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Dynamic Changes of Regulatory T Cells/CD4⁺ T Cells in Peripheral Blood of Adult Kidney Transplant Recipients: A Comparison of Pediatric and Adult Kidney Donors. 调节性T细胞/CD4的动态变化⁺ 成人肾移植受者外周血T细胞:儿童和成人供肾者的比较。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-09-26 DOI: 10.12659/AOT.940604
Qi Xiao, Zide Chen, Shitao Zhao, Kaifeng Luo, Fuping Cao, Zexu Zhang, Jia Liu, Jiansheng Xiao

BACKGROUND Inducing transplantation tolerance and monitoring the recipient's immune status to improve allograft survival remains the main goal for kidney transplantation (KTx). MATERIAL AND METHODS A total of 53 renal transplantation patients and 20 healthy individuals were assigned to the post-transplantation and healthy groups, respectively; 10 recipients with stable renal function for 2 years after kidney transplantation were assigned to Group C. Eleven kidney transplantation recipients were hospitalized due to lung infection. Flow cytometry was used to measure levels of Tregs/CD4⁺ T cells. RESULTS The Tregs/CD4⁺ T cells ratio reached homeostasis 6 months after KTx, with no significant difference between Group D (healthy control group) and pre-surgery or Group C (2 years after KTx group). The pediatric donor group and the adult donor group reached immune homeostasis 3 months after the operation. Immune homeostasis is maintaining a balance between immune tolerance and immunogenicity. There was no significant difference in graft function between the pediatric and adult donor groups before surgery, 1 day after surgery, 1 week after surgery, 2 weeks after surgery, and 1 month after surgery; however, graft function was significantly better in the pediatric donor group compared with the adult donor group at 3 mouths (eGFR: 51.7 (40.4-66.2) vs 73.0 (55.7-90.2), P=0.008<0.05) and 6 months (eGFR: 52.2 (37.5-62.8) vs 80.5 (64.1-90.4), P<0.001) after surgery. Pediatric donor kidneys reached immune homeostasis 3 months after surgery, with better graft function at this time compared with adult donor kidneys. The proportion of Tregs/CD4⁺ T cells in recipients with a pulmonary infection after KTx was lower than in those with infection recovery. CONCLUSIONS Expanding the use of pediatric kidneys should be further explored by the transplantation community. The proportion of Tregs/CD4⁺ T cells in recipients with a pulmonary infection after KTx was lower than in those with infection recovery.

背景诱导移植耐受并监测受体的免疫状态以提高同种异体移植物的存活率仍然是肾移植(KTx)的主要目标。材料和方法将53名肾移植患者和20名健康人分别分为移植后组和健康组;10名肾移植后肾功能稳定2年的受试者被分为C组。11名肾移植受试者因肺部感染住院。流式细胞术用于测量Tregs/CD4的水平⁺ T细胞。结果Tregs/CD4⁺ KTx后6个月,T细胞比例达到稳态,D组(健康对照组)与手术前或C组(KTx组后2年)之间无显著差异。儿童供体组和成人供体组在手术后3个月达到免疫稳态。免疫稳态是维持免疫耐受和免疫原性之间的平衡。手术前、术后1天、术后一周、术后2周和术后1个月,儿童和成人供体组的移植物功能没有显著差异;然而,与成人供体组相比,儿童供体组在3口时的移植物功能明显更好(eGFR:51.7(40.4-66.2)vs 73.0(55.7-90.2),P=0.008
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引用次数: 0
Living Donor Liver Transplantation in Patients with Preformed Donor-Specific Anti-Human Leukocyte Antigen Antibodies Using Preoperative Desensitization Therapy According to Intensity of Donor-Specific Antibodies: A Single-Center Study. 活体肝移植中预先形成的供体特异性抗人白细胞抗原抗体患者根据供体特异性抗体强度进行术前脱敏治疗:一项单中心研究
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-09-12 DOI: 10.12659/AOT.941346
Kohei Ogawa, Kei Tamura, Katsunori Sakamoto, Naotake Funamizu, Masahiko Honjo, Mikiya Shine, Yusuke Nishi, Tomoyuki Nagaoka, Chihiro Ito, Miku Iwata, Mio Uraoka, Yasutsugu Takada

BACKGROUND In liver transplantation (LT), preoperative desensitization therapy is considered necessary in patients positive for donor-specific anti-human leukocyte antigen antibodies (DSAs). However, the relationship between DSA intensity and the necessary desensitization therapy is unclear. MATERIAL AND METHODS A total of 37 adult living donor (LD) LTs performed between January 2016 and March 2022 were examined. Mycophenolate mofetil (MMF) was administered preoperatively in DSA-positive cases with positive lymphocyte cross-matching who underwent LDLT. In those with strongly positive DSA (mean fluorescence intensity 10 000), rituximab was administered 2 weeks before LDLT in addition to MMF. Cross-reactive epitope group antigen (CREG)-alone-positive cases were also treated with preoperative MMF when lymphocyte cross-matching was positive. RESULTS Of the 37 patients, 9 were DSA-positive, 7 were CREG-alone-positive, and the others were double-negative. Of 9 DSA-positive cases, desensitization therapy was performed in 7, among which rituximab administration was performed in 3 strongly DSA-positive cases. Of 7 CREG-alone-positive cases, 2 were lymphocyte cross-match-positive and underwent desensitization therapy. The 1-year survival rate was 100% in both DSA- and CREG-alone-positive cases. The frequency of T-cell mediated rejection in DSA-positive, CREG-alone-positive, and double-negative cases was 22%, 43%, and 29%, respectively, with no significant difference. Antibody-mediated rejection occurred in only 1 patient, who was strongly DSA-positive and blood-group incompatible. There was also no significant difference among the 3 groups in terms of the frequency of biliary complications or 90-day mortality. CONCLUSIONS Satisfactory LDLT results were achieved in DSA- and CREG-alone-positive cases following desensitization therapy.

