Clinical Transplantation最新文献_第9页

Adult Dual Kidney Transplantation Following Dual Renal Endarterectomy: A Case Series 双肾内膜切除术后成人双肾移植：一个病例系列。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-04 DOI: 10.1111/ctr.70377

Arianna Cabrales, Jigish Vyas, Giuseppe Orlando, Christopher Webb, Alan C. Farney, Robert J. Stratta

Introduction

Dual kidney transplantation (DKT) represents a method of expanding the donor pool and minimizing kidney nonutilization. For kidneys with severe renal artery atherosclerosis, back-bench eversion endarterectomy (EE) may be performed as a salvage procedure to further promote utilization.

Methods

We report five cases of DKT in which both kidneys underwent EE prior to implantation.

Results

Mean donor age was 60.2 ± 5.5 years, mean KDPI 84 ± 15%, and mean terminal serum creatinine 0.88 ± 0.3 mg/dL. There were three expanded criteria and three donations after circulatory death donors. All but one kidney was managed with hypothermic machine preservation (five with suboptimal pump parameters) and two were imported. Percentage glomerulosclerosis on biopsy ranged from 7% to 30% and cold ischemia times from 19.2 to 33.5 h. Mean recipient age was 63.0 ± 6.5 years, mean EPTS 65 ± 30%, and mean dialysis duration 19 ± 10.3 months. All recipients were chosen based on out-of-sequence allocation (median match run sequence #1480). Operating times ranged from 4 to 7 h; three cases were performed as unilateral and two bilateral extraperitoneal transplants. Three patients experienced delayed graft function; initial length of hospital stay ranged from 3 to 7 days. At 6 months follow-up, mean serum creatinine was 1.6 ± 0.3 mg/dL and GFR 46 ± 17 mL/min/1.73m². One patient died at 43 months, but the remaining four patients are doing well at a mean follow-up of 29 months. There were no vascular complications.

Conclusion

Based on this preliminary experience, we believe that acceptable outcomes can be achieved with DKT in appropriately selected cases, even in the setting of severe donor renal artery atherosclerosis requiring dual endarterectomy.

双肾移植（DKT）是一种扩大供体池和减少肾脏闲置的方法。对于严重肾动脉粥样硬化的肾脏，可以进行背台外翻动脉内膜切除术（EE）作为一种挽救性手术，以进一步促进其利用。方法：我们报告了5例双肾植入前接受EE的DKT病例。结果：平均供体年龄60.2±5.5岁，平均KDPI 84±15%，平均终末血肌酐0.88±0.3 mg/dL。有三个扩大的标准和三个循环死亡捐赠者后的捐赠。除1个肾脏外，其余均采用低温机器保存（5个泵参数不理想），2个进口肾脏。活检肾小球硬化百分比为7% ~ 30%，冷缺血时间为19.2 ~ 33.5 h。平均受体年龄为63.0±6.5岁，平均EPTS为65±30%，平均透析时间为19±10.3个月。所有接受者都是根据乱序分配选择的（中位数匹配运行序列#1480）。操作时间为4 ~ 7小时；3例为单侧腹腔外移植，2例为双侧腹腔外移植。3例患者出现移植物功能延迟；最初住院时间为3至7天。随访6个月，平均血清肌酐为1.6±0.3 mg/dL， GFR为46±17 mL/min/1.73m2。1例患者在43个月时死亡，但其余4例患者在平均29个月的随访中表现良好。没有血管并发症。结论：基于这一初步经验，我们相信在适当选择的病例中，DKT可以获得可接受的结果，即使是在严重供体肾动脉粥样硬化需要双动脉内膜切除术的情况下。

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引用次数: 0

Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Proteinuria in Kidney Transplant Recipients 钠-葡萄糖共转运蛋白2抑制剂对肾移植受者蛋白尿的影响。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-04 DOI: 10.1111/ctr.70365

Emili Anderson, Stephanie Shabanowitz, Kinley Jessup, Rachel Bassett Allen, Mary Chandran, Anita Yang

Introduction

Proteinuria is a marker of kidney dysfunction and increased cardiovascular mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiorenal protection in chronic kidney disease, regardless of type 2 diabetes mellitus (T2DM) status. However, data evaluating SGLT2i impact on cardiorenal outcomes in kidney transplant recipients (KTRs) are limited.

