Transplantation proceedings最新文献_第8页

Clinical and Anemia-Related Predictors of Short-Term Mortality in Renal Transplantation Recipients After Graft Rejection: A Retrospective Study 肾移植受者排斥后短期死亡率的临床和贫血相关预测因素：一项回顾性研究。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.06.023

Alper Tuna Güven , Kübra Yıldız Cömert , Elvar Mirzaevi , Cihat Burak Sayın

Introduction

Renal transplantation is the treatment of choice for end-stage chronic kidney disease (CKD). Rejection is a relatively common complication and mortality is increased compared to the general population. There are several established predictors of mortality in patients with renal transplantation. We aimed to investigate whether these factors are also applicable after graft rejection and whether anemia and related factors have an impact on short-term mortality after graft rejection.

Methodology

We conducted a retrospective chart study in a high-volume tertiary care renal transplantation referral center. We obtained clinical, demographic, and mortality data, as well as anemia- and transplantation-related variables, via electronic medical records. We analyzed short-term (6 months) mortality and hematological characteristics based on baseline variables and mortality predictors. Two 3-variable models were constructed using multivariate logistic regression (MLR) to identify factors associated with short-term mortality.

Results

The analysis included 67 patients who had received renal transplantation, experienced graft rejection and mortality. Months to graft rejection after transplantation were 24 (117), and months to death after rejection were 10 (77). Months to death after rejection showed positive correlation with months to graft rejection after transplantation and lowest hemoglobin (Hb_min), and negative correlation with age at transplantation and ferritin levels. MLR demonstrated in 2 different models that either erythropoietin use, months to graft rejection after transplantation, and Hb_min, or erythropoietin use, months to graft rejection after transplantation, and Log_Ferritin are independently associated with short-term mortality.

Discussion

Anemia and high ferritin levels—markers of inflammation—are associated with increased short-term mortality, and erythropoietin use is associated with improved survival among patients with renal graft rejection, similar to patients with non-dialysis or dialysis CKD, as well as renal transplantation patients.

肾移植是治疗终末期慢性肾病（CKD）的首选方法。排斥反应是一种相对常见的并发症，与一般人群相比，死亡率有所增加。有几个确定的预测肾移植患者死亡率的因素。我们的目的是研究这些因素是否也适用于移植排斥后，以及贫血及相关因素是否对移植排斥后的短期死亡率有影响。方法：我们在一个大容量三级保健肾移植转诊中心进行回顾性图表研究。我们通过电子病历获得了临床、人口统计学和死亡率数据，以及贫血和移植相关的变量。我们分析了基于基线变量和死亡率预测因子的短期（6个月）死亡率和血液学特征。采用多变量logistic回归（MLR）建立了两个3变量模型，以确定与短期死亡率相关的因素。结果：本研究纳入67例接受肾移植，发生排斥反应和死亡的患者。移植后发生排斥反应的月数为24个月（117个），排斥反应后死亡的月数为10个月（77个）。排斥反应后死亡月数与移植后排斥反应月数和最低血红蛋白（Hbmin）呈正相关，与移植年龄和铁蛋白水平负相关。MLR在两种不同的模型中证明，无论是使用促红细胞生成素，移植后发生排斥反应的月数，还是Hbmin，或使用促红细胞生成素，移植后发生排斥反应的月数，以及LogFerritin，都与短期死亡率独立相关。讨论：贫血和高铁蛋白水平（炎症的标志）与短期死亡率增加有关，在肾移植排斥患者中，使用促红细胞生成素与生存率提高有关，类似于非透析或透析CKD患者，以及肾移植患者。

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引用次数: 0

Safety and Efficacy of Early Introduction of Angiotensin II Receptor Blockers for Hypertension in Kidney Transplant Recipients: A Retrospective Observational Study Using Propensity Score Matching 早期引入血管紧张素受体阻滞剂治疗肾移植受者高血压的安全性和有效性：一项使用倾向评分匹配的回顾性观察研究

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.05.003

Shinsuke Kubo , Hiroshi Noguchi , Yu Hisadome , Kenji Ueki , Yuta Matsukuma , Shoji Tsuneyoshi , Yu Sato , Akihiro Tsuchimoto , Toshiaki Nakano , Keizo Kaku , Yasuhiro Okabe , Masafumi Nakamura

