Clinical Transplantation最新文献_第7页

Influence of Donor Transfusion on Heart Transplantation Outcomes: A United Network for Organ Sharing Registry Analysis 捐献者输血对心脏移植结果的影响：器官共享联合网络登记处分析。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-09 DOI: 10.1111/ctr.70053

Sooyun Caroline Tavolacci, Vasiliki Gregory, Kenji Okumura, Ameesh Isath, Junichi Shimamura, David Spielvogel, Suguru Ohira

Introduction

There is a lack of evidence regarding the impact of donor blood transfusion on heart transplant (HT) outcomes. We sought to elucidate the influence of donor transfusion on HT outcomes using the national database.

Methods

From January 2004 to March 2023, donor transfusion information was available for 40 538 recipients for HT in the United Network for Organ Sharing (UNOS) database. We used the UNOS 4-level designation of transfusion (no blood [N = 18 575], 1–5 units [N = 14 098], 6–10 units [N = 4766], and massive transfusion of > 10 units [N = 3099]).

Results

Among this cohort, 53.2% of donors (N = 20 220) received a blood transfusion during the same admission. Donors who required blood transfusion commonly had head trauma as a cause of death (no-blood, 22% vs. 1–5 units, 61%, 6–10 units, 88%, massive, 89%, p < 0.001). An increased amount of donor blood transfusion did not affect rates of acute rejection (no-blood, 18% vs. 1–5 units, 19%, 6–10 units, 17%, massive, 19%, p = 0.13). The number of units transfused also did not affect 1-year survival rates. The Cox hazard model showed no effect of massive transfusion on mortality following transplant (no-blood, reference vs. 1–5 units; HR, 1.02 [p = 0.35], 6–10 units; HR, 1.10 [p = 0.01], massive transfusion; HR 1.04 [p = 0.3]).

Conclusions

Massive transfusion in donors was not associated with increased recipient mortality. Additionally, the amount of donor blood transfusion did not affect rejection rates following HT. The present study suggests that a history of donor blood transfusion, as well as the amount of transfusion, should not preclude donor heart utilization.

关于供者输血对心脏移植（HT）结果的影响缺乏证据。我们试图利用国家数据库阐明供体输血对HT结果的影响。方法：从2004年1月至2023年3月，在联合器官共享网络（UNOS）数据库中获取40538例HT受体的供者输血信息。我们采用UNOS 4级输血标准（无血[N = 18 575]， 1-5单位[N = 14 098]， 6-10单位[N = 4766]，大量输血bbb10单位[N = 3099]）。结果：在该队列中，53.2%的献血者（N = 20220）在同一次入院期间接受了输血。需要输血的献血者通常以头部创伤作为死亡原因（无血，22% vs. 1-5单位，61%，6-10单位，88%，大量，89%,p < 0.001）。供者输血量的增加不影响急性排斥反应的发生率（无血18% vs. 1-5单位，19%，6-10单位，17%，大量，19%,p = 0.13）。输血单位数也不影响1年生存率。Cox风险模型显示大量输血对移植后死亡率没有影响(无血对照1-5单位；HR, 1.02 [p = 0.35]， 6-10个单位；HR, 1.10 [p = 0.01]，大量输血；HR 1.04 [p = 0.3])。结论：供体大量输血与受体死亡率增加无关。此外，供者输血量不影响HT后的排异率。目前的研究表明，献血者输血史以及输血量不应排除献血者的心脏利用。

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引用次数: 0

Multicenter, Real-World Clinical Evaluation of Alemtuzumab and Anti-Thymocyte Globulin for Severe Acute T Cell-Mediated Kidney Transplant Rejection 阿仑单抗和抗胸腺细胞球蛋白治疗严重急性T细胞介导的肾移植排斥反应的多中心、真实世界临床评价

