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Treating rare tumors with liver transplantation. 肝移植治疗罕见肿瘤。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-10-18 DOI: 10.1097/MOT.0000000000001118
Andrew Melehy, Vatche Agopian

Purpose of review: The success of liver transplantation (LT) in treating unresectable hepatocellular carcinoma (HCC) has resulted in interest in LT for other oncologic conditions. Here, we discuss the role of LT for rare oncologic indications including metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs), hepatic epitheliod hemangioendothelioma (HEHE), fibrolamellar hepatocellular carcinoma (FLC), and hepatic angiosarcoma (HAS).

Recent findings: Conditions reviewed have been documented indications for LT in the available literature. We summarize the experience of LT for these indications and proposed management guidelines.

Summary: GEP-NETs with isolated metastases to the liver can be treated with LT with excellent long-term outcomes (10-year survival 88%) if strict selection criteria are used (low-intermediate grade, Ki-67% < 20%, complete resection of primary tumor, stable disease for 6 months, <50% hepatic involvement). HEHE is a rare hepatic tumor for which LT can be performed with reported 10-year survival around 70%. FLC is a distinct clinical entity to HCC and is optimally treated with surgical resection though experience with LT is described in observational series (5-year survival 50%, recurrence in 10%). HAS is a rapidly progressive tumor with a dismal prognosis with or without treatment, including LT.

综述目的:肝移植(LT)在治疗不可切除的肝细胞癌(HCC)方面的成功引起了人们对LT治疗其他肿瘤学疾病的兴趣。在此,我们讨论了LT在罕见肿瘤适应症中的作用,包括转移性胃肠胰神经内分泌肿瘤(GEP-NETs)、肝上皮样血管内皮瘤(HEHE)、纤维板层肝细胞癌(FLC)和肝血管肉瘤(HAS)。我们总结了LT治疗这些适应症的经验,并提出了管理指南。总结:如果使用严格的选择标准(低-中级,Ki-67%<20%,原发肿瘤完全切除,疾病稳定6个月,
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引用次数: 0
Innovative surgical techniques in the intestine and multivisceral transplant. 创新的肠道和多器官移植手术技术。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-10-30 DOI: 10.1097/MOT.0000000000001098
Phillipe Abreu, Joao Manzi, Rodrigo Vianna

Purpose of review: This timely review delves into the evolution of multivisceral transplantation (MVT) over the past six decades underscoring how advancements in surgical techniques and immunosuppression have driven transformation, to provide insight into the historical development of MVT, shedding light on its journey from experimentation to a valuable clinical approach.

Recent findings: The review presents contemporary enhancements in surgical methods within the context of intestinal transplantation. The versatility of MVT is emphasized, accommodating diverse organ combinations and techniques. Both isolated intestinal transplantation (IIT) and MVT have seen expanded indications, driven by improved parenteral nutrition, transplantation outcomes, and surgical innovations. Surgical techniques are tailored based on graft type, with various approaches for isolated transplantation. Preservation strategies and ostomy techniques are also covered, along with graft assessment advancements involving donor-specific antibodies.

Summary: This review's findings underscore the remarkable evolution of MVT from experimental origins to a comprehensive clinical practice. The progress in surgical techniques and immunosuppression has broadened the spectrum of patients who can benefit from intestinal transplant, including both IIT and MVT. The expansion of indications offers hope to patients with complex gastrointestinal disorders. The detection of donor-specific antibodies in graft assessment advances diagnostic accuracy, ultimately improving patient outcomes.

综述目的:这篇及时的综述深入探讨了过去60年来多器官移植(MVT)的演变,强调了外科技术和免疫抑制的进步是如何推动变革的,以深入了解MVT的历史发展,揭示其从实验到有价值的临床方法的历程。最近的发现:这篇综述介绍了肠移植手术方法的当代改进。MVT的多功能性被强调,适应不同的器官组合和技术。由于肠外营养、移植结果和手术创新的改善,分离式肠移植(IIT)和MVT的适应症都有所扩大。手术技术是根据移植物类型量身定制的,有各种单独移植的方法。还涵盖了保存策略和造口术技术,以及涉及供体特异性抗体的移植物评估进展。综述:这篇综述的发现强调了MVT从实验起源到全面临床实践的显著演变。外科技术和免疫抑制的进步拓宽了可以从肠移植中受益的患者范围,包括IIT和MVT。适应症的扩大为患有复杂胃肠道疾病的患者带来了希望。移植物评估中供体特异性抗体的检测提高了诊断的准确性,最终改善了患者的预后。
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引用次数: 0
Hemodynamic monitoring in liver transplantation 'the hemodynamic system'. 肝移植血流动力学监测“血流动力学系统”。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-11-30 DOI: 10.1097/MOT.0000000000001125
Sherif Kandil, Ashraf Sedra

Purpose of review: The purpose of this article is to provide a comprehensive review of hemodynamic monitoring in liver transplantation.

