Transplantation proceedings最新文献

Background: Living donor liver transplantation is the definitive treatment for decompensated cirrhosis. While the prognosis for high Model for End-Stage Liver Disease (MELD) patients is well-studied, risk factors in low MELD patients remain unclear. This study aimed to identify prognostic risk factors for low MELD cases.

Methods: We analyzed 838 adult living donor liver transplantation patients from September 1998 to April 2024 and divided them into low MELD (≤15) and high MELD (>15) groups. The low MELD group was further categorized into early and non-early graft loss subgroups. The risk factors for recipient survival were analyzed.

Results: Of the 838 patients, 408 (48.7%) were in the low MELD group, and 430 (51.3%) were in the high MELD group. The survival rates were significantly higher in the low MELD group than in the high MELD group. In the low MELD group, 5.1% (21 patients) experienced early graft loss, and 94.9% (387 patients) were classified as non-early graft loss. Independent risk factors for early graft loss included donor body mass index ≥25 kg/m², absence of simultaneous splenectomy, and postoperative complications. One year survival rates were significantly lower in patients with more risk factors.

Conclusion: Donor body mass index, absence of simultaneous splenectomy, and postoperative complications were identified as independent risk factors for poor prognosis in living donor liver transplantation patients with low MELD. Surgeons must focus on performing meticulous surgeries to minimize the risk of complications.

Background: Hypothermic oxygenated perfusion (HOPE) is a promising technology to improve donated after cardiac death (DCD) liver graft. It was found that protein phosphatase 2A (PP2A) could regulate autophagy and apoptosis, which play a pivotal role in hepatic ischemia reperfusion injury (IRI). In this study, we aim to explore whether PP2A take part in the mechanism that reduces organ damage after HOPE.

Method: Adult male Sprague Dawley rats were divided into four groups at random. DCD livers of HOPE group were preserved in a HOPE system after 23 hours of cold storage (CS). All groups' livers were reperfused in an isolated perfused rat liver (IPRL) system for 1 hour at 37°C. After reperfusion, markers related to IRI and protein expression of PP2A related pathway were examined. BRL-3A cells were cultured and incubated with different concentrations H₂O₂ (0, 50 μM and100 μM). The cellular production of Reactive Oxygen Species (ROS) was detected via the fluorescent intensity of 2,7-Dichlorodihydrofluorescein diacetate (DCFH-DA), and PP2A related pathway protein expression was measured.

Results: HOPE group suffered the lighter IRI when compared with CS group, evidenced by the lower hepatocytes injury degree, apoptosis rate, and oxidative stress. Further, compared with CS group, the PP2A and ERK1/2 related autography pathway activation of HOPE group was higher, while the JNK and p38 related apoptosis pathway was down-regulated. Cellular experiment showed that mild oxidative stress (50 μM H₂O₂) could activate the expression of PP2A and autography pathway protein. Severe oxidative stress (100 μM H₂O₂) shown the opposite regulation effect.

Conclusion: Through reducing oxidative stress, HOPE attenuates IRI to rat DCD livers via activating PP2A related autography pathway and inhibiting apoptosis pathway.

Lung transplantation, as an important treatment for end-stage lung disease, significantly improves patients' quality of life and prognosis. However, optimizing postoperative immunosuppressive therapy remains a major challenge in clinical practice, particularly in balancing transplant rejection and infection risks. Current research shows that traditional immunosuppressive protocols have limitations in addressing the individual needs of different patients, leading to increased adverse reactions and transplant failure rates. Therefore, this article reviews the latest advancements in postlung transplant immunosuppressive therapy, focusing on the selection of basic immunosuppressive protocols, optimization of drug combinations, and formulation of personalized treatment strategies. The article also discusses individualized therapy guided by immune monitoring biomarkers, the application of novel immunosuppressive drugs, and precision management strategies for patients with varying immune risks, aiming to provide a theoretical basis and practical guidance for clinical practice to enhance the long-term survival rates and quality of life of lung transplant patients.

Objective: To investigate the association between LncRNA H19 single nucleotide polymorphisms and delayed graft function.

