Dawn Y. Nguyen, Anastacia Serluco, Justin K. Chen, Gwen Nance, Zeling He, Arene Butto
Background
Mycophenolic acid (MPA) is a common immunosuppressant used in children post-orthotopic heart transplant (OHT). Multiple MPA dosing strategies exist, with limited reports of comparisons between dosing strategies and patient outcomes.
Methods
We performed a retrospective review of heart transplant recipients ≤ 21 years from 2014 to 2022, comparing dose concordance and clinical outcomes of weight-based mycophenolate dosing (15 mg/kg/dose every 12 h) to body surface area (BSA)-based dosing (600 mg/m2/dose every 12 h).
Results
We analyzed 109 patients total (56% in the BSA-based cohort and 44% in the weight-based cohort). The BSA-based cohort received a higher total milligram dose (480 (IQR 200–563) vs. 636 (IQR 320–1000), p = 0.005), mg/kg dose (14.5 (IQR 13.7–16.1) vs. 20.7 (IQR 16.4–25.8), p < 0.001) and mg/m2 dose (382 (IQR 333–470) vs. 596 (IQR 572–612), p < 0.001) compared to the weight-based cohort. The BSA-based cohort experienced a lower hazard of rejection (HR 0.2, 95% CI 0.1–0.4 vs. weight-based) and a greater hazard for overall infection (HR 2.2, 95% CI 1.2–3.9). There was no significant difference in 1-year post-transplant mortality and incidence of post-transplant lymphoproliferative disorder (PTLD).
Conclusions
This study demonstrates the discordance between two common mycophenolate dosing strategies (1200 mg/m2/day vs. 30 mg/kg/day) and its resultant impact on pediatric heart transplant-related outcomes. Further multicenter data would be useful to elucidate the impact on post-heart transplant morbidity and mortality.
背景：霉酚酸（MPA）是儿童原位心脏移植（OHT）后常用的免疫抑制剂。存在多种MPA给药策略，但有关给药策略与患者预后比较的报道有限。方法：我们对2014年至2022年≤21岁的心脏移植受者进行回顾性分析，比较基于体重的霉酚酸酯给药（15mg /kg/剂量每12 h）和基于体表（BSA）的给药（600mg /m2/剂量每12 h）的剂量一致性和临床结果。结果：我们共分析了109例患者（56%基于bsa的队列，44%基于体重的队列）。基于bsa的队列接受了更高的总毫克剂量(480 (IQR 200-563) vs 636 (IQR 320-1000), p = 0.005)， mg/kg剂量(14.5 (IQR 13.7-16.1) vs 20.7 (IQR 16.4-25.8)， p2剂量(382 (IQR 333-470) vs 596 (IQR 572-612)， p结论：本研究证明了两种常见的麦考酚酸盐给药策略（1200mg /m2/天vs 30mg /kg/天）之间的不一致性及其对儿童心脏移植相关结果的影响。进一步的多中心数据将有助于阐明对心脏移植后发病率和死亡率的影响。
{"title":"Comparison of Mycophenolate Dosing Strategies in Pediatric Heart Transplant","authors":"Dawn Y. Nguyen, Anastacia Serluco, Justin K. Chen, Gwen Nance, Zeling He, Arene Butto","doi":"10.1111/ctr.70422","DOIUrl":"10.1111/ctr.70422","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mycophenolic acid (MPA) is a common immunosuppressant used in children post-orthotopic heart transplant (OHT). Multiple MPA dosing strategies exist, with limited reports of comparisons between dosing strategies and patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective review of heart transplant recipients ≤ 21 years from 2014 to 2022, comparing dose concordance and clinical outcomes of weight-based mycophenolate dosing (15 mg/kg/dose every 12 h) to body surface area (BSA)-based dosing (600 mg/m<sup>2</sup>/dose every 12 h).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed 109 patients total (56% in the BSA-based cohort and 44% in the weight-based cohort). The BSA-based cohort received a higher total milligram dose (480 (IQR 200–563) vs. 636 (IQR 320–1000), <i>p = </i>0.005), mg/kg dose (14.5 (IQR 13.7–16.1) vs. 20.7 (IQR 16.4–25.8), <i>p < </i>0.001) and mg/m<sup>2</sup> dose (382 (IQR 333–470) vs. 596 (IQR 572–612), <i>p < </i>0.001) compared to the weight-based cohort. The BSA-based cohort experienced a lower hazard of rejection (HR 0.2, 95% CI 0.1–0.4 vs. weight-based) and a greater hazard for overall infection (HR 2.2, 95% CI 1.2–3.9). There was no significant difference in 1-year post-transplant mortality and incidence of post-transplant lymphoproliferative disorder (PTLD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates the discordance between two common mycophenolate dosing strategies (1200 mg/m<sup>2</sup>/day vs. 30 mg/kg/day) and its resultant impact on pediatric heart transplant-related outcomes. Further multicenter data would be useful to elucidate the impact on post-heart transplant morbidity and mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145854870","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}
Hailey M. Shepherd, Nikki E. Rossetti, Yun Zhu Bai, Su-Hsin Chang, Yan Yan, Alejandro De Filippis, Anjana Delhi, Meagan R. Pilar, Ana A. Baumann, Marci S. Damiano, Andrew J. Bierhals, Ramsey R. Hachem, Chad A. Witt, Rodrigo V. Guillamet, Derek E. Byers, Daniel Kreisel, Ruben G. Nava, Benjamin D. Kozower, Bryan F. Meyers, G. Alexander Patterson, Gary F. Marklin, Varun Puri
Introduction
Venous thromboembolism (VTE) is a known complication in critically ill patients, yet its prevalence in deceased organ donors and impact on organ recipients remain poorly characterized. Standardized guidelines for donor VTE assessment and management are lacking.
