BACKGROUND Old donor allografts in liver transplantation(LT)account for 25%of all allografts,and their utilization is projected to increase with the aging general population.Older allografts are associated with higher...BACKGROUND Old donor allografts in liver transplantation(LT)account for 25%of all allografts,and their utilization is projected to increase with the aging general population.Older allografts are associated with higher rates of all-cause mortality and graft failure;however,there is limited literature exploring the specific phenotypic changes(e.g.,functional status,cause-specific mortality)observed in different donor:recipient age pairs.AIM To investigate differences in functional impairment and cause-specific mortality between different donor:recipient age pairs.METHODS This was a retrospective analysis of LT patients from the Scientific Registry of Transplant Recipients from 2002 to 2022.Donors were categorized into younger age donors,≤45-years(YAD),middle-aged donors,46-69-years(MAD),and older age donors,≥70-years(OAD).Recipients were categorized into younger age recipients,≤55-years(YAR)and older age recipients,>55-years(OAR)age recipients.Multivariate Fine-Gray competing risk and logistic regression analyses identified independent risk factors for cause-specific mortality and improvements in functional status,respectively.RESULTS Overall,126185 patients were included in the analysis:YAD:YAR(32.7%), YAD:OAR (25.2%), MAD:YAR (17.5%), MAD:OAR (20.7%), OAD:YAR (1.3%), and OAD:OAR (2.7%). Compared toYAD:YAR, OAD pairs had the lowest likelihoods of improved functional status 5 years post-LT (OAD:YAR oddsratio 0.53, 95% confidence interval 0.42-0.67, P < 0.001;OAD:OAR odds ratio 0.67, 95% confidence interval 0.51-0.89, P = 0.006). Donor:recipient age pairs with older donors had higher rates of graft- and infection-relatedmortality compared to those with younger donors (P < 0.001). Meanwhile, donor:recipient age pairs with olderrecipients had higher cardioneurovascular- or malignancy-related deaths compared to those with youngerrecipients (P < 0.001).CONCLUSIONDonor:recipient age mismatch was associated with differences in cause-specific mortality and functional status.These insights could potentially inform age-matched organ allocation strategies, though future work is warranted.展开更多
Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the “classical” recipient hepatectomy is believed to be one of the potential reaso...Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the “classical” recipient hepatectomy is believed to be one of the potential reasons to cause tumor evasion because of the possible increase of circulating tumor cells, thus leading to an increased recurrent rate. On this background, the no-touch oncological recipient hepatectomy technique has been developed. A comprehensive review of the development and the key surgical steps of the no-touch recipient hepatectomy is presented. This technique might improve clinical outcomes, especially for those recipients who are at a high risk for tumor recurrence. Multicenter prospective studies should be set up to further validate the prognostic role of this technique in patients with liver cancer treated with liver transplantation.展开更多
Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in in...Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in infants.However,the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant.This review explores historical developments,various approaches to measuring the required functional liver mass,and techniques to prevent complications associated with large-for-size grafts in infants.展开更多
BACKGROUND In the absence of effective antimicrobials,transplant surgery is not viable,and antirejection immunosuppressants cannot be administered,as resistant infections compromise the life-saving goal of organ trans...BACKGROUND In the absence of effective antimicrobials,transplant surgery is not viable,and antirejection immunosuppressants cannot be administered,as resistant infections compromise the life-saving goal of organ transplantation.AIM To evaluate the efficacy of antimicrobials in preventing resistance in solid organ transplant recipients.METHODS A systematic review was conducted using a search methodology consistent with the preferred reporting items for systematic reviews and meta-analyses.This review included randomized clinical trials that evaluated the efficacy of antimicrobial agents(prophylactic or therapeutic)aimed at preventing antimicrobial resistance.The search strategy involved analyzing multiple databases,including PubMed/MEDLINE,Web of Science,Embase,Scopus,and SciELO,as well as examining gray literature sources on Google Scholar.A comprehensive electronic database search was conducted from the databases’inception until May 2024,with no language restrictions.RESULTS After the final phase of the eligibility assessment,this systematic review ultimate-ly included 7 articles.A total of 2318 patients were studied.The most studied microorganisms were cytomegalovirus,although vancomycinresistant enterococci,Clostridioides difficile,and multidrug-resistant Enterobacterales were also analyzed.The antimicrobials used in the interventions were mainly maribavir,valganciclovir,gancic-lovir,and colistin-neomycin.Of concern,all clinical trials showed significant proportions of resistant microorga-nisms after the interventions,with no statistically significant differences between the groups(mean resistance 13.47%vs 14.39%),except for two studies that demonstrated greater efficacy of maribavir and valganciclovir(mean resistance 22.2%vs 41.1%in the control group;P<0.05).The total reported deaths in three clinical trials were 75,and there were 24 graft rejections in two studies.CONCLUSION All clinical trials reported significant proportions of antimicrobial-resistant microorganisms following interventions.More high-quality randomized clinical trials are needed to corroborate these results.展开更多
BACKGROUND The utilization of hearts from older donors has increased,particularly for older recipients.However,the impact of older donor hearts on recipients of different ages is less known.AIM To determine the impact...BACKGROUND The utilization of hearts from older donors has increased,particularly for older recipients.However,the impact of older donor hearts on recipients of different ages is less known.AIM To determine the impact of older donor hearts on post-transplant outcomes across different recipient age groups.METHODS The Organ Procurement and Transplant Network database was queried from 2006 to March 2024.Four groups were created stratifying by donor age(>55 years)and recipient age(>60 years).Kaplan-Meier curves and Cox regression models were used.RESULTS One thousand fifty out of 39868 transplants(2.6%)were performed utilizing hearts from older donors.The rate of older donor hearts in younger recipients was only 1.8%,while the older donor hearts were used 4.0%in older recipients(P<0.001).Old donor/old recipient and young donor/old recipient combinations were associated with post-transplant mortality[hazard ratio(HR):1.64(95%CI:1.42-1.90)and 1.42(95%CI:1.34-1.51)],while old donor/young recipient was not.Within each recipient age group,the older recipient groups showed greater differences in 1-and 5-year survival probabilities(80.4%and 67.4%with old donors,89.2%and 76.8%with young donors)than younger recipient groups(90.3%and 77.5%with old donors,92.2%and 80.3%with young donors).CONCLUSION This study demonstrates the higher utilization of older donor hearts(aged more than 55)in older recipients.Paradoxically,the combination of older donor hearts with older recipients is associated with a higher risk of mortality.However,these organs remain valuable options across all recipient age groups in current context of organ shortage.展开更多
