Tayseer Shamaa, Iman Bajjoka, Rohini Prashar, Matthew Callaghan, Salvatore Serra, Marwan Abouljoud, Jason Denny
Thirty-seven million adult Americans have chronic kidney disease with African Americans are significantly more likely to develop end-stage renal disease (ESRD) compared to other racial groups. Donor App was designed to help kidney transplant candidates (KTCs) identify potential living donors (LDs) by creating social media postings about their need for transplant. The purpose of this study is to evaluate the feasibility of using Donor App in improving awareness about living organ donation and rates of living donor kidney transplantation (LDKT). LD inquiries and transplant outcomes were compared between KTCs who used the Donor App with 1:3 matched historic controls from our center's waitlist. Forty-nine KTCs posted their stories using Donor App. The total views on all platforms and patients were 11 881. Ninety-three potential LD inquiries came on behalf of 26/49 KTCs (53%). KTCs with at least one potential LD inquiry were likely to have at least one donor champion (p = 0.01), used multiple social media outlets (p = 0.003), and had significantly higher median views versus candidates without inquiries (263 [interquartile range (IQR): 117–624] vs. 42 [IQR: 15–96], respectively; p < 0.001). To date, three underwent transplants (two LDKTs and one deceased direct donation). None of the matched controls had any potential LD inquiries (p = 0.01). The Donor App can significantly increase awareness and rate of living organ donation.
{"title":"Donor App Increases Awareness and Overall Living Kidney Organ Donation","authors":"Tayseer Shamaa, Iman Bajjoka, Rohini Prashar, Matthew Callaghan, Salvatore Serra, Marwan Abouljoud, Jason Denny","doi":"10.1111/ctr.70118","DOIUrl":"https://doi.org/10.1111/ctr.70118","url":null,"abstract":"<div>\u0000 \u0000 <p>Thirty-seven million adult Americans have chronic kidney disease with African Americans are significantly more likely to develop end-stage renal disease (ESRD) compared to other racial groups. Donor App was designed to help kidney transplant candidates (KTCs) identify potential living donors (LDs) by creating social media postings about their need for transplant. The purpose of this study is to evaluate the feasibility of using Donor App in improving awareness about living organ donation and rates of living donor kidney transplantation (LDKT). LD inquiries and transplant outcomes were compared between KTCs who used the Donor App with 1:3 matched historic controls from our center's waitlist. Forty-nine KTCs posted their stories using Donor App. The total views on all platforms and patients were 11 881. Ninety-three potential LD inquiries came on behalf of 26/49 KTCs (53%). KTCs with at least one potential LD inquiry were likely to have at least one donor champion (<i>p</i> = 0.01), used multiple social media outlets (<i>p</i> = 0.003), and had significantly higher median views versus candidates without inquiries (263 [interquartile range (IQR): 117–624] vs. 42 [IQR: 15–96], respectively; <i>p</i> < 0.001). To date, three underwent transplants (two LDKTs and one deceased direct donation). None of the matched controls had any potential LD inquiries (<i>p</i> = 0.01). The Donor App can significantly increase awareness and rate of living organ donation.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan E. Williams, John M. Trahanas, Jacob A. Klapper, Caitlin Demarest, Kiran H. Lagisetty, Andrew C. Chang, Dennis M. Lyu, David D. Odell, Matthew D. Bacchetta, Aaron M. Williams
Introduction
Use of normothermic regional perfusion (NRP) to recover donation after circulatory death (DCD) organs demonstrates increased heart utilization with favorable outcomes. Conversely, DCD lung allograft use when NRP was employed remains controversial. This is a contemporary analysis of DCD lung recipient outcomes in which NRP was used.
Methods
Utilizing the STAR-OPTN database, all adult DCD lung recipients in the United States between January 1, 2020, and June 30, 2024 were identified. NRP use was defined if the time between donor death and aortic clamp time was greater than 30 min. Recipient outcomes, including 30-, 60-, and 90-day mortality, grade-3 primary graft dysfunction (PGD), and postoperative length of stay were compared using multivariable logistic regression controlling for donor and recipient covariates. Survival analysis was performed using Cox proportional hazard modeling.
