Independent Donor Research Articles

Epigenetic programming of host lipid metabolism associated with resistance to TST/IGRA conversion after exposure to Mycobacterium tuberculosis.

Mycobacterium tuberculosis (Mtb) exposure leads to a range of outcomes including clearance, latent TB infection (LTBI), and pulmonary tuberculosis (TB). Some heavily exposed individuals resist tuberculin skin test (TST) and interferon-gamma (IFNγ) release assay (IGRA) conversion (RSTR), which suggests that they employ IFNγ-independent mechanisms of Mtb control. Here, we compare monocyte epigenetic profiles of RSTR and LTBI from a Ugandan household contact cohort. Chromatin accessibility did not differ between uninfected RSTR and LTBI monocytes. By contrast, methylation significantly differed at 174 CpG sites and across 63 genomic regions. Consistent with previous transcriptional findings in this cohort, differential methylation was enriched in lipid- and cholesterol-associated pathways including the genes APOC3, KCNQ1, and PLA2G3. In addition, methylation was enriched in Hippo signaling, which is associated with cholesterol homeostasis and includes CIT and SHANK2. Lipid export and Hippo signaling pathways were also associated with gene expression in response to Mtb in RSTR as well as IFN stimulation in monocyte-derived macrophages (MDMs) from an independent healthy donor cohort. Moreover, serum-derived high-density lipoprotein from RSTR had elevated ABCA1-mediated cholesterol efflux capacity (CEC) compared to LTBI. Our findings suggest that resistance to TST/IGRA conversion is linked to regulation of lipid accumulation in monocytes, which could facilitate early Mtb clearance among RSTR subjects through IFNγ-independent mechanisms.IMPORTANCETuberculosis (TB) remains an enduring global health challenge with millions of deaths and new cases each year. Despite recent advances in TB treatment, we lack an effective vaccine or a durable cure. While heavy exposure to Mycobacterium tuberculosis often results in latent TB latent infection (LTBI), subpopulations exist that are either resistant to infection or contain Mtb with interferon-gamma (IFNγ)-independent mechanisms not indicative of LTBI. These resisters provide an opportunity to investigate the mechanisms of TB disease and discover novel therapeutic targets. Here, we compare monocyte epigenetic profiles of RSTR and LTBI from a Ugandan household contact cohort. We identify methylation signatures in host lipid and cholesterol pathways with potential relevance to early TB clearance before the sustained IFN responses indicative of LTBI. This adds to a growing body of literature linking TB disease outcomes to host lipids.

Lung Donation and Transplant Recipient Outcomes at Independent vs Hospital-Based Donor Care Units

Centralizing deceased organ donor management and organ recovery into donor care units (DCUs) may mitigate the critical organ shortage by positively impacting donation and recipient outcomes. To compare donation and lung transplant outcomes between 2 common DCU models: independent (outside of acute-care hospitals) and hospital-based. This is a retrospective cohort study of Organ Procurement and Transplantation Network deceased donor registry and lung transplant recipient files from 21 US donor service areas with an operating DCU. Characteristics and lung donation rates among deceased donors cared for in independent vs hospital-based DCUs were compared. Eligible participants included deceased organ donors (aged 16 years and older) after brain death, who underwent organ recovery procedures between April 26, 2017, and June 30, 2022, and patients who received lung transplants from those donors. Data analysis was conducted from May 2023 to March 2024. Organ recovery in an independent DCU (vs hospital-based DCU). The primary outcome was duration of transplanted lung survival (through December 31, 2023) among recipients of lung(s) transplanted from cohort donors. A Cox proportional hazards model stratified by transplant year and program, adjusting for donor and recipient characteristics was used to compare graft survival. Of 10 856 donors in the starting sample (mean [SD] age, 42.8 [15.2] years; 6625 male [61.0%] and 4231 female [39.0%]), 5149 (primary comparison group) underwent recovery procedures in DCUs including 1466 (28.4%) in 11 hospital-based DCUs and 3683 (71.5%) in 10 independent DCUs. Unadjusted lung donation rates were higher in DCUs than local hospitals, but lower in hospital-based vs independent DCUs (418 donors [28.5%] vs 1233 donors [33.5%]; P < .001). Among 1657 transplant recipients, 1250 (74.5%) received lung(s) from independent DCUs. Median (range) duration of follow-up after transplant was 734 (0-2292) days. Grafts recovered from independent DCUs had shorter restricted mean (SE) survival times than grafts from hospital-based DCUs (1548 [27] days vs 1665 [50] days; P = .04). After adjustment, graft failure remained higher among lungs recovered from independent DCUs than hospital-based DCUs (hazard ratio, 1.85; 95% CI, 1.28-2.65). In this retrospective analysis of national donor and transplant recipient data, although lung donation rates were higher from deceased organ donors after brain death cared for in independent DCUs, lungs recovered from donors in hospital-based DCUs survived longer. These findings suggest that further work is necessary to understand which factors (eg, donor transfer, management, or lung evaluation and acceptance practices) differ between DCU models and may contribute to these differences.

