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Frailty assessments and changes in frailty over time in elderly veteran Kidney Transplant candidates: Effects on transplant evaluations 老年退伍军人肾移植候选者的虚弱评估和虚弱程度随时间的变化:对移植评估的影响
Q4 Medicine Pub Date : 2024-05-21 DOI: 10.1016/j.tpr.2024.100153
Cassie Cederberg , Cara Joyce , Manpreet Samra , Anuradha Wadhwa , Rupunder Sodhi , Oswaldo Aguirre , Reynold I. Lopez-Soler

Background and hypothesis

Frailty has emerged as an important factor in the pre-transplant evaluation process as studies have shown that it is associated with increased waitlist mortality, lower rates of transplant listing, and higher rates of delisting. There have not been many studies on frailty in elderly pre-transplant patients. In this study, we determined the common frailty phenotypes in an elderly population, and its effects on transplant success.

Methods

Over a 3-year period, frailty was determined for all patients evaluated at our center. Patient characteristics were summarized using descriptive statistics, overall and by level of frailty. Differences in patient characteristics by level of frailty were assessed for statistical significance using analysis of variance for age and chi-square or Fisher's exact test. Transplant outcomes such as listing success, transplant rates and post-transplant outcomes were tied to initial frailty assessments as well as the changes in frailty over time.

Results

A total of 375 patients were evaluated over the study period. The mean age was 64±9 years. African American patients were less likely to be frail. After adjusting for age and race, the most significant predictors of listing were the walk test (aOR: 0.42, 95 % CI: 0.22–0.79) and physical activity (aOR: 0.45, 95 % CI: 0.28–0.74). A total of 30 patients (8 %) with a pre-listing frailty evaluation died prior to transplantation. Frail walk test and physical activity assessment led to a 2-fold increase in pre-transplant mortality (7 % vs 17 %; 6 % vs 13 %).

Conclusion

Our study is the first to focus on a purely geriatric population and shows the importance of frailty on listing success, transplant rates and mortality prior to listing. These data point to the need for the development of tools to target frailty as a guide for improving transplant success in elderly patients.

背景和假设由于研究表明,体弱与等待名单死亡率增加、移植列表率降低和除名率升高有关,因此体弱已成为移植前评估过程中的一个重要因素。有关老年移植前患者体弱的研究并不多。在这项研究中,我们确定了老年人群中常见的虚弱表型及其对移植成功的影响。采用描述性统计方法总结了患者的总体特征和虚弱程度。使用年龄方差分析和卡方检验或费雪精确检验评估不同虚弱程度患者特征的差异是否具有统计学意义。移植结果(如挂号成功率、移植率和移植后结果)与最初的虚弱程度评估以及随时间推移的虚弱程度变化挂钩。平均年龄为 64±9 岁。非裔美国患者体弱的可能性较低。对年龄和种族进行调整后,最重要的预测指标是步行测试(aOR:0.42,95 % CI:0.22-0.79)和体力活动(aOR:0.45,95 % CI:0.28-0.74)。共有 30 名患者(8%)在移植前进行了体弱评估,并在移植前死亡。虚弱步行测试和体力活动评估导致移植前死亡率增加了 2 倍(7 % vs 17 %;6 % vs 13 %)。这些数据表明,有必要开发针对虚弱的工具,作为提高老年患者移植成功率的指南。
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引用次数: 0
Toxic effects of heavy metal exposure in solid organ transplant recipients 重金属暴露对实体器官移植受者的毒性影响
Q4 Medicine Pub Date : 2024-04-16 DOI: 10.1016/j.tpr.2024.100151
Daniel Glicklich , Muhamad Mustafa , Kevin Wolfe

Heavy metal toxicity has recently been described in solid organ transplant recipients. Allograft dysfunction or failure associated with arsenic, cadmium, chromium, cobalt and lead exposure have been reported, largely in renal transplant recipients, but also in small numbers of heart transplant recipients and a few liver and lung recipients. Conclusions: [1] In kidney transplant patients, highest tertile arsenic, cadmium and lead plasma levels were associated with increased allograft loss, compared to lower tertile levels; [2] Deteriorating metal hip prostheses may rarely cause heart failure due to cobalt and chromium cardiac toxicity in heart transplant and non-heart transplant patients, which resolves with prosthesis replacement; [3] Heavy metal testing should be considered in patients with multiple risk factors including occupational and environmental exposure, lower socioeconomic status, and multiple morbidities which could be associated with heavy metal toxicity; [4] Chelation therapy, used successfully in some non-transplant patients with chronic renal failure, has not been used systematically in transplant patients and studies are needed

