Transplantation proceedings最新文献_第4页

Perceptions of Health-Related Quality of Life Among Heart Transplant Recipients: A Qualitative Study 心脏移植受者对健康相关生活质量的认知：一项定性研究

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.025

Redouane Mahmoudi , Pascal Battistella , Laurent Sebbag , Latame Komla Adoli , Francis Guillemin , Cécile Couchoud

Background

There is a need to improve knowledge of the health-related quality of life (HRQoL) in the post-heart transplantation (HTx) period and the factors affecting it. This qualitative study aimed to identify the most important domains of HRQoL for heart transplant recipients and the factors that impact it.

Methods

This was a qualitative study across 5 geographically diverse large HTx centers in France from July 2022 to January 2023. We gathered a purposive sample of individuals who had undergone HTx. A face-to-face semi-structured interview guide was used for individual interviews. All interviews were audio-recorded and transcribed verbatim.

Results

A total of 14 individuals (10 men) were interviewed. The data analysis led to the development of 8 main themes (with sub-themes) that were relevant to participants: HRQoL perception (mental health, physical capacity, symptoms and comorbidities), participants’ experience during the HTx process, immunosuppressive treatments, relationship with the healthcare team, external and internal resources, socio-economic aspects and feelings about the donor. Recipients, spontaneously made connections between these themes.

Conclusions

Heart transplant recipients had diverse perceptions of their HRQoL in the post-HTx period. The rich variety of themes identified from the review highlights that recipients have a complex HRQoL profile which is not currently captured by standard HRQoL tools that are commonly employed. These aspects should be taken into account in the clinical follow-up and in the selection of the most appropriate Patient Reported Outcome Measures (PROMs).

背景：有必要提高对心脏移植后（HTx）期健康相关生活质量（HRQoL）及其影响因素的认识。本定性研究旨在确定心脏移植受者HRQoL的最重要领域及其影响因素。方法：从2022年7月至2023年1月，对法国5个地理位置不同的大型HTx中心进行定性研究。我们收集了一个有目的的样本，这些人都经历过HTx。个别访谈采用面对面半结构化访谈指南。所有采访都有录音记录，并逐字抄写。结果：共访谈14人（男性10人）。数据分析导致与参与者相关的8个主题（含子主题）的发展：HRQoL感知（心理健康、身体能力、症状和合并症）、参与者在HTx过程中的经历、免疫抑制治疗、与医疗团队的关系、外部和内部资源、社会经济方面和对捐赠者的感受。接受者会自发地将这些主题联系起来。结论：心脏移植受者在htx术后对其HRQoL有不同的看法。从审查中确定的丰富多样的主题突出表明，收件人具有复杂的HRQoL概况，目前通常使用的标准HRQoL工具无法捕捉到这一点。在临床随访和选择最合适的患者报告结果测量（PROMs）时应考虑到这些方面。

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引用次数: 0

Extracorporeal Support Can Avoid Pediatric Donor Organ Donation Failure Caused by Unfinished Brain Death Determination 体外支持可避免因未完成脑死亡判定而导致的儿童供体器官捐赠失败。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.019

Rongfang Deng , Chaoyang Gong , Decheng Deng , Jingcai Hou , Weixiang Cheng , Guojun Li , Xiaozu Liao , Yi Yu

Background

Unstable donors increase the difficulty and unpredictability of organ donation. The unsuccessful maintenance of unstable donors not only impacts the quality of donor organs, but may also affect the determination of brain or heart death. Two clinical determinations of pediatric brain death in most countries are a requirement. However, an emergency situation, such as cardiac arrest, could be encountered during the brain death determination process.

Case Report

An 11-year-old boy (145 cm tall and weighing 40 kg) weigh suffered from craniocerebral injury after a fall 6 days before being admitted to the local hospital on June 9, 2021. He was confirmed to satisfy the pediatric brain death criteria during a first determination. However, sudden cardiac arrest occurred owing to hemodynamic instability and infection. According to the Chinese pediatric brain death determination guideline, Maastricht class Ⅳ donation after circulatory death was not permitted owing to the incomplete determination of brain death. The conditions for Maastricht class Ⅴ donation after circulatory death were also not met because the donor was far from the operating room. Extracorporeal membrane oxygenation support was initiated, with a rotational speed of 2400 rotations per minute, a flow rate of 2.4 to 2.6 L/min, and a fraction of inspired oxygen of 100%. The patient was returned to a stable state with evidence of a normal electrocardiogram and blood oxygen saturation of 100%. The second brain death determination was successfully implemented, leading to successful donation and organ transplantation.

