Journal Of Transplantation[JOURNAL]
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200 papers
Incidence, Risk Factors, and Treatment of Autoimmune Cytopenia Following Pediatric Allogeneic Hematopoietic Stem Cell Transplantation.
Chen C, Wang Y, Meng Y … +5 more , Dou Y, Zhang L, Guan X, Lei X, Yu J
J Transplant · 2025 · PMID 41497549 · Full text
Autoimmune cytopenia (AIC) following pediatric allogeneic hematopoietic stem cell transplantation (allo-HSCT) is relatively rare but it is a challenging complication, and standardized treatment guidelines are lacking. We...
Autoimmune cytopenia (AIC) following pediatric allogeneic hematopoietic stem cell transplantation (allo-HSCT) is relatively rare but it is a challenging complication, and standardized treatment guidelines are lacking. We retrospectively analyzed 436 pediatric patients undergoing allo-HSCT; 37 (8.5%) developed AIC, characterized by autoimmune hemolytic anemia ( = 13), immune thrombocytopenia ( = 11), and Evans syndrome ( = 13). Risk factor analysis revealed that younger age at HSCT, nonmalignant diseases, unrelated donor transplantation, and chronic graft-versus-host disease (cGVHD) were significantly associated with the development of AIC. Through multivariate analysis, cGVHD was identified as an independent risk factor for AIC. In our study, the first-line treatment for AIC involved steroids and/or intravenous immunoglobulin, with a complete remission rate of 48.6%. Additional therapeutic strategies included rituximab, which led to complete remission in 5 of 12 patients we treated, and sirolimus, with 3 of 7 patients achieving complete remission. Three patients achieved partial remission, while 9 patients died due to complications, such as severe infections, extensive GVHD, and multiorgan bleeding. Our findings suggest that cGVHD is an independent risk factor for post-transplant AIC and is typically associated with adverse outcomes, highlighting the critical importance of timely and effective interventions.
Evaluation of Intraoperative Gentamicin Bladder Irrigation for Mitigation of Urinary Tract Infections After Kidney Transplantation: A Propensity Score-Matched Analysis of a Randomized Controlled Trial.
Gravetz A, Tennak V, Khamis M … +8 more , Mezhybovsky V, Gurevich M, Eisner S, Lubani T, Bielopolski D, Atamna A, Kanani F, Nesher E
J Transplant · 2025 · PMID 41356764 · Full text
BACKGROUND: Urinary tract infections (UTIs) remain the leading infectious complication after kidney transplantation. We evaluated intraoperative gentamicin bladder irrigation as a novel preventive strategy. METHODS: In t...
BACKGROUND: Urinary tract infections (UTIs) remain the leading infectious complication after kidney transplantation. We evaluated intraoperative gentamicin bladder irrigation as a novel preventive strategy. METHODS: In this randomized, double-blind controlled trial at a tertiary transplant center (January-December 2021), 147 kidney transplant recipients were randomized to receive intraoperative bladder irrigation with gentamicin (160 mg/250 mL) or saline during ureteroneocystostomy. Due to baseline imbalances, propensity score matching yielded 49 matched pairs. The primary endpoint was UTI incidence within 30 days post-transplant, defined by both microbiological (≥ 10 CFU/mL) and clinical criteria. RESULTS: UTI incidence was 26.5% (13/49) in controls versus 16.3% (8/49) with gentamicin (absolute risk reduction 10.2%, =0.325). The number needed to treat was 10 overall. Striking sex-specific differences emerged: females demonstrated 40.7% baseline UTI risk versus 14.1% in males (=0.004). Gentamicin efficacy varied markedly by sex, with the NNT of 5 for females (50.0%-30.8%) versus 17 for males (17.1%-11.1%). Living donor recipients showed greater benefit (NNT = 7) than deceased donor recipients (NNT = 23). No adverse events were attributable to gentamicin, with similar rates of bacteremia and surgical site infections between groups. CONCLUSIONS: Intraoperative gentamicin bladder irrigation safely reduced early post-transplant UTIs by 38.5%, with efficacy in female recipients. While underpowered for statistical significance, the clinically meaningful effect size and excellent safety profile support considering this intervention for high-risk recipients, especially females, pending larger confirmatory trials.
Liver Transplantation Outcomes in Younger Versus Older Adult Recipients: The Edmonton Experience.
Mathuram Thiyagarajan U, Marfil-Garza B, Dajani K … +4 more , Anderson B, Bigam D, Montano-Loza A, James Shapiro AM
J Transplant · 2025 · PMID 41293312 · Full text
INTRODUCTION: Liver transplantation (LT) offers a lifesaving treatment for patients with end-stage liver disease (ESLD). There have been conflicting reports of outcomes in younger and elderly patients undergoing LT. This...
