Pub Date : 2024-12-01DOI: 10.1016/j.transproceed.2024.11.018
Sinan Efe Yazici , Ahmet Atasever , Ebru Turan , Yildiray Yuzer
Introduction
Living donor liver transplantation is encouraged due to the limited availability of cadaveric donors. However, this patient group is at risk for various complications. Diaphragmatic hernia is a rare complication but often requires reoperation. Given its poor characterization, clinicians and radiologists should remain vigilant about this potential issue.
Case Series
At our center, after 1233 donor hepatectomy operations performed between 2004 and 2024, 2 cases (0.16%) of postoperative diaphragmatic hernia were observed. Both patients were operated on under emergency conditions and via a transabdominal approach. We present these 2 cases along with a literature review.
Results
Patients should be treated even if they are asymptomatic. As far as we know, 38 cases have been reported in the literature, with most treated surgically. Both transabdominal and transthoracic approaches can be used. Primary repair or mesh repair can be performed. The patients in our series are followed up without any problems after the operation. If left untreated, it can lead to complications that may result in death. In our article, we aim to present this rare complication through 2 case reports, accompanied by a review of the relevant literature.
{"title":"An Inside Into a Rare Living Liver Donor Hepatectomy Complication: Acute Mechanical Bowel Obstruction Resulting from a Diaphragmatic Hernia","authors":"Sinan Efe Yazici , Ahmet Atasever , Ebru Turan , Yildiray Yuzer","doi":"10.1016/j.transproceed.2024.11.018","DOIUrl":"10.1016/j.transproceed.2024.11.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Living donor liver transplantation is encouraged due to the limited availability of cadaveric donors. However, this patient group is at risk for various complications. Diaphragmatic hernia is a rare complication but often requires reoperation. Given its poor characterization, clinicians and radiologists should remain vigilant about this potential issue.</div></div><div><h3>Case Series</h3><div>At our center, after 1233 donor hepatectomy operations performed between 2004 and 2024, 2 cases (0.16%) of postoperative diaphragmatic hernia were observed. Both patients were operated on under emergency conditions and via a transabdominal approach. We present these 2 cases along with a literature review.</div></div><div><h3>Results</h3><div>Patients should be treated even if they are asymptomatic. As far as we know, 38 cases have been reported in the literature, with most treated surgically. Both transabdominal and transthoracic approaches can be used. Primary repair or mesh repair can be performed. The patients in our series are followed up without any problems after the operation. If left untreated, it can lead to complications that may result in death. In our article, we aim to present this rare complication through 2 case reports, accompanied by a review of the relevant literature.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"56 10","pages":"Pages 2219-2225"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.transproceed.2024.10.029
Elisabeth Kincaide , Alicia Brenner , Reed Hall , Holly Keyt , Kelley Hitchman , Kelsey Klein
Background
Antibody-mediated rejection (AMR) is an evolving diagnosis in lung transplantation. The presence of anti-human leukocyte antigen (HLA) donor-specific antibodies (DSAs) does not always correlate with clinical picture, leading to variation in treatment. This study sought to examine anti-HLA DSA response and lung allograft stabilization following AMR treatment.
Methods
A single-center, retrospective case series was conducted in adult lung transplant recipients treated for clinical and subclinical AMR. The primary outcome was anti-HLA DSA reduction (≥ 25% decrease in mean fluorescence intensity [MFI]). The secondary outcome was forced expiratory volume (FEV1) stabilization (≤ 10% decline) at peak FEV1 and at 6-months post-treatment.
Results
Fifteen bilateral lung transplant recipients were included. Eight (53%) patients achieved the primary outcome with median MFI reduction of –56.7% (interquartile range [IQR] = –41.3 to –69.5). Statistical significance was found on matched pairs analysis between 3 and 6 months post-treatment for anti-HLA DSA reduction. Of the subjects with available data, 7 of 9 (78%) patients had FEV1 stabilization from diagnosis to peak FEV1, and 5 of 7 (71%) patients had stabilization from diagnosis to 6 months post-treatment. A statistically significant decline was found from peak FEV1 post-treatment to 6 months post-treatment (–0.4 L ± 0.2, P = .05). Univariate analysis did not identify predictors affecting anti-HLA DSA response.
Conclusions
Anti-HLA DSA response was achieved in approximately half the cohort. A statistically significant decline in FEV1 was seen from peak FEV1 post-treatment but stabilized in most patients by 6 months. These results highlight the difficulty of DSA management and recovering lung function once lost, however, the finding of FEV1 stabilization after treatment is notable.
