Transplantation Reports最新文献_第2页

Xenotransplantation in India: Ethical challenges, historical lessons, and future prospects 印度异种器官移植：伦理挑战、历史教训和未来前景

Q4 Medicine

Transplantation Reports

Pub Date : 2025-11-07 DOI: 10.1016/j.tpr.2025.100184

Soumyadip Sain , Trisha Chattoraj

India faces an acute shortfall in organ donations, with a deceased donor rate of approximately 0.5 per million population—one of the lowest globally. Xenotransplantation—the transplantation of organs or tissues across species—has re-emerged internationally as a viable solution to organ shortages, particularly with advances in genetic engineering of pigs. However, its application in India is fraught with ethical complexities, religious sensitivities, biosafety concerns, and regulatory limitations. A pivotal moment in Indian medical history occurred in 1997 when Dr. Dhaniram Baruah conducted an unauthorized pig-to-human heart transplant in Assam. The operation ended in the patient's death and raised serious ethical and legal questions, shaping the Indian public and institutional attitude toward xenotransplantation. This review examines India’s current position in the global xenotransplantation landscape by critically analyzing historical precedents, sociocultural dynamics, ethical imperatives, infrastructural readiness, and regulatory gaps. It argues for a measured and inclusive approach involving the reform of legal frameworks, scientific infrastructure development, and public engagement through culturally sensitive discourse. Drawing on international guidelines and experiences, the article proposes a detailed roadmap for India’s preparedness to responsibly embrace xenotransplantation. Ethical and scientific vigilance, alongside cross-sectoral cooperation, will be key to ensuring that this frontier of medicine serves public health without compromising safety, equity, or public trust.

印度面临着器官捐献的严重短缺，每百万人中只有0.5人死亡，是全球最低的国家之一。异种移植——跨物种的器官或组织移植——作为器官短缺的可行解决方案在国际上重新出现，特别是随着猪基因工程的进展。然而，它在印度的应用充满了伦理复杂性、宗教敏感性、生物安全问题和监管限制。印度医学史上的一个关键时刻发生在1997年，当时达尼拉姆·巴鲁阿（Dhaniram Baruah）医生在阿萨姆邦进行了未经授权的猪到人的心脏移植手术。手术以病人死亡告终，引发了严重的伦理和法律问题，影响了印度公众和机构对异种移植的态度。这篇综述通过批判性地分析历史先例、社会文化动态、道德要求、基础设施准备和监管缺口，考察了印度在全球异种移植领域的当前地位。报告主张采取一种慎重和包容的方法，包括法律框架改革、科学基础设施发展和通过文化敏感话语进行公众参与。根据国际准则和经验，文章提出了印度准备负责任地接受异种移植的详细路线图。伦理和科学警惕以及跨部门合作将是确保这一医学前沿服务于公共卫生而不损害安全、公平或公众信任的关键。

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引用次数: 0

Improving access to minorities with A2 to B kidney transplantation: A systematic review and meta-analysis 改善少数民族A2到B肾移植的可及性：一项系统回顾和荟萃分析

Q4 Medicine

Transplantation Reports

Pub Date : 2025-07-03 DOI: 10.1016/j.tpr.2025.100181

Patricia Viana , Maria Meritxell Roca Mora , Jorge Eduardo Persson , André Milani-Reis , Harold Cliff Sullivan , Idelberto Raul Badell , Juliano Riella

Background

Studies have shown that A2 kidney transplants for blood group B recipients offer comparable graft and patient survival rates to ABO-compatible transplants, potentially improving transplant access for B recipients. However, the adoption of this strategy has been controversial.

Methods

We conducted a Systematic-Review and Meta-Analysis, comparing non-A1to B versus B to B blood type in kidney transplant patients. MEDLINE, Embase, and Cochrane databases were searched for studies that met our inclusion criteria. We analyzed binary and continuous endpoints using odds ratios (OR) and mean difference (MD), respectively, with a 95% confidence interval (CI). P-value < 0.05 was considered statistically significant.

