Clinical Transplantation最新文献_第7页

Tricuspid Regurgitation after Orthotopic Heart Transplantation: Trajectories and Association With Mortality 原位心脏移植后三尖瓣返流：轨迹及其与死亡率的关系。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-01-07 DOI: 10.1111/ctr.70062

Kiran Belani, Vincent Brinker, Matthew Fuller, Mary Cooter, Jacob N. Schroder, Negmeldeen Mamoun, Adam DeVore, Madhav Swaminathan, Alina Nicoara, Sharon L. McCartney

Background

Tricuspid regurgitation (TR) is common immediately after orthotopic heart transplantation (OHT), though the expected outcomes of TR over time remain undefined. In this study, we examined the natural trajectory of TR in the first 120 days post-transplantation. We observed the clinical phenotypes of trajectories of TR after OHT, and assessed trajectory correlation with 1-year mortality and degree of right ventricular (RV) dysfunction.

Methods

All patients who underwent OHT at a single institution from January 2009 to July 2019 were included, unless death occurred during the index hospitalization. TR and RV dysfunction on follow-up transthoracic echocardiograms were tracked on 4-point scales and latent-class mixed modeling (LCMM) identified classes of TR trajectories. Fisher's exact test was used to compare 1-year mortalities between classes.

Results

Based on LCMM, four distinct classes of TR trajectories emerged, characterized as sustained (n = 40), variable (n = 172), stable (n = 175), and recovered (n = 189) TR. Significant differences in mortality rates were found amongst classes at 10.0%, 8.1%, 4.0%, and 2.6%, respectively (p = 0.025). The degree of RV dysfunction mirrored TR severity in all subsets except the sustained TR group.

Conclusions

The trajectory of TR in the first 120 days post-OHT is associated with 1-year mortality. In many subsets, there is a close association with TR grade and RV function improvement. However, in the sustained TR group, RV function improved without subsequent improvement in TR severity. These findings could identify patients with higher mortality risk for whom more frequent follow-up or intervention is warranted.

背景：原位心脏移植（OHT）后立即出现三尖瓣反流（TR）是常见的，尽管随着时间的推移，TR的预期结果仍不明确。在这项研究中，我们检查了移植后最初120天TR的自然轨迹。我们观察了OHT后TR轨迹的临床表型，并评估了轨迹与1年死亡率和右心室功能障碍程度的相关性。方法：纳入2009年1月至2019年7月在单一机构接受OHT治疗的所有患者，除非在指数住院期间发生死亡。随访时经胸超声心动图上的TR和RV功能障碍采用4点量表进行跟踪，并使用潜级混合模型（LCMM）确定TR轨迹的类别。Fisher精确检验用于比较不同班级的1年死亡率。结果：基于LCMM，出现了四种不同类型的TR轨迹，其特征为持续（n = 40）、可变（n = 172）、稳定（n = 175）和恢复（n = 189） TR。不同类型的死亡率差异显著，分别为10.0%、8.1%、4.0%和2.6% （p = 0.025）。除持续TR组外，所有亚组的右心室功能障碍程度反映了TR的严重程度。结论：oht后最初120天的TR轨迹与1年死亡率相关。在许多亚群中，与TR等级和RV功能改善密切相关。然而，在持续TR组中，RV功能改善，但TR严重程度随后没有改善。这些发现可以确定死亡风险较高的患者，对其进行更频繁的随访或干预是有必要的。

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引用次数: 0

Risk of Post-Transplant Malignancy After Isolated Heart Transplant Among Adult Patients With Congenital Heart Disease 成年先天性心脏病患者孤立心脏移植术后恶性肿瘤的风险

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-01-07 DOI: 10.1111/ctr.70077

Orly Leiva, Stephanie Golob, Alex Reyentovich, Jose Alvarez-Cardona, Michelle Bloom, Dan Halpern, Adam Small

Introduction

Patients with congenital heart disease (CHD) are at increased risk of cancer. In patients with CHD and advanced heart failure, isolated heart transplantation (HT) can be considered. In the overall HT population, immunosuppression after HT increases the risk of post-transplant malignancy (PTM). However, cancer outcomes among adult HT patients with CHD have not been investigated.

Methods

Patients aged ≥ 18 years who received HT between January 1, 2010 and December 31, 2021 were identified using the United Network for Organ Sharing (UNOS) registry. Patients with CHD were compared to those without. T primary outcome was a composite outcome of PTM or death due to malignancy. Multivariable Fine-Gray competing-risk regression was used to estimate the subhazard ratio (SHR) of primary and secondary outcomes.

