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Factors associated with health inequities in access to kidney transplantation in the USA: A scoping review 在美国,与获得肾移植的卫生不公平相关的因素:范围审查
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.trre.2023.100751
Zachary Ernst , Andrew Wilson , Andriana Peña , Mitchell Love , Ty Moore , Matt Vassar

Background

The kidney is the most needed organ for transplantation in the United States. However, demand and scarcity of this organ has caused significant inequities for historically marginalized groups. In this review, we report on the frequency of inequities in all steps of kidney transplantation from 2016 to 2022. Search criteria was based on the National Institute of Health's (NIH) 2022 list of populations who experience health inequities, which includes: race and ethnicity; sex or gender; Lesbian, Gay, Bisexual, Transgender, Queer + (LGBTQ+); underserved rural communities; education level; income; and occupation status. We outline steps for future research aimed at assessing interventions and programs to improve health outcomes.

Methods

This scoping review was developed following guidelines from the Joanna Briggs Institute and PRISMA extension for scoping reviews. In July 2022, we searched Medline (via PubMed) and Ovid Embase databases to identify articles addressing inequities in access to kidney transplantation in the United States. Articles had to address at least one of the NIH's 2022 health inequity groups.

Results

Our sample of 44 studies indicate that Black race, female sex or gender, and low socioeconomic status are negatively associated with referral, evaluation, and waitlisting for kidney transplantation. Furthermore, only two studies from our sample investigated LGBTQ+ identity since the NIH's addition of SGM in 2016 regarding access to transplantation. Lastly, we found no detectable trend in studies for the four most investigated inequity groups between 2016 and 2022.

Conclusion

Investigations in inequities for access to kidney transplantation for the two most studied groups, race/ethnicity and sex or gender, have shown no change in frequencies. Regarding race and ethnicity, continued interventions focused on educating Black patients and staff of dialysis facilities may increase transplant rates. Studies aimed at assessing effectiveness of the Kidney Paired Donation program are highly warranted due to incompatibility problems in female patients. The sparse representation for the LGBTQ+ population may be due to a lack of standardized data collection for sexual orientation. We recommend this community be engaged via surveys and further investigations.

背景肾脏是美国最需要移植的器官。然而,这一器官的需求和稀缺性给历史上被边缘化的群体造成了严重的不平等。在这篇综述中,我们报告了2016年至2022年肾移植所有步骤中不公平的频率。搜索标准基于美国国立卫生研究院(NIH)2022年的健康不平等人群名单,其中包括:种族和民族;性别或性别;女同性恋、男同性恋、双性恋、变性人、酷儿+(LGBTQ+);服务不足的农村社区;教育水平;收入以及职业地位。我们概述了未来研究的步骤,旨在评估改善健康结果的干预措施和计划。方法本范围审查是根据乔安娜·布里格斯研究所和PRISMA扩展的范围审查指南制定的。2022年7月,我们搜索了Medline(通过PubMed)和Ovid Embase数据库,以确定解决美国肾移植不公平问题的文章。文章必须至少针对美国国立卫生研究院2022年的一个健康不平等群体。结果我们对44项研究的样本表明,黑人种族、女性或性别以及低社会经济地位与肾移植的转诊、评估和等待名单呈负相关。此外,自2016年美国国立卫生研究院在移植途径方面增加SGM以来,我们样本中只有两项研究调查了LGBTQ+身份。最后,我们在2016年至2022年间对四个调查最多的不平等群体的研究中没有发现可检测的趋势。结论对两个研究最多的群体(种族/民族和性别或性别)进行的肾移植不平等的调查显示,频率没有变化。关于种族和民族,继续以教育黑人患者和透析机构工作人员为重点的干预措施可能会提高移植率。由于女性患者的不相容性问题,旨在评估肾脏配对捐赠计划有效性的研究是非常有必要的。LGBTQ+人群的稀疏代表性可能是由于缺乏性取向的标准化数据收集。我们建议该社区通过调查和进一步调查参与进来。
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引用次数: 1
The short- and long-term outcomes in living-donor liver transplantation using small-for-size graft: A systematic review and meta-analysis 使用小尺寸移植物的活体肝移植的短期和长期结果:系统回顾和荟萃分析
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.trre.2023.100747
Ki-Hun Kim, Sang-Hoon Kim, Hwui-Dong Cho

Background

A standard graft-to-recipient weight ratio (GRWR) ≥0.8% is widely accepted in living-donor liver transplantation (LDLT); however, the potential donor pool is expanded to patients adopting small-for-size graft (SFSGs) with GRWR <0.8%. This study aimed to investigate the effect of SFSG on short- and long-term outcomes following LDLT.

