation. In contrast, secondary analyses demonstrated that patients transplanted in outpatient infusion clinics who experienced significantly reduced hospitalization had higher gut taxonomic α-diversity and differential β-diversity, although AMR gene diversity remained unchanged. In summary, randomization by transplant location did not impact the gut microbiota to the same extent as the duration of hospitalization, although secondary analyses were heavily confounded. Even when taxonomic differences were observed, AMR genes were similar between groups. This RCT represents a novel investigation into how care setting influences the gut microbiome during HCT. Our findings suggest that hospital duration, rather than randomization allocation alone, is the primary driver of microbial disruption. These results underscore the potential for reducing hospital duration to mitigate microbiome injury, thereby informing future interventions to reduce infection risk and improve patient outcomes.</p>","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330939","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":"BK Virus-Associated Nephropathy in Adult Patients Post Kidney Transplantation: What Progress in 30 Years of History?","authors":"Yassamine Bentata","doi":"10.21926/obm.transplant.2403221","DOIUrl":"https://doi.org/10.21926/obm.transplant.2403221","url":null,"abstract":"Completely unknown before the 90s and exceptional up to the 2000s, BK virus nephropathy (BKvN), usually known as polyomavirus-associated nephropathy, has emerged as a significant and severe viral complication in kidney transplantation (KT). More than twenty years after Gardner's discovery of BKv in 1971, Purighalla described, in 1995, the first case of BKvN. Four years later in 1999, Nickeleit et al. published a first series of five cases of BKvN and made very precious and pertinent contributions to understanding this new entity. It has been well established that in post-KT, 30 to 50% of kidney transplant recipients are positive for BK viruria, of whom approximately one-third will develop BK viremia and, without intervention, could progress in 1 to 10% of cases to BKvN, leading to kidney graft failure in more than half of the cases. For now, there is no preventive antiviral treatment for BKvN; only a strategy of rapid, efficient screening allows for the preservation of renal graft function. The only effective and sure treatment measure is to reduce the intensity of total immunosuppression, including immunosuppressive drugs and corticosteroids. Based on the current data, this review describes the physiopathology, diagnosis, and management of BKvN in adult KTRs. It presents the results of the fifty most important studies published during the last two decades.","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":"25 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141804510","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":"Impact of Intravenous Immunoglobulin Replacement Therapy on Hypogammaglobulinemia and Infection in Lung Transplant Recipients","authors":"Van Anh Vu, Joelle Nelson, Helen Sweiss, Reed Hall, Holly Keyt, Elisabeth Kincaide","doi":"10.21926/obm.transplant.2403220","DOIUrl":"https://doi.org/10.21926/obm.transplant.2403220","url":null,"abstract":"Secondary hypogammaglobulinemia (HGG) from immunosuppression therapy in lung transplant recipients has been associated with increased mortality, morbidity and higher risk of infection. Intravenous immunoglobulin (IVIG) for the treatment of HGG post-lung transplant is not well studied with conflicting evidence regarding efficacy. This single-center, retrospective cohort study analyzed adult lung transplant recipients with HGG receiving ≥1 dose of IVIG 0.3-0.5 g/kg. Resolution of HGG (IgG > 600 mg/dL within 30 days of IVIG) was evaluated for optimal dose and duration of IVIG therapy. Incidence of infection, patient survival, rejection, and chronic lung allograft dysfunction-free survival at 1 year were compared between resolved and persistent HGG. Results demonstrated majority of patients 46/58 (79.3%) achieved HGG resolution. Severe HGG (IgG < 400 mg/dL) was significantly associated with persistent HGG (50.5% vs 15.2%, p = 0.02), with comparable cumulative IVIG dose and duration between both groups (p = 0.96 and p = 0.39, respectively). No other variables correlated with HGG resolution. Overall infection rates were similar between groups (69.6% vs 58.3%, p = 0.50), suggesting HGG resolution did not correlate with incidence of infection. Lastly, use of IVIG for the treatment of HGG appears to be safe with minimal incidence of thrombosis found within each group.","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":"104 