Results

Of the total of 29717 patients with HT were included, 1017 (3.4%) had CHD. Patients with CHD were younger, more likely to be female, and have had prior cardiac surgery. After multivariable competing-risk regression, CHD was associated with a higher risk of the primary outcome (SHR 1.43, 95% CI 1.15–1.80). Among patients who developed PTM, the median time to diagnosis of first PTM (median 36 vs. 46 months, p = 0.027) was shorter in patients with CHD. Among patients with CHD, survival after PTM was significantly lower compared with patients without malignancy (HR 3.32, 95% CI 2.03–5.43).

Conclusions

Among adult patients with HT, CHD was associated with an increased risk of PTM. Further investigation is warranted to identify risk factors and screening strategies for malignancy in this patient population.

导读：先天性心脏病（CHD）患者患癌症的风险增加。在冠心病和晚期心力衰竭患者中，可以考虑孤立心脏移植（HT）。在整个HT人群中，HT后免疫抑制增加了移植后恶性肿瘤（PTM）的风险。然而，成人HT合并冠心病患者的癌症结局尚未被调查。方法：在2010年1月1日至2021年12月31日期间接受HT治疗的年龄≥18岁的患者使用联合器官共享网络（UNOS）登记。将冠心病患者与非冠心病患者进行比较。主要转归是PTM或恶性肿瘤死亡的综合转归。采用多变量细灰色竞争风险回归估计主要和次要结局的亚危险比（SHR）。结果：共纳入29717例HT患者，1017例（3.4%）合并冠心病。冠心病患者更年轻，更有可能是女性，并且之前有过心脏手术。在多变量竞争风险回归后，冠心病与主要结局的高风险相关（SHR 1.43, 95% CI 1.15-1.80）。在发生PTM的患者中，冠心病患者首次诊断PTM的中位时间（中位36个月对46个月，p = 0.027）较短。在冠心病患者中，与无恶性肿瘤患者相比，PTM后的生存率显著降低（HR 3.32, 95% CI 2.03-5.43）。结论：在成年HT患者中，冠心病与PTM风险增加相关。进一步的调查是必要的，以确定危险因素和筛查策略的恶性肿瘤的患者群体。

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引用次数: 0

Increased Mortality in Kidney Transplant Recipients During the Delta/Omicron Era of the COVID-19 Pandemic Despite Widespread Vaccination 在COVID-19大流行的Delta/Omicron时代，尽管广泛接种疫苗，肾移植受者的死亡率仍在增加。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-01-07 DOI: 10.1111/ctr.70071

Byron Smith, Sumi Nair, Hani Wadei, Martin Mai, Hasan Khamash, Carrie Schinstock, Yun Liang, Ahmed Abdelrheem, Walter Park, Andrew Badley, Mark D. Stegall

Introduction

The incidence of mortality late in the pandemic, particularly after widespread vaccine availability, is not well understood. Herein, we elucidate the effect of this impact of the COVID pandemic as well as risk factors for mortality during it.

Methods

The primary end point was death with a functioning graft with secondary endpoints of mortality rates in subgroups and at different time intervals during the pandemic.

Results

Despite widespread vaccination, mortality rates for kidney transplant (KTx) recipients almost doubled during the COVID-19 era (6.40 deaths per 100 person years vs. 3.54 pre-COVID). Mortality increased in all racial/ethnic groups but increased more in Native Americans, Hispanics, and African Americans compared to non-Hispanic Caucasians. The highest mortality rate occurred during the Delta and Omicron time frames. In contrast to the general population, mortality was more evenly spread across age groups in KTx recipients.

Conclusions

Mortality rates during the COVID-19 era were extremely high, more than doubling in some racial/ethnic groups. We conclude that the KTx population was a particularly vulnerable group during the COVID-19 era and suggests the need for further research into the management of variants in the future.

导言：大流行后期的死亡率，特别是在广泛接种疫苗之后的死亡率，尚不清楚。在此，我们阐明了COVID大流行的影响以及在此期间死亡的危险因素。方法：主要终点是移植功能正常的死亡，次要终点是大流行期间亚组和不同时间间隔的死亡率。结果：尽管广泛接种疫苗，但在COVID-19时代，肾移植（KTx）受者的死亡率几乎翻了一番（每100人年死亡6.40人，而COVID-19前为3.54人）。死亡率在所有种族/民族群体中都有所增加，但与非西班牙裔白人相比，美洲原住民、西班牙裔和非洲裔美国人的死亡率增加更多。死亡率最高的是“德尔塔”和“欧米克隆”时期。与一般人群相比，KTx接受者的死亡率在各年龄组之间分布更为均匀。结论：COVID-19时期的死亡率非常高，在一些种族/族裔群体中增加了一倍以上。我们得出结论，在COVID-19时代，KTx人群是一个特别脆弱的群体，并建议未来需要进一步研究变异的管理。

