Clinical Transplantation最新文献_第5页

Using Natural Language Processing to Characterize Early Steps in the Kidney Transplant Evaluation Process Documented in the National Veterans Affairs Electronic Health Record 使用自然语言处理来描述国家退伍军人事务电子健康记录中记录的肾脏移植评估过程的早期步骤。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70441

Hannah Eyre, David K. Prince, Sandra Abrahamson, Richard K. Blankenhorn, Evan P. Carey, Ryan J. Laundry, Whitney Showalter, Jeffrey Todd-Stenberg, Ann M. O'Hare, Catherine R. Butler

Background

Efforts to identify barriers and improve access to kidney transplantation in the United States are limited by a lack of population-level data on early steps in the transplant evaluation process.

Methods

We used a rule-based natural language processing (NLP) approach with clinical notes in the US Veterans Affairs Healthcare System (VA) electronic health record (EHR) and linkage with the United States Renal Data System registry to characterize sequential steps in the kidney transplant evaluation process. Adults with advanced kidney disease (estimated glomerular filtration rate ≤20 mL/min/1.73m²) from 1/1/2012–12/31/2019 who were receiving care within the VA were followed through 12/31/2021.

Results

Among 45,174 cohort members, the median age was 71 (IQR 64, 80) years, and 97.2% were men. There was documentation of kidney transplant being mentioned as a treatment option for 46.3% of cohort members, 28.2% engaged in some type of evaluation for transplant, and 8.4% were referred to and 5.4% evaluated at a VA kidney transplant center. 6.9% of cohort members were added to the national deceased donor waitlist and 3.1% received a kidney transplant. Compared with events identified through EHR chart search and manual review by two clinicians, NLP identified events within 90 days with a precision of 0.82–0.94 and recall of 0.56–0.89.

Conclusion

These results illuminate the substantial proportion of patients who engage in early steps in the kidney transplant evaluation process. The work also demonstrates that NLP can accurately identify these key steps in the process as documented in patients’ EHRs.

背景：由于缺乏移植评估过程中早期步骤的人口水平数据，在美国识别障碍和改善肾移植可及性的努力受到限制。方法：我们使用基于规则的自然语言处理（NLP）方法，结合美国退伍军人事务医疗保健系统（VA）电子健康记录（EHR）中的临床记录，并与美国肾脏数据系统注册表联系，以表征肾移植评估过程中的顺序步骤。2012年1月1日至2019年12月31日期间在VA内接受治疗的晚期肾病成人（估计肾小球滤过率≤20 mL/min/1.73m2）随访至2021年12月31日。结果：在45,174名队列成员中，中位年龄为71岁（IQR 64,80）岁，97.2%为男性。有文献记载，46.3%的队列成员提到肾移植作为一种治疗选择，28.2%的人参与了某种类型的移植评估，8.4%的人被推荐到VA肾移植中心，5.4%的人在VA肾移植中心接受评估。6.9%的队列成员加入了全国已故捐赠者等待名单，3.1%的人接受了肾脏移植。与通过EHR图表搜索和两位临床医生手动审查识别的事件相比，NLP识别90天内的事件，精度为0.82-0.94，召回率为0.56-0.89。结论：这些结果阐明了在肾移植评估过程中参与早期步骤的大量患者。这项工作还表明，NLP可以准确地识别患者电子病历中记录的过程中的这些关键步骤。

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引用次数: 0

Opioid Use as a Predictor of Pancreas Transplant Outcomes 阿片类药物使用作为胰腺移植结果的预测因子。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70453

Youngmin Ko, Eunbyeol Cho, Hye Eun Kwon, Jin-Myung Kim, Sung Shin, Young Hoon Kim, Edward Choi, Byunghyun Choi, Hyunwook Kwon

Background

Posttransplant opioid dependence has been linked to adverse outcomes in solid organ transplantation, but its impact on pancreas transplantation is underexplored.

Methods

This retrospective study analyzed 193 PTA/PAK recipients from Asan Medical Center (AMC) (2010–2022) and externally validated results in 77 recipients from Pusan National University Yangsan Hospital (PNUYH) (2015–2022). Posttransplant opioid dependence was defined as ≥ 10 opioid prescriptions between 3 and 12 months posttransplant. Logistic regression and three ML algorithms (CatBoost, XGBoost, and LightGBM) were used to identify risk factors and predict 5-year graft survival.