BACKGROUND Tacrolimus(TAC)is metabolized primarily by the CYP3A-encoded enzyme family(CYP3A4,CYP3A5,and CYP3A7).Individuals expressing the CYP3A51 allele are considered fast metabolizers and generally require higher T...BACKGROUND Tacrolimus(TAC)is metabolized primarily by the CYP3A-encoded enzyme family(CYP3A4,CYP3A5,and CYP3A7).Individuals expressing the CYP3A51 allele are considered fast metabolizers and generally require higher TAC doses to reach therapeutic levels.AIM To evaluate the predictive value of the TAC concentration-to-dose(C0/D)ratio for identifying CYP3A5 poly-morphisms in renal transplant recipients.METHODS Eighty-six de novo kidney transplant recipients with TAC-based immunosuppression from the Department of Nephrology and Dialysis at Military Hospital 103(Hanoi,Vietnam)were included in this retrospective study.Blood samples were collected within the first week post-transplantation to monitor TAC levels and to perform genotyping for CYP3A5 genetic polymorphisms.RESULTS The CYP3A53/3 genotype was identified in 37 patients(43%),CYP3A51/3 in 40 patients(46.5%),and CYP3A51/1 in 9 patients(10.5%).Patients carrying the CYP3A51/3 or CYP3A51/1 genotype,classified as fast metabolizers(CYP3A5 expressers),had significantly lower TAC C0 concentrations and C0/D ratios compared to slow meta-bolizers(CYP3A53/3 genotype)at multiple time points during follow-up(all P<0.001).Notably,the TAC C0/D ratio obtained on day 1(0.91)was shown to predict CYP3A5 polymorphism with a sensitivity of 84.6%and a specificity of 84.6%.CONCLUSION This study demonstrates that the TAC C0/D ratio provides a reliable predictive value for CYP3A5 polymorphisms,which can be used to individualize TAC dosing in renal transplant recipients in Vietnam and other low-income countries.展开更多
Robotic surgery has emerged as a new frontier in liver transplantation.Given the novelty of its application to recipient procedures,a comprehensive overview is crucial.This narrative review synthesizes the fragmented,...Robotic surgery has emerged as a new frontier in liver transplantation.Given the novelty of its application to recipient procedures,a comprehensive overview is crucial.This narrative review synthesizes the fragmented,foundational data on fully robotic recipient adult living donor liver transplantation(LDLT)on the basis of an appraisal of initial case reports and preliminary comparative studies.The literature was identifiedvia PubMed.The literature demonstrates the technical feasibility and favorable safety profileof the robotic approach.A significantreduction in morbidity was observed,as evidenced by a lower comprehensive complication index,reduced blood loss and transfusion need,and a lower incidence of postoperative infections.These benefitswere reflected in significantlyshorter intensive care unit and hospital stays.While the robotic approach was associated with prolonged operative and ischemia times,the studies revealed that these approaches did not compromise outcomes,with higher 6-month recipient survival noted in the robotic group.Fully robotic recipient LDLT is a groundbreaking technique,although the current evidence consists of initial case reports and non-randomized comparative data from a single center.The available literature suggests a promising safety profileand significantshort-term benefits,but these preliminary findingsrequire validation through multicenter,high-level research.展开更多
BACKGROUND Shortening the recipient warm ischemia time(rWIT)has been proven to be effective for improving the short-and long-term outcomes after liver transplantation(LT)and offsets the negative impact of an extended ...BACKGROUND Shortening the recipient warm ischemia time(rWIT)has been proven to be effective for improving the short-and long-term outcomes after liver transplantation(LT)and offsets the negative impact of an extended cold ischemia time.However,few studies have been conducted to explore the prognostic effects of shortening the rWIT in transplantations using a liver graft from an extendedcriteria donor(ECD).AIM To investigate whether shortening the rWIT could improve the outcomes of ECD LT.METHODS Rat ECD autologous orthotopic LT were performed with variable rWITs(0,10,20,and 30 minutes).Near-infrared fluorescence imaging(FI)was used for the real-time assessment of liver graft ischemia-reperfusion injury after the anhepatic phase.Survival was assessed,and liver function and histological analyses were performed on the third day after transplantation.RESULTS The FI curve growth rate and postoperative three-day survival rate significantly increased,and the liver function and Suzuki score of the liver grafts significantly improved when the rWIT was≤10 minutes(P<0.05).CONCLUSION The post-transplant outcomes were significantly better with a shorter rWIT(10 minutes or less)than with a longer rWIT,which could be a strategy for expanding the liver donor pool.展开更多
BACKGROUND Post-transplant diabetes mellitus(PTDM)adversely affects graft survival and is an independent predictor of adverse cardiovascular events.Observational studies in the general population as well as the post-t...BACKGROUND Post-transplant diabetes mellitus(PTDM)adversely affects graft survival and is an independent predictor of adverse cardiovascular events.Observational studies in the general population as well as the post-transplant setting suggest an association between the plasma 25-hydroxyvitamin D[25(OH)D]level and onset of type 2 diabetes mellitus.Literature is very limited in the context of PTDM.AIM To study the relationship between vitamin D deficiency at the time of kidney transplant and PTDM in the post-transplant period.METHODS In this single center study,72 patients who underwent kidney transplant were included.Blood samples for serum vitamin D level were collected on the day of transplant and analyzed at the end of study.The LIAISON®25(OH)D assay was used for quantitative estimation of total 25(OH)D in the serum.PTDM was diagnosed by either fasting plasma glucose(>126 mg/dL),2-h post prandial plasma glucose(>200 mg/dL),or 2-h oral glucose tolerance test after 45 days post-transplant.Hemoglobin A1c was not used to diagnose PTDM.Vitamin D levels were labeled as sufficient(≥30.0 ng/mL),insufficient(20.0-29.9 ng/mL),and deficient(<20.0 ng/mL).Patients were reviewed at 45 days and 1 year post transplant for the occurrence of PTDM.RESULTS In our study cohort 72 patients completed the study.Overall,32(43.8%)patients developed PTDM during the follow up of 1 year,44(61.1%)patients had deficient(<20 ng/mL)25(OH)D levels.Twenty-six(81.2%)patients with PTDM had deficient vitamin D levels as compared with 18(45.0%)patients without PTDM(P=0.007).This association was also significant when univariable[odds ratio(OR)=5.3,95%confidence interval(CI):1.79-15.67,P=0.003)]and multivariable(OR=8.21,95%CI:2.19-30.75,P=0.002)regression analysis was performed.A higher proportion of subjects having PTDM(15.6%)had a positive family history of diabetes mellitus than the controls(2.5%)(P=0.045).However,this association did not persist in the multivariable regression analysis(OR=12.6,95%CI:0.86-185.4,P=0.065).CONCLUSION Deficient vitamin D levels(<20 ng/mL)were significantly associated with PTDM in the post kidney transplant setting.Further studies are needed to see the effect of vitamin D replacement on PTDM.展开更多
AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. ...AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease(labM ELD)-score and the Eurotransplant Donor Risk Index(ET-DRI) to unravel their impact on 20-year survival after LT.RESULTS Twenty-year survivors were significantly younger(44 vs 50 years, P = 0.001), more likely to be female(49% vs 36%, P = 0.03) and less likely to be obese at the time of LT(19% vs 32%, P = 0.011). Mean labM ELD-score(P = 0.156), rate of high-urgency LT(P = 0.210), coldischemia time(P = 0.994), rate of retransplantation(P = 0.12) and average donor age(28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors(P = 0.007). ET-DRI > 1.4(P = 0.020) and donor age ≥ 30 years(P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labM ELD-score categories(P = 0.263).CONCLUSION LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.展开更多
AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.METHODS Ninety-nine kidney transplant recipients(KTRs) w...AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.METHODS Ninety-nine kidney transplant recipients(KTRs) were assigned to interventional exercise(Group A; n = 52) and a usual care cohort(Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life(HRQo L) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities.RESULTS Eighty-five KTRs completed the study(Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload(+13 W, P = 0.0003), V'O2 peak(+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor(+12 kg, P = 0.0368), height in the countermovement jump(+1.9 cm, P = 0.0293) and decreased in Body Mass Index(-0.5 kg/m^2, P = 0.0013). HRQo L significantly improved in physical function(P = 0.0019), physical-role limitations(P = 0.0321) and social functioning scales(P = 0.0346). Noimprovements were found in Group B.CONCLUSION Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.展开更多