Methods

Electronic databases were searched from January 1995 to January 2022 for studies comparing short- or long-term outcomes between patients with SFSG (GRWR <0.8%, SFSG group) and sufficient volume graft (GRWR ≥0.8%, non-SFSG group). The primary outcomes were one-, three-, and five-year overall survival (OS) and graft survival (GS), while the secondary outcome was postoperative complications.

Results

Twenty-four studies comprising 7996 patients were included. In terms of OS, SFSG group had poor three-year OS (HR: 1.48, 95% CI [1.01, 2.15], p = 0.04), but there were no significant differences between two groups in one-year OS (HR: 1.50, 95% CI [0.98, 2.29], p = 0.06) and five-year OS (HR: 1.40, 95% CI [0.95, 2.08], p = 0.02). In GS, there were no significant differences in one-year (HR 1.31, 95% CI [1.00, 1.72], p = 0.05), three-year (HR 1.33, 95% CI [0.97, 1.82], p = 0.07), and five-year GS (HR 1.17, 95% CI [0.95, 1.44], p = 0.13). The SFSG group had comparable postoperative complications, except for a high incidence of vascular complications and small-for-size syndromes.

Conclusions

Expanding the potential donor pool in LDLT to SFSG with GRWR <0.8% can be acceptable in terms of comparable long-term OS and GS, despite the risk for vascular complications and small-for-size syndrome.

背景标准移植物与受体重量比≥0.8%在活体供肝移植(LDLT)中被广泛接受;然而,潜在的供体库扩展到采用GRWR<;0.8%。本研究旨在调查SFSG对LDLT后短期和长期结果的影响。方法检索1995年1月至2022年1月的电子数据库,比较SFSG患者(GRWR<0.8%,SFSG组)和足够体积移植物(GRWR≥0.8%,非SFSG组。主要结果是一年、三年和五年总生存率(OS)和移植物生存率(GS),而次要结果是术后并发症。结果纳入了24项研究,共7996名患者。就OS而言,SFSG组的三年OS较差(HR:1.48,95%CI[1.01,2.15],p=0.04),但两组在一年OS(HR:1.50,95%CI[0.98,2.29],p=0.06)和五年OS(HR:1.40,95%CI[0.95,2.08],p=0.02)方面无显著差异。在GS中,一年OS无显著差异(HR 1.31,95%CI[1.00,1.72],p=0.05),三年期(HR 1.33,95%CI[0.97,1.82],p=0.07)和五年期GS(HR 1.17,95%CI=0.95,1.44],p=0.013)。除血管并发症发生率高和体积小综合征外,SFSG组的术后并发症相似。结论利用GRWR<;0.8%的长期OS和GS是可以接受的,尽管有血管并发症和小尺寸综合征的风险。
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引用次数: 1
Outcomes from organ donation following medical assistance in dying: A scoping review 医疗协助死亡后器官捐赠的结果:范围综述
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.trre.2023.100748
Vanessa Silva e Silva , Amina Silva , Andrea Rochon , Ken Lotherington , Laura Hornby , Tineke Wind , Jan Bollen , Lindsay C. Wilson , Aimee J. Sarti , Sonny Dhanani

Aim

To collate and summarize the current international literature on the transplant recipient outcomes of organs from Medical Assistance in Dying (MAiD) donors, as well as the actual and potential impact of organ donation following MAiD on the donation and transplantation system.

Background

The provision of organ donation following MAiD can impact the donation and transplantation system, as well as potential recipients of organs from the MAiD donor, therefore a comprehensive understanding of the potential and actual impact of organ donation after MAiD on the donation and transplantation systems is needed.

Design

Scoping review using the JBI framework.

Methods

We searched for published (MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Academic Search Complete), and unpublished literature (organ donation organization websites worldwide). Included references discussed the actual and potential impact of organ donation following MAiD on the donation and transplantation system. All references were screened, extracted and analysed by two independent reviewers.

Results

We included 78 references in this review and our finding were summarized across three categories: (1) Impact in the donor pool: (2) statistics on organ donation following MAiD; and (3) potential and actual impact of MAiD on the donation and transplant system.

