Clinical Transplantation最新文献_第3页

Organ Responses, Survival, and Safety of Belumosudil in Chronic Graft-Versus-Host Disease: A Systematic Review and Meta-Analysis 白莫硫地尔治疗慢性移植物抗宿主病的器官反应、生存和安全性：系统综述和荟萃分析

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-20 DOI: 10.1111/ctr.70458

Ahmed Farid Gadelmawla, Mohamed A. Alsaied, Mohanad A. Alkuwaiti, Najmah A. Alsaihati, Shahad Al-Hemidin, Hussam Al-Dakhil, Majed S. Alshertan, Shaden A. Aljohani, Shatha S. Aloglla, Munirah Aljoudi, Ahmed Al-Wusaybie, Naif Aljamlan, Fatimah S. Alshahrani

Chronic graft-versus-host disease (cGVHD) is a complex, immune-mediated, multisystem disease with a high symptom burden. While treatment with systemic corticosteroids is first-line, approximately 70% of patients require additional treatments because of either inadequate efficacy or steroid toxicity, highlighting the need for effective steroid-sparing therapies. Belumosudil, an oral ROCK2 inhibitor, has been studied in trials and real-world cohorts with varying results. We set out to systematically evaluate and meta-analyze the efficacy and safety of belumosudil in cGVHD. We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library databases for relevant studies published up until August 2025. Eligibility criteria were predefined to identify relevant studies assessing belumosudil for cGVHD. Quality assessment of included studies was assessed using the MINORS tool. Meta-analysis was conducted using Comprehensive Meta-Analysis (v.3), adopting an inverse variance random effect model. Systematic literature search yielded inclusion of eleven studies (total participants = 477 patients). At 12 months, the pooled overall response rate (ORR) was 73% (95% CI 64–81) and 58% of patients showed a reduction in corticosteroid use with 95% CI (46%–70%), with improvement in patient-reported quality of life assessed by the Lee Symptom Scale. In a meta-regression analysis, higher baseline cGVHD severity independently predicted corticosteroid tapering success (β = 0.027; OR = 1.03; p = 0.031). Overall survival was 87% (95% CI 82–91) at 12 months and 85% (95% CI 79–90) at 24 months; failure-free survival at 12 months was 65% (95% CI 52–75). Regarding safety of belumosudil, any-grade adverse events occurred in 98% (95% CI 95–99), serious adverse events in 38.9% (95% CI 32.6–45.6); common events were diarrhea 22.1%, headache 22.3%, and fatigue 20.5%. Belumosudil exhibits significant clinical efficacy in cGVHD refractory or dependent on steroids, evidenced by a high objective response rate at 12 months, substantial steroid-sparing benefits, durable survival, and amelioration of disease-associated symptoms.

慢性移植物抗宿主病（cGVHD）是一种复杂的、免疫介导的多系统疾病，具有很高的症状负担。虽然全身性皮质类固醇治疗是一线治疗，但由于疗效不足或类固醇毒性，大约70%的患者需要额外治疗，这突出了有效的类固醇保留治疗的必要性。Belumosudil是一种口服ROCK2抑制剂，已经在临床试验和现实世界队列中进行了研究，结果不同。我们开始系统地评估和荟萃分析白莫硫地尔在cGVHD中的疗效和安全性。我们系统地检索了PubMed、Scopus、Web of Science和Cochrane Library数据库，检索了截至2025年8月发表的相关研究。预定义资格标准以确定评估白莫硫地尔治疗cGVHD的相关研究。使用未成年人工具对纳入研究的质量进行评估。meta分析采用综合meta分析（v.3），采用逆方差随机效应模型。系统文献检索纳入了11项研究（总参与者= 477例患者）。在12个月时，合并总缓解率（ORR）为73% (95% CI 64-81)， 58%的患者显示皮质类固醇使用减少，95% CI(46%-70%)，通过Lee症状量表评估患者报告的生活质量有所改善。在meta回归分析中，较高的cGVHD基线严重程度独立预测皮质类固醇减量成功（β = 0.027; OR = 1.03; p = 0.031）。12个月时总生存率为87% (95% CI 82-91)， 24个月时总生存率为85% (95% CI 79-90)；12个月无失败生存率为65% （95% CI 52-75）。关于白莫硫地尔的安全性，98%发生了任何级别的不良事件（95% CI 95-99）， 38.9%发生了严重不良事件（95% CI 32.6-45.6）；常见事件为腹泻22.1%，头痛22.3%，疲劳20.5%。白莫硫地尔在难治性或依赖类固醇的cGVHD中表现出显著的临床疗效，12个月时的客观缓解率高，大量的类固醇节约效益，持久的生存期和疾病相关症状的改善。

