Pub Date : 2025-01-01DOI: 10.1016/j.transproceed.2024.11.027
Manuel Parra Collado , Paula Gandía Ureña , Eva Gavela Martínez , Julia Kanter Berga , Cristina Castro Alonso , Emma Calatayud Aristoy , Aina Quilis Pellicer , Sandra Beltrán Catalán , Belén Vizcaíno Castillo , Asunción Sancho Calabuig
Background
Patients with non-functioning renal grafts constitute approximately 4% of patients with incident dialysis. Complete withdrawal of immunosuppression has been associated with a higher risk of HLA sensitization and renal graft intolerance syndrome (GIS).
Methods
We conducted a retrospective observational study of 63 patients with renal graft failure (from January 2012 to December 2022). Immediate graft losses due to vascular thrombosis or technical complications were excluded. We analyzed demographic and clinical characteristics, as well as the evolution of GIS. A comparative study was performed with patients who did not develop GIS (non-GIS).
Results
Twenty-three patients (36.5%) developed GIS. The most common presentation was anemia (73.9%), followed by renal graft pain (65.2%). Seventeen patients (74%) required renal graft embolization. GIS was associated with a higher degree of sensitization. We did not find differences in prior HLA sensitization, causes of graft failure, history of acute rejection, or doses/levels of immunosuppression after graft failure, although rejections were more severe in the GIS group. Patients with GIS had a lower rate of retransplantation after graft failure (4.3% vs 25%, P = .02). Graft failure within the first 2 years after transplantation was the main predictive factor for GIS (hazard ratio = 2.740, 95% confidence interval = 1.06–7.06, P = .03).
Conclusions
GIS was more prevalent in patients who experienced graft failure within the first 2 years. Despite increased immunosuppression, a significant percentage required graft embolization. GIS was associated with an increase in HLA sensitization and a lower likelihood of retransplantation.
背景：无功能肾移植患者约占突发透析患者的4%。完全停止免疫抑制与HLA致敏和肾移植不耐受综合征（GIS）的高风险相关。方法：对63例移植肾衰竭患者（2012年1月至2022年12月）进行回顾性观察研究。由于血管血栓形成或技术并发症导致的移植物立即损失被排除在外。我们分析了人口统计学和临床特征，以及地理信息系统的发展。对未发生GIS（非GIS）的患者进行了比较研究。结果：23例（36.5%）发生GIS。最常见的表现是贫血（73.9%），其次是肾移植疼痛（65.2%）。17例（74%）患者需要肾移植栓塞。GIS与较高程度的敏感性相关。虽然GIS组的排斥反应更严重，但我们没有发现之前的HLA致敏性、移植物失败的原因、急性排斥史或移植物失败后免疫抑制的剂量/水平的差异。GIS患者移植失败后再移植率较低（4.3% vs 25%, P = 0.02）。移植后2年内移植物衰竭是GIS的主要预测因素（风险比= 2.740,95%可信区间= 1.06-7.06,P = 0.03）。结论：GIS在前2年内发生移植物衰竭的患者中更为普遍。尽管免疫抑制增强，但仍有很大比例的患者需要移植物栓塞。GIS与HLA敏化增加和再移植可能性降低有关。
{"title":"Graft Intolerance Syndrome Complicates Retransplantation","authors":"Manuel Parra Collado , Paula Gandía Ureña , Eva Gavela Martínez , Julia Kanter Berga , Cristina Castro Alonso , Emma Calatayud Aristoy , Aina Quilis Pellicer , Sandra Beltrán Catalán , Belén Vizcaíno Castillo , Asunción Sancho Calabuig","doi":"10.1016/j.transproceed.2024.11.027","DOIUrl":"10.1016/j.transproceed.2024.11.027","url":null,"abstract":"<div><h3>Background</h3><div>Patients with non-functioning renal grafts constitute approximately 4% of patients with incident dialysis. Complete withdrawal of immunosuppression has been associated with a higher risk of HLA sensitization and renal graft intolerance syndrome (GIS).</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study of 63 patients with renal graft failure (from January 2012 to December 2022). Immediate graft losses due to vascular thrombosis or technical complications were excluded. We analyzed demographic and clinical characteristics, as well as the evolution of GIS. A comparative study was performed with patients who did not develop GIS (non-GIS).</div></div><div><h3>Results</h3><div>Twenty-three patients (36.5%) developed GIS. The most common presentation was anemia (73.9%), followed by renal graft pain (65.2%). Seventeen patients (74%) required renal graft embolization. GIS was associated with a higher degree of sensitization. We did not find differences in prior HLA sensitization, causes of graft failure, history of acute rejection, or doses/levels of immunosuppression after graft failure, although rejections were more severe in the GIS group. Patients with GIS had a lower rate of retransplantation after graft failure (4.3% vs 25%, <em>P</em> = .02). Graft failure within the first 2 years after transplantation was the main predictive factor for GIS (hazard ratio = 2.740, 95% confidence interval = 1.06–7.06, <em>P</em> = .03).</div></div><div><h3>Conclusions</h3><div>GIS was more prevalent in patients who experienced graft failure within the first 2 years. Despite increased immunosuppression, a significant percentage required graft embolization. GIS was associated with an increase in HLA sensitization and a lower likelihood of retransplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 30-32"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928960","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 : 2025-01-01DOI: 10.1016/j.transproceed.2024.12.012