Conclusions

The potential impact of the MAiD donor on the transplant waiting list is relatively small as this process is still rare, however, due to the current organ shortage worldwide the contribution of this procedure should not be disregarded. Additionally, despite being limited, the existing research provided scanty evidence that organs retrieved from MAiD donors are associated with satisfactory graft function and survival rates and that outcomes from transplant recipients are comparable to those of organs from donation following brain death and may be better than those of organs from other types of donation after circulatory determined death. Still, further studies are required for comprehensive and reliable evidence.

目的整理和总结目前国际上关于临终医疗援助(MAiD)捐赠者器官移植受者结果的文献,以及MAiD后器官捐赠对捐赠和移植系统的实际和潜在影响。背景MAiD后提供器官捐赠会影响捐赠和移植系统,以及MAiD捐赠者器官的潜在接受者,因此需要全面了解MAiD后器官捐赠对捐赠和移植体系的潜在和实际影响。使用JBI框架进行DesignScoping审查。方法检索已发表(MEDLINE、Embase、CINAHL、PsycINFO、Web of Science和Academic Search Complete)和未发表的文献(器官捐献组织全球网站)。纳入的参考文献讨论了MAiD后器官捐献对捐献和移植系统的实际和潜在影响。所有参考文献均由两名独立评审员进行筛选、提取和分析。结果我们在这篇综述中纳入了78篇参考文献,我们的发现概括为三类:(1)对捐献者库的影响:(2)MAiD后器官捐献的统计数据;以及(3)MAiD对捐赠和移植系统的潜在和实际影响。结论MAiD捐献者在等待移植名单上的潜在影响相对较小,因为这一过程仍然很少见,然而,由于目前全球器官短缺,不应忽视这一过程的贡献。另外尽管受到限制,现有的研究提供了很少的证据,证明从MAiD捐献者那里获得的器官与令人满意的移植物功能和存活率有关,并且移植受者的结果与脑死亡后捐献的器官相当,并且可能比循环系统确定死亡后其他类型捐献的器官更好。尽管如此,仍需要进一步研究,以获得全面可靠的证据。
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引用次数: 2
Outcomes of live renal donors with a history of nephrolithiasis; A systematic review 有肾结石病史的活体肾供者的预后系统回顾
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.trre.2022.100746
Mohamed Eftal Bin Mohamed Ebrahim , Animesh Singla , Jinna Yao , Jerome Martin Laurence , Germaine Wong , Howard Lau , Taina Lee , Lawrence Yuen , Wai H. Lim , Henry Pleass

The clinical outcomes of kidney donors with a prior history of nephrolithiasis are poorly defined. We conducted a systematic review assessing the post-donation clinical outcomes of kidney donors with a history of nephrolithiasis. Electronic databases (Ovid and Embase) were searched between 1960 and 2021 using key terms and Medical Subject Headings (MeSH) – nephrolithiasis, renal stones, renal transplantation and renal graft. Articles included conference proceedings and journal articles and were not excluded based on patient numbers. Primary outcome was donor stone-related event. Secondary outcomes were renal function upon follow-up or post-operative nephrectomy complications. In summary, 340 articles were identified through database search. We identified 14 studies (16 cohorts) comprising 432 live donors followed up for a median of 26 months post live kidney donation. Six donors donated the stone-free kidney whilst 23 live donors had bilateral stones. Mean stone size was 4.2 ± 1.4 mm (1–16) with average follow up duration of 21.1 months (1–149). Twelve studies provided primary outcome (n = 138 patients) and eight (n = 348) for secondary outcomes. One donor had a stone-related event upon follow up. A total of 195 patients had eGFR <60 upon follow up. However, they were not significantly different when compared to renal function of live donors that didn't have pre-donation nephrolithiasis. Many of the studies couldn't provide long term follow up, coupled with limited data regarding the nature of the pre-donation stone disease. In conclusion, this systematic review shows that we have very limited information upon which to base recommendation regarding pre-donation risk of post-donation complications. Longer term follow up is required and lifelong follow up with live donor registries will aid further understanding.

