Pub Date : 2024-10-22DOI: 10.1016/j.trim.2024.102140
Mohamed I. Mohamed , Mattias Embretsen , Justin H. Nguyen
Background
Hepatic draining lymph nodes (HDLN) are implicated in allograft alloimmunity and tolerance. In contrast to experimental work, the role of HDLNs in human liver transplant (LT) is unknown due to lack of relevant clinical tissue.
Methods
During LT, the porta hepatis was dissected near the liver hilum during native hepatectomy. The HDLN in this region was taken prior to reperfusion (prereperfusion). Following complete reperfusion with recipient portal venous blood, hepatic arterial inflow into the allograft was established. As the recipient's common hepatic artery was fully mobilized, its HDLNs were removed and submitted to pathology (postreperfusion).
Results
Of 37 LTs performed between January 1, 2021, and July 9, 2022, 20 had both pre- and postreperfusion HDLNs archived (Group A); 11 had only postreperfusion HDLNs archived (Group B), and 6 had no archived HDLNs (Group C). Removing and archiving HDLNs did not increase operative times or transfusion requirements. For groups A, B, and C, mean (SD) warm ischemic times were 25.2 (2.0), 25.3 (3.2), and 28.3 (6.2) minutes, respectively (P > .05); operating times were 3.9 (0.7), 6.9 (7.8), and 7.9 (7.1) hours, respectively (A vs C, P = .017; C vs B, P > .05); and units of transfused packed red blood cells were 8.0 (3.8), 11.1 (10.3), and 12.2 (7.6), respectively (P > .05).
Conclusion
We describe an approach for clinical archiving of HDLNs obtained within the operative field during orthotopic LT in humans. Availability of relevant HDLNs is essential for investigations of primary immune responses potentially important in allograft alloimmunity and tolerance.
背景：肝引流淋巴结（HDLN）与同种异体免疫和耐受有关。与实验研究相反，由于缺乏相关的临床组织，HDLN 在人类肝移植（LT）中的作用尚不清楚：方法：在肝移植过程中，原发性肝切除术在肝门附近切除肝门。方法：肝移植过程中，在原肝切除术中解剖肝门附近，在再灌注（再灌注前）前提取该区域的高密度脂蛋白。用受体门静脉血液进行完全再灌注后，肝动脉血流入异体移植物。随着受体肝总动脉的完全活动，其高密度脂蛋白网被移除并提交病理检查（再灌注后）：结果：在2021年1月1日至2022年7月9日期间进行的37例LT手术中，20例在再灌注前和再灌注后均有HDLN存档（A组）；11例仅有再灌注后的HDLN存档（B组）；6例无HDLN存档（C组）。移除和存档 HDLN 不会增加手术时间或输血需求。A 组、B 组和 C 组的平均（标清）温暖缺血时间分别为 25.2 (2.0)、25.3 (3.2) 和 28.3 (6.2) 分钟（P > .05）；手术时间分别为 3.9 (0.7)、6.9 (7.8) 和 7.9 (7. 1) 小时（A 组 vs. B 组）。1）小时（A vs C，P = .017；C vs B，P > .05）；输注包装红细胞的单位分别为 8.0 (3.8)、11.1 (10.3) 和 12.2 (7.6)（P > .05）：我们描述了一种在人体正位LT过程中在手术区域内获得的HDLN的临床存档方法。获得相关的 HDLNs 对于研究可能对异体移植物同种免疫和耐受性很重要的原发性免疫反应至关重要。
{"title":"Hepatic draining lymph nodes in human liver transplant: Implications in alloimmunity and tolerance","authors":"Mohamed I. Mohamed , Mattias Embretsen , Justin H. Nguyen","doi":"10.1016/j.trim.2024.102140","DOIUrl":"10.1016/j.trim.2024.102140","url":null,"abstract":"<div><h3>Background</h3><div>Hepatic draining lymph nodes (HDLN) are implicated in allograft alloimmunity and tolerance. In contrast to experimental work, the role of HDLNs in human liver transplant (LT) is unknown due to lack of relevant clinical tissue.</div></div><div><h3>Methods</h3><div>During LT, the porta hepatis was dissected near the liver hilum during native hepatectomy. The HDLN in this region was taken prior to reperfusion (prereperfusion). Following complete reperfusion with recipient portal venous blood, hepatic arterial inflow into the allograft was established. As the recipient's common hepatic artery was fully mobilized, its HDLNs were removed and submitted to pathology (postreperfusion).</div></div><div><h3>Results</h3><div>Of 37 LTs performed between January 1, 2021, and July 9, 2022, 20 had both pre- and postreperfusion HDLNs archived (Group A); 11 had only postreperfusion HDLNs archived (Group B), and 6 had no archived HDLNs (Group C). Removing and archiving HDLNs did not increase operative times or transfusion requirements. For groups A, B, and C, mean (SD) warm ischemic times were 25.2 (2.0), 25.3 (3.2), and 28.3 (6.2) minutes, respectively (<em>P</em> > .05); operating times were 3.9 (0.7), 6.9 (7.8), and 7.9 (7.1) hours, respectively (A vs C, <em>P</em> = .017; C vs B, <em>P</em> > .05); and units of transfused packed red blood cells were 8.0 (3.8), 11.1 (10.3), and 12.2 (7.6), respectively (<em>P</em> > .05).</div></div><div><h3>Conclusion</h3><div>We describe an approach for clinical archiving of HDLNs obtained within the operative field during orthotopic LT in humans. Availability of relevant HDLNs is essential for investigations of primary immune responses potentially important in allograft alloimmunity and tolerance.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102140"},"PeriodicalIF":1.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508746","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 : 2024-10-21DOI: 10.1016/j.trim.2024.102137
Fizza Zulfiqar , Moazzam Shahzad , Muhammad Kashif Amin , Abhinav Vyas , Zouina Sarfraz , Anika Zainab , Hana Qasim , Dania Kaur , Naghmeh Khavandgar , Forat Lutfi , Peiman Hematti , Joseph P. McGuirk , Muhammad Umair Mushtaq
Background
Chimeric antigen receptor T cell (CAR-T) therapy is an emerging form of immunotherapy that has recently gained recognition for treating hematological malignancies. This successful utilization of CAR-T therapy has attracted interest in its application in refractory rheumatological diseases. Here, we will review the use of CAR-T therapy in rheumatological diseases.
