Clinical Transplantation最新文献_第9页

The Effect of Everolimus Versus Calcineurin Inhibitors on Quality of Life 10–12 Years After Heart Transplantation: The Results of a Randomized Controlled Trial (SCHEDULE Trial) 依维莫司与降钙素抑制剂对心脏移植术后 10-12 年生活质量的影响：随机对照试验（SCHEDULE 试验）的结果。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-22 DOI: 10.1111/ctr.70028

Ingelin Grov, Anne Relbo Authen, Satish Arora, Niklas Bergh, Katrine Rolid, Finn Gustafsson, Hans Eiskjær, Göran Rådegran, Einar Gude, Arne K. Andreassen, Thea Halden, Kaspar Broch, Lars Gullestad, the SCHEDULE investigators

Background

Calcineurin inhibitors (CNIs) are associated with long-term complications after heart transplantation (HTx). Everolimus (EVR)-based immunosuppression allows for CNI withdrawal. We used data from The Scandinavian heart transplant everolimus de novo study with early CNI avoidance (SCHEDULE) trial to assess whether health-related quality of life (HRQoL) differed between patients on long-term treatment with EVR versus a CNI-based regimen.

Methods

In SCHEDULE, we randomized 115 patients (mean age 51 ± 13 years, 27% women) to cyclosporine (CNI group; n = 59), or early introduction of EVR and cyclosporine withdrawal within 11 weeks of HTx (EVR group; n = 56). The primary endpoint was the glomerular filtration rate. We used the Short Form-36 (SF-36v2), the EuroQoL visual analogue scale (EQ VAS), and the Beck Depression Inventory (BDI) to assess HRQoL. We re-evaluated the participants after 10–12 years.

Results

Seventy-eight patients attended follow-up at a median of 11 years after HTx. The SF-36 physical component summary score increased from 32 ± 10 pre-HTx to 44 ± 12 11 years after HTx (p < 0.01) in the EVR group and from 33 ± 9 to 44 ± 11 (p < 0.01) with CNI. The mental component summary score increased from 46 ± 12 to 53 ± 13 (EVR); p = 0.04 and from 38 ± 13 to 49 ± 13 (CNI); p < 0.01. Similar improvements were observed regarding EQ-VAS and the BDI. There were no significant between-group differences for either measure of HRQoL.

Conclusions

In heart transplant recipients, an EVR-based immunosuppressive strategy resulted in similar long-term improvements in HRQoL as treatment with a CNI-based regimen.

背景：降钙素抑制剂（CNIs）与心脏移植（HTx）后的长期并发症有关。基于依维莫司（EVR）的免疫抑制可以停用钙神经蛋白抑制剂。我们利用斯堪的纳维亚心脏移植依维莫司新药研究与早期CNI避免（SCHEDULE）试验的数据，评估了长期接受EVR治疗的患者与接受CNI治疗的患者在健康相关生活质量（HRQoL）方面是否存在差异：在 SCHEDULE 试验中，我们将 115 名患者（平均年龄为 51 ± 13 岁，27% 为女性）随机分配到环孢素组（CNI 组，n = 59）或早期使用 EVR 并在 HTx 后 11 周内停用环孢素组（EVR 组，n = 56）。主要终点是肾小球滤过率。我们使用简表-36（SF-36v2）、欧洲生活质量视觉模拟量表（EQ VAS）和贝克抑郁量表（BDI）来评估患者的生活质量。我们在 10-12 年后对参与者进行了重新评估：结果：78 名患者接受了高频电刺激术后 11 年的中位随访。SF-36身体成分总分从移植前的32±10分增加到移植后11年的44±12分（P 结论：在心脏移植受者中，EVG（Enti-endi-endi-endi）是一种有效的抗氧化剂：在心脏移植受者中，以 EVR 为基础的免疫抑制策略与以 CNI 为基础的治疗方案在长期改善 HRQoL 方面效果相似。

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引用次数: 0

Senescence Biomarkers and Trajectories of Frailty and Physical Function After Kidney Transplantation 衰老生物标志物与肾移植后的虚弱和身体功能轨迹