Kidney transplantation (KTx) is the optimal treatment for end-stage kidney disease, but hypertension after KTx is significant complication affecting graft and patient survival. Although angiotensin II receptor blockers (ARBs) are widely used, the effect of their “early” introduction on outcomes remains unclear. This retrospective observational cohort study compared KTx recipients who started ARBs within the first 14 days post-transplant (early ARB [eARB] group) to those ARBs initiated after three months (conventional group). Propensity score matching was used to align the groups. Blood pressure control, estimated glomerular filtration rate, and serum potassium levels, urinary protein, and adverse events were analyzed. Between 2020 and 2022, 174 patients underwent living-donor KTx. Propensity score matching refined this to 38 matched pairs (76 individuals), which were analyzed. No significant difference in blood pressure control was observed between the two groups at any time point. Results showed that eARB use led to significantly lower urinary protein levels at 3 months compared to the conventional group (P = .019). There were no significant differences in adverse events, including hyperkalemia, rejection, or hypotension, between groups. Potassium-lowering agents were used slightly more in the eARB group, but the difference was not significant. Although eARBs initiation appears safe and potentially beneficial for kidney transplant recipients, further studies are needed to fully understand the long-term implications of this strategy.

肾移植（KTx）是终末期肾病的最佳治疗方法，但KTx后的高血压是影响移植和患者生存的重要并发症。尽管血管紧张素II受体阻滞剂（ARBs）被广泛使用，但其“早期”引入对预后的影响尚不清楚。这项回顾性观察队列研究比较了移植后14天内开始ARB的KTx受体（早期ARB组）和移植后3个月后开始ARB的KTx受体（常规组）。使用倾向评分匹配来对齐组。分析血压控制、估计肾小球滤过率、血清钾水平、尿蛋白和不良事件。在2020年至2022年期间，174名患者接受了活体供体KTx。倾向评分匹配将其细化为38对（76个人），并对其进行分析。两组在任何时间点的血压控制均无显著差异。结果显示，与常规组相比，使用eARB组在3个月时尿蛋白水平显著降低（P = 0.019）。两组之间的不良事件无显著差异，包括高钾血症、排斥反应或低血压。eARB组使用的降钾药物略多，但差异不显著。虽然启动eARBs似乎是安全的，并且对肾移植受者有潜在的益处，但需要进一步的研究来充分了解这一策略的长期影响。

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引用次数: 0

Intramuscular Tacrolimus Pharmacokinetics in a Pediatric Porcine Model for Partial Heart Transplantation 他克莫司肌内药代动力学在儿童猪部分心脏移植模型中的应用。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.07.030

Louis Steen , Herra Javed , Eli Contorno , David Irby , John Lowery , Mary Bradley , Kimberly Paige O’Brien , Brian Reemsten , T. Konrad Rajab

Objective

The cornerstone of immunosuppression for transplantation is tacrolimus. One of the most reliable routes for administering tacrolimus in porcine models is intramuscular injection. However, the pharmacokinetics of intramuscular tacrolimus in piglets remain unexplored. Here, we close this gap in knowledge to guide intramuscular tacrolimus dosing in pediatric porcine transplant models.

Method

In the dosing trial, piglets (n = 7) underwent partial heart transplantation. Post-operatively, the piglets received immunosuppression with tacrolimus at daily doses between 0.07-0.4mg/kg.

In the pharmacokinetic study, piglets (n = 6) underwent external jugular line placement. After a baseline blood draw, 0.25mg/kg of intramuscular tacrolimus was administered, and serial blood draws were performed to determine tacrolimus blood levels. The data was statistically analyzed to determine the pharmacokinetic parameters.

Results

The dosing trial showed that intramuscular tacrolimus daily doses between 0.217-0.421mg/kg most consistently achieved tacrolimus blood levels within the therapeutic window. Therefore, 0.25mg/kg was used for the pharmacokinetic study. This revealed a half-life of 7.7 ± 0.9 hours, an average elimination constant of 0.09 ± 0.01, and an average volume of distribution of 30.9 ± 5.3 liters.

Conclusions

Intramuscular tacrolimus achieves reliable blood levels with a predictable half-life. Despite high peak blood concentrations, a daily dose of 0.25 mg/kg did not result in clinical or laboratory evidence of toxicity.

