Kevin Gianaris, Arrey-Takor Paul Ayuk-Arrey, Jonathan A. Fridell, Katherine Ross-Driscoll
Background
Organ allocation has recently changed to acuity circle (AC)-based policies. This study aimed to quantify changes in travel distance and potential environmental impacts of AC policies.
Methods
Data were obtained from the Scientific Registry of Transplant Recipients for each solid organ for an equidistant window before and after AC implementation. We calculated the distance between the donor and recipient hospital for each organ. We used an interrupted time series model to calculate excess travel distance after AC along with associated carbon emissions.
Results
We analyzed travel distance for 226 731 deceased donor organs. There was a significant increase in total excess distance traveled: 1.5 × 106 miles for lung, 3.1 × 106 for heart, 2.2 × 106 miles for liver, and 3.2 × 106 miles for kidney. This led to increased estimated carbon emissions associated with transport ranging from: 175.7 to 193.4 kg CO2e per lung, 291.7 to 312.5 kg CO2e per heart, 114.9 to 131.7 kg CO2e per liver, and 0.2 to 5.3 kg CO2e per kidney.
Conclusions
Our findings quantify an increase in total distance traveled and potential carbon emissions after AC implementation. Environmental impacts of allocation policies should be considered, especially with upcoming continuous distribution.
{"title":"Many Moving Parts: New Transplant Allocation Models Are Associated With Increased Organ Travel and Potential Climate Implications","authors":"Kevin Gianaris, Arrey-Takor Paul Ayuk-Arrey, Jonathan A. Fridell, Katherine Ross-Driscoll","doi":"10.1111/ctr.70426","DOIUrl":"10.1111/ctr.70426","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Organ allocation has recently changed to acuity circle (AC)-based policies. This study aimed to quantify changes in travel distance and potential environmental impacts of AC policies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were obtained from the Scientific Registry of Transplant Recipients for each solid organ for an equidistant window before and after AC implementation. We calculated the distance between the donor and recipient hospital for each organ. We used an interrupted time series model to calculate excess travel distance after AC along with associated carbon emissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed travel distance for 226 731 deceased donor organs. There was a significant increase in total excess distance traveled: 1.5 × 10<sup>6</sup> miles for lung, 3.1 × 10<sup>6</sup> for heart, 2.2 × 10<sup>6</sup> miles for liver, and 3.2 × 10<sup>6</sup> miles for kidney. This led to increased estimated carbon emissions associated with transport ranging from: 175.7 to 193.4 kg CO2e per lung, 291.7 to 312.5 kg CO2e per heart, 114.9 to 131.7 kg CO2e per liver, and 0.2 to 5.3 kg CO2e per kidney.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings quantify an increase in total distance traveled and potential carbon emissions after AC implementation. Environmental impacts of allocation policies should be considered, especially with upcoming continuous distribution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12721351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803254","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}
Henrique M. S. Proença, Lúcio Requião-Moura, Nicolas K. Melaragno, Renato D. Foresto, Jose O. Medina Pestana, Helio Tedesco-Silva
Background
Procurement kidney biopsy has been used for over two decades, yet its value in guiding graft acceptance and allocation decisions remains debated. This study evaluated the performance of procurement biopsies in predicting kidney graft function within the first-year post-transplantation.
Methods
Retrospective cohort study including 339 procurement biopsies of kidneys transplanted between May 2018 and August 2019. All biopsies were paraffin embedded, stained (H&E, PAS, Jones Silver, and Masson's Trichrome), and prospectively analyzed and deemed suitable for transplantation by an experienced renal pathologist. All biopsies were retrospectively scored according to the Banff, Remuzzi, and MAPI classifications. Logistic regression was used to identify clinical and histological variables associated with unsatisfactory graft function, defined as eGFR <30 mL/min/1.73 m2 at 3 and 12 months. Model performance was assessed using the area under the receiver operating characteristic curve (AU-ROC).
Results
Global glomerulosclerosis (Banff scoring model, OR = 1.05; p = 0.007) and KDPI (OR = 1.04; p < 0.001), and Remuzzi score of 4–6 (OR = 2.47; p = 0.007) and KDPI (OR = 1.04; p < 0.001) were associated with lower 3 months eGFR. Cortical scarring (Banff scoring model, OR = 2.79; p = 0.005) and KDPI (OR = 1.05; p < 0.001) were associated with lower 12 months eGFR as well as Remuzzi scores of 4–6 (OR = 2.30; p = 0.009) and 7–12 (OR = 5.20; p = 0.04), and KDPI (OR = 1.04; p < 0.001). The Remuzzi score and KDPI combination achieved the highest predictive performance (AU-ROC = 0.760 and 0.762 at 3 and 12 months, respectively; p < 0.001).
Conclusion
Histological findings were associated with 3 and 12 months graft function, supporting the clinical utility of procurement biopsies in combination to clinical parameters to improve risk stratification.