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-05 DOI: 10.1111/ctr.70046

Lukas K. van Vugt, Erzsi Tegzess, Marieke van der Zwan, Marian C. Clahsen-van Groningen, Brenda C. M. de Winter, Priya Vart, Marlies E. J. Reinders, Jan Stephan F. Sanders, Stefan P. Berger, Dennis A. Hesselink

Background

Alemtuzumab can be an alternative to rabbit anti-thymocyte globulin (rATG) to treat severe or glucocorticoid-resistant acute T cell-mediated kidney transplant rejection (TCMR). Yet, there are few reports in which these two treatments are evaluated let alone, compared. This study describes the real-world clinical experience of both therapies and compares their efficacy and toxicity.

Methods

Kidney transplant recipients of two Dutch transplant centers who received lymphocyte-depleting antibody therapy for severe or glucocorticoid-resistant TCMR were retrospectively evaluated. In the first, alemtuzumab was the standard treatment for this indication, in the second, it was rATG. Patient survival, graft survival and function, and the occurrence of infections and malignancies were reported and compared.

Results

One hundred and forty-three patients treated with alemtuzumab and 57 patients with rATG were evaluated. Patient survival was not significantly different during follow-up (p = 0.55), and 5-year survival rates were 71.0% (95% confidence interval [CI]: 63.0–79.9) after alemtuzumab and 70.7% (95% CI: 58.3–85.7) after rATG. Graft survival was not significantly different during follow-up either (p = 0.24), and 5-year graft loss rates were 32.3% (95% CI: 24.2–40.5) after alemtuzumab and 29.2% (95% CI: 16.0–42.4) after rATG. The occurrence of infections and malignancies did not differ between groups.

Conclusion

Mostly, severe TCMRs have good long-term graft survival and function after either alemtuzumab or rATG therapy. No significant differences between the two therapies were found in this real-world clinical experience. Alemtuzumab is an effective alternative to rATG for the treatment of severe TCMR.

背景：阿仑单抗可以替代兔抗胸腺细胞球蛋白（rATG）治疗严重或糖皮质激素抵抗的急性T细胞介导的肾移植排斥反应（TCMR）。然而，很少有报道对这两种治疗方法进行评估，更不用说进行比较了。本研究描述了两种疗法的真实临床经验，并比较了它们的疗效和毒性。方法：回顾性评价两个荷兰移植中心接受淋巴细胞消耗抗体治疗严重或糖皮质激素耐药TCMR的肾移植受者。在第一项研究中，阿仑单抗是该适应症的标准治疗，在第二项研究中，它是rATG。报告并比较两组患者的生存、移植物的生存和功能、感染和恶性肿瘤的发生。结果：143例患者接受阿仑单抗治疗，57例患者接受rATG治疗。随访期间患者生存率无显著差异（p = 0.55），阿仑单抗组5年生存率为71.0%(95%可信区间[CI]: 63.0-79.9)，大鼠组5年生存率为70.7% （95% CI: 58.3-85.7）。随访期间移植物存活率也无显著差异（p = 0.24），阿仑单抗组的5年移植物损失率为32.3% (95% CI: 24.2-40.5)， rATG组为29.2% （95% CI: 16.0-42.4）。感染和恶性肿瘤的发生在两组之间没有差异。结论：大多数严重tcmr患者在阿仑单抗或rATG治疗后具有良好的长期移植物存活和功能。在这个真实世界的临床经验中，两种疗法之间没有显着差异。阿仑单抗是治疗严重TCMR的有效替代方案。

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引用次数: 0

Impact of Cold Ischemia Time and Donor Age on Donation After Circulatory Death Kidney Transplant Outcomes: A UNOS Mate-Kidney Analysis 冷缺血时间和供者年龄对循环死亡肾移植后捐献结果的影响：一项UNOS配对肾分析。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-05 DOI: 10.1111/ctr.70051

Gabriel Cojuc-Konigsberg, Belen Rivera, Stalin Cañizares, Martha Pavlakis, Devin Eckhoff, Bhavna Chopra

Background

The association between prolonged cold ischemia times (CIT), donor age, and outcomes in kidney transplant recipients (KTRs) from donors after circulatory death (DCD) remains uncertain. We aimed to compare allograft outcomes in DCD-donor KTRs according to CIT and age.

