Clinical Transplantation最新文献_第7页

Understanding Failure to Rescue in Solid Organ Transplantation: A Scoping Review 对实体器官移植抢救失败的理解：一项范围综述。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-21 DOI: 10.1111/ctr.70393

Jiro Kimura, Ayham Asassfeh, Emily Cooper, Kondragunta Rajendra Prasad, Matthew Cooper, Badi Rawashdeh

Background

The role of failure to rescue (FTR) in solid organ transplantation (SOT) is less clear. This scoping review aimed to evaluate the incidence, complications, and risk factors for FTR in SOT.

Methods

We systematically searched PubMed, Scopus, and Web of Science for studies reporting on FTR in SOT. Data on incidence, complications, risk factors, and definitions were extracted and synthesized narratively due to heterogeneity across studies.

Results

Seven studies were identified: four in liver transplantation, two in lung transplantation, and one in heart transplantation; none addressed kidney or pancreas transplantation. Definitions of FTR varied by time window, complication set, and analytic unit. Reported FTR rates ranged from 4.6% to 39.6% in liver, 19% to 26% in lung, and 11.5% in heart transplantation. Across organs, dialysis-requiring acute kidney injury (AKI) was the most frequent proximate pathway to death. Risk signals spanned patient-level factors (age, comorbidities, frailty/sarcopenia, functional status), donor factors (age, sex, race/ethnicity), and system-level factors (center volume, mortality tertile, insurance coverage). Notably, heart transplantation data revealed higher adjusted odds of FTR among Hispanic recipients.

Conclusions

Evidence on FTR in transplantation remains sparse and heterogeneous, but early findings suggest that both patient vulnerability and system capacity shape rescue outcomes, with AKI consistently emerging as a cross-organ target. Standardized definitions, multicenter analyses, and extension to kidney and pancreas transplantation are needed to establish FTR as a transplant-specific quality metric and to guide interventions that optimize rescue.

背景：抢救失败（FTR）在实体器官移植（SOT）中的作用尚不清楚。本综述旨在评估SOT患者FTR的发生率、并发症和危险因素。方法：我们系统地检索PubMed、Scopus和Web of Science关于SOT中FTR的研究报告。由于研究的异质性，我们提取并综合了关于发病率、并发症、危险因素和定义的数据。结果：确定了7项研究：4项肝移植，2项肺移植，1项心脏移植；没有涉及肾脏或胰腺移植。FTR的定义因时间窗、并发症集和分析单位而异。报道的肝移植的FTR率为4.6% - 39.6%，肺移植为19% - 26%，心脏移植为11.5%。在各个器官中，需要透析的急性肾损伤（AKI）是最常见的直接死亡途径。风险信号跨越患者层面因素（年龄、合并症、虚弱/肌肉减少症、功能状态）、供体因素（年龄、性别、种族/民族）和系统层面因素（中心容积、死亡率、保险覆盖率）。值得注意的是，心脏移植数据显示，西班牙裔受者的FTR调整几率更高。结论：移植中FTR的证据仍然稀少且不一致，但早期研究结果表明，患者易感性和系统能力共同决定了抢救结果，AKI一直是跨器官靶点。需要标准化的定义、多中心分析和扩展到肾脏和胰腺移植，以建立FTR作为移植特异性质量指标，并指导优化抢救的干预措施。

{"title":"Understanding Failure to Rescue in Solid Organ Transplantation: A Scoping Review","authors":"Jiro Kimura, Ayham Asassfeh, Emily Cooper, Kondragunta Rajendra Prasad, Matthew Cooper, Badi Rawashdeh","doi":"10.1111/ctr.70393","DOIUrl":"10.1111/ctr.70393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of failure to rescue (FTR) in solid organ transplantation (SOT) is less clear. This scoping review aimed to evaluate the incidence, complications, and risk factors for FTR in SOT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched PubMed, Scopus, and Web of Science for studies reporting on FTR in SOT. Data on incidence, complications, risk factors, and definitions were extracted and synthesized narratively due to heterogeneity across studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven studies were identified: four in liver transplantation, two in lung transplantation, and one in heart transplantation; none addressed kidney or pancreas transplantation. Definitions of FTR varied by time window, complication set, and analytic unit. Reported FTR rates ranged from 4.6% to 39.6% in liver, 19% to 26% in lung, and 11.5% in heart transplantation. Across organs, dialysis-requiring acute kidney injury (AKI) was the most frequent proximate pathway to death. Risk signals spanned patient-level factors (age, comorbidities, frailty/sarcopenia, functional status), donor factors (age, sex, race/ethnicity), and system-level factors (center volume, mortality tertile, insurance coverage). Notably, heart transplantation data revealed higher adjusted odds of FTR among Hispanic recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Evidence on FTR in transplantation remains sparse and heterogeneous, but early findings suggest that both patient vulnerability and system capacity shape rescue outcomes, with AKI consistently emerging as a cross-organ target. Standardized definitions, multicenter analyses, and extension to kidney and pancreas transplantation are needed to establish FTR as a transplant-specific quality metric and to guide interventions that optimize rescue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Utilization of Pediatric En Bloc Kidneys from Donation After Cardio-Circulatory Determination of Death: 15 Years of Experience 心肺功能确定死亡后儿童整体肾脏的使用：15年的经验。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-21 DOI: 10.1111/ctr.70397

Lucia De Gregorio, Oswaldo Aguirre, Gianna Mladenova, Luis Fernandez, Raquel Garcia-Roca

Introduction

Despite the efforts by the Organ Procurement and Transplantation Network (OPTN) to improve utilization of organs from very small pediatric donors, en bloc kidney grafts are still disproportionately discarded. Although associated with increased technical complications, en bloc kidney transplants achieve excellent graft function and longevity. We present our single-center experience with en bloc kidney transplants in adult recipients and compare outcomes between donation after cardio-circulatory death (DCD) and brain death/death by neurologic criteria (BD/DNC) organs.