INTRODUCTION: Liver transplantation (LT) offers a lifesaving treatment for patients with end-stage liver disease (ESLD). There have been conflicting reports of outcomes in younger and elderly patients undergoing LT. This study assesses the outcomes of younger and elderly LT recipients by complications and graft survival at early and late time-points, up to 10 years. PATIENTS AND METHODS: This retrospective study was conducted on a prospectively collected database of patients who underwent LT between January 2011 and December 2021 at the University of Alberta Hospital in Edmonton, Canada. RESULTS: A total of 696 patients who were 18 years and older were included and then classified into two groups: the younger adult group (YG; = 631, < 65 years old) and the older adult group (OG; = 65, > 65 years old). The YG was sicker, with a high model for ESLD (MELD) score, while the OG had a high incidence of coronary artery disease (CAD), hypertension, smoking, and hepatocellular carcinoma. The YG had a higher incidence of postoperative pleural effusion requiring drainage (108/631 [17%] versus 4/65 [6%]; value < 0.02) and more rejection episodes (202/631 [32%] versus 10/65 [15%]; value < 0.04). However, the OG had more hepatic artery thrombosis (HAT) (4/65 [6.1%] versus 10/631 [1.6%]; value 0.03). CAD and smoking history were associated with lower patient and graft survivals; acute rejection episodes were also associated with significantly lower graft survival. CONCLUSION: The patient and graft survival between the YG and OG are comparable at 30 days, 90 days, 1, 5 and 10 years. A history of CAD, smoking and rejection episodes decreased graft survival and age alone should not be a contraindication for LT.
A Retrospective Analysis of National Kidney Registry Integration at a Single Center in the Northern Great Plains.
Reuvekamp E, Limburg B, Dobbs K … +1 more , Sakpal SV
J Transplant · 2025 · PMID 41262542 · Full text
BACKGROUND: Despite the National Kidney Registry's (NKR) widespread adoption, limited data exist to explain center-specific trends in live kidney donation (LKD) in rural areas. METHODS: A retrospective review of 1776 ref...
BACKGROUND: Despite the National Kidney Registry's (NKR) widespread adoption, limited data exist to explain center-specific trends in live kidney donation (LKD) in rural areas. METHODS: A retrospective review of 1776 referrals (894 before and 882 after NKR integration on February 1, 2018) for LKD at our center between June 1, 2012, and May 31, 2022, was performed. LKD referrals were comparatively analyzed between pre- and post-NKR phases and followed through subsequent evaluation, donation, or termination of donor candidacy. RESULTS: Both pre- and post-NKR, donors were most likely to be White (93.2% vs. 89.4%, =0.33), women (73.0% vs. 66.0%, =0.51), from South Dakota or neighboring states (97.3% vs. 89.4%, =0.11), and employed (95.9% vs. 95.7%, =0.99). Following NKR affiliation, our center experienced a significant increase in LKDs (74 vs. 47, =0.008), most notably from nondirected (9 vs. 1, =0.04) and rural (37 vs. 18, =0.099) donors and those from socioeconomically disadvantaged (Area Deprivation Index: 3 vs. 4 state decile, =0.055, and 47 vs. 54 national percentile, =0.056) communities. Post-NKR donor pool showed greater diversity in educational backgrounds and lower rates of tobacco and illicit drug use. Also, post-NKR referrals were evaluated, on average, 10 days sooner (66 vs. 76 days and =0.01) and were less likely to retract or be lost to follow-up after evaluation (25.1% vs. 32.7% and =0.04). CONCLUSION: NKR potentiates expanded LKD at rural transplant centers. Efforts to increase LKD among men and People of Color remain areas of opportunity.
Incidence and Risk Factors of Obesity and Overweight in Kidney Transplant Recipients and Their Effect on Graft Outcome.
Khalil MAM, Sadagah NM, Mahmood HHK … +10 more , Ezzi AAW, Alghamdi SAM, Alsulami FSH, Basha AA, Ahmed MAS, Sharabas IN, Ragab HAAA, Cruz AJD, Aboalsamh GA, Al-Qurashi SH
J Transplant · 2025 · PMID 41246293 · Full text
BACKGROUND: Weight gain is common after kidney transplantation. This study assessed the incidence of overweight and obesity, identified the risk factors, and evaluated their impact on graft function and metabolic outcome...
BACKGROUND: Weight gain is common after kidney transplantation. This study assessed the incidence of overweight and obesity, identified the risk factors, and evaluated their impact on graft function and metabolic outcomes at 1 year. METHODS: This retrospective observational study included 179 kidney transplant recipients at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia, between January 2020 and December 2023. The baseline and 12-month BMI were recorded. Associations with demographic, clinical, and metabolic variables, as well as graft function and complications, were analyzed. Logistic regression identified independent predictors of being overweight (BMI ≥ 25 kg/m) and obese (BMI ≥ 30 kg/m). RESULTS: At baseline, 83 (46.4%) recipients had BMI < 25 kg/m, 55 (30.7%) were overweight, and 41 (22.9%) were obese. At 12 months, the prevalence of obesity increased to 67 (37.4%), while the normal BMI category decreased to 55 (30.7%), with the overweight category remaining relatively stable at 57 (31.8%). The baseline BMI was the strongest predictor of overweight (OR 1.72, 95% CI 1.45-2.04) and obesity (OR 1.74, 95% CI 1.47-2.05) at 12 months. In sensitivity analysis excluding the baseline BMI, a family history of diabetes predicted obesity (OR 4.41, 95% CI 1.78-10.96). Obese patients had numerically higher creatinine and lower eGFR, but differences were not statistically significant. No differences were observed in CMV infection, prediabetes, new-onset diabetes after transplantation, acute coronary syndrome, or mortality. Overall, patient survival was 100% at 12 months. CONCLUSION: Posttransplant overweight and obesity are common. The baseline BMI and family history of diabetes are key predictors. The higher BMI is associated with early metabolic changes and trends toward lower graft function, highlighting the need for early monitoring and targeted interventions.
