Background: Although COVID-19 is no longer a declared global health emergency, data remain limited on the impact of COVID-19 in lung transplant recipients.
Methods: We identified lung transplant recipients who were diagnosed with COVID-19 from March 2020 through August 2022 in our institutional database and investigated clinical outcomes. We then analyzed outcomes based on date of COVID-19 diagnosis (first wave March 2020-October 2020; second wave November 2020-2021; third wave December 2021-September 2022) and compared these results.
Results: Of the 210 lung transplant recipients (median age 67; 67% men) enrolled, 140 (67%) required hospital admission. Among admitted recipients, 35 (25%) were intubated and 7 (5%) were placed on extracorporeal membrane oxygenation. Overall survival was 67.1% at 1 y and 59.0% at 2 y post-COVID-19 diagnosis. COVID-19 led to mortality in all 5 patients diagnosed during their index admission for lung transplantation. Although overall survival was significantly better in recipients with COVID-19 during the third wave, in-hospital mortality remained high (first wave 28%, second wave 38%, and 28% third wave). Vaccination (partially vaccinated versus none and fully vaccinated versus none) was the only significant protective factor for hospital admission, and age 70 y and older and partially vaccinated (versus none or fully vaccinated) were independent risk factors for in-hospital mortality.
Conclusions: Overall survival after COVID-19 infection in lung transplant recipients continues to improve; however, in-hospital mortality remains remarkably high. Vaccination appears to have been impactful in preventing hospital admission, but its impact on in-hospital mortality is still unclear. Further research is needed to better identify lung transplant recipients at high risk for mortality from COVID-19.
{"title":"A Single-center Experience With >200 Lung Transplant Recipients With COVID-19 Infection.","authors":"Hiromu Kehara, Ashley Johnson-Whiting, Roh Yanagida, Kewal Krishan, Huaqing Zhao, Aaron Mishkin, Francis Cordova, Gerard J Criner, Yoshiya Toyoda, Norihisa Shigemura","doi":"10.1097/TXD.0000000000001676","DOIUrl":"10.1097/TXD.0000000000001676","url":null,"abstract":"<p><strong>Background: </strong>Although COVID-19 is no longer a declared global health emergency, data remain limited on the impact of COVID-19 in lung transplant recipients.</p><p><strong>Methods: </strong>We identified lung transplant recipients who were diagnosed with COVID-19 from March 2020 through August 2022 in our institutional database and investigated clinical outcomes. We then analyzed outcomes based on date of COVID-19 diagnosis (first wave March 2020-October 2020; second wave November 2020-2021; third wave December 2021-September 2022) and compared these results.</p><p><strong>Results: </strong>Of the 210 lung transplant recipients (median age 67; 67% men) enrolled, 140 (67%) required hospital admission. Among admitted recipients, 35 (25%) were intubated and 7 (5%) were placed on extracorporeal membrane oxygenation. Overall survival was 67.1% at 1 y and 59.0% at 2 y post-COVID-19 diagnosis. COVID-19 led to mortality in all 5 patients diagnosed during their index admission for lung transplantation. Although overall survival was significantly better in recipients with COVID-19 during the third wave, in-hospital mortality remained high (first wave 28%, second wave 38%, and 28% third wave). Vaccination (partially vaccinated versus none and fully vaccinated versus none) was the only significant protective factor for hospital admission, and age 70 y and older and partially vaccinated (versus none or fully vaccinated) were independent risk factors for in-hospital mortality.</p><p><strong>Conclusions: </strong>Overall survival after COVID-19 infection in lung transplant recipients continues to improve; however, in-hospital mortality remains remarkably high. Vaccination appears to have been impactful in preventing hospital admission, but its impact on in-hospital mortality is still unclear. Further research is needed to better identify lung transplant recipients at high risk for mortality from COVID-19.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29eCollection Date: 2024-09-01DOI: 10.1097/TXD.0000000000001692
Paul Secombe, Emslie Lankin, Rosalind Beadle, Greg McAnulty, Alex Brown, Michael Bailey, Rebecca Schultz, David Pilcher
Background: Organ transplantation is a well-established intervention but is reliant on the donation of organs and tissues, mostly from deceased donors. The proportion of Australians proceeding to organ donation (OD) has increased, but the proportion of Indigenous Australians proceeding remains two-thirds that of non-Indigenous Australians. We sought to explore perceived barriers and enablers for the involvement of Indigenous peoples in the OD process.
Methods: Qualitative methodology centered around focus groups was used to capture the experiences and perspectives of Indigenous people regarding OD. A purposively sampled group of Aboriginal Liaison Officers working within the Alice Springs Hospital Intensive Care Unit (ASH ICU) participated in up to 6 focus groups during 2021 with subsequent thematic analysis of the enablers and barriers to Indigenous participation in the OD process. The ASH ICU is the only ICU servicing Central Australia, and 70% of admissions are Indigenous patients.
Results: Four primary themes emerged: OD is a new and culturally taboo topic; conversations related to OD are confronting; education is needed (both about OD and cultural education for clinicians); and lack of trust in the healthcare system.
Conclusions: There are cultural barriers to engaging in the OD process and clinicians need more training on the delivery of culturally safe communication is needed. Despite this, there was a recognition that OD is important. Education about OD needs to be place based, culturally and linguistically appropriate, informed by local knowledge, delivered in community, and occur before a family member is admitted to ICU.