Methods
In this prospective observational study of brain-dead donors at a regional organ recovery center (October 1, 2021–August 1, 2023), all donors underwent duplex ultrasonography and CT pulmonary angiography to screen for deep vein thrombosis (DVT) and pulmonary embolism (PE). Donors with VTE received prompt therapeutic anticoagulation. Organ recovery data and recipient 1-year survival data were obtained from the Scientific Registry of Transplant Recipients (SRTR). Additionally, we surveyed US organ procurement organizations (OPOs) regarding VTE practices.
Results
Among 215 donors, 73 (34%) had VTE: 28% with DVT and 14% with PE. All VTE-positive donors received prompt anticoagulation and no bleeding complications were observed. Organ recovery rates and 1-year recipient survival did not differ by donor VTE status. Among 96 survey respondents from 41 of 56 U.S. OPOs, there was substantial variation in VTE practices, only 2% accurately estimated prevalence, and most respondents (83%) supported development of standardized guidelines.
Conclusion
VTE is common but underrecognized in brain-dead donors. In this observational cohort, prompt diagnosis and short-term management of donor VTE were feasible and were not associated with reduced organ utilization or early recipient outcomes, although the study was not designed to establish treatment efficacy.
{"title":"Venous Thromboembolism in Brain-Dead Organ Donors: A Prospective Study of Prevalence, Management, and Impact on Organ Utilization and Recipient Outcomes","authors":"Hailey M. Shepherd, Nikki E. Rossetti, Yun Zhu Bai, Su-Hsin Chang, Yan Yan, Alejandro De Filippis, Anjana Delhi, Meagan R. Pilar, Ana A. Baumann, Marci S. Damiano, Andrew J. Bierhals, Ramsey R. Hachem, Chad A. Witt, Rodrigo V. Guillamet, Derek E. Byers, Daniel Kreisel, Ruben G. Nava, Benjamin D. Kozower, Bryan F. Meyers, G. Alexander Patterson, Gary F. Marklin, Varun Puri","doi":"10.1111/ctr.70425","DOIUrl":"10.1111/ctr.70425","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Venous thromboembolism (VTE) is a known complication in critically ill patients, yet its prevalence in deceased organ donors and impact on organ recipients remain poorly characterized. Standardized guidelines for donor VTE assessment and management are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective observational study of brain-dead donors at a regional organ recovery center (October 1, 2021–August 1, 2023), all donors underwent duplex ultrasonography and CT pulmonary angiography to screen for deep vein thrombosis (DVT) and pulmonary embolism (PE). Donors with VTE received prompt therapeutic anticoagulation. Organ recovery data and recipient 1-year survival data were obtained from the Scientific Registry of Transplant Recipients (SRTR). Additionally, we surveyed US organ procurement organizations (OPOs) regarding VTE practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 215 donors, 73 (34%) had VTE: 28% with DVT and 14% with PE. All VTE-positive donors received prompt anticoagulation and no bleeding complications were observed. Organ recovery rates and 1-year recipient survival did not differ by donor VTE status. Among 96 survey respondents from 41 of 56 U.S. OPOs, there was substantial variation in VTE practices, only 2% accurately estimated prevalence, and most respondents (83%) supported development of standardized guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VTE is common but underrecognized in brain-dead donors. In this observational cohort, prompt diagnosis and short-term management of donor VTE were feasible and were not associated with reduced organ utilization or early recipient outcomes, although the study was not designed to establish treatment efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849005","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}
Gabriel A. L. do Carmo, Bárbara Carolina Silva Almeida, Gabriela Zamunaro Lopes Ruiz, Ana Cristina Carioca, Renato Braulio, Fábio Morato de Castilho, Mirely Gomes Gadelha de Oliveira, Victor Vieira Santos
Background
Type 1 cardiorenal syndrome requiring renal replacement therapy (RRT) commonly occurs in patients with advanced heart failure and cardiogenic shock. However, the prognostic impact of RRT in heart transplant (HT) candidates remains unclear, particularly in resource-limited settings without routine access to durable mechanical circulatory support (MCS).
Methods
We retrospectively analyzed a prospective cohort of adult HT recipients at a single Brazilian university hospital between April 2014 and November 2021. Patients with irreversible chronic kidney disease were excluded. Outcomes were compared between recipients who required pre-transplant RRT for Type 1 cardiorenal syndrome and those who did not. Multivariable logistic regression was used to identify independent predictors of 30-day mortality.
Results
Among 211 HT recipients, 33 (15.7%) required RRT prior to transplantation. The overall 30-day mortality was 15.2%. Patients requiring RRT had significantly higher 30-day mortality compared to those who did not (30.3% vs. 12.4%; OR 3.08; 95% CI, 1.30–7.33; p = 0.008). However, in a multivariable analysis, only Interagency Registry for Mechanically Assisted Circulatory (INTERMACS) profile 1 or 2 remained independently associated with mortality (OR 3.87; 95% CI, 1.47–10.26; p = 0.006). All RRT-dependent survivors recovered renal function before hospital discharge.
Conclusion
Pre-transplant RRT due to cardiorenal syndrome was not associated with increased early mortality. In the absence of durable mechanical circulatory support, heart transplantation may remain a viable option for carefully selected patients with potentially reversible renal dysfunction. The complete renal recovery observed among survivors further supports that RRT for cardiorenal syndrome should not be considered an absolute contraindication to transplantation.
