Progress in Transplantation最新文献

IntroductionLiving donor liver transplantation is expanding worldwide as a treatment for end-stage liver disease, especially in high-risk recipients. No standardized information is provided to donors during the informed consent process. Consequently, variable information may be provided to the donor about the recipient, which may undermine donor-informed consent.Research QuestionsIn high-risk donation scenarios, it is uncertain whether information disclosed about the recipient is sufficient for donor-informed decision-making. Would information about the recipient's potential adverse and beneficial short- and long-term outcomes help donors make a decision about donating?DesignAn online survey was conducted of previous living liver donors' likelihood of donating and information needs regarding their recipients in 3 hypothetical high-risk clinical scenarios: alcoholic liver disease (ALD) with high relapse risk, acute liver failure (ALF), and hepatocellular carcinoma (HCC) with high recurrence risk.ResultsA total of 98 living liver donors participated in this study. Most living liver donors expressed willingness to donate to a patient in each scenario: ALD (51%), ALF (56%), and HCC (85%). Most living liver donors (56% to 93%) reported desiring information about the recipient's diagnosis, clinical condition, and projected outcomes in their donation decision-making process. Most living liver donors (82%) considered an acute consultation service to be useful in deciding whether to donate to a patient with ALF.ConclusionsThe findings suggested that transplant programs should incorporate recipient health information with recipient consent into the informed consent process and offer consultation services to support living liver donors' decision-making.

IntroductionWhile most transplant recipients remain sedentary posttransplant, some transplant recipients are able to meet and even exceed recommended physical activity levels.Research QuestionThe objective of this study was (1) to explore what physical activity levels 25 recipient athletes could sustain over a 7-month period while preparing for and participating in the World Transplant Games in cycling and/or triathlon, and (2) what intensity levels recipients sustained in competitive conditions.DesignThe study adopted an observational descriptive research design and used physical activity self-reported data of 25 recipient athletes and self-tracked data from online social fitness network apps such as Strava. It also examined World Transplant Games performance metrics to evaluate transplant athletes' capabilities in competitive settings.ResultsFindings revealed that transplant athletes exceeded the current physical activity level guidelines by 300% over a 7-month period, with an average of 8.33 h per week of self-reported activities and 4.67 h per week of self-tracked moderate to intense physical activity.ConclusionThe findings highlighted the need to consider the capabilities of transplant athletes in reassessing the current physical activity guidelines since the results demonstrated that enhanced performance in competition settings was attainable through physical activity and support. There is a need for more personalised physical activity metrics and recommendations for transplant recipients.

IntroductionIn pediatric solid organ transplant and bone marrow transplant recipients, there is minimal data describing coronavirus disease 2019 (COVID-19) vaccine uptake and effectiveness.Research QuestionsWhat is the real-world experience of COVID-19 vaccination, subsequent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and vaccine efficacy in pediatric heart, liver, kidney and bone marrow transplant recipients?DesignThis observational cohort study assessed COVID-19 vaccination rates and outcomes between March 2020 and January 2024 among pediatric heart, liver, kidney, and bone marrow transplant recipients. This study was approved by the local institutional review board as exempt.ResultsOne hundred and thirty-three pediatric solid organ transplant or bone marrow recipients were included; 33 of 133 (24.8%) were unvaccinated, 100 and 133 (75.2%) had at least 1 dose, and 72 of 133 (54.1%) completed at least 3 doses of COVID-19 vaccination. Ninety-two SARS-CoV-2 infection episodes in 74 of 133 (55.6%) patients. Fifty-eight (63%) episodes were in those who were never vaccinated or before completion of 3 doses and 34 (36.9%) episodes were after completion of the primary series (P = 0.09). Hospitalization was required in 2 of 34 (5.9%) and 7 of 59 (11.9%) of the infections among vaccinated and unvaccinated patients. No severe cases occurred among vaccinated patients while severe infection was seen among those unvaccinated. Adjusted COVID-19 vaccine effectiveness against SARS-CoV-2 infection was estimated as 52.6% (95% CI 7.0% -72%).ConclusionCOVID-19 vaccine uptake remains suboptimal among pediatric transplant recipients and completion of primary series is low. Further studies to understand dynamics of vaccine acceptance and vaccine effectiveness among pediatric transplant patients are needed.

