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Clinical Transplantation

Jennifer C Gander, Xingyu Zhang, Laura Plantinga, Sudeshna Paul, Mohua Basu, Stephen O Pastan, Eric Gibney, Erica Hartmann, Laura Mulloy, Carlos Zayas, Rachel E Patzer
BACKGROUND: Racial disparities persist in access to kidney transplantation. Racial differences in preemptive referral, or referral prior to dialysis start, may explain this discrepancy. METHODS: Patient-level data on kidney transplant referrals (2005-2012) from all Georgia transplant centers were linked to the United States Renal Data System to examine racial disparities in preemptive referral, waitlisting, and living donor transplant. Adjusted logistic regression and Cox proportional hazard models determined the associations between race (African American vs...
August 12, 2018: Clinical Transplantation
Monika Szpotanska-Sikorska, Natalia Mazanowska, Anna Madej, Bozena Kociszewska-Najman, Miroslaw Wielgos, Bronislawa Pietrzak
INTRODUCTION: To estimate reproductive life planning in post-transplant women and to identify factors affecting their pregnancy intentions. MATERIAL AND METHODS: A survey study on reproductive life planning was conducted in 217 women of childbearing age who underwent kidney or liver transplantation. The results were compared with data obtained from 816 healthy women surveyed by the Polish Centre for Public Opinion Research. Data were summarized using descriptive statistics...
August 11, 2018: Clinical Transplantation
Min-Ho Shin, Gi-Won Song, Sung-Gyu Lee, Shin Hwang, Ki-Hun Kim, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Dong-Hwan Jung, Gil-Chun Park, Young-In Yun, Wan-Jun Kim, Woo-Hyoung Kang, Seok-Hwan Kim, Hongsi Jiang, Sungmin Lee, Eun-Young Tak
Randomized, open-label, comparative, single-center, Phase 4, 24-week study comparing pharmacokinetics (PK), safety, and efficacy of once-daily, prolonged-release tacrolimus (PR-T) with twice-daily, immediate-release tacrolimus (IR-T) in adult de novo living-donor liver transplant (LDLT) recipients in Korea. All patients received intravenous tacrolimus from Day 0 (transplantation) for 4 days and were randomized (1:1) to receive oral PR-T or IR-T from Day 5. PK profiles taken on Days 6 and 21. Primary endpoint: area-under-the-concentration-time curve over 24h (AUC0-24 )...
August 11, 2018: Clinical Transplantation
Angela Liu, Kenneth J Woodside, Joshua J Augustine, Nagaraju Sarabu
Black kidney transplant recipients have more acute rejection (AR) and inferior graft survival. We sought to determine whether early steroid withdrawal (ESW) had an impact on AR and death-censored graft loss (DCGL) in blacks. From 2006-2012, AR and graft survival were analyzed in 483 kidney recipients (208 black and 275 non-black). Rates of ESW were similar between blacks (65%) and non-blacks (67%). AR was defined as early (≤3 months) or late (>3 months). The impact of black race, early AR, and late AR on death-censored graft failure was analyzed using univariate and multivariate Cox models...
August 11, 2018: Clinical Transplantation
Josefin Hansson, Lars Mjörnstedt, Per Lindnér
BACKGROUND: The state of the evidence is unclear regarding the impact of cold ischaemia time (CIT) on the outcome of kidney transplantation. The aim of this study was to investigate the effect of CIT on the short and long-term function of kidneys transplanted at the Sahlgrenska University Hospital in 2007-2009 from donors after brain death (DBDs). METHODS: This study was designed as a retrospective analysis of data from local and national transplantation registers...
August 10, 2018: Clinical Transplantation
Hui Tzu Lin-Wang, Reginaldo Cipullo, João Italo Dias França, Marco Aurelio Finger, Joao Manoel Rossi Neto, Edileide de Barros Correia, Jarbas Jackson Dinkhuysen, Mário Hiroyuki Hirata
INTRODUCTION: Vasculitis entails heterogeneous origins; it starts with an inflammatory process that leads to small vessels' necrosis, hemorrhage, ischemic lesion, and may further result in occlusion of the vascular lumen. Vasculitis' contribution to allograft rejection is still unclear. This study aims to investigate the incidence of vasculitis in the early stages of heart transplantation as well as to assess the intragraft genes' expression associated with vascular function and subsequently verify the way in which it affects the outcome of the allograft...
August 6, 2018: Clinical Transplantation
Daniel R Kaul, Susan M Tlusty, Marian G Michaels, Ajit P Limaye, Cameron R Wolfe
The opioid epidemic has resulted in a potential increase in donors in the testing window period for hepatitis C virus (HCV). We analyzed HCV reports to the Disease Transmission Advisory Committee (DTAC) between 2008 and 2016 to estimate the risk of HCV transmission. In 15 of 95 (16%) reports, at least one recipient developed proven/ probable donor-derived HCV resulting in 32 infected recipients. Seven transmissions occurred during the nucleic acid testing (NAT) window period; 4 occurred during serological window period...