最近在实体器官移植受者中发现了重金属毒性。与砷、镉、铬、钴和铅暴露相关的移植功能障碍或衰竭已有报道,主要发生在肾移植受者中,也有少量心脏移植受者和少数肝脏和肺部受者。结论[1)在肾移植患者中,砷、镉和铅血浆水平的最高三分位数与同种异体移植损失的增加有关,而低三分位数的水平则与同种异体移植损失的增加有关;(2)在心脏移植和非心脏移植患者中,金属髋关节假体的退化可能会在极少数情况下因钴和铬的心脏毒性而导致心力衰竭,这种情况在更换假体后即可缓解;[3] 对于具有多种风险因素(包括职业和环境接触、较低的社会经济地位以及可能与重金属毒性有关的多种疾病)的患者,应考虑进行重金属检测;[4] 螯合疗法已成功用于一些慢性肾功能衰竭的非移植患者,但尚未在移植患者中系统使用,因此需要进行研究。
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引用次数: 0
Biovigilance systems: Cells, tissues, and organs donation and transplantation 生物警戒系统:细胞、组织和器官捐赠与移植
Q4 Medicine Pub Date : 2024-04-15 DOI: 10.1016/j.tpr.2024.100152
Bartira de Aguiar Roza , Sibele Maria Schuantes-Paim , Priscilla Caroliny Oliveira , Janine Schirmer , Ana Menjivar Hernandez , Mauricio Beltrán Durán

Objective: to describe Biovigilance Systems and their associated management tools among member countries of the World Health Organization. Method: overview conducted following the population, concept, and context strategy to develop the research question and objective. Structured searches were conducted in PubMed, CINAHL, Embase, and Scopus. Snowballing procedure in Google Scholar and health authorities’ websites as World Health Organization and Pan American Health Organization during the first semester of 2023. Language and time restrictions were not applied. Results: we examined more than 70 studies and non-scientific works. Biovigilance systems were identified in 12 countries members of WHO in 3 of 6 regions: Pan-American Region (Brazil and Colombia, Canada), Europe (England, France, Germany, Italy, Netherlands, Poland, Portugal, and Spain), and Western Pacific Region (Australia). Conclusion: This overview achieved its objective by describing biovigilance systems and their management tools among World Health Organization member countries. This research, designed as an overview, refrains from generalizing results but holds significance for countries and health authorities developing biovigilance systems, offering benchmark opportunities and supporting system improvement. The study contributes directly to the biovigilance discourse, guiding efforts to enhance safety and quality globally.

目标:描述世界卫生组织成员国的生物警戒系统及其相关管理工具。方法:按照人群、概念和背景策略进行概述,以提出研究问题和目标。在 PubMed、CINAHL、Embase 和 Scopus 中进行了结构化检索。在 2023 年第一学期,在 Google Scholar 以及世界卫生组织和泛美卫生组织等卫生机构的网站上进行滚雪球式搜索。语言和时间不受限制。结果:我们研究了 70 多项研究和非科学著作。在 6 个地区中的 3 个地区的 12 个世界卫生组织成员国中发现了生物警戒系统:泛美地区(巴西和哥伦比亚、加拿大)、欧洲(英国、法国、德国、意大利、荷兰、波兰、葡萄牙和西班牙)和西太平洋地区(澳大利亚)。结论:本综述介绍了世界卫生组织成员国的生物警戒系统及其管理工具,达到了预期目的。本研究作为一项综述性研究,避免将结果一概而论,但对正在开发生物警戒系统的国家和卫生当局具有重要意义,可提供基准机会并支持系统改进。这项研究直接促进了生物警戒方面的讨论,为在全球范围内提高安全和质量提供了指导。
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引用次数: 0
Improved kidney function and one-year survival with transitioning from intravenous to enteral tacrolimus in lung transplant recipients 肺移植受者从静脉注射过渡到肠道他克莫司可改善肾功能和一年存活率
Q4 Medicine Pub Date : 2024-04-14 DOI: 10.1016/j.tpr.2024.100150
Carrie Burt , Georgina Waldman , Linda Awdishu , Kamyar Afshar , Mark Mariski , Jade Kozuch , Gordon Yung , Eugene Golts , Ashley Feist

Background

Acute kidney injury (AKI) is common after lung transplant and may increase risk of chronic kidney disease (CKD). Calcineurin inhibitors (CNIs) such as tacrolimus contribute to AKI risk. This study evaluated outcomes among lung transplant recipients administered enteral or oral versus intravenous (IV) tacrolimus immediately post-lung transplant.