Polyomavirus BK(BKV) infects up to 90% of the general population. After primary infection, occurring early during childhood, a state of non-replicative infection is established in the reno-urinary tract, without compl...Polyomavirus BK(BKV) infects up to 90% of the general population. After primary infection, occurring early during childhood, a state of non-replicative infection is established in the reno-urinary tract, without complications for immunocompetent hosts. In immunocompromised individuals, particularly transplanted patients, asymptomatic BKV viremia and/or viruria can be observed. Renal grafts may also be sources of infection as BKV prefers kidneys rather than other solid organs for transplantation such as the liver. The mechanism behind the higher incidence of BKV infection in kidney transplant patients, compared to liver or heart transplantation, is unclear and the prevalence of BKV infection in non-renal solid organ transplants has not been yet thoroughly investigated. We evaluated the prevalence of Polyomavirus BK infection among liver transplant recipients. A Pub Med search was conducted using the terms BKV infection AND liver transplant recipients; BKV AND non-renal solid organ transplant*; BKV infection AND immunosuppression; the search was limited to title/abstract and English-language articles published from 2000, to March 2015. Eleven relevant studies suggest that the prevalence of BKV viruria and/or viremia among liver transplant recipients is less than that reported in kidney or heart transplant recipients, except when chronic kidney disease(CKD) is present at the same time. Data also suggest that viruric and viremic patients have higher levels of serum creatinine than BKV negative patients. Moreover, no specific immunosuppressive drugs are associated with the onset of BKV nephropathy. The comorbidity of transplantation and CKD could play a major role in promoting BKV replication.展开更多
Mycoviruses have been found to infect more than 12 species of Penicillium, but have not been isolated from Penicillium italicum(P. italicum). In this study, we isolated and characterized a new double-stranded RNA(ds R...Mycoviruses have been found to infect more than 12 species of Penicillium, but have not been isolated from Penicillium italicum(P. italicum). In this study, we isolated and characterized a new double-stranded RNA(ds RNA) virus, designated Penicillium italicum chrysovirus 1(Pi CV1), from the citrus pathogen P. italicum HSPi-YN1. Viral genome sequencing and molecular characterization indicated that Pi CV1 was highly homologous to the previously described Penicillium chrysogenum virus. We further constructed the mutant HSPi-YN1 Dpks P defective in the polyketide synthase gene(pks P), which is involved in pigment biosynthesis, and these mutants formed albino(white) colonies. Then we applied hyphal anastomosis method to horizontally transmit Pi CV1 from the white virus-donors(i.e., HSPi-YN1 mutants) to wild-type recipients(i.e., P.italicum strains HSPi-CQ54, HSPi-HB4, and HSPi-HN1), and the desirable Pi CV1-infected isogenic recipients, a certain part of blue wild-type strains, can be eventually selected and confirmed by viral genomic ds RNA profile analysis. This bluewhite colony screening would be an easier method to select virus-infected P. italicum recipients, according to distinguishable color phenotypes between blue virus-recipients and white virus-donors. In summary, the current work newly isolated and characterized Pi CV1, verified its horizontal transmission among dually cultured P. italicum isolates, and based on these, established an effective and simplified approach to screen Pi CV1-infected isogenic recipients.展开更多
Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially...Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially in an extensive wound,or in a complex trauma combined with vascular injury.From April 2014 to March 2018,we retrospectively reviewed patients with traumatic/posttraumatic,oncologic,and electrical wounds in the lower extremity.Those treated with muscle feeding artery as recipient vessels were included.The latissimus dorsi(LD)muscle free flap,anterior lateral thigh(ALT)perforator free flap,and deep inferior epigastric perforator(DIEP)free flap were raised.The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle,concomitant veins,and great saphenous vein were used as recipient vessels.Injuries included in the study were caused by tumour in 2 cases,car accident in 3 cases,crushing in 3 cases,burns in one case,and electrical injury in one case.The wound size varied from 14 cm x 6 cm to 30 cm x 20 cm.LD,ALT,and DIEP free flaps were used in 6,3,and 4 patients,respectively.The muscle feeding arteries to medial head of gastrocnemius muscle,to sartorius muscle,and to vastus lateral muscle were used as recipient arteries in 4,5,and one patient,respectively.Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients,respectively.Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses,particularly when the wound is located proximal to the mid-third of the lower leg.展开更多
Aim:This study aimed to explore depressive symptoms and associated factors among renal-transplant(RT)recipients in China.Methods:This study included 287 RT recipients.Data were collected from August to November 2014 b...Aim:This study aimed to explore depressive symptoms and associated factors among renal-transplant(RT)recipients in China.Methods:This study included 287 RT recipients.Data were collected from August to November 2014 by utilizing demographic forms,namely,the Self-rating Depression Scale and the Multidimensional Scale of Perceived Social Support.Descriptive statistics,Student's t test,Chi-square test,ANOVA,and multiple linear regression were used for data analysis.Results:More than half of the recipients presented depressive symptoms.All recipients in the four transplant period groups(≤5 yr,5e10 yr,10e15 yr,and>15 yr)reported greater depressive symptoms than the Norm.No significant difference was observed in the depressive symptoms in the four transplant period groups.Multiple linear regression indicated that depressive symptoms were significantly associated with employment status,economic burden,inhabitation area,and social support.Conclusion:Depression is common among RT recipients in China.Employment status,economic burden,inhabitation area,and social support are the main factors affecting depression among RT recipients.Follow-up clinics should prescribe the evaluation of depression as a routine examination for RT patients.Moreover,depressed recipients must be provided with individualized care by collecting information on the depressive symptoms,employment status,economic burden,inhabitation area,and perceived social support of recipients.展开更多
Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2,which the World Health Organization later designated as coronavirus disease 2019(COVID-19)...Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2,which the World Health Organization later designated as coronavirus disease 2019(COVID-19).The World Health Organization declared COVID-19 as a pandemic on March 11,2020.In the general population,COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill.Its mortality rate could be as high as 49%.The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions,among those who need immunosuppression after solid organ transplantation(SOT),are at an increased risk of developing severe illness from COVID-19.Liver transplantation is the second most prevalent SOT globally.Due to their immunosuppressed state,liver transplant(LT)recipients are more susceptible to serious infections.Therefore,comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19.It is crucial to comprehend the clinical picture,immunosuppressive management,prognosis,and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients.This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group.In the following sections,we discussed current COVID-19 therapy choices,reviewed standard practice in modifying immunosuppressant regimens,and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management.Additionally,we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.展开更多