{"title":"Procurement Kidney Biopsy and Donor Clinical Risk as Complementary Tools to Predict 3- and 12-Month Graft Function After Transplantation","authors":"Henrique M. S. Proença, Lúcio Requião-Moura, Nicolas K. Melaragno, Renato D. Foresto, Jose O. Medina Pestana, Helio Tedesco-Silva","doi":"10.1111/ctr.70421","DOIUrl":"10.1111/ctr.70421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Procurement kidney biopsy has been used for over two decades, yet its value in guiding graft acceptance and allocation decisions remains debated. This study evaluated the performance of procurement biopsies in predicting kidney graft function within the first-year post-transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study including 339 procurement biopsies of kidneys transplanted between May 2018 and August 2019. All biopsies were paraffin embedded, stained (H&E, PAS, Jones Silver, and Masson's Trichrome), and prospectively analyzed and deemed suitable for transplantation by an experienced renal pathologist. All biopsies were retrospectively scored according to the Banff, Remuzzi, and MAPI classifications. Logistic regression was used to identify clinical and histological variables associated with unsatisfactory graft function, defined as eGFR <30 mL/min/1.73 m<sup>2</sup> at 3 and 12 months. Model performance was assessed using the area under the receiver operating characteristic curve (AU-ROC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Global glomerulosclerosis (Banff scoring model, OR = 1.05; <i>p</i> = 0.007) and KDPI (OR = 1.04; <i>p</i> < 0.001), and Remuzzi score of 4–6 (OR = 2.47; <i>p</i> = 0.007) and KDPI (OR = 1.04; <i>p</i> < 0.001) were associated with lower 3 months eGFR. Cortical scarring (Banff scoring model, OR = 2.79; <i>p</i> = 0.005) and KDPI (OR = 1.05; <i>p</i> < 0.001) were associated with lower 12 months eGFR as well as Remuzzi scores of 4–6 (OR = 2.30; <i>p</i> = 0.009) and 7–12 (OR = 5.20; <i>p</i> = 0.04), and KDPI (OR = 1.04; <i>p</i> < 0.001). The Remuzzi score and KDPI combination achieved the highest predictive performance (AU-ROC = 0.760 and 0.762 at 3 and 12 months, respectively; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Histological findings were associated with 3 and 12 months graft function, supporting the clinical utility of procurement biopsies in combination to clinical parameters to improve risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793613","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}
Hanna L. Kleiboeker, Margaret R. Jorgenson, Michael J. Scolarici, Jillian L. Descourouez, Glen E. Leverson, Chris Saddler, Didier Mandlebrot, David Al-Adra
Background
Cytomegalovirus (CMV) is associated with morbidity and mortality after a kidney transplant (KT). Letermovir (LTV) was approved in high-risk KT recipients, providing an alternative to standard-of-care valganciclovir (VGC) associated with reduced myelosuppression.
Methods
Adult patients receiving a kidney transplant with moderate-risk CMV serostatus between 1/1/2021 and 6/6/2024 were evaluated. Patients were included in VGC or LTV cohort based on de novo prophylaxis regimen. The primary outcomes were efficacy and tolerability.
Results
Four hundred and eight KTRs met inclusion criteria: 316 received VGC, 92 received LTV. Cohorts were comparable; the majority received a primary (84.2% vs. 90.2%, p = 0.566) deceased donor (69.6% vs. 68.5%, p = 0.298) transplant with lymphocyte depleting induction (82.3% vs. 90.2%, p = 0.32). Significantly more patients in the VGC cohort required antiviral dose adjustment (61.7% vs. 1.1%, p < 0.0001). Patients in the LTV cohort were significantly more likely to complete antiviral prophylaxis (63.3% vs. 84.8%, p < 0.0001). Patients in the VGC cohort were significantly more likely to experience leukopenia (65.8% vs. 45.7%, p = 0.0006) and neutropenia (30.7% vs. 12.0%, p = 0.0002) during the first-year post-KT. Significantly more patients in the LTV cohort were on the equivalent of >1000 mg mycophenolate/day at 12 months post-KT (59.9% vs. 74.2%, p = 0.0173). Rates of CMV viremia and clinically significant disease through 1-year post-KT were comparable.
Conclusions
De novo LTV in R+ KTRs appears to be safe and effective compared to VGC. This study suggests antiviral prophylaxis is more likely to be successfully completed with LTV and requires less dose titration. Additionally, LTV appears to be associated with less myelosuppression, permitting higher mycophenolate doses at 12 months and avoiding corrective healthcare resource utilization.
