Keir Forgie, Sayed Himmat, Katie Du, Alynne Ribano, Abeline Watkins, Nicholas M. Fialka, Sanaz Hatami, Mubashir Khan, Xiuhua Wang, Ryan Edgar, Katie-Marie Buswell-Zuk, Darren H. Freed, Jayan Nagendran
Introduction
Preclinically, 24-hour continuous Ex-Situ Lung Perfusion (ESLP) is the longest duration achieved in large animal models and rejected human lungs. Here, we present our 36-hour Negative Pressure Ventilation (NPV)-ESLP protocol applied to porcine and rejected human lungs.
Methods
Five sets of donor domestic pig lungs (45-55 kg) underwent 36-hour NPV-ESLP. Two sets of clinically rejected human lungs were preserved on 36-hour NPV-ESLP. Graft function was assessed via physiologic parameters, edema formation, and cytokine profiles.
Results
Porcine and human lung function was stable with mean partial pressure of oxygen divided by the fraction of inspired oxygen (PaO2/FiO2; PF) ratios throughout preservation of 473±11.79 and 554.7±13.26, respectively (mean±standard error of the mean). In porcine lungs, mean compliance (Cdyn) during ESLP was 33.96±2.18, pulmonary artery pressure (PAP) 13.03±0.53, and pulmonary vascular resistance (PVR) 481.20 ±21.86. In human lungs, mean Cdyn was 82.68±3.54, PAP 6.00±0.33, and PVR 184.00±9.71. Average percentage weight-gain was 34.47±13.22 in porcine lungs and 116.3±6.65 in rejected human lungs.
Conclusion
NPV-ESLP can preserve porcine lungs and human lungs for 36-hours with acceptable physiologic function. Greater weight-gain in the human lungs is likely due to prolonged ischemic time prior to ESLP and use of an acellular perfusate. Continuous 36-hour NPV-ESLP could support therapies for endothelial protection and mitigate fluid accumulation.
{"title":"Negative Pressure Ventilation Ex-Situ Lung Perfusion Preserves Porcine and Human Lungs for 36-Hours","authors":"Keir Forgie, Sayed Himmat, Katie Du, Alynne Ribano, Abeline Watkins, Nicholas M. Fialka, Sanaz Hatami, Mubashir Khan, Xiuhua Wang, Ryan Edgar, Katie-Marie Buswell-Zuk, Darren H. Freed, Jayan Nagendran","doi":"10.1111/ctr.70083","DOIUrl":"10.1111/ctr.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Preclinically, 24-hour continuous Ex-Situ Lung Perfusion (ESLP) is the longest duration achieved in large animal models and rejected human lungs. Here, we present our 36-hour Negative Pressure Ventilation (NPV)-ESLP protocol applied to porcine and rejected human lungs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Five sets of donor domestic pig lungs (45-55 kg) underwent 36-hour NPV-ESLP. Two sets of clinically rejected human lungs were preserved on 36-hour NPV-ESLP. Graft function was assessed via physiologic parameters, edema formation, and cytokine profiles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Porcine and human lung function was stable with mean partial pressure of oxygen divided by the fraction of inspired oxygen (PaO2/FiO2; PF) ratios throughout preservation of 473±11.79 and 554.7±13.26, respectively (mean±standard error of the mean). In porcine lungs, mean compliance (Cdyn) during ESLP was 33.96±2.18, pulmonary artery pressure (PAP) 13.03±0.53, and pulmonary vascular resistance (PVR) 481.20 ±21.86. In human lungs, mean Cdyn was 82.68±3.54, PAP 6.00±0.33, and PVR 184.00±9.71. Average percentage weight-gain was 34.47±13.22 in porcine lungs and 116.3±6.65 in rejected human lungs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NPV-ESLP can preserve porcine lungs and human lungs for 36-hours with acceptable physiologic function. Greater weight-gain in the human lungs is likely due to prolonged ischemic time prior to ESLP and use of an acellular perfusate. Continuous 36-hour NPV-ESLP could support therapies for endothelial protection and mitigate fluid accumulation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001280","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}
Alexander G. Dragnich, Kaitlyn C. Chapin, Ke Xu, Jinyuan Liu, Loren Lipworth, Ciara M. Shaver, Anil J. Trindade
The importance of mental toughness on lung transplant outcomes is unknown. We performed a pilot study to assess whether pretransplant grit and resilience are associated with short-term posttransplant outcomes. We enrolled 31 lung transplant candidates, of whom 7 (26%) had greater mental toughness, defined as the upper tertile for both grit and resilience within our cohort. There were no differences in baseline characteristics between patients with higher and lower mental toughness. Greater mental toughness was associated with a shorter hospital length of stay (LOS) [12 days (interquartile range, IQR 10–12) vs. 17 days (IQR 14–24), p = 0.02] and reduced posttraumatic stress severity [median 0 (IQR 0–2) vs. 6.5 (IQR 4–9), p < 0.01]. On multivariable analyses adjusting for age and Duke Activity Status Index, greater mental toughness was associated with a shorter hospital LOS [beta = −11.96 (95% CI 0.05–23.86), p < 0.05] and reduced PTSD [beta = −10.7 (95% CI −21.6–0.04), p = 0.053]. Lung transplant candidates with greater mental toughness may have improved short-term outcomes.
