The decision of proceeding with a pancreas transplant (PTx) is a complex one, and patient education is important to allow transplant candidates to make an informed and autonomous decision. In this study, we assessed the readability and reliability of online information provided by PTx centers in the United States.
Methods
Websites of PTx centers active between 2022 and 2023 were searched for patient information on pancreas transplantation. Readability was assessed using eight validated formulas. Reliability was assessed using the Journal of the American Medical Association criteria.
Results
Of 117 PTx centers, 57 provided online information material. High-volume centers were more likely to provide patient information compared to medium- and low-volume centers (76.6%, 45.6%, 34.6%, respectively). Average readability was at the 11th grade and beyond, with no difference among the three groups (11.9, 11.4, 11.4). Reliability was low, with two centers providing information on the material sources. Only one center provided information in a language other than English.
Conclusions
Readability of online material on PTx provided by US transplant centers is low, well above the recommended 6th grade-level. Transplant centers, national societies and patient advocacy groups should collaborate in developing information material that is evidence-based, easy to read, and available in multiple languages.
{"title":"Evaluating Readability and Reliability of Online Information Provided by Pancreas Transplant Centers in the United States","authors":"Vincenzo Villani, Kumaran Shanmugarajah","doi":"10.1111/ctr.70055","DOIUrl":"10.1111/ctr.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The decision of proceeding with a pancreas transplant (PTx) is a complex one, and patient education is important to allow transplant candidates to make an informed and autonomous decision. In this study, we assessed the readability and reliability of online information provided by PTx centers in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Websites of PTx centers active between 2022 and 2023 were searched for patient information on pancreas transplantation. Readability was assessed using eight validated formulas. Reliability was assessed using the Journal of the American Medical Association criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 117 PTx centers, 57 provided online information material. High-volume centers were more likely to provide patient information compared to medium- and low-volume centers (76.6%, 45.6%, 34.6%, respectively). Average readability was at the 11<sup>th</sup> grade and beyond, with no difference among the three groups (11.9, 11.4, 11.4). Reliability was low, with two centers providing information on the material sources. Only one center provided information in a language other than English.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Readability of online material on PTx provided by US transplant centers is low, well above the recommended 6<sup>th </sup>grade-level. Transplant centers, national societies and patient advocacy groups should collaborate in developing information material that is evidence-based, easy to read, and available in multiple languages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817484","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}
Paolo Mendogni, Alessandro Palleschi, Giacomo Grisorio, Alessandra Mazzucco, Cristina Diotti, Letizia Corinna Morlacchi, Valeria Rosetti, Gianluca Bonitta, Mario Nosotti, Lorenzo Rosso
Suppurative lung diseases leading to end-stage respiratory failure are typical indications for bilateral lung transplantation (LuTx). Some cases may present severe chest asymmetry because of recurrent infections or previous surgical procedures, and the most used surgical options are single LuTx and contralateral pneumonectomy or bilateral transplantation with graft downsizing. Our purpose is to evaluate our treatment protocols for these patients and review surgical strategies reported by others.
We prospectively collected clinical data of patients with significant pleural cavity asymmetry who underwent bilateral LuTx at our center from 2017 to 2022. Clinical reports of all patients who underwent LuTx for end-stage suppurative disease in the same period were reviewed as the control group.
During the study period, 74 patients underwent bilateral LuTx for suppurative disease; seven of them presented with severe thoracic asymmetry, and all of them were extubated by the second postoperative day. The mean intensive care unit stay was 4 days. The postoperative radiological evaluation did not show clustering or atelectasis of the graft implanted in the smaller hemithorax. No perioperative major complications were recorded, and the average length of stay was 23 days. The perioperative course appeared remarkably good, and both the short- and long-term follow-up were similar to that of the control group.
{"title":"Bilateral Lung Transplantation in Patients With Severe Chest Asymmetry: A Case Series From a Single Center","authors":"Paolo Mendogni, Alessandro Palleschi, Giacomo Grisorio, Alessandra Mazzucco, Cristina Diotti, Letizia Corinna Morlacchi, Valeria Rosetti, Gianluca Bonitta, Mario Nosotti, Lorenzo Rosso","doi":"10.1111/ctr.70054","DOIUrl":"10.1111/ctr.70054","url":null,"abstract":"<p>Suppurative lung diseases leading to end-stage respiratory failure are typical indications for bilateral lung transplantation (LuTx). Some cases may present severe chest asymmetry because of recurrent infections or previous surgical procedures, and the most used surgical options are single LuTx and contralateral pneumonectomy or bilateral transplantation with graft downsizing. Our purpose is to evaluate our treatment protocols for these patients and review surgical strategies reported by others.</p><p>We prospectively collected clinical data of patients with significant pleural cavity asymmetry who underwent bilateral LuTx at our center from 2017 to 2022. Clinical reports of all patients who underwent LuTx for end-stage suppurative disease in the same period were reviewed as the control group.</p><p>During the study period, 74 patients underwent bilateral LuTx for suppurative disease; seven of them presented with severe thoracic asymmetry, and all of them were extubated by the second postoperative day. The mean intensive care unit stay was 4 days. The postoperative radiological evaluation did not show clustering or atelectasis of the graft implanted in the smaller hemithorax. No perioperative major complications were recorded, and the average length of stay was 23 days. The perioperative course appeared remarkably good, and both the short- and long-term follow-up were similar to that of the control group.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11640198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817470","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}
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.