Methods

Retrospective analysis was completed of all en bloc kidney transplants performed at a single-center academic transplant program, between 2008 and 2023. Two groups were defined according to the type of pediatric donor: DCD or BD/DNC. Demographic data, clinical variables, postoperative complications, and survival outcomes were compared between both groups.

Results

Forty-two adult recipients received pediatric en bloc kidneys, 11 of these from DCD donors. The DGF rate was higher for DCD en bloc kidneys (27% vs. 16% for BD/DNC); however, this difference was not statistically significant. Nearly one third of patients required re-operation during the index transplant admission (28.6%). Four grafts were lost secondary to thrombosis −4(10%). Urological complications occurred in 9.5% of cases. Nevertheless, technical complications were not statistically different between both groups. Patient and graft survival rates were excellent in both groups. All recipients sustained serum creatinine values below 1 mg/dL beyond the first year post-transplant.

Conclusion

Although en bloc kidney transplantation of pediatric en bloc kidneys can be associated with greater rates of technical complications, these grafts can lead to excellent graft function and patient longevity. Diligent patient selection and an experienced surgical team are paramount to optimize the outcomes of en bloc kidney transplants.

尽管器官获取和移植网络（OPTN）努力提高来自非常小的儿童供体的器官的利用率，但整体肾脏移植仍然不成比例地被丢弃。尽管与技术并发症增加有关，整体肾移植获得了良好的移植物功能和寿命。我们介绍了成人肾移植整体移植的单中心经验，并通过神经系统标准（BD/DNC）器官比较了心血管死亡（DCD）和脑死亡/死亡后捐赠的结果。方法：回顾性分析2008年至2023年间在单中心学术移植项目中进行的所有整体肾移植。根据儿童供体类型分为两组：DCD或BD/DNC。比较两组的人口学数据、临床变量、术后并发症和生存结果。结果：42名成人受者接受了儿童整体肾脏，其中11名来自DCD供者。DCD组的DGF率更高（27% vs. BD/DNC组的16%）；然而，这种差异在统计学上并不显著。近三分之一的患者在指数移植入院时需要再次手术（28.6%）。4个移植物因血栓形成而丢失-4（10%）。9.5%的病例出现泌尿系统并发症。然而，技术并发症在两组之间没有统计学差异。两组患者和移植物存活率均极好。移植后一年后，所有受者的血清肌酐值均低于1 mg/dL。结论：尽管儿童整体肾移植可能与更高的技术并发症发生率相关，但这些移植物可以带来良好的移植物功能和患者寿命。勤奋的患者选择和经验丰富的手术团队是优化整体肾移植结果的关键。

{"title":"Utilization of Pediatric En Bloc Kidneys from Donation After Cardio-Circulatory Determination of Death: 15 Years of Experience","authors":"Lucia De Gregorio, Oswaldo Aguirre, Gianna Mladenova, Luis Fernandez, Raquel Garcia-Roca","doi":"10.1111/ctr.70397","DOIUrl":"10.1111/ctr.70397","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite the efforts by the Organ Procurement and Transplantation Network (OPTN) to improve utilization of organs from very small pediatric donors, en bloc kidney grafts are still disproportionately discarded. Although associated with increased technical complications, en bloc kidney transplants achieve excellent graft function and longevity. We present our single-center experience with en bloc kidney transplants in adult recipients and compare outcomes between donation after cardio-circulatory death (DCD) and brain death/death by neurologic criteria (BD/DNC) organs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective analysis was completed of all en bloc kidney transplants performed at a single-center academic transplant program, between 2008 and 2023. Two groups were defined according to the type of pediatric donor: DCD or BD/DNC. Demographic data, clinical variables, postoperative complications, and survival outcomes were compared between both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-two adult recipients received pediatric en bloc kidneys, 11 of these from DCD donors. The DGF rate was higher for DCD en bloc kidneys (27% vs. 16% for BD/DNC); however, this difference was not statistically significant. Nearly one third of patients required re-operation during the index transplant admission (28.6%). Four grafts were lost secondary to thrombosis −4(10%). Urological complications occurred in 9.5% of cases. Nevertheless, technical complications were not statistically different between both groups. Patient and graft survival rates were excellent in both groups. All recipients sustained serum creatinine values below 1 mg/dL beyond the first year post-transplant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although en bloc kidney transplantation of pediatric en bloc kidneys can be associated with greater rates of technical complications, these grafts can lead to excellent graft function and patient longevity. Diligent patient selection and an experienced surgical team are paramount to optimize the outcomes of en bloc kidney transplants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessment of Donor-Specific Human Leukocyte Antigen Antibodies Following Pediatric Liver Transplantation: Predictors, Protectors, and Clinical Relevance 儿童肝移植后供体特异性人白细胞抗原抗体的评估：预测因子、保护因子和临床相关性。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-21 DOI: 10.1111/ctr.70390

Evelien Kanaan, Sinja Ohlsson, Simone Kathemann, Benas Prusinskas, Sofia Tsaka, Falko M. Heinemann, Andreas Heinold, Maren Schulze, Lars Pape, Elke Lainka

Background

Following pediatric liver transplantation (pLT), the significance and management of donor-specific antibodies (DSA) against human leukocyte antigen (HLA) remain undefined. The aim of this single-center study was to investigate the occurrence of DSA, their clinical impact on predictors for and protectors against DSA.

Patients and Methods

We compared anti-HLA DSA (cutoff for mean fluorescence intensity (MFI) ≥ 1000), clinical and laboratory results and outcome in a routine (RG, n = 142, standard DSA testing) and a hepatopathy group (HG, n = 19, DSA testing following indeterminate hepatopathy) in 161 pLT patients, treated 2000–2021, retrospectively.

Results

40% of RG and 32% of HG patients were DSA+ (39% of all patients, of which 13% with antibody-mediated rejection [AMR]). Most frequent DSA subtypes were HLA-DQ3, -DQ1, -DQ2 in RG and HLA-DQ2, -DR15 in HG. MFI was higher for anti-HLA II DSA (15 257 DSA+ vs. 5500 DSA−, p = 0.003), especially with AMR (21 000 DSA+ with AMR vs. 14 584 DSA+ without AMR, p = 0.042). Predictors for DSA included age at pLT, re-pLT, and cystic fibrosis. Living donation and cold ischemia time <8 h appeared to offer protection. Graft survival was poorer with DSA (RG 78% DSA+ vs. 97% DSA−, p = 0.018, HG 67% DSA+ vs. 100% DSA−, p = 0.0007). Patient survival was 97% for the entire cohort.

