American Journal of Transplantation最新文献

英文中文

Sowing “seeds of trust”: How trust in normothermic regional perfusion is built in a continuum of care 播下 "信任的种子"：如何在持续护理中建立对常温区域灌注的信任。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.05.017

Normothermic regional perfusion (NRP) is a promising technology to improve organ transplantation outcomes by reversing ischemic injury caused by controlled donation after circulatory determination of death. However, it has not yet been implemented in Canada due to ethical questions. These issues must be resolved to preserve public trust in organ donation and transplantation. This qualitative, constructivist grounded theory study sought to understand how those most impacted by NRP perceived the ethical implications. We interviewed 29 participants across stakeholder groups of donor families, organ recipients, donation and transplantation system leaders, and care providers. The interview protocol included a short presentation about the purpose of NRP and procedures in abdomen versus chest and abdomen NRP, followed by questions probing potential violations of the dead donor rule and concerns regarding brain reperfusion. The results present a grounded theory placing NRP within a trust-building continuum of care for the donor, their family, and organ recipients. Stakeholders consistently described both forms of NRP as an ethical intervention, but their rationales were predicated on assumptions that neurologic criteria for death had been met following circulatory death determination. Empirical validation of these assumptions will help ground the implementation of NRP in a trust-preserving way.

常温区域灌注（NRP）是一项很有前途的技术，它可以逆转在循环系统确定死亡后控制捐献造成的缺血性损伤，从而改善器官移植的效果。然而，由于伦理问题，加拿大尚未实施该技术。这些问题必须得到解决，以维护公众对器官捐赠和移植的信任。这项定性、建构主义的基础理论研究试图了解受 NRP 影响最大的人是如何看待其伦理影响的。我们采访了捐赠者家属、器官接受者、捐赠和移植系统领导者以及护理提供者等利益相关群体的 29 名参与者。访谈方案包括简短介绍 NRP 的目的以及腹部 NRP 与胸腹部 NRP 的程序，然后提出问题，探究可能违反死亡捐献者规则的行为以及对脑部再灌注的担忧。研究结果提出了一种基础理论，将 NRP 置于为捐献者、其家属和器官受者提供的建立信任的连续护理中。利益相关者一致认为两种形式的 NRP 都是合乎伦理的干预措施，但他们的理论依据都是假设在确定循环系统死亡后，神经系统的死亡标准已经达到。对这些假设进行经验验证将有助于以维护信任的方式实施 NRP。

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引用次数: 0

Intraoperative blood pressure management during kidney transplantation: Grafts under pressure 肾移植手术中的术中血压管理：压力下的移植物。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.06.017

引用次数: 0

Allostimulation leads to emergence of a human B cell population with increased expression of HLA class I antigen presentation–associated molecules and the immunoglobulin receptor FcRL5 异体刺激导致人类 B 细胞群的出现，其 HLA I 类抗原呈递相关分子和免疫球蛋白受体 FcRL5 的表达量增加。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.06.014

In the extensive literature characterizing lymphocyte contributions to transplant-related pathologies including allograft rejection and graft-versus-host disease, T cell–focused investigation has outpaced investigation of B cells. Most B cell–related reports describe regulatory and antibody-producing functions, with less focus on the potential role of antigen-presenting capacity. Using in vitro human mixed lymphocyte reactions (MLRs) to model allostimulation, we analyzed responder B cells using transcriptional analysis, flow cytometry, and microscopy. We observed emergence of an activated responder B cell subpopulation phenotypically similar to that described in individuals with graft-versus-host disease or allograft rejection. This population had markedly increased expression of FcRL5 (Fc receptor like 5) and molecules associated with human leukocyte antigen class I antigen presentation. Consistent with this phenotype, these cells demonstrated increased internalization of irradiated cell debris and dextran macromolecules. The proportion of this subpopulation within MLR responders also correlated with emergence of activated, cytotoxic CD8⁺ T cells. B cells of similar profile were quite infrequent in unstimulated blood from healthy individuals but readily identifiable in disaggregated human splenocytes and increased in both cases upon allostimulation. Further characterization of the emergence and function of this subpopulation could potentially contribute to identification of novel biomarkers and targeted therapeutics relevant to curbing transplant-related pathology.

