Clinical Transplantation最新文献_第10页

The Impact of Donor-Recipient Human Leukocyte Antigen Matching on Bronchiolitis Obliterans-Free Survival Among Lung Transplant Recipients With Connective Tissue Diseases 捐赠者-受者人类白细胞抗原匹配对患有结缔组织疾病的肺移植受者无支气管炎生存期的影响

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-08-13 DOI: 10.1111/ctr.15426

Andrew M. Courtwright, Joshua M. Diamond, Nora Sandorfi, Hilary J. Goldberg

Background

The development of connective tissue disease-associated lung diseases (CTD-LD) occurs in association with specific human leukocyte antigens (HLA). For CTD-LD patients who require lung transplant, it is unknown whether utilization of donor organs expressing these same HLA impacts posttransplant outcomes.

Methods

Using the Scientific Registry of Transplant Recipients, we assessed whether CTD-LD lung transplant recipients in the United States have worse bronchiolitis obliterans (BOS)-free survival based on the degree of donor HLA matching. This included overall degree of donor-recipient HLA matching, donor-recipient matching at DR loci, and recipient matching with specific donor HLA antigens associated with the development of pulmonary disease in their condition.

Results

Among 1413 patients with CTD-ILD, highly HLA-matched donor-recipients did not have worse adjusted survival (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.58–1.51, p = 0.77). Recipients who were fully matched at HLA DR did not have worse survival (HR = 0.82, 95% CI = 0.56–1.19, p = 0.29). Finally, among individual CTD-LD, including rheumatoid arthritis, systemic sclerosis, the idiopathic inflammatory myopathies, and systemic lupus erythematous, transplant with a donor expressing HLA antigens associated with lung manifestations in these conditions was not associated with worse BOS-free survival.

Conclusions

Among transplant recipients with CTD-LD, HLA donor-recipient matching, including at the DR loci, does not result in worse BOS-free survival. Based on these findings, there is no reason to treat these as unacceptable antigens when considering donor offers for CTD-LD candidates.

背景：结缔组织病相关肺病（CTD-LD）的发生与特定人类白细胞抗原（HLA）有关。对于需要进行肺移植的 CTD-LD 患者来说，使用表达相同 HLA 的供体器官是否会影响移植后的预后尚不清楚：我们利用移植受者科学注册中心（Scientific Registry of Transplant Recipients）评估了美国 CTD-LD 肺移植受者的无支气管炎（BOS）生存率是否会因供体 HLA 匹配程度而降低。这包括供体与受体HLA的总体匹配程度、供体与受体在DR位点上的匹配程度以及受体与与肺部疾病发展相关的特定供体HLA抗原的匹配程度：在1413名CTD-ILD患者中，HLA高度匹配的供体-受体的调整后生存率并不差（危险比[HR] = 0.93，95%置信区间[CI] = 0.58-1.51，P = 0.77）。HLA DR完全匹配的受者生存率也没有降低（HR = 0.82，95% CI = 0.56-1.19，P = 0.29）。最后，在包括类风湿性关节炎、系统性硬化症、特发性炎症性肌病和系统性红斑狼疮在内的CTD-LD个体中，与这些疾病的肺部表现相关的HLA抗原表达供体进行移植与无BOS生存率降低无关：结论：在 CTD-LD 移植受者中，HLA 供体与受体匹配（包括 DR 基因位点匹配）不会导致无 BOS 存活率降低。根据这些发现，在考虑为 CTD-LD 候选者提供供体时，没有理由将这些抗原视为不可接受的抗原。

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引用次数: 0

Utility of Quadratus Lumborum Blocks in Patients Who Undergo Liver Transplant: A Single-Center Retrospective Study 腰椎四头肌阻滞在肝移植患者中的应用：单中心回顾性研究

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-08-09 DOI: 10.1111/ctr.15430

Nicole C. McCoy, Joel M. Sirianni, Joseph Abro, Kaylee Massman, Bethany J. Wolf, William D. Stoll

Background

Regional anesthesia is an alternative to opioids for pain in patients undergoing liver transplantation. Quadratus lumborum blocks may provide appropriate dermatomal coverage with an excellent safety profile.

Methods

Data were collected retrospectively on adult patients who underwent liver transplant at an academic medical center from 2019 to 2022 (n = 207). The primary outcome was opioid administration during the 48 h after transplant.