Results

Posttransplant opioid dependence (OR 2.87, p = 0.005) independently predicted 5-year graft failure, along with pre-transplant retinopathy, bladder drainage, and lower BMI. ML models showed favorable internal AUROC (0.695–0.719) and moderate external AUROC (0.649–0.671). Opioid dependence consistently ranked among top predictive features across models.

Conclusions

Posttransplant opioid dependence is a significant predictor of graft failure after pancreas transplantation. Incorporating this variable into ML models may enhance risk stratification and candidate selection.

背景：移植后阿片类药物依赖与实体器官移植的不良结果有关，但其对胰腺移植的影响尚未得到充分探讨。方法：回顾性分析峨山医疗中心（AMC）（2010-2022年）193例PTA/PAK患者和釜山国立大学梁山医院（PNUYH）（2015-2022年）77例外部验证患者的结果。移植后阿片类药物依赖定义为移植后3至12个月期间阿片类药物处方≥10张。使用逻辑回归和三种ML算法（CatBoost、XGBoost和LightGBM）来识别危险因素并预测移植物的5年生存率。结果：移植后阿片类药物依赖（OR 2.87, p = 0.005）独立预测5年移植失败，以及移植前视网膜病变、膀胱引流和较低的BMI。ML模型显示良好的内部AUROC（0.695-0.719）和中等的外部AUROC（0.649-0.671）。阿片类药物依赖一直是各模型的主要预测特征之一。结论：移植后阿片类药物依赖是胰腺移植后移植失败的重要预测因素。将这一变量纳入ML模型可以增强风险分层和候选人选择。

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引用次数: 0

Cardiac Allograft Vasculopathy in Heart Transplantation From Circulatory Death Donors: A Systematic Review and Meta-Analysis 来自循环性死亡供者心脏移植的同种异体心脏移植血管病变：系统回顾和荟萃分析。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70435

Wasif Safdar, Marvyn Allen G. Chan, Lorenzo D'Angelo, Arjun Kumar, Snehal R. Patel, Omar Saeed, Daniel J. Goldstein, Ulrich P. Jorde, Shivank Madan

Background

Cardiac allograft vasculopathy (CAV) remains a major cause of long-term morbidity and mortality after heart transplantation (HT). With the growing use of donation after circulatory death (DCD) donors, it is crucial to assess the incidence of CAV in this population.

Methods

We conducted a systematic review and meta-analysis of studies published between January 2010 and December 2024. comparing 1-year CAV incidence and 1-year mortality between DCD and donation after brain death (DBD) HT recipients. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using fixed and random-effects models.

Results

Four studies met inclusion criteria, comprising 951 HTs (576 DBD and 375 DCD). Of these, 594 HTs contributed to the CAV analysis and 914 to the mortality analysis. Pooled analysis demonstrated no significant difference in 1-year CAV incidence between DCD and DBD recipients (OR = 0.71, 95% CI: 0.43–1.17, p = 0.17). Similarly, no difference was observed in 1-year mortality (OR = 0.87, 95% CI: 0.48–1.58, p = 0.66).

Conclusions

DCD and DBD-HT recipients demonstrated comparable 1-year CAV incidence and mortality. These findings support the continued and expanded use of DCD donors to address the ongoing shortage of suitable donor hearts.

背景：同种异体心脏移植血管病变（CAV）仍然是心脏移植（HT）术后长期发病和死亡的主要原因。随着循环死亡（DCD）供者捐献的使用越来越多，评估CAV在这一人群中的发病率至关重要。方法：我们对2010年1月至2024年12月发表的研究进行了系统回顾和荟萃分析。比较DCD和脑死亡后捐赠（DBD） HT受者1年CAV发病率和1年死亡率。使用固定效应和随机效应模型合并95%置信区间（CI）的优势比（OR）。结果：4项研究符合纳入标准，包括951个HTs（576个DBD和375个DCD）。其中，594例HTs用于CAV分析，914例用于死亡率分析。合并分析显示，DCD和DBD患者1年CAV发病率无显著差异（OR = 0.71, 95% CI: 0.43-1.17, p = 0.17）。同样，1年死亡率也无差异（OR = 0.87, 95% CI: 0.48-1.58, p = 0.66）。结论：DCD和DBD-HT受体1年CAV发病率和死亡率相当。这些发现支持继续和扩大使用DCD供体来解决合适供体心脏的持续短缺问题。