AIM: To evaluate whether there is a threshold sensitization level beyond which benefits of chronic steroid maintenance(CSM) emerge. METHODS: Using Organ Procurement and Transplant Network/United Network of Organ Shari...AIM: To evaluate whether there is a threshold sensitization level beyond which benefits of chronic steroid maintenance(CSM) emerge. METHODS: Using Organ Procurement and Transplant Network/United Network of Organ Sharing database, we compared the adjusted graft and patient survivals for CSM vs early steroid withdrawal(ESW) among patients who underwent deceased-donor kidney(DDK) transplantation from 2000 to 2008 who were stratified by peak-panel reactive antibody(peak-PRA) titers(0%-30%, 31%-60% and > 60%). All patients received perioperative induction therapy and maintenance immunosuppression based on calcineurin inhibitor(CNI) and mycophenolate mofetil(MMF).RESULTS: The study included 42851 patients. In the 0%-30% peak-PRA class, adjusted over-all graft-failure(HR 1.11, 95%CI: 1.03-1.20, P = 0.009) and patientdeath(HR 1.29, 95%CI: 1.16-1.43, P < 0.001) risks were higher and death-censored graft-failure risk(HR 1.06, 95%CI: 0.98-1.14, P = 0.16) similar for CSM(n = 25218) vs ESW(n = 7399). Over-all(HR 1.04, 95%CI: 0.85-1.28, P = 0.70) and death-censored(HR 0.97, 95%CI: 0.78-1.21, P = 0.81) graft-failure risks were similar and patient-death risk(HR 1.39, 95%CI: 1.03-1.87, P = 0.03) higher for CSM(n = 3495) vs ESW(n = 850) groups for 31%-60% peak-PRA class. In the > 60% peak-PRA class, adjusted overall graft-failure(HR 0.90, 95%CI: 0.76-1.08, P = 0.25) and patientdeath(HR 0.92, 95%CI: 0.71-1.17, P = 0.47) risks were similar and death-censored graft-failure risk lower(HR 0.84, 95%CI: 0.71-0.99, P = 0.04) for CSM(n = 4966)vs ESW(n = 923).CONCLUSION: In DDK transplant recipients who underwent perioperative induction and CNI/MMF maintenance, CSM appears to be associated with increased risk for death with functioning graft in minimally-sensitized patients and improved death-censored graft survival in highly-sensitized patients.展开更多
BACKGROUND Liver transplant patients are at higher risk of infection due to immunosuppression.Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2...BACKGROUND Liver transplant patients are at higher risk of infection due to immunosuppression.Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and will have worse outcomes than the general population if they develop coronavirus disease 2019(COVID-19)due to SARS-CoV-2 is a topic of ongoing studies,including ours.AIM To assess the clinical outcomes of COVID-19 in liver transplant recipients.METHODS This was a case-control study,with a database search performed(at the study site)from March 1,2020 through February 28,2021.Patients 18 years or older who tested positive for SARS-CoV-2 via polymerase chain reaction(PCR)were included in the study.Patients with infection other than pneumonia at the time of admission were excluded.After selection,patients who had been the recipient of liver transplant were considered cases and those without as controls.After being matched by age,sex,and obesity,two controls were randomly selected for each case.Death and hospitalization due to COVID-19 infection were the primary outcomes.Secondary outcomes were pertinent only to patients who were hospitalized,and they included duration of hospital stay,need for supplemental oxygen,presence of at least one type of end-organ damage,effects on liver enzymes,incidence of acute liver failure,effect on d-dimer levels,and incidence of venous thromboembolism(VTE).Chi-square or Fisher’s exact test was used to compare all primary and secondary outcomes with the exception of duration of hospital stay and d-dimer levels,which were compared using the Wilcoxon signed-rank test.Alpha criterion was set at 0.05.Logistic regression was performed for each primary outcome(as the dependent variable).Statistical analyses were performed using R software.RESULTS Of the 470 Liver transplant recipients who were tested for COVID-19 via the PCR test,39 patients tested positive(8.3%).There was no significant difference between cases and controls regarding death[odds ratio(OR):2.04,95%confidence interval(CI):0.14–29.17;P=0.60]and hospitalization rates(OR:1.38,95%CI:0.59–3.24;P=0.46).There also was no significant difference between cases and controls with respect to all secondary outcomes.Among all patients who had elevated liver enzymes,their levels were either normalized,improving,or remained stable at the time of discharge.No patient developed acute liver failure.Of the 31 hospitalized patients,27 received a prophylactic anticoagulation dose and no patient developed VTE in either group.Among cases who were hospitalized,immunosuppression was decreased in 5 patients and there was no change in immunosuppression among the remaining 7 patients.One patient died in each of these two subgroups.Logistic regression analysis was done,but all of the models had poor model predictions as well as insignificant predictors(independent variables).Therefore,they could not be used for either prediction or inference.CONCLUSION Clinical outcomes of COVID-19 in liver transplant recipients are not different than those without transplantation.COVID-19 should not impact timely health care access and immunosuppression continuation among these patients.展开更多
AIM To evaluate the outcomes of transplanting marginal kidneys preemptively compared to better-quality kidneys after varying dialysis vintage in older recipients.METHODS Using OPTN/United Network for Organ Sharing dat...AIM To evaluate the outcomes of transplanting marginal kidneys preemptively compared to better-quality kidneys after varying dialysis vintage in older recipients.METHODS Using OPTN/United Network for Organ Sharing database from 2001-2015, we identified deceased donor kidney(DDK) transplant recipients > 60 years of age who either underwent preemptive transplantation of kidneys with kidney donor profile index(KDPI) ≥ 85%(marginal kidneys) or received kidneys with KDPI of 35%-84%(better quality kidneys that older wait-listed patients would likely receive if waited longer) after being on dialysis for either 1-4 or 4-8 years. Using a multivariate Cox model adjusting for donor, recipient and transplant related factors-overall and death-censored graft failure risks along with patient death risk of preemptive transplant recipients were compared to transplant recipients in the 1-4 and 4-8 year dialysis vintage groups.RESUTLS The median follow up for the whole group was 37 mo(interquartile range of 57 mo). A total of 6110 DDK transplant recipients above the age of 60 years identified during the study period were found to be eligible to be included in the analysis. Among these patients350 received preemptive transplantation of kidneys with KDPI ≥ 85. The remaining patients underwent transplantation of better quality kidneys with KDPI 35-84% after being on maintenance dialysis for either 1-4 years(n = 3300) or 4-8 years(n = 2460). Adjusted overall graft failure risk and death-censored graft failure risk in preemptive high KDPI kidney recipients were similar when compared to group that received lower KDPI kidney after being on maintenance dialysis for either 1-4 years(HR 1.01, 95%CI: 0.90-1.14, P = 0.84 and HR 0.96, 95%CI: 0.79-1.16, P = 0.66 respectively) or 4-8 years(HR 0.82, 95%CI: 0.63-1.07, P = 0.15 and HR 0.81, 95%CI: 0.52-1.25, P = 0.33 respectively). Adjusted patient death risk in preemptive high KDPI kidney recipients were similar when compared to groups that received lower KDPI kidney after being on maintenance dialysis for 1-4 years(HR 0.99, 95%CI: 0.87-1.12, P = 0.89) but lower compared to patients who were on dialysis for 4-8 years(HR 0.74, 95%CI: 0.56-0.98, P = 0.037).CONCLUSION In summary, our study supports accepting a "marginal" quality high KDPI kidney preemptively in older waitlisted patients thus avoiding dialysis exposure.展开更多