Conclusion

When cardiac arrest occurs between the 2 required pediatric brain death determinations, promptly initiating extracorporeal support for donor maintenance and completing the second brain death assessment is more advantageous than proceeding directly to Maastricht category donation after circulatory death.

背景：不稳定的供者增加了器官捐献的难度和不可预测性。不稳定供体的维持不成功，不仅会影响供体器官的质量，还可能影响脑或心死亡的判定。在大多数国家，儿童脑死亡的两项临床鉴定是必需的。然而，在确定脑死亡的过程中，可能会遇到心脏骤停等紧急情况。病例报告：一名11岁男孩（身高145厘米，体重40公斤）在跌倒6天后发生颅脑损伤，于2021年6月9日住进当地医院。在第一次鉴定中，他被证实符合儿童脑死亡标准。然而，由于血流动力学不稳定和感染，心脏骤停发生。根据中国儿童脑死亡鉴定指南，由于脑死亡鉴定不完全，不允许循环死亡后的马斯特里赫特班级Ⅳ捐赠。马斯特里赫特级Ⅴ循环死亡后捐赠的条件也不符合，因为捐赠者远离手术室。启动体外膜氧合支持，转速2400转/分钟，流速2.4 ~ 2.6 L/min，吸入氧分数为100%。患者恢复到稳定状态，心电图正常，血氧饱和度100%。成功实施第二次脑死亡判定，成功捐赠和器官移植。结论：当两次所需的儿童脑死亡判定之间发生心脏骤停时，及时启动体外支持维持供体并完成第二次脑死亡评估比循环死亡后直接进行马斯特里赫特分类捐赠更有利。

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引用次数: 0

Murine Typhus in Heart and Kidney Transplant Recipients: First Reported Cases Diagnosed by Microbial Cell-Free DNA Sequencing 小鼠斑疹伤寒在心脏和肾脏移植受者：首次报道的病例诊断的微生物细胞无DNA测序。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.018

Baraa Saad , Sabiha Armin , Adrienne DaGue , Lucas S. Blanton , Rodrigo Hasbun

Murine typhus, caused by Rickettsia typhi, is a flea-borne illness that can present as an undifferentiated febrile syndrome and is often underrecognized in immunocompromised individuals. We report the first known cases in heart and kidney transplant recipients, both diagnosed using microbial cell-free DNA (mcfDNA) sequencing. The heart transplant patient presented with encephalopathy and hyponatremia, while the kidney transplant patient had fever and gastrointestinal symptoms. In both cases, mcfDNA sequencing enabled early detection of R. typhi prior to IgG seroconversion, allowing timely initiation of doxycycline and clinical recovery. These cases underscore the protean manifestations of murine typhus in solid organ transplant recipients and the utility of molecular diagnostics in this population. Clinicians should consider murine typhus in febrile transplant patients, especially those residing in or returning from endemic areas, to facilitate early recognition and appropriate treatment.

鼠斑疹伤寒由立克次体斑疹伤寒引起，是一种跳蚤传播的疾病，可表现为未分化的发热综合征，在免疫功能低下的个体中往往未得到充分认识。我们报告了心脏和肾脏移植受者的第一例已知病例，两者都使用无微生物细胞DNA （mcfDNA）测序进行诊断。心脏移植患者表现为脑病和低钠血症，肾移植患者表现为发热和胃肠道症状。在这两种情况下，mcfDNA测序能够在IgG血清转化之前早期检测到斑疹伤寒，从而及时启动强力霉素和临床恢复。这些病例强调了鼠斑疹伤寒在实体器官移植受者中的多种表现，以及分子诊断在这一人群中的应用。临床医生应考虑发热移植患者（特别是居住在流行地区或从流行地区返回的患者）是否患有鼠斑疹伤寒，以促进早期识别和适当治疗。

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引用次数: 0

Understanding Decision Making and Post-Donation Experiences for Robotic Single Port and Laparoscopic Donor Nephrectomy 机器人单口和腹腔镜供肾切除术的决策和术后经验。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.015

Daniel Wang , Christopher Connors , Juan Sebastian Arroyave Villada , Esther Kim , Julian Snyder , Micah Levy , Chih Peng Chin , Dianne LaPointe Rudow , Edward Chin , Alan Benvenisty , Ron Shapiro , Daniel Herron , Sander Florman , Modassar Awan , Francisca Larenas , Michael A. Palese

Introduction

Understanding decision-making and post-donation experiences in living kidney donors informs more effective pre-donation counseling and follow-up care. This study examined factors influencing donation decisions and post-operative experiences among patients who underwent laparoscopic donor nephrectomy (LDN) or single port robotic-assisted donor nephrectomy (SPRDN).