目的：他克莫司是移植免疫抑制的基础。在猪模型中给药他克莫司最可靠的途径之一是肌肉注射。然而，肌注他克莫司在仔猪体内的药代动力学尚未研究。在这里，我们缩小了这方面的知识差距，以指导小儿猪移植模型中肌肉注射他克莫司的剂量。方法：在给药试验中，7头仔猪进行部分心脏移植。术后给予他克莫司免疫抑制，日剂量为0.07 ~ 0.4mg/kg。在药代动力学研究中，仔猪（n = 6）接受颈外静脉置管。基线抽血后，给予0.25mg/kg肌注他克莫司，并连续抽血测定他克莫司血药水平。对数据进行统计分析，确定药代动力学参数。结果：给药试验表明，他克莫司肌注日剂量在0.217-0.421mg/kg之间最能在治疗窗内达到他克莫司血药水平。因此，采用0.25mg/kg进行药代动力学研究。其半衰期为7.7±0.9小时，平均消除常数为0.09±0.01，平均分布容积为30.9±5.3升。结论：肌注他克莫司可达到可靠的血药浓度和可预测的半衰期。尽管血药浓度峰值很高，但每日剂量为0.25 mg/kg并未产生临床或实验室毒性证据。

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引用次数: 0

Impact of Symptom Clusters on Fear of Progression in Kidney Transplant Recipients 肾移植受者症状群对进展恐惧的影响。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.07.029

Minghuan Zhong , Weiwei Cao , Jingjing Yang , Li Ma , Yulin Niu , Bei Ding

Objective

To investigate the association between symptom clusters and fear of progression (FoP) in kidney transplant recipients, and to provide evidence for clinical interventions.

Methods

A cross-sectional study was conducted using convenience sampling, enrolling 209 kidney transplant recipients from a tertiary hospital between September 2024 and January 2025. Participants were assessed using the Fear of Progression Questionnaire–Short Form (FoP-Q-SF) and the Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-62).

Results

The mean total FoP score was 25.15 ± 9.06. Exploratory factor analysis identified 5 symptom clusters, accounting for 72.3% of the total variance. The emotional-related symptom cluster had the highest prevalence (31/209), while patients with neurocognitive symptom clusters reported the highest FoP scores (31.5 ± 9.22). Spearman correlation analysis revealed that FoP was significantly and positively associated with the physical discomfort cluster (r = 0.194), the emotional-related cluster (r = 0.452), and the neurocognitive function cluster (r = 0.255) (P < .001). Multiple regression analysis confirmed that these 3 clusters explained 42.7% of the variance in FoP.

Conclusion

Symptom clusters are closely associated with FoP in kidney transplant recipients. Greater symptom severity is linked to higher levels of FoP. It is recommended that clinicians strengthen symptom cluster management and implement systematic interventions to reduce patients’ FoP.

目的：探讨肾移植受者症状聚类与进展恐惧（FoP）的关系，为临床干预提供依据。方法：采用方便抽样的横断面研究方法，于2024年9月至2025年1月在某三级医院纳入209例肾移植受者。使用恐惧进展问卷-短表（top - q - sf）和改良移植症状发生和症状困扰量表（MTSOSD-62）对参与者进行评估。结果：平均总FoP评分为25.15±9.06分。探索性因子分析鉴定出5个症状类，占总方差的72.3%。情绪相关症状群的患病率最高（31/209），而神经认知症状群的FoP评分最高（31.5±9.22）。Spearman相关分析显示，FoP与身体不适类（r = 0.194）、情绪相关类（r = 0.452）和神经认知功能类（r = 0.255）呈显著正相关（P < 0.001）。多元回归分析证实，这3个聚类解释了42.7%的FoP方差。结论：肾移植受者的症状群与FoP密切相关。更严重的症状与更高水平的FoP有关。建议临床医生加强症状群管理，并实施系统干预，以减少患者的FoP。

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引用次数: 0

Predictive Value of Pretransplant Cytomegalovirus-Specific Cellular Immunity for Posttransplant CMV Infection in Liver Transplant Recipients Under Antiviral Prophylaxis 抗病毒预防肝移植受者移植后巨细胞病毒特异性细胞免疫的预测价值

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.07.006

Elif Seren Tanriverdi , Yusuf Yakupogullari , Yasar Bayindir , Sami Akbulut , Sibel Altunisik Toplu , Harika Gozde Gozukara Bag , Burak Isik , Baris Otlu , Sezai Yilmaz

Background

Existing data suggest that cytomegalovirus (CMV)-specific cell-mediated immunity (CMV-CMI) in solid organ recipients may predict post-transplant CMV infection, but the available information is still limited, and needs to be validated for larger patient populations under certain circumstances. This study aimed to determine whether CMV-CMI could predict post-transplant CMV infection in liver transplant recipients (LTRs) receiving antiviral prophylaxis (AVP).