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-20 DOI: 10.1111/ctr.70022

Elizabeth C. Lorenz, Byron H. Smith, Hani M. Wadei, Girish Mour, Cassie C. Kennedy, Carrie A. Schinstock, Walter K. Kremers, Andrea L. Cheville, LaTonya J. Hickson, Elizabeth J. Atkinson, Thomas A. White, Andrew D. Rule, Nathan K. LeBrasseur

Cellular senescence is a biological mechanism of aging and age-related diseases. The aim of this study was to examine whether senescence biomarkers are associated with frailty and physical function trajectories in patients undergoing kidney transplantation (KT). We also discussed the relationship between senescence biomarkers and KT function. In this multicenter study, we prospectively assessed plasma levels of senescence biomarkers, frailty as measured by the Physical Frailty Phenotype, and physical function as measured by the Short Physical Performance Battery prior to KT. Frailty, physical function, and KT function were also measured 1 year after KT. Variable associations were assessed using Cox and relaxed least absolute shrinkage and selection operation regression. The cohort consisted of 197 participants (mean age 53 ± 13 years, 61.4% male, and 80.2% White race). Higher pre-KT levels of macrophage-derived chemokine (MDC/CCL22) and growth differentiation factor-15 (GDF-15) were independently associated with less improvement in frailty and/or physical function during the first year after KT. Higher pre-KT levels tumor necrosis factor receptor superfamily member 6 (FAS) and MMP-9 levels were independently associated with lower KT function one year after KT. Pre-KT cellular senescence may contribute to frailty, physical function, and kidney function trajectories during the first year after KT.

细胞衰老是导致衰老和老年相关疾病的一种生物学机制。本研究旨在探讨衰老生物标志物是否与肾移植（KT）患者的虚弱和身体功能轨迹相关。我们还讨论了衰老生物标志物与 KT 功能之间的关系。在这项多中心研究中，我们前瞻性地评估了肾移植前血浆中的衰老生物标志物水平、以体质虚弱表型（Physical Frailty Phenotype）衡量的虚弱程度以及以短期体能测试（Short Physical Performance Battery）衡量的体能。KT 1 年后，还对虚弱程度、身体功能和 KT 功能进行了测量。使用 Cox 和松弛最小绝对缩减和选择操作回归评估了变量之间的关联。队列由 197 名参与者组成（平均年龄为 53 ± 13 岁，61.4% 为男性，80.2% 为白种人）。KT前水平较高的巨噬细胞衍生趋化因子（MDC/CCL22）和生长分化因子-15（GDF-15）与KT后第一年虚弱和/或身体功能改善较少独立相关。KT前水平较高的肿瘤坏死因子受体超家族成员6（FAS）和MMP-9水平与KT一年后较低的KT功能独立相关。KT前细胞衰老可能会导致KT后第一年内的虚弱、身体功能和肾功能轨迹。

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引用次数: 0

Addressing Kidney Transplant Inequalities Facing Rural Americans 解决美国农村地区面临的肾移植不平等问题

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-20 DOI: 10.1111/ctr.70021

Rebecca J. Schmidt, Thomas G. Peters

引用次数: 0

The Impact of Statin Intensity on the Early Progression of Cardiac Allograft Vasculopathy 他汀类药物强度对心脏移植血管病早期进展的影响

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-18 DOI: 10.1111/ctr.70030

Xinyi Huang, Melana Yuzefpolskaya, Paolo C. Colombo, Jason Choe, Tara Shertel, Douglas L. Jennings

Background

Limited research has compared the relative risks and benefits different statins have after heart transplantation (HT).

Method

We hypothesize that higher statin intensity is associated with a smaller degree of allograft intimal thickening on intravascular ultrasound (IVUS) at 1-year post-HT. Allograft intima-media thickness (IMT) on the first annual IVUS was retrospectively compared in patients initiated on a low-intensity statin (pravastatin 20 mg daily) versus moderate-intensity statin (atorvastatin 20 mg daily) post-HT.

