Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2024.100170
Nadim Cassir , Benjamin Coiffard , Linda Hadjadj , Julien Bermudez , Liliane Okdah , Lucile Ailhaud , Sophie Alexandra Baron , Martine Reynaud-Gaubert , Xavier Benoit D'Journo , Sami Hraiech , Jean-Marc Rolain
Burkholderia cepacia complex (Bcc) is an important group of opportunistic pathogens most frequently affecting patients with cystic fibrosis and responsible for life-threatening infections. Therapeutic options are limited owing to high levels of resistance of the organism, either intrinsic or acquired, to many antimicrobial agents. We describe here the successful treatment of a patient with cystic fibrosis who developed post-transplant lung abscesses and sternal osteitis caused by pan-resistant Burkholderia cenocepacia. He was treated with a combination of ceftazidime-avibactam, ciprofloxacin, meropenem, minocycline, sulfadiazine, and tobramycin. Repurposing multitarget drugs including old and new antibiotics, and their combinations with synergistic effects is a promising strategy to overcome clinical therapeutic impasses with difficult-to-treat-resistance (DTR) bacteria.
{"title":"Multi-target combination of antibiotics as salvage therapy for severe infection caused by pan-resistant Burkholderia cenocepacia following lung transplantation","authors":"Nadim Cassir , Benjamin Coiffard , Linda Hadjadj , Julien Bermudez , Liliane Okdah , Lucile Ailhaud , Sophie Alexandra Baron , Martine Reynaud-Gaubert , Xavier Benoit D'Journo , Sami Hraiech , Jean-Marc Rolain","doi":"10.1016/j.tpr.2024.100170","DOIUrl":"10.1016/j.tpr.2024.100170","url":null,"abstract":"<div><div><em>Burkholderia cepacia</em> complex (Bcc) is an important group of opportunistic pathogens most frequently affecting patients with cystic fibrosis and responsible for life-threatening infections. Therapeutic options are limited owing to high levels of resistance of the organism, either intrinsic or acquired, to many antimicrobial agents. We describe here the successful treatment of a patient with cystic fibrosis who developed post-transplant lung abscesses and sternal osteitis caused by pan-resistant <em>Burkholderia cenocepacia.</em> He was treated with a combination of ceftazidime-avibactam, ciprofloxacin, meropenem, minocycline, sulfadiazine, and tobramycin. Repurposing multitarget drugs including old and new antibiotics, and their combinations with synergistic effects is a promising strategy to overcome clinical therapeutic impasses with difficult-to-treat-resistance (DTR) bacteria.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2024.100168
Mohammad Arammash , Barbara Hamilton , Charles Rickert
Liver transplantation has become widely available but remains a high-risk operation not suitable in the presence of severe comorbidities. Pre-operative planning to address potential challenges is key to ensuring optimal outcomes. In this report, we highlight a challenging clinical situation in which a patient with severe portal vein thrombosis and coronary artery disease developed a significant bleed post TIPS, necessitating emergent ligation of the portal structures and urgent liver transplantation. The patient successfully underwent coronary artery bypass grafting after liver transplantation. This case demonstrates an unconventional method for remediating inaccessible portal vein hemorrhage secondary to transjugular intrahepatic portosystemic shunting and the ability to perform coronary artery bypass grafting post-liver transplantation.
{"title":"Emergent management of severe post-TIPS bleed in patient with end-stage liver disease and coronary artery disease","authors":"Mohammad Arammash , Barbara Hamilton , Charles Rickert","doi":"10.1016/j.tpr.2024.100168","DOIUrl":"10.1016/j.tpr.2024.100168","url":null,"abstract":"<div><div>Liver transplantation has become widely available but remains a high-risk operation not suitable in the presence of severe comorbidities. Pre-operative planning to address potential challenges is key to ensuring optimal outcomes. In this report, we highlight a challenging clinical situation in which a patient with severe portal vein thrombosis and coronary artery disease developed a significant bleed post TIPS, necessitating emergent ligation of the portal structures and urgent liver transplantation. The patient successfully underwent coronary artery bypass grafting after liver transplantation. This case demonstrates an unconventional method for remediating inaccessible portal vein hemorrhage secondary to transjugular intrahepatic portosystemic shunting and the ability to perform coronary artery bypass grafting post-liver transplantation.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2024.100169
R. Goodwin , K. Champlin , B. Cloud , C. Yancey , C. Hendrix , S. Parikh , M. Howell , R. Ketcham , A. Milam , B. Nave , T. Campbell , M. Cheruvu
Purpose
This retrospective case study aims to clarify the roles played by various factors in determining the actual versus expected number of organs procured from pediatric trauma patients.
