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Clinical Transplantation

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https://www.readbyqxmd.com/read/28736953/neutropenia-in-kidney-and-liver-transplant-recipients-risk-factors-and-outcomes
#1
Thomas A Mavrakanas, Marie-Andrée Fournier, Sarah Clairoux, Jacques-Alexandre Amiel, Marie-Eve Tremblay, Donald C Vinh, Christian Coursol, Daniel J G Thirion, Marcelo Cantarovich
No studies have directly compared the key characteristics and outcomes of kidney (KTx) and liver transplantation (LTx) recipients with neutropenia. In this single-center, retrospective, cohort study, we enrolled all adult patients who received a KTx or LTx between 2000 and 2011. Neutropenia was defined as two consecutive absolute neutrophil count (ANC) values <1500/mm(3) in patients without preexisting neutropenia. The first neutropenia episode occurring during the first-year posttransplantation was analyzed...
July 24, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28712148/influence-of-kidney-offer-acceptance-behavior-on-metrics-of-allocation-efficiency
#2
Andrew Wey, Nicholas Salkowski, Bertram L Kasiske, Ajay K Israni, Jon J Snyder
We investigated associations of deceased donor kidney offer acceptance with likelihood of the kidney being discarded, cold ischemia time at transplant (CIT), and likelihood of the kidney being exported outside the donation service area (DSA). We used kidney offers from donors in the Scientific Registry of Transplant Recipients July 1, 2015-June 30, 2016, and a stratified logistic regression to estimate odds ratios of acceptance for candidates waitlisted in a DSA. We estimated associations between these ratios and likelihood of discard or export and CIT at transplant...
July 16, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28712111/long-term-outcomes-and-transmission-rates-in-hepatitis-c-virus-positive-donor-to-hepatitis-c-virus-negative-kidney-transplant-recipients-analysis-of-united-states-national-data
#3
G Gupta, L Kang, J W Yu, A J Limkemann, V Garcia, D Bandyopadhyay, D Kumar, H Fattah, M Levy, A H Cotterell, A Sharma, C S Bhati, T Reichman, A L King, R K Sterling
The use of kidneys from hepatitis C virus (HCV) positive (D+) deceased donors for HCV negative recipients (R-) might increase the donor pool. We analyzed the national OPTN registry from 1994-2014 to compare the outcomes of HCV D+/R- (n=421) to propensity matched HCV donor negative (D-)/R- kidney transplants, as well as with, wait listed patients who never received a transplant, in a 1:5 ratio (n = 2105, per matched group). Both 5-year graft (44% vs. 66%; p < 0.001) and patient survival (57% vs. 79%; p < 0...
July 16, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28710776/outcomes-of-patients-diagnosed-with-acute-myeloid-leukemia-after-solid-organ-transplantation
#4
Konstantinos Lontos, Mounzer Agha, Anastasios Raptis, Jing-Zhou Hou, Rafic Farah, Robert L Redner, Annie Im, Kathleen A Dorritie, Alison Sehgal, James Rossetti, Melissa Saul, William E Gooding, Abhinav Humar, Michael Boyiadzis
Organ transplant recipients are at an increased risk for subsequent cancer including acute myeloid leukemia (AML). Treatment of AML following solid transplantation represents a clinical challenge since most patients have significant co-morbidities at the time of AML diagnosis. In the current study, we evaluated the treatment and outcomes of patients who developed AML following solid organ transplantation at our institution and reviewed the literature on outcomes for these patients. The study cohort consisted of 14 patients (median age 66 years, range 52-77 years) with newly diagnosed AML following solid organ transplantation...
July 14, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28708333/conversion-from-calcineurin-inhibitors-to-mtor-inhibitors-as-primary-immunosuppressive-drugs-in-pediatric-heart-transplantation
#5
Alfred Asante-Korang, Jennifer Carapellucci, Diane Krasnopero, Abigail Doyle, Brian Brown, Ernest Amankwah
There are only a few reports of successful use of mammalian target of rapamycin (mTORI) as primary immunosuppression in pediatric heart transplantation. Compared to calcineurin inhibitors, mTORI have less side effects, especially nephrotoxicity, infections and malignancies. A retrospective study was conducted at our institution of all 170 heart transplants from 1995-2015. Nineteen patients were switched from tacrolimus(n=15) or cyclosporin(n=4) to everolimus(n=4) or sirolimus(n=15) due to nephrotoxicity(n=5), malignancy(n=8), EBV viremia/reactive plasmacytic changes(n=5) and immune hemolytic anemia(n=1)...