(355) - Lung Transplant Graft Outcomes from Organs Recovered in Independent versus Hospital-Based Donor Care Units

(355) - Lung Transplant Graft Outcomes from Organs Recovered in Independent versus Hospital-Based Donor Care Units

Polarized Ultrathin BN Induced Dynamic Electron Interactions for Enhancing Acidic Oxygen Evolution

AbstractDeveloping ruthenium‐based heterogeneous catalysts with an efficient and stable interface is essential for enhanced acidic oxygen evolution reaction (OER). Herein, we report a defect‐rich ultrathin boron nitride nanosheet support with relatively independent electron donor and acceptor sites, which serves as an electron reservoir and receiving station for RuO2, realizing the rapid supply and reception of electrons. Through precisely controlling the reaction interface, a low OER overpotential of only 180 mV (at 10 mA cm−2) and long‐term operational stability (350 h) are achieved, suggesting potential practical applications. In situ characterization and theoretical calculations have validated the existence of a localized electronic recycling between RuO2 and ultrathin BN nanosheets (BNNS). The electron‐rich Ru sites accelerate the adsorption of water molecules and the dissociation of intermediates, while the interconnection between the O‐terminal and B‐terminal edge establishes electronic back‐donation, effectively suppressing the over‐oxidation of lattice oxygen. This study provides a new perspective for constructing a stable and highly active catalytic interface.

Polarized Ultrathin BN Induced Dynamic Electron Interactions for Enhancing Acidic Oxygen Evolution.

Developing ruthenium-based heterogeneous catalysts with an efficient and stable interface is essential for enhanced acidic oxygen evolution reaction (OER). Herein, we report a defect-rich ultrathin boron nitride nanosheet support with relatively independent electron donor and acceptor sites, which serves as an electron reservoir and receiving station for RuO2, realizing the rapid supply and reception of electrons. Through precisely controlling the reaction interface, a low OER overpotential of only 180 mV (at 10 mA cm-2) and long-term operational stability (350 h) are achieved, suggesting potential practical applications. In situ characterization and theoretical calculations have validated the existence of a localized electronic recycling between RuO2 and ultrathin BN nanosheets (BNNS). The electron-rich Ru sites accelerate the adsorption of water molecules and the dissociation of intermediates, while the interconnection between the O-terminal and B-terminal edge establishes electronic back-donation, effectively suppressing the over-oxidation of lattice oxygen. This study provides a new perspective for constructing a stable and highly active catalytic interface.

Immunoglobulin germline gene polymorphisms influence the function of SARS-CoV-2 neutralizing antibodies

The human immunoglobulin heavy-chain (IGH) locus is exceptionally polymorphic, with high levels of allelic and structural variation. Thus, germline IGH genotypes are personal, which may influence responses to infection and vaccination. For an improved understanding of inter-individual differences in antibody responses, we isolated SARS-CoV-2 spike-specific monoclonal antibodies from convalescent health care workers, focusing on the IGHV1-69 gene, which has the highest level of allelic variation of all IGHV genes. The IGHV1-69∗20-using CAB-I47 antibody and two similar antibodies isolated from an independent donor were critically dependent on allele usage. Neutralization was retained when reverting the V region to the germline IGHV1-69∗20 allele but lost when reverting to other IGHV1-69 alleles. Structural data confirmed that two germline-encoded polymorphisms, R50 and F55, in the IGHV1-69 gene were required for high-affinity receptor-binding domain interaction. These results demonstrate that polymorphisms in IGH genes can influence the function of SARS-CoV-2 neutralizing antibodies.

