Clinical Transplantation最新文献_第10页

Influence of Acuity Circles on Hepatocellular Carcinoma and the Interaction of Gender and Race in Liver Transplantation 急性眼圈对肝移植中肝细胞癌的影响及性别、种族的相互作用

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-02 DOI: 10.1111/ctr.70045

Ahila Manivannan, Anjana Pillai, AnnMarie Liapakis, Neehar D. Parikh, Vineeta Kumar, Elizabeth C. Verna, Reena Salgia, Trueman Wu, Mei Lu, Michelle T. Jesse

The impact of liver transplant allocation policy using acuity circles (ACs) on interactions between race and gender on waitlist mortality or receipt of deceased donor liver transplant (DDLT) is unknown. Using data from the United Network for Organ Sharing (UNOS), we examined adults listed for DDLT from April 3, 2017, to October 4, 2022 (30 months pre- and post-AC). Fine-Gray sub-distribution hazard model explored AC indicators by race and gender interactions and their effect on receipt of DDLT or waitlist mortality. Also explored was AC's impact on hepatocellular carcinoma (HCC) diagnosis and receipt of DDLT or waitlist mortality. 59 592 patients (30 202 pre-AC, 29 390 post-AC) included. For both receipt of DDLT and waitlist mortality, there were no 3-way (AC by race by gender) interactions, indicating that the effects of race and gender on DDLT or waitlist mortality were consistent pre- and post-AC. Irrespective of AC implementation, Black and Hispanic women were less likely to receive DDLT and had an increased risk of waitlist mortality compared to White women. White, Black, and Hispanic men had lower waitlist mortality risk and greater likelihood of receiving DDLT compared to their female race/ethnic counterparts. Patients with HCC had a significantly greater chance for DDLT than non-HCC, although post-AC this effect was attenuated. Patients with HCC were also at greater risk of waitlist mortality pre- and post-AC compared to those without HCC however, the waitlist mortality post-AC was attenuated only for those patients without HCC. To our knowledge, this is the first study to show the interaction of gender and race on waitlist mortality and access to transplantation since the implementation of AC, showing continued disparate outcomes for women both within and across racial groups.

使用视圆（ACs）的肝移植分配政策对种族和性别对等待名单死亡率或接受已故供体肝移植（DDLT）的相互作用的影响尚不清楚。使用器官共享联合网络（UNOS）的数据，我们检查了2017年4月3日至2022年10月4日（ac前后30个月）登记为DDLT的成年人。细灰色亚分布风险模型通过种族和性别相互作用探讨AC指标及其对DDLT接收或等候名单死亡率的影响。还探讨了AC对肝细胞癌（HCC）诊断和接受DDLT或等候名单死亡率的影响。纳入59592例患者（30202例ac前，29390例ac后）。对于DDLT的接收和候补名单死亡率，没有3-way（种族和性别的AC）相互作用，表明种族和性别对DDLT或候补名单死亡率的影响在AC前后是一致的。无论是否实施AC，与白人妇女相比，黑人和西班牙裔妇女接受DDLT的可能性较小，等待名单死亡率风险增加。与女性相比，白人、黑人和西班牙裔男性的等待名单死亡风险较低，接受DDLT的可能性较大。HCC患者发生DDLT的机会明显高于非HCC患者，尽管ac后这种影响减弱。与没有HCC的患者相比，HCC患者在ac术前和ac后的等候名单死亡率风险也更高。然而，只有那些没有HCC的患者在ac后的等候名单死亡率有所降低。据我们所知，这是自AC实施以来首次显示性别和种族在等待名单死亡率和移植可及性方面的相互作用的研究，显示了种族群体内部和跨种族女性的持续差异结果。

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引用次数: 0

Outcomes of Lung Transplantation in Coal Workers Pneumoconiosis: Analysis of UNOS Database 煤工尘肺肺移植的预后：UNOS数据库分析

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-02 DOI: 10.1111/ctr.70042

Sravanthi Nandavaram, Xiaonan Mei, Tahir Khan, Muhammad Asad Faruqi, Zachary Fyffe, Suresh Keshavamurthy, Satish Chandrashekaran

Background

Coal worker's pneumoconiosis (CWP) poses a significant burden on affected individuals and is associated with increased morbidity and mortality. Lung transplantation (LT) is the only effective treatment for this progressive and fatal lung disease. This study aims to evaluate the outcomes of patients who have undergone LT for primary diagnosis of CWP.

