Transplantation proceedings最新文献

Background/aim: Platelets not only participate in physiological hemostasis but also play a major role in liver ischemia-reperfusion injury, liver damage, tissue repair, and liver regeneration. A decrease in platelet count can lead to spontaneous bleeding, infection, and other complications that can seriously impact patient prognosis. Thrombocytopenia has been associated with increased complications after partial hepatectomy, although the effects of thrombocytopenia on patient outcomes remain unclear. Therefore, this study aimed to examine the impact of thrombocytopenia on short- and long-term prognosis following liver transplantation (LT).

Methods: This was a retrospective analysis comprising 234 adult liver transplant recipients and conducted from January 2019 to June 2022. Preoperative and postoperative daily platelet counts were recorded up to the 30th postoperative day (POD). We defined people with platelet counts <70 × 10⁹/L as the low platelet group, and people with platelet counts >70 × 10⁹/L as the high platelet group. Multivariate analysis was carried out to determine whether low perioperative platelet count was a risk factor for postoperative complications, graft failure, and patient survival.

Results: Of the 234 patients analyzed in this study, approximately half (n = 112, 47.9%) developed persistent thrombocytopenia after LT. The most substantial decrease in platelet levels occurred on POD7. The cumulative survival rates at 1, 2, and 3 years in the high platelet group were higher than those in the low platelet group, 94%, 87%, and 85%, respectively, while those of the low platelet group were 84%, 78%, and 70% (P = .0014). In addition, the high platelet group had a lower incidence of biliary complications compared with the low platelet group (8% vs 19%, P = .020). At the same time, the high platelet group had a lower incidence of posttransplant lung infection (55% vs 75%, P = .040).

Conclusions: Thrombocytopenia is a common complication of LT. It indicates the severity of the postoperative course and is closely associated with patient survival. In particular, patients who undergo orthotopic liver transplantation (OLT) and have a platelet count <70 × 10⁹/L on the POD7 have significant negative prognostic implications and should be further investigated.

Introduction: Alpha-1-antitrypsin deficiency (A1AD) is a genetically determined antiproteinase deficiency that predisposes to early-onset emphysema and liver disease. Lung transplantation (LTx) is the final therapeutic option. Behçet's disease (BD) is a rare autoimmune disease characterized by oral and genital ulcers and deep venous thrombosis associated with large-vessel and small-vessel vasculitis and aneurysms. The association of A1AD and BD is unknown. We describe a rare case of concomitant presentation of these pathologies in a patient submitted to LTx.

Case report: In 2012, a 31-year-old female presented with oral and genital ulcers associated with cavernous sinus thrombosis, being diagnosed with BD. In 2018, debuted with progressive respiratory symptoms. A computed tomography (CT) scan revealed extensive pulmonary emphysema associated with decreased pulmonary function. A1AD was identified with a heterozygous "MZ" allelic combination. She was referred to our LTx center in 2021. After additional investigation, she was considered for LTx and underwent standard bilateral LTx in July 2022. In the postoperative period, special attention was given to the risk of vascular complications, and postoperative angiography-CT was performed actively searching for this possible outcome. No major events occurred, and after 1 year, she is fully functional with no signs of BD activity.

Conclusion: To our knowledge, this is the first description of LTx for A1AD in a patient with BD, proving its feasibility in a highly selected patient at an experienced and specialized center. Nonetheless, solid organ transplantation in patients with BD remains a high-risk procedure and should be indicated with caution.

Kidney transplant recipients, reliant on lifelong immunosuppressive therapy, face potential drug interactions with emerging treatments such as paxlovid. This study aims to provide guidance for safe administration by examining the impact of paxlovid on tacrolimus levels in kidney transplant recipients. Seven kidney transplant patients who received paxlovid between December 2022 and August 2023 were included for retrospective analysis. Tacrolimus concentration changes were investigated both during and after the administration of paxlovid. Genetic testing for CYP3A5 polymorphisms assessed individual responses. The patient's treatment process was divided into four phases according to the paxlovid administration and the Tacrolimus trough level. The variation of tacrolimus valley concentration, concentration-to-dose ratios (C/D), and creatinine values in different periods were subsequently described and analyzed. The results indicate that tacrolimus levels increased significantly after receiving paxlovid, peaking on day two with a median trough level of 21.8 ng/mL. Prior to the administration of paxlovid, the median C/D value was 6.8 times higher (903.1 to 132.5). Once the paxlovid was stopped, the C/D value and trough level progressively returned to their preadministration levels. Importantly, no graft rejections, adverse events, or neurotoxicity were noted. The levels of creatinine remained stable. During paxlovid treatment, patients adhered to a modified tacrolimus regimen and progressively resumed baseline dosage. In summary, this is the first study to indicate a significant influence of paxlovid on tacrolimus levels in Chinese patients undergoing kidney transplantation. During paxlovid treatment, careful observation and tailored tacrolimus management are crucial to guarantee safe administration and circumvent negative consequences.

Pulmonary gangrene (PG) is a potentially devastating complication of necrotizing pneumonia. We describe successful nonsurgical management of PG in a lung transplant recipient. The patient presented with symptoms and imaging consistent with pneumonia. Bronchoalveolar lavage cultures demonstrated polymicrobial growth and antibiotic treatments were tailored. Imaging demonstrated a large cavitary lesion with intracavitary lung tissue consistent with PG. Prolonged antibiotic therapy resulted in clinical improvement and radiographic resolution.

Objectives: Organ transplant recipients express trust in their physicians with the phrase, "I entrust my life first to Allah and then to you." However, trust is not reflected in organ donor rates in Turkey despite the rising incidence of end-stage organ failures. The aim of this study was to map individuals' attitudes, willingness, and behavior toward organ donation, relationships with distrust in the health care system, religious aspects, and demographic variables.