Methods

We conducted a retrospective survey of patients who underwent LDN or SPRDN by a single surgeon between 2013 and 2024 using a study-specific questionnaire. Participants rated pre-donation factors based on importance in their decision to donate. Responses were analyzed based on donor age, sex and relationship to recipient. Donors then reported on their post-donation experiences, and responses were analyzed by surgical approach.

Results

Sixty-eight patients completed the survey (44% response rate). Donors rated long-term renal function and personal fulfillment as the most important factors when deciding to donate. Additionally, female donors prioritized personal fulfillment significantly more than male donors and younger donors were significantly more concerned about post-operative complications and recovery than older donors. After donation, most donors reported increased happiness and minimal quality-of-life impact, though nearly half expressed greater caution in daily activities. Notably, SPRDN donors were significantly more likely to report faster-than-expected recovery compared to LDN donors.

Conclusions

Donors prioritize long-term kidney health and personal fulfillment when considering donation, underscoring the need to address these concerns during preoperative counseling. Following donation, ongoing lifestyle education is essential to address persistent post-donation caution and ensure long-term donor well-being. SPRDN is as a promising alternative for LKD, potentially enhancing the donor experience through faster recovery.

前言：了解活体肾脏供者的决策和捐赠后的经验，有助于更有效的捐献前咨询和后续护理。本研究探讨了影响腹腔镜供肾切除术（LDN）或单端口机器人辅助供肾切除术（SPRDN）患者捐赠决定和术后经历的因素。方法：我们对2013年至2024年间由单一外科医生进行LDN或SPRDN的患者进行回顾性调查，采用研究特异性问卷。参与者根据捐赠决定的重要性对捐赠前因素进行评级。根据供者的年龄、性别和与接受者的关系对反应进行分析。然后供者报告其捐赠后的经历，并通过手术方法分析反应。结果：68例患者完成调查，有效率44%。捐赠者将长期肾功能和个人成就感作为决定捐赠的最重要因素。此外，女性献血者比男性献血者更重视个人成就感，年轻献血者比年长献血者更关注术后并发症和恢复。捐赠后，大多数捐赠者报告幸福感增加，生活质量受到的影响最小，尽管近一半的人表示在日常活动中更加谨慎。值得注意的是，与LDN供者相比，SPRDN供者更有可能报告比预期更快的恢复。结论：捐赠者在考虑捐赠时优先考虑肾脏的长期健康和个人成就感，强调在术前咨询时需要解决这些问题。捐赠后，持续的生活方式教育对于解决捐赠后持续的谨慎和确保捐赠者的长期健康至关重要。SPRDN被认为是LKD的一种有希望的替代方案，通过更快的恢复，可能会改善供体的体验。

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引用次数: 0

Enhancing Organ Donation from Brain-Dead Patients: Efficacy of an Innovative Physician-Patient Communication Model 促进脑死亡患者器官捐献：创新医患沟通模式的效果。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.024

Min Zhang, Gaosheng Zhou

Objective

To identify factors influencing organ donation success among brain-dead patients and evaluate the efficacy of a novel physician-patient communication model (“1T+3S Principles” and “T-F-B Framework”).

Methods

In this randomized controlled trial, 153 eligible brain-dead patients from a tertiary ICU (September 2020-December 2023) were allocated to a control group (conventional communication, n = 77) or study group (innovative model, n = 76). Donation success rates, organ utilization, and predictive factors were analyzed.

Results

The study group demonstrated significantly higher donation success rates (heart: 27.63% vs. 3.90%; liver: 26.32% vs. 3.90%; kidney: 25.00% vs. 3.90%; all P < .001) and organ utilization (P < .05). Key success predictors included: higher education (Master’s↑: OR = 5.65, P = .010), hospitalization >7 days (OR = 7.70, P < .001), fewer immediate family members (OR = 6.58, P < .001), and reduced extended family intervention (OR = 7.16, P < .001). Low-income families (Monthly income<3000 RMB) showed greater donation acceptance (P = .003).

