Transplant International最新文献

Strain echocardiography (SE) may be used for surveillance in patients after heart transplantation (HTx); however, data on atrial strain are lacking. We aimed to compare the significance of ventricular and atrial strain with respect to an associated acute cellular rejection (ACR). Patients who underwent an endomyocardial biopsy (EMB) within 1 year after HTx were eligible for this retrospective analysis. The relationship between SE and ACR was assessed. EMB results of 52 patients (median age, 53 years; 63% male) at a median of 181 days post-HTx were identified. Mild ACR was present in 19 patients and ≥ moderate ACR in 6 patients. ACR ≥ moderate was associated with right ventricular free wall strain (OR 1.20, 95%CI 1.02-1.46, P = 0.04) and right atrial contraction strain (RASct; OR 1.55, 95%CI 1.18-2.43, P = 0.01). The RASct cut-off value of -9.3% had a sensitivity of 100% and a specificity of 79% for ≥ moderate ACR. None of these associations were observed for left ventricular or left atrial strain. A validation analysis was performed on another group of 23 HTx patients, which yielded similar results with regard to the specified RASct cut-off value. Our comprehensive strain analysis confirmed the association between reduced right ventricular strain and ACR and further identified robust associations between RASct and ACR. Right atrial strain analysis may be a promising method for excluding subclinical ACR after HTx.

We compared the long-term outcomes of pediatric kidney transplants from DCD and DBD donors over a 33-year period in the USA. Data were retrieved and analysed on kidney transplants from deceased donors in paediatric recipients in 1994-2020 from the OPTN. Data were compared between those receiving kidney transplants from DBD and DCD donors. There were 11,071 paediatric kidney transplants from deceased donors including 350 from DCD donors. DCD transplants were more likely to have delayed allograft function (20.1% vs. 11.9%, p < 0.01). However, there was no significant difference in allograft or patient survival between transplants from DBD and DCD donors at 10 years (56% vs. 55%, p = 0.76 and 90% vs. 91%, p = 0.89). We describe the largest cohort of pediatric DCD kidney transplant recipients in the literature. We showed that despite higher rates of delayed allograft function in DCD transplants, long-term outcomes were not significantly different. Kidney transplants from DCD donors are a viable option and should be offered to children comparable to DBD kidneys as their long-term outcomes do not differ. DCD transplantation is illegal in some countries, however, it offers an opportunity to increase the number of transplants for children; this data should be considered in ongoing policy discussions.

The prevalence of diabetes is increasing exponentially, accompanied by an increase in chronic complications, including nephropathy. Kidney transplantation may offer freedom from dialysis but adding a pancreas addresses the underlying disease. Type 2 diabetes mellitus (T2DM) is often described as a condition of insulin resistance and the concurrent beta-cell loss and dysfunction is potentially underestimated. The aim of this review was to provide a critical appraisal of simultaneous pancreas and kidney (SPK) transplantation in recipients with T2DM. The primary concern with SPK transplantation in this group is insulin resistance and the impact of obesity on outcomes. Multiple studies have shown comparable graft survival (GS), patient survival and complication rates when comparing T2DM and T1DM recipients. Furthermore, patients with T2DM had significantly improved GS with SPK when compared to kidney transplantation alone. Despite these findings, SPK transplantation is only selectively used in T2DM patients. Existing literature focuses on comparing transplant outcomes between patients with T1DM and T2DM. We believe the more relevant question is whether a patient with T2DM would derive a meaningful benefit from an SPK, and whether these benefits outweigh the risks, in the context of their other co-morbidities which are not completely similar to those associated with T1DM.

Achieving donor-specific immune tolerance has the potential to eliminate the need for lifelong immunosuppression in transplant recipients, but translating this goal into clinical practice remains challenging. Unlike laboratory rodents, humans are exposed to a variety of pathogens that generate memory T cells, which can interfere with tolerance induction. Establishing full donor hematopoietic chimerism, whether spontaneous or induced, can support robust immune tolerance. However, it often relies on graft-versus-host (GvH) reactivity, which carries significant risks, including graft-versus-host disease (GVHD) and infection. Although non-myeloablative conditioning protocols have shown promise, their broader use is limited by concerns about toxicity and the need to carefully balance GvH responses. Mixed and transient chimerism represents a less toxic alternative, but its effectiveness in humans is hindered by limited durability and resistance from memory T cells. Thymus transplantation offers another strategy by promoting central tolerance through donor-specific thymic education of developing T cells. Regulatory cell therapies combined with reduced immunosuppression have emerged as a safer approach. Early clinical trials have yielded encouraging results. Innovations in IL-2 pathway modulation and genetic engineering, including CAR-redirected regulatory T cells, may further enhance the precision, durability, and safety of strategies aimed at achieving transplantation tolerance.

It has been suggested that there is a significant conflict of interest between providing best care for the dying patient and a subsidiary role in facilitating the donation process. Should healthcare professionals who are involved in a patient's care and determination of death also be involved in discussing donation with families? If they are involved, should they disclose this potential conflict of interest? In this paper we address the issue of conflicts of interest in organ donation by examining current best practice in four European countries (Sweden, Netherlands, the United Kingdom and Spain) and discuss whether having clear separation of roles in order to avoid conflicts is preferable to having the same physician (or team) handle both the dying process and donation. We also analyse the benefits and burdens of disclosing such potential conflicts.

Objective: Patient Reported Outcome Measures (PROMs) are increasingly recognized in liver transplant (LT)-patients, yet recent evaluations of their quality are lacking. This systematic review gives a comprehensive overview of available PROMs in adults awaiting or undergoing LT and their measurement properties.

Method: A systematic search in MEDLINE, EMBASE, PubMed, and COCHRANE (01/2010-08/2023) included studies involving adult LT-candidates and/or recipients utilizing PROMs with original evaluations of measurement properties. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was used to ascertain the quality of measurement properties.

Results: In total, 23 studies encompassing 35 PROMs were identified, including nine disease-specific and 26 generic PROMs. The (Short-form) Liver Disease Quality of Life ((SF-)LDQoL), Transplant Effects Questionnaire (TxEQ) and Post-Liver Transplant Quality of Life (pLTQ) were the most utilized disease-specific PROMs. Most studies demonstrated low-quality evidence for measurement properties. pLTQ demonstrated high-quality evidence for internal consistency, reliability, and responsiveness; the generic Hospital Anxiety and Depression Scale (HADS) showed strong evidence for internal consistency and construct validity.

Conclusion: Measurement properties in LT-patients remains of low-quality. pLTQ stands out for its superior methodological quality among disease-specific PROMs. For future studies, there is a strong recommendation to focus more on patients' subjective measures and their measurement properties.