Results

A total of 172 adult patients were included (2018–2022, n = 86 in each group). At 1 year, the maximal IMT was lower in the moderate-intensity statin group, but the difference did not reach statistical significance. The LDL levels at 1 year trended lower with moderate-intensity statin therapy, while the rates of adverse reactions were not statistically different. A multivariate analysis of the logistic regression model showed moderate statin intensity at 12 months was protective, while donor-specific antibodies developed within the first-year posttransplant were associated with IMT ≥ 0.5 mm on the first annual IVUS.

Conclusion

This study found that using moderate-intensity statin to prevent the early progression was as safe and possibly more effective than low-intensity statin therapy for the prevention of early cardiac allograft vasculopathy.

背景：对心脏移植（HT）后不同他汀类药物的相对风险和益处进行比较的研究有限：我们假设，他汀类药物强度越高，心脏移植术后一年的血管内超声（IVUS）显示的异体移植物内膜增厚程度越小。我们回顾性比较了HT后开始服用低强度他汀类药物（普伐他汀20毫克/天）和中等强度他汀类药物（阿托伐他汀20毫克/天）的患者首次年度IVUS检查的移植物内膜中层厚度（IMT）：共纳入172名成年患者（2018-2022年，每组n=86）。1年后，中等强度他汀组的最大IMT较低，但差异未达到统计学意义。使用中等强度他汀类药物治疗一年后，低密度脂蛋白水平呈下降趋势，而不良反应发生率无统计学差异。逻辑回归模型的多变量分析显示，12个月时中等强度的他汀类药物具有保护作用，而移植后第一年内出现的供体特异性抗体与首次年度IVUS检查IMT≥0.5毫米有关：本研究发现，在预防早期心脏同种异体移植血管病变方面，使用中等强度的他汀类药物预防早期进展与低强度的他汀类药物治疗一样安全，甚至可能更有效。

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引用次数: 0

Veno-Venous Extracorporeal Membrane Oxygenation Support for Severe Primary Graft Dysfunction Is Associated With Reduced Airway Complications After Lung Transplantation 静脉体外膜氧合支持治疗严重的原发性移植物功能障碍与肺移植术后气道并发症的减少有关。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-18 DOI: 10.1111/ctr.70029

Kentaro Noda, Mohamed-Ali H. Jawad-Makki, Ernest G. Chan, John Ryan, Masashi Furukawa, Chadi A. Hage, Pablo G. Sanchez

Background

Early utilization of extracorporeal membrane oxygenation (ECMO) improves the clinical outcomes of patients with severe primary graft dysfunction (PGD3) after lung transplantation. Although there is a survival benefit, the impact of ECMO on airway complications has not been investigated. This study aims to describe the clinical association between posttransplant methods of support and the severity of acute airway anastomosis complications in patients with PGD3 following bilateral lung transplantation.

Methods

Data from adult bilateral lung transplant patients diagnosed with PGD3 at our institution were retrospectively reviewed. Bronchial anastomosis necrosis (ischemia reperfusion injury [IRI]) that developed within a month after transplantation was graded. The data were compared among the groups of veno-venous ECMO (VV-ECMO) (n = 77), veno-arterial ECMO (VA-ECMO) (n = 14), and mechanical ventilation (MV, n = 33).

Results

Higher levels of support (VV/VA-ECMO) were associated with a lower incidence of PGD3, which was highest in recipients on MV only (M² = 19.54, r = −0.41, p < 0.001). In a multivariable competing risk analysis, VV-ECMO was protective against chronic allograft dysfunction (CLAD) relative to the MV group (HR: 0.36 [0.13–0.96], p = 0.042). There was no relationship between posttransplant support and survival.

Conclusion

This study suggests posttransplant VV-ECMO support in patients who develop PGD3 may confer a protective advantage over MV alone in the prevention of ischemic reperfusion injury. VV-ECMO was associated with lower IRI grades and lower rates of BOS after transplantation. Future studies investigating the causal mechanisms are warranted.