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141683496","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":"Management of Calcareous Corneal Degeneration from Medication Washout to Corneal Transplantation. Case Series and Review of the Literature","authors":"Filippo Lixi, Benedetta Pintus, Giuseppe Giannaccare","doi":"10.21926/obm.transplant.2402218","DOIUrl":"https://doi.org/10.21926/obm.transplant.2402218","url":null,"abstract":"Calcareous corneal degeneration is a rare disease characterized by calcium phosphate deposition into the deep corneal layers. Corneal calcification has a multifactorial origin and is associated with various systemic and ocular conditions. Several treatment options showed promising results in the management of this disorder. Herein, two cases of calcareous degeneration occurring postoperatively in patients undergoing surgery for retinal detachment (case #1) and glaucoma (case #2) were reported. Despite normal serum calcium and phosphate levels, the patients developed corneal calcification after using topical steroid-phosphate drops. Treatment involved discontinuation of topical therapy and substitution with unpreserved phosphate-free lubricants. While case #1 resolved with conservative measures, which allowed a satisfactory visual recovery, case #2 required superficial keratectomy due to refractory calcification. Therefore, a correct diagnosis, careful lesion analysis, and tailored management are advisable in corneal calcification, with conservative measures being effective in most cases. At the same time, surgical intervention is necessary in refractory or advanced diseases.","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141372077","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":"Circulating lncRNAs HOTTIP and HOTAIR as Potential Biomarkers in Crigler-Najjar Syndrome: A Preliminary Report from Shiraz Liver Transplant Research Center","authors":"N. Motazedian, Masoud Mokhtari, Negar Azarpira, Kimia Falamarzi, Mohsen Mohammadi, S. Dehghani, Sarina Pourjafar, Maryam Ataollahi, Elaheh Esfandiari, Mahdokht Hossein-Aghdaie, S. Malekhosseini, Tayebeh Kazemi, Mahintaj Dara","doi":"10.21926/obm.transplant.2402217","DOIUrl":"https://doi.org/10.21926/obm.transplant.2402217","url":null,"abstract":"Crigler-Najjar syndrome (CNS) is a rare autosomal recessive disorder characterized by impaired bilirubin metabolism, leading to neurotoxic unconjugated bilirubin accumulation. Liver transplantation remains the only effective treatment, highlighting the need for novel diagnostic and therapeutic approaches. Long non-coding RNAs (lncRNAs) have emerged as potential biomarkers in various diseases, including cancer. This study aimed to evaluate the expression of lncRNAs HOTTIP and HOTAIR in CNS patients and healthy controls, exploring their potential as non-invasive diagnostic tools. Serum samples from CNS patients (n = 6) and healthy controls (n = 26) were analyzed using quantitative real-time polymerase chain reaction. While both lncRNAs showed decreased expression in CNS patients compared to controls, the differences were not statistically significant. However, receiver operating characteristic curve analysis revealed promising diagnostic performances for both lncRNAs. Correlations between lncRNA expression and clinical parameters were explored, revealing potential associations with disease progression. Overall, this study provides preliminary insights into the role of lncRNAs HOTTIP and HOTAIR in CNS and underscores the need for further research to validate their utility as biomarkers and therapeutic targets in this rare disorder.","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":"67 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141387178","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":"Is Donation after Circulatory Determination of Death in Japan Uncontrolled or Controlled?","authors":"Tatsuya Kin, Hirofumi Noguchi, Atsushi Kawaguchi","doi":"10.21926/obm.transplant.2402216","DOIUrl":"https://doi.org/10.21926/obm.transplant.2402216","url":null,"abstract":"Using donation after circulatory determination of death (DCD) donors has been shown to be a potential means of increasing the number of donors for organ transplantation. The purpose of this study was to examine the published practice of DCD in Japan to properly define their practice as controlled or uncontrolled. Through the Web of Science database, we systematically searched articles describing uncontrolled DCD, controlled DCD or Maastricht classification. A total of 12 articles (ten articles related to kidney, one to pancreas, another to islet transplantation), which were published between 