American Journal of Transplantation最新文献_第7页

Bartonella quintana infection in kidney transplant recipients from donor experiencing homelessness, United States, 2022 无家可归者肾移植受者的金通体感染，美国，2022。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2024.11.032

Marcus R. Pereira

引用次数: 0

OPTN/SRTR 2023 Annual Data Report: Deceased Organ Donation

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2025.01.026

Ajay K. Israni , David A. Zaun , Alina Martinez , Cory R. Schaffhausen , Cinthia Lozano , Warren T. McKinney , Jonathan M. Miller , Jon J. Snyder

The Annual Data Report is created using data from the Scientific Registry of Transplant Recipients (SRTR) to calculate variables such as organs recovered per donor, organs transplanted per donor, and organs recovered for transplant but not transplanted (ie, nonuse). SRTR uses data collected by the Organ Procurement and Transplantation Network. In 2023, there were 16,335 deceased donors, a 9.6% increase from 14,904 in 2022 and continuing the trend of increasing donors over the past decade. Donor characteristics have changed compared with 2013, with more donors with drug intoxication and cardiovascular mechanisms of death. In contrast, gunshot wound, blunt injury, and stroke have decreased as mechanisms of death in 2023 compared with 2013. The number of organs transplanted increased to 40,588 in 2023 (from 37,316 in 2022), including 10,818 left kidneys, 10,659 right kidneys, 372 en bloc kidneys, 917 pancreata, 9,910 livers, 95 intestines, 4,596 hearts, and 3,016 lungs. Compared with 2022, transplants of all organs increased. In 2023, 4,038 left kidneys, 4,220 right kidneys, 160 en block kidneys, 279 pancreata, 1,056 livers, 4 intestines, 68 hearts, and 260 lungs were not used. This nonuse of organs represents an opportunity to increase the number of transplants.

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引用次数: 0

Donor-derived posttransplant lymphoproliferative disease detection by donor-derived cell-free DNA 通过供体源性细胞游离 DNA 检测供体源性移植后淋巴组织增生性疾病。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2024.09.029

Mia Wungnema , Madelaine Hack , Evgeniya Vaskova , Natali Gulbahce , Hao Zhang , Marica Grskovic , Allison Miller , Megan Stack , Angelo de Mattos , Phillipp W. Raess , Wei Xie , Joanna Wiszniewska , Nicole K. Andeen , Vanderlene L. Kung , Erin Maynard , Shehzad Rehman

Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication of organ transplantation, commonly diagnosed after patients present with nonspecific constitutional symptoms and/or transplant organ dysfunction. In this article, we report a case of a kidney transplant recipient who was found to have highly elevated circulating donor-derived cell-free DNA (dd-cfDNA) levels on routine serum surveillance for allograft rejection, initially without organ dysfunction or evidence of allograft rejection on biopsy. Later, for cause imaging revealed retroperitoneal lymphadenopathy and an allograft hilar mass, which was biopsied to show PTLD/diffuse large B cell lymphoma. The elevated circulating dd-cfDNA levels in this patient prompted targeted next-generation sequencing of the same 266 single-nucleotide polymorphisms used to detect dd-cfDNA on the diffuse large B cell lymphoma, which identified it as derived from the donor. The patient achieved complete remission with retained allograft kidney function after reduced immunosuppression and 6 cycles of immunochemotherapy. This case suggests that dd-cfDNA may be an early detection tool in rare but potentially life-threatening cases of donor-derived malignancy, such as donor-derived PTLD.

