Transplantation proceedings最新文献_第5页

Cytomegalovirus Retinitis in the Modern Era of Solid Organ Transplantation 现代实体器官移植时代的巨细胞病毒视网膜炎。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-09-01 DOI: 10.1016/j.transproceed.2024.08.007

Sias J. Scherger , Kyle C. Molina , Alan G. Palestine , Paula E. Pecen , Valida Bajrovic

Background

Cytomegalovirus retinitis (CMVR) is a well-described complication of CMV disease in immunocompromised hosts. While robust data exists for CMVR in patients with acquired immunodeficiency syndrome (AIDS), the incidence and risk factors for CMVR in solid organ transplant recipients (SOTR) with CMV viremia are less defined.

Methods

We performed a retrospective cohort study of SOTR who had CMV viremia and underwent routine ophthalmologic examination between 1/1/2018 and 3/16/2022. Univariate statistics were performed to evaluate risk factors for development of CMVR.

Results

Overall, 38 patients were included, primarily kidney (78.9%), heart (7.9%), and liver (7.9%) transplant recipients. Five patients (13.2%) developed CMVR during the study period. CMVR was diagnosed an average 281 days after index transplantation, 84 days from the most recent rejection episode, and 69 days from onset of viremia. Only 1 patient (20%) had symptoms at the time of CMVR diagnosis. CMVR was associated with preceding allograft rejection as well as transplanted organ type.

Conclusion

While CMV tissue disease more commonly manifests in other organs, CMVR occurred relatively frequently in this group of high-risk SOTR with CMV viremia. As most of the patients in our study did not have ocular symptoms at the time of diagnosis, routine ophthalmologic screening should be considered in SOTR with CMV viremia.

背景：巨细胞病毒视网膜炎（CMVR巨细胞病毒视网膜炎（CMVR）是巨细胞病毒疾病在免疫功能低下的宿主中的一种常见并发症。虽然获得性免疫缺陷综合征（AIDS）患者中巨细胞病毒视网膜炎的数据很可靠，但对伴有巨细胞病毒感染的实体器官移植受者（SOTR）中巨细胞病毒视网膜炎的发病率和风险因素却不太清楚：我们对2018年1月1日至2022年3月16日期间接受常规眼科检查的CMV病毒血症实体器官移植受者进行了一项回顾性队列研究。研究采用单变量统计方法评估了CMVR发生的风险因素：共纳入38名患者，主要是肾脏（78.9%）、心脏（7.9%）和肝脏（7.9%）移植受者。在研究期间，5 名患者（13.2%）出现了 CMVR。CMVR平均在指数移植后281天确诊，距最近一次排斥发作84天，距病毒血症发生69天。只有 1 名患者（20%）在确诊 CMVR 时出现了症状。CMVR与之前的异体移植排斥反应以及移植器官类型有关：结论：虽然 CMV 组织病更常见于其他器官，但在这组伴有 CMV 病毒血症的高危 SOTR 中，CMVR 的发生率相对较高。由于我们研究中的大多数患者在确诊时没有眼部症状，因此应考虑对伴有 CMV 病毒血症的 SOTR 患者进行常规眼科筛查。

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引用次数: 0

Readmission Outcomes in Kidney Transplant Recipients With and Without Delayed Graft Function 有无移植物功能延迟的肾移植受者的再入院结果。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-09-01 DOI: 10.1016/j.transproceed.2024.08.003

Rachana Punukollu , Alex Nica , Stephanie Ohara , Kayla Kumm , Peter E. Frasco , Pooja Budhiraja , Amit Mathur , Raymond Heilman , Caroline C. Jadlowiec

Background

Delayed graft function (DGF) is a common post-transplant event associated with increased resource utilization. As a center with experience in DGF, we aimed to assess differences in readmissions and post-transplant outcomes between patients with and without DGF.

Methods

This was a retrospective review of deceased donor kidney transplant recipients at Mayo Clinic Arizona between 2015 and 2020. Recipients with at least one early readmission following kidney transplantation were included in the study. Two groups were identified: (1) recipients with DGF who required early readmission and (2) recipients without DGF who required early readmission.