Significance
Trauma patients often have injuries so extensive that there is no hope of recovery. However, if they are stabilized, they may be able to save lives through organ donation. The more organs are procured, the more lives may be saved.
Strategy and Implementation
In this retrospective study, we reviewed the records of pediatric organ donors from Saint Francis Children's Hospital from 2018 to 2022 and identified seven interesting cases involving children younger than 15 years old that showed the actual and expected numbers of organs transplanted. We examined the number of organs that we expected to transplant compared with how many organs were actually transplanted and which clinical data may have affected the ability to transplant.
Outcomes
The data analysis included but was not limited to the observed-to-expected ratio, donor management goals, hospital lab and biometric values before the time of referral, cause of death, age, sex, race, body mass index, blood type, kidney donor profile index, referral timeliness, donation conversations, donation conversation outcomes, hospital attending, pre-mentions of donation to potential families, referral and donation milestone date-time stamps, donor outcomes, organs recovered, organs transplanted, organs discarded, organs submitted to research, and survey responses. Based on the seven identified cases, this study shows that an observed-to-expected ratio greater than 1 is achievable.
Implications for Practice
Identifying factors that affect increased observed organ procurement will increase the potential of transplantable organs, thus leading to a higher number of lives saved.
{"title":"Observed vs. Expected organs transplanted in pediatric donors at Saint Francis hospital","authors":"R. Goodwin , K. Champlin , B. Cloud , C. Yancey , C. Hendrix , S. Parikh , M. Howell , R. Ketcham , A. Milam , B. Nave , T. Campbell , M. Cheruvu","doi":"10.1016/j.tpr.2024.100169","DOIUrl":"10.1016/j.tpr.2024.100169","url":null,"abstract":"<div><h3>Purpose</h3><div>This retrospective case study aims to clarify the roles played by various factors in determining the actual versus expected number of organs procured from pediatric trauma patients.</div></div><div><h3>Significance</h3><div>Trauma patients often have injuries so extensive that there is no hope of recovery. However, if they are stabilized, they may be able to save lives through organ donation. The more organs are procured, the more lives may be saved.</div></div><div><h3>Strategy and Implementation</h3><div>In this retrospective study, we reviewed the records of pediatric organ donors from Saint Francis Children's Hospital from 2018 to 2022 and identified seven interesting cases involving children younger than 15 years old that showed the actual and expected numbers of organs transplanted. We examined the number of organs that we expected to transplant compared with how many organs were actually transplanted and which clinical data may have affected the ability to transplant.</div></div><div><h3>Outcomes</h3><div>The data analysis included but was not limited to the observed-to-expected ratio, donor management goals, hospital lab and biometric values before the time of referral, cause of death, age, sex, race, body mass index, blood type, kidney donor profile index, referral timeliness, donation conversations, donation conversation outcomes, hospital attending, pre-mentions of donation to potential families, referral and donation milestone date-time stamps, donor outcomes, organs recovered, organs transplanted, organs discarded, organs submitted to research, and survey responses. Based on the seven identified cases, this study shows that an observed-to-expected ratio greater than 1 is achievable.</div></div><div><h3>Implications for Practice</h3><div>Identifying factors that affect increased observed organ procurement will increase the potential of transplantable organs, thus leading to a higher number of lives saved.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2025.100171
Jing Dong , Michael T. Zimmermann , Neshatul Haque , Shahram Arsang-Jang , Wael Saber , Xiaowu Gai , Raul Urrutia