Methods

A total of 1769 LTRs at the Inonu University Liver Transplantation Institute were retrospectively analyzed. CMV-CMI in a total of 334 patients (> 91% were CMV donor [D] positive/recipient [R] positive) who received AVP were analyzed using the CMV-Interferon (CMV-QF; QuantiFERON-CMV, Qiagen, Germany) assay within the week before transplantation. Patients were divided into two groups: group 1 (positive; n = 171, 51.2%) and group 2 (negative; n = 163, 48.8%). Patient variables were analyzed statistically.

Results

A total of 124 LTRs developed CMV infection. Patients’ pre-transplant characteristics did not differ significantly by their CMV-CMI result. A significantly lower percentage of LTRs with CMV-CMI positive developed infection than those with negatives (7.6% vs 68.1%, P < .001). All CMV-CMI positive patients fully recovered with antiviral treatment but only 76.6% of LTRs with negative CMV-CMI (P = .032). Logistic regression analysis showed that a negative CMV-CMI was associated with a 26 times increased risk of CMV infection compared to those with positive CMV-CMI (odds ratio [OR] = 25.9, P < .001). Female recipients developed CMV infection earlier after cessation of AVP than male recipients (median = 128 vs 144 days, P = .038).

Conclusions

The pre-transplant status of CMV-CMI may be a strong indicator of post-transplant CMV infection for LTRs receiving AVP. Therefore, further consideration should be made for the LTRs with negative CMV-CMI.

背景：现有数据表明，实体器官受者巨细胞病毒（CMV）特异性细胞介导免疫（CMV- cmi）可能预测移植后巨细胞病毒感染，但现有信息仍然有限，需要在某些情况下对更大的患者群体进行验证。本研究旨在确定CMV- cmi是否可以预测肝移植受者（LTRs）接受抗病毒预防（AVP）后的移植后CMV感染。方法：回顾性分析猪野大学肝移植研究所1769例LTRs。采用CMV-干扰素（CMV- qf; CMV- qf）对接受AVP治疗的334例患者CMV- cmi进行分析，其中CMV供体[D]阳性/受体[R]阳性的CMV- 91%；QuantiFERON-CMV, Qiagen, Germany)在移植前一周内检测。患者分为两组：1组(阳性；N = 171, 51.2%)和2组(阴性；N = 163, 48.8%)。对患者变量进行统计分析。结果：124例ltr发生巨细胞病毒感染。移植前患者的CMV-CMI结果无显著差异。CMV-CMI阳性的LTRs发生感染的比例明显低于阴性的LTRs （7.6% vs 68.1%, P < 0.001）。所有CMV-CMI阳性患者在抗病毒治疗后均完全康复，但CMV-CMI阴性的lts只有76.6% （P = 0.032）。Logistic回归分析显示，CMV- cmi阴性患者感染CMV的风险是CMV- cmi阳性患者的26倍（优势比[OR] = 25.9, P < 0.001）。AVP停止后，女性受体比男性受体更早发生巨细胞病毒感染（中位数= 128 vs 144天，P = 0.038）。结论：移植前CMV- cmi的状态可能是AVP术后ltr移植后CMV感染的一个重要指标。因此，对于CMV-CMI阴性的LTRs应进一步考虑。

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引用次数: 0

Revisiting the Biological Rationale for Cytomegalovirus Immune Globulin (CMVIG) in the Modern Era of Solid Organ Transplantation: Current State and Future Direction 巨细胞病毒免疫球蛋白（CMVIG）在现代实体器官移植中的生物学基础：现状和未来方向。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.08.010

Alesa Campbell , Timothy L. Pruett

Cytomegalovirus (CMV) continues to be a significant challenge in solid organ transplantation (SOT), contributing to morbidity, mortality, and allograft rejection. Although CMV immune globulin (CMVIG; Cytogam®) has been shown to reduce the incidence of CMV disease, its precise mechanism of action and clear correlation between anti-CMV activity and disease attenuation remain unclear. Despite advances in antiviral therapies, CMV remains a persistent threat, with resistance complicating treatment strategies. This review revisits the biological rationale for CMVIG, highlighting its potential to improve patient outcomes through mechanisms such as virus neutralization, prevention of viral entry, complement-mediated cell lysis, and immune activation. Although CMVIG appears to mitigate CMV-related complications, further research is needed to establish therapeutic dosing based on anti-CMV antibody titers, pharmacokinetics (PK), and the desired thresholds of anti-CMV activity. Emerging factors, such as the role of co-stimulatory blocking immunosuppression in CMV risk, further emphasize the need for refining CMVIG’s clinical application. Notably, CMVIG’s in vitro effects on cellular immunity suggest its potential to improve outcomes, particularly in SOT recipients undergoing co-stimulation blockade. Unanswered questions remain, such as optimal IgG target levels for efficacy, the role of intracellular and extracellular immune responses to CMVIG and understanding the antibody dose-response relationship. Re-evaluating the CMV treatment paradigm, with a focus on CMVIG and antiviral agents, holds promise for more effective strategies in the modern era of SOT.