Results

Among recipients with DGF, 43.9% (n = 405) required early readmission compared to 29.1% (n = 179) without DGF (P < .0001). There were no differences in the initial hospital length of stay (P = .08), and most recipients in both groups only required a single readmission (61.7% vs 72.1%, P = .02). Recipients with DGF were more likely to have ≥2 readmissions (P = .02) and a higher total readmission rate (P = .006). Recipients with DGF who required readmission also required more outpatient clinic visits (P = .003). When comparing recipients with and without DGF who required readmission, there were no differences in patient (P = .22) or death-censored (P = .72) graft survival. When comparing patients with and without DGF requiring one versus ≥2 readmissions, there were no differences in patient survival (P = .15), however patients with DGF and ≥2 readmissions had lower death-censored graft survival (P = .001).

Conclusions

Recipients with DGF are at increased risk of readmission. Transplant center-level changes to reduce readmissions and infections could have an important impact on DGF outcomes.

背景：移植物功能延迟（DGF）是一种常见的移植后事件，与资源利用率增加有关。作为一家在 DGF 方面经验丰富的中心，我们旨在评估有 DGF 和无 DGF 患者之间再入院率和移植后预后的差异：这是一项对亚利桑那州梅奥诊所 2015 年至 2020 年间已故供体肾移植受者的回顾性研究。研究纳入了肾移植后至少有一次早期再入院的受者。研究确定了两组受者：(1) 需要提前再入院的 DGF 受者；(2) 不需要提前再入院的 DGF 受者：结果：在患有 DGF 的受者中，43.9%（n = 405）需要提前再入院，而没有 DGF 的受者为 29.1%（n = 179）（P < .0001）。最初的住院时间没有差异（P = .08），两组中的大多数受试者只需再次入院一次（61.7% vs 72.1%，P = .02）。DGF受者再入院次数≥2次的可能性更大（P = .02），总再入院率更高（P = .006）。需要再次入院的 DGF 受者也需要更多的门诊就诊次数（P = .003）。在比较需要再入院的 DGF 受者和不需要再入院的 DGF 受者时，患者（P = .22）或死亡剪除（P = .72）移植物存活率没有差异。如果比较有DGF和没有DGF但需要一次和≥两次再入院的患者，患者存活率没有差异（P = .15），但有DGF且≥两次再入院的患者的死亡校正移植物存活率较低（P = .001）：结论：DGF受者再入院风险增加。移植中心为减少再入院和感染而做出的改变可能会对DGF的预后产生重要影响。

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引用次数: 0

Pre-transplant Anemia as a Marker of Short-term Outcomes in Lung Transplant Recipients 移植前贫血是肺移植受者短期预后的标志。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-09-01 DOI: 10.1016/j.transproceed.2024.06.007

Anil J. Trindade , Avery K. Fortier , William D. Tucker , Abigail K. Martel , Whitney D. Gannon , Matthew Bacchetta

Background

Anemia is a risk factor for increased morbidity and mortality in multiple medical conditions, yet the impact of pretransplant anemia in patients with advanced lung disease on post-transplant outcomes remains under-explored. We sought to determine whether pretransplant anemia serves as a marker of altered inflammation in the host and associates with short-term outcomes following lung transplantation.

Study Design and Methods

We performed a single-center, retrospective analysis of 238 lung transplant recipients. We assessed for risk factors of pretransplant anemia and identified associations with short-term post-transplant outcomes.

Results

Pretransplant anemia was associated with increased intraoperative transfusion of packed red blood cells and a trend towards increased index hospital length of stay and 1-year mortality. Conversely, pretransplant anemia was associated with a decreased incidence of acute cellular rejection.

Conclusion

These preliminary data suggest that anemia may be a biomarker of altered inflammation in the host recipient and influences post-transplant outcomes.

背景：贫血是多种疾病发病率和死亡率升高的风险因素，但晚期肺病患者移植前贫血对移植后预后的影响仍未得到充分探讨。我们试图确定移植前贫血是否是宿主炎症改变的标志物，并与肺移植后的短期预后有关：我们对 238 例肺移植受者进行了单中心回顾性分析。我们评估了移植前贫血的风险因素，并确定了与移植后短期预后的关联：结果：移植前贫血与术中输注更多的包装红细胞有关，并有增加住院时间和 1 年死亡率的趋势。相反，移植前贫血与急性细胞排斥反应发生率降低有关：这些初步数据表明，贫血可能是宿主受体炎症改变的生物标志物，并影响移植后的预后。

