Einar A. Hart, S. A. Braithwaite, J. A. J. Hermens, A. O. Kraaijeveld, F. Ramjankhan, L. W. van Laake, M. I. F. J. Oerlemans, M. K. Szymanski
Primary graft dysfunction (PGD) is the most common cause of early mortality following heart transplantation. Although PGD can affect both ventricles, isolated right ventricular dysfunction (RV-PGD) is observed in nearly half of PGD patients. RV-PGD requires specific medical management to support the preload, afterload, and function of the failing RV; however, the use of mechanical circulatory support of the RV (RV-MCS) might be required when optimal medical therapy is insufficient in preventing forward failure and retrograde venous congestion. While RV-MCS options provide the opportunity to prevent or to recover from circulatory shock states, MCS is associated with a significant risk of complications. As a result of recent developments in short-term mechanical support devices, less invasive, percutaneous options for RV-MCS are available. In this review, we discuss the available devices, their advantages and disadvantages, and reported outcomes in RV-PGD.
{"title":"Mechanical Circulatory Support for Right Ventricular Primary Graft Dysfunction After Heart Transplant: A Review","authors":"Einar A. Hart, S. A. Braithwaite, J. A. J. Hermens, A. O. Kraaijeveld, F. Ramjankhan, L. W. van Laake, M. I. F. J. Oerlemans, M. K. Szymanski","doi":"10.1111/ctr.70066","DOIUrl":"10.1111/ctr.70066","url":null,"abstract":"<p>Primary graft dysfunction (PGD) is the most common cause of early mortality following heart transplantation. Although PGD can affect both ventricles, isolated right ventricular dysfunction (RV-PGD) is observed in nearly half of PGD patients. RV-PGD requires specific medical management to support the preload, afterload, and function of the failing RV; however, the use of mechanical circulatory support of the RV (RV-MCS) might be required when optimal medical therapy is insufficient in preventing forward failure and retrograde venous congestion. While RV-MCS options provide the opportunity to prevent or to recover from circulatory shock states, MCS is associated with a significant risk of complications. As a result of recent developments in short-term mechanical support devices, less invasive, percutaneous options for RV-MCS are available. In this review, we discuss the available devices, their advantages and disadvantages, and reported outcomes in RV-PGD.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909437","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}
Patricia M. Campbell, Marcelo Cantarovich, Azim Gangji, Isabelle Houde, Anthony M. Jevnikar, Felix-Mauricio Monroy-Cuadros, Peter W. Nickerson, Michel R. Pâquet, G. V. Ramesh Prasad, Lynne Senécal, Jean-Luc Wolff, Jason J. Schwartz, David N. Rush
Introduction
Novel approaches to improve long-term outcomes in kidney transplant recipients are required. Here, we present the 5-year data from a multicenter, prospective, Phase 3b trial evaluating treatment outcomes with standard (STD) or low (LOW) dose prolonged-release tacrolimus (TAC) combined with ACEi/ARB or other antihypertensive therapy (OAHT) in Canadian kidney transplant recipients.
Methods
Adult de novo kidney transplant recipients were randomized 2 × 2 to STD or LOW dose TAC and ACEi/ARB or OAHT. Patients had received a first or second transplant from a living or deceased donor and had ≥ 1 human leukocyte antigen mismatch with their donor.
Results
There were 281 patients from 13 sites across Canada. Overall patient survival was 95.7% and was comparable between groups. Graft survival at study end was 89.7% in the LOW+OAHT group and 94.4%–97.1% in the other groups and BPAR, and Class II de novo donor-specific antibodies (dnDSA) were higher in the LOW+OAHT group than in the other groups. However, these differences were not statistically significant. Graft function, blood pressure (BP), and proteinuria were similar between the groups; however, between 2 and 5 years there was a 2-fold or greater increase in the use of ACEi/ARB in patients randomized initially to OAHT, mostly because of hypertension and proteinuria. There were no unexpected safety findings.