背景在肝移植(LT)中,对于供体特异性抗人白细胞抗原抗体(dsa)阳性的患者,术前脱敏治疗被认为是必要的。然而,DSA强度与必要的脱敏治疗之间的关系尚不清楚。材料与方法对2016年1月至2022年3月期间进行的37例成人活体供体(LD) LTs进行检查。dsa阳性,淋巴细胞交叉配型阳性,行LDLT的患者术前给予霉酚酸酯(MMF)。在DSA阳性(平均荧光强度10000)的患者中,除了MMF外,还在LDLT前2周给予利妥昔单抗。交叉反应性表位群抗原(CREG)单独阳性的患者,当淋巴细胞交叉匹配阳性时,也在术前接受MMF治疗。结果37例患者中,dsa阳性9例,单独creg阳性7例,双阴性7例。9例dsa阳性患者中,7例行脱敏治疗,其中3例dsa强阳性患者行利妥昔单抗治疗。7例单独creg阳性病例中,2例淋巴细胞交叉配型阳性,接受脱敏治疗。DSA阳性和单独creg阳性病例的1年生存率均为100%。dsa阳性、creg单独阳性和双阴性病例中t细胞介导的排斥反应频率分别为22%、43%和29%,差异无统计学意义。抗体介导的排斥反应仅发生在1例患者中,该患者dsa阳性且血型不相容。在胆道并发症发生频率和90天死亡率方面,三组间也无显著差异。结论DSA阳性和单独creg阳性患者脱敏治疗后LDLT效果满意。
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引用次数: 0
Free-Circulating Nucleic Acids as Biomarkers in Patients After Solid Organ Transplantation. 游离循环核酸作为实体器官移植后患者的生物标志物。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-08-15 DOI: 10.12659/AOT.939750
Joanna Raszeja-Wyszomirska, Michał Macech, Monika Kolanowska, Marek Krawczyk, Sławomir Nazarewski, Anna Wójcicka, Jolanta Małyszko

A number types of extracellular DNA (eg, cell-free, cfDNA) circulate in human blood, including mitochondrial, transcriptome, and regulatory DNA, usually at low concentrations. Larger amounts of cfDNA appear in any inflammatory condition, including organ damage due to a variety of reasons. The role of cfDNA in solid organ transplantation is discussed in this review as a valuable additional tool in the standard of care of transplant patients. Post-transplant monitoring requires the use of high-quality biomarkers for early detection of graft damage or rejection to be able to apply early therapeutic intervention. CfDNA complements the traditional monitoring strategies, being a risk stratification tool and an important prognostic marker. However, improving the sensitivity and specificity of cfDNA detection is necessary to facilitate personalized patient management, warranting further research in terms of measurement, test standardization, and storage, processing, and shipping. A diagnostic test (Allosure, CareDx, Inc., Brisbane, CA) for kidney, heart and lung transplant patients is now commercially available, and validation for other organs (eg, liver) is pending. To date, donor-derived cfDNA in combination with other biomarkers appears to be a promising tool in graft rejection as it is minimally invasive, time-sensitive, and cost-effective. However, improvement of sensitivity and specificity is required to facilitate personalized patient management. Whether it could be an alternate to graft biopsy remains unclear.

许多类型的细胞外DNA(如游离细胞DNA、cfDNA)在人体血液中循环,包括线粒体、转录组和调控DNA,通常浓度较低。大量的cfDNA出现在任何炎症情况下,包括由于各种原因造成的器官损伤。本综述讨论了cfDNA在实体器官移植中的作用,作为移植患者标准护理中有价值的附加工具。移植后监测需要使用高质量的生物标志物来早期检测移植物损伤或排斥反应,以便能够进行早期治疗干预。CfDNA是对传统监测策略的补充,是一种风险分层工具和重要的预后标志物。然而,提高cfDNA检测的灵敏度和特异性对于促进患者的个性化管理是必要的,需要在测量、测试标准化以及储存、处理和运输方面进行进一步的研究。一种用于肾脏、心脏和肺移植患者的诊断测试(Allosure, CareDx, Inc., Brisbane, CA)现已上市,用于其他器官(如肝脏)的验证尚待验证。迄今为止,供体衍生的cfDNA与其他生物标志物联合使用似乎是治疗移植物排斥反应的一种很有前途的工具,因为它具有微创性、时间敏感性和成本效益。然而,需要提高敏感性和特异性,以促进患者的个性化管理。是否可以作为移植物活检的替代方法尚不清楚。
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引用次数: 0
Graft and Patient Survival in Kidney Transplant with Deceased Donor Using KDRI (Kidney Donor Risk Index), KDPI (Kidney Donor Profile Index), and EPTS (Estimated Post-Transplant Survival) in Colombia. 在哥伦比亚使用KDRI(肾供者风险指数)、KDPI(肾供者概况指数)和EPTS(估计移植后生存)对已故供者肾移植的移植和患者存活率进行分析。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-08-01 DOI: 10.12659/AOT.940522
Anabel Vanin A, Luis Alfonso Valderrama Cometa, Carlos Fernando Acuña Roldan, Norman A Alhajj, Carlos Julián Devia Santacruz