Methods

This single-center, retrospective cohort study evaluated the safety and efficacy of SGLT2i therapy in adult KTRs transplanted between January 1, 2020 and December 31, 2023. Primary outcomes were changes in urine protein-to-creatinine ratio (UPCR) and urine albumin-to-creatinine ratio (UACR) at 1-, 3-, 6-, and 12-months post-initiation. Secondary outcomes included changes in estimated glomerular filtration rate (eGFR), BMI, and hemoglobin A1c (HbA1c). Safety outcomes were cardiovascular hospitalization, acute kidney injury, urinary tract infection, and biopsy-proven rejection within 12 months.

Results

SGLT2i therapy was initiated in 77 KTRs, 524 days post-transplant, predominantly in males (74.3%), African Americans (62.8%), and patients with T2DM (80.7%). Baseline UPCR and UACR were 0.387 g/g and 302.2 mg/g, respectively. No significant changes in UPCR, UACR, or eGFR were observed. Renal function was preserved at 12 months, with a transient decline at 1-month that returned to baseline by 3 months. HbA1c and BMI remained stable. Few safety events occurred.

Conclusions

In KTRs with moderate proteinuria, SGLT2i therapy was well tolerated with stable renal function over 12 months. A transient eGFR dip is consistent with patterns seen in non-transplant populations. Absence of significant metabolic changes may reflect well-controlled baseline parameters. Further studies are warranted to evaluate SGLT2i benefits in KTRs, especially in patients with higher grade proteinuria or early post-transplant initiation.

蛋白尿是肾功能不全和心血管疾病死亡率增高的标志。钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）已被证明对慢性肾脏疾病具有心脏肾保护作用，与2型糖尿病（T2DM）状态无关。然而，评估SGLT2i对肾移植受者（KTRs）心肾预后影响的数据有限。方法：这项单中心、回顾性队列研究评估了SGLT2i治疗在2020年1月1日至2023年12月31日期间移植的成人ktr的安全性和有效性。主要结局是治疗后1、3、6和12个月尿蛋白与肌酐比（UPCR）和尿白蛋白与肌酐比（UACR）的变化。次要结局包括肾小球滤过率（eGFR）、BMI和血红蛋白A1c （HbA1c）的变化。安全性指标为心血管住院、急性肾损伤、尿路感染和12个月内活检证实的排斥反应。结果：移植后524天，77例ktr患者开始了SGLT2i治疗，主要是男性（74.3%）、非洲裔美国人（62.8%）和T2DM患者（80.7%）。基线UPCR和UACR分别为0.387 g/g和302.2 mg/g。未观察到UPCR、UACR或eGFR的显著变化。12个月时肾功能保持，1个月时短暂下降，3个月时恢复到基线。HbA1c和BMI保持稳定。安全事件较少。结论：在中度蛋白尿的ktr患者中，SGLT2i治疗耐受性良好，肾功能稳定超过12个月。短暂的eGFR下降与未移植人群的模式一致。没有显著的代谢变化可能反映了基线参数控制良好。需要进一步的研究来评估SGLT2i对ktr患者的益处，特别是对有较高程度蛋白尿或移植后早期启动的患者。

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引用次数: 0

Cognitive Function Among Heart Transplant Recipients Before and After Intravenous Iron Supplement for Iron Deficiency: Results From a Randomized, Placebo-Controlled, Double-Blind Treatment Trial 静脉补铁治疗缺铁前后心脏移植受者的认知功能：一项随机、安慰剂对照、双盲治疗试验的结果

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-11-03 DOI: 10.1111/ctr.70370

Britta S. Bürker, Kristine V. Brautaset Englund, Charlotte Myrdal Østby, Stein Andersson, Lars Gullestad, Kaspar Broch

Background

Cognitive dysfunction after successful heart transplantation (HTx) is not uncommon. Lower hemoglobin levels have previously been associated with cognitive dysfunction in heart transplant recipients (HTx recipients). In a randomized, placebo-controlled, double-blind treatment trial, we assessed as a pre-specified secondary outcome whether a single intravenous iron supplement for iron deficiency in HTx recipients resulted in changes in cognitive function after 6 months.

