Clinical Transplantation最新文献

Background: Efforts to identify barriers and improve access to kidney transplantation in the United States are limited by a lack of population-level data on early steps in the transplant evaluation process.

Methods: We used a rule-based natural language processing (NLP) approach with clinical notes in the US Veterans Affairs Healthcare System (VA) electronic health record (EHR) and linkage with the United States Renal Data System registry to characterize sequential steps in the kidney transplant evaluation process. Adults with advanced kidney disease (estimated glomerular filtration rate ≤20 mL/min/1.73m²) from 1/1/2012-12/31/2019 who were receiving care within the VA were followed through 12/31/2021.

Results: Among 45,174 cohort members, the median age was 71 (IQR 64, 80) years, and 97.2% were men. There was documentation of kidney transplant being mentioned as a treatment option for 46.3% of cohort members, 28.2% engaged in some type of evaluation for transplant, and 8.4% were referred to and 5.4% evaluated at a VA kidney transplant center. 6.9% of cohort members were added to the national deceased donor waitlist and 3.1% received a kidney transplant. Compared with events identified through EHR chart search and manual review by two clinicians, NLP identified events within 90 days with a precision of 0.82-0.94 and recall of 0.56-0.89.

Conclusion: These results illuminate the substantial proportion of patients who engage in early steps in the kidney transplant evaluation process. The work also demonstrates that NLP can accurately identify these key steps in the process as documented in patients' EHRs.

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.

Background: Posttransplant opioid dependence has been linked to adverse outcomes in solid organ transplantation, but its impact on pancreas transplantation is underexplored.

Methods: This retrospective study analyzed 193 PTA/PAK recipients from Asan Medical Center (AMC) (2010-2022) and externally validated results in 77 recipients from Pusan National University Yangsan Hospital (PNUYH) (2015-2022). Posttransplant opioid dependence was defined as ≥ 10 opioid prescriptions between 3 and 12 months posttransplant. Logistic regression and three ML algorithms (CatBoost, XGBoost, and LightGBM) were used to identify risk factors and predict 5-year graft survival.

Results: Posttransplant opioid dependence (OR 2.87, p = 0.005) independently predicted 5-year graft failure, along with pre-transplant retinopathy, bladder drainage, and lower BMI. ML models showed favorable internal AUROC (0.695-0.719) and moderate external AUROC (0.649-0.671). Opioid dependence consistently ranked among top predictive features across models.

Conclusions: Posttransplant opioid dependence is a significant predictor of graft failure after pancreas transplantation. Incorporating this variable into ML models may enhance risk stratification and candidate selection.

Background: Horseshoe kidney (HSK) is a rare congenital fusion anomaly that poses distinct anatomical and surgical challenges in kidney transplantation. Owing to its low incidence, evidence on long-term outcomes remains limited. This study reports a 20-year single-center experience with HSK transplantation, comparing en bloc and split grafts.

Methods: A retrospective analysis was conducted on six HSK transplants from deceased donors performed since January 2005. All recipients had end-stage renal disease and were undergoing dialysis at transplantation. The choice between en bloc or split implantation was based on vascular, isthmic, and collecting system anatomy. Primary outcomes included graft function, patient survival, and postoperative complications; secondary outcomes were delayed graft function (DGF) and long-term renal function. Descriptive statistical analysis was applied to perioperative and follow-up data, including serum creatinine (SCr) and graft survival up to 20 years.

Results: Among six recipients (three en bloc, three split), one en bloc recipient died on postoperative Day 3 due to bowel infarction. The remaining five patients showed immediate graft function, except one with DGF. At a mean follow-up of 14 years, all surviving recipients maintained satisfactory renal function (mean SCr = 130 µmol/L). No graft loss or major surgical complications were observed.

Conclusion: HSK transplantation, though technically demanding, represents a viable strategy to expand the donor pool. With careful anatomical assessment and surgical planning, both en bloc and split grafts can achieve excellent long-term outcomes. However, en bloc transplantation may entail greater procedural and spatial challenges, emphasizing the need for accurate recipient selection and size matching.