背景:器官移植是一项成熟的干预措施,但有赖于器官和组织的捐赠,其中大部分来自已故捐赠者。澳大利亚人进行器官捐献(OD)的比例有所上升,但土著澳大利亚人进行器官捐献的比例仍然只有非土著澳大利亚人的三分之二。我们试图探索土著居民参与器官捐献过程的障碍和促进因素:方法:我们采用了以焦点小组为中心的定性方法,以了解土著居民在 OD 方面的经验和观点。2021 年期间,在爱丽斯泉医院重症监护室(ASH ICU)工作的原住民联络官有目的地参加了多达 6 个焦点小组,随后对原住民参与 OD 过程的促进因素和障碍进行了专题分析。艾尔泉医院重症监护室是澳大利亚中部地区唯一的重症监护室,70%的住院病人是土著人:出现了四个主要专题:OD是一个新的文化禁忌话题;与OD相关的对话令人感到不安;需要进行教育(包括关于OD的教育和对临床医生的文化教育);对医疗系统缺乏信任:结论:参与 OD 过程存在文化障碍,临床医生需要接受更多关于提供文化安全沟通的培训。尽管如此,人们还是认识到了开放式发展的重要性。有关定向行走的教育需要以地点为基础,在文化和语言上适当,以当地知识为依据,在社区进行,并在家庭成员入住重症监护病房之前进行。
{"title":"Aboriginal and Torres Strait Islander Attitudes to Organ Donation in Central Australia: A Qualitative Pilot Study.","authors":"Paul Secombe, Emslie Lankin, Rosalind Beadle, Greg McAnulty, Alex Brown, Michael Bailey, Rebecca Schultz, David Pilcher","doi":"10.1097/TXD.0000000000001692","DOIUrl":"10.1097/TXD.0000000000001692","url":null,"abstract":"<p><strong>Background: </strong>Organ transplantation is a well-established intervention but is reliant on the donation of organs and tissues, mostly from deceased donors. The proportion of Australians proceeding to organ donation (OD) has increased, but the proportion of Indigenous Australians proceeding remains two-thirds that of non-Indigenous Australians. We sought to explore perceived barriers and enablers for the involvement of Indigenous peoples in the OD process.</p><p><strong>Methods: </strong>Qualitative methodology centered around focus groups was used to capture the experiences and perspectives of Indigenous people regarding OD. A purposively sampled group of Aboriginal Liaison Officers working within the Alice Springs Hospital Intensive Care Unit (ASH ICU) participated in up to 6 focus groups during 2021 with subsequent thematic analysis of the enablers and barriers to Indigenous participation in the OD process. The ASH ICU is the only ICU servicing Central Australia, and 70% of admissions are Indigenous patients.</p><p><strong>Results: </strong>Four primary themes emerged: OD is a new and culturally taboo topic; conversations related to OD are confronting; education is needed (both about OD and cultural education for clinicians); and lack of trust in the healthcare system.</p><p><strong>Conclusions: </strong>There are cultural barriers to engaging in the OD process and clinicians need more training on the delivery of culturally safe communication is needed. Despite this, there was a recognition that OD is important. Education about OD needs to be place based, culturally and linguistically appropriate, informed by local knowledge, delivered in community, and occur before a family member is admitted to ICU.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29eCollection Date: 2024-09-01DOI: 10.1097/TXD.0000000000001656
Amr M T Alnagar, Shahab Hajibandeh, Shahin Hajibandeh, Abdul R Hakeem, Bobby V M Dasari
Background: The effect of donor body mass index (BMI) on liver transplantation (LT) outcomes remains unclear.
Methods: A systematic search of the MEDLINE, CENTRAL, Web of Science, and bibliographic reference lists was conducted. All comparative studies evaluating the outcomes of LT in obese (BMI > 30 kg/m2) and nonobese donors (BMI < 30 kg/m2) were included, and their risk of bias was assessed using the ROBINS-I assessment tool. Patient and graft survival, acute rejection, and graft failure requiring retransplantation were evaluated as outcome parameters. A random-effects model was used for outcome synthesis.
Results: We included 6 comparative studies reporting a total of 5071 liver transplant recipients from 708 obese and 4363 nonobese donors. There was no significant difference in 1-y (89.1% versus 84.0%, odds ratio [OR] 1.58; 95% CI 0.63-3.94, P = 0.33), 5-y (74.2%% versus 73.5%, OR 1.12; 95% CI 0.45-2.80, P = 0.81) graft survival, and 1-y (87.1% versus 90.3%, OR 0.71; 95% CI 0.43-1.15, P = 0.17) and 5-y (64.5% versus 71.6%, OR 0.71; 95% CI 0.49-1.05, P = 0.08) patient survival between 2 groups. Furthermore, recipients from obese and nonobese donors had a comparable risk of graft failure requiring retransplantation (OR 0.92; 95% CI 0.33-2.60, P = 0.88) or acute graft rejection (OR 0.70; 95% CI 0.45-1.11, P = 0.13).
Conclusions: A meta-analysis of the best available evidence (level 2a) demonstrates that donor obesity does not seem to have a negative impact on graft or patient outcomes. The available studies might be subject to selection bias as the grafts from obese donors are usually subject to biopsy to exclude steatosis and the recipients usually belong to the low-risk group. Future research is needed to evaluate the impact of donors subgrouped by various higher BMI on graft and patient-related outcomes as well as to capture data of the discarded grafts from obese donors; hence, selection criteria for the grafts that could be used for transplantation from obese donors is identified.