IntroductionWomen comprise 55% to 65% of living kidney donors. Most studies focus on individuals who underwent donor nephrectomies, rather than potential living donors prior to engagement with the healthcare system. Therefore, the underlying reasons for gender discrepancy are unclear.Research questionAmong relatives of patients with renal disease, do men and women differ in willingness to be evaluated for living kidney donation, regardless of prior donation behavior?DesignAn online survey administered in 2019 to US adult members of the Qualtrics Survey Panel whose relatives had weak or failing kidneys. The survey was designed to examine perspectives of living kidney donation from realistic potential donors. Self-reported willingness was compared between men and women for statistically significant differences. Average marginal effects of male gender on willingness and interaction effects estimated with multivariable logistic regression, adjusted for respondent/patient demographics and relationship.ResultsA total of 1647 responses showed 7.1% higher willingness among men (P = .016). Among those whose relatives (N = 808) were seeking transplants [subgroup], men had 13.1% higher willingness (P = .002). Interaction effect analysis showed men aged 70 to 79 years, with insurance, self-reported very good health, and self-reported medical contraindications, had significantly higher willingness than corresponding women. In the transplant subgroup, men aged 18 to 39 years and with full-time employment also had higher willingness.ConclusionMen showed 7.1% higher willingness to be evaluated for living kidney donation. Rather than reflecting a fixed difference, the existence and degree of gender difference were context-dependent. Identifying strategic interventions to facilitate male donation in contexts where they reported high willingness could improve access to transplantation.

IntroductionIntrapatient variability (IPV) of tacrolimus and its predictors post-lung transplant are unclear. Project AimsThis program evaluation aimed to characterize the IPV of immediate-release versus LCP-tacrolimus and predictors of variability ≥30% in lung transplant recipients. DesignAdult lung transplant recipients who received immediate-release- or LCP-tacrolimus from January 2016 through August 2023 were included in this single-center retrospective evaluation. Immediate-release- and LCP-tacrolimus groups were matched 2:1 by time from transplant, presence of azole antifungal, and ethnicity. Three previously published equations calculated IPV. Outcomes to determine clinical impact of tacrolimus variability included de novo donor-specific antibody (DSA) development, rejection, graft loss/mortality, eGFR <60 mL/min, infection. Time in therapeutic range was assessed. Data were analyzed to determine predictors of variability ≥30%. ResultsThere were no significant differences in the variability of immediate-release- versus LCP-tacrolimus among 3 equations used. There was no difference in de novo DSA development, rejection, graft loss, mortality, eGFR <60 mL/min, or infection between groups. Recipients with rejection during follow-up had higher variability compared to those who did not (P = .04). Presence of CYP34A inhibition predicted variability >30% in multivariate analysis. Immediate-release tacrolimus had higher time in therapeutic range versus LCP-tacrolimus, 67% versus 33%, (P = .15). ConclusionThe IPV and associated clinical outcomes of immediate-release versus LCP-tacrolimus in lung transplant recipients did not significantly differ. Development of acute cellular rejection within 1 year follow-up was associated with higher tacrolimus variability regardless of formulation.