Methods

In the “Intravenous Iron Supplement for Iron Deficiency in Cardiac Transplant Recipients” (IronIC) trial, we assessed cognitive function at baseline and at 6-month follow-up with the following tests of the Cambridge Neuropsychological Test Automated Battery: Reaction Time, Paired Associates Learning, and Spatial Working Memory. Of 94 participants with cognitive data at baseline and follow-up, 49 were randomized to the single intravenous iron supplement, while 45 received placebo.

Results

Raw score changes from baseline to follow-up did not differ statistically significantly between study groups (two measures of each test analyzed). In the total sample, 27%–44% of participants performed at baseline at least one standard deviation below the normative mean on measures of memory and working memory/executive functions. Exploratory analyses indicated that performance on measures of memory might decrease more than expected with increasing age.

Conclusion

A single intravenous iron supplement for iron deficiency in HTx recipients did not result in statistically significant cognitive changes after 6 months. The group as a whole performed approximately half a standard deviation below the normative mean on measures of memory and working memory/executive functions. Regular cognitive screening after HTx is recommended.

Clinical Trial Registration

Trial Registration: ClinicalTrials.gov identifier: NCT03662789

背景：心脏移植（HTx）成功后认知功能障碍并不少见。较低的血红蛋白水平与心脏移植受者（HTx受者）的认知功能障碍有关。在一项随机、安慰剂对照、双盲治疗试验中，作为预先指定的次要结局，我们评估了HTx受体因缺铁而单次静脉补铁是否会在6个月后导致认知功能的改变。方法：在“静脉补铁治疗心脏移植受者铁缺乏症”（讽刺）试验中，我们在基线和6个月随访时评估认知功能，使用剑桥神经心理测试自动化电池进行以下测试：反应时间、配对联想学习和空间工作记忆。在基线和随访时具有认知数据的94名参与者中，49名随机分配到单静脉补铁组，而45名接受安慰剂组。结果：从基线到随访的原始评分变化在研究组之间没有统计学上的显著差异（分析每个测试的两个测量值）。在整个样本中，27%-44%的参与者在记忆和工作记忆/执行功能的测量中至少比标准平均值低一个标准差。探索性分析表明，随着年龄的增长，记忆力指标的下降幅度可能比预期的要大。结论：单纯静脉补铁治疗HTx患者缺铁6个月后认知功能改变无统计学意义。整个小组在记忆力和工作记忆/执行功能方面的表现比标准平均值低了大约半个标准差。建议HTx术后定期进行认知筛查。临床试验注册：临床试验注册：ClinicalTrials.gov识别码：NCT03662789。

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引用次数: 0

Improved LCP Tacrolimus XR Dosing and Monitoring Outcomes With a Genotype-Based Dosing Algorithm Versus Weight Based Dosing 基于基因型给药算法与基于体重给药算法的改进LCP他克莫司XR给药和监测结果

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-10-31 DOI: 10.1111/ctr.70363

Christine S. Wolesensky, Neha Patel, Santosh Nagaraju, Steve Hanish, Morgan Roberts, Margaret Dorsett, David J. Taber

The aim of this study was to assess the impact of CYP3A5 genotype-based tacrolimus (tac) XR versus weight-based dosing among adult kidney transplant recipients. This was a retrospective longitudinal matched cohort analysis. From February 2021 to June 2023, tac XR was dosed using standard weight-based dosing. Starting in June 2023, genotype-based dosing was used; 148 patients were included (74 in each arm). Baseline characteristics were well balanced between the groups, except for age (control 46 ± 14 vs. 52 ± 14 years, p < 0.01); 32% were females, 36% were African American, 84% were living donors, 40% had DM, and 10% had DGF. At 90-days post-txp, the genotype guided cohort had an average of two fewer tacrolimus dose adjustments per patients (4 vs. 6, p < 0.0001), spent longer time in therapeutic range (59% vs. 47%, p = 0.004), and less time in concerning range (9% vs. 18%, p < 0.0001). Acute rejection, de novo donor specific antibodies, and eGFR was similar between the two cohorts. This matched cohort analysis assessing a genotype-based dosing algorithm demonstrated improved tac XR dosing efficiency. Patients on average, needed two fewer dose adjustments, spent longer time in therapeutic range and had significantly less time in concerning range.