背景:供体体重指数(BMI)对肝移植结果的影响仍不清楚:供体体重指数(BMI)对肝移植(LT)结果的影响仍不清楚:方法:对 MEDLINE、CENTRAL、Web of Science 和参考文献目录进行了系统检索。纳入了所有评估肥胖(体重指数大于 30 kg/m2)和非肥胖供体(体重指数小于 30 kg/m2)LT 结局的对比研究,并使用 ROBINS-I 评估工具对其偏倚风险进行了评估。患者和移植物存活率、急性排斥反应和需要再次移植的移植物失败作为结果参数进行评估。结果综合采用了随机效应模型:我们纳入了 6 项比较研究,报告了 708 名肥胖和 4363 名非肥胖供体的 5071 名肝移植受者。1年(89.1%对84.0%,几率比[OR]1.58;95% CI 0.63-3.94,P = 0.33)、5年(74.2%对73.5%,OR 1.12;95% CI 0.45-2.80,P = 0.两组之间的移植物存活率、1年(87.1% 对 90.3%,OR 0.71;95% CI 0.43-1.15,P = 0.17)和 5 年(64.5% 对 71.6%,OR 0.71;95% CI 0.49-1.05,P = 0.08)患者存活率也存在差异。此外,肥胖捐献者和非肥胖捐献者的受者发生需要再次移植的移植物失败(OR 0.92;95% CI 0.33-2.60,P = 0.88)或急性移植物排斥反应(OR 0.70;95% CI 0.45-1.11,P = 0.13)的风险相当:对现有最佳证据(2a 级)的荟萃分析表明,供体肥胖似乎不会对移植物或患者预后产生负面影响。现有的研究可能存在选择偏差,因为肥胖供体的移植物通常需要进行活检以排除脂肪变性,而受体通常属于低风险组。未来的研究需要评估按不同较高体重指数分组的供体对移植物和患者相关预后的影响,并获取肥胖供体废弃移植物的数据;因此,需要确定可用于肥胖供体移植的移植物的选择标准。
{"title":"Impact of Donor Obesity on Graft and Recipient Survival Outcomes After Liver Transplantation: A Systematic Review and Meta-analysis.","authors":"Amr M T Alnagar, Shahab Hajibandeh, Shahin Hajibandeh, Abdul R Hakeem, Bobby V M Dasari","doi":"10.1097/TXD.0000000000001656","DOIUrl":"10.1097/TXD.0000000000001656","url":null,"abstract":"<p><strong>Background: </strong>The effect of donor body mass index (BMI) on liver transplantation (LT) outcomes remains unclear.</p><p><strong>Methods: </strong>A systematic search of the MEDLINE, CENTRAL, Web of Science, and bibliographic reference lists was conducted. All comparative studies evaluating the outcomes of LT in obese (BMI > 30 kg/m<sup>2</sup>) and nonobese donors (BMI < 30 kg/m<sup>2</sup>) were included, and their risk of bias was assessed using the ROBINS-I assessment tool. Patient and graft survival, acute rejection, and graft failure requiring retransplantation were evaluated as outcome parameters. A random-effects model was used for outcome synthesis.</p><p><strong>Results: </strong>We included 6 comparative studies reporting a total of 5071 liver transplant recipients from 708 obese and 4363 nonobese donors. There was no significant difference in 1-y (89.1% versus 84.0%, odds ratio [OR] 1.58; 95% CI 0.63-3.94, <i>P</i> = 0.33), 5-y (74.2%% versus 73.5%, OR 1.12; 95% CI 0.45-2.80, <i>P</i> = 0.81) graft survival, and 1-y (87.1% versus 90.3%, OR 0.71; 95% CI 0.43-1.15, <i>P</i> = 0.17) and 5-y (64.5% versus 71.6%, OR 0.71; 95% CI 0.49-1.05, <i>P</i> = 0.08) patient survival between 2 groups. Furthermore, recipients from obese and nonobese donors had a comparable risk of graft failure requiring retransplantation (OR 0.92; 95% CI 0.33-2.60, <i>P</i> = 0.88) or acute graft rejection (OR 0.70; 95% CI 0.45-1.11, <i>P</i> = 0.13).</p><p><strong>Conclusions: </strong>A meta-analysis of the best available evidence (level 2a) demonstrates that donor obesity does not seem to have a negative impact on graft or patient outcomes. The available studies might be subject to selection bias as the grafts from obese donors are usually subject to biopsy to exclude steatosis and the recipients usually belong to the low-risk group. Future research is needed to evaluate the impact of donors subgrouped by various higher BMI on graft and patient-related outcomes as well as to capture data of the discarded grafts from obese donors; hence, selection criteria for the grafts that could be used for transplantation from obese donors is identified.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29eCollection Date: 2024-09-01DOI: 10.1097/TXD.0000000000001704
Alessia Trimigno, Jifang Zhao, William A Michaud, Dane C Paneitz, Chijioke Chukwudi, David A D'Alessandro, Greg D Lewis, Nathan F Minie, Joseph P Catricala, Douglas E Vincent, Manuela Lopera Higuita, Maya Bolger-Chen, Shannon N Tessier, Selena Li, Elizabeth M O'Day, Asishana A Osho, S Alireza Rabi
Background: The number of patients waiting for heart transplant far exceeds the number of hearts available. Donation after circulatory death (DCD) combined with machine perfusion can increase the number of transplantable hearts by as much as 48%. Emerging studies also suggest machine perfusion could enable allograft "reconditioning" to optimize outcomes. However, a detailed understanding of the energetic substrates and metabolic changes during perfusion is lacking.
Methods: Metabolites were analyzed using 1-dimensional 1H and 2-dimensional 13C-1H heteronuclear spectrum quantum correlation nuclear magnetic resonance spectroscopy on serial perfusate samples (N = 98) from 32 DCD hearts that were successfully transplanted. Wilcoxon signed-rank and Kruskal-Wallis tests were used to test for significant differences in metabolite resonances during perfusion and network analysis was used to uncover altered metabolic pathways.
