Clinical Transplantation最新文献_第5页

Impact of the Distance Between Patient Residency and Heart Transplant Center on Outcomes After Heart Transplantation 患者居住地与心脏移植中心之间的距离对心脏移植术后结果的影响

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-18 DOI: 10.1111/ctr.70008

Waleed Ahmad, Abdur Rehman

引用次数: 0

Association of Donor Vascular Endothelial Growth Factor Gene Polymorphism With Acute Renal Allograft Rejection 供体血管内皮生长因子基因多态性与急性肾移植排斥反应的关系

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-16 DOI: 10.1111/ctr.15475

Narayan Prasad, Brijesh Yadav, Mansi Bhatt, Ranjeet Chauhan, Vinita Agrawal

Background

Recipient's VEGF-A polymorphisms have been reported to be associated with the risk of acute allograft rejection. However, an association of the donor's VEGF-A gene polymorphism with rejection remained unelucidated till now.

Methods

In this study, VEGF-A gene SNPs at nine loci were analyzed in 160 kidney donors and recipients with rejection (rejectors, n = 80) and without rejection (non-rejectors, n = 80). Blood VEGF-A mRNA, plasma VEGF level, and intragraft VEGF expression were also analyzed by RT-PCR, ELISA, and immunohistochemistry, respectively.

Results

On comparing between the donor and rejectors, the polymorphic genotypes of VEGF –634 C>G [GG genotype, p < 0.0001; OR (95% CI) = 17.74 (5.16–60.96)]; VEGF –1154 G>A [AG genotype, p < 0.0001, OR (95% CI) = 16.07 (3.68–70.15)]; VEGF +936 C>T [CT genotype, p < 0.0001, OR (95% CI) = 178.64 (23.28–1370.9), and TT genotype, p < 0.0001; OR (95% CI) = 3149 (278.91–35 553)]; VEGF –1455 T>C [CC genotype, p value = 0.0464, OR (95% CI) = 3.13 (1.07–9.10)]; VEGF –2578 C>A [CA genotype, p = 0.0426, OR (95% CI) = 4.62 (1.03–20.59), and AA genotype, p value < 0.0001, OR (95% CI) = 21.89 (4.94–97.04)]; VEGF –2549 18 bp Insertion/Deletion [ID genotype, p value < 0.0001, OR (95% CI) = 27.27 (3.61–205.73) and DD genotype, p value < 0.0001, OR (95% CI) = 25.18 (3.30–191.89) were significantly associated with acute rejection risk. On comparing rejectors versus non-rejectors, GA genotype of VEGF –1190 G>A and TC genotype of VEGF –1455 T>C were associated with the risk of rejection. On comparing donor VEGF between rejectors and non-rejectors, CG genotype of VEGF –634 C>G, AG of VEGF –1154 G>A; GA of VEGF –1190 G>A were associated with rejection. The blood VEGF-A mRNA and plasma VEGF levels were higher in the rejectors group compared to non-rejectors.

Conclusions

Besides the recipient's VEGF SNPS, the donor's VEGF SNPs are also associated with the risk of acute rejection and may be closely monitored in evaluation to determine the risk of rejection.

背景据报道，受者的血管内皮生长因子-A基因多态性与急性同种异体移植排斥反应的风险有关。然而，供体的 VEGF-A 基因多态性与排斥反应的关系至今仍未阐明。方法在这项研究中，分析了160名肾脏供体和受体中存在排斥反应（排斥反应者，80人）和不存在排斥反应（非排斥反应者，80人）的9个位点的VEGF-A基因SNPs。此外，还分别通过 RT-PCR、ELISA 和免疫组化方法分析了血液 VEGF-A mRNA、血浆 VEGF 水平和移植物内 VEGF 表达。结果在供体和排斥者之间进行比较，VEGF -634 C>G [GG 基因型，p < 0.0001; OR (95% CI) = 17.74 (5.16-60.96)]; VEGF -1154 G>A [AG 基因型，p < 0.0001, OR (95% CI) = 16.07 (3.68-70.15)]; VEGF +936 C>T [CT 基因型，p < 0.0001, OR (95% CI) = 178.64 (23.28-1370.9), and TT 基因型，p < 0.0001; OR (95% CI) = 3149 (278.91-35 553)]; VEGF -1455 T>C [CC 基因型，p 值 = 0.0464, OR (95% CI) = 3.13 (1.07-9.10)]; VEGF -2578 C>A [CA 基因型，p = 0.0426, OR (95% CI) = 4.62 (1.03-20.59), AA 基因型，p 值 < 0.0001, OR (95% CI) = 21.89 (4.94-97. 04)]; VEGF -2578 T>C [VEGF -1455 T>C 基因型，p 值 = 0.04）]；VEGF -2549 18 bp插入/缺失[ID基因型，p值为< 0.0001，OR（95% CI）= 27.27（3.61-205.73）和DD基因型，p值为< 0.0001，OR（95% CI）= 25.18（3.30-191.89）]与急性排斥风险显著相关。比较排斥者与非排斥者，VEGF -1190 G>A 的 GA 基因型和 VEGF -1455 T>C 的 TC 基因型与排斥风险有关。比较排斥反应者和非排斥反应者的供体 VEGF，VEGF -634 C>G 的 CG 基因型、VEGF -1154 G>A 的 AG 基因型和 VEGF -1190 G>A 的 GA 基因型与排斥反应有关。与非排斥反应组相比，排斥反应组的血液 VEGF-A mRNA 和血浆 VEGF 水平更高。结论除受者的血管内皮生长因子 SNPS 外，供体的血管内皮生长因子 SNPS 也与急性排斥反应的风险有关，因此在评估确定排斥反应风险时应密切监测。