在描述淋巴细胞对移植相关病症（包括异体移植物排斥反应和移植物抗宿主疾病）的作用的大量文献中，以 T 细胞为重点的研究超过了对 B 细胞的研究。大多数与 B 细胞相关的报告都描述了 B 细胞的调节和抗体生成功能，而较少关注其抗原提呈能力的潜在作用。我们使用体外人类混合淋巴细胞反应（MLRs）来模拟异源刺激，并使用转录分析、流式细胞仪和显微镜分析了应答B细胞。我们观察到出现了一种活化的应答B细胞亚群，其表型与患有移植物抗宿主疾病或异体移植物排斥反应的个体所描述的亚群相似。该亚群的 FcRL5（类 Fc 受体 5）和 HLA I 类抗原呈递相关分子的表达明显增加。与这一表型相一致的是，这些细胞对辐照细胞碎片和葡聚糖大分子的内化也有所增加。该亚群在 MLR 反应者中的比例也与活化的细胞毒性 CD8+ T 细胞的出现相关。类似特征的 B 细胞在健康人的未刺激血液中并不常见，但在分解的人脾细胞中却很容易识别，并且在异体刺激时都会增加。对这一亚群的出现和功能的进一步描述可能有助于确定新型生物标志物和靶向治疗方法，从而遏制与移植相关的病理现象。

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引用次数: 0

Pediatric cardiac xenotransplantation and stakeholder engagement 小儿心脏异种移植与利益相关者的参与。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.06.020

引用次数: 0

Tissue-resident regulatory T cells as transient, tissue-agnostic immunomodulatory populations 组织驻留调节性 T 细胞是瞬时的组织识别性免疫调节群体。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.09.013

引用次数: 0

Robotic living donor hepatectomy is associated with superior outcomes for both the donor and the recipient compared with laparoscopic or open - A single-center prospective registry study of 3448 cases 与腹腔镜或开腹手术相比，机器人活体肝切除术对供体和受体都有更好的疗效 - 一项对 3,448 例病例进行的单中心前瞻性登记研究。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.04.020

Minimally invasive donor hepatectomy is an emerging surgical technique in living donor liver transplantation (LDLT). We examined outcomes across open, laparoscopic, and robotic LDLT using a prospective registry. We analyzed 3448 cases (1724 donor-recipient pairs) from January 2011 to March 2023 (NCT06062706). Among donors, 520 (30%) were female. Adult-to-adult LDLT comprised 1061 (62%) cases. A total of 646 (37%) of the donors underwent open, 165 (10%) laparoscopic, and 913 (53%) robotic hepatectomies. Primary outcomes: donor overall morbidity was 4% (35/903) for robotic, 8% (13/165) laparoscopic, and 16% (106/646) open (P < .001) procedures. Pediatric and adult recipient mortality was similar among the 3 donor hepatectomy approaches: robotic 1.5% and 7.0%, compared with 2.3% and 8.3% laparoscopic, and 1.6% and 5.5% for open donor surgery, respectively (P = .802, P = .564). Secondary outcomes: pediatric and adult recipients major morbidity after robotic hepatectomy was 15% and 23%, compared with 25% and 44% for laparoscopic surgery and 19% and 31% for open surgery, respectively (P = .033, P < .001). Graft and recipient 5-year survival were 90% and 93% for pediatrics and 79% and 80% for adults, respectively. In conclusion, robotic LDLT was associated with superior outcomes when compared with the laparoscopic and open approaches. Both donors and, for the first time reported, recipients benefitted from lower morbidity rates in robotic surgery, emphasizing its potential for further advancing this field.