Results
Of 987 DCD lung transplants, 92 (9.4%) utilized NRP. There were no differences in recipient characteristics between direct recovery and NRP cohorts. No difference in 30-, 60-, or 90-day mortality, grade-3 PGD, or length of stay was found between cohorts. 12-month survival was equivalent.
Conclusions
Outcomes between NRP lung recipients were equivalent to DCD direct recovery recipients. Thus, donor lungs may be considered for transplantation following NRP donation procedures.
{"title":"Use of Normothermic Regional Perfusion in Circulatory Death Donors for Lung Transplantation in the United States","authors":"Jonathan E. Williams, John M. Trahanas, Jacob A. Klapper, Caitlin Demarest, Kiran H. Lagisetty, Andrew C. Chang, Dennis M. Lyu, David D. Odell, Matthew D. Bacchetta, Aaron M. Williams","doi":"10.1111/ctr.70135","DOIUrl":"https://doi.org/10.1111/ctr.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Use of normothermic regional perfusion (NRP) to recover donation after circulatory death (DCD) organs demonstrates increased heart utilization with favorable outcomes. Conversely, DCD lung allograft use when NRP was employed remains controversial. This is a contemporary analysis of DCD lung recipient outcomes in which NRP was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Utilizing the STAR-OPTN database, all adult DCD lung recipients in the United States between January 1, 2020, and June 30, 2024 were identified. NRP use was defined if the time between donor death and aortic clamp time was greater than 30 min. Recipient outcomes, including 30-, 60-, and 90-day mortality, grade-3 primary graft dysfunction (PGD), and postoperative length of stay were compared using multivariable logistic regression controlling for donor and recipient covariates. Survival analysis was performed using Cox proportional hazard modeling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 987 DCD lung transplants, 92 (9.4%) utilized NRP. There were no differences in recipient characteristics between direct recovery and NRP cohorts. No difference in 30-, 60-, or 90-day mortality, grade-3 PGD, or length of stay was found between cohorts. 12-month survival was equivalent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Outcomes between NRP lung recipients were equivalent to DCD direct recovery recipients. Thus, donor lungs may be considered for transplantation following NRP donation procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julie Olabe, Cyril Garrouste, Bruno Pereira, Charlotte Colosio, Antoine Thierry, Jean-Philippe Rerolle, Dominique Bertrand, Maïté Jaureguy, Léonard Goblin, Mathias Buchler, Yannick Le Meur, Valerie Chatelet, Jean-François Augusto, Igor Tauveron, Marie Batisse-Lignier, Anne Elizabeth Heng, ASTRE Study group
Background and Hypothesis
Post-transplant diabetes mellitus (PTDM) is a common, dynamic complication after kidney transplantation (KT) that may resolve over time. To better understand and prevent PTDM, we analyzed its prevalence, evolution, and influencing factors.
Methods
Data from the French national ASTRE database at different post-transplantation periods (P) were analyzed. PTDM was defined by fasting blood glucose (FBG) ≥1.26 g/L, HbA1c ≥ 6.5%, or the use of hypoglycemic medications in kidney transplant recipients without diabetes. Patient trajectories were identified using group-based trajectory models (GBTM), and associated factors were examined.
Results
Among 2898 patients, PTDM prevalence was 27.3% at P1 (>M2, ≤M6), 21.3% at P2 (>M6, ≤M18), 19.8% at P3 (>M18, ≤M30), and 19.9% at P4 (>M30, ≤M42). Analysis of 1825 patients identified four trajectories: no PTDM (67%), late-onset PTDM (6%), remission after P1 (10%), and early, persistent PTDM (17%). Late-onset PTDM was linked to history of cardiovascular disease, higher BMI at transplantation, HCV positive status, and weight gain. Early, persistent PTDM was associated with older age, higher BMI, HVC positive status, history of cardiovascular disease, and tacrolimus use. PTDM remission was linked to lower BMI. Corticosteroids contributed to both late-onset and persistent PTDM, while switching between tacrolimus and cyclosporine did not significantly affect progression.
Conclusion
This study confirmed the high prevalence and dynamic nature of PTDM after transplantation, emphasizing the critical role of pretransplant cardiovascular disease, BMI, and early post-transplant weight gain in the onset or remission of PTDM.