Results

We included five studies with 14,959 patients, of whom 2,121 (14.2%) were non-A1 to B blood. No statistically significant differences were found between the groups for patient survival (OR 1.08; 95% CI 0.95 to 1.22; p=0.6), graft survival (OR 1.1; 95% CI 0.99 to 1.23; p=0.96), eGRF (MD 7.8 mL/min/1.73m²; 95% CI -8.27 to 23.87 mL/min/1.73m²; p=1.0), antibody-mediated rejection (OR 1.51; 95% CI 0.43 to 5.28; p = 0.52), and T-cell-mediated rejection (OR 1.12; 95% CI 0.43 to 2.93; p = 0.81).

Conclusion

We found no significant differences in patient and graft survival between non-A1 to B and B to B kidney transplantation. This finding underscores the potential to expand the donor pool without compromising outcomes, which has a profound impact on reducing waiting times and improving equity in renal transplant access.

研究表明，B血型受者的A2肾移植与abo相容移植相比具有相当的移植和患者存活率，可能改善B血型受者的移植可及性。然而，这一策略的采用一直存在争议。方法：我们进行了一项系统综述和荟萃分析，比较非a1血型与B血型与B血型的肾移植患者。检索MEDLINE、Embase和Cochrane数据库，寻找符合我们纳入标准的研究。我们分别使用优势比（OR）和平均差（MD）分析二元终点和连续终点，置信区间为95%。假定值& lt;0.05认为有统计学意义。结果我们纳入了5项研究，14959例患者，其中2121例（14.2%）为非a1 - B血。两组患者生存率差异无统计学意义(OR 1.08；95% CI 0.95 ~ 1.22；p=0.6)，移植物存活(OR 1.1；95% CI 0.99 ~ 1.23；p=0.96), eGRF (MD 7.8 mL/min/1.73m2；95% CI -8.27 ~ 23.87 mL/min/1.73m2；p=1.0)，抗体介导的排斥反应(OR 1.51；95% CI 0.43 ~ 5.28；p = 0.52)和t细胞介导的排斥反应(OR 1.12；95% CI 0.43 ~ 2.93；P = 0.81)。结论非a1到B肾移植与B到B肾移植在患者和移植物存活方面无显著差异。这一发现强调了在不影响结果的情况下扩大供体池的潜力，这对减少等待时间和提高肾移植获得的公平性具有深远的影响。

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引用次数: 0

Effect of tacrolimus formulation on neurocognition in older kidney transplant recipients: A randomized controlled trial 他克莫司制剂对老年肾移植受者神经认知的影响：一项随机对照试验

Q4 Medicine

Transplantation Reports

Pub Date : 2025-05-31 DOI: 10.1016/j.tpr.2025.100178

Hadia Lala Gul , Macey Sockolov , Katherine Howes , Amanpreet Kaur , Michelle Occhipinti , Heejung Bang , Muna Alnimri , Yihung Huang , Joy Dray , Ling-Xin Chen

Background

Tacrolimus is known to cause neurotoxicities that may be more severe in older individuals. We aimed to compare the neurocognitive side effects of immediate release (IR) and LCP tacrolimus in older kidney transplant recipients in the early post-transplant period.

Methods

In this single center, open-label, randomized and controlled trial of 64 kidney transplant recipients aged 60 or above, participants were randomized to LCP tacrolimus or IR tacrolimus between 4- and 8-weeks post-transplantation and followed for 6-weeks. The primary outcome of neurocognitive performance at 6-weeks compared with baseline was assessed by the Montreal Cognitive Assessment (MoCA) and Digit Symbol Substitution Test (DSST). Secondary outcomes included health-related quality of life as measured by the Quality of Life in Essential Tremor Questionnaire (QUEST) and Organ Transplant Symptom and Wellbeing Instrument (OTSWI).

Results

32 patients were randomized to IR tacrolimus and 31 to LCP tacrolimus. In the IR tacrolimus arm, the MOCA score increased by 1.2 points (SD 2.1) and the DSST score increased by 1.0 points (SD 7.8). In the LCP tacrolimus arm, the MOCA score increased by 0.2 points (SD 2.9) and the DSST score increased by 1.3 points (SD 7.5). No statistically significant difference was detected between arms in MOCA, DSST, QUEST or OTSWI scores. There was a trend toward improvement in tremor severity in the LCP tacrolimus arm.

Conclusions

No improvement was found in MoCA or DSST performance in patients switched to LCP tacrolimus as compared to IR tacrolimus after 6 weeks of exposure in the early post-transplant period.