既往有肾结石病史的供肾者的临床结果尚不明确。我们进行了一项系统综述,评估有肾结石病史的肾脏捐献者捐献后的临床结果。1960年至2021年间,使用关键术语和医学主题标题(MeSH)搜索了电子数据库(Ovid和Embase)——肾结石、肾结石、肾脏移植和肾移植。文章包括会议记录和期刊文章,未根据患者人数排除在外。主要结果是供体结石相关事件。次要结果是随访后的肾功能或肾切除术后的并发症。总之,通过数据库搜索确定了340篇文章。我们确定了14项研究(16个队列),包括432名活体捐赠者,他们在活体肾脏捐赠后平均随访26个月。6名捐献者捐献了无结石肾,而23名活体捐献者有双侧结石。平均结石大小为4.2±1.4 mm(1-16),平均随访时间为21.1个月(1-149)。12项研究提供了主要结果(n=138名患者),8项研究(n=348)提供了次要结果。一位捐赠者在随访中发生了与结石有关的事件。总共有195名患者具有eGFR<;60。然而,与没有捐赠前肾结石的活体捐赠者的肾功能相比,它们没有显著差异。许多研究无法提供长期随访,加上有关捐赠前结石疾病性质的数据有限。总之,这项系统综述表明,我们对捐赠前和捐赠后并发症风险的建议所依据的信息非常有限。需要进行更长期的随访,与活体捐赠者登记处进行终身随访将有助于进一步了解。
{"title":"Outcomes of live renal donors with a history of nephrolithiasis; A systematic review","authors":"Mohamed Eftal Bin Mohamed Ebrahim ,&nbsp;Animesh Singla ,&nbsp;Jinna Yao ,&nbsp;Jerome Martin Laurence ,&nbsp;Germaine Wong ,&nbsp;Howard Lau ,&nbsp;Taina Lee ,&nbsp;Lawrence Yuen ,&nbsp;Wai H. Lim ,&nbsp;Henry Pleass","doi":"10.1016/j.trre.2022.100746","DOIUrl":"10.1016/j.trre.2022.100746","url":null,"abstract":"<div><p><span><span>The clinical outcomes of kidney donors with a prior history of nephrolithiasis are poorly defined. We conducted a </span>systematic review assessing the post-donation clinical outcomes of kidney donors with a history of nephrolithiasis. Electronic databases </span><strong>(</strong><span>Ovid and Embase) were searched between 1960 and 2021 using key terms and Medical Subject Headings (MeSH) – nephrolithiasis, renal stones, renal transplantation<span> and renal graft<span>. Articles included conference proceedings and journal articles and were not excluded based on patient numbers. Primary outcome was donor stone-related event. Secondary outcomes were renal function upon follow-up or post-operative nephrectomy complications. In summary, 340 articles were identified through database search. We identified 14 studies (16 cohorts) comprising 432 live donors followed up for a median of 26 months post live kidney donation. Six donors donated the stone-free kidney whilst 23 live donors had bilateral stones. Mean stone size was 4.2 ± 1.4 mm (1–16) with average follow up duration of 21.1 months (1–149). Twelve studies provided primary outcome (</span></span></span><em>n</em> = 138 patients) and eight (<em>n</em><span> = 348) for secondary outcomes. One donor had a stone-related event upon follow up. A total of 195 patients had eGFR &lt;60 upon follow up. However, they were not significantly different when compared to renal function of live donors that didn't have pre-donation nephrolithiasis. Many of the studies couldn't provide long term follow up, coupled with limited data regarding the nature of the pre-donation stone disease. In conclusion, this systematic review shows that we have very limited information upon which to base recommendation regarding pre-donation risk of post-donation complications. Longer term follow up is required and lifelong follow up with live donor registries will aid further understanding.</span></p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"37 1","pages":"Article 100746"},"PeriodicalIF":4.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9691004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Best practices during COVID-19 pandemic in solid organ transplant programs in Spain 2019冠状病毒病大流行期间西班牙实体器官移植项目的最佳实践
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.trre.2023.100749
Julio Pascual , Auxiliadora Mazuecos , Gloria Sánchez-Antolín , Amparo Solé , Pedro Ventura-Aguiar , Marta Crespo , Marta Farrero , Constantino Fernández-Rivera , Iris P. Garrido , Francisco Gea , Esther González-Monte , Antonio González-Rodríguez , Román Hernández-Gallego , Carlos Jiménez , Verónica López-Jiménez , Alejandra Otero , Sonia Pascual , Gonzalo P. Rodríguez-Laiz , Juan Carlos Ruiz , Asunción Sancho , Juan F. Delgado

Clinical management of transplant patients abruptly changed during the first months of COVID-19 pandemic (March to May 2020). The new situation led to very significant challenges, such as new forms of relationship between healthcare providers and patients and other professionals, design of protocols to prevent disease transmission and treatment of infected patients, management of waiting lists and of transplant programs during state/city lockdown, relevant reduction of medical training and educational activities, halt or delays of ongoing research, etc.