{"title":"Treatment Response of Donor Specific Antibodies and Forced Expiratory Volume in Lung Transplant Recipients With Antibody Mediated Rejection","authors":"Elisabeth Kincaide , Alicia Brenner , Reed Hall , Holly Keyt , Kelley Hitchman , Kelsey Klein","doi":"10.1016/j.transproceed.2024.10.029","DOIUrl":"10.1016/j.transproceed.2024.10.029","url":null,"abstract":"<div><h3>Background</h3><div>Antibody-mediated rejection (AMR) is an evolving diagnosis in lung transplantation. The presence of anti-human leukocyte antigen (HLA) donor-specific antibodies (DSAs) does not always correlate with clinical picture, leading to variation in treatment. This study sought to examine anti-HLA DSA response and lung allograft stabilization following AMR treatment.</div></div><div><h3>Methods</h3><div>A single-center, retrospective case series was conducted in adult lung transplant recipients treated for clinical and subclinical AMR. The primary outcome was anti-HLA DSA reduction (≥ 25% decrease in mean fluorescence intensity [MFI]). The secondary outcome was forced expiratory volume (FEV1) stabilization (≤ 10% decline) at peak FEV1 and at 6-months post-treatment.</div></div><div><h3>Results</h3><div>Fifteen bilateral lung transplant recipients were included. Eight (53%) patients achieved the primary outcome with median MFI reduction of –56.7% (interquartile range [IQR] = –41.3 to –69.5). Statistical significance was found on matched pairs analysis between 3 and 6 months post-treatment for anti-HLA DSA reduction. Of the subjects with available data, 7 of 9 (78%) patients had FEV1 stabilization from diagnosis to peak FEV1, and 5 of 7 (71%) patients had stabilization from diagnosis to 6 months post-treatment. A statistically significant decline was found from peak FEV1 post-treatment to 6 months post-treatment (–0.4 L ± 0.2, <em>P</em> = .05). Univariate analysis did not identify predictors affecting anti-HLA DSA response.</div></div><div><h3>Conclusions</h3><div>Anti-HLA DSA response was achieved in approximately half the cohort. A statistically significant decline in FEV1 was seen from peak FEV1 post-treatment but stabilized in most patients by 6 months. These results highlight the difficulty of DSA management and recovering lung function once lost, however, the finding of FEV1 stabilization after treatment is notable.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"56 10","pages":"Pages 2242-2249"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.transproceed.2024.10.037
Stalin Cañizares , Gabriel Cojuc-Konigsberg , Belen Rivera , Aditya S. Pawar , Devin Eckhoff , Bhavna Chopra
Background
The role of steroid maintenance (SM) therapy in older adults with kidney retransplants is uncertain due to the intricate balance between rejection and adverse event risks. We aimed to assess their long-term outcomes, comparing SM versus early steroid withdrawal (ESW).
Methods
Retrospective United Network for Organ Sharing registry cohort study. We included adults older than 65 who underwent kidney-only retransplantation between 2010 and 2022, received induction and were discharged on tacrolimus. We evaluated patient death, all-cause allograft failure, and death-censored graft failure (DCGF) among individuals with SM vs ESW at discharge using multivariate Cox proportional hazards models adjusting for several donor, transplant, and recipient covariates. Outcomes were further stratified by calculated panel reactive antibody (cPRA) (<20, 20 to 80, >80).
Results
We included 1858 older adult retransplants (61.3% male, age 68 [interquartile ranges 66 to 71] years), follow-up 2.98 [interquartile ranges 1.00 to 5.28] years). Most (77.9%) received SM, whereas 22.1% had ESW. No statistically significant differences between ESW and SM were observed for patient death (hazard ratios [HR] 1.01, 95% confidence intervals [CI] 0.83 to 1.24), all-cause allograft failure (HR 0.95, 95% CI 0.78 to 1.16), and DCGF (HR 0.97, 95% CI 0.78 to 1.22). In the low cPRA subgroup, SM was associated with increased patient death (HR 1.45, 95% CI 1.01 to 2.08 In those with high cPRA, SM was associated with lower all-cause allograft failure (HR 0.70, 95% CI 0.52 to 0.95) and DCGF (HR 0.66, 95% CI 0.47 to 0.93).
Conclusion
Steroid-maintenance did not alter long-term outcomes in retransplants in adults older than 65. However, SM may be beneficial in high cPRA and harmful in low cPRA subgroups.
