Annals of Transplantation最新文献

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.

BACKGROUND Herbal medicine is commonly used in Saudi Arabia, and is widely viewed as natural and safe. However, its use among transplant recipients poses risks due to interactions with immunosuppressive therapies. This study explores herbal medicine use, knowledge, and attitudes among Saudi transplant recipients. MATERIAL AND METHODS A cross-sectional study of 203 transplant recipients from multiple clinics in Saudi Arabia was conducted using a structured questionnaire to assess demographics, herbal supplement use, awareness of risks, and attitudes. Statistical analyses compared users and non-users of herbal supplements. RESULTS Post-transplant herbal supplement use decreased significantly (44.3% to 19.2%, p=0.0001). Many relied on unreliable sources like friends or the internet, and 54.24% of reported supplements posed interaction risks with immunosuppressive drugs. Participants aware of these risks were significantly less likely to use herbal supplements (15% vs 88%, p=0.0007). Alarmingly, 81.1% received no pre-transplant education, and 70.4% received no post-transplant care, despite 81% desiring guidance from healthcare providers. CONCLUSIONS Herbal supplement use among transplant recipients in Saudi Arabia is prevalent and risky due to potential drug interactions. Most patients lack education about these risks, underscoring the need for improved healthcare education.

BACKGROUND Living donor liver transplantation (LDLT) is an established treatment for end-stage liver disease, where donor safety remains a top priority. Pulmonary embolism (PE) is an unpredictable but serious complication following liver donor hepatectomy (LDH), contributing significantly to postoperative morbidity and mortality. CASE REPORT This article reports 4 cases of PE in living donors following LDH, discussing their clinical presentations, diagnosis, and treatment, and reviewing the relevant literature. Patient 1 was a 46-year-old man who underwent laparotomy right hepatectomy and developed PE on postoperative day (POD) 2. Patient 2 was a 42-year-old woman who donated the left half liver for her son. On POD 8, she was diagnosed with PE by enhanced computed tomography (CT) scan. Patient 3 was a 65-year-old man with 2 years history of hypertension. He underwent a laparotomy right hepatectomy and developed PE on POD 2. Patient 4 was a 57-year-old woman who underwent laparotomy left hepatectomy with the middle hepatic vein. On POD 3, the patient suddenly developed dyspnea after ambulation, and the enhanced CT of pulmonary arteries showed extensive PE in both lungs. All donors developed symptoms such as dyspnea and hypoxemia postoperatively, and were diagnosed with PE through imaging studies. Prompt anticoagulation therapy led to favorable outcomes in all cases. CONCLUSIONS Although PE is a rare and serious complication after LDH, early recognition and timely intervention are crucial to prevent catastrophic outcomes for the donor. Improving perioperative management is key to enhancing donor safety.

BACKGROUND The standard conditioning regimen for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) is 200 mg/m² of melphalan (Mel200). Dosing is reduced by 30% (Mel140) in frail patients. Studies comparing the performance of these regimens report inconsistent findings, mainly confounded by non-consecutive patient inclusion, missing data, and heterogenous practices. The largest study reported an increased risk of death with Mel200 among patients with very good partial remission, or better, before ASCT. This retrospective study from a single center compared outcomes of patients with a first ASCT for myeloma treated with melphalan 140 mg/m² or 200 mg/m². MATERIAL AND METHODS This was a retrospective real-world analysis from a single center. Data from 159 consecutive, first, single ASCTs for MM between 2012 and 2021 were included. Mel200 and Mel140 were administered to 131 and 28 patients, respectively. Primary and secondary objectives were overall survival (OS) and progression-free survival (PFS), respectively. RESULTS Median follow-up was 5.8 years. Over 90% received bortezomib-based induction, and over 76% achieved at least very good partial remission (VGPR) before ASCT in either group. PFS estimates were similar between groups (P=0.49). OS was longer with Mel200 (HR=0.42, P=0.002). Mel200 maintained OS superiority in all relevant subgroups. CONCLUSIONS In a homogenous population of patients with MM, Mel200 was associated with longer OS, likely reflecting the physiological state of patients and tolerance to subsequent treatments. Concerns reported from EBMT data regarding the association of Mel200 with mortality among patients with VGPR or better before ASCT are not supported by this study's findings.

