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Results of Liver Retransplantation After Rescue Hepatectomy: A Single-Center Study. 抢救性肝切除术后肝再移植的结果:一项单中心研究。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-06-06 DOI: 10.12659/AOT.939557
Erika Laine, Hanna Al Sabeah, Marie Tranäng, Antonio Romano, Greg Nowak

BACKGROUND Liver retransplantation (reLT) is a well-accepted treatment for liver graft failure in selected patients. A rescue hepatectomy (RH), on the contrary, is a rare and controversial procedure in which a deteriorating liver graft causing failure of other organ systems is removed to stabilize the patient's condition before a new liver graft is available. MATERIAL AND METHODS In this retrospective cohort study, we evaluated the outcomes of the 104 patients who were listed for a first single-organ reLT in our center during the period 2000-2019, to compare the results after RH to other reLTs. RESULTS In the study population, RH was performed on 8 patients, while 7 of these received a new graft (8% of all first time reLTs) and 1 died before reLT. All RHs were performed within 1 week after the first transplantation. The median anhepatic time after RH was 36 hours (range 14-99). The 1-year patient survival rate was 57% for reLTs with RH and 69% for acute reLTs without RH that were performed within 14 days after the first transplantation (P=0.66). The 5-year survival rate was 50% in the RH and 47% in the non-RH group (P=1.0). CONCLUSIONS The use of RH prior to reLT results in a similar outcome to reLTs without RH. Therefore, RH should be considered in patients with a severe clinical instability caused by a deteriorating liver graft. However, further studies are needed to establish guidelines based on objective parameters for when RH should be performed.

背景:肝再移植(reLT)是一种被广泛接受的治疗肝移植失败的方法。相反,抢救性肝切除术(RH)是一种罕见且有争议的手术,在新的肝移植可用之前,切除恶化的肝移植导致其他器官系统衰竭,以稳定患者的病情。材料和方法在这项回顾性队列研究中,我们评估了2000-2019年期间在我们中心首次接受单器官肾移植的104例患者的结果,并将RH后的结果与其他肾移植后的结果进行比较。结果在研究人群中,8例患者接受了RH,其中7例接受了新的移植(占所有首次reLT的8%),1例在reLT前死亡。所有RHs均在首次移植后1周内完成。RH后无肝时间中位数为36小时(范围14-99小时)。首次移植后14天内进行RH的急性relt患者1年生存率为57%,无RH的急性relt患者1年生存率为69% (P=0.66)。RH组5年生存率为50%,非RH组为47% (P=1.0)。结论:在reLT之前使用RH与不使用RH的reLT结果相似。因此,在肝移植恶化导致严重临床不稳定的患者中应考虑RH。然而,需要进一步的研究来建立基于客观参数的指导方针,以确定何时应该进行RH。
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引用次数: 0
Outcomes from a Single Transplant Center of 5 Pediatric Cases of Domino Liver Transplantation from Live Donors with Maple Syrup Urine Disease. 单个移植中心对5例患有枫糖浆尿病的儿童活体供者进行多米诺骨牌肝移植的结果分析
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-05-30 DOI: 10.12659/AOT.939893
Jin-Ping Zhang, Zhi-Jun Zhu, Li-Ying Sun, Lin Wei, Wei Qu, Zhi-Gui Zeng, Hai-Ming Zhang, Ying Liu

BACKGROUND Maple syrup urine disease (MSUD) is a rare genetic deficiency of the branched-chain alpha-keto acid dehydrogenase (BCKAD) complex that breaks down amino acids, resulting in multi-organ failure. This report is of 5 pediatric cases of domino liver transplantation (DLT) from live donors with MSUD from a single transplant center in Beijing. CASE REPORT All MSUD donors were confirmed to have disease-causing mutations in BCKDHA (branched-chain keto acid dehydrogenase E1, alpha polypeptide) or BCKDHB (branched-chain keto acid dehydrogenase E1, ß polypeptide) genes by peripheral blood whole-exon sequencing. Serum leucine and valine concentrations were significantly higher than normal values. Recipients ranged in age from 0.75 to 9 years old. Three patients underwent auxiliary liver transplantation, and the other children all underwent liver or partial liver transplantation. This case report was followed up for 25 to 79 months. The prognosis, growth, and development of patients were followed up. By the end of the last follow-up, all children had survived. All patients had normal serum leucine and valine concentrations after surgery. In case 1, portal vein stenosis post-operatively. In case 2, stenosis of hepatic artery and bile duct occurred. In case 5, hepatic artery and portal vein stenosis occurred, resulting in graft loss.   CONCLUSIONS The findings from our center support the findings from other pediatric liver transplant centers that liver transplantation using MSUD donors can have successful outcomes without the development of MSUD in the recipient.

