Transplantation最新文献

Solid organ transplantation (SOT) offers people with end-stage organ disease an increased quality of life, which includes the return of fertility and the potential for pregnancy. Although the number of pregnancies has increased, definitive recommendations have been lacking. To address reproductive health in SOT recipients, the American Society of Transplantation Women's Health Community of Practice held a virtual Controversies Conference with subject matter experts gathered to discuss topics of contraception, immunosuppression, and pregnancy in SOT recipients and pregnancy post-living donation. This publication is a synthesis of expert guidance and available data regarding pregnancy management and outcomes after all types of SOTs.

Background: Kidney transplant recipients with graft loss (KTR-GL) are an increasing group of patients whose care needs are largely unmet. The lack of patient perspectives is a key research gap. We conducted an in-depth exploration of the experiences of KTR-GL to identify their healthcare needs.

Methods: This qualitative study adopted an interpretive descriptive methodology. Data collection entailed semistructured narrative interviews conducted until data saturation was achieved and was analyzed using inductive thematic analysis.

Results: Our sample included 23 KTR-GL (women: 34.8%; mean age, 54.3 y). Six themes were identified that represent areas in which participants' needs may be inadequately acknowledged and/or met: (1) setting expectations (longevity of the graft, transplant is not a cure, risk of graft failure, anticipating transplant loss, and balancing hope and realism), (2) communicating with care team (support and empathy and clarifying the cause of graft failure), (3) support for transition to dialysis (shaped by prior experience, preparedness for the initiation of dialysis, lack of options, and dialysis requires adjustment), (4) navigating the path to retransplantation (understanding patient preferences, clarity and transparency, addressing ineligibility, preemptive transplant, and living donation), (5) psychosocial resources (access to psychological services, specific and adequate psychological support, reliable social worker, and peer support), and (6) lessons learned (building mutual trust, self-advocacy, defining a successful transplant, and gaining resilience).

Conclusions: In this in-depth exploration of the experiences of KTR-GL, we have identified several unmet healthcare needs that have practice and policy implications. Incorporating a patient-centered approach is needed to improve the healthcare experiences and, potentially, the outcomes of KTR-GL.

Background: Kidney transplant offers better outcomes and reduced costs compared with chronic dialysis. However, racial and ethnic disparities in access to kidney transplant persist despite efforts to expand access to transplant and improve the equity of deceased donor allocation. Our objective was to evaluate after listing the association of race and ethnicity with access to deceased donor kidney transplant (DDKT) after changes to the allocation system in 2014.

Methods: This retrospective study evaluated access to DDKT after listing since the implementation of the 2014 kidney allocation system. Waitlist status and transplant outcomes were ascertained from data from the Scientific Registry of Transplant Recipients. Our analysis included every adult kidney transplant candidate on the waiting list in the US from January 1, 2015, through June 30, 2023.

Results: A total of 290 763 candidates were on the waiting list for DDKT during the study period. Of these, 36.4% of candidates were African American and 22.2% were Latino. Compared with White non-Latino patients, access to DDKT after listing was reduced for African American (unadjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.92-0.94) and Latino individuals (unadjusted HR, 0.88; 95% CI, 0.87-0.90). After controlling for demographic and clinical factors, these differences in access to transplant widened substantially for African American (HR, 0.78; 95% CI, 0.77-0.80) and Latino patients (HR, 0.73; 95% CI, 0.72-0.74).

Conclusions: African American and Latino patients had reduced access to DDKT after listing. More effective approaches to improving access for African American and Latino individuals after listing are needed.

Backgournd: Peritransplant ischemia/reperfusion injury (IRI) plays a central pathogenic role in nondelayed or delayed kidney allograft function immediately after transplantation and increases the risk of subsequent rejection. Potential therapies targeting specific cytokines or complement proteins to limit IRI have failed in clinical trials. Monoclonal antibody 107 (mAb107), a "pure" (nonactivating) inhibitor of the archetypal innate immune receptor integrin CD11b, has been shown to extend the survival of IRI nonhuman primate native kidneys in an in situ model.

Methods: Here, we administered mAb107 before allograft revascularization to determine its efficacy for extending the survival of ischemia-damaged donor kidneys transplanted into major histocompatibility complex-mismatched nonhuman primate recipients.

Results: We observed a significant delay in the onset of rejection and prolongation of allograft survival in mAb107-treated versus control recipients. Early allograft biopsies suggest this is secondary to the selective suppression of infiltrating neutrophils and macrophages.

Conclusions: These observations support the hypothesis that inactivating CD11b with mAb107 may provide an effective strategy for prolonging the survival of ischemia-damaged allografts and increasing the successful use of marginal donor organs.

Background: Simultaneous pancreas-kidney transplantation (SPKT) is the therapy of choice for selected patients with complicated type 1 diabetes mellitus and end-stage renal disease. Pancreas rescue allocation was implemented in Eurotransplant allocation algorithms to increase organ utilization, concurrently facilitating transplantation of supposedly inferior quality organs. The aim of this study was to examine whether outcomes of SPKT after rescue allocation, which can either be recipient-oriented extended allocation or competitive rescue allocation, were as good as after standard allocation.

Methods: This retrospective multicenter analysis of 1504 SPKT performed from 2013 to 2021 evaluated outcomes by allocation type considering survival of patients, pancreas grafts, and kidney grafts. Multivariable analyses further explored the influence of specific donor-, recipient-, and transplant-related variables on outcomes.

Results: Multivariable analyses showed no significant differences in SPKT outcome for standard allocation versus either rescue allocation type regarding patient, pancreas graft, and kidney graft survival. Rescue allocation organ donors were older, had higher body mass index, and were more likely to smoke. Rescue allocation had fewer HLA matches. Cold ischemic times of both pancreas and kidneys were longer in competitive rescue allocation but not in recipient-oriented extended allocation. Rescue allocation pancreas recipients had shorter waiting times. Multivariable analyses showed inferior pancreas and kidney graft survival for higher donor age. Higher recipient age correlated with higher mortality despite better pancreas graft survival.

Conclusions: SPKT outcome after rescue allocation is comparable with standard allocation in both patient and graft survival. Age of both donors and recipients essentially influences the success of SPKT.