本研究的目的是评估在成人肾移植受者中，基于CYP3A5基因型的他克莫司XR与基于体重的剂量的影响。这是一项回顾性纵向匹配队列分析。从2021年2月到2023年6月，tac XR使用标准体重给药。从2023年6月开始，采用基于基因型的给药；纳入148例患者（每组74例）。除年龄外，各组间基线特征平衡良好（对照组46±14岁vs 52±14岁，p < 0.01）；32%为女性，36%为非洲裔美国人，84%为活体献血者，40%患有糖尿病，10%患有DGF。在txp后90天，基因型引导队列平均每位患者少调整两次他克莫司剂量（4对6，p < 0.0001），在治疗范围内花费的时间更长（59%对47%，p = 0.004），在相关范围内花费的时间更短（9%对18%，p < 0.0001）。急性排斥反应、新生供体特异性抗体和eGFR在两个队列中相似。这项匹配队列分析评估了基于基因型的给药算法，证明了tac XR给药效率的提高。患者平均需要更少的两次剂量调整，在治疗范围内花费更长的时间，并且在有关范围内的时间显着减少。

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引用次数: 0

Survey on the Public Opinion and Attitudes Toward Uterus Transplantation in Hungary 匈牙利公众对子宫移植的舆论和态度调查。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-10-30 DOI: 10.1111/ctr.70356

Balint Farkas, Kata Szilvia Papp, Szilard Kolumban, Kalman Kovacs, Jozsef Bodis, Gabor Fazekas

Introduction

Uterus transplantation (UTx) is a novel and clinically successful treatment option for patients with absolute uterine factor infertility (AUFI) who wish to achieve biological motherhood. Although over 100 UTx procedures have been performed at 20 centers worldwide in the past decade, the procedure remains relatively unknown—even among healthcare professionals. This study aimed to assess public opinion regarding UTx and to identify knowledge gaps in the Hungarian population's awareness and perception of the procedure.

Methods

This prospective study was conducted between December 18, 2024, and January 5, 2025, via an online survey involving 2896 participants. A final representative sample of 1500 individuals was selected using an iterative mathematical weighting method, adjusted to the 2022 Hungarian census data. The sample was representative of the Hungarian internet-using population aged 18–70 years in terms of age, gender, education level, and place of residence. The 24-item questionnaire assessed participants’ views on organ donation, transplantation, infertility, surrogacy, and UTx.

Results

Most respondents (77%; 1155/1500) supported UTx (strongly agree: 44%, 660/1500; agree: 33%, 495/1500). Among participants personally affected by fertility issues, 84% (152/181) expressed support, with 51% (92/181) strongly agreeing that UTx should be offered. Only 4% of the total samples opposed the procedure. Notably, just 15% of respondents were previously aware that UTx had been performed internationally.

Conclusions

This online survey demonstrates substantial public approval for UTx in Hungary, particularly among individuals affected by infertility. However, public awareness of the procedure remains limited, indicating a need for increased education and communication to improve general knowledge on the topic.

