Pub Date : 2024-06-26eCollection Date: 2024-07-01DOI: 10.1097/TXD.0000000000001669
Michael B Keller, Junfeng Sun, Muhtadi Alnababteh, Lucia Ponor, Pali D Shah, Joby Mathew, Hyesik Kong, Ananth Charya, Helen Luikart, Shambhu Aryal, Steven D Nathan, Jonathan B Orens, Kiran K Khush, Moon Kyoo Jang, Sean Agbor-Enoh
Background: A prior single-center, retrospective cohort study identified baseline lung allograft dysfunction (BLAD) as a risk factor for death in bilateral lung transplant recipients. In this multicenter prospective cohort study, we test the association of BLAD with death in bilateral lung transplant recipients, identify clinical risk factors for BLAD, and assess its association with allograft injury on the molecular level.
Methods: This multicenter, prospective cohort study included 173 bilateral lung transplant recipients that underwent serial pulmonary function testing and plasma collection for donor-derived cell-free DNA at prespecified time points. BLAD was defined as failure to achieve ≥80% predicted for both forced expiratory volume in 1 s and forced vital capacity after lung transplant, on 2 consecutive measurements at least 3 mo apart.
Results: BLAD was associated with increased risk of death (hazard ratio, 1.97; 95% confidence interval [CI], 1.05-3.69; P = 0.03) but not chronic lung allograft dysfunction alone (hazard ratio, 1.60; 95% CI, 0.87-2.95; P = 0.13). Recipient obesity (odds ratio, 1.69; 95% CI, 1.15-2.80; P = 0.04) and donor age (odds ratio, 1.03; 95% CI, 1.02-1.05; P = 0.004) increased the risk of developing BLAD. Patients with BLAD did not demonstrate higher log10(donor-derived cell-free DNA) levels compared with no BLAD (slope [SE]: -0.0095 [0.0007] versus -0.0109 [0.0007]; P = 0.15).
Conclusions: BLAD is associated with an increased risk of death following lung transplantation, representing an important posttransplant outcome with valuable prognostic significance; however, early allograft specific injury on the molecular level does not increase the risk of BLAD, supporting further mechanistic insight into disease pathophysiology.
{"title":"Baseline Lung Allograft Dysfunction After Bilateral Lung Transplantation Is Associated With an Increased Risk of Death: Results From a Multicenter Cohort Study.","authors":"Michael B Keller, Junfeng Sun, Muhtadi Alnababteh, Lucia Ponor, Pali D Shah, Joby Mathew, Hyesik Kong, Ananth Charya, Helen Luikart, Shambhu Aryal, Steven D Nathan, Jonathan B Orens, Kiran K Khush, Moon Kyoo Jang, Sean Agbor-Enoh","doi":"10.1097/TXD.0000000000001669","DOIUrl":"10.1097/TXD.0000000000001669","url":null,"abstract":"<p><strong>Background: </strong>A prior single-center, retrospective cohort study identified baseline lung allograft dysfunction (BLAD) as a risk factor for death in bilateral lung transplant recipients. In this multicenter prospective cohort study, we test the association of BLAD with death in bilateral lung transplant recipients, identify clinical risk factors for BLAD, and assess its association with allograft injury on the molecular level.</p><p><strong>Methods: </strong>This multicenter, prospective cohort study included 173 bilateral lung transplant recipients that underwent serial pulmonary function testing and plasma collection for donor-derived cell-free DNA at prespecified time points. BLAD was defined as failure to achieve ≥80% predicted for both forced expiratory volume in 1 s and forced vital capacity after lung transplant, on 2 consecutive measurements at least 3 mo apart.</p><p><strong>Results: </strong>BLAD was associated with increased risk of death (hazard ratio, 1.97; 95% confidence interval [CI], 1.05-3.69; <i>P</i> = 0.03) but not chronic lung allograft dysfunction alone (hazard ratio, 1.60; 95% CI, 0.87-2.95; <i>P</i> = 0.13). Recipient obesity (odds ratio, 1.69; 95% CI, 1.15-2.80; <i>P</i> = 0.04) and donor age (odds ratio, 1.03; 95% CI, 1.02-1.05; <i>P</i> = 0.004) increased the risk of developing BLAD. Patients with BLAD did not demonstrate higher log<sub>10</sub>(donor-derived cell-free DNA) levels compared with no BLAD (slope [SE]: -0.0095 [0.0007] versus -0.0109 [0.0007]; <i>P</i> = 0.15).</p><p><strong>Conclusions: </strong>BLAD is associated with an increased risk of death following lung transplantation, representing an important posttransplant outcome with valuable prognostic significance; however, early allograft specific injury on the molecular level does not increase the risk of BLAD, supporting further mechanistic insight into disease pathophysiology.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477527","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 : 2024-06-20eCollection Date: 2024-07-01DOI: 10.1097/TXD.0000000000001642
Jia Hong Koh, Douglas Chee, Cheng Han Ng, Karn Wijarnpreecha, Mark Muthiah, Darren Jun Hao Tan, Wen Hui Lim, Rebecca Wenling Zeng, Benjamin Koh, Eunice Tan Xiang Xuan, Glenn Bonney, Shridhar Iyer, Dan Yock Young, Toru Nakamura, Hirokazu Takahashi, Mazen Noureddin, Mohammad Shadab Siddiqui, Tracey G Simon, Rohit Loomba, Daniel Q Huang
Background: The cause of liver disease is changing, but its impact on liver transplantation (LT) for hepatocellular carcinoma (HCC) in women and men is unclear. We performed a nationwide study to assess the prevalence and posttransplant survival outcomes of the various causes of liver disease in women and men with HCC.