Single Versus Dual Kidney Transplants From Marginal Donors: Balancing Survival and Resource Utilization.
D M K, Perkins JD, R B … +2 more , N L, L S
J Transplant · 2025 · PMID 41179833 · Full text
BACKGROUND: With population aging and increasing prevalence of kidney disease, a greater number of older patients could benefit from a kidney transplant. Organ shortage has led to expanding the pool of potential donors,...
BACKGROUND: With population aging and increasing prevalence of kidney disease, a greater number of older patients could benefit from a kidney transplant. Organ shortage has led to expanding the pool of potential donors, including both kidneys from the same donor as dual transplants into a single recipient. At present, there is no consistent criteria for determining suitability for single versus dual transplant. METHODS: We performed a retrospective analysis of the Organ Procurement and Transplantation Network database of all recipients undergoing single or dual kidney transplants from deceased donors from December 4, 2014, to March 31, 2024, excluding en bloc donors. We examined patient and graft survival rates and graft function in dual versus single kidney transplantation. In addition, we analyzed potential survival differences between using a single kidney transplantation over dual transplantation. RESULTS: During the study period, there were a total of 1015 dual kidney transplant recipients and 134,933 single kidney recipients. The donors of the dual transplants were older, had higher KDRI, and had increased rates of glomerulosclerosis, with > 20% glomerulosclerosis seen in 20% of the kidneys. Using 3:1 propensity matching, we did not observe a significant difference in overall patient survival. We did observe a significant increase in graft survival with dual transplants. Transplanting all dual kidneys as single kidneys could result in a 0.9% increase in overall successful transplants and a 3% reduction in waitlist deaths. CONCLUSION: Careful donor and recipient matching are crucial to optimize outcomes in this population. More emphasis needs to be placed on maximizing survival benefit from each donor kidney.
Older Kidney Transplant Patients Are Over Immunosuppressed Using Standard Protocols With Differential Sex-Based Complications.
Alshaer I, Hung RKY, Basu S … +8 more , Goldet G, Jones G, Harber M, Fernando R, Magee CN, Motallebzadeh R, Caplin B, Salama AD
J Transplant · 2025 · PMID 41127051 · Full text
BACKGROUND: Increasing numbers of older patients are undergoing kidney transplantation. While there is evidence for both sex- and age-related immunological variations increasing the risks of immunosuppression (IS), few c...
BACKGROUND: Increasing numbers of older patients are undergoing kidney transplantation. While there is evidence for both sex- and age-related immunological variations increasing the risks of immunosuppression (IS), few centers enforce age- or sex-specific IS adjustments. METHODS: We investigated outcomes of 148 kidney transplants performed in our center between April 2009 and March 2019 in recipients aged > 60 years and compared them to outcomes in 272 younger recipients (divided into age groups 18-34, 35-49, and 50-60 years), matched for degree of human leukocyte antigen (HLA) sensitization (calculated reaction frequency, cRF), number of donor-recipient HLA mismatches, and cytomegalovirus (CMV) serostatus, all treated with the same IS protocol. Outcomes were time to (i) first episode of biopsy-proven acute rejection (BPAR), (ii) first CMV viremia within the first 6 months, (iii) incidence of any new-onset malignancy, and (iv) development of donor-specific anti-HLA antibodies (DSAs). RESULTS: Overall rates of BPAR were highest in the recipients under the age of 35, but with no evidence of a difference between older age groups. Conversely, the risk of CMV viremia and malignancy was significantly higher in older recipients; in the > 60-year-old group, CMV viremia HR: 2.66 (95% CI: 1.49-4.75), and malignancy HR: 7.3 (95% CI: 1.7-31.10) versus the youngest group with little evidence was confounded by comorbidity or donor factors on multivariate analysis. The risk of CMV infection was most marked in the oldest female group, while the risk of malignancy was greatest in older males. The development of DSA was equal across all age groups. CONCLUSION: Our data indicate that older recipient age is associated with increased risk of CMV viremia and malignancy after transplantation, suggesting an age-associated vulnerability to IS, with the risk occurring mostly in older women and older men, respectively. These data support the need to develop age- and sex-specific protocol adjustments.
Latent Profiles of Deceased Organ Donation Registrants and Nonregistrants in the United States.
Kirshenbaum AP, Parent B, Goodgame Huffman L … +2 more , Kelsey V, Sofis MJ
J Transplant · 2025 · PMID 40718843 · Full text
Deceased organ donation is the greatest source of transplantable whole organs, but registration rates are a limiting factor because they remain low among certain populations. A stratified, nonprobability survey was used...