Methods

We performed a single-center retrospective study of lung transplant recipients from 2011 to 2019. Tacrolimus concentrations, rates of perioperative AKI, CKD, and one-year survival were compared between those that received IV versus oral tacrolimus post-LT.

Results

A total of 153 patients were included; 110 and 43 received IV tacrolimus and enteral or oral tacrolimus, respectively. AKI within 14 days post-LT occurred more frequently in patients that received IV tacrolimus versus enteral administration (84.5 vs 44.1 %, p = <0.001). Additionally, those patients that received IV tacrolimus had supratherapeutic tacrolimus concentrations for more days than those that received enteral (3 days, IQR 1–5 vs 1 day, IQR 0–1; p < 0.001). CKD rates at 1 year were not significantly different between groups. One year survival was 97.7 % in group that received enteral tacrolimus compared to 82.7 % in IV tacrolimus group (p = 0.01)

Conclusion

IV tacrolimus in the initial period post-LT was associated with higher AKI rates and lower 1-year survival compared to enteral tacrolimus. There was no difference in CKD rates at 1 year.

背景急性肾损伤(AKI)是肺移植后的常见病,可能会增加慢性肾病(CKD)的风险。他克莫司等钙神经蛋白抑制剂(CNIs)会增加急性肾损伤的风险。本研究评估了肺移植受者在肺移植术后立即服用肠道或口服他克莫司与静脉注射(IV)他克莫司的结果。结果 共纳入 153 例患者,其中 110 例和 43 例分别接受了静脉注射他克莫司和肠道或口服他克莫司治疗。LT术后14天内发生AKI的患者中,静脉注射他克莫司和肠服他克莫司的比例更高(分别为84.5%和44.1%,P = 0.001)。此外,与肠道给药相比,静脉注射他克莫司的患者他克莫司浓度超治疗浓度的天数更多(3 天,IQR 1-5 vs 1 天,IQR 0-1;p = 0.001)。各组间 1 年的 CKD 发生率无明显差异。接受肠内他克莫司治疗组的 1 年存活率为 97.7%,而静脉注射他克莫司组为 82.7%(P = 0.01)。1 年后的 CKD 发生率没有差异。
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引用次数: 0
Impact of a bone health protocol on adult lung transplant recipients 骨骼健康方案对成年肺移植受者的影响
Q4 Medicine Pub Date : 2023-12-30 DOI: 10.1016/j.tpr.2023.100149
Shelby Tungate , Chrissy Doligalski , Anita Yang , Roxanne McKnight , Raymond Coakley , L. Jason Lobo

Corticosteroids are a critical component of immunosuppressive regimens following lung transplantation; however, their use is associated with known deleterious effects on bone health. Protocolized preventative therapies and screening may improve bone health in this population. We retrospectively reviewed all adult lung transplant recipients (LTRs) at a single center before and after implementation of a bone health protocol. Fifty-eight LTRs were included; 38 pre-protocol and 20 post-protocol. Significant differences were noted for patients following a bone health protocol including dual x-ray absorptiometry (DEXA) completion (16 % vs. 70 %, p = <0.001), less significant decline in femur Z- and T-scores (p = 0.05 and 0.04, respectively), and were more likely to be prescribed anti-resorptive therapy (11 % vs 40 %, p = 0.008) and calcium therapy (24 % vs. 70 %, p = <0.001). Incidence of non-procedural fracture at two years was numerically lower in the post-protocol group (21 % vs. 15 %, p = 0.58). Our data suggests that institution of a bone health protocol for lung transplant recipients improves screening, bone health pharmacotherapy, improved bone density as measured by DEXA and may reduce risk of clinically significant fractures at two years post-transplant.

