Annals of Transplantation最新文献

BACKGROUND We previously reported that the Model for End-stage Liver Disease (MELD) score and donor age are risk factors for small-for-size syndrome in adult living donor liver transplantation (LDLT) involving small grafts. Since April 2021, we have performed splenectomy as a portal inflow modulation in LDLT using small grafts according to the presence of risk factors. In this study, we evaluated the validity of our splenectomy strategies for optimizing graft outcomes. MATERIAL AND METHODS We retrospectively reviewed patients who underwent primary LDLT using left lobe grafts with the middle hepatic vein from January 2005 to January 2024 at our institution. We also compared the graft outcomes between recipients who underwent LDLT beginning in April 2021 (current policy group) and those who underwent LDLT in the era when splenectomy as portal modulation was not indicated (previous policy group). RESULTS In total, 173 consecutive LDLTs (current policy group: n=15) involving left lobe grafts were analyzed. Splenectomy was performed in 9 of 15 (60.0%) patients in the current policy group. All 15 patients in the current policy group remained alive for a median follow-up of 20.5 months. The rate of early allograft dysfunction was significantly lower, and the rate of small-for-size syndrome tended to be lower in the current policy group than in the previous policy group (13.3% vs 39.2%, P=0.047 and 20.0% vs 36.1%, P=0.211, respectively). CONCLUSIONS LDLT with splenectomy for high-risk patients may expand the availability of small left lobe grafts and optimize graft outcomes.

BACKGROUND Recipient hepatic arteries are generally used for arterial reconstructions in living donor liver transplantation. When the hepatic arteries are not feasible, the right gastroepiploic artery is one of the options for arterial reconstructions. In this study, we evaluate the feasibility of using the right gastroepiploic artery and report the analyzed retrospective patient outcomes. MATERIAL AND METHODS We included 324 patients who underwent primary living donor liver transplantation between August 1997 and December 2023. The rates of complications and surgical outcomes for different arteries used for reconstruction were compared between the groups. RESULTS For primary arterial reconstruction, the right gastroepiploic artery was used in 18 patients. The incidence of arterial complications and biliary strictures was higher than in the remaining 306 patients (P=0.01 and P=0.21, respectively). The 1-year and 5-year graft survival rates were 83.3% and 77.8% in the right gastroepiploic artery group, and 83.7% and 70.1% in the hepatic artery group, respectively (P=0.58). Eleven patients underwent arterial re-reconstruction secondary to arterial complications. The right gastroepiploic artery was used for the first time in 7 of these patients because the hepatic arteries were not reusable. Arterial complications after arterial re-reconstruction occurred in 4 patients (36.4%). CONCLUSIONS Arterial reconstruction using the right gastroepiploic artery was an effective option when the hepatic arteries were not suitable options, as it offered graft outcomes comparable to those of hepatic artery reconstruction, despite an increased risk of arterial and biliary complications.

BACKGROUND Despite its surgical complexity, kidney transplantation (KT) with multiple renal arteries (MRA) is comparable in performance to KT with a single renal artery (SRA). This study aimed to evaluate the effect of MRA and to investigate risk factors for graft loss in living-donor KT with MRA. MATERIAL AND METHODS This study included living-donor KT recipients who underwent KT in our hospital from February 2002 to March 2023. The primary outcome was whether MRA decreased the prognosis of transplanted kidneys. The secondary outcomes were the risk factors for graft loss in KT with MRA, such as recipients' characteristic. RESULTS Out of 197 recipients, 47 (23.8%) received kidneys with MRA. In inverse probability of treatment weighting, the risk of graft loss did not increase in KT with MRA, as compared to that in KT with SRA (hazard ratio [HR]: 1.46; 95% confidence interval [CI]: 0.68-3.14). MRA were associated with graft loss in ABO blood-incompatible KT (HR: 5.09, 95% CI: 1.75-14.7). CONCLUSIONS In ABO blood-incompatible KT, MRA can increase risk of graft loss.

BACKGROUND Acute respiratory distress syndrome (ARDS) due to coronavirus 2019 (COVID-19) can result in severe disease requiring mechanical ventilatory support. A subset of these patients, however, demonstrate refractory hypoxemia/hypercarbia requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO) as adjunctive therapy. The primary goal of V-V ECMO is a "bridge" to recovery of native lung function; however, patients may progress to irreversible pulmonary damage requiring lung transplantation. MATERIAL AND METHODS We conducted a retrospective review of patients with refractory COVID-19 ARDS/pulmonary fibrosis that required a V-V ECMO bridge to lung transplantation at our institution from May 2021 to December 2022. Data for analysis included patient demographics, pre/post-transplantation course, and 1-year outcomes. RESULTS Nine patients (6 male, 3 female) with an average age of 44.6±12.1 years required V-V ECMO support for COVID-19 and subsequently underwent lung transplantation. The median number of ECMO days was 57 (IQR 53-78). At listing, these patients had a median lung allocation score (LAS) of 91.86 (IQR 89.05-92.13). The median hospital length-of-stay was 89 days (IQR 54-144) with the longest hospital stay at 255 days. All patients were discharged home and survived to 1-year post-transplant. CONCLUSIONS Our case series shows that patients with COVID-19 ARDS/pulmonary fibrosis had no meaningful difference in overall survival compared to our institution's overall 1-year lung transplant survival rate. Our results suggest that with careful selection and care, long-term lung transplantation outcomes can be equivalent for those requiring a bridge to transplantation with V-V ECMO support despite the severity of illness in the peri-transplant period.