Deceased organ donation is the greatest source of transplantable whole organs, but registration rates are a limiting factor because they remain low among certain populations. A stratified, nonprobability survey was used to identify population characteristics associated with nonregistration in the United States ( = 11,083). Latent profile analysis (LPA) was used to identify multivariate patterns of demographic, socioeconomic, and health-related factors associated with registration. LPA yielded three distinct profiles, which all reported similar average percentages of driver's license possession, medical insurance coverage, and income, indicating that profiles were not distinguished by these variables. Meaningful differences across the profiles included access to healthcare services, satisfaction with those services, general health and well-being, and age; those who are both healthy and young (mean age = 25.9 years) reported the lowest percentage of organ donation registration (35.3%). For this group, 71.48% listed either low priority or distrust in the donation process as the top reasons for nonregistration. Importantly, age as a standalone variable was not uniformly associated with donation and was conditionally dependent upon health status; poorer health in young adults was associated with greater registration. These findings reveal previously unidentified opportunities for tailoring donor registration campaigns to populations with a high potential for registration behavior change.
Right Versus Left Laparoscopic Donor Nephrectomy and Its Effects on Transplant Outcomes: Experience From Saudi Arabia.
Aboalsamh GA, Khalil MAM, Sadagah NM … +7 more , Mahmood HHK, Basha AA, Ahmed MAS, Cruz AJD, Sakran HIM, Assiri IMN, Al-Qurashi SH
J Transplant · 2025 · PMID 40607175 · Full text
Live kidney donation is increasingly common due to the shortage of organs. Surgeons prefer the left kidney due to easier access and longer renal vein. There are conflicting reports about the outcomes of right versus left...
Live kidney donation is increasingly common due to the shortage of organs. Surgeons prefer the left kidney due to easier access and longer renal vein. There are conflicting reports about the outcomes of right versus left kidney transplants. The objective of this study was to compare the immediate and long-term outcomes of right and left kidney recipients in live donor kidney transplants. A retrospective analysis of 215 live kidney donors from 2021 to 2023 was conducted to compare outcomes between the recipients of right and left kidneys. Data were collected on donor and recipient demographics, surgical outcomes, and complications. Baseline values were summarized using descriptive statistics, with the quantitative and qualitative data reported as means, medians, interquartile ranges, standard deviations, and frequencies. Differences between the groups were analyzed using the Chi-square test and -test. Among the 215 donors, 141 (65.6%) were male and 74 (34.4%) were female, with a mean nuclear GFR of 105.89 ± 10.91 mL/min. Left kidneys were donated in 176 cases (81.9%), and right kidneys in 39 cases (18.1%). The most common complications were delayed graft function (DGF) in 15 cases (6.9%), hematoma in six cases (2.7%), seroma in nine cases (4.2%), and rejection in 10 cases (4.7%). There were no significant differences between the groups for gender, cold ischemia time, operation time, hospital stay, intraoperative hemorrhage, blood transfusion, re-exploration, hematoma, seroma, urine leak, or the presence of donor-specific antibodies (DSA), BK or cytomegalovirus viremia, rejections, or death-censored graft loss. Right nephrectomies and re-exploration were identified as independent predictors of DGF. Creatinine levels and estimated glomerular filtration rates at discharge, 6 months, 1 year, and 2 years did not differ significantly between the recipients of the right and left kidneys. Laparoscopic left and right donor nephrectomies show comparable long-term outcomes with no significant differences in creatinine levels at 6 months, 1 year, and 2 years post-transplantation. Despite more DGF in right kidney recipients, both kidneys are suitable for transplantation without compromising long-term outcomes. These findings highlight the feasibility of utilizing the right kidney for donation when required.
An Interpretive Description of Patient and Provider Perspectives on the Impact of the COVID-19 Pandemic on Lung Transplant Care Access and Service Delivery in Alberta, Canada.
Brehon K, Hung P, Miciak M … +8 more , Varughese R, Halloran K, Perreault K, Ronksley PE, Stickland MK, Weatherald J, Gross DP, Lam GY
J Transplant · 2025 · PMID 40452945 · Full text
The COVID-19 pandemic impacted how health services were delivered for patients with chronic pulmonary conditions. To our knowledge, perceptions of patients with lung transplant (LT) and their providers on access to care...
The COVID-19 pandemic impacted how health services were delivered for patients with chronic pulmonary conditions. To our knowledge, perceptions of patients with lung transplant (LT) and their providers on access to care and service delivery during the COVID-19 pandemic have not been explored in our context of Alberta, Canada. Our objective was to explore LT patient and provider perspectives on the impact of the COVID-19 pandemic on healthcare access and service delivery. We used interpretive description, a qualitative approach with the end-goal of informing decisions and actions in clinical practice. Interviews were conducted virtually and confidentially transcribed verbatim. Data generation and analysis occurred concurrently. Analysis was informed by Braun and Clarke's six phases of reflexive thematic analysis. Strategies to enhance rigor and trustworthiness of the findings were utilized. We completed 17 interviews: 8 with patients and 9 with providers. Four key themes were generated: (1) "COVID-19 created a relational wall;" (2) "Determining how care should be delivered was a juggling act;" (3) "Balancing supply and demand;" and (4) "The unique costs of being immunocompromised during a global pandemic." The pandemic impacted social relationships for LT patients, especially through the use of virtual care. Several factors hindered access to care for LT patients. Provider participants highlighted how there were less transplants during the pandemic which created a backlog in transplant surgeries. Fear of COVID-19 meant that some LT patients were hesitant to seek healthcare services, resulting in later-term health consequences. A need for mental health services was identified among this population despite an apparent lack of available services. Participants highlighted the gap in COVID-19 resources that now exists for this population since testing and treatments are no longer as readily available. In conclusion, provider participants did the best that they could with the circumstances they faced to provide high-quality care to LT patients. However, while patient participants were generally understanding of circumstances, LT care suffered as a result of the COVID-19 pandemic. Care for this population generally needs to be in-person, but there is nuance surrounding this recommendation due to LT patients' immunocompromised nature. Health system leaders can leverage our findings to implement learnings from the pandemic and continue to improve services for the ever-growing LT population.