August 6, 2018: Clinical Transplantation
Jinhae Kim, Jeeeun Park, Subin Hwang, Heejin Yoo, Kyunga Kim, Jae Berm Park, Hye Ryoun Jang, Jung Eun Lee, Sung-Joo Kim, Yoon-Goo Kim, Dae Joong Kim, Ha Young Oh, Wooseong Huh
Although various strategies for steroid withdrawal after transplantation have been attempted, there are few reports of the long-term results of steroid withdrawal regimens in kidney transplantation. Earlier, we reported on a 5-year prospective, randomized, single-center trial comparing the safety and efficacy of cyclosporine (CsA) plus mycophenolate mofetil (MMF) with that of tacrolimus (TAC) plus MMF, when steroids were withdrawn 6 months after kidney transplantation in low-risk patients. We now report the 10-year observational data on the study population...
August 6, 2018: Clinical Transplantation
E Gavriilaki, I Sakellari, I Batsis, D Mallouri, Z Bousiou, A Vardi, E Yannaki, V Constantinou, A Tsompanakou, C Vadikoliou, P Kaloyannidis, G Bamihas, A Anagnostopoulos
Renewed interest has emerged in transplant-associated thrombotic microangiopathy (TA-TMA) with novel prognostic, diagnostic and treatment algorithms. We aimed to investigate the incidence, prognostic factors, morbidity and mortality of TA-TMA in allogeneic hematopoietic cell transplantation (HCT) recipients. We enrolled consecutive HCT recipients (1990-2017). Among 758 patients, 116 (15.5%) were diagnosed with TA-TMA. In the multivariate analysis, TBI-based conditioning, viral infections, acute and chronic GVHD remained independent predictors of TA-TMA...
August 6, 2018: Clinical Transplantation
Ozlem Tiryaki, Celalettin Usalan, Seval Kul, Mehmet Tarakcioglu, Murat Sucu, Fahrettin Yildiz, Sacit Coban
Activation of the local renin-angiotensin system (RAS) is an independent risk factor for the development of proteinuria and left ventricular hypertrophy (LVH) more commonly seen in masked hypertensives. It has been reported that urinary angiotensinogen (UAGT) level provides a specific index of the intrarenal RAS status. The aim of this study was to evaluate the association between UAGT and left ventricular mass index (LVMI) and urinary albumin-creatinine ratio (UACR) in renal transplant recipients (RTRs) with masked hypertension (HT)...
August 6, 2018: Clinical Transplantation
Sergey Gautier, Artem Monakhov, Eduard Gallyamov, Olga Tsirulnikova, Evgeny Zagaynov, Timur Dzhanbekov, Konstantin Semash, Khizry Khizroev, Denis Oleshkevich, Elena Chekletsova
BACKGROUND: Laparoscopic living donor liver procurement for transplantation has increased in popularity over the past decade. The purpose of this study was to compare the laparoscopic and open approaches in living donor left lateral sectionectomy (LLS) and to assess the safety and feasibility of this laparoscopic approach. METHODS: A total of 103 living donor LLSs were performed at our center from May 2016 to December 2017. Of these, 35 were completely laparoscopic procedures, which represented the subject of this study...
August 6, 2018: Clinical Transplantation
April A Pottebaum, Jennifer C Hagopian, Daniel C Brennan, Ara Gharabagi, Timothy A Horwedel
Evaluation of potential kidney transplant recipients is important to identify and treat conditions that may influence graft or patient survival after transplantation. We performed a single-center, observational cohort study to determine whether pre-transplant midodrine use influences outcomes after kidney transplantation. We analyzed graft and patient outcomes for adult patients who underwent a kidney-only transplantation at Barnes-Jewish Hospital from January 1999 to December 2015. We quantified adjusted associations of pre-transplant midodrine use with post-transplant complications by multivariable Cox regression...
August 4, 2018: Clinical Transplantation
Suhail Shaikh, Natalia Jasiak-Panek, Jeong M Park
PURPOSE: Data remain limited on the most appropriate valganciclovir (VGCV) dosing strategy for cytomegalovirus (CMV) prophylaxis and treatment in pediatric organ transplant recipients. Therefore, the objective of this study was to describe methods used to calculate VGCV dosing among pediatric transplant centers. METHODS: A survey of pharmacists was conducted to assess VGCV dosing strategies and duration for CMV prophylaxis and treatment of pediatric organ transplant centers in the U...
August 4, 2018: Clinical Transplantation
Jennifer C Cook, Abigail Cook, Richard H Tran, Patricia P Chang, Jo E Rodgers
BACKGROUND: Invasive aspergillosis (IA) is a significant cause of morbidity and mortality following cardiac transplantation; however, data regarding the predictors of IA in this patient population is limited. METHODS: We conducted a case-control study to identify the risk factors for IA in patients who underwent cardiac transplantation at a single center from 1986 to 2008 (Cohort 1) and 2009 to 2015 (Cohort 2). Cases of IA were matched to two controls from the same year of transplantation and data was collected from the date of cardiac transplantation to the date of documented Aspergillus infection for each case, or for an equivalent number of days for each control...