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引用次数: 0

Life Satisfaction and Psychosocial Adjustment in Lung Transplant Recipients: Work, Family, and Sexual Life 肺移植受者的生活满意度和社会心理适应：工作、家庭和性生活。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70434

Aleksandra Stańska, Maja Krajewska, Aleksandra Mikołajczyk, Anna Borzyszkowska, Sławomir Żegleń, Wojciech Karolak, Jacek Wojarski

Background

Lung transplantation (LTx) significantly improves survival in end-stage pulmonary “disease” but its impact on life satisfaction and psychosocial adjustment is still underexplored. This study aimed to assess global life satisfaction and satisfaction with work, family life, and sexual life among lung transplant recipients.

Methods

Fifty adults after LTx were interviewed using Polish-language instruments (validated where available), including the SWLS, Satisfaction with Job Scale, a widely used Polish Family Satisfaction Scale, and the Sexual Satisfaction Questionnaire. Pearson's correlations, Mann–Whitney U tests, and multiple linear regression were performed to examine associations and predictors of life satisfaction.

Results

The mean SWLS score indicated high overall life satisfaction (M = 26.90, SD = 5.38). Sexual satisfaction correlated significantly with global life satisfaction (r = 0.413, p = 0.007). Family and work satisfaction showed positive but non-significant trends. Gender comparisons revealed no significant differences in life satisfaction or its domains. Multiple regression showed that family-related satisfaction (β = 0.361, p = 0.013) and sexual satisfaction (β = 0.365, p = 0.013) were significant predictors of life satisfaction, explaining 33% of its variance. Time since LTx and gender were not significant predictors.

Conclusions

Findings highlight the central role of interpersonal well-being in life satisfaction after lung transplantation. Satisfaction with family and intimate relationships emerged as key factors supporting psychosocial adjustment. This underscores the need for comprehensive post-transplant care addressing relational and sexual well-being, beyond physical recovery.

背景：肺移植（LTx）可显著提高终末期肺“疾病”患者的生存率，但其对生活满意度和社会心理适应的影响仍未得到充分探讨。本研究旨在评估肺移植受者的总体生活满意度以及对工作、家庭生活和性生活的满意度。方法：使用波兰语量表（SWLS）、工作满意度量表、广泛使用的波兰家庭满意度量表和性满意度问卷，对50名LTx后的成年人进行访谈。使用Pearson相关、Mann-Whitney U检验和多元线性回归来检验生活满意度的关联和预测因素。结果：平均SWLS评分显示整体生活满意度较高（M = 26.90, SD = 5.38）。性满意度与整体生活满意度显著相关（r = 0.413, p = 0.007）。家庭满意度和工作满意度呈现正向但不显著的趋势。性别比较显示，生活满意度及其领域没有显著差异。多元回归结果显示，家庭满意度（β = 0.361, p = 0.013）和性满意度（β = 0.365, p = 0.013）是生活满意度的显著预测因子，可解释33%的方差。从LTx开始的时间和性别不是显著的预测因子。结论：研究结果强调人际关系幸福感在肺移植术后生活满意度中的核心作用。对家庭和亲密关系的满意度成为支持心理社会调整的关键因素。这强调了需要全面的移植后护理，解决关系和性健康，超越身体恢复。

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引用次数: 0

Changing Landscape of Procurement of Deceased Donor Organs: An Analysis of National Trends 获取死者供体器官的变化：国家趋势分析。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70442

Elizabeth J. Bashian, Eric W. Etchill, Thomas F. O'Shea, Ashtyn Philipsheck, Nicholas R. Teman, Michael T. Cain, Jordan R. H. Hoffman

Background

Donation after circulatory death (DCD) has historically been underutilized compared with donation after brain death (DBD). Advances in preservation strategies and policy reforms have accelerated DCD adoption, raising the potential for meaningful shifts in the US donor pool.

Methods

We analyzed national donor trends using Scientific Registry of Transplant Recipients (SRTR) Explorer data from 2015 to 2025. Donor type (DCD vs. DBD) was evaluated across organ types and organ procurement organizations (OPOs). Temporal trends were assessed and crossover intervals were identified.