Results: Metabolite differences were observed comparing baseline perfusate to samples from hearts at time points 1-2, 3-4, and 5-6 h of perfusion and all pairwise combinations. Among the most significant changes observed were a steady decrease in fatty acids and succinate and an increase in amino acids, especially alanine, glutamine, and glycine. This core set of metabolites was also altered in a DCD porcine model perfused with a nonblood-based perfusate.
Conclusions: Temporal metabolic changes were identified during ex vivo perfusion of DCD hearts. Fatty acids, which are normally the predominant myocardial energy source, are rapidly depleted, while amino acids such as alanine, glutamine, and glycine increase. We also noted depletion of ketone, β-hydroxybutyric acid, which is known to have cardioprotective properties. Collectively, these results suggest a shift in energy substrates and provide a basis to design optimal preservation techniques during perfusion.
{"title":"Metabolic Choreography of Energy Substrates During DCD Heart Perfusion.","authors":"Alessia Trimigno, Jifang Zhao, William A Michaud, Dane C Paneitz, Chijioke Chukwudi, David A D'Alessandro, Greg D Lewis, Nathan F Minie, Joseph P Catricala, Douglas E Vincent, Manuela Lopera Higuita, Maya Bolger-Chen, Shannon N Tessier, Selena Li, Elizabeth M O'Day, Asishana A Osho, S Alireza Rabi","doi":"10.1097/TXD.0000000000001704","DOIUrl":"10.1097/TXD.0000000000001704","url":null,"abstract":"<p><strong>Background: </strong>The number of patients waiting for heart transplant far exceeds the number of hearts available. Donation after circulatory death (DCD) combined with machine perfusion can increase the number of transplantable hearts by as much as 48%. Emerging studies also suggest machine perfusion could enable allograft \"reconditioning\" to optimize outcomes. However, a detailed understanding of the energetic substrates and metabolic changes during perfusion is lacking.</p><p><strong>Methods: </strong>Metabolites were analyzed using 1-dimensional <sup>1</sup>H and 2-dimensional <sup>13</sup>C-<sup>1</sup>H heteronuclear spectrum quantum correlation nuclear magnetic resonance spectroscopy on serial perfusate samples (N = 98) from 32 DCD hearts that were successfully transplanted. Wilcoxon signed-rank and Kruskal-Wallis tests were used to test for significant differences in metabolite resonances during perfusion and network analysis was used to uncover altered metabolic pathways.</p><p><strong>Results: </strong>Metabolite differences were observed comparing baseline perfusate to samples from hearts at time points 1-2, 3-4, and 5-6 h of perfusion and all pairwise combinations. Among the most significant changes observed were a steady decrease in fatty acids and succinate and an increase in amino acids, especially alanine, glutamine, and glycine. This core set of metabolites was also altered in a DCD porcine model perfused with a nonblood-based perfusate.</p><p><strong>Conclusions: </strong>Temporal metabolic changes were identified during ex vivo perfusion of DCD hearts. Fatty acids, which are normally the predominant myocardial energy source, are rapidly depleted, while amino acids such as alanine, glutamine, and glycine increase. We also noted depletion of ketone, β-hydroxybutyric acid, which is known to have cardioprotective properties. Collectively, these results suggest a shift in energy substrates and provide a basis to design optimal preservation techniques during perfusion.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29eCollection Date: 2024-09-01DOI: 10.1097/TXD.0000000000001697
Karim Yatim, Ayman Al Jurdi, Christopher El Mouhayyar, Leela Morena, Frank E Hullekes, Ruchama Verhoeff, Guilherme T Ribas, Daniel S Pearson, Leonardo V Riella
Background: There are no high-quality data to guide long-term mycophenolate mofetil (MMF) dosing in kidney transplant recipients (KTRs) to balance the long-term risks of allograft rejection with that of infections and malignancy. At our center, KTRs are managed with either a "preemptive" dose reduction strategy, where the MMF dose is reduced after the first year before the development of adverse events, or with a "reactive" dosing strategy, where they are maintained on the same MMF dose and only reduced if they develop an adverse event. We hypothesized that a preemptive MMF dosing strategy after the first year of transplantation is associated with decreased infections without increasing alloimmune complications.
Methods: We conducted a retrospective cohort study of all KTRs receiving MMF from January 1, 2015, to December 31, 2020. The primary outcome was the incidence of infections requiring hospitalization.
Results: One hundred forty-two KTRs met the inclusion criteria, of whom 44 (31%) were in the preemptive group and 98 (69%) were in the reactive group. The median follow-up was 4 y (interquartile range, 3.8-4.0). Multivariable analysis showed that a preemptive MMF dose reduction strategy was associated with a lower risk of infections requiring hospitalization (adjusted hazard ratio = 0.39; 95% confidence interval, 0.16-0.92). There was no difference in graft loss, rejection, or estimated glomerular filtration rate slope.
Conclusions: Preemptive MMF dose reduction in KTRs may be an effective strategy to prevent infections without increasing the risk of allograft rejection. Randomized clinical trials are needed to confirm these findings.