Conclusions

DSA were detectable in 39% and associated with AMR in 13% of children post-pLT in addition to worse graft survival in all patients. Patient survival of 97% was not influenced. Potential DSA and predictors and protectors were identified. Therefore, DSA diagnostics are recommended after pLT.

背景：在儿童肝移植（pLT）后，供体特异性抗体（DSA）对抗人类白细胞抗原（HLA）的意义和管理仍不明确。这项单中心研究的目的是调查DSA的发生，它们对DSA预测因子和预防因子的临床影响。患者和方法：我们回顾性比较了2000-2021年治疗的161例pLT患者的常规（RG, n = 142，标准DSA检测）和肝病组（HG, n = 19，不确定肝病后DSA检测）的抗hla DSA（平均荧光强度(MFI)≥1000的截止值）、临床和实验室结果和预后。结果：40%的RG患者和32%的HG患者为DSA+（占所有患者的39%，其中13%为抗体介导的排斥反应[AMR]）。最常见的DSA亚型为RG中的HLA-DQ3、- dq1、- dq2和HG中的HLA-DQ2、- dr15。抗hla - II DSA的MFI较高（15 257个DSA+ vs 5500个DSA-， p = 0.003），尤其是AMR（21 000个AMR + vs 14 584个AMR +， p = 0.042）。DSA的预测因素包括pLT年龄、再pLT年龄和囊性纤维化。结论：39%的plt后儿童检测到DSA， 13%的plt后儿童与AMR相关，所有患者的移植物存活率均较差。97%的患者生存率未受影响。确定了潜在的DSA、预测因子和保护因子。因此，建议在pLT后进行DSA诊断。

{"title":"Assessment of Donor-Specific Human Leukocyte Antigen Antibodies Following Pediatric Liver Transplantation: Predictors, Protectors, and Clinical Relevance","authors":"Evelien Kanaan, Sinja Ohlsson, Simone Kathemann, Benas Prusinskas, Sofia Tsaka, Falko M. Heinemann, Andreas Heinold, Maren Schulze, Lars Pape, Elke Lainka","doi":"10.1111/ctr.70390","DOIUrl":"10.1111/ctr.70390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Following pediatric liver transplantation (pLT), the significance and management of donor-specific antibodies (DSA) against human leukocyte antigen (HLA) remain undefined. The aim of this single-center study was to investigate the occurrence of DSA, their clinical impact on predictors for and protectors against DSA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We compared anti-HLA DSA (cutoff for mean fluorescence intensity (MFI) ≥ 1000), clinical and laboratory results and outcome in a routine (RG, <i>n</i> = 142, standard DSA testing) and a hepatopathy group (HG, <i>n</i> = 19, DSA testing following indeterminate hepatopathy) in 161 pLT patients, treated 2000–2021, retrospectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>40% of RG and 32% of HG patients were DSA+ (39% of all patients, of which 13% with antibody-mediated rejection [AMR]). Most frequent DSA subtypes were HLA-DQ3, -DQ1, -DQ2 in RG and HLA-DQ2, -DR15 in HG. MFI was higher for anti-HLA II DSA (15 257 DSA+ vs. 5500 DSA−, <i>p </i>= 0.003), especially with AMR (21 000 DSA+ with AMR vs. 14 584 DSA+ without AMR, <i>p </i>= 0.042). Predictors for DSA included age at pLT, re-pLT, and cystic fibrosis. Living donation and cold ischemia time <8 h appeared to offer protection. Graft survival was poorer with DSA (RG 78% DSA+ vs. 97% DSA−, <i>p </i>= 0.018, HG 67% DSA+ vs. 100% DSA−, <i>p </i>= 0.0007). Patient survival was 97% for the entire cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DSA were detectable in 39% and associated with AMR in 13% of children post-pLT in addition to worse graft survival in all patients. Patient survival of 97% was not influenced. Potential DSA and predictors and protectors were identified. Therefore, DSA diagnostics are recommended after pLT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Physical Domains, Access to Kidney Transplantation, and Waitlist Mortality 物理领域，获得肾移植和等候名单死亡率。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-20 DOI: 10.1111/ctr.70388

Nan-Su Huang, Jingyao Hong, Akanksha Nalatwad, Yiting Li, Nidhi Ghildayal, Nicole M. Ali, Aarti Mathur, Babak J. Orandi, Dorry L. Segev, Mara A. McAdams-DeMarco

Background

Frail kidney transplant (KT) candidates, characterized by low physical activity/function, have decreased chances of listing and increased risk of waitlist mortality. Impairments in these physical domains contribute to perceived physical burden and may exacerbate one another. Further, understanding the association of each domain individually with adverse outcomes may improve pre-KT risk stratification.

Methods

We leveraged 2708 KT candidates (age ≥ 18) from a two-center prospective cohort study (2014–2024). We assessed physical activity (Minnesota Leisure Time Physical Activity Questionnaire), physical function (gait speed), and physical burden (10 questions from the Kidney Disease Quality of Life Short Form) at evaluation. We quantified the association of these three physical domains with listing (Cox proportional hazards) and waitlist mortality (competing risks, Harrell's C-statistic).

Results

Among 2708 candidates, 40% had low physical activity, 16% had low physical function, and 54% had high physical burden. Candidates with impairment in these three physical domains were less likely to be listed (activity: adjusted hazard ratio [aHR] = 0.86, 95% confidence interval [CI]: 0.75–0.99; function: aHR = 0.54, 95%CI: 0.45–0.64; burden: aHR = 0.75, 95%CI: 0.67–0.83) and had a higher risk of waitlist mortality (activity: adjusted sub-hazard ratio [aSHR] = 1.51, 95%CI: 1.11–2.04; function: aSHR = 1.83, 95%CI: 1.30–2.58; burden: aSHR = 1.40, 95%CI: 1.09–1.82). Physical burden showed the best discrimination in predicting mortality after adjustment (Harrell's C-statistic = 0.6899).

