Clinical Transplantation最新文献

Background: Acute kidney injury frequently complicates the end stages of liver diseases, worsening the condition of patients waiting for liver transplants. Continuous renal replacement therapy during liver transplant is still a limited experience, with large variability in the indication criteria. The recent KDIGO guidelines on acute kidney injury may help identify patients who could potentially benefit from the procedure. Therefore, close collaboration between intensivists and nephrologists is essential for shared criteria and treatment management. This study aimed to assess the feasibility and safety in clinical practice of a joint intraoperative continuous renal replacement therapy (IO-CRRT) program. Some aspects of clinical impact were analyzed as a secondary outcome.

Methods: A collaborative organization between nephrologists and anesthesiologists was implemented at St. Orsola Hospital of Bologna (Italy) to manage liver transplant candidates with acute kidney injury. Feasibility, the main outcome, was assessed through adherence to clinical indications and operative details. We also compared a group receiving IO-CRRT (n = 20) and a historical control group (n = 13) without replacement therapy.

Results: No substantial operative deviations from the program were found, excluding 4 patients mistakenly enrolled. The IO-CRRT group had better control of lactates, serum bicarbonate gain, and smoother acute sodium changes compared to controls.

Conclusion: The overall organization proved to be feasible and safe, provided a high level of collaboration is guaranteed. The trend of some metabolic parameters appeared to benefit from IO-CRRT, which may reasonably help in balancing metabolism during liver transplant surgery. This strategy could increase the opportunity for transplant for some patients who otherwise would be excluded.

Current guidelines for heart transplant (HT) listing support body mass index (BMI) < 35 kg/m², though data supporting this recommendation is mixed. It is unclear if other more specific measurements of body composition are better predictors of outcomes post-HT. This retrospective study included patients who underwent HT between 2014 and 2019 and underwent an abdominal CT scan within 3 months of HT. Tissue characterization was performed using Slice-O-Matic software to derive measurements including BMI, fat mass index (FMI), visceral adipose tissue to subcutaneous adipose tissue ratio (VAT/SAT), fat free mass index (FFMI), and skeletal muscle index (SMI). Univariate and multivariate logistic regression analyses were used to investigate association of body composition variables by tertiles to 1 year mortality, readmission, primary graft dysfunction, length of stay, infection, and renal failure. Of the 104 patients, 80% were male and 56% were Caucasian. Highest and lowest BMI tertiles were significantly associated with an increased risk of hospital readmission within 1 year post HT (OR 3.4, [95%CI 1.1–11.4]; OR 5.9, [95% CI 1.7–25.1]; p = 0.01) as well as an increased risk of infections requiring hospitalization (OR 3.2, [95% CI 1.2–9.0]; OR 3.9, [95%CI 1.4–11.7]; p = 0.02). FMI, VAT/SAT, FFMI, and SMI were not associated with outcomes 1-year post-HT. Highest and lowest BMI tertiles were associated with increased rates of hospital readmission and infection in the first-year post HT, while other measurements of body composition were not associated with any poor outcomes post-HT. Although BMI does not predict mortality post-HT, it can differentiate risk better than all other metrics.

Normothermic regional perfusion (NRP) has emerged as a pivotal strategy in controlled donation after circulatory death (cDCD) liver transplantation, mitigating ischemia-reperfusion injury and improving graft outcomes. Compared to super rapid recovery (SRR), NRP significantly reduces rates of early allograft dysfunction, primary nonfunction, and biliary non-anastomotic stricture (NAS), with biliary complications reported in 5%–16% and NAS as low as 0%–2%. Outcomes from cDCD-NRP grafts are increasingly comparable to those of donation after brain death (DBD). Viability assessment during NRP remains variably defined across centers. Nonetheless, stable pump flow, stable or declining lactate levels, controlled transaminase levels, and favorable macroscopic appearance are commonly used parameters. Histological thresholds may guide graft acceptance but are not universally applied. Sequential use of ex situ machine perfusion following NRP offers additional benefits in marginal or prolonged ischemia settings. NRP implementation has improved liver utilization rates from 34% to 63% in the United Kingdom and from 39% to 71% in the United States. This review highlights NRP as a transformative platform that reshapes viability standards, expanding transplant access, and supports sustained growth in liver transplantation.

Background: In pediatric lung transplantation, the ability to estimate the projected waiting time could be particularly helpful for candidates and physicians. A score to predict waiting time has yet to be developed in this field. The purpose of this study was to create a score that predicts waitlist time for pediatric patients who are listed for lung transplantation.

Methods: A retrospective analysis was performed with publicly available de-identified OPTN lung transplant data from March 8, 2019, to March 8, 2025. After applying our exclusionary criteria, the sample included 218 pediatric patients, whom we divided into training and testing groups based on the implementation of the CAS. Univariable and multivariable analyses on the training group of pediatric patients identified independent recipient risk factors for the time spent on the waitlist. This model was used to make our score, the pediatric lung waitlist score (PLWS), which was then applied to the testing group to examine its validity.

Results: Five recipient factors were independently associated with time to transplant: adolescence, ECMO support, residence in OPTN Region 4, residence in Region 8, and very high oxygen supplementation (>15 LPM). The resulting score demonstrated a c-statistic of 0.71 in the training cohort and 0.73 in the testing cohort.

Conclusion: We identified five recipient characteristics that significantly predict pediatric lung transplant waitlist duration and incorporated them into a prognostic score, the PLWS, derived from a Cox proportional hazards model.