Elizabeth C. Lorenz, Byron H. Smith, Hani M. Wadei, Girish Mour, Cassie C. Kennedy, Carrie A. Schinstock, Walter K. Kremers, Andrea L. Cheville, LaTonya J. Hickson, Elizabeth J. Atkinson, Thomas A. White, Andrew D. Rule, Nathan K. LeBrasseur
Cellular senescence is a biological mechanism of aging and age-related diseases. The aim of this study was to examine whether senescence biomarkers are associated with frailty and physical function trajectories in patients undergoing kidney transplantation (KT). We also discussed the relationship between senescence biomarkers and KT function. In this multicenter study, we prospectively assessed plasma levels of senescence biomarkers, frailty as measured by the Physical Frailty Phenotype, and physical function as measured by the Short Physical Performance Battery prior to KT. Frailty, physical function, and KT function were also measured 1 year after KT. Variable associations were assessed using Cox and relaxed least absolute shrinkage and selection operation regression. The cohort consisted of 197 participants (mean age 53 ± 13 years, 61.4% male, and 80.2% White race). Higher pre-KT levels of macrophage-derived chemokine (MDC/CCL22) and growth differentiation factor-15 (GDF-15) were independently associated with less improvement in frailty and/or physical function during the first year after KT. Higher pre-KT levels tumor necrosis factor receptor superfamily member 6 (FAS) and MMP-9 levels were independently associated with lower KT function one year after KT. Pre-KT cellular senescence may contribute to frailty, physical function, and kidney function trajectories during the first year after KT.
{"title":"Senescence Biomarkers and Trajectories of Frailty and Physical Function After Kidney Transplantation","authors":"Elizabeth C. Lorenz, Byron H. Smith, Hani M. Wadei, Girish Mour, Cassie C. Kennedy, Carrie A. Schinstock, Walter K. Kremers, Andrea L. Cheville, LaTonya J. Hickson, Elizabeth J. Atkinson, Thomas A. White, Andrew D. Rule, Nathan K. LeBrasseur","doi":"10.1111/ctr.70022","DOIUrl":"10.1111/ctr.70022","url":null,"abstract":"<div>\u0000 \u0000 <p>Cellular senescence is a biological mechanism of aging and age-related diseases. The aim of this study was to examine whether senescence biomarkers are associated with frailty and physical function trajectories in patients undergoing kidney transplantation (KT). We also discussed the relationship between senescence biomarkers and KT function. In this multicenter study, we prospectively assessed plasma levels of senescence biomarkers, frailty as measured by the Physical Frailty Phenotype, and physical function as measured by the Short Physical Performance Battery prior to KT. Frailty, physical function, and KT function were also measured 1 year after KT. Variable associations were assessed using Cox and relaxed least absolute shrinkage and selection operation regression. The cohort consisted of 197 participants (mean age 53 ± 13 years, 61.4% male, and 80.2% White race). Higher pre-KT levels of macrophage-derived chemokine (MDC/CCL22) and growth differentiation factor-15 (GDF-15) were independently associated with less improvement in frailty and/or physical function during the first year after KT. Higher pre-KT levels tumor necrosis factor receptor superfamily member 6 (FAS) and MMP-9 levels were independently associated with lower KT function one year after KT. Pre-KT cellular senescence may contribute to frailty, physical function, and kidney function trajectories during the first year after KT.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675280","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}
Xinyi Huang, Melana Yuzefpolskaya, Paolo C. Colombo, Jason Choe, Tara Shertel, Douglas L. Jennings
Background
Limited research has compared the relative risks and benefits different statins have after heart transplantation (HT).
Method
We hypothesize that higher statin intensity is associated with a smaller degree of allograft intimal thickening on intravascular ultrasound (IVUS) at 1-year post-HT. Allograft intima-media thickness (IMT) on the first annual IVUS was retrospectively compared in patients initiated on a low-intensity statin (pravastatin 20 mg daily) versus moderate-intensity statin (atorvastatin 20 mg daily) post-HT.
Results
A total of 172 adult patients were included (2018–2022, n = 86 in each group). At 1 year, the maximal IMT was lower in the moderate-intensity statin group, but the difference did not reach statistical significance. The LDL levels at 1 year trended lower with moderate-intensity statin therapy, while the rates of adverse reactions were not statistically different. A multivariate analysis of the logistic regression model showed moderate statin intensity at 12 months was protective, while donor-specific antibodies developed within the first-year posttransplant were associated with IMT ≥ 0.5 mm on the first annual IVUS.