背景：需要肾替代治疗（RRT）的1型心肾综合征常见于晚期心力衰竭和心源性休克患者。然而，RRT对心脏移植（HT）候选人的预后影响尚不清楚，特别是在资源有限的环境中，没有常规的持久机械循环支持（MCS）。方法：我们回顾性分析了2014年4月至2021年11月在一家巴西大学医院接受HT治疗的成人前瞻性队列。排除不可逆慢性肾脏疾病患者。结果比较了1型心肾综合征移植前需要RRT和不需要RRT的受者。采用多变量logistic回归确定30天死亡率的独立预测因子。结果：在211名HT受体中，33名（15.7%）在移植前需要RRT。总体30天死亡率为15.2%。需要RRT的患者的30天死亡率明显高于不需要RRT的患者（30.3% vs. 12.4%; OR 3.08; 95% CI, 1.30-7.33; p = 0.008）。然而，在多变量分析中，只有机构间机械辅助循环登记（Interagency Registry for mechanical Assisted circulation， INTERMACS）档案1或档案2仍然与死亡率独立相关（or 3.87; 95% CI, 1.47-10.26; p = 0.006）。所有依赖rrt的幸存者在出院前均恢复了肾功能。结论：移植前因心肾综合征引起的RRT与早期死亡率增加无关。在缺乏持久的机械循环支持的情况下，对于精心挑选的具有潜在可逆性肾功能障碍的患者，心脏移植可能仍然是一个可行的选择。在幸存者中观察到的肾脏完全恢复进一步支持RRT治疗心肾综合征不应被视为移植的绝对禁忌症。
{"title":"Renal Recovery after Heart Transplantation in Patients With Type 1 Cardiorenal Syndrome Requiring Dialysis: Insights From a Cohort Without Mechanical Circulatory Support","authors":"Gabriel A. L. do Carmo, Bárbara Carolina Silva Almeida, Gabriela Zamunaro Lopes Ruiz, Ana Cristina Carioca, Renato Braulio, Fábio Morato de Castilho, Mirely Gomes Gadelha de Oliveira, Victor Vieira Santos","doi":"10.1111/ctr.70409","DOIUrl":"10.1111/ctr.70409","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Type 1 cardiorenal syndrome requiring renal replacement therapy (RRT) commonly occurs in patients with advanced heart failure and cardiogenic shock. However, the prognostic impact of RRT in heart transplant (HT) candidates remains unclear, particularly in resource-limited settings without routine access to durable mechanical circulatory support (MCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed a prospective cohort of adult HT recipients at a single Brazilian university hospital between April 2014 and November 2021. Patients with irreversible chronic kidney disease were excluded. Outcomes were compared between recipients who required pre-transplant RRT for Type 1 cardiorenal syndrome and those who did not. Multivariable logistic regression was used to identify independent predictors of 30-day mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 211 HT recipients, 33 (15.7%) required RRT prior to transplantation. The overall 30-day mortality was 15.2%. Patients requiring RRT had significantly higher 30-day mortality compared to those who did not (30.3% vs. 12.4%; OR 3.08; 95% CI, 1.30–7.33; <i>p</i> = 0.008). However, in a multivariable analysis, only Interagency Registry for Mechanically Assisted Circulatory (INTERMACS) profile 1 or 2 remained independently associated with mortality (OR 3.87; 95% CI, 1.47–10.26; <i>p</i> = 0.006). All RRT-dependent survivors recovered renal function before hospital discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pre-transplant RRT due to cardiorenal syndrome was not associated with increased early mortality. In the absence of durable mechanical circulatory support, heart transplantation may remain a viable option for carefully selected patients with potentially reversible renal dysfunction. The complete renal recovery observed among survivors further supports that RRT for cardiorenal syndrome should not be considered an absolute contraindication to transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848995","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}
Kevin Gianaris, Arrey-Takor Paul Ayuk-Arrey, Jonathan A. Fridell, Katherine Ross-Driscoll
Background
Organ allocation has recently changed to acuity circle (AC)-based policies. This study aimed to quantify changes in travel distance and potential environmental impacts of AC policies.
Methods
Data were obtained from the Scientific Registry of Transplant Recipients for each solid organ for an equidistant window before and after AC implementation. We calculated the distance between the donor and recipient hospital for each organ. We used an interrupted time series model to calculate excess travel distance after AC along with associated carbon emissions.
Results
We analyzed travel distance for 226 731 deceased donor organs. There was a significant increase in total excess distance traveled: 1.5 × 106 miles for lung, 3.1 × 106 for heart, 2.2 × 106 miles for liver, and 3.2 × 106 miles for kidney. This led to increased estimated carbon emissions associated with transport ranging from: 175.7 to 193.4 kg CO2e per lung, 291.7 to 312.5 kg CO2e per heart, 114.9 to 131.7 kg CO2e per liver, and 0.2 to 5.3 kg CO2e per kidney.
Conclusions
Our findings quantify an increase in total distance traveled and potential carbon emissions after AC implementation. Environmental impacts of allocation policies should be considered, especially with upcoming continuous distribution.