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引用次数: 0

Second Time Around: Increased Rate of Living Donation From Repeat Organ Donors

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-01-06 DOI: 10.1111/ctr.70049

Carolyn N. Sidoti, Kelly Terlizzi, Conor Donnelly, Ian S. Jaffe, Jennifer D. Motter, Benjamin Philosophe, Reed T. Jenkins, Sarah Hussain, Pedro Colon, Amit D. Tevar, Bonnie E. Lonze, Babak J. Orandi, Macey L. Levan, Dorry L. Segev, Allan B. Massie

Introduction

Some living organ donors will decide to donate again at a later date. Evidence has indicated that this practice may have increased in recent years. We evaluated the incidence and outcomes of this practice to inform counseling of potential repeat donors.

Methods

Using SRTR data from 1994 to 2023, we identified 220 repeat living donors and their 415 recipients. We constructed donor comparison groups using weighting by the odds. We described clinical and lab results at 6 months, 1 year, and 2 years post-donation separately for kidney-second donors and liver-second donors. We compared all-cause graft failure for their recipients with those of comparison donors.

Results

The annual count of repeat living donors increased from 5 in 2018 to 25 in 2019 (p < 0.001). Of 220 donors, 159 were liver-second donors (72.3%) and 55 were kidney-second donors (25.0). The percentage of nondirected donations increased from 30.5% at first donation to 53.2% at second donation (p < 0.001). Liver-second donors had one death approximately 2.5 years post-donation. Seventeen were re-admitted and 20 experienced complications requiring an interventional procedure or re-operation. Among kidney-second donors, no deaths, re-admissions, or post-donation complications were reported. Post-donation outcomes in both groups were comparable when evaluated against organ-specific comparison donors. Recipients of repeat living donors experienced graft survival similar to recipients of comparison donors.

Conclusions

Repeat living donation may be a safe practice for carefully selected living donors in the short term; however, long term safety is unknown. Outcomes for recipients are similar to recipients of comparison donors.

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引用次数: 0

Pretransplant Minimal Pleural and Peritoneal Effusion Is a Potential Poor Prognostic Indicator in Allogeneic Hematopoietic Stem Cell Transplantation 移植前微量胸膜和腹膜积液是异基因造血干细胞移植的潜在不良预后指标。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-01-06 DOI: 10.1111/ctr.70072

Takashi Oyama, Akira Honda, Yasutaka Masuda, Ken Morita, Hiroaki Maki, Yosuke Masamoto, Mineo Kurokawa

Background

Pleural effusion and ascites developing after allogeneic hematopoietic stem cell transplantation (allo-SCT) are generally associated with inferior overall survival (OS); however, the prognostic value of pretransplant effusion on transplant outcomes remained unclear.

Methods

We retrospectively evaluated minimal pleural effusion and ascites detected by computed tomography in 248 consecutive adult patients who underwent their first allo-SCT from January 2007 to December 2022.

Results

Forty-eight patients demonstrated minimal pleural effusion or ascites within 100 days before transplantation (Effusion group) and the other 200 had no effusion (No effusion group). Serum albumin level was significantly lower in the Effusion group than in the No effusion group (median 3.8 vs. 3.4 g/dL, p < 0.001). Performance status (PS) was significantly inferior and refined disease risk index tended to be higher in the Effusion group. The 2-year OS rate after transplantation was significantly worse in the Effusion group (57.1% vs. 36.7%, p < 0.001). The Effusion group had a significantly lower cumulative incidence of neutrophil and platelet engraftment and higher hepatic veno-occlusive disease. Moreover, a tendency toward higher cumulative incidence of relapse and non-relapse mortality was shown in the Effusion group. In multivariate analysis, the Effusion group had a significantly inferior OS with a hazard ratio of 1.848 (95% confidence interval 1.231–2.774), even after adjustment for disease risk, serum albumin level, PS, and Hematopoietic Cell Transplant-Comorbidity Index points.

Conclusion

Reflecting high disease activity and impaired general condition, pretransplant effusion can be a complementary indicator for poor prognosis in allo-SCT.

