Multiple intraoperative hemodynamic parameters are associated with an increased risk of early allograft dysfunction (EAD) following living donor liver transplantation (LDLT); however, there is significant center-to-center variability in terms of which parameters are used. We sought to determine which intraoperative hemodynamic parameters are most predictive of EAD following LDLT.
Methods
This is a systematic review following PRISMA guidelines (PROSPERO ID: CRD42023409711). Receiver operating characteristic (ROC) analyses were used to compare predictive parameters.
Results
A total of 4399 articles were identified from 3 large, international databases (PubMed, Embase, and Web of Science). Eighteen articles fit the inclusion criteria. The most commonly evaluated hemodynamic parameter was the postreperfusion portal venous pressure (PVP). A postreperfusion PVP of <15–20 mmHg was consistently associated with lower rates of EAD and, in some cases, improvements in patient survival. Other hemodynamic parameters evaluated included portal venous flow, hepatic arterial flow, portal venous velocities, and the hyperperfusion index.
Conclusion
Hemodynamic measurements indicative of portal hyperperfusion, especially elevated PVP, have been consistently associated with the development of EAD. Intraoperative hemodynamics should be monitored on all LDLT recipients, with portal inflow modulation procedures indicated if portal hyperperfusion is present.
{"title":"Intraoperative Hemodynamic Monitoring and Prediction of Early Allograft Dysfunction Following Living Donor Liver Transplantation: A Systematic Review","authors":"Audrey E. Brown, John Roberts","doi":"10.1111/ctr.70074","DOIUrl":"10.1111/ctr.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Multiple intraoperative hemodynamic parameters are associated with an increased risk of early allograft dysfunction (EAD) following living donor liver transplantation (LDLT); however, there is significant center-to-center variability in terms of which parameters are used. We sought to determine which intraoperative hemodynamic parameters are most predictive of EAD following LDLT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a systematic review following PRISMA guidelines (PROSPERO ID: CRD42023409711). Receiver operating characteristic (ROC) analyses were used to compare predictive parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4399 articles were identified from 3 large, international databases (PubMed, Embase, and Web of Science). Eighteen articles fit the inclusion criteria. The most commonly evaluated hemodynamic parameter was the postreperfusion portal venous pressure (PVP). A postreperfusion PVP of <15–20 mmHg was consistently associated with lower rates of EAD and, in some cases, improvements in patient survival. Other hemodynamic parameters evaluated included portal venous flow, hepatic arterial flow, portal venous velocities, and the hyperperfusion index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hemodynamic measurements indicative of portal hyperperfusion, especially elevated PVP, have been consistently associated with the development of EAD. Intraoperative hemodynamics should be monitored on all LDLT recipients, with portal inflow modulation procedures indicated if portal hyperperfusion is present.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
George E. Markakis, Jennifer C. Lai, Nikolaos D. Karakousis, George V. Papatheodoridis, Theodora Psaltopoulou, Manuela Merli, Theodoros N. Sergentanis, Evangelos Cholongitas
Introduction
This systematic review/meta-analysis evaluated the impact of sarcopenia in patients with cirrhosis before liver transplantation (LT) on outcomes after LT.
Methods
A systematic search was conducted in six medical databases until February 2022. The primary outcome was overall mortality after LT, while several secondary outcomes including liver graft survival and rejection, the need for transfusions, the length of the intensive care unit (ICU) and hospital stay, and surgical complications were evaluated. Sub-group analyses and meta-regression analyses were also performed.
Results
Fifty-three studies were evaluated in the systematic review, of which 30, including 5875 patients, were included in the meta-analysis. All studies included were cohort studies of good/high quality on the Newcastle-Ottawa scale (NOS), while in our analysis no publication bias was found, although there was substantial heterogeneity between the studies. Muscle mass was assessed using skeletal muscle index (SMI) in 14 studies, psoas muscle area (PMA) in seven studies, and psoas muscle index (PMI) in four studies. The prevalence of pre-LT sarcopenia ranged from 14.7% to 88.3%. Pre-LT sarcopenia was significantly associated with post-LT mortality (Relative Risk [RR] = 1.84, 95% CI:1.41,2.39), as well as with a high risk of infections post-LT, surgical complications, fresh frozen plasma (FFP) transfusions, and ICU length of stay (LOS).
Conclusions
Pre-LT sarcopenia in patients with cirrhosis is a strong risk factor for clinically meaningful adverse outcomes after LT. Assessment may help identify patients at the highest risk for poor outcomes who may benefit from targeted interventions.