Conclusion
This study found that using moderate-intensity statin to prevent the early progression was as safe and possibly more effective than low-intensity statin therapy for the prevention of early cardiac allograft vasculopathy.
{"title":"The Impact of Statin Intensity on the Early Progression of Cardiac Allograft Vasculopathy","authors":"Xinyi Huang, Melana Yuzefpolskaya, Paolo C. Colombo, Jason Choe, Tara Shertel, Douglas L. Jennings","doi":"10.1111/ctr.70030","DOIUrl":"10.1111/ctr.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Limited research has compared the relative risks and benefits different statins have after heart transplantation (HT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We hypothesize that higher statin intensity is associated with a smaller degree of allograft intimal thickening on intravascular ultrasound (IVUS) at 1-year post-HT. Allograft intima-media thickness (IMT) on the first annual IVUS was retrospectively compared in patients initiated on a low-intensity statin (pravastatin 20 mg daily) versus moderate-intensity statin (atorvastatin 20 mg daily) post-HT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 172 adult patients were included (2018–2022, <i>n</i> = 86 in each group). At 1 year, the maximal IMT was lower in the moderate-intensity statin group, but the difference did not reach statistical significance. The LDL levels at 1 year trended lower with moderate-intensity statin therapy, while the rates of adverse reactions were not statistically different. A multivariate analysis of the logistic regression model showed moderate statin intensity at 12 months was protective, while donor-specific antibodies developed within the first-year posttransplant were associated with IMT ≥ 0.5 mm on the first annual IVUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study found that using moderate-intensity statin to prevent the early progression was as safe and possibly more effective than low-intensity statin therapy for the prevention of early cardiac allograft vasculopathy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667011","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}
Kentaro Noda, Mohamed-Ali H. Jawad-Makki, Ernest G. Chan, John Ryan, Masashi Furukawa, Chadi A. Hage, Pablo G. Sanchez
Background
Early utilization of extracorporeal membrane oxygenation (ECMO) improves the clinical outcomes of patients with severe primary graft dysfunction (PGD3) after lung transplantation. Although there is a survival benefit, the impact of ECMO on airway complications has not been investigated. This study aims to describe the clinical association between posttransplant methods of support and the severity of acute airway anastomosis complications in patients with PGD3 following bilateral lung transplantation.
Methods
Data from adult bilateral lung transplant patients diagnosed with PGD3 at our institution were retrospectively reviewed. Bronchial anastomosis necrosis (ischemia reperfusion injury [IRI]) that developed within a month after transplantation was graded. The data were compared among the groups of veno-venous ECMO (VV-ECMO) (n = 77), veno-arterial ECMO (VA-ECMO) (n = 14), and mechanical ventilation (MV, n = 33).
Results
Higher levels of support (VV/VA-ECMO) were associated with a lower incidence of PGD3, which was highest in recipients on MV only (M2 = 19.54, r = −0.41, p < 0.001). In a multivariable competing risk analysis, VV-ECMO was protective against chronic allograft dysfunction (CLAD) relative to the MV group (HR: 0.36 [0.13–0.96], p = 0.042). There was no relationship between posttransplant support and survival.
Conclusion
This study suggests posttransplant VV-ECMO support in patients who develop PGD3 may confer a protective advantage over MV alone in the prevention of ischemic reperfusion injury. VV-ECMO was associated with lower IRI grades and lower rates of BOS after transplantation. Future studies investigating the causal mechanisms are warranted.