BACKGROUND EPTS (Estimated Post-Transplant Survival), KDRI (Kidney Donor Risk Index), and KDPI (Kidney Donor Profile Index) were developed aiming to ameliorate donor-recipient longevity matching in kidney transplants. They are based on a prediction model made using the United States population; evidence of their use outside EEUU remains limited. The aim of this study was to describe the quality of deceased-donor kidneys and to determine recipient and graft survival, glomerular filtration rate, and incidence of delayed graft function in renal transplantation according to these indices in Cali, Colombia. MATERIAL AND METHODS In this historical cohort study, Kaplan-Meier method was used to analyze survival of recipient and graft according to the values of the indices categorized by quintiles. Glomerular filtration rate and incidence of delayed graft function were also analyzed according to KDRI and KDPI. RESULTS We included 380 patients. Medians of EPTS, KDRI, and KDPI were 24% (IQR 9-60), 0.8 (IQR 0.71-0.99), and 27% (IQR 13-49), respectively. Two-year survival was 97.8% in recipients with EPTS ≤20% and it decreased with higher values of the index. Recipient and graft survival were lower for all periods when donors had KDPI >80%. Incidence of delayed graft function was higher in patients whose donors had KDPI ≥60% (44% vs 21%). Glomerular filtration rate decreased with the highest values of KDPI for all periods. CONCLUSIONS Our study represents the initial evaluation of the usefulness of these indices in Colombia. Our results suggest that KDRI, KDPI, and EPTS may serve as valuable tools for kidney allocation in our setting. Further research with larger sample sizes is necessary to validate these indices in our population.

EPTS(估计移植后生存)、KDRI(肾脏供体风险指数)和KDPI(肾脏供体概况指数)的发展旨在改善肾脏移植中供体-受体寿命匹配。它们是基于使用美国人口的预测模型;它们在欧盟以外使用的证据仍然有限。本研究的目的是描述死亡供体肾脏的质量,并根据哥伦比亚卡利的这些指标确定肾移植中受体和移植物的存活率、肾小球滤过率和移植物功能延迟的发生率。材料与方法在本历史队列研究中,采用Kaplan-Meier法根据五分位数分类的指标值分析受体和移植物的存活率。根据KDRI和KDPI分析肾小球滤过率和移植物功能延迟发生率。结果我们纳入了380例患者。EPTS、KDRI和KDPI的中位数分别为24% (IQR 9-60)、0.8 (IQR 0.71-0.99)和27% (IQR 13-49)。EPTS≤20%的患者2年生存率为97.8%,随着EPTS指数的升高而降低。当供体KDPI >80%时,受者和移植物的存活率在所有时期都较低。供体KDPI≥60%的患者移植物功能延迟的发生率更高(44% vs 21%)。肾小球滤过率随KDPI最高值而降低。结论:我们的研究代表了这些指标在哥伦比亚有用性的初步评估。我们的研究结果表明,KDRI、KDPI和EPTS可以作为有价值的肾脏分配工具。为了在我们的人群中验证这些指数,有必要进行更大样本量的进一步研究。
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引用次数: 0
Recurrent Membranoproliferative Glomerulonephritis After Kidney Transplantation: Risk Factors and Impact on Graft Survival. 肾移植后复发性膜增生性肾小球肾炎:危险因素及对移植物存活的影响。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-07-18 DOI: 10.12659/AOT.940502
Lais Ceccatto de Paula, Marilda Mazzali, Marcos Vinicius de Sousa