María Araceli Povedano Medina , Álvaro Arnau Prieto , Aitor Parra Zurutuza , Cristina Martínez Amunarriz , María Jesús Bustinduy Odriozola , Xabier Camino Ortiz de Barrón , Esther Pérez Santaolalla , Olga Maíz Alonso , Iasone Benavente Claveras , María Teresa Rodrigo de Tomas
Hemophagocytic lymphohistiocytosis is a potentially fatal multisystemic inflammatory syndrome that is better understood in the pediatric population. Consequently, the diagnostic criteria for adults still derives from studies conducted in the pediatric population. Several genetic mutations and secondary causes, including infections, autoimmunity, and malignancy, have been reported as significant actors in this condition, especially in adults. It is of the utmost importance to identify these triggers, as the treatment of this condition is largely dependent on addressing the underlying cause. Those who have undergone transplantation and whose immune response is already compromised are particularly susceptible to this condition. We present the case of a 74-year-old kidney transplant recipient who was admitted due to a persistent fever of unknown origin, pancytopenia, and splenomegaly. The patient was ultimately diagnosed with hemophagocytic lymphohistiocytosis in our hospital secondary to Epstein–Barr virus, aspergillosis, and leishmania infections. Targeted treatments for the aforementioned conditions led to the resolution of the syndrome and the recovery of the patient. Lymphohistiocytosis is a rare, albeit serious, condition that should be considered a differential diagnosis in the early stages of critical illness in transplant recipient patients. Doing so enables target treatments to be administered as soon as possible.
{"title":"Hemophagocytic Lymphohistiocytosis in a Kidney Transplant Recipient: Case Report","authors":"María Araceli Povedano Medina , Álvaro Arnau Prieto , Aitor Parra Zurutuza , Cristina Martínez Amunarriz , María Jesús Bustinduy Odriozola , Xabier Camino Ortiz de Barrón , Esther Pérez Santaolalla , Olga Maíz Alonso , Iasone Benavente Claveras , María Teresa Rodrigo de Tomas","doi":"10.1016/j.transproceed.2024.12.012","DOIUrl":"10.1016/j.transproceed.2024.12.012","url":null,"abstract":"<div><div>Hemophagocytic lymphohistiocytosis is a potentially fatal multisystemic inflammatory syndrome that is better understood in the pediatric population. Consequently, the diagnostic criteria for adults still derives from studies conducted in the pediatric population. Several genetic mutations and secondary causes, including infections, autoimmunity, and malignancy, have been reported as significant actors in this condition, especially in adults. It is of the utmost importance to identify these triggers, as the treatment of this condition is largely dependent on addressing the underlying cause. Those who have undergone transplantation and whose immune response is already compromised are particularly susceptible to this condition. We present the case of a 74-year-old kidney transplant recipient who was admitted due to a persistent fever of unknown origin, pancytopenia, and splenomegaly. The patient was ultimately diagnosed with hemophagocytic lymphohistiocytosis in our hospital secondary to Epstein–Barr virus, aspergillosis, and leishmania infections. Targeted treatments for the aforementioned conditions led to the resolution of the syndrome and the recovery of the patient. Lymphohistiocytosis is a rare, albeit serious, condition that should be considered a differential diagnosis in the early stages of critical illness in transplant recipient patients. Doing so enables target treatments to be administered as soon as possible.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 90-92"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928961","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 : 2025-01-01DOI: 10.1016/j.transproceed.2024.11.024
Andrea Severo , Javier González Martín , Cristina Mateo Gómez , Josefina Arias Mahiques , Alexia Denisse Aguzezko , María Eugenia Tanaro , Ruth Echeverría , Javier de Juan Bagudá , Christian Muñoz Guijosa , Francisco López Medrano , Juan Delgado , María Dolores García-Cosío Carmena
Background
Cytomegalovirus (CMV) infection is associated with worse outcomes after heart transplant (HT). CMV mismatch (donor positive, recipient negative serology, D+/R-) increases the risk of infection. Guidelines recommend 3 to 6 months of antiviral prophylaxis in these patients. An increase in primary CMV infections at our center prompted us to analyses this population in search of improvement.