Recent findings: Radial arterial blood pressure monitoring underestimates the aortic root arterial blood pressure and causes excessive vasopressor and worse outcomes. Brachial and femoral artery monitoring is well tolerated and should be considered in critically ill patients expected to be on high dose pressors. The pulmonary artery catheter is the gold standard of hemodynamic monitoring and is still widely used in liver transplantation; however, it is a highly invasive monitor with potential for serious complications and most of its data can be obtained by other less invasive monitors. Rescue transesophageal echocardiography relies on few simple views and should be available as a standby to manage sudden hemodynamic instability. Risk of esophageal bleeding from transesophageal echocardiography in liver transplantation is the same as in other patient populations. The arterial pulse waveform analysis based cardiac output devices are minimally invasive and have the advantage of real-time beat to beat monitoring of cardiac output. No hemodynamic monitor can improve clinical outcomes unless integrated into a goal-directed hemodynamic therapy. The hemodynamic monitoring technique should be tailored to the patient's medical status, surgical technique, and the anesthesiologist's level of expertise.

Summary: The current article provides a review of the current hemodynamic monitoring systems and their integration in goal-directed hemodynamic therapy.

综述目的:本文旨在对肝移植血流动力学监测进行综述。最近发现:桡动脉血压监测低估了主动脉根动脉血压,导致血管加压过度和更糟糕的结果。肱动脉和股动脉监测耐受性良好,应考虑在危重患者预期高剂量的压力。肺动脉导管是血流动力学监测的金标准,目前仍广泛应用于肝移植;然而,它是一种高侵入性监护仪,有可能出现严重并发症,其大部分数据可以通过其他侵入性较小的监护仪获得。抢救经食管超声心动图依赖于几个简单的视图,应作为处理突发性血流动力学不稳定的备用。肝移植患者经食管超声心动图显示食管出血的风险与其他患者相同。基于动脉脉冲波形分析的心输出量装置具有微创性和实时监测心输出量的优点。没有血流动力学监测可以改善临床结果,除非整合到目标导向的血流动力学治疗。血流动力学监测技术应根据患者的医疗状况、手术技术和麻醉师的专业水平进行调整。摘要:本文综述了当前血流动力学监测系统及其在目标导向血流动力学治疗中的应用。
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引用次数: 0
Pushing the limits of treatment for hepatocellular carcinoma. 推动肝细胞癌治疗的极限。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-11-30 DOI: 10.1097/MOT.0000000000001123
Michelle Jones-Pauley, David W Victor, Sudha Kodali

Purpose of review: We review existing and newer strategies for treatment and surveillance of hepatocellular carcinoma (HCC) both pre and postliver transplantation.

Summary: HCC is rising in incidence and patients are often diagnosed at later stages. Consequently, there is a need for treatment strategies which include collaboration of multiple specialties. Combinations of locoregional, systemic, and surgical therapies are yielding better postliver transplantation (post-LT) outcomes for patients with HCC than previously seen. Tumor biology (tumor size, number, location, serum markers, response to therapy) can help identify patients who are at high risk for HCC recurrence posttransplantation and may expand transplant eligibility for some patients.

综述目的:我们回顾了肝移植前后肝细胞癌(HCC)的治疗和监测的现有和更新的策略。摘要:HCC的发病率正在上升,患者往往在晚期才被诊断出来。因此,需要制定包括多专业合作在内的治疗策略。局部、全身和手术联合治疗肝癌患者肝移植后(后lt)的预后比以前所见的更好。肿瘤生物学(肿瘤大小、数量、位置、血清标志物、对治疗的反应)可以帮助识别移植后HCC复发的高危患者,并可能扩大一些患者的移植资格。
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引用次数: 0
Optimizing the prelung transplant candidate. 优化肺移植前候选者。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-11-07 DOI: 10.1097/MOT.0000000000001116
John Pagteilan, Scott Atay

Purpose of review: Lung transplant outcomes are impacted by multiple modifiable risk factors. Candidate deterioration on the wait list remains problematic. Innovative technology and strategies to identify and impact pretransplant morbidity have improved short- and long-term outcomes. We focus our review on recent advances in pretransplant recipient assessment and optimization.

