Pub Date : 2023-12-30DOI: 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。
{"title":"Impact of a bone health protocol on adult lung transplant recipients","authors":"Shelby Tungate , Chrissy Doligalski , Anita Yang , Roxanne McKnight , Raymond Coakley , L. Jason Lobo","doi":"10.1016/j.tpr.2023.100149","DOIUrl":"10.1016/j.tpr.2023.100149","url":null,"abstract":"<div><p>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 %, <em>p</em> = <0.001), less significant decline in femur Z- and T-scores (<em>p</em> = 0.05 and 0.04, respectively), and were more likely to be prescribed anti-resorptive therapy (11 % vs 40 %, <em>p</em> = 0.008) and calcium therapy (24 % vs. 70 %, <em>p</em> = <0.001). Incidence of non-procedural fracture at two years was numerically lower in the post-protocol group (21 % vs. 15 %, <em>p</em> = 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.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"9 1","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2451959623000240/pdfft?md5=ff0cb304d840419e38ae2c639c78641e&pid=1-s2.0-S2451959623000240-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139193320","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 : 2023-12-01DOI: 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 TransplantationReports 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.
{"title":"Donation after circulatory death: An international view","authors":"Barry D. Kahan","doi":"10.1016/j.tpr.2023.100137","DOIUrl":"10.1016/j.tpr.2023.100137","url":null,"abstract":"<div><p>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 <em><u>Transplantation</u> <u>Reports</u></em> 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.</p><p>On the one hand, there is little concern about the use of <em><u>ex vivo</u></em> machine perfusion to diagnose, mitigate and treat IRI in DCD organs. On the other hand, <em><u>in vivo</u></em> 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.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"8 4","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2451959623000124/pdfft?md5=892d43c881a713c94741929928ad2e41&pid=1-s2.0-S2451959623000124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43648488","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}
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.
{"title":"Management of incisional hernias in renal transplant patients","authors":"Ilektra Kanella , Kalaikshiga Kengadaran , Vassilios Papalois","doi":"10.1016/j.tpr.2023.100148","DOIUrl":"https://doi.org/10.1016/j.tpr.2023.100148","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"8 4","pages":"Article 100148"},"PeriodicalIF":0.0,"publicationDate":"2023-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49752395","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}
Pub Date : 2023-10-13DOI: 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).
{"title":"Impact of donor marrow cellularity on outcome of allogeneic stem cell transplantation","authors":"Memoona Khan, Ghassan Umair Shamshad, Qamar un Nisa Chaudhry, Raheel Iftikhar, Nighat Shahbaz, Mehreen Ali Khan, Farwa Raza, Haider Nisar, 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}
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.
{"title":"A case of kidney transplantation for complete C4 deficiency with recurrent IgM-monoclonal gammopathy of renal significance (MGRS) associated nephropathy","authors":"Yu Kijima , Tomokazu Shimizu , Shinya Kato , Kana Kano , Toshihide Horiuchi , Taiji Nozaki , Kazuya Omoto , Masashi Inui , Hiroshi Toma , Shoichi Iida , 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}
Pub Date : 2023-09-01DOI: 10.1016/j.tpr.2023.100139
Yvonne Schill , Mario Schiffer , Lars Pape
Introduction
The new LCP-formulation of tacrolimus (Tac) has shown pharmacokinetic advantages in patients after liver transplantation that are associated with better adherence. The influence of prolonged release Tac on adherence, trough levels and dosing of Tac remains unclear.
Pub Date : 2023-09-01DOI: 10.1016/j.tpr.2023.100144
Isha Thapa , Raymond Ye Lee , Marcelo Fernandez Vina , Bing Melody Zhang , Humera Ahmed , Andrew Y Shin , Nicholas Bambos , David N Rosenthal , David Scheinker
The virtual crossmatch is used in transplant medicine to assess the compatibility of organ donors and recipients. Virtual crossmatch methods vary considerably across institutions; require highly trained HLA laboratory experts and clinicians for interpretation; and do not generate data in a standardized format suitable for comparison across institutions. It is not known if standardized multi-center data collection and reporting could potentially facilitate the development of data-driven immunologic decision-making. We sought to examine the feasibility of an algorithmic approach to interpreting virtual crossmatch data.