背景：巨细胞病毒（CMV）与肾移植（KT）后的发病率和死亡率相关。Letermovir （LTV）被批准用于高风险KT受体，为标准治疗缬更昔洛韦（VGC）提供了一种替代方案，可降低骨髓抑制。方法：对2021年1月1日至2024年6月6日期间接受肾移植的CMV血清状态为中度危险的成年患者进行评估。根据新生预防方案将患者纳入VGC或LTV队列。主要结局是疗效和耐受性。结果：448例ktr符合纳入标准，其中VGC 316例，LTV 92例。队列具有可比性；大多数患者接受原发移植（84.2% vs. 90.2%, p = 0.566），死者供者（69.6% vs. 68.5%, p = 0.298），并诱导淋巴细胞消耗（82.3% vs. 90.2%, p = 0.32）。VGC队列中有更多的患者需要调整抗病毒剂量（61.7% vs 1.1%， p 1000 mg霉酚酸酯/天，kt后12个月）（59.9% vs 74.2%, p = 0.0173）。通过kt后1年的CMV病毒血症和临床显著疾病的发生率具有可比性。结论：与VGC相比，R+ KTRs的新生LTV似乎是安全有效的。这项研究表明抗病毒预防更有可能成功完成LTV，并且需要较少的剂量滴定。此外，LTV似乎与较少的骨髓抑制有关，允许在12个月时使用较高的霉酚酸盐剂量，并避免纠正保健资源的利用。
{"title":"De Novo Letermovir After Cytomegalovirus Seropositive Kidney Transplant Improves Toxicity and Mycophenolate Tolerance Over the Current Standard of Care","authors":"Hanna L. Kleiboeker, Margaret R. Jorgenson, Michael J. Scolarici, Jillian L. Descourouez, Glen E. Leverson, Chris Saddler, Didier Mandlebrot, David Al-Adra","doi":"10.1111/ctr.70423","DOIUrl":"10.1111/ctr.70423","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cytomegalovirus (CMV) is associated with morbidity and mortality after a kidney transplant (KT). Letermovir (LTV) was approved in high-risk KT recipients, providing an alternative to standard-of-care valganciclovir (VGC) associated with reduced myelosuppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients receiving a kidney transplant with moderate-risk CMV serostatus between 1/1/2021 and 6/6/2024 were evaluated. Patients were included in VGC or LTV cohort based on de novo prophylaxis regimen. The primary outcomes were efficacy and tolerability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred and eight KTRs met inclusion criteria: 316 received VGC, 92 received LTV. Cohorts were comparable; the majority received a primary (84.2% vs. 90.2%, <i>p</i> = 0.566) deceased donor (69.6% vs. 68.5%, <i>p</i> = 0.298) transplant with lymphocyte depleting induction (82.3% vs. 90.2%, <i>p</i> = 0.32). Significantly more patients in the VGC cohort required antiviral dose adjustment (61.7% vs. 1.1%, <i>p</i> < 0.0001). Patients in the LTV cohort were significantly more likely to complete antiviral prophylaxis (63.3% vs. 84.8%, <i>p</i> < 0.0001). Patients in the VGC cohort were significantly more likely to experience leukopenia (65.8% vs. 45.7%, <i>p</i> = 0.0006) and neutropenia (30.7% vs. 12.0%, <i>p</i> = 0.0002) during the first-year post-KT. Significantly more patients in the LTV cohort were on the equivalent of >1000 mg mycophenolate/day at 12 months post-KT (59.9% vs. 74.2%, <i>p</i> = 0.0173). Rates of CMV viremia and clinically significant disease through 1-year post-KT were comparable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>De novo LTV in R+ KTRs appears to be safe and effective compared to VGC. This study suggests antiviral prophylaxis is more likely to be successfully completed with LTV and requires less dose titration. Additionally, LTV appears to be associated with less myelosuppression, permitting higher mycophenolate doses at 12 months and avoiding corrective healthcare resource utilization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773317","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}
Claudia Minato, Amine Nasri, Pierre-Emmanuel Noly, Jacinthe Boulet, Marie-Claude Parent, Annik Fortier, Simon de Denus, Maxime Tremblsay-Gravel, Geneviève Giraldeau, Yoan Lamarche, Anique Ducharme
Background
Modern immunosuppressive regimens have been associated with lower rejection rates after heart transplantation (HTx), yet long-term outcomes have remained limited by drug-related complications. Since 2010, our program has implemented a protocolized corticosteroid withdrawal (CSW) strategy following induction with rabbit anti-thymocyte globulin (RATG) and methylprednisolone. The protocol consists of shifting from a high-dose regimen to a minimization approach with a goal of steroid discontinuation within 12 months.
Methods
We evaluated the impact of this approach on the combined primary endpoint of freedom from allograft rejection ISHLT ≥ 2R, infection, non-cutaneous cancer, or coronary artery vasculopathy (CAV). We conducted a retrospective single-center study including 418 HTx patients. Patients were divided according to era of HTx: Early (1983–1998); Recent (1999–02/2010), and Corticosteroid withdrawal (CSW) (03/2010-06/2018). Multivariate Cox analyses identified predictors of adverse outcomes.
Results
Five-year corticosteroid use markedly decreased over eras (Early 61, 4%, Recent 20, 3%, CSW 3, 4% at 5 years; p < 0.001). Freedom from the composite primary endpoint significantly improved with CSW (Early: HR: 3.42; 95% CI: 2.49–4.68; Recent: HR: 2.9; 95% CI: 4.1, both p < 0.0001 compared to CSW.) Only prednisone dose (HR:1.19; 95% CI: 1.09–1.30; p < 0.0001) and era of transplantation (Early vs. CSW: HR:2.70; 95% CI: 1.91–3.81; p < 0.0001; Recent vs. CSW: HR:2.38; 95% CI: 1.68–3.39; p < 0.0001) were independently associated with worse outcomes in the final multivariate Cox model. Notably, death, rejection, infection, and CAV were less frequent in the CSW era.
Conclusion
Protocolized CSW within 1 year after HTx was associated with improved long-term outcomes, including death, fewer rejection episodes, infections, and CAV. These findings support rapid steroid tapering as a safe and effective strategy in contemporary HTx.