背景：由于排斥反应和不良事件风险之间的复杂平衡，类固醇维持（SM）治疗在老年人肾再移植中的作用尚不确定。我们的目的是评估他们的长期结果，比较SM和早期类固醇停药（ESW）。方法：回顾性联合器官共享登记队列研究。我们纳入了在2010年至2022年间接受单纯肾再移植、接受诱导并服用他克莫司出院的65岁以上成年人。我们使用多变量Cox比例风险模型，调整了几个供体、移植和受体协变量，评估了SM与ESW患者出院时的患者死亡率、全因同种异体移植失败和死亡审查移植失败（DCGF）。结果通过计算的面板反应性抗体（cPRA）进一步分层（80）。结果：我们纳入了1858例老年人再移植（61.3%为男性，年龄68岁[四分位数范围66 ~ 71]岁），随访2.98年（四分位数范围1.00 ~ 5.28]年）。大多数患者（77.9%）接受SM治疗，22.1%接受ESW治疗。ESW和SM在患者死亡（风险比[HR] 1.01, 95%可信区间[CI] 0.83 ~ 1.24）、全因同种异体移植失败（HR 0.95, 95% CI 0.78 ~ 1.16）和DCGF （HR 0.97, 95% CI 0.78 ~ 1.22）方面无统计学差异。在低cPRA亚组中，SM与患者死亡率增加相关（HR 1.45, 95% CI 1.01 ~ 2.08）。在高cPRA亚组中，SM与全因同种异体移植失败（HR 0.70, 95% CI 0.52 ~ 0.95）和DCGF （HR 0.66, 95% CI 0.47 ~ 0.93）降低相关。结论：类固醇维持治疗不会改变65岁以上再移植患者的长期预后。然而，SM在高cPRA亚组中可能是有益的，在低cPRA亚组中可能是有害的。
{"title":"Early Steroid Withdrawal Versus Steroid Maintenance in Adults Older than 65 Receiving Second Kidney Transplants","authors":"Stalin Cañizares , Gabriel Cojuc-Konigsberg , Belen Rivera , Aditya S. Pawar , Devin Eckhoff , Bhavna Chopra","doi":"10.1016/j.transproceed.2024.10.037","DOIUrl":"10.1016/j.transproceed.2024.10.037","url":null,"abstract":"<div><h3>Background</h3><div>The role of steroid maintenance (SM) therapy in older adults with kidney retransplants is uncertain due to the intricate balance between rejection and adverse event risks. We aimed to assess their long-term outcomes, comparing SM versus early steroid withdrawal (ESW).</div></div><div><h3>Methods</h3><div>Retrospective United Network for Organ Sharing registry cohort study. We included adults older than 65 who underwent kidney-only retransplantation between 2010 and 2022, received induction and were discharged on tacrolimus. We evaluated patient death, all-cause allograft failure, and death-censored graft failure (DCGF) among individuals with SM vs ESW at discharge using multivariate Cox proportional hazards models adjusting for several donor, transplant, and recipient covariates. Outcomes were further stratified by calculated panel reactive antibody (cPRA) (<20, 20 to 80, >80).</div></div><div><h3>Results</h3><div>We included 1858 older adult retransplants (61.3% male, age 68 [interquartile ranges 66 to 71] years), follow-up 2.98 [interquartile ranges 1.00 to 5.28] years). Most (77.9%) received SM, whereas 22.1% had ESW. No statistically significant differences between ESW and SM were observed for patient death (hazard ratios [HR] 1.01, 95% confidence intervals [CI] 0.83 to 1.24), all-cause allograft failure (HR 0.95, 95% CI 0.78 to 1.16), and DCGF (HR 0.97, 95% CI 0.78 to 1.22). In the low cPRA subgroup, SM was associated with increased patient death (HR 1.45, 95% CI 1.01 to 2.08 In those with high cPRA, SM was associated with lower all-cause allograft failure (HR 0.70, 95% CI 0.52 to 0.95) and DCGF (HR 0.66, 95% CI 0.47 to 0.93).</div></div><div><h3>Conclusion</h3><div>Steroid-maintenance did not alter long-term outcomes in retransplants in adults older than 65. However, SM may be beneficial in high cPRA and harmful in low cPRA subgroups.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"56 10","pages":"Pages 2158-2162"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.transproceed.2024.10.028
Halil Erbis , Eyyup Mehmet Kilinc , Aynur Camkiran Firat , Cigdem Aliosmanoglu , Mevlut Harun Agca , Ibrahim Aliosmanoglu
Background
Liver transplantation (LT) is a crucial treatment for infants with end-stage liver disease, yet specific data on LT outcomes in infants under 12 months old remain limited. This study aims to present the clinical course and outcomes of infants who underwent LT, assessing the impact of demographic and etiological differences on mortality and survival.
Methods
A retrospective analysis was conducted on 64 infants (< 12 months) who underwent LT between January 2019 and March 2024. Demographic, clinical, and laboratory data were collected from their medical records. LT-specific details, postoperative complications, and survival data were analyzed.
Results
The median age of the infants was 157 days, with 37 boys (57.8%) and 27 girls (42.2%). Biliary atresia was the most common diagnosis (85.9%), and seven infants had undergone a previous Kasai procedure. The median pediatric end-stage liver disease (PELD) score was 15.5. Left lateral segmentectomy was the predominant graft type (60.9%). The median pediatric intensive care unit (PICU) and hospital stays were 5 and 21 days, respectively. Complications occurred in 20 infants (31.3%), with vascular and biliary complication rates both at 12.5%. The overall mortality rate was 17.2%, with early (30-day) and late mortality rates of 6.3% and 10.9%, respectively. The median overall survival (OS) was 204.5 days, and the 1-year survival rate was 32.8%. Kaplan-Meier and log rank analyses showed no significant impact of sex, age, diagnostic groups, graft type, or surgical complications on OS (P > .05).
