Transplantation proceedings最新文献

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: Determining effective ways to make prognostic predictions after kidney transplantation of patients is essential for the management of patients. This study examines how the PNI score affects renal outcomes after kidney transplantation. The potential impact of PNI on renal function beyond the overall nutritional status was also examined.

Methods: In this retrospective study, 100 kidney transplant patients were divided into three groups according to PNI scores: low (<40), intermediate (40-45) and high (>45). Demographic characteristics, clinical parameters, serum creatinine levels, estimated glomerular filtration rate (eGFR) and parenchymal thickness were evaluated. Logistic regression analysis was applied for the risk of graft rejection. Patients who were followed up for at least 6 months after kidney transplantation and had complete clinical data were included in the study. The mean follow-up period was 36 months (range: 6-60 months).

Results: There was no statistically significant correlation between PNI scores and renal function (P > .05). The mean creatinine level was 1.73 ± 1.11 mg/dL in the low PNI group and 1.37 ± 0.52 mg/dL in the high PNI group. Although this difference was close to the limit of statistical significance, it was not significant (P = .083). In logistic regression analysis, no significant effect of PNI score on graft rejection was observed (OR: 1.0015, 95% CI: 0.7975-1.2576, P = .9899). However, age (OR: 0.9247, P = .0347) and serum creatinine levels (OR: 2.8396, P = .0151) significantly affected the risk of graft rejection. No significant effect of PNI score on complication rates was observed.

Conclusions: This study demonstrated that PNI score alone is not a sufficient predictor of renal prognosis and graft rejection risk after kidney transplantation. Factors such as age and serum creatinine levels were found to be more predictive of the risk of graft rejection.

Background: Nonadherence to immunosuppressive therapy after heart transplantation, driven by factors such as patient, caregiver, institutional, policy-related issues, and health literacy, leads to rejection and increased mortality. This study aimed to investigate the relationship between health literacy and adherence to immunosuppressive therapy in heart transplant patients.

Methods: The sample of this cross-sectional study consisted of 57 patients who underwent heart transplantation in a university hospital in Izmir, Turkey. "Sociodemographic and Descriptive Characteristics Form", "Data on Immunosuppressive Drug Therapy Form", "Rapid Estimate of Adult Health Literacy in Medicine (REALM) Scale", and "Immunosuppressive Therapy Adherence Scale (ITAS)" were used to collect the data..

Results: The median score on the REALM scale was 64.00 (IQR = 3.00, min = 18.00, max = 66.00) and 80.7% of the patients scored adequately. The median score of the immunosuppressive therapy adherence scale was 11.00 (IQR= 1.00, min= 5.00, max= 12.00) and 42.1% of the patients scored full score. There was no statistically significant relationship between the median total scores of the REALM and ITAS scales in heart transplant patients (r = 0.181, P = .178).

Conclusions: In this study, the majority of heart transplant patients had adequate health literacy. It was found that less than half of these patients adhered to immunosuppressive therapy. Less than half of these patients were found to comply with immunosuppressive therapy. In this study, no relationship was found between health literacy and adherence to immunosuppressive therapy.

Purpose: Liver transplantation is a life-saving procedure for patients with end-stage liver disease. The postoperative period presents significant challenges, particularly in managing acid-base balance and lactate levels, which are crucial indicators of metabolic stability and tissue perfusion. While these parameters provide valuable insights into patient recovery, their role in predicting intensive care unit (ICU) length of stay remains unclear. This study evaluates whether early postoperative acid-base balance and lactate levels can reliably predict ICU length of stay in liver transplant recipients, aiming to enhance postoperative care strategies.

Methods: A retrospective observational study was conducted on 53 adult liver transplant recipients. Acid-base and lactate parameters were measured at two-time points: early (within the first 6 hours) and late (6-24 hours) postoperatively. Paired t-tests and Wilcoxon signed-rank tests were used to compare these measurements. Multiple linear regression modeling was employed to assess the impact of these parameters on ICU length of stay.

Results: Significant changes were observed in FiO₂, pH, Base Excess, HCO₃, lactate, and Strong Ion Difference (SID) between early and late postoperative measurements (P < .05). However, regression analysis revealed that maximum lactate and early SID were not strong predictors of ICU length of stay (R² = 0.062). Exploratory analyses indicated that patients with elevated SID and markedly high lactate levels tended to have prolonged ICU stays.

Conclusions: While postoperative acid-base balance and lactate levels are important indicators of physiological status in liver transplant recipients, they do not serve as strong independent predictors of ICU length of stay.

Background: The aim of this study was to investigate the relationship between ultrasonographic elastography score and long-term renal prognosis in renal transplant patients.