{"title":"Innovative Trajectory Analysis Reveals Dynamics and Risk Factors of Post-Kidney Transplant Diabetes Mellitus in a French Cohort","authors":"Julie Olabe, Cyril Garrouste, Bruno Pereira, Charlotte Colosio, Antoine Thierry, Jean-Philippe Rerolle, Dominique Bertrand, Maïté Jaureguy, Léonard Goblin, Mathias Buchler, Yannick Le Meur, Valerie Chatelet, Jean-François Augusto, Igor Tauveron, Marie Batisse-Lignier, Anne Elizabeth Heng, ASTRE Study group","doi":"10.1111/ctr.70116","DOIUrl":"https://doi.org/10.1111/ctr.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Hypothesis</h3>\u0000 \u0000 <p>Post-transplant diabetes mellitus (PTDM) is a common, dynamic complication after kidney transplantation (KT) that may resolve over time. To better understand and prevent PTDM, we analyzed its prevalence, evolution, and influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the French national ASTRE database at different post-transplantation periods (P) were analyzed. PTDM was defined by fasting blood glucose (FBG) ≥1.26 g/L, HbA1c ≥ 6.5%, or the use of hypoglycemic medications in kidney transplant recipients without diabetes. Patient trajectories were identified using group-based trajectory models (GBTM), and associated factors were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2898 patients, PTDM prevalence was 27.3% at P1 (>M2, ≤M6), 21.3% at P2 (>M6, ≤M18), 19.8% at P3 (>M18, ≤M30), and 19.9% at P4 (>M30, ≤M42). Analysis of 1825 patients identified four trajectories: no PTDM (67%), late-onset PTDM (6%), remission after P1 (10%), and early, persistent PTDM (17%). Late-onset PTDM was linked to history of cardiovascular disease, higher BMI at transplantation, HCV positive status, and weight gain. Early, persistent PTDM was associated with older age, higher BMI, HVC positive status, history of cardiovascular disease, and tacrolimus use. PTDM remission was linked to lower BMI. Corticosteroids contributed to both late-onset and persistent PTDM, while switching between tacrolimus and cyclosporine did not significantly affect progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study confirmed the high prevalence and dynamic nature of PTDM after transplantation, emphasizing the critical role of pretransplant cardiovascular disease, BMI, and early post-transplant weight gain in the onset or remission of PTDM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xingjie Li, Yu-Hui Chang, Stephanie Y. Ohara, Kunam S. Reddy, Caroline C. Jadlowiec, Amit K. Mathur, Michelle C. Nguyen
Introduction
Donation after circulatory death (DCD) allografts are underutilized in liver transplantation (LT) due to increased risk of complications. These risks stem from ischemic injury sustained during the total donor warm ischemia time (tDWIT), historically limited to 30 min. Normothermic machine perfusion (NMP) can mitigate these risks and facilitate LT of DCD grafts with extended tDWIT. We aimed to compare outcomes of DCD allografts with extended tDWIT preserved on NMP versus static cold storage (SCS).
Methods
This single-center study included adult DCD LT with tDWIT ≥ 30 from 2019 to 2023. Outcomes of NMP and SCS were compared including EAD, IC, graft survival, and patient survival.
Results
Among 68 DCD LT with tDWIT ≥ 30, 64.7% (n = 44) were preserved with NMP and 35.3% (n = 24) with SCS. No differences in donor or recipient demographics were observed. The median tDWIT was 33 min for NMP and 30.5 min for SCS (p < 0.01). Despite longer tDWIT, the NMP group had lower rates of EAD (4.5% vs. 66.7%, p < 0.01) and IC (2.3% vs. 29.2%, p < 0.01). One-year graft survival was higher in NMP (p < 0.01), and 1-year patient survival was comparable between groups (p = 0.18).
Conclusion
NMP challenges traditional tDWIT constraints and can increase the pool of viable DCD allografts for transplantation.