BACKGROUND Medical accessibility is important in liver transplantation (LT) because of the risk of infections associated with the use of immunosuppressants and complications that require continuous treatment, such as biliary stenosis. However, the effect of medical accessibility on LT success rates has yet to be scrutinized. The aim of this retrospective observational study is to determine whether medical accessibility affects LT outcomes. MATERIAL AND METHODS We enrolled patients who had undergone LT at Samsung Medical Center between January 2017 and December 2021. The level of medical access was divided into 2 categories (difficult and easy) based on a cutoff of a 120-min commute on public transportation to access LT. Baseline characteristics were calibrated with propensity score matching. The outcomes (overall survival and graft survival) and severity of emergency center visits according to medical accessibility were also investigated. RESULTS A total of 486 patients was included in this study. The median time to reach the hospital by public transportation was 135 min. Sex, Child-Pugh classification, Model for End-stage Liver Disease score, presence of hepatocellular carcinoma, and donor type were calibrated with propensity score matching, and each group consisted of 186 patients. The overall survival (88.3% vs 86.2%, P=0.67, 5-year) and graft survival (98.6% vs 95.4%, P=0.086, 5-year) showed no significant differences between the difficult-to-access and easy-to-access groups. While severity of emergency center visits differed between the difficult group (27.6%) and the easy group (15.5%), the difference was not statistically significant. CONCLUSIONS Medical access to LT did tend to increase emergency center presentation severity but did not affect long-term outcomes.

BACKGROUND Endothelial cells play a crucial role in the pathogenesis of renal interstitial fibrosis (RIF), with CD146 being upregulated on injured endothelial cells. However, the precise contribution of CD146⁺ endothelial cells to RIF remains unclear. This study aimed to observe and detect the relationship between CD146 expression and endothelial cells and to explore the role and possible mechanism of CD146 promoting endothelial-mesenchymal transition in RIF. MATERIAL AND METHODS In this study, we investigated the association between CD146⁺ endothelial cells and RIF. Double-label immunofluorescence was used in patients with chronic kidney disease, whereas multiplex immunofluorescence staining was used for the analysis in unilateral ureteral obstruction (UUO) mice. Hematoxylin and eosin and Masson trichrome staining were performed to evaluate RIF. RESULTS Our results revealed an elevation of CD146⁺ endothelial cells, which positively correlated with the degree of RIF in chronic kidney disease patients and UUO mice. Notably, CD146⁺ endothelial cells undergoing endothelial-mesenchymal transition (CD146⁺ EndMT) were significantly higher in subjects with severe renal interstitial fibrosis, as observed in chronic kidney disease patients and UUO mice. Additionally, with the progression of renal interstitial fibrosis, the expression of PDGFRb, the receptor of PDGF-B signaling pathway, increased and co-localized with CD146⁺ CD31⁺ a-SMA⁺ cells. The proportion of CD146⁺ CD31⁺ alpha-SMA⁺ PDGFRß⁺ cells in CD31⁺ cells increased. CONCLUSIONS In the process of renal interstitial fibrosis, CD146 is mainly expressed in renal interstitial vascular endothelial cells and participates in endothelial-to-mesenchymal transition, which may be related to the PDGF-B/PDGFR-ß signaling pathway.

BACKGROUND Liver transplantation (LT) is the preferred treatment for patients with cirrhosis who have hepatopulmonary syndrome (HPS). However, the effect of HPS on LT remains controversial. We assessed the correlation between HPS severity and LT survival and compared the incidence of postoperative complications between patients with and without HPS undergoing LT. MATERIAL AND METHODS We retrospectively reviewed the recipients who received living-donor LT in our institute between January 2016 and July 2019. Patients with HPS (HPS group) and patients without HPS (non-HPS group) were included in our study. HPS is defined as a defect in arterial oxygenation caused by the presence of intrapulmonary vascular dilatations, which is found by transthoracic echocardiography with pre-existing liver cirrhosis. HPS severity was graded according to the value of partial pressure of arterial oxygen. The demographic characteristics and clinical outcomes between the HPS and non-HPS groups were compared. RESULTS A total of 181 patients were enrolled. Among them, 104 patients (57.5%) had HPS. The mean overall survival of HPS and non-HPS groups was 69.82±3.1 vs 63.36±3.8 months, with no significant difference (P=0.332). The overall survival between different degrees of HPS was also compared, and showed no significant difference (P=0.466). The HPS group had a higher incidence of delayed extubation (22.1% vs 10.4%, P=0.028) and chest pigtail catheter insertion (16.3% vs 10.4%, P=0.012). Nevertheless, it did not lead to a longer Intensive Care Unit/hospital stay or higher risk of short-term mortality. CONCLUSIONS Patients with HPS tend to have more post-LT pulmonary complications, but the overall survival is not adversely influenced, regardless of the severity of HPS.