{"title":"Sarcopenia As a Predictor of Survival and Complications of Patients With Cirrhosis After Liver Transplantation: A Systematic Review and Meta-Analysis","authors":"George E. Markakis, Jennifer C. Lai, Nikolaos D. Karakousis, George V. Papatheodoridis, Theodora Psaltopoulou, Manuela Merli, Theodoros N. Sergentanis, Evangelos Cholongitas","doi":"10.1111/ctr.70088","DOIUrl":"10.1111/ctr.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This systematic review/meta-analysis evaluated the impact of sarcopenia in patients with cirrhosis before liver transplantation (LT) on outcomes after LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted in six medical databases until February 2022. The primary outcome was overall mortality after LT, while several secondary outcomes including liver graft survival and rejection, the need for transfusions, the length of the intensive care unit (ICU) and hospital stay, and surgical complications were evaluated. Sub-group analyses and meta-regression analyses were also performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-three studies were evaluated in the systematic review, of which 30, including 5875 patients, were included in the meta-analysis. All studies included were cohort studies of good/high quality on the Newcastle-Ottawa scale (NOS), while in our analysis no publication bias was found, although there was substantial heterogeneity between the studies. Muscle mass was assessed using skeletal muscle index (SMI) in 14 studies, psoas muscle area (PMA) in seven studies, and psoas muscle index (PMI) in four studies. The prevalence of pre-LT sarcopenia ranged from 14.7% to 88.3%. Pre-LT sarcopenia was significantly associated with post-LT mortality (Relative Risk [RR] = 1.84, 95% CI:1.41,2.39), as well as with a high risk of infections post-LT, surgical complications, fresh frozen plasma (FFP) transfusions, and ICU length of stay (LOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pre-LT sarcopenia in patients with cirrhosis is a strong risk factor for clinically meaningful adverse outcomes after LT. Assessment may help identify patients at the highest risk for poor outcomes who may benefit from targeted interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Majd Alsoubani, Gabriela Andujar Vazquez, Andrew Strand, Shira Doron, Jennifer Chow
Background
Invasive Candida infections (ICI) are the most common invasive fungal infections in solid organ transplant recipients. There are limited contemporary data on the risk factors for infection in heart transplant (HT) recipients especially since the expansion of temporary mechanical circulatory support (MCS) use.
Methods
This was a case-control study conducted at a tertiary care academic hospital of HT recipients from January 2022 to January 2024. All patients who developed ICI by the detection of Candida species from a normally sterile site were included as cases. Four controls who underwent HT, two before the case and two after the case, were selected. Fisher's exact or Mann-U-Whitney tests were used for the analysis.
Results
There were 12 cases and 48 controls out of a total of 117 transplants during the study period. The proportion of ICI was 10.6%. The median time to ICI from transplant was 16 days (IQR 10, 83). The most common organisms isolated were Candida parapsilosis and Candida albicans. The majority of infections were mediastinitis. Risk factors for ICI included receipt of antibiotics for more than 7 days within 1 month prior to transplant (58.3% vs. 22.9%, p = 0.03), tracheostomy (41.7% vs. 10.4%, p = 0.02), prolonged chest tube placement (13 vs. 9 days, p = 0.02), and temporary MCS (p = 0.042). Patients who developed ICI had increased 90-day all-cause mortality compared to controls (33.3% vs. 4.2%, p = 0.01).
Conclusion
This study identified several risk factors for ICI following HT. Further research is essential to develop interventions that mitigate these risk factors in this patient population.