Methods
Per PRISMA guidelines, a comprehensive literature search was performed on PubMed, Cochrane, and ClinicalTrials.gov using keywords for ‘CAR-T cell therapy’ and ‘Rheumatological diseases’ from inception to December 9, 2023. After screening 2977 articles, six studies reporting outcomes of CAR-T cell therapies in patients with underlying autoimmune /rheumatological diseases. Descriptive analysis was performed to represent demographics and clinical outcomes.
Results
A total of 101 adult patients from six studies were included in this systematic review. The median age of the participants was 50.8 years (IQR: 14.875), with ages ranging from 18 to 83 years. The included studies comprised 2 case reports, 1 case series, one observational study, and two clinical trials. The studies were conducted globally, including USA, Germany, and China. The underlying rheumatologic conditions were systemic lupus erythematosus (17.8 %), rheumatoid arthritis (23.8 %), myasthenia gravis (13.8 %), neuromyelitis optica (11.9 %), and others (32.7 %). The target of CAR-T therapy included CD-19 in four studies and B cell maturation antigen (BCMA) in two studies. All the patients were on prior therapy, including glucocorticoids and disease-modifying antirheumatic drugs. Follow-up ranged from a month to 1.5 years. Most of the studies reported improvement in the symptoms and decline in serological biomarkers of the underlying disease. The notable outcomes in the included studies were a 100 % response rate in five out of six studies. Grade 1 and 2 cytokine release syndrome (CRS) was observed in five studies. Only one study reported Grade 3 or higher CRS. 2 patients (1.98 %) developed neurotoxicity among the adverse effects.
Conclusion
CAR-T cell therapy is a paradigm shift in managing rheumatologic diseases, with symptomatic improvement and biochemical control of these diseases. Although preliminary evidence indicates promising results, long-term follow-up and prospective clinical trials are needed to establish optimal timing and assess the safety and efficacy of CAR-T immunotherapy.
{"title":"Outcomes with chimeric antigen receptor T-cell therapy in Rheumatological disorders: A systematic review","authors":"Fizza Zulfiqar , Moazzam Shahzad , Muhammad Kashif Amin , Abhinav Vyas , Zouina Sarfraz , Anika Zainab , Hana Qasim , Dania Kaur , Naghmeh Khavandgar , Forat Lutfi , Peiman Hematti , Joseph P. McGuirk , Muhammad Umair Mushtaq","doi":"10.1016/j.trim.2024.102137","DOIUrl":"10.1016/j.trim.2024.102137","url":null,"abstract":"<div><h3>Background</h3><div>Chimeric antigen receptor T cell (CAR-T) therapy is an emerging form of immunotherapy that has recently gained recognition for treating hematological malignancies. This successful utilization of CAR-T therapy has attracted interest in its application in refractory rheumatological diseases. Here, we will review the use of CAR-T therapy in rheumatological diseases.</div></div><div><h3>Methods</h3><div>Per PRISMA guidelines, a comprehensive literature search was performed on PubMed, Cochrane, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> using keywords for ‘CAR-T cell therapy’ and ‘Rheumatological diseases’ from inception to December 9, 2023. After screening 2977 articles, six studies reporting outcomes of CAR-T cell therapies in patients with underlying autoimmune /rheumatological diseases. Descriptive analysis was performed to represent demographics and clinical outcomes.</div></div><div><h3>Results</h3><div>A total of 101 adult patients from six studies were included in this systematic review. The median age of the participants was 50.8 years (IQR: 14.875), with ages ranging from 18 to 83 years. The included studies comprised 2 case reports, 1 case series, one observational study, and two clinical trials. The studies were conducted globally, including USA, Germany, and China. The underlying rheumatologic conditions were systemic lupus erythematosus (17.8 %), rheumatoid arthritis (23.8 %), myasthenia gravis (13.8 %), neuromyelitis optica (11.9 %), and others (32.7 %). The target of CAR-T therapy included CD-19 in four studies and B cell maturation antigen (BCMA) in two studies. All the patients were on prior therapy, including glucocorticoids and disease-modifying antirheumatic drugs. Follow-up ranged from a month to 1.5 years. Most of the studies reported improvement in the symptoms and decline in serological biomarkers of the underlying disease. The notable outcomes in the included studies were a 100 % response rate in five out of six studies. Grade 1 and 2 cytokine release syndrome (CRS) was observed in five studies. Only one study reported Grade 3 or higher CRS. 2 patients (1.98 %) developed neurotoxicity among the adverse effects.</div></div><div><h3>Conclusion</h3><div>CAR-T cell therapy is a paradigm shift in managing rheumatologic diseases, with symptomatic improvement and biochemical control of these diseases. Although preliminary evidence indicates promising results, long-term follow-up and prospective clinical trials are needed to establish optimal timing and assess the safety and efficacy of CAR-T immunotherapy.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102137"},"PeriodicalIF":1.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1016/j.trim.2024.102141
Júlia Plentz Portich , Aline Sinhorelo Ribeiro , Lisandra Della Costa Rigoni , Lúcia Mariano da Rocha Silla , Claudia Caceres Astigarraga , Liane Esteves Daudt , Alessandra Aparecida Paz
Background
Engraftment syndrome (ES) is a clinical condition that may occur during neutrophil recovery after hematopoietic stem cell transplantation (HSCT). Diagnosis is challenging because of the varying diagnostic criteria and the controversial relationship between ES and graft-versus-host disease (GVHD).