Conclusion
Patients randomized to LOW TAC with renin-angiotensin system (RAS) blockade had similar outcomes at 5 years as patients treated with STD TAC with or without RAS blockade, whereas those randomized to LOW TAC without RAS blockade showed a non-significant trend towards more rejections and dnDSA
{"title":"A Five-Year Prospective, Randomized, Open-Label Study of Standard-Dose Versus Low-Dose Prolonged-Release Tacrolimus With or Without Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Post Kidney Transplantation","authors":"Patricia M. Campbell, Marcelo Cantarovich, Azim Gangji, Isabelle Houde, Anthony M. Jevnikar, Felix-Mauricio Monroy-Cuadros, Peter W. Nickerson, Michel R. Pâquet, G. V. Ramesh Prasad, Lynne Senécal, Jean-Luc Wolff, Jason J. Schwartz, David N. Rush","doi":"10.1111/ctr.70067","DOIUrl":"10.1111/ctr.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Novel approaches to improve long-term outcomes in kidney transplant recipients are required. Here<b>, </b>we present the 5-year data from a multicenter, prospective, Phase 3b trial evaluating treatment outcomes with standard (STD) or low (LOW) dose prolonged-release tacrolimus (TAC) combined with ACEi/ARB or other antihypertensive therapy (OAHT) in Canadian kidney transplant recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult <i>de novo</i> kidney transplant recipients were randomized 2 × 2 to STD or LOW dose TAC and ACEi/ARB or OAHT. Patients had received a first or second transplant from a living or deceased donor and had ≥ 1 human leukocyte antigen mismatch with their donor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 281 patients from 13 sites across Canada. Overall patient survival was 95.7% and was comparable between groups. Graft survival at study end was 89.7% in the LOW+OAHT group and 94.4%–97.1% in the other groups and BPAR, and Class II <i>de novo </i>donor-specific antibodies (<i>dn</i>DSA) were higher in the LOW+OAHT group than in the other groups. However, these differences were not statistically significant. Graft function, blood pressure (BP), and proteinuria were similar between the groups; however, between 2 and 5 years there was a 2-fold or greater increase in the use of ACEi/ARB in patients randomized initially to OAHT, mostly because of hypertension and proteinuria. There were no unexpected safety findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients randomized to LOW TAC with renin-angiotensin system (RAS) blockade had similar outcomes at 5 years as patients treated with STD TAC with or without RAS blockade, whereas those randomized to LOW TAC without RAS blockade showed a non-significant trend towards more rejections and <i>dn</i>DSA</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration:</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT00933231</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909429","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}
Jiemei Ji, Shengfeng Liang, Jian Lai, Zhongxuan Mao, Yunan Lin, Yuyan Lan, Jingchen Liu
Background
Postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) following pediatric liver transplantation (PLT) have not been comprehensively studied. This study aimed to evaluate the correlation between AKI and both 1-year CKD and mortality.
Methods
This retrospective study included 132 children aged between 3 months and 12 years who underwent PLT between 2017 and 2021. Postoperative AKI and CKD after 1 year were assessed according to KDIGO criteria. AKI was classified as mild, moderate, or severe based on severity as well as transient (≤2 days) and persistent (>2 days) based on duration. CKD occurrence was the primary outcome, whereas all-cause mortality was the secondary outcome.
Results
AKI developed in 45.4% of children, with 40.7% mild, 37.1% moderate, and 22.2% severe. Half of the children with AKI subsequently developed CKD within 1 year, compared to 23.1% without AKI. Multivariate analysis indicated that moderate AKI, severe AKI, and persistent AKI were risk factors for CKD development (moderate AKI, OR = 3.8, 95% CI = 1.2–12.3; severe AKI, OR = 7.4, 95% CI = 1.4–38.3; persistent AKI, OR = 9.7, 95% CI = 2.3–36.4). The overall mortality rate within 1 year after surgery was 9.8%. Children with severe AKI and AKI lasting longer than 2 days exhibited a higher mortality rate than those without AKI.
Conclusions
The development of postoperative AKI is relatively common after PLT, and the severity and duration of AKI are associated with CKD and mortality within 1 year.