移植后淋巴组织增生性疾病（PTLD）是器官移植后一种危及生命的并发症，通常在患者出现非特异性体征和/或移植器官功能障碍后被诊断出来。我们在此报告了一例肾移植受者的病例，该受者在常规血清监测中发现循环供体衍生细胞游离 DNA（dd-cfDNA）水平高度升高，最初没有器官功能障碍，活检也没有发现同种异体排斥反应的证据。后来因病因成像检查发现腹膜后淋巴结病变和异体肝脏肿块，活检显示为移植后淋巴组织增生性疾病/弥漫性大B细胞淋巴瘤（DLBCL）。该患者循环中 dd-cfDNA 水平升高，促使对用于检测 DLBCL 上 dd-cfDNA 的 266 个单核苷酸多态性进行了有针对性的下一代测序，从而确定其为供体来源。患者在减少免疫抑制和接受了 6 个周期的免疫化疗后，病情完全缓解，异体肾功能得以保留。该病例表明，dd-cfDNA 可作为一种早期检测工具，用于罕见但可能危及生命的供体源性恶性肿瘤病例，如供体源性 PTLD。

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引用次数: 0

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2024.09.035

Julien Zuber , Juliette Leon , Julie Déchanet-Merville , Hannah Kaminski

Belatacept, a fusion protein combining cytotoxic T-lymphocyte antigen-4 (CTLA-4) and the Fc region of human IgG1, is increasingly used as a calcineurin inhibitor–sparing regimen in patients with chronic graft dysfunction. Older kidney transplant recipients, particularly from expanded criteria donors, may be switched to belatacept due to poor renal recovery. However, late-onset cytomegalovirus (CMV) reactivation is increasingly reported with this treatment, especially in older patients with graft dysfunction. This suggests a progressive loss of CMV-specific T cell response, potentially driven by T cell exhaustion. Contributing factors include preexisting T cell dysfunction, increased viral antigen exposure, and interference in the PD-L1/PD-1 pathway by belatacept. mTOR inhibitors have shown efficacy in preventing CMV reactivation by reinvigorating CMV-specific T cells. These findings support combining belatacept with mTOR inhibitors in high-risk CMV-seropositive recipients and emphasize the need for personalized immune assessments to guide immunosuppressive strategies.

贝拉替塞（Belatacept）是一种结合了 CTLA-4 和人类 IgG1 Fc 区的融合蛋白，越来越多地被用作慢性移植物功能障碍患者的钙神经抑制剂备用方案。年龄较大的肾移植受者，尤其是来自扩大标准供体的肾移植受者，可能会因肾功能恢复不佳而改用贝拉他赛普。然而，越来越多的报告显示，在接受这种治疗时，尤其是在移植物功能障碍的老年患者中，会出现晚期 CMV 再激活的情况。这表明 CMV 特异性 T 细胞反应逐渐丧失，可能是 T 细胞衰竭所致。mTOR抑制剂已显示出通过重振CMV特异性T细胞来预防CMV再激活的疗效。这些研究结果支持在 CMV 血清阳性的高风险受者中将贝拉替塞与 mTOR 抑制剂联合使用，并强调了进行个性化免疫评估以指导免疫抑制策略的必要性。

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引用次数: 0

Serum and tissue biomarkers of plasma cell-rich rejection in liver transplant recipients 肝移植受者富含浆细胞排斥反应的血清和组织生物标志物。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2024.10.006

Nivetha Saravanan , Anthony Demetris , Maria Isabel Fiel , Claire Harrington , Nigar Anjuman Khurram , Thomas D. Schiano , Josh Levitsky

The distinction between autoimmune and alloimmune reactions in liver transplant recipients can be challenging. Plasma cell-rich rejection (PCRR), previously known as de novo autoimmune hepatitis or plasma cell hepatitis, is an atypical and underrecognized form of allograft rejection observed post-liver transplantation, often in conjunction with features of T cell–mediated and antibody-mediated rejection. If PCRR is not recognized and treated with prompt immunosuppressive augmentation, patients can develop advanced hepatic fibrosis, necroinflammation, and allograft failure. Given the significant morbidity and mortality associated with PCRR, there exists a need to develop noninvasive biomarkers which can be used in screening, diagnosis, and treatment monitoring of PCRR. This study is a literature review of candidate serum-based and tissue-based biomarkers in adult and pediatric liver transplant PCRR. We also discuss biomarkers from plasma cell-rich processes observed in other disease states and other organ transplant recipients that might be tested in liver transplant PCRR. We conclude with proposed future directions in which biomarker implementation into clinical practice could lead to advances in personalized management of PCRR.

