Annals of Transplantation最新文献

BACKGROUND Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver tumor with poor prognosis. This retrospective study aimed to evaluate the outcomes and prognostic factors of 40 patients who underwent liver transplantation (LT) for cHCC-CC using data from the Korean Organ Transplant Registry (KOTRY). MATERIAL AND METHODS A cohort of 40 LT recipients diagnosed with cHCC-CC was selected from the KOTRY database between 2014 and 2019. Survival analyses were performed according to key clinicopathological variables, and risk factor analyses were conducted for overall survival (OS) and recurrence-free survival (RFS). RESULTS During a median follow-up of 21.4 months, 10 patients (25.0%) died and 9 patients (22.5%) experienced tumor recurrence. The 1-, 2-, and 3-year OS rates were 91.8%, 76.2%, and 59.3%, respectively, and the corresponding RFS rates were 88.8%, 70.5%, and 50.2%. Patients with a MELD score <20 (P=0.017) and a single tumor <3 cm (P=0.046) showed significantly better OS. On multivariate analysis, MELD score ≥20 (P=0.04), perineural invasion (P=0.04), and portal vein tumor thrombosis (P=0.005) were independent risk factors for poor OS, whereas microvascular invasion (P=0.01) was an independent risk factor for poor RFS. CONCLUSIONS LT can be a feasible treatment option for patients with early-stage cHCC-CC, providing favorable long-term survival. As most prognostic factors identified were pathology-related, further studies are needed to refine the selection criteria for LT candidates in this population.

BACKGROUND Advancements in transplant immunology and pharmacotherapy have led to improved outcomes in pediatric ABO-incompatible liver transplantation. However, the long-term dynamics of donor-specific versus non-donor-specific blood group antibodies (BGAs) in this population remain unclear. This study aimed to determine whether incomplete immune tolerance to donor-specific BGAs persists after ABO-incompatible liver transplantation. MATERIAL AND METHODS This retrospective study included 29 pediatric patients who underwent ABO-incompatible living donor liver transplantation with extended follow-up. Five of these patients exhibited persistent donor-specific BGA titers greater than 1: 64 (IgG or IgM) and received standardized preoperative immunosuppression; all 29 patients received intraoperative and postoperative immunosuppression. Demographic data, pre- and post-transplant BGA titers, and histopathological findings from liver biopsies were collected and analyzed. RESULTS All recipients were blood type O; 10 received grafts from blood type A donors, whereas 19 received grafts from blood type B donors. Donor-specific BGA titers (both IgG and IgM) remained persistently low and were significantly lower than non-donor-specific BGAs (P<0.001). Liver biopsy findings revealed mild to moderate antibody-mediated rejection in 5 patients. All patients achieved long-term survival. CONCLUSIONS The persistently low titers of donor-specific BGAs in pediatric ABO-incompatible living donor liver transplantation recipients may indicate a state of incomplete immune tolerance, possibly influenced by the developmental characteristics of the pediatric immune system and preconditioning with monoclonal antibodies. Further studies are warranted to confirm these findings and clarify the mechanisms underlying immune tolerance in this setting.

BACKGROUND Portal hypertension (PH) in end-stage liver disease remains a critical challenge, with traditional liver transplantation (LT) requiring a strict graft size criterion: graft-to-recipient weight ratio (GRWR) ³0.8%. Using small-for-size graft (SFSG) in auxiliary liver transplantation (ALT) as a "functional shunt" may offer a novel approach by retaining part of the native liver to buffer PH. MATERIAL AND METHODS A retrospective analysis was performed on 6 PH patients who underwent functional shunt with SFSG in ALT at Beijing Friendship Hospital from 2014 to 2018. Intraoperative parameters and postoperative monitoring data were collected to analyze the hepatic hemodynamic alterations. We performed descriptive analyses on relevant indicators to summarize hepatic hemodynamic changes and clinical outcomes after functional shunt. RESULTS No patients developed SFSS after functional shunt. Following the functional shunt procedure, the portal vein (PV) blood flow of the remnant native liver gradually declined to no perfusion, while hepatic artery flow velocity increased as part of a compensatory arterial buffer response. The PV blood flow of the graft increased gradually during the early postoperative period, but declined between day 5 to 10 after surgery, due to rising portal perfusion resistance. A subsequent increase was observed around day 10, and reached its peak approximately 1month after surgery, followed by a gradual decline toward stabilization. Abdominal drainage volume peaked between day 5 to 10 after surgery, and then decreased slowly, resolving around 1 month after functional shunt. CONCLUSIONS Functional shunt with SFSG in ALT appears to be promising and safe, and may expand the donor pool for PH patients who would otherwise be excluded from transplantation due to graft size criteria.

