Transplantation proceedings最新文献

Sclerosing Encapsulating Peritonitis (SEP) is a rare condition characterized by chronic inflammation of the peritoneum, of either idiopathic origin or sometimes due to local or systemic factors. The symptoms are often non-specific, and in many cases, the diagnosis is only made during laparotomy or laparoscopy. In severe cases, SEP can be a contraindication for liver transplantation because of the associated risk of surgical complications.

Method: To report on the incidence and management of SEP identified during liver transplantation at our center, and to document the associated Serious Adverse Events (SAEs).

Results: We present a series of 3 cases from 2022 to 2023, where SEP was diagnosed intraoperatively. These cases were marked by significant technical challenges, including extensive adhesions, dense fibrous encapsulations, and severe intraoperative hemorrhage necessitating blood transfusions. Despite these complexities, all transplants were successfully completed. One patient experienced a peak serum AST of 2000 U/L, and another had a bilirubin of 10 mg/dL, indicative of early graft dysfunction, both of which resolved within the first week. One patient required an emergency laparotomy due to hemorrhage. No additional severe complications were observed postoperatively. All patients are currently alive with functioning grafts and have been followed for at least 18 months.

Conclusions: A multidisciplinary approach and advanced surgical planning are crucial for successfully performing complex liver transplants in patients with SEP. Intraoperative recognition of SEP requires meticulous strategies to minimize blood loss and optimize hemostasis, while avoiding organ injuries, as these factors are critical for improving the survival outcomes in these patients.

Background: Immune system impairment and chemotherapies prior to autologous hematopoietic stem cell transplantation (auto-HSCT) significantly increase the risk of respiratory tract infections (RTIs), especially within 100 days after HSCT. Prophylaxis of RTIs among patients with HSCT are of high importance, clinical experiences have been learnt previously that oropharyngeal probiotic is safe and able to significantly reduce RTIs among patients with recurrent RTIs in both children and adults, the aim of this study is to explore the safety and preventive effects of oropharyngeal probiotics BP-OM1 on RTIs among patients after HSCT.

Methods: Sixteen subjects aged between 18 and 65 years old who underwent HSCT were enrolled in a multicenter, randomized controlled trial. The subjects were randomly assigned to the oropharyngeal probiotics group and the control group. Patients were intervened and monitored for 130 days.

Results: Less duration and severity of presented RTI-like symptoms observed among patients in the probiotic group resulted in a significantly decreased days of antibiotic consumption post-HSCT. No oropharyngeal probiotic-related adverse events were reported throughout this study, indicating that oropharyngeal probiotic BP-OM1 administration is safe for patients whose hematopoietic system are well reconstructed post-HSCT.

Conclusions: The administration of oropharyngeal probiotic BP-OM1 could potentially be a safe self-care approach for patients who underwent HSCT to manage the RTI prevention and reduce the risks of developing lower respiratory tract infection (LRTI), which favors the rational use of antibiotics, which is associated with a reduced risks colonization of multi-drug resistance microorganisms.

Pre-existing diabetes mellitus (DM) prior to solid organ transplant (SOT) and development of post-transplant diabetes mellitus (PTDM) is common. The use of novel agents, such as glucagon-like peptide-1 receptor agonists (GLP-1 RA), has increased in the general population due to beneficial effects on cardiovascular disease (CVD) and weight loss. However, there is limited data in the SOT population. A retrospective, observational, matched cohort study in outpatient SOT recipients on injectable diabetes therapy was performed at a single academic medical center. The purpose of the study was to compare glycemic control in SOT recipients using a GLP-1-RA-containing regimen compared with insulin-only when initiated within 12 months of transplant. Seventy patients were included in the analysis with 51% of subjects in each group reaching their A1c goal within 1 year after starting diabetes therapy. The median A1c was 7.0% in the GLP-1 RA group and 6.9% in the insulin only group (P = .30). One year after starting diabetes therapy, insulin use decreased to 69% in the GLP-1 RA group, while 94% of subjects in the insulin only group remained on insulin (P = .007). There were 7.2 fewer injections per week in the GLP-1 RA group compared to 4.6 more in the insulin group (P < 0.001). In SOT recipients within 12 months of transplant, the use of GLP-1 RA for blood glucose management had the same A1C goal attainment as insulin-only while allowing for fewer injections per week.

Background: Pre-emptive kidney transplantation is considered the optimal treatment for end stage kidney disease (ESKD). The aim of the study is to evaluate current state of pre-emptive kidney transplants in the United States with focus on mortality benefit with early pre-emptive transplants.

Methods: Using the United Network of Organ Sharing database, we explored trends in pre-emptive kidney transplantation in first time adult recipients. We created four groups (estimated glomerular filtration rate [eGFR] < 10 mL/min/1.73 m², 10 to < 15 mL/min/1.73 m², 15 to < 20 mL/min/1.73 m², and ≥ 20 mL/min/1.73 m²) based on the eGFR at the time of transplant. Multivariable Cox regression was used to assess the difference in mortality and cumulative incidence competing risk (CICR) method was used to compare risk of ESKD among the groups.