{"title":"Influence of Donor Transfusion on Heart Transplantation Outcomes: A United Network for Organ Sharing Registry Analysis","authors":"Sooyun Caroline Tavolacci, Vasiliki Gregory, Kenji Okumura, Ameesh Isath, Junichi Shimamura, David Spielvogel, Suguru Ohira","doi":"10.1111/ctr.70053","DOIUrl":"10.1111/ctr.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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 [<i>N</i> = 18 575], 1–5 units [<i>N</i> = 14 098], 6–10 units [<i>N</i> = 4766], and massive transfusion of > 10 units [<i>N</i> = 3099]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among this cohort, 53.2% of donors (<i>N</i> = 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%, <i>p</i> < 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%, <i>p</i> = 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 [<i>p</i> = 0.35], 6–10 units; HR, 1.10 [<i>p</i> = 0.01], massive transfusion; HR 1.04 [<i>p</i> = 0.3]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799719","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}
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.
{"title":"Multicenter, Real-World Clinical Evaluation of Alemtuzumab and Anti-Thymocyte Globulin for Severe Acute T Cell-Mediated Kidney Transplant Rejection","authors":"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","doi":"10.1111/ctr.70046","DOIUrl":"10.1111/ctr.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p</i> = 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 (<i>p</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11620281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784313","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}
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。
{"title":"Impact of Cold Ischemia Time and Donor Age on Donation After Circulatory Death Kidney Transplant Outcomes: A UNOS Mate-Kidney Analysis","authors":"Gabriel Cojuc-Konigsberg, Belen Rivera, Stalin Cañizares, Martha Pavlakis, Devin Eckhoff, Bhavna Chopra","doi":"10.1111/ctr.70051","DOIUrl":"10.1111/ctr.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784309","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}
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。
{"title":"Myosteatosis Is Associated With Frailty and Poor Physical Function in Patients Undergoing Liver Transplant Evaluation: A Cohort Study","authors":"Heidi E. Johnston, Melita Andelkovic, Hannah L. Mayr, Yanyan Chen, Aaron P. Thrift, Graeme A. Macdonald, Ingrid J. Hickman","doi":"10.1111/ctr.70034","DOIUrl":"https://doi.org/10.1111/ctr.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Myosteatosis was present in 74 (31%) patients. Patients with myosteatosis were 2.5 times (95% confidence interval [CI] 1.1–5.7, <i>p</i> = 0.03) more likely to be frail, and 3.0 times (95% CI 1.6–5.6, <i>p</i> < 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%, <i>p</i> = 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 (<i>p</i> = 0.39), post-LT complications (<i>p</i> = 0.93), or LOS in intensive care unit (ICU) (<i>p</i> = 0.66) or hospital (<i>p</i> = 0.34).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762355","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}
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.
{"title":"Ultrasound Utilization in Hospitalized Kidney Transplant Recipients: Useful or Overused?","authors":"Jason T. Bau, Jennifer Park, Yanhong Li, Christie Rampersad, S. Joseph Kim","doi":"10.1111/ctr.70048","DOIUrl":"https://doi.org/10.1111/ctr.70048","url":null,"abstract":"<p>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.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762314","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}
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.
{"title":"Attitudes Toward Use of an APOL1 Genetic Testing Chatbot in Living Kidney Donor Evaluation: A Focus Group Study","authors":"James L. Rogers, Jessica Gacki-Smith, Rochell Yacat, Catherine Wicklund, Debra Duquette, John Friedewald, Matthew Cooper, Alexander Gilbert, Akansha Agrawal, Elisa J. Gordon","doi":"10.1111/ctr.70026","DOIUrl":"https://doi.org/10.1111/ctr.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Living kidney donor (LKD) candidates of African ancestry are increasingly asked to undergo <i>Apolipoprotein</i> L1 (<i>APOL1</i>) genetic testing during the donor evaluation process to better understand their risk of kidney disease. LKD candidates’ attitudes about using a clinical chatbot on <i>APOL1</i> remain unknown. This study builds on prior work to culturally adapt the Gia (Genetic Information Assistant) chatbot on <i>APOL1</i> by assessing donor, recipient, and community member attitudes about the Gia chatbot for enhancing the integration of <i>APOL1</i> testing into the LKD clinical evaluation workflow.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study involved focus groups and a post-focus group survey in two US cities about the <i>APOL1</i> Gia chatbot. Qualitative data were analyzed via thematic analysis, and descriptive statistics were used for demographic data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 <i>APOL1</i> testing after using Gia, (3) <i>APOL1</i> 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individuals of African ancestry were highly receptive to integrating the <i>APOL1</i> chatbot into LKD candidate clinical evaluation, which bodes well for integrating chatbots into the <i>APOL1</i> clinical genetic testing process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762354","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}
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.
{"title":"Family Planning Counseling and Practices in Kidney Transplant Recipients","authors":"Swathi Rajagopal, Julia Ritchie, Dominika Seidman, Emily R. Perito, Deborah Adey, Monika Sarkar","doi":"10.1111/ctr.70047","DOIUrl":"https://doi.org/10.1111/ctr.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Half of all female kidney transplant (KT) recipients are reproductive-aged, though data on reproductive practices and counseling are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762356","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}
Benjamin Louis Thomae, Taisuke Kaihou, David F. Pinelli, John J. Friedewald, Juan C. Caicedo-Ramirez, Ankit Bharat, Satish Nadig, Chitaru Kurihara
{"title":"Successful Multiorgan Transplantation in Highly Sensitized Patients With Positive Crossmatch Donor","authors":"Benjamin Louis Thomae, Taisuke Kaihou, David F. Pinelli, John J. Friedewald, Juan C. Caicedo-Ramirez, Ankit Bharat, Satish Nadig, Chitaru Kurihara","doi":"10.1111/ctr.70040","DOIUrl":"https://doi.org/10.1111/ctr.70040","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"38 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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