区分肝移植受者的自身免疫反应和同种免疫反应可能很有难度。富含浆细胞的排斥反应（PCRR）以前被称为 "新生自身免疫性肝炎 "或 "浆细胞肝炎"，是肝移植术后出现的一种非典型、未得到充分认识的异体移植排斥反应，通常与T细胞介导的排斥反应和抗体介导的排斥反应并存。如果 PCRR 没有被及时发现并通过增强免疫抑制进行治疗，患者可能会发展为晚期肝纤维化、坏死性炎症和异体移植失败。鉴于 PCRR 会导致严重的发病率和死亡率，因此有必要开发可用于 PCRR 筛查、诊断和治疗监测的无创生物标志物。本文对成人和儿童肝移植 PCRR 的候选血清和组织生物标志物进行了文献综述。我们还讨论了在其他疾病状态和其他器官移植受者中观察到的血浆细胞丰富过程中的生物标记物，这些标记物可能会在肝移植 PCRR 中进行测试。最后，我们提出了未来的发展方向，将生物标志物应用于临床实践可促进 PCRR 的个性化管理。

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引用次数: 0

Contemporary prevalence and practice patterns of out-of-sequence kidney allocation 非等位肾脏分配的当代流行与实践模式。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2024.08.016

Luckmini N. Liyanage , Daniyar Akizhanov , Suhani S. Patel , Dorry L. Segev , Allan B. Massie , Darren E. Stewart , Sommer E. Gentry

Since 2021, the Organ Procurement and Transplantation Network has reported a nearly 10-fold rise in out-of-sequence (OOS) kidney allocation, generating concern and halting development of continuous distribution policies. We report contemporary (2022-2023) practice patterns in OOS allocation using Organ Procurement and Transplantation Network data. We examined in sequence vs OOS donors with multivariable logistic regression and skipped vs OOS-accepting recipients with conditional logistic regression. Nearly 20% of kidney placements were OOS, varying from 0% to 43% acsoss organ procurement organizations; the 5 highest OOS-organ procurement organizations accounted for 29% of all OOS. Of OOS kidneys, 33% were declined ≥100 times in the standard allocation sequence and 51% were declined by ≥10 centers before OOS allocation began; 4.5% were made without any in-sequence declines. Nearly, all OOS offers were open offers. OOS kidneys were more likely to be from female, Black, older, donation after cardiac death, hypertensive, diabetic, and elevated creatinine donors. Candidates receiving OOS kidneys were more likely female, Asian, and older than skipped candidates. Higher-volume centers and centers with more White, fewer Hispanic, and more educated waiting list patients underwent transplantation disproportionately with more OOS kidneys. These findings suggest that the current, highly variable, discretionary use of OOS might exacerbate disparities, yet the impact of OOS on organ utilization cannot be determined with data now collected.

自 2021 年以来，OPTN 报告的顺序外（OOS）肾脏分配增加了近 10 倍，引起了人们的关注，并阻碍了连续分配政策的发展。我们利用 OPTN 的数据报告了当代（2022-2023 年）OOS 分配的实践模式。我们通过多变量逻辑回归研究了顺序捐献者与OOS捐献者的关系，并通过条件逻辑回归研究了跳过捐献者与接受OOS捐献者的关系。近20%的肾脏配售为OOS，各OPO的OOS率从0%到43%不等；OOS率最高的5个OPO占所有OOS的29%。在 OOS 肾脏中，33% 的肾脏在标准分配序列中被拒绝超过 100 次，51% 的肾脏在 OOS 分配开始前被超过 10 个中心拒绝；4.5% 的肾脏在标准分配序列中未被任何中心拒绝。几乎所有的 OOS 供肾都是公开供肾。OOS肾更可能来自女性、黑人、老年人、DCD、高血压、糖尿病和肌酐升高的供体。接受 OOS 肾脏的候选者中，女性、亚裔和老年人的比例高于跳过的候选者。数量较多的中心以及白人较多、西班牙裔较少和受教育程度较高的候选者中心移植的OOS肾脏数量多得不成比例。这些研究结果表明，目前随意使用OOS的情况非常多变，可能会加剧差异，但目前收集的数据还无法确定OOS对器官利用率的影响。