Methods: Data were obtained from the United Network for Organ Sharing database from 2000 to 2022. Data related to the listing, transplant, waitlist mortality, and posttransplant mortality for HCC were extracted. The proportion of HCC related to the various causes of liver disease among LT candidates and recipients and posttransplant survival were compared between women and men.
Results: A total of 51 721 individuals (39 465 men, 12 256 women) with HCC were included. From 2000 to 2022, nonalcoholic steatohepatitis (NASH) was the fastest-growing cause of liver disease among female LT candidates with HCC (P < 0.01), followed by alcohol-associated liver disease. NASH overtook chronic hepatitis C as the leading cause of liver disease in 2020 and 2022 among waitlisted women and men with HCC, respectively. Female patients with HCC spent a significantly longer time on the LT waitlist compared with male patients (β: 8.73; 95% confidence interval [CI], 2.91-14.54). Female patients with HCC from alcohol-associated liver disease also have a lower probability of receiving LT (subdistribution hazard ratio: 0.90; 95% CI, 0.82-0.99). Among transplant recipients with NASH HCC, female sex was associated with lower posttransplant mortality compared with male sex (hazard ratio: 0.79; 95% CI, 0.70-0.89; P < 0.01).
Conclusions: Women have a significantly longer waitlist duration compared with men. NASH is now the leading cause of liver disease among both female and male LT candidates and recipients with HCC.
{"title":"Sex-based Disparities in Liver Transplantation for Hepatocellular Carcinoma and the Impact of the Growing Burden of NASH.","authors":"Jia Hong Koh, Douglas Chee, Cheng Han Ng, Karn Wijarnpreecha, Mark Muthiah, Darren Jun Hao Tan, Wen Hui Lim, Rebecca Wenling Zeng, Benjamin Koh, Eunice Tan Xiang Xuan, Glenn Bonney, Shridhar Iyer, Dan Yock Young, Toru Nakamura, Hirokazu Takahashi, Mazen Noureddin, Mohammad Shadab Siddiqui, Tracey G Simon, Rohit Loomba, Daniel Q Huang","doi":"10.1097/TXD.0000000000001642","DOIUrl":"10.1097/TXD.0000000000001642","url":null,"abstract":"<p><strong>Background: </strong>The cause of liver disease is changing, but its impact on liver transplantation (LT) for hepatocellular carcinoma (HCC) in women and men is unclear. We performed a nationwide study to assess the prevalence and posttransplant survival outcomes of the various causes of liver disease in women and men with HCC.</p><p><strong>Methods: </strong>Data were obtained from the United Network for Organ Sharing database from 2000 to 2022. Data related to the listing, transplant, waitlist mortality, and posttransplant mortality for HCC were extracted. The proportion of HCC related to the various causes of liver disease among LT candidates and recipients and posttransplant survival were compared between women and men.</p><p><strong>Results: </strong>A total of 51 721 individuals (39 465 men, 12 256 women) with HCC were included. From 2000 to 2022, nonalcoholic steatohepatitis (NASH) was the fastest-growing cause of liver disease among female LT candidates with HCC (<i>P</i> < 0.01), followed by alcohol-associated liver disease. NASH overtook chronic hepatitis C as the leading cause of liver disease in 2020 and 2022 among waitlisted women and men with HCC, respectively. Female patients with HCC spent a significantly longer time on the LT waitlist compared with male patients (β: 8.73; 95% confidence interval [CI], 2.91-14.54). Female patients with HCC from alcohol-associated liver disease also have a lower probability of receiving LT (subdistribution hazard ratio: 0.90; 95% CI, 0.82-0.99). Among transplant recipients with NASH HCC, female sex was associated with lower posttransplant mortality compared with male sex (hazard ratio: 0.79; 95% CI, 0.70-0.89; <i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>Women have a significantly longer waitlist duration compared with men. NASH is now the leading cause of liver disease among both female and male LT candidates and recipients with HCC.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443367","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 : 2024-06-13eCollection Date: 2024-07-01DOI: 10.1097/TXD.0000000000001653
Jillian S Caldwell, Gomathy Parvathinathan, Margaret R Stedman, Patrick Ahearn, Jane C Tan, Xingxing S Cheng
Background: Systemic barriers to posttransplant care, including access to immunosuppressant medications, contribute to higher rates of kidney transplant failure in racial minorities. Matching donor and recipient HLA alleles reduce allorecognition, easing reliance on immunosuppression. We hypothesize that 0-antigen mismatch transplants may provide stronger protection against graft loss in racial minorities.