{"title":"Many Moving Parts: New Transplant Allocation Models Are Associated With Increased Organ Travel and Potential Climate Implications","authors":"Kevin Gianaris, Arrey-Takor Paul Ayuk-Arrey, Jonathan A. Fridell, Katherine Ross-Driscoll","doi":"10.1111/ctr.70426","DOIUrl":"10.1111/ctr.70426","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Organ allocation has recently changed to acuity circle (AC)-based policies. This study aimed to quantify changes in travel distance and potential environmental impacts of AC policies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were obtained from the Scientific Registry of Transplant Recipients for each solid organ for an equidistant window before and after AC implementation. We calculated the distance between the donor and recipient hospital for each organ. We used an interrupted time series model to calculate excess travel distance after AC along with associated carbon emissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed travel distance for 226 731 deceased donor organs. There was a significant increase in total excess distance traveled: 1.5 × 10<sup>6</sup> miles for lung, 3.1 × 10<sup>6</sup> for heart, 2.2 × 10<sup>6</sup> miles for liver, and 3.2 × 10<sup>6</sup> miles for kidney. This led to increased estimated carbon emissions associated with transport ranging from: 175.7 to 193.4 kg CO2e per lung, 291.7 to 312.5 kg CO2e per heart, 114.9 to 131.7 kg CO2e per liver, and 0.2 to 5.3 kg CO2e per kidney.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings quantify an increase in total distance traveled and potential carbon emissions after AC implementation. Environmental impacts of allocation policies should be considered, especially with upcoming continuous distribution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12721351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henrique M. S. Proença, Lúcio Requião-Moura, Nicolas K. Melaragno, Renato D. Foresto, Jose O. Medina Pestana, Helio Tedesco-Silva
Background
Procurement kidney biopsy has been used for over two decades, yet its value in guiding graft acceptance and allocation decisions remains debated. This study evaluated the performance of procurement biopsies in predicting kidney graft function within the first-year post-transplantation.
Methods
Retrospective cohort study including 339 procurement biopsies of kidneys transplanted between May 2018 and August 2019. All biopsies were paraffin embedded, stained (H&E, PAS, Jones Silver, and Masson's Trichrome), and prospectively analyzed and deemed suitable for transplantation by an experienced renal pathologist. All biopsies were retrospectively scored according to the Banff, Remuzzi, and MAPI classifications. Logistic regression was used to identify clinical and histological variables associated with unsatisfactory graft function, defined as eGFR <30 mL/min/1.73 m2 at 3 and 12 months. Model performance was assessed using the area under the receiver operating characteristic curve (AU-ROC).
Results
Global glomerulosclerosis (Banff scoring model, OR = 1.05; p = 0.007) and KDPI (OR = 1.04; p < 0.001), and Remuzzi score of 4–6 (OR = 2.47; p = 0.007) and KDPI (OR = 1.04; p < 0.001) were associated with lower 3 months eGFR. Cortical scarring (Banff scoring model, OR = 2.79; p = 0.005) and KDPI (OR = 1.05; p < 0.001) were associated with lower 12 months eGFR as well as Remuzzi scores of 4–6 (OR = 2.30; p = 0.009) and 7–12 (OR = 5.20; p = 0.04), and KDPI (OR = 1.04; p < 0.001). The Remuzzi score and KDPI combination achieved the highest predictive performance (AU-ROC = 0.760 and 0.762 at 3 and 12 months, respectively; p < 0.001).
Conclusion
Histological findings were associated with 3 and 12 months graft function, supporting the clinical utility of procurement biopsies in combination to clinical parameters to improve risk stratification.
{"title":"Procurement Kidney Biopsy and Donor Clinical Risk as Complementary Tools to Predict 3- and 12-Month Graft Function After Transplantation","authors":"Henrique M. S. Proença, Lúcio Requião-Moura, Nicolas K. Melaragno, Renato D. Foresto, Jose O. Medina Pestana, Helio Tedesco-Silva","doi":"10.1111/ctr.70421","DOIUrl":"10.1111/ctr.70421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Procurement kidney biopsy has been used for over two decades, yet its value in guiding graft acceptance and allocation decisions remains debated. This study evaluated the performance of procurement biopsies in predicting kidney graft function within the first-year post-transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study including 339 procurement biopsies of kidneys transplanted between May 2018 and August 2019. All biopsies were paraffin embedded, stained (H&E, PAS, Jones Silver, and Masson's Trichrome), and prospectively analyzed and deemed suitable for transplantation by an experienced renal pathologist. All biopsies were retrospectively scored according to the Banff, Remuzzi, and MAPI classifications. Logistic regression was used to identify clinical and histological variables associated with unsatisfactory graft function, defined as eGFR <30 mL/min/1.73 m<sup>2</sup> at 3 and 12 months. Model performance was assessed using the area under the receiver operating characteristic curve (AU-ROC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Global glomerulosclerosis (Banff scoring model, OR = 1.05; <i>p</i> = 0.007) and KDPI (OR = 1.04; <i>p</i> < 0.001), and Remuzzi score of 4–6 (OR = 2.47; <i>p</i> = 0.007) and KDPI (OR = 1.04; <i>p</i> < 0.001) were associated with lower 3 months eGFR. Cortical scarring (Banff scoring model, OR = 2.79; <i>p</i> = 0.005) and KDPI (OR = 1.05; <i>p</i> < 0.001) were associated with lower 12 months eGFR as well as Remuzzi scores of 4–6 (OR = 2.30; <i>p</i> = 0.009) and 7–12 (OR = 5.20; <i>p</i> = 0.04), and KDPI (OR = 1.04; <i>p</i> < 0.001). The Remuzzi score and KDPI combination achieved the highest predictive performance (AU-ROC = 0.760 and 0.762 at 3 and 12 months, respectively; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Histological findings were associated with 3 and 12 months graft function, supporting the clinical utility of procurement biopsies in combination to clinical parameters to improve risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hanna L. Kleiboeker, Margaret R. Jorgenson, Michael J. Scolarici, Jillian L. Descourouez, Glen E. Leverson, Chris Saddler, Didier Mandlebrot, David Al-Adra
Background
Cytomegalovirus (CMV) is associated with morbidity and mortality after a kidney transplant (KT). Letermovir (LTV) was approved in high-risk KT recipients, providing an alternative to standard-of-care valganciclovir (VGC) associated with reduced myelosuppression.
Methods
Adult patients receiving a kidney transplant with moderate-risk CMV serostatus between 1/1/2021 and 6/6/2024 were evaluated. Patients were included in VGC or LTV cohort based on de novo prophylaxis regimen. The primary outcomes were efficacy and tolerability.