Methods
From 185 adult HT receptors in 10 years, we selected those with CMV D+/R-. Patients were followed until October 2023. We evaluated the patterns of transmission of CMV in accordance with current recommendations.
Results
We assessed 35 HT recipients with CMV mismatch (median age of 48.8 ± 13.8 years, 71% men). Median follow-up was 5.5 years [1.9-7.4]. Median duration of CMV prophylaxis was 3.7 (±2.1) months post-HT. CMV infection occurred in 74% of patients (96% within the first 6 months after ending prophylaxis) and CMV disease in 26%. Half of them required hospital admission. One third had concomitant infections by other microorganisms. There were no significant differences in the duration of prophylaxis between patients with and without CMV infection. Survival on follow-up was 77%. 2 patients died during CMV infection due to other infection.
Conclusions
CMV infection rate in D+/R- HT receptors remains high even after the prophylactic period recommended by current guidelines. A better knowledge of CMV-transmitted infection, coupled with the pursuit of a suitable equilibrium between the prevention of infection and rejection, have the potential to enhance the outcomes of this high-risk population through tailored protocols.
{"title":"High-risk Cytomegalovirus in Heart Transplant: How Can We Improve?","authors":"Andrea Severo , Javier González Martín , Cristina Mateo Gómez , Josefina Arias Mahiques , Alexia Denisse Aguzezko , María Eugenia Tanaro , Ruth Echeverría , Javier de Juan Bagudá , Christian Muñoz Guijosa , Francisco López Medrano , Juan Delgado , María Dolores García-Cosío Carmena","doi":"10.1016/j.transproceed.2024.11.024","DOIUrl":"10.1016/j.transproceed.2024.11.024","url":null,"abstract":"<div><h3>Background</h3><div>Cytomegalovirus (CMV) infection is associated with worse outcomes after heart transplant (HT). CMV mismatch (donor positive, recipient negative serology, D+/R-) increases the risk of infection. Guidelines recommend 3 to 6 months of antiviral prophylaxis in these patients. An increase in primary CMV infections at our center prompted us to analyses this population in search of improvement.</div></div><div><h3>Methods</h3><div>From 185 adult HT receptors in 10 years, we selected those with CMV D+/R-. Patients were followed until October 2023. We evaluated the patterns of transmission of CMV in accordance with current recommendations.</div></div><div><h3>Results</h3><div>We assessed 35 HT recipients with CMV mismatch (median age of 48.8 ± 13.8 years, 71% men). Median follow-up was 5.5 years [1.9-7.4]. Median duration of CMV prophylaxis was 3.7 (±2.1) months post-HT. CMV infection occurred in 74% of patients (96% within the first 6 months after ending prophylaxis) and CMV disease in 26%. Half of them required hospital admission. One third had concomitant infections by other microorganisms. There were no significant differences in the duration of prophylaxis between patients with and without CMV infection. Survival on follow-up was 77%. 2 patients died during CMV infection due to other infection.</div></div><div><h3>Conclusions</h3><div>CMV infection rate in D+/R- HT receptors remains high even after the prophylactic period recommended by current guidelines. A better knowledge of CMV-transmitted infection, coupled with the pursuit of a suitable equilibrium between the prevention of infection and rejection, have the potential to enhance the outcomes of this high-risk population through tailored protocols.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 67-69"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928962","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 : 2025-01-01DOI: 10.1016/j.transproceed.2024.11.030
Alba María Fernández González , Ninoska Moreira Lorenzo , Benito Cantador Huertos , Manuel Causse Del Río , Francisco Javier González García , Antonio Álvarez Kindelan
Introduction
Mucorales infections in the airways of lung transplant (LT) patients are rare but have a rising incidence in transplanted lungs.
Objective
We present our experience with LT in immediate postoperative infections due to mucormycosis.
Methods
Review of 767 LT performed in Andalusia between 2000 and 2023 identifying Mucorales through microbiological results and histological findings.
Results
The incidence of Mucorales was less than 1% of all LTs performed at our institution but resulted in 100% mortality. In our series, all cases underwent LT for chronic obstructive pulmonary disease. They presented with pulmonary infection that progressed to disseminated infection. Major associated risk factors included prior corticosteroid treatment, malnutrition, solid organ transplantation, single lung transplantation, immunosuppression, and concomitant Aspergillus infection.
Conclusions
Mucormycosis infection in grafts after lung transplantation is a lethal complication poorly documented in the literature. Vigilance for Mucorales in these patients is crucial for early diagnosis.