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引用次数: 0

Contrast-Enhanced T1-Weighted Magnetic Resonance Cholangiography Using Gadoxetate Disodium in Potential Living Liver Donors: Qualitative and Quantitative Improvement with 3-hour Delayed Imaging 使用钆喷酸二钠对潜在活体肝脏捐献者进行对比度增强 T1 加权磁共振胆管造影：延迟 3 小时成像的定性和定量改进。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-09-01 DOI: 10.1016/j.transproceed.2024.07.006

Sunyoung Lee , Kyoung Won Kim , Heon-Ju Kwon , Jin Kyoo Jang , Young-In Yoon , Gi-Won Song , Sung-Gyu Lee

Background

Contrast-enhanced T1-weighted magnetic resonance cholangiography (CE-T1-MRC) after gadoxetate disodium administration can be used for preoperative evaluation of the bile ducts in live liver donors. This study aimed to determine whether CE-T1-MRC with 3-hour delayed imaging improves bile duct visualization both qualitatively and quantitatively compared with 20-minute delayed imaging in potential living liver donors.

Methods

We retrospectively identified 33 potential living liver donors (mean age, 30.1 years; 18 men and 15 women) who underwent preoperative CE-T1-MRC with both 20-minute delayed and 3-hour delayed imaging in a single session. The radiologist scored biliary visualization for right and left hepatic ducts (RHD and LHD), their secondary confluences and segmental bile ducts, common hepatic duct (CHD), and cystic duct (CD), and measured relative contrast ratio (rC) and relative signal intensity (rS) for RHD, LHD, and CHD. The data were analyzed using Wilcoxon's signed-rank test and paired t-test.

Results

In qualitative analysis, duct visualization scores for RHD and LHD, their secondary confluences and segmental bile ducts, CHD, and CD were significantly higher on CE-T1-MRC with 3-hour delayed imaging than with 20-minute delayed imaging (all, P ≤ .046). In quantitative analysis, both rC and rS of RHD, LHD, and CHD were significantly higher on CE-T1-MRC with 3-hour delayed imaging than with 20-minute delayed imaging (all, P < .001).

Conclusions

CE-T1-MRC with 3-hour delay imaging improves bile duct visualization both qualitatively and quantitatively in potential living liver donors.

背景：钆喷酸二钠给药后的对比增强T1加权磁共振胆管造影（CE-T1-MRC）可用于活体肝脏捐献者胆管的术前评估。本研究旨在确定，与 20 分钟延迟成像相比，延迟 3 小时成像的 CE-T1-MRC 是否能定性和定量地改善潜在活体肝脏捐献者的胆管显像：我们回顾性地确定了33名潜在的活体肝脏捐献者（平均年龄30.1岁；18名男性和15名女性），他们在一次治疗中接受了术前CE-T1-MRC 20分钟延迟成像和3小时延迟成像。放射科医生对左右肝管（RHD 和 LHD）、其二级汇合处和节段性胆管、肝总管（CHD）和胆囊管（CD）的胆道显像进行评分，并测量 RHD、LHD 和 CHD 的相对对比度（rC）和相对信号强度（rS）。数据分析采用 Wilcoxon 符号秩检验和配对 t 检验：在定性分析中，延迟 3 小时成像的 CE-T1-MRC 中，RHD 和 LHD、其次级汇合点和节段性胆管、CHD 和 CD 的导管可视化评分明显高于延迟 20 分钟成像（所有评分，P ≤ .046）。在定量分析中，延迟 3 小时成像的 CE-T1-MRC RHD、LHD 和 CHD 的 rC 和 rS 均明显高于延迟 20 分钟成像的 RHD、LHD 和 CHD（均为 P <.001）：结论：延迟3小时成像的CE-T1-MRC可提高潜在活体肝脏捐献者胆管显像的质量和数量。

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引用次数: 0

Extended Criteria Donor Use in Lung Transplants From Donation After Controlled Circulatory Death 在控制循环死亡后捐献的肺移植中使用扩展标准捐献者。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-09-01 DOI: 10.1016/j.transproceed.2024.07.003

Wenxi Zhang, Chenyu Zhang, Hanqun Liu, Wenjie Jiao

Background

Most institutions apply the criteria for controlled donation after cardiac death (cDCD) lung retrieval identical to the criteria for donation after brain death (DBD). The availability of extended criteria donor (ECD) in lung transplants from cDCD remains unclear.