{"title":"Veno-Venous Extracorporeal Membrane Oxygenation Support for Severe Primary Graft Dysfunction Is Associated With Reduced Airway Complications After Lung Transplantation","authors":"Kentaro Noda, Mohamed-Ali H. Jawad-Makki, Ernest G. Chan, John Ryan, Masashi Furukawa, Chadi A. Hage, Pablo G. Sanchez","doi":"10.1111/ctr.70029","DOIUrl":"10.1111/ctr.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early utilization of extracorporeal membrane oxygenation (ECMO) improves the clinical outcomes of patients with severe primary graft dysfunction (PGD3) after lung transplantation. Although there is a survival benefit, the impact of ECMO on airway complications has not been investigated. This study aims to describe the clinical association between posttransplant methods of support and the severity of acute airway anastomosis complications in patients with PGD3 following bilateral lung transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from adult bilateral lung transplant patients diagnosed with PGD3 at our institution were retrospectively reviewed. Bronchial anastomosis necrosis (ischemia reperfusion injury [IRI]) that developed within a month after transplantation was graded. The data were compared among the groups of veno-venous ECMO (VV-ECMO) (<i>n</i> = 77), veno-arterial ECMO (VA-ECMO) (<i>n</i> = 14), and mechanical ventilation (MV, <i>n</i> = 33).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher levels of support (VV/VA-ECMO) were associated with a lower incidence of PGD3, which was highest in recipients on MV only (<i>M</i><sup>2</sup> = 19.54, <i>r</i> = −0.41, <i>p</i> < 0.001). In a multivariable competing risk analysis, VV-ECMO was protective against chronic allograft dysfunction (CLAD) relative to the MV group (HR: 0.36 [0.13–0.96], <i>p</i> = 0.042). There was no relationship between posttransplant support and survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study suggests posttransplant VV-ECMO support in patients who develop PGD3 may confer a protective advantage over MV alone in the prevention of ischemic reperfusion injury. VV-ECMO was associated with lower IRI grades and lower rates of BOS after transplantation. Future studies investigating the causal mechanisms are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol-related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcineurin inhibitor (CNI) discontinuation.
Methods
From 1990 to 2015, all patients transplanted for ALD were included.
Results
A total of 493 patients were included, 77.9% were male and the median age at LT was 54 years. After LT, 278 de novo malignancies were diagnosed in 214 patients (43.4%). The cumulative incidence of de novo malignancies was 16.3% at 5 years, 34.4% at 10 years, and 49.8% at 15 years. In multivariate analysis, the independent risk factors were male gender (HR = 1.6), and active or weaned smoking (HR = 2.0). Discontinuation of CNI was a protective factor (HR = 0.6). Survival after diagnosis of de novo malignancy was 42.7% at 5 years and 27.5% at 10 years.
Conclusion
Our results confirm the major incidence of de novo malignancies after LT for ALD, as well as the important role of non-modifiable risk factors such as smoking and gender. CNI discontinuation is a protective factor, and the only adaptable, and could be proposed in smoker male patients transplanted for ALD.
{"title":"Calcineurin-Inhibitor Discontinuation Could Reduce the Risk of De Novo Malignancies After Liver Transplantation for Alcohol-Related Liver Disease","authors":"Domitille Erard, Anouk Steiner, Olivier Boillot, Elsa Thimonier, Mélanie Vallin, Florian Veyre, Olivier Guillaud, Sylvie Radenne, Jérôme Dumortier","doi":"10.1111/ctr.70014","DOIUrl":"10.1111/ctr.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol-related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcineurin inhibitor (CNI) discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From 1990 to 2015, all patients transplanted for ALD were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 493 patients were included, 77.9% were male and the median age at LT was 54 years. After LT, 278 de novo malignancies were diagnosed in 214 patients (43.4%). The cumulative incidence of de novo malignancies was 16.3% at 5 years, 34.4% at 10 years, and 49.8% at 15 years. In multivariate analysis, the independent risk factors were male gender (HR = 1.6), and active or weaned smoking (HR = 2.0). Discontinuation of CNI was a protective factor (HR = 0.6). Survival after diagnosis of de novo malignancy was 42.7% at 5 years and 27.5% at 10 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results confirm the major incidence of de novo malignancies after LT for ALD, as well as the important role of non-modifiable risk factors such as smoking and gender. CNI discontinuation is a protective factor, and the only adaptable, and could be proposed in smoker male patients transplanted for ALD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed to explore the prevalence and predictive factors of sleep-disordered breathing (SDB) in patients with cystic fibrosis (pwCF) after lung transplantation (LTX).
Methods
We prospectively recruited adult pwCF who underwent LTX in our hospital from 2013 to 2022 and invited them for an attended overnight polysomnography (PSG) 1 year after transplantation. The apnea–hypopnea index (AHI) was the primary outcome, and SDB was defined as an AHI ≥ 5. Demographic, anthropometric, cardiometabolic, drug treatment, and pulmonary function variables were compared between pwCF with and without SDB. Multiple regression analysis was used to identify significant predictors of SDB. For a subset of participants who had available PSG before transplantation, sleep parameters were compared pre-post transplantation.