Methods

UNOS database study (2010–2024) of DCD-donor KTRs on tacrolimus maintenance. We developed a mate-kidney analysis, comparing outcomes where one mate kidney had CIT >24 and the other ≤24 h. We evaluated patient death, all-cause allograft failure, and death-censored graft failure (DCGF) using multivariable stratified Cox proportional hazards models. We compared outcomes across age groups (≥50 or <50 years) and 6-h-period CIT deltas between mate kidneys. We assessed delayed graft function (DGF) occurrence with multivariable conditional logistic regression.

Results

We included 4092 DCD-donor mate-kidney pairs. There were no differences between CIT >24 versus ≤24 h in patient death (aHR 1.12, 95% CI 0.97–1.30), all-cause allograft failure (aHR 1.10, 95% CI 0.98–1.24), or DCGF (aHR 1.07, 95% CI 0.90–1.27). Similar results were observed when comparing outcomes by age group and 6-h-period CIT deltas between mate kidneys. Compared to shorter CITs, CITs >24 h were associated with increased DGF likelihood (aOR 1.42, 95% CI 1.25–1.60), as were increasing CIT deltas.

Conclusion

CITs >24 h in DCD-donor KTRs were not associated with adverse allograft outcomes, irrespective of age group. However, prolonged CITs were associated with increased DGF likelihood. Increasing the acceptance of both mate kidney from DCD donors should be considered despite projected CITs >24 h.

背景：供体肾移植受者循环性死亡（DCD）后延长冷缺血时间（CIT）、供体年龄与预后之间的关系尚不确定。我们的目的是根据CIT和年龄比较cd供体KTRs的同种异体移植结果。方法：UNOS数据库（2010-2024）研究cd -供体ktr对他克莫司维持的影响。我们进行了配对肾脏分析，比较了一个配对肾脏CIT为bbbb24和另一个≤24小时的结果。我们使用多变量分层Cox比例风险模型评估了患者死亡、全因同种异体移植失败和死亡审查移植失败（DCGF）。我们比较了不同年龄组（≥50岁）的结果。结果：我们纳入了4092对cd供体配对肾脏。在患者死亡（aHR 1.12, 95% CI 0.97-1.30）、全因同种异体移植失败（aHR 1.10, 95% CI 0.98-1.24）或DCGF （aHR 1.07, 95% CI 0.90-1.27）方面，CIT 24小时与≤24小时之间没有差异。当按年龄组和配偶肾脏之间的6 h期CIT delta比较结果时，观察到类似的结果。与较短的CIT相比，CIT bbb24 h与DGF可能性增加相关（aOR 1.42, 95% CI 1.25-1.60）， CIT δ增加也是如此。结论：无论年龄如何，cd供体KTRs的CITs bbb24 h与同种异体移植的不良结果无关。然而，延长的CITs与DGF的可能性增加有关。尽管预计CITs为24小时，但仍应考虑增加DCD供者的双配偶肾的接受度。

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引用次数: 0

Myosteatosis Is Associated With Frailty and Poor Physical Function in Patients Undergoing Liver Transplant Evaluation: A Cohort Study 肝移植评估：一项队列研究：肌骨化病与虚弱和身体功能差有关

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-03 DOI: 10.1111/ctr.70034

Heidi E. Johnston, Melita Andelkovic, Hannah L. Mayr, Yanyan Chen, Aaron P. Thrift, Graeme A. Macdonald, Ingrid J. Hickman

Introduction

Myosteatosis is fat infiltration within skeletal muscle. The impact of myosteatosis on physical function and clinical outcomes in patients referred for liver transplantation (LT) is unclear. We explored associations between myosteatosis and sarcopenia, frailty, physical function, and pre- and early post-LT outcomes.