Conclusions
LT in infants can be performed with acceptable morbidity and mortality rates, particularly with increased experience and standardized protocols.
{"title":"Outcomes of Liver Transplantation in Infants: A Retrospective Cohort Study","authors":"Halil Erbis , Eyyup Mehmet Kilinc , Aynur Camkiran Firat , Cigdem Aliosmanoglu , Mevlut Harun Agca , Ibrahim Aliosmanoglu","doi":"10.1016/j.transproceed.2024.10.028","DOIUrl":"10.1016/j.transproceed.2024.10.028","url":null,"abstract":"<div><h3>Background</h3><div>Liver transplantation (LT) is a crucial treatment for infants with end-stage liver disease, yet specific data on LT outcomes in infants under 12 months old remain limited. This study aims to present the clinical course and outcomes of infants who underwent LT, assessing the impact of demographic and etiological differences on mortality and survival.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 64 infants (< 12 months) who underwent LT between January 2019 and March 2024. Demographic, clinical, and laboratory data were collected from their medical records. LT-specific details, postoperative complications, and survival data were analyzed.</div></div><div><h3>Results</h3><div>The median age of the infants was 157 days, with 37 boys (57.8%) and 27 girls (42.2%). Biliary atresia was the most common diagnosis (85.9%), and seven infants had undergone a previous Kasai procedure. The median pediatric end-stage liver disease (PELD) score was 15.5. Left lateral segmentectomy was the predominant graft type (60.9%). The median pediatric intensive care unit (PICU) and hospital stays were 5 and 21 days, respectively. Complications occurred in 20 infants (31.3%), with vascular and biliary complication rates both at 12.5%. The overall mortality rate was 17.2%, with early (30-day) and late mortality rates of 6.3% and 10.9%, respectively. The median overall survival (OS) was 204.5 days, and the 1-year survival rate was 32.8%. Kaplan-Meier and log rank analyses showed no significant impact of sex, age, diagnostic groups, graft type, or surgical complications on OS (<em>P</em> > .05).</div></div><div><h3>Conclusions</h3><div>LT in infants can be performed with acceptable morbidity and mortality rates, particularly with increased experience and standardized protocols.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"56 10","pages":"Pages 2213-2218"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urinary tract calculi (UTC) in patients awaiting living donor liver transplant (LDLT) requires proper management due to increased risk of infections in the post-liver transplant (LT) period.
Materials and Methods
A retrospective analysis of records of LDLT recipients with UTC was conducted between July 2019 and July 2023. No prisoners or paid participants were included.
Results
Thirty patients (25 women and 5 men) with a mean age of 44.45 ± 9.67 years, model of end stage liver disease with sodium (MELD-Na) of 20.5 ± 12.2 were diagnosed to have a UTC during pre-LT evaluation. Twenty-five patients had renal stones, whereas five patients had ureteric calculus (22 were unilateral and 8 were bilateral calculi). Fifteen patients underwent double J (DJ)-stenting prior to LT. The mean stone size in patients who underwent DJ stenting was 13.6 (±9.83) mm vs 4.78 (±5.3) mm in whom stenting was not done. Patients with preoperative DJ stenting had a significantly reduced hospital stay (18.5 ± 2.1 days), lower mortality rates (0%), and lower rates of hematuria (6.66%) vs (23.4 ± 12.8 days, 13.33% and 13.3%, respectively). Patients with preoperative DJ stenting underwent post-transplant definitive procedure for UTC without any complications.
Our Protocol for Incidentally Detected Ureteric Stones in LT Recipients:
a. Proximal-ureteric calculi: Preoperative DJ stenting (2-3 days prior/ on day of LT) → LT → ESWL/URS 2-3 weeks later → DJ stent removal after 2-3 weeks.
b. Distal-ureteric calculi: Preoperative DJ stenting ± URS (2-3 days prior/ day of LT) → LT → DJ stent removal after 2-3 weeks.
Our protocol for incidentally detected renal stones in LT recipients:
a. Stone size (< 5 mm) and nonobstructive calculi with no active UTI:
No surgical intervention → Liver transplant under antibiotics cover → medical management of stone.
b. Multiple calculi sized < 5 mm or single stone 5-10 mm:
DJ stent placement → LT → ESWL/RIRS after 4-6 weeks → DJ stent removal after 3 weeks.
c. Single stone size > 10 mm or multiple calculi > 5 mm:
DJ stent placement → LT → RIRS/PCNL after 4-6 weeks→DJ stent removal after 3-4 weeks.
Conclusion
A systemic minimally invasive approach is needed for pre-LT management of UTC for better patient outcomes.