Conclusion

Although impairment in physical activity, function, and burden was all associated with KT listing and waitlist mortality, physical burden was the strongest predictor of waitlist mortality. KT centers should consider measuring physical burden – a simple, low-cost tool to help identify high-risk candidates for prehabilitation.

背景：虚弱肾移植（KT）候选者，以低体力活动/功能为特征，其入选的机会减少，等待名单死亡的风险增加。这些身体领域的损伤会造成感知到的身体负担，并可能相互加剧。此外，单独了解每个领域与不良后果的关联可能会改善kt前的风险分层。方法：我们从一项双中心前瞻性队列研究（2014-2024）中选取2708名年龄≥18岁的KT候选人。我们在评估时评估了身体活动（明尼苏达州休闲时间身体活动问卷）、身体功能（步态速度）和身体负担（来自肾脏疾病生活质量简短表格的10个问题）。我们量化了这三个物理域与列表（Cox比例风险）和等待列表死亡率（竞争风险，Harrell c统计）的关联。结果：2708名考生中体力活动量低的占40%，体力功能低的占16%，体力负担高的占54%。在这三个身体领域有缺陷的候选人不太可能被列入候补名单（活动：调整风险比[aHR] = 0.86, 95%置信区间[CI]: 0.75-0.99；功能：调整风险比[aHR] = 0.54, 95%CI: 0.45-0.64；负担：aHR = 0.75, 95%CI: 0.67-0.83），并且有较高的死亡风险（活动：调整亚风险比[aSHR] = 1.51, 95%CI: 1.11-2.04；功能：调整亚风险比[aSHR] = 1.83, 95%CI: 1.30-2.58；负担：调整亚风险比[aSHR] = 1.40, 95%CI: 1.09-1.82）。身体负担在预测调整后死亡率方面具有最好的判别性（Harrell’sc统计量= 0.6899）。结论：虽然身体活动、功能和负担的损害都与KT名单和等候名单死亡率有关，但身体负担是等候名单死亡率的最强预测因子。KT中心应该考虑测量身体负担，这是一种简单、低成本的工具，可以帮助识别高危的康复候选人。

{"title":"Physical Domains, Access to Kidney Transplantation, and Waitlist Mortality","authors":"Nan-Su Huang, Jingyao Hong, Akanksha Nalatwad, Yiting Li, Nidhi Ghildayal, Nicole M. Ali, Aarti Mathur, Babak J. Orandi, Dorry L. Segev, Mara A. McAdams-DeMarco","doi":"10.1111/ctr.70388","DOIUrl":"10.1111/ctr.70388","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Frail kidney transplant (KT) candidates, characterized by low physical activity/function, have decreased chances of listing and increased risk of waitlist mortality. Impairments in these physical domains contribute to perceived physical burden and may exacerbate one another. Further, understanding the association of each domain individually with adverse outcomes may improve pre-KT risk stratification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We leveraged 2708 KT candidates (age ≥ 18) from a two-center prospective cohort study (2014–2024). We assessed physical activity (Minnesota Leisure Time Physical Activity Questionnaire), physical function (gait speed), and physical burden (10 questions from the Kidney Disease Quality of Life Short Form) at evaluation. We quantified the association of these three physical domains with listing (Cox proportional hazards) and waitlist mortality (competing risks, Harrell's <i>C</i>-statistic).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2708 candidates, 40% had low physical activity, 16% had low physical function, and 54% had high physical burden. Candidates with impairment in these three physical domains were less likely to be listed (activity: adjusted hazard ratio [aHR] = 0.86, 95% confidence interval [CI]: 0.75–0.99; function: aHR = 0.54, 95%CI: 0.45–0.64; burden: aHR = 0.75, 95%CI: 0.67–0.83) and had a higher risk of waitlist mortality (activity: adjusted sub-hazard ratio [aSHR] = 1.51, 95%CI: 1.11–2.04; function: aSHR = 1.83, 95%CI: 1.30–2.58; burden: aSHR = 1.40, 95%CI: 1.09–1.82). Physical burden showed the best discrimination in predicting mortality after adjustment (Harrell's <i>C</i>-statistic = 0.6899).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although impairment in physical activity, function, and burden was all associated with KT listing and waitlist mortality, physical burden was the strongest predictor of waitlist mortality. KT centers should consider measuring physical burden – a simple, low-cost tool to help identify high-risk candidates for prehabilitation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimizing Heparin Induced Thrombocytopenia Risk Assessment: Investigating the Role of the 4Ts Score After Lung Transplantation 优化肝素诱导的血小板减少风险评估：探讨肺移植后4Ts评分的作用。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-20 DOI: 10.1111/ctr.70396

Nicole Unwin, Kellie J. Goodlet, Josna Padiyar, Sofya Tokman, Christine Pham, Rhiannon Garcia

Background

Heparin induced thrombocytopenia (HIT) is often suspected among lung transplant recipients (LTRs) due to a high prevalence of thrombocytopenia and frequent heparin use. This study explores the utility of the 4Ts score in stratifying HIT risk among adult LTRs.

Methods

LTRs from a single large transplant center with post-transplant platelet factor 4 (PF4) antibody testing between January 2020 and June 2024 were included in the analysis. The 4Ts score was calculated retrospectively, and the risk of HIT was classified as low (4Ts score ≤3), intermediate (4–5), or high (≥6). The 4Ts risk classification was correlated with HIT laboratory testing results, with a positive serotonin release assay (SRA) representing confirmed HIT.

Results

A total of 205 LTRs were included. The median 4Ts score was 2 (IQR 2–4), 153 patients (74.6%) were classified as low risk, and 52 (25.4%) were intermediate or high risk. Among low-risk patients, none had confirmed HIT. In contrast, among intermediate or high-risk patients, six had HIT (11.5%), representing an overall incidence of 2.9%. Using a low 4Ts score to rule out HIT would have averted 153 PF4 tests (75% of total), 17 SRA tests (50% of total), and nine orders for direct thrombin inhibitors (53% of total).