{"title":"Association of Donor Vascular Endothelial Growth Factor Gene Polymorphism With Acute Renal Allograft Rejection","authors":"Narayan Prasad, Brijesh Yadav, Mansi Bhatt, Ranjeet Chauhan, Vinita Agrawal","doi":"10.1111/ctr.15475","DOIUrl":"https://doi.org/10.1111/ctr.15475","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recipient's VEGF-A polymorphisms have been reported to be associated with the risk of acute allograft rejection. However, an association of the donor's <i>VEGF-A</i> gene polymorphism with rejection remained unelucidated till now.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, <i>VEGF-A</i> gene SNPs at nine loci were analyzed in 160 kidney donors and recipients with rejection (rejectors, <i>n</i> = 80) and without rejection (non-rejectors, <i>n</i> = 80). Blood VEGF-A mRNA, plasma VEGF level, and intragraft VEGF expression were also analyzed by RT-PCR, ELISA, and immunohistochemistry, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>On comparing between the donor and rejectors, the polymorphic genotypes of VEGF –634 C>G [GG genotype, <i>p</i> < 0.0001; OR (95% CI) = 17.74 (5.16–60.96)]; VEGF –1154 G>A [AG genotype, <i>p</i> < 0.0001, OR (95% CI) = 16.07 (3.68–70.15)]; VEGF +936 C>T [CT genotype, <i>p</i> < 0.0001, OR (95% CI) = 178.64 (23.28–1370.9), and TT genotype, <i>p</i> < 0.0001; OR (95% CI) = 3149 (278.91–35 553)]; VEGF –1455 T><i>C</i> [CC genotype, <i>p</i> value = 0.0464, OR (95% CI) = 3.13 (1.07–9.10)]; VEGF –2578 C>A [CA genotype, <i>p</i> = 0.0426, OR (95% CI) = 4.62 (1.03–20.59), and AA genotype, <i>p</i> value < 0.0001, OR (95% CI) = 21.89 (4.94–97.04)]; VEGF –2549 18 bp Insertion/Deletion [ID genotype, <i>p</i> value < 0.0001, OR (95% CI) = 27.27 (3.61–205.73) and DD genotype, <i>p</i> value < 0.0001, OR (95% CI) = 25.18 (3.30–191.89) were significantly associated with acute rejection risk. On comparing rejectors versus non-rejectors, GA genotype of VEGF –1190 G>A and TC genotype of VEGF –1455 T>C were associated with the risk of rejection. On comparing donor VEGF between rejectors and non-rejectors, CG genotype of VEGF –634 C>G, AG of VEGF –1154 G>A; GA of VEGF –1190 G>A were associated with rejection. The blood VEGF-A mRNA and plasma VEGF levels were higher in the rejectors group compared to non-rejectors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Besides the recipient's VEGF SNPS, the donor's VEGF SNPs are also associated with the risk of acute rejection and may be closely monitored in evaluation to determine the risk of rejection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

PET-CT Defined Micro-Vascular Dysfunction and Cardiac Allograft Vasculopathy Risk Factors in Heart Transplant Recipients PET-CT 定义的心脏移植受者微血管功能障碍和心脏移植血管病风险因素

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-16 DOI: 10.1111/ctr.15445

Assi Milwidsky, Marvyn A. Chan, Mark Travin, Christiana Gjelaj, Omar Saeed, Sasa Vukelic, Yogita Rochlani, Shivank Madan, Julia J. Shin, Daniel B. Sims, Sandhya Murthy, Patricia Chavez, Ulrich P. Jorde, Snehal R. Patel

Microvascular dysfunction (MVD) is considered a form of cardiac allograft vasculopathy (CAV), independently associated with poor prognosis after heart transplantation (HTX). It is unknown whether traditional risk factors for CAV are also applicable to MVD. We retrospectively analyzed factors associated with MVD in 94 HTX recipients who completed a PET scan after a normal baseline left heart catheterization excluding epicardial CAV. MVD was defined by abnormal PET blood flow. The mean age was 52 ± 14 and MVD was found in 49 patients (53%). No donor risk factors were significantly associated with recipient MVD. Recipients risk factors for MVD included—diabetes mellitus (51% vs. 27%, p = 0.016) and hypertension (78% vs. 49%, p = 0.004) in patients with and without MVD, respectively. In a multivariate model, recipient hypertension and diabetes were the only significant determinants of MVD development (OR = 2.63, 95% CI [1.69–36.98], p = 0.009 and OR 2.1, 95% CI [1.10–15.38], p = 0.035, respectively). In conclusion, MVD was more associated with metabolic risk determinants rather than traditional CAV risk factors.

微血管功能障碍（MVD）被认为是心脏移植物血管病变（CAV）的一种形式，与心脏移植（HTX）后的不良预后密切相关。CAV的传统风险因素是否也适用于MVD，目前尚不清楚。我们回顾性分析了94例HTX受者中与MVD相关的因素，这些受者在基线左心导管检查正常后完成了PET扫描，排除了心外膜CAV。MVD 的定义是 PET 血流异常。平均年龄为 52 ± 14 岁，49 名患者（53%）发现了 MVD。供体风险因素与受体 MVD 无明显关联。有 MVD 和无 MVD 的受体风险因素分别包括糖尿病（51% 对 27%，p = 0.016）和高血压（78% 对 49%，p = 0.004）。在多变量模型中，受体高血压和糖尿病是 MVD 发生的唯一重要决定因素（OR = 2.63，95% CI [1.69-36.98]，p = 0.009 和 OR 2.1，95% CI [1.10-15.38]，p = 0.035）。总之，MVD 与代谢风险决定因素而非传统 CAV 风险因素的关系更大。