背景：同种异体造血干细胞移植（allogene hematopoietic stem cell transplantation, alloo - sct）后发生胸腔积液和腹水通常与较差的总生存期（OS）相关；然而，移植前积液对移植预后的预后价值尚不清楚。方法：我们回顾性评估了从2007年1月至2022年12月连续248例接受首次同种异体sct的成年患者的计算机断层扫描检测到的最小胸膜积液和腹水。结果：移植前100天出现少量胸腔积液或腹水者48例（积液组），无积液者200例（无积液组）。积液组血清白蛋白水平明显低于无积液组（中位数3.8 vs 3.4 g/dL, p < 0.001）。积液组表现状态（Performance status， PS）明显较差，精细化疾病风险指数有升高趋势。积液组移植后2年OS率明显更差（57.1% vs 36.7%, p < 0.001）。积液组中性粒细胞和血小板植入的累积发生率明显降低，肝静脉闭塞性疾病发生率较高。此外，积液组有较高的复发和非复发死亡率的趋势。在多因素分析中，即使在调整疾病风险、血清白蛋白水平、PS和造血细胞移植共病指数积分后，积液组的OS也明显低于积液组，风险比为1.848（95%可信区间为1.232 -2.774）。结论：移植前积液反映了高疾病活动性和一般状况受损，可作为异体细胞移植预后不良的补充指标。

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引用次数: 0

Has Sex-Based Disparity in Liver Transplantation Opportunities and Waitlist Mortality Improved in the MELD3.0 Era?: A Preliminary Study 在MELD3.0时代，基于性别的肝移植机会差异和等待名单死亡率是否有所改善？：初步研究。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-31 DOI: 10.1111/ctr.70064

Miho Akabane, Yuki Imaoka, Carlos O. Esquivel, Kazunari Sasaki

Background

In July 2023, the OPTN adopted MELD3.0 to address sex-based disparities in liver transplantation (LT) opportunity and waitlist mortality. No studies have proven that MELD3.0 alleviated them.

Methods

We evaluated sex-based disparities in LT opportunities and waitlist mortality, utilizing the UNOS data (August 2022–March 2024), comparing pre- and post-MELD3.0 eras.

Results

Among 11 795 LT candidates (pre-MELD3.0: 7263; post-MELD3.0: 4532), the proportion of females increased from 38.8% to 42.6% post-MELD3.0. In the transplanted population, females increased from 37.7% to 41.6% post-MELD3.0. The median MELD score difference (“MELD3.0–MELD-Na”) at listing was -0.26 [-2.13, 0.80] for females and -0.86 [-2.92, 0.00] for males (p < 0.01). Compared to females, males consistently showed a larger drop in points from MELD-Na to MELD3.0. In the pre-MELD3.0 era, females had lower LT opportunity (sub-hazard ratio [sHR]: 0.88 [0.83–0.93], p < 0.01) and higher waitlist mortality (sHR: 1.39 [1.20–1.62], p < 0.01). In the post-MELD3.0 era, there were no significant differences in LT opportunity (sHR: 0.93 [0.87–1.00], p = 0.07) and waitlist mortality (sHR: 1.25 [0.98–1.57], p = 0.26). Subgroup analyses based on MELD-Na groups showed that significant differences in LT opportunity and waitlist mortality in the pre-MELD3.0 era became insignificant in the post-MELD3.0 era. Multivariable competing-risk analysis showed that, in the pre-MELD3.0 era, female sex was a significant risk factor for LT opportunity (sHR: 0.90 [0.84–0.96], p < 0.01) and waitlist mortality (sHR: 1.19 [1.01–1.38], p = 0.03), but in the post-MELD3.0 era, it was not significant (sHR: 0.94 [0.86–1.02], p = 0.11 for LT opportunity/sHR: 1.08 [0.83–1.40], p = 0.57 for waitlist mortality).

Conclusions

Our preliminary findings suggest that MELD3.0 has the potential to reduce sex-based disparities in LT opportunities and waitlist mortality.