{"title":"Risk Factors and Outcomes of Invasive Candida Infections in Heart Transplant Recipients: A Case-Control Study","authors":"Majd Alsoubani, Gabriela Andujar Vazquez, Andrew Strand, Shira Doron, Jennifer Chow","doi":"10.1111/ctr.70091","DOIUrl":"10.1111/ctr.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Invasive Candida infections (ICI) are the most common invasive fungal infections in solid organ transplant recipients. There are limited contemporary data on the risk factors for infection in heart transplant (HT) recipients especially since the expansion of temporary mechanical circulatory support (MCS) use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a case-control study conducted at a tertiary care academic hospital of HT recipients from January 2022 to January 2024. All patients who developed ICI by the detection of Candida species from a normally sterile site were included as cases. Four controls who underwent HT, two before the case and two after the case, were selected. Fisher's exact or Mann-U-Whitney tests were used for the analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 12 cases and 48 controls out of a total of 117 transplants during the study period. The proportion of ICI was 10.6%. The median time to ICI from transplant was 16 days (IQR 10, 83). The most common organisms isolated were <i>Candida parapsilosis</i> and <i>Candida albicans</i>. The majority of infections were mediastinitis. Risk factors for ICI included receipt of antibiotics for more than 7 days within 1 month prior to transplant (58.3% vs. 22.9%, <i>p</i> = 0.03), tracheostomy (41.7% vs. 10.4%, <i>p</i> = 0.02), prolonged chest tube placement (13 vs. 9 days, <i>p</i> = 0.02), and temporary MCS (<i>p</i> = 0.042). Patients who developed ICI had increased 90-day all-cause mortality compared to controls (33.3% vs. 4.2%, <i>p</i> = 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified several risk factors for ICI following HT. Further research is essential to develop interventions that mitigate these risk factors in this patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058299","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}
Victoria Yin, Scott M. Atay, John C. S. Rodman, Sean C. Wightman, Graeme M. Rosenberg, Brooks V. Udelsman, Anthony W. Kim, Takashi Harano
Background
The goal of this study was to investigate the association between ex vivo lung perfusion (EVLP) use and inpatient hospitalization cost for lung transplantation in a nationwide sample.
Methods
Lung transplantation patients in 2018–2020 Nationwide Readmissions Database (NRD) were grouped based on use of EVLP. The primary outcome was total inpatient hospitalization cost. 1:2 propensity score matching by EVLP status was performed followed by multivariable linear regression to determine the association between inpatient cost and EVLP while adjusting for pre-transplant hospital days, high volume EVLP center status, and propensity score.
Results
There were 3902 lung transplants and 118 (3%) were recipients of EVLP lungs. Among EVLP patients, the median cost was $871 468 (IQR: $608 671–1 274 392), compared to $846 516 (IQR: $531 462–1 439 267, p = 0.871) among the total non-EVLP cohort. After 1:2 propensity score-matched cohort, recipients of EVLP lungs had longer median hospital length of stay (p = 0.046). In the multivariable model using the matched sample, increased cost was not associated with EVLP use (p = 0.783); however, high volume EVLP centers were associated with decreased cost (p = 0.018).
Conclusions
EVLP use was not associated with greater inpatient costs and may be favorable at high volume centers.
{"title":"Impact of Ex Vivo Lung Perfusion on Inpatient Cost: A Propensity Score-Matched Analysis of the US Nationwide Healthcare Cost and Utilization Project Database","authors":"Victoria Yin, Scott M. Atay, John C. S. Rodman, Sean C. Wightman, Graeme M. Rosenberg, Brooks V. Udelsman, Anthony W. Kim, Takashi Harano","doi":"10.1111/ctr.70096","DOIUrl":"10.1111/ctr.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The goal of this study was to investigate the association between ex vivo lung perfusion (EVLP) use and inpatient hospitalization cost for lung transplantation in a nationwide sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Lung transplantation patients in 2018–2020 Nationwide Readmissions Database (NRD) were grouped based on use of EVLP. The primary outcome was total inpatient hospitalization cost. 1:2 propensity score matching by EVLP status was performed followed by multivariable linear regression to determine the association between inpatient cost and EVLP while adjusting for pre-transplant hospital days, high volume EVLP center status, and propensity score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 3902 lung transplants and 118 (3%) were recipients of EVLP lungs. Among EVLP patients, the median cost was $871 468 (IQR: $608 671–1 274 392), compared to $846 516 (IQR: $531 462–1 439 267, <i>p</i> = 0.871) among the total non-EVLP cohort. After 1:2 propensity score-matched cohort, recipients of EVLP lungs had longer median hospital length of stay (<i>p</i> = 0.046). In the multivariable model using the matched sample, increased cost was not associated with EVLP use (<i>p</i> = 0.783); however, high volume EVLP centers were associated with decreased cost (<i>p</i> = 0.018).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EVLP use was not associated with greater inpatient costs and may be favorable at high volume centers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058295","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}
Since 1987, King Chulalongkorn Memorial Hospital (KCMH) has performed a substantial number of heart transplants as a specific therapy for advanced-stage heart failure. This descriptive study aimed to analyze post-transplant survival in the recent era compared to earlier periods and examine the pharmacogenetics of related immunosuppressants. Data from all recipients who underwent heart transplants from 1987 to 2021 were retrospectively retrieved from the electronic medical record. The genotypes of relevant pharmacogenes were analyzed in recipients who were alive during the enrollment period. Kaplan–Meier analysis revealed improved overall survival rates in the recent era compared to the past. Dilated cardiomyopathy was identified as the most common pretransplant diagnosis, while infection remained the leading cause of mortality. In conclusion, the findings demonstrate significant advancements in the quality of heart transplantation in Thailand. Future studies are warranted to explore the correlation between pharmacogenetic variations identified in this study and subsequent clinical outcomes, with a focus on genetic-guided treatment to optimize patient care.