Conclusion

The innovative communication model significantly improves donation success, particularly among educated, low-income families with streamlined decision-makers. Systematic adoption of this framework could mitigate China’s organ shortage crisis.

目的：探讨影响脑死亡患者器官捐献成功的因素，评价新型医患沟通模式（“1T+3S原则”和“T-F-B框架”）的效果。方法：在本随机对照试验中，153例符合条件的三级ICU脑死亡患者（2020年9月- 2023年12月）被分配到对照组（传统通讯组，n = 77）和研究组（创新模式组，n = 76）。分析捐赠成功率、器官利用率及预测因素。结果：研究组的捐献成功率（心脏27.63% vs. 3.90%；肝脏26.32% vs. 3.90%；肾脏25.00% vs. 3.90%, P < 0.001）和器官利用率（P < 0.05）均显著高于对照组。关键的成功预测因素包括：高等教育（硕士学位↑：OR = 5.65, P = 0.010）、住院7天（OR = 7.70, P < 0.001）、直系亲属减少（OR = 6.58, P < 0.001）和大家庭干预减少（OR = 7.16, P < 0.001）。结论：创新的沟通模式显著提高了捐赠成功率，尤其是在决策者精简的受过教育的低收入家庭中。系统地采用这一框架可以缓解中国的器官短缺危机。

{"title":"Enhancing Organ Donation from Brain-Dead Patients: Efficacy of an Innovative Physician-Patient Communication Model","authors":"Min Zhang, Gaosheng Zhou","doi":"10.1016/j.transproceed.2025.10.024","DOIUrl":"10.1016/j.transproceed.2025.10.024","url":null,"abstract":"<div><h3>Objective</h3><div>To identify factors influencing organ donation success among brain-dead patients and evaluate the efficacy of a novel physician-patient communication model (“1T+3S Principles” and “T-F-B Framework”).</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, 153 eligible brain-dead patients from a tertiary ICU (September 2020-December 2023) were allocated to a control group (conventional communication, n = 77) or study group (innovative model, n = 76). Donation success rates, organ utilization, and predictive factors were analyzed.</div></div><div><h3>Results</h3><div>The study group demonstrated significantly higher donation success rates (heart: 27.63% vs. 3.90%; liver: 26.32% vs. 3.90%; kidney: 25.00% vs. 3.90%; all <em>P < .</em>001) and organ utilization (<em>P < .</em>05). Key success predictors included: higher education (Master’s↑: OR = 5.65, <em>P = .</em>010), hospitalization >7 days (OR = 7.70, <em>P < .</em>001), fewer immediate family members (OR = 6.58, <em>P < .</em>001), and reduced extended family intervention (OR = 7.16, <em>P < .</em>001). Low-income families (Monthly income<3000 RMB) showed greater donation acceptance (<em>P = .</em>003).</div></div><div><h3>Conclusion</h3><div>The innovative communication model significantly improves donation success, particularly among educated, low-income families with streamlined decision-makers. Systematic adoption of this framework could mitigate China’s organ shortage crisis.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1849-1855"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446886","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}

引用次数: 0

De Novo HLA-DQ Donor-Specific Antibody Incidence in Korean Deceased Donor Solid Organ Transplant Recipients 韩国已故实体器官移植受者HLA-DQ特异性抗体的发生率。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.029

Si-Hwan Kim, Sang-Hyun Hwang, Heung-Bum Oh

Introduction

De novo human leukocyte antigen-DQ (HLA-DQ) donor-specific antibodies (DSAs) significantly impact graft survival after solid organ transplantation. In Korea, where organ allocation policies do not mandate DQ typing, detection of DQ de novo donor-specific antibodies (dnDSAs) remains challenging. This retrospective single-center study investigated the incidence of DQ dnDSAs and its association with DQ mismatches among Korean deceased donor transplantation.

Methods

We retrospectively analyzed data from 221 Korean recipients of kidney or heart transplants who underwent deceased donor organ transplantation between 2014 and 2024. Inclusion criteria required the availability of low-resolution HLA typing (A, B, DR, and DQ) and HLA single-antigen antibody testing results during both the pre- and posttransplant periods. Recipients with preformed DSAs were excluded. Kaplan-Meier survival analysis and Cox regression modeling assessed the impact of DQ and DR mismatches on the development of HLA class II (DR/DQ) dnDSA.