背景：儿童肝移植（PLT）术后急性肾损伤（AKI）和慢性肾脏疾病（CKD）的研究尚未全面。本研究旨在评估AKI与1年CKD和死亡率之间的相关性。方法：本回顾性研究纳入了2017年至2021年期间接受PLT治疗的132名3个月至12岁儿童。根据KDIGO标准评估术后1年AKI和CKD。AKI根据严重程度分为轻度、中度或重度，根据持续时间分为短暂性（≤2天）和持续性（>2天）。CKD的发生是主要结局，而全因死亡率是次要结局。结果：45.4%的儿童发生AKI，其中轻度40.7%，中度37.1%，重度22.2%。有一半患有AKI的儿童随后在1年内发展为CKD，而没有AKI的儿童则为23.1%。多因素分析表明，中度AKI、重度AKI和持续性AKI是CKD发展的危险因素(中度AKI， OR = 3.8, 95% CI = 1.2-12.3；重度AKI， OR = 7.4, 95% CI = 1.4-38.3；持续性AKI， OR = 9.7, 95% CI = 2.3-36.4)。术后1年内总死亡率为9.8%。重度AKI和AKI持续时间超过2天的儿童的死亡率高于无AKI的儿童。结论：PLT术后AKI的发生较为常见，AKI的严重程度和持续时间与CKD和1年内死亡率相关。
{"title":"Outcomes of Acute Kidney Injury After Pediatric Liver Transplantation: A 1-Year Follow-Up","authors":"Jiemei Ji, Shengfeng Liang, Jian Lai, Zhongxuan Mao, Yunan Lin, Yuyan Lan, Jingchen Liu","doi":"10.1111/ctr.70063","DOIUrl":"10.1111/ctr.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) following pediatric liver transplantation (PLT) have not been comprehensively studied. This study aimed to evaluate the correlation between AKI and both 1-year CKD and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 132 children aged between 3 months and 12 years who underwent PLT between 2017 and 2021. Postoperative AKI and CKD after 1 year were assessed according to KDIGO criteria. AKI was classified as mild, moderate, or severe based on severity as well as transient (≤2 days) and persistent (>2 days) based on duration. CKD occurrence was the primary outcome, whereas all-cause mortality was the secondary outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AKI developed in 45.4% of children, with 40.7% mild, 37.1% moderate, and 22.2% severe. Half of the children with AKI subsequently developed CKD within 1 year, compared to 23.1% without AKI. Multivariate analysis indicated that moderate AKI, severe AKI, and persistent AKI were risk factors for CKD development (moderate AKI, OR = 3.8, 95% CI = 1.2–12.3; severe AKI, OR = 7.4, 95% CI = 1.4–38.3; persistent AKI, OR = 9.7, 95% CI = 2.3–36.4). The overall mortality rate within 1 year after surgery was 9.8%. Children with severe AKI and AKI lasting longer than 2 days exhibited a higher mortality rate than those without AKI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The development of postoperative AKI is relatively common after PLT, and the severity and duration of AKI are associated with CKD and mortality within 1 year.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892610","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}
Jisun Choi, SangHyun Lee, Justin Sangwook Ko, Mi Sook Gwak, Gaab Soo Kim
Background
Although surgical competency and anesthesia for liver transplantation (LT) have evolved significantly in the past decades, intraoperative cardiac arrest (ICA) is still an event that brings a poor prognosis to the recipient. We report a second-decade experience of ICA as a follow-up study of our first report at our institution.
Methods
This is a retrospective observational study of the medical records and the Liver Transplant Program database of our institution. LT from January 2011 to June 2023 were included. Of the 1735 LT cases, a total of 1730 cases were included, excluding three non-Asian and two simultaneous heart and liver transplants (1598 adult LT, 132 pediatric LT).
Results
The ICA incidence during adult LT was 0.7% (11/1598) which is significantly lower compared to our first report (1.5%; 14/919) (p = 0.042). ICA occurred only in adult recipients. Post-reperfusion syndrome (PRS, six cases) and bleeding (four cases) were the primary causes in most cases and most ICA occurred after reperfusion (10/11). The mortality rates within 24 h, 30 days, and 1 year were 27.3%, 45.5%, and 54.5%, respectively. The survival curve did not show a significant difference from our first report (p = 0.570), and the survival rate of the ICA group was significantly lower compared to the non-ICA group. (p = 0.000)
Conclusion
The incidence of ICA has decreased, but the main causes of ICA as PRS and bleeding after reperfusion have not changed. Additionally, there was no significant difference in the survival curves from the first report. Because ICA is still fatal, efforts to reduce its incidence should be continued.