BACKGROUND Electrocardiography can predict development of postoperative atrial fibrillation (POAF). In renal transplant (RT) recipients, atrial fibrillation is associated with an increased risk of mortality, allograft failure, and stroke. Our study investigated whether P-wave dispersion (PWD) and P-wave peak time (PWPT) can predict the development of POAF in renal transplant recipients. MATERIAL AND METHODS We included 166 patients who underwent RT, divided into 2 groups based on the presence (POAF +) or absence (POAF -) of POAF. Preoperative PWD and PWPT were measured for each patient. RESULTS Smoking, hypertension (HT), chronic obstructive pulmonary disease, and coronary artery disease (CAD) were significantly more common in the POAF (+) group compared to the POAF (-) group. PreopPWD, PWPTDII, and PWPTV1 were significantly higher in the POAF (+) group compared to the POAF (-) group. Univariable logistic regression analysis showed that hypertension, chronic obstructive pulmonary disease, coronary artery disease, and electrocardiographic parameters, including preopPWD, PWPTDII, and PWPTV1, were significantly associated with POAF. Penalized regression analysis showed that HT, CAD, and preoperative PWD were independent predictors of POAF. CONCLUSIONS The integration of these non-invasive, cost-efficient, and readily accessible electrocardiographic parameters into preoperative evaluation protocols could substantially augment risk stratification paradigms, thereby facilitating the timely identification and preemptive management of patients predisposed to POAF.

BACKGROUND Allogeneic hematopoietic stem cell transplantation (HSCT) from haploidentical donors is a well-established treatment for patients without related or matched unrelated donors. Peripheral blood stem cells are preferred over bone marrow stem cells because of easier collection, faster engraftment, lower relapse rates, and improved progression-free survival, despite higher rates of graft-versus-host disease (GVHD). Previous studies have primarily compared granulocyte colony-stimulating factor (G-CSF)-primed peripheral blood stem cells with steady-state bone marrow grafts, rather than G-CSF-primed bone marrow grafts. MATERIAL AND METHODS This ambispective study included a retrospective analysis conducted at the University Hospital Centre Zagreb, Croatia, involving 61 patients who underwent bone marrow HSCT from haploidentical donors. Hospital records were reviewed to collect donor and recipient demographics, transplant details, and outcomes. Participants were consenting adults who received bone marrow transplantation from haploidentical donors. The prospective dataset comprised information regarding graft composition and collection times from 17 G-CSF-primed donors and 9 non-primed donors (controls). RESULTS G-CSF priming improved bone marrow collection efficiency and altered graft composition, increasing regulatory T-cell and dendritic cell content in accordance with a tolerogenic immune profile. These findings suggest a mechanism for reducing GVHD risk while maintaining engraftment efficacy. CONCLUSIONS G-CSF priming may enhance bone marrow collection efficiency and modify graft composition to reduce GVHD risk. The retrospective design and absence of a control group limit causal inference. Future studies should prospectively investigate the relationship between these immunological changes and clinical outcomes, refine priming regimens, and evaluate applicability according to donor type and conditioning protocol.