Methods

The United Network for Organ Sharing (UNOS) database was queried for adult lung transplants from cDCD, from May 03, 2005, to March 15, 2022. ECDs were defined by one or more items at variance from standard criteria: age 55 years or more, PaO₂:FiO₂ 300 or less, smoking 20 pack-years or more, diabetes, or purulent secretions upon bronchoscopy. Recipients were divided into the standard criteria donor (SCD) group and the ECD group, and assessed for short- and long-term survival and postoperative events.

Results

Among 827 records, the SCD and ECD group showed no differences in 5-year (P = .56) survival. No significant differences were found in 30-day, 90-day, 1-year mortality and postoperative outcomes before discharge, whether in length of hospital stay, rate of ventilator support for >48 hours or reintubation, incidence of grade 3 PGD 72 hours posttransplant, acute rejection, or dialysis. None of the 5 donor factors used as criteria for lung retrieval was independently associated with cDCD recipient survival.

Conclusions

Using donor lungs that extend the DBD criteria may be a safe strategy in cDCD lung transplantation. However, the current criteria may not be a perfect fit for cDCD lung retrieval. The specific DCD criteria for standard lung retrieval need to be determined.

背景：大多数机构采用与脑死亡（DBD）后捐献标准相同的心脏死亡（cDCD）后肺回收控制捐献标准。方法：对器官共享联合网络（UNOS）数据库进行了查询：方法：我们查询了器官共享联合网络（UNOS）数据库2005年5月3日至2022年3月15日期间cDCD成人肺移植的情况。ECD的定义有一项或多项与标准标准不一致：年龄55岁或以上、PaO2:FiO2 300或以下、吸烟20包年或以上、糖尿病或支气管镜检查有脓性分泌物。受者被分为标准标准供体（SCD）组和ECD组，并对短期和长期存活率及术后事件进行评估：结果：在 827 份记录中，SCD 组和 ECD 组的 5 年存活率没有差异（P = .56）。在出院前的 30 天、90 天、1 年死亡率和术后结果方面，无论是住院时间、呼吸机支持超过 48 小时或再次插管率、移植后 72 小时 3 级 PGD 发生率、急性排斥反应或透析，均未发现明显差异。作为取肺标准的5个供体因素均与cDCD受体存活率无关：结论：在 cDCD 肺移植中，使用扩大 DBD 标准的供肺可能是一种安全的策略。结论：在 cDCD 肺移植中使用扩展 DBD 标准的供肺可能是一种安全的策略，但目前的标准可能并不完全适合 cDCD 肺回收。标准肺取材的具体DCD标准有待确定。

{"title":"Extended Criteria Donor Use in Lung Transplants From Donation After Controlled Circulatory Death","authors":"Wenxi Zhang, Chenyu Zhang, Hanqun Liu, Wenjie Jiao","doi":"10.1016/j.transproceed.2024.07.003","DOIUrl":"10.1016/j.transproceed.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><p>Most institutions apply the criteria for controlled donation after cardiac death (cDCD) lung retrieval identical to the criteria for donation after brain death (DBD). The availability of extended criteria donor (ECD) in lung transplants from cDCD remains unclear.</p></div><div><h3>Methods</h3><p>The United Network for Organ Sharing (UNOS) database was queried for adult lung transplants from cDCD, from May 03, 2005, to March 15, 2022. ECDs were defined by one or more items at variance from standard criteria: age 55 years or more, PaO<sub>2</sub>:FiO<sub>2</sub> 300 or less, smoking 20 pack-years or more, diabetes, or purulent secretions upon bronchoscopy. Recipients were divided into the standard criteria donor (SCD) group and the ECD group, and assessed for short- and long-term survival and postoperative events.</p></div><div><h3>Results</h3><p>Among 827 records, the SCD and ECD group showed no differences in 5-year (<em>P</em> = .56) survival. No significant differences were found in 30-day, 90-day, 1-year mortality and postoperative outcomes before discharge, whether in length of hospital stay, rate of ventilator support for >48 hours or reintubation, incidence of grade 3 PGD 72 hours posttransplant, acute rejection, or dialysis. None of the 5 donor factors used as criteria for lung retrieval was independently associated with cDCD recipient survival.</p></div><div><h3>Conclusions</h3><p>Using donor lungs that extend the DBD criteria may be a safe strategy in cDCD lung transplantation. However, the current criteria may not be a perfect fit for cDCD lung retrieval. The specific DCD criteria for standard lung retrieval need to be determined.</p></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"56 7","pages":"Pages 1633-1638"},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057757","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

The Effect of Enhanced Recovery After Surgery Nursing on the Recovery in Patients After Liver Transplantation 加强术后恢复护理对肝移植术后患者恢复的影响。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-09-01 DOI: 10.1016/j.transproceed.2024.07.011

Zhiling Hu, Dan Li

Objective

To explore the effect of enhanced recovery after surgery nursing on the recovery in patients after liver transplantation.