Recent findings: Advancements in recipient management have focused on risk factor identification for adverse outcomes and the development of a lung transplant specific frailty assessment. Early surgical correction of gastroesophageal reflux disease (GERD), including the use of partial fundoplication in the setting of esophageal dysmotility, leads to improvements in graft function/longevity. New evidence supports expanding criteria for extracorporeal life support as a bridge to transplant.

Summary: Candidate optimization requires early intervention to limit functional deterioration potentially contributing to adverse outcomes. Frailty can be identified with a transplant specific frailty assessment, and positively impacted with dedicated rehabilitation. Pretransplant frailty is reversible following transplant and should be considered in the context of overall fitness at the time of candidate selection. Invasive support modes including extracorporeal membrane oxygenation (ECMO) are appropriate to preserve strength and mobility, with awake, ambulatory ECMO preferred. The deleterious effect of GERD on graft function can be managed with early fundoplication over medical management alone.

综述目的:肺移植的结果受到多种可改变的危险因素的影响。候选人在等待名单上的恶化仍然是个问题。识别和影响移植前发病率的创新技术和策略改善了短期和长期结果。我们重点回顾了在转运前受体评估和优化方面的最新进展。最近的发现:受体管理的进展集中在不良结果的风险因素识别和肺移植特异性虚弱评估的发展上。胃食管反流病(GERD)的早期手术矫正,包括在食管运动障碍的情况下使用部分胃底折叠术,可以改善移植物的功能/寿命。新的证据支持扩大体外生命支持作为移植桥梁的标准。总结:候选优化需要早期干预,以限制可能导致不良结果的功能恶化。虚弱可以通过移植特异性虚弱评估来识别,并通过专门的康复来产生积极影响。移植前的虚弱在移植后是可逆的,在选择候选人时应考虑整体健康状况。包括体外膜肺氧合(ECMO)在内的有创支持模式适用于保持力量和机动性,优选清醒、动态ECMO。胃食管反流术对移植物功能的有害影响可以通过早期胃底折叠术来控制,而不是单独进行药物治疗。
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引用次数: 0
Molecular profiling in the management of hepatocellular carcinoma. 分子分析在肝细胞癌治疗中的应用。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-12-01 DOI: 10.1097/MOT.0000000000001124
Nadine Soliman, Ashish Saharia, Maen Abdelrahim, Ashton A Connor

Purpose of review: The purpose of this review is to both summarize the current knowledge of hepatocellular carcinoma molecular biology and to suggest a framework in which to prospectively translate this knowledge into patient care. This is timely as recent guidelines recommend increased use of these technologies to advance personalized liver cancer care.

Recent findings: The main themes covered here address germline and somatic genetic alterations recently discovered in hepatocellular carcinoma, largely owing to next generation sequencing technologies, and nascent efforts to translate these into contemporary practice.

Summary: Early efforts of translating molecular profiling to hepatocellular carcinoma care demonstrate a growing number of potentially actionable alterations. Still lacking are a consensus on what biomarkers and technologies to adopt, at what scale and cost, and how to integrate them most effectively into care.

综述的目的:本综述的目的是总结当前肝细胞癌分子生物学的知识,并提出一个框架,其中前瞻性地将这些知识转化为患者护理。这是及时的,因为最近的指南建议增加使用这些技术来推进个性化的肝癌治疗。最近的发现:本文所涵盖的主要主题是最近在肝细胞癌中发现的种系和体细胞遗传改变,这主要归功于下一代测序技术,以及将这些技术转化为当代实践的初步努力。摘要:早期将分子谱分析转化为肝细胞癌治疗的努力表明,越来越多的潜在可行的改变。对于采用何种生物标志物和技术,采用何种规模和成本,以及如何最有效地将它们整合到护理中,目前仍缺乏共识。
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引用次数: 0
Ethical issues in solid organ transplantation: transfusion-free transplantation in Jehovah's witness patients. 实体器官移植的伦理问题:耶和华见证人患者的无输血移植。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-12-06 DOI: 10.1097/MOT.0000000000001128
Rick Selby, Taylor Selby-Medical, Michael Richman

Purpose of review: Jehovah's Witnesses do not accept transfusion of major allogeneic blood fractions. Successful solid organ transplantation is challenging for Jehovah's Witnesses when anemia, coagulation disturbances, and difficult technical aspects co-exist, and key blood bank resources cannot be utilized. Organ availability for transplantation is limited and demand exceeds supply for all organ types. Historically, the likelihood of poor outcomes in Jehovah's Witnesses patients placed ethical limitations on transplant candidacy for this population violating the precept of maximal utilization of a limited resource. The review's purpose is to describe advancements and strategies that make Jehovah's Witnesses transplant outcomes comparable to transfusion-eligible patients and allay the ethical concerns of their candidacy.