{"title":"Management of Incidentally Detected Urinary Tract Calculus in Patients Awaiting Living Donor Liver Transplantation: A Protocol-Based Approach","authors":"Anish Gupta , Yajvendra Pratapsingh Rana , Himanshu Kolhe , Gaurav Sood , Niteen Kumar , Imtiakum Jamir , Aditya Shriya , Vipin Pal Singh , Rekha Subramaniyam , Abhideep Chaudhary","doi":"10.1016/j.transproceed.2024.11.022","DOIUrl":"10.1016/j.transproceed.2024.11.022","url":null,"abstract":"<div><h3>Background</h3><div>Urinary tract calculi (UTC) in patients awaiting living donor liver transplant (LDLT) requires proper management due to increased risk of infections in the post-liver transplant (LT) period.</div></div><div><h3>Materials and Methods</h3><div>A retrospective analysis of records of LDLT recipients with UTC was conducted between July 2019 and July 2023. No prisoners or paid participants were included.</div></div><div><h3>Results</h3><div>Thirty patients (25 women and 5 men) with a mean age of 44.45 ± 9.67 years, model of end stage liver disease with sodium (MELD-Na) of 20.5 ± 12.2 were diagnosed to have a UTC during pre-LT evaluation. Twenty-five patients had renal stones, whereas five patients had ureteric calculus (22 were unilateral and 8 were bilateral calculi). Fifteen patients underwent double J (DJ)-stenting prior to LT. The mean stone size in patients who underwent DJ stenting was 13.6 (±9.83) mm vs 4.78 (±5.3) mm in whom stenting was not done. Patients with preoperative DJ stenting had a significantly reduced hospital stay (18.5 ± 2.1 days), lower mortality rates (0%), and lower rates of hematuria (6.66%) vs (23.4 ± 12.8 days, 13.33% and 13.3%, respectively). Patients with preoperative DJ stenting underwent post-transplant definitive procedure for UTC without any complications.</div><div>Our Protocol for Incidentally Detected Ureteric Stones in LT Recipients:</div><div> <!-->a. Proximal-ureteric calculi: Preoperative DJ stenting (2-3 days prior/ on day of LT) → LT → ESWL/URS 2-3 weeks later → DJ stent removal after 2-3 weeks.</div><div> <!-->b. Distal-ureteric calculi: Preoperative DJ stenting ± URS (2-3 days prior/ day of LT) → LT → DJ stent removal after 2-3 weeks.</div><div>Our protocol for incidentally detected renal stones in LT recipients:</div><div> <!-->a. Stone size (< 5 mm) and nonobstructive calculi with no active UTI:</div><div>No surgical intervention → Liver transplant under antibiotics cover → medical management of stone.</div><div> <!-->b. Multiple calculi sized < 5 mm or single stone 5-10 mm:</div><div>DJ stent placement → LT → ESWL/RIRS after 4-6 weeks → DJ stent removal after 3 weeks.</div><div> <!-->c. Single stone size > 10 mm or multiple calculi > 5 mm:</div><div>DJ stent placement → LT → RIRS/PCNL after 4-6 weeks→DJ stent removal after 3-4 weeks.</div></div><div><h3>Conclusion</h3><div>A systemic minimally invasive approach is needed for pre-LT management of UTC for better patient outcomes.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"56 10","pages":"Pages 2196-2202"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.transproceed.2024.10.039
Elizabeth W. Brombosz , Mark J. Hobeika , Sudha Kodali , Ashton A. Connor , Ashish Saharia , Constance M. Mobley , Caroline J. Simon , Yee Lee Cheah , Maen Abdelrahim , David W. Victor III , Edward A. Graviss , Duc T. Nguyen , Linda W. Moore , R. Mark Ghobrial
Background
The deceased donor shortage in the United States has led to increased utilization extended criteria donor (ECD) liver grafts. Centers often utilize ECD grafts in patients with low Model for End-Stage Liver Disease (MELD) scores, like patients with hepatocellular carcinoma (HCC). However, few studies have directly examined the outcomes of using ECD grafts in patients with HCC.
Methods
Adults receiving liver transplantation (LT) for HCC between 2010 and 2020 were identified in the Organ Procurement and Transplantation Network database. Recipients were categorized according to donor type: standard criteria donor (SCD), extended criteria donor, donation after brain death (ECD-DBD), and donation after circulatory death (DCD). Multivariable Cox regression analysis identified variables associated with overall or graft survival at 3 years post-LT.
Results
Most patients received ECD-DBD grafts (51.4%); only 8.3% received DCD grafts. The time on the waitlist was similar for ECD and SCD recipients (P = .79). SCD recipients had higher 5-year overall survival post-LT than ECD-DBD or DCD recipients (79.1%, 77.1%, and 76.8%, respectively, P < .001). Similarly, 5-year graft survival was also highest in SCD recipients (SCD = 77.8%, ECD-DBD = 75.7%, and DCD = 72.2%, P < .001). In multivariable analysis, DCD grafts increased mortality risk (hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.12–1.57, P = .001), but ECD-DBD grafts did not (HR = 1.10, 95% CI = 1.00–1.22, P = .052).