Methods

This study was performed in 128 patients underwent liver transplantation in our hospital. According to the random number table, these patients were divided into the control group (n = 64) and the experimental group (n = 64). Patients in the control group received traditional nursing, while those in the experimental group received enhanced recovery after surgery nursing. Completion time of the operation, the amount of infused red blood cells during operation, intraoperative anhepatic period, intensive care unit (ICU) stay, the total length of hospitalization, the number of patients reintubated after surgery, the survival rate within 1 year after surgery, and the incidence of postoperative complications were compared between the two groups.

Results

Intraoperative anhepatic period and the amount of infused red blood cells during operation in the experimental group were lower than those in the control group (both P < .05). Postoperative ICU stay, the total length of hospitalization, and the number of patients reintubated after surgery in the experimental group were decreased when compared with the control group, while postoperative ventilator weaning time was increased (all P < .05). The survival rates at 3 months, 6 months, and 1 year after surgery in the experimental group were higher than those in the control group (all P < .05). Compared with the control group, the total incidence of complications in the experimental group was reduced (P < .05).

Conclusion

The application of enhanced recovery after surgery nursing in liver transplantation patients contributes to the accelerated recovery of body function, shortened total length of hospitalization and ICU stay, declined complications, and increased survival rate within 1 year.

目的探讨加强术后恢复护理对肝移植患者术后恢复的影响：研究对象为在我院接受肝移植手术的 128 例患者。根据随机数字表将这些患者分为对照组（64 例）和实验组（64 例）。对照组患者接受传统护理，实验组患者接受术后康复强化护理。比较两组患者的手术完成时间、术中输注红细胞量、术中无肝期、重症监护室（ICU）住院时间、总住院时间、术后再次插管患者人数、术后 1 年内存活率以及术后并发症发生率：结果：实验组术中无肝期和输注红细胞量均低于对照组（P均<0.05）。与对照组相比，实验组的术后重症监护室住院时间、总住院时间和术后再次插管的患者人数均有所减少，而术后呼吸机断流时间则有所增加（均为 P < .05）。实验组术后 3 个月、6 个月和 1 年的存活率均高于对照组（均 P < .05）。与对照组相比，实验组的并发症总发生率降低（P < .05）：结论：在肝移植患者中应用加强术后恢复护理有助于加快患者身体功能的恢复，缩短住院时间和重症监护室住院时间，减少并发症的发生，提高患者一年内的存活率。

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引用次数: 0

Risk Factors and Outcomes of Mucorales Infection in a Modern Cohort of Solid Organ Transplant, Hematopoietic Cell Transplant, and Chimeric Antigen Receptor T-cell Therapy Recipients 现代实体器官移植、造血细胞移植和嵌合抗原受体 T 细胞疗法受者队列中黏菌类感染的风险因素和结果。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-09-01 DOI: 10.1016/j.transproceed.2024.07.005

Lauren Ogawa , Ashrit Multani , Omer E. Beaird , Pryce Gaynor , Margrit Carlson , Omai B. Garner , Gary Schiller , Joanna M. Schaenman

Background

Mucorales infections continue to cause significant morbidity and mortality in immunocompromised hosts despite the advent of new approaches for diagnosis and treatment of fungal infections. We aimed to evaluate risk factors and outcomes of Mucorales infection in solid organ transplant, hematopoietic cell transplant, and chimeric antigen receptor T-cell therapy recipients.

Methods

This single-center retrospective study included solid organ transplant, hematopoietic cell transplant, and chimeric antigen receptor T-cell patients with cultures positive for Mucorales.

Results

Forty-three patients were included for analysis; 34 solid organ transplant (79%) and 9 hematopoietic stem cell transplant or chimeric antigen receptor T-cell (21%). Infection with Mucorales occurred a median of 184 days after transplant. At the time of diagnosis, 36 patients were on antifungal prophylaxis with the majority receiving posaconazole (53%). Thirty-three had clinically significant disease; 30 received definitive anti-Mucorales therapy and 3 empiric antifungal therapy. Isavuconazole was the most common azole used for treatment in monotherapy recipients. All-cause mortality was 64% and, of these deaths, 18 (75%) were directly related to Mucormycosis. The highest mortality was seen in disseminated and intra-abdominal disease (100%), followed by pulmonary disease (50%). There was no significant association with mortality and transplant type or number of immunosuppressive agents.

