Transplantation Direct最新文献

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Case Report: The Use of Cryopreserved Saphenous Vein in Reconstruction of Transplant Renal Artery Dissection 病例报告：使用低温保存的隐静脉重建移植肾动脉裂口

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-12-12 DOI: 10.1097/TXD.0000000000001546

Jasmine C. Hwang, Michael J. Moritz

引用次数: 0

First Czech-Slovak Intercountry Islet Autotransplantation—Brief Case Report 首例捷克-斯洛伐克跨国胰岛自体移植手术--简要病例报告

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-12-12 DOI: 10.1097/TXD.0000000000001562

P. Girman, Jan Kriz, Lenka Németová, I. Leontovyc, K. Bittenglová, L. Nosáková, Miroslav Pindura, Patrik Horan, Peter Bánovčin, B. Palkóci, D. Osinová, Daniel Bolek, J. Miklušica

I slet autotransplantation is an effective procedure that prevents or lessens diabetes after a total pancreatectomy. Posttransplant insulin-independence rate may be as high as 30%, according to the recent data reported by experienced centers. 1 The procedure availability in various countries depends on the presence of an islet isolation laboratory. Transplantation success depends on the professional laboratory team and the number of islet isolations. Training the special isolation team is a long-term process, taking several years and requiring institutional support, funding, and overcoming the first period of unsuccessful isolations. Recent review of islet isolation facilities shows plenty of inactive or partially active laboratories. This is a significant obstacle to the further increase of islet transplantation numbers. 2

自体胰脏移植是预防或减轻全胰切除术后糖尿病的有效方法。根据经验丰富的中心最近报告的数据，移植后胰岛素独立率可能高达30%。1 .在不同的国家，这种方法的可用性取决于是否有胰岛隔离实验室。移植的成功取决于专业的实验室团队和胰岛分离的数量。培训特别隔离小组是一个长期过程，需要数年时间，需要机构支持和资金，并克服第一阶段不成功的隔离。最近对胰岛隔离设施的审查显示，许多实验室不活跃或部分活跃。这是阻碍胰岛移植数量进一步增加的重要因素。2

引用次数: 0

Medical and Surgical Management of the Failed Pancreas Transplant 胰腺移植失败的内外科治疗

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-12-12 DOI: 10.1097/TXD.0000000000001543

Michael J. Casey, N. Murakami, S. Ong, Joel T Adler, Neeraj Singh, Haris Murad, Sandesh Parajuli, Beatrice P. Concepcion, Michelle L. Lubetzky, M. Pavlakis, K. Woodside, Arman Faravardeh, A. Basu, E. Tantisattamo, A. Aala, Angelika G. Gruessner, D. Dadhania, K. Lentine, Matthew Cooper, Ronald F. Parsons, T. Alhamad

Despite the continued improvements in pancreas transplant outcomes in recent decades, a subset of recipients experience graft failure and can experience substantial morbidity and mortality. Here, we summarize what is known about the failed pancreas allograft and what factors are important for consideration of retransplantation. The current definition of pancreas allograft failure and its challenges for the transplant community are explored. The impacts of a failed pancreas allograft are presented, including patient survival and resultant morbidities. The signs, symptoms, and medical and surgical management of a failed pancreas allograft are described, whereas the options and consequences of immunosuppression withdrawal are reviewed. Medical and surgical factors necessary for successful retransplant candidacy are detailed with emphasis on how well-selected patients may achieve excellent retransplant outcomes. To achieve substantial medical mitigation and even pancreas retransplantation, patients with a failed pancreas allograft warrant special attention to their residual renal, cardiovascular, and pulmonary function. Future studies of the failed pancreas allograft will require improved reporting of graft failure from transplant centers and continued investigation from experienced centers.