背景：2023年7月，OPTN采用MELD3.0来解决肝移植（LT）机会和等待名单死亡率的性别差异。没有研究证明MELD3.0可以缓解这些症状。方法：我们利用UNOS数据（2022年8月至2024年3月），比较meld3.0之前和之后的时代，评估了基于性别的LT机会和等待名单死亡率差异。结果：在11795名LT候选人中(meld3.0前：7263；meld3.0后：4532)，女性比例从38.8%上升到42.6%。在移植人群中，雌性在meld3.0后从37.7%增加到41.6%。女性MELD评分中位差（“MELD3.0-MELD-Na”）为-0.26[-2.13,0.80]，男性为-0.86 [-2.92,0.00]（p < 0.01）。与女性相比，男性从MELD-Na到MELD3.0的分数下降幅度一贯较大。在meld3.0之前，女性的LT机会较低（亚危险比[sHR]: 0.88 [0.83-0.93], p < 0.01），等待名单死亡率较高（sHR: 1.39 [1.20-1.62], p < 0.01）。在后meld3.0时代，LT机会（sHR: 0.93 [0.87-1.00], p = 0.07）和等待名单死亡率（sHR: 1.25 [0.98-1.57], p = 0.26）无显著差异。基于MELD-Na组的亚组分析显示，meld3.0时代之前的LT机会和等待名单死亡率的显著差异在meld3.0时代之后变得不显著。多变量竞争风险分析结果显示，在meld3.0时代前，女性性别是LT机会（sHR: 0.90 [0.84-0.96], p < 0.01）和等待名单死亡率（sHR: 1.19 [1.01-1.38], p = 0.03）的显著危险因素，但在meld3.0时代后，女性性别不显著（sHR: 0.94 [0.86-1.02], p = 0.11， LT机会/sHR: 1.08 [0.83-1.40], p = 0.57）。结论：我们的初步研究结果表明，MELD3.0有可能减少基于性别的LT机会差异和等待名单死亡率。

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引用次数: 0

Predicting Sarcopenia and Frailty Risk in Patients Post Heart Transplantation 心脏移植后患者肌肉减少和虚弱风险的预测。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-31 DOI: 10.1111/ctr.70027

Trinidad Sentandreu-Mañó, Elena Marques-Sule, Luis Almenar-Bonet, José M. Tomás, Dominique Hansen, Pallav Deka, Raquel López-Vilella, Leonie Klompstra, Felipe V. C. Machado

Introduction

Currently, there is little evidence on the prevalence and factors associated with sarcopenia risk or frailty risk in patients post heart transplantation (HTx). The objective of this study was to analyze the influence of sociodemographic, lifestyle, physical, and psychological factors on sarcopenia and frailty risk in patients post-HTx.

Methods

133 patients post-HTx (59.4% men, mean age 56.5 ± 12.7 years) participated in this cross-sectional study. The main outcomes were sarcopenia and frailty risk, and potential related predictors were comorbidities, time from transplantation, body mass index, sociodemographic factors, musculoskeletal pain, functional capacity, kinesiophobia, sleep problems, depression, physical activity, and diet quality. Multiple regression models were performed with all predictors, including polynomial regressions for predictors with a nonlinear relationship.

Results

The predictor variables explained 73.93% of frailty's variance. Functional capacity (with a nonlinear relationship) and diet quality were significant predictors of frailty risk, while diabetes and physical activity were marginally significant. In addition, the predictors explained 73.52% of sarcopenia's variance. Diabetes, functional capacity (with a nonlinear relationship), and kinesiophobia were significant predictors of sarcopenia risk, while pain intensity and diet quality were marginally significant.

Conclusion

Multivariate analysis conducted on patients post-HTx revealed that functional capacity was associated with both sarcopenia and frailty risk. Additionally, diet quality was a predictive factor of frailty, while diabetes and kinesiophobia were predictors of sarcopenia. These findings emphasize the importance of proper management to prevent frailty and sarcopenia, which share common associated factors.

导论：目前，关于心脏移植（HTx）后患者肌肉减少症风险或虚弱风险的患病率和相关因素的证据很少。本研究的目的是分析社会人口学、生活方式、生理和心理因素对htx后患者肌肉减少症和虚弱风险的影响。方法：133例htx术后患者（男性59.4%，平均年龄56.5±12.7岁）参与本横断面研究。主要结局是肌肉减少症和虚弱风险，潜在的相关预测因素是合并症、移植时间、体重指数、社会人口因素、肌肉骨骼疼痛、功能能力、运动恐惧症、睡眠问题、抑郁、身体活动和饮食质量。对所有预测因子进行多元回归模型，包括对具有非线性关系的预测因子进行多项式回归。结果：预测变量解释了73.93%的脆性方差。功能能力（具有非线性关系）和饮食质量是衰弱风险的显著预测因子，而糖尿病和身体活动则是微显著的。此外，预测因子解释了73.52%的肌肉减少症方差。糖尿病、功能能力（非线性关系）和运动恐惧症是肌肉减少症风险的显著预测因子，而疼痛强度和饮食质量则是微显著的。结论：htx术后患者的多因素分析显示，功能能力与肌肉减少症和虚弱风险均相关。此外，饮食质量是虚弱的预测因素，而糖尿病和运动恐惧症是肌肉减少症的预测因素。这些发现强调了适当管理的重要性，以防止虚弱和肌肉减少症，这是共同的相关因素。

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引用次数: 0

Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D−/R−): Time to Reexamine Donor CMV Serostatus 来自CMV血清阴性供者的实体器官移植低危CMV血清阴性受者的当代巨细胞病毒（CMV）感染（D-/R-）：重新检查供者CMV血清状态的时间

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-31 DOI: 10.1111/ctr.70073

Madeleine R. Heldman, Julia A. Messina, Annette J. Schlueter, Mark J. Lee, Jennifer L. Saullo, Rachel A. Miller

Background

Early posttransplant cytomegalovirus (CMV) infections in CMV seronegative solid organ transplant recipients (SOTR) with CMV seronegative donors (D−/R−) are often attributed transfusion-transmitted CMV. The prevalence of false-negative donor CMV serology in D−/R− SOTR with early CMV infections has not been explored.