皮质类固醇是肺移植术后免疫抑制方案的重要组成部分;然而,已知使用皮质类固醇会对骨骼健康产生有害影响。规范的预防性疗法和筛查可改善这类人群的骨骼健康。我们对一个中心的所有成年肺移植受者(LTR)在实施骨健康方案前后的情况进行了回顾性研究。我们共纳入了 58 例肺部移植受者,其中 38 例在协议实施前,20 例在协议实施后。实施骨健康方案的患者在以下方面存在显著差异:完成双X射线吸收测定(DEXA)(16% vs. 70%,p = 0.001)、股骨Z值和T值的下降幅度较小(p = 0.05和0.04)、更有可能接受抗骨质吸收治疗(11% vs. 40%,p = 0.008)和钙治疗(24% vs. 70%,p = 0.001)。方案实施后组别两年内的非手术性骨折发生率较低(21% 对 15%,p = 0.58)。我们的数据表明,为肺移植受者制定骨健康方案可以改善筛查和骨健康药物治疗,提高通过 DEXA 测量的骨密度,并可降低移植后两年内发生临床意义骨折的风险。
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引用次数: 0
Erratum regarding previously published articles 关于以前发表的文章的勘误
Q4 Medicine Pub Date : 2023-12-01 DOI: 10.1016/j.tpr.2023.100142
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引用次数: 0
Donation after circulatory death: An international view 循环性死亡后的捐赠:国际视角
Q4 Medicine Pub Date : 2023-12-01 DOI: 10.1016/j.tpr.2023.100137
Barry D. Kahan

The blossoming transplantation enterprise has increased the demand for human organs beyond those available from living donors. While individuals undergoing donation after brain death (DBD) continue to yield the vast majority of cadaveric organs recovered worldwide, a growing practice recruits donors among patients displaying severe brain injury but not meeting the criterion of electrosilence. These patients include a cohort who cannot maintain their circulation after withdrawal of machine-assisted ventilation and whose families consent to organ retrieval – subjects for donation after cardiocirculatory death (DCD). Expositions in this collection of articles in Transplantation Reports reveal variable practices worldwide, not only in surgical procedures to recover DCD organs, but also to overcome the ischemia-reperfusion injuries (IRi) consequent to retrieval. The contributions reveal center, national and international guidelines for, as well as outcomes of kidney, liver, lung, cardiac and pancreas transplantations of DCD organs in The United States, South America, Europe, Asia and The Middle East.

On the one hand, there is little concern about the use of ex vivo machine perfusion to diagnose, mitigate and treat IRI in DCD organs. On the other hand, in vivo donor re-vitilization by cardiopulmonary bypass after declaration of death has incited considerable controversy even among medical professionals. Bioethical and biophilosophical considerations as well as public opinion and social consensus must inform forthcoming deliberations of The United States Uniform Determination of Death Act (UDDA) Commission in order to place DCD procedures on a firm footing to meet burgeoning patient needs.

移植事业的蓬勃发展增加了对活体器官捐献者以外的人体器官的需求。虽然脑死亡后捐献(DBD)的人继续提供全球绝大多数尸体器官,但在显示严重脑损伤但不符合电击标准的患者中招募捐献者的做法日益增多。这些患者包括在撤除机器辅助通气后无法维持血液循环的人群,他们的家属同意器官取回--这就是心循环死亡(DCD)后捐献的对象。移植报告》中的这组文章揭示了世界各地不同的做法,不仅包括恢复 DCD 器官的手术程序,还包括克服取回器官后的缺血再灌注损伤 (IRi)。这些文章揭示了美国、南美、欧洲、亚洲和中东的中心、国家和国际 DCD 器官移植指南以及肾、肝、肺、心脏和胰腺移植的结果。一方面,人们很少关注使用体外机器灌注来诊断、减轻和治疗 DCD 器官的 IRI。另一方面,在宣布死亡后通过心肺旁路对捐献者进行体内再灌注的做法甚至在医学专家中也引起了相当大的争议。美国《统一死亡判定法》(UDDA)委员会即将进行的审议必须考虑到生物伦理和生物哲学因素以及公众舆论和社会共识,以便为 DCD 程序奠定坚实的基础,满足不断增长的患者需求。
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引用次数: 0
Management of incisional hernias in renal transplant patients 肾移植患者切口疝的处理
Q4 Medicine Pub Date : 2023-10-14 DOI: 10.1016/j.tpr.2023.100148
Ilektra Kanella , Kalaikshiga Kengadaran , Vassilios Papalois

Background

Incisional hernia (IH) remains one of the most common complications following abdominal organ transplantation with no consensus on the optimal management. This study is a narrative review of the incidence, risk factors, diagnosis, and management of IH post-transplantation.

Methods

A literature search using the EMBASE and MEDLINE from 1.1.2016 to 15.8.2002 was conducted. Included studies reported on IH after open abdominal organ transplantation. The outcomes included in our analysis were the incidence of IH, significant patient risk factors, the diagnostic approach used to detect IH, and proposed strategies for the management of IH. 54 publications that involved 9336 transplant patients who developed IH were included.