Methods: We compared adult, single-organ, deceased-donor kidney transplants in the United States from 2007 to 2016 by degree of HLA mismatch (0- versus ≥1-antigen mismatch). We examined time-to-allograft failure, with death as a competing event, using multivariable Weibull models, stratified by recipient race (White versus non-White), and evaluated the interaction between mismatch and recipient race. We used Kaplan-Meier imputation to account for competing risk of death.
Results: We analyzed 102 114 transplants (median follow-up, 5.6 y; 16 862 graft losses, 18 994 deaths). Zero-antigen mismatch was associated with improved allograft survival (adjusted subdistribution hazard ratio [sHR] 0.80; 95% confidence interval [CI], 0.75-0.85). When stratified by recipient race, the effect of 0-antigen mismatch was more pronounced in White (unadjusted sHR 0.78; 95% CI, 0.72-0.83) versus non-White recipients (sHR 0.88; 95% CI, 0.79-0.99; interaction P = 0.04). The differential effect was attenuated after adjusting for covariates (sHR 0.78; 95% CI, 0.73-0.84 versus sHR 0.87; 95% CI, 0.77-0.98; interaction P = 0.10).
Conclusions: Zero-antigen mismatch transplants conferred a 20% risk reduction in allograft loss, which was similar between non-White and White recipients. This may reflect an increased degree of mismatch at other HLA alleles and non-HLA alleles in non-White recipients or because of the extent of systemic barriers to healthcare borne by minority recipients.
{"title":"Immunologic Benefits of 0-antigen Mismatched Transplants: No Added Boost for Racial and Ethnic Minorities.","authors":"Jillian S Caldwell, Gomathy Parvathinathan, Margaret R Stedman, Patrick Ahearn, Jane C Tan, Xingxing S Cheng","doi":"10.1097/TXD.0000000000001653","DOIUrl":"10.1097/TXD.0000000000001653","url":null,"abstract":"<p><strong>Background: </strong>Systemic barriers to posttransplant care, including access to immunosuppressant medications, contribute to higher rates of kidney transplant failure in racial minorities. Matching donor and recipient HLA alleles reduce allorecognition, easing reliance on immunosuppression. We hypothesize that 0-antigen mismatch transplants may provide stronger protection against graft loss in racial minorities.</p><p><strong>Methods: </strong>We compared adult, single-organ, deceased-donor kidney transplants in the United States from 2007 to 2016 by degree of HLA mismatch (0- versus ≥1-antigen mismatch). We examined time-to-allograft failure, with death as a competing event, using multivariable Weibull models, stratified by recipient race (White versus non-White), and evaluated the interaction between mismatch and recipient race. We used Kaplan-Meier imputation to account for competing risk of death.</p><p><strong>Results: </strong>We analyzed 102 114 transplants (median follow-up, 5.6 y; 16 862 graft losses, 18 994 deaths). Zero-antigen mismatch was associated with improved allograft survival (adjusted subdistribution hazard ratio [sHR] 0.80; 95% confidence interval [CI], 0.75-0.85). When stratified by recipient race, the effect of 0-antigen mismatch was more pronounced in White (unadjusted sHR 0.78; 95% CI, 0.72-0.83) versus non-White recipients (sHR 0.88; 95% CI, 0.79-0.99; interaction <i>P</i> = 0.04). The differential effect was attenuated after adjusting for covariates (sHR 0.78; 95% CI, 0.73-0.84 versus sHR 0.87; 95% CI, 0.77-0.98; interaction <i>P</i> = 0.10).</p><p><strong>Conclusions: </strong>Zero-antigen mismatch transplants conferred a 20% risk reduction in allograft loss, which was similar between non-White and White recipients. This may reflect an increased degree of mismatch at other HLA alleles and non-HLA alleles in non-White recipients or because of the extent of systemic barriers to healthcare borne by minority recipients.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11177818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331841","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 : 2024-05-28eCollection Date: 2024-06-01DOI: 10.1097/TXD.0000000000001648
Carson K L Lo, Christie Rampersad, Justin Barr, Shahid Husain
{"title":"Less Is More? Two Cases of Cryptococcosis Treated Using Single-dose Liposomal Amphotericin B as Part of Induction Therapy in Solid Organ Transplant Recipients.","authors":"Carson K L Lo, Christie Rampersad, Justin Barr, Shahid Husain","doi":"10.1097/TXD.0000000000001648","DOIUrl":"10.1097/TXD.0000000000001648","url":null,"abstract":"","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180754","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 : 2024-05-28eCollection Date: 2024-06-01DOI: 10.1097/TXD.0000000000001649
Maria Molina, Mario Fernández-Ruiz, Esther Gonzalez, Jimena Cabrera, Manuel Praga, Alfredo Rodriguez, Angel Tejido-Sánchez, Jose Medina-Polo, Alonso Mateos, Carlos Rubio-Chacón, Angel Sanchez, Ana Pla, Amado Andrés
Background: Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplantation (KT) at the expense of a higher risk of primary graft nonfunction (PNF). At least half of the cases of PNF are secondary to graft venous thrombosis. The potential benefit from prophylactic anticoagulation in this scenario remains unclear.