Results

We identified an interval in which the 30-day rolling donor count for DCD exceeded that of DBD for the first time (May 18 and June 18, 2025). During this period, DCD accounted for 52% of kidney, 44% of liver, and 26% of heart and lung recoveries. In 2025, DCD increased by 2.7 donors per day while DBD declined by 0.6 per day (p < 0.001). Over the past decade, DCD growth outpaced DBD nearly threefold, with kidney and lung showing the steepest increases. Both high- and low-volume OPOs demonstrated upward trends. Since reporting began in 2023, use of normothermic regional perfusion has expanded steadily.

Conclusions

This analysis identifies an interval in which the 30-day rolling donor count for DCD exceeded that of DBD, reflecting a notable shift in donor-availability trends. These findings underscore the need for standardized practices to ensure equitable allocation and minimize organ discard as reliance on DCD continues to grow.

背景：与脑死亡后捐赠相比，循环死亡后捐赠（DCD）历来未得到充分利用。保护策略和政策改革的进步加速了DCD的采用，提高了美国捐赠池发生重大转变的可能性。方法：我们使用科学移植受者登记处（SRTR） Explorer数据分析2015年至2025年国家供体趋势。通过器官类型和器官采购组织（opo）评估供体类型（DCD vs. DBD）。评估了时间趋势并确定了交叉区间。结果：我们确定了DCD的30天滚动供体计数首次超过DBD的间隔（2025年5月18日和6月18日）。在此期间，DCD占肾脏恢复的52%，肝脏恢复的44%，心肺恢复的26%。2025年，DCD每天增加2.7个供体，而DBD每天减少0.6个供体(p)。结论：该分析确定了DCD的30天滚动供体数量超过DBD的间隔，反映了供体可用性趋势的显着变化。这些发现强调了标准化实践的必要性，以确保公平分配和最大限度地减少器官丢弃，因为对DCD的依赖持续增长。

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引用次数: 0

Prolonged Invasive Mechanical Ventilation is Associated With Decreased Survival After Lung Transplantation Among Recipients With Primary Graft Dysfunction: A Lung Transplant Outcomes Group Study 长期有创机械通气与原发性移植物功能障碍患者肺移植后生存率降低相关：一项肺移植结果组研究

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70447

Meghan Aversa, Shaf Keshavjee, Tereza Martinu, Marcelo Cypel, Andrew T. Sage, Joshua M. Diamond, Jonathan P. Singer, Scott M. Palmer, Krishna Pandya, Edward Cantu, Jason D. Christie, Michaela R. Anderson

Introduction

Prolonged invasive mechanical ventilation (IMV) after lung transplantation is an appealing early prognostic outcome as it can be reproducibly assessed both prospectively and retrospectively. Whether use of IMV at 72 h after lung transplantation is associated with post-transplant graft survival is unknown.

Methods

We performed a retrospective cohort study of 1511 participants in the multi-center Lung Transplant Outcomes Group cohort (2011–2018). Using Cox proportional hazards models and restricted mean survival time, we investigated whether IMV at 72 h was associated with post-transplant graft survival. We secondarily evaluated whether IMV at 72 h was concordant with severe primary graft dysfunction (PGD).

Results

Participants requiring IMV at 72 h after transplant were sicker at transplantation (higher lung allocation score [LAS], increased extracorporeal membrane oxygenation, or IMV bridge) and more likely to have severe PGD. Use of IMV at 72 h was associated with 55% (95% CI 26%–92%) increased hazards of death or re-transplantation after adjustment for age, ECMO, diagnosis, LAS, and intra-operative transfusion. The association between IMV and graft survival was modified by severe PGD (p-for interaction 0.002) but not by pre-transplant ECMO (p-for interaction 0.88) or pre-transplant IMV (p-for interaction 0.92). IMV was associated with increased risk of death or re-transplantation among those with PGD (HR 2.35, 95% CI 1.43–3.85) but not among those without PGD (HR 1.04, 95% CI 0.77-1.41).

Conclusion

Requirement of IMV at 72 h is an important early post-transplant outcome associated with post-transplant survival. This appears driven by those with severe PGD.

