Transplantation proceedings最新文献

Background

Understanding COVID-19 vaccine hesitancy in organ transplant recipients (OTRs) is critical given clear—albeit attenuated—benefits from vaccination.

Methods

Adult OTRs were surveyed regarding sociodemographic data, medical history, and vaccine-related values. A novel outcome variable called the Vaccine Acceptance Composite Score (VACS) was built as the average Likert score of seven domains of vaccine confidence. To examine its association with several factors and individual adherence to COVID-19 vaccine recommendations, univariable odds ratios and relative operating characteristic areas under the curve (AUC) values were calculated.

Results

Of 46 OTRs included, 32.6% identified as female, 13.3% as Black, and 6.77% as Hispanic or Latino/a/x. The median age was 58 years old. 93.5% of patients were kidney transplant recipients, and 63.0% previously had COVID-19. Patients were most concerned about COVID-19 vaccine-associated risks (46.3%), its potential effect on allograft (47.6%), and motives of government officials involved with vaccine policy (55.6%). Politically conservative patients were likelier to have lower VACS, whereas those who lived with someone ≥65 years old were likelier to have higher VACS. The VACS was not significantly associated with race, income, religious beliefs, comorbidities, COVID-19 history, or influenza vaccination status. Higher VACS was associated with ≥3 and ≥4 COVID-19 immunizations.

Conclusions

This study highlighted political beliefs and elderly household members as correlates of vaccine acceptance among OTRs. The VACS may be a useful tool to help standardize multifaceted analyses in vaccination-focused behavioral research. In clinical practice, it could help identify individuals and groups at risk for vaccine hesitancy, who may benefit from tailored outreach and educational interventions.

Late recurrence of hepatocellular carcinoma (HCC) following orthotopic liver transplant (OLT) is infrequently reported, and among cases, those isolated to the spine are rare. Prognoses are poor for this patient population, and no work has been undertaken to create uniform guidelines for management. Here, we report two cases of late recurrent HCC to the spine after OLT and favorable survival outcomes following intervention.

Background

The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft versus host disease (GVHD) for haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT). There is limited data on the role of PTCy as GVHD prophylaxis in matched-sibling and fully matched-unrelated donor (MSD/MUD) allo-HSCT.

Methods

Our single-center retrospective study aims to compare outcomes of PTCy alone or in combination with mycophenolate mofetil and tacrolimus (PTCy/MMF/TAC) relative to methotrexate and tacrolimus (MTX/TAC). The primary endpoint of our study was GVHD-free, relapse free survival (GRFS). Secondary endpoints were overall survival (OS), disease free survival (DFS), and incidence of severe acute and chronic GVHD. We identified 74 adult patients who underwent MSD/MUD allo-HSCT at our institution from 2015 to 2023.

Results

Within our cohort, 33.8% (n = 25) received MTX/TAC, while 54.0% (n = 40) received PTCy/MMF/TAC, and 12.2% (n = 9) received PTCy alone. Patients receiving PTCY had the longest time to neutrophil engraftment relative to MTX/TAC (15 days vs. 12 days, P = .010). PTCy/MMF/TAC was associated with improved GRFS relative to MTX/TAC (hazard ratio [HR] = HR 0.42, 95% CI 0.19-0.93, P = .031), which persisted when controlling for age. Incidence of chronic GVHD was lower in the PTCy/MMF/TAC group compared to MTX/TAC (1-year 9.0% vs. 30.1%, HR 0.19, 95% CI 0.06-0.59, P = .005). However, OS and DFS were comparable across all groups.

Conclusions

Our results demonstrate decreased rates of severe chronic GVHD resulting in improved GRFS when using PTCy/TAC/MTX as GVHD prophylaxis compared to MTX/TAC in MSD/MUD.

Introduction

Patients with advanced lung disease who have HLA antibodies against potential donors have reduced opportunities for transplant. Not all HLA antibodies, however, have the same impact on post-transplant outcomes. It is unknown whether HLA antibodies arising in the context of autoimmune lung disease are associated with increased antibody mediated rejection (AMR) or bronchiolitis obliterans stage 1 (BOS1)-free survival.

Methods

This study used retrospective data from SRTR to examine BOS1-free survival and AMR among sensitized recipients with autoimmune ILD compared to sensitization recipients with nonautoimmune ILD, accounting for other sources of sensitization such as pregnancy and blood transfusions. This study did not use organs from prisoners and participants were neither coerced nor paid.