Methods: In this single-center retrospective study we compared 2 consecutive cohorts of KT from uDCD with increased (≥0.8) renal resistive index (RRI) in the Doppler ultrasound examination performed within the first 24-72 h after transplantation: 36 patients did not receive anticoagulation ("nonanticoagulation group") and 71 patients underwent prophylactic anticoagulation until normalization of RRI in follow-up Doppler examinations ("anticoagulation group").
Results: Anticoagulation was initiated at a median of 2 d (interquartile range, 2-3) after transplantation and maintained for a median of 12 d (interquartile range, 7-18). In 4 patients (5.6%), anticoagulation had to be prematurely stopped because of the development of a hemorrhagic complication. In comparison with the nonanticoagulation group, recipients in the anticoagulation group had a lower 2-wk cumulative incidence of graft venous thrombosis (19.4% versus 0.0%; P < 0.001) and PNF (19.4% versus 2.8%; P = 0.006). The competing risk analysis with nonthrombotic causes of PNF as the competitive event confirmed the higher risk of graft thrombosis in the nonanticoagulation group (P = 0.0001). The anticoagulation group had a higher incidence of macroscopic hematuria (21.1% versus 5.6%; P = 0.049) and blood transfusion requirements (39.4% versus 19.4%; P = 0.050) compared with the nonanticoagulation group. No graft losses or deaths were attributable to complications potentially associated with anticoagulation.
Conclusions: Early initiation of prophylactic anticoagulation in selected KT recipients from uDCD with an early Doppler ultrasound RRI of ≥0.8 within the first 24-72 h may reduce the incidence of graft venous thrombosis as a cause of PNF.
{"title":"Prophylactic Anticoagulation Reduces the Risk of Kidney Graft Venous Thrombosis in Recipients From Uncontrolled Donation After Circulatory Death Donors With High Renal Resistive Index.","authors":"Maria Molina, Mario Fernández-Ruiz, Esther Gonzalez, Jimena Cabrera, Manuel Praga, Alfredo Rodriguez, Angel Tejido-Sánchez, Jose Medina-Polo, Alonso Mateos, Carlos Rubio-Chacón, Angel Sanchez, Ana Pla, Amado Andrés","doi":"10.1097/TXD.0000000000001649","DOIUrl":"10.1097/TXD.0000000000001649","url":null,"abstract":"<p><strong>Background: </strong>Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplantation (KT) at the expense of a higher risk of primary graft nonfunction (PNF). At least half of the cases of PNF are secondary to graft venous thrombosis. The potential benefit from prophylactic anticoagulation in this scenario remains unclear.</p><p><strong>Methods: </strong>In this single-center retrospective study we compared 2 consecutive cohorts of KT from uDCD with increased (≥0.8) renal resistive index (RRI) in the Doppler ultrasound examination performed within the first 24-72 h after transplantation: 36 patients did not receive anticoagulation (\"nonanticoagulation group\") and 71 patients underwent prophylactic anticoagulation until normalization of RRI in follow-up Doppler examinations (\"anticoagulation group\").</p><p><strong>Results: </strong>Anticoagulation was initiated at a median of 2 d (interquartile range, 2-3) after transplantation and maintained for a median of 12 d (interquartile range, 7-18). In 4 patients (5.6%), anticoagulation had to be prematurely stopped because of the development of a hemorrhagic complication. In comparison with the nonanticoagulation group, recipients in the anticoagulation group had a lower 2-wk cumulative incidence of graft venous thrombosis (19.4% versus 0.0%; <i>P</i> < 0.001) and PNF (19.4% versus 2.8%; <i>P</i> = 0.006). The competing risk analysis with nonthrombotic causes of PNF as the competitive event confirmed the higher risk of graft thrombosis in the nonanticoagulation group <i>(P</i> = 0.0001). The anticoagulation group had a higher incidence of macroscopic hematuria (21.1% versus 5.6%; <i>P</i> = 0.049) and blood transfusion requirements (39.4% versus 19.4%; <i>P</i> = 0.050) compared with the nonanticoagulation group. No graft losses or deaths were attributable to complications potentially associated with anticoagulation.</p><p><strong>Conclusions: </strong>Early initiation of prophylactic anticoagulation in selected KT recipients from uDCD with an early Doppler ultrasound RRI of ≥0.8 within the first 24-72 h may reduce the incidence of graft venous thrombosis as a cause of PNF.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180757","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}
Background: There is no consensus on the ideal strategy to treat posttransplant focal segmental glomerulosclerosis. The multiple-target therapy, which consisted of high-dose intravenous cyclosporine, prednisone, and plasmapheresis, showed favorable results.
Methods: This single-center, prospective study sought to evaluate the multiple-target therapy in an independent cohort of patients.
Results: Thirteen patients with posttransplant focal segmental glomerulosclerosis received multiple-target therapy. Complete remission was achieved in 2 patients (15.4%), and partial remission in another 2 patients (15.4%). Four patients (30.7%) did not show remission, and 5 patients (38%) lost the graft because of posttransplant focal segmental glomerulosclerosis during the 12-mo follow-up. Premature discontinuation of treatment occurred in 10 patients (77%), all associated with infectious adverse events. Cytomegalovirus was the most common complication, and preemptive therapy was used instead of prophylaxis.
