Annals of Transplantation最新文献

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.

BACKGROUND The recurrence of IgA nephropathy (IgAN) after kidney transplantation (KT) varies between 9% and 51%. Our analysis aimed to identify risk and protective HLA alleles for the development of IgAN and its recurrence after KT. MATERIAL AND METHODS This retrospective single-center analysis included all patients after KT. Patients underwent HLA typing prior to being listed on the waiting list for KT. Comparisons were performed with a cohort of 10 000 healthy donors from the Eurotransplant registry. RESULTS A total of 470 patients were included. Biopsy-proven IgAN, as the underlying cause of renal failure, was found in 7.2% (n=48), of whom 77% were male (n=37). The DRB1*11 allele was present in 47.92% and was identified as a significant risk factor for IgAN (OR 2.09, P=0.0048). The DRB1*03 allele was detected in 4.17%, and we identified it as potentially protective (OR 0.2, P=0.5472). Recurrence of IgAN was detected in 20.8%, 100% of whom were male. The mean time to confirm recurrence was 56.1 months. We identified the DRB1*11 risk allele in 77.8% of patients with confirmed recurrence but did not identify it as an independent risk factor (HR 2.3967; P=0.3956). We found a significant correlation of IgAN recurrence with the development of DSA after KT (r 0.3980, P=0.0218). CONCLUSIONS Our study identified a 20.8% incidence of IgAN recurrence after KT; 77.8% of these patients had the HLA-DRB1*11 allele, which we also identified as a risk allele for the development of IgAN in native kidneys. De novo DSA after KT was correlated with IgAN recurrence.

BACKGROUND Portal vein stenosis (PVS) is a prevalent complication following pediatric liver transplantation (pLT) and significantly impacts long-term graft outcomes. This study assessed the efficacy and safety of balloon angioplasty and stent placement, calculated rates of restenosis or reintervention, and determined optimal interventional strategies for managing PVS following pLT. MATERIAL AND METHODS We retrospectively analyzed 884 pLT recipients at our institution. PVS occurred in 67 patients; 64 successfully underwent interventional procedures. We comparatively analyzed patients who achieved satisfactory results following initial balloon angioplasty with those who required subsequent interventions. Factors, including history of portal vein bridging and donor-recipient portal vein discrepancy rate, were analyzed. Significant factors were used to develop a logistic regression-based risk prediction model. Kaplan-Meier curves estimated patient and graft survival rates. RESULTS Fifty-two patients (81.25%) demonstrated satisfactory recovery following initial balloon angioplasty among the 64 pLT recipients with PVS. Twelve patients had restenosis; 10 underwent subsequent interventions with successful outcomes. A comparative analysis between the initial balloon angioplasty success group and the reintervention group showed significant differences between the groups with respect to portal vein bridging history and portal vein discrepancy rate (P<0.05). A logistic regression-based prediction model for restenosis was established. Kaplan-Meier survival analysis indicated an overall patient survival rate of 98.5% and a graft survival rate of 92.5% during the study period. CONCLUSIONS Patients with portal vein bridging history or poor donor-recipient PV matching are more prone to restenosis after initial balloon angioplasty. For such cases, we recommend direct stent placement as the initial treatment strategy.

BACKGROUND Chronotropic incompetence often prolongs dobutamine stress echocardiography (DSE) and provokes adverse events in liver-transplant (LT) candidates. We evaluated whether administering atropine 1 stage earlier than conventionally recommended improves test efficiency and tolerability. MATERIAL AND METHODS In this retrospective single-center study, 69 end-stage liver disease patients were assigned to 3 cohorts according to the protocol used: Group 1 - high-dose dobutamine alone (n=24); Group 2 - "late" atropine (1 mg at 40 µg/kg/min; n=22); Group 3 - "early" atropine (at 30 µg/kg/min; n=23). Primary endpoints were target heart rate (HR) achievement, procedure time, hypotension, and ventricular extrasystole (VES). RESULTS Target HR was reached in 83%, 86%, and 95% of Groups 1-3, respectively (P<0.001). Mean procedure duration fell from 27.82±2.06 min with late atropine to 18.48±0.95 min with early atropine (-33.6%). Hypotension dropped from 50.0% to 8.7% (relative reduction≈83%) and VES decreased from 59.1% to 13.0% (≈78%). Cumulative dobutamine exposure was halved (≈1 113→≈554 µg/kg). No early-atropine patients experienced test-terminating complications. CONCLUSIONS Introducing atropine at the preceding dobutamine stage offers a simple, cost-neutral modification that accelerates DSE, halves drug exposure, and substantially improves hemodynamic and arrhythmic safety in LT candidates. Prospective trials should confirm whether this streamlined protocol can be adopted as the new standard for chronotropically challenging patients.