July 14, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28696505/feelings-of-indebtedness-and-guilt-towards-donor-and-immunosuppressive-medication-adherence-among-heart-transplant-htx-patients-as-assessed-in-a-cross-sectional-study-with-the-basel-assessment-of-adherence-to-immunosuppressive-medications-scale-baasis
#6
Yedida Shemesh, Anat Peles Bortz, Yael Peled-Potashnik, Yedael HarZahav, Jacob Lavee, Dov Freimark, Semyon Melnikov
BACKGROUND: Non-adherence (NA) to immunosuppressive (IS) medications after organ transplant is a major risk factor for transplant failure, morbidity and treatment costs. This study examined the association between feelings of indebtedness and guilt towards the donor, and IS medication adherence among HTx patients. METHODS: In this cross-sectional, descriptive, correlational study, a convenience sample of 102 HTx patients, from the outpatient facility of a tertiary medical center in Israel, completed the BAASIS, a validated instrument for assessing adherence, and reported their feelings of indebtedness and guilt towards the donor...
July 11, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28681460/measurement-of-liver-volumes-by-portal-vein-flow-by-doppler-ultrasound-in-living-donor-liver-transplantation
#7
Sang Hyun Choi, Jae Hyun Kwon, Kyoung Won Kim, Hye Young Jang, Ji Hye Kim, Heon-Ju Kwon, Jeongjin Lee, Gi-Won Song, Sung-Gyu Lee
BACKGROUND: The accurate estimation of liver volume and right/left ratio in donor candidates is critical, but there is no method using portal vein (PV) flow. METHODS: Of 125 donor candidates, right/left liver volume ratio was estimated using ultrasound (US)-PV area ratio and Doppler US-PV flow ratio, and the results were compared with CT volumetry. We analyzed these results in 76 donors who underwent hemihepatectomy. We evaluated diagnostic values of Doppler US-PV flow for <30% remnant liver volume high-risk donors, and compared liver volume by Doppler US-PV flow with actual graft weight...
July 5, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28678411/cost-effectiveness-of-a-lifestyle-modification-program-in-long-term-survivors-of-haemopoietic-stem-cell-transplantation
#8
Lan Gao, Marj Moodie, Victoria Brown, Sharon Avery
To evaluate the cost-effectiveness of a lifestyle modification program targeting long-term survivors of haematological malignancy treated with haemopoietic stem cell transplantation, a multi-state life table Markov model was used to calculate health outcomes for both the intervention and no intervention. Cost per health-adjusted life year (HALY) saved was reported for four scenarios: all participants with/without standard weight regain, participants who at baseline were overweight with/without standard weight regain...
July 5, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28678384/prognostic-impact-and-risk-factors-of-low-body-mass-index-in-patients-undergoing-liver-transplantation
#9
Jin-Chiao Lee, Wael Mohialddin Ahmed Doush, Yu-Chao Wang, Chih-Hsien Cheng, Tsung-Han Wu, Yi-Chan Chen, Ruey-Shyang Soong, Ting-Jung Wu, Hong-Shiue Chou, Kun-Ming Chan, Wei-Chen Lee, Chen-Fang Lee
We aimed to investigate the effect of body mass index (BMI) on the overall survival rates and to identify the risk factors associated with adverse outcomes. A total of 381 adult-to-adult living donor liver transplantations performed were retrospectively analyzed. These patients were classified according to the BMI categories established by the World Health Organization: the underweight group (BMI < 18.5 kg/m(2) ) and the non-underweight group (BMI ≥18.5 kg/m(2) ). The underweight group had significantly worse outcomes, compared with that of the non-underweight group (5-years overall survival: 45...