巨细胞病毒（CMV）仍然是实体器官移植（SOT）的一个重大挑战，导致发病率、死亡率和同种异体移植排斥反应。虽然CMV免疫球蛋白（CMVIG; Cytogam®）已被证明可以降低CMV疾病的发病率，但其确切的作用机制以及抗CMV活性与疾病衰减之间的明确相关性尚不清楚。尽管抗病毒治疗取得了进展，巨细胞病毒仍然是一个持续的威胁，耐药性使治疗策略复杂化。这篇综述回顾了CMVIG的生物学原理，强调了其通过病毒中和、防止病毒进入、补体介导的细胞裂解和免疫激活等机制改善患者预后的潜力。尽管CMVIG似乎可以减轻cmv相关并发症，但需要进一步的研究来确定基于抗cmv抗体滴度、药代动力学（PK）和抗cmv活性所需阈值的治疗剂量。新出现的因素，如共刺激阻断免疫抑制在巨细胞病毒风险中的作用，进一步强调需要完善CMVIG的临床应用。值得注意的是，CMVIG在体外对细胞免疫的影响表明，它有可能改善结果，特别是在接受共刺激阻断的SOT受体中。尚未解决的问题仍然存在，例如最佳的IgG靶水平，细胞内和细胞外免疫反应对CMVIG的作用以及对抗体剂量-反应关系的理解。以CMVIG和抗病毒药物为重点，重新评估巨细胞病毒治疗模式，有望在现代SOT时代找到更有效的治疗策略。

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引用次数: 0

Role of Artificial Intelligence in Lung Transplantation: Current State, Challenges, and Future Directions 人工智能在肺移植中的作用：现状、挑战和未来方向。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.08.016

Robert P. Duncheskie , Omar Al Omari , Fatima Anjum

Lung transplantation remains a critical treatment for end-stage lung diseases, yet it continues to have 1 of the lowest survival rates among solid organ transplants. Despite its life-saving potential, the field faces several challenges, including organ shortages, suboptimal donor matching, and post-transplant complications. The rapidly advancing field of artificial intelligence (AI) offers significant promise in addressing these challenges. Traditional statistical models, such as linear and logistic regression, have been used to predict post-transplant outcomes but struggle to adapt to new trends and evolving data. In contrast, machine learning algorithms can evolve with new data, offering dynamic and updated predictions. AI holds the potential to enhance lung transplantation at multiple stages. In the pre-transplant phase, AI can optimize waitlist management, refine donor selection, and improve donor-recipient matching, and enhance diagnostic imaging by harnessing vast datasets. Post-transplant, AI can help predict allograft rejection, improve immunosuppressive management, and better forecast long-term patient outcomes, including quality of life. However, the integration of AI in lung transplantation also presents challenges, including data privacy concerns, algorithmic bias, and the need for external clinical validation. This review explores the current state of AI in lung transplantation, summarizes key findings from recent studies, and discusses the potential benefits, challenges, and ethical considerations in this rapidly evolving field, highlighting future research directions.

肺移植仍然是终末期肺部疾病的重要治疗方法，但它仍然是实体器官移植中存活率最低的方法之一。尽管该领域具有挽救生命的潜力，但仍面临着一些挑战，包括器官短缺、供体匹配不理想以及移植后并发症。快速发展的人工智能（AI）领域为解决这些挑战提供了巨大的希望。传统的统计模型，如线性和逻辑回归，已被用于预测移植后的结果，但难以适应新的趋势和不断变化的数据。相比之下，机器学习算法可以随着新数据的发展而发展，提供动态和更新的预测。人工智能具有在多个阶段增强肺移植的潜力。在移植前阶段，人工智能可以优化等待名单管理，优化供体选择，改善供体-受体匹配，并通过利用大量数据集增强诊断成像。移植后，人工智能可以帮助预测同种异体移植排斥反应，改善免疫抑制管理，更好地预测患者的长期预后，包括生活质量。然而，人工智能在肺移植中的整合也面临挑战，包括数据隐私问题、算法偏差以及需要外部临床验证。本文探讨了人工智能在肺移植中的现状，总结了近期研究的主要发现，并讨论了这一快速发展领域的潜在益处、挑战和伦理考虑，并强调了未来的研究方向。