BACKGROUND Membranoproliferative glomerulonephritis (MPGN) is an uncommon cause of end-stage renal disease (ESRD). Recurrence rates after transplantation range from 11.8% to 18.9% after 5 and 15 years, respectively. This study aimed to assess the risk factors of MPGN recurrence after kidney transplantation and its impact on graft survival. MATERIAL AND METHODS This was a single-center retrospective cohort, including renal transplant recipients older than 18 years, with a diagnosis of MPGN in native kidneys. Data were obtained from medical records during the first 5-year post-transplant follow-up. Primary endpoints were graft function and survival. Secondary endpoints were MPGN recurrence risk factors and these cases' clinical, laboratory, and histological features. RESULTS Twenty-eight patients were included; the majority male (60.7%), with a mean age of 24.0±9.4 years. At MPGN native diagnosis, all patients presented proteinuria, with C3 consumption in 42.9%. Histological analysis showed 13 (42.9%) MPGN type I and 5 (17.9%) type II, with no cases of type III. MPGN recurrence occurred in 7 (25.0%) patients; 85.7% were male, 57.1% were recipients from a living donor, all presenting nephrotic syndrome and hematuria, with C3 consumption in 71.4%. The graft function was similar between the groups. Two (28.6%) patients progressed to graft failure in the recurrence group, and 1 died with a functioning graft. CONCLUSIONS The MPGN recurrence rate was 25%, most of them recipients of kidneys from living donors. Nephrotic syndrome and C3 consumption were frequent at recurrence. The graft function was similar between the groups, and the 5-year graft survival rate in the recurrence group was higher than in other studies.

背景膜增生性肾小球肾炎(MPGN)是终末期肾脏疾病(ESRD)的罕见病因。移植后5年和15年的复发率分别为11.8%至18.9%。本研究旨在探讨肾移植术后MPGN复发的危险因素及其对移植物存活的影响。材料和方法这是一项单中心回顾性队列研究,包括年龄大于18岁、诊断为原生肾脏MPGN的肾移植受者。数据来自移植后第一个5年随访期间的医疗记录。主要终点是移植物功能和生存。次要终点是MPGN复发的危险因素以及这些病例的临床、实验室和组织学特征。结果共纳入28例患者;男性居多(60.7%),平均年龄24.0±9.4岁。在MPGN原生诊断中,所有患者均出现蛋白尿,42.9%的患者有C3消耗。组织学分析显示MPGN I型13例(42.9%),II型5例(17.9%),无III型病例。7例(25.0%)患者出现MPGN复发;85.7%为男性,57.1%为活体供者,均表现为肾病综合征和血尿,71.4%为C3消耗。两组间移植物功能相似。复发组2例(28.6%)患者进展为移植物衰竭,1例死亡时移植物功能正常。结论MPGN复发率为25%,以活体供体肾脏受体居多。肾病综合征和C3消耗常复发。两组间移植物功能相似,复发组5年移植物存活率高于其他研究。
{"title":"Recurrent Membranoproliferative Glomerulonephritis After Kidney Transplantation: Risk Factors and Impact on Graft Survival.","authors":"Lais Ceccatto de Paula,&nbsp;Marilda Mazzali,&nbsp;Marcos Vinicius de Sousa","doi":"10.12659/AOT.940502","DOIUrl":"https://doi.org/10.12659/AOT.940502","url":null,"abstract":"<p><p>BACKGROUND Membranoproliferative glomerulonephritis (MPGN) is an uncommon cause of end-stage renal disease (ESRD). Recurrence rates after transplantation range from 11.8% to 18.9% after 5 and 15 years, respectively. This study aimed to assess the risk factors of MPGN recurrence after kidney transplantation and its impact on graft survival. MATERIAL AND METHODS This was a single-center retrospective cohort, including renal transplant recipients older than 18 years, with a diagnosis of MPGN in native kidneys. Data were obtained from medical records during the first 5-year post-transplant follow-up. Primary endpoints were graft function and survival. Secondary endpoints were MPGN recurrence risk factors and these cases' clinical, laboratory, and histological features. RESULTS Twenty-eight patients were included; the majority male (60.7%), with a mean age of 24.0±9.4 years. At MPGN native diagnosis, all patients presented proteinuria, with C3 consumption in 42.9%. Histological analysis showed 13 (42.9%) MPGN type I and 5 (17.9%) type II, with no cases of type III. MPGN recurrence occurred in 7 (25.0%) patients; 85.7% were male, 57.1% were recipients from a living donor, all presenting nephrotic syndrome and hematuria, with C3 consumption in 71.4%. The graft function was similar between the groups. Two (28.6%) patients progressed to graft failure in the recurrence group, and 1 died with a functioning graft. CONCLUSIONS The MPGN recurrence rate was 25%, most of them recipients of kidneys from living donors. Nephrotic syndrome and C3 consumption were frequent at recurrence. The graft function was similar between the groups, and the 5-year graft survival rate in the recurrence group was higher than in other studies.</p>","PeriodicalId":7935,"journal":{"name":"Annals of Transplantation","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/0a/anntransplant-28-e940502.PMC10362803.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9847533","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
Drug Overdose and Cardiovascular Deaths Among Deceased Organ Donors: Implications for Donor Utilization and Data Reporting. 死亡器官捐献者中的药物过量和心血管死亡:对捐献者利用和数据报告的影响。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-07-04 DOI: 10.12659/AOT.940255
Michie A Adjei, Steven A Wisel, Irene K Kim, Justin A Steggerda