背景：早期使用体外膜肺氧合（ECMO）可改善肺移植术后严重原发性移植物功能障碍（PGD3）患者的临床疗效。虽然 ECMO 有助于患者生存，但其对气道并发症的影响尚未得到研究。本研究旨在描述双肺移植后 PGD3 患者移植后支持方法与急性气道吻合并发症严重程度之间的临床关联：方法：对本院确诊为PGD3的成人双肺移植患者的数据进行回顾性研究。对移植后一个月内发生的支气管吻合口坏死（缺血再灌注损伤 [IRI]）进行分级。数据在静脉-静脉 ECMO（VV-ECMO）（77 人）、静脉-动脉 ECMO（VA-ECMO）（14 人）和机械通气（MV，33 人）组之间进行了比较：结果：较高水平的支持（VV/VA-ECMO）与较低的 PGD3 发生率相关，仅使用 MV 的受者中 PGD3 发生率最高（M2 = 19.54，r = -0.41，p 结论：该研究表明，移植后静脉-动脉 ECMO（VA-ECMO）和机械通气（MV，n = 33）可降低 PGD3 的发生率：本研究表明，在预防缺血再灌注损伤方面，对出现 PGD3 的患者进行移植后 VV-ECMO 支持可能比单纯 MV 更具有保护性优势。VV-ECMO与移植后较低的IRI分级和较低的BOS率有关。未来有必要对其因果机制进行研究。

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引用次数: 0

Calcineurin-Inhibitor Discontinuation Could Reduce the Risk of De Novo Malignancies After Liver Transplantation for Alcohol-Related Liver Disease 停用降钙素抑制剂可降低酒精相关肝病肝移植后新发恶性肿瘤的风险

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-17 DOI: 10.1111/ctr.70014

Domitille Erard, Anouk Steiner, Olivier Boillot, Elsa Thimonier, Mélanie Vallin, Florian Veyre, Olivier Guillaud, Sylvie Radenne, Jérôme Dumortier

Background

De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol-related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcineurin inhibitor (CNI) discontinuation.

Methods

From 1990 to 2015, all patients transplanted for ALD were included.

Results

A total of 493 patients were included, 77.9% were male and the median age at LT was 54 years. After LT, 278 de novo malignancies were diagnosed in 214 patients (43.4%). The cumulative incidence of de novo malignancies was 16.3% at 5 years, 34.4% at 10 years, and 49.8% at 15 years. In multivariate analysis, the independent risk factors were male gender (HR = 1.6), and active or weaned smoking (HR = 2.0). Discontinuation of CNI was a protective factor (HR = 0.6). Survival after diagnosis of de novo malignancy was 42.7% at 5 years and 27.5% at 10 years.

Conclusion

Our results confirm the major incidence of de novo malignancies after LT for ALD, as well as the important role of non-modifiable risk factors such as smoking and gender. CNI discontinuation is a protective factor, and the only adaptable, and could be proposed in smoker male patients transplanted for ALD.

背景：新发恶性肿瘤是肝移植（LT）后死亡的主要原因之一，尤其是因酒精相关肝病（ALD）而接受移植的患者。这项回顾性研究旨在评估恶性肿瘤的风险因素，并评估停用钙神经蛋白抑制剂（CNI）的影响：方法：纳入1990年至2015年所有因ALD而接受移植的患者：结果：共纳入493例患者，其中77.9%为男性，LT时的中位年龄为54岁。LT后，214名患者（43.4%）确诊为278例新发恶性肿瘤。新发恶性肿瘤的累积发病率分别为：5年16.3%，10年34.4%，15年49.8%。在多变量分析中，男性（HR = 1.6）、吸烟或已戒烟（HR = 2.0）是独立的风险因素。停用 CNI 是一个保护因素（HR = 0.6）。诊断为新发恶性肿瘤后，5年存活率为42.7%，10年存活率为27.5%：我们的研究结果证实了ALD接受LT治疗后新发恶性肿瘤的主要发病率，以及吸烟和性别等不可改变的风险因素的重要作用。停用氯化萘类药物是一种保护性因素，也是唯一一种适应性强的因素，建议用于因ALD而接受移植的吸烟男性患者。

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引用次数: 0

Sleep and Respiratory Parameters After Lung Transplantation in Adult Patients With Cystic Fibrosis 囊性纤维化成年患者肺移植后的睡眠和呼吸参数

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-14 DOI: 10.1111/ctr.70023

Alexandros Kalkanis, Dimitrios Papadopoulos, Robin Vos, Lieven Dupont, Bertien Buyse, Dries Testelmans

Objective

We aimed to explore the prevalence and predictive factors of sleep-disordered breathing (SDB) in patients with cystic fibrosis (pwCF) after lung transplantation (LTX).