Results
Sixty-two pwCF (31 females) were enrolled. Thirty participants had SDB, but only 11 of them had moderate-to-severe SDB (AHI ≥ 15). The average Epworth Sleepiness Scale (ESS) score indicated the absence of excessive daytime sleepiness. Older age (p < 0.001), male sex (p < 0.001), and smaller thoracic gas volume (p = 0.002) significantly predicted higher AHI. Comparison between pre- and post-transplantation polysomnographic data showed a significant increase in the percentage of slow wave sleep (p = 0.047), as well as a significant improvement in mean nocturnal oxygen saturation (p = 0.007). A statistically significant increase in the AHI was also observed (p = 0.047), but its clinical importance is uncertain (p = 0.476 for the increase in the ESS score).
Conclusions
We may conclude that SDB is prevalent in pwCF after LTX, but its severity is mild. Older male pwCF with greater improvement in lung hyperinflation after transplantation might be at risk for SDB and should be followed for symptoms or signs of sleep apnea.
{"title":"Sleep and Respiratory Parameters After Lung Transplantation in Adult Patients With Cystic Fibrosis","authors":"Alexandros Kalkanis, Dimitrios Papadopoulos, Robin Vos, Lieven Dupont, Bertien Buyse, Dries Testelmans","doi":"10.1111/ctr.70023","DOIUrl":"10.1111/ctr.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to explore the prevalence and predictive factors of sleep-disordered breathing (SDB) in patients with cystic fibrosis (pwCF) after lung transplantation (LTX).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We prospectively recruited adult pwCF who underwent LTX in our hospital from 2013 to 2022 and invited them for an attended overnight polysomnography (PSG) 1 year after transplantation. The apnea–hypopnea index (AHI) was the primary outcome, and SDB was defined as an AHI ≥ 5. Demographic, anthropometric, cardiometabolic, drug treatment, and pulmonary function variables were compared between pwCF with and without SDB. Multiple regression analysis was used to identify significant predictors of SDB. For a subset of participants who had available PSG before transplantation, sleep parameters were compared pre-post transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-two pwCF (31 females) were enrolled. Thirty participants had SDB, but only 11 of them had moderate-to-severe SDB (AHI ≥ 15). The average Epworth Sleepiness Scale (ESS) score indicated the absence of excessive daytime sleepiness. Older age (<i>p</i> < 0.001), male sex (<i>p</i> < 0.001), and smaller thoracic gas volume (<i>p</i> = 0.002) significantly predicted higher AHI. Comparison between pre- and post-transplantation polysomnographic data showed a significant increase in the percentage of slow wave sleep (<i>p</i> = 0.047), as well as a significant improvement in mean nocturnal oxygen saturation (<i>p</i> = 0.007). A statistically significant increase in the AHI was also observed (<i>p</i> = 0.047), but its clinical importance is uncertain (<i>p</i> = 0.476 for the increase in the ESS score).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We may conclude that SDB is prevalent in pwCF after LTX, but its severity is mild. Older male pwCF with greater improvement in lung hyperinflation after transplantation might be at risk for SDB and should be followed for symptoms or signs of sleep apnea.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616170","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}
David C. Cron, Arnold E. Kuk, Layla Parast, S. Ali Husain, Vanessa M. Welten, Miko Yu, Sumit Mohan, Joel T. Adler
Introduction
How offer notifications are distributed early in the kidney allocation timeline, including how widely they are offered, is unclear. A better understanding of offer notification practices across organ procurement organizations (OPOs) may identify opportunities for more efficient allocation.
Methods
We merged the Scientific Registry of Transplant Recipients potential transplant recipient file with additional offer notification time stamps to identify 54 631 deceased-donor kidney match runs from 2017 to 2023. Offer notifications for a given match run are sent to candidates/centers in “batches.” We quantified the number of offers in the initial batch—which theoretically reflects the OPO's initial estimate of how widely a kidney should be offered—and compared this metric across OPOs.
Results
Kidneys were offered to a median of 14 candidates (IQR 9–38) in the first batch of notifications, and this varied across OPOs from 3 to 746 candidates per initial batch. Batch size at the OPO-level did not correlate with rank at kidney placement or OPO nonuse rate. OPOs in the highest quartile of batch size sent more offers (median 100) than presumably necessary to place kidneys (median rank at placement 21), and OPOs in the lowest quartile of batch size sent fewer offers (6) than needed to place kidneys (rank at placement 19).