Methods

The Scientific Registry of Transplant Recipients (SRTR) data from the United Network of Organ Sharing (UNOS) was queried to identify recipients who underwent lung transplantation (LT) between May 2005 and June 2021 in the lung allocation score (LAS) era across all transplant centers reporting to SRTR. A comparison was conducted between baseline characteristics, perioperative variables, and post-transplant outcomes of patients who underwent LT for CWP and those who received LT for other indications. Kaplan–Meier survival analysis and multivariable Cox regression analysis were performed to assess graft and patient survival post LT.

Results

Between May 2005 and June 2021, 158 patients underwent LT for CWP. Overall graft survival (Log-rank p = 0.889) and patient survival (Log-rank p = 0.910) were not significantly different between the two groups. CWP group was noted to have higher mean pulmonary artery pressures, LAS, need for prolonged intubation and extracorporeal membrane oxygenation (ECMO) at 72 h and the need for dialysis at the time of discharge.

Conclusion

Patients who underwent LT for coal workers' pneumoconiosis (CWP) had comparable post-transplant outcomes to those with other diagnoses. Therefore, LT for CWP can be safely performed. It is crucial to recognize the severity of the illness and be aware of the potential challenges in the perioperative transplant course to effectively manage this population.

煤炭工人尘肺病（CWP）对患者造成了重大负担，并与发病率和死亡率增加有关。肺移植（LT）是治疗这种进行性和致命性肺病的唯一有效方法。本研究旨在评估行肝移植的CWP患者的初步诊断结果。方法查询来自联合器官共享网络（UNOS）的移植受者科学登记处（SRTR）数据，以确定2005年5月至2021年6月间在肺分配评分（LAS）时代接受肺移植（LT）的所有移植中心的移植受者。比较了因CWP接受肝移植的患者和因其他适应症接受肝移植的患者的基线特征、围手术期变量和移植后结果。Kaplan-Meier生存分析和多变量Cox回归分析评估移植后移植物和患者的生存。结果2005年5月至2021年6月，158例患者因CWP接受了移植。两组间移植物总生存率（Log-rank p = 0.889）和患者生存率（Log-rank p = 0.910）无显著差异。注意到CWP组有较高的平均肺动脉压，LAS，在72小时需要延长插管和体外膜氧合（ECMO），并且在出院时需要透析。结论煤工尘肺（CWP）患者接受肝移植后的预后与其他诊断的患者相当。因此，可以安全地进行CWP的LT。重要的是要认识到疾病的严重性，并意识到在围手术期移植过程中的潜在挑战，以有效地管理这一人群。

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引用次数: 0

What Makes Non-Directed Living Kidney Donors Tick? Actionable Items to Increase Non-Directed Live Organ Donation 是什么让非定向活体肾脏捐赠者做出选择？增加非定向活体器官捐赠的行动项目

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-29 DOI: 10.1111/ctr.70044

Amy S. Wang, Kasi McCune, Ilona Wiener, Brian Runge, Daniela Pasantes, Eric Johnson, Lloyd E. Ratner

Background

Non-directed donors (NDDs), individuals who donate their organs with no intended recipient, in the United States increased 90-fold from 1999 to 2019. There is a paucity of studies investigating the motivations of NDDs. The objective of our study is to identify actionable items to increase NDDs.

Methods

A survey of kidney NDDs at CUIMC from 2009 to 2021 was conducted. The survey was conducted via Qualtrics.

Results

Seventy individuals met the study criteria. Forty-seven (67.1%) individuals completed the survey. A total of 98% of respondents reported participating in other altruistic activities prior to donation. A total of 70% donors identified as religious, and 57% reported religion/spirituality positively affected the decision to donate. The three most common factors that got respondents interested in NDD included: (1) hearing about an individual in need of a transplant, (2) knowing someone who had donated an organ, and (3) as a next step in altruistic behavior. A total of 85% said that donating a kidney met or exceeded expectations. A total of 44% and 31% of NDDs were interested in being either liver or uterus NDDs, respectively.

Conclusions

We identified six potential action items: (1) Identify pools of receptive individuals who participated in other altruistic behaviors and/or identify as religious. (2) Outreach to individuals who came forward as directed donors, but whose intended recipient was successfully transplanted with a kidney from another donor. (3) Promote stories of those who need organ transplants or whose lives have been changed by transplantation. (4) Promote NDDs as resources for potential NDDs. (5) Educate interested kidney NDDs about liver and uterus transplant programs. (6) Decrease financial barriers to donation.