{"title":"Intraoperative Cardiac Arrests in Asian Recipients of Liver Transplantation—Second Report After Learning Curve","authors":"Jisun Choi, SangHyun Lee, Justin Sangwook Ko, Mi Sook Gwak, Gaab Soo Kim","doi":"10.1111/ctr.70038","DOIUrl":"https://doi.org/10.1111/ctr.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although surgical competency and anesthesia for liver transplantation (LT) have evolved significantly in the past decades, intraoperative cardiac arrest (ICA) is still an event that brings a poor prognosis to the recipient. We report a second-decade experience of ICA as a follow-up study of our first report at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective observational study of the medical records and the Liver Transplant Program database of our institution. LT from January 2011 to June 2023 were included. Of the 1735 LT cases, a total of 1730 cases were included, excluding three non-Asian and two simultaneous heart and liver transplants (1598 adult LT, 132 pediatric LT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ICA incidence during adult LT was 0.7% (11/1598) which is significantly lower compared to our first report (1.5%; 14/919) (<i>p</i> = 0.042). ICA occurred only in adult recipients. Post-reperfusion syndrome (PRS, six cases) and bleeding (four cases) were the primary causes in most cases and most ICA occurred after reperfusion (10/11). The mortality rates within 24 h, 30 days, and 1 year were 27.3%, 45.5%, and 54.5%, respectively. The survival curve did not show a significant difference from our first report (<i>p</i> = 0.570), and the survival rate of the ICA group was significantly lower compared to the non-ICA group. (<i>p</i> = 0.000)</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The incidence of ICA has decreased, but the main causes of ICA as PRS and bleeding after reperfusion have not changed. Additionally, there was no significant difference in the survival curves from the first report. Because ICA is still fatal, efforts to reduce its incidence should be continued.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868810","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}
Murdoch Leeies, Karen Doucette, Brenden Dufault, Tricia Carta, Owen Mooney, Carmen Hrymak, Nicolette Balzer, Ben Borys, Yasmine El-Salakawy, Mirna Ragheb, Davie Xie, Emily Christie, David Collister, Matthew J. Weiss, Sonny Dhanani, Julie Ho
Background
Current donor risk assessments to identify risk of infectious transmission through transplantation have been criticized as unnecessarily discriminatory for sexual and gender minorities. Little is known about how increased infectious risk donor (IIRD) patients transition through the deceased donation system. We sought to evaluate how IIRD status and other equity-relevant identities impacted the likelihood of a caregiver of a deceased donor being approached for organ donation and the likelihood of caregiver consent.
Methods
We conducted a retrospective, observational cohort study of potential deceased donors referred to a Canadian provincial organ donation organization (ODO) from 2015 to 2021. Our primary outcome is the difference in the likelihood of being approached by the ODO for organ donation for IIRDs compared to baseline risk donors, amongst referred potential deceased organ donors. Secondary outcomes include the difference in caregiver consent for donation for IIRDs compared to baseline risk donors, amongst approached deceased organ donors. We built multivariable logistic regression models to evaluate these outcomes.
Results
Amongst all referred potential deceased organ donors, IIRD status did not impact the likelihood of being approached by our ODO for deceased organ donation compared to baseline risk donors (OR 1.695, 95% CI 0.902–3.197). Amongst approached deceased organ donors, there was no significant difference in caregiver consent for donation between IIRD and baseline risk donors (OR 1.854, 95% CI 0.902–3.929). Approached eligible IIRDs were younger with fewer comorbidities, lower KDPI scores, were more likely to have died from anoxic brain injuries and have death determined by neurologic criteria, and more likely to have non-medical injection drug use than baseline risk donors. There were no cases of donor-derived human immunodeficiency virus (HIV), hepatitis C virus (HCV), or hepatitis B virus (HBV) reported for any donors included, regardless of IIRD status, during the study period.