Allogeneic hematopoietic stem-cell transplantation (allo-HCT), an early developed methodology for precision medicine, remains the only curative therapy for myelodysplastic syndromes (MDS). However, allo-HCT carries significant risks of morbidity and mortality due to relapse and transplant-related complications. Recurrent mutations in mitochondrial DNA (mtDNA) have been identified as significant prognostic indicators for MDS outcomes following allo-HCT. However, the biological mechanisms of mtDNA mutations remain unclear. Thus, here we performed deep variant phenotyping by integrating computational biophysics and structural genomics approaches to reveal the molecular mechanisms underlying mtDNA variant dysfunction. This emerging genomics discipline employs structural models, molecular mechanic calculations, and accelerated molecular dynamic simulations to analyze gene products, focusing on their structures and motions that determine their function. We applied this methodology on the variants in the mitochondria-encoded complex I genes that are associated with MDS pathobiology and prognosis after allo-HCT. Our results demonstrate that this approach significantly outperforms conventional analytical methods, providing enhanced and more accurate information to support the potential pathogenicity of these variants and better infer their dysfunctional mechanisms. We conclude that the adoption and further expansion of computational structural genomics approaches, as applied to the mitochondrial genome, have the potential to significantly increase our understanding of molecular mechanisms underlying the disease. Our study lays a foundation for translating mitochondrial biology into clinical applications, which will advance the integration of precision medicine with allo-HCT.
{"title":"Advancing deep variant phenotyping of mitochondrial enzyme complexes for precision medicine in allogeneic hematopoietic stem-cell transplantation","authors":"Jing Dong , Michael T. Zimmermann , Neshatul Haque , Shahram Arsang-Jang , Wael Saber , Xiaowu Gai , Raul Urrutia","doi":"10.1016/j.tpr.2025.100171","DOIUrl":"10.1016/j.tpr.2025.100171","url":null,"abstract":"<div><div>Allogeneic hematopoietic stem-cell transplantation (allo-HCT), an early developed methodology for precision medicine, remains the only curative therapy for myelodysplastic syndromes (MDS). However, allo-HCT carries significant risks of morbidity and mortality due to relapse and transplant-related complications. Recurrent mutations in mitochondrial DNA (mtDNA) have been identified as significant prognostic indicators for MDS outcomes following allo-HCT. However, the biological mechanisms of mtDNA mutations remain unclear. Thus, here we performed deep variant phenotyping by integrating computational biophysics and structural genomics approaches to reveal the molecular mechanisms underlying mtDNA variant dysfunction. This emerging genomics discipline employs structural models, molecular mechanic calculations, and accelerated molecular dynamic simulations to analyze gene products, focusing on their structures and motions that determine their function. We applied this methodology on the variants in the mitochondria-encoded complex I genes that are associated with MDS pathobiology and prognosis after allo-HCT. Our results demonstrate that this approach significantly outperforms conventional analytical methods, providing enhanced and more accurate information to support the potential pathogenicity of these variants and better infer their dysfunctional mechanisms. We conclude that the adoption and further expansion of computational structural genomics approaches, as applied to the mitochondrial genome, have the potential to significantly increase our understanding of molecular mechanisms underlying the disease. Our study lays a foundation for translating mitochondrial biology into clinical applications, which will advance the integration of precision medicine with allo-HCT.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.tpr.2025.100172
K Afshar , JM Kozuch , M Don , C Gaissert , E Golts
Lymphomas arising in the setting of immune deficiency and/or dysregulation, also known as post-transplant lymphoproliferative disorder (PTLD) is frequently associated with immunosuppressive therapies and the Epstein Barr Virus after solid organ transplantation. Primary central nervous system PTLD (PCNS-PTLD) is extremely rare. Our group presents only the third reported case of PCNS-PTLD in the setting of lung transplantation.