BACKGROUND Physical activity levels are significantly lower in kidney transplant(KT)recipients compared to the general population.The effects of exercise training in KT recipients with diabetes mellitus remain unclear...BACKGROUND Physical activity levels are significantly lower in kidney transplant(KT)recipients compared to the general population.The effects of exercise training in KT recipients with diabetes mellitus remain unclear,and so little is known about the role of increased exercise on cardiovascular risk and metabolic profile of KT patients.AIM To investigate the effects of a 6-mo home-based exercise training program on functional capacity,glucose levels and lipid profile of diabetic KT patients.METHODS In total,21 type II diabetic KT recipients were randomly assigned into two groups:Exercise(n=11,aged 52.9±10.1 years)and control(n=10,aged 53.01±9.5 years).All participants at baseline and the end of the study underwent biochemical tests for fasting plasma glucose levels,glycated hemoglobin and lipid profile and cardiopulmonary exercise testing for maximum oxygen uptake[(VO2)peak]estimation.The exercise group followed a 6-mo supervised home-based aerobic and progressive resistance exercise program of moderate intensity 3 times per week,while the control group continued to receive usual care.RESULTS At the end of the 6-mo study,the exercise group had significantly lower values in fasting plasma glucose by 13.4%(from 120.6±28.9 mg/dL to 104.8±21.9 mg/dL,P=0.01),glycated hemoglobin by 1.5%(from 6.7%±0.4 to 6.6%±0.4,P=0.01)and triglycerides by 8.5%(from 164.7±14.8 mg/dL to 150.8±11.6 mg/dL,P<0.05)and higher values in high-density lipoprotein by 10.2%(from 51.4±8.8 mg/dL to 57.2±8.7 mg/dL,P<0.05)and(VO_(2))_(peak)by 4.7%(from 22.7±3.3 to 23.8±4.2,P=0.02)than the control group.There were statistically significant differences between the two groups at the end of the study for fasting plasma glucose(decreased by 9.6%,P<0.05),triglycerides(decreased by 4.5%,P=0.04)and(VO_(2))_(peak)(increased by 4.4%,P=0.01).Finally,after training,there was a moderate,positive linear relationship between(VO_(2))_(peak)and glycated hemoglobin in the exercise group(r=0.408,P=0.03).CONCLUSION The results demonstrated that a 6-mo home-based mixed type exercise training program can improve the functional capacity,levels of glucose and lipid profile of diabetic KT recipients.展开更多
文摘BACKGROUND Old donor allografts in liver transplantation(LT)account for 25%of all allografts,and their utilization is projected to increase with the aging general population.Older allografts are associated with higher rates of all-cause mortality and graft failure;however,there is limited literature exploring the specific phenotypic changes(e.g.,functional status,cause-specific mortality)observed in different donor:recipient age pairs.AIM To investigate differences in functional impairment and cause-specific mortality between different donor:recipient age pairs.METHODS This was a retrospective analysis of LT patients from the Scientific Registry of Transplant Recipients from 2002 to 2022.Donors were categorized into younger age donors,≤45-years(YAD),middle-aged donors,46-69-years(MAD),and older age donors,≥70-years(OAD).Recipients were categorized into younger age recipients,≤55-years(YAR)and older age recipients,>55-years(OAR)age recipients.Multivariate Fine-Gray competing risk and logistic regression analyses identified independent risk factors for cause-specific mortality and improvements in functional status,respectively.RESULTS Overall,126185 patients were included in the analysis:YAD:YAR(32.7%), YAD:OAR (25.2%), MAD:YAR (17.5%), MAD:OAR (20.7%), OAD:YAR (1.3%), and OAD:OAR (2.7%). Compared toYAD:YAR, OAD pairs had the lowest likelihoods of improved functional status 5 years post-LT (OAD:YAR oddsratio 0.53, 95% confidence interval 0.42-0.67, P < 0.001;OAD:OAR odds ratio 0.67, 95% confidence interval 0.51-0.89, P = 0.006). Donor:recipient age pairs with older donors had higher rates of graft- and infection-relatedmortality compared to those with younger donors (P < 0.001). Meanwhile, donor:recipient age pairs with olderrecipients had higher cardioneurovascular- or malignancy-related deaths compared to those with youngerrecipients (P < 0.001).CONCLUSIONDonor:recipient age mismatch was associated with differences in cause-specific mortality and functional status.These insights could potentially inform age-matched organ allocation strategies, though future work is warranted.
基金supported in part by grants from National Nat-ural Science Foundation of China (82200726 and U23A20451)Key Program of the National Natural Science Foundation of China (81930016)National Key Research and Development Program of China (2021YFA1100500)。
文摘Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the “classical” recipient hepatectomy is believed to be one of the potential reasons to cause tumor evasion because of the possible increase of circulating tumor cells, thus leading to an increased recurrent rate. On this background, the no-touch oncological recipient hepatectomy technique has been developed. A comprehensive review of the development and the key surgical steps of the no-touch recipient hepatectomy is presented. This technique might improve clinical outcomes, especially for those recipients who are at a high risk for tumor recurrence. Multicenter prospective studies should be set up to further validate the prognostic role of this technique in patients with liver cancer treated with liver transplantation.
文摘Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in infants.However,the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant.This review explores historical developments,various approaches to measuring the required functional liver mass,and techniques to prevent complications associated with large-for-size grafts in infants.
文摘BACKGROUND In the absence of effective antimicrobials,transplant surgery is not viable,and antirejection immunosuppressants cannot be administered,as resistant infections compromise the life-saving goal of organ transplantation.AIM To evaluate the efficacy of antimicrobials in preventing resistance in solid organ transplant recipients.METHODS A systematic review was conducted using a search methodology consistent with the preferred reporting items for systematic reviews and meta-analyses.This review included randomized clinical trials that evaluated the efficacy of antimicrobial agents(prophylactic or therapeutic)aimed at preventing antimicrobial resistance.The search strategy involved analyzing multiple databases,including PubMed/MEDLINE,Web of Science,Embase,Scopus,and SciELO,as well as examining gray literature sources on Google Scholar.A comprehensive electronic database search was conducted from the databases’inception until May 2024,with no language restrictions.RESULTS After the final phase of the eligibility assessment,this systematic review ultimate-ly included 7 articles.A total of 2318 patients were studied.The most studied microorganisms were cytomegalovirus,although vancomycinresistant enterococci,Clostridioides difficile,and multidrug-resistant Enterobacterales were also analyzed.The antimicrobials used in the interventions were mainly maribavir,valganciclovir,gancic-lovir,and colistin-neomycin.Of concern,all clinical trials showed significant proportions of resistant microorga-nisms after the interventions,with no statistically significant differences between the groups(mean resistance 13.47%vs 14.39%),except for two studies that demonstrated greater efficacy of maribavir and valganciclovir(mean resistance 22.2%vs 41.1%in the control group;P<0.05).The total reported deaths in three clinical trials were 75,and there were 24 graft rejections in two studies.CONCLUSION All clinical trials reported significant proportions of antimicrobial-resistant microorganisms following interventions.More high-quality randomized clinical trials are needed to corroborate these results.
基金Supported by The Jewel and Frank Benson Family Endowment.
文摘BACKGROUND The utilization of hearts from older donors has increased,particularly for older recipients.However,the impact of older donor hearts on recipients of different ages is less known.AIM To determine the impact of older donor hearts on post-transplant outcomes across different recipient age groups.METHODS The Organ Procurement and Transplant Network database was queried from 2006 to March 2024.Four groups were created stratifying by donor age(>55 years)and recipient age(>60 years).Kaplan-Meier curves and Cox regression models were used.RESULTS One thousand fifty out of 39868 transplants(2.6%)were performed utilizing hearts from older donors.The rate of older donor hearts in younger recipients was only 1.8%,while the older donor hearts were used 4.0%in older recipients(P<0.001).Old donor/old recipient and young donor/old recipient combinations were associated with post-transplant mortality[hazard ratio(HR):1.64(95%CI:1.42-1.90)and 1.42(95%CI:1.34-1.51)],while old donor/young recipient was not.Within each recipient age group,the older recipient groups showed greater differences in 1-and 5-year survival probabilities(80.4%and 67.4%with old donors,89.2%and 76.8%with young donors)than younger recipient groups(90.3%and 77.5%with old donors,92.2%and 80.3%with young donors).CONCLUSION This study demonstrates the higher utilization of older donor hearts(aged more than 55)in older recipients.Paradoxically,the combination of older donor hearts with older recipients is associated with a higher risk of mortality.However,these organs remain valuable options across all recipient age groups in current context of organ shortage.
基金Supported by the Vietnam National Foundation for Science and Technology Development,No.NAFOSTED 04/2020/TN.