Results

The incidence of IH ranged from 1.7 % to 43 % in liver transplant patients and was lower following kidney transplantation (1.1 %-7.0 %). Patient risk factors predisposing to IH were body mass index>30, age (>50), smoking history, previous open abdominal surgery, open surgical repair, a Mercedes or inverse T incision and surgical site infections. The most common diagnostic approach for IH is clinical examination, followed by US or CT imaging in cases of complex IH. Following IH repair, recurrence rates ranged from 0 to 76.9 %, and complication rates from 12 % - 52.9 %, the most common of which were surgical site occurrences (11.0–79.2 %) including infection (0 - 65.4 %) and seroma formation (0–8 %). Management of IH should include preoperative optimisation of patients through weight reduction, smoking cessation and adjustment of immunosuppression using a multidisciplinary (MDT) approach. Mesh repair, either open or laparoscopic, is the gold standard for the treatment of IH, resulting in a significantly lower recurrence rate than primary closure. There is no consensus on the type and positioning of mesh, and very limited studies have reported on other perioperative factors such as wound closure.

Conclusions

Prehabilitation and MDT approach are important in ensuring good outcomes following IH repair. Further prospective studies and the establishment of a relevant registry are required to propose a consensus pathway for IH repair in the transplanted population.

背景切口疝(IH)仍然是腹部器官移植术后最常见的并发症之一,但对最佳治疗方法尚未达成共识。本研究对移植后IH的发生率、危险因素、诊断和管理进行了叙述性综述。方法从2016年1月1日至2002年8月15日,使用EMBASE和MEDLINE进行文献检索。包括腹部器官移植后IH的研究报告。我们分析的结果包括IH的发生率、重要的患者风险因素、用于检测IH的诊断方法以及提出的IH管理策略。54篇出版物涉及9336名出现IH的移植患者。结果肝移植患者IH的发生率为1.7%~43%,肾移植后IH发生率较低(1.1%~7.0%);30岁、年龄(>;50)、吸烟史、既往腹部开放性手术、开放性手术修复、Mercedes或倒T切口和手术部位感染。IH最常见的诊断方法是临床检查,其次是复杂IH的US或CT成像。IH修复后,复发率为0至76.9%,并发症发生率为12%至52.9%,其中最常见的是手术部位发生率(11.0至79.2%),包括感染(0至65.4%)和血清瘤形成(0至8%)。IH的管理应包括通过多学科(MDT)方法,通过减肥、戒烟和调整免疫抑制对患者进行术前优化。网状物修复,无论是开放式还是腹腔镜,都是治疗IH的金标准,其复发率明显低于原发性闭合术。关于网状物的类型和位置还没有达成共识,关于其他围手术期因素(如伤口闭合)的研究报道也非常有限。结论康复和MDT方法是确保IH修复后良好疗效的重要方法。需要进一步的前瞻性研究和建立相关的登记册,以提出移植人群IH修复的一致途径。
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引用次数: 0
Impact of donor marrow cellularity on outcome of allogeneic stem cell transplantation 供体骨髓细胞数量对同种异体干细胞移植结果的影响
Q4 Medicine Pub Date : 2023-10-13 DOI: 10.1016/j.tpr.2023.100147
Memoona Khan, Ghassan Umair Shamshad, Qamar un Nisa Chaudhry, Raheel Iftikhar, Nighat Shahbaz, Mehreen Ali Khan, Farwa Raza, Haider Nisar, Mehwish Gilani

Background

Outcomes of allogeneic hematopoietic stem cell transplant (HSCT) are affected by a number of donor and patient related factors like extent of human leucocyte antigen mismatch, age, source of stem cells, female donor to male recipient and stem cell dose. All of these factors have been extensively investigated; however, effect of donor bone marrow cellularity on HSCT outcomes has not been evaluated.

Methods

This was a prospective study carried out at Armed forces bone marrow transplant center (AFBMTC/NIBMT) from January 2018 to December 2022. Bone marrow cellularity of donors was determined by separate assessment by two experienced Hematopathologists and classified as normocellular, hypocellular or hypercellular according to donor age. Total nucleated cells (TNC) were assessed by automated hematology analyzer and stem cell quantification was done by flowcytometric assay based on CD34, CD45 and 7-AAD immunophenotyping markers. Primary outcome measures were time to achieve neutrophil and platelet engraftment. Secondary outcome measures assessed were overall survival (OS), disease free survival (DFS) and graft versus host disease (GVHD). Frequency and percentage were calculated for categorical variables while Chi-square test was used for quantitative variables. Multivariate Cox regression analysis was used to determine significance of different variables and effect of cellularity on them. Kaplan Meier estimates with group differences were calculated using log rank tests for OS and DFS. A p value of 0.05 or less was considered statistically significant.