Conclusions: In this cohort of patients, the efficacy of the multiple-target therapy was poor and limited by the high incidence of infectious adverse events.
{"title":"Multiple-target Therapy for Posttransplant Focal Segmental Glomerulosclerosis.","authors":"Juliana Mansur, Domingo Chang-Dávila, Marcela Giraldes Simões, Marina Pontello Cristelli, Suelen Bianca Stopa Martins, Henrique Machado de Sousa Proença, Laila Almeida Viana, Alexandra Nicolau Ferreira, Marisa Petrucelli Doher, José Medina-Pestana, Gianna Mastroianni Kirsztajn, Helio Tedesco-Silva","doi":"10.1097/TXD.0000000000001651","DOIUrl":"10.1097/TXD.0000000000001651","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on the ideal strategy to treat posttransplant focal segmental glomerulosclerosis. The multiple-target therapy, which consisted of high-dose intravenous cyclosporine, prednisone, and plasmapheresis, showed favorable results.</p><p><strong>Methods: </strong>This single-center, prospective study sought to evaluate the multiple-target therapy in an independent cohort of patients.</p><p><strong>Results: </strong>Thirteen patients with posttransplant focal segmental glomerulosclerosis received multiple-target therapy. Complete remission was achieved in 2 patients (15.4%), and partial remission in another 2 patients (15.4%). Four patients (30.7%) did not show remission, and 5 patients (38%) lost the graft because of posttransplant focal segmental glomerulosclerosis during the 12-mo follow-up. Premature discontinuation of treatment occurred in 10 patients (77%), all associated with infectious adverse events. Cytomegalovirus was the most common complication, and preemptive therapy was used instead of prophylaxis.</p><p><strong>Conclusions: </strong>In this cohort of patients, the efficacy of the multiple-target therapy was poor and limited by the high incidence of infectious adverse events.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180756","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 : 2024-05-28eCollection Date: 2024-06-01DOI: 10.1097/TXD.0000000000001650
Sai Rithin Punjala, April Logan, Jing Han, Ayato Obana, Ashley J Limkemann, Austin D Schenk, William K Washburn
Background: Variation in donation after circulatory death (DCD) organ recovery and liver transplant practices exist among transplant centers. This study aimed to evaluate these practices among centers in the United States.
Methods: Scientific Registry of Transplant Recipients data were accessed to identify centers that performed liver transplantation in 2021 and 2022. Surveys were sent to transplant centers that consistently performed ≥5 DCD liver transplants per year.
Results: DCD liver transplants were performed by 95 centers (65.1%) of the 146 liver transplant centers in the United States. Survey results were recorded from 42 centers that consistently performed ≥5 DCD liver transplants per year, with a 59.5% response rate. Withdrawal-to-asystole and agonal time were used to define donor warm ischemia time (WIT) in 16% and 84% centers, respectively. Fifty-six percent of the centers did not use oxygen saturation to define donor WIT. Systolic blood pressure cutoffs used to define agonal time varied between 50 and 80 mm Hg, donor age cutoffs ranged between 55 and 75 y, and cold ischemia times varied between 4 and 10 h. Seventy-six percent of centers used normothermic machine perfusion for DCD liver transplantation.
Conclusions: This study highlights the wide variation in use, recovery, and definition of donor WIT. Using national data to rigorously define best practices will encourage greater utilization of this important donor resource.
{"title":"Variation in DCD Liver Transplant Protocols Among Transplant Centers in the United States.","authors":"Sai Rithin Punjala, April Logan, Jing Han, Ayato Obana, Ashley J Limkemann, Austin D Schenk, William K Washburn","doi":"10.1097/TXD.0000000000001650","DOIUrl":"10.1097/TXD.0000000000001650","url":null,"abstract":"<p><strong>Background: </strong>Variation in donation after circulatory death (DCD) organ recovery and liver transplant practices exist among transplant centers. This study aimed to evaluate these practices among centers in the United States.</p><p><strong>Methods: </strong>Scientific Registry of Transplant Recipients data were accessed to identify centers that performed liver transplantation in 2021 and 2022. Surveys were sent to transplant centers that consistently performed ≥5 DCD liver transplants per year.</p><p><strong>Results: </strong>DCD liver transplants were performed by 95 centers (65.1%) of the 146 liver transplant centers in the United States. Survey results were recorded from 42 centers that consistently performed ≥5 DCD liver transplants per year, with a 59.5% response rate. Withdrawal-to-asystole and agonal time were used to define donor warm ischemia time (WIT) in 16% and 84% centers, respectively. Fifty-six percent of the centers did not use oxygen saturation to define donor WIT. Systolic blood pressure cutoffs used to define agonal time varied between 50 and 80 mm Hg, donor age cutoffs ranged between 55 and 75 y, and cold ischemia times varied between 4 and 10 h. Seventy-six percent of centers used normothermic machine perfusion for DCD liver transplantation.</p><p><strong>Conclusions: </strong>This study highlights the wide variation in use, recovery, and definition of donor WIT. Using national data to rigorously define best practices will encourage greater utilization of this important donor resource.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180777","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 : 2024-05-16eCollection Date: 2024-06-01DOI: 10.1097/TXD.0000000000001641
Tao Liang, Jordan H Salas, Mary G Bowring, Oyinkan Kusemiju, Brittany Barnaba, Matthew Wingler, Deborah McRann, Alghidak Salama, R Patrick Wood, Allan Massie, William Werbel, Aaron A R Tobian, Dorry L Segev, Christine M Durand
Background: The HIV Organ Policy Equity Act legalizes organ procurement from donors with HIV (HIV D+). A prior survey of Organ Procurement Organizations (OPOs) estimated >2000 HIV D+ referrals/year; however, only 30-35 HIV D+/year have had organs procured. Given this gap, we sought to understand HIV D+ referrals and procurements in practice.