Methods: This retrospective study included 827 kidney transplantations performed between January 1, 2015, and December 31, 2022, and fifty recipients with delayed graft function were assigned to the DGF group, while fifty recipients with immediate graft function were assigned to the IGF group. The DGF recipients and the IGF recipients had donor kidneys from the same donor. Single nucleotide polymorphisms (SNPs) of LncRNA H19 (rs217727, rs2067051, rs2251375, rs492994, rs2839698, and rs10732516) were genotyped using peripheral blood samples, rs2067051, rs2251375, rs492994, rs2839698 and rs10732516.

Results: Patients in the DGF group had 43 homozygous, 2 wild-type, and 5 heterozygous rs492994 gene loci, and 38 homozygous, 2 wild-type, and 10 heterozygous rs2839698 gene loci. Patients in the IGF group had 34 homozygous, 2 wild-type, and 14 heterozygous rs492994 gene loci, and 48 homozygous, 1 wild-type, and 1 heterozygous rs2839698 gene loci. There were differences in SNP between the DGF group and the IGF group at the rs492994 and rs2839698 gene loci, with P < .05 and statistically significant differences. However, there was no statistically significant difference in SNP at the other 4 gene loci, with P > .05. Since the donor kidneys in the DGF group and the IGF group come from the same donor, their donor data are identical and there are no differences. However, there were no significant differences between the 2 groups in donor kidney laterality, cold ischemia time, vascular anastomosis time, or key recipient characteristics (e.g., age, gender, body mass index, HLA mismatch rate) (all P > .05).

Conclusion: The polymorphisms rs492994 and rs2839698 in LncRNA H19 are significantly associated with the occurrence of DGF after kidney transplantation.

Background: Antibody medicated rejection is a challenging condition for patients undergoing liver transplantation. This study aims to investigate the mechanism of AMR and identify potential serum ma`rkers for AMR diagnosis.

Method: The liver tissue of 4 patients with AMR and 4 patients without AMR were collected. Whole transcriptome sequencing (RNA-seq) was performed to compare the transcriptomic alterations between the 2 groups of patients, and between tissues obtained before AMR and after AMR cure. Mass spectrometry was also performed to compare the serum proteomic changes of the 2 groups.

Results: Transcriptomic analysis between patients with and without AMR revealed differential expression of mRNA, lncRNA and circRNA. Analysis of differential mRNA revealed the alterations of CD and IL markers, possibly involving M1 macrophages, T cells and dendritic cells. The fold changes of mRNA levels of HLA type I and II molecules between 1.57 and 3.13 (P < .05) suggested increased expression of HLA in all nucleated cells. In contrast, significant alterations in lncRNA and circRNA linked genes suggested comprehensive up- or down-regulations in T, B, NK cells, DCs and monocytes. Serum protein analysis between patients with or without AMR identified significant down-regulation of complement C3 (fold change: 0.63, P = .028), C6 (fold change: 0.72, P = .05), C8 (fold change: 0.67, P = .020), factor H (fold change: 0.54, P = .007), and C4-binding proteins(fold change: 0.70, P = .025), and significant up-regulation of HLA class I molecules(fold change: 2.53, P = .006), IgKappa (fold change: 2.17, P = .023), low-affinity IgGamma (fold change: 1,74, P = .024), which could be potential serum markers for AMR. Further transcriptomic analysis revealed comprehensive and unspecific alterations of immune cell levels, HLA antigen levels and cytokine expression in patients recovered from AMR following treatment, suggesting the presence of immune changes even after AMR cure.

Conclusions: AMR caused a wide range of changes in the cellular microenvironment in the graft liver, including cell composition, antigen expression and cytokine expression. A panel of serum protein markers related to AMR has been identified and may potentially be used for ARM diagnosis.

Objective: Examine the existing dynamics of intimate relationships between kidney transplant recipients and their spouses, assess its relationship with the hardship of spousal caring, and establish a foundation for the creation of pertinent interventions to mitigate caregiving burdens.

