Annals of Transplantation最新文献

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.

BACKGROUND Kidney transplantation is the best therapeutic option for patients with end-stage kidney disease. Despite advances in surgical techniques, the surgical procedure itself is associated with a risk of postoperative complications, with an incidence rate of 5-25%. The aim of this retrospective analysis was to identify risk factors for surgical complications after kidney transplantation. MATERIAL AND METHODS The study included 283 patients who underwent kidney transplantation at our center over an 11-year period (2013-2023). Baseline characteristics of the recipients (age, sex, and type of donor) and factors influencing the development of surgical complications (type of induction therapy, diabetes mellitus, BK positivity) were recorded. Patients who developed a surgical complication (bleeding, lymphocele, ureteral stenosis) were identified and analyzed in relation to potential independent risk factors. RESULTS Surgical complications occurred in 15.8% of patients (n=45), with ureteral stenosis comprising 60% of all surgical complications. The average time to surgical complication onset ranged from 5.4 to 8.6 months. By using Cox proportional-hazard regression multivariate analysis, none of the parameters that were looked at were found to be independent risk factors for the development of surgical complications (endpoints: surgical complications itself, bleeding, ureteral stenosis, lymphocele/lymphorrhea). CONCLUSIONS Kidney transplantation significantly improves quality of life and survival in patients with end-stage kidney disease. Surgical complications remain a significant post-transplant challenge, with urological, vascular, and parietal complications being most common. While we found no independent risk factors among the parameters studied, minimizing these complications is essential to reduce the need for reinterventions and to improve outcomes.

BACKGROUND Given the scarcity of donor organs in the United States, the ability to prolong kidney transplant graft survival is a significant public health concern. Although it has been suggested that donor-recipient race-matching could improve kidney transplant outcomes, findings of previous studies are inconsistent. Therefore, the objective of this study was to conduct a systematic review examining the relationship between Black and White donor-recipient race-matching and graft and patient survival in adult primary kidney transplant recipients. MATERIAL AND METHODS Ovid Medline and Embase literature searches were conducted from earliest index date through October 2024. The following data were extracted and summarized: study characteristics, patient population characteristics, and findings associated with graft and patient survival. Quality assessment and magnitude of effects were evaluated, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to determine evidence certainty. RESULTS Of 4676 citations, 7 studies met inclusion criteria. Two studies reported Black-Black donor-recipient pairings, 2 studies reported Black-White donor-recipient pairings, and 3 studies reported White-Black donor-recipient pairings were at significantly higher risk for graft failure than the reference group; however, effect magnitude was small. Studies found the relationship between race-matching and patient survival was not statistically significant. Per GRADE, evidence concerning graft and patient survival is of low certainty or quality. CONCLUSIONS Studies generally found no differences in patient survival, and although Black-Black, Black-White, and White-Black donor-recipient pairings were associated with decreased graft survival in some studies, effects were small and likely clinically irrelevant. Further investigation of modifiable factors influencing graft survival is needed.

BACKGROUND Living donor liver transplantation (LDLT) faces increasing challenges due to the rising prevalence of hepatic steatosis among potential donors. Moderate steatosis (30-60%) is particularly problematic, often leading to donor exclusion and reducing the available donor pool. Preoperative interventions aiming to reduce hepatic fat content have emerged as a potential strategy, but data regarding their safety and efficacy remain limited. MATERIAL AND METHODS This retrospective, single-center study evaluated 34 living liver donors between June 2023 and August 2024. Fourteen donors received preoperative treatment for moderate hepatic steatosis, while 20 donors with mild or no steatosis served as controls. Pre- and post-treatment assessments included body mass index (BMI), liver fat assessment via computed tomography (CT), liver function tests, and perioperative outcomes. RESULTS Preoperative treatment significantly reduced hepatic fat content, with all treated donors achieving steatosis levels below 30% (P<0.001). BMI and GGT levels also decreased significantly after treatment (P=0.01 and P=0.04, respectively). Postoperative liver function, intensive care unit stay, and hospital discharge times were comparable between the treated and control groups (P>0.05). No donor experienced serious complications during the early postoperative period or the first year of follow-up. All donors maintained satisfactory graft and remnant liver function, and no treatment-related adverse events were observed. CONCLUSIONS Preoperative management of moderate hepatic steatosis in living liver donors is effective in reducing liver fat to acceptable levels without compromising donor safety. This approach offers a promising strategy to expand the LDLT donor pool. Further large-scale, multicenter studies with extended follow-up are necessary to validate these findings.