Methods: We prospectively collected data on all OPO-reported HIV D+ referrals, including reasons for nonprocurement. We evaluated trends and compared HIV D+ characteristics by procurement status using regression, chi-squared tests, and Wilcoxon rank-sum tests.
Results: From December 23, 2015 to May 31, 2021, there were 710 HIV D+ referrals from 49 OPOs, of which 171 (24%) had organs procured. HIV D+ referrals increased from 7 to 15 per month (P < 0.001), and the procurement rate increased from 10% to 39% (P < 0.001). Compared with HIV D+ without procurement, HIV D+ with procurement were younger (median age 36 versus 50 y), more commonly White (46% versus 36%), and more often had trauma-related deaths (29% versus 8%) (all P < 0.001). Nonprocurement was attributed to medical reasons in 63% of cases, of which 36% were AIDS-defining infections and 64% were HIV-unrelated, commonly due to organ failure (36%), high neurologic function (31%), and cancer (14%). Nonprocurement was attributed to nonmedical reasons in 26% of cases, commonly due to no authorization (42%), no waitlist candidates (21%), or no transplant center interest (20%).
Conclusions: In the early years of the HIV Organ Policy Equity Act, actual HIV D+ referrals were much lower than prior estimates; however, the numbers and procurement rates increased over time. Nonprocurement was attributed to both medical and nonmedical issues, and addressing these issues could increase organ availability.
背景:HIV 器官政策公平法案》规定,从 HIV 感染者(HIV D+)捐献者处获取器官是合法的。此前对器官获取组织(OPOs)进行的一项调查估计,每年有超过 2000 名 HIV D+ 转介;然而,每年只有 30-35 名 HIV D+ 获取了器官。鉴于这一差距,我们试图了解实际中 HIV D+ 的转诊和采购情况:我们前瞻性地收集了所有 OPO 报告的 HIV D+ 转诊数据,包括未采购的原因。我们使用回归、卡方检验和Wilcoxon秩和检验评估了趋势,并比较了不同采购状态下HIV D+的特征:从 2015 年 12 月 23 日到 2021 年 5 月 31 日,49 家 OPO 共转介了 710 例 HIV D+ 患者,其中 171 例(24%)采购了器官。HIV D+ 转介从每月 7 例增加到 15 例(P P P 结论):在《HIV 器官政策公平法案》实施的最初几年,实际的 HIV D+ 转介数量远低于之前的估计值;然而,随着时间的推移,转介数量和采购率都有所上升。未获得器官的原因既有医疗问题,也有非医疗问题,解决这些问题可以增加器官的可用性。
{"title":"Deceased Donors With HIV in the Era of the HOPE Act: Referrals and Procurement.","authors":"Tao Liang, Jordan H Salas, Mary G Bowring, Oyinkan Kusemiju, Brittany Barnaba, Matthew Wingler, Deborah McRann, Alghidak Salama, R Patrick Wood, Allan Massie, William Werbel, Aaron A R Tobian, Dorry L Segev, Christine M Durand","doi":"10.1097/TXD.0000000000001641","DOIUrl":"10.1097/TXD.0000000000001641","url":null,"abstract":"<p><strong>Background: </strong>The HIV Organ Policy Equity Act legalizes organ procurement from donors with HIV (HIV D+). A prior survey of Organ Procurement Organizations (OPOs) estimated >2000 HIV D+ referrals/year; however, only 30-35 HIV D+/year have had organs procured. Given this gap, we sought to understand HIV D+ referrals and procurements in practice.</p><p><strong>Methods: </strong>We prospectively collected data on all OPO-reported HIV D+ referrals, including reasons for nonprocurement. We evaluated trends and compared HIV D+ characteristics by procurement status using regression, chi-squared tests, and Wilcoxon rank-sum tests.</p><p><strong>Results: </strong>From December 23, 2015 to May 31, 2021, there were 710 HIV D+ referrals from 49 OPOs, of which 171 (24%) had organs procured. HIV D+ referrals increased from 7 to 15 per month (<i>P</i> < 0.001), and the procurement rate increased from 10% to 39% (<i>P</i> < 0.001). Compared with HIV D+ without procurement, HIV D+ with procurement were younger (median age 36 versus 50 y), more commonly White (46% versus 36%), and more often had trauma-related deaths (29% versus 8%) (all <i>P</i> < 0.001). Nonprocurement was attributed to medical reasons in 63% of cases, of which 36% were AIDS-defining infections and 64% were HIV-unrelated, commonly due to organ failure (36%), high neurologic function (31%), and cancer (14%). Nonprocurement was attributed to nonmedical reasons in 26% of cases, commonly due to no authorization (42%), no waitlist candidates (21%), or no transplant center interest (20%).</p><p><strong>Conclusions: </strong>In the early years of the HIV Organ Policy Equity Act, actual HIV D+ referrals were much lower than prior estimates; however, the numbers and procurement rates increased over time. Nonprocurement was attributed to both medical and nonmedical issues, and addressing these issues could increase organ availability.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11104717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141069686","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 : 2024-05-15eCollection Date: 2024-06-01DOI: 10.1097/TXD.0000000000001625
Brian T Lee, Nathan T Chen, Tse-Ling Fong, Jennifer L Dodge
Background: MELD 3.0 introduces changes to address waitlist disparities for liver transplant (LT) candidates. Ascites and hepatic encephalopathy (HE) are important milestones in the natural history of cirrhosis regardless of the Model for End-Stage Liver Disease (MELD) score. We aim to assess the impact of ascites and HE and its interaction with MELD 3.0 on waitlist mortality.