{"title":"Normothermic Machine Perfusion Improves Outcomes for Donation After Cardiac Death Allografts With Extended Donor Warm Ischemia Time","authors":"Xingjie Li, Yu-Hui Chang, Stephanie Y. Ohara, Kunam S. Reddy, Caroline C. Jadlowiec, Amit K. Mathur, Michelle C. Nguyen","doi":"10.1111/ctr.70133","DOIUrl":"https://doi.org/10.1111/ctr.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Donation after circulatory death (DCD) allografts are underutilized in liver transplantation (LT) due to increased risk of complications. These risks stem from ischemic injury sustained during the total donor warm ischemia time (tDWIT), historically limited to 30 min. Normothermic machine perfusion (NMP) can mitigate these risks and facilitate LT of DCD grafts with extended tDWIT. We aimed to compare outcomes of DCD allografts with extended tDWIT preserved on NMP versus static cold storage (SCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center study included adult DCD LT with tDWIT ≥ 30 from 2019 to 2023. Outcomes of NMP and SCS were compared including EAD, IC, graft survival, and patient survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 68 DCD LT with tDWIT ≥ 30, 64.7% (<i>n</i> = 44) were preserved with NMP and 35.3% (<i>n</i> = 24) with SCS. No differences in donor or recipient demographics were observed. The median tDWIT was 33 min for NMP and 30.5 min for SCS (<i>p</i> < 0.01). Despite longer tDWIT, the NMP group had lower rates of EAD (4.5% vs. 66.7%, <i>p</i> < 0.01) and IC (2.3% vs. 29.2%, <i>p</i> < 0.01). One-year graft survival was higher in NMP (<i>p</i> < 0.01), and 1-year patient survival was comparable between groups (<i>p</i> = 0.18).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NMP challenges traditional tDWIT constraints and can increase the pool of viable DCD allografts for transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yunda Wang, Joy Mohnot, Kanhua Yin, Nikola Dobrilovic, Yong Zhan
Background
This study aims to analyze the patient characteristics, clinical outcomes, and contemporary trends concerning type A aortic dissection (TAAD) in previous recipients of abdominal solid organ transplantation (ASOT) in the United States.
Methods
The National Inpatient Sample was queried to identify all patients aged ≥18 with TAAD and a history of ASOT (TAAD-ASOT) between 2002 and 2015Q3 using ICD-9 diagnosis and procedure codes. Baseline characteristics and in-hospital outcomes were compared between TAAD-ASOT patients and TAAD patients without a history of ASOT (TAAD-non-ASOT).
Results
We identified a weighted total of 71 061 TAAD patients. Among them, 346 (0.49%) were ASOT recipients; of these, 318 (91.9%) were kidney transplant recipients, and 28 (8.1%) were liver transplant recipients. There is an increasing trend in the incidence of TAAD among ASOT recipients over the study period (p-trend < 0.001). Compared to TAAD-non-ASOT patients, TAAD-ASOT patients were younger (54.7 vs. 60.7 years, p < 0.001), less likely to be White (53.8% vs. 69.1%, p = 0.008), and associated with a higher Charlson Comorbidity Index (3.79 vs. 2.26, p < 0.001). TAAD-ASOT patients also exhibited significantly higher in-hospital mortality (27.4% vs. 17.8%, p = 0.03) and a greater risk of renal complications (53.5% vs. 29.7%, p < 0.001). Multivariable analysis indicated that a history of ASOT was independently associated with an increased in-hospital mortality rate in TAAD patients (adjusted odds ratio = 1.83, 95% CI = 1.01–3.31, p = 0.04).
Conclusions
TAAD-ASOT patients were younger but presented a higher comorbidity burden, an elevated in-hospital mortality rate, and an increased risk of postoperative complications compared to TAAD-non-ASOT patients. The rising incidence and unfavorable outcomes emphasize the need for future preventative measures and enhancements in surgical outcomes.