Objective
To investigate the incidence of ES and its relationship with GVHD in patients undergoing allogeneic HSCT at our institution.
Study design
This retrospective cohort study included patients who underwent allogeneic HSCT (alloHSCT) at a Brazilian tertiary hospital between January 2015 and December 2016. ES was diagnosed based on the Spitzer or Maiolino criteria.
Results
Of the 79 patients who underwent alloHSCT, three presented with graft failure and were excluded from the analysis. The incidence of ES, according to both Spitzer's and Maiolino's criteria, was 16.5 % and 9.8 % in patients older than 14 years and 28.6 % in children, respectively, with a significant correlation (P < 0.05, Pearson's chi-squared test). ES was associated with prolonged hospitalization (P = 0.01; Student's t-test). No correlation was observed between acute GVHD and ES. There was a positive correlation between the use of broad-spectrum antibiotics against multidrug-resistant bacteria and ES development (P < 0.05, Pearson's chi-squared test).
Conclusions
The general incidence of ES in this cohort was consistent with that reported in the literature. Remarkably, ES was associated with prolonged hospitalization (14 days longer than in patients without ES). Moreover, patients who used antibiotics against multidrug-resistant bacteria had a higher incidence of ES.
背景：移植综合征（ES）是造血干细胞移植（HSCT）后中性粒细胞恢复期间可能出现的一种临床症状。由于诊断标准不一，且ES与移植物抗宿主疾病（GVHD）之间的关系存在争议，因此诊断具有挑战性：研究设计：这项回顾性队列研究纳入了2015年1月至2016年12月期间在巴西一家三级医院接受异基因造血干细胞移植（alloHSCT）的患者。ES根据Spitzer或Maiolino标准进行诊断：在接受同种异体造血干细胞移植的79名患者中，有3人出现移植失败，被排除在分析之外。根据Spitzer和Maiolino的标准，14岁以上患者的ES发生率分别为16.5%和9.8%，儿童患者的ES发生率为28.6%，两者之间存在显著相关性（P 结论：ES的发生率与移植失败率之间存在显著相关性：本组人群中 ES 的总体发病率与文献报道一致。值得注意的是，ES 与住院时间延长有关（比没有 ES 的患者多住院 14 天）。此外，使用抗生素治疗耐多药细菌的患者 ES 发生率更高。
{"title":"Institutional insights into engraftment syndrome: A cohort study on allogeneic transplantation outcomes","authors":"Júlia Plentz Portich , Aline Sinhorelo Ribeiro , Lisandra Della Costa Rigoni , Lúcia Mariano da Rocha Silla , Claudia Caceres Astigarraga , Liane Esteves Daudt , Alessandra Aparecida Paz","doi":"10.1016/j.trim.2024.102141","DOIUrl":"10.1016/j.trim.2024.102141","url":null,"abstract":"<div><h3>Background</h3><div>Engraftment syndrome (ES) is a clinical condition that may occur during neutrophil recovery after hematopoietic stem cell transplantation (HSCT). Diagnosis is challenging because of the varying diagnostic criteria and the controversial relationship between ES and graft-versus-host disease (GVHD).</div></div><div><h3>Objective</h3><div>To investigate the incidence of ES and its relationship with GVHD in patients undergoing allogeneic HSCT at our institution.</div></div><div><h3>Study design</h3><div>This retrospective cohort study included patients who underwent allogeneic HSCT (alloHSCT) at a Brazilian tertiary hospital between January 2015 and December 2016. ES was diagnosed based on the Spitzer or Maiolino criteria.</div></div><div><h3>Results</h3><div>Of the 79 patients who underwent alloHSCT, three presented with graft failure and were excluded from the analysis. The incidence of ES, according to both Spitzer's and Maiolino's criteria, was 16.5 % and 9.8 % in patients older than 14 years and 28.6 % in children, respectively, with a significant correlation (<em>P</em> < 0.05, Pearson's chi-squared test). ES was associated with prolonged hospitalization (<em>P</em> = 0.01; Student's <em>t</em>-test). No correlation was observed between acute GVHD and ES. There was a positive correlation between the use of broad-spectrum antibiotics against multidrug-resistant bacteria and ES development (<em>P</em> < 0.05, Pearson's chi-squared test).</div></div><div><h3>Conclusions</h3><div>The general incidence of ES in this cohort was consistent with that reported in the literature. Remarkably, ES was associated with prolonged hospitalization (14 days longer than in patients without ES). Moreover, patients who used antibiotics against multidrug-resistant bacteria had a higher incidence of ES.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102141"},"PeriodicalIF":1.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508758","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 : 2024-10-21DOI: 10.1016/j.trim.2024.102138
Nele Van De Winkel , Marina Gabriela M.C. Mori da Cunha , Antoine Dubois , Ewout Muylle , Lisanne Terrie , Ina Hennion , Gert De Hertogh , Heleen Fehervary , Lieven Thorrez , Marc Miserez , Jacques Pirenne , André D’Hoore , Laurens J. Ceulemans
Complex abdominal wall repair remains a major surgical challenge. In transplant patients, non-vascularized rectus fascia (NVRF) is successfully used to bridge the defect. To extrapolate this to non-transplant patients, we developed a rabbit model of NVRF-transplantation without immunosuppression comparing syngeneic versus allogeneic transplants. Short-term outcome (4 weeks) was evaluated macroscopically (ingrowth, seroma/hematoma, herniation, and infection), histologically at the graft interface and center (inflammation, neovascularization, and collagen deposition) and by mechanical testing. In both groups a similar macroscopic ingrowth of the NVRF was observed. In the syn-group, one seroma and one hematoma was seen. Two small herniations were detected at the suture line in the allo-group. No surgical site infections were observed. Histologically, graft neovascularization was observed in all animals. Infiltration of T-lymphocytes was seen at the graft interface in both groups, but more in the allo-group (p < 0.0001). Deposition of collagen was not different between groups. Macrophages were present in both groups around sutures and in the center more abundantly in the allo-group (p = 0.0001). Graft stiffness and strength were similar for both groups. With this model, we showed that allogeneic transplantation without immunosuppression results in favorable short-term inflammatory and mechanical outcomes. Long-term experiments are needed to further evaluate the effect on graft integration and hernia development.