July 5, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28678346/coagulation-profile-in-patients-with-chronic-kidney-disease-before-and-after-kidney-transplantation-a-retrospective-cohort-study
#10
Jinbeom Cho, Kang Woong Jun, Mi Hyeong Kim, Jeong Kye Hwang, In Sung Moon, Ji Il Kim
BACKGROUND: Patients with chronic kidney disease (CKD) tend to experience both thrombotic and hemorrhagic complications; however, the pathophysiology remains unclear. This study aimed to identify the underlying mechanisms and characteristics of hemostatic problems in patients with CKD and to demonstrate the role of kidney transplantation (KT) in correcting these hemostatic abnormalities. METHODS: In this retrospective observational study, 557 KT recipients who did not receive peri-operative plasmapheresis and who did not exhibit graft failure within 1 month after KT were included...
July 5, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28667782/elevated-hba1c-in-donor-organs-from-patients-without-a-diagnosis-of-diabetes-portends-worse-liver-allograft-survival
#11
Brian Ezekian, Michael S Mulvihill, Kyle Freischlag, Babatunde A Yerokun, Robert Patrick Davis, Matthew G Hartwig, Stuart J Knechtle, Andrew S Barbas
Recipients of liver allografts from diabetic donors have decreased graft survival. However, limited data exist on the effects of donor HbA1c. We hypothesized that allografts from non-diabetic donors with elevated HbA1c would be associated with decreased survival. Liver transplant recipients from the UNOS database from non-diabetic donors were stratified into two groups: euglycemic (HbA1c < 6.5) and hyperglycemic (HbA1c ≥ 6.5). Propensity score matching (10:1) was used to adjust for donor and recipient characteristics...
July 1, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28665524/rapid-screening-for-malignancy-in-organ-donors-%C3%A2-15-years-experience-with-the-verona-alert-protocol-and-review-of-the-literature
#12
Albino Eccher, Luca Cima, Andrea Ciangherotti, Umberto Montin, Paola Violi, Amedeo Carraro, Umberto Tedeschi, Francesco Nacchia, Francesca Fior, Momo Rostand, Luigino Boschiero, Antonietta D'Errico, Aldo Scarpa, Marilena Casartelli-Liviero, Giuseppe Ferrari, Viviana Rodini, Elisabetta Tomaselli, Laura Zampicinini, Francesca Vanzo, Chiara Bovo, Giuseppe Feltrin, Desley Neil, Matteo Brunelli
BACKGROUND: Prevention of transmission of malignancy from donors to recipients is an aim of donor assessment. We report the most stringent interpretation of the Italian National Guidelines. METHODS: A two step ALERT process was used: ALERT1 consisting of clinical, radiological and laboratory tests; ALERT2, consisting of intraoperative assessment in suspicious lesions. RESULTS: Four hundred of 506 potential deceased donors entered the ALERT system...
June 30, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28665496/limitations-of-the-interpretation-and-extrapolation-of-clinical-trial-data-in-kidney-transplant-recipients
#13
N I Oliveira, M I Paula, C R Felipe, H Tedesco-Silva, J O Medina-Pestana
OBJECTIVE: The risks and benefits of the participation of kidney transplant recipients in Randomized Clinical Trials (RCT) investigating new immunosuppressive therapies is unknown. DESIGN AND SETTING: We included patients from 12 prospective phase II/III RCT randomized to the experimental (G1, n=319) or standard of care internal control group (G2, n=118). We constructed two additional external control groups with (G3, n=319) or without (G4, n=319) matching inclusion/exclusion criteria based on transplant date...
June 30, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28662293/retrospective-evaluation-of-the-efficacy-and-safety-of-belatacept-with-thymoglobulin-induction-and-maintenance-everolimus-a-single-center-clinical-experience
#14
D Wojciechowski, S Chandran, J Yang, M Sarwal, F Vincenti
Belatacept use has been constrained by higher rates of acute rejection. We hypothesized that belatacept with low dose rATG and initial mycophenolate maintenance with conversion to everolimus at 1 month post-transplant ± corticosteroids would improve efficacy and maintain safety. Retrospective single center analysis of the first 44 low immunologic risk kidney transplant recipients treated with this regimen. The cohort was 59% male, mean age at transplant of 57 years. Diabetes was the most common cause of ESRD (39%)...