尽管近几十年来胰腺移植的结果不断改善，但一小部分受者经历了移植失败，并可能经历大量的发病率和死亡率。在这里，我们总结了关于胰腺移植失败的已知情况以及考虑再次移植的重要因素。目前胰脏移植失败的定义及其对移植界的挑战进行了探讨。胰腺异体移植失败的影响，包括患者生存和由此产生的发病率。异体胰腺移植失败的体征、症状、医疗和外科治疗被描述，而免疫抑制退出的选择和后果被审查。对成功的再移植候选资格所必需的医学和外科因素进行了详细介绍，重点是如何精心选择患者才能获得良好的再移植结果。为了实现实质性的医疗缓解甚至胰腺再移植，移植胰腺失败的患者需要特别注意其残余的肾脏、心血管和肺功能。未来对同种异体胰腺移植失败的研究将需要移植中心改进移植失败的报告，并需要有经验的中心继续进行调查。

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引用次数: 0

Local Postoperative Graft Inflammation in Pancreas Transplant Patients With Early Graft Thrombosis 胰腺移植患者术后局部移植物炎症与早期移植物血栓形成

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-12-12 DOI: 10.1097/TXD.0000000000001567

Kristina Rydenfelt, G. Kjøsen, R. Horneland, J. Krey Ludviksen, Trond Geir Jenssen, P. Line, T. Tønnessen, T. E. Mollnes, H. Haugaa, Søren Erik Pischke

Background. Graft thrombosis is the main cause of early graft loss following pancreas transplantation, and is more frequent in pancreas transplant alone (PTA) compared with simultaneous pancreas-kidney (SPK) recipients. Ischemia-reperfusion injury during transplantation triggers a local thromboinflammatory response. We aimed to evaluate local graft inflammation and its potential association with early graft thrombosis. Methods. In this observational study, we monitored 67 pancreas-transplanted patients using microdialysis catheters placed on the pancreatic surface during the first postoperative week. We analyzed 6 cytokines, interleukin-1 receptor antagonist (IL-1ra), IL-6, IL-8, interferon gamma-induced protein 10 (IP-10), macrophage inflammatory protein 1β (MIP-1β), IL-10, and the complement activation product complement activation product 5a (C5a) in microdialysis fluid. We compared the dynamic courses between patients with pancreas graft thrombosis and patients without early complications (event-free) and between PTA and SPK recipients. Levels of the local inflammatory markers, and plasma markers C-reactive protein, pancreas amylase, and lipase were evaluated on the day of thrombosis diagnosis compared with the first week in event-free patients. Results. IL-10 and C5a were not detectable. Patients with no early complications (n = 34) demonstrated high IL-1ra, IL-6, IL-8, IP-10, and MIP-1β concentrations immediately after surgery, which decreased to steady low levels during the first 2 postoperative days (PODs). Patients with early graft thrombosis (n = 17) demonstrated elevated IL-6 (P = 0.003) concentrations from POD 1 and elevated IL-8 (P = 0.027) concentrations from POD 2 and throughout the first postoperative week compared with patients without complications. IL-6 (P < 0.001) and IL-8 (P = 0.003) were higher on the day of thrombosis diagnosis compared with patients without early complications. No differences between PTA (n = 35) and SPK (n = 32) recipients were detected. Conclusions. Local pancreas graft inflammation was increased in patients experiencing graft thrombosis, with elevated postoperative IL-6 and IL-8 concentrations, but did not differ between PTA and SPK recipients. Investigating the relationship between the local cytokine response and the formation of graft thrombosis warrants further research.

背景。移植物血栓形成是胰腺移植术后早期移植物损失的主要原因，在单独胰腺移植(PTA)中比在胰肾联合移植(SPK)中更常见。移植过程中的缺血再灌注损伤触发局部血栓炎症反应。我们的目的是评估局部移植物炎症及其与早期移植物血栓形成的潜在关联。方法。在这项观察性研究中，我们在术后第一周使用放置在胰腺表面的微透析导管监测67例胰腺移植患者。我们分析了微透析液中的6种细胞因子，白介素-1受体拮抗剂(IL-1ra)、IL-6、IL-8、干扰素- γ诱导蛋白10 (IP-10)、巨噬细胞炎症蛋白1β (MIP-1β)、IL-10和补体激活产物补体激活产物5a (C5a)。我们比较了胰腺移植血栓患者和无早期并发症(无事件)患者以及PTA和SPK受体之间的动态病程。在血栓形成诊断当天与无事件患者第一周比较，评估局部炎症标志物、血浆标志物c反应蛋白、胰腺淀粉酶和脂肪酶的水平。结果。IL-10和C5a未检出。无早期并发症的患者(n = 34)术后立即表现出较高的IL-1ra、IL-6、IL-8、IP-10和MIP-1β浓度，在术后前2天(pod)降至稳定的低水平。与无并发症的患者相比，早期移植物血栓患者(n = 17)表现出POD 1中IL-6 (P = 0.003)浓度升高，POD 2中IL-8 (P = 0.027)浓度升高，并且贯穿术后第一周。IL-6 (P < 0.001)和IL-8 (P = 0.003)在血栓诊断当日高于无早期并发症的患者。PTA (n = 35)和SPK (n = 32)受者之间无差异。结论。在移植物血栓形成的患者中，局部胰腺移植物炎症增加，术后IL-6和IL-8浓度升高，但PTA和SPK受体之间没有差异。局部细胞因子反应与移植物血栓形成的关系有待进一步研究。