{"title":"Primary central nervous system post-transplant lymphoproliferative Disorder in a lung transplant recipient despite reduction of immunosuppression","authors":"K Afshar , JM Kozuch , M Don , C Gaissert , E Golts","doi":"10.1016/j.tpr.2025.100172","DOIUrl":"10.1016/j.tpr.2025.100172","url":null,"abstract":"<div><div>Lymphomas arising in the setting of immune deficiency and/or dysregulation, also known as post-transplant lymphoproliferative disorder (PTLD) is frequently associated with immunosuppressive therapies and the Epstein Barr Virus after solid organ transplantation. Primary central nervous system PTLD (PCNS-PTLD) is extremely rare. Our group presents only the third reported case of PCNS-PTLD in the setting of lung transplantation.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 1","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.tpr.2024.100165
Mahdi Awwad , Nasim Afif AbuKaresh , Hamza A. Abdul-Hafez , Ma'moun Qawasmeh , Mohanad Jaber , Ahmad Thiab Albaw , Mohammad Alnees
Introduction and importance
Primary hyperoxaluria (PH) is a metabolic condition that leads to oxalate production, resulting in kidney failure and oxalate nephropathy. Posttransplant mobilization of oxalate poses a risk of recurrence. This case emphasizes the importance of measures in cases of end-stage kidney disease (ESKD) with unknown origins.
Case presentation
A 53-year-old man with a history of hypothyroidism, recurring kidney stones, and a family background of renal disease and stomach cancer presented with high blood pressure and elevated creatinine levels (2 mg/dL). A subsequent renal biopsy confirmed PH1. Despite initiating hemodialysis, his kidney function deteriorated, necessitating a liver and kidney transplant. Following the transplant, the patient developed lymph node enlargement. Experienced humoral rejection, leading to the resumption of hemodialysis.
Clinical discussion
The case discussion highlights the treatment complexities associated with PH1, emphasizing the importance of detection and vigilant monitoring post transplantation and multidisciplinary care for managing complications effectively.
Conclusion
Early detection, thorough diagnostics, and customized posttransplant care play roles in managing hyperoxaluria. Future research should focus on enhancing methods, refining transplantation techniques, and developing strategies to prevent and manage complications effectively.
{"title":"Management challenges in primary hyperoxaluria type 1 with end-stage kidney disease: A case report","authors":"Mahdi Awwad , Nasim Afif AbuKaresh , Hamza A. Abdul-Hafez , Ma'moun Qawasmeh , Mohanad Jaber , Ahmad Thiab Albaw , Mohammad Alnees","doi":"10.1016/j.tpr.2024.100165","DOIUrl":"10.1016/j.tpr.2024.100165","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Primary hyperoxaluria (PH) is a metabolic condition that leads to oxalate production, resulting in kidney failure and oxalate nephropathy. Posttransplant mobilization of oxalate poses a risk of recurrence. This case emphasizes the importance of measures in cases of end-stage kidney disease (ESKD) with unknown origins.</div></div><div><h3>Case presentation</h3><div>A 53-year-old man with a history of hypothyroidism, recurring kidney stones, and a family background of renal disease and stomach cancer presented with high blood pressure and elevated creatinine levels (2 mg/dL). A subsequent renal biopsy confirmed PH1. Despite initiating hemodialysis, his kidney function deteriorated, necessitating a liver and kidney transplant. Following the transplant, the patient developed lymph node enlargement. Experienced humoral rejection, leading to the resumption of hemodialysis.</div></div><div><h3>Clinical discussion</h3><div>The case discussion highlights the treatment complexities associated with PH1, emphasizing the importance of detection and vigilant monitoring post transplantation and multidisciplinary care for managing complications effectively.</div></div><div><h3>Conclusion</h3><div>Early detection, thorough diagnostics, and customized posttransplant care play roles in managing hyperoxaluria. Future research should focus on enhancing methods, refining transplantation techniques, and developing strategies to prevent and manage complications effectively.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 4","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Donor hepatectomy is considered as a major surgical procedure and can lead to severe complications. Since 2012, 64 deceased donor liver transplantation (DDLT) and 420 living donor liver transplantation were performed in Kazakhstan. Efforts to increase deceased liver donation have shown no success. In this study, we analyzed major and minor complications among living liver donor after left and right liver lobe donation, performed in our center. Patients and methods This retrospective study was conducted in compliance with the principles of the Declaration of Helsinki. The Local Ethics Committee of NROC approved this study. All data regarding living liver donors, who underwent donor hepatectomy between 2016 and 2023 were retrieved from electronic records. Results The mean age of living donors was 32 years (range 18–61).Male/female ratio was 51(70.8 %)/21(29.2). 4 left liver grafts;2 left lateral grafts and 66 right liver grafts. Bile leak occurred in 9 cases (12.5 %), 2 cases of bile leakage in living donors required surgery (Clavien grade III). Bleeding totally occurred in 3 living donors (4.2 %), in 2 cases it required surgery. PHLF occurred in 15(20.8 %) cases after right liver lobe donation. No living liver donor death was encountered in our study. Conclusions Our experience in living donor hepatectomy was not fully safe procedure. However, complication occurrence was comparable with other reports from transplant centers.