Conclusions
Offer notification practices vary widely across OPOs, and many OPOs offer kidneys far more widely than necessary for placement. Optimization of offer notification practices may reduce unnecessary communications. Further research into allocation processes is needed to identify opportunities to improve efficiency of allocation for OPOs and transplant centers.
{"title":"Variation Across Organ Procurement Organizations in Deceased-Donor Kidney Offer Notification Practices","authors":"David C. Cron, Arnold E. Kuk, Layla Parast, S. Ali Husain, Vanessa M. Welten, Miko Yu, Sumit Mohan, Joel T. Adler","doi":"10.1111/ctr.70024","DOIUrl":"10.1111/ctr.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>How offer notifications are distributed early in the kidney allocation timeline, including how widely they are offered, is unclear. A better understanding of offer notification practices across organ procurement organizations (OPOs) may identify opportunities for more efficient allocation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We merged the Scientific Registry of Transplant Recipients potential transplant recipient file with additional offer notification time stamps to identify 54 631 deceased-donor kidney match runs from 2017 to 2023. Offer notifications for a given match run are sent to candidates/centers in “batches.” We quantified the number of offers in the <i>initial</i> batch—which theoretically reflects the OPO's initial estimate of how widely a kidney should be offered—and compared this metric across OPOs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Kidneys were offered to a median of 14 candidates (IQR 9–38) in the first batch of notifications, and this varied across OPOs from 3 to 746 candidates per initial batch. Batch size at the OPO-level did not correlate with rank at kidney placement or OPO nonuse rate. OPOs in the highest quartile of batch size sent more offers (median 100) than presumably necessary to place kidneys (median rank at placement 21), and OPOs in the lowest quartile of batch size sent fewer offers (6) than needed to place kidneys (rank at placement 19).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Offer notification practices vary widely across OPOs, and many OPOs offer kidneys far more widely than necessary for placement. Optimization of offer notification practices may reduce unnecessary communications. Further research into allocation processes is needed to identify opportunities to improve efficiency of allocation for OPOs and transplant centers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616173","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 Ali Husain, Brendan R. Emmons, Miko E. Yu, Anne M. Huml, Sumit Mohan
{"title":"Association Between Split Function of the Retained Kidney and Early Changes in Kidney Function After Living Kidney Donation","authors":"Syed Ali Husain, Brendan R. Emmons, Miko E. Yu, Anne M. Huml, Sumit Mohan","doi":"10.1111/ctr.70025","DOIUrl":"10.1111/ctr.70025","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616167","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}
Yizhan Guo, John Ryan, Ernest Chan, Masashi Furukawa, Chadi A. Hage, Pablo G. Sanchez
Multiorgan transplantation is offered to a selected group of patients every year. The sequence in which organs are transplanted depends on ischemic time graft tolerance and the sickest organ first strategy. In the case of Lung-Liver transplantation, lung allografts are usually implanted before the liver. There are some theoretical advantages to a liver-first strategy and a few centers have reported a series of cases that spark a growing interest in the feasibility and potential benefits of this approach. In this contemporary study of the United Network for Organ Sharing (UNOS) database, we evaluate and report outcomes using either strategy.
{"title":"Utilization of the Liver-First Approach in Combined Lung-Liver Transplant Provides Comparable Outcomes to the Traditional Lung-First Approach: A UNOS Study","authors":"Yizhan Guo, John Ryan, Ernest Chan, Masashi Furukawa, Chadi A. Hage, Pablo G. Sanchez","doi":"10.1111/ctr.70003","DOIUrl":"10.1111/ctr.70003","url":null,"abstract":"<div>\u0000 \u0000 <p>Multiorgan transplantation is offered to a selected group of patients every year. The sequence in which organs are transplanted depends on ischemic time graft tolerance and the sickest organ first strategy. In the case of Lung-Liver transplantation, lung allografts are usually implanted before the liver. There are some theoretical advantages to a liver-first strategy and a few centers have reported a series of cases that spark a growing interest in the feasibility and potential benefits of this approach. In this contemporary study of the United Network for Organ Sharing (UNOS) database, we evaluate and report outcomes using either strategy.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616171","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}
Andrew Kalra, Jessica M. Ruck, Alice L. Zhou, Armaan F. Akbar, Albert Leng, Bin You, Alfred J. Casillan, Jinny S. Ha, Christian A. Merlo, Errol L. Bush
Background
In January 2014, states expanded Medicaid access under the Affordable Care Act. We studied the financial implications of this policy on lung transplantation, a costly procedure.