从1999年到2019年，美国的非定向捐赠者（ndd）增加了90倍。非定向捐赠者是指在没有预定接受者的情况下捐赠器官的个人。调查ndd动机的研究很少。我们研究的目的是确定可操作的项目来增加ndd。方法对2009 ~ 2021年我院肾脏ndd进行调查。这项调查是通过Qualtrics进行的。结果70例符合研究标准。47人（67.1%）完成了调查。总共有98%的受访者表示在捐赠之前参与了其他利他活动。总共有70%的捐赠者是宗教人士，57%的人表示宗教/灵性对他们的捐赠决定有积极影响。让受访者对NDD感兴趣的三个最常见的因素包括：(1)听说有个人需要移植，(2)知道有人捐献了器官，(3)作为利他行为的下一步。85%的人表示捐肾达到或超过了预期。分别有44%和31%的ndd患者有兴趣成为肝脏ndd或子宫ndd。我们确定了六个潜在的行动项目：(1)确定参与其他利他行为和/或宗教信仰的接受性个体池。(2)向直接捐赠者提供服务，但其预期接受者成功移植了另一个捐赠者的肾脏。(3)宣传需要器官移植或因器官移植而改变生活的人的故事。(4)促进ndd作为潜在ndd的资源。(5)对感兴趣的肾脏NDDs进行肝脏和子宫移植手术的教育。(6)减少捐赠的经济障碍。

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引用次数: 0

Impact of Letermovir for Cytomegalovirus Primary Prophylaxis on Myelosuppression and Immunosuppression in Lung Transplant Recipients 用于巨细胞病毒一级预防的来替莫韦对肺移植受者骨髓抑制和免疫抑制的影响

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-27 DOI: 10.1111/ctr.70033

Hanna L. Kleiboeker, Alyson Prom, Krista Paplaczyk, Jacob Wang, Nicole Borkowski, Brad Miner, Jennifer Wright, Mrinalini Venkata Subramani, Ambalavanan Arunachalam, Alan D. Betensley, Rade Tomic, Catherine N. Myers

Background

Cytomegalovirus (CMV) is associated with detrimental outcomes after lung transplantation (LTX); primary prophylaxis (PPX) with valganciclovir (VGC) is guideline-recommended. VGC is associated with myelosuppression, spurring interest in letermovir (LTV).

Methods

Adults undergoing LTX between January 1, 2021, and July 30, 2022 at our institution who were converted from VGC to LTV for PPX were evaluated. Outcomes included antimetabolite dosing during PPX, the incidence and frequency of myelosuppressive events, and the time to the first myelosuppressive event.

Results

Twenty-nine LTX recipients met the inclusion criteria. Most patients received non-lymphocyte-depleting induction (96.6%) and had moderate risk CMV serostatus (D+/R+, 48.3%). Patients transitioned from VGC to LTV 177 days (IQR 102 days) post-transplant. After conversion to LTV, patients tolerated higher daily doses of mycophenolate (721 mg vs. 1000 mg, p = 0.008) or azathioprine (33.3 mg vs. 62.5 mg, p = 0.478). The incidence of myelosuppressive events was reduced (100.0% vs. 62.1%, p < 0.001) including leukopenia (96.6% vs. 58.6%, p = 0.001), severe leukopenia (82.8% vs 31.0%, p < 0.001) and neutropenia requiring GCSF (96.6% vs. 48.3%, p < 0.001) while on VGC compared to LTV. While on LTV, patients had a reduced rate of myelosuppressive events compared to VGC (1 event per 6.2 patient days vs. 1 event per 14.7 patient days, p < 0.001). While on LTV, one patient had breakthrough viremia (3.4%) that was treated with (val)ganciclovir.

Conclusions

In this single-center study, patients tolerated higher doses of antimetabolite immunosuppression, and the incidence and frequency of myelosuppressive events were reduced while on LTV compared to VGC. This evidence expands upon the current literature demonstrating improved tolerability of LTV in LTX recipients.