复杂的腹壁修复仍然是一项重大的手术挑战。在移植患者中，无血管直肌筋膜（NVRF）被成功用于弥补缺损。为了将这一方法推广到非移植患者中，我们建立了一个无免疫抑制的无血管直肌筋膜移植兔模型，对同种异体移植进行了比较。对短期结果（4 周）进行了宏观评估（生长、血清肿/血肿、疝和感染）、移植物界面和中心的组织学评估（炎症、新生血管和胶原沉积）以及机械测试。在两组患者中，都观察到了类似的新生血管再造阵列的宏观生长情况。在同步组中，发现了一个血清肿和一个血肿。异体组在缝合线处发现两个小的疝气。未观察到手术部位感染。从组织学角度看，所有动物均观察到移植物新生血管。两组动物的移植物界面都出现了 T 淋巴细胞浸润，但异体组的 T 淋巴细胞浸润更多（p＜0.05）。
{"title":"Allogeneic abdominal non-vascularized rectus fascia transplantation without immunosuppression equals syngeneic transplantation in a rabbit model at short-term follow-up","authors":"Nele Van De Winkel , Marina Gabriela M.C. Mori da Cunha , Antoine Dubois , Ewout Muylle , Lisanne Terrie , Ina Hennion , Gert De Hertogh , Heleen Fehervary , Lieven Thorrez , Marc Miserez , Jacques Pirenne , André D’Hoore , Laurens J. Ceulemans","doi":"10.1016/j.trim.2024.102138","DOIUrl":"10.1016/j.trim.2024.102138","url":null,"abstract":"<div><div>Complex abdominal wall repair remains a major surgical challenge. In transplant patients, non-vascularized rectus fascia (NVRF) is successfully used to bridge the defect. To extrapolate this to non-transplant patients, we developed a rabbit model of NVRF-transplantation without immunosuppression comparing syngeneic versus allogeneic transplants. Short-term outcome (4 weeks) was evaluated macroscopically (ingrowth, seroma/hematoma, herniation, and infection), histologically at the graft interface and center (inflammation, neovascularization, and collagen deposition) and by mechanical testing. In both groups a similar macroscopic ingrowth of the NVRF was observed. In the <em>syn</em>-group, one seroma and one hematoma was seen. Two small herniations were detected at the suture line in the allo-group. No surgical site infections were observed. Histologically, graft neovascularization was observed in all animals. Infiltration of T-lymphocytes was seen at the graft interface in both groups, but more in the allo-group (<em>p</em> < 0.0001). Deposition of collagen was not different between groups. Macrophages were present in both groups around sutures and in the center more abundantly in the allo-group (<em>p</em> = 0.0001). Graft stiffness and strength were similar for both groups. With this model, we showed that allogeneic transplantation without immunosuppression results in favorable short-term inflammatory and mechanical outcomes. Long-term experiments are needed to further evaluate the effect on graft integration and hernia development.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102138"},"PeriodicalIF":1.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508760","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 : 2024-10-04DOI: 10.1016/j.trim.2024.102136
Raza Ullah Asif, Eijaz Ghani, Muhammad Ali Rathore, Saadiya Mushtaq, Faraz Ahmed, Hammad Hussain
Background
The BK polyomavirus infection poses a substantial challenge for organ transplant recipients due to immunosuppression, resulting in BK virus-associated nephropathy (BKVAN) and a considerable risk of graft loss. Screening and prompt decrease of immunosuppression are essential for averting these consequences. We examined the frequency of BK viruria (viral load in urine) among post-renal transplant recipients, along with its association with age, viral load, and the timing of viral reactivation.
Methods
The prospective cohort study was conducted at the Tertiary Care Hospital in Rawalpindi over a 12-month period, from January 1 to December 31, 2023. Urine specimens from 108 renal transplant recipients were collected and analysed for BK viruria every three months during the follow-up assessments. DNA extraction was performed using TANbead extractor, and amplification was carried out with Bio-Rad CFX-96 thermal cycler using Sacace TM amplification kit. Data was analysed using SPSS version 27.
Results
In the cohort of 108 renal transplant recipients, BK viruria was detected in 16.7 % of cases. There was a higher prevalence of BK viruria in females (20 %) than males (16 %). The majority of positive cases were within the 41–60 years age group (61.1 %). Most of the patients (66.6 %) had viral loads below 1 million copies/ml. BK viruria was predominantly detected during the third quarter (between 7 and 9 months) post-transplant. The Chi-square test was applied between age and viral load, showing a significant association (p = 0.01). Similarly, gender and viral load also showed a significant relationship (p = 0.019).
Conclusion
The study showed the frequency of 16.7 % of BK viruria in our small cohort after renal transplantation during the initial 12 months post-transplant. Age of recipients correlated with viral load and time of viral reactivation: middle-aged recipients had higher viral loads. BK viruria increased progressively over the initial nine months, with peak incidence in the third quarter post-transplant.
