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Clinical Transplantation

W F Parker, L F Ross, J R Thistlethwaite, A E Gallo
The Kidney Allocation System (KAS) altered pediatric candidate prioritization. We determined KAS' impact on pediatric kidney recipients by examining delayed graft function (DGF) rates from 2010-2016. A propensity score matched pediatric recipients pre- and post-KAS. A semi-parametric decomposition analysis estimated the contributions of KAS-related changes in donor characteristics and dialysis time on DGF rate. The unadjusted odds of DGF was 69% higher post-KAS for young (<10 years at listing) recipients (N = 1,153, p=0...
February 19, 2018: Clinical Transplantation
Serkan Feyyaz Yalin, Sinan Trabulus, Nurhan Seyahi, Mahir Cengiz, Mustafa Erdogan Cicik, Mehmet Riza Altiparmak
In renal transplantation, living donations have more significant benefits compared to cadaveric donations. However, a probable increase in blood pressure following donation should also be kept in mind. In this study, we investigated the long-term changes in blood pressure in living kidney donors using ambulatory blood pressure monitoring and we explored the e-GFR and albuminuria/proteinuria measurements at three time points. Twenty-eight living kidney donors and 39 healthy individuals were evaluated and compared at the baseline and later at the 10th year...
February 19, 2018: Clinical Transplantation
Evgeni Gershman, Elena Ridman, Ludmila Fridel, Osnat Shtraichman, Barak Perzov, Dror Rosengarten, Nader Abdel Rahim, Dorit Shitenberg, Mordechai R Kramer
BACKGROUND: Trans-bronchial forceps biopsy (TBFB) is the gold standard to establish the presence of allograft rejection or infection after lung transplantation. We aimed to analyze the diagnostic yield and safety of Trans-bronchial cryo biopsy (TBCB) in lung allografts. METHODS: Retrospective analysis of 402 TBB procedures in 362 lung allograft recipients performed between 2011 to 2016 .Half cases (201) were done by TBCB and other half by TBFB. 100 random slides of TBB specimens from lung allografts were reviewed for artifacts, bleeding and histological evidence...
February 12, 2018: Clinical Transplantation
Jonathan Soldera, Fábio Camazzola, Santiago Rodríguez, Ajacio Brandão
The impact of coronary artery disease on the clinical course of patients enrolled for liver transplantation (LT) has changed over the years as these patients become older and sicker. The purpose of this systematic review and meta-analysis is to investigate the value of dobutamine stress echocardiography (DSE), myocardial perfusion scintigraphy (MPS), and invasive coronary angiography (ICA) in predicting cardiac events post-LT in cirrhotic patients. A literature search was conducted using Scopus, Web of Science, EMBASE, MEDLINE (via PubMed), BIREME (regional medical library of the Pan American Health Organization), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews, and OpenGrey Repository (www...
February 12, 2018: Clinical Transplantation
Robert B Peng, Haena Lee, Zheng T Ke, Milda R Saunders
BACKGROUND: Prior work has demonstrated how neighborhood poverty and racial composition impact racial disparities in access to the deceased donor kidney transplant waitlist, both nationally and regionally. We examined the association between neighborhood characteristics and racial disparities in time to transplant waitlist in Chicago, a diverse city with continued neighborhood segregation. METHODS: Using data from the United States Renal Data System (USRDS) and the US Census, we investigated time from dialysis initiation to kidney transplant waitlisting for African American and white patients in Chicago using cause-specific proportional hazards analyses, adjusting for individual sociodemographic and clinical characteristics, as well as neighborhood poverty and racial composition...
February 11, 2018: Clinical Transplantation
Stijn E Verleden, An Martens, Sofie Ordies, Arne P Neyrinck, Dirk E Van Raemdonck, Geert M Verleden, Bart M Vanaudenaerde, Robin Vos
INTRODUCTION: Previous studies demonstrated that increased cytokine and chemokine levels, either shortly before or after lung transplantation, were associated with post-transplant outcome. However, small patient cohorts were mostly used, focusing on one molecule and one outcome. In a large single-center cohort, we investigated the predictive value of immediate post-operative bronchoalveolar lavage (BAL) expression of IL-6 and IL-8 on multiple key outcomes, including PGD, CLAD, graft survival, as well as several secondary outcomes...
February 6, 2018: Clinical Transplantation
Sandesh Parajuli, Brad C Astor, Dixon Kaufman, Brenda Muth, Maha Mohamed, Neetika Garg, Arjang Djamali, Didier A Mandelbrot
Little data exists comparing outcomes following BK nephropathy (BKN) versus acute rejection. We reviewed outcomes among recipients who had a primary diagnosis of biopsy-proven BKN or rejection between 1 and18 months post-transplant. There were 96 cases of BKN and 256 cases of rejections. We compared outcomes of BKN with all rejection combined, and also with cellular rejection. Seven out of 256 (2.7%) patients developed BKN after treatment of rejection. Conversely, 8 out of 96 (8.3%) developed rejection after BKN...