Methods

Myosteatosis was assessed by computed tomography (CT) in 237 patients referred for LT (March 2018 to September 2022). Chi-square/Fishers exact tests and multivariable regression compared myosteatosis and sarcopenia, frailty (liver frailty index), physical function (short physical performance battery, SPPB); and associations with pre-LT unplanned hospitalizations, post-LT surgical complications (Clavien–Dindo grade ≥ 3), and LT admission length of stay (LOS). Kaplan–Meier and Cox-proportional hazards models explored myosteatosis and time to LT and unplanned admission. Fine–Gray model evaluated the competing risks of receiving an LT.

Results

Myosteatosis was present in 74 (31%) patients. Patients with myosteatosis were 2.5 times (95% confidence interval [CI] 1.1–5.7, p = 0.03) more likely to be frail, and 3.0 times (95% CI 1.6–5.6, p < 0.001) more likely to have a poor physical function (SPPB ≤ 9/12) than those without myosteatosis. Patients with myosteatosis versus those without were more likely to have a pre-LT unplanned hospitalization (51% vs. 36%, p = 0.03), but significance was lost after adjusting for age, sex, Model for End-stage Liver Disease (MELD), and the presence of hepatocellular carcinoma. Myosteatosis did not impact the likelihood of receiving an LT (p = 0.39), post-LT complications (p = 0.93), or LOS in intensive care unit (ICU) (p = 0.66) or hospital (p = 0.34).

Conclusions

Myosteatosis is prevalent in patients referred for LT and is associated with impaired physical function. Using existing CTs to assess myosteatosis in practice may help identify physically compromised patients.

肌骨化病是骨骼肌内脂肪浸润。肌骨增生症对肝移植患者身体功能和临床结果的影响尚不清楚。我们探讨了肌骨化病与肌肉减少症、虚弱、身体功能以及肝移植前后早期预后之间的关系。方法对237例LT患者（2018年3月至2022年9月）进行CT评估。卡方/ fisher精确检验和多变量回归比较了骨骼肌病和肌肉减少症、虚弱（肝脏虚弱指数）、身体功能（短体能电池，SPPB）；以及与肝移植前非计划住院、肝移植后手术并发症（Clavien-Dindo分级≥3）和肝移植住院时间（LOS）的关联。Kaplan-Meier和cox比例风险模型探讨了肌骨化症与肝移植和非计划入院时间的关系。Fine-Gray模型评估了接受lt的竞争风险。结果74例（31%）患者存在肌骨化病。肌骨增生症患者体弱的可能性是前者的2.5倍（95%可信区间[CI] 1.1-5.7, p = 0.03），是后者的3.0倍(95% CI 1.6-5.6, p <；0.001)比无骨骼肌病者更容易出现身体功能不良（SPPB≤9/12）。有肌骨增生症的患者比没有肌骨增生症的患者更有可能在肝移植前发生计划外住院（51%对36%，p = 0.03），但在调整年龄、性别、终末期肝病模型（MELD）和肝细胞癌的存在后，这一差异没有统计学意义。肌肥大症对接受肝移植（p = 0.39）、肝移植后并发症（p = 0.93）或重症监护病房（ICU）（p = 0.66）或住院（p = 0.34）的LOS的可能性没有影响。结论：肌骨化病在肝移植患者中普遍存在，并与身体功能受损有关。在实践中使用现有的ct来评估肌骨增生症可能有助于识别身体受损的患者。

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引用次数: 0

Ultrasound Utilization in Hospitalized Kidney Transplant Recipients: Useful or Overused? 超声在住院肾移植受者中的应用：有用还是过度使用？