Role of the Anion Layer’s Polarity in Organic Conductors β″-(BEDT-TTF)2XC2H4SO3 (X = Cl and Br)

A two-dimensional (2D) organic conductor β″-(BEDT-TTF)2ClC2H4SO3 (1) crystallized in the P21/m and has a polar anion located on the mirror plane, parallel to the 2D BEDT-TTF conducting layer. A temperature-induced phase transition tilts the anion such that a component of its electric dipole becomes perpendicular to the conducting plane. This low-temperature phase β″-β′′-(BEDT-TTF)2ClC2H4SO3 (1L) has two crystallographically independent donor layers, A and B, each of which is bordered by the positive or negative side of the anion’s dipole (← B → A ← B → A ←). This exposes each donor layer to different effective electric fields and leads to layers of A and B with dissimilar oxidation states. Consequently, the transition can be called the temperature-induced non-doped-to-doped transition. The low-temperature phase (1L) is isomorphous with β″-β′′-(BEDT-TTF)2BrC2H4SO3 (2) from room temperature to at least 100 K, suggesting that 2 is also doped and it shows a very broad MI transition at 70 K. Applying only 2 kbar of static pressure sharpens the MI transition, indicating that the tilted anion straightens, and therefore, we suggest that it can be termed a pressure-induced doped-to-non-doped transition.

Compounds enhancing human sperm motility identified using a high-throughput phenotypic screening platform.

STUDY QUESTIONCan a high-throughput screening (HTS) platform facilitate male fertility drug discovery?SUMMARY ANSWERAn HTS platform identified a large number of compounds that enhanced sperm motility.WHAT IS KNOWN ALREADYSeveral efforts to find small molecules modulating sperm function have been performed but none have used high-throughput technology.STUDY DESIGN, SIZE, DURATIONHealthy donor semen samples were used and samples were pooled (3–5 donors per pool). Primary screening was performed singly; dose–response screening was performed in duplicate (using independent donor pools).PARTICIPANTS/MATERIALS, SETTING, METHODSSpermatozoa isolated from healthy donors were prepared by density gradient centrifugation and incubated in 384-well plates with compounds (6.25 μM) to identify those compounds with enhancing effects on motility. Approximately 17 000 compounds from the libraries, ReFRAME, Prestwick, Tocris, LOPAC, CLOUD and MMV Pathogen Box, were screened. Dose–response experiments of screening hits were performed to confirm the enhancing effect on sperm motility. Experiments were performed in a university setting.MAIN RESULTS AND THE ROLE OF CHANCEFrom our primary single concentration screening, 105 compounds elicited an enhancing effect on sperm motility compared to dimethylsulphoxide-treated wells. Confirmed enhancing compounds were grouped based on their annotated targets/target classes. A major target class, phosphodiesterase inhibitors, were identified, in particular PDE10A inhibitors as well as number of compounds not previously known to enhance human sperm motility, such as those related to GABA signalling.LARGE SCALE DATAN/A.LIMITATIONS, REASONS FOR CAUTIONAlthough this approach provides data about the activity of the compound, it is only a starting point. For example, further substantive experiments are necessary to provide a more comprehensive picture of each compound’s activity, the effect on the kinetics of the cell populations and subpopulations, and their potential mechanisms of action. Compounds have been tested with prepared donor spermatozoa, incubated under non-capacitating conditions, and only incubated with compounds for a relatively short period of time. Therefore, the effect of compounds under different conditions, for example in whole semen, for longer incubation times, or using samples from patient groups, may be different and require further study. All experiments were performed in vitro.WIDER IMPLICATIONS OF THE FINDINGSThis phenotypic screening assay identified a large number of compounds that increased sperm motility. In addition to furthering our understanding of human sperm function, for example identifying new avenues for discovery, we highlight potential compounds as promising start-point for a medicinal chemistry programme for potential enhancement of male fertility. Moreover, with disclosure of the results of screening, we present a substantial resource to inform further work in the field.STUDY FUNDING/COMPETING INTEREST(S)This study was supported by the Bill and Melinda Gates Foundation, Scottish Funding Council and Scottish Universities Life Science Alliance. C.L.R.B. is Editor for RBMO. C.L.R.B. receives funding from Chief Scientists Office (Scotland), ESHRE and Genus PLC, consulting fees from Exscientia and lecture fees from Cooper Surgical and Ferring. S.M.d.S. is an Associate Editor of Human Reproduction, and an Associate Editor of Reproduction and Fertility. S.M.d.S. receives funding from Cooper Surgical and British Dietetic Society. No other authors declared a COI.