{"title":"Mucormycosis Infection in Lung Transplant Patients: Experience in Andalusia, Spain","authors":"Alba María Fernández González , Ninoska Moreira Lorenzo , Benito Cantador Huertos , Manuel Causse Del Río , Francisco Javier González García , Antonio Álvarez Kindelan","doi":"10.1016/j.transproceed.2024.11.030","DOIUrl":"10.1016/j.transproceed.2024.11.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Mucorales infections in the airways of lung transplant (LT) patients are rare but have a rising incidence in transplanted lungs.</div></div><div><h3>Objective</h3><div>We present our experience with LT in immediate postoperative infections due to mucormycosis.</div></div><div><h3>Methods</h3><div>Review of 767 LT performed in Andalusia between 2000 and 2023 identifying Mucorales through microbiological results and histological findings.</div></div><div><h3>Results</h3><div>The incidence of Mucorales was less than 1% of all LTs performed at our institution but resulted in 100% mortality. In our series, all cases underwent LT for chronic obstructive pulmonary disease. They presented with pulmonary infection that progressed to disseminated infection. Major associated risk factors included prior corticosteroid treatment, malnutrition, solid organ transplantation, single lung transplantation, immunosuppression, and concomitant Aspergillus infection.</div></div><div><h3>Conclusions</h3><div>Mucormycosis infection in grafts after lung transplantation is a lethal complication poorly documented in the literature. Vigilance for Mucorales in these patients is crucial for early diagnosis.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 70-72"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928966","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 : 2025-01-01DOI: 10.1016/j.transproceed.2024.12.002
Ignacio Fernández-Granda , Rodrigo Alonso-Moralejo , Carlos-Andrés Quezada-Loaiza , Virginia-Luz Pérez-González , Francisco López-Medrano , Ana Pérez-Ayala , Beatriz González-Blanco , Iván Martínez-Serna , Felisa Jaén-Herreros , Alicia de Pablo-Gafas
The incidence of invasive fungal infections has increased in recent years among transplant patients, with Trichosporon inkin being a rare but relevant etiological agent. This study examines the experience of our multidisciplinary lung transplant unit in the diagnosis and treatment of 6 cases of T. inkin infection in transplant patients from 2016 to 2023. The cumulative incidence was 1.25% (6/480), with 2 temporal clusters: 5 cases between 2016 and 2017, and 1 case in 2023. The patients had a mean age of 59 ± 5.5 years, and all had undergone bilateral lung transplantation. The median time from transplantation to diagnosis was 53 days. Three patients (50%) presented with local dissemination, while the other three (50%) showed hematogenous spread, resulting in a 66.6% (2/3) mortality rate in the latter group. Treatment included the use of azoles, with voriconazole administered either as monotherapy or in combination with other antifungals such as amphotericin B, fluconazole or micafungin. The overall mortality was 33.3% (2/6). These findings highlight the importance of early diagnosis of T. inkin infection in lung transplant patients, as hematogenous dissemination is associated with a significantly worse prognosis. Azole therapy, combined with surgical interventions for localized infections, was effective in the majority of patients. Additional preventive measures were implemented following the initial 5 cases, including environmental cultures, carrier screening, and reverse isolation protocols.
{"title":"Infection by Trichosporon Inkin in Lung Transplant: Rare Infection, or Not So Rare?","authors":"Ignacio Fernández-Granda , Rodrigo Alonso-Moralejo , Carlos-Andrés Quezada-Loaiza , Virginia-Luz Pérez-González , Francisco López-Medrano , Ana Pérez-Ayala , Beatriz González-Blanco , Iván Martínez-Serna , Felisa Jaén-Herreros , Alicia de Pablo-Gafas","doi":"10.1016/j.transproceed.2024.12.002","DOIUrl":"10.1016/j.transproceed.2024.12.002","url":null,"abstract":"<div><div>The incidence of invasive fungal infections has increased in recent years among transplant patients, with <em>Trichosporon inkin</em> being a rare but relevant etiological agent. This study examines the experience of our multidisciplinary lung transplant unit in the diagnosis and treatment of 6 cases of <em>T. inkin</em> infection in transplant patients from 2016 to 2023. The cumulative incidence was 1.25% (6/480), with 2 temporal clusters: 5 cases between 2016 and 2017, and 1 case in 2023. The patients had a mean age of 59 ± 5.5 years, and all had undergone bilateral lung transplantation. The median time from transplantation to diagnosis was 53 days. Three patients (50%) presented with local dissemination, while the other three (50%) showed hematogenous spread, resulting in a 66.6% (2/3) mortality rate in the latter group. Treatment included the use of azoles, with voriconazole administered either as monotherapy or in combination with other antifungals such as amphotericin B, fluconazole or micafungin. The overall mortality was 33.3% (2/6). These findings highlight the importance of early diagnosis of <em>T. inkin</em> infection in lung transplant patients, as hematogenous dissemination is associated with a significantly worse prognosis. Azole therapy, combined with surgical interventions for localized infections, was effective in the majority of patients. Additional preventive measures were implemented following the initial 5 cases, including environmental cultures, carrier screening, and reverse isolation protocols.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 82-85"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934191","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 : 2025-01-01DOI: 10.1016/j.transproceed.2024.11.031
Alejandra Comins-Boo , Víctor Manuel Mora-Fernández , Paula Padrón-Aunceame , María Toriello-Suárez , Elena González-López , Adriel Roa-Bautista , Carolina Castro-Hernández , David Iturbe-Fernández , Manuel Cifrián José , Marco López-Hoyos , David San Segundo
Background
Antibody-mediated rejection (ABMR) has become one of the leading causes of chronic lung graft dysfunction. However, in lung transplantation, this entity is sometimes difficult and controversial to diagnose. It is mainly caused by the appearance of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA), although there are situations with C4d deposits in biopsy in the absence of circulating DSA. The aim of this work was to study the potential role of non-HLA antibodies in the development of ABMR without DSA after lung transplantation.