Results

Cellularity of 95 donors was assessed, 39 (41.1 %) had normocellular marrow while 56 (58.9 %) were hypocellular for age. Median time from diagnosis to transplant was 13 months. In 38 (40 %) the indication for donation was for patients with bone marrow failure syndromes, 23 (24.2 %) for hematological malignancies, 21(22.1 %) for beta thalassemia major and 13 (13.6 %) for miscellaneous disorders including immune deficiencies. Median stem cell / CD 34 dose was 6 × 106/kg and median TNC dose was 5.09 × 108/kg. Median time of neutrophil engraftment was 13.6 days while that of platelet engraftment was 27.1 days. Mean OS was 84.2 %. OS for normocellular donors was 84.6 % and that for hypocellular donors was 83.9 % (p 0.995). DFS for normocellular donors was 84.6 % and for hypocellular donors was 83.9 % (p 0.96). No statistically significant association between the disease group and transplant type with donor marrow cellularity (p value 0.32 and 0.358 respectively) was determined. Multivariate logistic regression model and Backwald test showed no significant association between donor marrow cellularity and CD 34 dose (p 0.65), TNC (p 0.78), neutrophil engraftment (p 0.23), platelet engraftment (p 0.27), Acute GVHD (p 0.83), and chronic GVHD (p 0.44).