子宫移植（UTx）是一种新颖且临床上成功的治疗选择，适用于希望获得生物学母性的绝对子宫因素不孕（AUFI）患者。尽管在过去的十年中，在全球20个中心进行了超过100例UTx手术，但这种手术仍然相对不为人所知，甚至在医疗保健专业人员中也是如此。这项研究旨在评估公众对UTx的意见，并确定匈牙利人口对该程序的认识和看法方面的知识差距。方法：本前瞻性研究于2024年12月18日至2025年1月5日期间通过在线调查进行，涉及2896名参与者。使用迭代数学加权法选择1500人的最终代表性样本，并根据2022年匈牙利人口普查数据进行调整。样本在年龄、性别、教育水平和居住地方面代表了匈牙利18-70岁的互联网用户。24项调查问卷评估了参与者对器官捐赠、移植、不孕症、代孕和UTx的看法。结果：大多数受访者（77%;1155/1500）支持UTx（强烈同意：44%，660/1500；同意：33%，495/1500）。在个人受生育问题影响的参与者中，84%（152/181）表示支持，51%（92/181）强烈同意应该提供UTx。只有4%的样本反对这一程序。值得注意的是，只有15%的受访者以前知道在国际上进行过UTx。结论：这项在线调查显示匈牙利公众对UTx的认可，特别是在不孕不育的人群中。然而，公众对这一程序的认识仍然有限，这表明需要加强教育和交流，以提高对这一专题的一般认识。

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引用次数: 0

Vancomycin Monitoring in Kidney Transplants Within 1 Year 万古霉素在肾移植术后1年内的监测。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-10-29 DOI: 10.1111/ctr.70362

Keaton Tauer, Kathyrn Barrett, Clara Ni, Celina Ferey, Ryan J Winstead

引用次数: 0

Correction to “Early Removal of Ureteral Stents When Attached to the Foley Catheter in Living Donor Kidney Transplant Recipients Reduces Urinary Tract Infections” 对“在活体肾移植受者中早期切除连接Foley导尿管的输尿管支架可减少尿路感染”的更正。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-10-28 DOI: 10.1111/ctr.70361

J. Lam, I. Elali, M. Mahgoub, et al. “Early Removal of Ureteral Stents When Attached to the Foley Catheter in Living Donor Kidney Transplant Recipients Reduces Urinary Tract Infections,” Clinical Transplantation 39, no. 10 (2025): e70329. https://doi.org/10.1111/ctr.70329.

The institutional address of the author “Esma Kesik” is incorrect in the published version. The correct address should be: William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.

We apologize for this error.

J. Lam， I. Elali， M. Mahgoub，等。“在活体肾移植受者中早期移除连接Foley导尿管的输尿管支架可减少尿路感染，”临床移植，39,no。10 (2025): e70329。https://doi.org/10.1111/ctr.70329.The作者“Esma Kesik”的机构地址在已发布的版本中不正确。正确地址应为：William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota， USA。我们为这个错误道歉。

引用次数: 0

Risk Factors and Outcomes of Recurrent Cytomegalovirus Infection in Heart Transplant Recipients 心脏移植受者巨细胞病毒感染复发的危险因素和结局。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-10-27 DOI: 10.1111/ctr.70342

Vaisak O. Nair, Zachary A. Yetmar, Bismarck S. Bisono-Garcia, Lisa Brumble, Holenarasipur R. Vikram, Raymund R. Razonable, Elena Beam

Purpose

The purpose of this study was to evaluate the incidence and risk factors for developing recurrent clinically significant cytomegalovirus infections (csCMVi) in heart transplant recipients.

Methods

We conducted a retrospective cohort study involving adult heart transplant recipients at three large transplant centers in the United States between January 2011 and March 2019. All patients with a history of csCMVi, defined as CMV disease or CMV infection requiring preemptive therapy, were followed from the date of treatment completion for the primary csCMVi episode. Outcomes of interest were recurrent csCMVi and all-cause mortality.

Results

Among 98 heart transplant recipients with csCMVi, 22 (22.4%) episodes of recurrent csCMVi occurred. Median time-to-recurrent csCMVi was 31.5 (IQR 21.3–59.8) days following treatment completion. A preceding episode of CMV disease (versus infection) was associated with a lower risk of recurrent csCMVi (HR 0.29, 95% CI 0.08–0.98; p = 0.047). Patients with lymphopenia had higher rates of recurrent csCMVi without statistical significance (HR 2.13, 95% CI 0.88–5.13; p = 0.093). Seroconversion by the end-of-therapy among CMV D+/R− mismatched patients was associated with a reduced risk of csCMVi recurrence (HR 0.07, 95% CI 0.02–0.30; p < 0.001). Overall, 17 (17.3%) patients died during follow-up, which was not significantly higher among those with recurrent csCMVi (HR 2.13, 95% CI 0.78–5.79; p = 0.141).