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引用次数: 0

Pediatric Lung Waitlist Score (PLWS): A Score to Predict Waitlist Time for Pediatric Lung Transplant Candidates 儿童肺等待名单评分（PLWS）：预测儿童肺移植候选人等待名单时间的评分。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-19 DOI: 10.1111/ctr.70454

Jose Ramirez, Spoorthi Kamepalli, Abbas Rana

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.

背景：在儿童肺移植中，估计预计等待时间的能力对候选者和医生特别有帮助。在这一领域，预测等待时间的分数尚未开发。本研究的目的是建立一个分数，预测等待肺移植的儿科患者的等待时间。方法：对2019年3月8日至2025年3月8日公开获取的去识别OPTN肺移植数据进行回顾性分析。在应用我们的排除标准后，样本包括218名儿科患者，我们根据CAS的实施情况将其分为培训组和测试组。对儿科患者训练组的单变量和多变量分析确定了在等待名单上花费时间的独立受体风险因素。该模型用于制作我们的评分，即儿科肺部等待列表评分（PLWS），然后将其应用于试验组以检验其有效性。结果：5个受体因素与移植时间独立相关：青春期、ECMO支持、居住在OPTN 4区、居住在8区、高氧补充（>15 LPM）。结果显示，训练组的c统计量为0.71，测试组为0.73。结论：我们确定了五个显著预测儿童肺移植等待名单持续时间的受体特征，并将其纳入预后评分PLWS，该评分来自Cox比例风险模型。

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引用次数: 0

Transplantation of Horseshoe Kidneys: Surgical Strategies and 15-Year Functional Outcomes From a Tertiary Center Experience 马蹄形肾移植：三级中心经验的外科策略和15年功能结果。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-19 DOI: 10.1111/ctr.70460

Francesco Nacchia, Riccardo Bertolo, Rostand Emmanuel Nguefouet Momo, Paola Donato, Gabriele Ugolini, Giovanni Corghi, Luigino Boschiero, Alessandro Antonelli

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.

背景：马蹄肾（HSK）是一种罕见的先天性融合畸形，在肾移植中具有独特的解剖学和外科挑战。由于发病率低，关于长期结果的证据仍然有限。本研究报告了20年单中心HSK移植的经验，比较了整体移植和分裂移植。方法：回顾性分析2005年1月以来6例死亡供体HSK移植病例。所有受者均患有终末期肾病，并在移植时接受透析治疗。整体植入或分裂植入的选择是基于血管、峡部和收集系统解剖。主要结局包括移植物功能、患者生存和术后并发症；次要结果是延迟移植功能（DGF）和长期肾功能。描述性统计分析应用于围手术期和随访数据，包括血清肌酐（SCr）和移植存活长达20年。结果：6例受术者（3例整体，3例分开）中，1例整体受术者在术后第3天因肠梗死死亡。除1例DGF外，其余5例患者表现出立即的移植物功能。在平均14年的随访中，所有存活的受者保持了满意的肾功能（平均SCr = 130µmol/L）。未观察到移植物丢失或主要手术并发症。结论：HSK移植虽然在技术上要求很高，但却是一种扩大供体池的可行策略。通过仔细的解剖评估和手术计划，整体和分裂移植都可以获得良好的长期效果。然而，整体移植可能会带来更大的程序和空间挑战，强调需要准确的受体选择和大小匹配。

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引用次数: 0

Integrating Obesity and Metabolic Management in Kidney Transplantation: A Commentary on Metoyer et al 在肾移植中整合肥胖和代谢管理：Metoyer等人的评论。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-16 DOI: 10.1111/ctr.70450