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引用次数: 0

Successful Living-donor Lobar Lung Transplantation With BK Virus-related Hemorrhagic Cystitis Throughout the Perioperative Period BK病毒相关出血性膀胱炎围手术期的活体供体肺叶移植手术获得成功

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-12-12 DOI: 10.1097/TXD.0000000000001556

Y. Tomioka, S. Otani, S. Tanaka, K. Miyoshi, M. Okazaki, S. Sugimoto, M. Yamane, Shinichi Toyooka

，

引用次数: 0

Relationship of Social Deprivation Among Living Kidney Donor–Recipient Pairs 活体肾脏捐献者与受捐者配对之间的社会贫困关系

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-12-12 DOI: 10.1097/TXD.0000000000001559

MD Anne M. Huml, MD Yara Bilen, PhD Jesse D. Schold, MA Susana Arrigain, PhD R. Blake Buchalter

Background. Living kidney transplant is the most effective renal replacement therapy for patients with end-stage kidney disease. Community-level factors contribute to pervasive socioeconomic and racial disparities in access to living donor kidney transplantation. Little is known about social and environmental conditions between living donors and recipients. Further understanding of these relationships may enhance opportunities for transplantation. Methods. From 2010 to 2020, 59 575 living kidney donor–recipient pairs (≥18 y old) were identified using the Scientific Registry of Transplant Recipients. Living donors and recipients were geocoded to area-level social deprivation index (SDI). The primary outcome was difference between recipient and donor SDI. We used multivariable logistic regression to examine recipient and donor characteristics association with residence in different SDI communities. Results. Living kidney donation occurs across all strata of social deprivation; including when donors, recipients or both reside in more disadvantaged communities. Donor–recipient race combination and biological relationship are associated with differences in SDI. When compared with White recipients of White donors, Black and Hispanic recipients were more likely to reside in more disadvantaged areas (odds ratio = 2.41 [2.19-2.66] and 1.97 [1.78-2.19]). Recipients in anonymous and paired donations were more likely to reside in areas of more disadvantage than their donors (odds ratio = 1.27 [1.15-1.40] and 1.32 [1.23-1.41] compared with biological); attenuating socioeconomic disparities in access to living donor transplantation. Conclusions. Findings illustrate the social and environmental relationships between living kidney donor–recipient pairs that are important to develop targeted approaches and address barriers to living kidney transplantation. Best practices from areas of high deprivation with successful living kidney transplantation can be shared.

背景。活体肾移植是终末期肾病患者最有效的肾脏替代疗法。社区层面的因素导致在获得活体肾移植方面普遍存在社会经济和种族差异。人们对活体捐赠者和接受者之间的社会和环境条件知之甚少。进一步了解这些关系可能会增加移植的机会。方法。从2010年到2020年，使用移植接受者科学登记处确定了59575对活体肾脏供体-受体(≥18岁)。活体供体和受者按区域社会剥夺指数(SDI)进行地理编码。主要结局是受者和供者SDI之间的差异。我们使用多变量逻辑回归来检验不同SDI社区的受者和供者特征与居住地的关系。结果。活体肾脏捐献发生在社会贫困的各个阶层;包括当捐助者、受援者或两者都居住在更弱势的社区时。供受体种族组合和生物学关系与SDI差异有关。与白人捐赠者的白人接受者相比，黑人和西班牙裔接受者更有可能居住在更贫困的地区(优势比分别为2.41[2.19-2.66]和1.97[1.78-2.19])。匿名捐赠和配对捐赠的接受者比其捐赠者更有可能居住在更不利的地区(优势比为1.27[1.15-1.40]和1.32 [1.23-1.41]);减少获得活体供体移植的社会经济差异。结论。研究结果说明了活体肾供体-受体对之间的社会和环境关系，这对于开发有针对性的方法和解决活体肾移植障碍非常重要。可以分享来自高贫困地区成功活体肾移植的最佳实践。