心理韧性对肺移植结果的重要性尚不清楚。我们进行了一项初步研究，以评估移植前砂砾和恢复力是否与移植后短期结果相关。我们招募了31名肺移植候选人，其中7名（26%）具有更强的精神韧性，在我们的队列中被定义为毅力和恢复力的上限。心理韧性较高和较低患者的基线特征无差异。更强的精神韧性与更短的住院时间（LOS）相关[12天（四分位数范围，IQR 10-12）比17天（IQR 14-24）， p = 0.02]和创伤后应激严重程度降低[中位数0 （IQR 0-2）比6.5 (IQR 4-9), p < 0.01]。在调整年龄和杜克活动状态指数的多变量分析中，更强的精神韧性与更短的医院LOS [β = -11.96 (95% CI 0.05-23.86), p < 0.05]和更少的PTSD [β = -10.7 (95% CI -21.6-0.04), p = 0.053]相关。具有较强心理韧性的肺移植候选者可能有较好的短期预后。
{"title":"Association of Grit and Resilience With Short-Term Post-Transplant Outcomes in Lung Allograft Recipients","authors":"Alexander G. Dragnich, Kaitlyn C. Chapin, Ke Xu, Jinyuan Liu, Loren Lipworth, Ciara M. Shaver, Anil J. Trindade","doi":"10.1111/ctr.70082","DOIUrl":"10.1111/ctr.70082","url":null,"abstract":"<p>The importance of mental toughness on lung transplant outcomes is unknown. We performed a pilot study to assess whether pretransplant grit and resilience are associated with short-term posttransplant outcomes. We enrolled 31 lung transplant candidates, of whom 7 (26%) had greater mental toughness, defined as the upper tertile for both grit and resilience within our cohort. There were no differences in baseline characteristics between patients with higher and lower mental toughness. Greater mental toughness was associated with a shorter hospital length of stay (LOS) [12 days (interquartile range, IQR 10–12) vs. 17 days (IQR 14–24), <i>p</i> = 0.02] and reduced posttraumatic stress severity [median 0 (IQR 0–2) vs. 6.5 (IQR 4–9), <i>p</i> < 0.01]. On multivariable analyses adjusting for age and Duke Activity Status Index, greater mental toughness was associated with a shorter hospital LOS [beta = −11.96 (95% CI 0.05–23.86), <i>p</i> < 0.05] and reduced PTSD [beta = −10.7 (95% CI −21.6–0.04), <i>p</i> = 0.053]. Lung transplant candidates with greater mental toughness may have improved short-term outcomes.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969924","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}
Kevin Yi, Vicki Avery, John McCall, Hannah Giles, Helen Lindsay, Ed Gane, David Orr, Louise Barbier
Introduction
Previous guidelines considered body mass index (BMI) over 40 kg/m2 a relative contra-indication to liver transplantation (LT). The aims were to examine the selection process and study outcomes of patients with Class I–III obesity.