Results
Four hundred and eight KTRs met inclusion criteria: 316 received VGC, 92 received LTV. Cohorts were comparable; the majority received a primary (84.2% vs. 90.2%, p = 0.566) deceased donor (69.6% vs. 68.5%, p = 0.298) transplant with lymphocyte depleting induction (82.3% vs. 90.2%, p = 0.32). Significantly more patients in the VGC cohort required antiviral dose adjustment (61.7% vs. 1.1%, p < 0.0001). Patients in the LTV cohort were significantly more likely to complete antiviral prophylaxis (63.3% vs. 84.8%, p < 0.0001). Patients in the VGC cohort were significantly more likely to experience leukopenia (65.8% vs. 45.7%, p = 0.0006) and neutropenia (30.7% vs. 12.0%, p = 0.0002) during the first-year post-KT. Significantly more patients in the LTV cohort were on the equivalent of >1000 mg mycophenolate/day at 12 months post-KT (59.9% vs. 74.2%, p = 0.0173). Rates of CMV viremia and clinically significant disease through 1-year post-KT were comparable.
Conclusions
De novo LTV in R+ KTRs appears to be safe and effective compared to VGC. This study suggests antiviral prophylaxis is more likely to be successfully completed with LTV and requires less dose titration. Additionally, LTV appears to be associated with less myelosuppression, permitting higher mycophenolate doses at 12 months and avoiding corrective healthcare resource utilization.
背景：巨细胞病毒（CMV）与肾移植（KT）后的发病率和死亡率相关。Letermovir （LTV）被批准用于高风险KT受体，为标准治疗缬更昔洛韦（VGC）提供了一种替代方案，可降低骨髓抑制。方法：对2021年1月1日至2024年6月6日期间接受肾移植的CMV血清状态为中度危险的成年患者进行评估。根据新生预防方案将患者纳入VGC或LTV队列。主要结局是疗效和耐受性。结果：448例ktr符合纳入标准，其中VGC 316例，LTV 92例。队列具有可比性；大多数患者接受原发移植（84.2% vs. 90.2%, p = 0.566），死者供者（69.6% vs. 68.5%, p = 0.298），并诱导淋巴细胞消耗（82.3% vs. 90.2%, p = 0.32）。VGC队列中有更多的患者需要调整抗病毒剂量（61.7% vs 1.1%， p 1000 mg霉酚酸酯/天，kt后12个月）（59.9% vs 74.2%, p = 0.0173）。通过kt后1年的CMV病毒血症和临床显著疾病的发生率具有可比性。结论：与VGC相比，R+ KTRs的新生LTV似乎是安全有效的。这项研究表明抗病毒预防更有可能成功完成LTV，并且需要较少的剂量滴定。此外，LTV似乎与较少的骨髓抑制有关，允许在12个月时使用较高的霉酚酸盐剂量，并避免纠正保健资源的利用。
{"title":"De Novo Letermovir After Cytomegalovirus Seropositive Kidney Transplant Improves Toxicity and Mycophenolate Tolerance Over the Current Standard of Care","authors":"Hanna L. Kleiboeker, Margaret R. Jorgenson, Michael J. Scolarici, Jillian L. Descourouez, Glen E. Leverson, Chris Saddler, Didier Mandlebrot, David Al-Adra","doi":"10.1111/ctr.70423","DOIUrl":"10.1111/ctr.70423","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cytomegalovirus (CMV) is associated with morbidity and mortality after a kidney transplant (KT). Letermovir (LTV) was approved in high-risk KT recipients, providing an alternative to standard-of-care valganciclovir (VGC) associated with reduced myelosuppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients receiving a kidney transplant with moderate-risk CMV serostatus between 1/1/2021 and 6/6/2024 were evaluated. Patients were included in VGC or LTV cohort based on de novo prophylaxis regimen. The primary outcomes were efficacy and tolerability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred and eight KTRs met inclusion criteria: 316 received VGC, 92 received LTV. Cohorts were comparable; the majority received a primary (84.2% vs. 90.2%, <i>p</i> = 0.566) deceased donor (69.6% vs. 68.5%, <i>p</i> = 0.298) transplant with lymphocyte depleting induction (82.3% vs. 90.2%, <i>p</i> = 0.32). Significantly more patients in the VGC cohort required antiviral dose adjustment (61.7% vs. 1.1%, <i>p</i> < 0.0001). Patients in the LTV cohort were significantly more likely to complete antiviral prophylaxis (63.3% vs. 84.8%, <i>p</i> < 0.0001). Patients in the VGC cohort were significantly more likely to experience leukopenia (65.8% vs. 45.7%, <i>p</i> = 0.0006) and neutropenia (30.7% vs. 12.0%, <i>p</i> = 0.0002) during the first-year post-KT. Significantly more patients in the LTV cohort were on the equivalent of >1000 mg mycophenolate/day at 12 months post-KT (59.9% vs. 74.2%, <i>p</i> = 0.0173). Rates of CMV viremia and clinically significant disease through 1-year post-KT were comparable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>De novo LTV in R+ KTRs appears to be safe and effective compared to VGC. This study suggests antiviral prophylaxis is more likely to be successfully completed with LTV and requires less dose titration. Additionally, LTV appears to be associated with less myelosuppression, permitting higher mycophenolate doses at 12 months and avoiding corrective healthcare resource utilization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Claudia Minato, Amine Nasri, Pierre-Emmanuel Noly, Jacinthe Boulet, Marie-Claude Parent, Annik Fortier, Simon de Denus, Maxime Tremblsay-Gravel, Geneviève Giraldeau, Yoan Lamarche, Anique Ducharme
Background
Modern immunosuppressive regimens have been associated with lower rejection rates after heart transplantation (HTx), yet long-term outcomes have remained limited by drug-related complications. Since 2010, our program has implemented a protocolized corticosteroid withdrawal (CSW) strategy following induction with rabbit anti-thymocyte globulin (RATG) and methylprednisolone. The protocol consists of shifting from a high-dose regimen to a minimization approach with a goal of steroid discontinuation within 12 months.