Methods
A case-control study was designed with a cohort of lung transplant recipients at our institution. Twenty-seven patients with ABMR and without anti-HLA antibodies were identified after lung transplantation, and a control group of 21 transplant recipients was selected with the same post-transplant follow-up without evidence of rejection. Non-HLA antibodies were studied pretransplant using Luminex (ThermoFisher, One Lambda).
Results
The median of the pretransplant non-HLA–positive antibodies in the group with ABMR without DSA is significantly higher than in the control group: 2 (interquartile range, 0–16) vs 0 (interquartile range, 0–1; P < .01). Patients with >1.5 pretransplant non-HLA antibodies were more likely to develop ABMR without DSA (sensitivity, 80.95%; specificity, 55.55%; area under the curve, 71.3%).
Conclusion
The increase of non-HLA antibodies before lung transplantation has recently been shown to increase the risk of chronic lung allograft dysfunction. These results confirm that patients with a higher number of non-HLA antibodies could be at risk of developing ABMR without DSA. These results point out the possible usefulness of pre-lung transplant non-HLA antibodies to identify patients with end-stage lung disease at risk of developing ABMR without DSA.
背景：抗体介导的排斥反应（ABMR）已成为慢性肺移植功能障碍的主要原因之一。然而，在肺移植中，这种实体有时很难诊断并且存在争议。它主要是由供体特异性抗人白细胞抗原（HLA）抗体（DSA）的出现引起的，尽管在没有循环DSA的情况下，活检中也有C4d沉积。这项工作的目的是研究非hla抗体在肺移植后无DSA的ABMR发展中的潜在作用。方法：设计一项病例对照研究，纳入我院肺移植受者队列。在肺移植后发现27例ABMR且无抗hla抗体的患者，并选择21例移植受者作为对照组，接受相同的移植后随访，无排斥反应证据。移植前使用Luminex （ThermoFisher, One Lambda）检测非hla抗体。结果：无DSA的ABMR组移植前非hla阳性抗体中位数显著高于对照组：2（四分位数范围，0-16）vs 0(四分位数范围，0-1；P < 0.01)。移植前非hla抗体为bbb1.5的患者更容易发生无DSA的ABMR(敏感性为80.95%；特异性,55.55%;曲线下面积为71.3%)。结论：肺移植前非hla抗体升高可增加慢性同种异体肺移植功能障碍的风险。这些结果证实，非hla抗体数量较高的患者在没有DSA的情况下可能有发生ABMR的风险。这些结果指出，肺移植前非hla抗体可能有助于识别无DSA的终末期肺病患者发生ABMR的风险。
{"title":"Non-HLA Antibodies and the Risk of Antibody-mediated Rejection without Donor-specific Anti-HLA Antibodies After Lung Transplantation","authors":"Alejandra Comins-Boo , Víctor Manuel Mora-Fernández , Paula Padrón-Aunceame , María Toriello-Suárez , Elena González-López , Adriel Roa-Bautista , Carolina Castro-Hernández , David Iturbe-Fernández , Manuel Cifrián José , Marco López-Hoyos , David San Segundo","doi":"10.1016/j.transproceed.2024.11.031","DOIUrl":"10.1016/j.transproceed.2024.11.031","url":null,"abstract":"<div><h3>Background</h3><div>Antibody-mediated rejection (ABMR) has become one of the leading causes of chronic lung graft dysfunction. However, in lung transplantation, this entity is sometimes difficult and controversial to diagnose. It is mainly caused by the appearance of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA), although there are situations with C4d deposits in biopsy in the absence of circulating DSA. The aim of this work was to study the potential role of non-HLA antibodies in the development of ABMR without DSA after lung transplantation.</div></div><div><h3>Methods</h3><div>A case-control study was designed with a cohort of lung transplant recipients at our institution. Twenty-seven patients with ABMR and without anti-HLA antibodies were identified after lung transplantation, and a control group of 21 transplant recipients was selected with the same post-transplant follow-up without evidence of rejection. Non-HLA antibodies were studied pretransplant using Luminex (ThermoFisher, One Lambda).