{"title":"Safety and Efficacy of a Preemptive Mycophenolate Mofetil Dose Reduction Strategy in Kidney Transplant Recipients.","authors":"Karim Yatim, Ayman Al Jurdi, Christopher El Mouhayyar, Leela Morena, Frank E Hullekes, Ruchama Verhoeff, Guilherme T Ribas, Daniel S Pearson, Leonardo V Riella","doi":"10.1097/TXD.0000000000001697","DOIUrl":"10.1097/TXD.0000000000001697","url":null,"abstract":"<p><strong>Background: </strong>There are no high-quality data to guide long-term mycophenolate mofetil (MMF) dosing in kidney transplant recipients (KTRs) to balance the long-term risks of allograft rejection with that of infections and malignancy. At our center, KTRs are managed with either a \"preemptive\" dose reduction strategy, where the MMF dose is reduced after the first year before the development of adverse events, or with a \"reactive\" dosing strategy, where they are maintained on the same MMF dose and only reduced if they develop an adverse event. We hypothesized that a preemptive MMF dosing strategy after the first year of transplantation is associated with decreased infections without increasing alloimmune complications.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all KTRs receiving MMF from January 1, 2015, to December 31, 2020. The primary outcome was the incidence of infections requiring hospitalization.</p><p><strong>Results: </strong>One hundred forty-two KTRs met the inclusion criteria, of whom 44 (31%) were in the preemptive group and 98 (69%) were in the reactive group. The median follow-up was 4 y (interquartile range, 3.8-4.0). Multivariable analysis showed that a preemptive MMF dose reduction strategy was associated with a lower risk of infections requiring hospitalization (adjusted hazard ratio = 0.39; 95% confidence interval, 0.16-0.92). There was no difference in graft loss, rejection, or estimated glomerular filtration rate slope.</p><p><strong>Conclusions: </strong>Preemptive MMF dose reduction in KTRs may be an effective strategy to prevent infections without increasing the risk of allograft rejection. Randomized clinical trials are needed to confirm these findings.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23eCollection Date: 2024-09-01DOI: 10.1097/TXD.0000000000001700
Sherene Lattimore, Anastasia Chambers, Isabella Angeli-Pahim, Abhishek Shrestha, Benjamin O Eke, Ariel Pomputius, Carma Bylund, Megan E Gregory, Ali Zarrinpar
Background: To investigate the impact of intrapatient variability (IPV) in the levels of immunosuppressant drugs on health outcomes after liver transplantation.
Methods: A comprehensive systematic review and meta-analysis were conducted, examining literature from MEDLINE/PubMed, Embase, Web of Science, Cochrane Reviews, and Cochrane CENTRAL.
Results: The analysis focused on acute rejection, graft survival, acute kidney injury, and cancer risk as health outcomes. Of 2901 articles screened, 10 met the inclusion criteria. The results indicate a 19% reduction in the risk of acute rejection in patients with lower IPV (RR = 0.81; 95% confidence interval, 0.66-0.99), although 6 studies found no significant association between high IPV and acute rejection. Contrasting results were observed for graft survival, with 1 study indicating worse outcomes for high IPV, whereas another reported no significant difference. High IPV was consistently associated with acute kidney injury across 3 studies. One study suggested a link between high IPV and hepatocellular carcinoma, although a meta-analysis for these outcomes was not feasible.
Conclusions: These findings point to a marginal but statistically significant association between high IPV and an increased risk of acute rejection, highlighting the importance of precise management of immunosuppressive drugs in liver transplant recipients to enhance patient outcomes.
{"title":"Impact of Intrapatient Immunosuppression Variability in Liver Transplantation Outcomes: A Systematic Review and Meta-analysis.","authors":"Sherene Lattimore, Anastasia Chambers, Isabella Angeli-Pahim, Abhishek Shrestha, Benjamin O Eke, Ariel Pomputius, Carma Bylund, Megan E Gregory, Ali Zarrinpar","doi":"10.1097/TXD.0000000000001700","DOIUrl":"10.1097/TXD.0000000000001700","url":null,"abstract":"<p><strong>Background: </strong>To investigate the impact of intrapatient variability (IPV) in the levels of immunosuppressant drugs on health outcomes after liver transplantation.</p><p><strong>Methods: </strong>A comprehensive systematic review and meta-analysis were conducted, examining literature from MEDLINE/PubMed, Embase, Web of Science, Cochrane Reviews, and Cochrane CENTRAL.</p><p><strong>Results: </strong>The analysis focused on acute rejection, graft survival, acute kidney injury, and cancer risk as health outcomes. Of 2901 articles screened, 10 met the inclusion criteria. The results indicate a 19% reduction in the risk of acute rejection in patients with lower IPV (RR = 0.81; 95% confidence interval, 0.66-0.99), although 6 studies found no significant association between high IPV and acute rejection. Contrasting results were observed for graft survival, with 1 study indicating worse outcomes for high IPV, whereas another reported no significant difference. High IPV was consistently associated with acute kidney injury across 3 studies. One study suggested a link between high IPV and hepatocellular carcinoma, although a meta-analysis for these outcomes was not feasible.</p><p><strong>Conclusions: </strong>These findings point to a marginal but statistically significant association between high IPV and an increased risk of acute rejection, highlighting the importance of precise management of immunosuppressive drugs in liver transplant recipients to enhance patient outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11346865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23eCollection Date: 2024-09-01DOI: 10.1097/TXD.0000000000001703
Evelyn S Ferreira, Lucio Requião-Moura, Mônica R Nakamura, Renato Demarchi Foresto, José Medina Pestana, Hélio Tedesco-Silva
Background: Dialysis vintage is associated with worse outcomes after kidney transplantation. The reasons behind this observation include immunological and nonimmunological risk factors. To mitigate the influence of immunological factors, we examined the association between time on dialysis and clinical outcomes in a cohort of HLA-identical kidney transplant recipients.