The two main objectives of the current report are: 1) to promote a project of best practices in transplantation taking advantage of the knowledge and experience acquired by professionals during the evolving situation of the COVID-19 pandemic, both in performing their usual care activity, as well as in the adjustments taken to adapt to the clinical context, and 2) to create a document that collects these best practices, thus allowing the creation of a useful compendium for the exchange of knowledge between different Transplant Units.

The scientific committee and expert panel finally standardized 30 best practices, including for the pretransplant period (n = 9), peritransplant period (n = 7), postransplant period (n = 8) and training and communication (n = 6). Many aspects of hospitals and units networking, telematic approaches, patient care, value-based medicine, hospitalization, and outpatient visit strategies, training for novelties and communication skills were covered.

Massive vaccination has greatly improved the outcomes of the pandemic, with a decrease in severe cases requiring intensive care and a reduction in mortality. However, suboptimal responses to vaccines have been observed in transplant recipients, and health care strategic plans are necessary in these vulnerable populations. The best practices contained in this expert panel report may aid to their broader implementation.

在新冠肺炎大流行的头几个月(2020年3月至5月),移植患者的临床管理突然发生了变化。新情况带来了非常重大的挑战,例如医疗保健提供者与患者和其他专业人员之间的新形式关系,预防疾病传播和治疗感染患者的协议的设计,州/市封锁期间等待名单和移植计划的管理,相关的医疗培训和教育活动的减少,当前报告的两个主要目标是:1)利用专业人员在新冠肺炎大流行的演变过程中获得的知识和经验,促进移植最佳实践项目,包括在进行日常护理活动和调整以适应临床环境方面,以及2)创建一份收集这些最佳实践的文件,从而能够创建一份有用的简编,用于不同移植单位之间的知识交流。科学委员会和专家小组最终标准化了30种最佳实践,包括移植前(n=9)、移植周(n=7)、移植后(n=8)以及培训和沟通(n=6)。涵盖了医院和单位网络、远程信息处理方法、患者护理、基于价值的医疗、住院和门诊就诊策略、创新培训和沟通技能的许多方面。大规模疫苗接种大大改善了疫情的结果,需要重症监护的重症病例减少,死亡率降低。然而,在移植受者中观察到对疫苗的反应不理想,在这些弱势人群中有必要制定医疗保健战略计划。本专家小组报告中所载的最佳做法可能有助于更广泛地实施这些做法。
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引用次数: 0
Technical challenges in LDLT – Overcoming small for size syndrome and venous outflow reconstruction LDLT的技术挑战-克服小尺寸综合征和静脉流出重建
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.trre.2023.100750
Paola A. Vargas , Narmina Khanmammadova , Deniz Balci , Nicolas Goldaracena

Living Donor Liver Transplantation (LDLT) emerged as an alternative treatment option for patients with end-stage liver disease waiting for an organ from a deceased donor. In addition to allowing for a faster access to transplantation, LDLT provides improved recipient outcomes when compared to deceased donor LT. However, it represents a more complex and demanding procedure for the transplant surgeon. In addition to a comprehensive preoperative donor assessment and stringent technical considerations during the donor hepatectomy to ensure upmost donor safety, the recipient procedure also comes with intrinsic challenges during LDLT. A proper approach during both procedures will result in favorable donor and recipient's outcomes. Hence, it is critical for the transplant surgeon to know how to overcome such technical challenges and avoid deleterious complications. One of the most feared complications following LDLT is small-for-size syndrome (SFSS). Although, surgical advances and deeper understanding of the pathophysiology behind SFSS has allowed for a safer implementation of LDLT, there is currently no consensus on the best strategy to prevent or manage this complication. Therefore, we aim to review current practices in technically challenging situations during LDLT, with a particular focus on management of small grafts and venous outflow reconstructions, as they possess one of the biggest technical challenges faced during LDLT.