{"title":"Type A Aortic Dissection Following Abdominal Solid Organ Transplantation: Population-Level Outcomes in the United States","authors":"Yunda Wang, Joy Mohnot, Kanhua Yin, Nikola Dobrilovic, Yong Zhan","doi":"10.1111/ctr.70130","DOIUrl":"https://doi.org/10.1111/ctr.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aims to analyze the patient characteristics, clinical outcomes, and contemporary trends concerning type A aortic dissection (TAAD) in previous recipients of abdominal solid organ transplantation (ASOT) in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The National Inpatient Sample was queried to identify all patients aged ≥18 with TAAD and a history of ASOT (TAAD-ASOT) between 2002 and 2015Q3 using ICD-9 diagnosis and procedure codes. Baseline characteristics and in-hospital outcomes were compared between TAAD-ASOT patients and TAAD patients without a history of ASOT (TAAD-non-ASOT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified a weighted total of 71 061 TAAD patients. Among them, 346 (0.49%) were ASOT recipients; of these, 318 (91.9%) were kidney transplant recipients, and 28 (8.1%) were liver transplant recipients. There is an increasing trend in the incidence of TAAD among ASOT recipients over the study period (p-trend < 0.001). Compared to TAAD-non-ASOT patients, TAAD-ASOT patients were younger (54.7 vs. 60.7 years, <i>p</i> < 0.001), less likely to be White (53.8% vs. 69.1%, <i>p</i> = 0.008), and associated with a higher Charlson Comorbidity Index (3.79 vs. 2.26, <i>p</i> < 0.001). TAAD-ASOT patients also exhibited significantly higher in-hospital mortality (27.4% vs. 17.8%, <i>p</i> = 0.03) and a greater risk of renal complications (53.5% vs. 29.7%, <i>p</i> < 0.001). Multivariable analysis indicated that a history of ASOT was independently associated with an increased in-hospital mortality rate in TAAD patients (adjusted odds ratio = 1.83, 95% CI = 1.01–3.31, <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TAAD-ASOT patients were younger but presented a higher comorbidity burden, an elevated in-hospital mortality rate, and an increased risk of postoperative complications compared to TAAD-non-ASOT patients. The rising incidence and unfavorable outcomes emphasize the need for future preventative measures and enhancements in surgical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143602451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Quentin Perrier, Alexandra Rose Monetti, Natalia Vladimirovn Sakhovskaya, Alejandra N. Mena Gutierrez, Amber Reeves-Daniel, William Doares, Christopher J. Webb, Robert J. Stratta, Giuseppe Orlando
{"title":"Safety and Efficacy of Belatacept in Pancreas Transplantation: A Case Series","authors":"Quentin Perrier, Alexandra Rose Monetti, Natalia Vladimirovn Sakhovskaya, Alejandra N. Mena Gutierrez, Amber Reeves-Daniel, William Doares, Christopher J. Webb, Robert J. Stratta, Giuseppe Orlando","doi":"10.1111/ctr.70131","DOIUrl":"https://doi.org/10.1111/ctr.70131","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miho Akabane, Yuki Imaoka, Toshihiro Nakayama, Carlos O. Esquivel, Kazunari Sasaki
Background
Renal function varies among liver transplantation (LT) candidates with the same Model for End-Stage Liver Disease (MELD)3.0 score. The impact of marginal grafts on post-LT renal function and prognosis varies based on the pre-LT renal function. We explored the effects of matching recipients with low renal function to marginal donors on graft survival (GS) and post-LT kidney function.
Methods
We analyzed data from the Scientific Registry of Transplant Recipients (SRTR), categorizing pre-LT renal function by estimated glomerular filtration rate (eGFR) into low (<30 mL/min/1.73 m2) and high (≥30 mL/min/1.73 m2). Marginal donors were defined by criteria including donation after cardiac death, age ≥ 65, severe macrosteatosis (≥30%), or body mass index ≥ 40 kg/m2. The primary outcome was to compare 3-year post-LT GS between patients with low and high pre-LT renal function. Additionally, we examined post-LT eGFR 1–3 months post-LT.
Results
Of 13 279 LT recipients, 12 851 had high pre-LT eGFR and 428 had low pre-LT eGFR. Kaplan–Meier survival analysis showed that recipients with low pre-LT eGFR had significantly lower 3-year GS compared to those with high eGFR (p < 0.01). Recipients of organs from marginal donors also exhibited a significant reduction in 3-year GS (p < 0.01). This adverse effect persisted within the same MELD3.0 category. Additionally, lower pre-LT eGFR was associated with an increased risk of post-LT kidney function deterioration, especially among those receiving grafts from marginal donors. Multivariable logistic regression identified recipient age > 65 as a significant risk factor for post-LT kidney function decline (OR 3.34 [1.05–10.7]; p = 0.03).