1999 and 2023 from Japanese institutes, were eligible for our study. Systematic review revealed that most DCD in Japan occurs when a terminally ill patient undergoes an expected cardiac arrest without rapid discontinuation from a ventilator, and in some cases with premortem interventions such as cannulation to the femoral vessels. Surprisingly, these DCD donors in Japan have been categorized as uncontrolled DCD. This categorization confuses the donation and transplantation community globally because the international consensus is that uncontrolled DCD occurs after an unexpected cardiac arrest. Further clear definition of terminology would be required within Japan as well as other countries practicing uncontrolled DCD.","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":"55 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141272334","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":"Advances in Managing Infections in Lung Transplantation: A Review","authors":"Shourjo Chakravorty, Ashka Patel","doi":"10.21926/obm.transplant.2402215","DOIUrl":"https://doi.org/10.21926/obm.transplant.2402215","url":null,"abstract":"Transplanted lung allografts are particularly susceptible to infection among SOT due to the constant exposure to the environment, aggressive immunosuppressive strategies, and impaired clearance mechanisms after denervation of the transplanted lung. Though prophylactic antimicrobial, antifungal, and antiviral regimens are used as preventive strategies to mitigate the risk of infection, complications related to allograft infection remain one of the primary causes of morbidity and mortality after lung transplantation. Here we will review the common bacterial, viral, and fungal complications after lung transplantation, and discuss some newer agents and treatment strategies that have been implemented recently.","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":" 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140993502","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":"Frequency of Unplanned Readmissions Following Lung Transplantation During the SAR-COV-2 Pandemic When Hospital Resources Were Strained","authors":"Justin Cole, E. Golts, Michael Bernales, Dina Shirazi, Deepa Kurup, S. Golts, Gordon Yung, A. Kafi, Christine M. Lin, Travis Pollema, Kamyar Afshar","doi":"10.21926/obm.transplant.2402214","DOIUrl":"https://doi.org/10.21926/obm.transplant.2402214","url":null,"abstract":"Despite the concerted efforts by lung transplant recipients (LTR) and their medical teams, hospital readmissions are common in the first year following transplantation. Reasons for unplanned readmissions include allograft rejection, infections, and respiratory failure before the SARS-COV-2 pandemic. Clinical predictors of readmissions have changed over time with the higher risk factors of acceptable criteria for recipients and donors. We aimed to assess more recent readmission rates based on group classifications to better understand specific groups that are at risk for various readmissions during the SARS-COV-2 pandemic when hospital resources were strained. A retrospective analysis for LTR at UCSD was performed from 1/1/2018 to 6/30/2022. We recorded the baseline demographics; LAS at the time of lung transplant; mechanical ventilation prior to lung transplant; the need for VV-or VA-ECMO prior to or after lung transplantation; categories for UNOS listing (groups A, B, C, D); PGD grade 3 based on the ISHLT definition; and acquisition of serious donor-derived infections. We recorded the primary reason for all the readmissions and the duration of admission. Descriptive statistics were used for the analysis of this 4.5-year patient cohort. 149 LT were performed. 29 were single LTR while 120 were bilateral LTR. Median age of 57 years, 63 patients (42%) were female. Indications for transplantation included 28 (19%) group A, 19 (13%) group B, 12 (8%) group C, and 90 (60%) group D. The median length of follow-up following lung transplant was 1.7 years. Collectively, there were 73 patients (49%) that required readmissions. On average, there are 2.5 readmissions per patient for our cohort. Most common reasons for unplanned readmission included infections, transplant-related (transplant rejection, other complications of transplant, etc.), and GI Related. This was primarily seen in the group D cohort. The median hospital LOS at readmission was 3.8 days (4 hours to 34.6 days). Despite infection being the leading cause of readmission, only 11 cases were related to COVID-19 infection. No death occurred with a readmission. Groups B and D appear to be at a higher risk for readmission, irrespective of the pre-LT LAS and need for