</div></div><div><h3>Results</h3><div>The median of the pretransplant non-HLA–positive antibodies in the group with ABMR without DSA is significantly higher than in the control group: 2 (interquartile range, 0–16) vs 0 (interquartile range, 0–1; <em>P</em> < .01). Patients with >1.5 pretransplant non-HLA antibodies were more likely to develop ABMR without DSA (sensitivity, 80.95%; specificity, 55.55%; area under the curve, 71.3%).</div></div><div><h3>Conclusion</h3><div>The increase of non-HLA antibodies before lung transplantation has recently been shown to increase the risk of chronic lung allograft dysfunction. These results confirm that patients with a higher number of non-HLA antibodies could be at risk of developing ABMR without DSA. These results point out the possible usefulness of pre-lung transplant non-HLA antibodies to identify patients with end-stage lung disease at risk of developing ABMR without DSA.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 73-76"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928967","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 : 2025-01-01DOI: 10.1016/j.transproceed.2024.11.025
Camino Rodríguez-Villar, Andrea Tomás Pulgarín, Rebeca Roque Ardá, David Paredes-Zapata, Carolina Sanchez Marcos, Sabina Herrera Fernández, Ángel Ruíz Arranz
Background
The viability of the liver pre-transplant depends on the type of donor, age, medical history, circumstances of death, result of analytics, and complementary exploration of the abdominal cavity. Abdominal ultrasound is the initial option for the assessment of previously unknown liver disease, such as the qualitative determination of hepatic steatosis. The presence of hepatic steatosis is considered a risk factor for graft failure after liver transplantation, therefore, at the time of clinical assessment of the donor or its presence in the macroscopic assessment in the operating room can be cause for rejection of the organ by the transplant teams. The objective is the usefulness of ultrasound for the diagnosis of hepatic steatosis and degree of agreement with macroscopic and microscopic findings of the hepatic graft accepted for transplantation.
Methods
We analyzed the results of ultrasound in the population of donors accepted for assessment of the hepatic graft for transplantation and the correlation with the macroscopic finding determined by surgery in the operating room and with the microscopic finding determined by histology in the transplanted grafts. The determinations made describe the demographic variables of the different types of donors, probability of presenting hepatic steatosis, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the use of ultrasound and degree of agreement with macroscopic and microscopic findings.
Results
Of the grafts evaluated, hepatic steatosis was described by ultrasound in 48 of 299 cases (16.05%) and by macroscopic aspect in 79 of 299 cases (26.4%). Coinciding in 29 of 79 (36.70%) of the cases (kappa = 0.328, P = .000). The 63.21% (189/299) of the livers evaluated were valid for transplantation. Of the valid grafts, 9.6% presented steatosis by ultrasound, 8.4% by macroscopy, and 21.4% by histology. An ultrasound that reports hepatic steatosis implies an increase of 1.87 of log-odds that the donor presents macroscopic steatosis (95% confidence interval [CI] = 3.34–12.65, P = .000) according to the binary logistic regression model. The sensitivity of ultrasound for hepatic steatosis based on microscopy was 29%, specificity 91%, PPV 66%, and NPV 68%.
Conclusions
Given the moderate or low agreement among ultrasound, macroscopy, and histology, the bedside portable ultrasound for the diagnosis of hepatic steatosis seems to be a method that undervalues the presence of hepatic steatosis in potential donors accepted for liver transplantation.