枫糖浆尿病(MSUD)是一种罕见的遗传缺陷,支链α -酮酸脱氢酶(BCKAD)复合物可分解氨基酸,导致多器官功能衰竭。本文报道了5例来自北京同一移植中心的MSUD活体供者骨牌肝移植(DLT)。病例报告:所有MSUD供者外周血全外显子测序均证实存在BCKDHA(支链酮酸脱氢酶E1, α多肽)或BCKDHB(支链酮酸脱氢酶E1, β多肽)基因的致病突变。血清亮氨酸和缬氨酸浓度明显高于正常值。接受者的年龄从0.75岁到9岁不等。3例患儿行辅助肝移植,其余患儿均行肝或部分肝移植。对该病例进行了25 ~ 79个月的随访。随访患者的预后、生长发育情况。到最后一次随访结束时,所有的孩子都活了下来。所有患者术后血清亮氨酸和缬氨酸浓度均正常。病例1:术后门静脉狭窄。病例2发生肝动脉及胆管狭窄。病例5发生肝动脉、门静脉狭窄,导致移植物丢失。结论本中心的研究结果支持了其他儿童肝移植中心的研究结果,即使用MSUD供体进行肝移植可以获得成功的结果,而受体中没有MSUD的发展。
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引用次数: 0
Safety and Efficacy of 4 mg·kg⁻¹ Sugammadex for Simultaneous Pancreas-Kidney Transplantation Recipients: A Prospective Randomized Trial. 一项前瞻性随机试验:4mg·kg糖美德用于同时进行胰肾移植的安全性和有效性。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-05-23 DOI: 10.12659/AOT.940211
Jiancheng Tang, Rongzhi He, Lei Zhang, Shiyuan Xu
Background Simultaneous pancreas-kidney transplantation (SPK) is a time-consuming and important surgical procedure, which can provide a physiological mean of achieving normoglycemia and render patients free of dialysis. The potential clinical benefits of sugammadex include fast and predictable reverse deep neuromuscular blockade (NMB), but whether sugammadex affects the function of SPK grafts is uncertain. Material/Methods Forty-eight patients were studied and reversed deep NMB with either sugammadex (n=24) or neostigmine (n=24). The safety variables included serum creatinine (Scr), creatinine clearance rate (CCr), serum amylase (AMS), blood glucose (Glu), mean arterial pressure (MAP), and heart rate (HR). Secondary outcomes were time from administration of sugammadex/neostigmine at the scheduled time to recovery of a TOF ratio to 0.7 and 0.9, and post-acute pulmonary complications. Results Scr at T2–6 was significantly lower than that at T0–1 (P<0.01), while CCr was higher (P<0.05). Between the 2 groups, Scr, CCr, and AMS were similar at the same timepoints (P>0.05). MAP, HR, and Glu were higher in group S than in group N at T1 (P<0.05). The recovery time of TOF=0.7 was 3 (2.4–4.2) min for group S and 12.1 (10.2–15.9) min for group N (P<0.001), and recovery time to TOFr ≥0.9 was 4.8 (3.6–7.1) min for group S and 23.5 (19.8–30.8) in group S. Compared to group N, group S had lower risk for post-acute pulmonary complications: supplemental oxygen requirements 0 vs 4 (16.7%), pulmonary atelectasis 0 vs 2 (0.83%), pneumonia 1 (4.2%) vs 3 (12.5%), and hypoxemia 1 (4.2%) vs 4 (16.7%). Conclusions Sugammadex administration is safe and effective for SPK transplantation recipients.
同时胰肾移植(SPK)是一项耗时且重要的外科手术,它可以提供一种生理手段来实现正常血糖并使患者免于透析。sugammadex的潜在临床益处包括快速和可预测的反向深度神经肌肉阻断(NMB),但sugammadex是否影响SPK移植物的功能尚不确定。材料与方法对48例患者进行了研究,并使用sugammadex (n=24)或新斯的明(n=24)逆转了深部NMB。安全性变量包括血清肌酐(Scr)、肌酐清除率(CCr)、血清淀粉酶(AMS)、血糖(Glu)、平均动脉压(MAP)和心率(HR)。次要结局是从预定时间给药糖马德/新斯的明到TOF比恢复到0.7和0.9的时间,以及急性后肺部并发症。结果T2-6时Scr显著低于t2 -1时(P0.05)。T1时,S组MAP、HR、Glu均高于N组(P
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引用次数: 1
Breaking Antimicrobial Resistance: High-Dose Amoxicillin with Clavulanic Acid for Urinary Tract Infections Due to Extended-Spectrum Beta-Lactamase (ESBL)-Producing Klebsiella pneumoniae. 打破抗菌素耐药性:大剂量阿莫西林加克拉维酸治疗由广谱β -内酰胺酶(ESBL)产生的肺炎克雷伯菌引起的尿路感染。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-05-16 DOI: 10.12659/AOT.939258
Piotr Wilkowski, Ewa Hryniewiecka, Kornelia Jasińska, Leszek Pączek, Michał Ciszek