Methods: This retrospective study included 13 321 kidney transplant recipients between 1999 and 2016, of whom 589 were HLA identical followed for at least 5 y. Patient and graft survivals were compared according to dialysis time (<12 or >12 mo) using the log-rank test and Cox regression analysis. We compared surgical complications, cytomegalovirus infection, acute rejection, disease recurrence, and the trajectories of estimated glomerular filtration rate (eGFR).
Results: Median time on dialysis was 15 mo; 9.2% of patients received preemptive transplants, and 55.3% of patients were on dialysis for >12 mo. After a median follow-up time of 154 mo, there were no differences in unadjusted and adjusted patient and graft survivals (1, 5, 10, and 15 y) between the 2 groups. There were no differences in the incidence of surgical complications (6.2% versus 3.1%), acute rejection (6.1% versus 7.7%), cytomegalovirus infection (7.6% versus 4.0%), and disease recurrence (4.2% versus 4.0%), respectively. There were no differences in mean eGFR during 5 y or in the proportion of patients with an eGFR <30 mL/min at 5 y (9.9% versus 9.2%).
Conclusions: In this low immunological risk cohort of HLA-identical kidney transplant recipients, we did not observe any association between dialysis vintage on patient survival and graft survival.
{"title":"Impact of Dialysis Time on Long-term Outcomes in HLA-identical Living Donor Kidney Transplant Recipients.","authors":"Evelyn S Ferreira, Lucio Requião-Moura, Mônica R Nakamura, Renato Demarchi Foresto, José Medina Pestana, Hélio Tedesco-Silva","doi":"10.1097/TXD.0000000000001703","DOIUrl":"10.1097/TXD.0000000000001703","url":null,"abstract":"<p><strong>Background: </strong>Dialysis vintage is associated with worse outcomes after kidney transplantation. The reasons behind this observation include immunological and nonimmunological risk factors. To mitigate the influence of immunological factors, we examined the association between time on dialysis and clinical outcomes in a cohort of HLA-identical kidney transplant recipients.</p><p><strong>Methods: </strong>This retrospective study included 13 321 kidney transplant recipients between 1999 and 2016, of whom 589 were HLA identical followed for at least 5 y. Patient and graft survivals were compared according to dialysis time (<12 or >12 mo) using the log-rank test and Cox regression analysis. We compared surgical complications, cytomegalovirus infection, acute rejection, disease recurrence, and the trajectories of estimated glomerular filtration rate (eGFR).</p><p><strong>Results: </strong>Median time on dialysis was 15 mo; 9.2% of patients received preemptive transplants, and 55.3% of patients were on dialysis for >12 mo. After a median follow-up time of 154 mo, there were no differences in unadjusted and adjusted patient and graft survivals (1, 5, 10, and 15 y) between the 2 groups. There were no differences in the incidence of surgical complications (6.2% versus 3.1%), acute rejection (6.1% versus 7.7%), cytomegalovirus infection (7.6% versus 4.0%), and disease recurrence (4.2% versus 4.0%), respectively. There were no differences in mean eGFR during 5 y or in the proportion of patients with an eGFR <30 mL/min at 5 y (9.9% versus 9.2%).</p><p><strong>Conclusions: </strong>In this low immunological risk cohort of HLA-identical kidney transplant recipients, we did not observe any association between dialysis vintage on patient survival and graft survival.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11346849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19eCollection Date: 2024-09-01DOI: 10.1097/TXD.0000000000001701
Matthew D Johnson, Kristopher A Urrea, Brianna L Spencer, Jasnoor Singh, Joseph B Niman, Gabe E Owens, Jonathan W Haft, Robert H Bartlett, Daniel H Drake, Alvaro Rojas-Peña
Background: Heart transplantation is always an emergency because the transplant needs to occur within 6 h after procurement to prevent primary graft dysfunction. Static cold storage (SCS) is the gold-standard preservation method. This study describes the outcomes of hearts preserved after prolonged SCS (12 and 24 h); those are then resuscitated with a novel normothermic ex situ heart perfusion (NEHP) system.
Methods: Anesthetized piglets (n = 10) were used as heart donors. Hearts were procured and stored at 5 °C CoStorSol following standard SCS protocols. Two groups were studied: SCS-12 h and SCS-24 h. After SCS, 8 h of NEHP (37 °C blood-based perfusate) was performed at 0.7-1.0 mL/min/g of cardiac tissue. NEHP parameters were monitored continuously. Results were corroborated with 3 additional hearts transplanted orthotopically in healthy recipients (n = 3) after SCS (24 h) + NEHP (5 h). Recipients were observed for 90 min after weaning off cardiopulmonary bypass support.
Results: All hearts (after 12 and 24 h of SCS) regained normal function and metabolism within 10 min and retained it throughout 8 h of NEHP. No differences were observed in NEHP parameters and histopathology between groups. Three hearts were successfully transplanted after a total ~30 h of preservation (24 h of SCS + 5 h of NEHP + 1 h of second cold ischemia time). The 3 recipients were weaned off cardiopulmonary bypass with mild vasopressor support.
Conclusions: NEHP has the potential to routinely resuscitate porcine hearts that have undergone SCS for up to 24 h, restoring them to viable function. By objectively assessing heart function before transplant, NEHP may enhance the success rate of transplants. If these resuscitated hearts can be successfully transplanted, it would support the effectiveness of NEHP in ensuring heart viability.