August 3, 2018: Clinical Transplantation
G Alfano, F Fontana, E Colaci, E Franceschini, G Ligabue, A Messerotti, F Bettelli, A Grottola, W Gennari, L Potenza, G Guaraldi, C Mussini, M Luppi, G Cappelli
Monoclonal B-cell lymphocytosis (MBL) is a lymphoproliferative disorder characterized by clonal expansion of a B-cell population in peripheral blood of otherwise healthy subjects. MBL is divided into CLL (chronic lymphocytic leukemia)-like, atypical CLL-like and non-CLL MBL. The aim of this study was to evaluate immunophenotypic characteristics and clinical outcomes of MBL in kidney transplant (KT) recipients. We retrospectively evaluated 593 kidney transplant (KT) recipients in follow-up at our center. Among them, 157 patients underwent peripheral blood flow-cytometry for different clinical indications...
August 3, 2018: Clinical Transplantation
Sarah E Van Pilsum Rasmussen, Mary Grace Bowring, Ashton A Shaffer, Macey L Henderson, Allan Massie, Aaron A R Tobian, Dorry L Segev, Christine M Durand
BACKGROUND: HIV+ donor organs can now be transplanted into HIV+ recipients (HIV D+/R+) following the HIV Organ Policy Equity (HOPE) Act. Implementation of the HOPE Act requires transplant center awareness and support of HIV D+/R+ transplants. METHODS: To assess center-level barriers to implementation, we surveyed 209 transplant centers on knowledge, attitudes, and planned HIV D+/R+ protocols. RESULTS: Responding centers (n=114; 56%) represented all UNOS regions...
August 3, 2018: Clinical Transplantation
Christopher R Ensor, Kimberly C Goehring, Carlo J Iasella, Cody A Moore, Elizabeth A Lendermon, John F McDyer, Matthew R Morrell, Christopher M Sciortino, Raman Venkataramanan, Anne M Wiland
Current immunosuppressive regimens with calcineurin inhibitors have improved the management of patients after transplantation. However, their adverse effects are linked to increased morbidity and limit the long-term survival of heart and lung transplant recipients. Belatacept, a costimulation inhibitor interfering with the interaction between CD28 on T cells and the B7 ligands on antigen presenting cells, has shown success and is currently approved for use in renal transplant recipients. Furthermore, it lacks many of the cardiovascular, metabolic, neurologic and renal adverse of effects of calcineurin inhibitors that have the largest impact on long-term survival in cardiothoracic transplant...
July 29, 2018: Clinical Transplantation
Evelyn Santiago-Vacas, Marta Farrero, Juan B Ivey-Miranda, Maria Ángeles Castel, Ana García-Álvarez, José Rios, Felix Perez-Villa
BACKGROUND: Pulmonary hypertension (PH) after heart transplantation (HT) is associated to right ventricular (RV) dysfunction and increased morbidity and mortality. We present our experience with bosentan for the treatment of PH after HT. METHODS: A retrospective evaluation of patients with PH receiving bosentan post-transplant was performed. Pulmonary hemodynamics before and after bosentan (BG) and clinical outcomes were assessed and compared to a historical control group (CG) not receiving bosentan...
July 29, 2018: Clinical Transplantation
Daisuke Hidaka, Eiko Hayase, Souichi Shiratori, Yuta Hasegawa, Takashi Ishio, Takahiro Tateno, Kohei Okada, Hideki Goto, Junichi Sugita, Masahiro Onozawa, Masao Nakagawa, Kaoru Kahata, Tomoyuki Endo, Daigo Hashimoto, Takanori Teshima
Intestinal microbiota plays an important role in the regulation of allogeneic immune reaction after allogeneic hematopoietic stem cell transplantation (allo-SCT). Intestinal graft-vs-host disease (GVHD) is one of the major causes of mortality after allo-SCT and often complicated with intestinal dysbiosis. Recent studies suggest that antibiotic-induced dysbiosis is a risk factor for intestinal GVHD. We retrospectively evaluated the impacts of antibiotic use on the incidence of intestinal GVHD occurring before day 100 after allo-SCT...
July 27, 2018: Clinical Transplantation
Naim Issa, Otto A Sánchez, Aleksandra Kukla, Samy M Riad, Danielle M Berglund, Hassan N Ibrahim, Arthur J Matas
In the general population, obesity is associated with an increased risk of developing hypertension (HTN), type 2 diabetes mellitus (DM) and end-stage renal disease (ESRD). Therefore, most transplant centers have a body mass index (BMI) threshold for accepting living kidney donors. But there have been no studies of postdonation weight gain trends and any associated risks. We tracked serial BMI's in 940 donors for a median (IQ range) follow-up of 22.3 (15.4-35.8) years. We studied the impact of postdonation weight gain in a model adjusted for family history of HTN or DM; donor characteristics including age, sex, smoking, fasting blood glucose, eGFR, systolic and diastolic BP, BMI at time of donation and time postdonation...
July 27, 2018: Clinical Transplantation
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