Methods
Lung transplant (LT) hospitalizations were identified within the National Inpatient Sample (2005–2020). Recipients were categorized as “pre-expansion” (1/2005–12/2013) versus “post-expansion” (1/2014–12/2020) of Medicaid and as being in “expander” versus “non-expander” regions. We calculated difference-in-differences estimates comparing pre- and post-expansion eras in expander versus non-expander regions for inflation-adjusted hospitalization costs and for discharge disposition. We evaluated total hospitalization costs using multivariable generalized linear regression, adjusting for recipient demographics, Charlson Comorbidity Index, single versus double-lung transplant, and extracorporeal membrane oxygenation (ECMO), ex-vivo lung perfusion (EVLP), and mechanical ventilation usage.
Results
Of the 29 225 LT recipients identified, 14 085 were pre-expansion and 15 140 were post-expansion. More recipients were insured by Medicaid in expander n = 735 (9%) versus non-expander n = 220, (3%) regions (p = 0.01) post-expansion. Hospitalization costs increased post- versus pre-expansion by $20 948 (95% CI = $8713–$33 183, p < 0.001) more in expander versus non-expander regions even after adjustment for risk factors associated with increased costs. Within expander regions, recipients post- versus pre-expansion were less likely to be discharged routinely (n = 2625, 28% vs. n = 3959, 44%) and more likely to be discharged to care facilities (n = 2045, 22% vs. n = 1045, 12%, p < 0.001).
Conclusions
Although Medicaid expansion resulted in greater access to care, it was associated with increased hospitalization costs and fewer routine discharges for LT recipients. Further research is warranted to identify the reasons that underpin the financial sequelae of Medicaid expansion, including changes in access to care for sicker patients.
{"title":"Higher Hospitalization Costs and Fewer Routine Discharges in the Medicaid Expansion Era for Lung Transplant Recipients","authors":"Andrew Kalra, Jessica M. Ruck, Alice L. Zhou, Armaan F. Akbar, Albert Leng, Bin You, Alfred J. Casillan, Jinny S. Ha, Christian A. Merlo, Errol L. Bush","doi":"10.1111/ctr.70017","DOIUrl":"10.1111/ctr.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In January 2014, states expanded Medicaid access under the Affordable Care Act. We studied the financial implications of this policy on lung transplantation, a costly procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Lung transplant (LT) hospitalizations were identified within the National Inpatient Sample (2005–2020). Recipients were categorized as “pre-expansion” (1/2005–12/2013) versus “post-expansion” (1/2014–12/2020) of Medicaid and as being in “expander” versus “non-expander” regions. We calculated difference-in-differences estimates comparing pre- and post-expansion eras in expander versus non-expander regions for inflation-adjusted hospitalization costs and for discharge disposition. We evaluated total hospitalization costs using multivariable generalized linear regression, adjusting for recipient demographics, Charlson Comorbidity Index, single versus double-lung transplant, and extracorporeal membrane oxygenation (ECMO), ex-vivo lung perfusion (EVLP), and mechanical ventilation usage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 29 225 LT recipients identified, 14 085 were pre-expansion and 15 140 were post-expansion. More recipients were insured by Medicaid in expander <i>n</i> = 735 (9%) versus non-expander <i>n</i> = 220, (3%) regions (<i>p</i> = 0.01) post-expansion. Hospitalization costs increased post- versus pre-expansion by $20 948 (95% CI = $8713–$33 183, <i>p</i> < 0.001) more in expander versus non-expander regions even after adjustment for risk factors associated with increased costs. Within expander regions, recipients post- versus pre-expansion were less likely to be discharged routinely (<i>n</i> = 2625, 28% vs. <i>n</i> = 3959, 44%) and more likely to be discharged to care facilities (<i>n</i> = 2045, 22% vs. <i>n</i> = 1045, 12%, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although Medicaid expansion resulted in greater access to care, it was associated with increased hospitalization costs and fewer routine discharges for LT recipients. Further research is warranted to identify the reasons that underpin the financial sequelae of Medicaid expansion, including changes in access to care for sicker patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616169","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}
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