Conclusions

About one in five heart recipients with csCMVi developed post-treatment recurrence. A preceding episode of CMV disease and seroconversion was protective against recurrence. Lymphopenia may be a practical biomarker to stratify recurrence risk. Overall, recurrent csCMVi was not significantly associated with mortality.

目的：本研究的目的是评估心脏移植受者复发性临床显著巨细胞病毒感染（csCMVi）的发生率和危险因素。方法：我们在2011年1月至2019年3月期间对美国三个大型移植中心的成年心脏移植受者进行了一项回顾性队列研究。所有有cmmvi病史的患者，定义为CMV疾病或需要先发制人治疗的CMV感染，从治疗结束之日起随访原发性csCMVi发作。关注的结果是复发性csCMVi和全因死亡率。结果：在98例csCMVi心脏移植受者中，22例（22.4%）发生复发性csCMVi。治疗结束后csCMVi复发的中位时间为31.5天（IQR为21.3-59.8天）。先前CMV疾病发作（与感染相比）与csCMVi复发风险较低相关（HR 0.29, 95% CI 0.08-0.98; p = 0.047）。淋巴细胞减少患者的csCMVi复发率较高，但差异无统计学意义（HR 2.13, 95% CI 0.88-5.13; p = 0.093）。CMV D+/R-不匹配患者治疗结束时血清转换与csCMVi复发风险降低相关（HR 0.07, 95% CI 0.02-0.30; p）结论：大约五分之一的csCMVi心脏受者在治疗后复发。先前的巨细胞病毒疾病发作和血清转化对复发有保护作用。淋巴细胞减少可能是对复发风险进行分层的实用生物标志物。总体而言，复发性csCMVi与死亡率无显著相关性。

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引用次数: 0

Outcomes and Tolerability of Early Mammalian Target of Rapamycin Inhibitor Initiation for Renal Sparing in Heart Transplant Recipients 心脏移植受者早期雷帕霉素抑制剂靶的结果和耐受性。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-10-27 DOI: 10.1111/ctr.70364

Avery Marcotte, Rachel Rikard, Chelsea Castor, Margeaux Meilhac, Patricia Chang, Mirnela Byku, Christina Teeter Doligalski

Purpose

Renal dysfunction in heart transplant recipients (HTRs) is a significant post-transplant complication. This study aims to assess the effects of early mammalian target of rapamycin inhibitor (mTORi) initiation on renal and graft outcomes in HTRs.

Methods

A single-center retrospective analysis of first-time adult HTRs transplanted from 2018 to 2023 was conducted. HTRs converted to mTORi were compared to those maintained on tacrolimus and mycophenolate immunosuppression (SOC). Patient demographics along with renal and graft outcomes were collected for the first 2 years post-transplant.

Results

Eighty-one HTRs were included; 30 (37%) were initiated on an mTORi. Compared to the SOC group, the mTORi group had a significantly higher improvement in eGFR from 6 to 24 months post-transplant (36.8% vs. 11.0%, p = 0.027). No cardiac allograft vasculopathy was observed in the mTOR group at 24 months compared to 7 (13.7%) HTRs in the SOC group (p = 0.03), and there were no differences in treated ACR >30 days post-transplant, AMR, or DSAs with mTORi versus SOC.

Conclusion

In our experience, early mTORi initiation was associated with renal benefits in HTRs when compared to SOC. Conversion to mTORi allowed for lower tacrolimus levels without an increased risk for rejection or DSAs and was associated with less cardiac allograft vasculopathy at 24 months.