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引用次数: 0

Crossing national borders for transplantation: A focused evaluation of deceased donor lung exports from the United States 跨越国界进行移植：对美国已故捐献者肺移植的重点评估。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2024.08.025

Rocio Lopez , Sumit Mohan , Seyd Ali Husain , Miko Yu , Susana Arrigain , Deena Brosi , Jordan R.H. Hoffman , Kenneth R. McCurry , Bruce Kaplan , Elizabeth A. Pomfret , Jesse D. Schold

Organ transplantation is a life-saving treatment for end-stage organ failure patients, but the United States (US) faces a shortage of available organs. US policies incentivize identifying recipients for all recovered organs. Technological advancements have extended donor organ viability, creating new opportunities for long-distance transport and international sharing. We aimed to assess organ exports from deceased US donors to candidates abroad, a component of allocation policy allowed without suitable domestic candidates. Based on the national Scientific Registry of Transplant Recipients data from January 2014 to September 2023, 388 342 organs were recovered for transplantation, with 511 (0.13%) exported. Most exported organs were lungs (80%). Exported lung donors were older (41 vs 34 years, P < .001), more likely hepatitis C positive (22% vs 4%, P < .001), and more likely donors after circulatory death (20% vs 7%, P < .001). Lungs that were eventually exported were offered to more US potential transplant recipients (median = 65) than those kept in the US (median = 21 and 41 for lungs recovered by nonexporting and exporting organ procurement organizations, respectively; P < .001). Our study highlights the necessity for further research and clear policy initiatives to balance the benefits of cross-border sharing while considering potential opportunities for more aggressive organ allocation within the US.

器官移植是挽救终末期器官衰竭患者生命的治疗方法，但美国面临可用器官短缺的问题。美国的政策鼓励为所有回收的器官确定受体。技术进步延长了捐献者器官的存活时间，为长途运输和国际共享创造了新的机会。我们旨在评估美国已故捐献者向国外候选者输出器官的情况，这是在没有合适国内候选者的情况下允许的分配政策的一部分。根据 2014 年 1 月至 2023 年 9 月的全国 SRTR 数据，共有 388342 个器官被回收用于移植，其中 511 个（0.13%）被出口。大部分出口器官为肺脏（80%）。出口的肺捐献者年龄较大（41 岁对 34 岁，p

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引用次数: 0

Unique multidisciplinary approach in living donor liver transplantation to achieve total physiological revascularization in a patient with complete occlusion of portal vein system with combined chronic and subacute thrombosis 在活体肝移植手术中采用独特的多学科方法，为一名门静脉系统完全闭塞并合并慢性和亚急性血栓形成的患者实现完全生理性血管再通。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2024.09.033

Francesca Albanesi , Jae-Yoon Kim , Kwang-Woong Lee , YoungRok Choi , Nam-Joon Yi , Suk-Kyun Hong , Kyung-Suk Suh

Patients receiving liver transplantation in a setting of complete portal vein (PV) and superior mesenteric vein (SMV) thrombosis (Yerdel grade 4) experience lower outcomes after surgery; prognosis is independently influenced by the portal flow reconstruction technique, showing better outcomes in physiological surgical strategies. We describe a case of living donor liver transplantation in which the patient could not receive common physiological reconstructions preoperatively due to multiple small collaterals and extensive thrombosis down to first branches of SMV. We performed thromboendovenectomy of the PV and SMV first, but acute thrombosis developed recurrently even with interposition venous homograft between pericholedochal collateral vein and proximal recipient PV. Immediate after surgery, an intervention radiologist performed stent insertion into 3 stenotic points. Through multidisciplinary approach, complete physiological recanalization was obtained with normal liver function.