We examined Histocompatibility and Immunogenetics laboratory data from 1,152 transplant patients and 1,180 donors from an academic medical transplant center over a ten-year time interval. Principal component analysis was used to simplify the complex high-dimensional data with rare outcomes into a format better suited for analysis. Machine learning models were used to predict negative flow crossmatch results. A training subset of the oldest 80% of the data was used to identify the top-performing model. The model's performance was assessed on the newest 20% of the data with the area under receiver operating characteristic curve (AUC).
The final dataset included 2205 crossmatch results from 1446 patient-donor pairs of which 2019 (91.6%) were negative and 186 (8.4%) positive. The top-performing model test set AUC was 0.80.
This study offers the first proof-of-concept of the feasibility of an algorithmic approach to estimate physical crossmatch results. Standardized, multi-institution data collection is necessary to further explore the possibility of a standardized, data-driven virtual crossmatch process.
{"title":"Examining the feasibility of data-driven decision support for the virtual crossmatch for solid organ transplantation: A single center study","authors":"Isha Thapa , Raymond Ye Lee , Marcelo Fernandez Vina , Bing Melody Zhang , Humera Ahmed , Andrew Y Shin , Nicholas Bambos , David N Rosenthal , David Scheinker","doi":"10.1016/j.tpr.2023.100144","DOIUrl":"https://doi.org/10.1016/j.tpr.2023.100144","url":null,"abstract":"<div><p>The virtual crossmatch is used in transplant medicine to assess the compatibility of organ donors and recipients. Virtual crossmatch methods vary considerably across institutions; require highly trained HLA laboratory experts and clinicians for interpretation; and do not generate data in a standardized format suitable for comparison across institutions. It is not known if standardized multi-center data collection and reporting could potentially facilitate the development of data-driven immunologic decision-making. We sought to examine the feasibility of an algorithmic approach to interpreting virtual crossmatch data.</p><p>We examined Histocompatibility and Immunogenetics laboratory data from 1,152 transplant patients and 1,180 donors from an academic medical transplant center over a ten-year time interval. Principal component analysis was used to simplify the complex high-dimensional data with rare outcomes into a format better suited for analysis. Machine learning models were used to predict negative flow crossmatch results. A training subset of the oldest 80% of the data was used to identify the top-performing model. The model's performance was assessed on the newest 20% of the data with the area under receiver operating characteristic curve (AUC).</p><p>The final dataset included 2205 crossmatch results from 1446 patient-donor pairs of which 2019 (91.6%) were negative and 186 (8.4%) positive. The top-performing model test set AUC was 0.80.</p><p>This study offers the first proof-of-concept of the feasibility of an algorithmic approach to estimate physical crossmatch results. Standardized, multi-institution data collection is necessary to further explore the possibility of a standardized, data-driven virtual crossmatch process.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"8 3","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49751632","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}
Pub Date : 2023-09-01DOI: 10.1016/j.tpr.2023.100136
Nihal Bashir , Mohamed Alfaki
Background
Renal transplant adds survival benefits to end-stage renal disease patients over dialysis, and a similar concept applies to elderly patients. Some of the challenges of transplanting old patients may involve age-related cancers and comorbid conditions such as cardiovascular disease. Studies had shown that advanced age is associated with better outcomes compared to dialysis despite receiving poorer quality organs.
Aim
This extended literature review aims to identify the common complications, outcomes, and survival benefits of kidney transplantation in the elderly population.