目的：心脏移植受者肾功能不全是心脏移植后的重要并发症。本研究旨在评估早期哺乳动物雷帕霉素抑制剂靶点（mTORi）起始对htr患者肾脏和移植物预后的影响。方法：对2018年至2023年首次移植的成人htr进行单中心回顾性分析。比较他克莫司和霉酚酸酯免疫抑制（SOC）维持的htr转化为mTORi。收集移植后头2年的患者人口统计数据以及肾脏和移植结果。结果：纳入81例htr；30例（37%）接受了mTORi。与SOC组相比，移植后6至24个月，mTORi组eGFR的改善显著高于SOC组（36.8% vs. 11.0%, p = 0.027）。与SOC组相比，mTOR组在24个月时没有观察到同种异体心脏移植血管病变，而SOC组有7例（13.7%）HTRs (p = 0.03)， mTORi组与SOC组在移植后30天治疗的ACR bb0、AMR或dsa方面没有差异。结论：根据我们的经验，与SOC相比，早期开始mTORi与htr患者的肾脏益处相关。转换为mTORi可降低他克莫司水平，而不会增加排斥反应或dsa的风险，并且与24个月时同种异体心脏移植血管病变的减少有关。

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引用次数: 0

The Eastern Cooperative Oncology Group Score Rather Than Donor Type Impacts Clinical Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Severe Aplastic Anemia Patients Aged 51–60 Years: A Retrospective Study From the Chinese Blood and Marrow Transplant Registry 东方肿瘤合作组评分而非供体类型影响51-60岁严重再生障碍性贫血患者异基因造血干细胞移植的临床结果：来自中国血液和骨髓移植登记的回顾性研究

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation

Pub Date : 2025-10-26 DOI: 10.1111/ctr.70359

Xin Zhao, Ming Zhou, Bao-Dong Ye, Er-Lie Jiang, Dai-Hong Liu, Peihua Lu, Fang Zhou, Gui-Fang Ou-Yang, Ya-Jing Xu, Xin Li, Wei-Wei Qin, Hai Yi, Guan-Chen Bai, Zi-Min Sun, Xue-Jun Zhang, Xue-Hong Ran, Jian-Ping Zhang, Guo-Hong Su, Jin-Xiong Huang, Tai-Wu Xiao, Xian-Min Song, Hui-Xia Liu, Jin-Song Yan, Ke-Hong Bi, Xi Zhang, Xiao-Jun Huang, Shun-Qing Wang, Lan-Ping Xu

Our study includes 103 patients aged between 51 and 60 years who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) from matched sibling donors (MSDs) (n = 36), haploidentical donors (HIDs) (n = 56), and unrelated donors (URDs) (n = 11). Multivariate analysis exploring the relationship between risk factors and survival confirmed that survival outcomes were only independently impacted by Eastern Cooperative Oncology Group (ECOG) score (ECOG scores ≥2 vs. ECOG scores of 0–1, overall survival [OS] HR: 2.91 [95% CI 1.35–6.27], p = 0.006; failure free survival [FFS] HR: 2.93 [95% CI 1.33–5.88], p = 0.006; graft-versus-host disease–free/relapse-free survival [GRFS] HR: 2.80 [95% CI 1.33–5.88], p = 0.006), while age, specific donor source and hematopoietic cell transplantation-comorbidity index (HCT-CI) score did not significantly influence prognosis in this age group. After applying propensity score-matching (PSM) to balance the pretransplant clinical factors between patients with ECOG scores 0–1 cohort and those with ECOG scores ≥2 cohort, poor performance status remains a negative factor for survival outcomes (OS p = 0.04; FFS p = 0.03; GRFS p = 0.03). Further analysis in subgroup patients with HCT-CI scores 0–1 found the retained significance of ECOG score in predicting inferior survival. In conclusion, our results indicate good long-term results of allo-HSCT in elderly SAA adults regardless of donor type. Higher ECOG score is associated with poor post-transplant outcomes and has to be taken into account for patients, even at a low-risk comorbidly burden.