BACKGROUND Carbapenems are the primary treatment for urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae. However, the recurrence rate is high, and patients often require rehospitalization. We present the results of an observational study on patients with recurrent UTIs who were treated in an outpatient setting with maximal therapeutic oral doses of amoxicillin with clavulanic acid. MATERIAL AND METHODS All patients had pyuria and ESBL-producing K. pneumoniae in urine culture. The starting dosage was 2875 g of amoxicillin twice daily and 125 mg of clavulanic acid twice daily. We down-titrated the doses every 7-14 days and continued prophylactic therapy with amoxicillin/clavulanic acid at 250/125 mg for up to 3 months. We defined therapeutic failure as ESBL-positive K. pneumoniae in urine culture during therapy and recurrence as positive urine culture with the same strain within 1 month after the end of treatment. RESULTS We included 9 patients: 7 kidney graft recipients, 1 liver graft recipient, and 1 patient with chronic kidney disease. We observed no therapeutic failures and no recurrences in the study group during the study period. In 1 case, the patient experienced a subsequent UTI caused by ESBL-producing K. pneumoniae 4 months after completing the therapy. CONCLUSIONS In conclusion, it is possible to break the resistance of ESBL-producing K. pneumoniae strains with high doses of oral amoxicillin with clavulanic acid. Such treatment could be an alternative to carbapenems in select cases.

碳青霉烯类药物是由广谱β -内酰胺酶(ESBL)产生的肺炎克雷伯菌引起的尿路感染(uti)的主要治疗方法。然而,复发率高,患者往往需要再次住院。我们报告了一项观察性研究的结果,该研究针对复发性尿路感染患者,这些患者在门诊接受了最大剂量的口服阿莫西林和克拉维酸治疗。材料与方法所有患者尿培养均有脓尿和产esbl肺炎克雷伯菌。起始剂量为阿莫西林2875 g,克拉维酸125 mg,每日2次。我们每7-14天降低一次剂量,并继续使用阿莫西林/克拉维酸250/125 mg的预防性治疗长达3个月。我们将治疗失败定义为治疗期间尿培养中esbl阳性肺炎克雷伯菌,将复发定义为治疗结束后1个月内尿培养中同一菌株阳性。结果纳入9例患者:7例肾移植患者,1例肝移植患者,1例慢性肾病患者。在研究期间,我们观察到研究组没有治疗失败和复发。在1例中,患者在完成治疗4个月后出现由产esbl肺炎克雷伯菌引起的后续尿路感染。结论大剂量口服阿莫西林加克拉维酸有可能破坏产esbl肺炎克雷伯菌的耐药性。在某些情况下,这种治疗可以替代碳青霉烯类药物。
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引用次数: 0
Outcomes of Kidney Transplantation in Older Recipients. 老年肾移植受者的预后。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-05-09 DOI: 10.12659/AOT.938692
Ehab Hammad, Dieter Broering, Yaser Shah, Ahmed Nazmi, Amira Al Abassi, Jens G Brockmann, Samir Elshouny, Layal Fajji, Hassan Aleid, Tariq Ali