Methods

We determined the frequency and characteristics of CMV DNAemia that occurred within 90 days of transplant among adult SOTR classified as D−/R− who underwent a first SOT at a single center between February 25, 2014 and February 25, 2024. Repeat donor CMV antibody testing was performed on stored donor sera if possible.

Results

Thirteen of 737 (1.8%) D−/R− SOTR from 12 donors developed CMV DNAemia within 90 days of transplant (median time to DNAemia: 28 days, interquartile range 23–42 days). Five (38%) recipients experienced CMV disease either before (n = 2) or after (n = 3) CMV DNAemia was identified, and five (38%) developed CMV antiviral resistance mutations during their course. Repeat CMV antibody testing was performed on sera from four donors to five recipients and was positive in three (75%) tested donors.

Conclusions

Early CMV infections in D−/R− SOTR are uncommon but associated with high morbidity. CMV transmission from organ donors with false negative CMV serology is an important source of early CMV infections in D−/R− SOTR. Clinicians should suspect and promptly report early CMV infections in D−/R− SOTR as potential donor-derived processes, regardless of donor and/or recipient transfusion histories. Reporting such cases is essential to promote broader investigations that may identify suboptimal donor CMV screening assays.

背景：巨细胞病毒血清阴性实体器官移植受者（SOTR）与巨细胞病毒血清阴性供者（D-/R-）的移植后早期巨细胞病毒（CMV）感染通常归因于输血传播的巨细胞病毒。在早期巨细胞病毒感染的D-/R- SOTR患者中，供体巨细胞病毒血清学假阴性的患病率尚未得到探讨。方法：我们确定了2014年2月25日至2024年2月25日期间在单一中心接受首次SOT的成人SOTR中，在移植后90天内发生CMV dna血症的频率和特征。如果可能的话，对储存的供者血清进行重复供者巨细胞病毒抗体检测。结果：来自12名供者的737例（1.8%）D-/R- SOTR中有13例在移植90天内发生巨细胞病毒dna血症（发生dna血症的中位时间：28天，四分位数范围23-42天）。5名（38%）受者在检测CMV dna血症之前（n = 2）或之后（n = 3）出现了CMV疾病，5名（38%）受者在治疗过程中出现了CMV抗病毒耐药性突变。对4名供者至5名受者的血清进行了重复巨细胞病毒抗体检测，其中3名（75%）供者检测呈阳性。结论：早期巨细胞病毒感染在D-/R- SOTR中并不常见，但与高发病率相关。巨细胞病毒血清学假阴性器官供体的巨细胞病毒传播是D-/R- SOTR早期巨细胞病毒感染的重要来源。临床医生应怀疑并及时报告D-/R- SOTR中早期巨细胞病毒感染为潜在的供者源性感染，无论供者和/或受体输血史如何。报告此类病例对于促进更广泛的调查至关重要，这些调查可能会确定不理想的供体巨细胞病毒筛查分析。

{"title":"Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D−/R−): Time to Reexamine Donor CMV Serostatus","authors":"Madeleine R. Heldman, Julia A. Messina, Annette J. Schlueter, Mark J. Lee, Jennifer L. Saullo, Rachel A. Miller","doi":"10.1111/ctr.70073","DOIUrl":"10.1111/ctr.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early posttransplant cytomegalovirus (CMV) infections in CMV seronegative solid organ transplant recipients (SOTR) with CMV seronegative donors (D−/R−) are often attributed transfusion-transmitted CMV. The prevalence of false-negative donor CMV serology in D−/R− SOTR with early CMV infections has not been explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We determined the frequency and characteristics of CMV DNAemia that occurred within 90 days of transplant among adult SOTR classified as D−/R− who underwent a first SOT at a single center between February 25, 2014 and February 25, 2024. Repeat donor CMV antibody testing was performed on stored donor sera if possible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen of 737 (1.8%) D−/R− SOTR from 12 donors developed CMV DNAemia within 90 days of transplant (median time to DNAemia: 28 days, interquartile range 23–42 days). Five (38%) recipients experienced CMV disease either before (<i>n</i> = 2) or after (<i>n</i> = 3) CMV DNAemia was identified, and five (38%) developed CMV antiviral resistance mutations during their course. Repeat CMV antibody testing was performed on sera from four donors to five recipients and was positive in three (75%) tested donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early CMV infections in D−/R− SOTR are uncommon but associated with high morbidity. CMV transmission from organ donors with false negative CMV serology is an important source of early CMV infections in D−/R− SOTR. Clinicians should suspect and promptly report early CMV infections in D−/R− SOTR as potential donor-derived processes, regardless of donor and/or recipient transfusion histories. Reporting such cases is essential to promote broader investigations that may identify suboptimal donor CMV screening assays.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906797","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