Discussion
GS was notably worse in recipients with low pre-LT eGFR, particularly when matched with marginal donors. A recipient age > 65 is a risk indicator for post-LT kidney function deterioration with marginal donors, underscoring the importance of careful donor-recipient matching, especially with compromised pre-LT kidney function.
{"title":"Exploring the Viability of Matching Marginal Donors With Low Renal Function Recipients in Liver Transplantation","authors":"Miho Akabane, Yuki Imaoka, Toshihiro Nakayama, Carlos O. Esquivel, Kazunari Sasaki","doi":"10.1111/ctr.70123","DOIUrl":"https://doi.org/10.1111/ctr.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Renal function varies among liver transplantation (LT) candidates with the same Model for End-Stage Liver Disease (MELD)3.0 score. The impact of marginal grafts on post-LT renal function and prognosis varies based on the pre-LT renal function. We explored the effects of matching recipients with low renal function to marginal donors on graft survival (GS) and post-LT kidney function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the Scientific Registry of Transplant Recipients (SRTR), categorizing pre-LT renal function by estimated glomerular filtration rate (eGFR) into low (<30 mL/min/1.73 m<sup>2</sup>) and high (≥30 mL/min/1.73 m<sup>2</sup>). Marginal donors were defined by criteria including donation after cardiac death, age ≥ 65, severe macrosteatosis (≥30%), or body mass index ≥ 40 kg/m<sup>2</sup>. The primary outcome was to compare 3-year post-LT GS between patients with low and high pre-LT renal function. Additionally, we examined post-LT eGFR 1–3 months post-LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 13 279 LT recipients, 12 851 had high pre-LT eGFR and 428 had low pre-LT eGFR. Kaplan–Meier survival analysis showed that recipients with low pre-LT eGFR had significantly lower 3-year GS compared to those with high eGFR (<i>p</i> < 0.01). Recipients of organs from marginal donors also exhibited a significant reduction in 3-year GS (<i>p</i> < 0.01). This adverse effect persisted within the same MELD3.0 category. Additionally, lower pre-LT eGFR was associated with an increased risk of post-LT kidney function deterioration, especially among those receiving grafts from marginal donors. Multivariable logistic regression identified recipient age > 65 as a significant risk factor for post-LT kidney function decline (OR 3.34 [1.05–10.7]; <i>p</i> = 0.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>GS was notably worse in recipients with low pre-LT eGFR, particularly when matched with marginal donors. A recipient age > 65 is a risk indicator for post-LT kidney function deterioration with marginal donors, underscoring the importance of careful donor-recipient matching, especially with compromised pre-LT kidney function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie R. C. Zacharias, Danielle Grandjean, Elizabeth Stearns, Girish Mour, David G. Lott
Medical advances have enabled the realization of vascularized composite allografts and to date have demonstrated reasonably successful graft survival rates. Larynx and Trachea Transplantation (LT) has long been contemplated as a therapeutic option for severe laryngeal trauma and patients following total laryngectomy. Progress has been limited most likely due to lack of awareness as an option, technical and surgical expertise, limited transplant centers worldwide, need for multidisciplinary engagement from hospital leadership, Otolaryngology, and transplant medicine to build a successful program. As one of the first programs to exist in the United States, we have had to create new pathways, develop new workflows, work with numerous regulatory bodies, educate many people about the need for an LT, and learn many lessons along the way. The objectives of this paper are to help others navigate the complexities of creating a new LT transplant program so that this important treatment option may become more available to patients worldwide. We will provide a checklist for developing an LT program and discuss our experiences with the strategic development of an LT transplant program in an academic medical institution.