BACKGROUND Access to kidney transplantation is limited for elderly patients with end-stage renal disease (ESRD), who often die while on the waiting list or receive kidneys from marginal deceased donors. In our transplantation center, most donated kidneys were from younger living relatives, in whom donations to elderly outcomes were not previously studied. In this study, we aimed to determine the short- and long-term outcomes of patients aged ³65 years to justify the use of kidneys from younger donors in older recipients. We also compared the outcomes between those who received kidneys from living donors (LDs) and deceased donors (DDs). MATERIAL AND METHODS We analyzed the patients' demographic data and the 1-, 5-, and 10-year patient and graft survival rates of patients aged ≥65 years who received kidney transplants between January 2005 and December 2020. RESULTS Among 158 patients, 136 received kidneys from LD and 22 from DD. The mean age was 69 years old. In this cohort, the most common cause of ESRD was diabetes. The graft survival rates were 99%, 96%, and 94% after 1, 5, and 10 years, respectively. Patient survival was 94%, 83%, and 61% after 1, 5, and 10 years, respectively. Delayed graft function rates, 1-year patient survival, and 5- and 10-year graft survival rates were lower in the DD group. Ischemic heart disease and transplantation from DD were independent risk factors for mortality. CONCLUSIONS Our study demonstrated reasonably good patient and graft survival rates in older patients. Outcomes were better in patients who received kidneys from LD.

背景:终末期肾病(ESRD)的老年患者获得肾移植的机会有限,他们经常在等待名单上死亡或接受边缘已故供者的肾脏。在我们的移植中心,大多数捐赠的肾脏来自年轻的在世亲属,在此之前没有研究过捐赠给老年人的结果。在这项研究中,我们旨在确定65岁患者的短期和长期结果,以证明老年受者使用年轻供体肾脏的合理性。我们还比较了接受活体供体(ld)和已故供体(dd)肾脏的患者的预后。材料与方法:我们分析了2005年1月至2020年12月期间接受肾脏移植的年龄≥65岁患者的人口统计学数据以及1、5、10年患者和移植物存活率。结果158例患者中,LD患者136例,DD患者22例,平均年龄69岁。在这个队列中,ESRD最常见的原因是糖尿病。术后1年、5年和10年的存活率分别为99%、96%和94%。1年、5年和10年后,患者生存率分别为94%、83%和61%。延迟移植功能率、1年患者生存率、5年和10年移植存活率在DD组较低。缺血性心脏病和DD移植是死亡的独立危险因素。结论:我们的研究表明,老年患者的患者和移植物存活率相当好。接受LD肾移植的患者预后更好。
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引用次数: 0
The Incidence of Brain-Dead Donors Based on Screening and Management Led by Intensivists. 基于重症监护医师主导的脑死亡供者的筛查与管理。
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-05-02 DOI: 10.12659/AOT.939521
Hyo Jin Lee, Seung Bin Kim, Hyun Woo Lee, Jung-Kyu Lee, Yong Won Seong, Eun Young Heo, Deog Kyeom Kim, Tae Yun Park

BACKGROUND This study aimed to compare the incidence of brain-dead (BD) donors and potential brain-dead (PBD) donors before vs after the introduction of intensivists. MATERIAL AND METHODS This longitudinal retrospective study was performed between January 2012 and December 2020 at Seoul Metropolitan Government-Seoul National University Boramae Medical Center. Four dedicated intensivists were introduced in January 2016. The periods before and after introduction of the intensivists were defined as the pre-introduction period (2012-2015) and post-introduction period (2016-2020), respectively. RESULTS During the study period, there were 2872 discharges in the Intensive Care Unit, of which there were a total of 113 PBD (3.93%) and 36 BD (1.25%) donors. The number of PBD and BD donors increased in the post-introduction period compared in the pre-introduction period (PBD, 47.84 vs 27.14 per 1000 discharges; BD, 13.59 vs 11.03 per 1000 discharges). Poisson regression analysis showed the annual incidence rate of PBD donors significantly increased post-introduction (PBD, 27.53% vs 48.11%, P=0.044), while those of BD donors were similar between the 2 groups (BD, 11.41% vs 13.9%; P=0.743). The annual incidence rate of the total number of organ donations, multi-organ donations (>3 organs), and donation of organs (heart, lung, and kidney) increased in the post-introduction period compared to that in the pre-introduction period. CONCLUSIONS Our findings suggest a beneficial role of a dedicated intensivist, not only in improving actual organ donation and discovering PBD donors, but also in affecting the yield of the heart and lung transplantation in actual organ donation compared to donors without a dedicated intensivist.