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引用次数: 0

Intraoperative Risk Factors of Early Allograft Dysfunction at a Liver Transplantation Center in Brazil: A Retrospective Study 巴西肝移植中心早期同种异体移植功能障碍的术中危险因素：一项回顾性研究。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.09.005

Geisiane Custódio , Andrew Maykon Massutti , Sofia Stein Corrêa da Cunha , Cristiane Bauermann Leitão , Tatiana Helena Rech

Background

Early allograft dysfunction (EAD) is a serious complication of liver transplantation. Multiple donor, recipient, and intraoperative risk factors contribute to its development. This study aims to assess the impact of intraoperative risk factors for EAD on clinical outcomes of liver transplant recipients.

Methods

This retrospective study enrolled brain-dead donors and adult liver graft recipients. Recipient-donor matching was facilitated via a crossover list, and comprehensive clinical and laboratory data were recorded for donors, recipients, and surgical procedures. The primary outcome assessed was EAD. Secondary outcomes were the association between anatomical variants with bleeding volume and need for blood transfusions, length of ICU and hospital stay, retransplantation, and patient and graft survival after 12 months.

Results

A total of 228 patients underwent liver transplants from brain-dead donors between January 2019 and December 2021. The incidence of EAD was 25%. In the univariate analysis, liver graft steatosis, previous abdominal surgery, biliary reconstruction in Roux-in-Y, total transplantation time, bleeding volume, and the need for all types of blood products were associated with EAD. However, after adjustment for the Model for End Stage Liver Disease (MELD) score, only biliary reconstruction in Roux-in-Y (OR 4.58, 95% CI 1.63-12.83, P = .004) and total transplantation time (OR 1.01, 95% CI 1.003-1.014, P = .0002) persisted in association with EAD. Anatomical variants were not associated with EAD, increased bleeding and the need for blood transfusions or other clinical outcomes.

Conclusions

Biliary reconstruction in Roux-in-Y and total transplantation time were associated with EAD development while anatomical artery variants were not.

背景：早期同种异体移植物功能障碍（EAD）是肝移植的严重并发症。多种供体、受体和术中危险因素导致其发展。本研究旨在评估术中EAD危险因素对肝移植受者临床预后的影响。方法：本回顾性研究纳入脑死亡供体和成人肝移植受者。通过交叉列表促进了供体与受体的匹配，并记录了供体、受体和手术过程的综合临床和实验室数据。主要评价指标为EAD。次要结局是解剖变异与出血量和输血需求、ICU和住院时间、再移植以及12个月后患者和移植物存活之间的关系。结果：2019年1月至2021年12月期间，共有228名患者接受了脑死亡供体的肝脏移植。EAD的发生率为25%。在单变量分析中，肝移植脂肪变性、既往腹部手术、Roux-in-Y胆道重建、总移植时间、出血量和所有类型血液制品的需求与EAD相关。然而，在调整终末期肝病模型（MELD）评分后，只有Roux-in-Y胆道重建（OR 4.58, 95% CI 1.63-12.83, P = 0.004）和总移植时间（OR 1.01, 95% CI 1.003-1.014, P = 0.002）与EAD持续相关。解剖变异与EAD、出血增加、输血需求或其他临床结果无关。结论：Roux-in-Y胆道重建和总移植时间与EAD的发生有关，而解剖动脉变异与EAD的发生无关。

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引用次数: 0

Outcomes of Liver Transplantation Among Patients Diagnosed With Acute-on-Chronic Liver Failure: A Single-Center Experience 在诊断为急性慢性肝衰竭的患者中肝移植的结果：单中心经验。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.06.015

Yoshitaka Saegusa , Masahiro Ohira , Naruhiko Honmyo , Ryosuke Nakano , Hiroshi Sakai , Seiichi Shimizu , Shintaro Kuroda , Hiroyuki Tahara , Kentaro Ide , Tsuyoshi Kobayashi , Yuka Tanaka , Hideki Ohdan

Background

Acute-on-chronic liver failure (ACLF) describes the rapid deterioration of liver function triggered by factors including alcohol consumption, infection(s), and exacerbation(s) of chronic liver disease, and is characterized by a persistent “cytokine storm.” While liver transplantation is the most effective treatment, comprehensive data regarding patient outcomes are limited.