{"title":"PET-CT Defined Micro-Vascular Dysfunction and Cardiac Allograft Vasculopathy Risk Factors in Heart Transplant Recipients","authors":"Assi Milwidsky, Marvyn A. Chan, Mark Travin, Christiana Gjelaj, Omar Saeed, Sasa Vukelic, Yogita Rochlani, Shivank Madan, Julia J. Shin, Daniel B. Sims, Sandhya Murthy, Patricia Chavez, Ulrich P. Jorde, Snehal R. Patel","doi":"10.1111/ctr.15445","DOIUrl":"https://doi.org/10.1111/ctr.15445","url":null,"abstract":"<div>\u0000 \u0000 <p>Microvascular dysfunction (MVD) is considered a form of cardiac allograft vasculopathy (CAV), independently associated with poor prognosis after heart transplantation (HTX). It is unknown whether traditional risk factors for CAV are also applicable to MVD. We retrospectively analyzed factors associated with MVD in 94 HTX recipients who completed a PET scan after a normal baseline left heart catheterization excluding epicardial CAV. MVD was defined by abnormal PET blood flow. The mean age was 52 ± 14 and MVD was found in 49 patients (53%). No donor risk factors were significantly associated with recipient MVD. Recipients risk factors for MVD included—diabetes mellitus (51% vs. 27%, <i>p</i> = 0.016) and hypertension (78% vs. 49%, <i>p</i> = 0.004) in patients with and without MVD, respectively. In a multivariate model, recipient hypertension and diabetes were the only significant determinants of MVD development (OR = 2.63, 95% CI [1.69–36.98], <i>p</i> = 0.009 and OR 2.1, 95% CI [1.10–15.38], <i>p</i> = 0.035, respectively). In conclusion, MVD was more associated with metabolic risk determinants rather than traditional CAV risk factors.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Progress in Noninvasive Surveillance for Acute Rejection in Pediatric Heart Transplant Recipients: A Real-World Analysis of Donor-Derived Cell-Free DNA-Based Surveillance Protocol 无创监测小儿心脏移植受者急性排斥反应的进展：基于无捐献细胞 DNA 的监测方案的真实世界分析

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-16 DOI: 10.1111/ctr.15481

Leor Akabas, Stephen A. Bravo, Yun Zhang, Anna Simonelli, Warren A. Zuckerman, Marc E. Richmond, Irene D. Lytrivi

Purpose

Acute cellular (ACR) and antibody-mediated (AMR) rejection are risk factors for allograft loss in heart transplant (HT) recipients. Endomyocardial biopsy (EMB), although considered the gold standard for rejection surveillance, is invasive and has high interobserver variability. Noninvasive donor-derived cell-free DNA (dd-cfDNA) sampling has a high negative predictive value (NPV) for rejection in adults and is increasingly used in pediatrics. This single center study aimed to test the performance of dd-cfDNA in screening for acute rejection (AR) and donor-specific antibodies (DSAs) in pediatric HT recipients.

Methods

Blood samples for dd-cfDNA were obtained per clinical protocol for all eligible HT recipients in our center from July 1, 2022 to December 31, 2023. Primary endpoints were episodes of AR, pathology grading of EMBs temporally related to ddcfDNA sampling (0–150 days), and presence of DSAs.

Results

There were 471 interpretable samples, in 192 unique patients. Of those, 199 dd-cfDNA tests were paired with EMB ± DSA in 152 patients. Abnormal dd-cfDNA (> 0.2%) was found in 77 samples (median 0.48%, range 0.21%–11%) and led to EMB, where one sample was positive for ACR (grade 2R), 13 for AMR, yielding an NPV of 97% for AMR. After excluding abnormal ddcfDNA testing associated with AR, 65 abnormal dd-cfDNA tests were paired with DSA testing. The NPV of the test for detection of DSAs was 93%.

Conclusion

Implementation of noninvasive rejection surveillance with dd-cfDNA in a pediatric cohort demonstrates high NPV for AR and high DSAs, making it an ideal screening tool for long-term monitoring of allograft health in pediatrics.

目的急性细胞（ACR）和抗体介导（AMR）排斥反应是心脏移植（HT）受者丧失异体移植物的风险因素。心内膜活检（EMB）虽然被认为是监测排斥反应的黄金标准，但它具有创伤性，而且观察者之间的差异很大。无创供体源性无细胞DNA（dd-cfDNA）采样对成人排斥反应具有较高的阴性预测值（NPV），并越来越多地应用于儿科。这项单中心研究旨在测试 dd-cfDNA 在筛查小儿 HT 受者急性排斥反应（AR）和供体特异性抗体（DSA）方面的性能。方法从 2022 年 7 月 1 日到 2023 年 12 月 31 日，我们中心按照临床协议为所有符合条件的 HT 受者采集了 dd-cfDNA 血液样本。主要终点是AR发作、与ddcfDNA采样时间相关的EMB病理分级（0-150天）以及是否存在DSA。结果 192 名患者共采集了 471 份可解释样本。其中，199 例 dd-cfDNA 检测与 152 例患者的 EMB ± DSA 配对。在 77 份样本中发现了异常 dd-cfDNA（> 0.2%）（中位数为 0.48%，范围为 0.21%-11%），并进行了 EMB 检测，其中一份样本为 ACR 阳性（2R 级），13 份样本为 AMR 阳性，AMR 的 NPV 为 97%。在排除与 AR 相关的异常 ddcfDNA 检测后，65 例异常 dd-cfDNA 检测与 DSA 检测配对。检测 DSA 的 NPV 为 93%。结论利用 dd-cfDNA 在儿科队列中实施无创排斥监测，对 AR 和高 DSA 有很高的 NPV，使其成为长期监测儿科同种异体移植物健康的理想筛查工具。