Vineeta Kumar, Sima Saberi, Hector Madariaga, Sabiha M. Hussain

引用次数: 0

Donor-Derived Cell-Free DNA Levels and Prediction of Resolution of Rejection in Kidney Transplant Recipients 肾移植受者供体来源的游离细胞DNA水平和排异反应的预测。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-16 DOI: 10.1111/ctr.70443

Elaine Ku, Erica Winnicki, Sabrina Legaspi, Feng Lin, Charles E. McCulloch, Deborah Adey

The gold standard approach to the diagnosis of rejection in kidney transplant recipients currently relies on tissue obtained during biopsies. However, repeat performance of biopsies is cumbersome, and use of dd-cfDNA in conjunction with eGFR may help inform whether ongoing rejection may be persistent after a diagnosis of rejection is made by biopsy and anti-rejection treatment administered. In this single-center prospective study, 52 patients with rejection were followed longitudinally over time with quarterly dd-cfDNA measurements, of whom 78% had repeat biopsies to confirm the presence or absence of persistent rejection. With every 1 percentage point higher baseline (“first”) dd-cfDNA levels drawn at time of enrollment, the odds of persistent rejection were 1.35 (95% CI 1.18-1.55) higher. With every 1 percentage point increase in the slope of dd-cfDNA levels over time, the odds of persistent rejection were 1.62 times higher (95% CI 1.10-2.38). Models including only baseline and the slope of dd-cfDNA provided moderate risk discrimination for rejection (c = 0.73), which improved to c = 0.75 with the addition of eGFR at baseline and change in eGFR over time. Monitoring of dd-cfDNA may offer reasonable discrimination of the likelihood of persistent rejection following anti-rejection therapy. Further validation of these findings is needed.

目前，诊断肾移植受者排斥反应的金标准方法依赖于活检过程中获得的组织。然而，活检的重复检查是繁琐的，使用dd-cfDNA结合eGFR可能有助于了解在活检诊断为排斥反应并给予抗排斥治疗后，持续的排斥反应是否可能持续。在这项单中心前瞻性研究中，对52例排斥患者进行了纵向随访，每季度进行一次dd-cfDNA测量，其中78%的患者进行了重复活检以确认是否存在持续性排斥反应。在入组时，每提高1个百分点的基线（“第一”）dd-cfDNA水平，持续排斥的几率就增加1.35 （95% CI 1.18-1.55）。随着时间的推移，dd-cfDNA水平的斜率每增加1个百分点，持续排斥反应的几率增加1.62倍（95% CI 1.10-2.38）。仅包括基线和dd-cfDNA斜率的模型提供了中等排斥风险判别（c = 0.73），随着基线时eGFR的增加和eGFR随时间的变化，该风险判别提高到c = 0.75。监测dd-cfDNA可以合理地区分抗排斥治疗后持续排斥的可能性。需要进一步验证这些发现。

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引用次数: 0

Combined Multiorgan Heart and Kidney Transplants With Single Donor Allografts: Simultaneous Versus Staged? 单异体供体联合多器官心脏和肾脏移植：同步还是分期？

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-15 DOI: 10.1111/ctr.70400

Jacqueline I. Kim, Suhani S. Patel, Nader Moazami, Jeffrey M. Stern, Dorry L. Segev, Allan B. Massie

Background

Multiorgan heart and kidney transplants (HKTx) performed for patients with end-stage heart failure and chronic kidney disease have increased in recent years. However, no established protocols exist on whether a heart and kidney from the same donor should be transplanted in the same operation versus 1–2 days apart.

Methods

Using SRTR data 1993–2023, we compared same-donor HKTx recipients with both transplants performed on the same day (“simultaneous”) to recipients with kidney transplants performed within 1 day of the heart transplant (“staged”). We examined differences in weighted post-transplant clinical characteristics using average treatment effect. Post-transplant mortality and graft failure was also assessed using Kaplan–Meier curves and instrumental variable analysis adjusted for recipient characteristics and year of transplant.