{"title":"Rapid Corticosteroid Withdrawal After Cardiac Transplantation Improves Outcomes","authors":"Claudia Minato, Amine Nasri, Pierre-Emmanuel Noly, Jacinthe Boulet, Marie-Claude Parent, Annik Fortier, Simon de Denus, Maxime Tremblsay-Gravel, Geneviève Giraldeau, Yoan Lamarche, Anique Ducharme","doi":"10.1111/ctr.70420","DOIUrl":"10.1111/ctr.70420","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Modern immunosuppressive regimens have been associated with lower rejection rates after heart transplantation (HTx), yet long-term outcomes have remained limited by drug-related complications. Since 2010, our program has implemented a protocolized corticosteroid withdrawal (CSW) strategy following induction with rabbit anti-thymocyte globulin (RATG) and methylprednisolone. The protocol consists of shifting from a high-dose regimen to a minimization approach with a goal of steroid discontinuation within 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated the impact of this approach on the combined primary endpoint of freedom from allograft rejection ISHLT ≥ 2R, infection, non-cutaneous cancer, or coronary artery vasculopathy (CAV). We conducted a retrospective single-center study including 418 HTx patients. Patients were divided according to era of HTx: Early (1983–1998); Recent (1999–02/2010), and Corticosteroid withdrawal (CSW) (03/2010-06/2018). Multivariate Cox analyses identified predictors of adverse outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five-year corticosteroid use markedly decreased over eras (Early 61, 4%, Recent 20, 3%, CSW 3, 4% at 5 years; <i>p</i> < 0.001). Freedom from the composite primary endpoint significantly improved with CSW (Early: HR: 3.42; 95% CI: 2.49–4.68; Recent: HR: 2.9; 95% CI: 4.1, both <i>p</i> < 0.0001 compared to CSW.) Only prednisone dose (HR:1.19; 95% CI: 1.09–1.30; <i>p</i> < 0.0001) and era of transplantation (Early vs. CSW: HR:2.70; 95% CI: 1.91–3.81; <i>p</i> < 0.0001; Recent vs. CSW: HR:2.38; 95% CI: 1.68–3.39; <i>p</i> < 0.0001) were independently associated with worse outcomes in the final multivariate Cox model. Notably, death, rejection, infection, and CAV were less frequent in the CSW era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Protocolized CSW within 1 year after HTx was associated with improved long-term outcomes, including death, fewer rejection episodes, infections, and CAV. These findings support rapid steroid tapering as a safe and effective strategy in contemporary HTx.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12710205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767356","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}
Sanne J. J. Langmuur, Leonard Seghers, Rogier A. S. Hoek, Jos A. Bekkers, Maarten ter Horst, Edris A. F. Mahtab
Background
Clamshell thoracotomy is the traditional approach for bilateral sequential lung transplantation (LuTx), despite considerable morbidity. The bilateral anterolateral thoracotomy without sternal division is proposed as an alternative, less invasive method. Since this technique is more surgically challenging, the aim of this study was to evaluate the more favorable surgical approach.
Methods
Adult patients undergoing LuTx between 2010 and 2022 were included in this single-center retrospective cohort study. Multivariable regression analyses were performed to assess the effect of surgical approach on mortality, operative outcomes, and complications.
Results
A total of 249 patients (anterolateral thoracotomy: n = 132, clamshell: n = 117) were included. Recipients in the anterolateral thoracotomy group were older, on the waiting list for a shorter period of time, classified less often as highly urgent, and differed in their indications for LuTx. After multivariable correction, operating and ischemic times were longer for patients in the anterolateral thoracotomy group. However, patients with an anterolateral thoracotomy incision had less intraoperative extracorporeal circulation (ECC) use, blood loss, and need for transfusion. While survival was similar, ICU and hospital stay, and duration of mechanical ventilation were shorter. Patients in the anterolateral thoracotomy group also had significantly less wound-related complications. The use of intraoperative ECC, which was much higher in the clamshell group, seemed to play an important role in these differences in outcomes.
Conclusion
Performing LuTx through the less invasive anterolateral thoracotomy is a favorable alternative to the clamshell incision. Despite increased technical difficulty and a limited increase in operating and ischemic times, survival is similar, but the anterolateral thoracotomy patients had significantly less peri- and post-operative complications and a faster recovery.
