Progress in Transplantation最新文献

Introduction: Organ shortage is a global issue. A disaster like an earthquake not only increases the number of people in need of organs but also negatively affects the treatment processes of patients who have already undergone transplants. Aim: The aim of this study is to examine the impact of the earthquake that occurred on February 6, 2023, in Türkiye on organ donation and transplantation. Methods: The study was conducted using open-access statistical data of 2022-2023 years available on the official website of the Tissue, Organ Transplantation, and Dialysis Services of the Ministry of Health in Türkiye. Results: It was found that the earthquake did not affect the number of organ transplants, organ donations, brain death diagnoses, and family consent in Türkiye, but in the provinces affected by the earthquake, it decreased the number of organ donations, brain death diagnoses, and living donors and increased the number of family consent. Conclusion: Healthcare professionals in disaster-affected regions should receive specialized training to maintain critical organ donation protocols, supported by decentralized coordination systems that ensure the continuity of these processes even when central networks are disrupted.

IntroductionWhile survival following liver transplantation has improved over the past 3 decades, few studies have examined the changes over time in hospital length of stay (LOS), a surrogate for healthcare expenditure and an important short-term outcome measure.Research questionThe purpose of this study was to compare post-transplantation LOS over the last 3 decades.DesignA cross-sectional analysis of 150 603 adult liver transplant recipients between September 1987 and July 2021 from the UNOS database was conducted. The patients were placed into 3 eras (1987-1989, 1990-1999, and 2000-2021) based on a Join point regression analysis of significant time points of change in LOS trends. Risk factors that were significant in univariate analysis (P < .05) were included in the multivariable Cox regression analysis, which controlled for 29 donor/recipient characteristics.ResultsAmong adult patients, the average LOS following liver transplantation changed from 51.5 days in 1987 to 16.3 days in 2021, with a relatively steeper decline prior to 2000. On multivariable Cox regression, patients in both the 1987-1989 cohort (hazard ratio [HR]: 0.54, 95% confidence interval [CI]: 0.52-0.57) and the 1990-1999 cohort (HR: 0.77, CI: 0.76-0.78) had significantly prolonged lengths of stay (HR < 1 associated with later hospital discharge) compared to the 2000-2021 cohort.ConclusionsThis analysis found that mean LOS decreased over time in adult liver transplant recipients, even after controlling for donor and recipient-level factors. Future studies are needed to elucidate root cause factors for this decline in LOS over time.

Introduction: Anxiety symptoms influence health outcomes in pediatric organ transplant recipients. Assessing the quality of anxiety scales is critical to address the psychological challenges these patients face. Variability in how anxiety is conceptualized across scales highlights the need for selecting appropriate instruments.

Objective: This systematic review aimed to search and synthesize anxiety scales used in pediatric organ transplant studies, evaluate their reliability and validity, examine factors and group differences related to anxiety, and identify promising scales for this population.

Methods: A systematic search was conducted using the terms "(Anxiety) AND (organ transplant) AND (child* OR youth OR pediatric* OR adolescen*)." Ten electronic databases were accessed.

Results: Eighteen anxiety scales from 30 articles were identified. Fourteen scales measured specific anxiety types. Most scales demonstrated good to excellent reliability and validity. Associations between anxiety and demographics, psychological well-being, factors related to illness and treatment were observed. Five types of anxiety-related differences among groups and 6 promising anxiety scales for the target population were identified.

Discussion: General and specialized anxiety scales were identified. Incomplete reporting of psychometric evidence restricted the quality assessment. Limitations include cultural and publication biases. Future research should focus on transplant-specific scales with psychometric validation across culturally diverse settings to ensure their quality and applicability.

Conclusion: This review identified well-validated scales, such as State-Trait Anxiety Inventory for Children and Generalized Anxiety Disorder-7, effective for quick screening. Specialized instruments were used for nuanced anxiety concepts such as needle-related anxiety, illness-specific anxiety, and anxiety during the transition to adult care, but further psychometric validation is needed.

Introduction: There is a need for a noninvasive, affordable, sensitive, and specific biomarker to diagnose early acute rejection, to negate the need for frequent biopsies. Dd-cfDNA is a powerful adjunct yet there is limited data on the ethnic differences in its values. There is anecdotal evidence that dd-cfDNA values at rejection may be higher in Black as compared to non-Black recipients. This study aims to add to this literature while defining such variability and comparing it to previously validated cutoffs for dd-cfDNA of 0.5% or 1%.

Design: This was a single-center retrospective observational study of patients who underwent graft biopsies with a preceding, paired, dd-cfDNA value. Recipients were separated into White, Black, and Hispanic racial and ethnic groups, and dd-cfDNA values at rejection versus nonrejection were compared.

Results: With 0.5% and 1% cutoffs, false negative rates for rejection were 13% and 22%, respectively. The false positive rate was 38.4%. 12.2% of Black recipients, 11.8% of Hispanic recipients, and 44% of White recipients had rejection with a negative AlloSure^®. Values >0.5% corresponded to histologic rejection in 61.5% of Black, 66.7% of White, and 56.3% of Hispanic recipients. Antibody-mediated rejection occurred in 65.5% of rejection cases in Black recipients, while exhibiting the lowest rate of T-cell-mediated rejection. Dd-cfDNA values gave an accurate diagnosis of rejection in 52.8% of recipients with AMR versus 19.3% in TCMR.

Conclusion: This study demonstrated that dd-cfDNA was applicable to Black recipients with a robust ability to detect antibody-mediated rejection, as compared to White and Hispanic recipients.

Introduction: Eliminating racial inequities in access to kidney transplantation requires multilevel interventions that target both patients and health systems.

Research question: The aim of this study was to determine whether adding culturally sensitive, web-based patient education to a transplant center-level intervention was associated with increased knowledge, motivation to pursue living donor kidney transplant, and confidence in the behavioral skills to discuss living donation among Black/African American patients with end-stage kidney disease.

Design: A total of 411 transplant candidates were randomized to intervention (N = 222) or control groups (N = 189) and completed measures at baseline and immediate follow-up during the transplant evaluation visit.

Results: Results indicated no significant change in knowledge across time or study condition. At immediate follow-up, participants of both study conditions exhibited a significantly higher motivation to pursue living donation (t = 3.066, P < .01) versus at baseline. Both study conditions demonstrated increased confidence in the behavioral skills to discuss living donation over time (t = 3.580, P < .001). Process evaluation findings demonstrated limited engagement with the online video content across both conditions.

Conclusion: Results suggest that the intervention did not perform better than control but raised important considerations for the delivery of transplant education targeting Black/African American patients in a busy clinical setting.