{"title":"Advancement of Heart Transplantation in Thai Recipients: Survival Trends and Pharmacogenetic Insights","authors":"Siwaporn Manomaisantiphap, Pasawat Boon-yasidhi, Napatsanan Tanathitiphuwarat, Kanokwan Thammanatsakul, Sarinya Puwanant, Akekarach Ariyachaipanich, Supanee Sinphurmsukskul, Monvasi Pachinburavan, Pajaree Chariyavilaskul, Sarawut Siwamogsatham, Pat Ongcharit","doi":"10.1111/ctr.70092","DOIUrl":"10.1111/ctr.70092","url":null,"abstract":"<div>\u0000 \u0000 <p>Since 1987, King Chulalongkorn Memorial Hospital (KCMH) has performed a substantial number of heart transplants as a specific therapy for advanced-stage heart failure. This descriptive study aimed to analyze post-transplant survival in the recent era compared to earlier periods and examine the pharmacogenetics of related immunosuppressants. Data from all recipients who underwent heart transplants from 1987 to 2021 were retrospectively retrieved from the electronic medical record. The genotypes of relevant pharmacogenes were analyzed in recipients who were alive during the enrollment period. Kaplan–Meier analysis revealed improved overall survival rates in the recent era compared to the past. Dilated cardiomyopathy was identified as the most common pretransplant diagnosis, while infection remained the leading cause of mortality. In conclusion, the findings demonstrate significant advancements in the quality of heart transplantation in Thailand. Future studies are warranted to explore the correlation between pharmacogenetic variations identified in this study and subsequent clinical outcomes, with a focus on genetic-guided treatment to optimize patient care.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058328","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}
Stalin Canizares, Adriana Montalvan, Devin Eckhoff, Kalathil K. Sureshkumar, Bhavna Chopra
Calcineurin inhibitors have been the choice for maintenance immunosuppression (IS) in kidney transplant recipients (KTR), but they are associated with nephrotoxicity and metabolic side effects. We aim to compare the long-term outcomes of KTR on belatacept (bela) versus tacrolimus (tac) IS, in all KTRs and various subgroups. Using the UNOS-STAR files, we identified adult first-KTR from 2010 to 2022. Patients were categorized based on maintenance-IS at index transplant admission by creating a propensity score matched cohort at 1:5 rate using several clinical characteristics. Primary outcomes included patient death, graft failure (GF), and death-censored graft failure (DCGF). Secondary outcomes included delayed graft function (DGF), acute-rejections (AR) within a year, and serum creatinine (Cr) at 1-year. The propensity-matched cohort included KTRs on bela (N = 2612) and tac (N = 12760). There was no significant difference in the hazard ratio of death (1.03 [0.92, 1.14]), GF (1.07 [0.97, 1.17]), or DCGF (1.11 [0.98, 1.25]). A sensitivity analysis comparing a propensity-matched cohort of bela + tac (n = 2033) versus tac (n = 9004); demonstrated significantly reduced risks of death (0.87 [0.76–1.00], p = 0.043) and GF (0.73 [0.64–0.83] p < 0.001) compared to those on Tac alone. In conclusion, bela + tac seems to be a nephron-sparing and rejection-lowering IS regimen with overall improved graft and patient outcomes when compared to the current standard of tacrolimus. Larger Randomized Controlled studies are needed.
