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Current Opinion in Organ Transplantation最新文献

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Medical intestinal rehabilitation. 医学肠道康复。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-08-01 DOI: 10.1097/MOT.0000000000001077
Maria C Segovia

Purpose of review: Medical intestinal rehabilitation is a part of the very complex management of patients with intestinal failure. The goal is to achieve enteral autonomy and minimize need for parenteral nutrition and hydration. In this manuscript, we will review the strategies to achieve this goal with dietary optimization and pharmacologic interventions.

Recent findings: We will review the most updated recommendations on medical management of patients with intestinal failure.

Summary: Medical intestinal rehabilitation is just a portion of a multistep strategy that aims to minimize need of parenteral support in patients with intestinal failure, with the ultimate goal of achieving enteral autonomy. This needs to be done by a multidisciplinary team via dietary and pharmacologic optimization.

综述目的:医学肠道康复是肠衰竭患者复杂治疗的一部分。目标是实现肠内自主和减少需要肠外营养和水合作用。在这篇文章中,我们将回顾通过饮食优化和药物干预来实现这一目标的策略。最近的发现:我们将回顾肠衰竭患者医疗管理的最新建议。摘要:医学肠道康复只是多步骤策略的一部分,旨在减少肠衰竭患者对肠外支持的需求,最终目标是实现肠内自主。这需要一个多学科团队通过饮食和药物优化来完成。
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引用次数: 0
Mind the gaps: reframing patient selection and organ allocation in liver transplantation. 注意差距:重构肝移植中的患者选择和器官分配。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-08-01 DOI: 10.1097/MOT.0000000000001086
Joseph DiNorcia
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引用次数: 0
Editorial introduction. 编辑介绍。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-08-01 DOI: 10.1097/MOT.0000000000001087
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引用次数: 0
Stroke and kidney transplantation. 中风和肾移植。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-08-01 DOI: 10.1097/MOT.0000000000001078
Adrian P Abreo, Deepak Kataria, Chaitanya Amrutkar, Ayush Singh, Millie Samaniego, Neeraj Singh

Purpose of review: This review will focus on the epidemiological data, risk factors, and management of stroke before and after kidney transplant. Stroke is highly prevalent in waitlisted patients as well as kidney transplant recipients and is associated with impaired transplant outcomes. Multiple traditional, nontraditional, and transplanted risk factors increase the risk of stroke.

Recent findings: Although the risk of stroke is reduced after kidney transplantation compared with remaining on dialysis, the morbidity and mortality from stroke after transplantation remain significant.

Summary: Early screening for risk factors before and after a kidney transplant and following the Kidney Disease Improving Global Outcomes (KDIGO) management guidelines could minimize the incidence of stroke and transplant outcomes.

综述目的:本综述将关注肾移植前后卒中的流行病学资料、危险因素和管理。中风在等待移植的患者和肾移植受者中非常普遍,并且与移植结果受损有关。多种传统的、非传统的和移植的危险因素增加了中风的危险。最近的研究发现:尽管肾移植后卒中的风险与继续透析相比降低了,移植后卒中的发病率和死亡率仍然很高。摘要:肾移植前后早期筛查危险因素,并遵循肾脏疾病改善全球结局(KDIGO)管理指南,可以最大限度地减少中风和移植结果的发生率。
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引用次数: 0
The sex disparity in liver transplantation. 肝脏移植手术中的性别差异。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-08-01 Epub Date: 2023-06-09 DOI: 10.1097/MOT.0000000000001081
Rachel Hogen, Matthew Hunter Witt, Kiran Dhanireddy

Purpose of the review: This review describes the sex disparity in liver transplantation (LT) and explains its underlying causes.

Recent findings: There is a small but persistent sex disparity in transplant rate and waitlist mortality that disappears once women are listed as Status 1. Allocation systems that could replace the Model for End Stage Liver Disease (MELD)-Na with scores less reliant on serum creatine and muscle mass have the potential to alleviate part of the sex disparity. Women perform worse on frailty assessments and are more likely to have nonalcoholic steatohepatitis (NASH). A diagnosis of NASH is compounding risk factor for frailty.