Conclusion

A low 4Ts score ruled out HIT among LTRs at our large transplant center. Incorporating the 4Ts clinical risk assessment into the diagnostic process may help avoid unnecessary HIT testing and use of alternative anticoagulation.

背景：肝素诱发的血小板减少症（HIT）在肺移植受者（ltr）中经常被怀疑是由于高患病率的血小板减少症和频繁使用肝素。本研究探讨了4Ts评分对成人ltr中HIT风险分层的效用。方法：分析2020年1月至2024年6月间单个大型移植中心移植后血小板因子4 （PF4）抗体检测的ltr。回顾性计算4Ts评分，HIT风险分为低（4Ts评分≤3）、中（4-5）和高（≥6）。4Ts风险分类与HIT实验室检测结果相关，血清素释放试验（SRA）阳性代表HIT确诊。结果：共纳入ltr 205例。4Ts评分中位数为2 (IQR 2-4)， 153例（74.6%）为低危，52例（25.4%）为中危或高危。在低风险患者中，没有人确诊HIT。相比之下，在中高危患者中，有6例HIT(11.5%)，总发病率为2.9%。使用低4Ts评分来排除HIT可以避免153次PF4试验（占总数的75%），17次SRA试验（占总数的50%）和9次直接凝血酶抑制剂试验（占总数的53%）。结论：在我们的大型移植中心，低4Ts评分排除了ltr中HIT的可能性。将4Ts临床风险评估纳入诊断过程可能有助于避免不必要的HIT测试和使用替代抗凝剂。

{"title":"Optimizing Heparin Induced Thrombocytopenia Risk Assessment: Investigating the Role of the 4Ts Score After Lung Transplantation","authors":"Nicole Unwin, Kellie J. Goodlet, Josna Padiyar, Sofya Tokman, Christine Pham, Rhiannon Garcia","doi":"10.1111/ctr.70396","DOIUrl":"10.1111/ctr.70396","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heparin induced thrombocytopenia (HIT) is often suspected among lung transplant recipients (LTRs) due to a high prevalence of thrombocytopenia and frequent heparin use. This study explores the utility of the 4Ts score in stratifying HIT risk among adult LTRs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>LTRs from a single large transplant center with post-transplant platelet factor 4 (PF4) antibody testing between January 2020 and June 2024 were included in the analysis. The 4Ts score was calculated retrospectively, and the risk of HIT was classified as low (4Ts score ≤3), intermediate (4–5), or high (≥6). The 4Ts risk classification was correlated with HIT laboratory testing results, with a positive serotonin release assay (SRA) representing confirmed HIT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 205 LTRs were included. The median 4Ts score was 2 (IQR 2–4), 153 patients (74.6%) were classified as low risk, and 52 (25.4%) were intermediate or high risk. Among low-risk patients, none had confirmed HIT. In contrast, among intermediate or high-risk patients, six had HIT (11.5%), representing an overall incidence of 2.9%. Using a low 4Ts score to rule out HIT would have averted 153 PF4 tests (75% of total), 17 SRA tests (50% of total), and nine orders for direct thrombin inhibitors (53% of total).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A low 4Ts score ruled out HIT among LTRs at our large transplant center. Incorporating the 4Ts clinical risk assessment into the diagnostic process may help avoid unnecessary HIT testing and use of alternative anticoagulation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Emerging National Trends in Normothermic Regional Perfusion for Simultaneous Pancreas–Kidney Transplantation 同时进行胰肾联合移植的常温区域灌注的新兴国家趋势。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-19 DOI: 10.1111/ctr.70389

Raphaël M. J. Fischer, Nicolas Muñoz, Olivia Ong, Peter L. Abt, Angelika C. Gruessner, Ronald F. Parsons

Background

Normothermic regional perfusion (NRP) is rapidly gaining adoption for donation after cardiac death (DCD) organ recovery in the United States. However, little is known about trends in NRP procured grafts for simultaneous pancreas–kidney transplantation (SPK).

Design

SPK recipients between January 2021 and June 2025 were identified using the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN) national data.

Patients

DCD-SPK donors and recipients were included and grouped by recovery method.

Measurements

Donor and recipient demographic data were described. Primary outcomes were pancreas and kidney graft survival at 1 year, evaluated with Kaplan–Meier survival curves. Kidney outcomes included delayed graft function and creatinine levels.

Results

A total of 137 DCD SPKs were included, with NRP and super-rapid recovery (SRR) performed in 33 (24%) and 104 (76%) of donors, respectively. Donors in the NRP group were older (28 [22–34] vs. 22 [18–29], p < 0.05) and had a longer withdrawal-to-death time (22 [18–24] vs. 18 [15–22], p < 0.05). Recipients in the NRP group were younger (38 [35–46] vs. 48 [39-55], p < 0.05), more frequently transplanted for Type 1 diabetes, and had worse functional status at the time of transplant. NRP was associated with lower rates of delayed kidney graft function (6% vs. 33%, p < 0.05) and a trend toward lower 6-month creatinine (1.1 vs. 1.3 mg/dL, p = 0.054), with similar 1-year values. One-year pancreas and kidney graft survival following NRP were 91% and 100%, respectively.

Conclusions

Since the introduction of NRP, 24% of the DCD-SPK grafts were procured with NRP. Comparable 1-year kidney and pancreas graft survival between SRR and NRP with lower rates of kidney dysfunction following NRP.