背景：巨细胞病毒（CMV）与肺移植（LTX）后的不良预后有关；指南推荐使用缬更昔洛韦（VGC）进行一级预防（PPX）。缬更昔洛韦（VGC）与骨髓抑制有关，激发了人们对来特莫韦（LTV）的兴趣：方法：对我院 2021 年 1 月 1 日至 2022 年 7 月 30 日期间接受 LTX 治疗的成人进行了评估，他们因 PPX 而从 VGC 转为 LTV。结果包括 PPX 期间的抗代谢药物剂量、骨髓抑制事件的发生率和频率以及发生首次骨髓抑制事件的时间：29名LTX受者符合纳入标准。大多数患者接受了非淋巴细胞消耗诱导（96.6%），CMV血清状态为中度风险（D+/R+，48.3%）。患者在移植后 177 天（IQR 102 天）从 VGC 转为 LTV。转为LTV后，患者可耐受更高的霉酚酸盐（721毫克对1000毫克，p = 0.008）或硫唑嘌呤（33.3毫克对62.5毫克，p = 0.478）日剂量。与LTV相比，服用VGC时骨髓抑制事件的发生率降低（100.0% vs. 62.1%，p < 0.001），包括白细胞减少症（96.6% vs. 58.6%，p = 0.001）、严重白细胞减少症（82.8% vs. 31.0%，p < 0.001）和需要使用GCSF的中性粒细胞减少症（96.6% vs. 48.3%，p < 0.001）。与VGC相比，患者在LTV期间发生骨髓抑制事件的比率有所降低（每6.2个患者日发生1起事件 vs. 每14.7个患者日发生1起事件，p < 0.001）。在接受LTV治疗期间，一名患者出现了突破性病毒血症（3.4%），并接受了(val)更昔洛韦治疗：在这项单中心研究中，患者可以耐受更大剂量的抗代谢物免疫抑制，与VGC相比，服用LTV时骨髓抑制事件的发生率和频率均有所降低。现有文献显示，LTX受者对LTV的耐受性有所改善，这一证据进一步证实了这一点。

{"title":"Impact of Letermovir for Cytomegalovirus Primary Prophylaxis on Myelosuppression and Immunosuppression in Lung Transplant Recipients","authors":"Hanna L. Kleiboeker, Alyson Prom, Krista Paplaczyk, Jacob Wang, Nicole Borkowski, Brad Miner, Jennifer Wright, Mrinalini Venkata Subramani, Ambalavanan Arunachalam, Alan D. Betensley, Rade Tomic, Catherine N. Myers","doi":"10.1111/ctr.70033","DOIUrl":"10.1111/ctr.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cytomegalovirus (CMV) is associated with detrimental outcomes after lung transplantation (LTX); primary prophylaxis (PPX) with valganciclovir (VGC) is guideline-recommended. VGC is associated with myelosuppression, spurring interest in letermovir (LTV).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults undergoing LTX between January 1, 2021, and July 30, 2022 at our institution who were converted from VGC to LTV for PPX were evaluated. Outcomes included antimetabolite dosing during PPX, the incidence and frequency of myelosuppressive events, and the time to the first myelosuppressive event.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine LTX recipients met the inclusion criteria. Most patients received non-lymphocyte-depleting induction (96.6%) and had moderate risk CMV serostatus (D+/R+, 48.3%). Patients transitioned from VGC to LTV 177 days (IQR 102 days) post-transplant. After conversion to LTV, patients tolerated higher daily doses of mycophenolate (721 mg vs. 1000 mg, <i>p</i> = 0.008) or azathioprine (33.3 mg vs. 62.5 mg, <i>p</i> = 0.478). The incidence of myelosuppressive events was reduced (100.0% vs. 62.1%, <i>p</i> < 0.001) including leukopenia (96.6% vs. 58.6%, <i>p</i> = 0.001), severe leukopenia (82.8% vs 31.0%, <i>p</i> < 0.001) and neutropenia requiring GCSF (96.6% vs. 48.3%, <i>p</i> < 0.001) while on VGC compared to LTV. While on LTV, patients had a reduced rate of myelosuppressive events compared to VGC (1 event per 6.2 patient days vs. 1 event per 14.7 patient days, <i>p</i> < 0.001). While on LTV, one patient had breakthrough viremia (3.4%) that was treated with (val)ganciclovir.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this single-center study, patients tolerated higher doses of antimetabolite immunosuppression, and the incidence and frequency of myelosuppressive events were reduced while on LTV compared to VGC. This evidence expands upon the current literature demonstrating improved tolerability of LTV in LTX recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726508","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}

引用次数: 0

Outcomes of Hematopoietic Stem Cell Transplantation in Patients With Thalassemia Major: How Do Anti-HLA Antibodies Impact? 重型地中海贫血患者的造血干细胞移植结果：抗-HLA抗体如何影响？抗-HLA抗体对重型地中海贫血移植结果的影响。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-27 DOI: 10.1111/ctr.70035

Gizem Zengin Ersoy, Basak Adakli Aksoy, Melek Erdem, Lokman Karataş, Selime Aydoğdu, Özlem Başoğlu Öner, Gürcan Dikme, Ceyhun Bozkurt, Tunç Fışgın

Aim

To investigate the effects of anti-human Leucocyte Antigen (HLA) antibody positivity on early hematopoietic stem cell transplantation (HSCT) results in patients with thalassemia major (TM).