Results

Patient demographics did not differ between groups. No association was found between patients who received a block and postoperative opioid administration (p = 0.848). However, among patients extubated in the operating room, patients who received a block reported, on average, a 0.9-unit lower pain score than patients who received no block (p = 0.041). Patients who received a block were also more likely to be extubated in the operating room (87.8% block vs. 44.4% no block; p < 0.001).

Conclusion

Patients who underwent liver transplantation had similar postoperative opioid use whether or not they received a quadratus lumborum block. Yet, when evaluating additional factors, such as extubation, pain scores were lower in patients who received a quadratus lumborum block. This important finding supports the idea that quadratus lumborum blocks may be a safe and valuable technique for controlling postoperative pain in adult patients who undergo liver transplantation.

背景：区域麻醉是替代阿片类药物治疗肝移植患者疼痛的一种方法。腰椎四头肌阻滞可提供适当的皮区覆盖，且安全性极佳：回顾性收集了2019年至2022年在一家学术医疗中心接受肝移植的成年患者（n = 207）的数据。主要结果是移植后 48 小时内阿片类药物的使用情况：各组患者的人口统计学特征无差异。接受阻滞的患者与术后阿片类药物用量之间没有关联（p = 0.848）。然而，在手术室拔管的患者中，接受阻滞的患者的疼痛评分平均比未接受阻滞的患者低 0.9 个单位（p = 0.041）。接受阻滞的患者也更有可能在手术室拔管（87.8%的患者接受阻滞，44.4%的患者未接受阻滞；p < 0.001）：结论：无论是否接受腰椎四头肌阻滞，接受肝移植手术的患者术后使用阿片类药物的情况相似。然而，在评估拔管等其他因素时，接受腰椎四头肌阻滞的患者疼痛评分较低。这一重要发现支持了这样一种观点，即对于接受肝移植手术的成年患者来说，腰椎四头肌阻滞可能是一种安全且有价值的控制术后疼痛的技术。

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引用次数: 0

Tuscany Normothermic Regional Perfusion Mobile Teams for Controlled Donation After Circulatory Death 托斯卡纳常温区域灌注流动小组，用于循环死亡后的控制性捐献。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-08-08 DOI: 10.1111/ctr.15429

Chiara Lazzeri, Bonizzoli Manuela, Sara Bagatti, Stefano Antonelli, Paolo Lo Pane, Davide Ghinolfi, Adriano Peris

Introduction

To facilitate the implementation of controlled donation after circulatory death (cDCD) programs even in hospitals not equipped with a local extracorporeal membrane oxygenation (ECMO) team, some countries have launched a local cDCD network with an ECMO mobile team for normothermic regional perfusion (NRP). In the Tuscany region, in 2021, the Regional Transplant Authority launched a cDCD program to make the cDCD pathway feasible even in peripheral hospitals with NRP mobile teams, which were “converted” existing ECMO mobile teams, composed of highly skilled and experienced personnel.

Methods

We describe the Tuscany cDCD program, (2021–2023), for cDCD from peripheral hospitals with NRP mobile teams.

Results

Twenty-six cDCDs (26/40, 65%) came from peripheral hospitals. Following the launch of the cDCD program, cDCDs from peripheral hospitals increased, from 33% (2021) to 75% (2022 and 2023) of the overall cDCDs. The mean age was 63 years, with older donors (>75 years) in half the cases. The median warm ischemia time was 45 min (20 min are required by the Italian law for death certification), ranging from 35 to 59 min. Among the 20 livers retrieved and 18 kidneys retrieved, 16 livers, and 11 kidneys (single kidney transplantation) were transplanted, after ex vivo reperfusion, respectively.

Conclusions

The use of NRP mobile teams proved to be feasible and safe in the management of cDCD in peripheral hospitals. No complications were reported with NRP despite the advanced age of most cDCDs.