文摘BACKGROUND Tacrolimus(TAC)is metabolized primarily by the CYP3A-encoded enzyme family(CYP3A4,CYP3A5,and CYP3A7).Individuals expressing the CYP3A51 allele are considered fast metabolizers and generally require higher TAC doses to reach therapeutic levels.AIM To evaluate the predictive value of the TAC concentration-to-dose(C0/D)ratio for identifying CYP3A5 poly-morphisms in renal transplant recipients.METHODS Eighty-six de novo kidney transplant recipients with TAC-based immunosuppression from the Department of Nephrology and Dialysis at Military Hospital 103(Hanoi,Vietnam)were included in this retrospective study.Blood samples were collected within the first week post-transplantation to monitor TAC levels and to perform genotyping for CYP3A5 genetic polymorphisms.RESULTS The CYP3A53/3 genotype was identified in 37 patients(43%),CYP3A51/3 in 40 patients(46.5%),and CYP3A51/1 in 9 patients(10.5%).Patients carrying the CYP3A51/3 or CYP3A51/1 genotype,classified as fast metabolizers(CYP3A5 expressers),had significantly lower TAC C0 concentrations and C0/D ratios compared to slow meta-bolizers(CYP3A53/3 genotype)at multiple time points during follow-up(all P<0.001).Notably,the TAC C0/D ratio obtained on day 1(0.91)was shown to predict CYP3A5 polymorphism with a sensitivity of 84.6%and a specificity of 84.6%.CONCLUSION This study demonstrates that the TAC C0/D ratio provides a reliable predictive value for CYP3A5 polymorphisms,which can be used to individualize TAC dosing in renal transplant recipients in Vietnam and other low-income countries.
文摘Robotic surgery has emerged as a new frontier in liver transplantation.Given the novelty of its application to recipient procedures,a comprehensive overview is crucial.This narrative review synthesizes the fragmented,foundational data on fully robotic recipient adult living donor liver transplantation(LDLT)on the basis of an appraisal of initial case reports and preliminary comparative studies.The literature was identifiedvia PubMed.The literature demonstrates the technical feasibility and favorable safety profileof the robotic approach.A significantreduction in morbidity was observed,as evidenced by a lower comprehensive complication index,reduced blood loss and transfusion need,and a lower incidence of postoperative infections.These benefitswere reflected in significantlyshorter intensive care unit and hospital stays.While the robotic approach was associated with prolonged operative and ischemia times,the studies revealed that these approaches did not compromise outcomes,with higher 6-month recipient survival noted in the robotic group.Fully robotic recipient LDLT is a groundbreaking technique,although the current evidence consists of initial case reports and non-randomized comparative data from a single center.The available literature suggests a promising safety profileand significantshort-term benefits,but these preliminary findingsrequire validation through multicenter,high-level research.
基金Supported by The Key R&D Plan of Shaanxi Province,No.2021GXLH-Z-047.
文摘BACKGROUND Shortening the recipient warm ischemia time(rWIT)has been proven to be effective for improving the short-and long-term outcomes after liver transplantation(LT)and offsets the negative impact of an extended cold ischemia time.However,few studies have been conducted to explore the prognostic effects of shortening the rWIT in transplantations using a liver graft from an extendedcriteria donor(ECD).AIM To investigate whether shortening the rWIT could improve the outcomes of ECD LT.METHODS Rat ECD autologous orthotopic LT were performed with variable rWITs(0,10,20,and 30 minutes).Near-infrared fluorescence imaging(FI)was used for the real-time assessment of liver graft ischemia-reperfusion injury after the anhepatic phase.Survival was assessed,and liver function and histological analyses were performed on the third day after transplantation.RESULTS The FI curve growth rate and postoperative three-day survival rate significantly increased,and the liver function and Suzuki score of the liver grafts significantly improved when the rWIT was≤10 minutes(P<0.05).CONCLUSION The post-transplant outcomes were significantly better with a shorter rWIT(10 minutes or less)than with a longer rWIT,which could be a strategy for expanding the liver donor pool.
文摘BACKGROUND Post-transplant diabetes mellitus(PTDM)adversely affects graft survival and is an independent predictor of adverse cardiovascular events.Observational studies in the general population as well as the post-transplant setting suggest an association between the plasma 25-hydroxyvitamin D[25(OH)D]level and onset of type 2 diabetes mellitus.Literature is very limited in the context of PTDM.AIM To study the relationship between vitamin D deficiency at the time of kidney transplant and PTDM in the post-transplant period.METHODS In this single center study,72 patients who underwent kidney transplant were included.Blood samples for serum vitamin D level were collected on the day of transplant and analyzed at the end of study.The LIAISON®25(OH)D assay was used for quantitative estimation of total 25(OH)D in the serum.PTDM was diagnosed by either fasting plasma glucose(>126 mg/dL),2-h post prandial plasma glucose(>200 mg/dL),or 2-h oral glucose tolerance test after 45 days post-transplant.Hemoglobin A1c was not used to diagnose PTDM.Vitamin D levels were labeled as sufficient(≥30.0 ng/mL),insufficient(20.0-29.9 ng/mL),and deficient(<20.0 ng/mL).Patients were reviewed at 45 days and 1 year post transplant for the occurrence of PTDM.RESULTS In our study cohort 72 patients completed the study.Overall,32(43.8%)patients developed PTDM during the follow up of 1 year,44(61.1%)patients had deficient(<20 ng/mL)25(OH)D levels.Twenty-six(81.2%)patients with PTDM had deficient vitamin D levels as compared with 18(45.0%)patients without PTDM(P=0.007).This association was also significant when univariable[odds ratio(OR)=5.3,95%confidence interval(CI):1.79-15.67,P=0.003)]and multivariable(OR=8.21,95%CI:2.19-30.75,P=0.002)regression analysis was performed.A higher proportion of subjects having PTDM(15.6%)had a positive family history of diabetes mellitus than the controls(2.5%)(P=0.045).However,this association did not persist in the multivariable regression analysis(OR=12.6,95%CI:0.86-185.4,P=0.065).CONCLUSION Deficient vitamin D levels(<20 ng/mL)were significantly associated with PTDM in the post kidney transplant setting.Further studies are needed to see the effect of vitamin D replacement on PTDM.
文摘AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease(labM ELD)-score and the Eurotransplant Donor Risk Index(ET-DRI) to unravel their impact on 20-year survival after LT.RESULTS Twenty-year survivors were significantly younger(44 vs 50 years, P = 0.001), more likely to be female(49% vs 36%, P = 0.03) and less likely to be obese at the time of LT(19% vs 32%, P = 0.011). Mean labM ELD-score(P = 0.156), rate of high-urgency LT(P = 0.210), coldischemia time(P = 0.994), rate of retransplantation(P = 0.12) and average donor age(28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors(P = 0.007). ET-DRI > 1.4(P = 0.020) and donor age ≥ 30 years(P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labM ELD-score categories(P = 0.263).CONCLUSION LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.
文摘AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.METHODS Ninety-nine kidney transplant recipients(KTRs) were assigned to interventional exercise(Group A; n = 52) and a usual care cohort(Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life(HRQo L) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities.RESULTS Eighty-five KTRs completed the study(Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload(+13 W, P = 0.0003), V'O2 peak(+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor(+12 kg, P = 0.0368), height in the countermovement jump(+1.9 cm, P = 0.0293) and decreased in Body Mass Index(-0.5 kg/m^2, P = 0.0013). HRQo L significantly improved in physical function(P = 0.0019), physical-role limitations(P = 0.0321) and social functioning scales(P = 0.0346). Noimprovements were found in Group B.CONCLUSION Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.