微创供体肝切除术是活体肝移植（LDLT）中一种新兴的外科技术。我们通过前瞻性登记研究了开腹、腹腔镜和机器人 LDLT 的结果。我们分析了2011年1月至2023年3月期间的3448个病例（1724对供体-受体）（NCT06062706）。在捐献者中，724 人（42%）为女性。成人对成人 LDLT 有 1,061 例（62%）。646名（37%）供体接受了开腹肝切除术，165名（10%）接受了腹腔镜肝切除术，913名（53%）接受了机器人肝切除术。主要结果：机器人肝切除术后，供体总发病率为4%（35/903），腹腔镜手术为8%（13/165），开腹手术为16%（106/646）（p次要结果：机器人肝切除术后，儿童和成人受体的主要发病率分别为15%和23%，而腹腔镜手术和开腹手术的发病率分别为25%和44%和19%和31%（p=0.033，pIrb approval id：rac 2121012 clinicaltrials.gov：NCT06062706。

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引用次数: 0

Invasive aspergillosis in liver transplant recipients in the current era 当今时代肝移植受者的侵袭性曲霉菌病

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.05.016

Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multicenter 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in 8 cases (13%). Twelve-week all-cause mortality of IA was 37%. In multivariate analyses, systemic antibiotic usage (adjusted odds ratio [aOR], 4.74; P = .03) and history of pneumonia (aOR, 48.7; P = .01) were identified as independent risk factors associated with the occurrence of IA. Moreover, reoperation (aOR, 5.99; P = .01), systemic antibiotic usage (aOR, 5.03; P = .04), and antimold prophylaxis (aOR, 11.9; P = .02) were identified as independent risk factors associated with the occurrence of early IA. Among IA cases, Aspergillus colonization (adjusted hazard ratio [aHR], 86.9; P < .001), intensive care unit stay (aHR, 3.67; P = .02), disseminated IA (aHR, 8.98; P < .001), and dialysis (aHR, 2.93; P = .001) were identified as independent risk factors associated with 12-week all-cause mortality, while recent receipt of tacrolimus (aHR, 0.11; P = .001) was protective. Mortality among LiTRs with IA remains high in the current era. The identified risk factors and protective factors may be useful for establishing robust targeted antimold prophylactic and appropriate treatment strategies against IA.

侵袭性曲霉菌病（IA）是肝移植受者（LiTR）中一种罕见但致命的疾病。我们进行了一项多中心 1:2 病例对照研究，比较了确诊为已证实/可能感染侵袭性曲霉菌病的肝移植受者和未感染侵袭性真菌的对照组。我们纳入了 62 例 IA 病例和 124 例匹配对照。只有 8 例（13%）发生了播散性感染。IA的12周全因死亡率为37%。在多变量分析中，全身使用抗生素（调整赔率 [aOR]，4.74；p=0.03）和肺炎病史（aOR，48.7；p=0.01）被确定为与 IA 发生相关的独立风险因素。此外，再次手术（aOR，5.99；p=0.01）、全身使用抗生素（aOR，5.03；p=0.04）和抗霉菌预防（aOR，11.9；p=0.02）被认为是与早期 IA 发生相关的独立危险因素。在 IA 病例中，曲霉菌定植（调整危险比 [aHR], 86.9; p

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引用次数: 0

Corrigendum to ‘A novel scoring system to predict short-term mortality after living donor liver transplantation for acute liver failure’ [American Journal of Transplantation 24 (2024): 1857–1867] 预测急性肝功能衰竭活体肝移植术后短期死亡率的新型评分系统 "的更正，《美国移植杂志》，2024 年 4 月 29 日在线出版，校正稿。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.08.001

引用次数: 0

Development of an improved Scientific Registry of Transplant Recipients deceased donor heart yield model using donor critical care data from the Donor Management Goal Registry cohort 利用捐献者管理目标登记队列中的捐献者危重症护理数据，开发改进的移植受者科学登记处已故捐献者心脏产量模型。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.07.001

Organ procurement organizations (OPOs) face increasing regulatory scrutiny, and the performance of predictive models used to assess OPO performance is critical. We sought to determine whether adding deceased donor physiological and critical care data to the existing Scientific Registry of Transplant Recipients (SRTR) heart yield model would improve the model’s performance. Donor data and heart transplanted (yes/no), the outcome of interest, were obtained from the United Network for Organ Sharing Donor Management Goal (DMG) Registry for 19 141 donors after brain death, from 25 OPOs. The data were split into training and testing portions. Multivariable LASSO regression was used to develop a statistical model incorporating DMG data elements with the existing components of the SRTR model. The DMG + SRTR and SRTR models were applied to the test data to compare the predictive performance of the models. The sensitivity (84%-86%) and specificity (84%-86%) were higher for the DMG + SRTR model compared to the SRTR model (71%-75% and 76%-77%, respectively). For the DMG + SRTR model, the C-statistic was 0.92 to 0.93 compared to 0.80 to 0.81 for the SRTR model. DMG data elements improve the predictive performance of the heart yield model. The addition of DMG data elements to the Organ Procurement and Transplantation Network data collection requirements should be considered.