{"title":"Anterolateral vs. Clamshell Thoracotomy for Bilateral Lung Transplantation","authors":"Sanne J. J. Langmuur, Leonard Seghers, Rogier A. S. Hoek, Jos A. Bekkers, Maarten ter Horst, Edris A. F. Mahtab","doi":"10.1111/ctr.70406","DOIUrl":"10.1111/ctr.70406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clamshell thoracotomy is the traditional approach for bilateral sequential lung transplantation (LuTx), despite considerable morbidity. The bilateral anterolateral thoracotomy without sternal division is proposed as an alternative, less invasive method. Since this technique is more surgically challenging, the aim of this study was to evaluate the more favorable surgical approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients undergoing LuTx between 2010 and 2022 were included in this single-center retrospective cohort study. Multivariable regression analyses were performed to assess the effect of surgical approach on mortality, operative outcomes, and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 249 patients (anterolateral thoracotomy: <i>n</i> = 132, clamshell: <i>n</i> = 117) were included. Recipients in the anterolateral thoracotomy group were older, on the waiting list for a shorter period of time, classified less often as highly urgent, and differed in their indications for LuTx. After multivariable correction, operating and ischemic times were longer for patients in the anterolateral thoracotomy group. However, patients with an anterolateral thoracotomy incision had less intraoperative extracorporeal circulation (ECC) use, blood loss, and need for transfusion. While survival was similar, ICU and hospital stay, and duration of mechanical ventilation were shorter. Patients in the anterolateral thoracotomy group also had significantly less wound-related complications. The use of intraoperative ECC, which was much higher in the clamshell group, seemed to play an important role in these differences in outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Performing LuTx through the less invasive anterolateral thoracotomy is a favorable alternative to the clamshell incision. Despite increased technical difficulty and a limited increase in operating and ischemic times, survival is similar, but the anterolateral thoracotomy patients had significantly less peri- and post-operative complications and a faster recovery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12710450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767294","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}
Alberto Costa Silva, Teresa Pina-Vaz, Ana Pinho, Ana Cerqueira, Inês Ferreira, Manuela Bustorff, Susana Sampaio, Margarida Rios, Roberto Roncon Albuquerque Jr, Manuel Pestana, Carlos Martins-Silva, Tiago Antunes-Lopes, João Alturas Silva
Introduction
Vascular complications in kidney transplantation are a major concern. While kidneys from uncontrolled donation after circulatory death (uDCD) offer a viable organ source, the incidence of vascular complications in these cases remains poorly studied. This study aims to compare the vascular complications between transplants from uDCD and donation after brain death (DBD).
Methods
Between January 2016 and November 2023, we performed a prospective analysis concerning vascular complications (arterial and venous) based on kidney transplants from uDCD and DBD with standard criteria (SCD) or expanded criteria (ECD).
Results
Among the 523 kidney transplants, 142 were from uDCD and, of those, 7.0% had vascular complications comprising arterial (2.8%) and venous (4.2%) complications. The rates of vascular complications showed no significant difference between kidney transplants from uDCD and SCD (7.0% vs. 3.1%, p = 0.120) and between uDCD and ECD (7.0% vs. 8.5%, p = 0.766). Donor age over 50 years was associated with vascular complications in uDCD (p = 0.016). The incidence of delayed graft function was significantly higher in the uDCD group compared with SCD and ECD (69.7% vs. 37.6% and 43.9%, respectively; p < 0.001).
Conclusion
Vascular complication rates in uDCD transplantation were comparable to those in SCD and ECD transplants. Donor age appears to be a contributing factor to vascular complications in the uDCD setting. While these findings suggest similar outcomes, the small number of events highlights the need for larger studies.
肾移植中的血管并发症是一个重要的问题。虽然循环死亡（uDCD）后不受控制捐赠的肾脏提供了一个可行的器官来源，但这些病例中血管并发症的发生率仍未得到充分研究。本研究旨在比较脑死亡后移植与脑死亡后捐赠的血管并发症。方法：在2016年1月至2023年11月期间，我们对标准标准（SCD）或扩展标准（ECD）的uDCD和DBD肾移植的血管并发症（动脉和静脉）进行了前瞻性分析。结果：523例肾移植中，uDCD肾移植142例，其中7.0%存在血管并发症，包括动脉并发症（2.8%）和静脉并发症（4.2%）。uDCD肾移植与SCD肾移植血管并发症发生率无统计学差异（7.0% vs. 3.1%, p = 0.120）， uDCD肾移植与ECD肾移植血管并发症发生率无统计学差异（7.0% vs. 8.5%, p = 0.766）。供体年龄大于50岁与uDCD的血管并发症相关（p = 0.016）。uDCD组移植物功能延迟发生率明显高于SCD和ECD组（分别为69.7%比37.6%和43.9%,p < 0.001）。结论：uDCD移植与SCD、ECD移植的血管并发症发生率相当。供体年龄似乎是uDCD患者血管并发症的一个因素。虽然这些发现表明了类似的结果，但少数事件突出了进行更大规模研究的必要性。
{"title":"Vascular Complications Following Kidney Transplantation From Uncontrolled Donation After Circulatory Death: A Prospective Study","authors":"Alberto Costa Silva, Teresa Pina-Vaz, Ana Pinho, Ana Cerqueira, Inês Ferreira, Manuela Bustorff, Susana Sampaio, Margarida Rios, Roberto Roncon Albuquerque Jr, Manuel Pestana, Carlos Martins-Silva, Tiago Antunes-Lopes, João Alturas Silva","doi":"10.1111/ctr.70417","DOIUrl":"10.1111/ctr.70417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vascular complications in kidney transplantation are a major concern. While kidneys from uncontrolled donation after circulatory death (uDCD) offer a viable organ source, the incidence of vascular complications in these cases remains poorly studied. This study aims to compare the vascular complications between transplants from uDCD and donation after brain death (DBD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between January 2016 and November 2023, we performed a prospective analysis concerning vascular complications (arterial and venous) based on kidney transplants from uDCD and DBD with standard criteria (SCD) or expanded criteria (ECD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 523 kidney transplants, 142 were from uDCD and, of those, 7.0% had vascular complications comprising arterial (2.8%) and venous (4.2%) complications. The rates of vascular complications showed no significant difference between kidney transplants from uDCD and SCD (7.0% vs. 3.1%, <i>p</i> = 0.120) and between uDCD and ECD (7.0% vs. 8.5%, <i>p</i> = 0.766). Donor age over 50 years was associated with vascular complications in uDCD (<i>p</i> = 0.016). The incidence of delayed graft function was significantly higher in the uDCD group compared with SCD and ECD (69.7% vs. 37.6% and 43.9%, respectively; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Vascular complication rates in uDCD transplantation were comparable to those in SCD and ECD transplants. Donor age appears to be a contributing factor to vascular complications in the uDCD setting. While these findings suggest similar outcomes, the small number of events highlights the need for larger studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12710453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767402","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}
Shivani S. Bisen, Tanveen Ishaque, Alvin G. Thomas, Madeleine M. Waldram, Daniel S. Warren, Jaclyn Bannon, Joseph R. Scalea, Dorry L. Segev, Jacqueline M. Garonzik-Wang, Allan B. Massie, Macey L. Levan
Introduction
The United States Organ Procurement and Transplantation Network mandates collection of 6-month, 1-year, and 2-year post-donation follow-up data on living kidney donors (LKDs), but many centers struggle to meet these requirements. This study investigated whether providing a financial incentive (mailed gift card) could increase patient compliance with LKD follow-up.
Methods
A parallel, non-blinded, 1:1 superiority randomized control trial of LKDs was conducted at two centers from March 2017 to February 2021. The control arm received standard of care (SOC): instructions to complete the mandated LKD follow-up consisting of a health questionnaire and laboratory measurements at 6 months, 1 year, and 2 years post-donation. The intervention arm received SOC and was mailed a $25 gift card for each timely completed follow-up. Compliance rates were compared at each timepoint using Poisson regression.
Results
A total of 175 donors consented to participate. The 6-month, 1-year, and 2-year follow-up compliance rates were 65.2%, 63%, and 65.2% in the control arm, and 71.1%, 60.2%, and 53.0% in the intervention arm, respectively. No statistically significant improvement in compliance was observed with the gift card intervention (IRR = 0.891.091.34 at 6 months, 0.760.961.21 at 1 year, and 0.630.811.05 at 2 years). Similarly, no differences were observed in compliance with clinical follow-up, laboratory follow-up, or individual questions or lab values.
Conclusion
Mailed gift cards did not improve patient compliance with LKD follow-up requirements; such interventions may be counterproductive among LKDs. Further research is needed to investigate and address barriers to completing LKD follow-up.
{"title":"A Two-Center Randomized Controlled Trial to Assess Financial Incentives for Compliance With Living Kidney Donor Follow-Up in the United States","authors":"Shivani S. Bisen, Tanveen Ishaque, Alvin G. Thomas, Madeleine M. Waldram, Daniel S. Warren, Jaclyn Bannon, Joseph R. Scalea, Dorry L. Segev, Jacqueline M. Garonzik-Wang, Allan B. Massie, Macey L. Levan","doi":"10.1111/ctr.70401","DOIUrl":"10.1111/ctr.70401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The United States Organ Procurement and Transplantation Network mandates collection of 6-month, 1-year, and 2-year post-donation follow-up data on living kidney donors (LKDs), but many centers struggle to meet these requirements. This study investigated whether providing a financial incentive (mailed gift card) could increase patient compliance with LKD follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A parallel, non-blinded, 1:1 superiority randomized control trial of LKDs was conducted at two centers from March 2017 to February 2021. The control arm received standard of care (SOC): instructions to complete the mandated LKD follow-up consisting of a health questionnaire and laboratory measurements at 6 months, 1 year, and 2 years post-donation. The intervention arm received SOC and was mailed a $25 gift card for each timely completed follow-up. Compliance rates were compared at each timepoint using Poisson regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 175 donors consented to participate. The 6-month, 1-year, and 2-year follow-up compliance rates were 65.2%, 63%, and 65.2% in the control arm, and 71.1%, 60.2%, and 53.0% in the intervention arm, respectively. No statistically significant improvement in compliance was observed with the gift card intervention (IRR = <sub>0.89</sub>1.09<sub>1.34</sub> at 6 months, <sub>0.76</sub>0.96<sub>1.21</sub> at 1 year, and <sub>0.63</sub>0.81<sub>1.05</sub> at 2 years). Similarly, no differences were observed in compliance with clinical follow-up, laboratory follow-up, or individual questions or lab values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mailed gift cards did not improve patient compliance with LKD follow-up requirements; such interventions may be counterproductive among LKDs. Further research is needed to investigate and address barriers to completing LKD follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT03090646</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755314","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}
Jiro Kimura, Badi Rawashdeh, Beje Thomas, Ty Blink Dunn, Matthew Cooper, Emre Arpali
Aim
This study investigated the risk factors for both high post-void residual (PVR) and the need for urinary re-catheterization (RC) following kidney transplantation (KT). Our objectives were to develop a predictive risk model for high PVR and to outline a management strategy for patients who experience posttransplant elevated PVR.