背景：在美国，常温区域灌注（NRP）正迅速被用于心脏死亡（DCD）器官恢复后的捐赠。然而，对于同时胰肾移植（SPK）中NRP获得的移植物的趋势知之甚少。设计：使用联合器官共享网络(UNOS)/器官获取和移植网络（OPTN）的国家数据确定2021年1月至2025年6月之间的SPK接受者。患者：纳入DCD-SPK供体和受体，按恢复方式分组。测量方法：描述了供体和受体的人口统计数据。主要结果是胰腺和肾脏移植1年生存率，用Kaplan-Meier生存曲线进行评估。肾脏预后包括移植物功能和肌酐水平的延迟。结果：共纳入137例DCD SPKs，分别对33例（24%）和104例（76%）供者进行了NRP和超快速恢复（SRR）。NRP组的供体年龄较大（28岁[22-34]vs. 22岁[18-29]）。结论：自引入NRP以来，24%的DCD-SPK移植是使用NRP获得的。SRR和NRP的1年肾脏和胰腺移植存活率比较，NRP后肾功能不全率较低。

{"title":"Emerging National Trends in Normothermic Regional Perfusion for Simultaneous Pancreas–Kidney Transplantation","authors":"Raphaël M. J. Fischer, Nicolas Muñoz, Olivia Ong, Peter L. Abt, Angelika C. Gruessner, Ronald F. Parsons","doi":"10.1111/ctr.70389","DOIUrl":"10.1111/ctr.70389","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Normothermic regional perfusion (NRP) is rapidly gaining adoption for donation after cardiac death (DCD) organ recovery in the United States. However, little is known about trends in NRP procured grafts for simultaneous pancreas–kidney transplantation (SPK).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>SPK recipients between January 2021 and June 2025 were identified using the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN) national data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>DCD-SPK donors and recipients were included and grouped by recovery method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Donor and recipient demographic data were described. Primary outcomes were pancreas and kidney graft survival at 1 year, evaluated with Kaplan–Meier survival curves. Kidney outcomes included delayed graft function and creatinine levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 137 DCD SPKs were included, with NRP and super-rapid recovery (SRR) performed in 33 (24%) and 104 (76%) of donors, respectively. Donors in the NRP group were older (28 [22–34] vs. 22 [18–29], <i>p</i> < 0.05) and had a longer withdrawal-to-death time (22 [18–24] vs. 18 [15–22], <i>p</i> < 0.05). Recipients in the NRP group were younger (38 [35–46] vs. 48 [39-55], <i>p</i> < 0.05), more frequently transplanted for Type 1 diabetes, and had worse functional status at the time of transplant. NRP was associated with lower rates of delayed kidney graft function (6% vs. 33%, <i>p</i> < 0.05) and a trend toward lower 6-month creatinine (1.1 vs. 1.3 mg/dL, <i>p</i> = 0.054), with similar 1-year values. One-year pancreas and kidney graft survival following NRP were 91% and 100%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Since the introduction of NRP, 24% of the DCD-SPK grafts were procured with NRP. Comparable 1-year kidney and pancreas graft survival between SRR and NRP with lower rates of kidney dysfunction following NRP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dr. Clyde F. Barker (1932–2025) 克莱德·巴克博士（1932-2025）。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-19 DOI: 10.1111/ctr.70386

Ali Naji

引用次数: 0

Impact of Academic Background on Early Hospital Readmission and Graft Survival After Liver Transplantation: A Single-Center Experience in Ohio 学术背景对肝移植术后早期再入院和移植物存活的影响：俄亥俄州的单中心研究

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-18 DOI: 10.1111/ctr.70392

Ayato Obana, Miho Akabane, Hannah Chi, Nolan Ladd, Andrew Nguyen, Lin Abigail Tan, Rithin Punjala, Kejal Shah, Matthew Hamilton, Ashley Limkemann, Musab Alebrahim, Khalid Mumtaz, Austin Schenk, Sylvester Black, Kenneth Washburn, Navdeep Singh

Introduction

Most studies on socioeconomic factors in liver transplantation (LT) rely on national databases without considering regional characteristics. This study uniquely investigated how educational attainment, income, and insurance status simultaneously impact early readmission and graft survival among LT recipients at a single center in Ohio, accounting for county-level characteristics.

Methods

This retrospective observational cohort study included 782 adult primary orthotopic LT recipients at Ohio State University Wexner Medical Center (2016–2023). Educational attainment was stratified into high, intermediate, and low levels. Income was estimated from county-level census data. Insurance status was categorized as private or public. Graft survival (GS) and 30-day readmission were analyzed using Kaplan–Meier methodology and multivariate regression.

Results

Higher education correlated with higher income (p < 0.001) and lower BMI (p = 0.04). Three-year GS rates were 92.7%, 88.6%, and 86.0% for high, intermediate, and low educational groups, respectively (high vs. low, p = 0.01). Private insurance showed superior GS compared to public insurance (90.2% vs. 83.5%, p = 0.02). Multivariate analysis identified low education (HR: 1.61, 95% CI: 1.01–2.59, p = 0.047 with high educational level as reference) as an independent risk factor for graft failure. The high educational group had significantly lower 30-day readmission rates compared to the intermediate group (27.4% vs. 37.0%, p = 0.047).

Conclusion

By focusing exclusively on Ohio's population and comprehensively analyzing multiple socioeconomic factors simultaneously, this study demonstrates that educational attainment independently influences post-LT outcomes. Patients with lower educational backgrounds may benefit from enhanced post-discharge education and more intensive follow-up.

大多数关于肝移植（LT）社会经济因素的研究依赖于国家数据库，而没有考虑区域特征。本研究独特地调查了教育程度、收入和保险状况如何同时影响俄亥俄州单一中心的肝移植受者的早期再入院和移植存活率，并考虑了县级特征。方法：这项回顾性观察队列研究纳入了2016-2023年在俄亥俄州立大学韦克斯纳医学中心接受原位肝移植的782名成人。受教育程度被分为高、中、低三个层次。收入是根据县级人口普查数据估算的。保险状况分为私人保险和公共保险。采用Kaplan-Meier方法和多元回归分析移植物存活（GS）和30天再入院情况。结果：高等教育与高收入相关(p)结论：本研究仅以俄亥俄州人口为研究对象，同时综合分析了多种社会经济因素，表明受教育程度独立影响了lt后的预后。教育程度较低的患者可能从加强出院后教育和更深入的随访中受益。