器官获取组织（OPO）面临着越来越多的监管审查，用于评估 OPO 性能的预测模型的性能至关重要。我们试图确定在现有的器官移植受者科学登记处（SRTR）心脏产量模型中添加已故捐献者生理和重症监护数据是否会提高该模型的性能。我们从器官共享联合网络（United Network for Organ Sharing）的器官捐献者管理目标（DMG）登记处获得了25个器官移植组织的19141名脑死亡后捐献者的捐献者数据和心脏移植结果（是/否）。数据分为训练和测试两部分。使用多变量 LASSO 回归法建立了一个统计模型，将 DMG 数据元素与 SRTR 模型的现有组成部分结合在一起。将 DMG+SRTR 模型和 SRTR 模型应用于测试数据，以比较模型的预测性能。与 SRTR 模型（分别为 71-75% 和 76-77%）相比，DMG+SRTR 模型的灵敏度（84-86%）和特异度（84-86%）更高。DMG+SRTR模型的C统计量为0.92-0.93，而SRTR模型的C统计量为0.80-0.81。DMG 数据元素提高了心脏产量模型的预测性能。应考虑在器官获取与移植网络数据收集要求中增加 DMG 数据元素。

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引用次数: 0

From prognostication to therapeutics: Four key questions to accelerate the development of therapeutics for patients with acute-on-chronic liver failure 从诊断到治疗：加速 ACLF 患者治疗药物开发的四个关键问题。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2024-11-01 DOI: 10.1016/j.ajt.2024.06.007

Acute-on-chronic liver failure (ACLF) has come a long way as a clinical concept within the hepatology and liver transplant communities. Though the term was proposed in 1995, the first recognition of the entity along with a consensus definition emerged in 2009. Subsequently, the entity has sparked great interest, inspired several consensus conferences, and inspired national societies to form professional ACLF affinity groups (eg, special interest group). Multicenter consortia have been established all over the world to study this condition, including the North American Consortium for the Study of End-Stage Liver Disease, Chronic Liver Failure consortium, Asian Pacific Association for the Study of Liver Diseases ACLF Research Consortium, Chronic Liver disease Evolution And Registry for Events and Decompensation, and the LiverHope Consortium. Collectively, these consortia have enrolled tens of thousands of patients with or at risk for ACLF across dozens of countries and characterized in detail the predictors, pathogenesis, and progression of patients with ACLF. Perhaps most importantly, they have produced essential data characterizing the excess morbidity and mortality that patients with ACLF face, making a compelling case for the urgent need for therapeutic strategies for this condition.

急性慢性肝衰竭（ACLF）作为肝脏病学和肝脏移植界的一个临床概念，已经走过了漫长的历程。虽然该术语在 1995 年就已提出，但 2009 年才首次确认该实体并达成共识定义。随后，该实体引发了极大的兴趣，促成了数次共识会议，并促使各国学会成立了专业的 ACLF 亲和小组（如特殊兴趣小组）。世界各地都成立了多中心联盟来研究这一病症，包括北美终末期肝病研究联盟、慢性肝衰竭联盟、亚太肝病研究协会 ACLF 研究联盟、慢性肝病演变及事件和失代偿登记处以及 LiverHope 联盟。这些联盟在数十个国家共招募了数万名 ACLF 患者或高危患者，并详细描述了 ACLF 患者的预测因素、发病机制和病情进展。也许最重要的是，它们提供的重要数据说明了 ACLF 患者所面临的发病率和死亡率过高的问题，从而有力地证明了对这种疾病的治疗策略的迫切需求。

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