文摘Polyomavirus BK(BKV) infects up to 90% of the general population. After primary infection, occurring early during childhood, a state of non-replicative infection is established in the reno-urinary tract, without complications for immunocompetent hosts. In immunocompromised individuals, particularly transplanted patients, asymptomatic BKV viremia and/or viruria can be observed. Renal grafts may also be sources of infection as BKV prefers kidneys rather than other solid organs for transplantation such as the liver. The mechanism behind the higher incidence of BKV infection in kidney transplant patients, compared to liver or heart transplantation, is unclear and the prevalence of BKV infection in non-renal solid organ transplants has not been yet thoroughly investigated. We evaluated the prevalence of Polyomavirus BK infection among liver transplant recipients. A Pub Med search was conducted using the terms BKV infection AND liver transplant recipients; BKV AND non-renal solid organ transplant*; BKV infection AND immunosuppression; the search was limited to title/abstract and English-language articles published from 2000, to March 2015. Eleven relevant studies suggest that the prevalence of BKV viruria and/or viremia among liver transplant recipients is less than that reported in kidney or heart transplant recipients, except when chronic kidney disease(CKD) is present at the same time. Data also suggest that viruric and viremic patients have higher levels of serum creatinine than BKV negative patients. Moreover, no specific immunosuppressive drugs are associated with the onset of BKV nephropathy. The comorbidity of transplantation and CKD could play a major role in promoting BKV replication.
基金supported by the National Natural Science Foundations of China (No. 31371893)the Natural Science Fund of Hubei Province (No. 2018CFB676)the Project of Hubei Key Laboratory of Genetic Regulation and Integrative Biology (Grant No. GRIB20184)
文摘Mycoviruses have been found to infect more than 12 species of Penicillium, but have not been isolated from Penicillium italicum(P. italicum). In this study, we isolated and characterized a new double-stranded RNA(ds RNA) virus, designated Penicillium italicum chrysovirus 1(Pi CV1), from the citrus pathogen P. italicum HSPi-YN1. Viral genome sequencing and molecular characterization indicated that Pi CV1 was highly homologous to the previously described Penicillium chrysogenum virus. We further constructed the mutant HSPi-YN1 Dpks P defective in the polyketide synthase gene(pks P), which is involved in pigment biosynthesis, and these mutants formed albino(white) colonies. Then we applied hyphal anastomosis method to horizontally transmit Pi CV1 from the white virus-donors(i.e., HSPi-YN1 mutants) to wild-type recipients(i.e., P.italicum strains HSPi-CQ54, HSPi-HB4, and HSPi-HN1), and the desirable Pi CV1-infected isogenic recipients, a certain part of blue wild-type strains, can be eventually selected and confirmed by viral genomic ds RNA profile analysis. This bluewhite colony screening would be an easier method to select virus-infected P. italicum recipients, according to distinguishable color phenotypes between blue virus-recipients and white virus-donors. In summary, the current work newly isolated and characterized Pi CV1, verified its horizontal transmission among dually cultured P. italicum isolates, and based on these, established an effective and simplified approach to screen Pi CV1-infected isogenic recipients.
文摘Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially in an extensive wound,or in a complex trauma combined with vascular injury.From April 2014 to March 2018,we retrospectively reviewed patients with traumatic/posttraumatic,oncologic,and electrical wounds in the lower extremity.Those treated with muscle feeding artery as recipient vessels were included.The latissimus dorsi(LD)muscle free flap,anterior lateral thigh(ALT)perforator free flap,and deep inferior epigastric perforator(DIEP)free flap were raised.The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle,concomitant veins,and great saphenous vein were used as recipient vessels.Injuries included in the study were caused by tumour in 2 cases,car accident in 3 cases,crushing in 3 cases,burns in one case,and electrical injury in one case.The wound size varied from 14 cm x 6 cm to 30 cm x 20 cm.LD,ALT,and DIEP free flaps were used in 6,3,and 4 patients,respectively.The muscle feeding arteries to medial head of gastrocnemius muscle,to sartorius muscle,and to vastus lateral muscle were used as recipient arteries in 4,5,and one patient,respectively.Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients,respectively.Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses,particularly when the wound is located proximal to the mid-third of the lower leg.
基金The study was funded by the National Natural Science Foundation of China(No.81171860)The authors thank the RT recipients who participated in this study.
文摘Aim:This study aimed to explore depressive symptoms and associated factors among renal-transplant(RT)recipients in China.Methods:This study included 287 RT recipients.Data were collected from August to November 2014 by utilizing demographic forms,namely,the Self-rating Depression Scale and the Multidimensional Scale of Perceived Social Support.Descriptive statistics,Student's t test,Chi-square test,ANOVA,and multiple linear regression were used for data analysis.Results:More than half of the recipients presented depressive symptoms.All recipients in the four transplant period groups(≤5 yr,5e10 yr,10e15 yr,and>15 yr)reported greater depressive symptoms than the Norm.No significant difference was observed in the depressive symptoms in the four transplant period groups.Multiple linear regression indicated that depressive symptoms were significantly associated with employment status,economic burden,inhabitation area,and social support.Conclusion:Depression is common among RT recipients in China.Employment status,economic burden,inhabitation area,and social support are the main factors affecting depression among RT recipients.Follow-up clinics should prescribe the evaluation of depression as a routine examination for RT patients.Moreover,depressed recipients must be provided with individualized care by collecting information on the depressive symptoms,employment status,economic burden,inhabitation area,and perceived social support of recipients.
文摘Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2,which the World Health Organization later designated as coronavirus disease 2019(COVID-19).The World Health Organization declared COVID-19 as a pandemic on March 11,2020.In the general population,COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill.Its mortality rate could be as high as 49%.The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions,among those who need immunosuppression after solid organ transplantation(SOT),are at an increased risk of developing severe illness from COVID-19.Liver transplantation is the second most prevalent SOT globally.Due to their immunosuppressed state,liver transplant(LT)recipients are more susceptible to serious infections.Therefore,comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19.It is crucial to comprehend the clinical picture,immunosuppressive management,prognosis,and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients.This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group.In the following sections,we discussed current COVID-19 therapy choices,reviewed standard practice in modifying immunosuppressant regimens,and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management.Additionally,we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.
基金supported in part by Health Resources and Services Administration contract 231-00-0115
文摘AIM: To evaluate whether there is a threshold sensitization level beyond which benefits of chronic steroid maintenance(CSM) emerge. METHODS: Using Organ Procurement and Transplant Network/United Network of Organ Sharing database, we compared the adjusted graft and patient survivals for CSM vs early steroid withdrawal(ESW) among patients who underwent deceased-donor kidney(DDK) transplantation from 2000 to 2008 who were stratified by peak-panel reactive antibody(peak-PRA) titers(0%-30%, 31%-60% and > 60%). All patients received perioperative induction therapy and maintenance immunosuppression based on calcineurin inhibitor(CNI) and mycophenolate mofetil(MMF).RESULTS: The study included 42851 patients. In the 0%-30% peak-PRA class, adjusted over-all graft-failure(HR 1.11, 95%CI: 1.03-1.20, P = 0.009) and patientdeath(HR 1.29, 95%CI: 1.16-1.43, P < 0.001) risks were higher and death-censored graft-failure risk(HR 1.06, 95%CI: 0.98-1.14, P = 0.16) similar for CSM(n = 25218) vs ESW(n = 7399). Over-all(HR 1.04, 95%CI: 0.85-1.28, P = 0.70) and death-censored(HR 0.97, 95%CI: 0.78-1.21, P = 0.81) graft-failure risks were similar and patient-death risk(HR 1.39, 95%CI: 1.03-1.87, P = 0.03) higher for CSM(n = 3495) vs ESW(n = 850) groups for 31%-60% peak-PRA class. In the > 60% peak-PRA class, adjusted overall graft-failure(HR 0.90, 95%CI: 0.76-1.08, P = 0.25) and patientdeath(HR 0.92, 95%CI: 0.71-1.17, P = 0.47) risks were similar and death-censored graft-failure risk lower(HR 0.84, 95%CI: 0.71-0.99, P = 0.04) for CSM(n = 4966)vs ESW(n = 923).CONCLUSION: In DDK transplant recipients who underwent perioperative induction and CNI/MMF maintenance, CSM appears to be associated with increased risk for death with functioning graft in minimally-sensitized patients and improved death-censored graft survival in highly-sensitized patients.