Identification of Factors Influencing Donor-Derived Cell-Free DNA Levels up to One Year After Kidney Transplant.
Mirza A, Gani I, Parvez I … +3 more , Weaver C, Mulloy L, Kapoor R
J Transplant · 2024 · PMID 39781105 · Full text
Donor-derived cell-free DNA (dd-cfDNA) in the peripheral blood of allograft recipients has shown to early identify allograft injury. In this study, we assessed the factors that influence the amount of circulating dd-cfDN...
Donor-derived cell-free DNA (dd-cfDNA) in the peripheral blood of allograft recipients has shown to early identify allograft injury. In this study, we assessed the factors that influence the amount of circulating dd-cfDNA during the first month postkidney transplant as well as its longitudinal trend. A consecutive series of 98 adult kidney transplant recipients at a single center between July 2018 and January 2020 were included in this study. All demographic and operative details were collected for donors and recipients of the organ transplant. Median eGFR, dd-cfDNA, and serum creatinine were calculated at 1, 2, 3, 6, and 12 month posttransplant. Descriptive statistics were used for patient demographics. Nonparametric comparisons of dd-cfDNA cumulative distributions between dichotomized groupings were evaluated using Kruskal-Wallis or Mann-Whitney tests. The median age of recipients was 54.5 years (IQR: 42.7-62.2). The cause of ESRD among recipients was hypertension (43%) and Type II diabetes mellitus (29%). Eighty-two percentage of patients received a deceased donor allograft, 14% received a living unrelated allograft, and 4% received a living related allograft. Sixteen percentage of recipients experienced delayed graft function (DGF). Median creatinine level at 1 month posttransplant was 1.75 mg/dL (IQR: 1.34-2.26) and median eGFR at 1 month posttransplant was 49.6 mL/min/1.73 m (IQR: 35-65). The median dd-cfDNA score at 1 month posttransplant for all recipients was 0.4% (IQR: 0.15-5.3). Donor sex was a statistically significant differential for dd-cfDNA score. Recipients from male donors had a significantly higher median dd-cf DNA score at 1 month posttransplant versus those who received a female kidney (0.57% vs. 0.28%, < 0.01). Highest median score was recorded at the first month posttransplant (0.4%, IQR: 0.26-0.74), and a sustained downward trend was observed through Month 2 (0.19%, IQR: 0.17-0.31) and Month 3 (0.19%, IQR: 0.15-0.26). Correlation between 1-, 2-, 3-, 6-, and 12-month posttransplant median dd-cfDNA scores between deceased donor and living donor (LRD and LURD) cohorts was not statistically significant. This study provides further insight into donor and recipient variables' effects on dd-cfDNA in the early posttransplant phase by analyzing a more diverse cohort of patients and adds to the knowledge around interpreting dd-cfDNA scores with clinical correlation for posttransplant management.
Right Heart Recovery Post Lung Transplant With COVID-19-Related Acute Respiratory Distress Syndrome.
Arunachalam A, Toyoda T, Nayak T … +12 more , Jankowski M, Cerier EJ, Kaihou T, Joudi A, Mohsin S, Yeldandi A, Venkata Subramani M, Myers C, Tomic R, Bharat A, Maganti K, Kurihara C
J Transplant · 2024 · PMID 39583316 · Full text
Right heart remodeling is noted in patients with severe COVID-19-associated acute respiratory distress syndrome (ARDS). There is limited information regarding right heart recovery following lung transplantation in this c...
Right heart remodeling is noted in patients with severe COVID-19-associated acute respiratory distress syndrome (ARDS). There is limited information regarding right heart recovery following lung transplantation in this cohort. Retrospective review of institutional transplant database from June 2020 to June 2022 was performed at Northwestern University in Chicago, Illinois. Demographic, laboratory, histopathologic, lung transplant outcomes, and pre- and postoperative echocardiographic data were recorded and analyzed. Of the 42 patients who underwent lung transplantation for COVID-19-related ARDS, 6 patients were excluded due to having either a single-lung transplant ( = 2), lobar transplant ( = 1), or dual-organ transplant ( = 1) or for missing postoperative TTE data ( = 2) and 36 were included in the study; there were no 90-day deaths, and the 1-year survival rate was 88.8%. Intraoperative hemodynamics data showed a mean pulmonary artery pressure of 49 ± 23 mm Hg. Preoperative echocardiography was evaluated at a median of 15.5 (10-34.3) (IQR) days preoperatively and 140 (108-201) days (IQR) postoperatively. RV size grade improved from an average of 1.7 ± 0.85 to 1.3 ± 0.6 ( < 0.05), while RV function improved from an average of 2.2 ± 1.2 to 1 ± 1 ( < 0.05). There was a reduction in RVSP from 46.5 ± 18 mmHg to 30.1 ± 7.8 mmHg ( < 0.05) and RV free wall strain showed improvement from -13.9 ± 6.1% to -18.5 ± 5.4% ( < 0.05). The results showed that the RV size and systolic function demonstrate improvement with normalization in a relatively short period following lung transplantation for patients with COVID-19-associated ARDS.