Results

The proportion of staged HKTx increased from 20.7% in 2015 to 58.8% in 2023. Recipients of simultaneous versus staged HKTx had similar rates of stroke (3.4% vs. 4.1%, p = 0.3), permanent pacemaker prior to discharge (2.0% vs. 1.8%, p = 0.7), and kidney primary non-function (2.7% vs. 2.6%, p = 0.8). However, simultaneous HKTx recipients had shorter kidney cold ischemic time (median (IQR) (h) 10.0 (7.5 vs. 14.6) versus 20.3 (15.9, 24.8), p < 0.001) and a lower weighted hospital stay compared to staged HKTx recipients (_1.08 1.09 _1.11, p < 0.001). Weighted patient mortality, all cause heart failure (ACHF), and all cause kidney failure (ACKF) 4 years post-transplant were slightly lower for simultaneous versus staged HKTx recipients (17.1% vs. 19.9%, 17.2% vs. 20.1%, 20.8% vs. 24.7%). However, instrumental variable analysis found no meaningful differences in adjusted patient survival, ACHF, or ACKF by HKTx type.

Conclusion

Simultaneous HKTx recipients have shorter hospital stays, decreased mortality, and higher rates of graft survival post-transplant compared to staged HKTx recipients, which may reflect favorable patient factors that enable both operations to be performed on the same day rather than an inherent benefit of simultaneous HKTx, given equivalent adjusted patient mortality, ACHF, and ACKF.

背景：近年来，多器官心脏和肾脏移植（HKTx）用于终末期心力衰竭和慢性肾脏疾病的患者有所增加。然而，对于同一供者的心脏和肾脏是否应该在同一手术中移植，还是相隔1-2天，目前还没有既定的方案。方法：使用1993-2023年的SRTR数据，我们比较了同一天（“同时”）进行两次移植的同一供体HKTx受者与在心脏移植后1天内进行肾脏移植的受者（“分阶段”）。我们使用平均治疗效果来检查加权移植后临床特征的差异。移植后死亡率和移植失败也通过Kaplan-Meier曲线和校正受体特征和移植年份的工具变量分析进行评估。结果：上演HKTx的比例从2015年的20.7%上升到2023年的58.8%。同时接受与分期接受HKTx的患者卒中发生率相似（3.4% vs. 4.1%, p = 0.3），出院前永久性起搏器（2.0% vs. 1.8%, p = 0.7），肾脏原发性无功能（2.7% vs. 2.6%, p = 0.8）。然而，同时HKTx受体的肾冷缺血时间较短(中位（IQR） (h) 10.0 (7.5 vs. 14.6) vs. 20.3 (15.9, 24.8), p 1.08 1.09 1.11, p与分期接受移植的患者相比，同时接受移植的患者住院时间更短，死亡率更低，移植后移植存活率更高，考虑到相同的调整后患者死亡率、ACHF和ACKF，这可能反映了有利的患者因素，使两项手术能够在同一天进行，而不是同时接受移植的固有益处。