Methods
We evaluated the impact of this approach on the combined primary endpoint of freedom from allograft rejection ISHLT ≥ 2R, infection, non-cutaneous cancer, or coronary artery vasculopathy (CAV). We conducted a retrospective single-center study including 418 HTx patients. Patients were divided according to era of HTx: Early (1983–1998); Recent (1999–02/2010), and Corticosteroid withdrawal (CSW) (03/2010-06/2018). Multivariate Cox analyses identified predictors of adverse outcomes.
Results
Five-year corticosteroid use markedly decreased over eras (Early 61, 4%, Recent 20, 3%, CSW 3, 4% at 5 years; p < 0.001). Freedom from the composite primary endpoint significantly improved with CSW (Early: HR: 3.42; 95% CI: 2.49–4.68; Recent: HR: 2.9; 95% CI: 4.1, both p < 0.0001 compared to CSW.) Only prednisone dose (HR:1.19; 95% CI: 1.09–1.30; p < 0.0001) and era of transplantation (Early vs. CSW: HR:2.70; 95% CI: 1.91–3.81; p < 0.0001; Recent vs. CSW: HR:2.38; 95% CI: 1.68–3.39; p < 0.0001) were independently associated with worse outcomes in the final multivariate Cox model. Notably, death, rejection, infection, and CAV were less frequent in the CSW era.
Conclusion
Protocolized CSW within 1 year after HTx was associated with improved long-term outcomes, including death, fewer rejection episodes, infections, and CAV. These findings support rapid steroid tapering as a safe and effective strategy in contemporary HTx.
{"title":"Rapid Corticosteroid Withdrawal After Cardiac Transplantation Improves Outcomes","authors":"Claudia Minato, Amine Nasri, Pierre-Emmanuel Noly, Jacinthe Boulet, Marie-Claude Parent, Annik Fortier, Simon de Denus, Maxime Tremblsay-Gravel, Geneviève Giraldeau, Yoan Lamarche, Anique Ducharme","doi":"10.1111/ctr.70420","DOIUrl":"10.1111/ctr.70420","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Modern immunosuppressive regimens have been associated with lower rejection rates after heart transplantation (HTx), yet long-term outcomes have remained limited by drug-related complications. Since 2010, our program has implemented a protocolized corticosteroid withdrawal (CSW) strategy following induction with rabbit anti-thymocyte globulin (RATG) and methylprednisolone. The protocol consists of shifting from a high-dose regimen to a minimization approach with a goal of steroid discontinuation within 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated the impact of this approach on the combined primary endpoint of freedom from allograft rejection ISHLT ≥ 2R, infection, non-cutaneous cancer, or coronary artery vasculopathy (CAV). We conducted a retrospective single-center study including 418 HTx patients. Patients were divided according to era of HTx: Early (1983–1998); Recent (1999–02/2010), and Corticosteroid withdrawal (CSW) (03/2010-06/2018). Multivariate Cox analyses identified predictors of adverse outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five-year corticosteroid use markedly decreased over eras (Early 61, 4%, Recent 20, 3%, CSW 3, 4% at 5 years; <i>p</i> < 0.001). Freedom from the composite primary endpoint significantly improved with CSW (Early: HR: 3.42; 95% CI: 2.49–4.68; Recent: HR: 2.9; 95% CI: 4.1, both <i>p</i> < 0.0001 compared to CSW.) Only prednisone dose (HR:1.19; 95% CI: 1.09–1.30; <i>p</i> < 0.0001) and era of transplantation (Early vs. CSW: HR:2.70; 95% CI: 1.91–3.81; <i>p</i> < 0.0001; Recent vs. CSW: HR:2.38; 95% CI: 1.68–3.39; <i>p</i> < 0.0001) were independently associated with worse outcomes in the final multivariate Cox model. Notably, death, rejection, infection, and CAV were less frequent in the CSW era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Protocolized CSW within 1 year after HTx was associated with improved long-term outcomes, including death, fewer rejection episodes, infections, and CAV. These findings support rapid steroid tapering as a safe and effective strategy in contemporary HTx.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12710205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanne J. J. Langmuur, Leonard Seghers, Rogier A. S. Hoek, Jos A. Bekkers, Maarten ter Horst, Edris A. F. Mahtab
Background
Clamshell thoracotomy is the traditional approach for bilateral sequential lung transplantation (LuTx), despite considerable morbidity. The bilateral anterolateral thoracotomy without sternal division is proposed as an alternative, less invasive method. Since this technique is more surgically challenging, the aim of this study was to evaluate the more favorable surgical approach.
Methods
Adult patients undergoing LuTx between 2010 and 2022 were included in this single-center retrospective cohort study. Multivariable regression analyses were performed to assess the effect of surgical approach on mortality, operative outcomes, and complications.
Results
A total of 249 patients (anterolateral thoracotomy: n = 132, clamshell: n = 117) were included. Recipients in the anterolateral thoracotomy group were older, on the waiting list for a shorter period of time, classified less often as highly urgent, and differed in their indications for LuTx. After multivariable correction, operating and ischemic times were longer for patients in the anterolateral thoracotomy group. However, patients with an anterolateral thoracotomy incision had less intraoperative extracorporeal circulation (ECC) use, blood loss, and need for transfusion. While survival was similar, ICU and hospital stay, and duration of mechanical ventilation were shorter. Patients in the anterolateral thoracotomy group also had significantly less wound-related complications. The use of intraoperative ECC, which was much higher in the clamshell group, seemed to play an important role in these differences in outcomes.