Methods: This is a retrospective study of patients listed for LT in the Organ Procurement and Transplantation Network database from 2016 to 2021. The primary outcome was waitlist mortality (death/delisting for too sick to LT). Ascites/HE were classified as moderate ascites without moderate HE (mAscites), moderate HE without moderate ascites (mHE), both moderate ascites/HE (mBoth), and neither. MELD 3.0 scores were categorized as <20, 20-29, 30-39, and ≥40.
Results: Of 39 025 candidates, 29% had mAscites, 3% mHE, and 8% mBoth. One-year waitlist mortality was 30%, 38%, and 47%, respectively, compared with 17% (all P < 0.001) for those with neither. In multivariable Cox regression, the adjusted risk of waitlist mortality associated with mAscites (versus neither) was a hazard ratio (HR) of 1.76 (95% confidence interval [CI], 1.55-2.00) when the MELD 3.0 score was <20, significantly higher than when the MELD 3.0 score was 20-29 (HR 1.40; 95% CI, 1.27-1.54), 30-39 (HR 1.19; 95% CI, 1.04-1.35), and ≥40 (HR 1.14; 95% CI, 0.91-1.43, interaction P < 0.05 for all). A similar pattern was observed by MELD 3.0 for both moderate ascites/HE.
Conclusions: The presence of moderate ascites alone, or combined with moderate HE, not only increases the risk of waitlist mortality but also has a differential effect by MELD 3.0, especially at lower MELD scores. Earlier strategies addressing this group and improving treatment plans or access to LT regardless of MELD remain needed.
背景:MELD 3.0引入了一些变化,以解决肝移植(LT)候选者等待名单上的差异。无论终末期肝病模型(MELD)评分如何,腹水和肝性脑病(HE)都是肝硬化自然病史中的重要里程碑。我们旨在评估腹水和 HE 及其与 MELD 3.0 的相互作用对候补病例死亡率的影响:这是一项回顾性研究,研究对象是2016年至2021年器官获取和移植网络数据库中列入LT的患者。主要结果是等待名单死亡率(死亡/因病重无法接受LT而被除名)。腹水/高血压分为无中度高血压的中度腹水(mAscites)、无中度腹水的中度高血压(mHE)、中度腹水/高血压均有(mBoth)和两者均无。MELD 3.0 评分分为 结果:在 39 025 名候选者中,29% 患有中度腹水,3% 患有中度 HE,8% 患有中度 HE。候选者一年的死亡率分别为 30%、38% 和 47%,而候选者一年的死亡率为 17%(均为 P P 结论:单独存在中度腹水或合并中度 HE 不仅会增加候补病例死亡的风险,而且会对 MELD 3.0 产生不同的影响,尤其是在 MELD 评分较低的情况下。无论 MELD 分值如何,仍需尽早制定针对这一群体的策略,并改善治疗计划或 LT 的获取途径。
{"title":"Differential Effects of Ascites and Hepatic Encephalopathy on Waitlist Mortality in Liver Transplantation by MELD 3.0.","authors":"Brian T Lee, Nathan T Chen, Tse-Ling Fong, Jennifer L Dodge","doi":"10.1097/TXD.0000000000001625","DOIUrl":"10.1097/TXD.0000000000001625","url":null,"abstract":"<p><strong>Background: </strong>MELD 3.0 introduces changes to address waitlist disparities for liver transplant (LT) candidates. Ascites and hepatic encephalopathy (HE) are important milestones in the natural history of cirrhosis regardless of the Model for End-Stage Liver Disease (MELD) score. We aim to assess the impact of ascites and HE and its interaction with MELD 3.0 on waitlist mortality.</p><p><strong>Methods: </strong>This is a retrospective study of patients listed for LT in the Organ Procurement and Transplantation Network database from 2016 to 2021. The primary outcome was waitlist mortality (death/delisting for too sick to LT). Ascites/HE were classified as moderate ascites without moderate HE (mAscites), moderate HE without moderate ascites (mHE), both moderate ascites/HE (mBoth), and neither. MELD 3.0 scores were categorized as <20, 20-29, 30-39, and ≥40.</p><p><strong>Results: </strong>Of 39 025 candidates, 29% had mAscites, 3% mHE, and 8% mBoth. One-year waitlist mortality was 30%, 38%, and 47%, respectively, compared with 17% (all <i>P</i> < 0.001) for those with neither. In multivariable Cox regression, the adjusted risk of waitlist mortality associated with mAscites (versus neither) was a hazard ratio (HR) of 1.76 (95% confidence interval [CI], 1.55-2.00) when the MELD 3.0 score was <20, significantly higher than when the MELD 3.0 score was 20-29 (HR 1.40; 95% CI, 1.27-1.54), 30-39 (HR 1.19; 95% CI, 1.04-1.35), and ≥40 (HR 1.14; 95% CI, 0.91-1.43, interaction <i>P</i> < 0.05 for all). A similar pattern was observed by MELD 3.0 for both moderate ascites/HE.</p><p><strong>Conclusions: </strong>The presence of moderate ascites alone, or combined with moderate HE, not only increases the risk of waitlist mortality but also has a differential effect by MELD 3.0, especially at lower MELD scores. Earlier strategies addressing this group and improving treatment plans or access to LT regardless of MELD remain needed.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956554","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}