BACKGROUND Nutritional status can be an important, dynamic determinant of clinical outcomes in kidney transplant recipients. This study investigated the trajectory and potential classes of the prognostic nutritional index (PNI) in kidney transplant recipients using a latent class growth model (LCGM), and assessed their predictive role in renal allograft function. MATERIAL AND METHODS This retrospective study included 257 kidney transplant recipients who received treatment in a tertiary hospital in Anhui Province from January 2019 to November 2020. Their data were collected at each 4 timepoints: T0 (pre-surgery, using the results of the recipient's most recent laboratory test prior to transplant), T1, T2, and T3 (1, 6, and 12 months, respectively after transplant surgery). The LCGM was conducted using Mplus 8.4, and a multiple linear regression model was employed to examine the ability of PNI trajectory to predict renal allograft function. RESULTS Using LCGM, 2 classes of PNI patterns best fit the sample: the low PNI slow growth group (C1, n=122,47.5%) and the high PNI fast growth group (C2, n=135, 52.5%). The linear regression showed that being a woman and being in the high PNI fast growth group were negative predictors of a high creatinine level (B=-35.946, P<0.001; B=-15.147, P=0.023). CONCLUSIONS There were 2 trajectories of PNI in the sample, with lower creatinine values 1 year after transplantation in the high PNI fast growth class. The initial level and developmental rate of PNI can positively predict renal allograft function. PNI may serve as a prognostic marker for renal allograft function in kidney transplant recipients.

BACKGROUND Liver transplant (LT) recipients have an increased risk for the development of postoperative atrial fibrillation (POAF). POAF has been associated with serious long-term outcomes such as thromboembolic events, stroke, heart failure, and even graft instability. MATERIAL AND METHODS We assessed potential clinical, biochemical, and ECG predictors of POAF in LT recipients between 2012 and 2024.The patients were divided into 2 groups: POAF and non-POAF (34.5%, n: 38 and 65.4, n: 72, respectively). RESULTS Basal characteristics and comorbidities of the 2 groups were similar. Patients in the POAF group had significantly higher heart rates (81.16±18.62 bpm vs 65.11±12.47 bpm, P<0.01) and longer maximal P-wave durations (169.47±20.41ms vs 145.06±33.99 ms, P<0.01). Maximal P-wave duration, PR interval, P-wave peak time in lead II (PWPT-II), QRS duration, and QTc interval were also significantly longer in the POAF group compared to the non-POAF group. With these consistent findings, we may consider that changes or abnormalities in P-wave indices are significant indicators of atrial conduction delay, even before the development of LA enlargement. CONCLUSIONS Our results are valuable in providing the prediction of POAF, which may be associated with major adverse outcomes such as mortality in LT recipients, using a simple and inexpensive tool like ECG. Such risks can be minimized by strategies such as optimization of beta-blocker therapy, fluid and electrolyte balance, and intraoperative temperature regulation.

BACKGROUND Living donor liver transplantation (LDLT) has been shown to be safe in the curative treatment of liver cirrhosis. Portal flow modulation techniques, such as splenic artery ligation (SAL), have been used to avoid complications like small-for-size syndrome (SFSS). However, the effects of SAL on portal flow, splenic function, and hematologic outcomes remain underexplored. MATERIAL AND METHODS This retrospective study analyzed 60 LDLT recipients treated at a single center from January 2023 to December 2024. Thirty patients underwent SAL (SAL+) while 30 did not undergo SAL (SAL-). Data on demographic and clinical characteristics, portal flow dynamics, spleen volume, hematologic parameters, and postoperative complications were collected and analyzed using IBM SPSS 20.0. Statistical significance was set at P<0.05. RESULTS SAL significantly reduced portal flow from 3148±989 mL/min to 1949±830 mL/min (P<0.001), optimizing the portal flow/graft weight ratio. SAL also decreased splenic volume by 21% and alleviated thrombocytopenia, with postoperative platelet counts increasing 3.8-fold compared to preoperative levels (P<0.001). There were fewer complications in the SAL+ group, with significant reductions in biliary complications and improved graft function. No severe ischemic splenic changes or thromboembolic events were observed in the SAL+ group. CONCLUSIONS SAL is an effective strategy for portal flow modulation in LDLT, significantly reducing portal flow to optimal levels and improving hematologic outcomes. By preserving splenic function and minimizing complications, SAL is a safe and beneficial approach to managing SFSS and improving graft performance in LDLT patients.