Materials and methods: In a descriptive cross-sectional approach, a face-to-face questionnaire was issued to randomly selected 557 patients in family medicine clinics of 2 tertiary hospitals in Istanbul City. Positive and negative attitudes' subscales of the organ donation attitude scale and distrust in the health care system scale were used.

Results: The organ donation rate was 12.4%, and 37.9% of participants were willing to donate. A higher education level revealed higher rates of willingness but did not supply a higher donation rate (P = .001, P = .048). The liver was the organ with the most potential to donate (90.3%). The average positive and negative attitude scores toward organ donation were 48.10 ± 21.41 and 72.11 ± 26.47, highlighting negative tendency. The rate of refusals donated for religious reasons was 30.1%. It was observed that individuals who religiously refused organ donation were less willing to donate and showed higher distrust in the health care system (P < .001; P < .001), but they exhibited more positive and less negative donation attitude scores vs others (P < .001; P < .001). Approximately half of the participants reported awareness of organ donation law and brain death principles supporting a significantly higher donation rate (P < .001; P < .001).

Conclusions: Our findings highlight a crucial mismatch among willingness, attitudes, distrust, religious aspects, and actual behavior regarding organ donation. Strategically, educational materials and interventions on relevant laws, brain death principles, and reasons for becoming donors may be more effective than focusing solely on increasing donation rates.

Background: It is thought that the Fracture Risk Assessment Tool (FRAX) score of the World Health Organization (WHO) determines a 10-year fracture risk. This study aimed to investigate the major osteoporotic fracture (MOF) and hip fracture (HF) values determined with the FRAX score and practicality of the FRAX score in kidney transplant recipients (KTRs).

Methods: This study was conducted with 44 female and 59 male KTRs and 100 subjects in the healthy control group. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. FRAX scores were calculated from baseline information (age, height, weight, BMD of the femur and neck T score, fracture history, glucocorticoid use, smoking status, alcohol consumption, and presence of rheumatoid arthritis).

Results: In KTRs, FRAX score MOF, and FRAX score HF were found to be significantly elevated, whereas the BMD femur T score was determined to be significantly low. No significant relationship was found among the FRAX score MOF and HF and kidney function tests and bone parameters. In the receiver operating characteristic (ROC) analysis, which was performed based on the determination of the FRAX score, the cutoff point was determined as ≥ 3.4 for MOF and ≥ 0.4 for HF.

Conclusion: In KTRs, increased FRAX score MOF and HF compared with healthy individuals were determined. FRAX score MOF ≥ 3.4 and HF ≥ 0.4 values indicate high-risk patients for increased fracture risk. The high accuracy rates determined suggest that the use of the FRAX score in KTRs is a valuable method for determining fracture risk.

Although diabetes is not an absolute contraindication for kidney donation, donor kidneys with severe diabetic nephropathy (DN) are frequently discarded. Current experience with the use of donor kidneys with severe DN is limited. Herein, we report a case of deceased donor kidney with Renal Pathology Society (RPS) classification scheme class III DN transplanted to a female recipient without postoperative hyperglycemia. Although kidney allograft biopsy still showed class III DN at 6 months, it turned to RPS class IIa DN combined with chronic antibody-mediated rejection at 4.5 years and 9 years. At the last follow-up approximately 10 years after transplantation, the patient's serum creatinine was 2.27 mg/dL. Our case indicates that with careful selection of potential recipients, favorable clinical outcomes can be achieved even with donor kidneys with severe DN. Thus, RPS class III diabetic donor kidneys deserve further evaluation and should not always be discarded.

Objective: The objective of this study was to compare the effects of two kinds of gargles (Koushu & Koutai) on oral mucositis (OM) in patients with agranulocytosis.

Methods: One hundred eighty patients who underwent allogeneic hematopoietic stem cell transplantation in the Peking University Institute of Hematology were enrolled from March 2018 to January 2019. The subjects were randomly divided into two groups by random number table. The observation group gargled with Koushu gargle, whereas the control group gargled with Koutai gargle. Patients in both groups used 10 to 15 mL of gargles for 2 minutes when awake in the morning, 30 minutes after each meal, and before sleep. The two groups used the same way to gargle except the types of gargle used. The difference of incidence, grade, healing time, and pain grade of oral mucositis were analyzed.

Results: The incidence of oral mucositis in the observation group was significantly lower than that in the control group (P < .01).There were no significant difference in grade of OM, healing time, or pain grade between the two groups (P > .05). The effect of the Koushu gargle on the prevention of OM among the patients with agranulocytosis is better than that of the Koutai gargle. The Koushu gargle is better suited than the Koutai gargle as a prevention and treatment option for the patients.

BK virus-associated nephritis (BKVAN) is an important cause of graft loss in renal transplant recipients B K viremia occurs in up to 30% of renal transplant recipients. Since the discovery of BKV in 1971, effective prophylaxis and treatment have not been established, and it is not uncommon for a transplant kidney to be lost without cure of BKVAN. BK virus infection is reactivated when cellular immunity is suppressed, which is often during the first year after kidney transplantation when cellular immunity is most suppressed. Clinically, it is caused by reactivation of latent infection or new infection from the donor kidney, leading to viremia, viremia, and transplant nephropathy. BK virus nephropathy is currently diagnosed definitively by measuring the amount of BK virus DNA in the blood and proving SV40-positive cells in transplant kidney tissue obtained by transplant kidney biopsy, but the time required for diagnosis and the low sensitivity of immunohistochemistry using antibodies are problematic. Therefore, we investigated whether the diagnosis of BK virus nephropathy could be made earlier by searching for miRNAs in the urine of renal transplant recipients.