背景：已知他克莫司可引起神经毒性，对老年人可能更严重。我们的目的是比较即时释放（IR）和LCP他克莫司在老年肾移植术后早期的神经认知副作用。方法在这项单中心、开放标签、随机对照试验中，64名年龄在60岁及以上的肾移植受者在移植后4- 8周随机接受LCP他克莫司或IR他克莫司治疗，并随访6周。通过蒙特利尔认知评估（MoCA）和数字符号替代测试（DSST）评估6周时与基线比较的神经认知表现的主要结局。次要结局包括与健康相关的生活质量，通过特发性震颤问卷（QUEST）和器官移植症状和健康量表（OTSWI）的生活质量来衡量。结果32例患者随机分为IR组和LCP组。在IR他克莫司组中，MOCA评分提高1.2分（SD 2.1）， DSST评分提高1.0分（SD 7.8）。LCP他克莫司组MOCA评分提高0.2分（SD 2.9）， DSST评分提高1.3分（SD 7.5）。MOCA、DSST、QUEST或OTSWI评分两组间无统计学差异。LCP他克莫司组有改善震颤严重程度的趋势。结论移植后早期使用LCP他克莫司6周后，与使用IR他克莫司相比，使用LCP他克莫司患者的MoCA或DSST表现未见改善。

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引用次数: 0

Emerging technologies in corneal transplantation: innovations, challenges, and global implications 角膜移植的新兴技术：创新、挑战和全球影响

Q4 Medicine

Transplantation Reports

Pub Date : 2025-05-31 DOI: 10.1016/j.tpr.2025.100180

Khayry Al-Shami , Salman Almurabi , Andreea Pop , Clara Vincent , Aniela Popescu , Iulia Cezara Pop , Noor S. Bader , Hala Faour , Rahaf Barhoush , Saja Karaja

Precision, reduction of rejection rates, and reduction of dependency on long-term immune suppression are being advanced by advancements in corneal transplantation (CT) using femtosecond laser-assisted keratoplasty (FLAK), Descemet membrane endothelial keratoplasty (DMEK), and Bowman layer transplantation (BLT). Also, technologies such as bioengineered tissues, CRISPR-Cas9 gene editing, and bioadhesives seek to enhance graft integration and survival in mechanisms to supply a global shortage of donor corneas, particularly in low-income countries with the greatest demand. Despite this, bioengineered corneas represent an alternative to traditional transplants that incur ethical and practical hurdles, including regulation, cost, and biases in resource allocation. The application of artificial intelligence (AI), in particular diagnosis and surgical planning, in ophthalmology in general, and especially in corneal disease management, has great promise. However, the 'black box' decision-making of AI, its biases, and lack of transparency could be barriers to accountability and consistent use in practice. The other obstacle is the high costs that discourage access to and availability of advanced technologies for many low- and middle-income countries (LMICs), whose healthcare infrastructures are also limited. To ensure these innovations can be integrated into mainstream corneal care, particularly serving the needs of underserved populations, we need to address these technological, economic, and ethical issues. However, these technologies require more clinical trials and policy considerations for their optimization for accessible, effective, global eye care.

随着飞秒激光辅助角膜移植术（FLAK）、Descemet膜内皮角膜移植术（DMEK）和鲍曼层移植（BLT）等角膜移植（CT）技术的进步，精确性、排异率的降低和对长期免疫抑制的依赖正在不断提高。此外，生物工程组织、CRISPR-Cas9基因编辑和生物粘合剂等技术寻求提高移植物的整合和存活机制，以满足全球供体角膜短缺的需求，特别是在需求最大的低收入国家。尽管如此，生物工程角膜代表了传统移植的另一种选择，传统移植会带来伦理和实践上的障碍，包括监管、成本和资源分配方面的偏见。人工智能（AI）的应用，特别是诊断和手术计划，在眼科，特别是在角膜疾病管理方面，具有很大的前景。然而，人工智能的“黑箱”决策、其偏见和缺乏透明度可能成为问责制和在实践中持续使用的障碍。另一个障碍是高昂的成本，阻碍了许多低收入和中等收入国家获得和获得先进技术，这些国家的卫生保健基础设施也很有限。为了确保这些创新能够融入主流角膜护理，特别是满足服务不足人群的需求，我们需要解决这些技术、经济和伦理问题。然而，这些技术需要更多的临床试验和政策考虑，以优化其可获得、有效的全球眼科护理。

