American Journal of Transplantation最新文献

The implications of a lung malignancy in a lung transplant recipient are poorly understood. Here, we linked national transplant and cancer databases to determine how lung cancer impacted prognosis in lung transplant recipients with incidentally explanted lung cancers (IELCs). Records from the Scientific Registry of Transplant Recipients and National Cancer Database were linked to identify 186 patients who received a lung transplant and were subsequently diagnosed with lung cancer. These patients were determined to have IELC and were compared to control patients who received a lung transplant but were not diagnosed with IELC. Of the 186 patients, 144 had non-small cell lung cancer (NSCLC), 6 had small cell lung cancer, and 36 had a neuroendocrine cancer. Patients with stage I/II NSCLC or any stage neuroendocrine cancer had comparable overall survival and rates of cancer-related mortality compared to controls. Conversely, patients with stage III/IV NSCLC had worse overall survival, higher rates of cancer-related mortality, and infrequently received cancer-specific non-operative treatment. Taken together, stage I/II NSCLC and neuroendocrine cancers should be reconsidered as an absolute contraindication to transplant. Conversely, patients with stage III/IV NSCLC had worse outcomes, and strategies are needed to increase the use of adjuvant therapy.

In this study using a discordant, xenogeneic, transplant model we demonstrate functionality and safety of the first stent-based bioartificial pancreas device implanted endovascularly into an artery, harnessing the high oxygen content in blood to support islet viability. The device is a self-expanding nitinol stent that is coated with a bilayer of polytetrafluorethylene (PTFE) that forms channels to hold islets embedded in hydrogel. We completed a one-month study in the non-diabetic swine model (N=3) to test the safety of the device and to assess islet functionality after device retrieval. The luminal diameter of the devices from three animals on day 0 and day 30 was 10.01 ± 0.408 mm and 10.05 ± 0.25 mm, respectively. The stimulation index of the control and eBAP devices explanted at day 30 were 3.35 ± 0.97 and 4.83 ±1.20, respectively, and the islets stained positively for insulin and glucagon after 30 days in-vivo. This pilot study shows that BAP implantation into a peripheral artery is safe and supports islet functionality over 30 days, providing groundwork for future work assessing in-vivo function of the device in diabetic swine.

Induction immunosuppression in solid organ transplantation involves a short course of potent immunosuppression in the perioperative period, with the goal of preventing early acute rejection and delaying initiation or reducing the dose of calcineurin inhibitors to minimize kidney injury. The use of induction immunosuppression in lung transplantation has increased over time, with over 80% of adult lung transplant recipients receiving some form of induction therapy. Currently, more than 70% of lung transplant recipients receive induction with an IL-2 receptor antagonist, and basiliximab is the most used agent. Despite this now common practice, the evidence to support and guide induction immunosuppression following lung transplantation is limited, making the use of induction somewhat controversial. Here, we review the available literature addressing the use of induction immunosuppression in lung transplant recipients.

Kidney Transplant is the preferred treatment for end-stage renal disease (ESRD) patients. However, a subset of otherwise eligible patients have severe iliac artery calcification that preclude them from receiving a kidney transplant. This report highlights the application of a physician-modified external iliac artery stent graft with a side branch extension (SBE) to facilitate successful kidney transplantation in a 69-year-old African American female who was otherwise ineligible for kidney transplant due to the presence of severe circumferential bilateral iliac artery calcification. Four months later, the patient received a kidney transplant and recovered without complications. Her duplex ultrasound (DUS) revealed patent vasculature to the kidney graft, she produced adequate urine output, and creatinine and glomerular filtration rate (GFR) normalized by discharge. This underscores the potential for stent graft with SBE as an option for patients who were traditionally ineligible for kidney transplantation due to the presence of severe aortoiliac calcification.

Kaposi sarcoma herpesvirus/human herpesvirus-8 (HHV-8) neoplastic and non-neoplastic disease in solid organ transplant (SOT) recipients can be life-threatening. We evaluated the seroprevalence of HHV-8 infection among donors (D) and recipients (R), the incidence of HHV-8 transmission/reactivation, and the clinical characteristics, management, and outcomes of HHV-8-related diseases, including Kaposi sarcoma herpesvirus-associated inflammatory cytokine syndrome (KICS), in consecutive SOT patients from 2011 to 2023. HHV-8 seroprevalence was 3.3% in 1349 donors and 8.4% in 1856 recipients screened (p<0.0001). Among the D+/R- group (n=49), 13 patients developed HHV-8-related diseases: 7 liver recipients had KICS, and 1 lung recipient had Kaposi sarcoma (KS) with subsequent KICS. Four KICS patients treated with rituximab survived, while the 3 patients not treated with rituximab died. Within the D-/R- group, out of 5 (0.3%) patients with non-donor-derived primary HHV-8 infection, 3 liver recipients developed KICS. In the R+ patients (n=155), 3 developed KS. In our cohort, 25/944 (2.6%) liver transplant recipients had a primary HHV-8 infection, and 10 of them (40%) developed KICS; 40% (4/10) of HHV-8 seropositive heart transplant recipients developed reactivation and 2 of them (50%) had fatal KS. Serologic screening and molecular surveillance of D+/R- patient groups facilitate early recognition and effective therapy of KICS.

Developing real-world evidence from electronic health records (EHR) is vital to advance kidney transplantation (KT). We assessed the feasibility of studying KT using the Epic Cosmos aggregated EHR dataset, which includes 274 million unique individuals cared for in 238 U.S. health systems, by comparing it with the Scientific Registry of Transplant Recipients (SRTR). We identified 69,418 KT recipients transplanted between January 2014 and December 2022 in Cosmos (39.4% of all US KT transplants during this period). Demographics and clinical characteristics of recipients captured in Cosmos were consistent with the overall SRTR cohort. Survival estimates were generally comparable, although there were some differences in long-term survival. At 7 years post-transplant, patient survival was 80.4% in Cosmos and 77.8% in SRTR. Multivariable Cox regression showed consistent associations between clinical factors and mortality in both cohorts, with minor discrepancies in the associations between death and both age and race. In summary, Cosmos provides a reliable platform for KT research, allowing EHR-level clinical granularity not available with either the transplant registry or healthcare claims. Consequently, Cosmos will enable novel analyses to improve our understanding of KT management on a national scale.