Methods
Retrospective analysis of outcomes of obese patients assessed for LT at our center between 2010 and 2023, divided into three groups: Class I (BMI30-34.9 kg/m2), Class II (BMI35-39.9 kg/m2), and Class III (BMI>40 kg/m2). Survival of non-obese adult patients was used for comparison.
Results
Three hundred fifteen patients with BMI ≥30 kg/m2 were assessed for LT. Seventeen (5.4%) were not wait-listed due to comorbidities. One hundred sixty-eight patients were transplanted: 100 Class I, 43 Class II, and 25 Class III. There were no differences in postoperative complications (Clavien-Dindo Grade 3 or more; 41%, 42%, 48% for Class I–III obesity respectively) or patient and graft survival (5-y rates 84.4% and 82.7%, respectively, for the whole cohort) according to the different classes of obesity. Furthermore, patient and graft survival was not different between non-obese and obese patients (p = 0.932).
Conclusion
With a rigorous selection process, short-term outcomes after LT for patients with Class III obesity were comparable to patients with Class I–II obesity. Long-term survival was identical for obese and non-obese patients.
{"title":"Liver Transplantation in Well-Selected Class III Obese Recipients Yields Good Outcomes","authors":"Kevin Yi, Vicki Avery, John McCall, Hannah Giles, Helen Lindsay, Ed Gane, David Orr, Louise Barbier","doi":"10.1111/ctr.70060","DOIUrl":"10.1111/ctr.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Previous guidelines considered body mass index (BMI) over 40 kg/m<sup>2</sup> a relative contra-indication to liver transplantation (LT). The aims were to examine the selection process and study outcomes of patients with Class I–III obesity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective analysis of outcomes of obese patients assessed for LT at our center between 2010 and 2023, divided into three groups: Class I (BMI30-34.9 kg/m<sup>2</sup>), Class II (BMI35-39.9 kg/m<sup>2</sup>), and Class III (BMI>40 kg/m<sup>2</sup>). Survival of non-obese adult patients was used for comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three hundred fifteen patients with BMI ≥30 kg/m<sup>2</sup> were assessed for LT. Seventeen (5.4%) were not wait-listed due to comorbidities. One hundred sixty-eight patients were transplanted: 100 Class I, 43 Class II, and 25 Class III. There were no differences in postoperative complications (Clavien-Dindo Grade 3 or more; 41%, 42%, 48% for Class I–III obesity respectively) or patient and graft survival (5-y rates 84.4% and 82.7%, respectively, for the whole cohort) according to the different classes of obesity. Furthermore, patient and graft survival was not different between non-obese and obese patients (<i>p</i> = 0.932).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With a rigorous selection process, short-term outcomes after LT for patients with Class III obesity were comparable to patients with Class I–II obesity. Long-term survival was identical for obese and non-obese patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969930","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}
Daniel M. Kaufman, James D. Perkins, Nicolae Leca, Ramasamy Bakthavatsalam, Lena Sibulesky
Background
The use of donor kidneys with acute kidney injury (AKI) aims to expand the organ pool, but uncertainty remains regarding their outcomes across different Kidney Donor Profile Index (KDPI) groups and preservation methods.
Methods
We retrospectively analyzed 108 160 deceased donor kidney transplants from the OPTN database, focusing on adult recipients of kidneys from donors with or without AKI between December 2014 and December 2022. Propensity matching was used for each KDPI group (1–20, 21–59, 60–84, and 85–100), comparing donors with AKIN stages 0–1 to AKIN stages 2–3. Cox proportional hazards analysis assessed graft survival by AKIN stages and preservation type.
Results
The use of AKIN stage 2–3 kidneys significantly increased over the study period. AKIN does not negatively impact graft survival in the KDPI 1–20 group and is linked to improved survival in KDPI 21–59 and 60–84. In the KDPI 85–100 group, AKIN stage 2–3 shows a trend toward increased graft failure. Pump preservation reduces delayed graft function (DGF) across most KDPI groups but does not consistently improve long-term survival, except in KDPI 85–100.