Methods

One hundred and twenty-four HLA-matched HSCTs were performed in patients with TM between 2015 and 2022. Ninety-one patients were screened for anti-HLA antibodies by testing panel reactive antigens (PRA). Demographic and transplantation characteristics of patients were recorded. The presence of PRA was tested with the Antibody Testing Assay (Luminex LIFECODES HLA Antibody Identification System).

Results

The number of PRA-positive patients was 54. There was no relationship between acute graft versus host disease (GVHD), chronic GVHD, grade of GVHD, and viral reactivation of the patients. However, platelet engraftment took around 3 days longer in the PRA-positive group (p = 0.05). The median number of erythrocyte transfusions was significantly higher in PRA-positive patients in the post-transplant period (p = 0.003), as was the median number of platelet transfusions (p = 0.003). Treosulfan conditioning increased the stable mixed chimerism (MC) rate by 3.8-fold (p = 0.011). In contrast, reduced rates of MC were found in patients who received matched unrelated donor cells or peripherally derived stem cells (p = 0.011 and p = 0.039, respectively) in the posttransplantation period in TM patients. PRA-positivity did not affect MC (p = 0.478). However, 80% of patients who had primary graft failure (n = 5; p = 0.59) and 75% of patients who died (n = 4) were PRA positive (p = 0.64), but these results were statistically insignificant due to the low number of patients.

Conclusion

Anti-HLA antibodies primarily delayed platelet engraftment in TM patients and increased the erythrocyte and thrombocyte transfusion requirements. Although PRA positivity was more common in patients with primary graft failure or who died, there was no statistically significant impact of PRA positivity on chimerism, acute or chronic GVHD, viral activation, or mortality rates.

目的：研究抗人类白细胞抗原（HLA）抗体阳性对重型地中海贫血（TM）患者早期造血干细胞移植（HSCT）结果的影响：2015年至2022年期间，为重型地中海贫血患者进行了124例HLA匹配造血干细胞移植。通过检测面板反应抗原（PRA）筛查了91名患者的抗HLA抗体。记录了患者的人口统计学特征和移植特征。使用抗体检测试剂盒（Luminex LIFECODES HLA 抗体识别系统）检测是否存在 PRA：结果：PRA阳性患者人数为54人。急性移植物抗宿主疾病（GVHD）、慢性 GVHD、GVHD 级别和患者的病毒再激活之间没有关系。不过，PRA 阳性组的血小板移植时间延长了约 3 天（P = 0.05）。PRA 阳性患者在移植后输注红细胞的中位数明显增加（p = 0.003），输注血小板的中位数也是如此（p = 0.003）。特罗硫安治疗使稳定的混合嵌合体（MC）率增加了 3.8 倍（p = 0.011）。相比之下，在TM患者移植后期间，接受匹配的非亲属供体细胞或外周衍生干细胞的患者的MC率降低（分别为p = 0.011和p = 0.039）。PRA阳性并不影响MC（p = 0.478）。然而，80%的原发性移植失败患者（n = 5；p = 0.59）和75%的死亡患者（n = 4）均为PRA阳性（p = 0.64），但由于患者人数较少，这些结果在统计学上并不显著：结论：抗 HLA 抗体主要延迟了 TM 患者的血小板移植，增加了红细胞和血小板输注需求。虽然 PRA 阳性在原发性移植物失败或死亡的患者中更为常见，但 PRA 阳性对嵌合体、急性或慢性 GVHD、病毒激活或死亡率并无统计学意义。

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引用次数: 0

CT-Based Lung Size Matching in Delayed Chest Closure for Systemic Sclerosis Lung Transplantation 基于 CT 的肺大小匹配在系统性硬化肺移植延迟胸腔闭合中的应用

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-27 DOI: 10.1111/ctr.70041

Jatin Singh, Xin Meng, Joseph K. Leader, John Ryan, Ernest G. Chan, Norihisa Shigemura, Chadi A. Hage, Pablo G. Sanchez, Jiantao Pu

Purpose

Delayed chest closure (DCC) during lung transplantation (LTx) is a controversial surgical approach that lacks research in systemic sclerosis (SSc) patients. We investigated outcomes, clinical risk factors, and CT-based lung size-matching parameters associated with DCC in SSc recipients.

Methods

This retrospective study included 92 SSc recipients (age 51 years ± 10, 56/92 (61.0%) females) who underwent bilateral LTx between 2007 and 2020. Of the recipients, 34.8% (32/92) underwent DCC. Recipient lung and chest cavity volumes were automatically computed from CT imaging using deep learning algorithms. Survival between groups was compared using Kaplan–Meier analysis. Multivariate logistic regression was used to identify risk factors and predict DCC occurrence using preoperative variables.