{"title":"Progress in Noninvasive Surveillance for Acute Rejection in Pediatric Heart Transplant Recipients: A Real-World Analysis of Donor-Derived Cell-Free DNA-Based Surveillance Protocol","authors":"Leor Akabas, Stephen A. Bravo, Yun Zhang, Anna Simonelli, Warren A. Zuckerman, Marc E. Richmond, Irene D. Lytrivi","doi":"10.1111/ctr.15481","DOIUrl":"https://doi.org/10.1111/ctr.15481","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Acute cellular (ACR) and antibody-mediated (AMR) rejection are risk factors for allograft loss in heart transplant (HT) recipients. Endomyocardial biopsy (EMB), although considered the gold standard for rejection surveillance, is invasive and has high interobserver variability. Noninvasive donor-derived cell-free DNA (dd-cfDNA) sampling has a high negative predictive value (NPV) for rejection in adults and is increasingly used in pediatrics. This single center study aimed to test the performance of dd-cfDNA in screening for acute rejection (AR) and donor-specific antibodies (DSAs) in pediatric HT recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Blood samples for dd-cfDNA were obtained per clinical protocol for all eligible HT recipients in our center from July 1, 2022 to December 31, 2023. Primary endpoints were episodes of AR, pathology grading of EMBs temporally related to ddcfDNA sampling (0–150 days), and presence of DSAs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 471 interpretable samples, in 192 unique patients. Of those, 199 dd-cfDNA tests were paired with EMB ± DSA in 152 patients. Abnormal dd-cfDNA (> 0.2%) was found in 77 samples (median 0.48%, range 0.21%–11%) and led to EMB, where one sample was positive for ACR (grade 2R), 13 for AMR, yielding an NPV of 97% for AMR. After excluding abnormal ddcfDNA testing associated with AR, 65 abnormal dd-cfDNA tests were paired with DSA testing. The NPV of the test for detection of DSAs was 93%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Implementation of noninvasive rejection surveillance with dd-cfDNA in a pediatric cohort demonstrates high NPV for AR and high DSAs, making it an ideal screening tool for long-term monitoring of allograft health in pediatrics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Changes in Medication Adherence Across the Posttransplant Period in Pediatric Organ Transplant Recipients 小儿器官移植受者移植后用药依从性的变化

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-10 DOI: 10.1111/ctr.15442

Michael O. Killian, Callie W. Little, Sonnie E. Mayewski

Introduction

Limited research has explored immunosuppressant medication adherence over time in pediatric transplant patients, who often struggle with posttransplant regimen adherence, resulting in poor outcomes.

Methods

This study investigated the longitudinal growth in immunosuppressive medication levels following transplantation. Medication level variability index (MLVI) scores from tacrolimus blood levels of pediatric organ transplant recipients at a major medical center were analyzed. Linear mixed effect models (LMEM) assessed individual MLVI change trajectories and predictors of growth, exploring both linear and curvilinear growth patterns posttransplant.

Results

A sample of 181 patients with at least 4 years of MLVI data were analyzed. Growth curve modeling identified the cubic model as the best fit for the quarterly MLVI values, which significantly decreased within the first 2 years posttransplant before stabilizing. Gender significantly predicted MLVI change, with females showing greater MLVI decreases, while age at transplant did not significantly predict changes. Significant variation in MLVI among individual patients was found in all models.

Conclusions

The study demonstrated a significant decrease in MLVI values over time, indicating improved medication adherence in pediatric transplant patients, with females exhibiting more adherent growth patterns than males. Future research should aim to identify pediatric patients at high risk of nonadherence.

简介：对儿科移植患者长期服用免疫抑制剂的研究有限：对儿科移植患者长期坚持服用免疫抑制剂的研究有限，这些患者往往在移植后难以坚持用药，导致治疗效果不佳：本研究调查了移植后免疫抑制剂用药量的纵向增长情况。研究分析了一家大型医疗中心儿科器官移植受者他克莫司血药浓度的用药水平变异指数（MLVI）得分。线性混合效应模型（LMEM）评估了单个 MLVI 的变化轨迹和增长预测因素，探讨了移植后的线性和曲线增长模式：结果：分析了 181 例至少有 4 年 MLVI 数据的患者样本。生长曲线模型确定立方模型是最适合季度 MLVI 值的模型，MLVI 值在移植后头两年内显著下降，然后趋于稳定。性别在很大程度上预测了 MLVI 的变化，女性的 MLVI 下降幅度更大，而移植时的年龄并不能显著预测变化。在所有模型中都发现了患者个体间 MLVI 的显著差异：该研究表明，随着时间的推移，MLVI 值明显下降，这表明儿科移植患者的用药依从性有所改善，其中女性比男性表现出更依从的生长模式。未来的研究应着眼于识别不坚持用药的高风险儿科患者。

{"title":"Changes in Medication Adherence Across the Posttransplant Period in Pediatric Organ Transplant Recipients","authors":"Michael O. Killian, Callie W. Little, Sonnie E. Mayewski","doi":"10.1111/ctr.15442","DOIUrl":"10.1111/ctr.15442","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Limited research has explored immunosuppressant medication adherence over time in pediatric transplant patients, who often struggle with posttransplant regimen adherence, resulting in poor outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study investigated the longitudinal growth in immunosuppressive medication levels following transplantation. Medication level variability index (MLVI) scores from tacrolimus blood levels of pediatric organ transplant recipients at a major medical center were analyzed. Linear mixed effect models (LMEM) assessed individual MLVI change trajectories and predictors of growth, exploring both linear and curvilinear growth patterns posttransplant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A sample of 181 patients with at least 4 years of MLVI data were analyzed. Growth curve modeling identified the cubic model as the best fit for the quarterly MLVI values, which significantly decreased within the first 2 years posttransplant before stabilizing. Gender significantly predicted MLVI change, with females showing greater MLVI decreases, while age at transplant did not significantly predict changes. Significant variation in MLVI among individual patients was found in all models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The study demonstrated a significant decrease in MLVI values over time, indicating improved medication adherence in pediatric transplant patients, with females exhibiting more adherent growth patterns than males. Future research should aim to identify pediatric patients at high risk of nonadherence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cover Image, Volume 38, Issue 8 封面图片，第 38 卷第 8 期

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-09 DOI: 10.1111/ctr.15469

Karima Alghannam, Jeffrey Fine, Brian Howard, Jennifer Loza, Naeem M. Goussous, Junichiro Sageshima, Neal M. Mineyev, Aileen X. Wang, Richard V. Perez, Peter A. Than

The cover image is based on the article Impact of Warm Ischemia Time on Donation After Circulatory Death Kidney Transplant Outcomes by Karima Alghannam et al., https://doi.org/10.1111/ctr.15436.