Conclusion
Performing LuTx through the less invasive anterolateral thoracotomy is a favorable alternative to the clamshell incision. Despite increased technical difficulty and a limited increase in operating and ischemic times, survival is similar, but the anterolateral thoracotomy patients had significantly less peri- and post-operative complications and a faster recovery.
{"title":"Anterolateral vs. Clamshell Thoracotomy for Bilateral Lung Transplantation","authors":"Sanne J. J. Langmuur, Leonard Seghers, Rogier A. S. Hoek, Jos A. Bekkers, Maarten ter Horst, Edris A. F. Mahtab","doi":"10.1111/ctr.70406","DOIUrl":"10.1111/ctr.70406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clamshell thoracotomy is the traditional approach for bilateral sequential lung transplantation (LuTx), despite considerable morbidity. The bilateral anterolateral thoracotomy without sternal division is proposed as an alternative, less invasive method. Since this technique is more surgically challenging, the aim of this study was to evaluate the more favorable surgical approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients undergoing LuTx between 2010 and 2022 were included in this single-center retrospective cohort study. Multivariable regression analyses were performed to assess the effect of surgical approach on mortality, operative outcomes, and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 249 patients (anterolateral thoracotomy: <i>n</i> = 132, clamshell: <i>n</i> = 117) were included. Recipients in the anterolateral thoracotomy group were older, on the waiting list for a shorter period of time, classified less often as highly urgent, and differed in their indications for LuTx. After multivariable correction, operating and ischemic times were longer for patients in the anterolateral thoracotomy group. However, patients with an anterolateral thoracotomy incision had less intraoperative extracorporeal circulation (ECC) use, blood loss, and need for transfusion. While survival was similar, ICU and hospital stay, and duration of mechanical ventilation were shorter. Patients in the anterolateral thoracotomy group also had significantly less wound-related complications. The use of intraoperative ECC, which was much higher in the clamshell group, seemed to play an important role in these differences in outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Performing LuTx through the less invasive anterolateral thoracotomy is a favorable alternative to the clamshell incision. Despite increased technical difficulty and a limited increase in operating and ischemic times, survival is similar, but the anterolateral thoracotomy patients had significantly less peri- and post-operative complications and a faster recovery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12710450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alberto Costa Silva, Teresa Pina-Vaz, Ana Pinho, Ana Cerqueira, Inês Ferreira, Manuela Bustorff, Susana Sampaio, Margarida Rios, Roberto Roncon Albuquerque Jr, Manuel Pestana, Carlos Martins-Silva, Tiago Antunes-Lopes, João Alturas Silva
Introduction
Vascular complications in kidney transplantation are a major concern. While kidneys from uncontrolled donation after circulatory death (uDCD) offer a viable organ source, the incidence of vascular complications in these cases remains poorly studied. This study aims to compare the vascular complications between transplants from uDCD and donation after brain death (DBD).
Methods
Between January 2016 and November 2023, we performed a prospective analysis concerning vascular complications (arterial and venous) based on kidney transplants from uDCD and DBD with standard criteria (SCD) or expanded criteria (ECD).
Results
Among the 523 kidney transplants, 142 were from uDCD and, of those, 7.0% had vascular complications comprising arterial (2.8%) and venous (4.2%) complications. The rates of vascular complications showed no significant difference between kidney transplants from uDCD and SCD (7.0% vs. 3.1%, p = 0.120) and between uDCD and ECD (7.0% vs. 8.5%, p = 0.766). Donor age over 50 years was associated with vascular complications in uDCD (p = 0.016). The incidence of delayed graft function was significantly higher in the uDCD group compared with SCD and ECD (69.7% vs. 37.6% and 43.9%, respectively; p < 0.001).
Conclusion
Vascular complication rates in uDCD transplantation were comparable to those in SCD and ECD transplants. Donor age appears to be a contributing factor to vascular complications in the uDCD setting. While these findings suggest similar outcomes, the small number of events highlights the need for larger studies.