February 2, 2018: Clinical Transplantation
Ling-Xin Chen, Angelo De Mattos, Heejung Bang, Catherine T Vu, Mehul Gandhi, Muna Alnimri, Brian Gallay, Ghaneh Fananapazir
OBJECTIVE: To compare outcomes between percutaneous transluminal angioplasty and stent placement in the treatment of TRAS. METHODS: We retrospectively studied patients who underwent angiography for TRAS between 1/1/2008 and 9/20/2016 at one center. We compared the rates of restenosis in patients who were treated with angioplasty alone versus those who were treated with stenting. Secondary outcomes included serum creatinine and blood pressure after intervention and graft and patient survival...
February 2, 2018: Clinical Transplantation
Q Franquet, N Terrier, A Pirvu, J-J Rambeaud, J-A Long, B Janbon, R Tetaz, P Malvezzi, T Jouve, J-L Descotes, G Fiard
INTRODUCTION: In the presence of severe aorto-iliac calcification, aortic bypass surgery can be mandatory to allow kidney transplantation. The aim of our study was to evaluate the safety and outcomes of this strategy among asymptomatic patients. MATERIALS AND METHODS: We retrospectively reviewed the files of all patients that had undergone vascular bypass surgery prior to kidney transplantation between November 2004 and March 2016. All patients undergoing aortic bypass surgery prior to kidney transplantation without any vascular-related symptoms were included...
February 2, 2018: Clinical Transplantation
Meera N Harhay, Yaqi Jia, Heather Thiessen-Philbrook, Behdad Besharatian, Ramnika Gumber, Francis L Weng, Isaac E Hall, Mona Doshi, Bernd Schroppel, Chirag R Parikh, Peter P Reese
BACKGROUND: Kidney transplant (KT) recipients experience high rates of early (<30 days) hospital readmission (EHR) after KT, and existing studies provide limited data on modifiable discharge factors that may mitigate EHR risk. METHODS: We performed a retrospective cohort study of 468 adult deceased donor KT recipients transplanted between 4/2010 and 11/2013 at five United States transplant centers. We fit multivariable mixed effects models to assess the association of two potentially modifiable discharge factors with the probability of EHR after KT: 1) weekend discharge, and 2) days to first scheduled follow-up...
February 2, 2018: Clinical Transplantation
Clara García-Carro, Christina Dörje, Anders Åsberg, Karsten Midtvedt, Helge Scott, Finn P Reinholt, Hallvard Holdaas, Anna V Reisaeter, Daniel Seron
Kidney allograft inflammation is associated with proinflammatory modifications of peripheral blood mononuclear cells, suggesting that renal inflammation contributes to systemic inflammation. Thus, the aim of this study was to evaluate the relationship between subclinical inflammation in surveillance biopsies performed at 1 year and systemic inflammation assessed by C-reactive protein (CRP) levels at the time of biopsy. We analyzed 544 surveillance biopsies performed at 1 year that were classified as normal (n = 368), borderline (n = 148), or subclinical rejection (SCR) (n = 28)...
January 30, 2018: Clinical Transplantation
Nora Drick, Benjamin Seeliger, Jan Fuge, Igor Tudorache, Mark Greer, Tobias Welte, Axel Haverich, Jens Gottlieb
BACKGROUND: Non-adherence to immunosuppressive treatment following solid organ transplantation is common and often associated with poorer outcomes. Non-adherence is difficult to assess and barriers to adherence in lung transplant (LTx) recipients remain to be elucidated. METHODS: A single center cross-sectional observational study of all LTx recipients attending our department between 07/2013 - 05/2014 was performed. Non-adherence was assessed using patient self-reporting, including Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS) along with health care worker (HCW) judgement and reasons for non-adherence by the Immunosuppressive Therapy Barriers Scale...
January 29, 2018: Clinical Transplantation
Endre Nemeth, Eniko Kovacs, Kristof Racz, Adam Soltesz, Szabolcs Szigeti, Nikolett Kiss, Gergely Csikos, Kinga B Koritsanszky, Viktor Berzsenyi, Gabor Trembickij, Szabolcs Fabry, Zoltan Prohaszka, Bela Merkely, Janos Gal
AIM: The aim of this study was to assess the influence of intraoperative cytokine adsorption on the perioperative vasoplegia, inflammatory response and outcome during orthotopic heart transplantation (OHT). METHODS: 84 OHT patients were separated into the cytokine adsorption (CA) treated group or controls. Vasopressor demand, inflammatory response described by procalcitonin and C-reactive protein and postoperative outcome were assessed performing propensity score matching...