封面图片根据 Karima Alghannam 等人撰写的文章《温热缺血时间对循环死亡后肾移植结果的影响》（Impact of Warm Ishemia Time on Donation After Circulatory Death Kidney Transplant Outcomes）制作，https://doi.org/10.1111/ctr.15436。

引用次数: 0

Enhanced Artificial Intelligence Methods for Liver Steatosis Assessment Using Machine Learning and Color Image Processing: Liver Color Project 利用机器学习和彩色图像处理增强肝脏脂肪变性评估的人工智能方法：肝脏颜色项目。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-09 DOI: 10.1111/ctr.15465

Concepción Gómez-Gavara, Itxarone Bilbao, Gemma Piella, Javier Vazquez-Corral, Berta Benet-Cugat, Elizabeth Pando, José Andrés Molino, María Teresa Salcedo, Mar Dalmau, Laura Vidal, Daniel Esono, Miguel Ángel Cordobés, Ángela Bilbao, Josa Prats, Mar Moya, Cristina Dopazo, Christopher Mazo, Mireia Caralt, Ernest Hidalgo, Ramon Charco

Background

The use of livers with significant steatosis is associated with worse transplantation outcomes. Brain death donor liver acceptance is mostly based on subjective surgeon assessment of liver appearance, since steatotic livers acquire a yellowish tone. The aim of this study was to develop a rapid, robust, accurate, and cost-effective method to assess liver steatosis.

Methods

From June 1, 2018, to November 30, 2023, photographs and tru-cut needle biopsies were taken from adult brain death donor livers at a single university hospital for the study. All the liver photographs were taken by smartphones then color calibrated, segmented, and divided into patches. Color and texture features were then extracted and used as input, and the machine learning method was applied. This is a collaborative project between Vall d'Hebron University Hospital and Barcelona MedTech, Pompeu Fabra University, and is referred to as LiverColor.

Results

A total of 192 livers (362 photographs and 7240 patches) were included. When setting a macrosteatosis threshold of 30%, the best results were obtained using the random forest classifier, achieving an AUROC = 0.74, with 85% accuracy.

Conclusion

Machine learning coupled with liver texture and color analysis of photographs taken with smartphones provides excellent accuracy for determining liver steatosis.

背景：使用严重脂肪变性的肝脏与较差的移植结果有关。脑死亡供体肝脏的接受主要基于外科医生对肝脏外观的主观评估，因为脂肪变性的肝脏呈淡黄色。本研究旨在开发一种快速、稳健、准确且经济有效的方法来评估肝脏脂肪变性：从 2018 年 6 月 1 日至 2023 年 11 月 30 日，在一家大学医院对成人脑死亡捐献者的肝脏进行了拍照和真切针活检。所有肝脏照片均由智能手机拍摄，然后进行颜色校准、分割并划分成斑块。然后提取颜色和纹理特征作为输入，并应用机器学习方法。这是瓦勒德希伯伦大学医院和庞培法布拉大学巴塞罗那医疗技术中心的一个合作项目，被称为 LiverColor.Results：结果：共纳入了 192 个肝脏（362 张照片和 7240 个斑块）。当设定大骨质疏松症阈值为 30% 时，使用随机森林分类器获得了最佳结果，AUROC = 0.74，准确率达 85%：机器学习加上对智能手机拍摄的照片进行肝脏纹理和颜色分析，可为确定肝脏脂肪变性提供极高的准确性。

{"title":"Enhanced Artificial Intelligence Methods for Liver Steatosis Assessment Using Machine Learning and Color Image Processing: Liver Color Project","authors":"Concepción Gómez-Gavara, Itxarone Bilbao, Gemma Piella, Javier Vazquez-Corral, Berta Benet-Cugat, Elizabeth Pando, José Andrés Molino, María Teresa Salcedo, Mar Dalmau, Laura Vidal, Daniel Esono, Miguel Ángel Cordobés, Ángela Bilbao, Josa Prats, Mar Moya, Cristina Dopazo, Christopher Mazo, Mireia Caralt, Ernest Hidalgo, Ramon Charco","doi":"10.1111/ctr.15465","DOIUrl":"10.1111/ctr.15465","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of livers with significant steatosis is associated with worse transplantation outcomes. Brain death donor liver acceptance is mostly based on subjective surgeon assessment of liver appearance, since steatotic livers acquire a yellowish tone. The aim of this study was to develop a rapid, robust, accurate, and cost-effective method to assess liver steatosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From June 1, 2018, to November 30, 2023, photographs and tru-cut needle biopsies were taken from adult brain death donor livers at a single university hospital for the study. All the liver photographs were taken by smartphones then color calibrated, segmented, and divided into patches. Color and texture features were then extracted and used as input, and the machine learning method was applied. This is a collaborative project between Vall d'Hebron University Hospital and Barcelona MedTech, Pompeu Fabra University, and is referred to as LiverColor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 192 livers (362 photographs and 7240 patches) were included. When setting a macrosteatosis threshold of 30%, the best results were obtained using the random forest classifier, achieving an AUROC = 0.74, with 85% accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Machine learning coupled with liver texture and color analysis of photographs taken with smartphones provides excellent accuracy for determining liver steatosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.15465","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388630","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}

引用次数: 0

Transient Elastography for Noninvasive Evaluation of Posttransplant Liver Graft Fibrosis in Turkish Children, Ege University Children Hospital Experience 瞬态弹性成像用于无创评估土耳其儿童移植后肝脏移植物纤维化，埃格大学儿童医院的经验。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-05 DOI: 10.1111/ctr.15474

Barut Dogan, Bora Kunay, Veysel Umman, Ezgi Kıran Taşçı, Ziya Kumcuoğlu, Fatih Gulbahar, Deniz Nart, Miray Karakoyun, Funda Cetin, Sema Aydogdu

Objectives

The influence of advancing fibrosis on graft survival in the context of pediatric liver transplantation accentuates the critical role of protocol-driven liver biopsies, a practice adopted by numerous medical centers. Consequently, the exigency for noninvasive methodologies to assess graft fibrosis assumes heightened importance when conventional clinical and laboratory parameters fail to reveal signs of liver damage.