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-03 DOI: 10.1111/ctr.70048

Jason T. Bau, Jennifer Park, Yanhong Li, Christie Rampersad, S. Joseph Kim

Kidney transplant ultrasonography is an important diagnostic tool in the care of transplant recipients. This modality of nonradiation-based imaging allows for precise and expedient reporting of allograft architecture, which can inform clinical decision-making. However, as with any diagnostic tool, overuse may lead to unnecessary interventions and costs on the healthcare system. To better understand the use of ultrasonography in hospitalized kidney transplant recipients and outcomes of subsequent interventions, we conducted a single-center retrospective study at a large transplant program in Ontario, Canada. We noted that over 30% of admissions resulted in a ultrasonographic survey within the first 24 h of presentation; however, most of these did not change clinical management or lead to a subsequent procedural intervention. Using multivariable logistic regression, we identified predictors for receiving an ultrasound, including time from transplantation, elevated serum creatinine and infectious diagnosis. Procedural interventions (e.g., drain or biopsy) resulted from less than 20% of all ultrasound investigations, with patients closer to the time of index transplant or with elevated serum creatinine values more likely to receive an intervention. In conducting a cost analysis, we estimated that approximately $80 000 CAD per year could be saved with more selective decisions on ultrasound requisitions. Overall, our results indicate that despite being an informative tool, the broad use of ultrasonography in the kidney transplant population may not yield significant changes to transplant care.

肾移植超声检查是肾移植受者护理的重要诊断工具。这种非放射成像的方式可以精确和方便地报告同种异体移植物的结构，这可以为临床决策提供信息。然而，与任何诊断工具一样，过度使用可能导致不必要的干预和医疗保健系统的成本。为了更好地了解超声检查在住院肾移植受者中的应用以及后续干预措施的结果，我们在加拿大安大略省的一个大型移植项目中进行了一项单中心回顾性研究。我们注意到，超过30%的入院患者在发病后24小时内进行了超声检查；然而，其中大多数没有改变临床管理或导致随后的手术干预。使用多变量逻辑回归，我们确定了接受超声检查的预测因素，包括移植后的时间、血清肌酐升高和感染诊断。程序性干预（如引流或活检）在所有超声检查中所占比例不到20%，接近指数移植时间或血清肌酐值升高的患者更有可能接受干预。在进行成本分析时，我们估计，在超声波申请方面做出更有选择性的决定，每年可以节省大约8万加元。总的来说，我们的结果表明，尽管超声检查是一种信息丰富的工具，但在肾移植人群中广泛使用超声检查可能不会对移植护理产生重大变化。

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引用次数: 0

Attitudes Toward Use of an APOL1 Genetic Testing Chatbot in Living Kidney Donor Evaluation: A Focus Group Study 对在活体肾供者评估中使用APOL1基因检测聊天机器人的态度：焦点小组研究

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-03 DOI: 10.1111/ctr.70026

James L. Rogers, Jessica Gacki-Smith, Rochell Yacat, Catherine Wicklund, Debra Duquette, John Friedewald, Matthew Cooper, Alexander Gilbert, Akansha Agrawal, Elisa J. Gordon

Background

Living kidney donor (LKD) candidates of African ancestry are increasingly asked to undergo Apolipoprotein L1 (APOL1) genetic testing during the donor evaluation process to better understand their risk of kidney disease. LKD candidates’ attitudes about using a clinical chatbot on APOL1 remain unknown. This study builds on prior work to culturally adapt the Gia (Genetic Information Assistant) chatbot on APOL1 by assessing donor, recipient, and community member attitudes about the Gia chatbot for enhancing the integration of APOL1 testing into the LKD clinical evaluation workflow.

Methods

This study involved focus groups and a post-focus group survey in two US cities about the APOL1 Gia chatbot. Qualitative data were analyzed via thematic analysis, and descriptive statistics were used for demographic data.