Background: Kidney transplant centers lack consistent diagnostic malnutrition tools. The Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition Adult Malnutrition Criteria (AMC) is the widely accepted and utilized tool by Registered Dietitian Nutritionists (RDNs) to diagnose malnutrition.
Methods: In this single-center, retrospective observational study, we evaluated the outcomes of prekidney transplant malnutrition based on Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition AMC, as well as the individual components of the AMC, on posttransplant outcomes including length of stay, delayed graft function (DGF), early readmission, cardiovascular events, acute rejection, death-censored graft failure, and death. Bivariable and multivariable logistic regression models were used to assess the association of malnutrition or its components with outcomes of interest.
Results: A total of 367 recipients were included, of whom 36 (10%) were malnourished (23 moderately and 13 severely) at pretransplant evaluation. In adjusted models, pretransplant malnutrition was significantly associated with increased risk for early readmission (adjusted odds ratio 2.86; 95% confidence interval: 1.14-7.21; P = 0.03) and with DGF (adjusted odds ratio 8.33; 95% confidence interval: 1.07-64.6; P = 0.04). Muscle depletion was also associated with an increased risk for readmission and with DGF. Fat depletion and reduced functionality in the adjusted model were only associated with increased risk for readmission.
Conclusions: Malnutrition could be an important consideration for selecting kidney transplant recipients because it was associated with poor clinical outcomes. A multidisciplinary approach with the involvement of RDNs to outline a nutrition intervention plan may help mitigate some of the poor outcomes.
{"title":"Pretransplant Malnutrition, Particularly With Muscle Depletion Is Associated With Adverse Outcomes After Kidney Transplantation.","authors":"Heather Lorden, Jessa Engelken, Katrina Sprang, Megan Rolfson, Didier Mandelbrot, Sandesh Parajuli","doi":"10.1097/TXD.0000000000001619","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001619","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplant centers lack consistent diagnostic malnutrition tools. The Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition Adult Malnutrition Criteria (AMC) is the widely accepted and utilized tool by Registered Dietitian Nutritionists (RDNs) to diagnose malnutrition.</p><p><strong>Methods: </strong>In this single-center, retrospective observational study, we evaluated the outcomes of prekidney transplant malnutrition based on Academy of Nutrition and Dietetics and American Society of Parenteral Nutrition AMC, as well as the individual components of the AMC, on posttransplant outcomes including length of stay, delayed graft function (DGF), early readmission, cardiovascular events, acute rejection, death-censored graft failure, and death. Bivariable and multivariable logistic regression models were used to assess the association of malnutrition or its components with outcomes of interest.</p><p><strong>Results: </strong>A total of 367 recipients were included, of whom 36 (10%) were malnourished (23 moderately and 13 severely) at pretransplant evaluation. In adjusted models, pretransplant malnutrition was significantly associated with increased risk for early readmission (adjusted odds ratio 2.86; 95% confidence interval: 1.14-7.21; <i>P</i> = 0.03) and with DGF (adjusted odds ratio 8.33; 95% confidence interval: 1.07-64.6; <i>P</i> = 0.04). Muscle depletion was also associated with an increased risk for readmission and with DGF. Fat depletion and reduced functionality in the adjusted model were only associated with increased risk for readmission.</p><p><strong>Conclusions: </strong>Malnutrition could be an important consideration for selecting kidney transplant recipients because it was associated with poor clinical outcomes. A multidisciplinary approach with the involvement of RDNs to outline a nutrition intervention plan may help mitigate some of the poor outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860441","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}