在门静脉（PV）和肠系膜上静脉（SMV）完全血栓形成（耶德尔4级）的情况下接受肝移植的患者术后预后较差；预后受门静脉血流重建技术的独立影响，生理手术策略的预后较好。我们描述了一例活体肝移植病例，患者术前无法接受普通的生理性重建，原因是存在多条小分支和SMV第一分支的广泛血栓形成。我们首先对门静脉和 SMV 进行了血栓内静脉切除术，但即使在胆总管旁静脉和受体门静脉近端之间进行了静脉同种异体移植，急性血栓仍反复形成。手术后，放射科介入医生立即对 3 个狭窄点进行了支架植入术。通过多学科合作，手术后肝功能恢复正常，实现了完全的生理性再通畅。

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引用次数: 0

Evaluation for genetic disease in kidney transplant candidates: A practice resource 肾移植候选者遗传病评估：实践资源。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2024.10.019

Elizabeth G. Ames , Prince M. Anand , Mir Reza Bekheirnia , Mona D. Doshi , Mireille El Ters , Margaret E. Freese , Rasheed A. Gbadegesin , Lisa M. Guay-Woodford , Anuja Java , Daniel Ranch , Nancy M. Rodig , Xiangling Wang , Christie P. Thomas

The increasing availability of clinically approved genetic tests for kidney disease has spurred the growth in the use of these tests in kidney transplant practice. Neither the testing options nor the patient population where this should be deployed has been defined, and its value in kidney transplant evaluation has not been demonstrated. Transplant providers may not always be aware of the limitations of genetic testing and may need guidance on comprehending test results and providing counsel, as many centers do not have easy access to a renal genetic counselor or a clinical geneticist. In this practice resource, a working group of nephrologists, geneticists, and a genetic counselor provide a pragmatic, tailored approach to genetic testing, advocating for its use only where the genetic diagnosis or its exclusion can impact the choices available for transplantation or posttransplant management or the workup of living donor candidates at increased risk for heritable disease.

临床认可的肾脏疾病基因检测方法越来越多，推动了这些检测方法在肾移植实践中的应用。但无论是检测方案还是应使用基因检测的患者人群都尚未确定，而且基因检测在肾移植评估中的价值也未得到证实。肾移植服务提供者可能并不总能意识到基因检测的局限性，在理解检测结果和提供咨询方面可能需要指导，因为许多中心并不容易找到肾脏遗传咨询师或临床遗传学家。在这一实践资源中，由肾脏病专家、遗传学家和遗传咨询师组成的工作小组为基因检测提供了一种务实的、量身定制的方法，主张只有在基因诊断或排除基因诊断会影响移植或移植后管理的选择，或影响遗传性疾病风险增加的活体捐赠候选者的检查时，才使用基因检测。

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引用次数: 0

OPTN/SRTR 2023 Annual Data Report: Introduction

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2025-02-01 DOI: 10.1016/j.ajt.2025.01.019

David P. Schladt , Ajay K. Israni

The OPTN/SRTR 2023 Annual Data Report presents the status of the solid organ transplant system in the United States from 2012 through 2023. Organ-specific chapters are presented for kidney, pancreas, liver, intestine, heart, and lung transplant. Each organ-specific chapter is organized to present waitlist information, donor information (both deceased and living, as appropriate), transplant information, and patient outcomes. Data pertaining to pediatric patients are generally presented separately from the adult data; however, many chapters now have a Donation section, which includes data on adult and pediatric organ donation. The data presented in the Annual Data Report are descriptive in nature. In other words, most tables and figures present raw data without statistical adjustment for possible confounding or changes over time. Therefore, the reader should keep in mind the observational nature of the data when attempting to draw inferences before trying to ascribe a cause to any observed patterns or trends. This introduction provides a brief overview of trends in candidates on the waiting list, new additions to the waiting list, transplant activity, and posttransplant patient survival, with a focus on 2013-2023. More detailed descriptions can be found in the respective organ-specific chapters.

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引用次数: 0