Results

Sensitized recipients with autoimmune ILD did not have differences in BOS1-free survival when adjusting for sensitizing exposures (HR = 0.90, 95% CI: 0.70-1.16) or clinical covariates (HR = 0.96, 95% CI: 0.83-1.12). There was also no difference in AMR (OR = 1.92, 95% CI: 1.04-3.52).

Conclusions

HLA antibodies arising in the context of autoimmune ILD do not appear to have a differential impact on BOS1-free survival or AMR. This provides further evidence that patients sensitized via autoimmune lung diseases do not require separate decision-making regarding HLA antibody status compared to the overall sensitized population.

Background

The early detection of myeloid engraftment after hematopoietic stem cell transplantation (HSCT) is of clinical importance for clinicians. In this study, we evaluated whether serum lactic dehydrogenase enzyme levels are significant predictors in the early detection of successful myeloid engraftment after HSCT.

Methods

The study included 74 patients, all of whom underwent HSCT between February 2014 and June 2020. Serum lactic dehydrogenase (LDH) enzyme and complete blood parameters were evaluated at the start of the preparation regimen, on the day of product infusion, 5 days before myeloid engraftment, on the day of myeloid engraftment, and 5 days after engraftment.

Results

LDH enzyme levels increased statistically significantly 5 days before myeloid engraftment (P = .005), and this increase was observed to continue on the day of engraftment, and 5 days after engraftment, but the differences between the measurements 5 days before engraftment and those on the day of engraftment, and 5 days after engraftment were statistically insignificant (P > .05). There was no significant difference in LDH enzyme levels between the measurements made at the beginning of the preparation regimen and those made on the infusion day (P > .05).

Conclusions

Increased LDH enzyme levels after HSCT are associated with increased myelopoiesis in the bone marrow. The monitoring of serum LDH levels and the detection of the onset of increase in enzyme levels in patients undergoing HSCT may be predictors of engraftment.

Background

Polycystic kidney disease (PKD) is the most common hereditary kidney disorder. In most patients, the disease progresses to end stage kidney disease, which is treated preferably by kidney transplantation. In certain clinical circumstances, a pretransplant nephrectomy is indicated. Data regarding long-term outcomes of pretransplant nephrectomy are limited. In this study, we aimed to compare patient and graft survival, as well as other long-term outcomes of kidney transplantation, between patients with PKD who had a pretransplant nephrectomy and those who have not.

Methods

A retrospective analysis of 112 adult kidney transplant recipients with PKD, 36 (32.14%) of which underwent a pretransplant nephrectomy.

Results

In a mean follow-up period of 79 and 129 months (for patients who underwent nephrectomy and patients who did not, respectively), no significant differences were found in patient and graft survival, after adjustment to age and donor type. In addition, rate of hospitalizations, urinary tract infections requiring hospitalization, diabetes mellitus, and erythrocytosis post-transplant were similar in both cohorts.

Conclusions

Pretransplant nephrectomy in patients with PKD is not associated with increased risk of mortality and other long-term complications following kidney transplantation.

Background

Complications and comorbidities that may develop after living donor liver transplantation may necessitate rehospitalization after discharge. We aimed to investigate the demographic and clinical factors affecting rehospitalization after discharge.

Methods

Two hundred seventy patients who underwent living-donor liver transplantation (LDLT) for end-stage liver cirrhosis were included in the study. Patients were divided into two groups as readmission group and others for statistical analysis. Age, gender, body mass index (BMI), model for end-stage liver disease (MELD), Child scores, etiology, blood product transfusion, anhepatic phase, cold ischemia time, operation time, graft-to-recipient weight ratio (GRWR), the type of recipient hepatic artery and hepatic vein utilized in the anastomoses, presence of liver segment 5, segment 8 and inferior accessory hepatic vein, presence of thrombosed, single or reconstructed portal vein, number of bile ducts, use of right, left/left lateral segment graft, postoperative intensive care unit and total hospitalization durations, surgical complications such as leakage/stricture, postoperative portal vein thrombosis, postoperative hepatic vein thrombosis, primary graft dysfunction, intra-abdominal hemorrhage, and postoperative early reoperation were statistically analyzed for readmission. In addition, patients with rehospitalization and others were statistically compared in terms of mortality and survival.