本研究旨在比较引入重症监护医师前后脑死亡(BD)供者和潜在脑死亡(PBD)供者的发生率。材料和方法本纵向回顾性研究于2012年1月至2020年12月在首尔市政府-首尔国立大学Boramae医疗中心进行。2016年1月引进了四名专门的重症监护医生。引入强化者前后分别定义为引入前(2012-2015年)和引入后(2016-2020年)。结果研究期间重症监护病房共出院2872例,其中PBD供者113例(3.93%),BD供者36例(1.25%)。与引入前相比,引入后PBD和BD供者的数量有所增加(PBD, 47.84 vs 27.14 / 1000次出院;BD, 13.59 vs 11.03 / 1000次排放)。泊松回归分析显示,引入后PBD供者的年发病率显著增加(PBD, 27.53% vs 48.11%, P=0.044),而两组之间BD供者的年发病率相似(BD, 11.41% vs 13.9%;P = 0.743)。器官捐献总数、多器官捐献(>3个器官)和器官(心、肺、肾)捐献的年发病率在引入后较引入前增加。结论:我们的研究结果表明,专职强化医生不仅在提高实际器官捐赠和发现PBD供者方面发挥了有益的作用,而且与没有专职强化医生的供者相比,在实际器官捐赠中也影响了心肺移植的产量。
{"title":"The Incidence of Brain-Dead Donors Based on Screening and Management Led by Intensivists.","authors":"Hyo Jin Lee,&nbsp;Seung Bin Kim,&nbsp;Hyun Woo Lee,&nbsp;Jung-Kyu Lee,&nbsp;Yong Won Seong,&nbsp;Eun Young Heo,&nbsp;Deog Kyeom Kim,&nbsp;Tae Yun Park","doi":"10.12659/AOT.939521","DOIUrl":"https://doi.org/10.12659/AOT.939521","url":null,"abstract":"<p><p>BACKGROUND This study aimed to compare the incidence of brain-dead (BD) donors and potential brain-dead (PBD) donors before vs after the introduction of intensivists. MATERIAL AND METHODS This longitudinal retrospective study was performed between January 2012 and December 2020 at Seoul Metropolitan Government-Seoul National University Boramae Medical Center. Four dedicated intensivists were introduced in January 2016. The periods before and after introduction of the intensivists were defined as the pre-introduction period (2012-2015) and post-introduction period (2016-2020), respectively. RESULTS During the study period, there were 2872 discharges in the Intensive Care Unit, of which there were a total of 113 PBD (3.93%) and 36 BD (1.25%) donors. The number of PBD and BD donors increased in the post-introduction period compared in the pre-introduction period (PBD, 47.84 vs 27.14 per 1000 discharges; BD, 13.59 vs 11.03 per 1000 discharges). Poisson regression analysis showed the annual incidence rate of PBD donors significantly increased post-introduction (PBD, 27.53% vs 48.11%, P=0.044), while those of BD donors were similar between the 2 groups (BD, 11.41% vs 13.9%; P=0.743). The annual incidence rate of the total number of organ donations, multi-organ donations (>3 organs), and donation of organs (heart, lung, and kidney) increased in the post-introduction period compared to that in the pre-introduction period. CONCLUSIONS Our findings suggest a beneficial role of a dedicated intensivist, not only in improving actual organ donation and discovering PBD donors, but also in affecting the yield of the heart and lung transplantation in actual organ donation compared to donors without a dedicated intensivist.</p>","PeriodicalId":7935,"journal":{"name":"Annals of Transplantation","volume":"28 ","pages":"e939521"},"PeriodicalIF":1.1,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/70/anntransplant-28-e939521.PMC10163827.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9423612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of Sodium Bicarbonate Ringer's Solution on Intraoperative Blood Gas Analysis and Postoperative Recovery Time in Liver Transplantation: A Single-Center Retrospective Study. 碳酸氢钠林格液对肝移植术中血气分析及术后恢复时间的影响:一项单中心回顾性研究
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-04-28 DOI: 10.12659/AOT.939097
Haiyan Xian, Qiuwen Xie, Ke Qin, Xiangfei Ma, Xueke Du