{"title":"Successful Resuscitation of Porcine Hearts After 12 and 24 h of Static Cold Storage With Normothermic Ex Situ Perfusion.","authors":"Matthew D Johnson, Kristopher A Urrea, Brianna L Spencer, Jasnoor Singh, Joseph B Niman, Gabe E Owens, Jonathan W Haft, Robert H Bartlett, Daniel H Drake, Alvaro Rojas-Peña","doi":"10.1097/TXD.0000000000001701","DOIUrl":"10.1097/TXD.0000000000001701","url":null,"abstract":"<p><strong>Background: </strong>Heart transplantation is always an emergency because the transplant needs to occur within 6 h after procurement to prevent primary graft dysfunction. Static cold storage (SCS) is the gold-standard preservation method. This study describes the outcomes of hearts preserved after prolonged SCS (12 and 24 h); those are then resuscitated with a novel normothermic ex situ heart perfusion (NEHP) system.</p><p><strong>Methods: </strong>Anesthetized piglets (n = 10) were used as heart donors. Hearts were procured and stored at 5 °C CoStorSol following standard SCS protocols. Two groups were studied: SCS-12 h and SCS-24 h. After SCS, 8 h of NEHP (37 °C blood-based perfusate) was performed at 0.7-1.0 mL/min/g of cardiac tissue. NEHP parameters were monitored continuously. Results were corroborated with 3 additional hearts transplanted orthotopically in healthy recipients (n = 3) after SCS (24 h) + NEHP (5 h). Recipients were observed for 90 min after weaning off cardiopulmonary bypass support.</p><p><strong>Results: </strong>All hearts (after 12 and 24 h of SCS) regained normal function and metabolism within 10 min and retained it throughout 8 h of NEHP. No differences were observed in NEHP parameters and histopathology between groups. Three hearts were successfully transplanted after a total ~30 h of preservation (24 h of SCS + 5 h of NEHP + 1 h of second cold ischemia time). The 3 recipients were weaned off cardiopulmonary bypass with mild vasopressor support.</p><p><strong>Conclusions: </strong>NEHP has the potential to routinely resuscitate porcine hearts that have undergone SCS for up to 24 h, restoring them to viable function. By objectively assessing heart function before transplant, NEHP may enhance the success rate of transplants. If these resuscitated hearts can be successfully transplanted, it would support the effectiveness of NEHP in ensuring heart viability.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08eCollection Date: 2024-09-01DOI: 10.1097/TXD.0000000000001690
Leela Morená, Ayman Al Jurdi, Christopher El Mouhayyar, Rucháma Verhoeff, Nora Alzahrani, Camille N Kotton, Leonardo V Riella
Background: In solid organ transplant recipients (SOTRs), studies investigating post-acute sequelae of SARS-CoV-2 infection (PASC) are limited, and risk factors for their development require further investigation.
Methods: In this cross-sectional study, we evaluated PASC symptoms among SOTRs followed at our institutions who had COVID-19 during the Omicron period from December 28, 2021, to November 4, 2022. Participants were surveyed using a newly published PASC score containing 13 symptoms experienced for ≥30 d. PASC was defined as a score of ≥12.
Results: Of 299 SOTRs invited, 93 completed the survey and were analyzed. The mean age was 58 y and 43% were women. Forty-six individuals (49%) reported experiencing ≥1 PASC symptom for ≥30 d, of whom 13 (14%) met the PASC definition. Multivariable analysis showed that female sex (adjusted odds ratio [aOR] = 0.32; 95% confidence interval [CI], 0.12-0.83), years from transplantation (aOR = 0.90 per additional year; 95% CI, 0.81-0.99), and tixagevimab-cilgavimab preexposure prophylaxis (aOR = 0.33; 95% CI, 0.12-0.84) were associated with significantly lower odds of developing ≥1 PASC symptom.
Conclusions: PASC symptoms are common in SOTRs infected during the Omicron period. PASC symptoms are less frequent in those with a longer time since transplant and in those who received tixagevimab-cilgavimab. New SARS-CoV-2 prevention and treatment strategies should also evaluate PASC symptoms as outcomes.
{"title":"Post-acute Sequelae of COVID-19 Among Solid Organ Transplant Recipients: Insights From the Omicron Period.","authors":"Leela Morená, Ayman Al Jurdi, Christopher El Mouhayyar, Rucháma Verhoeff, Nora Alzahrani, Camille N Kotton, Leonardo V Riella","doi":"10.1097/TXD.0000000000001690","DOIUrl":"10.1097/TXD.0000000000001690","url":null,"abstract":"<p><strong>Background: </strong>In solid organ transplant recipients (SOTRs), studies investigating post-acute sequelae of SARS-CoV-2 infection (PASC) are limited, and risk factors for their development require further investigation.</p><p><strong>Methods: </strong>In this cross-sectional study, we evaluated PASC symptoms among SOTRs followed at our institutions who had COVID-19 during the Omicron period from December 28, 2021, to November 4, 2022. Participants were surveyed using a newly published PASC score containing 13 symptoms experienced for ≥30 d. PASC was defined as a score of ≥12.</p><p><strong>Results: </strong>Of 299 SOTRs invited, 93 completed the survey and were analyzed. The mean age was 58 y and 43% were women. Forty-six individuals (49%) reported experiencing ≥1 PASC symptom for ≥30 d, of whom 13 (14%) met the PASC definition. Multivariable analysis showed that female sex (adjusted odds ratio [aOR] = 0.32; 95% confidence interval [CI], 0.12-0.83), years from transplantation (aOR = 0.90 per additional year; 95% CI, 0.81-0.99), and tixagevimab-cilgavimab preexposure prophylaxis (aOR = 0.33; 95% CI, 0.12-0.84) were associated with significantly lower odds of developing ≥1 PASC symptom.</p><p><strong>Conclusions: </strong>PASC symptoms are common in SOTRs infected during the Omicron period. PASC symptoms are less frequent in those with a longer time since transplant and in those who received tixagevimab-cilgavimab. New SARS-CoV-2 prevention and treatment strategies should also evaluate PASC symptoms as outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08eCollection Date: 2024-09-01DOI: 10.1097/TXD.0000000000001680
Malte Ziemann, Monika Lindemann, Michael Hallensleben, Wolfgang Altermann, Karina Althaus, Klemens Budde, Gunilla Einecke, Ute Eisenberger, Andrea Ender, Thorsten Feldkamp, Florian Grahammer, Martina Guthoff, Christopher Holzmann-Littig, Christian Hugo, Teresa Kauke, Stephan Kemmner, Martina Koch, Nils Lachmann, Matthias Marget, Christian Morath, Martin Nitschke, Lutz Renders, Sabine Scherer, Julian Stumpf, Vedat Schwenger, Florian Sommer, Bernd Spriewald, Caner Süsal, Daniel Zecher, Falko M Heinemann, Murielle Verboom
Background: Preformed donor-specific HLA antibodies (DSA) are a well-known risk factor in kidney transplantation. There is still considerable debate, however, about the optimal risk stratification among patients with preformed DSA. Additionally, data on the prognostic value of different crossmatch assays in DSA-positive patients are scarce.