Methods

This study aimed to assess the reliability of transient elastography (TE) in pediatric liver transplant recipients to detect graft fibrosis and compare the results of TE in patients who underwent biopsy.

Results

This prospective cohort study included liver transplanted children who underwent biopsy at Ege University Children's Hospital between October 1, 2021, and October 31, 2022, and a healthy control group. According to TE, fibrosis was detected in 40 patients, and no fibrosis was detected in 50. The median time to develop fibrosis was 100 months (95% CI [83.1–116.8]). A statistically significant positive correlation existed between LSM and METAVIR fibrosis score (r = 0.562, p = 0.001). There was a statistically significant difference in LSM between patients with F2 fibrosis (7.8–8.8 kPa ± 3.2) compared to patients with F0 fibrosis (5.2 kPa ± 0.7) (p = 0.005) and F1 fibrosis (6.1 kPa ± 1.5) (p = 0.041), on ANOVA.

Conclusion

Liver allograft fibrosis is common in long-term follow-up in children who have undergone liver transplantation. Abnormal TE may guide physicians to consider liver biopsy to detect late allograft fibrosis in these children.

目的：在小儿肝移植中，纤维化的发展对移植物存活率的影响凸显了按方案进行肝活检的关键作用，许多医疗中心都采用了这种做法。因此，当传统的临床和实验室参数无法显示肝脏损伤迹象时，评估移植物纤维化的无创方法就显得更加重要：本研究旨在评估瞬态弹性成像（TE）在小儿肝移植受者中检测移植物纤维化的可靠性，并比较活检患者的TE结果：这项前瞻性队列研究包括2021年10月1日至2022年10月31日期间在埃格大学儿童医院接受活检的肝移植患儿和健康对照组。根据 TE，40 名患者发现了肝纤维化，50 名患者未发现肝纤维化。发生纤维化的中位时间为 100 个月（95% CI [83.1-116.8]）。LSM 与 METAVIR 纤维化评分之间存在统计学意义上的正相关（r = 0.562，p = 0.001）。经方差分析，F2纤维化患者的LSM（7.8-8.8 kPa ± 3.2）与F0纤维化患者的LSM（5.2 kPa ± 0.7）（p = 0.005）和F1纤维化患者的LSM（6.1 kPa ± 1.5）（p = 0.041）相比，差异有统计学意义：结论：在对接受肝移植的儿童进行长期随访时，肝脏移植物纤维化很常见。异常的TE可指导医生考虑进行肝活检，以检测这些儿童的晚期异体肝纤维化。

{"title":"Transient Elastography for Noninvasive Evaluation of Posttransplant Liver Graft Fibrosis in Turkish Children, Ege University Children Hospital Experience","authors":"Barut Dogan, Bora Kunay, Veysel Umman, Ezgi Kıran Taşçı, Ziya Kumcuoğlu, Fatih Gulbahar, Deniz Nart, Miray Karakoyun, Funda Cetin, Sema Aydogdu","doi":"10.1111/ctr.15474","DOIUrl":"10.1111/ctr.15474","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The influence of advancing fibrosis on graft survival in the context of pediatric liver transplantation accentuates the critical role of protocol-driven liver biopsies, a practice adopted by numerous medical centers. Consequently, the exigency for noninvasive methodologies to assess graft fibrosis assumes heightened importance when conventional clinical and laboratory parameters fail to reveal signs of liver damage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study aimed to assess the reliability of transient elastography (TE) in pediatric liver transplant recipients to detect graft fibrosis and compare the results of TE in patients who underwent biopsy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This prospective cohort study included liver transplanted children who underwent biopsy at Ege University Children's Hospital between October 1, 2021, and October 31, 2022, and a healthy control group. According to TE, fibrosis was detected in 40 patients, and no fibrosis was detected in 50. The median time to develop fibrosis was 100 months (95% CI [83.1–116.8]). A statistically significant positive correlation existed between LSM and METAVIR fibrosis score (<i>r</i> = 0.562, <i>p</i> = 0.001). There was a statistically significant difference in LSM between patients with F2 fibrosis (7.8–8.8 kPa ± 3.2) compared to patients with F0 fibrosis (5.2 kPa ± 0.7) (<i>p</i> = 0.005) and F1 fibrosis (6.1 kPa ± 1.5) (<i>p</i> = 0.041), on ANOVA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Liver allograft fibrosis is common in long-term follow-up in children who have undergone liver transplantation. Abnormal TE may guide physicians to consider liver biopsy to detect late allograft fibrosis in these children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.15474","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379190","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}

引用次数: 0

Reexamining Transplant Outcomes in Acute Kidney Injury Kidneys Through Machine Learning 通过机器学习重新审视急性肾损伤肾脏的移植结果。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-05 DOI: 10.1111/ctr.15470

Caroline C. Jadlowiec, Charat Thongprayoon, Supawadee Suppadungsuk, Supawit Tangpanithandee, Napat Leeaphorn, Raymond Heilman, Matthew Cooper, Wisit Cheungpasitporn

Background

Despite many people awaiting kidney transplant, kidney allografts from acute kidney injury (AKI) donors continue to be underutilized. We aimed to cluster kidney transplant recipients of AKI kidney allografts using an unsupervised machine learning (ML) approach.

Methods

Using Organ Procurement and Transplantation Network–United Network for Organ Sharing (OPTN/UNOS) data, a consensus clustering cohort analysis was performed in 12 356 deceased donor kidney transplant recipients between 2015 and 2019 in whom donors had a terminal serum creatinine ≥1.5 mg/dL. Significant cluster characteristics were determined, and outcomes were compared.