肺移植术后延长有创机械通气（IMV）是一个很有吸引力的早期预后结果，因为它可以进行前瞻性和回顾性的可重复性评估。肺移植后72小时使用IMV是否与移植后移植物存活相关尚不清楚。方法：我们对多中心肺移植结局组队列（2011-2018）的1511名参与者进行了回顾性队列研究。使用Cox比例风险模型和限制平均生存时间，我们研究了72 h的IMV是否与移植后移植物存活相关。我们对72 h的IMV是否与严重原发性移植物功能障碍（PGD）相符进行了二次评估。结果：移植后72小时需要IMV的参与者在移植时病情更重（肺分配评分[LAS]更高，体外膜氧合或IMV桥增加），更有可能出现严重的PGD。在调整年龄、ECMO、诊断、LAS和术中输血后，72小时使用IMV与死亡或再移植风险增加55% （95% CI 26%-92%）相关。严重PGD（相互作用的p值为0.002）改变了IMV与移植物存活之间的关系，但移植前ECMO（相互作用的p值为0.88）或移植前IMV（相互作用的p值为0.92）没有改变。IMV与PGD患者死亡或再移植风险增加相关（HR 2.35, 95% CI 1.43-3.85），但与无PGD患者无关（HR 1.04, 95% CI 0.77-1.41）。结论：72h的IMV需求是与移植后生存相关的重要早期预后指标。这似乎是由那些患有严重PGD的人驱动的。

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引用次数: 0

Efficacy of a Single Dose of Intravesical Aminoglycoside for the Prevention of Urinary Tract Infections in Kidney Transplant Recipients 单剂量膀胱内氨基糖苷预防肾移植受者尿路感染的疗效。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-14 DOI: 10.1111/ctr.70449

Sarah Dean, Andrew Santeusanio, Gopi Patel, Vikram Wadhera, Ron Shapiro

Introduction

Urinary tract infections (UTIs) occur commonly following kidney transplant and are associated with significant morbidity. Some providers perform intra-operative antibiotic bladder irrigation at the time of ureteroneocystostomy, although practice varies widely among surgeons. As a result, this study was performed to assess outcomes following a single intravesical gentamicin injection for the prevention of UTIs.

Methods

This was a retrospective cohort study of adult patients who underwent a first isolated kidney transplant between January 2018 and January 2023. Outcomes were compared between patients who received bladder irrigation with a single dose of gentamicin and controls who did not receive antibiotic irrigation. The primary end point was the incidence of culture-confirmed UTI within 3-months of transplant. Key secondary endpoints included delayed allograft function and serum creatinine at 3-months.

Results

A total of 764 patients were included in the study analysis (gentamicin = 406 vs. control = 358). At 3 months, the incidence of UTIs was 18.2% in the gentamicin group compared to 13.1% in the control group (p = 0.05). A higher incidence of BK viremia >10,000 copies/mL was also observed in the gentamicin group compared with control patients (5.9% vs. 2.5%; p = 0.02). After multivariable regression analysis older age, female sex, early rejection, longer dialysis vintage, and urinary catheter duration were all found to be positively correlated with the incidence of UTIs.

Conclusion

Among kidney transplant recipients, bladder irrigation with gentamicin was not found to reduce the incidence of UTIs at 3 months. Additional studies should explore a possible association between antibiotic bladder irrigation and subsequent BK viremia.

导读：尿路感染（uti）常见于肾移植术后，发病率高。一些提供者在输尿管膀胱造口术中进行抗生素膀胱冲洗，尽管不同外科医生的做法差别很大。因此，本研究旨在评估单次膀胱内注射庆大霉素预防尿路感染的结果。方法：这是一项回顾性队列研究，纳入了2018年1月至2023年1月期间首次接受分离肾移植的成年患者。结果比较了接受单剂量庆大霉素膀胱冲洗的患者和未接受抗生素冲洗的对照组。主要终点是移植后3个月内培养证实的尿路感染的发生率。关键次要终点包括3个月时的延迟同种异体移植物功能和血清肌酐。结果：共有764例患者被纳入研究分析（庆大霉素= 406，对照组= 358）。3个月时，庆大霉素组尿路感染发生率为18.2%，对照组为13.1% （p = 0.05）。庆大霉素组的BK病毒血症发生率也高于对照组（5.9% vs. 2.5%, p = 0.02）。多变量回归分析发现，年龄较大、女性、早期排斥反应、透析时间较长、尿管时间均与尿路感染发生率呈正相关。结论：在肾移植受者中，庆大霉素膀胱冲洗不能降低3个月时尿路感染的发生率。进一步的研究应该探索抗生素膀胱冲洗与随后的BK病毒血症之间的可能联系。