{"title":"Impact of Academic Background on Early Hospital Readmission and Graft Survival After Liver Transplantation: A Single-Center Experience in Ohio","authors":"Ayato Obana, Miho Akabane, Hannah Chi, Nolan Ladd, Andrew Nguyen, Lin Abigail Tan, Rithin Punjala, Kejal Shah, Matthew Hamilton, Ashley Limkemann, Musab Alebrahim, Khalid Mumtaz, Austin Schenk, Sylvester Black, Kenneth Washburn, Navdeep Singh","doi":"10.1111/ctr.70392","DOIUrl":"10.1111/ctr.70392","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Most studies on socioeconomic factors in liver transplantation (LT) rely on national databases without considering regional characteristics. This study uniquely investigated how educational attainment, income, and insurance status simultaneously impact early readmission and graft survival among LT recipients at a single center in Ohio, accounting for county-level characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational cohort study included 782 adult primary orthotopic LT recipients at Ohio State University Wexner Medical Center (2016–2023). Educational attainment was stratified into high, intermediate, and low levels. Income was estimated from county-level census data. Insurance status was categorized as private or public. Graft survival (GS) and 30-day readmission were analyzed using Kaplan–Meier methodology and multivariate regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher education correlated with higher income (<i>p</i> < 0.001) and lower BMI (<i>p</i> = 0.04). Three-year GS rates were 92.7%, 88.6%, and 86.0% for high, intermediate, and low educational groups, respectively (high vs. low, <i>p</i> = 0.01). Private insurance showed superior GS compared to public insurance (90.2% vs. 83.5%, <i>p</i> = 0.02). Multivariate analysis identified low education (HR: 1.61, 95% CI: 1.01–2.59, <i>p</i> = 0.047 with high educational level as reference) as an independent risk factor for graft failure. The high educational group had significantly lower 30-day readmission rates compared to the intermediate group (27.4% vs. 37.0%, <i>p</i> = 0.047).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By focusing exclusively on Ohio's population and comprehensively analyzing multiple socioeconomic factors simultaneously, this study demonstrates that educational attainment independently influences post-LT outcomes. Patients with lower educational backgrounds may benefit from enhanced post-discharge education and more intensive follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145539399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Correlation Between Health Literacy and Tacrolimus Variability in Solid Organ Transplant Recipients 实体器官移植受者健康素养与他克莫司变异性的相关性

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-18 DOI: 10.1111/ctr.70304

Astrid Bacle, Pauline Blanc-Petitjean, Elouan Demay, Sarah Pelletier, Virginie Migeot, Marie-Claude Langevin, Jean-Philippe Adam

Background

Adherence to immunosuppressive therapy is crucial for successful outcomes in solid organ transplantation. Tacrolimus intra-patient variability (%CV) is a validated marker of adherence and has been associated with graft outcomes. Health literacy (HL), a modifiable factor, may influence this variability, but its role remains unexplored.

Methods

We conducted a prospective observational study including adult kidney, liver, and lung transplant recipients receiving tacrolimus. HL was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA); a score <23 indicated insufficient HL. Tacrolimus %CV was calculated over 6 months post-discharge. Linear regression models, adjusted for sociodemographic variables, evaluated the association between HL and %CV.

Results

Ninety-eight patients were included (kidney: n = 38, liver: n = 24, lung: n = 36). Patients with insufficient HL had higher %CV than those with sufficient HL (31.5% vs. 16.1%, p < 0.05). HL remained independently associated with %CV after adjusting for age and transplant type (β = −1.60, SE = 0.17, p < 0.05). The final model explained 53% of %CV variability.

Conclusions

HL is independently associated with tacrolimus variability. HL screening and targeted educational interventions may help improve medication stability and long-term transplant outcomes.

背景：坚持免疫抑制治疗是实体器官移植成功的关键。他克莫司患者内变异性（%CV）是一种有效的依从性标记，与移植结果相关。健康素养（HL）是一个可改变的因素，可能会影响这种可变性，但其作用仍未得到探索。方法：我们进行了一项前瞻性观察研究，包括接受他克莫司治疗的成人肾、肝和肺移植受者。使用成人功能健康素养短测试（S-TOFHLA）评估HL；结果：共纳入98例患者（肾：38例，肝：24例，肺：36例）。HL不足患者的%CV高于HL充足患者（31.5% vs. 16.1%, p）。结论：HL与他克莫司变异性独立相关。HL筛查和有针对性的教育干预可能有助于改善药物稳定性和长期移植结果。

{"title":"Correlation Between Health Literacy and Tacrolimus Variability in Solid Organ Transplant Recipients","authors":"Astrid Bacle, Pauline Blanc-Petitjean, Elouan Demay, Sarah Pelletier, Virginie Migeot, Marie-Claude Langevin, Jean-Philippe Adam","doi":"10.1111/ctr.70304","DOIUrl":"10.1111/ctr.70304","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Adherence to immunosuppressive therapy is crucial for successful outcomes in solid organ transplantation. Tacrolimus intra-patient variability (%CV) is a validated marker of adherence and has been associated with graft outcomes. Health literacy (HL), a modifiable factor, may influence this variability, but its role remains unexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective observational study including adult kidney, liver, and lung transplant recipients receiving tacrolimus. HL was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA); a score <23 indicated insufficient HL. Tacrolimus %CV was calculated over 6 months post-discharge. Linear regression models, adjusted for sociodemographic variables, evaluated the association between HL and %CV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-eight patients were included (kidney: <i>n</i> = 38, liver: <i>n</i> = 24, lung: <i>n</i> = 36). Patients with insufficient HL had higher %CV than those with sufficient HL (31.5% vs. 16.1%, <i>p</i> < 0.05). HL remained independently associated with %CV after adjusting for age and transplant type (<i>β</i> = −1.60, SE = 0.17, <i>p</i> < 0.05). The final model explained 53% of %CV variability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HL is independently associated with tacrolimus variability. HL screening and targeted educational interventions may help improve medication stability and long-term transplant outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12624817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145539402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ambient Air Pollution, Cognitive Impairment, and Dementia Among Older Patients Being Evaluated for Kidney Transplantation 环境空气污染、认知障碍和老年肾移植患者痴呆的评估

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-17 DOI: 10.1111/ctr.70376

Jingyao Hong, Malika Wilson, Jane J. Long, Yiting Li, Nidhi Ghildayal, Byoungjun Kim, Nicole M. Ali, Aarti Mathur, Terry Gordon, George D. Thurston, Dorry L. Segev, Mara A. McAdams-DeMarco

Background

Older patients who are evaluated for kidney transplantation (KT) experience an earlier onset of cognitive impairment due to dialysis, comorbidities, and inactivity. Ambient fine particulate matter (PM_2.5) is a modifiable risk factor for dementia among community-dwelling older adults. Inflammatory responses and oxidative stress caused by inactivity in older patients evaluated for KT may heighten vulnerability to PM_2.5. Thus, the impact of PM_2.5 on dementia may be more severe in this population.