Conclusion

Mucormycosis is an important cause of morbidity and mortality in immunocompromised patients. Breakthrough infection was not uncommon in this study. Data regarding the incidence of infection at approximately 6 months after transplantation can inform prophylaxis and treatment regimens. The spectrum of antifungal regimens used reflects the lack of consensus on ideal regimens for these organisms and a need for more studies.

背景：尽管出现了诊断和治疗真菌感染的新方法，但真菌感染仍会在免疫功能低下的宿主中造成严重的发病率和死亡率。我们旨在评估实体器官移植、造血细胞移植和嵌合抗原受体 T 细胞疗法受者感染真菌的风险因素和结果：这项单中心回顾性研究纳入了粘孢子菌培养阳性的实体器官移植、造血细胞移植和嵌合抗原受体T细胞患者：43例患者被纳入分析，其中34例为实体器官移植患者（占79%），9例为造血干细胞移植或嵌合抗原受体T细胞患者（占21%）。感染粘孢子菌的时间中位数为移植后 184 天。确诊时，36名患者正在接受抗真菌预防治疗，其中大多数接受了泊沙康唑治疗（53%）。33名患者的病情有临床意义；30名患者接受了明确的抗口腔真菌治疗，3名患者接受了经验性抗真菌治疗。伊沙夫康唑是单药治疗中最常用的唑类药物。全因死亡率为 64%，其中 18 例（75%）直接与粘孢子菌病有关。死亡率最高的是播散性疾病和腹腔内疾病（100%），其次是肺部疾病（50%）。死亡率与移植类型或免疫抑制剂数量无明显关联：结论：黏菌病是免疫功能低下患者发病和死亡的重要原因。在这项研究中，突破性感染并不少见。有关移植后约 6 个月感染发生率的数据可为预防和治疗方案提供参考。所使用的抗真菌治疗方案的范围反映了人们对这些微生物的理想治疗方案缺乏共识，需要进行更多的研究。

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引用次数: 0

Effect of CYP3A5 Gene Polymorphisms on Tacrolimus Blood Concentrations and Adverse Events in Allogeneic Hematopoietic Stem Cell Transplant Patients CYP3A5 基因多态性对同种异体造血干细胞移植患者他克莫司血药浓度和不良事件的影响

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-09-01 DOI: 10.1016/j.transproceed.2024.08.012

Jia Jiang, Jiajie Luan

Background

Tacrolimus is the core basic immunosuppressant after transplantation. Cytochrome P450 3A5 (CYP3A5) is the main enzyme involved in tacrolimus metabolism, and rs776746A>G is the most frequently studied polymorphism in the CYP3A5 gene. The aim of this study was to investigate the effect of CYP3A5 gene polymorphisms on tacrolimus blood concentrations and acute graft versus host disease (GVHD) in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods

This study included adult patients who received allo-HSCT at the First Affiliated Hospital of Wannan Medical College from January 2021 to June 2022, and received postoperative treatment with tacrolimus. Tacrolimus blood levels were obtained by fully automatic chemiluminescence immunoassay analyzer. Polymerase chain reaction/restriction fragment length polymorphism was used to genotype for CYP3A5*3 allelic variants.

Results

In a total of 50 transplant patients, 30 patients were detected with CYP3A5*3/*3 genotype, 15 patients with CYP3A5*1/*3 genotype, and 5 patients with CYP3A5*1/*1 genotype. The initial tacrolimus blood concentrations in allo-HSCT patients with CYP3A5*1/*1, *1/*3, and *3/*3 genes were 7.75, 8.61, and 10.19 ng/mL, respectively; The initial blood concentration/dose (C/D) ratios were 4.08, 4.42 and 5.66 ng/(mL·mg), respectively. The C/D ratios of allo-HSCT patients carrying CYP3A5*1/*1, *1/*3, and *3/*3 genes were 4.35 and 4.71 and 5.58, 4.19, 4.56 and 5.71 ng/(mL·mg) in the second and 3rd weeks after operation. These results showed that the blood concentration and C/D ratio of tacrolimus in patients with CYP3A5*3/*3 genotype were significantly higher than those in patients with CYP3A5*1/*3 or CYP3A5*1/*1 genotype. Moreover, the incidence of acute GVHD after allo-HSCT in patients with CYP3A5*1/*1 genotype was significantly higher than that in patients with CYP3A5*1/*3 or CYP3A5*3/*3 genotype.