Conclusion
Transplantation with AKIN stage 2–3 kidneys is viable, but outcomes vary by KDPI group. Tailored guidelines should consider transplant center capabilities.
{"title":"Tailoring Kidney Transplant Strategies: Unraveling the Impact of Acute Kidney Injury and Preservation Methods Across Different Strata of Kidney Risk","authors":"Daniel M. Kaufman, James D. Perkins, Nicolae Leca, Ramasamy Bakthavatsalam, Lena Sibulesky","doi":"10.1111/ctr.70078","DOIUrl":"10.1111/ctr.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of donor kidneys with acute kidney injury (AKI) aims to expand the organ pool, but uncertainty remains regarding their outcomes across different Kidney Donor Profile Index (KDPI) groups and preservation methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 108 160 deceased donor kidney transplants from the OPTN database, focusing on adult recipients of kidneys from donors with or without AKI between December 2014 and December 2022. Propensity matching was used for each KDPI group (1–20, 21–59, 60–84, and 85–100), comparing donors with AKIN stages 0–1 to AKIN stages 2–3. Cox proportional hazards analysis assessed graft survival by AKIN stages and preservation type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The use of AKIN stage 2–3 kidneys significantly increased over the study period. AKIN does not negatively impact graft survival in the KDPI 1–20 group and is linked to improved survival in KDPI 21–59 and 60–84. In the KDPI 85–100 group, AKIN stage 2–3 shows a trend toward increased graft failure. Pump preservation reduces delayed graft function (DGF) across most KDPI groups but does not consistently improve long-term survival, except in KDPI 85–100.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Transplantation with AKIN stage 2–3 kidneys is viable, but outcomes vary by KDPI group. Tailored guidelines should consider transplant center capabilities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962067","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}
Weekend hospital discharges are often associated with reduced staffing, potentially impacting the quality of patient care. We studied the effects of weekend discharge after liver transplantation (LT) on early readmission rates, overall survival (OS), and graft survival (GS).
Method
We analyzed data from the Ohio State University Wexner Medical Center database (January 2016 to December 2023). The study included initial LT recipients (LTRs) including donation after brain death (DBD) and donation after cardiac death (DCD). Primary outcomes encompassed early readmission rates, and secondary outcomes included OS and GS.
Results
The cohort comprised 915 LTRs (645 DBD, 270 DCD), with 156 (17.0%) weekend and 759 (83.0%) weekday discharges. Regarding discharge disposition, 681 (74.4%) patients were discharged home, 210 (22.9%) were discharged to healthcare facilities. No significant differences were identified in the length of hospital stay (8 days vs. 9 days, weekend vs. weekday, respectively, p = 0.22) or 30-day readmission (29.5% vs. 32.5%, weekend vs. weekday, respectively, p = 0.75). There were no significant differences in OS (90.9% vs. 92.7% at 1-year, 84.4% vs. 88.0% at 3-year, weekend vs. weekday, p = 0.27) and GS (90.9% vs. 91.5% at 1-year, 84.0% vs. 86.6% at 3-year, weekend vs. weekday, p = 0.50). Multivariate logistic analysis showed no significant impact of weekend discharge (OR: 0.84 [0.57–1.22], p = 0.35) or discharge disposition (OR: 1.00 [0.75–1.33], p = 1.00) on 30-day readmission. Multivariate Cox regression analysis found no significant impact of weekend discharge or discharge disposition on OS and GS (all p > 0.05).
Conclusion
Weekend discharge does not impact early readmission, OS, or GS in LTRs. These findings are a testament to our multidisciplinary team efforts and suggest that with appropriate discharge planning and follow-up care, the timing of discharge may be less critical than previously assumed.