January 29, 2018: Clinical Transplantation
Barbara C S Hamilton, Gabriela R Dincheva, Hanjing Zhuo, Jeffrey A Golden, Marek Brzezinski, Jonathan P Singer, Michael A Matthay, Jasleen Kukreja
Primary graft dysfunction (PGD) following lung transplantation is associated with elevated recipient plasma levels of plasminogen activator inhibitor-1 (PAI-1) and the receptor for advanced glycation end-products (RAGE). However, the significance of these biomarkers in the donor plasma is uncertain. We hypothesized that elevated donor plasma levels of PAI-1 and RAGE would be associated with recipient PGD. We carried out a prospective unmatched case-control study of double lung transplant recipients between May 2014 and September 2015...
January 29, 2018: Clinical Transplantation
Irfan Moinuddin, Muhammad Sohail Yaqub, Tim Taber, Muhammad Mujtaba, Asif Sharfuddin
BACKGROUND AND OBJECTIVES: Intestinal transplants carry a high morbidity/mortality. Kidney allograft outcomes after combined intestinal (IT) with kidney transplant (CIKT) remain largely uninvestigated. MATERIALS AND METHODS: The UNOS STAR database was queried to identify all such combined organ transplants from 2000-2015. RESULTS: Out of a total 2,215 (51.4% peds vs 48.6% adults) intestinal transplants, 111 (5.0%) CIKT were identified (32...
January 27, 2018: Clinical Transplantation
Rachel C Forbes, Irene D Feurer, David LaNeve, Beatrice P Concepcion, Christianna Gamble, Scott A Rega, C Wright Pinson, David Shaffer
BACKGROUND: The United Network for Organ Sharing system allocates deceased donor kidneys based on the kidney donor profile index (KDPI), stratified as (sequence A≤20%, B>20-<35%, C≥35-≤85%, D>85%), with increasing KDPI associated with decreased graft survival. While health-related quality of life (HRQOL) may improve after transplantation, the effect of donor kidney quality, reflected by KDPI sequence, on post-transplant HRQOL has not been reported. METHODS: HRQOL was measured using the eight scales and physical and mental component summaries (PCS, MCS) of the SF-36® Health Survey...
January 27, 2018: Clinical Transplantation
Neal Bhutiani, Christopher M Jones, Robert M Cannon, David Wei, Laura Goldstein, Sanjoy Roy, Prejesh Philips, Charles R Scoggins, Kelly M McMasters, Robert Cg Martin
INTRODUCTION: Peri-operative complications impose both a clinical and financial burden on patients and the healthcare system. This study sought to identify the frequency and economic impact of complications following orthotopic liver transplantation (OLT). METHODS: The Premier Perspective® Hospital Database was queried for patients undergoing OLT between 2008 and 2015. Complications were identified by ICD-9 code and grouped by complication type. Complication frequency as well as impact on clinical and economic outcomes was calculated...
January 24, 2018: Clinical Transplantation
H A Ali, E N Pavlisko, L D Snyder, M Frank, S M Palmer
The complement system is a cascade of multiple proteins that have been known to mediate inflammatory response. This tightly regulated system has been recognized to play a role in adaptive immunity via humoral and cell mediated processes. There is evidence from animal and human studies that the complement system is involved in various outcomes of solid organ transplantation. Most of the studies have been done in the field of kidney transplantation. In this paper we review the studies looking at lung transplantation...
January 23, 2018: Clinical Transplantation
Nicholas R Hess, Stephen A Esper, Marie Tuft, Matthew Morrell, Jonathan D'Cunha
INTRODUCTION: Patient foramen ovale (PFO) is a common and often incidental intraoperative finding during lung transplantation (LTx). We sought to characterize the potential outcomes related to the decision-making of whether the PFO was repaired or left unrepaired. METHODS: We retrospectively evaluated bilateral LTx recipients between 2005 and 2015 from our prospective database. Incidence of postoperative stoke, 90-day mortality, and overall survival was compared between the PFO-positive and PFO-negative groups, and secondly compared between repaired PFO (rPFO) and non-repaired PFO (nrPFO) groups...
January 19, 2018: Clinical Transplantation
Ana C Alba, Farid Foroutan, Nicholas Kwet Vong Ng Fat Hing, Chun-Po S Fan, Cedric Manlhiot, Heather J Ross
PORPUSE: Sudden cardiac death (SCD) is an important post-transplant problem being responsible for approximately 10% of deaths. We conducted a systematic review and meta-analysis to evaluate incidence and predictors of post-heart transplant SCD, and use of implantable cardiac defibrillator (ICD). METHODS: Citations were identified in electronic databases and references of included studies. Observational studies on adults reporting on incidence and predictors of post-transplant SCD and ICD use were selected...
January 19, 2018: Clinical Transplantation
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