{"title":"Long Term Outcomes of Transplant Recipients Comparing Belatacept vs. Tacrolimus: A UNOS Database Analysis","authors":"Stalin Canizares, Adriana Montalvan, Devin Eckhoff, Kalathil K. Sureshkumar, Bhavna Chopra","doi":"10.1111/ctr.70075","DOIUrl":"10.1111/ctr.70075","url":null,"abstract":"<div>\u0000 \u0000 <p>Calcineurin inhibitors have been the choice for maintenance immunosuppression (IS) in kidney transplant recipients (KTR), but they are associated with nephrotoxicity and metabolic side effects. We aim to compare the long-term outcomes of KTR on belatacept (bela) versus tacrolimus (tac) IS, in all KTRs and various subgroups. Using the UNOS-STAR files, we identified adult first-KTR from 2010 to 2022. Patients were categorized based on maintenance-IS at index transplant admission by creating a propensity score matched cohort at 1:5 rate using several clinical characteristics. Primary outcomes included patient death, graft failure (GF), and death-censored graft failure (DCGF). Secondary outcomes included delayed graft function (DGF), acute-rejections (AR) within a year, and serum creatinine (Cr) at 1-year. The propensity-matched cohort included KTRs on bela (<i>N</i> = 2612) and tac (<i>N</i> = 12760). There was no significant difference in the hazard ratio of death (1.03 [0.92, 1.14]), GF (1.07 [0.97, 1.17]), or DCGF (1.11 [0.98, 1.25]). A sensitivity analysis comparing a propensity-matched cohort of bela + tac (<i>n</i> = 2033) versus tac (<i>n</i> = 9004); demonstrated significantly reduced risks of death (0.87 [0.76–1.00], <i>p</i> = 0.043) and GF (0.73 [0.64–0.83] <i>p</i> < 0.001) compared to those on Tac alone. In conclusion, bela + tac seems to be a nephron-sparing and rejection-lowering IS regimen with overall improved graft and patient outcomes when compared to the current standard of tacrolimus. Larger Randomized Controlled studies are needed.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045832","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}
Annabel K. Gravely, Marco P. A. W. Claasen, Tommy Ivanics, Erin Winter, Peregrina Peralta, Markus Selzner, Gonzalo Sapisochin
Background
Low post-operative day (POD) 1 Factor V has been retrospectively associated with graft loss after liver transplantation when stratified by a cutoff of 0.36 U/mL. We aimed to validate this prospectively.
Methods
Patients transplanted at Toronto General Hospital were recruited (May 2018–March 2021). Factor V measurements were obtained on POD1-3, 5, and 7. Graft and patient survival at 3, 6, and 12 months were primary and secondary outcomes, respectively. We identified an optimal cutoff through receiver operating characteristic (ROC) analysis and the Youden index. Kaplan–Meier method and Log-rank tests were used to assess/compare survival.
Results
One hundred and twenty-nine patients were included. One hundred and eight had Factor V >0.36 and 21 had ≤0.36 U/mL. This cutoff was predictive of 6- and 12-month graft survival and 12-month patient survival. With an optimal cutoff of 0.46 U/mL on POD1, 87 patients had Factor V >0.46 and 42 had ≤0.46 U/mL. Three-, 6-, and 12-month graft survival rates were 100%, 98.8%, and 98.8%, for patients with Factor V >0.46 U/mL, and 92.9%, 87.7%, and 87.7% for Factor V ≤0.46 U/mL. Similarly, 3-, 6-, and 12-month patient survival rates were 98.8%, 96.4%, and 95.0% for patients with Factor V >0.46 U/mL, and 92.9%, 88.0%, and 82.9% for Factor V ≤0.46 U/mL. Stratification below the novel cutoff was associated with decreased graft survival at months 3 (p = 0.012), 6 (p = 0.006), and 12 (p = 0.006), and decreased patient survival at 12 months (p = 0.022).
Conclusions
Factor V serves as an early biomarker for graft loss, with an optimal predictive cutoff of 0.46 U/mL in this prospective population. Validation of this new cutoff is necessary.