Conclusions
DCD and ECD-DBD recipients had significantly lower overall and graft survival. However, the survival benefit of LT for patients with HCC greatly outweighs the small differences in patient and graft survival from using ECD grafts. Further research should investigate whether treatment of ECD grafts with machine perfusion may ameliorate this discrepancy.
背景：在美国，死亡供体短缺导致延长标准供体（ECD）肝移植的使用增加。中心通常在终末期肝病模型（MELD）评分较低的患者，如肝细胞癌（HCC）患者中使用ECD移植。然而，很少有研究直接检查ECD移植在HCC患者中的效果。方法：在器官获取和移植网络数据库中确定2010年至2020年间接受HCC肝移植（LT）的成年人。根据供体类型对受者进行分类：标准标准供体（SCD）、扩展标准供体、脑死亡后供体（ECD-DBD）和循环死亡后供体（DCD）。多变量Cox回归分析确定了与肝移植术后3年总生存率或移植物生存率相关的变量。结果：接受ECD-DBD移植的患者最多（51.4%）；只有8.3%的人接受了DCD移植。ECD和SCD受者的等待时间相似（P = 0.79）。SCD接受者在lt后的5年总生存率高于ECD-DBD或DCD接受者（分别为79.1%、77.1%和76.8%,P < 0.001）。同样，SCD受者的5年移植存活率也最高（SCD = 77.8%, ECD-DBD = 75.7%, DCD = 72.2%, P < 0.001）。在多变量分析中，DCD移植增加了死亡风险（风险比[HR] = 1.33, 95%可信区间[CI] = 1.12-1.57, P = .001），而ECD-DBD移植没有增加死亡风险（HR = 1.10, 95% CI = 1.00-1.22, P = .052）。结论：DCD和ECD-DBD受者的总生存率和移植物存活率显著降低。然而，肝细胞癌患者肝移植的生存益处大大超过了使用ECD移植在患者和移植物生存方面的微小差异。进一步的研究应该探讨机器灌注治疗ECD移植物是否可以改善这种差异。
{"title":"Outcomes of Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation Utilizing Extended Criteria Donor Grafts","authors":"Elizabeth W. Brombosz , Mark J. Hobeika , Sudha Kodali , Ashton A. Connor , Ashish Saharia , Constance M. Mobley , Caroline J. Simon , Yee Lee Cheah , Maen Abdelrahim , David W. Victor III , Edward A. Graviss , Duc T. Nguyen , Linda W. Moore , R. Mark Ghobrial","doi":"10.1016/j.transproceed.2024.10.039","DOIUrl":"10.1016/j.transproceed.2024.10.039","url":null,"abstract":"<div><h3>Background</h3><div>The deceased donor shortage in the United States has led to increased utilization extended criteria donor (ECD) liver grafts. Centers often utilize ECD grafts in patients with low Model for End-Stage Liver Disease (MELD) scores, like patients with hepatocellular carcinoma (HCC). However, few studies have directly examined the outcomes of using ECD grafts in patients with HCC.</div></div><div><h3>Methods</h3><div>Adults receiving liver transplantation (LT) for HCC between 2010 and 2020 were identified in the Organ Procurement and Transplantation Network database. Recipients were categorized according to donor type: standard criteria donor (SCD), extended criteria donor, donation after brain death (ECD-DBD), and donation after circulatory death (DCD). Multivariable Cox regression analysis identified variables associated with overall or graft survival at 3 years post-LT.</div></div><div><h3>Results</h3><div>Most patients received ECD-DBD grafts (51.4%); only 8.3% received DCD grafts. The time on the waitlist was similar for ECD and SCD recipients (<em>P</em> = .79). SCD recipients had higher 5-year overall survival post-LT than ECD-DBD or DCD recipients (79.1%, 77.1%, and 76.8%, respectively, <em>P</em> < .001). Similarly, 5-year graft survival was also highest in SCD recipients (SCD = 77.8%, ECD-DBD = 75.7%, and DCD = 72.2%, <em>P</em> < .001). In multivariable analysis, DCD grafts increased mortality risk (hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.12–1.57, <em>P</em> = .001), but ECD-DBD grafts did not (HR = 1.10, 95% CI = 1.00–1.22, <em>P</em> = .052).</div></div><div><h3>Conclusions</h3><div>DCD and ECD-DBD recipients had significantly lower overall and graft survival. However, the survival benefit of LT for patients with HCC greatly outweighs the small differences in patient and graft survival from using ECD grafts. Further research should investigate whether treatment of ECD grafts with machine perfusion may ameliorate this discrepancy.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"56 10","pages":"Pages 2203-2212"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.transproceed.2024.10.038
Pranav Modi , Kelly Pennington , Surbhi Shah , Abhishek Mangaonkar , Umesh Goswami
Limited data exists concerning the post lung transplantation outcomes of patients diagnosed with myelodysplastic syndrome (MDS). We delineate the clinical trajectories and outcomes for 3 patients with MDS and Short Telomere Syndrome (STS) who underwent lung transplantation. Our findings suggest that patients with STS and low-risk MDS, especially those harboring the SF3B1 mutation, tolerated standard immunosuppression and antimicrobial prophylaxis well without significant deviation from a typical post-transplant course. Therefore, individuals with low-risk MDS should not be automatically excluded from lung transplantation consideration. Post-transplant monitoring is crucial to promptly detect and manage cytopenias. Conversely, our patient, diagnosed with high-risk MDS post-transplantation faced a poor prognosis, with severe cytopenias limiting immunosuppression treatment and resulting in rejection. Thus, abundance of caution is warranted when contemplating lung transplantation for individuals with high-risk MDS and STS. Further research is necessary to validate these findings.