Methods
An extended literature review was done to identify studies that compared elderly transplant recipients with the younger kidney transplant recipient population. The study population included elderly kidney recipients aged sixty and above and younger kidney recipients below the age of sixty. This literature review aims to discuss complications facing elderly kidney recipients and compare transplant outcomes to younger kidney recipients. PubMed, Midline, and google scholar databases were searched and papers meeting the pre-set inclusion criteria were identified.
Results
A total of 212 papers were identified. After screening the results, 12 papers met the inclusion criteria and were included for review. 10/12 papers included patients' age cutoff point, one paper had cut-off age between 60 and 80 years, while the last paper recruited patients with ages above 70. Most of the studies mentioned young group age as below 60, 2/12 papers divided the young group into further subgroups of age. Two studies used paired donor organs for both young and elderly groups to eliminate donor bias. While other studies used living, deceased, or both living and deceased donors for both elderly and young groups. One study matched donor type and gender in both groups. The studies looked at patient and graft survival and complications. Elderly transplant patients suffered more hospitalization, infections, cardiovascular complications, malignancy, and surgical complications. Post-transplant diabetes was higher in the young recipient group in one study.
Conclusion
In the case of elderly renal transplant recipients, the cut-off point for age to perform renal transplant is not clear but studies showed better survival and cost-effectiveness in elderly patients compared to patients on the waiting list even in older patient cohorts
{"title":"A review of elderly transplantation regarding complications, outcomes, and survival","authors":"Nihal Bashir , Mohamed Alfaki","doi":"10.1016/j.tpr.2023.100136","DOIUrl":"10.1016/j.tpr.2023.100136","url":null,"abstract":"<div><h3>Background</h3><p>Renal transplant adds survival benefits to end-stage renal disease patients over dialysis, and a similar concept applies to elderly patients. Some of the challenges of transplanting old patients may involve age-related cancers and comorbid conditions such as cardiovascular disease. Studies had shown that advanced age is associated with better outcomes compared to dialysis despite receiving poorer quality organs.</p></div><div><h3>Aim</h3><p>This extended literature review aims to identify the common complications, outcomes, and survival benefits of kidney transplantation in the elderly population.</p></div><div><h3>Methods</h3><p>An extended literature review was done to identify studies that compared elderly transplant recipients with the younger kidney transplant recipient population. The study population included elderly kidney recipients aged sixty and above and younger kidney recipients below the age of sixty. This literature review aims to discuss complications facing elderly kidney recipients and compare transplant outcomes to younger kidney recipients. PubMed, Midline, and google scholar databases were searched and papers meeting the pre-set inclusion criteria were identified.</p></div><div><h3>Results</h3><p>A total of 212 papers were identified. After screening the results, 12 papers met the inclusion criteria and were included for review. 10/12 papers included patients' age cutoff point, one paper had cut-off age between 60 and 80 years, while the last paper recruited patients with ages above 70. Most of the studies mentioned young group age as below 60, 2/12 papers divided the young group into further subgroups of age. Two studies used paired donor organs for both young and elderly groups to eliminate donor bias. While other studies used living, deceased, or both living and deceased donors for both elderly and young groups. One study matched donor type and gender in both groups. The studies looked at patient and graft survival and complications. Elderly transplant patients suffered more hospitalization, infections, cardiovascular complications, malignancy, and surgical complications. Post-transplant diabetes was higher in the young recipient group in one study.</p></div><div><h3>Conclusion</h3><p>In the case of elderly renal transplant recipients, the cut-off point for age to perform renal transplant is not clear but studies showed better survival and cost-effectiveness in elderly patients compared to patients on the waiting list even in older patient cohorts</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"8 3","pages":"Article 100136"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45576243","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}