Summary: Women remain disadvantaged in their access to LT despite multiple evolutions of the allocation system. An allocation system that relies less heavily on serum creatinine could partially alleviate the sex disparity. As NASH becomes more prevalent and frailty becomes more important in listing decisions, we may also need to carefully consider differences in the manifestations of frailty between the genders.

综述的目的:本综述描述了肝移植(LT)中的性别差异,并解释了其根本原因:在移植率和等待者死亡率方面,性别差异虽小,但持续存在,一旦女性被列为 "状态 1",性别差异就会消失。用不太依赖血清肌酸和肌肉质量的评分来取代肝病终末期模型(MELD)-Na的分配系统有可能缓解部分性别差异。女性在虚弱评估中的表现更差,更有可能患有非酒精性脂肪性肝炎(NASH)。总结:尽管分配制度经历了多次演变,但女性在获得低温治疗方面仍然处于不利地位。减少对血清肌酐依赖的分配制度可以部分缓解性别差异。随着 NASH 的发病率越来越高,虚弱程度在上市决策中变得越来越重要,我们可能还需要仔细考虑两性之间虚弱表现的差异。
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引用次数: 0
Equity in liver transplantation: are we any closer? 肝脏移植的公平性:我们离公平还有多远?
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-08-01 Epub Date: 2023-06-19 DOI: 10.1097/MOT.0000000000001085
Moronke Ogundolie, Norine Chan, Lisa M McElroy

Purpose of review: As policies governing liver transplantation (LT) continue to change and influence clinical practice, it is important to monitor trends in equitable access and outcomes amongst patients. The purpose of this review is to closely examine recent advances and findings in health equity research in LT over the last 2 years; specifically evaluating inequities at the different stages of LT (referral, evaluation, listing, waitlist outcomes and post-LT outcomes).

Recent findings: Advancements in geospatial analysis have enabled investigators to identify and begin to study the role of community level factors (such as neighborhood poverty, increased community capital/urbanicity score) in driving LT disparities. There has also been a shift in investigating center specific characteristics that contributes to disparities in waitlist access. Modification to the current model for end stage liver disease (MELD) score policy accounting for height differences is also crucial to eradicating the disparity in LT amongst sexes. Lastly, Black pediatric patients have been shown to have higher rates of death and worse posttransplant outcome after transitioning to adult healthcare.

Summary: Although, there have been some advances in methodology and policies, inequities in waitlist access, waitlist outcomes and posttransplant outcomes continue to be pervasive in the field of LT. Future directions include expansion of social determinants of health measures, inclusion of multicenter designs, MELD score modification and investigation into drivers of worse posttransplant outcomes in Black patients.

审查目的:随着肝移植(LT)政策的不断变化和对临床实践的影响,监测患者公平获得肝移植和肝移植结果的趋势非常重要。本综述旨在仔细研究过去两年中肝移植健康公平研究的最新进展和发现;特别是评估肝移植不同阶段(转诊、评估、列表、候诊结果和肝移植后结果)的不公平现象:地理空间分析的进步使研究人员能够识别并开始研究社区层面的因素(如邻里贫困、社区资本增加/城市化得分)在推动LT差异方面的作用。此外,调查中心的具体特征也发生了变化,这些特征导致了候补名单获取方面的差异。修改现行的肝病终末期模型(MELD)评分政策以考虑身高差异,对于消除不同性别间的LT差异也至关重要。最后,黑人儿科患者在过渡到成人医疗服务后,死亡率更高,移植后效果更差。总结:尽管在方法和政策方面取得了一些进展,但在等待名单获取、等待结果和移植后效果方面的不公平现象在LT领域仍然普遍存在。未来的发展方向包括:扩大健康社会决定因素的衡量范围、纳入多中心设计、修改 MELD 评分以及调查导致黑人患者移植后预后较差的原因。
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引用次数: 0
Postoperative surgical complications after pediatric kidney transplantation in low weight recipients (<15 kg): a systematic review. 小儿肾移植术后低体重受者(<15 千克)的手术并发症:系统综述。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-08-01 Epub Date: 2023-05-19 DOI: 10.1097/MOT.0000000000001074
Thomas Prudhomme, Benoit Mesnard, Olivier Abbo, Beatriz Banuelos, Angelo Territo

Purpose of review: Kidney transplantation in low-weight recipients (<15 kg) is a challenging surgery with special characteristics. We proposed to perform a systematic review to determine the postoperative complication rate and the type of complications after kidney transplantation in low-weight recipients (<15 kg). The secondary objectives were to determine graft survival, functional outcomes, and patient survival after kidney transplantation in low-weight recipients.