{"title":"Strategic Development of a Larynx and Trachea Transplantation Program: The Mayo Clinic Arizona Experience","authors":"Stephanie R. C. Zacharias, Danielle Grandjean, Elizabeth Stearns, Girish Mour, David G. Lott","doi":"10.1111/ctr.70126","DOIUrl":"https://doi.org/10.1111/ctr.70126","url":null,"abstract":"<div>\u0000 \u0000 <p>Medical advances have enabled the realization of vascularized composite allografts and to date have demonstrated reasonably successful graft survival rates. Larynx and Trachea Transplantation (LT) has long been contemplated as a therapeutic option for severe laryngeal trauma and patients following total laryngectomy. Progress has been limited most likely due to lack of awareness as an option, technical and surgical expertise, limited transplant centers worldwide, need for multidisciplinary engagement from hospital leadership, Otolaryngology, and transplant medicine to build a successful program. As one of the first programs to exist in the United States, we have had to create new pathways, develop new workflows, work with numerous regulatory bodies, educate many people about the need for an LT, and learn many lessons along the way. The objectives of this paper are to help others navigate the complexities of creating a new LT transplant program so that this important treatment option may become more available to patients worldwide. We will provide a checklist for developing an LT program and discuss our experiences with the strategic development of an LT transplant program in an academic medical institution.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Syed S. Mujtahedi, Colleen L. Jay, Natalia Sakhovskaya, Amber Reeves-Daniel, Alejandra Mena-Gutierrez, Christopher J. Webb, Emily K. E. McCracken, Alan C. Farney, Giuseppe Orlando, Jigish Vyas, Arianna Cabrales, Robert J. Stratta
Introduction
An increasing number of elderly patients are undergoing either primary kidney transplantation (PrKT) or retransplantation (ReKT).
Methods
Single-center retrospective cohort study of all deceased donor KTs (DDKTs) performed in elderly patients (age ≥65 years).
Results
From December 2004 through August 2022, we performed 668 DDKTs in elderly patients including 39 ReKTs and 629 PrKTs. Mean donor age was lower in the ReKT group (44 ± 17 ReKT vs. 54 ± 13 years PrKT), as was KDPI (58 ± 24 vs. 74 ± 21% PrKT, both p < 0.05). A total of 44% of ReKT patients had a cPRA level above 50% compared to 10.3% PrKT (p < 0.0001). Rates were comparable between groups for primary nonfunction (2.6% ReKT vs. 3.7% PrKT) and delayed graft function (23% ReKT vs. 32% PrKT, p = 0.29). Five-year patient (55.2% ReKT vs. 74.3% PrKT, p = 0.03) and graft survival rates (GSRs, 55.2% ReKT vs. 64.7% PrKT, p = 0.32) were higher in the PrKT group. Death with functioning graft (DWFG) occurred in 59% of ReKT versus 37.4% of PrKT patients (p = 0.01) and accounted for 79.3% ReKT and 65.3% PrKT graft losses. Death-censored GSRs were not different (62.5% ReKT vs. 68.3% PrKT, p = 0.6).
Conclusions
Elderly recipients of deceased donor ReKTs have a higher risk of DWFG, but death-censored outcomes are comparable to age-matched PrKT recipients.
{"title":"Kidney Retransplantation in the Elderly: Are the Benefits Worth the Risks?","authors":"Syed S. Mujtahedi, Colleen L. Jay, Natalia Sakhovskaya, Amber Reeves-Daniel, Alejandra Mena-Gutierrez, Christopher J. Webb, Emily K. E. McCracken, Alan C. Farney, Giuseppe Orlando, Jigish Vyas, Arianna Cabrales, Robert J. Stratta","doi":"10.1111/ctr.70129","DOIUrl":"https://doi.org/10.1111/ctr.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>An increasing number of elderly patients are undergoing either primary kidney transplantation (PrKT) or retransplantation (ReKT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-center retrospective cohort study of all deceased donor KTs (DDKTs) performed in elderly patients (age ≥65 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From December 2004 through August 2022, we performed 668 DDKTs in elderly patients including 39 ReKTs and 629 PrKTs. Mean donor age was lower in the ReKT group (44 ± 17 ReKT vs. 54 ± 13 years PrKT), as was KDPI (58 ± 24 vs. 74 ± 21% PrKT, both <i>p</i> < 0.05). A total of 44% of ReKT patients had a cPRA level above 50% compared to 10.3% PrKT (<i>p</i> < 0.0001). Rates were comparable between groups for primary nonfunction (2.6% ReKT vs. 3.7% PrKT) and delayed graft function (23% ReKT vs. 32% PrKT, <i>p</i> = 0.29). Five-year patient (55.2% ReKT vs. 74.3% PrKT, <i>p</i> = 0.03) and graft survival rates (GSRs, 55.2% ReKT vs. 64.7% PrKT, <i>p</i> = 0.32) were higher in the PrKT group. Death with functioning graft (DWFG) occurred in 59% of ReKT versus 37.4% of PrKT patients (<i>p</i> = 0.01) and accounted for 79.3% ReKT and 65.3% PrKT graft losses. Death-censored GSRs were not different (62.5% ReKT vs. 68.3% PrKT, <i>p</i> = 0.6).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elderly recipients of deceased donor ReKTs have a higher risk of DWFG, but death-censored outcomes are comparable to age-matched PrKT recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wairimu Magua, Octav Cristea, Emily M. Eichenberger, Geeta M. Karadkhele, Alanna A. Morris, Kenneth Newell, Joseph B. Rickert, Christian P. Larsen
Introduction
Kidney function at 1-year post-transplant is an indicator of long-term graft function. Using functional data analysis (FDA), we evaluate the relationship between early renal recovery trajectories and kidney function at 1 year.