背景：回顾性研究发现，术后第 1 天（POD）因子 V 偏低与肝移植后移植物丢失有关，其分层临界值为 0.36 U/mL。我们的目的是对其进行前瞻性验证：招募了多伦多总医院的移植患者（2018 年 5 月至 2021 年 3 月）。因子 V 的测量在 POD1-3、5 和 7 进行。3、6 和 12 个月的移植物存活率和患者存活率分别是主要和次要结果。我们通过接收者操作特征（ROC）分析和尤登指数确定了最佳截断点。采用卡普兰-梅耶法和对数秩检验来评估/比较存活率：结果：共纳入 129 名患者。其中 108 例患者的因子 V >0.36，21 例患者的因子 V ≤0.36 U/mL。这一临界值可预测 6 个月和 12 个月的移植物存活率以及 12 个月的患者存活率。POD1 的最佳临界值为 0.46 U/mL，87 例患者的因子 V >0.46 U/mL，42 例患者的因子 V ≤0.46 U/mL。因子 V >0.46 U/mL 的患者 3 个月、6 个月和 12 个月的移植物存活率分别为 100%、98.8% 和 98.8%，因子 V ≤0.46 U/mL 的患者 3 个月、6 个月和 12 个月的移植物存活率分别为 92.9%、87.7% 和 87.7%。同样，因子 V >0.46 U/mL 的患者 3 个月、6 个月和 12 个月的生存率分别为 98.8%、96.4% 和 95.0%，因子 V ≤0.46 U/mL 的患者 3 个月、6 个月和 12 个月的生存率分别为 92.9%、88.0% 和 82.9%。低于新临界值的分层与第3个月（p = 0.012）、第6个月（p = 0.006）和第12个月（p = 0.006）的移植物存活率下降以及12个月的患者存活率下降（p = 0.022）有关：结论：因子 V 是移植物丢失的早期生物标志物，在该前瞻性研究人群中，最佳预测截断值为 0.46 U/mL。有必要对这一新的临界值进行验证。
{"title":"Factor V Serves as an Early Biomarker for Graft Loss After Liver Transplant: A Prospective Evaluation","authors":"Annabel K. Gravely, Marco P. A. W. Claasen, Tommy Ivanics, Erin Winter, Peregrina Peralta, Markus Selzner, Gonzalo Sapisochin","doi":"10.1111/ctr.70086","DOIUrl":"10.1111/ctr.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low post-operative day (POD) 1 Factor V has been retrospectively associated with graft loss after liver transplantation when stratified by a cutoff of 0.36 U/mL. We aimed to validate this prospectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients transplanted at Toronto General Hospital were recruited (May 2018–March 2021). Factor V measurements were obtained on POD1-3, 5, and 7. Graft and patient survival at 3, 6, and 12 months were primary and secondary outcomes, respectively. We identified an optimal cutoff through receiver operating characteristic (ROC) analysis and the Youden index. Kaplan–Meier method and Log-rank tests were used to assess/compare survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and twenty-nine patients were included. One hundred and eight had Factor V >0.36 and 21 had ≤0.36 U/mL. This cutoff was predictive of 6- and 12-month graft survival and 12-month patient survival. With an optimal cutoff of 0.46 U/mL on POD1, 87 patients had Factor V >0.46 and 42 had ≤0.46 U/mL. Three-, 6-, and 12-month graft survival rates were 100%, 98.8%, and 98.8%, for patients with Factor V >0.46 U/mL, and 92.9%, 87.7%, and 87.7% for Factor V ≤0.46 U/mL. Similarly, 3-, 6-, and 12-month patient survival rates were 98.8%, 96.4%, and 95.0% for patients with Factor V >0.46 U/mL, and 92.9%, 88.0%, and 82.9% for Factor V ≤0.46 U/mL. Stratification below the novel cutoff was associated with decreased graft survival at months 3 (<i>p</i> = 0.012), 6 (<i>p</i> = 0.006), and 12 (<i>p</i> = 0.006), and decreased patient survival at 12 months (<i>p</i> = 0.022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Factor V serves as an early biomarker for graft loss, with an optimal predictive cutoff of 0.46 U/mL in this prospective population. Validation of this new cutoff is necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katya Loban, Emilie Trinh, Kathleen Gaudio, Diya Nijjar, Jorane-Tiana Robert, Ngan Lam, Scott McKay, Heather Badenoch, Marie-Chantal Fortin, Ann Bugeja, Rahul Mainra, Christine Dipchand, Shaifali Sandal
Optimizing the long-term care and follow-up of living kidney donors (LKDs) has been challenging, and prior LKDs have reported suboptimal healthcare experiences. Long-term care of LKDs is largely undertaken by primary care practitioners such as family physicians (FPs). We conducted a cross-sectional survey of Canadian FPs (n = 151). In our sample, 21.9% of participants reported that ≥1 patient had expressed interest in becoming a LKD, and 39.9% provided care to prior LKDs. While 55.5% knew how to find information on living kidney donation, 75.5% reported that information was not available in their practice. Only a minority had formal training in living kidney donation (<5%), and self-reported knowledge was low (median = 3 [scale 1 = not strong to 10 = very strong]). Knowledge improved significantly with educational activities, resources, experience, and practice needs. Attitudes toward living kidney donation were generally favorable with 71.5% stating that FPs should be involved in post-donation care. Clinical care guidelines (78.8%) were the most desired resource, followed by clear communication and reliable contact at transplant centers. Our findings inform the transplant community of an avenue to optimize LKD care by better-supporting FPs, who provide care to LKDs. This may enhance data collection on LKD outcomes and potentially increase donation rates.