背景：由于免疫抑制，BK 多瘤病毒感染给器官移植受者带来了巨大挑战，导致 BK 病毒相关性肾病（BKVAN）和相当大的移植物丢失风险。筛查和及时减少免疫抑制对避免这些后果至关重要。我们研究了肾移植术后受者出现 BK 病毒尿（尿液中病毒载量）的频率及其与年龄、病毒载量和病毒再激活时间的关系：这项前瞻性队列研究于 2023 年 1 月 1 日至 12 月 31 日在拉瓦尔品第三级医院进行，为期 12 个月。在随访评估期间，每三个月收集 108 名肾移植受者的尿液标本并分析 BK 病毒。使用 TANbead 提取器提取 DNA，并使用 Bio-Rad CFX-96 热循环仪和 Sacace TM 扩增试剂盒进行扩增。数据使用 SPSS 27 版进行分析：结果：在 108 例肾移植受者中，16.7% 的病例检测出 BK 病毒。女性 BK 病毒感染率（20%）高于男性（16%）。大多数阳性病例年龄在 41-60 岁之间（61.1%）。大多数患者（66.6%）的病毒载量低于 100 万拷贝/毫升。BK 病毒主要在移植后第三季度（7 至 9 个月）检测到。年龄与病毒载量之间进行了卡方检验，结果显示两者之间存在显著关联（p = 0.01）。同样，性别与病毒载量也有显著关系（P = 0.019）：研究表明，在我们的小规模队列中，肾移植后最初 12 个月内 BK 病毒感染率为 16.7%。受者年龄与病毒载量和病毒再激活时间相关：中年受者的病毒载量较高。在最初的九个月中，BK 病毒感染率逐渐增加，在移植后的第三季度达到高峰。
{"title":"Evaluation of new-onset BK viruria in post-renal transplant recipients by quantitative PCR","authors":"Raza Ullah Asif, Eijaz Ghani, Muhammad Ali Rathore, Saadiya Mushtaq, Faraz Ahmed, Hammad Hussain","doi":"10.1016/j.trim.2024.102136","DOIUrl":"10.1016/j.trim.2024.102136","url":null,"abstract":"<div><h3>Background</h3><div>The BK polyomavirus infection poses a substantial challenge for organ transplant recipients due to immunosuppression, resulting in BK virus-associated nephropathy (BKVAN) and a considerable risk of graft loss. Screening and prompt decrease of immunosuppression are essential for averting these consequences. We examined the frequency of BK viruria (viral load in urine) among post-renal transplant recipients, along with its association with age, viral load, and the timing of viral reactivation.</div></div><div><h3>Methods</h3><div>The prospective cohort study was conducted at the Tertiary Care Hospital in Rawalpindi over a 12-month period, from January 1 to December 31, 2023. Urine specimens from 108 renal transplant recipients were collected and analysed for BK viruria every three months during the follow-up assessments. DNA extraction was performed using TANbead extractor, and amplification was carried out with Bio-Rad CFX-96 thermal cycler using Sacace TM amplification kit. Data was analysed using SPSS version 27.</div></div><div><h3>Results</h3><div>In the cohort of 108 renal transplant recipients, BK viruria was detected in 16.7 % of cases. There was a higher prevalence of BK viruria in females (20 %) than males (16 %). The majority of positive cases were within the 41–60 years age group (61.1 %). Most of the patients (66.6 %) had viral loads below 1 million copies/ml. BK viruria was predominantly detected during the third quarter (between 7 and 9 months) post-transplant. The Chi-square test was applied between age and viral load, showing a significant association (<em>p</em> = 0.01). Similarly, gender and viral load also showed a significant relationship (<em>p</em> = 0.019).</div></div><div><h3>Conclusion</h3><div>The study showed the frequency of 16.7 % of BK viruria in our small cohort after renal transplantation during the initial 12 months post-transplant. Age of recipients correlated with viral load and time of viral reactivation: middle-aged recipients had higher viral loads. BK viruria increased progressively over the initial nine months, with peak incidence in the third quarter post-transplant.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102136"},"PeriodicalIF":1.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381726","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 : 2024-10-04DOI: 10.1016/j.trim.2024.102134
Mingwei Sheng , Weihua Liu , Zhangjiu Lu , Yuanbang Lin , Wenli Yu
Objective
Steatotic livers exhibit higher susceptibility to ischemia reperfusion (IR) injury, which increase the risk of primary graft non-function following liver transplantation. S100A9 is identified as a pivotal innate immune sensor that regulates the progression of liver diseases. However, its significance in steatotic liver IR injury remains under-investigated.
Methods
In mice model, we generated S100A9 knockout (S100A9 KO) mice to investigate the role of S100A9 in IR-stimulated steatotic livers. In vitro, primary bone marrow-derived macrophages were utilized to explore the effect of S100A9 in regulating macrophage polarization and inflammation.
Results
S100A9 expression was markedly increased in steatotic livers of mice subjected to IR insult. S100A9 deletion significantly attenuated liver inflammatory injury, as evidenced by the diminished infiltration of both monocytes/macrophages and neutrophils (p < 0.05). The expression of proinflammatory factors was reduced (p < 0.05) at the same time. Additionally, S100A9-deficient livers demonstrated M1 polarization decrease and Toll-like receptor 4 (TLR4) suppression (p < 0.05). In vitro, genetic TLR4 inhibition led to nuclear factor kappa B (NF-κB) inactivation and subsequent M1 polarization decrease (p < 0.05) in macrophages treated with recombinant S100A9. Conclusion
In this study, we highlight the pivotal role of TLR4/NF-κB as a critical mediator of S100A9 in inducing M1 macrophage polorization- dependent inflammation in steatotic livers IR injury.