Methods
This prospective study included 110 adult patients who underwent KT. High PVR was defined as > 150 mL in non-anuric patients and > 50 mL in anuric patients. Logistic regression analysis was conducted to identify predictive factors for high PVR. Urinary RC was evaluated as a secondary outcome.
Results
High PVR was observed in 31 (28.2%) patients. On multivariate analysis, DM (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.22–7.94; p = 0.02) and anuria before transplantation (OR, 3.80; 95% CI, 1.34–10.80; p = 0.01) were identified as significant predictors of high PVR. The area under the curve of the receiver operating characteristic for the risk model using these factors was 0.72 (95% CI, 0.61–0.82). Urinary RC was required in 14 (12.7%) patients, and among male recipients, those who required RC due to high PVR had significantly larger prostate volume (p = 0.003).
Conclusions
The present study demonstrated that DM and anuria are predictive factors for high PVR and larger prostate volume in male recipients was associated with an increased likelihood of RC. To prevent the following complications, PVR should be routinely measured especially in patients with a history of diabetes or anuria.
目的：本研究探讨肾移植术后高空后残留（PVR）和尿再导尿（RC）的危险因素。我们的目标是建立高PVR的预测风险模型，并概述移植后PVR升高患者的管理策略。方法：这项前瞻性研究纳入了110例接受KT治疗的成年患者。无尿患者的高PVR定义为>150ml，无尿患者的高PVR定义为>50ml。采用Logistic回归分析确定高PVR的预测因素。尿RC作为次要结局进行评估。结果：高PVR 31例（28.2%）。在多因素分析中，DM（比值比[OR]， 3.11； 95%可信区间[CI]， 1.22-7.94; p = 0.02）和移植前无尿（比值比[OR]， 3.80; 95% CI, 1.34-10.80; p = 0.01）被确定为高PVR的重要预测因素。使用这些因素的风险模型的受试者工作特征曲线下面积为0.72 （95% CI, 0.61-0.82）。14例（12.7%）患者需要尿RC，在男性受体中，由于PVR高而需要RC的患者前列腺体积明显较大（p = 0.003）。结论：目前的研究表明，糖尿病和无尿是高PVR的预测因素，男性受体前列腺体积较大与RC的可能性增加有关。为预防以下并发症，应常规测量PVR，特别是有糖尿病或无尿史的患者。
{"title":"Risk Factors Associated With High Post-Void Residual Urine and Urethral Re-Catheterization in the Early Postoperative Period Following Kidney Transplantation","authors":"Jiro Kimura, Badi Rawashdeh, Beje Thomas, Ty Blink Dunn, Matthew Cooper, Emre Arpali","doi":"10.1111/ctr.70418","DOIUrl":"10.1111/ctr.70418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study investigated the risk factors for both high post-void residual (PVR) and the need for urinary re-catheterization (RC) following kidney transplantation (KT). Our objectives were to develop a predictive risk model for high PVR and to outline a management strategy for patients who experience posttransplant elevated PVR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective study included 110 adult patients who underwent KT. High PVR was defined as > 150 mL in non-anuric patients and > 50 mL in anuric patients. Logistic regression analysis was conducted to identify predictive factors for high PVR. Urinary RC was evaluated as a secondary outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High PVR was observed in 31 (28.2%) patients. On multivariate analysis, DM (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.22–7.94; <i>p</i> = 0.02) and anuria before transplantation (OR, 3.80; 95% CI, 1.34–10.80; <i>p</i> = 0.01) were identified as significant predictors of high PVR. The area under the curve of the receiver operating characteristic for the risk model using these factors was 0.72 (95% CI, 0.61–0.82). Urinary RC was required in 14 (12.7%) patients, and among male recipients, those who required RC due to high PVR had significantly larger prostate volume (<i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The present study demonstrated that DM and anuria are predictive factors for high PVR and larger prostate volume in male recipients was associated with an increased likelihood of RC. To prevent the following complications, PVR should be routinely measured especially in patients with a history of diabetes or anuria.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755335","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}
This article aims to review unresolved ethical issues and raise additional questions to be answered regarding the use of intraoperative brain monitoring during thoracoabdominal normothermic regional perfusion (TA-NRP). We discuss the following ethical questions, as well as offer preliminary recommendations to advance the discourse around use of brain monitoring during TA-NRP: (1) Does brain monitoring admit violation of the dead donor rule? (2) Which monitoring techniques should be implemented during TA-NRP? (3) How should we manage positive findings? (4) How should we manage ambiguous findings on brain monitoring? (5) What procedural and institutional barriers remain to utilizing intraoperative brain monitoring for TA-NRP on a wider scale? We argue that preventing inadvertent brain reperfusion is central to ensuring TA-NRP complies with ethical standards, and that blood flow monitoring is the most direct monitor for reperfusion. We assess potential brain monitors during TA-NRP and suggest that transcranial doppler (TCD) with cerebral oximetry may be the closest existing tests to an ideal monitor for this application. We likewise review remaining questions regarding diagnostic uncertainty around these tests and the implications of this uncertainty or positive findings of brain reperfusion on the donor, their families, and public trust. To begin addressing these questions, necessary first steps include standardization of surgical protocols to include venting and consolidating data around TA-NRP.
