Clinical Transplantation最新文献

Introduction: Transplant is a complex psychosocial experience, and rates of suicide are increased after abdominal transplant. This study aimed to characterize the suicide rates of heart and lung transplant recipients and to identify risk factors associated with suicide after thoracic transplant.

Methods: We used the United Network for Organ Sharing(UNOS)/Organ Procurement and Transplantation Network(OPTN) database to identify deceased adult (≥ 18 years) recipients of isolated primary heart or lung transplant between 1995 and 2022 and stratified by cause of death of suicide vs. other causes. Multivariable logistic regression was performed to identify factors associated with suicide.

Results: From 1995 to 2022, there were 112 deaths by suicide among 46 945 deceased recipients. The overall suicide rate for heart and lung transplant recipients was 109.41 per 100 000. Recipients who died by suicide were more likely to be male (86.6% vs. 65.8%, p < 0.001), white (90.2% vs. 77.6%, p = 0.006), and receive a heart (66.1% vs. 50.2%, p = 0.001). Recipients who died by suicide also had a shorter hospital length of stay (LOS) (13 vs. 16 days, p = 0.003). White recipient race (aOR 3.98, p = 0.008) and male sex (aOR 4.42, p < 0.001) were associated with increased risk of suicide, while increased age, longer LOS, and receipt of a lung versus heart were associated with lower risk of suicide.

Conclusions: Suicide rates among heart and lung transplant recipients exceed national averages. White and male recipients are at the highest risk, while older, lung recipients with longer LOS are at lower risk. To address this, psychiatric care in transplant teams is important, especially for those identified as at high risk of suicide.

Introduction: Living donor liver transplantation (LDLT) offers an alternative for adults with Model for End-Stage Liver Disease (MELD) scores below 20, who often face prolonged wait times under urgency-based allocation. Although LDLT can reduce waitlist mortality and provide excellent transplant outcomes, deceased donor liver transplantation (DDLT), particularly from donation after circulatory death (DCD) donors, may similarly benefit patients with low MELD scores.

Methods: Using the United Network for Organ Sharing database, adult candidates (age >17 years) listed or transplanted between 2010 and 2024 were evaluated. Annual volumes of LDLT and DDLT for low MELD patients and one-year cumulative incidence of DDLT or waitlist dropout among those with MELD-Na<20 (without exception scores) were analyzed. Recipient characteristics and graft survival were compared between patients receiving LDLT and DCD LT, including the impact of normothermic machine perfusion (NMP).

Results: Among 167 392 candidates, 5124 underwent LDLT. Annual LDLT volumes decreased by 14.8% from 2023 to 2024. Meanwhile, the number of DDLTs for MELD-Na<20 grew from 492 in 2010 to 2049 in 2024, with 46.0% of those cases coming from DCD donors in 2024. Over the study period, one-year cumulative incidence of DDLT increased for patients with MELD-Na<20. At two years post-transplant, graft survival was similar between LDLT and DCD LT with NMP (90.5% vs. 89.1%, p = 0.36).

Conclusion: Deceased donor availability has substantially increased for patients with low MELD-Na, yielding graft survival comparable to LDLT. Further expansion of DCD LT could lower reliance on LDLT, thereby minimizing risks to healthy donors.

Background: Impaired kidney function in the non-transplant chronic kidney disease (CKD) population has been shown to negatively affect patients' health related quality of life (HRQOL). The relationship between posttransplant graft function, as measured by estimated glomerular filtration rate (eGFR), and patient-reported outcomes (PRO) remains poorly understood. This study evaluates the associations between eGFR and PRO in kidney transplant recipients to inform clinical strategies aimed at optimizing both physical and psychological well-being.

Methods: Longitudinal data were collected using previously-described procedures and a multi-survey PRO battery. Logistic regression models evaluated relationships, at the last follow-up point, between eGFR strata, time posttransplant, age at PRO, whether there had been a previous kidney transplant or the donor was deceased or living, and the likelihood of physical or mental HRQOL being substantive low and of symptoms of depression or anxiety being reported. Parallel multivariable mixed effects models, that included all longitudinal data points for each participant, examined relationships between eGFR and continuous PRO scores and their temporal trajectories.