mech vent or VV-ECMO.","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141001214","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":"Contribution of a Single Islet Transplant Program to Basic Researchers in North America, Europe, and Asia through Distributing Human Islets","authors":"Tatsuya Kin, D. O’Gorman, Wendy Zhai, Jennifer Moriarty, Kyle Park, Advaita Ganguly, S. Rosichuk, AM James Shapiro","doi":"10.21926/obm.transplant.2402212","DOIUrl":"https://doi.org/10.21926/obm.transplant.2402212","url":null,"abstract":"There has been a steady expansion in islet isolation and transplantation activity worldwide. In addition to preparing human islets for transplantation, we have been providing human islets to basic researchers. The aim of this study was to review the activity of distribution of human islets to basic researchers in North America, Europe, and Asia, and to investigate if there are any differences in utilization rate of islets among three continents. We reviewed our islet isolation batch files, donor records, and documents related to shipping from 2007 to 2023. We have distributed islets to a total of 49 researchers (11 at the University of Alberta campus, 21 in North America, 7 in Europe, 10 in Asia). The yearly average [±SD] of islets distributed was 6,607,443 [±1,782,547] islet equivalents obtained from 28 [±5] pancreases, resulting in 230 [±88] shipments. Standard delivery to Europe or Asia takes at least 2 days whereas researchers in North America receive islets the next day. On top of this fact, we found that delayed delivery occurred more often in Asia (31.9%, 201/631 shipments) and Europe (30.8%, 134/435) than in North America (6.8%, 114/1682). Interestingly, the utilization rate of islets within delayed deliveries was highest in Asia (91.5%, 184/201) followed by Europe (83.6%, 112/134) and North America (77.2%, 88/114). There were disparities in the frequency of delayed deliveries and in the utilization rate among three continents. Our program with a 17-year track record has been actively distributing human islets to researchers in three continents.","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":"47 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667366","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":"Thrombotic Microangiopathy in Solid Organ Transplantation","authors":"S. Nandavaram, Hannah Twist, Rickey Evans, Sravanthi Paluri, Ana Castellanos, Andres Pelaez","doi":"10.21926/obm.transplant.2402211","DOIUrl":"https://doi.org/10.21926/obm.transplant.2402211","url":null,"abstract":"Thrombotic Microangiopathy (TMA) is a syndrome characterized by microangiopathic hemolytic anemia (MAHA) and thrombocytopenia. The presence of schistocytes on peripheral smear, a negative Coombs test, elevated lactate dehydrogenase, increased reticulocyte count and low haptoglobin are often the clues for MAHA. The microvascular process often targets vasculature in kidneys, brain, gastrointestinal system, heart, and skin. A timely diagnosis and treatment are often crucial to prevent severe end organ damage and death. TMA is classified into primary and secondary forms. Primary TMA includes TTP and complement mediated or atypical hemolytic uremic syndrome (aHUS), often related to a mutation or deficiency and clinically expressed in the setting of a precipitant condition. Secondary TMA is a manifestation of underlying disorder and can occur in clinical scenarios associated with autoimmune disease, malignancy, infections, SOT (Solid Organ Transplant), pregnancy, HSCT (Hematopoietic Stem Cell Transplantation), medications, or methylmalonic acidemia. Transplant associated TMA (TA-TMA) can be complement mediated or aHUS and could be related to the ischemic reperfusion injury, induction regimen, calcineurin inhibitor (CNI) use, mammalian target of rapamycin (MTOR) inhibitor use, or could be infection related. Cost, access, and turnaround time are often the limitations for certain TTP and complement specific testing. Treatment should not be delayed while waiting for such tests. Treatment must be individualized based on the underlying cause of TMA. Terminal complement blockade utilizing monoclonal antibodies directed against C5 complement is the treatment for complement mediated TMA. C5 inhibitors have also been used successfully in treatment of secondary HUS cases where, unlike aHUS, defects in complement cannot be demonstrated. Such treatment has demonstrated improvement in renal function, MAHA and platelet counts.","PeriodicalId":92826,"journal":{"name":"OBM transplantation","volume":"288 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719834","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}