Results

A total of 9.0% of patients (20 of 221) developed DQ dnDSA, while 11.3% (25 of 221) developed HLA class II dnDSA. Notably, recipients with two antigenic DQ mismatches demonstrated significantly higher cumulative incidence of DQ dnDSA compared with those with fewer mismatches (log-rank test, P = .004). Multivariable analysis identified DQ mismatch as an independent risk factor for the development of HLA class II dnDSA (HR = 2.88; P = .012).

Conclusion

Our findings highlight the potential benefits of incorporating routine HLA-DQ typing into deceased donor evaluation and organ allocation policies, which could potentially improve transplantation outcomes in Korea.

从头生成人白细胞抗原- dq （HLA-DQ）供体特异性抗体（dsa）显著影响实体器官移植后移植物的存活。在韩国，器官分配政策没有强制要求DQ分型，DQ de novo供体特异性抗体（ddsa）的检测仍然具有挑战性。本回顾性单中心研究调查了韩国已故供体移植中DQ ddsas的发生率及其与DQ错配的关系。方法：我们回顾性分析了2014年至2024年期间221例韩国肾脏或心脏移植受者接受的死亡供体器官移植的数据。纳入标准要求在移植前后均有低分辨率HLA分型（A、B、DR和DQ）和HLA单抗原抗体检测结果。排除预先形成dsa的接受者。Kaplan-Meier生存分析和Cox回归模型评估DQ和DR错配对HLA II类（DR/DQ） dnDSA发展的影响。结果：221例患者中有20例（9.0%）发生DQ型dnDSA，其中25例（11.3%）发生HLA II型dnDSA。值得注意的是，两次抗原DQ错配的受者与错配较少的受者相比，DQ dnDSA的累积发病率明显更高（log-rank检验，P = 0.004）。多变量分析发现DQ错配是HLAⅱ类dnDSA发生的独立危险因素（HR = 2.88; P = 0.012）。结论：我们的研究结果强调了将常规HLA-DQ分型纳入已故供者评估和器官分配政策的潜在益处，这可能会改善韩国的移植结果。

{"title":"De Novo HLA-DQ Donor-Specific Antibody Incidence in Korean Deceased Donor Solid Organ Transplant Recipients","authors":"Si-Hwan Kim, Sang-Hyun Hwang, Heung-Bum Oh","doi":"10.1016/j.transproceed.2025.10.029","DOIUrl":"10.1016/j.transproceed.2025.10.029","url":null,"abstract":"<div><h3>Introduction</h3><div>De novo human leukocyte antigen-DQ (HLA-DQ) donor-specific antibodies (DSAs) significantly impact graft survival after solid organ transplantation. In Korea, where organ allocation policies do not mandate DQ typing, detection of DQ de novo donor-specific antibodies (dnDSAs) remains challenging. This retrospective single-center study investigated the incidence of DQ dnDSAs and its association with DQ mismatches among Korean deceased donor transplantation.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 221 Korean recipients of kidney or heart transplants who underwent deceased donor organ transplantation between 2014 and 2024. Inclusion criteria required the availability of low-resolution HLA typing (A, B, DR, and DQ) and HLA single-antigen antibody testing results during both the pre- and posttransplant periods. Recipients with preformed DSAs were excluded. Kaplan-Meier survival analysis and Cox regression modeling assessed the impact of DQ and DR mismatches on the development of HLA class II (DR/DQ) dnDSA.</div></div><div><h3>Results</h3><div>A total of 9.0% of patients (20 of 221) developed DQ dnDSA, while 11.3% (25 of 221) developed HLA class II dnDSA. Notably, recipients with two antigenic DQ mismatches demonstrated significantly higher cumulative incidence of DQ dnDSA compared with those with fewer mismatches (log-rank test, <em>P</em> = .004). Multivariable analysis identified DQ mismatch as an independent risk factor for the development of HLA class II dnDSA (HR = 2.88; <em>P</em> = .012).</div></div><div><h3>Conclusion</h3><div>Our findings highlight the potential benefits of incorporating routine HLA-DQ typing into deceased donor evaluation and organ allocation policies, which could potentially improve transplantation outcomes in Korea.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 2022-2027"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454477","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}