Results: The study included 2116 adult kidney transplant recipients and over 9500 unique multi-survey observation points over a 19-year period. After adjusting for age (p < 0.001), donor type, time posttransplant, and prior kidney transplantation, there was a statistically significant association between eGFR/CKD strata and the likelihood of physical HRQOL being substantively low (p < 0.001) at the last PRO assessment. CKD stage 4 or 5 was independently associated with a 1.5 times increased likelihood of reporting symptoms of depression (OR: 1.50; 95% CI 1.16, 1.95) and anxiety (OR = 1.48; 95%CI: 1.14, 1.92) compared to those with eGFR ≥ 60 mL/min/1.73m². Longitudinal analyses comprising all data points demonstrated that increased eGFR was associated with better physical and mental HRQOL and reduced symptoms of depression and anxiety.

Conclusions: Impaired graft function is significantly associated with decreased physical HRQOL and increased symptoms of depression and anxiety in kidney transplant recipients. These findings underscore the importance of close monitoring and early interventions targeting physical and psychological well-being as graft function declines.

Background: A minority of liver transplant (LT) recipients are not diagnosed with HCC (u-HCC) until their explanted liver is examined. The primary aim of this study was to examine HCC screening before LT in patients with u-HCC compared to those with known HCC (k-HCC). Secondary aims included assessment of inter-reader variability of diagnostic imaging used for HCC screening; predictors of u-HCC; and post-LT outcomes in u-HCC.

Methods: A single center retrospective review of patients with HCC on explant from 2012-2023 was performed. A randomized subset of imaging studies from patients with k-HCC and u-HCC was reevaluated by two independent, blinded radiologists and inter-reader concordance was measured.

Results: Thirty-seven (7.8%) patients had u-HCC, of whom 26 (70.3%) underwent contrast-enhanced magnetic resonance imaging (MRI) and 11 (29.7%) underwent computed tomography with delayed contrast phase (73% within 6 months of LT). Patients with metabolic liver disease and steatohepatitic HCC were more likely to have u-HCC (32% vs 16%, p = 0.01; 19% vs 7%, p = 0.01, respectively). Thirty-two patients with u-HCC had no suspicious lesions noted on imaging. 60% of all studies with second evaluation by blinded radiologists had concordant findings compared to 44% in metabolic liver disease.

Conclusions: Patients with metabolic liver disease may be at higher risk of u-HCC compared to other etiologies of liver disease despite regular, contrast-enhanced, cross-sectional imaging. One possible explanation for this is the difficulty of HCC detection in metabolic liver disease, as demonstrated by greater likelihood of inter-reader discordance in imaging assessment in these patients. KEYWORDS (INDEX MEDICUS).

Introduction: Although psychiatric disorders after kidney transplantation (KT) are associated with adverse outcomes, the associated risk factors, treatment patterns, and financial burden remain poorly characterized. We sought to address these gaps by characterizing psychiatric diagnoses, their treatment, and patient financial liability in the first year following KT.

Methods: Adult KT recipients (KTRs) from 2006 to 2021 were identified using IQVIA PharMetrics Plus for Academics, a large population-based commercial insurance claims database. Psychiatric diagnoses were defined using International Classification of Diseases-Ninth Revision (ICD9)/Tenth Revision (ICD10) codes, and patient characteristics and total financial liability within the first year post-transplant were compared between KTRs with and without a psychiatric diagnosis. Regression analyses identified factors associated with post-KT psychiatric diagnoses.

Results: Among 2148 KTRs, 291 (13.5%) had a prevalent psychiatric diagnosis within 1 year post-KT; 102 (35.1%) were incident diagnoses. Prevalence varied by KTR transplant era, with 17.3% of the 2014-2017 cohort having an ICD9/10 psychiatric diagnosis code in the year following KT. The strongest factor associated with post-KT psychiatric diagnosis was a pre-existing psychiatric diagnosis (aOR 21.68), while incident diagnoses were significantly associated with hospital length of stay >1 week (aOR 2.10). Early post-KT complications were also associated with subsequent psychiatric diagnosis (aOR 1.96; 95% CI 1.23-3.07). Only half of those with a psychiatric diagnosis (N = 148/291) had a claim for treatment (i.e., pharmacotherapy and/or psychotherapy). The median total patient liability for 1 year of post-KT care was $2100 (IQR $700-8200), and not significantly different between those with and without psychiatric diagnoses (p = 0.29).

Conclusions: Despite higher healthcare utilization in KTRs with psychiatric diagnoses, median total financial liability was not significantly different between groups. Clinicians should be attentive to risk factors for psychiatric complications and consider protocols to screen symptoms among high-risk individuals.