Methods

We prospectively recruited adult pwCF who underwent LTX in our hospital from 2013 to 2022 and invited them for an attended overnight polysomnography (PSG) 1 year after transplantation. The apnea–hypopnea index (AHI) was the primary outcome, and SDB was defined as an AHI ≥ 5. Demographic, anthropometric, cardiometabolic, drug treatment, and pulmonary function variables were compared between pwCF with and without SDB. Multiple regression analysis was used to identify significant predictors of SDB. For a subset of participants who had available PSG before transplantation, sleep parameters were compared pre-post transplantation.

Results

Sixty-two pwCF (31 females) were enrolled. Thirty participants had SDB, but only 11 of them had moderate-to-severe SDB (AHI ≥ 15). The average Epworth Sleepiness Scale (ESS) score indicated the absence of excessive daytime sleepiness. Older age (p < 0.001), male sex (p < 0.001), and smaller thoracic gas volume (p = 0.002) significantly predicted higher AHI. Comparison between pre- and post-transplantation polysomnographic data showed a significant increase in the percentage of slow wave sleep (p = 0.047), as well as a significant improvement in mean nocturnal oxygen saturation (p = 0.007). A statistically significant increase in the AHI was also observed (p = 0.047), but its clinical importance is uncertain (p = 0.476 for the increase in the ESS score).

Conclusions

We may conclude that SDB is prevalent in pwCF after LTX, but its severity is mild. Older male pwCF with greater improvement in lung hyperinflation after transplantation might be at risk for SDB and should be followed for symptoms or signs of sleep apnea.

目的我们旨在探讨肺移植（LTX）后囊性纤维化患者（pwCF）睡眠呼吸障碍（SDB）的患病率和预测因素：我们前瞻性地招募了2013年至2022年期间在我院接受肺移植手术的成年囊性纤维化患者，并邀请他们在移植手术1年后参加一次通宵多导睡眠图（PSG）检查。呼吸暂停-低通气指数（AHI）是主要结果，AHI≥5定义为SDB。对有和没有 SDB 的 pwCF 的人口统计学、人体测量、心脏代谢、药物治疗和肺功能变量进行了比较。多元回归分析用于确定 SDB 的重要预测因素。对于移植前有 PSG 的参与者，对移植前和移植后的睡眠参数进行了比较：共有 62 名儿童慢性阻塞性肺疾病患者（31 名女性）入组。其中 30 人患有 SDB，但只有 11 人患有中重度 SDB（AHI ≥ 15）。埃普沃思嗜睡量表（ESS）的平均得分表明没有白天过度嗜睡的情况。年龄较大（P我们可以得出结论，SDB 在 LTX 后的肺心病患者中普遍存在，但其严重程度较轻。移植后肺过度充气情况得到较大改善的老年男性患儿可能有发生 SDB 的风险，因此应密切关注他们是否出现睡眠呼吸暂停的症状或体征。

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引用次数: 0

Variation Across Organ Procurement Organizations in Deceased-Donor Kidney Offer Notification Practices 不同器官获取组织在已故捐肾者供肾通知做法上的差异。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-14 DOI: 10.1111/ctr.70024

David C. Cron, Arnold E. Kuk, Layla Parast, S. Ali Husain, Vanessa M. Welten, Miko Yu, Sumit Mohan, Joel T. Adler

Introduction

How offer notifications are distributed early in the kidney allocation timeline, including how widely they are offered, is unclear. A better understanding of offer notification practices across organ procurement organizations (OPOs) may identify opportunities for more efficient allocation.

Methods

We merged the Scientific Registry of Transplant Recipients potential transplant recipient file with additional offer notification time stamps to identify 54 631 deceased-donor kidney match runs from 2017 to 2023. Offer notifications for a given match run are sent to candidates/centers in “batches.” We quantified the number of offers in the initial batch—which theoretically reflects the OPO's initial estimate of how widely a kidney should be offered—and compared this metric across OPOs.

