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Stroke and kidney transplantation. 中风和肾移植。
IF 2.2 4区 医学 Q2 Medicine 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 Q2 Medicine 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
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 Q2 Medicine 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
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 Q2 Medicine 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
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 Q2 Medicine 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 Q2 Medicine 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 Q2 Medicine 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
Lung transplantation for coronavirus disease 2019 acute respiratory distress syndrome/fibrosis: silver lining of a global pandemic. 2019冠状病毒病急性呼吸窘迫综合征/纤维化的肺移植:全球大流行的一线希望
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1097/MOT.0000000000001068
Emily J Cerier, Ankit Bharat

Purpose of review: The COVID-19 pandemic revolutionized the field of lung transplantation, as lung transplant is now an acceptable life-saving therapy for select patients with COVID-19-associated acute respiratory distress syndrome (ARDS), while prior to the pandemic, few transplants were performed for ARDS. This review article details the establishment of lung transplantation as a viable therapy for COVID-19-related respiratory failure, how to evaluate COVID-19 patients for lung transplant, and specific technical considerations for the operation.

Recent findings: Lung transplantation is a life-altering treatment for two distinct cohorts of COVID-19 patients: those with irrecoverable COVID-19-associated ARDS and those who recover from the initial COVID-19 insult but are left with chronic, debilitating post-COVID fibrosis. Both cohorts require stringent selection criteria and extensive evaluation to be listed for lung transplantation. As the first COVID-19 lung transplantation was recently performed, long-term outcomes are lacking; however, short-term outcome data of COVID-19-related lung transplants are promising.

Summary: Given the challenges and complexities associated with COVID-19-related lung transplantation, strict patient selection and evaluation are required with an experienced multidisciplinary team at a high-volume/resource center. With promising short-term outcome data, ongoing studies are needed to assess long-term outcomes of COVID-19-related lung transplants.

回顾目的:COVID-19大流行彻底改变了肺移植领域,肺移植现在是一种可接受的挽救COVID-19相关急性呼吸窘迫综合征(ARDS)患者生命的治疗方法,而在大流行之前,ARDS很少进行移植。本文综述了肺移植作为新型冠状病毒相关呼吸衰竭可行治疗方法的建立、对新型冠状病毒相关呼吸衰竭患者肺移植的评估以及手术的具体技术注意事项。对于两组不同的COVID-19患者来说,肺移植是一种改变生活的治疗方法:一组患者患有无法治愈的COVID-19相关ARDS,另一组患者从最初的COVID-19损伤中恢复,但留下慢性、衰弱的COVID-19后纤维化。这两个队列都需要严格的选择标准和广泛的评估才能列入肺移植。由于首例COVID-19肺移植是最近进行的,缺乏长期结果;然而,与covid -19相关的肺移植的短期结果数据是有希望的。总结:鉴于与covid -19相关的肺移植面临的挑战和复杂性,需要在高容量/资源中心由经验丰富的多学科团队进行严格的患者选择和评估。有了有希望的短期结果数据,需要正在进行的研究来评估与covid -19相关的肺移植的长期结果。
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引用次数: 0
Beyond donation to organ utilization in the UK. 从器官捐献到器官利用。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1097/MOT.0000000000001071
Maria Ibrahim, Chris J Callaghan

Purpose of review: Optimizing deceased donor organ utilization is gaining recognition as a topical and important issue, both in the United Kingdom (UK) and globally. This review discusses pertinent issues in the field of organ utilization, with specific reference to UK data and recent developments within the UK.

Recent findings: A multifaceted approach is likely required in order to improve organ utilization. Having a solid evidence-base upon which transplant clinicians and patients on national waiting lists can base decisions regarding organ utilization is imperative in order to bridge gaps in knowledge regarding the optimal use of each donated organ. A better understanding of the risks and benefits of the uses of higher risk organs, along with innovations such as novel machine perfusion technologies, can help clinician decision-making and may ultimately reduce the unnecessary discard of precious deceased donor organs.

Summary: The issues facing the UK with regards to organ utilization are likely to be similar to those in many other developed countries. Discussions around these issues within organ donation and transplantation communities may help facilitate shared learning, lead to improvements in the usage of scarce deceased donor organs, and enable better outcomes for patients waiting for transplants.

综述目的:在英国和全球范围内,优化死者供体器官的利用正在成为一个热门和重要的问题。这篇综述讨论了器官利用领域的相关问题,具体参考了英国的数据和英国近期的发展。最近的发现:为了提高器官的利用率,可能需要一个多方面的方法。有一个坚实的证据基础,移植临床医生和国家等待名单上的患者可以根据这个基础来决定器官的使用,这是必要的,以便弥合关于每个捐赠器官最佳使用的知识差距。更好地了解使用高风险器官的风险和益处,以及新型机器灌注技术等创新,可以帮助临床医生做出决策,并可能最终减少对宝贵的已故供体器官的不必要丢弃。总结:英国在器官利用方面面临的问题可能与许多其他发达国家相似。在器官捐赠和移植社区内围绕这些问题的讨论可能有助于促进共享学习,改善稀缺的已故供体器官的使用,并为等待移植的患者带来更好的结果。
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引用次数: 1
Social and biologic determinants in lung transplant allocation. 肺移植分配的社会和生物决定因素。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1097/MOT.0000000000001069
Kara Calhoun, Joshua Smith, Alice L Gray

Purpose of review: Lung transplant is a life-saving intervention for many with end-stage lung disease. As usable donor lungs are a limited resource and the risk of death on the waitlist is not uniform among candidates, organ allocation must consider many variables in order to be equitable.

Recent findings: The lung allocation score (LAS) system, implemented in 2005, accounted for disease severity, risk of death without transplant, and 1-year survival estimates; however, recipient size, allosensitization, and blood type, biologic features that influence donor pool for a given recipient, do not impact allocation priority. Additionally, social determinants such as geography, socioeconomic status, race, and ethnicity can impact the likelihood of receiving a transplant. This has resulted in certain groups being transplanted at lower rates and at higher risk of dying on the waitlist. In order to address these disparities, lung organ allocation in the United States transitioned to a continuous distribution system using the composite allocation score (CAS) on 9 March 2023.

Summary: In this article, we will review some of the data demonstrating the impact that biologic and social determinants have had on lung allocation in order to provide background as to why these have been incorporated into the CAS.

综述目的:肺移植是许多终末期肺病患者的救命干预手段。由于可用的供体肺是一种有限的资源,并且候选者的死亡风险在候选者中并不统一,因此器官分配必须考虑许多变量才能公平。最近的研究发现:2005年实施的肺分配评分(LAS)系统考虑了疾病严重程度、无移植死亡风险和1年生存估计;然而,受体大小、同种异体致敏性和血型等生物学特征会影响给定受体的供体池,但不影响分配优先级。此外,地理、社会经济地位、种族和民族等社会决定因素也会影响接受移植的可能性。这导致某些群体的移植率较低,在等待名单上死亡的风险较高。为了解决这些差异,美国的肺器官分配于2023年3月9日过渡到使用复合分配评分(CAS)的连续分配系统。摘要:在本文中,我们将回顾一些数据,证明生物和社会决定因素对肺分配的影响,以便为将这些因素纳入CAS提供背景。
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引用次数: 0
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Current Opinion in Organ Transplantation
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