{"title":"Combined Multiorgan Heart and Kidney Transplants With Single Donor Allografts: Simultaneous Versus Staged?","authors":"Jacqueline I. Kim, Suhani S. Patel, Nader Moazami, Jeffrey M. Stern, Dorry L. Segev, Allan B. Massie","doi":"10.1111/ctr.70400","DOIUrl":"10.1111/ctr.70400","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Multiorgan heart and kidney transplants (HKTx) performed for patients with end-stage heart failure and chronic kidney disease have increased in recent years. However, no established protocols exist on whether a heart and kidney from the same donor should be transplanted in the same operation versus 1–2 days apart.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using SRTR data 1993–2023, we compared same-donor HKTx recipients with both transplants performed on the same day (“simultaneous”) to recipients with kidney transplants performed within 1 day of the heart transplant (“staged”). We examined differences in weighted post-transplant clinical characteristics using average treatment effect. Post-transplant mortality and graft failure was also assessed using Kaplan–Meier curves and instrumental variable analysis adjusted for recipient characteristics and year of transplant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of staged HKTx increased from 20.7% in 2015 to 58.8% in 2023. Recipients of simultaneous versus staged HKTx had similar rates of stroke (3.4% vs. 4.1%, <i>p</i> = 0.3), permanent pacemaker prior to discharge (2.0% vs. 1.8%, <i>p</i> = 0.7), and kidney primary non-function (2.7% vs. 2.6%, <i>p</i> = 0.8). However, simultaneous HKTx recipients had shorter kidney cold ischemic time (median (IQR) (h) 10.0 (7.5 vs. 14.6) versus 20.3 (15.9, 24.8), <i>p</i> < 0.001) and a lower weighted hospital stay compared to staged HKTx recipients (<sub>1.08</sub> 1.09 <sub>1.11</sub>, <i>p</i> < 0.001). Weighted patient mortality, all cause heart failure (ACHF), and all cause kidney failure (ACKF) 4 years post-transplant were slightly lower for simultaneous versus staged HKTx recipients (17.1% vs. 19.9%, 17.2% vs. 20.1%, 20.8% vs. 24.7%). However, instrumental variable analysis found no meaningful differences in adjusted patient survival, ACHF, or ACKF by HKTx type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Simultaneous HKTx recipients have shorter hospital stays, decreased mortality, and higher rates of graft survival post-transplant compared to staged HKTx recipients, which may reflect favorable patient factors that enable both operations to be performed on the same day rather than an inherent benefit of simultaneous HKTx, given equivalent adjusted patient mortality, ACHF, and ACKF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988434","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

Evolving Long-Term Outcomes of Heart Transplantation Using COVID-19 Positive Donors COVID-19阳性供体心脏移植的长期预后变化

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70439

Ye In Christopher Kwon, Brian Bao, Jack Guiry, David T. Zhu, Alan Lai, Matthew Ambrosio, Aditya Kesari, Jay Patel, Zachary Fitch, Josue Chery, Patricia Nicolato, Vigneshwar Kasirajan, Zubair A. Hashmi

Background

As COVID-19 becomes endemic, evaluating COVID-19+ donors for heart transplantation (HT) remains important. We assessed long-term outcomes using national data and propensity-matched analysis.

Methods

All adults (>18 years) undergoing HT between 4/2020 and 9/2024 were identified in the UNOS database. They were stratified into COVID-19+ versus –, defined by either a positive nucleic acid or antigen test within 7 days of HT. Groups were then 3:1 nearest propensity score matched. Survival was estimated by the Kaplan–Meier method. Mortality risk was assessed using Cox regression models.

Results

A total of 879 recipients of COVID-19– hearts were matched with 293 recipients of COVID-19+ hearts. We found no significant differences in 3-year landmark survival between cohorts (p = 0.23). Rates of acute rejection (p = 0.15), length of hospital stay (LOS) (p > 0.9), and postoperative stroke (p = 0.53) did not differ significantly between groups. However, dialysis (17% vs. 12%, p = 0.04) and primary graft dysfunction rates at 24-h post-HT were significantly higher in COVID-19+ heart recipients (5.5% vs. 1.8%, p = 0.01). Donor COVID-19+ status was not significantly associated with mortality risk (HR 1.01, p = 0.66). COVID-19+ donor HTs in recent years (2022–2024) were associated with decreased mortality risk (HR 0.82, p = 0.02), rates of acute rejection (p < 0.001), LOS (p = 0.01), and dialysis (18% vs. 8.9%, p = 0.03).

Conclusions

COVID-19+ hearts demonstrate adequate long-term outcomes, particularly in recent years. Future studies should assess the impact of donor vaccination to optimize survival benefits.

