Annals of Transplantation最新文献

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.

BACKGROUND Transplantation using kidneys from older donors or those with specific risk factors (marginal kidneys) offers improved outcomes compared to remaining on dialysis. Matched-pair analysis potentiates control for confounding donor factors and the impact of recipient characteristics on transplant survival. MATERIAL AND METHODS Data from 200 transplants using marginal deceased donors were retrospectively analyzed. Paired comparisons between mate kidney recipients, McNemar's test, and multivariable Cox regression were performed to identify recipient factors and histological features from zero-time biopsy associated with graft survival. RESULTS Graft survival was significantly longer in recipients with shorter pre-transplant dialysis exposure (mean 58.10 vs 68.86 months, P=0.001) and fewer HLA mismatches (3.40 vs 3.78, P=0.013). Severe acute tubular injury (ATI) in pre-implantation biopsy was associated with reduced graft survival (P=0.04). In multivariable Cox regression, the presence of severe ATI (P<0.001), older recipient age (HR=0.1 per year, P=0.002), HLA mismatches (HR=1.21, P=0.011), and elevated 1-year serum creatinine level (HR=0.72, P=0.030) remained independently associated with shorter graft survival. CONCLUSIONS Matched-pair analysis and multivariable modelling identified recipient dialysis duration, age, HLA mismatches,1-year serum creatinine, and pre-transplant biopsy findings, particularly severe ATI, as key predictors of graft survival in marginal kidney transplantation. These insights may support improved recipient selection and post-transplant management of marginal-donor kidneys.

BACKGROUND Among the limited analgesic options, plane blocks are of great importance in providing effective postoperative analgesia to donors and recipients in renal transplantation surgery. We aimed to demonstrate that anterior type quadratus lumborum plane block provides better analgesia than intravenous paracetamol in open and closed nephrectomy patients. MATERIAL AND METHODS We conducted a prospective cohort study. Renal recipients and donors were divided into 2 groups. One group received anterior quadratus lumborum plane block and the other group received intravenous paracetamol. Pain levels and total tramadol consumption at 1, 2, 6, 12, and 24 hours postoperatively were recorded as primary data. RESULTS Demographic data of donors and recipients were similar between the QLB and IVA groups, and there was no significant difference in the time spent for surgery, anesthesia, or hospitalization. In renal donors, we found that total tramadol consumption and pain scores of the quadratus lumborum block group were significantly lower than in the intravenous analgesia group (P<0.001). In renal recipients, we found that postoperative tramadol consumption and pain levels of the quadratus lumborum block group were significantly lower than in the intravenous analgesia group (P<0.001). Additionally, the duration of rescue analgesic requirement was significantly shorter in renal recipients and donors who underwent quadratus lumborum plane block compared to the intravenous analgesic group (P<0.001). CONCLUSIONS The anterior type quadratus lumborum plane block provides effective analgesia to recipients and donors in renal transplantation surgery and reduces postoperative opioid consumption.

BACKGROUND New-onset diabetes after transplantation (NODAT) is a common complication following liver transplantation, with serious patient and graft outcomes. The recent advances in transplant techniques and management have improved patient survival and consequently led to an increase in NODAT. Therefore, this study aimed to evaluate the current trends in the incidence, risk factors, and impact of NODAT on outcomes using a large national-level database. MATERIAL AND METHODS Adult liver transplant recipients who underwent the procedure between 2013 and 2022 were identified from the Scientific Registry of Transplant Recipients database. NODAT was defined as diabetes newly diagnosed after transplantation. Logistic regression was used to identify risk factors. Kaplan-Meier analysis and Cox regression analysis were performed to assess the impact of NODAT on patient and graft survival. RESULTS Among 39 828 recipients who met the study criteria, 2973 (7.5%) developed NODAT. Independent risk factors for NODAT included recipient age >50 years, male sex, BMI >25 kg/m², cytomegalovirus infection, steroid and tacrolimus use at discharge, deceased donor, longer warm ischemia time, and donor diabetes history. NODAT was associated with decreased graft survival (HR=1.28, 95% CI=1.10-1.48, P<0.001) but not patient survival. Moreover, the recipients who developed NODAT had higher rates of graft failure due to vascular thrombosis. CONCLUSIONS NODAT affects 7.5% of liver transplant recipients and is associated with decreased graft survival. Identifying high-risk patients and optimizing modifiable risk factors may help improve outcomes.