{"title":"Identifying the Views and Needs of Family Physicians on Providing Care to Living Kidney Donors: A Cross-Sectional Survey","authors":"Katya Loban, Emilie Trinh, Kathleen Gaudio, Diya Nijjar, Jorane-Tiana Robert, Ngan Lam, Scott McKay, Heather Badenoch, Marie-Chantal Fortin, Ann Bugeja, Rahul Mainra, Christine Dipchand, Shaifali Sandal","doi":"10.1111/ctr.70085","DOIUrl":"10.1111/ctr.70085","url":null,"abstract":"<p>Optimizing the long-term care and follow-up of living kidney donors (LKDs) has been challenging, and prior LKDs have reported suboptimal healthcare experiences. Long-term care of LKDs is largely undertaken by primary care practitioners such as family physicians (FPs). We conducted a cross-sectional survey of Canadian FPs (<i>n</i> = 151). In our sample, 21.9% of participants reported that ≥1 patient had expressed interest in becoming a LKD, and 39.9% provided care to prior LKDs. While 55.5% knew how to find information on living kidney donation, 75.5% reported that information was not available in their practice. Only a minority had formal training in living kidney donation (<5%), and self-reported knowledge was low (median = 3 [scale 1 = not strong to 10 = very strong]). Knowledge improved significantly with educational activities, resources, experience, and practice needs. Attitudes toward living kidney donation were generally favorable with 71.5% stating that FPs should be involved in post-donation care. Clinical care guidelines (78.8%) were the most desired resource, followed by clear communication and reliable contact at transplant centers. Our findings inform the transplant community of an avenue to optimize LKD care by better-supporting FPs, who provide care to LKDs. This may enhance data collection on LKD outcomes and potentially increase donation rates.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily L. Larson, Yusuf Ciftci, Reed T. Jenkins, Alice L. Zhou, Jessica M. Ruck, Benjamin Philosophe
Introduction
Hepatic epithelioid hemangioendothelioma (HEH) is a rare indication of liver transplant with limited evidence.
Methods
Adult recipients undergoing first-time liver-only transplant from 2002 to 2021 in the United States were identified using the UNOS/OPTN database. We compared post-transplant outcomes of recipients receiving liver transplant for HEH versus other diagnoses. Survival was visualized using Kaplan-Meier curves and compared using log-rank test and multivariable Cox regression. Propensity score matching for recipient age, sex, and MELD was performed, with baseline characteristics and survival compared between groups.
Results
Of 111 558 liver transplant recipients identified, 121 (0.1%) underwent transplant for HEH. Donors to HEH recipients were more often living donors. Recipients with HEH were younger, more likely to be female, and had lower BMI. Recipients with HEH had higher albumin, lower bilirubin, lower INR, and lower serum creatinine, as well as lower MELD scores and rates of ascites and encephalopathy. Similar post-transplant survival was observed for recipients with HEH (16.6 [lower 95% CI 14.9] years) and non-HEH diagnoses (13.8 [95% CI 13.6–13.9] years, log-rank p = 0.28), even after adjusting for baseline donor and recipient characteristics (aHR 1.28 [95% CI 0.94–1.74], p = 0.12). The propensity score matched cohort also had similar post-LT survival.
Conclusions
This national study represents the largest known report on liver transplant for HEH. The survival of recipients with HEH was similar to other etiologies, supporting the use of liver transplantation (LT) in advanced HEH.