{"title":"Report on living liver donor risk and outcomes: Single center experience","authors":"Jamilya Saparbay , Abylaikhan Sharmenov , Chokhan Aytbayev , Assylmurat Zhumukov , Bekkhozha Yeskendirov , Zhanat Spatayev , Asan Zhexembayev","doi":"10.1016/j.tpr.2024.100166","DOIUrl":"10.1016/j.tpr.2024.100166","url":null,"abstract":"<div><div>Introduction Donor hepatectomy is considered as a major surgical procedure and can lead to severe complications. Since 2012, 64 deceased donor liver transplantation (DDLT) and 420 living donor liver transplantation were performed in Kazakhstan. Efforts to increase deceased liver donation have shown no success. In this study, we analyzed major and minor complications among living liver donor after left and right liver lobe donation, performed in our center. Patients and methods This retrospective study was conducted in compliance with the principles of the Declaration of Helsinki. The Local Ethics Committee of NROC approved this study. All data regarding living liver donors, who underwent donor hepatectomy between 2016 and 2023 were retrieved from electronic records. Results The mean age of living donors was 32 years (range 18–61).Male/female ratio was 51(70.8 %)/21(29.2). 4 left liver grafts;2 left lateral grafts and 66 right liver grafts. Bile leak occurred in 9 cases (12.5 %), 2 cases of bile leakage in living donors required surgery (Clavien grade III). Bleeding totally occurred in 3 living donors (4.2 %), in 2 cases it required surgery. PHLF occurred in 15(20.8 %) cases after right liver lobe donation. No living liver donor death was encountered in our study. Conclusions Our experience in living donor hepatectomy was not fully safe procedure. However, complication occurrence was comparable with other reports from transplant centers.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 4","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.tpr.2024.100164
Jade M Kozuch , Alicia Lichvar , Dana Abraham , Eugene Golts , Christine M Lin , Aarya Kafi , Gordon Yung , Kamyar Afshar
The proportion of elderly lung transplant recipients has increased substantially in recent years. The immunosuppressants required significantly increase the risk for infection and malignancy in the elderly population. However, there is a paucity of data on immunosuppression management practices in this group. Herein, we report results of the first national aggregation of immunosuppressant strategies in elderly lung transplant recipients within the US.