Recent findings: Immunomodulation from allogeneic transfusion is a cause of significant postop morbidity. Blood conservation strategies have led to improved outcomes across different medical and surgical cohorts and set the stage for expanded utility in Jehovah's Witnesses with organ insufficiency.Published single-center series with descriptions of specific peri-operative strategies describe the path to major blood product avoidance.

Summary: Comparable outcomes in solid organ transplantation for Jehovah's Witnesses without allogeneic transfusion are possible when inclusion-exclusion criteria are respected, and blood conservation strategies employed.

审查目的:耶和华见证会不接受输注主要的异体血液成分。当贫血、凝血障碍和困难的技术问题同时存在,且无法利用关键的血库资源时,成功进行实体器官移植对耶和华见证会来说是一项挑战。可供移植的器官有限,所有类型的器官都供不应求。从历史上看,耶和华见证会患者可能出现不良预后,这就从伦理上限制了这一人群的移植候选资格,违反了最大限度利用有限资源的原则。这篇综述的目的是介绍使耶和华见证会患者的移植结果与符合输血条件的患者相媲美的先进技术和策略,并消除对他们作为移植候选者的伦理顾虑:最新研究结果:异体输血引起的免疫调节是导致术后严重发病的原因之一。最近的研究结果:异体输血引起的免疫调节是导致术后严重发病的原因之一。血液保存策略改善了不同内科和外科组群的治疗效果,并为在器官功能不全的耶和华见证会患者中推广使用奠定了基础。已发表的单中心系列研究描述了避免使用主要血液制品的具体围手术期策略。
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引用次数: 0
Transplantation for colorectal liver metastasis. 大肠癌肝转移的移植治疗。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-11-23 DOI: 10.1097/MOT.0000000000001126
Pål-Dag Line, Svein Dueland

Purpose of review: Liver transplantation has emerged as a possible treatment for selected patients with nonresectable colorectal liver metastasis, but controversy still exists regarding optimal selection criteria and acceptable outcomes.

Recent findings: Univariate analysis in the largest cohorts confirms that metachronous disease, Oslo score = 0-1, metabolic tumor volume (MTV) less than 70 cm 3 , and tumor burden score less than 9 are positive predictive factors for good overall survival outcomes. Some recent trials might suggest that technical resectability is not a valid exclusion criterion for patients with high tumor load and favorable prognostic scores in the transplant evaluation. Recent developments in circulation DNA technology and liquid biopsy may play a future role in the selection and monitoring of patients.

Summary: Evaluation for transplant needs multidisciplinary involvement and should not be delayed until the failure of conventional oncological therapy. Larger data sets are needed to refine the selection criteria for liver transplantation in colorectal liver metastasis (CRLM).

综述目的:肝移植已成为不可切除的结直肠肝转移患者的一种可能的治疗方法,但关于最佳选择标准和可接受的结果仍然存在争议。最新发现:在最大队列中的单因素分析证实,异时性疾病、奥斯陆评分= 0-1、代谢肿瘤体积(MTV)小于70 cm3和肿瘤负担评分小于9是良好总生存结局的积极预测因素。最近的一些试验可能表明,在移植评估中,技术可切除性并不是高肿瘤负荷和预后评分良好的患者的有效排除标准。循环DNA技术和液体活检的最新发展可能在未来的患者选择和监测中发挥作用。总结:移植的评估需要多学科的参与,不应该延迟到传统的肿瘤治疗失败。需要更大的数据集来完善结肠直肠癌肝转移(CRLM)患者肝移植的选择标准。
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引用次数: 0
Enhanced recovery after surgery for liver transplantation: a review of recent literature. 肝移植术后恢复增强:近期文献综述。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-11-08 DOI: 10.1097/MOT.0000000000001117
Cara E Crouch, Erin Stewart, Adrian Hendrickse

Purpose of review: This review was created to highlight important articles from the past year related to the evolving field of enhanced recovery after surgery (ERAS) in liver transplantation that are relevant to the transplant anesthesiologist.

Recent findings: The International Liver Transplantation Society (ILTS) recently completed a landmark project, the ERAS4OLT.org project, which culminated in 80 recommendations for ERAS in liver transplantation. These recommendations encompass management for deceased donor recipients, living donor recipients and living donors. This review highlights selected articles relevant to the perioperative management of deceased donor liver transplant recipients.