BACKGROUND The present study evaluated expanded cause of death (COD) definitions and its implications on donor utilization for solid organ transplantation. MATERIAL AND METHODS The OPTN Standard Transplant and Research file was queried for potential donors between 2005 and 2019. Donor- and organ-specific utilization were evaluated. Expanded donor COD were identified: trauma, cardiovascular (CV), cerebrovascular accident (CVA) or stroke, drug intoxication (DI), anoxia not otherwise specified (NOS), and other. Descriptive analyses and multivariable logistic regression analyses for donor utilization were performed. RESULTS Among 132 783 potential donors identified, the most common COD was CVA/Stroke (n=44 707, 33.7%), followed by trauma (n=43 356, 32.7%), CV (n=20 053, 15.1%), anoxia-NOS (n=12 261, 9.2%), DI (n=10 205, 7.7%), and other causes (n=2201, 1.7%). Significant differences between CV, DI, and anoxia-NOS groups existed for donor age, sex, ethnicity, body mass index, and comorbidities. Donors from trauma had the highest unadjusted utilization rate (97.2%) while CV donors had the lowest (90.1%). Multivariable analysis of brain-dead donors (DBD) showed that compared to trauma, donors from DI had higher likelihood of utilization (odds ratio 1.217, 95% 1.025-1.446) while CV donors were lower (OR 0.717, 95% CI 0.642-0.800, P<0.001). Among donation after circulatory death (DCD) donors, there was decreased utilization compared to trauma for both CV (OR 0.607, 95% CI 0.523-0.705) and DI (OR 0.754, 95% CI 0.603-0.914, P<0.001). CONCLUSIONS Current COD definitions should be expanded to capture significant differences in the donor population. DI donors are the fastest growing cohort and the most likely utilized DBD donors, while trauma donors remain the most likely utilized DCD donors.

本研究评估了扩展死因(COD)定义及其对实体器官移植供体利用的影响。材料和方法在2005年至2019年期间查询OPTN标准移植和研究文件中的潜在捐赠者。评估供体和器官特异性利用。扩大供体COD:外伤、心血管(CV)、脑血管意外(CVA)或中风、药物中毒(DI)、无其他原因缺氧(NOS)等。对供体利用情况进行描述性分析和多变量logistic回归分析。结果在132783例潜在供者中,最常见的COD是CVA/卒中(n=44 707, 33.7%),其次是创伤(n=43 3556, 32.7%)、CV (n=20 053, 15.1%)、缺氧- nos (n=12 261, 9.2%)、DI (n=10 205, 7.7%)和其他原因(n=2201, 1.7%)。CV组、DI组和缺氧- nos组在供者年龄、性别、种族、体重指数和合并症方面存在显著差异。创伤供者未经调整的使用率最高(97.2%),而CV供者最低(90.1%)。脑死亡供者(DBD)的多变量分析显示,与创伤供者相比,脑死亡供者的利用可能性更高(比值比1.217,95% 1.025-1.446),而CV供者的利用可能性更低(比值比0.717,95% CI 0.642-0.800, P
{"title":"Drug Overdose and Cardiovascular Deaths Among Deceased Organ Donors: Implications for Donor Utilization and Data Reporting.","authors":"Michie A Adjei,&nbsp;Steven A Wisel,&nbsp;Irene K Kim,&nbsp;Justin A Steggerda","doi":"10.12659/AOT.940255","DOIUrl":"https://doi.org/10.12659/AOT.940255","url":null,"abstract":"<p><p>BACKGROUND The present study evaluated expanded cause of death (COD) definitions and its implications on donor utilization for solid organ transplantation. MATERIAL AND METHODS The OPTN Standard Transplant and Research file was queried for potential donors between 2005 and 2019. Donor- and organ-specific utilization were evaluated. Expanded donor COD were identified: trauma, cardiovascular (CV), cerebrovascular accident (CVA) or stroke, drug intoxication (DI), anoxia not otherwise specified (NOS), and other. Descriptive analyses and multivariable logistic regression analyses for donor utilization were performed. RESULTS Among 132 783 potential donors identified, the most common COD was CVA/Stroke (n=44 707, 33.7%), followed by trauma (n=43 356, 32.7%), CV (n=20 053, 15.1%), anoxia-NOS (n=12 261, 9.2%), DI (n=10 205, 7.7%), and other causes (n=2201, 1.7%). Significant differences between CV, DI, and anoxia-NOS groups existed for donor age, sex, ethnicity, body mass index, and comorbidities. Donors from trauma had the highest unadjusted utilization rate (97.2%) while CV donors had the lowest (90.1%). Multivariable analysis of brain-dead donors (DBD) showed that compared to trauma, donors from DI had higher likelihood of utilization (odds ratio 1.217, 95% 1.025-1.446) while CV donors were lower (OR 0.717, 95% CI 0.642-0.800, P<0.001). Among donation after circulatory death (DCD) donors, there was decreased utilization compared to trauma for both CV (OR 0.607, 95% CI 0.523-0.705) and DI (OR 0.754, 95% CI 0.603-0.914, P<0.001). CONCLUSIONS Current COD definitions should be expanded to capture significant differences in the donor population. DI donors are the fastest growing cohort and the most likely utilized DBD donors, while trauma donors remain the most likely utilized DCD donors.</p>","PeriodicalId":7935,"journal":{"name":"Annals of Transplantation","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dc/2b/anntransplant-28-e940255.PMC10329409.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764546","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
A 15-Year Retrospective Study of Supportive Extracorporeal Therapies Including Plasma Exchange and Continuous Venovenous Hemodiafiltration of 114 Adults with Acute Liver Failure Awaiting Liver Transplantation. 114例等待肝移植的急性肝衰竭患者的支持性体外治疗包括血浆置换和持续静脉静脉血液滤过的15年回顾性研究。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-06-27 DOI: 10.12659/AOT.939745
Ilhan Ocak