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引用次数: 0

Early Metabolic Measures Predict Long-term Insulin Independence in Recipients of Total Pancreatectomy and Islet Autotransplantation 早期代谢指标预测全胰切除术和胰岛自体移植受者的长期胰岛素依赖性

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-12-12 DOI: 10.1097/TXD.0000000000001561

Y. Nanno, James S. Hodges, Martin L. Freeman, G. Trikudanathan, S. Schwarzenberg, E. Downs, Karthik Ramanathan, Timothy L. Pruett, Gregory J. Beilman, S. Chinnakotla, Bernhard J. Hering, M. Bellin

Background. Although diabetes after total pancreatectomy and islet autotransplantation (TP-IAT) is one of the biggest concerns for TP-IAT recipients and physicians, reliable prediction of post-TP-IAT glycemic control remains unestablished. This study was conducted to identify early predictors of insulin independence and goal glycemic control by hemoglobin A1c (HbA1c) ≤ 6.5% after TP-IAT. Methods. In this single-center, retrospective study, patients who underwent TP-IAT (n = 227) were reviewed for simple metabolic markers or surrogate indices of β-cell function obtained 3 mo after TP-IAT as part of standard clinical testing. Long-term metabolic success was defined as (1) insulin independence and (2) HbA1c ≤ 6.5% 1, 3, and 5 y after TP-IAT. Single- and multivariate modeling used 3-mo markers to predict successful outcomes. Results. Of the 227 recipients, median age 31 y, 30% male, 1 y after TP-IAT insulin independence, and HbA1c ≤ 6.5% were present in 39.6% and 72.5%, respectively. In single-predictor analyses, most of the metabolic markers successfully discriminated between those attaining and not attaining metabolic goals. Using the best model selected by random forests analysis, we accurately predicted 1-y insulin independence and goal HbA1c control in 77.3% and 86.4% of the patients, respectively. A simpler “clinically feasible” model using only transplanted islet dose and BETA-2 score allowed easier prediction at a small accuracy loss (74.1% and 82.9%, respectively). Conclusions. Metabolic testing measures performed 3 mo after TP-IAT were highly associated with later diabetes outcomes and provided a reliable prediction model, giving valuable prognostic insight early after TP-IAT and help to identify recipients who require early intervention.

背景。尽管全胰切除术和胰岛自体移植(TP-IAT)后的糖尿病是TP-IAT接受者和医生最关心的问题之一，但TP-IAT后血糖控制的可靠预测仍未建立。本研究旨在通过糖化血红蛋白(HbA1c)≤6.5%确定TP-IAT后胰岛素独立性和目标血糖控制的早期预测指标。方法。在这项单中心、回顾性研究中，接受TP-IAT的患者(n = 227)在TP-IAT后3个月作为标准临床检测的一部分获得了简单的代谢标志物或β细胞功能的替代指标。长期代谢成功定义为(1)胰岛素独立性和(2)HbA1c≤6.5%在TP-IAT后1,3和5年。单变量和多变量建模使用3个月标记来预测成功的结果。结果。在227名接受治疗的患者中，中位年龄31岁，男性占30%，TP-IAT胰岛素独立后1岁，HbA1c≤6.5%分别占39.6%和72.5%。在单预测分析中，大多数代谢标记成功地区分了达到和未达到代谢目标的人。使用随机森林分析选择的最佳模型，我们分别准确预测了77.3%和86.4%的患者的1-y胰岛素独立性和目标HbA1c控制。一种更简单的“临床可行”模型，仅使用移植胰岛剂量和β -2评分，更容易预测，准确性损失较小(分别为74.1%和82.9%)。结论。TP-IAT后3个月进行的代谢测试与后期糖尿病结局高度相关，并提供了可靠的预测模型，为TP-IAT后早期提供了有价值的预后洞察，并有助于确定需要早期干预的接受者。

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引用次数: 0

Abstracts for the 2023 Transplantation Society of Australia and New Zealand Annual Scientific Meeting 澳大利亚和新西兰移植协会 2023 年科学年会论文摘要

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-12-01 DOI: 10.1097/txd.0000000000001560

引用次数: 0

Erratum: Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient: Erratum. 勘误:肺移植受者血管埃勒-丹洛斯综合征的死后鉴定:勘误。

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-11-17 eCollection Date: 2023-12-01 DOI: 10.1097/TXD.0000000000001570

[This corrects the article DOI: 10.1097/TXD.0000000000001469.].