背景：随着COVID-19成为流行病，评估COVID-19+心脏移植供体（HT）仍然很重要。我们使用国家数据和倾向匹配分析来评估长期结果。方法：所有在2020年4月至2024年9月期间接受HT治疗的成年人（bb0 - 18岁）在UNOS数据库中被识别。他们被分为COVID-19+和-，通过在HT后7天内的核酸或抗原检测阳性来确定。各组的最接近倾向评分匹配比例为3:1。生存率用Kaplan-Meier法估计。采用Cox回归模型评估死亡风险。结果：共有879例COVID-19心脏受者与293例COVID-19+心脏受者匹配。我们发现队列间3年里程碑生存率无显著差异（p = 0.23）。急性排斥反应率（p = 0.15）、住院时间（LOS）（p > 0.9）和术后卒中（p = 0.53）组间无显著差异。然而，透析（17% vs. 12%, p = 0.04）和移植后24小时的原发性移植物功能障碍率在COVID-19+心脏受者中显著更高（5.5% vs. 1.8%, p = 0.01）。供体COVID-19+状态与死亡风险无显著相关性（HR 1.01, p = 0.66）。近年来（2022-2024年），COVID-19+供体心脏移植与死亡风险降低（HR 0.82, p = 0.02）、急性排斥反应率(p)相关。结论：COVID-19+心脏显示出足够的长期结果，特别是近年来。未来的研究应评估供体疫苗接种的影响，以优化生存效益。

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引用次数: 0

Risk Factors and Outcomes of Reintubation Following Combined Heart-Lung Transplantation 联合心肺移植术后再插管的危险因素和结果。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70437

Ye In Christopher Kwon, Michael Keller, Alan Lai, Brian Bao, Joshua Pei, Matthew Ambrosio, Jay Patel, Motaz Al-Yafi, Zachary Fitch, Josue Chery, Patricia Nicolato, Vigneshwar Kasirajan, Zubair A. Hashmi

Background

Unplanned reintubation after combined heart-lung transplantation (HLT) significantly affects morbidity and mortality, yet national data are limited. We evaluated the incidence, predictors, timing, and outcomes associated with reintubation after HLT.

Methods

We retrospectively reviewed adults undergoing primary HLT in the UNOS registry from January 2004 to September 2024. Patients were stratified by reintubation status (defined as re-established mechanical ventilation (MV) after initial extubation). Propensity matching (1:1) balanced recipient and donor characteristics. Multivariable logistic regression models identified independent risk factors.

Results

Among 609 adult HLT recipients, 165 (27.1%) required postoperative reintubation. After 1:1 propensity score matching, 146 patients who were reintubated were compared with 146 patients who were successfully extubated. Reintubation was associated with significantly higher early mortality: 30-day (8.2% vs. 3.4%; p = 0.023), 90-day (11.6% vs. 5.5%; p = 0.030), and 6-month (15.1% vs. 8.2%; p = 0.028) mortality rates were all higher in the reintubated cohort, although long-term survival at 1, 3, and 5 years was similar between groups. Early graft failure was more frequent among reintubated patients at 30 days (5.5% vs. 0.7%; p = 0.018) and 90 days (6.2% vs. 1.4%; p = 0.031), with no significant differences thereafter. Reintubated recipients also demonstrated worse functional recovery at discharge (moderate-to-severe limitation: p = 0.012), longer duration of mechanical ventilation (extubated ≤48 h: 20.6% vs. 41.8%; p = 0.003), markedly prolonged hospital stays (73.4 ± 68.8 vs. 37.7 ± 35.3 days; p < 0.0001), and higher rates of stroke (5.5% vs. 3.4%; p = 0.035) and dialysis (37.7% vs. 20.6%; p = 0.001).

Conclusions

Reintubation after HLT significantly increases morbidity and mortality. Identified predictors provide actionable targets for enhanced perioperative airway management.

背景：联合心肺移植（HLT）术后计划外再插管显著影响发病率和死亡率，但国家数据有限。我们评估了HLT后再插管的发生率、预测因素、时间和结果。方法：我们回顾性地回顾了2004年1月至2024年9月UNOS登记的接受原发性HLT的成年人。根据重新插管状态（定义为首次拔管后重新建立机械通气（MV））对患者进行分层。倾向匹配（1:1）平衡了接受者和捐赠者的特征。多变量logistic回归模型确定了独立的危险因素。结果：609名成人HLT受者中，165名（27.1%）需要术后再插管。1:1倾向评分匹配后，将146例重新插管的患者与146例成功拔管的患者进行比较。重新插管与较高的早期死亡率显著相关：重新插管组的30天（8.2%对3.4%,p = 0.023）、90天（11.6%对5.5%,p = 0.030）和6个月（15.1%对8.2%,p = 0.028）死亡率均较高，尽管两组间1年、3年和5年的长期生存率相似。再插管患者在30天（5.5% vs. 0.7%, p = 0.018）和90天（6.2% vs. 1.4%, p = 0.031）早期移植物衰竭发生率更高，此后无显著差异。再插管患者出院时功能恢复也较差（中重度限制：p = 0.012），机械通气持续时间较长（拔管≤48小时：20.6%对41.8%;p = 0.003），住院时间明显延长（73.4±68.8对37.7±35.3天）；p结论：HLT后再插管显著增加发病率和死亡率。确定的预测因子为加强围手术期气道管理提供了可操作的目标。