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引用次数: 0

Voriconazole-induced Periostitis Following Lung Transplantation: Case Series 肺移植后伏立康唑引起的骨膜炎：病例系列

Q4 Medicine

Transplantation Reports

Pub Date : 2025-05-31 DOI: 10.1016/j.tpr.2025.100179

Gouji Toyokawa , Miho Yamaguchi , Takafumi Yamaya , Mitsuaki Kawashima , Chihiro Konoeda , Koh Okamoto , Masaaki Sato

Voriconazole, the first-choice treatment for invasive aspergillosis, can induce periostitis. For unknown reasons, most reports on this rare side effect are in the field of organ transplantation, especially lung transplantation, and mostly from Western countries. However, in Asian countries, including Japan, the incidence of this complication may be underestimated. Herein, we report three Japanese patients who developed voriconazole-induced periostitis after lung transplantation. The patients’ initial symptoms were pain in the left shoulder, bilateral axillae, and left upper arm. The duration of voriconazole treatment before symptom onset ranged from 5 to 59 months. The diagnosis was confirmed by bone scintigraphy in two patients and computed tomography scan in one patient with or without elevation of alkaline phosphatase levels. All three patients experienced symptom relief within 7 days of voriconazole discontinuation, and the bone scintigraphy findings and alkaline phosphatase elevation were reversible.

伏立康唑是治疗侵袭性曲霉病的首选药物，可诱发骨膜炎。由于未知的原因，大多数关于这种罕见副作用的报道都是在器官移植领域，尤其是肺移植领域，而且大多来自西方国家。然而，在亚洲国家，包括日本，这种并发症的发生率可能被低估了。在此，我们报告了三名日本患者在肺移植后发生伏立康唑诱导的骨膜炎。患者最初的症状是左肩、双侧腋窝和左上臂疼痛。出现症状前伏立康唑治疗持续时间为5 ~ 59个月。两名患者的骨显像和一名患者的计算机断层扫描证实了诊断，有或没有碱性磷酸酶水平升高。3例患者均在停药7天内症状缓解，骨显像结果和碱性磷酸酶升高均可逆。

引用次数: 0

Xenotransplantation: The next quarter century 异种移植：下一个四分之一个世纪

Q4 Medicine

Transplantation Reports

Pub Date : 2025-03-17 DOI: 10.1016/j.tpr.2025.100177

A. Joseph Tector , Matt Tector , Rodrigo Vianna , Andrew Adams

Transplantation has become a preferred therapy for the treatment of end stage organ failure, improving the quality and duration of recipients lives. The major limitation of organ transplantation is the shortage of suitable donor organs available for clinical use. Xenotransplantation using genetically modified pig organs could provide an unlimited source of organs, allowing all patients in need to receive a transplant in a timely fashion. Xenotransplantation was limited to the experimental realm because of the presence of anti-pig antibodies that are present in the blood of every human (1, 2).

The development of genetic engineering tools, especially CRISPR/Cas9 and somatic cell nuclear transfer made it possible to create pigs missing key glycan pig antigens so that the antibodies did not bind to the new pig (3-5). Preclinical results using kidneys from new donor pigs has improved to the point where nonhuman primate recipients are living for more than 4 years (Andrew Adams personal communication). The improvements in survival seen in preclinical models has led to clinical attempts at heart and kidney xenotransplantation (6, 7). Thus far in the first 5 clinical xenotransplant cases success has been modest, with only one graft (kidney) functioning past 60 days to date. The other patients receiving pig xenografts (2 hearts and 2 kidneys) succumbed to early antibody mediated rejection (AMR) (7-9). Nevertheless, the developments in preclinical and compassionate use xenotransplantation have resulted in the first FDA approved clinical trial with renal xenotransplantation. This article will deal with the issues that are likely to be the focus of the next 25 years with regards to development of clinical xenotransplantation.