Methods: DSA-positive living kidney transplant recipients were selected from a multicenter study examining 4233 consecutive renal transplants. An additional 7 patients from 2 further centers were included. Flow cytometric crossmatches (FXM), Luminex-based crossmatches, and virtual crossmatches based on C1q- and C3d-binding antibodies (C1qXM and C3dXM) were performed retrospectively using pretransplant sera and lymphocytes isolated from fresh samples. These samples were obtained from 44 donor and recipient pairs from 12 centers. Clinical outcome data and the control group without DSA were compiled from the previous study and were supplemented by data on 10-y death-censored graft survival (10yGS).
Results: Between 19% (C3dXM) and 46% (FXM) of crossmatches were positive. Crossmatch-positive patients showed high incidences of antibody-mediated rejection (AMR) within 6 mo (up to 60% in B-cell FXM+ patients). The incidence of AMR in crossmatch-negative patients ranged between 5% (FXM-) and 13% (C1qXM-). 10yGS was significantly impaired in patients with positive T-cell FXM and total FXM compared with both patients without DSA and those with DSA with negative FXM.
Conclusions: Especially FXM are useful for risk stratification, as the outcome of DSA-positive, FXM-negative patients is similar to that of DSA-negative patients, whereas FXM-positive patients have both more AMR and decreased 10yGS. Because of their lower sensitivity, the significance of Luminex-based crossmatches, C1qXM, and C3dXM would have to be examined in patients with stronger DSA.
{"title":"Risk Stratification Before Living Donor Kidney Transplantation in Patients With Preformed Donor-specific Antibodies by Different Crossmatch Methods.","authors":"Malte Ziemann, Monika Lindemann, Michael Hallensleben, Wolfgang Altermann, Karina Althaus, Klemens Budde, Gunilla Einecke, Ute Eisenberger, Andrea Ender, Thorsten Feldkamp, Florian Grahammer, Martina Guthoff, Christopher Holzmann-Littig, Christian Hugo, Teresa Kauke, Stephan Kemmner, Martina Koch, Nils Lachmann, Matthias Marget, Christian Morath, Martin Nitschke, Lutz Renders, Sabine Scherer, Julian Stumpf, Vedat Schwenger, Florian Sommer, Bernd Spriewald, Caner Süsal, Daniel Zecher, Falko M Heinemann, Murielle Verboom","doi":"10.1097/TXD.0000000000001680","DOIUrl":"10.1097/TXD.0000000000001680","url":null,"abstract":"<p><strong>Background: </strong>Preformed donor-specific HLA antibodies (DSA) are a well-known risk factor in kidney transplantation. There is still considerable debate, however, about the optimal risk stratification among patients with preformed DSA. Additionally, data on the prognostic value of different crossmatch assays in DSA-positive patients are scarce.</p><p><strong>Methods: </strong>DSA-positive living kidney transplant recipients were selected from a multicenter study examining 4233 consecutive renal transplants. An additional 7 patients from 2 further centers were included. Flow cytometric crossmatches (FXM), Luminex-based crossmatches, and virtual crossmatches based on C1q- and C3d-binding antibodies (C1qXM and C3dXM) were performed retrospectively using pretransplant sera and lymphocytes isolated from fresh samples. These samples were obtained from 44 donor and recipient pairs from 12 centers. Clinical outcome data and the control group without DSA were compiled from the previous study and were supplemented by data on 10-y death-censored graft survival (10yGS).</p><p><strong>Results: </strong>Between 19% (C3dXM) and 46% (FXM) of crossmatches were positive. Crossmatch-positive patients showed high incidences of antibody-mediated rejection (AMR) within 6 mo (up to 60% in B-cell FXM+ patients). The incidence of AMR in crossmatch-negative patients ranged between 5% (FXM-) and 13% (C1qXM-). 10yGS was significantly impaired in patients with positive T-cell FXM and total FXM compared with both patients without DSA and those with DSA with negative FXM.</p><p><strong>Conclusions: </strong>Especially FXM are useful for risk stratification, as the outcome of DSA-positive, FXM-negative patients is similar to that of DSA-negative patients, whereas FXM-positive patients have both more AMR and decreased 10yGS. Because of their lower sensitivity, the significance of Luminex-based crossmatches, C1qXM, and C3dXM would have to be examined in patients with stronger DSA.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}