Conclusions
We found no significant difference in the likelihood of ODO approach in IIRDs compared to baseline risk donors. There was no difference in caregiver consent for donation in IIRDs compared to baseline risk donors. A greater proportion of IIRDs became successful donors compared to baseline risk donors.
{"title":"Increased Infectious Risk Donor Status and Equity-Relevant Predictors of Organ Donation Organization Approach and Caregiver Consent for Deceased Organ Donation in a Canadian Province (2015–2021)","authors":"Murdoch Leeies, Karen Doucette, Brenden Dufault, Tricia Carta, Owen Mooney, Carmen Hrymak, Nicolette Balzer, Ben Borys, Yasmine El-Salakawy, Mirna Ragheb, Davie Xie, Emily Christie, David Collister, Matthew J. Weiss, Sonny Dhanani, Julie Ho","doi":"10.1111/ctr.70058","DOIUrl":"https://doi.org/10.1111/ctr.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Current donor risk assessments to identify risk of infectious transmission through transplantation have been criticized as unnecessarily discriminatory for sexual and gender minorities. Little is known about how increased infectious risk donor (IIRD) patients transition through the deceased donation system. We sought to evaluate how IIRD status and other equity-relevant identities impacted the likelihood of a caregiver of a deceased donor being approached for organ donation and the likelihood of caregiver consent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective, observational cohort study of potential deceased donors referred to a Canadian provincial organ donation organization (ODO) from 2015 to 2021. Our primary outcome is the difference in the likelihood of being approached by the ODO for organ donation for IIRDs compared to baseline risk donors, amongst referred potential deceased organ donors. Secondary outcomes include the difference in caregiver consent for donation for IIRDs compared to baseline risk donors, amongst approached deceased organ donors. We built multivariable logistic regression models to evaluate these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Amongst all referred potential deceased organ donors, IIRD status did not impact the likelihood of being approached by our ODO for deceased organ donation compared to baseline risk donors (OR 1.695, 95% CI 0.902–3.197). Amongst approached deceased organ donors, there was no significant difference in caregiver consent for donation between IIRD and baseline risk donors (OR 1.854, 95% CI 0.902–3.929). Approached eligible IIRDs were younger with fewer comorbidities, lower KDPI scores, were more likely to have died from anoxic brain injuries and have death determined by neurologic criteria, and more likely to have non-medical injection drug use than baseline risk donors. There were no cases of donor-derived human immunodeficiency virus (HIV), hepatitis C virus (HCV), or hepatitis B virus (HBV) reported for any donors included, regardless of IIRD status, during the study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found no significant difference in the likelihood of ODO approach in IIRDs compared to baseline risk donors. There was no difference in caregiver consent for donation in IIRDs compared to baseline risk donors. A greater proportion of IIRDs became successful donors compared to baseline risk donors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868811","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}
{"title":"Recovery and Stabilization of Kidney Allograft Function Following Post-Implantation Cholesterol Crystal Embolization","authors":"Subrahmanian Sathiavageesan","doi":"10.1111/ctr.70068","DOIUrl":"https://doi.org/10.1111/ctr.70068","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142867966","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}
Jeanne M. Chen, Richard S. Mangus, Asif A. Sharfuddin, John A. Powelson, Muhammad S. Yaqub, Oluwafisayo O. Adebiyi, Muhammad Y. Jan, Andrew J. Lutz, Jonathan A. Fridell
This single-center retrospective study was designed to evaluate the use of basiliximab as an alternative rescue maintenance immunosuppression in situations where standard maintenance immunosuppression is not tolerated after a pancreas transplant. All pancreas transplants performed between January 11, 2006, and January 6, 2022, were reviewed. All recipients received rabbit antithymocyte globulin (rATG) induction with tacrolimus + sirolimus maintenance for simultaneous pancreas and kidney (SPK) and additional low-dose mycophenolic acid for pancreas transplant alone (PTA). Basiliximab 40mg IV q 4 weeks was either added to or in replacement of adjunct immunosuppression in cases of medication intolerance. All recipients who received ≥3 months of basiliximab with ≥1 year follow-up were included. 29/557 (5.2%) recipients (5 SPK and 24 PTA) were identified. Median time to switch was 13 months. When compared 1:2 to matched controls on standard immunosuppression, there was no difference in pancreas rejection, allograft loss, or mortality. Eleven recipients had 13 episodes of pancreas rejection at a median of 28 months post conversion. Eight pancreas allografts failed at a median of 28 months post conversion, and there were five deaths—all occurring in PTA, 4/5 occurring ≥1 year after discontinuation of basiliximab. Renal allograft rejection occurred in one SPK and there was one renal allograft loss. Five PTA developed renal failure. Ten remain on basiliximab (2/5 SPK, 8/24 PTA) at a median of 44 months with good pancreas and kidney function; 4 pts > 4 years. Basiliximab can be considered an alternative rescue maintenance strategy in pancreas transplant recipients who failed other conventional agents.