Results

Kidneys were offered to a median of 14 candidates (IQR 9–38) in the first batch of notifications, and this varied across OPOs from 3 to 746 candidates per initial batch. Batch size at the OPO-level did not correlate with rank at kidney placement or OPO nonuse rate. OPOs in the highest quartile of batch size sent more offers (median 100) than presumably necessary to place kidneys (median rank at placement 21), and OPOs in the lowest quartile of batch size sent fewer offers (6) than needed to place kidneys (rank at placement 19).

Conclusions

Offer notification practices vary widely across OPOs, and many OPOs offer kidneys far more widely than necessary for placement. Optimization of offer notification practices may reduce unnecessary communications. Further research into allocation processes is needed to identify opportunities to improve efficiency of allocation for OPOs and transplant centers.

导言：目前尚不清楚在肾脏分配时间表的早期如何分发募捐通知，包括募捐范围有多广。更好地了解器官获取组织（OPO）的肾脏分配通知做法，可以发现提高分配效率的机会：我们合并了移植受者科学登记处的潜在移植受者档案和额外的要约通知时间戳，以确定2017年至2023年期间的54 631次死亡供肾匹配运行。特定配型的配型通知是分 "批次 "发送给候选人/中心的。我们量化了初始批次中提供肾脏的数量--这在理论上反映了OPO对肾脏提供范围的初步估计--并对不同OPO的这一指标进行了比较：在第一批通知中，向14名候选人（IQR为9-38）提供了肾脏，不同OPO的初始批次中，向3至746名候选人提供了肾脏。OPO 一级的批次规模与肾脏安置排名或 OPO 未使用率没有关联。批量规模最高四分位数的 OPO 发出的录取通知（中位数 100 份）多于安置肾脏所需的数量（安置排名中位数 21），而批量规模最低四分位数的 OPO 发出的录取通知（6 份）少于安置肾脏所需的数量（安置排名 19）：结论：各 OPO 的报价通知方式差异很大，许多 OPO 的肾脏报价范围远远超过了肾脏置入所需的范围。优化报价通知方法可以减少不必要的沟通。需要进一步研究分配流程，以确定提高 OPO 和移植中心分配效率的机会。

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引用次数: 0

Association Between Split Function of the Retained Kidney and Early Changes in Kidney Function After Living Kidney Donation 留存肾脏的分裂功能与活体肾脏捐献后肾功能的早期变化之间的关系

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-14 DOI: 10.1111/ctr.70025

Syed Ali Husain, Brendan R. Emmons, Miko E. Yu, Anne M. Huml, Sumit Mohan

引用次数: 0

Utilization of the Liver-First Approach in Combined Lung-Liver Transplant Provides Comparable Outcomes to the Traditional Lung-First Approach: A UNOS Study 在肺肝联合移植中采用 "肝脏优先 "方法可提供与传统 "肺脏优先 "方法相当的结果：一项 UNOS 研究。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2024-11-13 DOI: 10.1111/ctr.70003

Yizhan Guo, John Ryan, Ernest Chan, Masashi Furukawa, Chadi A. Hage, Pablo G. Sanchez

Multiorgan transplantation is offered to a selected group of patients every year. The sequence in which organs are transplanted depends on ischemic time graft tolerance and the sickest organ first strategy. In the case of Lung-Liver transplantation, lung allografts are usually implanted before the liver. There are some theoretical advantages to a liver-first strategy and a few centers have reported a series of cases that spark a growing interest in the feasibility and potential benefits of this approach. In this contemporary study of the United Network for Organ Sharing (UNOS) database, we evaluate and report outcomes using either strategy.

每年都会为部分患者提供多器官移植手术。器官移植的先后顺序取决于缺血时间、移植耐受性和重症器官优先策略。在肺肝移植中，肺异体移植通常先于肝脏植入。先肝后肺的策略在理论上有一些优势，一些中心已经报告了一系列病例，引发了人们对这种方法的可行性和潜在益处的兴趣。在这项对器官共享联合网络（UNOS）数据库的当代研究中，我们评估并报告了采用这两种策略的结果。

引用次数: 0