BACKGROUND Sodium bicarbonate Ringer's solution (BRS) is the latest generation of balanced crystal solutions. BRS does not increase the liver burden, but its impact in liver transplantation is unclear. The aim of this study was to investigate the effect of BRS as a fluid therapy on intraoperative blood gas analysis and postoperative recovery time in orthotopic liver transplantation (LT) patients. MATERIAL AND METHODS The study included 101 patients who received classical in situ liver transplantation at the Second Affiliated Hospital of Guangxi Medical University from November 2019 to January 2022. The patients were divided into 2 groups according to the intraoperative fluid infusion: the BRS group and the sodium lactate Ringer's solution group (LRS group). Intraoperative blood gas analysis, including pH, base excess (BE), bicarbonate, and lactic acid levels of radial artery blood, were collected after induction (T0), 30 min before opening (T1), 30 min after no liver period (T2), 30 min after opening (T3), and at the end of the operation (T4). Postoperative ICU catheter time, ICU stay time, and total hospitalization days were also recorded and compared between the 2 groups. RESULTS Lactic acid levels were decreased significantly at T3 in the BRS group (P<0.05). ICU catheter time, ICU hospitalization days, and total hospitalization days were significantly shorter in the BRS group (P<0.05). CONCLUSIONS BRS can decrease the lactic acid level at 30 min after opening, reducing the postoperative recovery time. BRS is more effective than LRS in liver transplantation.

碳酸氢钠林格溶液(BRS)是最新一代的平衡晶体溶液。BRS不增加肝脏负担,但其对肝移植的影响尚不清楚。本研究的目的是探讨BRS作为液体疗法对原位肝移植(LT)患者术中血气分析和术后恢复时间的影响。材料与方法本研究纳入了2019年11月至2022年1月在广西医科大学第二附属医院接受经典原位肝移植的101例患者。根据术中输液情况将患者分为两组:BRS组和乳酸钠林格液组(LRS组)。取术中血气分析,包括诱导后(T0)、开放前30 min (T1)、无肝期后30 min (T2)、开放后30 min (T3)、手术结束时(T4)桡动脉血pH、碱过量(BE)、碳酸氢盐、乳酸水平。记录两组患者术后ICU置管时间、ICU住院时间、总住院天数。结果BRS组大鼠T3时乳酸水平显著降低(P
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引用次数: 0
Levels of Procollagen Type I C-Terminal Pro-Peptide and Galectin-3, Arterial Stiffness Measured By Pulse Wave Velocity, and Cardiovascular Morbidity and Mortality in 44 Patients 2 Years After Kidney Transplantation. 肾移植术后2年44例患者I型前胶原c末端前肽和半乳糖凝集素-3水平、脉搏波速度测量的动脉硬度和心血管发病率和死亡率
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-04-25 DOI: 10.12659/AOT.938137
Madonna Salib, Nicolas Girerd, Arnaud Simon, Anna Kearney-Schwartz, Kévin Duarte, Céline Leroy, Patrick Rossignol, Athanase Benetos, Luc Frimat, Sophie Girerd