活体肝移植(LDLT)是等待已故捐赠者器官移植的终末期肝病患者的一种替代治疗选择。与已故供体LT相比,LDLT除了可以更快地进行移植外,还可以改善接受者的预后。然而,它对移植外科医生来说是一种更复杂、要求更高的手术。除了在供体肝切除术中进行全面的术前供体评估和严格的技术考虑以确保最大的供体安全外,受体手术在LDLT过程中也面临着固有的挑战。在这两个过程中,正确的方法将产生有利的捐赠者和接受者的结果。因此,对于移植外科医生来说,了解如何克服这些技术挑战并避免有害并发症是至关重要的。LDLT后最令人担忧的并发症之一是小体型综合征(SFSS)。尽管外科学的进步和对SFSS背后病理生理学的深入理解使LDLT得以更安全地实施,但目前还没有就预防或管理这种并发症的最佳策略达成共识。因此,我们旨在回顾LDLT期间技术挑战性情况下的当前实践,特别关注小型移植物和静脉流出重建的管理,因为它们是LDLT期间面临的最大技术挑战之一。
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引用次数: 1
Use of sodium-glucose co-transporter 2 inhibitors in solid organ transplant recipients with pre-existing type 2 or post-transplantation diabetes mellitus: A systematic review 钠-葡萄糖共转运蛋白2抑制剂在实体器官移植受者已有2型或移植后糖尿病患者中的应用:一项系统综述
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.trre.2022.100729
Yolanda Lin , Merisa Mok , Jennifer Harrison , Marisa Battistella , Ashley Farrell , Marianna Leung , Catherine Cheung
<div><h3>Introduction</h3><p>Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors have demonstrated kidney, cardiovascular and mortality benefits in the general population; however, the evidence is limited in solid organ transplant recipients. The aim of this systematic review was to evaluate the current efficacy and safety data of SGLT2 inhibitors in adult kidney, heart, lung, and liver transplant recipients with pre-existing type 2 or post-transplantation diabetes mellitus.</p></div><div><h3>Method</h3><p><span>We searched MEDLINE, MEDLINE Epub, CENTRAL, CDSR, EMBASE, CINAHL, and sources of unpublished literature. All primary interventional and observational studies on SGLT2 inhibitors in transplant recipients were included. Clinical outcomes included mortality, cardiovascular and kidney events, and adverse events such as graft rejection. Surrogate markers including </span>hemoglobin A1c<span> (HbA1c) and weight reduction were also evaluated.</span></p></div><div><h3>Results</h3><p><span>Of the 17 studies that were included in this systematic review, there were 15 studies on kidney transplant recipients (</span><em>n</em><span> = 2417 patients) and two studies on heart transplant recipients (</span><em>n</em><span> = 122 patients). There was only one randomized controlled trial<span><span><span> which evaluated 49 kidney transplant patients over 24 weeks. Overall, studies were heterogeneous in study design, sample size, duration of diabetes, time to SGLT2 inhibitor initiation post-transplantation (ranging from 0.88 to 11 years post kidney transplant; five to 5.7 years post heart transplant) and follow-up (ranging from 0.4 to 5.25 years in kidney transplant patients; 0.75 to one year in heart transplant patients). Only one retrospective study evaluated mortality as a part of a composite outcome in kidney transplant patients; however, study limitations restrict generalizability of results. Overall, studies could not confirm clinical cardiovascular and kidney benefits in the transplant population. Findings suggested that SGLT2 inhibitors may improve glycemic control; however, they are associated with urinary tract infection. </span>Diabetic ketoacidosis and </span>acute kidney injury<span><span> also occurred in these studies, with precipitating factors such as infection and </span>acute heart failure exacerbation.</span></span></span></p></div><div><h3>Conclusions</h3><p>While SGLT2 inhibitors are promising agents with expanding indications in the non-transplant population, these agents may not be suitable for all solid organ transplant recipients, and close monitoring (e.g. for urinary tract infections) and patient education (e.g. sick day management) are essential if these agents are initiated. Evidence is based on short-term findings and suggests an association with hemoglobin A1c reduction and increased adverse events. Further long-term randomized controlled trials are needed to evaluate the effect of SGLT2 inhibitors on clinically important ou
引言钠-葡萄糖共转运蛋白2(SGLT2)抑制剂已在普通人群中证明对肾脏、心血管和死亡率有益处;然而,实体器官移植受者的证据有限。本系统综述的目的是评估SGLT2抑制剂在已有2型或移植后糖尿病的成年肾、心、肺和肝移植受者中的当前疗效和安全性数据。方法检索MEDLINE、MEDLINE-Epub、CENTRAL、CDSR、EMBASE、CINAHL及未发表文献。纳入了所有关于移植受者SGLT2抑制剂的主要介入和观察研究。临床结果包括死亡率、心血管和肾脏事件以及移植物排斥反应等不良事件。还评估了包括血红蛋白A1c(HbA1c)和体重减轻在内的替代标记物。结果在纳入本系统综述的17项研究中,有15项关于肾移植受者的研究(n=2417名患者)和2项关于心脏移植受者(n=122名患者)。只有一项随机对照试验在24周内评估了49名肾移植患者。总体而言,研究在研究设计、样本量、糖尿病持续时间、移植后SGLT2抑制剂启动时间(肾移植后0.88至11年;心脏移植后5至5.7年)和随访(肾移植患者0.4至5.25年,心脏移植患者0.75至1年)方面存在异质性。只有一项回顾性研究将死亡率作为肾移植患者综合结果的一部分进行了评估;然而,研究的局限性限制了结果的可推广性。总体而言,研究无法证实移植人群对心血管和肾脏的临床益处。研究结果表明,SGLT2抑制剂可能改善血糖控制;然而,它们与尿路感染有关。在这些研究中也发生了糖尿病酮症酸中毒和急性肾损伤,并伴有感染和急性心力衰竭恶化等诱因。结论虽然SGLT2抑制剂在非移植人群中是一种有前景的药物,适应症不断扩大,但这些药物可能不适用于所有实体器官移植受者,如果开始使用这些药物,密切监测(如尿路感染)和患者教育(如病假管理)至关重要。证据基于短期发现,表明与血红蛋白A1c降低和不良事件增加有关。需要进一步的长期随机对照试验来评估SGLT2抑制剂对实体器官移植受者临床重要结果的影响,包括降低死亡率。
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引用次数: 3
Alloimmune risk assessment for antibody-mediated rejection in kidney transplantation: A practical proposal 肾移植中抗体介导的排斥反应的同种免疫风险评估:一个实用的建议
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.trre.2022.100745
Laura Llinàs-Mallol , Dàlia Raïch-Regué , Julio Pascual , Marta Crespo