{"title":"Intraoperative Brain Monitoring During Thoracoabdominal Normothermic Regional Perfusion: Practical and Ethical Considerations","authors":"Alexander J. Quan, Brendan S. Parent","doi":"10.1111/ctr.70383","DOIUrl":"10.1111/ctr.70383","url":null,"abstract":"<div>\u0000 \u0000 <p>This article aims to review unresolved ethical issues and raise additional questions to be answered regarding the use of intraoperative brain monitoring during thoracoabdominal normothermic regional perfusion (TA-NRP). We discuss the following ethical questions, as well as offer preliminary recommendations to advance the discourse around use of brain monitoring during TA-NRP: (1) Does brain monitoring admit violation of the dead donor rule? (2) Which monitoring techniques should be implemented during TA-NRP? (3) How should we manage positive findings? (4) How should we manage ambiguous findings on brain monitoring? (5) What procedural and institutional barriers remain to utilizing intraoperative brain monitoring for TA-NRP on a wider scale? We argue that preventing inadvertent brain reperfusion is central to ensuring TA-NRP complies with ethical standards, and that blood flow monitoring is the most direct monitor for reperfusion. We assess potential brain monitors during TA-NRP and suggest that transcranial doppler (TCD) with cerebral oximetry may be the closest existing tests to an ideal monitor for this application. We likewise review remaining questions regarding diagnostic uncertainty around these tests and the implications of this uncertainty or positive findings of brain reperfusion on the donor, their families, and public trust. To begin addressing these questions, necessary first steps include standardization of surgical protocols to include venting and consolidating data around TA-NRP.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755317","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}
Michael G. Megaly, William C. Miller, Jessica Thul, Peter Gullickson, Abraham J. Matar, Michael Dryden, Matthew Wright, David Mathews, Jessica Fisher, Heidi Sarumi, Levi Teigen, Scott Lunos, Timothy L. Pruett
Sarcopenia is a known predictor of morbidity and mortality after liver transplantation (LT); it has been assessed with computed tomography (CT) derived Psoas Area Index (PAI) and mean Hounsfield units (mHU). While literature is abundant regarding the adverse outcomes of liver transplant in sarcopenic patients, a paucity of data exists describing the change in psoas muscle area and density from pre- to post-liver transplant. One hundred and four adult liver transplant recipients had pre- and post-transplant CT scans analyzed with respect to PAI and mHU. Mean PAI pre-transplant was 7.94 and 6.99 cm2/m2 post-transplant (12% loss). Mean mHU pre-transplant was 35.47 and 33.00 post-transplant (7% reduction). However, stratified by pre-transplant quartiles, PAI reduction was −15%, −12%, and −6% for the upper, mid-two, and lower quartiles, respectively (p value = 0.0028). The mHU stratification was −15%, −8%, and + 12% for the upper, mid-two, and lower quartiles, respectively (p value = 0.0004). No relationship was noted between PAI and mHU. PAI and mHU decreased following liver transplantation; however, the most pronounced decrease in muscle mass and density was in patients with the highest starting muscle mass and density. However, muscle mass (PAI) and composition (mHU) appear to be affected by multiple factors.
{"title":"Decrease in Psoas Muscle Mass and Density Following Liver Transplantation Is Greatest in Patients With the Highest Muscle Quantity and Density Pre-Transplant","authors":"Michael G. Megaly, William C. Miller, Jessica Thul, Peter Gullickson, Abraham J. Matar, Michael Dryden, Matthew Wright, David Mathews, Jessica Fisher, Heidi Sarumi, Levi Teigen, Scott Lunos, Timothy L. Pruett","doi":"10.1111/ctr.70410","DOIUrl":"10.1111/ctr.70410","url":null,"abstract":"<p>Sarcopenia is a known predictor of morbidity and mortality after liver transplantation (LT); it has been assessed with computed tomography (CT) derived Psoas Area Index (PAI) and mean Hounsfield units (mHU). While literature is abundant regarding the adverse outcomes of liver transplant in sarcopenic patients, a paucity of data exists describing the change in psoas muscle area and density from pre- to post-liver transplant. One hundred and four adult liver transplant recipients had pre- and post-transplant CT scans analyzed with respect to PAI and mHU. Mean PAI pre-transplant was 7.94 and 6.99 cm<sup>2</sup>/m<sup>2</sup> post-transplant (12% loss). Mean mHU pre-transplant was 35.47 and 33.00 post-transplant (7% reduction). However, stratified by pre-transplant quartiles, PAI reduction was −15%, −12%, and −6% for the upper, mid-two, and lower quartiles, respectively (<i>p</i> value = 0.0028). The mHU stratification was −15%, −8%, and + 12% for the upper, mid-two, and lower quartiles, respectively (<i>p</i> value = 0.0004). No relationship was noted between PAI and mHU. PAI and mHU decreased following liver transplantation; however, the most pronounced decrease in muscle mass and density was in patients with the highest starting muscle mass and density. However, muscle mass (PAI) and composition (mHU) appear to be affected by multiple factors.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755330","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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