导言：为了促进循环死亡后控制性捐献（cDCD）计划的实施，即使在当地没有配备体外膜肺氧合（ECMO）团队的医院，一些国家已经启动了当地的cDCD网络，并配备了常温区域灌注（NRP）的ECMO流动团队。2021 年，托斯卡纳地区器官移植管理局启动了一项 cDCD 计划，目的是让拥有 NRP 流动团队的外围医院也能采用 cDCD 途径，NRP 流动团队由现有的 ECMO 流动团队 "改造 "而成，由技术娴熟、经验丰富的人员组成：我们介绍了托斯卡纳 cDCD 计划（2021-2023 年），该计划针对拥有 NRP 流动小组的外围医院的 cDCD：结果：26 个 cDCD（26/40，65%）来自外围医院。在 cDCD 计划启动后，来自外围医院的 cDCD 人数有所增加，在整个 cDCD 人数中所占比例从 33%（2021 年）增至 75%（2022 年和 2023 年）。平均年龄为 63 岁，半数病例的供体年龄较大（大于 75 岁）。温暖缺血时间的中位数为 45 分钟（意大利法律规定死亡证明时间为 20 分钟），从 35 分钟到 59 分钟不等。在取回的 20 个肝脏和 18 个肾脏中，分别有 16 个肝脏和 11 个肾脏（单肾移植）在体外再灌注后进行了移植：结论：事实证明，在外围医院管理 cDCD 时，使用 NRP 流动小组是可行且安全的。结论：事实证明，在外围医院使用 NRP 流动小组治疗 cDCD 是可行和安全的，尽管大多数 cDCD 患者年龄偏高，但 NRP 未出现任何并发症。

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引用次数: 0

Evolving Trends and Impact of Waitlist Transfusion on Recipient Outcomes Following Heart Transplantation 等待名单输血的演变趋势及其对心脏移植后受者预后的影响。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-08-08 DOI: 10.1111/ctr.15422

Yeahwa Hong, Nidhi Iyanna, Nicholas R. Hess, Luke A. Ziegler, Mohamed Abdullah, Ander Dorken-Gallastegi, Michael A. Mathier, Mary E. Keebler, Gavin W. Hickey, David J. Kaczorowski

Background

This study evaluates the clinical trends, risk factors, and impact of waitlist blood transfusion on outcomes following isolated heart transplantation.

Methods

The UNOS registry was queried to identify adult recipients from January 1, 2014, to June 30, 2022. The recipients were stratified into two groups depending on whether they received a blood transfusion while on the waitlist. The incidence of waitlist transfusion was compared before and after the 2018 allocation policy change. The primary outcome was survival. Propensity score-matching was performed. Multivariable logistic regression was performed to identify predictors of waitlist transfusion. A sub-analysis was performed to evaluate the impact of waitlist time on waitlist transfusion.

Results

From the 21 926 recipients analyzed in this study, 4201 (19.2%) received waitlist transfusion. The incidence of waitlist transfusion was lower following the allocation policy change (14.3% vs. 23.7%, p < 0.001). The recipients with waitlist transfusion had significantly reduced 1-year posttransplant survival (88.8% vs. 91.9%, p < 0.001) compared to the recipients without waitlist transfusion in an unmatched comparison. However, in a propensity score-matched comparison, the two groups had similar 1-year survival (90.0% vs. 90.4%, p = 0.656). Multivariable analysis identified ECMO, Impella, and pretransplant dialysis as strong predictors of waitlist transfusion. In a sub-analysis, the odds of waitlist transfusion increased nonlinearly with longer waitlist time.

Conclusion

There is a lower incidence of waitlist transfusion among transplant recipients under the 2018 allocation system. Waitlist transfusion is not an independent predictor of adverse posttransplant outcomes but rather a marker of the patient's clinical condition. ECMO, Impella, and pretransplant dialysis are strong predictors of waitlist transfusion.

背景：本研究评估了临床趋势、风险因素以及等待输血对离体心脏移植术后结果的影响：本研究评估了临床趋势、风险因素以及等待名单输血对离体心脏移植术后预后的影响：方法：通过查询 UNOS 注册表，确定 2014 年 1 月 1 日至 2022 年 6 月 30 日期间的成年受者。根据受者在等待名单上是否输血，将其分为两组。比较了 2018 年分配政策变化前后等待输血的发生率。主要结果是存活率。进行了倾向评分匹配。进行了多变量逻辑回归，以确定等待输血的预测因素。还进行了一项子分析，以评估等待时间对等待输血的影响：在本研究分析的 21 926 名受者中，有 4201 人（19.2%）接受了候诊输血。分配政策改变后，等待输血的发生率降低了（14.3% 对 23.7%，P < 0.001）。在非配对比较中，与未进行等待输血的受者相比，进行了等待输血的受者移植后 1 年生存率明显降低（88.8% 对 91.9%，p < 0.001）。然而，在倾向得分匹配比较中，两组的 1 年生存率相似（90.0% 对 90.4%，p = 0.656）。多变量分析确定 ECMO、Impella 和移植前透析是候补名单输血的有力预测因素。在一项子分析中，等待输血的几率随着等待时间的延长而非线性增加：结论：在2018年分配制度下，移植受者等待输血的发生率较低。等待输血并非移植后不良结局的独立预测因素，而是患者临床状况的标志。ECMO、Impella和移植前透析是等待输血的有力预测因素。