{"title":"A national survey of immunosuppression adjustment in elderly lung transplant recipients","authors":"Jade M Kozuch , Alicia Lichvar , Dana Abraham , Eugene Golts , Christine M Lin , Aarya Kafi , Gordon Yung , Kamyar Afshar","doi":"10.1016/j.tpr.2024.100164","DOIUrl":"10.1016/j.tpr.2024.100164","url":null,"abstract":"<div><div>The proportion of elderly lung transplant recipients has increased substantially in recent years. The immunosuppressants required significantly increase the risk for infection and malignancy in the elderly population. However, there is a paucity of data on immunosuppression management practices in this group. Herein, we report results of the first national aggregation of immunosuppressant strategies in elderly lung transplant recipients within the US.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 4","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.tpr.2024.100163
Lorenzo Olivero , Hong Liang , Ian A. Makey , Si M. Pham , Jorge Sinclair , Stephen Aniskevich III , Sadia Z. Shah , Dana K. Perry , Wesley L. Allen , Nathan H. Waldron , Liu Yang , Pramod K. Guru , Candido E. Rivera , Pablo Moreno Franco , Tathagat Narula
Combined lung and liver transplantation (CLLT) is a rare intervention for end-stage lung and liver diseases. It poses a challenge for patients with increased bleeding risk due to Hemophilia A and liver coagulopathy. We present the first documented case of CLLT in an elderly male with Hemophilia A, HCV-associated cirrhosis, and Idiopathic Pulmonary Fibrosis (IPF). Despite the patient exhibiting stable liver function and hemophilia, his lung condition rapidly deteriorated, prompting the listing for transplant. The patient underwent a successful CLLT with perioperative management coordinated by the multidisciplinary team to address the unique challenges of Hemophilia A, resulting in intra-operative correction of coagulopathy. The patient exhibited a favorable recovery, with no requirement for Factor FVIII replacement therapy postoperatively. This case demonstrates that CLLT can address three diseases with distinct pathophysiologies: end-stage lung and liver disease, and correct the hemophilia A phenotype. Our report contributes to the limited literature on the suitability of CLLT in patients with hemophilia A.
肺肝联合移植（CLLT）是一种罕见的治疗终末期肺病和肝病的干预措施。对于因血友病 A 和肝凝血功能障碍而导致出血风险增加的患者来说，这是一项挑战。我们介绍了首例有记录的 CLLT 病例，患者是一名患有血友病 A、丙型肝炎病毒相关性肝硬化和特发性肺纤维化（IPF）的老年男性。尽管患者的肝功能和血友病病情稳定，但他的肺部状况却迅速恶化，因此被列入移植名单。患者成功接受了 CLLT，多学科团队协调了围手术期管理，以应对血友病 A 的独特挑战，从而在术中纠正了凝血病。患者术后恢复良好，无需进行因子 FVIII 替代治疗。本病例表明，CLLT 可以治疗三种病理生理不同的疾病：终末期肺病和肝病，并纠正 A 型血友病表型。我们的报告为有关 CLLT 是否适用于 A 型血友病患者的有限文献做出了贡献。
{"title":"Combined lung and liver transplant for cirrhosis, idiopathic pulmonary fibrosis, and hemophilia A: Case report","authors":"Lorenzo Olivero , Hong Liang , Ian A. Makey , Si M. Pham , Jorge Sinclair , Stephen Aniskevich III , Sadia Z. Shah , Dana K. Perry , Wesley L. Allen , Nathan H. Waldron , Liu Yang , Pramod K. Guru , Candido E. Rivera , Pablo Moreno Franco , Tathagat Narula","doi":"10.1016/j.tpr.2024.100163","DOIUrl":"10.1016/j.tpr.2024.100163","url":null,"abstract":"<div><div>Combined lung and liver transplantation (CLLT) is a rare intervention for end-stage lung and liver diseases. It poses a challenge for patients with increased bleeding risk due to Hemophilia A and liver coagulopathy. We present the first documented case of CLLT in an elderly male with Hemophilia A, HCV-associated cirrhosis, and Idiopathic Pulmonary Fibrosis (IPF). Despite the patient exhibiting stable liver function and hemophilia, his lung condition rapidly deteriorated, prompting the listing for transplant. The patient underwent a successful CLLT with perioperative management coordinated by the multidisciplinary team to address the unique challenges of Hemophilia A, resulting in intra-operative correction of coagulopathy. The patient exhibited a favorable recovery, with no requirement for Factor FVIII replacement therapy postoperatively. This case demonstrates that CLLT can address three diseases with distinct pathophysiologies: end-stage lung and liver disease, and correct the hemophilia A phenotype. Our report contributes to the limited literature on the suitability of CLLT in patients with hemophilia A.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 4","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142723158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.tpr.2024.100162
Jordan Leal, William Wesson, Liza Rodriguez, Jason Gray, Kelly Bosak, Joseph McGuirk, Kristin Grdinovac
Background
Steroid-induced hyperglycemia (SIH) worsens overall outcomes in the allo-SCT population. Currently, there is no standardized workflow for monitoring SIH. To address this need, a quality improvement (QI) initiative was implemented, as part of a Doctor of Nursing Practice project for the University of Kansas School of Nursing, to standardize glucose monitoring after the initiation of glucocorticoids (CGs) for the treatment of acute or chronic graft-versus-host-disease (GVHD).