我们的研究包括103例年龄在51至60岁之间的患者，他们接受了来自匹配的兄弟姐妹供体（MSDs）（n = 36）、单倍体供体（HIDs）（n = 56）和非亲属供体（URDs）（n = 11）的同种异体造血干细胞移植（alloo - hsct）。多因素分析探讨了危险因素与生存之间的关系，证实生存结果仅受东部肿瘤合作组（ECOG）评分（ECOG评分≥2 vs ECOG评分0-1）的独立影响，总生存[OS] HR: 2.91 [95% CI 1.35-6.27], p = 0.006；无失败生存[FFS] HR: 2.93 [95% CI 1.33-5.88], p = 0.006；移植物抗宿主无病/无复发生存率[GRFS] HR: 2.80 [95% CI 1.33-5.88], p = 0.006]，而年龄、特定供体来源和造血细胞移植合并症指数（HCT-CI）评分对该年龄组的预后无显著影响。应用倾向评分匹配（PSM）来平衡ECOG评分0-1组与ECOG评分≥2组患者移植前临床因素后，不良表现状态仍然是影响生存结果的一个不利因素（OS p = 0.04; FFS p = 0.03; GRFS p = 0.03）。进一步分析HCT-CI评分为0-1的亚组患者，发现ECOG评分在预测不良生存方面仍然具有重要意义。总之，我们的结果表明，无论供体类型如何，老年SAA成人的同种异体造血干细胞移植的长期效果良好。较高的ECOG评分与较差的移植后预后相关，即使在低风险的合并症负担下，患者也必须考虑到这一点。

{"title":"The Eastern Cooperative Oncology Group Score Rather Than Donor Type Impacts Clinical Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Severe Aplastic Anemia Patients Aged 51–60 Years: A Retrospective Study From the Chinese Blood and Marrow Transplant Registry","authors":"Xin Zhao, Ming Zhou, Bao-Dong Ye, Er-Lie Jiang, Dai-Hong Liu, Peihua Lu, Fang Zhou, Gui-Fang Ou-Yang, Ya-Jing Xu, Xin Li, Wei-Wei Qin, Hai Yi, Guan-Chen Bai, Zi-Min Sun, Xue-Jun Zhang, Xue-Hong Ran, Jian-Ping Zhang, Guo-Hong Su, Jin-Xiong Huang, Tai-Wu Xiao, Xian-Min Song, Hui-Xia Liu, Jin-Song Yan, Ke-Hong Bi, Xi Zhang, Xiao-Jun Huang, Shun-Qing Wang, Lan-Ping Xu","doi":"10.1111/ctr.70359","DOIUrl":"10.1111/ctr.70359","url":null,"abstract":"<div>\u0000 \u0000 <p>Our study includes 103 patients aged between 51 and 60 years who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) from matched sibling donors (MSDs) (<i>n</i> = 36), haploidentical donors (HIDs) (<i>n</i> = 56), and unrelated donors (URDs) (<i>n</i> = 11). Multivariate analysis exploring the relationship between risk factors and survival confirmed that survival outcomes were only independently impacted by Eastern Cooperative Oncology Group (ECOG) score (ECOG scores ≥2 vs. ECOG scores of 0–1, overall survival [OS] HR: 2.91 [95% CI 1.35–6.27], <i>p</i> = 0.006; failure free survival [FFS] HR: 2.93 [95% CI 1.33–5.88], <i>p</i> = 0.006; graft-versus-host disease–free/relapse-free survival [GRFS] HR: 2.80 [95% CI 1.33–5.88], <i>p</i> = 0.006), while age, specific donor source and hematopoietic cell transplantation-comorbidity index (HCT-CI) score did not significantly influence prognosis in this age group. After applying propensity score-matching (PSM) to balance the pretransplant clinical factors between patients with ECOG scores 0–1 cohort and those with ECOG scores ≥2 cohort, poor performance status remains a negative factor for survival outcomes (OS <i>p</i> = 0.04; FFS <i>p</i> = 0.03; GRFS <i>p</i> = 0.03). Further analysis in subgroup patients with HCT-CI scores 0–1 found the retained significance of ECOG score in predicting inferior survival. In conclusion, our results indicate good long-term results of allo-HSCT in elderly SAA adults regardless of donor type. Higher ECOG score is associated with poor post-transplant outcomes and has to be taken into account for patients, even at a low-risk comorbidly burden.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370180","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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