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引用次数: 0

Primary Team Versus Local Recovery in Liver Transplantation in the Modern Era: A National Analysis of the United Network for Organ Sharing Database 现代肝移植中的初级团队与局部恢复：器官共享联合网络数据库的全国性分析。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-08-08 DOI: 10.1111/ctr.15418

Jenna N. Whitrock, Stephanie Sisak, Catherine G. Pratt, Aaron M. Delman, Adam D. Price, Koffi Wima, Shimul A. Shah, Ralph Cutler Quillin III

Background

The implementation of acuity circles (AC) in 2020 and the COVID-19 pandemic increased the use of local surgeons to recover livers for transplant; however, the impact on liver transplant (LT) outcomes is unknown.

Methods

Deceased donor adult LT recipients from the UNOS database were identified.  Recipients were grouped by donor surgeon: local versus primary recovery.  Patient and graft survival as well as trends in local recovery in the 2 years pre-AC and post-AC were assessed.

Results

The utilization of local recovery in LT increased from 22.3% to 37.9% post-AC (p < 0.01).  LTs with local recovery had longer cold ischemia times (6.5 h [5.4–7.8] vs. 5.3 h [4.4–6.5], p < 0.01) and traveled further (210 miles [89–373] vs. 73 miles [11–196], p < 0.01) than those using primary recovery. Multivariate analyses revealed no differences in patient or graft survival between local and primary recovery, and between OPO and local surgeon. There was no difference in survival when comparing simultaneous liver–kidney, donation after circulatory death, MELD ≥ 30, or redo-LT by recovery team.  Recovery and utilization rates were also noted to be higher post-AC (51.4% vs. 48.6% pre-AC, p < 0.01) as well as when OPO surgeons recovered the allografts (72.5% vs. 66.0%, p < 0.01).

Conclusion

Nearly 40% of LTs are performed using local recovery, and utilization rates and trends continue to change with changing organ-sharing paradigms such as AC.  This practice appears safe with outcomes similar to recovery by the primary team in appropriately selected recipients and may lead to increased access and the ability to transplant more livers.

背景：2020 年实施的敏锐圈（AC）和 COVID-19 大流行增加了当地外科医生回收肝脏用于移植的使用；然而，对肝移植（LT）结果的影响尚不清楚：方法：从 UNOS 数据库中确定了已故捐献者的成人 LT 受体。方法：对 UNOS 数据库中的死亡供体成人肝移植受者进行了鉴定，并根据供体外科医生进行了分组：本地外科医生和主要回收外科医生。评估了患者和移植物的存活率，以及器官移植前和器官移植后两年内局部复苏的趋势：结果：LT术中局部复苏的使用率从22.3%上升到AC术后的37.9%（p 结论：近40%的LT术使用局部复苏：近40%的LT使用局部复苏，随着器官共享模式（如AC）的改变，使用率和趋势也在不断变化。在适当选择受体的情况下，这种做法似乎是安全的，其结果与主治团队的复苏相似，可能会增加移植机会和移植更多肝脏的能力。

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引用次数: 0

Contemporary Immunosuppression Management and 1-Year Outcomes in Dual Organ Heart Transplantation 双器官心脏移植手术中的现代免疫抑制管理和 1 年疗效。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-08-08 DOI: 10.1111/ctr.15420

Xinyi Huang, David Salerno, Danielle Kovac, Jenna Scheffert, Jessica Hedvat, Bayleigh Carver, Jason Choe, Tara Shertel, Melana Yuzefpolskaya, Paolo C. Colombo, Douglas L. Jennings

Background

There have been limited reports on immunosuppression strategies and outcomes in dual organ heart transplant populations, primarily from before the 2018 United Network for Organ Sharing (UNOS) heart allocation policy change. Recent data suggested that outcomes with heart–lung and heart–liver transplants remained comparable in the new allocation era, yet heart–kidney recipients have worse 1-year survival.