BACKGROUND Evidence on psychological factors associated with post-transplant post-traumatic stress disorder (PTSD) in liver transplantation (LT) patients is limited. Identifying the psychological factors associated with post-transplant PTSD would help to understand the symptoms of PTSD and take preventive measures. The aim of this study was to investigate factors influencing stress disorders in Intensive Care Unit (ICU) patients 1 year after LT. MATERIAL AND METHODS We assessed data from 184 LT patients at our hospital between January 2020 and December 2022. According to the PCL-C score, the patients were divided into the PTSD group (score ≤37) and the non-PTSD group (score >37). The demographic data, clinical data, the pain visual analogue scale (VAS), the anxiety and depression scale (HADS), and the psychological resilience scale (CD-RISC score) were compared between the 2 groups. Pearson correlation analysis was used to analyze the correlation between PCL-C and VAS, HADS, and CD-RISC, and logistic regression was used to analyze the factors influencing PTSD. SPSS 23.0 software was used for statistical analysis. RESULTS The average age of the 184 participants was 53.17 years (±3.47) and 66.85% of the subjects were male. The prevalence rate of post-transplant PTSD was 22.83% and the total score on the PCL-C scale was 32.47±7.81. Pearson correlation analysis showed that PCL-C score was positively correlated with VAS (r=0.312, P=0.012) and HADS (r=0.412, P<0.001), and negatively correlated with CD-RISC (r=-0.468, P<0.001). Logistic regression analysis showed that the symptom of post-transplant PTSD was significantly associated with higher VAS (OR=1.058, P=0.007) and HADS (OR=1.885, P<0.001) scores and lower CD-RISC (OR=2.213, P<0.001) score, which indicated that higher VAS and HAD scores were risk factors that contributed to PTSD and lower CD-RISC was a protective factor against PTSD. CONCLUSIONS We found that pain, anxiety, depression, and resilience were associated with symptoms of PTSD in LT patients in the ICU. Nursing staff should seek to relieve their patients' pain and assure provision of targeted health education and personalized psychological counseling to reduce the risk of PTSD after LT.

BACKGROUND Acute kidney injury (AKI) is a common issue in intensive care units and is a potentially lethal consequence of severe burns. In severely burned patients with non-renal indications, renal replacement treatment is frequently used. This study's aim was to compile a 10-year summary of continuous renal replacement therapy (CRRT) experience at a single burn center, including patient outcomes, effectiveness, and potential complications in the context of severe burns. MATERIAL AND METHODS This retrospective analysis included the clinical data from 723 burned patients. The data analysis of 300 patients with CRRT therapy included clinical data, laboratory tests, and CRRT parameters. The study group was split into 2 subgroups regarding onset of CRRT: early (up to 7 days after the trauma) and late. RESULTS Age, burn extent, length of stay, and inhalation injury all had an impact on survival. Early CRRT was linked to a greater probability of death (P<0.005). Upon admission to the burn center, patients with early CRRT exhibited a bigger burn area, higher Baux and SOFA scores, and were younger (P<0.05). Sepsis was diagnosed more frequently in the late CRRT group. CONCLUSIONS Our findings show that patients who require CRRT within the first 7 days following a burn injury have a poorer prognosis; however, this is not due to CRRT's effect, but rather to the trauma's severity. Future studies should explore long-term patient outcomes of CRRT among burn patients.

BACKGROUND Psychological function after transplantation has garnered increased attention, and the relationship between recipients and corresponding donors has been investigated in medical research. Here, we investigated potential qualitative and quantitative psychological and lifestyle changes among recipients after heart transplantation and their correlation with donors. MATERIAL AND METHODS Transplant recipients, their families, and the donor's families were interviewed. The interview was semi-structured, featuring open-ended questions related to 5 domains: preference, emotions and temperament, memory, self-identity, and social identity. Qualitative data were analyzed by triangulation and deductive content analysis. Quantitative data were collected using the Big Five Inventory-19 (BFI-19) questionnaire, to complement the domain of emotions and temperament. RESULTS Overall, 20 recipients, 15 recipients' families, and 13 corresponding donors' families were interviewed (5 recipients' families and 7 donors' families refused to participate) between October 2020 and July 2021. The data were matched to 13 groups, each including at least 1 recipient and the corresponding donor. Finally, 13 recipients, 9 corresponding recipients' families, and 13 corresponding donors' families were identified. Similarities between recipients' psychological and lifestyle changes and the corresponding donors' traits were primarily identified in the aspects of diet, emotions and temperament, and special experiences other than dreams. The BFI-19 data showed no significant correlations between recipients and the corresponding donors' families. CONCLUSIONS Our findings indicate significant psychological and lifestyle changes in recipients before and after heart transplantation, with 38% exhibiting characteristics partly similar to those of their donors. Further investigation is needed to explore the psychobiological correlation between recipients and donors.