引用次数: 0

Intraoperative Management of Severe Hyponatremia During Orthotopic Liver Transplant Surgery: Case Series 原位肝移植手术中严重低钠血症的术中处理：病例系列。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.012

Jacob E. Pollard, Alexander A. Vitin, Charles E. Galaviz, H. Cameron Norris, Evelyn C. Loose, Jacob B. Brandenburg, Wendell H. Williams, F. Arran Seiler, Bianca E. Rich, Maegan R. Tupinio, Claire M. Lu

Hyponatremia in patients with ESLD is a relatively common and serious condition that warrants gradual and meticulous correction to avoid rapid increase in serum sodium concentration, which can lead to osmotic demyelination syndrome, a devastating, potentially lethal, neurologic complication. Intraoperative management of hyponatremia in patients undergoing a liver transplant presents a substantial challenge because many surgery-related factors can result in a rapid increase in sodium concentration, such as massive transfusion of blood products, fluid shifts, and more. We present two cases, where recipients of liver transplants with severe/profound hyponatremia were successfully managed intraoperatively by using continuous veno-venous hemodialysis with specially modified dialysate.

ESLD患者的低钠血症是一种相对常见和严重的疾病，需要逐步和细致的纠正，以避免血清钠浓度的快速增加，这可能导致渗透性脱髓鞘综合征，这是一种破坏性的，潜在致命的神经系统并发症。肝移植患者术中低钠血症的处理是一项重大挑战，因为许多手术相关因素可导致钠浓度迅速升高，如大量输血、液体转移等。我们报告了两例重度/重度低钠血症的肝移植受者，通过使用特殊改良的透析液进行持续的静脉-静脉血液透析，成功地在术中进行了治疗。

引用次数: 0

ABO-Incompatible Liver Transplantation Is an Underused Resource for Improving Access to Liver Transplantation abo血型不相容的肝移植是改善肝移植可及性的未充分利用的资源。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.004

Angela L. Hill , Amen Z. Kiani , Neeta Vachharajani , Gregory R. Martens , Sakil Kulkarni , Caleb Harsin , Omar Alomar , Diego F. Chaparro-Zaraza , Tess Coker , Jessica D. Lindemann , William C. Chapman , Majella B. Doyle , Adeel S. Khan

BACKGROUND

Historically, ABO incompatibility (ABOi) has been considered a relative contraindication to liver transplant (LT) due to inferior postoperative outcomes. We seek to reassess ABOi LTs as an underused graft supply.

METHODS

We retrospectively reviewed all adult and pediatric patients who underwent LT, 1987-2022. Recipients were categorized by donor blood type compatibility: incompatible (ABOi), compatible (ABOc), and identical (ABOid). Propensity scoring of 1:1:1 was performed to account for recipient age and acuity at transplant.

RESULTS

Of 193,751 LTs, 2699 were ABOi (1.4%). ABOi recipients had the highest proportion of status 1 listings (22.5% versus 20.5% ABOc, 4.9% ABOid, P < 0.0001) and the highest model for end-stage liver disease (30 versus 28 ABOc, 26 ABOid, P < 0.0001) and pediatric end-stage liver disease scores at transplant (33 versus 28 ABOc, 25 ABOid, P < 0.0001). When analyzing the unmatched cohort, ABOi was associated with worse GS (HR 1.2, P < 0.001), OS (HR 1.1, P = 0.033), and increased rates of retransplantation (HR 1.35, P = 0.001). However, after performing propensity matching, there were no differences in GS, OS, or retransplantation between groups.

CONCLUSIONS

There is no difference in outcomes between ABOi LT recipients and recipients of ABOc and ABOid grafts after accounting for recipient age and acuity. ABOi LT may decrease blood group disparities and improve timely LT access.

背景：历史上，ABO血型不相容（ABOi）一直被认为是肝移植（LT）的相对禁忌症，因为术后预后较差。我们试图重新评估ABOi lt作为未充分利用的移植物供应。方法：我们回顾性分析了1987-2022年间所有接受肝移植的成人和儿童患者。受体按献血者血型相容性分类：不相容（ABOi）、相容（ABOc）和相同（ABOid）。采用1:1:1的倾向性评分来考虑移植时受者的年龄和敏锐度。结果：193,751例LTs中，2699例为ABOi（1.4%）。ABOi受者的状态1列表比例最高（22.5%比20.5% ABOc, 4.9% ABOid, P < 0.0001），终末期肝病模型最高（30比28 ABOc， 26, P < 0.0001），移植时儿科终末期肝病评分最高（33比28 ABOc， 25 ABOid, P < 0.0001）。当分析未匹配的队列时，ABOi与较差的GS （HR 1.2, P < 0.001）、OS （HR 1.1, P = 0.033）和再移植率增加（HR 1.35, P = 0.001）相关。然而，在进行倾向匹配后，两组之间的GS、OS或再移植没有差异。结论：考虑到受者的年龄和视力，ABOi移植与ABOc和ABOid移植的结果没有差异。ABOi LT可以减少血型差异，改善及时LT获取。