背景：周末出院通常与人员减少有关，这可能会影响患者护理的质量。我们研究了肝移植术后周末出院对早期再入院率、总生存期（OS）和移植物生存期（GS）的影响。方法：分析俄亥俄州立大学Wexner医学中心数据库（2016年1月至2023年12月）的数据。该研究纳入了初始肝移植受体（LTRs），包括脑死亡后捐赠（DBD）和心脏死亡后捐赠（DCD）。主要结局包括早期再入院率，次要结局包括OS和GS。结果：该队列包括915例ltr(645例DBD， 270例DCD)，其中156例（17.0%）周末出院，759例（83.0%）工作日出院。出院处置方面，681例（74.4%）患者出院回家，210例（22.9%）患者出院到医疗机构。住院时间（8天vs. 9天，周末vs.工作日，分别p = 0.22）或30天再入院（29.5% vs. 32.5%，周末vs.工作日，分别p = 0.75）无显著差异。OS（1年90.9% vs. 92.7%， 3年84.4% vs. 88.0%，周末vs.工作日，p = 0.27）和GS（1年90.9% vs. 91.5%， 3年84.0% vs. 86.6%，周末vs.工作日，p = 0.50）无显著差异。多因素logistic分析显示，周末出院（OR: 0.84 [0.57-1.22], p = 0.35）或出院处理（OR: 1.00 [0.75-1.33], p = 1.00）对30天再入院无显著影响。多因素Cox回归分析发现，周末放血和放血处置对OS和GS无显著影响（p < 0.05）。结论：周末出院对ltr患者早期再入院、OS或GS无影响。这些发现证明了我们多学科团队的努力，并建议通过适当的出院计划和随访护理，出院时间可能不像以前假设的那么重要。
{"title":"Does Weekend Discharge Affect Readmission and Survival in Liver Transplant Patients? Insights From a Cohort Study","authors":"Ayato Obana, Miho Akabane, Hannah Chi, Nolan Ladd, Matthew Yoder, Lily Kaufman, Rithin Punjala, Kejal Shah, Matthew Hamilton, Ashley Limkemann, Austin Schenk, Navdeep Singh, Black Slyvester, Khalid Mumtaz, Kenneth Washburn, Musab Alebrahim","doi":"10.1111/ctr.70081","DOIUrl":"10.1111/ctr.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Weekend hospital discharges are often associated with reduced staffing, potentially impacting the quality of patient care. We studied the effects of weekend discharge after liver transplantation (LT) on early readmission rates, overall survival (OS), and graft survival (GS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We analyzed data from the Ohio State University Wexner Medical Center database (January 2016 to December 2023). The study included initial LT recipients (LTRs) including donation after brain death (DBD) and donation after cardiac death (DCD). Primary outcomes encompassed early readmission rates, and secondary outcomes included OS and GS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort comprised 915 LTRs (645 DBD, 270 DCD), with 156 (17.0%) weekend and 759 (83.0%) weekday discharges. Regarding discharge disposition, 681 (74.4%) patients were discharged home, 210 (22.9%) were discharged to healthcare facilities. No significant differences were identified in the length of hospital stay (8 days vs. 9 days, weekend vs. weekday, respectively, <i>p</i> = 0.22) or 30-day readmission (29.5% vs. 32.5%, weekend vs. weekday, respectively, <i>p</i> = 0.75). There were no significant differences in OS (90.9% vs. 92.7% at 1-year, 84.4% vs. 88.0% at 3-year, weekend vs. weekday, <i>p</i> = 0.27) and GS (90.9% vs. 91.5% at 1-year, 84.0% vs. 86.6% at 3-year, weekend vs. weekday, <i>p</i> = 0.50). Multivariate logistic analysis showed no significant impact of weekend discharge (OR: 0.84 [0.57–1.22], <i>p</i> = 0.35) or discharge disposition (OR: 1.00 [0.75–1.33], <i>p</i> = 1.00) on 30-day readmission. Multivariate Cox regression analysis found no significant impact of weekend discharge or discharge disposition on OS and GS (all <i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Weekend discharge does not impact early readmission, OS, or GS in LTRs. These findings are a testament to our multidisciplinary team efforts and suggest that with appropriate discharge planning and follow-up care, the timing of discharge may be less critical than previously assumed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962065","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}
Melissa A. Lyle, Juan Maria M. Farina, Erin Wiedmeier-Nutor, Vanda Lindpere, Molly Klanderman, Jose N. Nativi-Nicolau, Juan Carlos Leoni Moreno, Rohan M. Goswami, Daniel S. Yip, Parag C. Patel, Taimur Sher, Andrew N. Rosenbaum, Omar F. AbouEzzeddine, Barry A. Boilson, Sudhir S. Kushwaha, Alfredo L. Clavell, David E. Steidley, Brian W. Hardaway, Robert L. Scott, Lisa M. LeMond, Rafael Fonseca, Morie A. Gertz, Angela Dispenzieri, Martha Grogan, Julie L. Rosenthal
Background
The prognosis in patients with advanced cardiac amyloidosis (CA) remains poor.