BACKGROUND Coronary vasculopathy is one of the most serious late complications after heart transplantation (Htx). The aim of this study was to assess the utility and safety of the invasive assessment of coronary physiology and investigate the occurrence of coronary microvascular dysfunction (CMD) and its association with clinical characteristics of recipients and donors. MATERIAL AND METHODS Coronary microcirculation was assessed during routine coronary angiography, performed prospectively between December 1, 2020, and July 24, 2023, by using index of microcirculatory resistance (IMR) and coronary flow reserve (CFR). Values of IMR ³25 or CFR <2.0 confirmed CMD. RESULTS Thirty-three patients aged 49±14 years were included; 21 (64%) were men. CMD was found in 8 (24%) patients. There were no complications, and examination was performed in all patients. The median values for IMR and CFR were 13 [IQR: 10-20] and 3.6 [IQR: 2.2-4.9], respectively. CMD was more common in younger patients: 40±16 vs 51±13 years (P=0.045), and those with lower BMI: 22±4 vs 26±4 kg/m² (P=0.016). Patients with CMD were more likely to require pacemaker implantation, with 3 (38%) vs 1 (4%) in the post-transplant period (P=0.012). The median time since Htx was 2 [IQR: 2-10] years and was higher in the CMD group: 9.5 [IQR: 6-16] vs 2 [IQR: 1-8] years, (P=0.042). There were no significant differences in other recipient and donor characteristics. CONCLUSIONS Invasive assessment of coronary physiology was safe and effective and diagnosed CMD in nearly one-fourth of heart transplant recipients. CMD is related to age, time since transplantation, and chronotropic graft dysfunction.

BACKGROUND Diabetes mellitus after kidney transplantation (post-transplant diabetes mellitus PTDM) is a commonly observed metabolic complication. Its incidence ranges from 4% to 25%. The aim of this study was to analyze potential risk factors associated with PTDM in kidney transplant recipients. Additionally, the study focused on determining differences between older and younger patients with PTDM. MATERIAL AND METHODS In this retrospective study, we screened 375 patients who received a kidney transplant between January 2021 and February 2024. PTDM was defined based on the 2013 International Consensus Meeting on Post-transplant Diabetes Mellitus. Kidney transplant recipients who developed PTDM were compared with patients without PTDM, and then patients with PTDM were divided into 2 subgroups based on age (≥60 years, and <60 years), and compared. RESULTS The data of 218 kidney transplant recipients were analyzed. Of those, 55 patients (25%) developed PTDM. Age (p<0.001), elevated body mass index (p<0.001), hypomagnesemia (p<0.013), hypertriglyceridemia (p<0.001), and hypercholesterolemia (p<0.001) were significant risk factors for PTDM occurrence. A comparison between older and younger patients with PTDM did not reveal significant differences in terms of BMI, hypomagnesemia, hypertriglyceridemia, and hypercholesterolemia. CONCLUSIONS PTDM is a common complication after kidney transplantation. Older age showed the strongest association with PTDM. Patients who are at high risk should be carefully monitored and treated aggressively if the diabetes develops. More research comparing older and younger patients with PTDM is needed so that a better and more individualized approaches can be implemented.

BACKGROUND Organ transplant patients take immunosuppressants to prevent transplant rejection. These substances, including cyclosporine, tacrolimus (TAC), sirolimus, and mycophenolate mofetil (MMF), can cause a variety of adverse reactions such as systemic infections, neoplastic lesions, and agranulocytosis, while the oral cavity can present with aphthous ulcers, leucoplakia, glossitis, erosions and ulcers, exophytic lesions in the oral mucosa, gingival hypertrophy, and mucosal hyperplasia. The most commonly used immunosuppressant in liver transplant (LTx) recipients is tacrolimus (TAC). Improvements in surgical techniques and the use of modern immunosuppressants have increased the long-term survival of transplant recipients, but they are still at high risk of oral lesions. CASE REPORT In the 2 liver transplant recipient patients described in this article, TAC caused necrotic and ulcerative lesions in the oral mucosa. Both patients presented similar lesions. After exclusion of other etiological factors of the lesions and the modification of immunosuppressive therapy, the lesions healed in 3-4 weeks. CONCLUSIONS Tacrolimus-induced necrotic oral ulcers are a rare adverse reaction and should be considered in the differential diagnosis for organ transplant patients with mucositis who are receiving tacrolimus therapy. Lesions of this nature occurred in both patients reported. After tacrolimus was discontinued, there was complete healing of the lesions in 3-4 weeks. Therefore, modification of the immunosuppressants used should be considered once other possible etiological factors for the lesions have been excluded. The lesions should be differentiated from mucosal injuries, blistering skin diseases, autoimmune and proliferative diseases, and hematological abnormalities. The mechanism for the development of ulcer-like lesions in the oral mucosa during therapy with tacrolimus is not known.