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引用次数: 0

Induction Regimens and Kidney Re-Transplant Outcomes after BK Nephropathy–Related Graft Loss: A U.S. Cohort Study 诱导方案和BK肾病相关移植物丢失后的肾再移植结果：一项美国队列研究

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-08 DOI: 10.1111/ctr.70446

Rasha El-Rifai, Lauren Fontana, Scott Jackson, Byron H. Smith, Amir Hossein Shams, Artur Quintiliano, Andrew J. Bentall, Raymund R. Razonable, Raja Kandaswamy, Samy M. Riad

This study investigated the association between induction type and long-term outcomes in kidney retransplant recipients who experienced graft loss due to BK virus–associated nephropathy (BKVAN). Using Scientific Registry of Transplant Recipients data (2003–2021), we identified 277 adult kidney-alone retransplant recipients with BKVAN-related graft loss and categorized them by induction regimen: depletional (n = 217) and nondepletional (n = 60). The groups were similar overall, except the nondepletional cohort had lower panel-reactive antibodies, a shorter time between transplants, and more live donor kidneys. Kaplan–Meier curves assessed 10-year recipient and graft survival, and Cox proportional hazards models, adjusted for key donor and recipient factors, evaluated associations between induction type and outcomes. Rates of delayed graft function, one-year rejection, and estimated glomerular filtration rate were comparable between groups. Ten-year recipient and death-censored graft survival did not differ by induction type (recipient survival: HR 1.09; 95% CI 0.43–2.77; p = 0.85; graft survival: HR 0.85; 95% CI 0.24–2.97; p = 0.79). Recurrent BKVAN-related graft failure occurred only in the depletional group (5 of 217; 2.3%), while rejection-related graft failure was more common in the nondepletional group (5 of 60; 8.3% vs. 6 of 217; 2.8%). Although these differences did not translate into long-term graft survival disparities, they highlight the competing risks of viral recurrence and rejection. Thus, clinicians should interpret these results with caution and weigh the risks and benefits of induction choice in retransplant recipients with prior BKVAN, recognizing that this observational study cannot establish causality.

本研究调查了因BK病毒相关性肾病（BKVAN）而遭受移植物损失的肾再移植受者诱导类型与长期预后之间的关系。使用移植受者科学登记处（2003-2021）的数据，我们确定了277例bkvan相关移植物丢失的成人单肾再移植受者，并根据诱导方案将其分类：耗尽型（n = 217）和非耗尽型（n = 60）。两组总体上相似，除了非消耗组有较低的抗体反应性，移植间隔时间较短，以及更多的活体供体肾脏。Kaplan-Meier曲线评估10年受体和移植物存活率，Cox比例风险模型，调整关键供体和受体因素，评估诱导类型和结果之间的关系。移植功能延迟率、一年排斥反应率和肾小球滤过率在两组之间具有可比性。10年受者和死亡切除的移植物存活率因诱导类型而无差异（受者存活率：HR 1.09; 95% CI 0.43-2.77; p = 0.85；移植物存活率：HR 0.85; 95% CI 0.24-2.97; p = 0.79）。复发性bkvan相关的移植物衰竭仅发生在衰竭组（217例中有5例，2.3%），而排斥相关的移植物衰竭在非衰竭组更常见（60例中有5例，8.3%，217例中有6例，2.8%）。尽管这些差异并没有转化为长期移植存活的差异，但它们强调了病毒复发和排斥反应的竞争风险。因此，临床医生应该谨慎地解释这些结果，并权衡先前有BKVAN的再移植受者诱导选择的风险和益处，认识到这项观察性研究不能建立因果关系。

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引用次数: 0

Correction to “Financial Impact of Donation After Circulatory Death Heart Transplantation: A Single-Center Analysis” 更正“循环死亡心脏移植后捐赠的财务影响：一项单中心分析”。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-08 DOI: 10.1111/ctr.70428

Urban M, Ryan TR, Um JY, Siddique A, Castleberry AW, Lowes BD. Financial impact of donation after circulatory death heart transplantation: A single-center analysis. Clin Transplant. 2024; 38:e15296. https://doi.org/10.1111/ctr.15296.