Objectives
We sought to describe survival post heart transplantation (HT) in amyloid compared with non-amyloid recipients, highlight waitlist times within the new allocation system across three Organ Procurement and Transplantation Network (OPTN) regions, and describe multiorgan transplantation (MOT) in hereditary amyloidosis.
Methods
This is a retrospective review of end-stage CA patients who underwent HT at Mayo Clinic from January 2007 to December 2020. Wait time was compared in the new versus old OPTN allocation era starting December 18, 2018 by Wilcoxon rank sum test. All-cause mortality for those with and without CA was compared using Kaplan–Meier estimates with log rank analysis, censoring December 16, 2022.
Results
Fifty-five patients with CA underwent HT between 2007 and 2020, 8 light chain amyloidosis (AL) (14.5%), 28 hereditary transthyretin (ATTRv) (50.9%), 17 wildtype transthyretin (ATTRwt) (30.9%), and 2 hereditary apolipoprotein A1 (AApoA1) amyloidosis patients (3.6%). No significant difference in overall survival post-transplant was seen in amyloid compared with non-amyloid (p = 0.816). Median time to HT was shorter in the new system, 45 days (IQR 24, 78) versus 174 days (IQR 76.5, 483.5), p = 0.006. There was a decline in MOT in hereditary amyloidosis over time with the concomitant rise in disease-targeted therapies.
Conclusions
HT survival in CA patients was similar to non-amyloid patients. The new allocation system benefits this cohort with shorter wait times. There is less MOT in hereditary amyloidosis with increased utilization of disease-targeted therapy.
{"title":"Amyloidosis and Heart Transplantation in a New Era","authors":"Melissa A. Lyle, Juan Maria M. Farina, Erin Wiedmeier-Nutor, Vanda Lindpere, Molly Klanderman, Jose N. Nativi-Nicolau, Juan Carlos Leoni Moreno, Rohan M. Goswami, Daniel S. Yip, Parag C. Patel, Taimur Sher, Andrew N. Rosenbaum, Omar F. AbouEzzeddine, Barry A. Boilson, Sudhir S. Kushwaha, Alfredo L. Clavell, David E. Steidley, Brian W. Hardaway, Robert L. Scott, Lisa M. LeMond, Rafael Fonseca, Morie A. Gertz, Angela Dispenzieri, Martha Grogan, Julie L. Rosenthal","doi":"10.1111/ctr.70070","DOIUrl":"10.1111/ctr.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The prognosis in patients with advanced cardiac amyloidosis (CA) remains poor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We sought to describe survival post heart transplantation (HT) in amyloid compared with non-amyloid recipients, highlight waitlist times within the new allocation system across three Organ Procurement and Transplantation Network (OPTN) regions, and describe multiorgan transplantation (MOT) in hereditary amyloidosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective review of end-stage CA patients who underwent HT at Mayo Clinic from January 2007 to December 2020. Wait time was compared in the new versus old OPTN allocation era starting December 18, 2018 by Wilcoxon rank sum test. All-cause mortality for those with and without CA was compared using Kaplan–Meier estimates with log rank analysis, censoring December 16, 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-five patients with CA underwent HT between 2007 and 2020, 8 light chain amyloidosis (AL) (14.5%), 28 hereditary transthyretin (ATTRv) (50.9%), 17 wildtype transthyretin (ATTRwt) (30.9%), and 2 hereditary apolipoprotein A1 (AApoA1) amyloidosis patients (3.6%). No significant difference in overall survival post-transplant was seen in amyloid compared with non-amyloid (<i>p</i> = 0.816). Median time to HT was shorter in the new system, 45 days (IQR 24, 78) versus 174 days (IQR 76.5, 483.5), <i>p</i> = 0.006. There was a decline in MOT in hereditary amyloidosis over time with the concomitant rise in disease-targeted therapies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HT survival in CA patients was similar to non-amyloid patients. The new allocation system benefits this cohort with shorter wait times. There is less MOT in hereditary amyloidosis with increased utilization of disease-targeted therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945818","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}
{"title":"Use of LCP-Tacrolimus in Kidney Transplant Recipients With Altered Gastrointestinal Anatomy","authors":"Sarah E. Bova, Bethany Lane, Mohamed M. Ibrahim","doi":"10.1111/ctr.70079","DOIUrl":"10.1111/ctr.70079","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945846","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}
End-stage heart failure (ESHF) remains a significant challenge despite optimal treatment, with heart transplantation (HTx) being the gold standard of care. Mechanical circulatory support (MCS) devices such as left ventricular assist devices (LVADs) are increasingly used for temporary or permanent treatment. Psychiatric comorbidities are common in patients with ESHF and may affect treatment outcomes, but the relationship between sociodemographic, clinical, and psychiatric characteristics remains unclear.