Methods

This single-center retrospective study evaluated adult heart–kidney, heart–liver, and heart–lung transplant recipients from September 2019 to May 2023. Immunosuppression regimen, infectious complications, and graft outcomes were collected for 12 months.

Results

A total of 36 patients (kidney n = 20, liver n = 9, and lung n = 7) were included in this study. Basiliximab was the most commonly employed induction strategy across the organ groups (12/20 in kidney, 4/9 in liver, and 7/7 in lung). All patients were on triple immunosuppression at 12 months posttransplant with prednisone wean achieved in one heart–liver recipient. Infection complications were frequently reported (95% kidney, 75% liver, 100% lung group). One patient went back to dialysis due to focal segmental glomerulosclerosis. One chronic lung allograft dysfunction was reported, but no other severe biopsy-proven rejection or retransplant was reported. The 1-year survival was 85% (17/20) in heart–kidney, 78% (7/9) in heart–liver, and 86% (6/7) in heart–lung recipients.

Conclusion

This study summarized real-world immunosuppression strategies and outcomes in dual organ heart transplant recipients.

背景：关于双器官心脏移植人群的免疫抑制策略和结果的报道很有限，主要是2018年器官共享联合网络（UNOS）心脏分配政策改变之前的报道。最近的数据表明，在新的分配时代，心肺移植和心肝移植的结果仍具有可比性，但心肾受者的1年存活率较低：这项单中心回顾性研究对 2019 年 9 月至 2023 年 5 月期间的成年心肾、心肝和心肺移植受者进行了评估。研究收集了12个月的免疫抑制方案、感染并发症和移植结果：本研究共纳入 36 例患者（肾脏 20 例、肝脏 9 例、肺脏 7 例）。在各器官组中，巴西利西单抗是最常用的诱导策略（肾脏12/20例，肝脏4/9例，肺脏7/7例）。所有患者在移植后12个月时都接受了三联免疫抑制，其中一名心肝受者实现了泼尼松断药。感染并发症屡见报端（肾组 95%、肝组 75%、肺组 100%）。一名患者因局灶节段性肾小球硬化而再次接受透析治疗。据报道，有一名患者出现了慢性肺异体移植功能障碍，但没有其他经活检证实的严重排斥反应或再移植的报道。心肾受者的1年存活率为85%（17/20），心肝受者的1年存活率为78%（7/9），心肺受者的1年存活率为86%（6/7）：本研究总结了现实世界中双器官心脏移植受者的免疫抑制策略和结果。

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引用次数: 0

Does Severity of Donor Acute Kidney Injury Influence Outcomes Following Kidney Transplantation? 供体急性肾损伤的严重程度会影响肾移植后的预后吗？

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-08-08 DOI: 10.1111/ctr.15425

Alexandra R. Monetti, Christopher J. Webb, Colleen L. Jay, Emily McCracken, Berjesh Sharda, Matthew Garner, Alan C. Farney, Giuseppe Orlando, Amber Reeves-Daniel, Alejandra Mena-Gutierrez, Natalia Sakhovskaya, Robert J. Stratta

Introduction

The study purpose was to review retrospectively our single-center experience transplanting kidneys from deceased donors (DD) with acute kidney injury (AKI) according to terminal serum creatinine (tSCr) level.

Methods

AKI kidneys were defined by a doubling of the DD's admission SCr and a tSCr ≥ 2.0 mg/dL.

Results

From 1/07 to 11/21, we transplanted 236 AKI DD kidneys, including 100 with a tSCr ≥ 3.0 mg/dL (high SCr AKI group, mean tSCr 4.2 mg/dL), and the remaining 136 from DDs with a tSCr of 2.0–2.99 mg/dL (lower SCr AKI group, mean tSCr 2.4 mg/dL). These two AKI groups were compared to 996 concurrent control patients receiving DD kidneys with a tSCr < 1.0 mg/dL. Mean follow-up was 69 months. Delayed graft function (DGF) rates were 51% versus 46% versus 29% (p < 0.0001), and 5-year patient and death-censored kidney graft survival rates were 96.8% versus 83.5% versus 82.2% (p = 0.002) and 86.7% versus 77.8% versus 78.8% (p = 0.18) in the high tSCr AKI versus lower tSCr AKI versus control groups, respectively.