Methods: A convenience sampling method was employed to select 76 pairs of recipients and spouses who were consistently monitored postkidney transplantation at a tertiary hospital in Nanjing, Jiangsu Province, China, utilizing a general information questionnaire, the Intimate Bond Measure (IBM), Lock-Wallace Marital Adjustment Test (MAT), Zarit Caregiver Burden Interview (ZBI) and Distress Thermometer (DT) for a cross-sectional study.

Results: The IBM scores for kidney transplant recipients and their spouses were (40.86 ± 8.05) and (41.09 ± 7.79), respectively, indicating a moderate level of marital intimacy. The MAT scores for recipients and spouses were (122.38 ± 27.08) and (121.76 ± 22.73), respectively, with 80.26% demonstrating good marital adjustment. The spouses' total ZBI score was (19.30 ± 10.98), reflecting a mildly burdensome level. The total DT score for spouses was 3.12 ± 2.30, with 26.32% exhibiting psychological disturbances requiring further evaluation and treatment. Correlation analysis indicated a negative relationship between spousal intimacy and spousal care burden (P < .01). Multiple linear regression analysis revealed that four variables-income level of kidney transplant recipients, duration of recipients' illness, frequency of intimacy behaviors, and degree of spousal psychological distress-were included in the regression equation, collectively accounting for 77.9% of the total variance in spousal care burden (P < .001).

Conclusion: The intimacy between spouses in kidney transplant recipients is inversely related to the stress of caregiving experienced by the spouse. Healthcare professionals should underscore the beneficial role of spouses in therapeutic care, implementing strategies to enhance spousal intimacy and alleviate caregiving burdens, thereby improving the quality of spousal care and the survival outcomes of kidney transplant recipients.

Background: Although several studies have assessed factors associated with intraoperative blood loss (IBL) during liver transplantation, most have been conducted on brain-dead donors, with few studies on living donors that have reported inconsistent findings. This study retrospectively investigated factors associated with IBL in living-donor liver transplantation (LDLT).

Methods: This study included 250 patients aged ≥20 years who underwent LDLT at our institution between January 2013 and September 2018. IBL, obtained from anesthetic records, was subjected to log-transformation and analyzed using a general linear regression model. The backward method was used for variable selection and the values were exponentially transformed to describe the results.

Results: Multivariable analysis revealed that male sex (vs female, 1.37-fold, 95% confidence interval (CI): 1.14-1.66), body mass index (BMI) (1.05-fold for every 1 kg/m² increase, 95% CI: 1.03-1.08), platelet count (0.98-fold for every 10,000/µL increase, 95% CI: 0.96-0.99), white blood cell (WBC) count (1.04-fold for every 1000/µL increase, 95% CI: 1.002-1.08), serum sodium ion (Na⁺) levels (0.96-fold for every 1 mEq/L increase, 95% CI: 0.94-0.98), serum total protein (TP) (0.88-fold for every 1 g/dL increase, 95% CI: 0.79-0.98), and use of a venous bypass (vs nonuse, 1.96-fold, 95% CI: 1.01-3.73) were significantly associated with IBL.

Conclusions: Male sex, high BMI, low platelet count, high WBC count, low Na⁺ levels, low TP levels, and the use of venous bypass can lead to excessive IBL during LDLT. Preoperative assessment of these factors is crucial for perioperative management.

Background: Biliary complications remain a common adverse event after pediatric liver transplantation, with distinct etiologies and management approaches based on timing. This study aimed to evaluate the incidence, risk factors, and outcomes of early and late biliary complications in a high-volume living donor pediatric liver transplant center.

Methods: We retrospectively analyzed 98 pediatric liver transplantations performed between January 2018 and February 2024. Biliary complications were categorized as early (≤90 days) or late (>90 days) post-transplant. Risk factors were assessed using univariate and multivariable logistic regression models. The impact of biliary complications on overall survival was also evaluated.

Results: Biliary complications occurred in 34.6% (n = 34) of cases. Early complications (19.4%, n = 19) were predominantly bile leaks, with duct-to-duct anastomosis identified as an independent risk factor (OR: 5.179, 95% CI: 1.511-17.756). Late complications (15.3%, n = 15) were primarily biliary strictures. Older recipient age and EBV viremia emerged as significant independent risk factors for late biliary complications (OR: 1.140 and OR: 60.793, respectively). No significant difference in overall survival was observed between patients with and without biliary complications (P = .158).