Results

We conducted 10 focus groups including 54 participants (25 LKDs, 23 community members, and 6 living donor kidney transplant recipients of African ancestry). Five themes emerged: (1) participants supported LKD candidates using the Gia chatbot before the nephrologist clinic visit, (2) participants were interested in undergoing APOL1 testing after using Gia, (3) APOL1 testing costs may influence LKD candidates’ willingness to get tested, (4) patients of African ancestry may hold varying preferences for using chatbots in the healthcare setting, and (5) individual-level barriers may limit the use of Gia in the healthcare setting.

Conclusions

Individuals of African ancestry were highly receptive to integrating the APOL1 chatbot into LKD candidate clinical evaluation, which bodes well for integrating chatbots into the APOL1 clinical genetic testing process.

背景：越来越多的非洲血统的活体肾供者（LKD）候选人被要求在供者评估过程中进行载脂蛋白L1 （APOL1）基因检测，以更好地了解他们患肾脏疾病的风险。LKD候选人对APOL1使用临床聊天机器人的态度尚不清楚。本研究建立在先前工作的基础上，通过评估供体、受体和社区成员对Gia聊天机器人的态度，在APOL1上对Gia聊天机器人进行文化调整，以加强APOL1测试与LKD临床评估工作流程的整合。方法在美国两个城市对APOL1 Gia聊天机器人进行焦点小组和后焦点小组调查。定性数据采用专题分析，人口统计数据采用描述性统计。结果我们进行了10个焦点小组，包括54名参与者（25名lkd， 23名社区成员和6名非洲血统的活体肾移植受者）。出现了五个主题：(1)受试者支持LKD患者在肾病专家门诊就诊前使用Gia聊天机器人；(2)受试者在使用Gia聊天机器人后有兴趣进行APOL1测试；(3)APOL1测试成本可能影响LKD患者接受测试的意愿；(4)非洲血统患者在医疗保健环境中使用聊天机器人的偏好可能不同。(5)个人层面的障碍可能会限制Gia在医疗保健环境中的使用。结论非洲人对将APOL1聊天机器人整合到LKD候选人的临床评估中具有较高的接受度，这预示着将聊天机器人整合到APOL1临床基因检测过程中是一个良好的兆头。

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引用次数: 0

Family Planning Counseling and Practices in Kidney Transplant Recipients 肾移植受者的计划生育咨询与实践

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-03 DOI: 10.1111/ctr.70047

Swathi Rajagopal, Julia Ritchie, Dominika Seidman, Emily R. Perito, Deborah Adey, Monika Sarkar

Introduction

Half of all female kidney transplant (KT) recipients are reproductive-aged, though data on reproductive practices and counseling are limited.

Methods

This cross-sectional survey evaluated patient experiences, practices, and preferences surrounding contraception and pregnancy in female KT patients (listed or post-transplant) ages 14–45 years.

Results

A total of 152/682 eligible participants (22%; 50 pre- and 102 post-KT) completed the survey with 26% unaware at the time of KT that future pregnancy was possible. The majority (72%) of sexually active patients used contraception during the first year post-KT, though 24% exclusively used high failure-rate methods. Less than half (48%) felt their pre-KT reproductive counseling was adequate to guide decision-making, although 63% reported satisfaction with post-KT counseling. Discussions with transplant providers were the single most favored counseling modality at 74%. Misconceptions of intrauterine device safety and efficacy were identified.

Conclusion

Reproductive counseling commonly occurred, although information was inadequate for guiding pregnancy and contraceptive decisions in most pre-KT patients. Misconceptions about pregnancy potential and contraceptive efficacy and safety were common, as well as patient reliance on high-failure contraceptive methods. Improving patient knowledge and access to contraception and pregnancy planning is essential for honoring patients’ reproductive wishes while lowering obstetric, graft, and perinatal risks in post-KT pregnancies.