肾移植中的血管并发症是一个重要的问题。虽然循环死亡（uDCD）后不受控制捐赠的肾脏提供了一个可行的器官来源，但这些病例中血管并发症的发生率仍未得到充分研究。本研究旨在比较脑死亡后移植与脑死亡后捐赠的血管并发症。方法：在2016年1月至2023年11月期间，我们对标准标准（SCD）或扩展标准（ECD）的uDCD和DBD肾移植的血管并发症（动脉和静脉）进行了前瞻性分析。结果：523例肾移植中，uDCD肾移植142例，其中7.0%存在血管并发症，包括动脉并发症（2.8%）和静脉并发症（4.2%）。uDCD肾移植与SCD肾移植血管并发症发生率无统计学差异（7.0% vs. 3.1%, p = 0.120）， uDCD肾移植与ECD肾移植血管并发症发生率无统计学差异（7.0% vs. 8.5%, p = 0.766）。供体年龄大于50岁与uDCD的血管并发症相关（p = 0.016）。uDCD组移植物功能延迟发生率明显高于SCD和ECD组（分别为69.7%比37.6%和43.9%,p < 0.001）。结论：uDCD移植与SCD、ECD移植的血管并发症发生率相当。供体年龄似乎是uDCD患者血管并发症的一个因素。虽然这些发现表明了类似的结果，但少数事件突出了进行更大规模研究的必要性。
{"title":"Vascular Complications Following Kidney Transplantation From Uncontrolled Donation After Circulatory Death: A Prospective Study","authors":"Alberto Costa Silva, Teresa Pina-Vaz, Ana Pinho, Ana Cerqueira, Inês Ferreira, Manuela Bustorff, Susana Sampaio, Margarida Rios, Roberto Roncon Albuquerque Jr, Manuel Pestana, Carlos Martins-Silva, Tiago Antunes-Lopes, João Alturas Silva","doi":"10.1111/ctr.70417","DOIUrl":"10.1111/ctr.70417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vascular complications in kidney transplantation are a major concern. While kidneys from uncontrolled donation after circulatory death (uDCD) offer a viable organ source, the incidence of vascular complications in these cases remains poorly studied. This study aims to compare the vascular complications between transplants from uDCD and donation after brain death (DBD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between January 2016 and November 2023, we performed a prospective analysis concerning vascular complications (arterial and venous) based on kidney transplants from uDCD and DBD with standard criteria (SCD) or expanded criteria (ECD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 523 kidney transplants, 142 were from uDCD and, of those, 7.0% had vascular complications comprising arterial (2.8%) and venous (4.2%) complications. The rates of vascular complications showed no significant difference between kidney transplants from uDCD and SCD (7.0% vs. 3.1%, <i>p</i> = 0.120) and between uDCD and ECD (7.0% vs. 8.5%, <i>p</i> = 0.766). Donor age over 50 years was associated with vascular complications in uDCD (<i>p</i> = 0.016). The incidence of delayed graft function was significantly higher in the uDCD group compared with SCD and ECD (69.7% vs. 37.6% and 43.9%, respectively; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Vascular complication rates in uDCD transplantation were comparable to those in SCD and ECD transplants. Donor age appears to be a contributing factor to vascular complications in the uDCD setting. While these findings suggest similar outcomes, the small number of events highlights the need for larger studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12710453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shivani S. Bisen, Tanveen Ishaque, Alvin G. Thomas, Madeleine M. Waldram, Daniel S. Warren, Jaclyn Bannon, Joseph R. Scalea, Dorry L. Segev, Jacqueline M. Garonzik-Wang, Allan B. Massie, Macey L. Levan
Introduction
The United States Organ Procurement and Transplantation Network mandates collection of 6-month, 1-year, and 2-year post-donation follow-up data on living kidney donors (LKDs), but many centers struggle to meet these requirements. This study investigated whether providing a financial incentive (mailed gift card) could increase patient compliance with LKD follow-up.
Methods
A parallel, non-blinded, 1:1 superiority randomized control trial of LKDs was conducted at two centers from March 2017 to February 2021. The control arm received standard of care (SOC): instructions to complete the mandated LKD follow-up consisting of a health questionnaire and laboratory measurements at 6 months, 1 year, and 2 years post-donation. The intervention arm received SOC and was mailed a $25 gift card for each timely completed follow-up. Compliance rates were compared at each timepoint using Poisson regression.
Results
A total of 175 donors consented to participate. The 6-month, 1-year, and 2-year follow-up compliance rates were 65.2%, 63%, and 65.2% in the control arm, and 71.1%, 60.2%, and 53.0% in the intervention arm, respectively. No statistically significant improvement in compliance was observed with the gift card intervention (IRR = 0.891.091.34 at 6 months, 0.760.961.21 at 1 year, and 0.630.811.05 at 2 years). Similarly, no differences were observed in compliance with clinical follow-up, laboratory follow-up, or individual questions or lab values.
Conclusion
Mailed gift cards did not improve patient compliance with LKD follow-up requirements; such interventions may be counterproductive among LKDs. Further research is needed to investigate and address barriers to completing LKD follow-up.
{"title":"A Two-Center Randomized Controlled Trial to Assess Financial Incentives for Compliance With Living Kidney Donor Follow-Up in the United States","authors":"Shivani S. Bisen, Tanveen Ishaque, Alvin G. Thomas, Madeleine M. Waldram, Daniel S. Warren, Jaclyn Bannon, Joseph R. Scalea, Dorry L. Segev, Jacqueline M. Garonzik-Wang, Allan B. Massie, Macey L. Levan","doi":"10.1111/ctr.70401","DOIUrl":"10.1111/ctr.70401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The United States Organ Procurement and Transplantation Network mandates collection of 6-month, 1-year, and 2-year post-donation follow-up data on living kidney donors (LKDs), but many centers struggle to meet these requirements. This study investigated whether providing a financial incentive (mailed gift card) could increase patient compliance with LKD follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A parallel, non-blinded, 1:1 superiority randomized control trial of LKDs was conducted at two centers from March 2017 to February 2021. The control arm received standard of care (SOC): instructions to complete the mandated LKD follow-up consisting of a health questionnaire and laboratory measurements at 6 months, 1 year, and 2 years post-donation. The intervention arm received SOC and was mailed a $25 gift card for each timely completed follow-up. Compliance rates were compared at each timepoint using Poisson regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 175 donors consented to participate. The 6-month, 1-year, and 2-year follow-up compliance rates were 65.2%, 63%, and 65.2% in the control arm, and 71.1%, 60.2%, and 53.0% in the intervention arm, respectively. No statistically significant improvement in compliance was observed with the gift card intervention (IRR = <sub>0.89</sub>1.09<sub>1.34</sub> at 6 months, <sub>0.76</sub>0.96<sub>1.21</sub> at 1 year, and <sub>0.63</sub>0.81<sub>1.05</sub> at 2 years). Similarly, no differences were observed in compliance with clinical follow-up, laboratory follow-up, or individual questions or lab values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mailed gift cards did not improve patient compliance with LKD follow-up requirements; such interventions may be counterproductive among LKDs. Further research is needed to investigate and address barriers to completing LKD follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT03090646</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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