Results

Recipients who underwent DCC had longer total vent duration (p = 0.001), more use of postoperative mechanical support (p = 0.001), longer ICU length of stay (p = 0.008), and lower incidence of pneumonia post-operation (p = 0.031). No significant difference in survival was observed between DCC and PCC recipients at 30 days (p = 0.713), 90 days (p = 0.267), 1 year (p = 0.941), and 5 years (p = 0.651). Clinical risk factors for DCC included BMI > 30 kg/m² (p = 0.009), tracheostomy (p = 0.002), atrial fibrillation (p = 0.012), decreased preoperative FEV1/FVC (p = 0.013), and previous chest operation (p = 0.020). Two CT-based measurements of lung matching were significantly associated with DCC occurrence (p = 0.021 and 0.050). The regression model achieved a mean AUC of 0.82 (0.70, 0.94) in retrospectively predicting DCC occurrence.

Conclusion

SSc recipients undergoing DCC have similar survival rates but experience more complications than PCC recipients. Clinical risk factors and CT-based size matching can be leveraged to predict DCC pre-transplant.

目的：肺移植（LTx）过程中的延迟胸腔闭合（DCC）是一种有争议的手术方法，对系统硬化症（SSc）患者缺乏研究。我们调查了SSc受者中与DCC相关的结果、临床风险因素和基于CT的肺大小匹配参数：这项回顾性研究纳入了 2007 年至 2020 年间接受双侧 LTx 的 92 名 SSc 受者（年龄 51 岁 ± 10，女性 56/92 (61.0%)）。其中 34.8%（32/92）的受者接受了 DCC。受者的肺和胸腔容积是利用深度学习算法通过 CT 成像自动计算得出的。采用卡普兰-梅耶尔分析法比较各组间的生存率。采用多变量逻辑回归确定风险因素，并利用术前变量预测DCC的发生：结果：接受 DCC 的受者总通气时间较长（p = 0.001），术后使用机械支持较多（p = 0.001），重症监护室住院时间较长（p = 0.008），术后肺炎发生率较低（p = 0.031）。在 30 天（p = 0.713）、90 天（p = 0.267）、1 年（p = 0.941）和 5 年（p = 0.651）的存活率方面，DCC 和 PCC 受试者无明显差异。DCC 的临床风险因素包括 BMI > 30 kg/m2 (p=0.009)、气管切开术 (p=0.002)、心房颤动 (p=0.012)、术前 FEV1/FVC 降低 (p = 0.013) 和既往胸部手术 (p=0.020)。两种基于 CT 的肺匹配测量结果与 DCC 的发生显著相关（p = 0.021 和 0.050）。回归模型在回顾性预测 DCC 发生率方面的平均 AUC 为 0.82 (0.70, 0.94)：结论：接受DCC治疗的SSc受者生存率相似，但并发症发生率高于PCC受者。临床风险因素和基于CT的大小匹配可用于预测移植前的DCC。

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引用次数: 0

Prognostic Factors Associated With Increased Mortality in Pediatric Veno-Occlusive Disease Following Hematopoietic Cell Transplantation 与小儿造血细胞移植后静脉闭塞症死亡率增加相关的预后因素

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-27 DOI: 10.1111/ctr.70037

Irina Zaidman, Natalie Barsoum, Ehud Even-Or, Miriam Daher, Adi Avniel Aran, Polina Stepensky, Aharon Gefen

Background

Hepatic veno-occlusive disease (VOD) is a life-threatening complication of hematopoietic cell transplantation (HCT) and is categorized as a transplant-related, systemic endothelial disease. Severe VOD can lead to multi-organ dysfunction (MOF) and is associated with a high mortality rate.

Objective

To evaluate the incidence of VOD in children after HCT and analyze the outcomes and risk factors associated with increased mortality.

Study Design

A retrospective cohort study of 1243 children with malignant and non-malignant diseases who underwent HCT at two large pediatric centers over 20 years.