Conclusion: Duct-to-duct anastomosis remains a safe and reliable option in anatomically suitable pediatric cases when performed by experienced teams, despite a higher risk of early complications. EBV viremia and increased recipient age are significant predictors of late biliary strictures. These findings emphasize the need for vigilant surveillance, individualized transplant timing, and standardized EBV management strategies to reduce long-term biliary morbidity.

Current guidelines differ on the duration that hepatitis B immunoglobulin (HBIG) therapy should be offered after liver transplant for hepatitis B. Most guidelines state that selected patients who are considered at low risk of recurrence could discontinue HBIG therapy 6 to 12 months posttransplant. At Vancouver General Hospital, a cohort of patients remains on HBIG therapy long term. The aim of this audit was to evaluate whether we are following the proposed guidelines established by several organizations (American Association for the Study of Liver Diseases, European Association for the Study of the Liver, Canadian Association for the Study of the Liver). Our unit maintains a database of all patients currently on HBIG therapy since the inception of the program. This database was accessed, and all patients currently receiving HBIG therapy were included in the audit. The cases were manually reviewed, and data were collected for date of transplant, indication for transplant, presence of hepatocellular carcinoma in explant, hepatitis B virus DNA level at the time of transplant, presence of HIV or hepatitis D virus coinfection, hepatitis B serology, any episodes of relapse, and which antiviral the patient was taking. Twenty-two patients were included in the audit. Eight patients (36%) have been identified who are currently receiving HBIG therapy that could be ceased. Three patients developed a recurrence of hepatitis B surface antigen on lamivudine. These patients could be changed to tenofovir and have their HBIG ceased with monitoring as per protocol. This project demonstrates that patients receiving HBIG therapy should be more regularly reviewed for consideration of cessation, in line with the guidelines.

Purpose: To assess long-term ocular complications and identify factors affecting these complications who have undergone liver transplantation.

Methods: We included 147 patients who had a complete ophthalmologic examination at least 1 year after liver transplantation. The patients were divided into two groups: adult (group 1) and pediatric liver transplant patients (group 2). Data collected included best corrected visual acuity, intraocular pressure (measured with Full Auto Tonometer TX-F; Topcon), refractive error (measured with KR-8900; Topcon, Tokyo, Japan), slit-lamp examination of the anterior segment, and dilated fundus examination for both eyes. Refractive error, lens opacity, eye dryness, pterygium pinguecula, arcus lipoides, corneal calcification, macular drusen, central serous chorioretinopathy, hypertensive retinopathy, and diabetic retinopathy were all recorded. All patients received a maintenance immunosuppressive protocol consisting of combinations of steroids, calcineurin inhibitors, mycophenolate mofetil, and mammalian target of rapamycin inhibitors.

Results: Our study included 106 recipients in group 1 and 41 recipients in group 2. In group 1, 8 participants (7.5%); in group 2, 5 participants (12.2%) needed myopic correction. Additionally, 12 participants (11.3%) in group 1 required hyperopic correction, compared to 2 participants (4.9%) in group 2. No statistically significant difference was found between the two groups (P > .05). Regarding anterior segment findings, 18 participants (16%) in group 1 and 1 recipients (2.4%) in group 2 were diagnosed with dry eye, with a statistically significant higher incidence in group 1 (P = .02). The rates of arcus lipoides, pterygium, pinguecula, cataract, and glaucoma were similar in both groups (P > .05). For posterior segment findings were higher in the adult group, no statistically significant difference was found (P > .05). We identified dry eyes and cataracts as the most common ocular complications and more prevalent in group 1.

Conclusion: Different ocular complications involving the anterior and posterior segments can be seen in the long-term after liver transplantation. The fact that postoperative anterior and posterior segment complications were statistically higher in the adult age group suggests that the risk of postoperative complications may be related to age and age-related systemic diseases such as diabetes, hypertension; or cumulative drug use.