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Although an improvement in graft survival has been observed in the last decades with the use of different immunosuppressive drugs, this is still limited in time with antibody-mediated rejection being a main cause of graft-loss. Immune monitoring and risk assessment of antibody-mediated rejection before and after kidney transplantation with useful biomarkers is key to tailoring treatments to achieve the best outcomes. Here, we provide a review of the rationale and several accessible tools for immune monitoring, from the most classic to the modern ones. Finally, we end up discussing a practical proposal for alloimmune risk assessment in kidney transplantation, including histocompatibility leukocyte antigen (HLA) and non-HLA antibodies, HLA molecular mismatch analysis and characterization of peripheral blood immune cells.

肾移植是终末期肾病患者的首选治疗方法。尽管在过去几十年中,通过使用不同的免疫抑制药物已经观察到移植物存活率的提高,但这在时间上仍然是有限的,因为抗体介导的排斥反应是移植物丢失的主要原因。使用有用的生物标志物对肾移植前后抗体介导的排斥反应进行免疫监测和风险评估是定制治疗以获得最佳结果的关键。在这里,我们回顾了免疫监测的基本原理和几种可用的工具,从最经典的到现代的。最后,我们讨论了肾移植中同种免疫风险评估的实用建议,包括组织相容性白细胞抗原(HLA)和非HLA抗体、HLA分子错配分析和外周血免疫细胞的特征。
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引用次数: 0
Cannabinoids and solid organ transplantation: Psychiatric perspectives and recommendations 大麻素和实体器官移植:精神病学观点和建议
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2022-12-01 DOI: 10.1016/j.trre.2022.100715
Gerald Scott Winder , Sarah R. Andrews , Arpita Goswami Banerjee , Filza Hussain , Ana Ivkovic , Kristin Kuntz , Lesley Omary , Akhil Shenoy , Thida Thant , Amy VandenBerg , Paula Zimbrean