BACKGROUND Recently, there has been a recommendation to utilize a combination of supportive extracorporeal therapies, specifically plasma exchange and continuous venovenous hemodiafiltration, in patients with acute liver failure. This 15-year retrospective study aimed to evaluate supportive extracorporeal therapy, including plasma exchange and continuous venovenous hemodiafiltration, for 114 adults with acute liver failure awaiting liver transplant. MATERIAL AND METHODS In this retrospective study, the medical records of 1288 adult patients who underwent liver transplantation and 161 adult patients who received alternative therapy were analyzed; 114 patients who received combined supportive extracorporeal therapy for acute liver failure were included in the study. Biochemical laboratory data were compared before and after therapy. RESULTS The study included 50 male and 64 female patients. The first group (34 patients) recovered with liver transplantation, and 4 patients died in the first year after liver transplantation. In the second group (80 patients), 66 patients recovered without liver transplantation, while 14 patients died within the first 2 weeks after therapy. All patients showed significant reductions in serum hepatic function tests (alanine transaminase, aspartate transaminase, and total bilirubin), ammonia, and prothrombin time/international normalized ratio after discontinuation of combined supportive extracorporeal therapy (P<0.01). There was also a significant improvement in the hemodynamic parameter. CONCLUSIONS This combined extracorporeal therapy can be used as a supportive treatment for both recovery and bridge to liver transplantation in patients with acute liver failure. In addition, treatment can be continued until liver regeneration and until a usable donor is found.

最近,有研究建议对急性肝衰竭患者联合使用体外支持治疗,特别是血浆置换和持续静脉静脉血液滤过。这项为期15年的回顾性研究旨在评估114例等待肝移植的急性肝衰竭患者的支持性体外治疗,包括血浆置换和持续静脉静脉血液滤过。材料与方法回顾性分析1288例接受肝移植的成人患者和161例接受替代治疗的成人患者的病历;114例接受联合体外支持治疗的急性肝衰竭患者纳入研究。比较治疗前后生化实验室数据。结果男性50例,女性64例。第一组34例患者经肝移植术后恢复,4例患者在肝移植术后1年内死亡。第二组(80例)66例患者未行肝移植康复,14例患者在治疗后2周内死亡。所有患者在停止体外支持治疗后血清肝功能(谷丙转氨酶、天冬氨酸转氨酶和总胆红素)、氨和凝血酶原时间/国际标准化比率均显著降低(P
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引用次数: 0
Survival analysis of transplant-associated thrombotic microangiopathy under different diagnostic criteria and the efficacy of plasma exchange. 不同诊断标准下移植相关血栓性微血管病的生存分析及血浆置换的疗效。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-06-20 DOI: 10.12659/AOT.939890
Yifan Xu, Yan Wei, Lijun Wang, Ning Lu, Yongli Wu, Liping Dou, Daihong Liu, Meng Li, Chunji Gao

BACKGROUND Transplant-associated thrombotic microangiopathy (TA-TMA) is a serious complication of hematopoietic stem cell transplantation (HSCT). The efficacy and survival of plasma exchange (PE) for TA-TM have not been fully clarified. In addition, there is a lack of consensus on diagnostic criteria for TA-TMA.  MATERIAL AND METHODS We retrospectively analyzed 32 patients diagnosed with TA-TMA by different diagnostic criteria from January 2018 to February 2022 at the First Medical Center of the PLA General Hospital. RESULTS (1) The patients with TA-TMA treated with PE in this study had a remission rate of 42.8%, a 100-day OS of 47.6%, and a 6-month OS of 38.1%. The only factor affecting the response to PE treatment was the number of PE sessions (P = 0.047). (2) III-IV aGVHD prior to TA-TMA diagnosis (P = 0.002), renal or neurological dysfunction (P = 0.021), and the time to onset of TA-TMA (P = 0.002) were independent risk factors for overall survival with TA- TMA. (3) Probable TA-TMA had the highest survival rate, but the Jodele criteria are expected to diagnose earlier and provide the greatest benefit to patients. CONCLUSIONS PE is an effective treatment for TA-TMA especially in cases where complement blockers are not available. In addition, probable TA-TMA improved prognostic survival through early detection of patients with TA-TMA. There is a need for further large prospective trials to identify the population more suitable for PE treatment of TA-TMA and more valid diagnostic criteria.

