Clinical Transplantation最新文献

Introduction: There are no effective therapeutic agents for preventing or treating delayed graft function (DGF) among deceased donor kidney transplant recipients (DDKTRs). Donor and recipient factors are important to predicting DGF and associated outcomes, which we hypothesize differed over time.

Methods: DDKTRs were stratified by transplant year into four eras-E1 (2000-2005), E2 (2006-2011), E3 (2012-2017), and E4 (2018-2021). We analyzed risk factors for DGF, along with one-year uncensored graft failure (UCGF), death-censored graft failure (DCGF), death with a functioning graft (DWFG), and acute rejection (AR) by era.

Results: A total of 3085 DDKTRs were included (E1: 804, E2: 882, E3: 909, E4: 490). The proportion of patients with DGF differed significantly by era. Duration of DGF and median dialysis count were lower in recent eras. In E1-E4, donation after circulatory death, higher donor terminal serum creatinine, and pretransplant duration of dialysis were risk factors for DGF, while preemptive transplant was associated with lower odds of DGF. Other factors were not consistently associated with DGF across eras. The risk of one-year AR was significantly lower in E3 (aHR: 0.46; 95% CI: 0.30-0.69, p < 0.001) and E4 (aHR: 0.16; 95% CI: 0.07-0.36, p < 0.001) compared to E1. There were trends towards decreased risk for UCGF and DWFG in E2, E3, and E4.

Conclusion: Some risk factors for DGF remained consistent, while others differed. Likely due to improved management, the risk for AR in the DGF setting improved in recent eras. There were trends of improved uncensored graft and patient survival in recent eras.

Background: Complement system overactivation contributes to transplanted kidney injury in both ischemia-reperfusion and antibody-mediated rejection, ultimately affecting post-transplant renal function. C1 esterase inhibitor (C1-INH) may reduce complement-mediated injury, yet its effects on renal function and safety outcomes remain uncertain in randomized trials.

Methods: Four RCTs were included, all focusing on the use of C1-INH in kidney transplant recipients, comparing it with control groups receiving saline. The studies were evaluated for methodological quality using the Jadad scoring system and the Cochrane Risk of Bias tool. Meta-analysis was performed using RevMan software, assessing outcomes such as renal function (eGFR), AMR incidence, and SAE occurrences.

Results: This study included four randomized controlled trials encompassing 148 kidney transplant recipients. The findings suggest that treatment with C1-INH may be associated with an improvement in renal function, as reflected by eGFR. No statistically significant difference was observed in the incidence of delayed graft function or antibody-mediated rejection between the treatment and control groups. The overall incidence of serious adverse events was comparable between groups, with no significant differences detected in infection-related, renal, cardiovascular, or gastrointestinal events.

Conclusion: The use of C1-INH may be associated with improved graft renal function following kidney transplantation. However, no significant benefit was observed with respect to delayed graft function or antibody-mediated rejection. The available evidence suggests an acceptable safety profile for C1-INH in this setting. Nevertheless, given the clinical heterogeneity of the included studies and the limited cumulative sample size, these findings should be interpreted as preliminary. Larger, well-designed randomized controlled trials are required to further clarify the therapeutic role of C1-INH in kidney transplantation.

Background: Kidney transplant recipients are at increased risk for infections such as BK virus, with few treatment options. This study assessed how nonidentical but compatible ABO blood types influence BKPyV-DNAemia risk.

Methods: We conducted a retrospective single-center study from 1/1/2011 to 1/12/2021, focusing on BK viremia (>10 000 copies/mL in two consecutive measurements one week apart) within the first posttransplant year. We used stepwise forward regression for multivariate analysis.

Results: Of the 1244 transplants, 1084 involved identical blood types. The percentage of living donor grafts was 63.3% (787 cases), with 98.8% (158 cases) in the mismatched blood type group. There were 78 significant BK viremia episodes in the first year, occurring in 5.5% of matched and 11.3% of mismatched blood type recipients (OR 2.16, p = 0.006). For living donors, the viremia rate was 6% overall, with 4.6% in the matched blood type group and 11.4% in the mismatched blood type group (OR 2.22, p = 0.001). Multivariate analysis revealed an increased risk of mismatched blood types in living donor grafts (OR = 2.75, p = 0.002).

Conclusions: This study revealed an association between blood type mismatch and increased BK viremia in kidney transplant recipients, highlighting a modifiable risk factor for clinicians in organ procurement.

Aim(s): To explore heart transplant recipients' perspectives on unanticipated challenges following transplantation and to identify experiential insights that may inform patient-centered education.

Design: Exploratory qualitative descriptive study.

Methods: Data were collected using an anonymous, open-ended online survey distributed through a large international heart transplant support group using purposeful sampling. Participants responded to two open-ended questions addressing unanticipated challenges and advice for individuals awaiting heart transplantation. Data were analyzed using thematic analysis with independent coding and consensus development.