Methods

Clinical data from 187 patients, who underwent liver transplantation (excluding re-transplantations and acute liver failure) between 2009 and 2023, were analyzed in accordance with Japan’s ACLF diagnostic criteria. Immunological analysis included a mixed lymphocyte reaction with carboxyfluorescein succinimidyl ester staining (CFSE-MLR).

Results

Among 171 patients, 13 had ACLF (grade 0, n = 6; grade 2, n = 5; grade 3, n = 2), and 158 had non-ACLF. Five-year survival rates for the ACLF and non-ACLF groups were similar regardless of ACLF severity. Patients with ACLF had higher preoperative Model for End-stage Liver Disease (ie, “MELD”) scores and Child–Pugh scores, and higher rates of dialysis, renal dysfunction, and respiratory failure (P < .05). The graft rejection rate was higher in the ACLF group than that in the non-ACLF group, and the CFSE-MLR assay revealed significantly elevated CD8-positive T cell responses to donor antigens in the first week post-transplantation.

Conclusion

Patients with ACLF achieved favorable postoperative outcomes despite poor preoperative conditions. High mortality rates among patients with ACLF on transplant waitlists emphasize the importance of timely transplantation. The increased anti-donor immune response after transplantation suggests a role for the underlying cytokine storm and underscores the need for careful postoperative management.

背景：急性慢性肝衰竭（ACLF）描述了由酒精摄入、感染和慢性肝病恶化等因素引发的肝功能迅速恶化，其特征是持续的“细胞因子风暴”。虽然肝移植是最有效的治疗方法，但有关患者预后的综合数据有限。方法：根据日本ACLF诊断标准，对2009 - 2023年间187例肝移植（不包括再移植和急性肝衰竭）患者的临床资料进行分析。免疫学分析包括混合淋巴细胞反应，羧基荧光素琥珀酰酰酯染色（CFSE-MLR）。结果：171例患者中，ACLF患者13例(0级，n = 6；2级，n = 5；3级，n = 2)，非aclf 158例。无论ACLF的严重程度如何，ACLF组和非ACLF组的5年生存率相似。ACLF患者术前终末期肝病模型（MELD）评分和Child-Pugh评分较高，透析、肾功能不全和呼吸衰竭发生率较高（P < 0.05）。ACLF组的排异率高于非ACLF组，CFSE-MLR检测显示，在移植后第一周，cd8阳性T细胞对供体抗原的反应显著升高。结论：ACLF患者术前条件较差，但术后预后良好。等待移植的ACLF患者的高死亡率强调了及时移植的重要性。移植后增加的抗供体免疫反应提示潜在的细胞因子风暴的作用，并强调需要仔细的术后管理。

{"title":"Outcomes of Liver Transplantation Among Patients Diagnosed With Acute-on-Chronic Liver Failure: A Single-Center Experience","authors":"Yoshitaka Saegusa , Masahiro Ohira , Naruhiko Honmyo , Ryosuke Nakano , Hiroshi Sakai , Seiichi Shimizu , Shintaro Kuroda , Hiroyuki Tahara , Kentaro Ide , Tsuyoshi Kobayashi , Yuka Tanaka , Hideki Ohdan","doi":"10.1016/j.transproceed.2025.06.015","DOIUrl":"10.1016/j.transproceed.2025.06.015","url":null,"abstract":"<div><h3>Background</h3><div>Acute-on-chronic liver failure (ACLF) describes the rapid deterioration of liver function triggered by factors including alcohol consumption, infection(s), and exacerbation(s) of chronic liver disease, and is characterized by a persistent “cytokine storm.” While liver transplantation is the most effective treatment, comprehensive data regarding patient outcomes are limited.</div></div><div><h3>Methods</h3><div>Clinical data from 187 patients, who underwent liver transplantation (excluding re-transplantations and acute liver failure) between 2009 and 2023, were analyzed in accordance with Japan’s ACLF diagnostic criteria. Immunological analysis included a mixed lymphocyte reaction with carboxyfluorescein succinimidyl ester staining (CFSE-MLR).</div></div><div><h3>Results</h3><div>Among 171 patients, 13 had ACLF (grade 0, n = 6; grade 2, n = 5; grade 3, n = 2), and 158 had non-ACLF. Five-year survival rates for the ACLF and non-ACLF groups were similar regardless of ACLF severity. Patients with ACLF had higher preoperative Model for End-stage Liver Disease (ie, “MELD”) scores and Child–Pugh scores, and higher rates of dialysis, renal dysfunction, and respiratory failure (<em>P</em> < .05). The graft rejection rate was higher in the ACLF group than that in the non-ACLF group, and the CFSE-MLR assay revealed significantly elevated CD8-positive T cell responses to donor antigens in the first week post-transplantation.</div></div><div><h3>Conclusion</h3><div>Patients with ACLF achieved favorable postoperative outcomes despite poor preoperative conditions. High mortality rates among patients with ACLF on transplant waitlists emphasize the importance of timely transplantation. The increased anti-donor immune response after transplantation suggests a role for the underlying cytokine storm and underscores the need for careful postoperative management.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 8","pages":"Pages 1568-1573"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669247","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