Methods
We analyzed 1748 adults who underwent deceased-donor kidney transplantation between 2010 and 2021. Renal recovery trajectory functions were derived from longitudinal inverse creatinine values. Functional linear regression models were used to evaluate how well early (<90 days) renal recovery trajectory functions, and their rate of change explained 1-year eGFR. The explanatory power of the functional regression models was compared to results from ordinary least squares models, which used cross-sectional inverse creatinine values and linear slopes. Models were adjusted for age, sex, kidney donor profile index (KDPI), delayed graft function (DGF), race, body mass index (BMI), rejection, diabetes, hypertension, cytomegalovirus (CMV) serostatus risk, index admission length of stay, and immunosuppression agent. The R2 coefficient quantified the 1-year eGFR variation explained by model variables.
Results
Adjusted functional linear models with renal recovery trajectory and trajectory velocity functions as independent variables explained 68% (65, 71), 70% (67, 74), 70% (66, 74), 70% (66, 75), and 73% (69, 79) of the variation in 1-year eGFR by 7, 14, 30, 60, and 90 days, respectively. By comparison, the ordinary least squares linear models explained a maximum of 69% of the variation in 1-year eGFR at 90 days.
Conclusion
Renal recovery patterns captured as continuous functions as early as 14 days are predictive of renal function at 1 year and may enable early personalized care of recipients at increased risk of poor graft function.
{"title":"Early Post-Transplant Renal Recovery Trajectory and Trajectory Velocity Functions Are Predictors of Estimated GFR at 1 Year: A Functional Data Analysis Approach","authors":"Wairimu Magua, Octav Cristea, Emily M. Eichenberger, Geeta M. Karadkhele, Alanna A. Morris, Kenneth Newell, Joseph B. Rickert, Christian P. Larsen","doi":"10.1111/ctr.70119","DOIUrl":"https://doi.org/10.1111/ctr.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Kidney function at 1-year post-transplant is an indicator of long-term graft function. Using functional data analysis (FDA), we evaluate the relationship between early renal recovery trajectories and kidney function at 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 1748 adults who underwent deceased-donor kidney transplantation between 2010 and 2021. Renal recovery trajectory functions were derived from longitudinal inverse creatinine values. Functional linear regression models were used to evaluate how well early (<90 days) renal recovery trajectory functions, and their rate of change explained 1-year eGFR. The explanatory power of the functional regression models was compared to results from ordinary least squares models, which used cross-sectional inverse creatinine values and linear slopes. Models were adjusted for age, sex, kidney donor profile index (KDPI), delayed graft function (DGF), race, body mass index (BMI), rejection, diabetes, hypertension, cytomegalovirus (CMV) serostatus risk, index admission length of stay, and immunosuppression agent. The <i>R</i><sup>2</sup> coefficient quantified the 1-year eGFR variation explained by model variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adjusted functional linear models with renal recovery trajectory and trajectory velocity functions as independent variables explained 68% (65, 71), 70% (67, 74), 70% (66, 74), 70% (66, 75), and 73% (69, 79) of the variation in 1-year eGFR by 7, 14, 30, 60, and 90 days, respectively. By comparison, the ordinary least squares linear models explained a maximum of 69% of the variation in 1-year eGFR at 90 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Renal recovery patterns captured as continuous functions as early as 14 days are predictive of renal function at 1 year and may enable early personalized care of recipients at increased risk of poor graft function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143554364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号