Results

The median donor terminal creatinine was 2.2 (interquartile range [IQR] 1.7–3.3) mg/dL. Cluster analysis was performed on 12 356 AKI kidney recipients, and three clinically distinct clusters were identified. Young, sensitized kidney re-transplant patients characterized Cluster 1. Cluster 2 was characterized by first-time kidney transplant patients with hypertensive and diabetic kidney diseases. Older diabetic recipients characterized Cluster 3. Clusters 1 and 2 donors were young and met standard kidney donor profile index (KDPI) criteria; Cluster 3 donors were older, more likely to have hypertension or diabetes, and meet high KDPI criteria. Cluster 1 had a higher risk of acute rejection, 3-year patient death, and graft failure. Cluster 3 had a higher risk of death-censored graft failure, patient death, and graft failure at 1 and 3 years. Cluster 2 had the best patient-, graft-, and death-censored graft survival at 1 and 3 years. Compared to non-AKI kidney recipients, the AKI clusters showed a higher incidence of delayed graft function (DGF, AKI: 43.2%, 41.7%, 45.3% vs. non-AKI: 25.5%); however, there were comparable long-term outcomes specific to death-censored graft survival (AKI: 93.6%, 93.4%, 90.4% vs. non-AKI: 92.3%), patient survival (AKI: 89.1%, 93.2%, 84.2% vs. non-AKI: 91.2%), and overall graft survival (AKI: 84.7%, 88.2%, 79.0% vs. non-AKI: 86.0%).

Conclusions

In this unsupervised ML approach study, AKI recipient clusters demonstrated differing, but good clinical outcomes, suggesting opportunities for transplant centers to incrementally increase kidney utilization from AKI donors.

背景：尽管有许多人在等待肾移植，但急性肾损伤（AKI）供体的肾脏异体移植仍未得到充分利用。我们的目标是使用无监督机器学习（ML）方法对AKI肾脏异体移植受者进行聚类：利用器官采购与移植网络-器官共享联合网络（OPTN/UNOS）的数据，对 2015 年至 2019 年期间 12 356 名死亡供体肾移植受者进行了共识聚类队列分析，这些受者的供体末期血清肌酐≥1.5 mg/dL。确定了重要的群组特征，并对结果进行了比较：供体末期血肌酐中位数为 2.2（四分位距[IQR] 1.7-3.3）mg/dL。对 12 356 名 AKI 肾脏受者进行了聚类分析，发现了三个临床上截然不同的聚类。年轻、敏感的肾脏再移植患者是群组 1 的特征。第 2 组的特征是患有高血压和糖尿病肾病的首次肾移植患者。老年糖尿病受者是第 3 组的特征。群组 1 和群组 2 的供体都很年轻，符合标准的肾脏供体档案指数（KDPI）标准；群组 3 的供体年龄较大，更有可能患有高血压或糖尿病，并符合较高的 KDPI 标准。第 1 组发生急性排斥反应、3 年患者死亡和移植物失败的风险较高。第 3 组发生死亡校验后的移植物失败、患者死亡以及 1 年和 3 年移植物失败的风险较高。第2组患者、移植物和死亡校正移植物1年和3年存活率最高。与非 AKI 肾脏受者相比，AKI 群组显示出更高的移植物功能延迟发生率（DGF，AKI：43.2%、41.7%、45.3% vs. 非 AKI：25.5%）；然而，死亡校验移植物存活率的长期结果却相当（AKI：93.6%、93.4%、90.4% vs. non-AKI：92.3%）、患者生存率（AKI：89.1%、93.2%、84.2% vs. non-AKI：91.2%）和总体移植物生存率（AKI：84.7%、88.2%、79.0% vs. non-AKI：86.0%）：在这项无监督 ML 方法研究中，AKI 受体群表现出不同但良好的临床结果，这表明移植中心有机会逐步提高 AKI 供体的肾脏利用率。

{"title":"Reexamining Transplant Outcomes in Acute Kidney Injury Kidneys Through Machine Learning","authors":"Caroline C. Jadlowiec, Charat Thongprayoon, Supawadee Suppadungsuk, Supawit Tangpanithandee, Napat Leeaphorn, Raymond Heilman, Matthew Cooper, Wisit Cheungpasitporn","doi":"10.1111/ctr.15470","DOIUrl":"10.1111/ctr.15470","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite many people awaiting kidney transplant, kidney allografts from acute kidney injury (AKI) donors continue to be underutilized. We aimed to cluster kidney transplant recipients of AKI kidney allografts using an unsupervised machine learning (ML) approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Organ Procurement and Transplantation Network–United Network for Organ Sharing (OPTN/UNOS) data, a consensus clustering cohort analysis was performed in 12 356 deceased donor kidney transplant recipients between 2015 and 2019 in whom donors had a terminal serum creatinine ≥1.5 mg/dL. Significant cluster characteristics were determined, and outcomes were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median donor terminal creatinine was 2.2 (interquartile range [IQR] 1.7–3.3) mg/dL. Cluster analysis was performed on 12 356 AKI kidney recipients, and three clinically distinct clusters were identified. Young, sensitized kidney re-transplant patients characterized Cluster 1. Cluster 2 was characterized by first-time kidney transplant patients with hypertensive and diabetic kidney diseases. Older diabetic recipients characterized Cluster 3. Clusters 1 and 2 donors were young and met standard kidney donor profile index (KDPI) criteria; Cluster 3 donors were older, more likely to have hypertension or diabetes, and meet high KDPI criteria. Cluster 1 had a higher risk of acute rejection, 3-year patient death, and graft failure. Cluster 3 had a higher risk of death-censored graft failure, patient death, and graft failure at 1 and 3 years. Cluster 2 had the best patient-, graft-, and death-censored graft survival at 1 and 3 years. Compared to non-AKI kidney recipients, the AKI clusters showed a higher incidence of delayed graft function (DGF, AKI: 43.2%, 41.7%, 45.3% vs. non-AKI: 25.5%); however, there were comparable long-term outcomes specific to death-censored graft survival (AKI: 93.6%, 93.4%, 90.4% vs. non-AKI: 92.3%), patient survival (AKI: 89.1%, 93.2%, 84.2% vs. non-AKI: 91.2%), and overall graft survival (AKI: 84.7%, 88.2%, 79.0% vs. non-AKI: 86.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this unsupervised ML approach study, AKI recipient clusters demonstrated differing, but good clinical outcomes, suggesting opportunities for transplant centers to incrementally increase kidney utilization from AKI donors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association Between Liver Graft to Recipient Weight Ratio and Acute Kidney Injury Following Liver Transplantation: A Historical Cohort Study 肝移植后肝脏移植物与受体体重比与急性肾损伤之间的关系：历史队列研究

