Annals of Transplantation最新文献

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.

BACKGROUND Persistence of large spontaneous splenorenal shunt (SSRS) can result in graft failure in adult living donor liver transplantation (LDLT) due to portal flow steal; thus, it is necessary to block SSRS to ensure sufficient portal blood flow. MATERIAL AND METHODS We performed a retrospective 20-year observational follow-up study subsequent to a prior prospective study to evaluate the long-term outcomes following ligation of the proximal left renal vein (LRV). Between October 2001 and January 2005, 44 liver cirrhosis patients underwent LDLT with LRV ligation. These patients were followed up until April 2024 or patient death. RESULTS Portal flow was significantly increased after LRV ligation. Renal function recovered uneventfully after LDLT in 40 patients. Eighteen patients died due to cancer recurrence (n=6), pneumonia (n=3), and other causes (n=9), thus 1-, 5-, 10-, and 20-year overall patient survival rates were 95.5%, 86.4%, 81.8%, and 59.1%, respectively. Solitary atrophy of the left kidney was not observed. SSRS was completely resolved in 20 patients, but the other 20 patients showed persistently identifiable SSRS of variable extents to date or at patient death. The LRV was reopened to make large SSRS in another 4 patients, in which retrograde transvenous obliteration was performed in 2 for variceal bleeding control and in another 2 for portal flow augmentation. CONCLUSIONS This study demonstrated that LRV ligation is a safe and effective method to control SSRS. Currently, direct ligation of the SSRS is preferred, but LRV ligation still can be a good therapeutic option when direct access to SSRS is not feasible.

BACKGROUND The optimization of tacrolimus dosing during the early postoperative hospitalization period is essential to prevent rejection, minimize nephrotoxicity, and minimize the risk of opportunistic infections. Patient pharmacokinetic variability poses challenges in dose adjustment. This study aimed to evaluate tacrolimus dosing optimization using machine learning and statistical methods. MATERIAL AND METHODS We conducted a retrospective study of 749 kidney transplant recipients at Seoul St. Mary's Hospital between January 2015 and December 2019. Data on tacrolimus doses, trough levels, and other clinical variables were collected and analyzed during the first 12 postoperative days of hospitalization. Three approaches were evaluated: Extreme Gradient Boosting (XGBoost), Elastic Net regression (EN), and Linear regression (LR). The models were trained and validated using 5-fold cross-validation, with performance assessed using R² errors and alignment with clinically acceptable error margins. RESULTS Elastic Net showed the best performance with R² (Coefficient of Determination) of 0.861±0.044 and RMSE (Root Mean Square Error) of 0.930±0.220. Linear Regression and XGBoost provided clinically relevant predictions but with slightly lower accuracy. External validation was not performed, limiting the generalizability of the results. CONCLUSIONS The Elastic Net is a practical and reliable model for predicting the optimal tacrolimus dose. Machine learning and statistical methods are useful tools for optimizing tacrolimus dosing during hospitalization after kidney transplantation. Future studies should incorporate multi-center validation to improve clinical applicability.

BACKGROUND Living donor liver transplantation (LDLT) from a family member, particularly adult children, is common in South Korea. Although LDLT is restricted to donors with altruistic motivations, some still experience post-donation regret. However, the role of family-related motivation in post-donation regret remains underexplored. This study examined whether family-related motivations were associated with regret intensity and whether these associations varied by the type of family relationship (child vs spouse, sibling, or parent donors). MATERIAL AND METHODS This study was a cross-sectional secondary analysis. The sample comprised 124 postoperative living liver donors. They completed a family-related motivation subscale of the Donor Motivation Questionnaire and a single-item measure of regret intensity. For moderation analysis, Model 1 of the PROCESS macro was used. RESULTS The mean score of post-donation regret was 1.3 out of 4. Non-child donors reported higher levels of regret than child donors. Particularly in non-child donors, family-related motivation was inversely associated with regret intensity, after adjusting for age, sex, caregiver role, postoperative complications, and months since donation. CONCLUSIONS These findings suggest that child and non-child donors have distinct motivations, which are linked to differing levels of regret. Accordingly, transplant teams should provide tailored information and support services based on the donor's family relationship type.

BACKGROUND The incidence of anxiety, depression, and sleep disturbances is high among patients after liver transplantation, significantly impacting their quality of life. However, existing nursing programs often lack a comprehensive focus on psychological and physical health outcomes. This study aimed to evaluate the effectiveness of a targeted nursing program in reducing anxiety, depression, and sleep disturbances among liver transplantation patients through psychological care, lifestyle guidance, pain management, and rehabilitation training. MATERIAL AND METHODS A randomized controlled trial was conducted with 80 liver transplantation patients at Beijing Youan Hospital (2021-2023). Patients were randomly assigned to the control group (traditional nursing, n=40) or the intervention group (targeted nursing, n=40). The intervention included psychological care, lifestyle guidance, pain management, and rehabilitation training. Anxiety, depression, and sleep quality were assessed using the SDS, HAMA, and PSQI at 4 time points: 0-60, 61-120, 121-180, and 181-360 days after surgery. RESULTS The incidence of anxiety, depression, and insomnia at 0-60, 61-120, 121-180, and 181-360 days after liver transplantation was 42.50%, 37.50%, 35.00%, and 30.00%; 14.50%, 9.40%, 3.20%, and 1.20%; and 15.80%, 12.10%, 7.30%, and 6.50%, respectively. After the care program, the depression, anxiety, and sleep scores were lower in the intervention group than in the control group and gradually decreased over time (p<0.05). CONCLUSIONS The nursing program after liver transplantation includes postoperative psychology, pain care, life strategies, and rehabilitation training, which can effectively reduce the depression, anxiety, and sleep scores of patients and is recommended for wide use.