Methods

We leveraged a prospective cohort (2009–2019) of older (age ≥ 50) patients evaluated for KT (n = 2073) with Modified Mini-Mental State Examination (3MS). We derived annual PM_2.5 from residential ZIP codes (high: PM_2.5> 9 µg/m³), quantifying its association with global cognitive function (linear regression), impairment (logistic regression), and risk of dementia (Cox proportional hazards model). We tested the interaction between PM_2.5 and dementia risk factors using a Wald test. Models were adjusted for confounders, including social determinants of health.

Results

High PM_2.5 was associated with worse global cognitive function (difference = −3.00 points [3MS score], 95% CI: −3.93 to −2.07), with a stronger association among patients with low physical activity (p [interaction] < 0.001). High PM_2.5 was associated with 1.90-fold higher odds of global cognitive impairment (95% CI: 1.48–2.46), and 3.29-fold higher risk of dementia (95% CI: 1.14–9.55).

Conclusion

High PM_2.5 was associated with worse cognitive function among older patients evaluated for KT, particularly those with low physical activity. The association was stronger than prior findings among community-dwelling older adults. Clinicians may counsel patients to monitor air quality. Patients in high PM_2.5 neighborhoods should discuss cognitive assessments and ways to increase physical activity with providers.

背景：评估肾移植（KT）的老年患者由于透析、合并症和不活动而出现认知障碍的时间更早。环境细颗粒物（PM2.5）是社区居住老年人痴呆的可改变危险因素。在评估KT的老年患者中，不活动引起的炎症反应和氧化应激可能会增加对PM2.5的易感性。因此，PM2.5对痴呆的影响可能在这一人群中更为严重。方法：我们利用一项前瞻性队列研究（2009-2019年），对年龄≥50岁的老年患者（n = 2073）进行KT评估，采用改良迷你精神状态检查（3MS）。我们提取了居住邮政编码地区的年度PM2.5（高：PM2.5 bbb9µg/m3），量化了其与全球认知功能（线性回归）、损伤（逻辑回归）和痴呆风险（Cox比例风险模型）的关系。我们使用Wald检验来检验PM2.5与痴呆风险因素之间的相互作用。模型根据混杂因素进行了调整，包括健康的社会决定因素。结果：高PM2.5与较差的整体认知功能相关（差异= -3.00分[3MS评分]，95% CI: -3.93至-2.07），与低体力活动患者的相关性更强(p[交互作用]2.5与高1.90倍的整体认知功能障碍相关（95% CI: 1.48至2.46），与高3.29倍的痴呆风险相关（95% CI: 1.14至9.55）。结论：在接受KT评估的老年患者中，高PM2.5与认知功能恶化有关，尤其是那些体力活动较少的患者。在社区居住的老年人中，这种关联比先前的发现更强。临床医生可能会建议患者监测空气质量。PM2.5浓度高的社区的患者应该与医疗服务提供者讨论认知评估和增加身体活动的方法。

{"title":"Ambient Air Pollution, Cognitive Impairment, and Dementia Among Older Patients Being Evaluated for Kidney Transplantation","authors":"Jingyao Hong, Malika Wilson, Jane J. Long, Yiting Li, Nidhi Ghildayal, Byoungjun Kim, Nicole M. Ali, Aarti Mathur, Terry Gordon, George D. Thurston, Dorry L. Segev, Mara A. McAdams-DeMarco","doi":"10.1111/ctr.70376","DOIUrl":"10.1111/ctr.70376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older patients who are evaluated for kidney transplantation (KT) experience an earlier onset of cognitive impairment due to dialysis, comorbidities, and inactivity. Ambient fine particulate matter (PM<sub>2.5</sub>) is a modifiable risk factor for dementia among community-dwelling older adults. Inflammatory responses and oxidative stress caused by inactivity in older patients evaluated for KT may heighten vulnerability to PM<sub>2.5</sub>. Thus, the impact of PM<sub>2.5</sub> on dementia may be more severe in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We leveraged a prospective cohort (2009–2019) of older (age ≥ 50) patients evaluated for KT (<i>n</i> = 2073) with Modified Mini-Mental State Examination (3MS). We derived annual PM<sub>2.5</sub> from residential ZIP codes (high: PM<sub>2.5 </sub>> 9 µg/m<sup>3</sup>), quantifying its association with global cognitive function (linear regression), impairment (logistic regression), and risk of dementia (Cox proportional hazards model). We tested the interaction between PM<sub>2.5</sub> and dementia risk factors using a Wald test. Models were adjusted for confounders, including social determinants of health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High PM<sub>2.5</sub> was associated with worse global cognitive function (difference = −3.00 points [3MS score], 95% CI: −3.93 to −2.07), with a stronger association among patients with low physical activity (<i>p</i> [interaction] < 0.001). High PM<sub>2.5</sub> was associated with 1.90-fold higher odds of global cognitive impairment (95% CI: 1.48–2.46), and 3.29-fold higher risk of dementia (95% CI: 1.14–9.55).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>High PM<sub>2.5</sub> was associated with worse cognitive function among older patients evaluated for KT, particularly those with low physical activity. The association was stronger than prior findings among community-dwelling older adults. Clinicians may counsel patients to monitor air quality. Patients in high PM<sub>2.5</sub> neighborhoods should discuss cognitive assessments and ways to increase physical activity with providers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0