Conclusions

Despite a higher incidence of DGF, patients receiving kidneys from DDs with tSCr levels ≥3.0 mg/dL have acceptable medium-term outcomes compared to either AKI DDs with a lower tSCr or DDs with a tSCr < 1.0 mg/dL.

简介：研究目的是根据终末血清肌酐（tSCr）水平回顾性回顾我们单中心移植急性肾损伤（AKI）已故供体（DD）肾脏的经验：AKI肾脏的定义是DD入院SCr增加一倍且tSCr≥2.0 mg/dL：从2007年1月1日到2011年11月21日，我们移植了236个AKI DD肾脏，其中100个tSCr≥3.0 mg/dL（高SCr AKI组，平均tSCr为4.2 mg/dL），其余136个来自tSCr为2.0-2.99 mg/dL的DD（低SCr AKI组，平均tSCr为2.4 mg/dL）。这两组 AKI 患者与同时接受 DD 肾脏且 tSCr < 1.0 mg/dL 的 996 名对照组患者进行了比较。平均随访时间为 69 个月。在高tSCr AKI组与低tSCr AKI组和对照组中，移植功能延迟（DGF）率分别为51%对46%对29%（p < 0.0001），5年患者和死亡剪除肾脏移植存活率分别为96.8%对83.5%对82.2%（p = 0.002）和86.7%对77.8%对78.8%（p = 0.18）：结论：尽管DGF的发生率较高，但与tSCr水平≥3.0 mg/dL的AKI DD或tSCr<1.0 mg/dL的DD相比，接受tSCr水平≥3.0 mg/dL的DD肾脏的患者的中期预后是可以接受的。

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引用次数: 0

Posttransplant Lymphoproliferative Disease Following Pancreas Transplantation: A 40 Year Single-Center Experience 胰腺移植后淋巴组织增生症：40 年的单中心经验

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-08-01 DOI: 10.1111/ctr.15386

Abraham J. Matar, Erik B. Finger, Joseph Maakaron, Emmanuel Minja, Karthik Ramanathan, Vanessa Humphreville, Joseph S. Rao, Jessica Fisher, David E. R. Sutherland, Arthur J. Matas, Raja Kandaswamy

Background

Chronic immunosuppression following pancreas transplantation carries significant risk, including posttransplant lymphoproliferative disease (PTLD). We sought to define the incidence, risk factors, and long-term outcomes of PTLD following pancreas transplantation at a single center.

Methods

All adult pancreas transplants between February 1, 1983 and December 31, 2023 at the University of Minnesota were reviewed, including pancreas transplant alone (PTA), simultaneous pancreas–kidney transplants (SPK), and pancreas after kidney transplants (PAK).

Results

Among 2353 transplants, 110 cases of PTLD were identified, with an overall incidence of 4.8%. 17.3% were diagnosed within 1 year of transplant, 32.7% were diagnosed within 5 years, and 74 (67.3%) were diagnosed after 5 years. The overall 30-year incidence of PTLD did not differ by transplant type—7.4% for PTA, 14.2% for SPK, and 19.4% for PAK (p = 0.3). In multivariable analyses, older age and Epstein-Barr virus seronegativity were risk factors for PTLD, and PTLD was a risk factor for patient death. PTLD-specific mortality was 32.7%, although recipients with PTLD had similar median posttransplant survival compared to those without PTLD (14.9 year vs. 15.6 year, p = 0.9).

Conclusions

PTLD following pancreas transplantation is associated with significant mortality. Although the incidence of PTLD has decreased over time, a high index of suspicion for PTLD following PTx should remain in EBV-negative recipients.