Conclusions

Most patients carry the mutant allele CYP3A5*3. CYP3A5 gene polymorphisms affect tacrolimus blood concentrations and acute GVHD after allo-HSCT.

背景：他克莫司是移植后的核心基础免疫抑制剂。细胞色素 P450 3A5 (CYP3A5) 是参与他克莫司代谢的主要酶，而 rs776746A>G 是 CYP3A5 基因中最常被研究的多态性。本研究旨在探讨 CYP3A5 基因多态性对他克莫司血药浓度和异基因造血干细胞移植（allo-HSCT）患者急性移植物抗宿主疾病（GVHD）的影响：本研究纳入了2021年1月至2022年6月在皖南医学院第一附属医院接受异基因造血干细胞移植并在术后接受他克莫司治疗的成年患者。使用全自动化学发光免疫分析仪检测他克莫司的血药浓度。聚合酶链反应/限制性片段长度多态性用于对 CYP3A5*3 等位基因变异进行基因分型：结果：在总共 50 例移植患者中，30 例患者检测出 CYP3A5*3/*3 基因型，15 例患者检测出 CYP3A5*1/*3 基因型，5 例患者检测出 CYP3A5*1/*1 基因型。CYP3A5*1/*1、*1/*3和*3/*3基因型的异体HSCT患者初始他克莫司血药浓度分别为7.75、8.61和10.19纳克/毫升；初始血药浓度/剂量（C/D）比分别为4.08、4.42和5.66纳克/（毫升-毫克）。携带 CYP3A5*1/*1、*1/*3 和 *3/*3 基因的异体 HSCT 患者在术后第二周和第三周的 C/D 比值分别为 4.35、4.71 和 5.58、4.19、4.56 和 5.71 ng/（mL-mg）。这些结果表明，CYP3A5*3/*3 基因型患者的他克莫司血药浓度和 C/D 比值明显高于 CYP3A5*1/*3 或 CYP3A5*1/*1 基因型患者。此外，CYP3A5*1/*1基因型患者在allo-HSCT后急性GVHD的发生率明显高于CYP3A5*1/*3或CYP3A5*3/*3基因型患者：大多数患者携带突变等位基因CYP3A5*3。CYP3A5基因多态性会影响他克莫司的血药浓度和allo-HSCT后的急性GVHD。

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引用次数: 0

Parichay Patient Support Program: Useful Tool for Improving Compliance in Kidney Transplant Recipients Parichay 患者支持计划：提高肾移植受者依从性的有用工具。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-09-01 DOI: 10.1016/j.transproceed.2024.08.002

Sanjeev Gulati , Deepak Shankar Ray , Vishwanath Siddini , Vivek Kute , Yashpal Jadeja

Background

Medication nonadherence (MNA) in organ transplant recipients is associated with increased risk of rejection, allograft loss, patient death, and higher healthcare costs. Various approaches have been used in an attempt to reduce MNA. A patient support program (PSP) can be an invaluable tool for improving patient outcomes. The aim of this study was to analyze available data of PSP for kidney transplant recipients.

Methods

A total of 3352 patients from all over the country were prospectively enrolled in the Parichay PSP between January 2021 and April 2023. Baseline demographic details were recorded. A monthly call was made thereafter. Data were analyzed for demographic details, compliance rate, dropouts, and tacrolimus levels when available.

Results

The Parichay PSP had enrolled a total of 1371 kidney transplant patients in 2021, 1620 in 2022, and 361 in 2023 (January-April) from different parts of India (North, 25%; East, 35%; South, 26%; West, 14%). (n=2626) Of the 2626 patients who received tacrolimus (Tacrograf), 2158 (82%) were male, with a mean age of 42 years. The majority of patients (61%) were age 28 to 48 years. A patient compliance rate of >90% was maintained for longer than 13 months (n = 1920; April 2022 to April 2023). Of the 3352 patients, 250 (7.4%) dropped out of the study. Thus, use of PSP ensured a compliance rate of 92.6% in this study.

Conclusions

This analysis demonstrates that participation in a PSP can be a useful tool for monitoring compliance and tacrolimus therapeutic drug monitoring in kidney transplant recipients.