BACKGROUND The present study assessed medication adherence to immunosuppressive therapy in pediatric patients following heart transplantation at a tertiary care center. MATERIAL AND METHODS A cross-sectional interview-based study combined with immunosuppressant level monitoring was conducted to encompass all pediatric patients who underwent heart transplants at King Abdulaziz Medical City-Central Region over a period of 5 months from January to May 2024. RESULTS More than 95% of patients' parents completed the questionnaire and were included in the final analysis. Among the pediatric post-heart transplant patients, 12 (60%) were males, aged from 6 to 18 years. Most patients (85%) were on tacrolimus, while 15% were on tacrolimus and sirolimus. Using the average blood serum drug levels and the ITAS, the prevalence of non-adherence was found to be 10% and 5%, respectively. Almost 95% of parents reported that they "Never forget about taking immunosuppressive medication". However, a small percentage reported occasional carelessness and missing administration of immunosuppressive medication to their children (5%). One reason given for stopping or missing medication were due to the child feeling worse in overall health (5%). CONCLUSIONS The results of this study indicate generally good adherence among pediatric post-heart transplant patients. Most participants demonstrated acceptable adherence behaviors. Continuous monitoring, support, and education are still necessary to maintain optimal adherence.

BACKGROUND Acute liver failure (ALF) remains a critical concern, accounting for about 8% of all liver transplants, with acetaminophen overdose contributing to nearly half of these cases. Besides synthetic toxins, natural toxins such as phallotoxin from Amanita phalloides mushrooms also lead to severe hepatocyte damage. This study investigates the outcomes of liver transplantation (LT) as a life-saving intervention in patients suffering from ALF due to acetaminophen and Amanita phalloides poisoning. MATERIAL AND METHODS We conducted a retrospective analysis of 39 patients who underwent LT for ALF induced by acetaminophen (n=18) or A. phalloides (n=21) poisoning at the Medical University of Warsaw. Various statistical analyses, including logistic regression, Mann-Whitney-U, and chi-squared tests, were employed. Survival rates were determined using Kaplan-Meier analysis. RESULTS The cohort included 24 females and 15 males, with a median age of 41. The 90-day mortality rate was 22.2% for acetaminophen poisoning and 38.1% for A. phalloides poisoning (P=0.284), with an estimated 5-year survival rate of 59.6%. Key factors associated with increased 90-day mortality included the number of red blood cells transfused (OR 1.574 per unit; P=0.011), fresh frozen plasma units (OR 1.346 per unit; P=0.003), acute kidney failure requiring hemodialysis (OR 13.50; P=0.021), and days from listing to LT (OR 2.289 per day; P=0.013). CONCLUSIONS Liver transplantation for ALF, though inherently high-risk, offers substantial survival benefits. Outcomes are largely influenced by the patient's condition at the time of transplant, organ availability, and intraoperative management. Despite significant mortality risks, LT remains a crucial intervention for ALF due to acetaminophen and Amanita phalloides toxicity.

BACKGROUND Infection is a cause of morbidity and mortality in solid-organ transplantation (SOT). We evaluated a new score that is applied during the first month after transplantation. The score comprises biomarkers of innate and acquired immunity to predict infections in SOT. MATERIAL AND METHODS Prospectively collected blood samples from 377 heart, liver, or kidney recipients were analyzed at 2 centers in Madrid (Spain) and Lima (Peru). Biomarkers were tested before transplantation and at days 7 and 30 after transplantation. During the first 6 months after transplantation, 183 (48.5%) patients developed severe infections (bacterial infections and/or CMV disease). Risk for severe infection was assessed using logistic regression analysis. We designed a score, the routine immunity score (RIS2020), which is based on the sum of the hazard ratios (HRs) of each biomarker. RESULTS The risk factors for severe infection were as follows: Moderate IgG hypogammaglobulinemia (IgG <600 mg/dL at days 7 or 30, HR 2.07, 95% CI 1.37-3.12, p=0.0005, 2 points), CD4 <400 cells/uL at day 30 (HR 1.76, 95% CI 1.03-3.04, p=0.039, 2 points), C3 <80 mg/dL at day 30 (HR 2.18, 95%CI 1.16-4.06, p=0.014, 2 points), and CRP >3 mg/dL at day 30 (HR 2.11, 95% CI 1.12-3.97, p=0.02, 2 points). In patients with ≥4 points, the HR for infection was 5.18 (95% CI 3.06-8.75; p<0.001). RIS2020 was an independent predictor of severe infection in multivariate models. CONCLUSIONS An immunological score combining moderate IgG hypogammaglobulinemia and other parameters of innate and acquired immunity could better identify the risk for severe infection in SOT.