Objective
This QI initiative aimed to decrease the median time to identification of SIH and the initiation of treatment in allo-SCT recipients on GCs for GVHD.
Study Design
The study took place at a large Midwestern blood and marrow transplant program. Patients diagnosed with acute or chronic GVHD and prescribed ≥0.5 mg kg-1/day prednisone equivalent (PE) steroids were requested to monitor postprandial blood glucose values for 14 days. A control group (retrospective chart review) was used for comparison. Time to the identification of SIH was compared between the two groups, as well as the time to treatment of hyperglycemia.
Results
Over 9 weeks, 19 patients enrolled in the QI initiative. The control group consisted of 21 patients. The median PE steroid dose was 1 mg kg-1/day in both groups (p = 0.8100). Eighteen of the 19 patients (95 %) had at least 1 blood glucose (BG) > 180 mg/dL and only 6 of 21 patients (29 %) had at least 1 BG > 180 mg/dL (p < 0.0001). The median time to a BG > 180 mg/dL was 1.5 days in the QI group and 7 days in the control group (p = 0.0232). The median time to insulin was 2 days in the QI group and 10 days in the control group (p = 0.0355).
Conclusion
This project demonstrated that daily postprandial blood glucose monitoring is superior for the earlier identification and treatment of SIH when compared to monitoring at routine clinic visits alone.
{"title":"Implementing a standardized workflow for early detection of steroid-induced hyperglycemia in allogeneic stem cell transplant recipients: A quality improvement project","authors":"Jordan Leal, William Wesson, Liza Rodriguez, Jason Gray, Kelly Bosak, Joseph McGuirk, Kristin Grdinovac","doi":"10.1016/j.tpr.2024.100162","DOIUrl":"10.1016/j.tpr.2024.100162","url":null,"abstract":"<div><h3>Background</h3><div>Steroid-induced hyperglycemia (SIH) worsens overall outcomes in the allo-SCT population. Currently, there is no standardized workflow for monitoring SIH. To address this need, a quality improvement (QI) initiative was implemented, as part of a Doctor of Nursing Practice project for the University of Kansas School of Nursing, to standardize glucose monitoring after the initiation of glucocorticoids (CGs) for the treatment of acute or chronic graft-versus-host-disease (GVHD).</div></div><div><h3>Objective</h3><div>This QI initiative aimed to decrease the median time to identification of SIH and the initiation of treatment in allo-SCT recipients on GCs for GVHD.</div></div><div><h3>Study Design</h3><div>The study took place at a large Midwestern blood and marrow transplant program. Patients diagnosed with acute or chronic GVHD and prescribed ≥0.5 mg kg<sup>-1</sup>/day prednisone equivalent (PE) steroids were requested to monitor postprandial blood glucose values for 14 days. A control group (retrospective chart review) was used for comparison. Time to the identification of SIH was compared between the two groups, as well as the time to treatment of hyperglycemia.</div></div><div><h3>Results</h3><div>Over 9 weeks, 19 patients enrolled in the QI initiative. The control group consisted of 21 patients. The median PE steroid dose was 1 mg kg<sup>-1</sup>/day in both groups (<em>p</em> = 0.8100). Eighteen of the 19 patients (95 %) had at least 1 blood glucose (BG) > 180 mg/dL and only 6 of 21 patients (29 %) had at least 1 BG > 180 mg/dL (<em>p</em> < 0.0001). The median time to a BG > 180 mg/dL was 1.5 days in the QI group and 7 days in the control group (<em>p</em> = 0.0232). The median time to insulin was 2 days in the QI group and 10 days in the control group (<em>p</em> = 0.0355).</div></div><div><h3>Conclusion</h3><div>This project demonstrated that daily postprandial blood glucose monitoring is superior for the earlier identification and treatment of SIH when compared to monitoring at routine clinic visits alone.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 4","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142434332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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