Cannabinoid use in patients seeking solid organ transplantation (SOT) is an important and unsettled matter which all transplantation clinicians regularly encounter. It is also a multifaceted, interprofessional issue, difficult for any specialty alone to adequately address in a research article or during clinical care. Such uncertainty lends itself to bias for or against cannabinoid use accompanied by inconsistent policies and procedures. Scientific literature in SOT regarding cannabinoids often narrowly examines the issue and exists mostly in liver and kidney transplantation. Published recommendations from professional societies are mosaics of vagueness and specificity mirroring the ongoing dilemma. The cannabinoid information SOT clinicians need for clinical care may require data and perspectives from diverse medical literature which are rarely synthesized. SOT teams may not be adequately staffed or trained to address various neuropsychiatric cannabinoid effects and risks in patients. In this article, authors from US transplantation centers conduct a systematized review of the few existing studies regarding clinician perceptions, use rates, and clinical impact of cannabinoid use in SOT patients; collate representative professional society guidance on the topic; draw from diverse medical literature bases to detail facets of cannabinoid use in psychiatry and addiction pertinent to all transplantation clinicians; provide basic clinical and policy recommendations; and indicate areas of future study.

大麻素在寻求实体器官移植(SOT)患者中的使用是所有移植临床医生经常遇到的重要和未解决的问题。这也是一个多方面的、跨专业的问题,任何专业都难以单独在研究文章或临床护理中充分解决。这种不确定性导致支持或反对大麻素使用的偏见,同时伴随着不一致的政策和程序。关于大麻素的SOT科学文献通常只对这个问题进行了狭隘的研究,并且主要存在于肝和肾移植中。专业协会发表的建议是模糊和特异性的马赛克,反映了目前的困境。SOT临床医生需要临床护理的大麻素信息可能需要来自不同医学文献的数据和观点,这些文献很少被合成。SOT团队可能没有足够的人员或培训来解决各种神经精神大麻素对患者的影响和风险。在这篇文章中,来自美国移植中心的作者对少数现有的关于SOT患者使用大麻素的临床医生看法、使用率和临床影响的研究进行了系统的回顾;整理有代表性的专业学会对课题的指导意见;从不同的医学文献基础,以详细方面大麻素在精神病学和成瘾相关的所有移植临床医生;提供基本的临床和政策建议;并指出未来研究的领域。
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引用次数: 2
The art of interprofessional psychosocial communication: Optimizing patient interfaces with psychiatric specialists in liver transplantation 跨专业社会心理沟通的艺术:优化患者与肝移植精神病专家的界面
IF 4 2区 医学 Q2 IMMUNOLOGY Pub Date : 2022-12-01 DOI: 10.1016/j.trre.2022.100728
Gerald Scott Winder , Erin G. Clifton , Ponni Perumalswami , Jessica L. Mellinger

Psychiatric and substance use disorders (SUD) commonly cause and contribute to advanced liver diseases and psychosocial phenomena remain some of the most challenging matters that liver transplantation (LT) teams encounter. Patients are often most focused on biomedical aspects of their treatment and LT course rather than subtler psychosocial factors which must be addressed alongside medical and surgical problems. This means that patients may not accept teams' recommendations for psychiatric and SUD treatment despite their primary role in treating liver disease and promoting successful LT. Alcohol-related liver disease is the archetype of these challenges. A crucial, actionable, and rarely discussed factor in creating a therapeutic interface between liver patients and psychiatric and SUD specialists is medical and surgical clinicians' interprofessional psychosocial communication (IPC; i.e., a clinician's personal ability to communicate effectively with patients about psychiatric and substance-related matters). In this article, we describe three crucial IPC timepoints during a typical ALD transplantation timeline, briefly review and synthesize diverse literature and perspectives into an overview of potential IPC pitfalls, propose practical IPC strategies for institutions and clinicians, and indicate future areas of study.

精神和物质使用障碍(SUD)通常导致并促成晚期肝脏疾病和社会心理现象,仍然是肝移植(LT)团队遇到的一些最具挑战性的问题。患者通常最关注其治疗和LT过程的生物医学方面,而不是必须与医疗和手术问题一起解决的更微妙的社会心理因素。这意味着患者可能不接受团队对精神病学和SUD治疗的建议,尽管它们在治疗肝病和促进lt成功方面起着主要作用。酒精相关肝病是这些挑战的原型。在肝病患者与精神病学和SUD专家之间建立治疗界面的一个关键、可操作但很少被讨论的因素是内科和外科医生的跨专业心理社会沟通(IPC;例如,临床医生与患者就精神病学和药物相关问题进行有效沟通的个人能力)。在本文中,我们描述了典型ALD移植时间表中的三个关键IPC时间点,简要回顾并综合了各种文献和观点,概述了潜在的IPC陷阱,为机构和临床医生提出了实用的IPC策略,并指出了未来的研究领域。
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引用次数: 1
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Transplantation Reviews
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