Implementation of a Comprehensive Protocol for Enhanced Recovery After Surgery (ERAS) in Kidney Transplant Recipients Improves Patient and Graft Outcomes 实施一项促进肾移植受者术后恢复（ERAS）的综合方案可改善患者和移植物的预后。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-31 DOI: 10.1111/ctr.70056

Mohamed Eltemamy, Paul J. Oh, Hafiz Umair Siddiqui, Yi-Chia Lin, M. Cecilia Lansang, Emilio Poggio, David Goldfarb, Venkatesh Krishnamurthi, Alvin Wee

Background

Enhanced recovery after surgery (ERAS) protocols have gained widespread acceptance as a means to enhance surgical outcomes. However, the intricate care required for kidney transplant recipients has not yet led to the establishment of a universally recognized and dependable ERAS protocol for kidney transplantation.

Objective

We devised a customized ERAS protocol to determine its effectiveness in improving surgical and postoperative outcomes among kidney transplant recipients.

Design, Setting, and Participants

This was a retrospective, single-center study performed at our tertiary care institution. Three hundred and fifty-six patients in the conventional group (from January 1, 2015 to December 31, 2017) and 442 patients from the ERAS group (from January 1, 2018 to June 1, 2020) were compared. Patients were followed for 1 year postoperatively.

Intervention

Changes were made in the preoperative, operative, postoperative, and outpatient follow-up settings after transplantation.

Outcome Measurements and Statistical Analysis

Primary endpoints were hospital length of stay (LOS) and 30-day readmission rates. We also measured surgical outcomes, graft performance, and patient survival. Wilcoxon rank-sum, Pearson's Chi-squared, or Fisher's exact tests were used to compare groups.

Results

Our ERAS protocol was associated with a decrease in hospital LOS from 5 to 3 days (p < 0.001) and 57.1% lower odds of hospital readmissions within 30 days compared to the conventional group (p < 0.001, 95% CI 0.26–0.7). Decreases in operative estimated blood loss, blood transfusion rates, and delayed graft function were also associated with the ERAS protocol.

Conclusion

Our multi-layered ERAS protocol is effective in improving outcomes for kidney transplant recipients. A future multi-institutional study with healthcare savings analysis may suggest that widespread benefits are yet to be realized by the greater implementation of such enhanced recovery protocols.

背景：增强术后恢复（ERAS）方案作为提高手术效果的手段已被广泛接受。然而，肾移植受者所需的复杂护理尚未导致建立一个普遍认可和可靠的肾移植ERAS协议。目的：我们设计了一个定制的ERAS方案，以确定其在改善肾移植受者手术和术后预后方面的有效性。设计、环境和参与者：这是一项在我们三级医疗机构进行的回顾性单中心研究。对常规组356例患者（2015年1月1日至2017年12月31日）和ERAS组442例患者（2018年1月1日至2020年6月1日）进行比较。术后随访1年。干预措施：移植后术前、手术、术后和门诊随访设置发生改变。结果测量和统计分析：主要终点是住院时间（LOS）和30天再入院率。我们还测量了手术结果、移植物性能和患者生存率。使用Wilcoxon秩和、Pearson卡方或Fisher精确检验进行组间比较。结果：我们的ERAS方案可降低5 - 3天的住院LOS (p)。结论：我们的多层ERAS方案可有效改善肾移植受者的预后。未来的多机构研究与医疗节约分析可能表明，广泛的效益尚未实现更大的实施这种增强恢复协议。

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引用次数: 0

Do Factors Influencing Acceptance of Kidney Stone Formers as Donors Predict Subsequent Stone Events? 影响肾结石患者接受供体的因素能否预测随后的结石事件？

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-31 DOI: 10.1111/ctr.70069

Mira T. Keddis, Matthew R. Howard, Nan Zhang, Jaxon K. Quillen, Matthew R. D'Costa, Hasan A. Khamash, Carrie C. Jadlowiec, Hani M. Wadei, Ivan E. Porter, Karen L. Stern, Andrew D. Rule

Purpose

This study aimed to assess whether kidney stone burden and risk factors at the time of kidney donor evaluation were associated with a symptomatic stone event post-donor evaluation.