尽管关于生殖实践和咨询的数据有限，但所有女性肾移植（KT）接受者中有一半是育龄妇女。方法：本横断面调查评估14-45岁女性KT患者（已登记或移植后）在避孕和妊娠方面的经历、做法和偏好。结果共有152/682名符合条件的参与者(22%；50名KT前和102名KT后完成了调查，其中26%的人在KT时不知道未来可能怀孕。大多数（72%）性活跃的患者在kt后的第一年使用避孕措施，尽管24%的患者只使用高失败率的方法。不到一半（48%）的人认为他们在kt前的生殖咨询足以指导决策，尽管63%的人对kt后的咨询表示满意。与移植提供者讨论是最受欢迎的咨询方式，占74%。发现了对宫内节育器安全性和有效性的误解。结论生殖咨询是普遍存在的，但信息不足以指导大多数kt前患者的妊娠和避孕决策。对怀孕潜力和避孕有效性和安全性的误解是常见的，以及患者对高失败的避孕方法的依赖。提高患者对避孕和妊娠计划的了解和获取对于尊重患者的生育意愿，同时降低kt后妊娠的产科、移植物和围产期风险至关重要。

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引用次数: 0

Successful Multiorgan Transplantation in Highly Sensitized Patients With Positive Crossmatch Donor 高敏感患者交叉配型阳性多器官移植的成功案例

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-02 DOI: 10.1111/ctr.70040

Benjamin Louis Thomae, Taisuke Kaihou, David F. Pinelli, John J. Friedewald, Juan C. Caicedo-Ramirez, Ankit Bharat, Satish Nadig, Chitaru Kurihara

引用次数: 0

Randomized Controlled Trial to Evaluate a New Tool to Support Patient Decision-making on Transplant Centers 随机对照试验评估支持移植中心患者决策的新工具

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-02 DOI: 10.1111/ctr.70043

Warren T. McKinney, Kareena Israni, Cory R. Schaffhausen, David P. Schladt, Grace R. Lyden, Arthur Matas, Jack Wolf, Sandra Japuntich, Ajay K. Israni

Patients are not always aware of listing criteria and offer acceptance across transplant programs. Factors such as age and body mass index can impact access to transplants as centers have different candidate criteria. Therefore, we created a transplant center search tool (transplantcentersearch.org) (TCST) to help patients find comparative information on transplant programs. We conducted a cross-over randomized controlled trial (RCT) to assess whether the TCST improved comprehension compared to the existing Scientific Registry of Transplant Recipients website among adults seeking kidney transplants at two centers. To assess comprehension participants were asked to use the TCST and the SRTR website to identify which transplant program within a prespecified area had the most recipients over 70 years of age; and which programs had the most recipients with BMI >40. Participants were asked to provide qualitative feedback on using both websites. Sixty-eight candidates participated in the RCT. Participants were more likely to identify the correct program when using the TCST compared to the existing SRTR website (OR 8.13, 95% CI 1.87–35.33). Participants stated they preferred the TCST over the SRTR website (52.9% vs. 25.0%, respectively, p = 0.009). With increased comprehension, patients would be better equipped to identify programs that transplant patients like them.

Trial Registration: ClinicalTrials.gov identifier: NCT03610555

患者并不总是知道列出的标准，并在移植项目中提供接受。由于各中心有不同的候选标准，年龄和体重指数等因素会影响移植的获得。因此，我们创建了一个移植中心搜索工具（transplantcentersearch.org）（TCST）来帮助患者找到移植项目的比较信息。我们进行了一项交叉随机对照试验（RCT），以评估在两个中心寻求肾脏移植的成年人中，与现有的移植接受者科学注册网站相比，TCST是否提高了理解能力。为了评估理解能力，参与者被要求使用TCST和SRTR网站来确定在预先指定的区域内哪个移植项目中70岁以上的受者最多；以及哪些项目的受助人BMI指数为40。参与者被要求提供使用这两个网站的定性反馈。68名候选人参加了随机对照试验。与现有的SRTR网站相比，使用TCST时，参与者更有可能识别正确的程序（OR 8.13, 95% CI 1.87-35.33）。参与者表示他们更喜欢TCST而不是SRTR网站（分别为52.9%对25.0%,p = 0.009）。随着理解的增加，患者将更好地确定移植病人喜欢他们的项目。试验注册：ClinicalTrials.gov标识符：NCT03610555