{"title":"Outcomes of Liver Transplant for Hepatic Epithelioid Hemangioendothelioma","authors":"Emily L. Larson, Yusuf Ciftci, Reed T. Jenkins, Alice L. Zhou, Jessica M. Ruck, Benjamin Philosophe","doi":"10.1111/ctr.70087","DOIUrl":"10.1111/ctr.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hepatic epithelioid hemangioendothelioma (HEH) is a rare indication of liver transplant with limited evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult recipients undergoing first-time liver-only transplant from 2002 to 2021 in the United States were identified using the UNOS/OPTN database. We compared post-transplant outcomes of recipients receiving liver transplant for HEH versus other diagnoses. Survival was visualized using Kaplan-Meier curves and compared using log-rank test and multivariable Cox regression. Propensity score matching for recipient age, sex, and MELD was performed, with baseline characteristics and survival compared between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 111 558 liver transplant recipients identified, 121 (0.1%) underwent transplant for HEH. Donors to HEH recipients were more often living donors. Recipients with HEH were younger, more likely to be female, and had lower BMI. Recipients with HEH had higher albumin, lower bilirubin, lower INR, and lower serum creatinine, as well as lower MELD scores and rates of ascites and encephalopathy. Similar post-transplant survival was observed for recipients with HEH (16.6 [lower 95% CI 14.9] years) and non-HEH diagnoses (13.8 [95% CI 13.6–13.9] years, log-rank <i>p</i> = 0.28), even after adjusting for baseline donor and recipient characteristics (aHR 1.28 [95% CI 0.94–1.74], <i>p</i> = 0.12). The propensity score matched cohort also had similar post-LT survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This national study represents the largest known report on liver transplant for HEH. The survival of recipients with HEH was similar to other etiologies, supporting the use of liver transplantation (LT) in advanced HEH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045836","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}
Natalie E. Allen, Jie Zhang, Charles N. J. McGhee, Akilesh Gokul, Rachael Niederer
Aim
To identify the demographics and trends of individuals intending to donate their organs, based on intentions at the time of driver's license registration.
Methods
Data were collected from 4 742 475 individuals first registering for a New Zealand (NZ) driver's license, between January 1, 1974, and November 16, 2023, with positive or negative organ donor intentions recorded. Gender, ethnicity, and year of registration were collected. Predictors of positive organ donation intention were examined with a multivariate logistic regression model.
Results
A positive response to the question regarding organ donation intentions was reported in 2 476 914 individuals (52.2%). This included 1 201 275 males (48.4%) and 1 275 639 females (56.4%). Positive organ donation intention was reported in 1 695 672 NZ Europeans (66.2%), 246 303 Māori (36.2%), 76 749 Pasifika (27.6%), 273 879 Asians (34.4%), 52 137 Middle Eastern, Latin American and African (MELAA) (47.0%), 48 876 “Other” ethnicity (63.5%), and 83 298 “Not otherwise specified” (34.7%). On multivariate logistic regression, the female gender was associated with an increased likelihood of organ donation intention (OR 1.37, p < 0.001), and driver's license registration in a more recent year was associated with an increased likelihood of organ donation intention (OR 1.02, p < 0.001). Compared to all other ethnicities, NZ Europeans were associated with a higher likelihood of positive organ donation intention.
Conclusions
This is the largest study of organ donation intention published in Australasia. It demonstrates a higher likelihood of organ donation intentions in females, ethnic differences, and increasing donation intention rates over time. Further investigation is required to explore the difference between intentions and end-of-life organ donation.
{"title":"The Impact of Gender, Ethnicity, and the COVID-19 Pandemic on Organ Donation Intentions Over 50 Years in New Zealand","authors":"Natalie E. Allen, Jie Zhang, Charles N. J. McGhee, Akilesh Gokul, Rachael Niederer","doi":"10.1111/ctr.70089","DOIUrl":"10.1111/ctr.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To identify the demographics and trends of individuals intending to donate their organs, based on intentions at the time of driver's license registration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from 4 742 475 individuals first registering for a New Zealand (NZ) driver's license, between January 1, 1974, and November 16, 2023, with positive or negative organ donor intentions recorded. Gender, ethnicity, and year of registration were collected. Predictors of positive organ donation intention were examined with a multivariate logistic regression model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A positive response to the question regarding organ donation intentions was reported in 2 476 914 individuals (52.2%). This included 1 201 275 males (48.4%) and 1 275 639 females (56.4%). Positive organ donation intention was reported in 1 695 672 NZ Europeans (66.2%), 246 303 Māori (36.2%), 76 749 Pasifika (27.6%), 273 879 Asians (34.4%), 52 137 Middle Eastern, Latin American and African (MELAA) (47.0%), 48 876 “Other” ethnicity (63.5%), and 83 298 “Not otherwise specified” (34.7%). On multivariate logistic regression, the female gender was associated with an increased likelihood of organ donation intention (OR 1.37, <i>p</i> < 0.001), and driver's license registration in a more recent year was associated with an increased likelihood of organ donation intention (OR 1.02, <i>p</i> < 0.001). Compared to all other ethnicities, NZ Europeans were associated with a higher likelihood of positive organ donation intention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the largest study of organ donation intention published in Australasia. It demonstrates a higher likelihood of organ donation intentions in females, ethnic differences, and increasing donation intention rates over time. Further investigation is required to explore the difference between intentions and end-of-life organ donation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021581","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}
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