Results: Fifty-one heart transplant recipients participated. Participants described substantial gaps between expectations and lived experiences following transplantation. Two overarching domains emerged: what recipients wish they knew before transplantation and advice for individuals awaiting a heart transplant. Key themes included lack of education and transparency, development of chronic conditions, medication-related side effects, mental health challenges, and unanticipated physical and psychosocial challenges. Advice emphasized self-advocacy, realistic recovery expectations, prioritization of mental health, adherence to lifestyle recommendations, maintaining hope, and trust in the healthcare team.

Conclusion: Heart transplant recipients frequently experience complex and unanticipated challenges extending beyond surgery and early recovery. Greater transparency and patient-centered education are needed to align expectations with lived realities.

Implications for the profession and/or patient care: Findings were used to develop an evidence based educational electronic resource to enhance informed decision-making, self-efficacy, and nurse-led conversations across the transplant continuum.

Impact: Problem: Limited transparency regarding lived experiences and realities of recovery after heart transplantation.

Findings: Heart transplant recipients often face unanticipated physical, psychological, and social challenges.

Impact: Findings and an electronic resource can help inform education for patients and families about the realities of the heart transplant journey.

Reporting method: This study adheres to the Standards for Reporting Qualitative Research (SRQR) guidelines.

Patient or public contribution: Heart transplant recipients contributed data through sharing lived experiences that informed analysis, interpretation, and development of a patient-centered educational resource.

Background: Antibodies to donor HLA (DSA) and non-HLA antigens are associated with detrimental outcomes in kidney, heart, and lung transplants. Such data are scarce in liver transplants (LTx). We aim to study the roles of DSA and non-HLA antibodies in T-cell-mediated rejection (TCMR) of LTx.

Methods: Allograft biopsies (n = 103) from adult LTx recipients were studied. Biopsy-paired serums were retrospectively tested for anti-angiotensin II type 1 receptor (AT1R) and the Luminex panel of 60 non-HLA Antibodies.

Results: TCMR was detected in 59 of 103 (57.3%) biopsies. Twenty-six biopsies were categorized as moderate-severe (MS-TCMR), 77 as negative-mild (NM-TCMR). DSA was positive in 95/103 (92.2%) cases and wasn't associated with MS-TCMR. Anti-AT1R antibodies were elevated in serum paired with MS-TCMR vs. NM-TCMR (18.8[15.2-40.0] vs. 13.0[10.0-21.5] U/ml, p < 0.01). Positive anti-AT1R antibodies were associated with a higher incidence of MS-TCMR (HR = 12.4[1.5-101.6], p = 0.02). A panel of 18 non-HLA Abs was significantly associated with MS-TCMR. The number of panel-18 non-HLA antibodies was higher with MS-TCMR vs. NM-TCMR (3[2-5] vs. 1[0-1], p < 0.001). The incidence of MS-TCMR was higher in cases with panel-18 non-HLA antibodies ≥3 vs. <3 (HR = 19.6[6.0-64.8], p < 0.001). The frequency of MS-TCMR was the highest when DSA, anti-AT1R, and panel-18 non-HLA antibodies were all present.

Conclusions: Non-HLA antibodies to AT1R or the Luminex panel are associated with MS-TCMR in LTx biopsies. The incidence of MS-TCMR is higher when non-HLA antibodies are present concomitantly with DSA, indicating an additive effect. Further studies are warranted to investigate the utility of routinely monitoring DSA and non-HLA antibodies in LTx recipients.

Introduction: Donor age is a key determinant of liver transplant (LT) outcomes, but its impact varies across recipient age groups. Specific donor age thresholds associated with excess risk remain undefined.

Methods: Using data from the Scientific Registry of Transplant Recipients (2011-2021; follow-up through 2024), we analyzed first-time, single-organ LT recipients. Donors and recipients were stratified by age. Outcomes included patient, graft, and death-censored graft survival. Multivariable Cox regression models adjusted for liver disease severity, comorbidities, graft type, and transplant year were used to identify donor age thresholds associated with increased risk in each recipient age group.

Results: Among 70 078 recipients (median age, 57 years), mean donor age rose from 39.6 to 40.9 years (p =  .004), while recipient age increased from 50.7 to 51.9 years (p =  .003). Donor age ≥50 years was associated with a sixfold increase in mortality in pediatric recipients (aHR, 6.48; 95% CI, 1.92-21.83; p =  .003). For adults aged 18.1-30 years, excess mortality and graft loss were observed with donors >55 years (aHRs >2.5). In recipients aged 40.1-60 years, risk increased progressively with donor age. Among recipients ≥65 years, donor age was not significantly associated with outcomes. These thresholds were consistent across outcomes and robust in sensitivity analyses.

Conclusions: This is the first national study to define recipient age-specific donor age thresholds associated with post-LT risk. These findings support the development of age-informed allocation strategies and call for a reassessment of organ discard practices as donor and recipient ages continue to rise.