Methods: A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline and Embase databases were searched to identify all studies reporting outcomes on kidney transplantation in low-weight recipients (<15 kg).

Results: A total of 1254 patients in 23 studies were included. The median postoperative complications rate was 20.0%, while 87.5% of those were major complications (Clavien ≥3). Further, urological and vascular complications rates were 6.3% (2.0-11.9) and 5.0% (3.0-10.0), whereas the rate of venous thrombosis ranged from 0 to 5.6%. Median 10-year graft and patient survival were 76 and 91.0%.

Summary: Kidney transplantation in low-weight recipients is a challenging procedure complicated by a high rate of morbidity. Finally, pediatric kidney transplantation should be performed in centers with expertise and multidisciplinary pediatric teams.

综述目的:低体重受者的肾移植(方法:根据系统综述和荟萃分析的首选报告项目进行系统综述。对 Medline 和 Embase 数据库进行了检索,以确定所有报告低体重受者肾移植结果的研究(结果:共纳入了 23 项研究中的 1254 名患者。术后并发症发生率中位数为 20.0%,其中 87.5% 为主要并发症(Clavien ≥3)。此外,泌尿系统和血管并发症的发生率分别为6.3%(2.0-11.9)和5.0%(3.0-10.0),而静脉血栓的发生率为0-5.6%。中位 10 年移植物存活率和患者存活率分别为 76% 和 91.0%。最后,小儿肾移植应在具备专业知识和多学科儿科团队的中心进行。
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引用次数: 0
Liver transplantation for unresectable colorectal liver metastasis. 肝移植治疗无法切除的结直肠肝转移瘤。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-08-01 Epub Date: 2023-06-19 DOI: 10.1097/MOT.0000000000001083
Mariana Chávez-Villa, Luis I Ruffolo, Roberto Hernandez-Alejandro

Purpose of review: To summarize the current state of liver transplantation (LT) for unresectable colorectal liver metastases (uCRLM), and to address future directions.

Recent findings: The Norwegian secondary cancer (SECA) I and SECA II studies demonstrated that after LT the 5-year survival of a highly selected group of patients with uCRLM could be as high as 60% and 83%, respectively. After long-term follow-up, the 5- and 10-year survival was shown to be 43% and 26%, respectively. Furthermore, data has accumulated in other countries and a North American study reported a 1.5-year survival of 100%. In addition, steady growth has been demonstrated in the US, with 46 patients transplanted to date and 19 centers enrolling patients for this indication. Lastly, although recurrence is almost universal in patients with a high tumor burden, it has not been an accurate surrogate for survival, reflecting the relatively indolent nature of recurrence after LT.

Summary: Growing evidence has shown that excellent survival and even cure can be achieved in highly selected patients with uCRLM, with survival rates far superior than in patients treated with chemotherapy. The next step is to create national registries to standardize selection criteria and establish the optimal approach and best practices for incorporating LT for uCRLM into the treatment armamentarium.

综述的目的:总结肝移植(LT)治疗不可切除结直肠肝转移瘤(uCRLM)的现状,并探讨未来的发展方向:挪威二次癌症(SECA)I和SECA II研究表明,经过高度筛选的uCRLM患者在肝移植后的5年生存率分别高达60%和83%。长期随访显示,5 年和 10 年生存率分别为 43% 和 26%。此外,其他国家也积累了相关数据,北美的一项研究报告显示,1.5 年存活率为 100%。此外,美国的数据也在稳步增长,迄今已有 46 名患者接受了移植手术,19 个中心也在为这一适应症招募患者。小结:越来越多的证据表明,经过严格筛选的尿道癌淋巴瘤患者可以获得极佳的生存率,甚至治愈,其生存率远高于接受化疗的患者。下一步是建立国家登记册,以统一选择标准,确定最佳方法和最佳实践,将LT治疗尿道癌纳入治疗手段。
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引用次数: 0
Overview of pregnancy in solid-organ transplantation. 实体器官移植妊娠概述。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-08-01 Epub Date: 2023-05-23 DOI: 10.1097/MOT.0000000000001075
Priya Yenebere, Mohankumar Doraiswamy, Aijaz Gundroo

Purpose of review: Pregnancy in solid organ transplantation (SOT) is a very complex part of transplant medicine wherein there is scarce information available in the literature. Solid organ transplant recipients often have comorbidities, such as hypertension and diabetes, which add additional risk to a pregnancy.