{"title":"S100A9 regulates M1 macrophage polarization and exacerbates steatotic liver ischemia-reperfusion injury","authors":"Mingwei Sheng , Weihua Liu , Zhangjiu Lu , Yuanbang Lin , Wenli Yu","doi":"10.1016/j.trim.2024.102134","DOIUrl":"10.1016/j.trim.2024.102134","url":null,"abstract":"<div><h3>Objective</h3><div>Steatotic livers exhibit higher susceptibility to ischemia reperfusion (IR) injury, which increase the risk of primary graft non-function following liver transplantation. S100A9 is identified as a pivotal innate immune sensor that regulates the progression of liver diseases. However, its significance in steatotic liver IR injury remains under-investigated.</div></div><div><h3>Methods</h3><div>In mice model, we generated S100A9 knockout (S100A9 KO) mice to investigate the role of S100A9 in IR-stimulated steatotic livers. In vitro, primary bone marrow-derived macrophages were utilized to explore the effect of S100A9 in regulating macrophage polarization and inflammation.</div></div><div><h3>Results</h3><div>S100A9 expression was markedly increased in steatotic livers of mice subjected to IR insult. S100A9 deletion significantly attenuated liver inflammatory injury, as evidenced by the diminished infiltration of both monocytes/macrophages and neutrophils (<em>p</em> < 0.05). The expression of proinflammatory factors was reduced (<em>p</em> < 0.05) at the same time. Additionally, S100A9-deficient livers demonstrated M1 polarization decrease and Toll-like receptor 4 (TLR4) suppression (<em>p</em> < 0.05). In vitro, genetic TLR4 inhibition led to nuclear factor kappa B (NF-κB) inactivation and subsequent M1 polarization decrease (p < 0.05) in macrophages treated with recombinant S100A9. <strong>Conclusion</strong></div><div>In this study, we highlight the pivotal role of TLR4/NF-κB as a critical mediator of S100A9 in inducing M1 macrophage polorization- dependent inflammation in steatotic livers IR injury.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102134"},"PeriodicalIF":1.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378248","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 : 2024-10-04DOI: 10.1016/j.trim.2024.102135
Moazzam Shahzad , Muhammad Atif Khan , Muhammad Kashif Amin , Zouina Sarfraz , Fizza Zulfiqar , Hana Qasim , Rajat Bansal , Kyle Brownback , Nausheen Ahmed , Sunil H. Abhyankar , Joseph P. McGuirk , Anurag K. Singh , Muhammad Umair Mushtaq
<div><h3>Background</h3><div>Idiopathic Pneumonia Syndrome (IPS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a life-threatening complication with high morbidity and mortality. IPS is thought to arise from damage caused by various inflammatory mediators. This study assesses the effectiveness of Ruxolitinib, a Janus Kinase (JAK) 1 and 2 inhibitor that blocks cytokine production, in combination with corticosteroids (CS) for managing IPS after allo-HSCT, compared to the conventional use of CS alone in a case series and a systematic review of previously published literature.</div></div><div><h3>Methods</h3><div>The study includes a retrospective case series of three patients treated for IPS with Ruxolitinib and CS from the University of Kansas Medical Center and a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement 2020 guidelines. The systematic review encompassed seven studies involving 346 cases including three cases from the case series. Statistical analyses were conducted using SPSS v.25.</div></div><div><h3>Results</h3><div>The case series included three patients with IPS after allo-HSCT who received ruxolitinib and CS with favorable results. All patients showed substantial improvement with no IPS-associated mortality. Two of the three patients in the case series were discharged on a 2 L nasal cannula, which was later discontinued during follow-up visits, while the third was discharged on room air. There was marked improvement observed on the computed tomography (CT) following the use of ruxolitinib. Of the total 346 cases included in the systematic review, the median age was 46.6 years (Range 5–72), and 62 % were males. The primary disorders were acute leukemia (52 %), chronic myeloid leukemia (12 %), myelodysplastic syndrome (11 %), Lymphoma (10 %), and others (21 %). Stem cell sources were peripheral blood (45 %), bone marrow (49 %), and cord blood (6 %). Donor types involved match unrelated (55 %), match related (36 %), and mismatched related (4.5 %). Most patients received myeloablative conditioning (81 %). Acute GVHD was observed in 47 %, and chronic GVHD in 38 %. The primary treatment was CS (96 %), with limited use of ruxolitinib (1 %) and etanercept (9.5 %). The mortality rate was 63.3 %, whereas in our case series with the use of ruxolitinib, it was zero.</div></div><div><h3>Conclusion</h3><div>The combination of Ruxolitinib and CS for treating IPS post-allo-HSCT suggested promising results in the case series, with favorable response and improved survival by blocking the cytokine production contributing to IPS. The significant mortality difference in the systematic review supports the need for innovative treatment approaches, highlighting the potential role of Ruxolitinib in CS-refractory cases. Despite the positive outcomes in the case series, the absence of randomized controlled trials emphasizes the necessity for further research.</div></di