{"title":"The Use of Long-Term Monthly Basiliximab Infusions as Rescue Maintenance Immunosuppression in Pancreas Transplant Recipients","authors":"Jeanne M. Chen, Richard S. Mangus, Asif A. Sharfuddin, John A. Powelson, Muhammad S. Yaqub, Oluwafisayo O. Adebiyi, Muhammad Y. Jan, Andrew J. Lutz, Jonathan A. Fridell","doi":"10.1111/ctr.70050","DOIUrl":"10.1111/ctr.70050","url":null,"abstract":"<p>This single-center retrospective study was designed to evaluate the use of basiliximab as an alternative rescue maintenance immunosuppression in situations where standard maintenance immunosuppression is not tolerated after a pancreas transplant. All pancreas transplants performed between January 11, 2006, and January 6, 2022, were reviewed. All recipients received rabbit antithymocyte globulin (rATG) induction with tacrolimus + sirolimus maintenance for simultaneous pancreas and kidney (SPK) and additional low-dose mycophenolic acid for pancreas transplant alone (PTA). Basiliximab 40mg IV q 4 weeks was either added to or in replacement of adjunct immunosuppression in cases of medication intolerance. All recipients who received ≥3 months of basiliximab with ≥1 year follow-up were included. 29/557 (5.2%) recipients (5 SPK and 24 PTA) were identified. Median time to switch was 13 months. When compared 1:2 to matched controls on standard immunosuppression, there was no difference in pancreas rejection, allograft loss, or mortality. Eleven recipients had 13 episodes of pancreas rejection at a median of 28 months post conversion. Eight pancreas allografts failed at a median of 28 months post conversion, and there were five deaths—all occurring in PTA, 4/5 occurring ≥1 year after discontinuation of basiliximab. Renal allograft rejection occurred in one SPK and there was one renal allograft loss. Five PTA developed renal failure. Ten remain on basiliximab (2/5 SPK, 8/24 PTA) at a median of 44 months with good pancreas and kidney function; 4 pts > 4 years. Basiliximab can be considered an alternative rescue maintenance strategy in pancreas transplant recipients who failed other conventional agents.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834380","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}
The decision of proceeding with a pancreas transplant (PTx) is a complex one, and patient education is important to allow transplant candidates to make an informed and autonomous decision. In this study, we assessed the readability and reliability of online information provided by PTx centers in the United States.
Methods
Websites of PTx centers active between 2022 and 2023 were searched for patient information on pancreas transplantation. Readability was assessed using eight validated formulas. Reliability was assessed using the Journal of the American Medical Association criteria.
Results
Of 117 PTx centers, 57 provided online information material. High-volume centers were more likely to provide patient information compared to medium- and low-volume centers (76.6%, 45.6%, 34.6%, respectively). Average readability was at the 11th grade and beyond, with no difference among the three groups (11.9, 11.4, 11.4). Reliability was low, with two centers providing information on the material sources. Only one center provided information in a language other than English.
Conclusions
Readability of online material on PTx provided by US transplant centers is low, well above the recommended 6th grade-level. Transplant centers, national societies and patient advocacy groups should collaborate in developing information material that is evidence-based, easy to read, and available in multiple languages.