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-10-04 DOI: 10.1111/ctr.15473

Maxime Soucy-Proulx, Francois Martin Carrier, Christian Vincelette, Tristan Grogan, Victor Xia, Christopher Wray, Mansi Sheth, Christine Nguyen-Buckley, Stephanie Roullet, Joanna Ramadan, Leila Toubal, Salima Naili, Antonio Sa Cunha, Daniel Azoulay, Daniel Cherqui, Alexandre Joosten

Introduction

Acute kidney injury (AKI) is a frequent complication following liver transplantation (LT) that has a multifactorial etiology. While some perioperative risk factors have been associated with postoperative AKI, the impact of liver graft weight to recipient body weight ratio (GW/RBW) has been poorly explored. We hypothesized that a high GW/RBW ratio would be associated with AKI after LT.

Methods

This single-center historical cohort study included all consecutive adults who had LT at Paul Brousse Hospital between 2018 and 2022. Patients requiring preoperative renal replacement therapy, combined solid organ transplantation, retransplantation, split or domino graft were excluded, as well as those with missing graft weight and creatinine values during the first postoperative week. The primary exposure was GW/RBW ratio expressed as a proportion. The primary outcome was the incidence of postoperative AKI within 7 days after surgery, defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The secondary outcome was the AKI severity (KDIGO grades). We estimated logistic and ordinal regression models adjusted for potential confounding factors and explored nonlinear associations.

Results

Of 467 patients analyzed, 211 (45%) developed AKI. A high GW/RBW ratio was associated with both the risk of postoperative AKI and the severity of AKI (KDIGO grades), especially above a threshold of 2.5% (non-linear effect).

Conclusion

A high GW/RBW ratio was associated with an exponential increase in the risk of AKI after LT. A high GW/RBW ratio was also associated with an increased AKI severity. Our findings may help improve graft allocation in patients undergoing LT.

导言：急性肾损伤（AKI）是肝移植（LT）术后常见的并发症，其病因是多因素的。虽然一些围手术期风险因素与术后急性肾损伤有关，但肝脏移植物重量与受体体重之比（GW/RBW）的影响尚未得到充分探讨。我们假设，高GW/RBW比率与LT术后AKI相关：这项单中心历史队列研究纳入了2018年至2022年间在保罗布鲁塞医院接受LT手术的所有连续成人患者。排除了需要术前肾脏替代治疗、合并实体器官移植、再次移植、分体或多米诺移植物的患者，以及术后第一周移植物重量和肌酐值缺失的患者。主要暴露是以比例表示的 GW/RBW 比率。主要结果是术后 7 天内的术后 AKI 发生率：改善全球预后 (KDIGO) 标准定义。次要结果是 AKI 严重程度（KDIGO 分级）。我们估计了调整潜在混杂因素后的逻辑回归模型和序数回归模型，并探讨了非线性关联：在分析的 467 名患者中，211 人（45%）发生了 AKI。高GW/RBW比值与术后AKI风险和AKI严重程度（KDIGO分级）相关，尤其是超过2.5%的阈值（非线性效应）：结论：高GW/RBW比值与LT术后AKI风险的指数增加有关。结论：高GW/RBW比率与LT后AKI风险的指数增加有关，高GW/RBW比率还与AKI严重程度的增加有关。我们的研究结果可能有助于改善LT患者的移植物分配。

{"title":"Association Between Liver Graft to Recipient Weight Ratio and Acute Kidney Injury Following Liver Transplantation: A Historical Cohort Study","authors":"Maxime Soucy-Proulx, Francois Martin Carrier, Christian Vincelette, Tristan Grogan, Victor Xia, Christopher Wray, Mansi Sheth, Christine Nguyen-Buckley, Stephanie Roullet, Joanna Ramadan, Leila Toubal, Salima Naili, Antonio Sa Cunha, Daniel Azoulay, Daniel Cherqui, Alexandre Joosten","doi":"10.1111/ctr.15473","DOIUrl":"10.1111/ctr.15473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Acute kidney injury (AKI) is a frequent complication following liver transplantation (LT) that has a multifactorial etiology. While some perioperative risk factors have been associated with postoperative AKI, the impact of liver graft weight to recipient body weight ratio (GW/RBW) has been poorly explored. We hypothesized that a high GW/RBW ratio would be associated with AKI after LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center historical cohort study included all consecutive adults who had LT at Paul Brousse Hospital between 2018 and 2022. Patients requiring preoperative renal replacement therapy, combined solid organ transplantation, retransplantation, split or domino graft were excluded, as well as those with missing graft weight and creatinine values during the first postoperative week. The primary exposure was GW/RBW ratio expressed as a proportion. The primary outcome was the incidence of postoperative AKI within 7 days after surgery, defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The secondary outcome was the AKI severity (KDIGO grades). We estimated logistic and ordinal regression models adjusted for potential confounding factors and explored nonlinear associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 467 patients analyzed, 211 (45%) developed AKI. A high GW/RBW ratio was associated with both the risk of postoperative AKI and the severity of AKI (KDIGO grades), especially above a threshold of 2.5% (non-linear effect).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A high GW/RBW ratio was associated with an exponential increase in the risk of AKI after LT. A high GW/RBW ratio was also associated with an increased AKI severity. Our findings may help improve graft allocation in patients undergoing LT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.15473","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371163","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}

引用次数: 0