[这更正了文章DOI: 10.1097/TXD.0000000000001469.]。

引用次数: 0

Establishing a HOPE Program in a Real-life Setting: A Brazilian Case Series. 在现实生活中建立希望计划:一个巴西案例系列。

IF 2.3 Q3 TRANSPLANTATION

Transplantation Direct

Pub Date : 2023-11-08 eCollection Date: 2023-12-01 DOI: 10.1097/TXD.0000000000001555

Amanda P C S Boteon, Marisa R D Lima, Bianca Della Guardia, Mauricio F Carvalho, Andrea Schlegel, Yuri L Boteon

Background: Although hypothermic oxygenated perfusion (HOPE) improves posttransplant outcomes, setting up machine perfusion programs may be subjected to specific obstacles under different conditions. This study aims to describe the establishment of HOPE in a real-life setting in Brazil.

Methods: Extended criteria donors in donation after brain death organs preserved by HOPE were accepted for higher-risk candidates needing expedited transplantation, perceived as those who would benefit most from the technique because of its limited availability. Extended criteria donors was defined by the Eurotransplant criteria. High-risk transplant candidates were characterized by suboptimal surgical conditions related to the recipient or the procedure.

Results: Six HOPE-preserved grafts were transplanted from February 2022 to August 2022. The mean donor risk index was 1.7 (SD 0.5). One organ was severely steatotic, and 3 had an anticipated cold ischemia time above 12 h. Recipients' mean model for end-stage liver disease was 28.67 (SD 6.79), with 1 case of retransplant, 1 of refractory ascites, and 1 of acute-on-chronic liver failure. The mean cold ischemia time was 5 h 42 min (SD 82 min), HOPE 6 h 3 min (SD 150 min), and total preservation time 11 h 46 min (SD 184 min). No case had early allograft dysfunction. The mean length of hospital stay was 10 d with 100% graft and patient survival and no ischemic cholangiopathies at a median follow-up of 15 mo (min 12, max 18). Costs and country-specific legal regulations for device utilization were the major hurdles to implementing the program.

Conclusion: We presented a pathway to introduce and rationalize the use of HOPE in a scenario of challenging donor-recipient matching with good results. These findings may aid in implementing machine perfusion programs, especially in settings with limited resources or complex transplant logistics.

背景:虽然低温氧灌注(hypothermic oxygenated perfusion, HOPE)可以改善移植后的预后，但在不同情况下，设置机器灌注程序可能会遇到特定的障碍。本研究旨在描述希望在巴西现实生活中的建立。方法:对于需要加速移植的高风险候选人，接受由HOPE保存的脑死亡后器官捐赠的扩展标准供者，因为其有限的可用性，被认为是那些将从该技术中获益最多的人。扩展标准供体由欧洲移植标准定义。高危移植候选者的特点是与受体或手术相关的次优手术条件。结果:2022年2月至2022年8月，6例保存希望的移植物移植。平均供者风险指数为1.7 (SD 0.5)。1个器官严重脂肪变性，3个预计冷缺血时间超过12小时。受者终末期肝病的平均模型为28.67例(SD 6.79)，再移植1例，难治性腹水1例，急性慢性肝衰竭1例。平均冷缺血时间为5 h 42 min (SD 82 min)， HOPE为6 h 3 min (SD 150 min)，总保存时间为11 h 46 min (SD 184 min)。无一例出现早期同种异体移植物功能障碍。平均住院时间为10天，移植100%，患者存活率为100%，中位随访15个月(最短12个月，最长18个月)无缺血性胆管病变。成本和国家特定的设备使用法律法规是实施该计划的主要障碍。结论:我们提出了在具有挑战性的供体-受体匹配场景中引入和合理化HOPE使用的途径，并取得了良好的效果。这些发现可能有助于实施机器灌注方案，特别是在资源有限或移植后勤复杂的情况下。

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