{"title":"Clinical Outcomes of Lung Transplant Recipients with Myelodysplastic Syndrome and Short Telomere Syndrome—Case Series","authors":"Pranav Modi , Kelly Pennington , Surbhi Shah , Abhishek Mangaonkar , Umesh Goswami","doi":"10.1016/j.transproceed.2024.10.038","DOIUrl":"10.1016/j.transproceed.2024.10.038","url":null,"abstract":"<div><div>Limited data exists concerning the post lung transplantation outcomes of patients diagnosed with myelodysplastic syndrome (MDS). We delineate the clinical trajectories and outcomes for 3 patients with MDS and Short Telomere Syndrome (STS) who underwent lung transplantation. Our findings suggest that patients with STS and low-risk MDS, especially those harboring the SF3B1 mutation, tolerated standard immunosuppression and antimicrobial prophylaxis well without significant deviation from a typical post-transplant course. Therefore, individuals with low-risk MDS should not be automatically excluded from lung transplantation consideration. Post-transplant monitoring is crucial to promptly detect and manage cytopenias. Conversely, our patient, diagnosed with high-risk MDS post-transplantation faced a poor prognosis, with severe cytopenias limiting immunosuppression treatment and resulting in rejection. Thus, abundance of caution is warranted when contemplating lung transplantation for individuals with high-risk MDS and STS. Further research is necessary to validate these findings.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"56 10","pages":"Pages 2237-2241"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.transproceed.2024.10.032
Chao Liu , Qian Chen , Zhou Sun , Guofu Liang , Fu Yan , Yulin Niu
Background
Studies have shown that kidney transplantation is affected by pretransplant comorbidities. However, their impacts on mortality and graft loss remain inconsistent. Therefore, the purpose of our study was to collect data from multiple studies to analyze the impact of pretransplant diabetes mellitus on kidney transplant outcomes.
Method
We conducted comprehensive searches of the PubMed, Embase, and Web of Science databases to identify studies that met the inclusion criteria. All-cause mortality and graft loss were compared between patients with pretransplant diabetes mellitus and patients without pretransplant diabetes mellitus. The impact of pretransplant diabetes mellitus was assessed using pooled hazard ratios and 95% confidence intervals.
Result
This meta-analysis included 103,983 kidney transplant recipients with diabetes mellitus and 271,667 kidney transplant recipients without diabetes mellitus. All-cause mortality was 68% (HR:1.68, 95% CI 1.65-1.71, P < .01) greater in patients with pretransplant diabetes mellitus than in patients without diabetes mellitus. Additionally, graft loss was 11% (HR:1.11, 95% CI 1.07-1.15, P < .01) greater in diabetic patients than in nondiabetic patients. The heterogeneity in the 2 analyses was very significant and meta-regression was used to determine the source of heterogeneity. Unfortunately, it was not found in the analysis of all-cause mortality. However, in the analysis of graft loss, sample size and median age at transplantation may be sources of high heterogeneity.
Conclusion
Pretransplant diabetes mellitus is associated with increased risk of mortality and graft loss. However, due to significant heterogeneity and insufficient evidence, further studies are still needed to support our conclusions.