背景：器官移植受者不遵医嘱用药（MNA）与排斥反应风险增加、异体移植损失、患者死亡和医疗成本增加有关。为了减少不依从用药，人们采用了各种方法。患者支持计划（PSP）是改善患者预后的宝贵工具。本研究旨在分析肾移植受者患者支持计划的现有数据：方法：2021 年 1 月至 2023 年 4 月期间，全国共有 3352 名患者前瞻性地加入了 Parichay PSP。记录了基线人口统计学细节。此后每月进行一次电话访问。分析数据包括人口统计学细节、依从率、辍学率和他克莫司水平（如有）：帕里夏 PSP 在 2021 年共招募了 1371 名肾移植患者，2022 年招募了 1620 名，2023 年招募了 361 名（1 月至 4 月），这些患者来自印度不同地区（北部，25%；东部，35%；南部，26%；西部，14%）。(n=2626）在接受他克莫司（Tacrograf）治疗的 2626 名患者中，2158 人（82%）为男性，平均年龄为 42 岁。大多数患者（61%）的年龄在 28 至 48 岁之间。患者依从率大于 90% 的时间超过 13 个月（n = 1920；2022 年 4 月至 2023 年 4 月）。在 3352 名患者中，有 250 人（7.4%）退出了研究。因此，在这项研究中，PSP 的使用确保了 92.6% 的依从率：这项分析表明，参与 PSP 是监测肾移植受者依从性和他克莫司治疗药物监测的有效工具。

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引用次数: 0

Application of Flow-through Anterolateral Thigh Perforator Flaps in Replantation of Complex Severed Limb 流式大腿前外侧穿孔器皮瓣在复杂断肢再植中的应用

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2024-08-31 DOI: 10.1016/j.transproceed.2024.08.013

Ning Zhang, Fei Liu, Cun Huang, Zhixue Kang, Wujun Du, Jianming Yang, Linrui Ma

Objective

To explore the clinical application value of flow-through anterolateral thigh perforator (ALTP) flaps in replantation of complex severed limbs.

Methods

Thirteen severe vascular, nerve injury, and skin or soft tissue defects in patients with complex severed limbs from August 2017 to January 2019 were enrolled in this retrospective study. The skin flap has covered the wound by using the flow-through ALTP flap technique. The main vascular defect was repaired by using the descending branch of the lateral circumflex femoral artery, and the blood supply of the transplanted limb was reconstructed. The blood supply of the flap and wound healing observed were observed after the operation. Regular follow-up was performed to observe the survival and functional recovery of the replanted limb.

Results

Eleven cases of replanted limb and perforator flap survived completely. Limb shortening occurred in 3 patients owing to bone defects caused by distal amputation. After the second stage of bone transplantation, the limb length and function of those 3 patients recovered well. One case showed necrosis of the little finger after replantation of the severed palm. One case showed that the crushed forearm was severed completely. The anastomotic vascular inflammatory embolism was caused by infection and necrosis of soft tissue after replantation for 2 weeks, and then the stump wound was covered with a survived skin flap in the second stage.

Conclusion

The flow-through ALTP flap technique has a good therapeutic effect on the functional reconstruction of complex severed limbs with severe skin and vascular injuries.

目的探讨血流穿行大腿前外侧穿孔器（ALTP）皮瓣在复杂断肢再植中的临床应用价值：2017年8月至2019年1月，13例严重血管、神经损伤及皮肤或软组织缺损的复杂断肢患者被纳入本次回顾性研究。皮瓣通过流式ALTP皮瓣技术覆盖伤口。利用股外侧周动脉降支修复了主血管缺损，并重建了移植肢体的血液供应。术后观察了皮瓣的血液供应和伤口愈合情况。定期随访观察再植肢体的存活率和功能恢复情况：结果：11 例再植肢体和穿孔器皮瓣完全存活。结果：11 例再植肢体和穿孔器皮瓣完全存活，3 例患者因远端截肢导致骨缺损而发生肢体缩短。经过第二阶段的骨移植，这 3 名患者的肢体长度和功能恢复良好。一例患者在断掌再植后出现小指坏死。一例患者被压断的前臂完全断裂。吻合口血管炎性栓塞是由再植两周后感染和软组织坏死引起的，然后在第二阶段用存活的皮瓣覆盖残端伤口：结论：流式ALTP皮瓣技术对严重皮肤和血管损伤的复杂断肢的功能重建具有良好的治疗效果。

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引用次数: 0