{"title":"Evaluating Readability and Reliability of Online Information Provided by Pancreas Transplant Centers in the United States","authors":"Vincenzo Villani, Kumaran Shanmugarajah","doi":"10.1111/ctr.70055","DOIUrl":"10.1111/ctr.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The decision of proceeding with a pancreas transplant (PTx) is a complex one, and patient education is important to allow transplant candidates to make an informed and autonomous decision. In this study, we assessed the readability and reliability of online information provided by PTx centers in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Websites of PTx centers active between 2022 and 2023 were searched for patient information on pancreas transplantation. Readability was assessed using eight validated formulas. Reliability was assessed using the Journal of the American Medical Association criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 117 PTx centers, 57 provided online information material. High-volume centers were more likely to provide patient information compared to medium- and low-volume centers (76.6%, 45.6%, 34.6%, respectively). Average readability was at the 11<sup>th</sup> grade and beyond, with no difference among the three groups (11.9, 11.4, 11.4). Reliability was low, with two centers providing information on the material sources. Only one center provided information in a language other than English.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Readability of online material on PTx provided by US transplant centers is low, well above the recommended 6<sup>th </sup>grade-level. Transplant centers, national societies and patient advocacy groups should collaborate in developing information material that is evidence-based, easy to read, and available in multiple languages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817484","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}
Paolo Mendogni, Alessandro Palleschi, Giacomo Grisorio, Alessandra Mazzucco, Cristina Diotti, Letizia Corinna Morlacchi, Valeria Rosetti, Gianluca Bonitta, Mario Nosotti, Lorenzo Rosso
Suppurative lung diseases leading to end-stage respiratory failure are typical indications for bilateral lung transplantation (LuTx). Some cases may present severe chest asymmetry because of recurrent infections or previous surgical procedures, and the most used surgical options are single LuTx and contralateral pneumonectomy or bilateral transplantation with graft downsizing. Our purpose is to evaluate our treatment protocols for these patients and review surgical strategies reported by others.
We prospectively collected clinical data of patients with significant pleural cavity asymmetry who underwent bilateral LuTx at our center from 2017 to 2022. Clinical reports of all patients who underwent LuTx for end-stage suppurative disease in the same period were reviewed as the control group.
During the study period, 74 patients underwent bilateral LuTx for suppurative disease; seven of them presented with severe thoracic asymmetry, and all of them were extubated by the second postoperative day. The mean intensive care unit stay was 4 days. The postoperative radiological evaluation did not show clustering or atelectasis of the graft implanted in the smaller hemithorax. No perioperative major complications were recorded, and the average length of stay was 23 days. The perioperative course appeared remarkably good, and both the short- and long-term follow-up were similar to that of the control group.
{"title":"Bilateral Lung Transplantation in Patients With Severe Chest Asymmetry: A Case Series From a Single Center","authors":"Paolo Mendogni, Alessandro Palleschi, Giacomo Grisorio, Alessandra Mazzucco, Cristina Diotti, Letizia Corinna Morlacchi, Valeria Rosetti, Gianluca Bonitta, Mario Nosotti, Lorenzo Rosso","doi":"10.1111/ctr.70054","DOIUrl":"10.1111/ctr.70054","url":null,"abstract":"<p>Suppurative lung diseases leading to end-stage respiratory failure are typical indications for bilateral lung transplantation (LuTx). Some cases may present severe chest asymmetry because of recurrent infections or previous surgical procedures, and the most used surgical options are single LuTx and contralateral pneumonectomy or bilateral transplantation with graft downsizing. Our purpose is to evaluate our treatment protocols for these patients and review surgical strategies reported by others.</p><p>We prospectively collected clinical data of patients with significant pleural cavity asymmetry who underwent bilateral LuTx at our center from 2017 to 2022. Clinical reports of all patients who underwent LuTx for end-stage suppurative disease in the same period were reviewed as the control group.</p><p>During the study period, 74 patients underwent bilateral LuTx for suppurative disease; seven of them presented with severe thoracic asymmetry, and all of them were extubated by the second postoperative day. The mean intensive care unit stay was 4 days. The postoperative radiological evaluation did not show clustering or atelectasis of the graft implanted in the smaller hemithorax. No perioperative major complications were recorded, and the average length of stay was 23 days. The perioperative course appeared remarkably good, and both the short- and long-term follow-up were similar to that of the control group.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11640198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817470","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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