Results

One hundred one patients (8%) developed VOD post HCT. Most patients developed VOD post allogeneic HCT (76%) versus autologous (24%). The incidence of VOD was twice as high in children with malignant diseases compared to non-malignant (68% vs. 32%). A much higher incidence of VOD occurred in patients after a busulfan-based regimen versus total body irradiation-based and treosulfan-based, 73%, 18%, and 1%, respectively. The 100-day survival rate of HCT patients with VOD was 69%. The overall survival rate of the entire group was 50%, showing improvement over the span of the study years, from 40% between 2000 and 2009 to 63% between 2010 and 2021 (p = 0.022). Factors associated with increased mortality included infections before transplant (p = 0.013), conditioning regimen (p = 0.01), abnormal liver function (p = 0.019), presence of ascites (p = 0.008), MOF (p < 0.001), and the need for admission to a pediatric intensive care unit (p < 0.001). There was no significant difference in survival rates between children treated with defibrotide alone or with those treated with defibrotide and steroids (61% and 65%, respectively; p = 0.685).

Conclusions

Severe VOD in pediatric patients following HCT remains a life-threatening complication with a high mortality rate. Early diagnosis and treatment with defibrotide are critical for managing this condition. In our cohort, the addition of steroids to defibrotide was not associated with improved outcomes.

背景肝静脉闭塞症（VOD）是造血细胞移植（HCT）的一种危及生命的并发症，被归类为移植相关的全身性内皮疾病。严重的 VOD 可导致多器官功能障碍 (MOF)，并与高死亡率相关。目的评估儿童 HCT 后 VOD 的发病率，并分析与死亡率增加相关的结果和风险因素。研究设计对在两家大型儿科中心接受 HCT 的 1243 名患有恶性和非恶性疾病的儿童进行回顾性队列研究，历时 20 年。结果 101名患者（8%）在接受 HCT 后出现 VOD。大多数患者在接受异体造血干细胞移植（76%）和自体造血干细胞移植（24%）后出现 VOD。恶性疾病患儿的 VOD 发生率是非恶性疾病患儿的两倍（68% 对 32%）。以丁胺磺胺为基础的治疗方案与以全身照射为基础的治疗方案和以曲硫磺为基础的治疗方案相比，VOD发生率要高得多，分别为73%、18%和1%。有 VOD 的 HCT 患者的 100 天存活率为 69%。整组患者的总生存率为50%，在研究期间有所提高，从2000年至2009年的40%提高到2010年至2021年的63%（P = 0.022）。与死亡率增加相关的因素包括移植前感染（p = 0.013）、调理方案（p = 0.01）、肝功能异常（p = 0.019）、腹水（p = 0.008）、MOF（p < 0.001）和需要入住儿科重症监护室（p < 0.001）。单独使用去纤维化药物治疗的患儿与使用去纤维化药物和类固醇治疗的患儿在存活率上没有明显差异（分别为61%和65%；P = 0.685）。结论 HCT 后儿童患者的严重 VOD 仍是一种危及生命的并发症，死亡率很高。早期诊断和使用去纤维化药物治疗对控制病情至关重要。在我们的队列中，在使用去纤肽的同时使用类固醇与改善预后无关。

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引用次数: 0

Homozygous Phospholamban Mutation Causing Dilated Cardiomyopathy in a Young Man: From Cardiogenic Shock to Tennis Tournaments 同卵磷脂班突变导致一名年轻男子发生扩张型心肌病：从心源性休克到网球锦标赛

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-25 DOI: 10.1111/ctr.70031

Federica Mazzone, Lorenzo Giovannico, Giuseppe Fischetti, Domenico Parigino, Andrea Igoren Guaricci, Cinzia Forleo, Massimo Padalino, Nicoletta Resta, Marco Matteo Ciccone, Tomaso Bottio

引用次数: 0

Terbutaline for Management of Relative Bradycardia Post-Orthotopic Heart Transplant: A Single Center Experience 特布他林治疗异位心脏移植术后相对性心动过缓：单中心经验

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-25 DOI: 10.1111/ctr.70036

Zoe H. Tu, Allison N. Yun, Janardhana Gorthi, Ashrith Guha, Jill C. Krisl, Arvind Bhimaraj

Background

Vagal nerve denervation during the heart transplant procedure results in higher resting heart rates in these recipients compared to the general population. Relative bradycardia (RB) is a common and often temporary post-operative complication that can be managed with agents like terbutaline; however, little data exist on the efficacy, safety, and necessity of long-term terbutaline use post-heart transplant.

Methods

This was a single-center, retrospective, descriptive study conducted at a large academic medical center investigating oral terbutaline use for RB management in heart transplant recipients. Outcomes included time to and reason for terbutaline discontinuation post-transplant, adverse event rates, and permanent pacemaker (PPM) placement rates.

Results

In the 229 patients included, the median (IQR) time to terbutaline initiation was 8 (5, 12) days post-heart transplant, with a median (IQR) time to discontinuation of 56 (20, 96) days from the first dose. In most cases, terbutaline was successfully tapered off outpatient due to the resolution of RB. Tachyarrhythmias occurred in 29 (12.7%) patients without long-term sequelae. At 3 months post-transplant, PPM had been placed for chronotropic support in 15 patients (6.6%) with a median time (IQR) to PPM placement of 24 (19, 77) days from transplant.