BACKGROUND Cardiovascular (CV) mortality remains high despite the improvement of kidney function after kidney transplantation. In heart failure (HF), high concentrations of biomarkers of fibrosis, related to cardiac and/or vascular impairment, are associated with CV outcomes, but their significance in kidney transplantation is still unclear. Our aim was to investigate the association of procollagen type I C-terminal pro-peptide (PICP) and galectin-3 (Gal-3), markers of fibrosis, with arterial stiffness measured by pulse wave velocity (PWV) and CV morbi-mortality in kidney transplantation recipients from the prospective monocenter TRANSARTE study (Transplantation and Arteries), which compared the evolution of arterial stiffness in transplanted patients and patients remained on dialysis. MATERIAL AND METHODS PICP and Gal-3 were measured at 2 years after transplantation in 44 kidney transplantation patients. Spearman's rank-order correlation analysis was conducted to assess the relationship between biomarkers and PWV. Association of biomarkers with CV morbi-mortality was evaluated using Cox regression analysis adjusted for age, renal function, and PWV. RESULTS There was no significant correlation between PWV and PICP (r=-0.16, P=0.3) or Gal-3 (r=0.03, P=0.85). Gal-3, after adjusting for key prognostic factors, including PWV, was significantly associated with CV morbi-mortality [HR (95% CI)=4.30 (1.01-18.22), P=0.048], whereas PICP was not significantly associated with outcome. CONCLUSIONS In multivariable adjusted analysis, elevated Gal-3 concentrations were associated with CV morbi-mortality in kidney transplantation patients, whereas PICP was not. As Gal-3 was not related to PWV, other sources of fibrosis (eg, cardiac fibrosis) may be underlying the prognostic value of Gal-3 in kidney transplantation.

背景:尽管肾移植术后肾功能得到改善,但心血管(CV)死亡率仍然很高。在心力衰竭(HF)中,与心脏和/或血管损伤相关的高浓度纤维化生物标志物与CV结果相关,但其在肾移植中的意义尚不清楚。我们的目的是研究前胶原I型c端前肽(PICP)和半凝集素-3 (Gal-3)(纤维化标志物)与肾移植受者动脉硬度的关系,通过脉搏波速度(PWV)和CV发病率-死亡率来测量,该研究比较了移植患者和继续透析患者动脉硬度的演变。材料与方法对44例肾移植患者进行移植后2年PICP和Gal-3测定。采用Spearman秩序相关分析评估生物标志物与PWV之间的关系。使用Cox回归分析评估生物标志物与CV发病-死亡率的相关性,校正年龄、肾功能和PWV。结果PWV与PICP (r=-0.16, P=0.3)、Gal-3 (r=0.03, P=0.85)无显著相关性。在校正关键预后因素(包括PWV)后,Gal-3与CV发病率-死亡率显著相关[HR (95% CI)=4.30 (1.01-18.22), P=0.048],而PICP与预后无显著相关性。结论:在多变量调整分析中,Gal-3浓度升高与肾移植患者的CV发病率-死亡率相关,而PICP与此无关。由于Gal-3与PWV无关,其他来源的纤维化(如心脏纤维化)可能是Gal-3在肾移植中的预后价值的基础。
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引用次数: 0
Converting from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in Patients with Hepatitis B Following Liver Transplantation. 乙肝患者肝移植后从富马酸替诺福韦二氧吡酯到替诺福韦阿拉芬胺的转化
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-04-21 DOI: 10.12659/AOT.938731
Chih-Hsien Cheng, Hao-Chien Hung, Jin-Chiao Lee, Yu-Chao Wang, Tsung-Han Wu, Chen-Fang Lee, Ting-Jung Wu, Hong-Shiue Chou, Kun-Ming Chan, Wei-Chen Lee

BACKGROUND Taiwan has a high prevalence of hepatitis B virus (HBV) infection. HBV-related end-stage liver disease is the leading cause of liver transplantation (LT). Tenofovir alafenamide (TAF) is a recently approved agent for the treatment of chronic HBV infection that improves renal profiles compared with tenofovir disoproxil fumarate (TDF) in phase III trials. This study aimed to assess the outcomes of TAF treatment in LT recipients. MATERIAL AND METHODS This retrospective study analyzed 17 LT recipients who underwent treatment with TDF and TAF. Changes in baseline renal function were compared. RESULTS Seventeen LT recipients received TDF for ≥48 weeks and were switched to TAF. During TDF treatment, estimated glomerular filtration rate (eGFR) (using the Modification of Diet in Renal Disease [MDRD] formula) decreased significantly at weeks 24 and 48. At week 48, only 2 patients (11.8%) displayed improved renal function, whereas the other patients showed decreased eGFR ranging from 5.48% to 62.84%. After switching to TAF, the median eGFR increased by 3.01% at week 24 and decreased by 0.31% at week 48. Seven patients (47%) showed improved renal function at week 48 after TAF treatment. CONCLUSIONS Switching from TDF to TAF was associated with fewer short-term renal impairment while maintaining the antiviral efficacy in LT recipients.