背景：胰腺移植后的慢性免疫抑制具有重大风险，包括移植后淋巴组织增生性疾病（PTLD）。我们试图在一个中心确定胰腺移植后淋巴组织增生性疾病的发病率、风险因素和长期结果：方法：回顾明尼苏达大学1983年2月1日至2023年12月31日期间的所有成人胰腺移植手术，包括单纯胰腺移植（PTA）、胰肾同步移植（SPK）和肾移植后胰腺移植（PAK）：结果：在 2353 例移植中，发现了 110 例 PTLD，总发病率为 4.8%。17.3%在移植后 1 年内确诊，32.7%在 5 年内确诊，74 例（67.3%）在 5 年后确诊。PTLD的30年总发病率因移植类型而异，PTA为7.4%，SPK为14.2%，PAK为19.4%（P = 0.3）。在多变量分析中，年龄较大和Epstein-Barr病毒血清阴性是PTLD的风险因素，而PTLD是患者死亡的风险因素。PTLD特异性死亡率为32.7%，但与无PTLD的受者相比，有PTLD的受者移植后中位生存期相似（14.9年对15.6年，P = 0.9）：结论：胰腺移植后的PTLD与严重的死亡率有关。尽管随着时间的推移，PTLD 的发病率有所下降，但对于 EBV 阴性的受者，仍应高度怀疑 PTLD 的存在。

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引用次数: 0

LCP-Tacrolimus Extended-Release (Envarsus XR) Use in Adolescent and Young Adult Solid Organ Transplant Recipients LCP-他克莫司缓释剂（Envarsus XR）在青少年和年轻成人实体器官移植受者中的应用。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-08-01 DOI: 10.1111/ctr.15417

Esther K. Bae, Mary Moss Chandran, Melanie D. Everitt, Eric Benz, Margret Bock

Introduction

Limited published experience describes once daily, extended-release tacrolimus (LCP-Tac) use in pediatric solid organ transplantation (SOT), particularly nonrenal SOT. LCP-Tac can simplify immunosuppression (IS) regimens, minimize immediate release-tacrolimus (IR-Tac)-associated adverse effects, and promote adherence. This study describes the successful use of LCP-Tac in adolescent and young adult (AYA) SOT populations.

Methods

A single-center, retrospective chart review of AYA SOT recipients (age < 25 years) converted from IR-Tac to LCP-Tac. Graft survival, biopsy-proven acute rejection (BPAR), infection rates, estimated glomerular filtration rate (eGFR), and pill burden were assessed at five time points postconversion (1, 3, 6, 12, and 24 months). Intrapatient variability of tacrolimus, as assessed by coefficient of variability (CV%), was also analyzed.

Results

Twenty-nine AYA SOT recipients (19 heart, 6 kidney, and 4 liver) were converted to LCP-Tac, with a median age of 17.4 years at conversion. Conversion, mainly due to perceived or identified medication nonadherence, occurred at a median of 5.4 years posttransplant. No graft loss occurred within 24 months of conversion, and BPAR incidence rate was consistent with previous reports for these populations. Only one patient experienced CMV infection. Renal function remained stable postconversion.

Conclusion

Successful conversion from IR-Tac to LCP-Tac was demonstrated in AYA heart, kidney, and liver transplant recipients. These AYA SOT recipients experienced reduced pill burden and improved tacrolimus trough concentration variability. However, the impact on medication adherence warrants further investigation. Future research should explore the targeted use of LCP-Tac to enhance IS tolerability and medication adherence in young SOT populations.

简介：已发表的关于在儿科实体器官移植（SOT）中使用每日一次缓释他克莫司（LCP-Tac）的经验有限，尤其是在非肾脏移植中。LCP-Tac可简化免疫抑制（IS）方案，最大限度地减少速释他克莫司（IR-Tac）相关不良反应，并提高依从性。本研究介绍了在青少年和年轻成人（AYA）SOT人群中成功使用LCP-Tac的情况：方法：对从 IR-Tac 转为 LCP-Tac 的青少年 SOT 受者（年龄小于 25 岁）进行单中心回顾性病历审查。在转换后的五个时间点（1、3、6、12 和 24 个月）评估了移植物存活率、活组织检查证实的急性排斥反应（BPAR）、感染率、估计肾小球滤过率（eGFR）和药片负担。此外，还分析了以变异系数（CV%）评估的患者体内他克莫司的变异性：结果：29 名亚健康 SOT 受体（19 名心脏受体、6 名肾脏受体和 4 名肝脏受体）转为 LCP-Tac，转为 LCP-Tac 时的中位年龄为 17.4 岁。移植后中位年龄为 17.4 岁，主要因认为或确定的不遵医嘱用药而改用 LCP-Tac，中位时间为移植后 5.4 年。移植后 24 个月内没有发生移植物丢失，BPAR 发生率与之前关于这些人群的报告一致。只有一名患者发生了 CMV 感染。肾功能在转换后保持稳定：结论：亚裔心脏、肾脏和肝脏移植受者成功地从 IR-Tac 转为 LCP-Tac。这些青壮年器官移植受者的用药负担减轻，他克莫司谷浓度变异性提高。不过，对用药依从性的影响还有待进一步研究。未来的研究应探索有针对性地使用 LCP-Tac 来提高年轻 SOT 群体的 IS 耐受性和用药依从性。