Clinical Efficacy and Safety of a Modified Conditioning Regimen Reducing the Dosage of Busulfan and Adding Thiotepa in Allogeneic Hematopoietic Stem Cell Transplantation for Pediatric Acute Myeloid Leukemia 减少布苏凡剂量加硫替帕治疗小儿急性髓系白血病异基因造血干细胞移植的临床疗效和安全性

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings

Pub Date : 2025-10-01 DOI: 10.1016/j.transproceed.2025.07.027

Na Song, Mincui Zheng, Pang Wu, Wenyong Kuang, Shan He, Shaoyang Deng, Zhijun Huang, Benshan Zhang

Objective

This study aimed to investigate the efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with a conditioning regimen that reduces the dosage of busulfan and incorporates thiotepa in children with acute myeloid leukemia (AML).

Methods

A retrospective analysis was conducted on 55 pediatric patients with AML who underwent allo-HSCT at Hunan Children's Hospital from December 2019 to December 2023. Group A (n = 33) included patients with thiotepa in the conditioning regimen, while Group B (n = 22) included patients without thiotepa. Conditioning regemen of Group A was modified to reduce 1 day dosage of busulfan and add an additional dose of thiotepa at 10 mg/kg.

Results

With a median follow-up of 31 months, the OS for all patients was 94.5%. Group A had a higher survival rate compared to Group B, though the difference was not statistically significant (96.9% vs 90.9%, P = .388). For patients who were measurable residual disease positive before transplantation, the OS in Group A was significantly higher than in Group B (100% vs 75%, P = .039). The total relapse rate was 5.45%, with no significant difference between the groups (Group A 6% vs Group B 4.55%, P = .648). The non-relapse mortality was 1.8%, with only 1 death due to severe sinusoidal obstruction syndrome (SOS) in Group B. The incidence rates of acute graft-versus-host disease (aGVHD), severe aGVHD, SOS, and transplant-associated thrombotic microangiopathy (TA-TMA) were lower in Group A, particularly for aGVHD and severe aGVHD (30.3% vs 45.4%, P = .252; 12.1% vs 27.3%, P = .175), although these differences were not statistically significant.

Conclusion

The modified conditioning regimen demonstrated promising clinical efficacy and safety. This modified regimen has the potential to enhance the prognosis of pediatric AML patients, especially those with MRD-positive pre-transplantation.

目的：本研究旨在探讨同种异体造血干细胞移植（allogeneic hematopoietic stem cell transplantation，简称alloo - hsct）治疗急性髓性白血病（AML）患儿的疗效和安全性，该治疗方案采用减少布苏凡剂量并合并硫替帕的治疗方案。方法：回顾性分析2019年12月至2023年12月在湖南省儿童医院行同种异体造血干细胞移植的55例急性髓系白血病患儿。A组（n = 33）采用硫替帕调节方案，B组（n = 22）不采用硫替帕。对A组的调节方案进行修改，减少1天的丁硫凡剂量，并加用10 mg/kg的硫替帕剂量。结果：中位随访31个月，所有患者的总生存率为94.5%。A组生存率高于B组，但差异无统计学意义（96.9% vs 90.9%, P = 0.388）。对于移植前可测量残留病阳性的患者，A组的OS显著高于B组（100% vs 75%, P = 0.039）。总复发率为5.45%，两组比较差异无统计学意义（A组为6%，B组为4.55%,P = 0.648）。非复发死亡率为1.8%，其中b组只有1例死于严重鼻窦阻塞综合征（SOS）。急性移植物抗宿主病（aGVHD）、严重aGVHD、SOS和移植相关血栓性微血管病（TA-TMA）的发生率在A组较低，特别是aGVHD和严重aGVHD的发生率（30.3%比45.4%,P = 0.252； 12.1%比27.3%,P = 0.175），尽管这些差异无统计学意义。结论：改良调理方案具有良好的临床疗效和安全性。这种改良方案有可能改善儿科AML患者的预后，特别是那些mrd阳性的移植前患者。

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引用次数: 0