文摘BACKGROUND Liver transplant patients are at higher risk of infection due to immunosuppression.Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and will have worse outcomes than the general population if they develop coronavirus disease 2019(COVID-19)due to SARS-CoV-2 is a topic of ongoing studies,including ours.AIM To assess the clinical outcomes of COVID-19 in liver transplant recipients.METHODS This was a case-control study,with a database search performed(at the study site)from March 1,2020 through February 28,2021.Patients 18 years or older who tested positive for SARS-CoV-2 via polymerase chain reaction(PCR)were included in the study.Patients with infection other than pneumonia at the time of admission were excluded.After selection,patients who had been the recipient of liver transplant were considered cases and those without as controls.After being matched by age,sex,and obesity,two controls were randomly selected for each case.Death and hospitalization due to COVID-19 infection were the primary outcomes.Secondary outcomes were pertinent only to patients who were hospitalized,and they included duration of hospital stay,need for supplemental oxygen,presence of at least one type of end-organ damage,effects on liver enzymes,incidence of acute liver failure,effect on d-dimer levels,and incidence of venous thromboembolism(VTE).Chi-square or Fisher’s exact test was used to compare all primary and secondary outcomes with the exception of duration of hospital stay and d-dimer levels,which were compared using the Wilcoxon signed-rank test.Alpha criterion was set at 0.05.Logistic regression was performed for each primary outcome(as the dependent variable).Statistical analyses were performed using R software.RESULTS Of the 470 Liver transplant recipients who were tested for COVID-19 via the PCR test,39 patients tested positive(8.3%).There was no significant difference between cases and controls regarding death[odds ratio(OR):2.04,95%confidence interval(CI):0.14–29.17;P=0.60]and hospitalization rates(OR:1.38,95%CI:0.59–3.24;P=0.46).There also was no significant difference between cases and controls with respect to all secondary outcomes.Among all patients who had elevated liver enzymes,their levels were either normalized,improving,or remained stable at the time of discharge.No patient developed acute liver failure.Of the 31 hospitalized patients,27 received a prophylactic anticoagulation dose and no patient developed VTE in either group.Among cases who were hospitalized,immunosuppression was decreased in 5 patients and there was no change in immunosuppression among the remaining 7 patients.One patient died in each of these two subgroups.Logistic regression analysis was done,but all of the models had poor model predictions as well as insignificant predictors(independent variables).Therefore,they could not be used for either prediction or inference.CONCLUSION Clinical outcomes of COVID-19 in liver transplant recipients are not different than those without transplantation.COVID-19 should not impact timely health care access and immunosuppression continuation among these patients.
文摘AIM To evaluate the outcomes of transplanting marginal kidneys preemptively compared to better-quality kidneys after varying dialysis vintage in older recipients.METHODS Using OPTN/United Network for Organ Sharing database from 2001-2015, we identified deceased donor kidney(DDK) transplant recipients > 60 years of age who either underwent preemptive transplantation of kidneys with kidney donor profile index(KDPI) ≥ 85%(marginal kidneys) or received kidneys with KDPI of 35%-84%(better quality kidneys that older wait-listed patients would likely receive if waited longer) after being on dialysis for either 1-4 or 4-8 years. Using a multivariate Cox model adjusting for donor, recipient and transplant related factors-overall and death-censored graft failure risks along with patient death risk of preemptive transplant recipients were compared to transplant recipients in the 1-4 and 4-8 year dialysis vintage groups.RESUTLS The median follow up for the whole group was 37 mo(interquartile range of 57 mo). A total of 6110 DDK transplant recipients above the age of 60 years identified during the study period were found to be eligible to be included in the analysis. Among these patients350 received preemptive transplantation of kidneys with KDPI ≥ 85. The remaining patients underwent transplantation of better quality kidneys with KDPI 35-84% after being on maintenance dialysis for either 1-4 years(n = 3300) or 4-8 years(n = 2460). Adjusted overall graft failure risk and death-censored graft failure risk in preemptive high KDPI kidney recipients were similar when compared to group that received lower KDPI kidney after being on maintenance dialysis for either 1-4 years(HR 1.01, 95%CI: 0.90-1.14, P = 0.84 and HR 0.96, 95%CI: 0.79-1.16, P = 0.66 respectively) or 4-8 years(HR 0.82, 95%CI: 0.63-1.07, P = 0.15 and HR 0.81, 95%CI: 0.52-1.25, P = 0.33 respectively). Adjusted patient death risk in preemptive high KDPI kidney recipients were similar when compared to groups that received lower KDPI kidney after being on maintenance dialysis for 1-4 years(HR 0.99, 95%CI: 0.87-1.12, P = 0.89) but lower compared to patients who were on dialysis for 4-8 years(HR 0.74, 95%CI: 0.56-0.98, P = 0.037).CONCLUSION In summary, our study supports accepting a "marginal" quality high KDPI kidney preemptively in older waitlisted patients thus avoiding dialysis exposure.
文摘BACKGROUND Physical activity levels are significantly lower in kidney transplant(KT)recipients compared to the general population.The effects of exercise training in KT recipients with diabetes mellitus remain unclear,and so little is known about the role of increased exercise on cardiovascular risk and metabolic profile of KT patients.AIM To investigate the effects of a 6-mo home-based exercise training program on functional capacity,glucose levels and lipid profile of diabetic KT patients.METHODS In total,21 type II diabetic KT recipients were randomly assigned into two groups:Exercise(n=11,aged 52.9±10.1 years)and control(n=10,aged 53.01±9.5 years).All participants at baseline and the end of the study underwent biochemical tests for fasting plasma glucose levels,glycated hemoglobin and lipid profile and cardiopulmonary exercise testing for maximum oxygen uptake[(VO2)peak]estimation.The exercise group followed a 6-mo supervised home-based aerobic and progressive resistance exercise program of moderate intensity 3 times per week,while the control group continued to receive usual care.RESULTS At the end of the 6-mo study,the exercise group had significantly lower values in fasting plasma glucose by 13.4%(from 120.6±28.9 mg/dL to 104.8±21.9 mg/dL,P=0.01),glycated hemoglobin by 1.5%(from 6.7%±0.4 to 6.6%±0.4,P=0.01)and triglycerides by 8.5%(from 164.7±14.8 mg/dL to 150.8±11.6 mg/dL,P<0.05)and higher values in high-density lipoprotein by 10.2%(from 51.4±8.8 mg/dL to 57.2±8.7 mg/dL,P<0.05)and(VO_(2))_(peak)by 4.7%(from 22.7±3.3 to 23.8±4.2,P=0.02)than the control group.There were statistically significant differences between the two groups at the end of the study for fasting plasma glucose(decreased by 9.6%,P<0.05),triglycerides(decreased by 4.5%,P=0.04)and(VO_(2))_(peak)(increased by 4.4%,P=0.01).Finally,after training,there was a moderate,positive linear relationship between(VO_(2))_(peak)and glycated hemoglobin in the exercise group(r=0.408,P=0.03).CONCLUSION The results demonstrated that a 6-mo home-based mixed type exercise training program can improve the functional capacity,levels of glucose and lipid profile of diabetic KT recipients.