Hepatic Duct Division During Robotic Living Donor Hepatectomy: A Comparison Between the Novel Triple C (Clip-Clamp-Cut) and the Cut-Suture Techniques.
Soin AS, Yadav KS, Valappil F … +6 more , Shetty N, Bansal R, Chaudhary S, Gupta A, Rastogi A, Bhangui P
J Transplant · 2024 · PMID 39450325 · Full text
In robotic donor hepatectomy (RDH), hepatic duct division (HDD) and its stump closure technique are of paramount importance in avoiding postoperative biliary complications in both donors and recipients. We describe our n...
In robotic donor hepatectomy (RDH), hepatic duct division (HDD) and its stump closure technique are of paramount importance in avoiding postoperative biliary complications in both donors and recipients. We describe our novel triple C ("clip-clamp-cut") technique of HDD. Out of 4016 living donor liver transplant (LDLT) (2004-October 2023), we have performed 208 RDH cases since December 2019. This study is a retrospective analysis of the first 160 RDH cases. After excluding the first 20 RDH cases (learning curve) and 3 left-sided RDH cases, 137 cases with no exclusion criteria were included. We divided these 137 donors into the "cut and suture" (CS) group ( = 33) and the "triple C" technique group ( = 104). We compared intraoperative details and postoperative outcomes. All 137 robotic donors and 128/137 recipients are currently well. Donor biliary leak rate was significantly lower among the triple C group ( = 3, 2.9%) compared to the CS group ( = 5, 15.2%) (=0.009). No other differences in postdonation morbidity were observed among the two groups. Recipient biliary complication rate was lower in the triple C group than in the CS group although not statistically significant (10.6% vs. 15.1%; =0.537), despite more multiple biliary anastomoses in the former. No significant differences in post-transplant recipient morbidity and mortality were observed. Our simple yet novel triple C technique enables clean, precise, bloodless HDD resulting in lower donor and potentially recipient biliary complication rates. The ease and reproducibility make it ideal for widespread adoption.
Pneumatosis Intestinalis and Pneumoperitoneum After Lung Transplantation: Single-Center Experience and Systematic Review.
Kagawa H, Furukawa M, Chan E … +2 more , Morrell M, Sanchez PG
J Transplant · 2024 · PMID 39450324 · Full text
Pneumatosis intestinalis (PI) and pneumoperitoneum are some of the complications after lung transplantation (LT). But only limited reports are published. The purpose of this study is to review our experience and perform...
Pneumatosis intestinalis (PI) and pneumoperitoneum are some of the complications after lung transplantation (LT). But only limited reports are published. The purpose of this study is to review our experience and perform a systematic review to discuss the possible causes, risk factors, and management. We reviewed the characteristics, management, and outcome of the patients who developed PI or pneumoperitoneum after LT in our institution from 2013 to 2022. We also performed a systematic review to discuss the management and outcome. PI and pneumoperitoneum were found in 15 out of 729 patients (2.06%) in our institution. We also found 50 patients in the systematic review. Tracheostomy was performed in 40% and gastrointestinal procedures were performed in 55.6%. Laparotomy was performed in 23.4%. A total of 44.6% of patients had benign physical exams or no symptoms. Rejection was seen in 42.9%. A total of 28.6% of patients died during follow-up periods. This report has the largest number of patients so far with PI and pneumoperitoneum after LT. These conditions have a high rejection and high mortality rate. Mechanical ventilation, tracheostomy, gastrointestinal procedure, CMV infection, infection, and immunosuppression can be the risk factors, and the management includes laparotomy or conservative management. It is generally recommended to proceed with laparotomy if patients have portal venous gas, elevated white blood cell count, elevated lactic acid level, decreased bicarbonate level, elevated amylase level, metabolic acidosis, abdominal tenderness, or abdominal distension. Otherwise, most of the patients recover with conservative management with nil per os (NPO), metronidazole, ganciclovir, antibiotics, high-flow oxygen, and holding mycophenolate mofetil (MMF).
Psychosocial Trauma History Negatively Impacts Liver Transplant Access in Women with Chronic Liver Disease.
Cooper KM, Colletta A, Amin D … +2 more , Herscovici DM, Devuni D
J Transplant · 2024 · PMID 39165271 · Full text
INTRODUCTION: Few studies have evaluated the impact of psychological trauma (mental, emotional, or physical) on liver transplant (LT) candidacy and outcomes. METHODS: We performed a single center retrospective analysis o...