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引用次数: 0

Lack of Association Between Donor-Derived Cell-Free DNA and Cardiac Allograft Vasculopathy 捐献者来源的细胞游离 DNA 与心脏移植血管病变之间缺乏关联。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-07-26 DOI: 10.1111/ctr.15416

Rami Alharethi, Stacey Knight, Helen I. Luikart, Theresa Wolf-Doty, Daniel L. Bride, Daniel. T. Kim, Kiran K. Khush

Cardiac allograft vasculopathy (CAV) is a leading cause of death after heart transplantation (HT). We evaluated donor-derived cell-free DNA (dd-cfDNA) as a noninvasive biomarker of CAV development after HT.

The INSPIRE registry at the Intermountain Medical Center was queried for stored plasma samples from HT patients with and without CAV. At Stanford University, HT patients with CAV (cases) and without CAV (controls) were enrolled prospectively, and blood samples were collected. All the samples were analyzed for dd-cfDNA using the AlloSure assay (CareDx, Inc.). CAV was defined per the ISHLT 2010 standardized classification system. Univariate associations between patient demographics and clinical characteristics and their CAV grade were tested using chi-square and Wilcoxon rank sum tests. Associations between their dd-cfDNA levels and CAV grades were examined using a nonparametric Kruskal–Wallis test.

A total of 69 pts were included, and 101 samples were analyzed for dd-cfDNA. The mean age at sample collection was 58.6 ± 13.7 years; 66.7% of the patients were male, and 81% were White. CAV 0, 1, 2, and 3 were present in 37.6%, 22.8%, 22.8%, and 16.8% of included samples, respectively. The median dd-cfDNA level was 0.13% (0.06, 0.33). The median dd-cfDNA level was not significantly different between CAV (−) and CAV (+): 0.09% (0.05%–0.32%) and 0.15% (0.07%–0.33%), respectively, p = 0.25 and with similar results across all CAV grades.

In our study, dd-cfDNA levels did not correlate with the presence of CAV and did not differ across CAV grades. As such, dd-cfDNA does not appear to be a reliable noninvasive biomarker for CAV surveillance.

心脏移植物血管病变（CAV）是心脏移植（HT）后死亡的主要原因。我们评估了供体来源的无细胞 DNA（dd-cfDNA）作为心脏移植后 CAV 发生的非侵入性生物标志物的作用。我们在山间医疗中心的 INSPIRE 登记处查询了患有和不患有 CAV 的 HT 患者的血浆样本。斯坦福大学对患有 CAV 的 HT 患者（病例）和未患有 CAV 的 HT 患者（对照）进行了前瞻性登记，并采集了血液样本。使用 AlloSure 分析法（CareDx, Inc.）CAV 根据 ISHLT 2010 标准化分类系统进行定义。采用秩方检验和 Wilcoxon 秩和检验对患者人口统计学特征和临床特征与 CAV 分级之间的单变量关系进行了检验。使用非参数 Kruskal-Wallis 检验法检验了 dd-cfDNA 水平与 CAV 分级之间的关系。共纳入 69 名患者，对 101 份样本进行了 dd-cfDNA 分析。样本采集时的平均年龄为 58.6 ± 13.7 岁；66.7% 的患者为男性，81% 为白人。37.6%、22.8%、22.8% 和 16.8% 的样本存在 CAV 0、1、2 和 3。dd-cfDNA 水平的中位数为 0.13% (0.06, 0.33)。中位 dd-cfDNA 水平在 CAV (-) 和 CAV (+) 之间无显著差异：分别为 0.09% (0.05%-0.32%) 和 0.15% (0.07%-0.33%)，p = 0.25，所有 CAV 等级的结果相似。在我们的研究中，dd-cfDNA水平与CAV的存在并无相关性，在不同CAV分级中也无差异。因此，dd-cfDNA 似乎不是监测 CAV 的可靠无创生物标志物。

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引用次数: 0