移植已成为治疗终末期器官衰竭的首选治疗方法，提高了受者的生活质量和寿命。器官移植的主要限制是缺乏适合临床使用的供体器官。使用转基因猪器官的异种移植可以提供无限的器官来源，使所有需要移植的患者都能及时接受移植。异种移植被限制在实验领域，因为每个人的血液中都存在抗猪抗体（1,2）。基因工程工具的发展，特别是CRISPR/Cas9和体细胞核移植，使得制造出缺少关键糖聚糖猪抗原的猪成为可能，这样抗体就不会与新猪结合（3-5）。使用新供体猪的肾脏的临床前结果已经得到改善，非人类灵长类动物受体的寿命超过4年（Andrew Adams个人通信）。在临床前模型中观察到的生存率的提高导致了心脏和肾脏异种移植的临床尝试（6,7）。到目前为止，在前5例临床异种移植病例中，成功的情况并不多，迄今为止只有一例移植（肾脏）功能超过60天。其他接受猪异种移植（2个心脏和2个肾脏）的患者出现早期抗体介导的排斥反应（AMR）（7-9）。尽管如此，临床前和同情使用异种移植的发展导致了第一个FDA批准的肾脏异种移植临床试验。这篇文章将处理的问题，可能是未来25年的重点，关于临床异种移植的发展。

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引用次数: 0

Targeting Ischemia-reperfusion injury in liver transplant rejuvenation 肝移植返老还童中的靶向缺血再灌注损伤

Q4 Medicine

Transplantation Reports

Pub Date : 2025-02-26 DOI: 10.1016/j.tpr.2025.100176

Kenneth J. Dery, Fady Kaldas, Jerzy W. Kupiec-Weglinski

Background

Hepatic ischemia-reperfusion injury (HIRI) is a multifaceted pathophysiological process involving a cascade of interconnected cellular events. The initial ischemic stress, followed by the reestablishment of blood circulation to the liver, triggers a feed-forward innate immune-driven response that exacerbates the hepatocellular injury. HIRI poses a significant clinical challenge in liver transplantation (LT), as it can result in tissue damage, organ dysfunction, and poor clinical outcomes.

Methods and results

This review highlights current key issues in HIRI translational research, as revealed by recent bibliometric studies. It examines the mechanisms that facilitate homeostatic regulation after HIRI. Additionally, it addresses refined pharmacological strategies aimed at mitigating oxidative stress and inflammation. Hot topic areas in HIRI research include autophagy, donation after circulatory death, and NLRP3-dependent inflammasome activation following LT. New pharmacological agents, such as anti-oxidative compounds, metabolic modulators, and plant-derived compounds, are being explored to influence inflammatory responses. There is a strong clinical emphasis on broadening the donor pool by utilizing marginal donor grafts and advanced machine perfusion techniques. Enhancing translational research through the development of human-relevant organoids or ex vivo liver perfusion systems is essential for connecting laboratory discoveries with clinical practices in life-saving surgical procedures.

Conclusion

A comprehensive approach that emphasizes the regulatory mechanisms of cellular responses to oxygen stress and immune cell activation, alongside innovative donor organ preservation, like machine perfusion, will shape the future direction of HIRI research by enhancing graft viability and revitalizing suboptimal donor organs.

背景肝脏缺血再灌注损伤（HIRI）是一个多方面的病理生理过程，涉及一连串相互关联的细胞事件。最初的缺血应激，随后肝脏血液循环的重建，引发了前馈性先天性免疫驱动反应，加剧了肝细胞损伤。肝细胞损伤是肝移植（LT）的一个重大临床挑战，因为它可能导致组织损伤、器官功能障碍和不良的临床结果。它探讨了促进 HIRI 后体内平衡调节的机制。此外，它还探讨了旨在减轻氧化应激和炎症的精细药理策略。HIRI 研究的热门话题领域包括自噬、循环死亡后的捐赠以及 LT 后 NLRP3 依赖性炎性体的激活。目前正在探索新的药理制剂，如抗氧化化合物、代谢调节剂和植物提取的化合物，以影响炎症反应。临床上非常重视利用边缘供体移植物和先进的机器灌注技术来扩大供体库。通过开发与人体相关的器官组织或体内外肝脏灌注系统来加强转化研究，对于将实验室发现与挽救生命的外科手术的临床实践联系起来至关重要。结论强调细胞对氧应激和免疫细胞激活反应的调控机制的综合方法，以及创新的供体器官保存方法（如机器灌注），将通过提高移植物的存活率和活化次优供体器官来塑造未来的 HIRI 研究方向。