In the article cited above, grant information is updated as follows:

Marian Urban was supported by the National Institutes of Health (P20 GM152326).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

引用本文：刘建军，刘建军，刘建军，刘建军。心脏移植术后肾移植术后肾移植的临床疗效分析。临床移植。2024；38: e15296。https://doi.org/10.1111/ctr.15296.In上面引用的文章，资助信息更新如下：Marian Urban由美国国立卫生研究院（P20 GM152326）支持。内容完全是作者的责任，并不一定代表美国国立卫生研究院的官方观点。

引用次数: 0

Heart Transplantation in Patients With Systemic Sclerosis 系统性硬化症患者的心脏移植。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2026-01-08 DOI: 10.1111/ctr.70424

Morgan D. Smith, Miroslav Sekulic, Matthew Regan, Ilan Richter, Dor Lotan, Adi Hertz, Kyung T. Oh, Boaz Elad, Julia Baranowska, Irina Sobol, Evelyn Horn, Jayant Raikhelkar, Ersilia M. DeFilippis, Kevin Clerkin, Farhana Latif, Gabriel T. Sayer, Nir Uriel

Introduction

Systemic sclerosis (SSc) is a multisystem disease, frequently leading to heart failure (HF). Heart transplant (HT) remains the definitive therapy for advanced HF, but HT outcomes in SSc patients remain poorly characterized. This study aims to report the outcomes of HT in patients with SSc.

Methods

A retrospective analysis of all HT recipients with SSc between 2007 and 2024 at two transplant centers. Baseline characteristics, index admission, and post HT outcomes were captured from the electronic medical record. Pathology of explants and allograft biopsies was read by a dedicated pathologist.

Results

Seven of 1153 patients who received HT had SSc. Six of these received HT alone, while one received a heart–lung transplant. Five (71%) were waitlist status 2 at the time of transplant. Median age was 52, and five patients (71%) were male. Pathologic examination of the seven patients’ explanted native hearts showed that two (29%) had active inflammation, six (86%) had fibrosis, and four (57%) had vascular remodeling. With a median follow-up of 3.2 years (range: 1.0–18.2) post-HT, six patients (86%) had a preserved ejection fraction at last assessment, while one suffered graft failure due to acute cellular (ACR) and antibody-mediated rejection (AMR). Two patients (29%) developed 2R ACR (range: 0–1 months), and two (29%) developed AMR (range: 4–5 years). Post-HT, one patient developed gastroparesis due to SSc, and one required a renal transplant due to complications of immunosuppression.

Conclusions

HT in SSc patients demonstrates good mid-term graft function despite an increased incidence of rejection, supporting feasibility in carefully selected candidates.

系统性硬化症（SSc）是一种多系统疾病，常导致心力衰竭（HF）。心脏移植（HT）仍然是晚期HF的最终治疗方法，但SSc患者的HT结果仍然缺乏特征。本研究旨在报道SSc患者HT治疗的结果。方法：回顾性分析2007年至2024年在两个移植中心接受SSc的所有HT受体。从电子病历中获取基线特征、索引入院和HT后结果。病理外植体和异体移植物活检是由专门的病理学家阅读。结果：1153例接受HT治疗的患者中有7例有SSc。其中6人单独接受了HT治疗，1人接受了心肺移植。5例（71%）在移植时处于2号候补名单状态。中位年龄52岁，男性5例（71%）。病理检查显示2例（29%）有活动性炎症，6例（86%）有纤维化，4例（57%）有血管重构。ht后中位随访时间为3.2年（范围：1.0-18.2年），6名患者（86%）在最后一次评估中保留了射血分数，而1名患者因急性细胞（ACR）和抗体介导的排斥反应（AMR）而发生移植物衰竭。2例（29%）发生2R ACR（范围：0-1个月），2例（29%）发生AMR（范围：4-5年）。ht后，1例患者因SSc发生胃轻瘫，1例患者因免疫抑制并发症需要肾移植。结论：尽管排异反应发生率增加，但在SSc患者中HT表现出良好的中期移植物功能，支持了精心挑选的候选人的可行性。

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