Conclusion

Majority of the donors h

背景异基因造血干细胞移植(HSCT)的结果受到许多供体和患者相关因素的影响,如人类白细胞抗原错配程度、年龄、干细胞来源、女性供体对男性受体以及干细胞剂量。所有这些因素都得到了广泛的调查;然而,供体骨髓细胞数量对HSCT结果的影响尚未得到评估。方法这是一项前瞻性研究,于2018年1月至2022年12月在武装部队骨髓移植中心(AFBMTC/NIBMT)进行。由两位经验丰富的血液病理学家分别评估捐献者的骨髓细胞数量,并根据捐献者年龄分为正常细胞、低细胞或高细胞。通过自动血液学分析仪评估总有核细胞(TNC),并通过基于CD34、CD45和7-AAD免疫表型标记的流式细胞术测定进行干细胞定量。主要的结果指标是实现中性粒细胞和血小板植入的时间。评估的次要结果指标是总生存率(OS)、无病生存率(DFS)和移植物抗宿主病(GVHD)。分类变量采用频率和百分比计算,定量变量采用卡方检验。多变量Cox回归分析用于确定不同变量的显著性以及细胞性对它们的影响。使用OS和DFS的对数秩检验计算具有组差异的Kaplan-Meier估计值。0.05或更小的p值被认为具有统计学意义。结果对95例供者进行了细胞性评价,其中39例(41.1%)为正常骨髓,56例(58.9%)为低细胞供者。从诊断到移植的中位时间为13个月。在38例(40%)中,骨髓衰竭综合征患者的捐献指征,血液系统恶性肿瘤患者23例(24.2%),严重β地中海贫血患者21例(22.1%),包括免疫缺陷在内的其他疾病患者13例(13.6%)。中位干细胞/CD34剂量为6×106/kg,中位TNC剂量为5.09×108/kg。平均OS为84.2%。正常细胞供体的OS为84.6%,低细胞供体的OS83.9%(p 0.995)。正常细胞捐献者的DFS为84.6%和低细胞捐献者的DFS83.9%(p 0.96)。疾病组和移植类型与供体骨髓细胞数之间没有统计学上的显著关联(p值分别为0.32和0.358)。多因素logistic回归模型和Backward检验显示,供体骨髓细胞数量与CD34剂量(p 0.65)、TNC(p 0.78)、中性粒细胞植入(p 0.23)、血小板植入(p 0.27)、急性移植物抗宿主病(p 0.83)和慢性移植物抗逆转录病毒(p 0.44)之间无显著相关性。骨髓细胞数量对所获得的CD34和TNC剂量没有统计学上的显著影响;也不影响移植后中性粒细胞和血小板的植入、OS和DFS。需要进一步的基于人群的研究来确认巴基斯坦人群中正常的骨髓细胞数量,以及使其细胞减少的各种遗传和环境因素的影响。
{"title":"Impact of donor marrow cellularity on outcome of allogeneic stem cell transplantation","authors":"Memoona Khan,&nbsp;Ghassan Umair Shamshad,&nbsp;Qamar un Nisa Chaudhry,&nbsp;Raheel Iftikhar,&nbsp;Nighat Shahbaz,&nbsp;Mehreen Ali Khan,&nbsp;Farwa Raza,&nbsp;Haider Nisar,&nbsp;Mehwish Gilani","doi":"10.1016/j.tpr.2023.100147","DOIUrl":"https://doi.org/10.1016/j.tpr.2023.100147","url":null,"abstract":"<div><h3>Background</h3><p>Outcomes of allogeneic hematopoietic stem cell transplant (HSCT) are affected by a number of donor and patient related factors like extent of human leucocyte antigen mismatch, age, source of stem cells, female donor to male recipient and stem cell dose. All of these factors have been extensively investigated; however, effect of donor bone marrow cellularity on HSCT outcomes has not been evaluated.</p></div><div><h3>Methods</h3><p>This was a prospective study carried out at Armed forces bone marrow transplant center (AFBMTC/NIBMT) from January 2018 to December 2022. Bone marrow cellularity of donors was determined by separate assessment by two experienced Hematopathologists and classified as normocellular, hypocellular or hypercellular according to donor age. Total nucleated cells (TNC) were assessed by automated hematology analyzer and stem cell quantification was done by flowcytometric assay based on CD34, CD45 and 7-AAD immunophenotyping markers. Primary outcome measures were time to achieve neutrophil and platelet engraftment. Secondary outcome measures assessed were overall survival (OS), disease free survival (DFS) and graft versus host disease (GVHD). Frequency and percentage were calculated for categorical variables while Chi-square test was used for quantitative variables. Multivariate Cox regression analysis was used to determine significance of different variables and effect of cellularity on them. Kaplan Meier estimates with group differences were calculated using log rank tests for OS and DFS. A <em>p</em> value of 0.05 or less was considered statistically significant.</p></div><div><h3>Results</h3><p>Cellularity of 95 donors was assessed, 39 (41.1 %) had normocellular marrow while 56 (58.9 %) were hypocellular for age. Median time from diagnosis to transplant was 13 months. In 38 (40 %) the indication for donation was for patients with bone marrow failure syndromes, 23 (24.2 %) for hematological malignancies, 21(22.1 %) for beta thalassemia major and 13 (13.6 %) for miscellaneous disorders including immune deficiencies. Median stem cell / CD 34 dose was 6 × 106/kg and median TNC dose was 5.09 × 108/kg. Median time of neutrophil engraftment was 13.6 days while that of platelet engraftment was 27.1 days. Mean OS was 84.2 %. OS for normocellular donors was 84.6 % and that for hypocellular donors was 83.9 % (p 0.995). DFS for normocellular donors was 84.6 % and for hypocellular donors was 83.9 % (p 0.96). No statistically significant association between the disease group and transplant type with donor marrow cellularity (<em>p value</em> 0.32 and 0.358 respectively) was determined. Multivariate logistic regression model and Backwald test showed no significant association between donor marrow cellularity and CD 34 dose (p 0.65), TNC (p 0.78), neutrophil engraftment (p 0.23), platelet engraftment (p 0.27), Acute GVHD (p 0.83), and chronic GVHD (p 0.44).</p></div><div><h3>Conclusion</h3><p>Majority of the donors h","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"8 4","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49751842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A case of kidney transplantation for complete C4 deficiency with recurrent IgM-monoclonal gammopathy of renal significance (MGRS) associated nephropathy 完全性C4缺乏症伴复发性igm -单克隆伽玛病(MGRS)肾病肾移植1例
Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.tpr.2023.100138
Yu Kijima , Tomokazu Shimizu , Shinya Kato , Kana Kano , Toshihide Horiuchi , Taiji Nozaki , Kazuya Omoto , Masashi Inui , Hiroshi Toma , Shoichi Iida , Toshio Takagi