背景：肝移植前的生存能力取决于供体类型、年龄、病史、死亡情况、分析结果以及对腹腔的补充探查。腹部超声是评估以前未知的肝脏疾病的最初选择，如肝脂肪变性的定性测定。肝脂肪变性的存在被认为是肝移植后移植物衰竭的危险因素，因此，在对供体进行临床评估时或在手术室进行宏观评估时，肝脂肪变性的存在可能是移植团队排斥器官的原因。目的是超声诊断肝脂肪变性的有用性，以及与接受移植的肝移植物的宏观和微观表现的一致程度。方法：分析肝移植供体人群的超声检查结果，以及与手术室手术确定的宏观表现和移植肝脏组织学确定的微观表现的相关性。所做的决定描述了不同类型供体的人口统计学变量，表现为肝脂肪变性的概率，敏感性，特异性，超声使用的阳性预测值（PPV），阴性预测值（NPV）以及与宏观和微观结果的一致程度。结果：299例肝移植中超声表现为肝脂肪变性48例（16.05%），宏观表现为79例（26.4%）。79例中有29例（36.70%）吻合（kappa = 0.328, P = 0.000）。63.21%（189/299）的肝脏可用于移植。在有效移植物中，9.6%超声表现为脂肪变性，8.4%宏镜表现为脂肪变性，21.4%组织学表现为脂肪变性。根据二元logistic回归模型，超声报告肝脏脂肪变性意味着供体呈现宏观脂肪变性的对数概率增加1.87（95%置信区间[CI] = 3.34-12.65, P = 0.000）。超声对显微镜下肝脂肪变性的敏感性为29%，特异性为91%，PPV为66%，NPV为68%。结论：考虑到超声、宏镜和组织学之间的中等或低一致性，床边便携式超声诊断肝脂肪变性似乎是一种低估肝移植接受的潜在供者肝脂肪变性存在的方法。
{"title":"Usefulness of Portable Ultrasound for the Diagnosis of Hepatic Steatosis and Degree of Agreement With Macroscopic and Microscopic Findings of the Hepatic Graft Accepted for Transplantation","authors":"Camino Rodríguez-Villar, Andrea Tomás Pulgarín, Rebeca Roque Ardá, David Paredes-Zapata, Carolina Sanchez Marcos, Sabina Herrera Fernández, Ángel Ruíz Arranz","doi":"10.1016/j.transproceed.2024.11.025","DOIUrl":"10.1016/j.transproceed.2024.11.025","url":null,"abstract":"<div><h3>Background</h3><div>The viability of the liver pre-transplant depends on the type of donor, age, medical history, circumstances of death, result of analytics, and complementary exploration of the abdominal cavity. Abdominal ultrasound is the initial option for the assessment of previously unknown liver disease, such as the qualitative determination of hepatic steatosis. The presence of hepatic steatosis is considered a risk factor for graft failure after liver transplantation, therefore, at the time of clinical assessment of the donor or its presence in the macroscopic assessment in the operating room can be cause for rejection of the organ by the transplant teams. The objective is the usefulness of ultrasound for the diagnosis of hepatic steatosis and degree of agreement with macroscopic and microscopic findings of the hepatic graft accepted for transplantation.</div></div><div><h3>Methods</h3><div>We analyzed the results of ultrasound in the population of donors accepted for assessment of the hepatic graft for transplantation and the correlation with the macroscopic finding determined by surgery in the operating room and with the microscopic finding determined by histology in the transplanted grafts. The determinations made describe the demographic variables of the different types of donors, probability of presenting hepatic steatosis, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the use of ultrasound and degree of agreement with macroscopic and microscopic findings.</div></div><div><h3>Results</h3><div>Of the grafts evaluated, hepatic steatosis was described by ultrasound in 48 of 299 cases (16.05%) and by macroscopic aspect in 79 of 299 cases (26.4%). Coinciding in 29 of 79 (36.70%) of the cases (kappa = 0.328, <em>P</em> = .000). The 63.21% (189/299) of the livers evaluated were valid for transplantation. Of the valid grafts, 9.6% presented steatosis by ultrasound, 8.4% by macroscopy, and 21.4% by histology. An ultrasound that reports hepatic steatosis implies an increase of 1.87 of log-odds that the donor presents macroscopic steatosis (95% confidence interval [CI] = 3.34–12.65, <em>P =</em> .000) according to the binary logistic regression model. The sensitivity of ultrasound for hepatic steatosis based on microscopy was 29%, specificity 91%, PPV 66%, and NPV 68%.</div></div><div><h3>Conclusions</h3><div>Given the moderate or low agreement among ultrasound, macroscopy, and histology, the bedside portable ultrasound for the diagnosis of hepatic steatosis seems to be a method that undervalues the presence of hepatic steatosis in potential donors accepted for liver transplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 43-47"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960925","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}
Liver transplantation is an important treatment option for liver cirrhosis in patients with HIV/HCV coinfection. In Japan, the limited number of deceased donors may force the selection of living donor liver transplantation. Appropriate graft selection is the key to success.