移植相关血栓性微血管病(TA-TMA)是造血干细胞移植(HSCT)的严重并发症。血浆置换(PE)治疗TA-TM的疗效和生存率尚未完全明确。此外,对TA-TMA的诊断标准也缺乏共识。材料与方法回顾性分析解放军总医院第一医疗中心2018年1月至2022年2月32例经不同诊断标准诊断为TA-TMA的患者。结果(1)本研究中接受PE治疗的TA-TMA患者缓解率为42.8%,100天OS为47.6%,6个月OS为38.1%。影响PE治疗反应的唯一因素是PE治疗的次数(P = 0.047)。(2) TA-TMA诊断前III-IV期aGVHD (P = 0.002)、肾脏或神经功能障碍(P = 0.021)和TA-TMA发病时间(P = 0.002)是TA-TMA患者总生存的独立危险因素。(3)可能TA-TMA的生存率最高,但Jodele标准有望更早诊断并为患者提供最大的益处。结论PE是治疗TA-TMA的有效方法,特别是在补体阻滞剂不可用的情况下。此外,通过早期发现TA-TMA患者,可能的TA-TMA改善了预后生存。需要进一步的大型前瞻性试验来确定更适合TA-TMA的PE治疗人群和更有效的诊断标准。
{"title":"Survival analysis of transplant-associated thrombotic microangiopathy under different diagnostic criteria and the efficacy of plasma exchange.","authors":"Yifan Xu,&nbsp;Yan Wei,&nbsp;Lijun Wang,&nbsp;Ning Lu,&nbsp;Yongli Wu,&nbsp;Liping Dou,&nbsp;Daihong Liu,&nbsp;Meng Li,&nbsp;Chunji Gao","doi":"10.12659/AOT.939890","DOIUrl":"https://doi.org/10.12659/AOT.939890","url":null,"abstract":"<p><p>BACKGROUND Transplant-associated thrombotic microangiopathy (TA-TMA) is a serious complication of hematopoietic stem cell transplantation (HSCT). The efficacy and survival of plasma exchange (PE) for TA-TM have not been fully clarified. In addition, there is a lack of consensus on diagnostic criteria for TA-TMA.  MATERIAL AND METHODS We retrospectively analyzed 32 patients diagnosed with TA-TMA by different diagnostic criteria from January 2018 to February 2022 at the First Medical Center of the PLA General Hospital. RESULTS (1) The patients with TA-TMA treated with PE in this study had a remission rate of 42.8%, a 100-day OS of 47.6%, and a 6-month OS of 38.1%. The only factor affecting the response to PE treatment was the number of PE sessions (P = 0.047). (2) III-IV aGVHD prior to TA-TMA diagnosis (P = 0.002), renal or neurological dysfunction (P = 0.021), and the time to onset of TA-TMA (P = 0.002) were independent risk factors for overall survival with TA- TMA. (3) Probable TA-TMA had the highest survival rate, but the Jodele criteria are expected to diagnose earlier and provide the greatest benefit to patients. CONCLUSIONS PE is an effective treatment for TA-TMA especially in cases where complement blockers are not available. In addition, probable TA-TMA improved prognostic survival through early detection of patients with TA-TMA. There is a need for further large prospective trials to identify the population more suitable for PE treatment of TA-TMA and more valid diagnostic criteria.</p>","PeriodicalId":7935,"journal":{"name":"Annals of Transplantation","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/d2/anntransplant-28-e939890.PMC10290434.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10066271","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
Errate: Modification of Venous Outflow to Avoid Thrombotic Graft Failure in Pancreas Transplantation. 修正静脉流出以避免胰腺移植中血栓性移植物衰竭。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-06-19 DOI: 10.12659/AOT.941495
Je Ho Ryu, Jae Ryong Shim, Tae Beom Lee, Kwangho Yang, Taeun Kim, Seo Rin Kim, Byunghyun Choi

The authors asked for an errata to correct the affiliation information. The corrected affiliations are as follows:Je Ho Ryu1,2, Jae Ryong Shim1, Tae Beom Lee1, Kwang Ho Yang1, Taeun Kim3, Seo Rin Kim4, Byung Hyun Choi1,21 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, South Korea2 Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea3 Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea4 Department of Internal medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine,  Yangsan, South KoreaThe change of affiliation does not affect the content or findings of the publication in any way. It is solely an update to the -authors' institutional affiliations.Reference:Je Ho Ryu, Jae Ryong Shim, Tae Beom Lee, Kwangho Yang, Taeun Kim, Seo Rin Kim, Byunghyun Choi. Modification of Venous Outflow to Avoid Thrombotic Graft Failure in Pancreas Transplantation. Ann Transplant. 2022; 27: e937514. DOI: 10.12659/AOT.937514.