We present a rare case of a patient with complete C4 deficiency who underwent kidney transplantation and experienced immunoglobulin M-monoclonalgammopathyofrenalsignificance (IgM-MGRS) recurrence after the procedure. A 45-year-old male patient presented with end-stage renal failure due to membranoproliferative glomerulonephritis (MPGN). The initial immunosuppressive regimen consisted of tacrolimus, steroids, mycophenolate mofetil, basiliximab, and rituximab. He underwent ABO-incompatible kidney transplantation from his mother in August 2021. The clinical course after kidney transplantation was uneventful for a month. A biopsy of the transplanted kidney was performed due to decreased renal function. The allograft biopsy result led to the suspicion of primary macroglobulinemia-associated nephropathy. Bone marrow biopsy revealed an increase in plasma cells; however, no diagnosis of primary macroglobulinemia was made. At this point, IgM-MGRS was diagnosed instead of primary macroglobulinemia. A follow-up allograft biopsy was performed, and IgM-MGRS-associated nephropathy was diagnosed. Eventually, his retrieved autologous kidney biopsy from the initial examination showed that the primary disease was not MPGN but recurrent IgM-MGRS-associated nephropathy. Dexamethasone, rituximab, and cyclophosphamide (DRC) were started to treat IgM-MGRS due to worsening renal function (serum creatinine levels were in the 4–5 mg/dL range). Additional doses of DRC with 20 cycles of plasma exchange were introduced. Severe side effects occurred but did not result in death.

我们报告一例罕见的完全性C4缺乏症患者,他接受了肾移植手术,术后出现免疫球蛋白m -单克隆淋巴细胞病变(IgM-MGRS)复发。一例45岁男性患者因膜增生性肾小球肾炎(MPGN)导致终末期肾功能衰竭。最初的免疫抑制方案包括他克莫司、类固醇、霉酚酸酯、巴昔昔单抗和利妥昔单抗。他于2021年8月接受了母亲abo血型不合的肾移植手术。肾移植后一个月的临床过程平淡无奇。由于肾功能下降,对移植肾进行活检。同种异体移植活检结果导致怀疑原发性巨球蛋白相关肾病。骨髓活检显示浆细胞增多;然而,没有诊断原发性巨球蛋白血症。此时,诊断为IgM-MGRS而不是原发性巨球蛋白血症。进行了随访的同种异体移植活检,诊断为igm - mgrs相关肾病。最终,他从最初的检查中取出的自体肾活检显示原发疾病不是MPGN,而是复发的igm - mgrs相关肾病。由于肾功能恶化(血清肌酐水平在4-5 mg/dL范围内),开始使用地塞米松、利妥昔单抗和环磷酰胺(DRC)治疗IgM-MGRS。引入了额外剂量的DRC,并进行了20个血浆交换周期。发生了严重的副作用,但没有导致死亡。
{"title":"A case of kidney transplantation for complete C4 deficiency with recurrent IgM-monoclonal gammopathy of renal significance (MGRS) associated nephropathy","authors":"Yu Kijima ,&nbsp;Tomokazu Shimizu ,&nbsp;Shinya Kato ,&nbsp;Kana Kano ,&nbsp;Toshihide Horiuchi ,&nbsp;Taiji Nozaki ,&nbsp;Kazuya Omoto ,&nbsp;Masashi Inui ,&nbsp;Hiroshi Toma ,&nbsp;Shoichi Iida ,&nbsp;Toshio Takagi","doi":"10.1016/j.tpr.2023.100138","DOIUrl":"10.1016/j.tpr.2023.100138","url":null,"abstract":"<div><p>We present a rare case of a patient with complete C4 deficiency who underwent kidney transplantation and experienced <u>immunoglobulin M-monoclonalgammopathyofrenalsignificance (IgM-MGRS)</u> recurrence after the procedure. A 45-year-old male patient presented with end-stage renal failure due to membranoproliferative glomerulonephritis (MPGN). The initial immunosuppressive regimen consisted of tacrolimus, steroids, mycophenolate mofetil, basiliximab, and rituximab. He underwent ABO-incompatible kidney transplantation from his mother in August 2021. The clinical course after kidney transplantation was uneventful for a month. A biopsy of the transplanted kidney was performed due to <u>decreased</u> renal function. The allograft biopsy result led to the suspicion of primary macroglobulinemia-associated nephropathy. Bone marrow biopsy revealed an increase in plasma cells; however, no diagnosis of primary macroglobulinemia was made. At this point, <u>IgM-MGRS</u> was diagnosed instead of primary macroglobulinemia. A follow-up allograft biopsy was performed, and <u>IgM-MGRS</u>-associated nephropathy was diagnosed. Eventually, his retrieved autologous kidney biopsy from the initial examination showed that the primary disease was not MPGN but recurrent <u>IgM-MGRS</u>-associated nephropathy. Dexamethasone, rituximab, and cyclophosphamide (DRC) were started to treat <u>IgM-MGRS</u> due to worsening renal function (serum creatinine levels were in the 4–5 mg/dL range). Additional doses of DRC with 20 cycles of plasma exchange were introduced. Severe side effects occurred but did not result in death.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"8 3","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48055706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Transplantation Reports
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