Case presentation
The patient, a 66-year-old male with hemophilia A, acquired HIV and HCV through blood transfusions. He had a multidrug-resistant HIV strain, requiring frequent changes in antiretroviral therapy. Although his HCV cleared spontaneously, liver fibrosis progressed. With a Child-Pugh score of 9 and a MELD score of 13, liver transplantation was considered. His child became the living donor. A factor VIII concentrate test was performed preoperatively, and his HIV treatment was adjusted to avoid drug interactions. The chosen graft was a posterior segment (graft-to-recipient weight ratio of 0.8), and surgery lasted 787 min with a blood loss of 7046 g. Factor VIII concentrate was stopped on the second postoperative day as activity increased. The patient was discharged on postoperative day 47.
Conclusion
This is the first reported living donor liver transplantation using a posterior segment graft in a hemophilia patient coinfected with HIV and HCV. Liver transplantation can be safely performed by formulating a preoperative coagulation factor supplementation protocol.
{"title":"Living Donor Liver Transplantation Using Right Posterior Section Graft in a Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patient With Hemophilia: A Case Report","authors":"Takanobu Hara , Ayaka Sato , Akihiko Soyama , Hajime Matsushima , Takashi Hamada , Hajime Imamura , Ayaka Kinoshita , Kazushige Migita , Yuta Kawaguchi , Tomohiko Adachi , Tetsuya Hara , Tomoyuki Endo , Susumu Eguchi","doi":"10.1016/j.transproceed.2024.12.033","DOIUrl":"10.1016/j.transproceed.2024.12.033","url":null,"abstract":"<div><h3>Background</h3><div>Liver transplantation is an important treatment option for liver cirrhosis in patients with HIV/HCV coinfection. In Japan, the limited number of deceased donors may force the selection of living donor liver transplantation. Appropriate graft selection is the key to success.</div></div><div><h3>Case presentation</h3><div>The patient, a 66-year-old male with hemophilia A, acquired HIV and HCV through blood transfusions. He had a multidrug-resistant HIV strain, requiring frequent changes in antiretroviral therapy. Although his HCV cleared spontaneously, liver fibrosis progressed. With a Child-Pugh score of 9 and a MELD score of 13, liver transplantation was considered. His child became the living donor. A factor VIII concentrate test was performed preoperatively, and his HIV treatment was adjusted to avoid drug interactions. The chosen graft was a posterior segment (graft-to-recipient weight ratio of 0.8), and surgery lasted 787 min with a blood loss of 7046 g. Factor VIII concentrate was stopped on the second postoperative day as activity increased. The patient was discharged on postoperative day 47.</div></div><div><h3>Conclusion</h3><div>This is the first reported living donor liver transplantation using a posterior segment graft in a hemophilia patient coinfected with HIV and HCV. Liver transplantation can be safely performed by formulating a preoperative coagulation factor supplementation protocol.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 122-125"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967684","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 : 2025-01-01DOI: 10.1016/j.transproceed.2024.11.013
Hany M. El Hennawy , Eisa Al Atta , Amal Awadh , Omar Safar , Shaher Al Kawasmeh , Yasser S. Mansour , Mohammad F. Zaitoun , Abdullah S. Al Faifi
Short donor renal artery during nephrectomy poses a technical challenge. We present a main renal artery (RA) reconstruction case in Living-donor kidney transplantation (LDKT) using an extension polytetrafluoroethylene vascular graft(PTFE). A 57-year-old man received LDKT from his son. Postlaparoscopic donor nephrectomy, a PTFE graft was used to reconstruct the short RA. Excellent reperfusion, good renal turgor, and immediate urine production were noted. Serial Doppler assessments on postoperative days 1, 3, and 7 and 180 confirmed good blood flow. The PTFE graft did not cause any additional morbidity or complications related to kidney transplantation.
{"title":"Successful Vascular Graft Reconstruction of Short Renal Artery Using Polytetrafluoroethylene (PTFE) in Living Donor Kidney Transplantation—A Case Report and Review of Literature","authors":"Hany M. El Hennawy , Eisa Al Atta , Amal Awadh , Omar Safar , Shaher Al Kawasmeh , Yasser S. Mansour , Mohammad F. Zaitoun , Abdullah S. Al Faifi","doi":"10.1016/j.transproceed.2024.11.013","DOIUrl":"10.1016/j.transproceed.2024.11.013","url":null,"abstract":"<div><div>Short donor renal artery during nephrectomy poses a technical challenge. We present a main renal artery (RA) reconstruction case in Living-donor kidney transplantation (LDKT) using an extension polytetrafluoroethylene vascular graft(PTFE). A 57-year-old man received LDKT from his son. Postlaparoscopic donor nephrectomy, a PTFE graft was used to reconstruct the short RA. Excellent reperfusion, good renal turgor, and immediate urine production were noted. Serial Doppler assessments on postoperative days 1, 3, and 7 and 180 confirmed good blood flow. The PTFE graft did not cause any additional morbidity or complications related to kidney transplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 1","pages":"Pages 100-104"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782145","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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