BACKGROUND Induction immunosuppressive therapy is essential to prevent early acute rejection in kidney transplantation. While basiliximab is typically used in low-immunological-risk patients, low-dose rabbit anti-thymocyte globulin (r-ATG) may offer comparable efficacy with potentially higher infection risk. Evidence comparing both strategies in living-donor transplantation remains limited. MATERIAL AND METHODS This retrospective cohort study included 150 adult patients undergoing their first kidney transplant from living donors at the 108 Military Central Hospital (Vietnam) between January 2022 and January 2025. All recipients were classified as low immunologic risk and received either low-dose r-ATG (4 mg/kg, n=37) or basiliximab (n=113) as induction therapy. Outcomes evaluated included graft and patient survival, biopsy-proven acute rejection (BPAR), renal function (eGFR), and post-transplant infection rates. Multivariable Cox regression was used to identify predictors of rejection. RESULTS The median follow-up duration was 26.65 months. Both groups had 100% patient survival during the follow-up period. Graft failure occurred in 2.7% (r-ATG) and 1.77% (basiliximab) of recipients. BPAR rates were 10.81% and 13.27% in the r-ATG and basiliximab groups, respectively. No significant differences in eGFR or infection rates (CMV, BK virus, bacterial/fungal infections) were observed. HLA mismatch was the only significant predictor of rejection (Class I HR: 3.06; Class II HR: 5.59). CONCLUSIONS In low-risk living-donor kidney transplantation, low-dose r-ATG provides efficacy and safety comparable to basiliximab in terms of graft survival, rejection, and infection rates. These findings support the use of individualized induction strategies, with low-dose r-ATG being a viable alternative to basiliximab in selected patients.

BACKGROUND Combined hepatocellular carcinoma-cholangiocarcinoma (CHC), a rare disease, is usually an incidental diagnosis after liver transplantation (LT). In this study, we investigated the long-term post-transplant outcomes of CHC patients. MATERIAL AND METHODS From 2000 to 2022, 60 CHC patients were identified from a single-center database containing 6985 adult LT cases. RESULTS The incidence of CHC in adult LT patients was 0.9%. All CHC cases, except 1, were diagnosed incidentally in explanted livers. The mean CHC tumor diameter was 2.5±1.7 cm, and 51 recipients (85.0%) had a single tumor. Viable hepatocellular carcinoma (HCC) co-existed CHC in 23 patients (38.3%). The 5-year all-type tumor recurrence (TR) and overall survival (OS) rates were 37.9% and 57.7%, respectively. The presence of concurrent HCC did not affect all-type TR (p=0.228) or OS (p=0.083). The tumor stage of CHC was a significant prognostic factor for TR (p=0.017) and OS (p=0.038). In 37 patients with CHC alone, TR occurred in 13 (35.1%). In 23 patients with concurrent HCC, all-type TR occurred in 11 cases (47.8%). The 5-year TR and OS rates for 17 patients with very early-stage CHC without concurrent HCC were 17.6% and 82.4%, respectively. CONCLUSIONS CHC is a rare diagnosis following LT, and 38.3% of patients in this study had concurrent HCC. The post-transplant prognosis of CHC was unfavorable, except for patients with very early-stage CHC. Given that the majority of recurrences occur within the first 5 years after transplantation, intensive surveillance is crucial during this high-risk period. Patients with very early-stage CHC may be appropriate candidates for LT.