Summary: Though, there are now published internationally agreed upon recommendations for ERAS topics specific to liver transplantation, there is an obvious need for further investigation into this area to provide high quality evidence to support these recommendations. It is reasonable to utilize these recommendations in ERAS protocols for individual institutions; however, more evidence is needed in several areas to confirm the effects of these protocols on short-term outcomes.

综述目的:本综述旨在强调过去一年中与肝移植术后增强恢复(ERAS)领域发展相关的重要文章,这些文章与移植麻醉师有关。最近的发现:国际肝移植学会(ILTS)最近完成了一个里程碑式的项目,ERAS4OLT.org项目,该项目最终提出了80项关于肝移植ERAS的建议。这些建议包括对已故捐赠者、在世捐赠者和在世捐赠者的管理。这篇综述重点介绍了与已故供肝移植受者围手术期管理相关的精选文章。摘要:尽管目前已经发表了针对肝移植特定ERAS主题的国际商定建议,但显然需要对这一领域进行进一步调查,以提供高质量的证据来支持这些建议。在个别机构的电子逆向拍卖协议中使用这些建议是合理的;然而,在几个领域还需要更多的证据来证实这些方案对短期结果的影响。
{"title":"Enhanced recovery after surgery for liver transplantation: a review of recent literature.","authors":"Cara E Crouch, Erin Stewart, Adrian Hendrickse","doi":"10.1097/MOT.0000000000001117","DOIUrl":"10.1097/MOT.0000000000001117","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review was created to highlight important articles from the past year related to the evolving field of enhanced recovery after surgery (ERAS) in liver transplantation that are relevant to the transplant anesthesiologist.</p><p><strong>Recent findings: </strong>The International Liver Transplantation Society (ILTS) recently completed a landmark project, the ERAS4OLT.org project, which culminated in 80 recommendations for ERAS in liver transplantation. These recommendations encompass management for deceased donor recipients, living donor recipients and living donors. This review highlights selected articles relevant to the perioperative management of deceased donor liver transplant recipients.</p><p><strong>Summary: </strong>Though, there are now published internationally agreed upon recommendations for ERAS topics specific to liver transplantation, there is an obvious need for further investigation into this area to provide high quality evidence to support these recommendations. It is reasonable to utilize these recommendations in ERAS protocols for individual institutions; however, more evidence is needed in several areas to confirm the effects of these protocols on short-term outcomes.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71479205","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}
引用次数: 0
Advances in desensitization for human leukocyte antigen incompatible kidney transplantation. 人类白细胞抗原不相容肾移植脱敏疗法的进展。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2023-12-14 DOI: 10.1097/mot.0000000000001131
Ashley Vo, Noriko Ammerman, Stanley C Jordan
Human leukocyte antigen (HLA) sensitization is a major barrier to kidney transplantation induced by exposure to alloantigens through pregnancy, blood product exposure and previous transplantations. Desensitization strategies are undertaken to improve the chances of finding compatible organ offers. Standard approaches to desensitization include the use of plasmapheresis/low dose intravenous immunoglobulin (IVIG) or high dose IVIG plus anti-CD20. However, current methods to reduce HLA antibodies are not always successful, especially in those with calculated panel reactive antibody 99-100%.
人类白细胞抗原(HLA)致敏是肾移植的一个主要障碍,其诱因是通过怀孕、接触血液制品和以前的移植手术而暴露于异体抗原。采取脱敏策略是为了增加找到匹配器官的机会。脱敏的标准方法包括使用浆细胞分离/小剂量静脉注射免疫球蛋白(IVIG)或大剂量 IVIG 加抗 CD20。然而,目前减少 HLA 抗体的方法并不总是成功的,尤其是那些计算出的面板反应性抗体为 99-100% 的患者。
{"title":"Advances in desensitization for human leukocyte antigen incompatible kidney transplantation.","authors":"Ashley Vo, Noriko Ammerman, Stanley C Jordan","doi":"10.1097/mot.0000000000001131","DOIUrl":"https://doi.org/10.1097/mot.0000000000001131","url":null,"abstract":"Human leukocyte antigen (HLA) sensitization is a major barrier to kidney transplantation induced by exposure to alloantigens through pregnancy, blood product exposure and previous transplantations. Desensitization strategies are undertaken to improve the chances of finding compatible organ offers. Standard approaches to desensitization include the use of plasmapheresis/low dose intravenous immunoglobulin (IVIG) or high dose IVIG plus anti-CD20. However, current methods to reduce HLA antibodies are not always successful, especially in those with calculated panel reactive antibody 99-100%.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138680407","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}
引用次数: 0
期刊
Current Opinion in Organ Transplantation
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