Results: Pre-emptive kidney transplant remain at roughly 18% of total kidney transplant (33% were from deceased donors and 67% from living donors). White patients with a higher level of education and with private insurance were most likely to receive pre-emptive kidney transplant. No difference in mortality was found in the four eGFR groups. In a subgroup analysis looking only at recipients of pre-emptive kidney transplant from living donors, no mortality difference was again noted among the four groups.

Conclusions: Pre-emptive kidney transplants continue to favor a select population and remain at low numbers (9% of total deceased donor kidney transplants and 33% of living donor kidney transplants [LDKTs]). Early pre-emptive living donor kidney transplant did not confer a mortality benefit compared to transplantation when eGFR was < 15 mL/min/1.73 m².

Acute liver failure (ALF) caused by hepatic vascular injury during cholecystectomy is a rare but serious indication of liver transplantation (LT). We present a case of acute liver failure secondary to portal vein, hepatic artery, and common bile duct injury during laparoscopic cholecystectomy, requiring a same-day emergency living donor liver transplantation (LDLT). A 57-year-old man underwent elective laparoscopic cholecystectomy at an external facility. During the operation, uncontrolled bleeding from the liver hilum led to conversion to open surgery. Despite attempts to control the bleeding with sutures, the patient developed abnormal liver enzymes postoperatively. A computed tomography scan revealed necrosis of the right liver lobe and hypoplasia of the left lobe, leading to the patient to be transferred to our center. Upon admission, the patient was found to have encephalopathy, coagulopathy, hypotension, and oliguria, with elevated transaminase levels. Based on these findings, an emergency LT was deemed necessary. Due to the unavailability of a cadaveric organ, the patient's daughter was prepared as a living donor. Exploratory laparotomy revealed a necrotic right liver lobe, atrophic left lobe, transection of the right hepatic artery and common bile duct, and a thrombosed right portal vein. The patient successfully underwent LDLT from his daughter within 24 hours. At the seventh-month follow-up, he had no complications. Hepatic vascular injury during laparoscopic cholecystectomy can lead to ALF, which carries a high mortality risk. In such cases, LDLT may be a life-saving strategy. Early referral of a patient with ALF to a transplant center is life-saving.

Aim: We aimed to investigate the effects of Empagliflozin on cardiac arrhythmias and heart rate variability in kidney transplant recipients (KTRs).

Methods: Twenty-seven diabetic patients who underwent kidney transplantation between August 2020 and August 2023 were included. Patients with HbA1c >8% were received Empagliflozin treatment. A 24-hour Holter ECG monitoring was performed before and one year after beginning Empagliflozin. Holter ECGs were evaluated by a single cardiologist, comparing ventricular ectopic beats (VEB) and supraventricular ectopic beats (SEB) arrhythmias and heart rate variability parameters before and after one year of Empagliflozin treatment.

Results: Twenty-seven patients completed the study, and the mean patient age was 56.1 ± 10 years. Fifteen of the patients (55.6%) were male. The mean duration since transplant before starting Empagliflozin was 62.8 ± 46.2 months. In follow-up, HbA1c decreased from 8.2% to 7.7%(P = .075), urine protein/creatinine ratio reduced from 0.437 ± 0.428 to 0.267 ± 0.146 gr/g (P = .056), and platelet count increased significantly (P = .004). After one year of treatment, the number of VEBs and SEBs in the patients decreased compared to pretreatment. They decreased from 173.5 ± 460.8 and 514.8 ± 265 beats before treatment to 125.1 ± 231.7 and 125.1 ± 231.7 beats after treatment, respectively, but did not reach statistical significance (P > .05). No significant changes were found in heart rate variability parameters (P > .05). No significant correlation was found between VEBs and SEBs and cardiac inflammation indicators (P > .05).

Conclusion: This study, for the first time, investigated the effect of Empagliflozin on cardiac arrhythmias and heart rate variability in diabetic KTRs. Empagliflozin did not significantly affect cardiac arrhythmias and heart rate variability in KTRs.

Background: Vascularized composite allotransplantation (VCA) holds significant promise for patients with complex structural defects, providing solutions unattainable through traditional methods. Despite technical successes, graft rejection and ischemia-reperfusion injury (IRI) present major challenges, with high rejection rates even under modern immunosuppression protocols. This review synthesizes current literature on immunologic pretreatments (IPTs) designed to mitigate these issues, focusing on interventions applied to donor tissues between procurement and transplantation.

Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 11 relevant studies, categorizing IPTs into donor tissue modification (DTM), deoxygenated perfusate, and oxygenation methods.

Results: DTM, the most common IPT method, shows promise in reducing immunogenicity and prolonging graft survival, primarily through techniques such as recipient bone marrow-derived cell conditioning and MHC-I knockdown using small interfering RNA (siRNA). Deoxygenated perfusate studies highlighted mitomycin C's potential in reducing immune response and extending graft viability. Oxygenation methods, aimed at minimizing IRIs, utilized perfusion techniques to maintain graft viability ex vivo.