Methods: A retrospective cohort study of 100 patients who underwent renal transplantation in our hospital between 2005 and 2022 was performed. Patients were divided into two groups as those with elastography scores higher than 8.45 kPa (n = 50) and those with elastography scores equal to or lower than 8.45 kPa (n = 50). Elastography measurements were performed with Siemens Acuson S2000 ultrasound system and the scores were compared with renal function parameters and other clinical characteristics.

Results: Patients with high elastography scores had smaller kidney size (P = .010), lower eGFR (P = .002), and higher proteinuria and albuminuria levels (P < .05) than patients with low elastography scores. There was a significant association between elastography score and the risk of renal dysfunction (OR = 1.039, P = .006).

Conclusions: A large elastography score may act as a significant biomarker for prognosing the risk of renal dysfunction in subjects undergoing kidney transplantation. These findings suggest that elastography may become an invaluable noninvasive tool during the long-term follow-up of patients with renal transplants.

Background: Hyperparathyroidism (HPT) often persists after successful kidney transplantation (KTx). Although parathyroidectomy (PTx) is an effective treatment option for post-KTx HPT, it is associated with postoperative elevation of serum creatinine levels. We hypothesized that pre-PTx calcimimetic treatment could alleviate the post-PTx increase in serum creatinine levels.

Methods: This retrospective cohort study enrolled KTx patients who underwent initial PTx between 2004 and 2023. Patients' background characteristics and laboratory data were investigated. The primary outcome was a change in the estimated glomerular filtration rate (eGFR). The cohort was divided into 2 groups based on the presence of pre-PTx calcimimetic treatment. Multivariate linear regression analysis assessed the association between calcimimetic treatment and percent eGFR 1 week after PTx.

Results: Of the 77 KTx patients who underwent PTx, 28 were treated with pre-PTx calcimimetics (calcimimetic group), and the others were not (noncalcimimetic group). Compared with the noncalcimimetic group, the calcimimetic group had lower serum calcium levels before PTx (10.3 vs 11.2 mg/dL, P < .001) and a significantly higher percentage of eGFR 1 week after PTx (95.1% vs 81.5%, P < .001). According to the multivariate analysis, pre-PTx calcimimetic treatment was positively associated with percent eGFR (regression coefficient estimate, 13.76; 95% confidence interval, 7.02-20.50; P < .001) 1 week after PTx.

Conclusion: Pre-PTx calcimimetic treatment may prevent post-PTx elevation of serum creatinine levels in KTx patients.

Background: The Coronavirus disease 2019 (COVID-19) pandemic has been a global reality for longer than 3 years. Serologic studies have great importance for understanding the virus's behavior in populations, as it can suggest the status of the epidemic in a community. This cross-sectional study aimed to analyze the serologic profile for COVID-19 in patients before and after pediatric heart transplantation.

Methods: Serology data on IgG and IgM antibodies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were collected in patients of the Pediatric Cardiology and Congenital Heart Diseases unit of a Brazilian hospital between January and August 2022. A total of 174 patients were recruited, including 28 on the transplantation waiting list and 146 heart transplant recipients. Information for each patient, including demographics (age, sex, state of origin), type of heart disease (congenital or acquired), and time after transplantation, was analyzed.

Results: Overall, 72 patients had a positive serology for anti-N antibodies (48.0%), including 62 heart transplant recipients and 10 patients on the transplantation waiting list, The positivity rates in these 2 groups were 48.1% and 47.6%, respectively. Positivity rates for previously infected individuals were 62.5% and 62.1%, respectively.

Conclusions: Approximately one-half of our study sample had IgM or IgG antibodies against the SARS-CoV-2 virus. Serologic studies on the duration and level of protection provided by these antibodies are relevant public health tools for health promotion of vulnerable groups and can be useful for future studies on antibody behavior.

Background: COVID-19, caused by SARS-CoV-2, was responsible for higher morbidity and mortality in renal transplant recipients (RTx). The objective of the study was to evaluate the impact of COVID-19 infection on RTx in a single center in Brazil.

Methods: A cohort of 135 RTx was evaluated between December 2019 and June 202l, and demographics, clinical, and laboratory profiles were analyzed from deceased donors with COVID-19.

Results: Diabetic and RTx from extended criterion donors presented more frequently the severe form of the disease. Serum creatinine (sCr) after 3 months of diagnosis of COVID-19 varied according to the severity of infection. The lethality rate was higher in the group with severe symptoms (65%) compared with those with mild infection (1.5%).

Conclusion: The increase in sCr was associated with disease severity. The lethality rate for COVID-19 was 26.6%. These rates are 10-20 times higher than those reported in the general population and suggest that rigorous observation, early diagnosis, and disease prevention measures are crucial in RTx.