INTRODUCTION: Few studies have evaluated the impact of psychological trauma (mental, emotional, or physical) on liver transplant (LT) candidacy and outcomes. METHODS: We performed a single center retrospective analysis of patients who completed routine LT evaluation between October 2017 and June 2021. We identified the prevalence of psychological trauma history in men and women LT candidates and evaluated the association between trauma history and LT access. The primary outcome measure was listing for LT. RESULTS: A total of 463 patients completed LT evaluation, of which 17% ( = 79) reported a history of trauma: 49 of 159 women and 30 of 304 men. Trauma history was significantly more common in women than in men (31% vs. 10%, < 0.001). Women with trauma history were less likely to be listed for LT (80% vs. 93%, = 0.016). Women with trauma history were also more likely to be removed from the LT waitlist (26% vs. 12%, = 0.045); this persists when excluding patients removed for transfer to another center or for medical improvement (22% vs. 7%, = 0.020). In contrast, listing for LT (87% vs. 86%, = 0.973) and waitlist removal (12% vs. 10%, = 0.766) did not differ in men with and without trauma history. In those that received a LT ( = 107), post-LT relapse, rejection, readmissions, and death did not differ in patients with (n=13)and without (n=94) trauma history. CONCLUSIONS: Trauma history is associated with reduced access to LT in women but not men with chronic liver disease. Further studies are needed to understand the impact of psychological trauma on LT access and post-LT outcomes.
Long-Term Outcomes of Recipients of Liver Transplants from Living Donors Treated with a Very Low-Calorie Diet.
Wozniak H, Naimimohasses S, Goto T … +5 more , Sapisochin G, Sayed B, Ghanekar A, Cattral M, Selzner N
J Transplant · 2024 · PMID 38725471 · Full text
The increasing prevalence of steatotic liver disease (SLD) in potential living donors is concerning, as it limits donor's availability amid rising demand. OPTIFAST very low-calorie diet (VLCD), a meal replacement product...
The increasing prevalence of steatotic liver disease (SLD) in potential living donors is concerning, as it limits donor's availability amid rising demand. OPTIFAST very low-calorie diet (VLCD), a meal replacement product, effectively reduces weight and hepatic steatosis before transplantation. However, data on the outcomes of recipients of VLCD-treated donors are lacking. We conducted a single-center, retrospective study on 199 living donor liver transplant recipients at Toronto General Hospital, Canada, between January 2015 and January 2020. We compared the 1-year posttransplant outcomes between recipients who received organs from donors treated with VLCD ( = 34) for either weight loss or steatosis reduction, with those who did not require treatment ( = 165). Our analysis revealed no statistically significant differences in the rates of postoperative complications (23% vs 32.4%, =0.3) or intensive care unit stays (70.9% vs 70.6%, =1) between recipients of non-VLCD and VLCD grafts. Following adjusted multivariate logistic regression, receipt of VLCD grafts was not associated with increased hospital length of stay. In addition, one-year mortality did not differ between the two groups (4.2% non-VLCD recipients vs 2.9% VLCD recipients, =0.6). OPTIFAST VLCD treatment for liver donors demonstrates positive and safe outcomes in recipients, expanding the pool of potential living donors for increased organ availability.
Addressing Kidney Transplant Shortage: The Potential of Kidney Paired Exchanges in Jordan.
Al-Thnaibat MH, Balaw MK, Al-Aquily MK … +6 more , Ghannam RA, Mohd OB, Alabidi F, Alabidi S, Hussein F, Rawashdeh B
J Transplant · 2024 · PMID 38577225 · Full text
Jordan performed the Middle East's first living-donor kidney transplant in 1972. In 1977, the country became one of the first Arab countries to regulate organ donation and transplantation. Despite these early advances in...
Jordan performed the Middle East's first living-donor kidney transplant in 1972. In 1977, the country became one of the first Arab countries to regulate organ donation and transplantation. Despite these early advances in living donor transplantation, Jordan's organ donation after brain death program remains inactive, making it challenging to meet organ demand and placing many patients on long transplant waiting lists. As of 2020, only 14.2% of the patients with end-stage kidney disease have access to a living donor. The scarcity of compatible living donors exacerbates Jordan's organ shortage, leaving patients with extended waits and uncertain transplant prospects. Due to the lack of living donors and the inactive brain death donation program, additional options are needed to meet organ demand. Kidney paired exchange (KPE), emerges as a potential solution to the problem of donor shortage and donor-recipient incompatibility. By allowing living donors to direct their donated organs to different compatible recipients, KPE offers the promise of expanding transplant opportunities for patients without suitable living donors. However, the current Jordanian law restricting living kidney donation to fifth-degree relatives further limits the pool of potential donors, aggravating the organ shortage situation. This article explores the feasibility of implementing KPE in Jordan and proposes an approach to implementing KPE in Jordan, considering ethical and legal aspects to substantially increase kidney transplants.
Impact of Early Rejection Treatment on Infection Development in Kidney Transplant Recipients: A Propensity Analysis.
Gupta S, Gea-Banacloche J, Heilman RL … +5 more , Yaman RN, Me HM, Zhang N, Vikram HR, Kodali L
J Transplant · 2024 · PMID 38463548 · Full text
INTRODUCTION: The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature. METHODS: We conducted a retrospective cohort study of 185 rejection (case) and 185...