Conclusion

This study's overall low PPM placement rate suggests that early sinus node dysfunction can be treated with pharmacotherapy without committing to a permanent device, and that terbutaline can be used safely in early post-heart transplant recipients. If patients require long-term chronotropic support, the risk-benefit of PPM placement versus continued terbutaline should be considered.

背景在心脏移植过程中进行迷走神经去神经支配会导致受者的静息心率高于普通人群。相对心动过缓（RB）是一种常见的术后并发症，通常是暂时性的，可以使用特布他林等药物进行控制；然而，关于心脏移植术后长期使用特布他林的有效性、安全性和必要性的数据却很少。方法这是一项单中心、回顾性、描述性研究，在一家大型学术医疗中心进行，调查心脏移植受者口服特布他林治疗 RB 的情况。研究结果包括移植后停用特布他林的时间和原因、不良事件发生率和永久起搏器（PPM）安置率。结果在纳入的 229 例患者中，开始使用特布他林的中位数（IQR）时间为心脏移植后 8（5，12）天，停用特布他林的中位数（IQR）时间为首次给药后 56（20，96）天。在大多数病例中，特布他林可在门诊成功减量，原因是RB症状缓解。29例（12.7%）患者发生了快速性心律失常，但没有留下长期后遗症。移植后 3 个月时，15 名患者（6.6%）植入了 PPM 以获得慢性心动过速支持，植入 PPM 的中位时间（IQR）为移植后 24 天（19，77）。结论本研究的 PPM 置入率总体较低，这表明早期窦房结功能障碍可通过药物疗法治疗，而无需使用永久性装置，并且特布他林可安全地用于心脏移植后的早期受者。如果患者需要长期的促时差支持，则应考虑置入 PPM 与继续使用特布他林的风险效益。

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引用次数: 0

Heart Transplant Outcomes in Older Adults in the Modern Era of Transplant 现代移植时代老年人的心脏移植结果。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-22 DOI: 10.1111/ctr.70032

Stephanie Golob, Orly Leiva, Randal Goldberg, Bernard Kadosh, Haider Nazeer, Amit Alam, Shaline Rao, Nader Moazami, John A. Dodson, Alex Reyentovich

Background

Because of advances in medical treatment of heart failure, patients are living longer than in previous eras and may approach the need for advanced therapies, including heart transplantation, at older ages. This study assesses practices surrounding heart transplant in older adults (> 70 years) and examines short- and medium-term outcomes.

Methods and Results

This study is a retrospective analysis using the United Network for Organ Sharing (UNOS) database from 2010 to 2021. The absolute number of older adults being transplanted is increasing. Older adults were more likely to have had a prior malignancy or ischemic cardiomyopathy and less likely to be on extra-corporeal membrane oxygenation or have a high UNOS status prior to transplant. Mortality at 1-year was higher for older adults (27.8% vs. 23.4%), but at 5 years there was no significant difference (22.3% vs. 19.4%.). Older adults were more likely to die of malignancy or infection. Adults under 70 were more likely to die of cardiovascular causes or graft failure. There was less rejection in older adults. Mortality has not changed for older adults transplanted before versus after the 2018 UNOS allocation change.

Conclusions

Carefully selected older adults may be considered for heart transplantation, given similar intermediate-term mortality.

背景：由于心力衰竭医疗技术的进步，患者的寿命比以前更长，可能到了老年就需要接受包括心脏移植在内的先进疗法。本研究评估了老年人（大于 70 岁）心脏移植的相关做法，并检查了短期和中期结果：本研究是一项回顾性分析，使用的是 2010 年至 2021 年器官共享联合网络（UNOS）数据库。接受移植手术的老年人的绝对数量正在增加。老年人更有可能在移植前患有恶性肿瘤或缺血性心肌病，更不可能在移植前进行体外膜肺氧合或具有较高的UNOS状态。老年人的 1 年死亡率较高（27.8% 对 23.4%），但 5 年死亡率没有显著差异（22.3% 对 19.4%）。老年人更有可能死于恶性肿瘤或感染。70岁以下的成年人更有可能死于心血管疾病或移植失败。老年人的排斥反应较少。2018年UNOS分配变化之前和之后移植的老年人死亡率没有变化：由于中期死亡率相似，经过仔细挑选的老年人可考虑接受心脏移植。

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引用次数: 0