作者要求更正隶属关系信息的勘误表。更正的隶属关系如下:Je Ho ryu 1,2, Jae Ryong Shim1, Tae Beom le1, Kwang Ho Yang1, Taeun Kim3, Seo Rin Kim4, Byung Hyun Choi1,21韩国釜山大学梁山医院外科肝胆胰外科移植科,釜山大学医学院,韩国梁山,釜山大学梁山医院,生物医学科学与技术融合研究所,釜山大学梁山医院,梁山,韩国3国立釜山大学梁山医院放射科,国立釜山大学医学院,梁山,韩国4国立釜山大学梁山医院内科,国立釜山大学医学院,梁山,韩国合作关系的改变不会以任何方式影响出版物的内容或研究结果。这仅仅是对作者机构隶属关系的更新。参考:刘济浩、沈载龙、李泰范、杨光浩、金泰恩、金徐麟、崔炳贤修改静脉流出避免胰腺移植血栓性移植物衰竭。Ann Transplant. 2022;27: e937514。DOI: 10.12659 / AOT.937514。
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引用次数: 0
Incidence of Thromboembolic Complications Following Kidney Transplantation with Short and Extended Aspirin Prophylaxis: A Retrospective Single-Center Study. 短期和长期阿司匹林预防肾移植后血栓栓塞并发症的发生率:一项回顾性单中心研究。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2023-06-13 DOI: 10.12659/AOT.939143
Angus H Pegler, Katharine Hegerty, Ryan P Gately, Carmel M Hawley, David W Johnson, Yeoungjee Cho, Dev K Jegatheesan, Andrew B McCann, Michelle E Harfield, Nicole M Isbel

BACKGROUND Aspirin prophylaxis has been associated with reduced graft-related thrombosis following kidney transplantation. Aspirin cessation, however, can increase risk of venous thromboembolic complications, including pulmonary thromboembolism and deep venous thrombosis. This single-center, retrospective, pre-post interventional study from Brisbane, Australia, aimed to compare the rate of thrombotic complications in 1208 adult kidney transplant recipients receiving postoperative aspirin for 5 days or >6 weeks. MATERIAL AND METHODS We enrolled1208 kidney transplant recipients who received 100 mg aspirin for 5 days (n=571) or >6 weeks (n=637) postoperatively. The primary outcome was venous thromboembolism (VTE) in the first 6 weeks after transplant, examined by multivariable logistic regression analysis. Secondary outcomes were renal vein/artery thrombosis, 1-month serum creatinine, rejection, myocardial infarction, stroke, blood transfusion, dialysis at day 5 and day 28, and mortality. RESULTS Sixteen (1.3%) patients experienced VTE (5-day n=8, 1.4%; >6-week n=8, 1.3%; P=0.8). Extended aspirin duration was not independently associated with a reduction in VTE (OR 0.91, 95% CI 0.32-2.57; P=0.9). Graft thrombosis was rare (n=3, 0.25%). Aspirin duration was not associated with cardiovascular events, blood transfusion, graft thrombosis, graft dysfunction, rejection, or mortality. VTE was independently associated with older age (OR 1.09, 95% CI 1.04-1.16; P=0.002), smoking (OR 3.59, 95% CI 1.20-13.2; P=0.032), younger donor age (OR 0.96, 95% CI 0.93-1.00; P=0.036), and thymoglobulin use (OR 10.5, 95% CI 3.09-32.1; P≥0.001). CONCLUSIONS Extended-duration aspirin use did not significantly reduce the incidence of VTE in the first 6 weeks following kidney transplantation. An association was identified between anti-human thymocyte immunoglobulin and VTE, which requires further assessment.

背景:阿司匹林预防与肾移植后移植物相关血栓的减少有关。然而,停用阿司匹林会增加静脉血栓栓塞并发症的风险,包括肺血栓栓塞和深静脉血栓形成。这项来自澳大利亚布里斯班的单中心、回顾性、介入前和介入后研究,旨在比较1208名成年肾移植受者术后服用阿司匹林5天或>6周的血栓并发症发生率。材料和方法我们招募了1208名肾移植受者,他们在术后5天(n=571)或>6周(n=637)服用100mg阿司匹林。通过多变量logistic回归分析,主要结局为移植后前6周静脉血栓栓塞(VTE)。次要结局是肾静脉/动脉血栓形成、1个月血清肌酐、排斥反应、心肌梗死、中风、输血、第5天和第28天透析和死亡率。结果16例(1.3%)患者发生静脉血栓栓塞(5天n=8, 1.4%;>6周n=8, 1.3%;P = 0.8)。延长阿司匹林服用时间与静脉血栓栓塞降低没有独立相关性(OR 0.91, 95% CI 0.32-2.57;P = 0.9)。移植物血栓罕见(n=3, 0.25%)。阿司匹林持续时间与心血管事件、输血、移植物血栓形成、移植物功能障碍、排斥反应或死亡率无关。静脉血栓栓塞与年龄较大独立相关(OR 1.09, 95% CI 1.04-1.16;P=0.002),吸烟(OR 3.59, 95% CI 1.20-13.2;P=0.032),较年轻的供体年龄(OR 0.96, 95% CI 0.93-1.00;P=0.036),胸腺球蛋白的使用(OR 10.5, 95% CI 3.09-32.1;P≥0.001)。结论:在肾移植后的前6周,长期服用阿司匹林并没有显著降低静脉血栓栓塞的发生率。抗人胸腺细胞免疫球蛋白与静脉血栓栓塞之间存在关联,这需要进一步的评估。
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引用次数: 0
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Annals of Transplantation
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