Methods
A medical record based, descriptive cross-sectional study was conducted on 94 ESHF patients scheduled for HTx or LVAD therapy. Sociodemographic, clinical, and psychiatric data, including psychiatric diagnoses and systemic inflammatory markers, were collected from medical records. Univariate analyses compared patients with (PD) and without psychiatric disorders (No-PD).
Results
Of the participants, 37% had active psychopathology, with major depressive disorder (MDD) and generalized anxiety disorder (GAD) being prevalent. Approximately half of those diagnosed received their first psychiatric diagnosis at the time of assessment. Sociodemographic factors did not differ significantly between the PD and No-PD groups. While no significant difference was observed in ejection fraction (%) and inflammatory markers such as C-reactive protein (CRP), lymphocyte count was higher in the PD group.
Conclusions
Preoperative psychiatric assessment is crucial to identify psychiatric comorbidities in ESHF patients undergoing HTx or LVAD therapy. Despite limitations, this study sheds light on previously unexplored aspects, such as the relationship between ejection fraction and psychiatric comorbidities and the relationship between depressive symptoms and inflammatory markers obtained from complete blood count. Furthermore, the fact that almost half of the patients with psychiatric comorbidity were first diagnosed during the pre-treatment psychiatric assessment underlines the importance of pre-LVAD and pre-HTX psychiatric evaluation.
{"title":"Psychiatric Disorders and Associated Factors in Left Ventricular Assist Device Implantation and Heart Transplant Candidates","authors":"Selvi Ceran, Esra Emekli, Gonca Aşut, Atilla Sezgin","doi":"10.1111/ctr.70052","DOIUrl":"10.1111/ctr.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>End-stage heart failure (ESHF) remains a significant challenge despite optimal treatment, with heart transplantation (HTx) being the gold standard of care. Mechanical circulatory support (MCS) devices such as left ventricular assist devices (LVADs) are increasingly used for temporary or permanent treatment. Psychiatric comorbidities are common in patients with ESHF and may affect treatment outcomes, but the relationship between sociodemographic, clinical, and psychiatric characteristics remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A medical record based, descriptive cross-sectional study was conducted on 94 ESHF patients scheduled for HTx or LVAD therapy. Sociodemographic, clinical, and psychiatric data, including psychiatric diagnoses and systemic inflammatory markers, were collected from medical records. Univariate analyses compared patients with (PD) and without psychiatric disorders (No-PD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the participants, 37% had active psychopathology, with major depressive disorder (MDD) and generalized anxiety disorder (GAD) being prevalent. Approximately half of those diagnosed received their first psychiatric diagnosis at the time of assessment. Sociodemographic factors did not differ significantly between the PD and No-PD groups. While no significant difference was observed in ejection fraction (%) and inflammatory markers such as C-reactive protein (CRP), lymphocyte count was higher in the PD group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preoperative psychiatric assessment is crucial to identify psychiatric comorbidities in ESHF patients undergoing HTx or LVAD therapy. Despite limitations, this study sheds light on previously unexplored aspects, such as the relationship between ejection fraction and psychiatric comorbidities and the relationship between depressive symptoms and inflammatory markers obtained from complete blood count. Furthermore, the fact that almost half of the patients with psychiatric comorbidity were first diagnosed during the pre-treatment psychiatric assessment underlines the importance of pre-LVAD and pre-HTX psychiatric evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945826","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}
Kiran Belani, Vincent Brinker, Matthew Fuller, Mary Cooter, Jacob N. Schroder, Negmeldeen Mamoun, Adam DeVore, Madhav Swaminathan, Alina Nicoara, Sharon L. McCartney
Background
Tricuspid regurgitation (TR) is common immediately after orthotopic heart transplantation (OHT), though the expected outcomes of TR over time remain undefined. In this study, we examined the natural trajectory of TR in the first 120 days post-transplantation. We observed the clinical phenotypes of trajectories of TR after OHT, and assessed trajectory correlation with 1-year mortality and degree of right ventricular (RV) dysfunction.