Conclusions: Although IPTs for extending graft survival have seen moderate clinical translation, those targeting immunogenicity remain largely experimental. This review underscores the potential of these IPT modalities to improve VCA outcomes by reducing rejection and IRIs. However, it also highlights the need for further research, particularly multi-center clinical trials, to validate these techniques for broader clinical adoption. This comprehensive synthesis aims to guide future studies and enhance clinical strategies for VCA, ultimately improving patient outcomes.

Objective: We evaluated the willingness and influencing factors of Chinese medical students to donate an organ.

Methods: A total of 17 articles on the willingness of Chinese medical students to donate organs and related influencing factors were collected from domestic and foreign databases. The retrieval period was from the inception of the database to August 31, 2023. RevMan5.3 software was used to conduct a meta-analysis of the binary data in the included literature, and meta-integration was performed on the influencing factors of organ donation.

Results: In this study, we found that 52% of medical students in China (95% confidence interval, 39%-66%) were willing to donate organs. A subgroup analysis showed that clinical medical students (69%) had greater willingness to donate than nursing students (27%), and medical students in the western region (58%) had a greater willingness to donate than those in the eastern region (51%). Studies with a small sample size (54%) found a greater willingness to donate than studies with a large sample size (49%), and the difference was statistically significant (P < .001). Fifty influencing factors were summarized in the included study, categorizing them into 10 categories, and further integrating them into 3 factors, namely personal factors, family factors, and social factors.

Conclusions: The willingness to organs donation among medical students in China remains at a moderate level, and the demonstration effect has not been reflected fully.

Alcohol-associated liver disease is now the leading indication for liver transplantation in the United States in the context of liver transplantation for patients with less than 6 months of abstinence from alcohol. To determine whether patients with less than 6 months of sobriety have worse perioperative outcomes than those with standard sobriety requirements, we performed a retrospective cohort study, comparing limited and standard sobriety patients undergoing orthotopic liver transplantation from May 2018 to October 2022 at a single academic tertiary transplant center. The limited sobriety cohort comprised adult patients with end-stage liver disease secondary to alcohol use disorder who presented with their first episode of hepatic decompensation, with less than 6 months of sobriety. This group was compared with a standard sobriety cohort, consisting of patients with alcohol-associated liver disease with more than 6 months of sobriety. A total of 169 patients were selected for analysis, with 58 in the limited sobriety group and 111 in the standard sobriety group. The limited- sobriety group was younger (median 42 years vs 54 years; P < .01) and had more severe liver disease than the standard sobriety group (median Model for End-stage Liver Disease scores of 39 vs 34; P < .01) at the time of transplantation. There were no statistically significant differences in the primary outcomes between the 2 groups. Despite having more severe liver disease, the limited sobriety management pathway was not associated with worse perioperative outcomes than the standard sobriety pathway. Our findings indicate liver transplantation in patients with limited sobriety do not require increased perioperative resources.

Purpose: This study aims to determine whether intraoperative analysis of arterial and portal venous flow using transit time flow measurement (TTFM) data is associated with a reduced incidence of vascular complications after orthotopic liver transplantation.

Methods: This is a retrospective chart review of all adult orthotopic liver transplant recipients at Saint Louis University Hospital from 2015-2020 (n = 188). We reviewed intraoperative flow probe use, as well as documentation of abnormal flow patterns detected during surgery. Normal graft flow measurements were defined as hepatic artery flow >100 ml/min and portal vein flow >0.5 ml/min/gram-liver. Postoperative imaging and ultrasonographic data were then reviewed for reports of vascular complications requiring intervention between the time of transplant and December 31, 2020. The incidence of VCs was compared between those who received intraoperative TTFM and those who did not. We then compared the demographic composition of these 2 groups to ensure similarity and screen for potential confounding factors.

Results: 188 liver transplant operative reports met the criteria for inclusion and were reviewed. TTFM use was documented in 78 (41.5%) cases and abnormal flow was detected in 8 (10.3%) of these cases, prompting intraoperative correction. Subsequently, no patients who received intraoperative TTFM developed vascular complications during the postoperative course. Conversely, of the 110 (58.5%) cases with no reported intraoperative flow data, 6 (5.5%, P = .042) patients later developed vascular complications. Reported vascular complications included hepatic artery stenosis, hepatic artery thrombosis, portal vein thrombosis, hepatic vein thrombosis, and IVC thrombosis. There was no significant difference in patient population between patients who received intraoperative TTFM and those who did not, apart from the type of liver implantation. There was a significantly higher prevalence of bicaval liver implantations in the group of patients who did not receive TTFM than those who did (P = .002).

Conclusions: Transit time flow measurement may be a useful tool for the detection of vascular flow abnormalities intraoperatively, allowing for early correction and prevention of vascular complications during the postoperative course. This could potentially result in enhanced graft survival and reduced recipient mortality following orthotopic liver transplantation.