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引用次数: 0

Waiting List Mortality and Potential Risk Factors in Lung Transplant Candidates: A Single-Center Data 肺移植候选者的等待名单死亡率和潜在危险因素：单中心数据。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.001

Ertan Sarıbaş , Ayse Nigar Halis , Sevinc Citak , Ahmet Murat Kazan , Fatma Feyza Alkilic , Mustafa Vayvada , Murat Ersin Cardak , Ahmet Erdal Tasci

Objective

Lung transplantation (LTx) is a vital treatment for end-stage lung diseases; however, donor lung availability remains limited. This study aimed to evaluate survival durations, mortality risk factors, and waiting list mortality among patients listed for LTx at a single center.

Materials and Methods

We conducted a retrospective analysis of patients listed for lung transplantation at Kartal Koşuyolu Specialized Training and Research Hospital between January 2017 and May 2023. Patients were classified into 5 diagnostic groups: Obstructive, Vascular, Suppurative, Major Idiopathic Interstitial Pneumonia (IIP), and Others. Survival analyses were performed using Kaplan–Meier curves and log-rank tests, while Cox regression identified independent mortality risk factors.

Results

Among 202 patients listed, 66.8% (n = 135) were male, with a mean age of 42.9 ± 15.3 years. Overall, 34.7% (n = 70) died while on the waiting list. The Major IIP group exhibited the highest mortality rate (47.7%). Significant predictors of mortality included shorter height, diagnosis of Major IIP or vascular disease, elevated systolic pulmonary artery pressure (PAPs), reduced echocardiographic TAPSE/PAPs ratio, and increased pulmonary vascular resistance (PVR). A PAPs ≥52 mmHg was associated with a 3.99-fold increased risk of mortality. Patients in the vascular group had the shortest survival time (15.6 ± 5.0 months).

Conclusion

Donor organ scarcity prolongs lung transplantation waiting times, contributing to considerable mortality. Recognition of key mortality risk factors, especially in Major IIP and vascular disease patients is essential for optimizing listing strategies and clinical management to improve outcomes.

目的：肺移植是治疗终末期肺部疾病的重要手段；然而，供体肺的可用性仍然有限。本研究旨在评估单个中心LTx患者的生存时间、死亡危险因素和等待名单死亡率。材料与方法：回顾性分析2017年1月至2023年5月在Kartal ko尤尤鲁专业培训研究医院登记的肺移植患者。患者分为5个诊断组：梗阻性、血管性、化脓性、严重特发性间质性肺炎（IIP）和其他。生存分析采用Kaplan-Meier曲线和log-rank检验，Cox回归确定独立死亡危险因素。结果：202例患者中，男性占66.8% (n = 135)，平均年龄42.9±15.3岁。总体而言，34.7% （n = 70）在等待名单上死亡。重度IIP组死亡率最高（47.7%）。死亡率的重要预测因素包括身高较矮、主要IIP或血管疾病的诊断、肺动脉收缩压（PAPs）升高、超声心动图TAPSE/PAPs比值降低和肺血管阻力（PVR）增加。pap≥52 mmHg与死亡风险增加3.99倍相关。血管组患者生存时间最短（15.6±5.0个月）。结论：供体器官的稀缺延长了肺移植的等待时间，导致了相当大的死亡率。认识到关键的死亡危险因素，特别是在重大IIP和血管疾病患者中，对于优化清单策略和临床管理以改善结果至关重要。