Results

There was no statistical difference among etiologic factors, demographic findings, decompensation findings, comorbidities, perioperative findings, hospital durations, mortality, and survival (P > .05). Only patients with bile leakage/stricture had a statistically higher rehospitalization rate (P = .000).

Conclusion

Biliary complications are the most frequent cause of hospital rehospitalization following living donor liver transplantation.

Background

China experienced one of the largest spikes in COVID-19 several months ago, followed by multiple rounds of reinfections. COVID-19 predisposes to the development of acute kidney injury (AKI) which has a higher developing risk in organ transplant recipients. However, few studies reported multiple infections and changes in renal function in the kidney transplant population in China.

Method

We followed up the patients who underwent kidney transplantation who completed our questionnaire at the initial spike of the epidemic and analyzed their infections and changes in renal function and analyzed the factors affecting the changes in renal function.

Result

A total of 148 patients were included and the follow-up time was 9 months. One hundred forty (94.6%) of our patients were infected with SARS-CoV-2 with clear evidence. Hospitalization rates were highest in the fifth month at 25.0%, and in the first month was at 15.0%. No patients were found to have been transferred to the intensive care unit or died during the follow-up period. Before the COVID-19 epidemic, the glomerular filtration rate (GFR) was 92.71 ± 28.80 (95% confidence interval [CI] = 88.02–97.41) mL/min /1.73 m², and at the follow-up time it was 90.81 ± 28.12 (95% CI = 86.23–95.40) mL/min /1.73 m² (P = 0.050). Fifty-seven (38.8%) patients had a rise in their GFR, and 4 (2.7%) patients increased over 30%. No patient resumed dialysis during the follow-up period. No factors significantly affected the GFR of the patients.

Conclusion

Kidney transplant recipients were more symptomatic only with the first SARS-CoV-2 infection and less symptomatic with subsequent repeat infections. SARS-CoV-2 has little effect on renal function in the kidney transplantation population.

Quality of life (QoL) is a vital aspect of postdonation amongst donors, especially elderly donors. There is a limited study from India assessing the QoL amongst young live donors (YLD), and no study has been done on the elderly sub-group. This study was undertaken to determine the donors' sociodemographic and essential clinical characteristics, as well as to study the QoL of the live kidney donors and compare the QoL of elderly and young donors. Baseline demographic characters taken from the RTR registration register and SF-36 questionnaire were used to assess the QoL at baseline, discharge post-transplant, 1 month, 3 months, 6 months, and 12 months through an interview. We found that the QoL of the elderly donors in postkidney donation returns to baseline at the end of 6 months in all dimensions of the QoL amongst the North Indian population. The physical function is better amongst elderly donors at the end of 3 and 6 months than among young donors. The study's findings must be propagated to increase the donation of kidneys to older people. This is the first of its kind from India, necessitating further multicentric study.

Objective

The aim of this study was to observe the recovery of liver function in patients with early allograft dysfunction (EAD) at one month postoperatively and explore whether early postoperative ultrasonic hemodynamic parameters can predict this outcome.

Methods

Patients with EAD postoperatively, who underwent orthotopic liver transplantation (OLT) in our hospital from December 2012 to June 2021, were retrospectively collected. Based on the recovery of liver function within one month, patients were divided into two groups: the recovery group (FR-1M) and the non-recovery group (Non-FR-1M). Ultrasonic hemodynamic parameters within the first seven days postoperatively were compared between the two groups.

Results

Among the 254 EAD patients included in this study, 158 (62%) patients recovered their liver function within one month. Of the 96 (38%) patients who did not recover, The RI of the non-FR-1M group was significantly lower than that of the FR-1M group on postoperative day 6 (POD6) and POD7. In the high resistance interval (RI all > 0.7), Group FR-1M represents a significant proportion (29/3, ratio 12/1), while in the low resistance interval (RI < 0.5 at least once), Group non-FR-1M accounts for a relatively high proportion (12/27, ratio 5/11). In the middle resistance interval (more than 1 time ≤ 0.7 and all ≥ 0.5), the proportions of the two groups are balanced (85/88, ratio 1/1).

Conclusion

Liver function typically recovers within 1 month in most patients with EAD. The high resistance state of the hepatic artery in the early postoperative period is illustrative an important role in its recovery. Low-resistance state is most unfavorable for the recovery of liver function.