Recent findings: We present this review article on the various aspects of different types of immunosuppressant medications used in pregnancy with added inputs on contraception and fertility after transplant. We described the antepartum and postpartum considerations and discussed the adverse effects of the immunosuppressive medications. Maternal and fetal complications of each SOT have been also discussed in this article.

Summary: This article will serve as the primary review articles for the use of immunosuppressive medications during pregnancy with consideration during pregnancy after SOT.

综述目的:实体器官移植(SOT)中的妊娠是移植医学中非常复杂的一部分,目前文献中的相关信息非常少。实体器官移植受者通常患有高血压和糖尿病等合并症,这给妊娠增加了额外的风险:我们在这篇综述文章中介绍了妊娠期使用的不同类型免疫抑制剂的各个方面,并增加了有关移植后避孕和生育的内容。我们介绍了产前和产后的注意事项,并讨论了免疫抑制剂的不良反应。本文还讨论了每种 SOT 的母体和胎儿并发症。摘要:本文将作为妊娠期使用免疫抑制剂的主要综述文章,并考虑到 SOT 后的妊娠期。
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引用次数: 0
Growing experience of surgical gut rehabilitation: essential role in the management of gut failure in adult patients. 外科肠道康复经验的增长:在成人患者肠道衰竭管理中的重要作用。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2023-06-01 DOI: 10.1097/MOT.0000000000001070
Masato Fujiki, Mohammed Osman, Kareem Abu-Elmagd

Purpose of review: With the inherent therapeutic limitations of gut transplantation, the concept of surgical gut rehabilitation was introduced to restore nutritional autonomy in pediatric patients. With favorable outcomes in these young patients, there has been increasing interest in the applicability of gut rehabilitative surgery to a growing population of adults with gut failure due to various etiologies. We aim to review the current status of surgical gut rehabilitation for adult gut failure patients in the era of multidisciplinary gut rehabilitation and transplantation.

Recent findings: Indications for surgical gut rehabilitation have been gradually expanding, with gut failure after bariatric surgery recently added. Serial transverse enteroplasty (STEP) has been used with favorable outcomes in adult patients, including those with intrinsic intestinal disease. Autologous gut reconstruction (AGR) is the most frequently used surgical rehabilitative method; its outcome is further improved with conjunctive use of bowel lengthening and enterocyte growth factor as a part of comprehensive gut rehabilitation.

Summary: Accumulated experiences have validated the efficacy of gut rehabilitation for survival, nutritional autonomy, and quality of life in adults with gut failure of various etiology. Further progress is expected with growing experience around the world.

综述目的:由于肠道移植固有的治疗局限性,引入了手术肠道康复的概念,以恢复儿科患者的营养自主权。由于这些年轻患者的预后良好,肠道康复手术对越来越多因各种病因导致的肠道衰竭的成年人的适用性越来越感兴趣。我们旨在回顾在多学科肠道康复和移植时代,成人肠道衰竭患者的外科肠道康复的现状。最近的发现:手术肠道康复的适应症逐渐扩大,最近增加了减肥手术后的肠道衰竭。连续横向肠成形术(STEP)已被用于成人患者,包括那些患有内在肠道疾病的患者,并取得了良好的结果。自体肠道重建(AGR)是最常用的外科康复方法;联合使用肠延长和肠细胞生长因子作为全面肠道康复的一部分,其结果进一步改善。总结:积累的经验已经证实了肠道康复对各种病因的成人肠道衰竭患者的生存、营养自主和生活质量的疗效。随着世界各地经验的增加,预计将取得进一步进展。
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引用次数: 0
期刊
Current Opinion in Organ Transplantation
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