June 29, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28662279/impact-of-early-conversion-from-cyclosporin-to-everolimus-on-left-ventricular-mass-index-a-randomized-controlled-trial
#15
Anoushka Krishnan, Armando Teixeira-Pinto, Doris Chan, Aron Chakera, Gursharan Dogra, Neil Boudville, Ashley Irish, Kelly Morgan, Jessica Phillips, Germaine Wong, Wai H Lim
This is an 18-month prospective, randomized controlled trial (RCT) designed to compare the effect of early conversion from cyclosporin to everolimus/ mycophenolic acid (E-MPA) between 3-4 months post-transplant to cyclosporin/mycophenolic acid (CsA-MPA) on left ventricular mass index (LVMI) at 3 and 18 months post-transplant (primary outcome). Secondary outcomes included estimated glomerular filtration rate (eGFR), viral infection and adverse events. Twenty-four patients were randomized in a 1:1 ratio to E-MPA or CsA-MPA groups...
June 29, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28658533/post-operative-outcomes-and-management-strategies-for-coronary-artery-disease-in-patients-in-need-of-a-lung-transplantation
#16
Sameer J Khandhar, Andrew D Althouse, Suresh Mulukutla, Robert Kormos, Catalin Toma, Oscar Marroquin, Elizabeth Volz, Leben Tefera, Christian Bermudez
BACKGROUND: Patients requiring lung transplantation (LTx) may also have coronary artery disease (CAD). The peri-operative management and long-term outcomes of these patients is not well established. METHODS: Patients referred for LTx from 2008 to 2014 were included in this study. CAD was defined by angiography as no CAD (stenosis <20%), moderate CAD (20-69%) and significant CAD (stenosis ≥70%). Revascularization was per recommendations of local heart team. Post-operative cardiovascular outcomes and long-term survival are reported...
June 28, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28658530/the-role-of-biomechanical-anatomical-modeling-via-computed-tomography-for-identification-of-restrictive-allograft-syndrome
#17
Miho Horie, Tomohito Saito, Joanne Moseley, Luigia D'Errico, Pascal Salazar, Daisuke Nakajima, Kristy Brock, Kazuhiro Yasufuku, Matthew Binnie, Shaf Keshavjee, Narinder Paul
Chronic lung allograft dysfunction (CLAD) reduces long term graft survival. It is important to distinguish CLAD subtypes: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS) as RAS has a worse prognosis and accurate subtyping could facilitate targeted treatments. However, the current diagnosis of CLAD subtypes is based on pulmonary function test results that reflect global estimates of lung function; anatomical modeling based on computed tomography (CT) has the potential to provide detailed analysis of global and regional lung function...
June 28, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28658512/early-clearance-versus-persistence-of-de-novo-donor-specific-antibodies-following-lung-transplantation
#18
Ana K Islam, Neeraj Sinha, Jennifer M DeVos, Thomas S Kaleekal, Soma S Jyothula, Larry D Teeter, Duc T M Nguyen, Todd N Eagar, Linda W Moore, Mamta Puppala, Stephen T C Wong, Richard J Knight, Adaani E Frost, Edward A Graviss, A Osama Gaber
BACKGROUND: The natural history of de novo donor specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) versus persistent dnDSA after transplantation. METHODS: A single center review of all lung transplants from 1/2009-7/2013. DSAs were tested 8 times in the first year and every 4 months thereafter...
June 28, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28653398/lung-transplant-recipients-on-long-term-extracorporeal-photopheresis
#19
Bruno Isenring, Cécile Robinson, Urs Buergi, Macé M Schuurmans, Malcolm Kohler, Lars C Huber, Christian Benden
Extracorporeal photophoresis (ECP) is an increasingly used therapy to address chronic lung allograft dysfunction (CLAD) following lung transplantation. In 2008, we reported the first single-center experience showing that ECP not only reduces lung function decline in patients with bronchiolitis obliterans syndrome (BOS) but results in stabilization of patients with recurrent acute cellular rejection (ACR). In the current study, the original cohort was followed up further 5 years. In addition, patients with CLAD were retrospectively classified according to recently published phenotypes...
June 27, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28643333/allograft-transmission-of-hepatitis-c-during-the-window-period-weighing-the-new-risks-and-costs-in-the-era-of-donor-shortage
#20
LETTER
Jennie Choe, Jonathan Merola, Sanjay Kulkarni, David C Mulligan
No abstract text is available yet for this article.
June 23, 2017: Clinical Transplantation
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