{"title":"Efficacy of Ruxolitinib with corticosteroids in idiopathic pneumonia syndrome post-allogeneic hematopoietic stem cell transplantation: A single-center experience and systematic review","authors":"Moazzam Shahzad , Muhammad Atif Khan , Muhammad Kashif Amin , Zouina Sarfraz , Fizza Zulfiqar , Hana Qasim , Rajat Bansal , Kyle Brownback , Nausheen Ahmed , Sunil H. Abhyankar , Joseph P. McGuirk , Anurag K. Singh , Muhammad Umair Mushtaq","doi":"10.1016/j.trim.2024.102135","DOIUrl":"10.1016/j.trim.2024.102135","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic Pneumonia Syndrome (IPS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a life-threatening complication with high morbidity and mortality. IPS is thought to arise from damage caused by various inflammatory mediators. This study assesses the effectiveness of Ruxolitinib, a Janus Kinase (JAK) 1 and 2 inhibitor that blocks cytokine production, in combination with corticosteroids (CS) for managing IPS after allo-HSCT, compared to the conventional use of CS alone in a case series and a systematic review of previously published literature.</div></div><div><h3>Methods</h3><div>The study includes a retrospective case series of three patients treated for IPS with Ruxolitinib and CS from the University of Kansas Medical Center and a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement 2020 guidelines. The systematic review encompassed seven studies involving 346 cases including three cases from the case series. Statistical analyses were conducted using SPSS v.25.</div></div><div><h3>Results</h3><div>The case series included three patients with IPS after allo-HSCT who received ruxolitinib and CS with favorable results. All patients showed substantial improvement with no IPS-associated mortality. Two of the three patients in the case series were discharged on a 2 L nasal cannula, which was later discontinued during follow-up visits, while the third was discharged on room air. There was marked improvement observed on the computed tomography (CT) following the use of ruxolitinib. Of the total 346 cases included in the systematic review, the median age was 46.6 years (Range 5–72), and 62 % were males. The primary disorders were acute leukemia (52 %), chronic myeloid leukemia (12 %), myelodysplastic syndrome (11 %), Lymphoma (10 %), and others (21 %). Stem cell sources were peripheral blood (45 %), bone marrow (49 %), and cord blood (6 %). Donor types involved match unrelated (55 %), match related (36 %), and mismatched related (4.5 %). Most patients received myeloablative conditioning (81 %). Acute GVHD was observed in 47 %, and chronic GVHD in 38 %. The primary treatment was CS (96 %), with limited use of ruxolitinib (1 %) and etanercept (9.5 %). The mortality rate was 63.3 %, whereas in our case series with the use of ruxolitinib, it was zero.</div></div><div><h3>Conclusion</h3><div>The combination of Ruxolitinib and CS for treating IPS post-allo-HSCT suggested promising results in the case series, with favorable response and improved survival by blocking the cytokine production contributing to IPS. The significant mortality difference in the systematic review supports the need for innovative treatment approaches, highlighting the potential role of Ruxolitinib in CS-refractory cases. Despite the positive outcomes in the case series, the absence of randomized controlled trials emphasizes the necessity for further research.</div></di","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102135"},"PeriodicalIF":1.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1016/j.trim.2024.102097
Nasim Azizgolshani, David Blitzer, Monica Colvin, Hannah Copeland
Cardiac surgery and cardiology consistently have the lowest representation of women and racial minorities among all the specialties. The poor representation of minorities and women in cardiology and cardiac surgery is compounded by the fact that heart failure risk continues to rise in the United States (US) and disproportionately affects non-white patients. Inclusion in academia is imperative in diversifying the workforce and in turn, in improving the care we provide to all of our patients.
{"title":"The status of diversity in the heart transplant workforce.","authors":"Nasim Azizgolshani, David Blitzer, Monica Colvin, Hannah Copeland","doi":"10.1016/j.trim.2024.102097","DOIUrl":"10.1016/j.trim.2024.102097","url":null,"abstract":"<p><p>Cardiac surgery and cardiology consistently have the lowest representation of women and racial minorities among all the specialties. The poor representation of minorities and women in cardiology and cardiac surgery is compounded by the fact that heart failure risk continues to rise in the United States (US) and disproportionately affects non-white patients. Inclusion in academia is imperative in diversifying the workforce and in turn, in improving the care we provide to all of our patients.</p>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":" ","pages":"102097"},"PeriodicalIF":1.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376095","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 : 2024-09-20DOI: 10.1016/j.trim.2024.102131
Lei Deng, Xiaolin Yu, Xiaocheng Song, Rui Guan, Wenjun Li, Ximing Liu, Yan Shao, Yixi Hou, Yuerong Zhao, Jing Wang, Yue Liu, Qianqian Xiao, Bo Xin, Fang Zhou
Relapse and graft-versus-host disease (GVHD) are currently the predominant causes of mortality post allogeneic hematopoietic stem cell transplantation (allo-HSCT). The contentious use of antithymocyte globulin (ATG) for preventing GVHD in matched sibling HSCT scenarios has been a topic of significant debate. A retrospective analysis was conducted on matched sibling HSCT cases with high-risk factors for GVHD in our center from January 2018 to June 2023. Our assessment revealed that the group administered with ATG exhibited a 30 % incidence of acute GVHD (aGVHD), in contrast to 81.8 % in the non-ATG cohort (P = 0.037) among matched sibling HSCT cases with high GVHD risk factors. Furthermore, chronic GVHD (cGVHD) occurred in 20 % of the ATG group and 72.7 % of the non-ATG group (P = 0.03). Notably, the administration of ATG did not significantly impact disease relapse (p = 0.149), infection rates (p = 0.64), granulocyte recovery time (p = 0.15), platelet recovery time (p = 0.12), overall survival (p = 0.889), or disease-free survival time (p = 0.787). The use of rabbit antithymocyte globulin (r-ATG) at a 5 mg/kg dosage demonstrated a notable reduction in aGVHD and cGVHD incidences within sibling matched HSCT cases with high-risk factors for GVHD, without increasing rates of disease recurrence or infections. These findings highlight the potential benefit of using low-dose r-ATG in high-risk of GVHD sibling matched allogeneic HSCTs, although further validation with a larger cohort is necessary.