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引用次数: 0

Using Natural Language Processing to Characterize Early Steps in the Kidney Transplant Evaluation Process Documented in the National Veterans Affairs Electronic Health Record 使用自然语言处理来描述国家退伍军人事务电子健康记录中记录的肾脏移植评估过程的早期步骤。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70441

Hannah Eyre, David K. Prince, Sandra Abrahamson, Richard K. Blankenhorn, Evan P. Carey, Ryan J. Laundry, Whitney Showalter, Jeffrey Todd-Stenberg, Ann M. O'Hare, Catherine R. Butler

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.

背景：由于缺乏移植评估过程中早期步骤的人口水平数据，在美国识别障碍和改善肾移植可及性的努力受到限制。方法：我们使用基于规则的自然语言处理（NLP）方法，结合美国退伍军人事务医疗保健系统（VA）电子健康记录（EHR）中的临床记录，并与美国肾脏数据系统注册表联系，以表征肾移植评估过程中的顺序步骤。2012年1月1日至2019年12月31日期间在VA内接受治疗的晚期肾病成人（估计肾小球滤过率≤20 mL/min/1.73m2）随访至2021年12月31日。结果：在45,174名队列成员中，中位年龄为71岁（IQR 64,80）岁，97.2%为男性。有文献记载，46.3%的队列成员提到肾移植作为一种治疗选择，28.2%的人参与了某种类型的移植评估，8.4%的人被推荐到VA肾移植中心，5.4%的人在VA肾移植中心接受评估。6.9%的队列成员加入了全国已故捐赠者等待名单，3.1%的人接受了肾脏移植。与通过EHR图表搜索和两位临床医生手动审查识别的事件相比，NLP识别90天内的事件，精度为0.82-0.94，召回率为0.56-0.89。结论：这些结果阐明了在肾移植评估过程中参与早期步骤的大量患者。这项工作还表明，NLP可以准确地识别患者电子病历中记录的过程中的这些关键步骤。

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引用次数: 0

Opioid Use as a Predictor of Pancreas Transplant Outcomes 阿片类药物使用作为胰腺移植结果的预测因子。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70453

Youngmin Ko, Eunbyeol Cho, Hye Eun Kwon, Jin-Myung Kim, Sung Shin, Young Hoon Kim, Edward Choi, Byunghyun Choi, Hyunwook Kwon

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.

背景：移植后阿片类药物依赖与实体器官移植的不良结果有关，但其对胰腺移植的影响尚未得到充分探讨。方法：回顾性分析峨山医疗中心（AMC）（2010-2022年）193例PTA/PAK患者和釜山国立大学梁山医院（PNUYH）（2015-2022年）77例外部验证患者的结果。移植后阿片类药物依赖定义为移植后3至12个月期间阿片类药物处方≥10张。使用逻辑回归和三种ML算法（CatBoost、XGBoost和LightGBM）来识别危险因素并预测移植物的5年生存率。结果：移植后阿片类药物依赖（OR 2.87, p = 0.005）独立预测5年移植失败，以及移植前视网膜病变、膀胱引流和较低的BMI。ML模型显示良好的内部AUROC（0.695-0.719）和中等的外部AUROC（0.649-0.671）。阿片类药物依赖一直是各模型的主要预测特征之一。结论：移植后阿片类药物依赖是胰腺移植后移植失败的重要预测因素。将这一变量纳入ML模型可以增强风险分层和候选人选择。

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引用次数: 0