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引用次数: 0

Influence of Acuity Circles on Hepatocellular Carcinoma and the Interaction of Gender and Race in Liver Transplantation 急性眼圈对肝移植中肝细胞癌的影响及性别、种族的相互作用

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-12-02 DOI: 10.1111/ctr.70045

Ahila Manivannan, Anjana Pillai, AnnMarie Liapakis, Neehar D. Parikh, Vineeta Kumar, Elizabeth C. Verna, Reena Salgia, Trueman Wu, Mei Lu, Michelle T. Jesse

The impact of liver transplant allocation policy using acuity circles (ACs) on interactions between race and gender on waitlist mortality or receipt of deceased donor liver transplant (DDLT) is unknown. Using data from the United Network for Organ Sharing (UNOS), we examined adults listed for DDLT from April 3, 2017, to October 4, 2022 (30 months pre- and post-AC). Fine-Gray sub-distribution hazard model explored AC indicators by race and gender interactions and their effect on receipt of DDLT or waitlist mortality. Also explored was AC's impact on hepatocellular carcinoma (HCC) diagnosis and receipt of DDLT or waitlist mortality. 59 592 patients (30 202 pre-AC, 29 390 post-AC) included. For both receipt of DDLT and waitlist mortality, there were no 3-way (AC by race by gender) interactions, indicating that the effects of race and gender on DDLT or waitlist mortality were consistent pre- and post-AC. Irrespective of AC implementation, Black and Hispanic women were less likely to receive DDLT and had an increased risk of waitlist mortality compared to White women. White, Black, and Hispanic men had lower waitlist mortality risk and greater likelihood of receiving DDLT compared to their female race/ethnic counterparts. Patients with HCC had a significantly greater chance for DDLT than non-HCC, although post-AC this effect was attenuated. Patients with HCC were also at greater risk of waitlist mortality pre- and post-AC compared to those without HCC however, the waitlist mortality post-AC was attenuated only for those patients without HCC. To our knowledge, this is the first study to show the interaction of gender and race on waitlist mortality and access to transplantation since the implementation of AC, showing continued disparate outcomes for women both within and across racial groups.

使用视圆（ACs）的肝移植分配政策对种族和性别对等待名单死亡率或接受已故供体肝移植（DDLT）的相互作用的影响尚不清楚。使用器官共享联合网络（UNOS）的数据，我们检查了2017年4月3日至2022年10月4日（ac前后30个月）登记为DDLT的成年人。细灰色亚分布风险模型通过种族和性别相互作用探讨AC指标及其对DDLT接收或等候名单死亡率的影响。还探讨了AC对肝细胞癌（HCC）诊断和接受DDLT或等候名单死亡率的影响。纳入59592例患者（30202例ac前，29390例ac后）。对于DDLT的接收和候补名单死亡率，没有3-way（种族和性别的AC）相互作用，表明种族和性别对DDLT或候补名单死亡率的影响在AC前后是一致的。无论是否实施AC，与白人妇女相比，黑人和西班牙裔妇女接受DDLT的可能性较小，等待名单死亡率风险增加。与女性相比，白人、黑人和西班牙裔男性的等待名单死亡风险较低，接受DDLT的可能性较大。HCC患者发生DDLT的机会明显高于非HCC患者，尽管ac后这种影响减弱。与没有HCC的患者相比，HCC患者在ac术前和ac后的等候名单死亡率风险也更高。然而，只有那些没有HCC的患者在ac后的等候名单死亡率有所降低。据我们所知，这是自AC实施以来首次显示性别和种族在等待名单死亡率和移植可及性方面的相互作用的研究，显示了种族群体内部和跨种族女性的持续差异结果。

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引用次数: 0