Pub Date : 2023-09-01DOI: 10.1016/j.tpr.2023.100143
Leticia Itzel Orozco-Ureña , Luis Enrique Juárez Villegas , Felix Gaytan Morales , V. Ivan Castorena , Catalina Cortes Flores , Juan Manuel Colín-Ruiz , Gerardo Aparicio-Ozores , Monica Moreno-Galván
Vascular endothelial growth factors are proteins that participate in processes related to normal physiology, solid tumors and hematologic malignancies; however, their role in hematopoietic stem cell transplantation (HSCT) requires further investigation. To better define the role and changes in vascular endothelial growth factor-A (VEGF-A) in the context of HSCT, we conducted an observational prospective analysis of VEGF-A expression during the early period after HSCT in pediatric patients. Thirty-seven pediatric patients who underwent hematopoietic stem cell transplantation at the Federico Gómez Children's Hospital in Mexico between June 2016 and July 2018 were prospectively enrolled in this study. Ribonucleic acid was isolated from the venous blood of these patents on Days 0, +7, +14, +21, +28, and +35 after transplantation, and TaqMan reverse transcription-polymerase chain reaction was performed using specific primers and a probe for VEGF-A. The concentration of VEGF-A was determined using a complementary deoxyribonucleic acid control. Data were analyzed using one-way ANOVA and Dunnett post hoc tests. Statistical analysis was performed using SPSS version 25. There were significant differences in the concentrations of VEGF-A between Day 0 vs. Day +28 (p = 0.009 95% CI=0.02–0.24), Day 0 vs. Day +35 (p = 0.006; 95% CI=0.03–0.28) and Day 7 vs. Day + 35 (p = 0.006; 95% CI=0.03–0.24) after allogeneic HSCT. We observed significant increases in the VEGF-A concentration during the early period after stem cell transplantation in pediatric patients. Our results provide important insights that should be considered a basis for future clinical trials of pediatric HSCT, including the monitoring of VEGF-A concentrations, proteins and in vitro analysis.
{"title":"Monitoring vascular endothelial growth factor-a levels during follow-up after hematopoietic stem cell transplantation in pediatric patients at a Mexican hospital: A pilot study","authors":"Leticia Itzel Orozco-Ureña , Luis Enrique Juárez Villegas , Felix Gaytan Morales , V. Ivan Castorena , Catalina Cortes Flores , Juan Manuel Colín-Ruiz , Gerardo Aparicio-Ozores , Monica Moreno-Galván","doi":"10.1016/j.tpr.2023.100143","DOIUrl":"10.1016/j.tpr.2023.100143","url":null,"abstract":"<div><p>Vascular endothelial growth factors are proteins that participate in processes related to normal physiology, solid tumors and hematologic malignancies; however, their role in hematopoietic stem cell transplantation (HSCT) requires further investigation. To better define the role and changes in vascular endothelial growth factor-A (VEGF-A) in the context of HSCT, we conducted an observational prospective analysis of VEGF-A expression during the early period after HSCT in pediatric patients. Thirty-seven pediatric patients who underwent hematopoietic stem cell transplantation at the Federico Gómez Children's Hospital in Mexico between June 2016 and July 2018 were prospectively enrolled in this study. Ribonucleic acid was isolated from the venous blood of these patents on Days 0, +7, +14, +21, +28, and +35 after transplantation, and TaqMan reverse transcription-polymerase chain reaction was performed using specific primers and a probe for VEGF-A. The concentration of VEGF-A was determined using a complementary deoxyribonucleic acid control. Data were analyzed using one-way ANOVA and Dunnett post hoc tests. Statistical analysis was performed using SPSS version 25. There were significant differences in the concentrations of VEGF-A between Day 0 vs. Day +28 (<em>p</em> = 0.009 95% CI=0.02–0.24), Day 0 vs. Day +35 (<em>p</em> = 0.006; 95% CI=0.03–0.28) and Day 7 vs. Day + 35 (<em>p</em> = 0.006; 95% CI=0.03–0.24) after allogeneic HSCT. We observed significant increases in the VEGF-A concentration during the early period after stem cell transplantation in pediatric patients. Our results provide important insights that should be considered a basis for future clinical trials of pediatric HSCT, including the monitoring of VEGF-A concentrations, proteins and <em>in vitro</em> analysis.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"8 3","pages":"Article 100143"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47929489","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}
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