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引用次数: 0

Assessing drug-drug interactions of Tacrolimus with Fluconazole and/or Verapamil and developing the predictive model for Tacrolimus concentrations in kidney transplant recipients 评估他克莫司与氟康唑和/或维拉帕米的药物相互作用，并建立肾移植受者他克莫司浓度的预测模型

Q4 Medicine

Transplantation Reports

Pub Date : 2025-02-24 DOI: 10.1016/j.tpr.2025.100175

Mingkwan Na Takuathung , Kajohnsak Noppakun , Chotiwit Sakuludomkan , Nahathai Dukaew , Nuttapong Chailungkar , Naruemon Suyayai , Nut Koonrungsesomboon

Maintaining optimal tacrolimus serum concentrations is crucial for kidney transplant recipients due to its narrow therapeutic window and pharmacokinetic variability. The use of CYP3A4/5 inhibitors, such as fluconazole and verapamil, can increase tacrolimus serum concentrations. Understanding these interactions is vital for predicting and optimizing tacrolimus levels. This study aimed to investigate the impact of co-administering fluconazole, verapamil, or their combination on tacrolimus concentration/dose (C/D) in kidney transplant recipients and develop a predictive model for these scenarios. This retrospective study involved kidney transplant recipients treated with tacrolimus and co-administered fluconazole and/or verapamil. The Generalized Estimating Equations (GEE) approach was used to explore predictive variables associated with tacrolimus C/D. A total of 177 kidney transplant recipients were included. Repeated measure correlation analysis revealed positive correlations between tacrolimus C/D and dosages of fluconazole (b = 0.37, 95 % CI = 0.29 to 0.45, p < 0.001) and verapamil (b = 0.15, 95 % CI = 0.07 to 0.23, p < 0.001). This study offers a predictive model for optimizing tacrolimus levels when fluconazole and/or verapamil are co-administered in kidney transplant recipients.

维持最佳的他克莫司血清浓度对于肾移植受者来说是至关重要的，因为它具有狭窄的治疗窗口和药代动力学变异性。使用CYP3A4/5抑制剂，如氟康唑和维拉帕米，可增加他克莫司的血清浓度。了解这些相互作用对于预测和优化他克莫司水平至关重要。本研究旨在探讨氟康唑、维拉帕米或两者联合使用对肾移植受者他克莫司浓度/剂量（C/D）的影响，并为这些情况建立预测模型。这项回顾性研究涉及接受他克莫司和氟康唑和/或维拉帕米联合治疗的肾移植受者。采用广义估计方程（GEE）方法探讨与他克莫司C/D相关的预测变量。共纳入177名肾移植受者。重复测量相关性分析显示他克莫司C/D与氟康唑剂量呈正相关(b = 0.37, 95% CI = 0.29 ~ 0.45, p <；0.001)和维拉帕米(b = 0.15, 95% CI = 0.07 ~ 0.23, p <；0.001)。本研究提供了一个预测模型，用于优化氟康唑和/或维拉帕米在肾移植受者中联合应用时他克莫司的水平。

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引用次数: 0

COVID-19 vaccine evaluation among solid organ transplant recipients at a single academic center 单一学术中心实体器官移植受者COVID-19疫苗评估

Q4 Medicine

Transplantation Reports

Pub Date : 2025-02-21 DOI: 10.1016/j.tpr.2025.100174

Kristen Lay , Marina Feffer , David Slade , Fritzie S. Albarillo

Background

Solid organ transplant recipients (SOTRs) may have a higher risk of serious disease and death due to COVID-19. It is necessary to determine the main motivators and demotivators for SOTRs to receive COVID-19 vaccinations to improve patient education.

Methods

A voluntary and anonymous survey was created using questions adopted from the Center for Disease Control COVID-19 Vaccine Confidence: Rapid Community Assessment. Questions included demographics, vaccination status and opinions in multiple choice and free response format. The survey was distributed in July 2023 and was open for one month.

Results

A total of 127 SOTRs responded which included patients 18 years and older who received one of the following transplants: heart (12.6 %), lung(s) (37.01 %), liver (31.5 %), kidney (11.81 %), and liver and kidney (7.09 %). The overwhelming majority of respondents received a primary vaccination series (97.64 %). Among the vaccinated, 68.55 % received a bivalent booster vaccination and 32.28 % have received a second booster vaccination. The greatest motivating factors among vaccinated were “protecting my health” (84.68 %) “protecting the health of family and friends” (66.13 %), and “to protect the health of the community” (36.29 %). Only 3 SOTRs were unvaccinated, all of whom reported that they felt the vaccine was unsafe.