Methods

We identified adults evaluated at Mayo Clinic (two sites) (2000–2011) for living kidney donation and had either a personal history or radiological evidence of kidney stone disease. We analyzed demographics, stone risk factors, stone number/size, and the committee's donation decision and reasons. A follow-up survey (2022–2023) assessed post-evaluation symptomatic kidney stones and related morbidity.

Results

Among 412 potential donors with kidney stone disease, 258 donated, 75 did not donate due to kidney stones, and 79 did not donate for other reasons. Multivariable analysis showed that candidates not donating due to stones had higher body mass index (BMI), prior symptomatic kidney stones, multiple stones on imaging, bilateral kidney stones, and diameter of largest stone ≥3 mm. Of 147 who completed the survey, 26 (18%) had a symptomatic kidney stone post-donor evaluation. Younger age (p = 0.031) and multiple stones on imaging (p = 0.02) were significant predictors of post-evaluation symptomatic stones regardless of donation status (p = 0.41).

Conclusions

Stone burden on imaging and prior symptomatic stone events were associated with not donating. Younger age and stone burden on imaging were the primary risk factors for a symptomatic kidney stone event after donor evaluation.

目的：本研究旨在评估肾脏供者评估时的肾结石负担和危险因素是否与供者评估后的症状性结石事件相关。方法：我们选取了2000-2011年在梅奥诊所（Mayo Clinic）（两个站点）接受活体肾脏捐赠评估的成年人，他们有肾结石病史或影像学证据。我们分析了人口统计学、结石风险因素、结石数量/大小以及委员会的捐赠决定和原因。一项随访调查（2022-2023）评估了评估后症状性肾结石和相关发病率。结果：在412名有肾结石疾病的潜在献血者中，258人捐献，75人因肾结石未捐献，79人因其他原因未捐献。多变量分析显示，因结石而未捐献的候选人体重指数（BMI）较高，既往有肾结石症状，影像学上有多发结石，双侧肾结石，最大结石直径≥3mm。在147名完成调查的患者中，26名（18%）在供体评估后出现症状性肾结石。年龄较小（p = 0.031）和影像学上有多发结石（p = 0.02）是评估后症状性结石的显著预测因素，与捐献状态无关（p = 0.41）。结论：影像学结石负担和既往症状性结石事件与不捐献相关。供体评估后，较年轻的年龄和影像学上的结石负担是出现症状性肾结石事件的主要危险因素。

{"title":"Do Factors Influencing Acceptance of Kidney Stone Formers as Donors Predict Subsequent Stone Events?","authors":"Mira T. Keddis, Matthew R. Howard, Nan Zhang, Jaxon K. Quillen, Matthew R. D'Costa, Hasan A. Khamash, Carrie C. Jadlowiec, Hani M. Wadei, Ivan E. Porter, Karen L. Stern, Andrew D. Rule","doi":"10.1111/ctr.70069","DOIUrl":"10.1111/ctr.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to assess whether kidney stone burden and risk factors at the time of kidney donor evaluation were associated with a symptomatic stone event post-donor evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified adults evaluated at Mayo Clinic (two sites) (2000–2011) for living kidney donation and had either a personal history or radiological evidence of kidney stone disease. We analyzed demographics, stone risk factors, stone number/size, and the committee's donation decision and reasons. A follow-up survey (2022–2023) assessed post-evaluation symptomatic kidney stones and related morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 412 potential donors with kidney stone disease, 258 donated, 75 did not donate due to kidney stones, and 79 did not donate for other reasons. Multivariable analysis showed that candidates not donating due to stones had higher body mass index (BMI), prior symptomatic kidney stones, multiple stones on imaging, bilateral kidney stones, and diameter of largest stone ≥3 mm. Of 147 who completed the survey, 26 (18%) had a symptomatic kidney stone post-donor evaluation. Younger age (<i>p</i> = 0.031) and multiple stones on imaging (<i>p</i> = 0.02) were significant predictors of post-evaluation symptomatic stones regardless of donation status (<i>p</i> = 0.41).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Stone burden on imaging and prior symptomatic stone events were associated with not donating. Younger age and stone burden on imaging were the primary risk factors for a symptomatic kidney stone event after donor evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906798","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