Methods
All patients who underwent OHT at a single institution from January 2009 to July 2019 were included, unless death occurred during the index hospitalization. TR and RV dysfunction on follow-up transthoracic echocardiograms were tracked on 4-point scales and latent-class mixed modeling (LCMM) identified classes of TR trajectories. Fisher's exact test was used to compare 1-year mortalities between classes.
Results
Based on LCMM, four distinct classes of TR trajectories emerged, characterized as sustained (n = 40), variable (n = 172), stable (n = 175), and recovered (n = 189) TR. Significant differences in mortality rates were found amongst classes at 10.0%, 8.1%, 4.0%, and 2.6%, respectively (p = 0.025). The degree of RV dysfunction mirrored TR severity in all subsets except the sustained TR group.
Conclusions
The trajectory of TR in the first 120 days post-OHT is associated with 1-year mortality. In many subsets, there is a close association with TR grade and RV function improvement. However, in the sustained TR group, RV function improved without subsequent improvement in TR severity. These findings could identify patients with higher mortality risk for whom more frequent follow-up or intervention is warranted.
{"title":"Tricuspid Regurgitation after Orthotopic Heart Transplantation: Trajectories and Association With Mortality","authors":"Kiran Belani, Vincent Brinker, Matthew Fuller, Mary Cooter, Jacob N. Schroder, Negmeldeen Mamoun, Adam DeVore, Madhav Swaminathan, Alina Nicoara, Sharon L. McCartney","doi":"10.1111/ctr.70062","DOIUrl":"10.1111/ctr.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tricuspid regurgitation (TR) is common immediately after orthotopic heart transplantation (OHT), though the expected outcomes of TR over time remain undefined. In this study, we examined the natural trajectory of TR in the first 120 days post-transplantation. We observed the clinical phenotypes of trajectories of TR after OHT, and assessed trajectory correlation with 1-year mortality and degree of right ventricular (RV) dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients who underwent OHT at a single institution from January 2009 to July 2019 were included, unless death occurred during the index hospitalization. TR and RV dysfunction on follow-up transthoracic echocardiograms were tracked on 4-point scales and latent-class mixed modeling (LCMM) identified classes of TR trajectories. Fisher's exact test was used to compare 1-year mortalities between classes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Based on LCMM, four distinct classes of TR trajectories emerged, characterized as sustained (<i>n</i> = 40), variable (<i>n</i> = 172), stable (<i>n</i> = 175), and recovered (<i>n</i> = 189) TR. Significant differences in mortality rates were found amongst classes at 10.0%, 8.1%, 4.0%, and 2.6%, respectively (<i>p</i> = 0.025). The degree of RV dysfunction mirrored TR severity in all subsets except the sustained TR group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The trajectory of TR in the first 120 days post-OHT is associated with 1-year mortality. In many subsets, there is a close association with TR grade and RV function improvement. However, in the sustained TR group, RV function improved without subsequent improvement in TR severity. These findings could identify patients with higher mortality risk for whom more frequent follow-up or intervention is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945844","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}
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