Conclusion

While the overwhelming majority of SOTRs were vaccinated against COVID-19 to protect their health and the health of others, a minority have hesitations about receiving booster vaccinations. Targeting patient education towards these concerns will improve the protection of the SOTR community.

背景：实体器官移植受者（SOTRs）因COVID-19可能有更高的严重疾病和死亡风险。有必要确定sotr接受COVID-19疫苗接种的主要激励因素和抑制因素，以改善患者教育。方法采用疾病控制中心COVID-19疫苗信心：快速社区评估的问题进行自愿匿名调查。问题包括人口统计、疫苗接种状况和意见，采用多项选择和自由回答形式。该调查于2023年7月发放，为期一个月。结果共有127例SOTRs应答，包括18岁及以上接受心脏（12.6%）、肺（37.01%）、肝（31.5%）、肾（11.81%）和肝肾合一（7.09%）移植的患者。绝大多数应答者（97.64%）接受了一次系列疫苗接种。在接种者中，68.55%的人接受了二价加强疫苗接种，32.28%的人接受了第二次加强疫苗接种。最大的激励因素是“保护自己的健康”（84.68%）、“保护家人和朋友的健康”（66.13%）和“保护社区的健康”（36.29%）。只有3个sotr未接种疫苗，他们都报告说他们觉得疫苗不安全。结论绝大多数SOTRs接种了COVID-19疫苗，以保护自己和他人的健康，但少数人对接种加强疫苗犹豫不决。针对这些问题进行患者教育将改善对SOTR社区的保护。

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引用次数: 0

Current state of artificial intelligence in liver transplantation 人工智能在肝移植中的应用现状

Q4 Medicine

Transplantation Reports

Pub Date : 2025-02-10 DOI: 10.1016/j.tpr.2025.100173

Ashley E. Montgomery , Abbas Rana

Over the past few decades, substantial progress has been made in the field of liver transplantation. Yet, challenges remain in the field due to an increasing organ allograft shortage as well as significant waitlist mortality. With these challenges, organ allocation policies have been developed and are constantly being modified to result in more efficient organ allocation. One tool that has been explored to improve the field of liver transplantation is artificial intelligence, which is an umbrella term for techniques such as machine learning and deep learning. This review article explores the use of artificial intelligence in the field of liver transplantation. Specifically, studies have shown potential applications of artificial intelligence in improving waitlist mortality models, assessing allograft characteristics, using large language models for research question development and patient education, developing post-transplant models, as well as predicting multiple risk factors such as cardiovascular disease, infection, graft failure, malignancy, graft fibrosis, and pneumonia. However, even with these studies, several limitations for the use of artificial intelligence exist such as biased data sets leading to biased model development, lack of extensive validation of the artificial intelligence models, and the need for large datasets for model development. With additional studies evaluating the use of artificial intelligence and wide-scale validation of these studies highlighted, the use of artificial intelligence may transform the field of transplantation in the future.

在过去的几十年里，肝移植领域取得了实质性的进展。然而，由于同种异体器官移植短缺的增加以及大量的等待者死亡率，该领域仍然存在挑战。面对这些挑战，器官分配政策已经制定，并不断修改，以实现更有效的器官分配。人工智能是改善肝移植领域的一种工具，它是机器学习和深度学习等技术的总称。本文综述了人工智能在肝移植领域的应用。具体而言，研究表明人工智能在以下方面的潜在应用：改进等候名单死亡率模型、评估同种异体移植物特征、使用大型语言模型进行研究问题开发和患者教育、开发移植后模型，以及预测多种危险因素，如心血管疾病、感染、移植物衰竭、恶性肿瘤、移植物纤维化和肺炎。然而，即使有了这些研究，人工智能的使用也存在一些限制，例如有偏见的数据集导致有偏见的模型开发，缺乏对人工智能模型的广泛验证，以及模型开发需要大型数据集。随着更多评估人工智能应用的研究和这些研究的大规模验证，人工智能的应用可能会在未来改变移植领域。

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