INTRODUCTION: The impact of renal allograft rejection treatment on infection development has not been formally defined in the literature. METHODS: We conducted a retrospective cohort study of 185 rejection (case) and 185 nonrejection (control) kidney transplant patients treated at our institution from 2014 to 2020 to understand the impact of rejection on infection development. Propensity scoring was used to match cohorts. We collected data for infections within 6 months of rejection for the cases and 18 months posttransplant for controls. RESULTS: In 370 patients, we identified 466 infections, 297 in the controls, and 169 in the cases. Urinary tract infections (38.9%) and cytomegalovirus viremia (13.7%) were most common. Cumulative incidence of infection between the case and controls was 2.17 (CI 1.54-3.05); < 0.001. There was no difference in overall survival (HR 0.90, CI 0.49-1.66) or graft survival (HR 1.27, CI 0.74-2.20) between the groups. There was a significant difference in overall survival (HR 2.28, CI 1.14-4.55; = 0.019) and graft survival (HR 1.98, CI 1.10-3.56; = 0.023) when patients with infection were compared to those without. CONCLUSIONS: As previously understood, rejection treatment is a risk factor for subsequent infection development. Our data have defined this relationship more clearly. This study is unique, however, in that we found that infections, but not rejection, negatively impacted both overall patient survival and allograft survival, likely due to our institution's robust post-rejection protocols. Clinicians should monitor patients closely for infections in the post-rejection period and have a low threshold to treat these infections while also restarting appropriate prophylaxis.
Single-Center Outcomes of Epstein-Barr Virus DNAemia in Adult Solid Organ Transplant Recipients.
Dong SW, Blair BM, Alonso CD
J Transplant · 2024 · PMID 38283325 · Full text
BACKGROUND: Immunosuppression in solid organ transplantation (SOT) increases the risk of Epstein-Barr virus (EBV) DNAemia, which may herald development of posttransplant lymphoproliferative disease (PTLD). Few studies ha...
BACKGROUND: Immunosuppression in solid organ transplantation (SOT) increases the risk of Epstein-Barr virus (EBV) DNAemia, which may herald development of posttransplant lymphoproliferative disease (PTLD). Few studies have characterized the incidence, risk factors, and clinical impact of EBV DNAemia in adult SOT recipients (SOTR). METHODS: A single-center, retrospective review of adult (≥18 years) SOTR between 01 January 2015 and 31 December 2019 was conducted. Patients were stratified by the primary study endpoint of development of EBV DNAemia (whole blood EBV DNA PCR > 200 copies/mL). Secondary endpoints included development of PTLD, reduction in immunosuppression (RIS), use of pre-emptive therapy, and all-cause mortality. RESULTS: Among 442 adult SOTR, the predominant transplant organs were the kidney (258, 58%) and liver (141, 31.9%). EBV serostatus in most subjects (430, 97%) was classified as intermediate risk (R+). Eight subjects (2%) were high risk (donor (D+/R-), and 4 (1%) were low risk (D-/R-). The overall incidence of EBV DNAemia was 4.1% (18/442) with a median time to detection of 14 months (range 3-60). The highest proportion of DNAemia was observed in D+/R- subjects (37.5%; < 0.001). Development of PTLD was significantly associated with EBV DNAemia and occurred in 3/18 patients with DNAemia (16.7%) vs. 3/424 (0.7%) without DNAemia ( < 0.001). All patients with PTLD were managed with RIS and rituximab. CONCLUSION: We observed that EBV D+/R- serostatus and development of sustained EBV DNAemia were high risk features associated with subsequent development of PTLD in our cohort of adult SOTR.
Haematopoietic Stem Cell Transplant Trends in Pakistan: Activity Survey from Pakistan Bone Marrow Transplant Group.
Ali N, Iftikhar R, Ayaz Mir M … +20 more , Bokhari SW, Rehman JU, Zaidi U, Nasir S, Adil SN, Satti T, Nisa Chaudhry QU, Farhan M, Farzana T, Ghafoor T, Ahsan B, Khan AS, Khan FA, Fatima SI, Samad SA, Batool A, Nadeem HM, Abbas Bukhari SN, Ansari SH, Ahmed P
J Transplant · 2023 · PMID 37810405 · Full text
Pakistan is the fifth most populous country with a population of 225 million and has health expenditure accounting for only 2.8 percent of gross domestic product (GDP). Accordingly, there are a limited number of haematol...
Pakistan is the fifth most populous country with a population of 225 million and has health expenditure accounting for only 2.8 percent of gross domestic product (GDP). Accordingly, there are a limited number of haematology-oncology and transplant centers in the country. The Pakistan Blood and Marrow Transplant (PBMT) group was established in 2020, and this report is the first activity survey from January 2021 to December 2022 focusing on the trends of matched-related donor, haploidentical, and autologous transplants in a developing country. A total of 12 transplant centers contributed data on the modified PBMT survey form retrospectively and 806 haematopoietic stem cell transplants (HSCTs) were carried out during the study duration. Allogeneic HSCT constituted 595 (73.8%) of all the transplants; this is in stark contrast to Western data, where autologous HSCT accounts for the majority of transplants. -thalassemia major and aplastic anemia were the commonest indications for allogeneic HSCT, in contrast to Western data, where acute leukemia is the leading transplant indication. Autologous transplants were more frequently performed for Hodgkin's lymphoma as compared to non-Hodgkin's lymphoma and multiple myeloma. The use of peripheral and bone marrow stem cells was comparable. A myeloablative conditioning regimen was routinely used in patients with acute leukemia. This report provides an insight of HSCT trends in Pakistan which are different from those of Western centers contributing to transplant data from South Asia.
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