BACKGROUND Hepatic artery thrombosis is the most common and severe vascular complication after liver transplantations. Transcatheter arterial thrombolysis is a viable alternative with high selectivity, low drug dosage, high local drug concentration, and minimal effect on systemic coagulation function. Intra-arterial contrast-enhanced ultrasound (IA-CEUS) is radiation-free and repeatable, can be performed bedside, and could be an alternative for continuous monitoring. We described the efficacy of IA-CEUS in assessing the effect of continuous transcatheter arterial thrombolysis in post-liver transplant hepatic artery thrombosis in a series of cases. MATERIAL AND METHODS Eight patients with diagnosis of hepatic artery thrombosis after liver transplantation between November 2016 and May 2023 were selected. All 8 patients underwent continuous transcatheter arterial thrombolysis, using urokinase. Dynamic IA-CEUS monitoring was performed for each patient during the thrombolysis treatment. Hepatic artery digital subtraction angiography was used to verify the results. RESULTS Two patients showed a hepatic artery perfusion defect. Six patients demonstrated good perfusion of artery. Three patients developed biloma. One patient developed a dissection aneurysm. One patient developed a pseudoaneurysm with catheter displacement in it. One patient developed retroperitoneal hematoma. None of the patients experienced contrast agent-related complications. CONCLUSIONS IA-CEUS was found to be safe and feasible as a new option for evaluating the efficacy of transcatheter arterial thrombolysis in post-liver transplant hepatic artery thrombosis.

BACKGROUND The incidence of ABO-incompatible (ABO-i) kidney transplantation (KT) is increasing. Furthermore, it has a higher early mortality rate than ABO-compatible (ABO-c) KT, which is largely attributed to the extensive use of immunosuppressive agents. While steroid use in patients with ABO-c KT is being reduced, this effort is less prevalent in patients with ABO-i KT. Therefore, our study investigated the specific impact of steroid withdrawal on graft survival in patients with ABO-i KT. MATERIAL AND METHODS This study evaluated 33 patients who underwent ABO-i KT. The primary outcome was biopsy-proven acute rejection. The secondary outcomes were graft function, infection, new-onset diabetes mellitus after transplantation (NODAT), and delayed graft function. RESULTS In an average follow-up period of 57.0±23.7 months, the cumulative probabilities of biopsy-proven rejection at 3 years post-transplantation were 30.8% in the steroid maintenance group and 40.0% in the steroid withdrawal group, with no significant difference (hazard ratio, 1.11; 95% confidence interval 0.32-3.9; P=0.648). Graft function was similar between the 2 groups. Steroid withdrawal did not affect the rates of infection, NODAT, osteoporosis, cardiovascular disease, BK virus viremia, or cytomegalovirus viremia. CONCLUSIONS Steroid withdrawal did not differ from steroid maintenance in the rate of rejection or graft function due to any cause.

BACKGROUND Horseshoe kidney is a rare congenital anomaly, occurring in approximately 1 in 400 to 1 in 1800 individuals. When considering transplantation, horseshoe kidneys present unique challenges due to vascular and urinary tract anomalies. They can be transplanted either as a whole, en bloc unit or as 2 separate, split fragments. The complexities in vascular and urinary reconstruction require careful consideration to ensure successful transplantation. CASE REPORT We present a case involving the transplantation of a horseshoe kidney from a deceased 36-year-old male donor with confirmed brain death due to intracerebral bleeding. The kidney had a complex vascular arrangement, with 7 arteries, 2 veins, and 2 ureters. A surgical division and vascular reconstruction were performed. The kidney fragments were successfully transplanted into 64- and 65-year-old male recipients. Both grafts exhibited excellent reperfusion, and at 2-month follow-up, both patients demonstrated satisfactory graft function, without dialysis or acute rejection episodes. CONCLUSIONS In light of the ongoing shortage of kidney grafts, horseshoe kidneys represent a valuable yet challenging option for transplantation. While vascular and urinary tract anomalies can complicate their use, this case illustrates that, with meticulous surgical technique, horseshoe kidney transplantation can be both viable and safe. Nevertheless, the absence of standardized guidelines for splitting techniques and pre-procurement anatomical assessment underscores the need for further research and consensus in this area.

BACKGROUND Tacrolimus trough-level concentration variability and patient non-adherence are risk factors for poorer graft and patient survival. This study investigated long-term outcomes in kidney transplant recipients who were converted from twice-daily immediate-release tacrolimus to once-daily prolonged-release tacrolimus. MATERIAL AND METHODS CHORUS (NCT02555787) is a 5-year, real-world, prospective, global, non-interventional study. Kidney transplant recipients (KTRs; ≥18 years, N=4389) were grouped by post-transplant conversion timing (early converters [ECs], ≤6 months; late converters [LCs], >6 months). The primary endpoint was the change from baseline in estimated glomerular filtration rate (eGFR) from conversion to 5 years. Secondary endpoints included tacrolimus dose and trough levels, clinical and biopsy-proven acute rejection (BPAR), graft and patient survival, emergence of donor-specific antibodies, and safety. RESULTS The full analysis set included 4028 patients (1060 ECs and 2968 LCs). Overall, eGFR remained stable 5 years after conversion, with a mean change from baseline of -1.4 (early converters, 3.4; late converters, -3.0) mL/min/1.73 m². Mean daily tacrolimus dose and trough levels remained stable 5 years after conversion. Clinically-diagnosed and BPAR-free survival 5-year estimates were 91.2% and 93.9%, respectively. Graft and patient 5-year survival estimates were 95.0% and 97.1%, respectively. Donor-specific antibodies (DSA) occurrence was observed in 4.9% of patients after conversion. Prolonged-release tacrolimus (PRT)-related adverse events were reported by 19.3% of patients and were the cause of discontinuation in 5.5% of patients. CONCLUSIONS In this large and diverse cohort of KTRs, conversion to PRT, independent of conversion timing, was effective and well tolerated in routine clinical practice, supporting its continued long-term use.