{"title":"Waiting List Mortality and Potential Risk Factors in Lung Transplant Candidates: A Single-Center Data","authors":"Ertan Sarıbaş , Ayse Nigar Halis , Sevinc Citak , Ahmet Murat Kazan , Fatma Feyza Alkilic , Mustafa Vayvada , Murat Ersin Cardak , Ahmet Erdal Tasci","doi":"10.1016/j.transproceed.2025.10.001","DOIUrl":"10.1016/j.transproceed.2025.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>Lung transplantation (LTx) is a vital treatment for end-stage lung diseases; however, donor lung availability remains limited. This study aimed to evaluate survival durations, mortality risk factors, and waiting list mortality among patients listed for LTx at a single center.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective analysis of patients listed for lung transplantation at Kartal Koşuyolu Specialized Training and Research Hospital between January 2017 and May 2023. Patients were classified into 5 diagnostic groups: Obstructive, Vascular, Suppurative, Major Idiopathic Interstitial Pneumonia (IIP), and Others. Survival analyses were performed using Kaplan–Meier curves and log-rank tests, while Cox regression identified independent mortality risk factors.</div></div><div><h3>Results</h3><div>Among 202 patients listed, 66.8% (n = 135) were male, with a mean age of 42.9 ± 15.3 years. Overall, 34.7% (n = 70) died while on the waiting list. The Major IIP group exhibited the highest mortality rate (47.7%). Significant predictors of mortality included shorter height, diagnosis of Major IIP or vascular disease, elevated systolic pulmonary artery pressure (PAPs), reduced echocardiographic TAPSE/PAPs ratio, and increased pulmonary vascular resistance (PVR). A PAPs ≥52 mmHg was associated with a 3.99-fold increased risk of mortality. Patients in the vascular group had the shortest survival time (15.6 ± 5.0 months).</div></div><div><h3>Conclusion</h3><div>Donor organ scarcity prolongs lung transplantation waiting times, contributing to considerable mortality. Recognition of key mortality risk factors, especially in Major IIP and vascular disease patients is essential for optimizing listing strategies and clinical management to improve outcomes.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1979-1987"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357333","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}

引用次数: 0

Immunosuppression Minimization in Belatacept-Treated Kidney Transplant Recipients Guided by Combined Cell-Free DNA and Blood Gene Expression Monitoring 联合无细胞DNA和血液基因表达监测指导下belatacept治疗肾移植受者免疫抑制最小化。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-12-01 DOI: 10.1016/j.transproceed.2025.10.023

Thomas Vanhove , David Wojciechowski , Hannah Gilligan

Background

This study examined whether the combined use of donor-derived cell-free DNA (cfDNA) and gene expression profile testing can facilitate immunosuppression minimization in belatacept-treated kidney transplant recipients.

Methods

Patients at least one year out from transplant with stable renal function, no history of rejection, negative donor-specific antibodies (DSA), urine protein/creatinine ratio <0.5 g/g, cfDNA <1% and negative gene expression profile at baseline were eligible. Mycophenolate (MMF), mTOR inhibitors and steroids were tapered off and stopped over 10 months. Belatacept dosing was not changed. During a 24-month follow-up period, cfDNA and gene expression tests were performed monthly.

Results

Out of 13 participants, 8 were weaned to belatacept monotherapy. In the remaining patients, immunosuppression was only partially reduced. Three had repeated gene expression test quality control failures (all after the first MMF dose reduction), one experienced a transient decrease in eGFR with a rejection ruled out by kidney biopsy and one patient developed transient proteinuria >0.5 g/g. There were no results suggesting (sub)clinical rejection or any other safety signals for these patients throughout the remainder of follow-up.

Conclusion

These novel immune monitoring tools can help identify patients in a likely state of immunologic quiescence, who may be eligible for reductions in immunosuppressive therapy.

背景：本研究探讨了联合使用供体来源的无细胞DNA （cfDNA）和基因表达谱检测是否可以促进belataccept治疗的肾移植受者免疫抑制最小化。方法：移植后1年以上肾功能稳定、无排斥史、供体特异性抗体（DSA）阴性、尿蛋白/肌酐比阴性的患者。结果：13例患者中，8例断奶后接受单药治疗。在其余患者中，免疫抑制仅部分减轻。3例患者反复出现基因表达检测质量控制失败（均在首次减少MMF剂量后），1例患者eGFR短暂下降，肾活检排除排斥反应，1例患者出现短暂性蛋白尿>.5 g/g。在接下来的随访中，没有结果表明这些患者出现（亚）临床排斥反应或任何其他安全信号。结论：这些新的免疫监测工具可以帮助识别可能处于免疫静止状态的患者，这些患者可能有资格减少免疫抑制治疗。

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