{"title":"The prophylactic application of low-dose rabbit antithymocyte globulin in matched siblings HSCT with high-risk factors for graft-versus-host disease","authors":"Lei Deng, Xiaolin Yu, Xiaocheng Song, Rui Guan, Wenjun Li, Ximing Liu, Yan Shao, Yixi Hou, Yuerong Zhao, Jing Wang, Yue Liu, Qianqian Xiao, Bo Xin, Fang Zhou","doi":"10.1016/j.trim.2024.102131","DOIUrl":"10.1016/j.trim.2024.102131","url":null,"abstract":"<div><div>Relapse and graft-versus-host disease (GVHD) are currently the predominant causes of mortality post allogeneic hematopoietic stem cell transplantation (allo-HSCT). The contentious use of antithymocyte globulin (ATG) for preventing GVHD in matched sibling HSCT scenarios has been a topic of significant debate. A retrospective analysis was conducted on matched sibling HSCT cases with high-risk factors for GVHD in our center from January 2018 to June 2023. Our assessment revealed that the group administered with ATG exhibited a 30 % incidence of acute GVHD (aGVHD), in contrast to 81.8 % in the non-ATG cohort (<em>P</em> = 0.037) among matched sibling HSCT cases with high GVHD risk factors. Furthermore, chronic GVHD (cGVHD) occurred in 20 % of the ATG group and 72.7 % of the non-ATG group (<em>P</em> = 0.03). Notably, the administration of ATG did not significantly impact disease relapse (<em>p</em> = 0.149), infection rates (<em>p</em> = 0.64), granulocyte recovery time (<em>p</em> = 0.15), platelet recovery time (<em>p</em> = 0.12), overall survival (<em>p</em> = 0.889), or disease-free survival time (<em>p</em> = 0.787). The use of rabbit antithymocyte globulin (r-ATG) at a 5 mg/kg dosage demonstrated a notable reduction in aGVHD and cGVHD incidences within sibling matched HSCT cases with high-risk factors for GVHD, without increasing rates of disease recurrence or infections. These findings highlight the potential benefit of using low-dose r-ATG in high-risk of GVHD sibling matched allogeneic HSCTs, although further validation with a larger cohort is necessary.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102131"},"PeriodicalIF":1.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296303","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 : 2024-09-20DOI: 10.1016/j.trim.2024.102132
Britney Sun , Sasha Deutsch-Link , Marina Serper
Social determinants of health, both individual and structural, impact access to liver transplantation (LT). We aimed to evaluate the association between structural social determinants of health (SSDoH) and individual-level psychosocial factors (as measured by the Stanford Integrated Psychosocial Assessment for Transplant, SIPAT score) on failure to waitlist for LT. We conducted a single-center retrospective cohort study of 2762 patients evaluated for LT. SSDoH exposures included the Social Deprivation Index (SDI), the proportion of households on cash public assistance or supplemental nutrition assistance (% public assistance), and distance to the transplant center. Neighborhood SDI score in the highest quartile (OR 1.32, 95 % CI 1.07–1.63) and % on public assistance in the highest quartile (OR 1.41, 95 % CI 1.14–1.75) were associated with increased odds of not being waitlisted for LT. These associations remained significant after adjusting for individual psychosocial risk using SIPAT scores (≥21, high psychosocial risk). Highest quartile neighborhood SDI (OR 1.70, 95 % CI 1.13–2.54) and the highest quartile of % on public assistance (OR 1.67, 95 % CI 1.11–2.53) were also associated with increased odds of failure to waitlist for psychosocial reasons. However, these associations were no longer significant after adjusting for individual SIPAT scores. High-risk SIPAT scores were more prevalent in neighborhoods with the highest quartile of SSDoH measures. Transplant centers can design initiatives to build individual psychosocial support to mitigate the impact of structural barriers.
个人和结构性的健康社会决定因素会影响肝移植（LT）的获得。我们的目的是评估结构性健康社会决定因素（SSDoH）和个人层面的社会心理因素（通过斯坦福移植综合社会心理评估（SIPAT）评分来衡量）与未能等待肝移植之间的关联。我们对 2762 名接受 LT 评估的患者进行了单中心回顾性队列研究。SSDoH 暴露包括社会贫困指数（SDI）、接受现金公共援助或补充营养援助的家庭比例（公共援助百分比）以及与移植中心的距离。最高四分位数的邻里 SDI 分数（OR 1.32，95 % CI 1.07-1.63）和最高四分位数的公共援助比例（OR 1.41，95 % CI 1.14-1.75）与未被列入 LT 候选名单的几率增加有关。在使用 SIPAT 分数对个人社会心理风险进行调整后（≥21 分，社会心理风险高），这些相关性仍然显著。最高四分位数的社区 SDI（OR 1.70，95 % CI 1.13-2.54）和最高四分位数的公共援助百分比（OR 1.67，95 % CI 1.11-2.53）也与因社会心理原因未能进入候选名单的几率增加有关。然而，在对个人 SIPAT 分数进行调整后，这些关联不再显著。高风险的 SIPAT 分数在 SSDoH 测量最高四分位数的社区更为普遍。移植中心可以设计一些措施来建立个人社会心理支持，以减轻结构性障碍的影响。
{"title":"Structural social determinants of health as barriers to liver transplant waitlisting","authors":"Britney Sun , Sasha Deutsch-Link , Marina Serper","doi":"10.1016/j.trim.2024.102132","DOIUrl":"10.1016/j.trim.2024.102132","url":null,"abstract":"<div><div>Social determinants of health, both individual and structural, impact access to liver transplantation (LT). We aimed to evaluate the association between structural social determinants of health (SSDoH) and individual-level psychosocial factors (as measured by the Stanford Integrated Psychosocial Assessment for Transplant, SIPAT score) on failure to waitlist for LT. We conducted a single-center retrospective cohort study of 2762 patients evaluated for LT. SSDoH exposures included the Social Deprivation Index (SDI), the proportion of households on cash public assistance or supplemental nutrition assistance (% public assistance), and distance to the transplant center. Neighborhood SDI score in the highest quartile (OR 1.32, 95 % CI 1.07–1.63) and % on public assistance in the highest quartile (OR 1.41, 95 % CI 1.14–1.75) were associated with increased odds of not being waitlisted for LT. These associations remained significant after adjusting for individual psychosocial risk using SIPAT scores (≥21, high psychosocial risk). Highest quartile neighborhood SDI (OR 1.70, 95 % CI 1.13–2.54) and the highest quartile of % on public assistance (OR 1.67, 95 % CI 1.11–2.53) were also associated with increased odds of failure to waitlist for psychosocial reasons. However, these associations were no longer significant after adjusting for individual SIPAT scores. High-risk SIPAT scores were more prevalent in neighborhoods with the highest quartile of SSDoH measures. Transplant centers can design initiatives to build individual psychosocial support to mitigate the impact of structural barriers.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"87 ","pages":"Article 102132"},"PeriodicalIF":1.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296302","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号