BACKGROUND Adult polycystic liver disease (PLD) is a rare disorder frequently associated with polycystic kidney disease (PKD). This study aimed to evaluate the therapeutic outcomes of organ transplantation in patients with PLD. MATERIAL AND METHODS A retrospective analysis was conducted on the clinical data of 9 PLD patients who underwent organ transplantation at our center from May 2015 to Jan 2024. Intraoperative conditions and postoperative complications were closely monitored and documented. The survival rates of recipients and grafts, the use of immunosuppressants in recipients, and graft function were all monitored. RESULTS All 9 patients were female, with a mean age of 51.6±7.9 years. Among them, 8 had PLD combined with polycystic kidney disease (PKD), and 1 had PLD with left renal cysts. Among the 9 patients, 7 underwent combined liver and kidney transplantation (including 2 sequential liver and kidney transplantation), while 2 underwent liver transplantation alone. Two patients developed liver graft rejection postoperatively, and 1 patient developed kidney stones and post-transplant lymphoproliferative disease (PTLD). One patient who underwent sequential liver-kidney transplantation died 135 days after kidney transplantation due to severe infection. The median follow-up time for the surviving patients was 45.0 months (range 16.0 to 108.4 months). The survival rate was 88.9%. Among the 6 surviving patients who underwent combined liver and kidney transplantation, the preoperative estimated glomerular filtration rate (eGFR) was 19.8±16.4 mL/min, while the postoperative follow-up eGFR was 64.2±12.3 mL/min. CONCLUSIONS Organ transplantation provides a reliable solution for patients with PLD and end-stage renal failure.

BACKGROUND Simultaneous liver-kidney transplantation (SLKT) is a complex procedure essential for patients with end-stage liver and kidney disease. Most SLKT outcome reports originate from large transplant centers in developed countries, with limited data from Latin America. This study aimed to describe SLKT outcomes at a high-complexity center in Colombia to assess their comparability with existing literature. MATERIAL AND METHODS A retrospective, single-center study included adult and pediatric patients who underwent SLKT between January 2005 and December 2023. Data on demographics, perioperative status, in-hospital course, and follow-up outcomes were collected from hospital databases and medical records. Kaplan-Meier survival analysis and descriptive statistics were utilized. RESULTS During the study, 41 SLKTs were performer - 31 in adults and 10 in children - accounting for 4.18% of liver transplants and 5.73% of kidney transplants. Alcoholic cirrhosis was the primary indication for adult liver transplants (38.7%), while congenital hepatic fibrosis was prevalent in children (50%). Diabetic nephropathy was the leading cause of adult kidney disease (48.3%), with nephronophthisis and polycystic kidney disease common in pediatric cases (30% each). All adult grafts were from deceased donors; 50% of pediatric cases used living donors. No intraoperative dialysis was required. Four early postoperative deaths occurred due to sepsis and multiple organ failure. Survival rates at 1, 3, and 5 years were 92.6%, 80.4%, and 75.6%, respectively. CONCLUSIONS SLKT outcomes at the institution are satisfactory and comparable to other series, though pediatric patients face a higher risk of early septic complications.

BACKGROUND Malnutrition has been linked to unfavorable outcomes in patients undergoing living donor liver transplantation. However, the utility of the preoperative prognostic nutritional index (PNI) as a predictor for postoperative pulmonary infections and in-hospital deaths remains uncertain. The current study aimed to assess the predictive utility of preoperative PNI in patients who undergo liver transplantation. MATERIAL AND METHODS A total of 177 patients who received deceased donor liver transplants from January 2020 to June 2021 were retrospectively enrolled. The potential predictive factors for postoperative pulmonary infection and in-hospital mortality were identified using univariate and multivariate analyses, and a predictive model was created, with the predictive performance assessed using the area under the receiver operating characteristic curve (AUC). RESULTS Of 177 included patients, the prevalence of postoperative pulmonary infection and in-hospital mortality was 46 (25.99%) and 25 (14.12%), respectively. Multivariate analysis indicated that preoperative normal PNI was associated with a reduced risk of postoperative pulmonary infection compared with low PNI (OR: 0.21; 95% CI: 0.09-0.49; P=0.001), and the predictive value of preoperative PNI on subsequent postoperative pulmonary infection was moderate, with an AUC of 0.66 (95% CI: 0.59-0.73). Furthermore, we noted preoperative normal PNI was associated with a reduced risk of in-hospital mortality (OR: 0.23; 95% CI: 0.08-0.70; P<0.001), and the predictive value of preoperative PNI on in-hospital mortality was mild, with an AUC of 0.65 (95% CI: 0.56-0.73). CONCLUSIONS Preoperative PNI was significantly associated with postoperative pulmonary infection and in-hospital mortality, and the predictive value of the PNI was moderate.