Annals of Transplantation最新文献

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.

BACKGROUND Multidrug-resistant bacterial (MDRB) infections are a major complication after liver transplantation, contributing to increased morbidity, prolonged hospitalization, and reduced survival. Immunosuppression, invasive procedures, and prolonged intensive care stay are known to increase susceptibility to MDRB. However, specific clinical risk factors in post-transplant patients remain incompletely understood. This study aimed to identify risk factors for MDRB infections following liver transplantation. MATERIAL AND METHODS We retrospectively analyzed data on 350 patients who underwent liver transplantation at our hospital between January 2019 and March 2023. Patients were divided into a non-MDRB infection group (300 cases) and an MDRB infection group (50 cases). Clinical parameters were compared between groups. Multivariate logistic regression was used to identify independent risk factors for MDRB infection. RESULTS The 1-year survival rate was significantly lower in the MDRB group compared to the non-MDRB group (72.0% vs 87.7%, P<0.001). Univariate analysis identified 6 potential risk factors: tracheal intubation ≥48 h post-transplant, reoperation, tacrolimus (Tac) blood concentration, hospital stay ≥30 days, Child-Pugh classification, and intensive care unit stay ≥72 h (all P<0.05). Multivariate analysis showed that tracheal intubation ≥48 h (OR=2.714, 95% CI: 1.821-4.260, P=0.015), reoperation (OR=2.681, 95% CI: 2.015-5.402, P=0.001), and peak Tac blood concentration (OR=2.612, 95% CI: 1.405-4.710, P=0.007) were independent risk factors. CONCLUSIONS Prolonged tracheal intubation, reoperation, and elevated Tac blood concentration are key risk factors for MDRB infections after liver transplantation. Early identification and management of these factors may reduce MDRB incidence and improve patient outcomes.

BACKGROUND Post-transplant outcomes were analyzed in adult patients with primary extrahepatic malignancies (EHM) who underwent living donor liver transplantation (LDLT). Few studies to date have analyzed post-transplant outcomes in adult patients with primary extrahepatic malignancies (EHM) who underwent LDLT. MATERIAL AND METHODS The study cohort included 109 patients who were treated for EHM more than 6 months before LDLT between January 2000 and December 2022. The clinicopathological characteristics of EHMs and outcomes of LDLT, including EHM recurrence and patient survival, were analyzed. RESULTS The most common primary EHM was stomach cancer (27.5%), followed by thyroid (11.0%), breast (11.0%), colorectal (10.1%), and kidney (10.1%) cancer. The mean and median intervals between final EHM treatment and LT were 84.9±78.0 months and 27 months (range: 6-336 months), respectively. During mean follow-up period of 84.9±78.0 months, 15 patients died. The 1-, 5-, 10-, and 20-year patient survival rates were 96.3%, 88.5%, 85.0%, and 70.8%, respectively. Five patients (4.6%) experienced post-transplant EHM recurrence, with 4 dying due to sepsis during EHM treatment (n=2), progression of EHM recurrence (n=1), and pneumonia (n=1). The mean and median intervals between LT and recurrence of pretransplant EHM were 71.6±82.8 months and 25 months (range: 19-213 months), respectively. The cumulative 1-, 5-, 10-, and 20-year EHM recurrence rates were 0%, 3.1%, 4.6%, and 18.3%, respectively. CONCLUSIONS Patients with previously treated EHMs may be considered for LDLT following careful multidisciplinary evaluation and implementation of individualized post-transplant surveillance strategies.

BACKGROUND Patients with chronic kidney disease (CKD) have a markedly increased cardiovascular risk, largely due to persistent endothelial dysfunction (ED). Kidney transplantation improves cardiovascular status, but whether transplant type-living donor (LDT) or cadaver donor transplantation (CDT)-differentially affects coronary endothelial function remains unclear. MATERIAL AND METHODS In this prospective observational study, 75 kidney transplant recipients (LDT: n=50; CDT: n=25) and 25 healthy controls (HC) underwent CFVR measurement at baseline (CFVR-1) and 6 months post-transplantation (CFVR-2). Left ventricular ejection fraction (LV-EF), diameters, and NT-proBNP were also assessed. Group comparisons and pre-/post-transplant changes were analyzed. RESULTS Baseline CFVR was higher in HC than in transplant groups (p0.05), but CFVR-1 0.05). A ≥10% EF increase occurred in 36% of patients in each group. CONCLUSIONS Kidney transplantation improves coronary endothelial function and cardiac performance regardless of donor type, though severe baseline CFVR impairment is more common in cadaveric recipients.