背景：研究表明肾移植会受到移植前合并症的影响。然而，它们对死亡率和移植物损失的影响仍然不一致。因此，本研究的目的是收集多项研究的数据，分析移植前糖尿病对肾移植结局的影响。方法：我们对PubMed、Embase和Web of Science数据库进行了全面的检索，以确定符合纳入标准的研究。比较移植前糖尿病患者和非移植前糖尿病患者的全因死亡率和移植物损失。采用合并风险比和95%置信区间评估移植前糖尿病的影响。结果：本荟萃分析包括103,983例糖尿病肾移植受者和271,667例非糖尿病肾移植受者。移植前糖尿病患者的全因死亡率为68% (HR:1.68, 95% CI 1.65-1.71, P < 0.01)，高于无糖尿病患者。此外，糖尿病患者的移植物损失比非糖尿病患者高11% （HR:1.11, 95% CI 1.07-1.15, P < 0.01）。两项分析的异质性非常显著，采用meta回归确定异质性的来源。不幸的是，在全因死亡率分析中没有发现。然而，在移植物损失的分析中，样本量和移植时的中位年龄可能是高度异质性的来源。结论：移植前糖尿病与死亡和移植物丢失的风险增加有关。然而，由于异质性显著且证据不足，仍需要进一步的研究来支持我们的结论。
{"title":"Pretransplant Diabetes Mellitus and Kidney Transplant Outcomes: A Systematic Review and Meta-Analysis","authors":"Chao Liu , Qian Chen , Zhou Sun , Guofu Liang , Fu Yan , Yulin Niu","doi":"10.1016/j.transproceed.2024.10.032","DOIUrl":"10.1016/j.transproceed.2024.10.032","url":null,"abstract":"<div><h3>Background</h3><div>Studies have shown that kidney transplantation is affected by pretransplant comorbidities. However, their impacts on mortality and graft loss remain inconsistent. Therefore, the purpose of our study was to collect data from multiple studies to analyze the impact of pretransplant diabetes mellitus on kidney transplant outcomes.</div></div><div><h3>Method</h3><div>We conducted comprehensive searches of the PubMed, Embase, and Web of Science databases to identify studies that met the inclusion criteria. All-cause mortality and graft loss were compared between patients with pretransplant diabetes mellitus and patients without pretransplant diabetes mellitus. The impact of pretransplant diabetes mellitus was assessed using pooled hazard ratios and 95% confidence intervals.</div></div><div><h3>Result</h3><div>This meta-analysis included 103,983 kidney transplant recipients with diabetes mellitus and 271,667 kidney transplant recipients without diabetes mellitus. All-cause mortality was 68% (HR:1.68, 95% CI 1.65-1.71, <em>P</em> < .01) greater in patients with pretransplant diabetes mellitus than in patients without diabetes mellitus. Additionally, graft loss was 11% (HR:1.11, 95% CI 1.07-1.15, <em>P</em> < .01) greater in diabetic patients than in nondiabetic patients. The heterogeneity in the 2 analyses was very significant and meta-regression was used to determine the source of heterogeneity. Unfortunately, it was not found in the analysis of all-cause mortality. However, in the analysis of graft loss, sample size and median age at transplantation may be sources of high heterogeneity.</div></div><div><h3>Conclusion</h3><div>Pretransplant diabetes mellitus is associated with increased risk of mortality and graft loss. However, due to significant heterogeneity and insufficient evidence, further studies are still needed to support our conclusions.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"56 10","pages":"Pages 2149-2157"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-29DOI: 10.1016/j.transproceed.2024.11.008
Toyokazu Endo, Jaimin Trivedi, Erin M. Schumer, Victor H. van Berkel, Matthew P. Fox
There are reports of successful lung transplants using SARS-CoV-2+ donors, but the data on their overall outcome is limited. We used the United Network for Organ Sharing Database (UNOS) to identify all lung transplant patients who received lungs from SARS-CoV-2+ donors between 2020 and 2023. There was no difference in survival between those who received lungs from SARS-CoV-2- and SARS-CoV-2+ donors (P = .60). In addition, the timing of the SARS-CoV-2 test for donors did not affect the outcomes among recipients. Among all SARS-CoV-2+ donors identified since 2020, the lungs used came from younger donors, had better chest x-ray findings, and had a higher P/F ratio. Our data suggest that organ function may be more important than SARS-CoV-2 status when using lungs from SARS-CoV-2+ donors. Further research and follow-up are still needed to adequately address the use of lungs from SARS-CoV-2+ donors, thus further increasing the donor pool.
{"title":"Short-Term Outcomes Among Lung Transplant Recipients from SARS-CoV-2+ Donors and Evaluation of Lung Function Among SARS-CoV-2+ Donors","authors":"Toyokazu Endo, Jaimin Trivedi, Erin M. Schumer, Victor H. van Berkel, Matthew P. Fox","doi":"10.1016/j.transproceed.2024.11.008","DOIUrl":"10.1016/j.transproceed.2024.11.008","url":null,"abstract":"<div><div>There are reports of successful lung transplants using SARS-CoV-2+ donors, but the data on their overall outcome is limited. We used the United Network for Organ Sharing Database (UNOS) to identify all lung transplant patients who received lungs from SARS-CoV-2+ donors between 2020 and 2023. There was no difference in survival between those who received lungs from SARS-CoV-2- and SARS-CoV-2+ donors (<em>P =</em> .60). In addition, the timing of the SARS-CoV-2 test for donors did not affect the outcomes among recipients. Among all SARS-CoV-2+ donors identified since 2020, the lungs used came from younger donors, had better chest x-ray findings, and had a higher P/F ratio. Our data suggest that organ function may be more important than SARS-CoV-2 status when using lungs from SARS-CoV-2+ donors. Further research and follow-up are still needed to adequately address the use of lungs from SARS-CoV-2+ donors, thus further increasing the donor pool.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 2","pages":"Pages 332-338"},"PeriodicalIF":0.8,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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