Introduction: Sleep quality after lung transplant is important for recovery, overall health, and performance of healthy behaviors, such as exercise. Research Aim: The purpose of this study was to explore the associations between sleep quality and factors likely to influence and/or be influenced by sleep. Design: This was a secondary analysis of data from a randomized controlled trial of a tele-rehab exercise intervention for lung transplant recipients. Baseline demographic and clinical characteristics, sleep quality, physical activity, symptom burden, and psychological distress data were collected. Multivariate logistic regression model was used to identify factors associated with poor sleep quality. Results: Participants (N=88) were aged 56.4 (13.0) years and male (54.5%). Seventy-four percent of the patients met the established cut-off for poor sleep quality and the mean Pittsburgh Sleep Quality Index total score was 7.1 (3.7). Recipients reported anxiety (n=21, 23.9%) and depression (n=27, 30.7%). When lung-specific items of the sleep questionnaire were explored, the reported presence of cough or snoring loudly was associated with poor sleep (P = .010). Patients reporting any psychological distress (n=33, 37.5%) had increased odds of experiencing poor sleep (odds ratio [OR]=13.72; 95% confidence interval [CI] =2.33, 264.7.01; P=.017). In a model examining respiratory symptoms concurrently, wheezing increased the odds of reporting poor sleep quality (OR=10.88, 95% CI=1.65, 222.02; P=.037). Conclusion: Clinical attention is needed to detect and manage symptom burden and psychological distress to improve sleep quality and optimize posttransplant recovery among lung recipients. Future studies examining these variables are needed to help guide screening and treatment protocols.

Due to increased risk of myalgia and rhabdomyolysis associated with the use of simvastatin with cyclosporine, use of high-intensity 3-hydroxy-3-methylglutaryl Coenzyme A reductase inhibitors (statins) is often avoided in transplant recipients. Aim: This program evaluation aimed to determine the safety of high-intensity statins in liver and kidney transplant recipients taking tacrolimus. Design: All liver and kidney transplant recipients who filled prescriptions for tacrolimus and any statin except for simvastatin between June 15, 2020 and July 22, 2022 were screened for inclusion. High-intensity was defined as atorvastatin 40 or 80 mg, or rosuvastatin 20 or 40 mg. The primary outcome was a composite of statin-related myalgia, statin-related rhabdomyolysis, and creatine kinase above the upper limit of normal. Secondary outcomes included liver function tests above 3 times the upper limit of normal, statin discontinuation, and statin dose decrease and associated reason. Results: A total of 178 recipients were included, with 100 receiving low-to-moderate-intensity statins and 78 receiving high-intensity statins. There were no differences between groups for statin-related myalgia, and no reported cases of statin-related rhabdomyolysis in either group. Low to moderate intensity statin use was associated with an increased rate of liver function test elevation (26% vs 11.5%, P = .014) occurring a median of 306 days (interquartile range [IQR] 134-725) post-statin initiation. Conclusion: In liver and kidney transplant recipients receiving tacrolimus, the use of high-intensity statins was not associated with an increased risk of myalgia, rhabdomyolysis, or elevated creatinine kinase when compared with low-to-moderate-intensity statin use.

Introduction: Rising discrepancies between supply and demand of lifesaving organs necessitates considering advancements to improve the health outcomes of Canadians. There is an increased use of organs after death by circulatory criteria, however the evolution of this treatment should be explored to continue to advance practices and save lives. Objective: To summarize the literature on the evolution and use of organ donation after death by circulatory criteria in Canada, to highlight how this donation modality may support future advancements. Methods: A search of electronic databases for any date until June 1st, 2024, was performed. Additional searches of grey literature using Google Scholar and the snowball technique were performed. Applicable documents underwent a multi-phase screening process, and data were extracted, analyzed, and evaluated. Results: There were 793 documents located, and 50 were included in this review. Three main categories emerged among the documents that described the evolution of guidelines for death by circulatory criteria organ donation, experiences with program development and delivery for death by circulatory criteria organ donation and Canadian perspectives of this donation modality. Discussion: Canada has made strides in circulatory criteria organ donation practices through consensus meetings and discussions on key topics, yet variations in practice exist across the country that warrant further investigation when considering future advancements. Conclusion: While national efforts have advanced practices, ongoing variations across programs highlighted the need for continued evaluation, education and harmonization to maximize the life-saving potential of organ donation practices.