背景台湾是乙型肝炎病毒(HBV)感染的高发地区。hbv相关的终末期肝病是肝移植(LT)的主要原因。替诺福韦alafenamide (TAF)是最近被批准用于治疗慢性HBV感染的药物,与富马酸替诺福韦二氧吡酯(TDF)相比,在III期试验中,TAF可改善肾脏状况。本研究旨在评估肝移植受体TAF治疗的结果。材料和方法本回顾性研究分析了17例接受TDF和TAF治疗的LT受体。比较基线肾功能的变化。结果17例接受TDF治疗≥48周后转为TAF治疗。在TDF治疗期间,估计肾小球滤过率(eGFR)(使用肾脏疾病饮食修正[MDRD]配方)在第24周和第48周显著下降。在第48周,只有2例患者(11.8%)表现出肾功能改善,而其他患者的eGFR下降范围为5.48%至62.84%。改用TAF后,第24周时中位eGFR上升3.01%,第48周时下降0.31%。7例患者(47%)在TAF治疗后48周肾功能改善。结论:从TDF切换到TAF与短期肾脏损害较少相关,同时保持了LT受体的抗病毒疗效。
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引用次数: 0
Postoperative Outcomes in 415 Patients Following Liver Transplantation Using Extended Donor Criteria: A Study from a Single Center in Germany. 415例采用扩展供体标准肝移植患者的术后结果:来自德国单一中心的研究
IF 1.1 4区 医学 Q3 SURGERY Pub Date : 2023-04-07 DOI: 10.12659/AOT.939060
Aladdin Ali Deeb, Utz Settmacher, Johannes Fritsch, Felix Dondorf, Oliver Rohland, Falk Rauchfuß

BACKGROUND Because of the massive organ shortage worldwide, marginal organs are increasingly being considered. The aim of this study was to present a comprehensive analysis of donor-related factors clinically supposed to influence the outcome after liver transplantation. This study from a single center in Germany aimed to evaluate postoperative outcomes in 415 patients following liver transplantation using extended donor criteria. MATERIAL AND METHODS Extended donor criteria (EDC) were considered according to the official guidelines issued through the German Medical Association. Other factors and the Eurotransplant Donor Risk Index (ET-DRI) were also considered. Correlation studies, logistic regression, and Kaplan-Meier-estimator were used to evaluate the outcome. RESULTS The postoperative outcomes with or without EDC were comparable. Other factors had an impact on early allograft failure (EAD), including male donors (χ²=14.135, P=0.0001). Other donor-unrelated factors, like cold ischemia time, also had an impact on EAD (r=0.135, P=0.010), especially in patients with model for end-stage liver disease (MELD) <25 (ß=0.001, P=0.008). ET-DRI was a crucial factor in estimating overall and allograft survival after liver transplantation. CONCLUSIONS The findings from this study support the possibility of liver transplantation using organs obtained by EDC. Other factors, like donor sex and cold ischemic time, are not part of the EDC, although they have an impact on EAD. Organs obtained by EDC continue to be an option to address the organ shortage.

背景:由于世界范围内器官的严重短缺,边缘器官越来越受到重视。本研究的目的是全面分析临床认为影响肝移植后预后的供者相关因素。这项来自德国单一中心的研究旨在使用扩展供体标准评估415例肝移植患者的术后结果。材料和方法根据德国医学协会发布的官方指南考虑扩展供体标准(EDC)。其他因素和欧洲移植供者风险指数(ET-DRI)也被考虑在内。使用相关研究、逻辑回归和kaplan - meier估计来评估结果。结果伴有或不伴有EDC的两组术后结果具有可比性。其他因素对早期同种异体移植衰竭(EAD)也有影响,包括男性供体(χ²=14.135,P=0.0001)。其他与供体无关的因素,如冷缺血时间,也对EAD有影响(r=0.135, P=0.010),特别是在终末期肝病模型(MELD)患者中。
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引用次数: 2
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Annals of Transplantation
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