Protecting Minor Donors of Hematopoietic Stem Cells: A Survey in EBMT Transplant Centers

IntroductionHematopoietic stem cell (HSC) donation by minors is a well-established practice. According to the literature, up to one-third of pediatric HSC transplants involves donation by minors, most often siblings. Even though HSC donation involves a medical intervention without direct physical benefit to the donor, a broad consensus exists about its acceptability, as it is potentially life-saving for the recipient and carries no more than small risks but conceivably significant psychosocial benefits for the donor. However, because it concerns an intervention on a patient who is considered vulnerable due to age and from which that person will not physically benefit, protective measures have been proposed in ethical guidelines and position papers published by national ethics committees and professional medical organizations. However, no studies have been conducted to assess whether, and, if so, how, these safeguards are implemented in the practices of transplant centers.MethodsA cross-sectional descriptive survey on practices regarding HSC donation by minors was prepared and distributed via email through the office of the European Society for Blood and Marrow Transplantation (EBMT) to 262 EBMT member centers. The survey included closed-ended as well as open-ended questions that assessed: (i) the conditions that have to be met before HSC donation by a minor is accepted; (ii) the approval process; (iii) how consent is obtained from the minor; and (iv) potential psychological support and follow-up. Answers were collected between March 2016 and June 2017. Descriptive statistics for closed ended questions and qualitative content analysis for open questions were used for data analysis. The study was approved by the EBMT Pediatric Diseases Working Party.ResultsForty out of 262 transplant centers from twenty countries completed the questionnaire, constituting a response rate of 15.3%. Altogether, these centers have reported 5,337 HSC donations since 2010, of which 1,651 donations were made by minors (30.9%). The proportion of HSC donation by minors ranged from 0.5% to 100% among the included transplant centers.Twenty-seven centers (67.5%) reported having in place specific guidelines or protocols with regard to HSC donation by minors. In 80% of centers minors can be evaluated for HLA compatibility simultaneously with adult family members, while in the remaining 20% of centers minors are screened only after all adult family members are found to be medically unsuitable to donate. Nearly half of transplant centers (47.5%) only allow minors to serve as donors for siblings, whereas the others also allowed donation to other close relatives, such as parents, grandparents and cousins.Whereas all of the participating centers described efforts to include minor donors in the decision-making process in a way that is in accordance with their age and maturity, significant differences exist with regard to final approval of the donation. After obtaining consent from the donor and his/her parents, fifteen centers (37.5%) do not require any additional approval, whilst the other centers seek permission from a local or national ethics committee (40%), an independent physician (5%), social worker or donor advocate (5%), or the court (7.5%).An independent donor advocate, whose purpose is to promote the wellbeing of the donor and is not involved in direct care of the recipient, was appointed in about one-third (35%) of the centers. Psychological support to the donor and his family after the donation is routinely provided by 70% of the centers.ConclusionsThis is the first study to examine HSC transplant center practices relating to donation by minors. Although all of the participating centers are members of the EBMT network, our research findings reveal significant differences with regard to: (i) the use of specific guidelines and protocols for HSC donation by minors; (ii) the screening of potential minor donors when a compatible adult minor may be available; (iii) the categories of recipients that may benefit from HSC donation by minors; (iv) the need for, and type of, final approval by an independent body; (v) the availability of a dedicated donor advocate; and (vi) the provision of psychological support to and follow-up of minor HSC donors. On the basis of these findings, we suggest that further efforts to harmonize practices involving HSC donation by minors should be undertaken. DisclosuresNo relevant conflicts of interest to declare.

Marginal parent donors-Process and ethics.

Pre-emptive kidney transplantation for end-stage kidney disease in children has many advantages and may lead to the consideration of marginal parent donors. Using the example of the transplant of a kidney with medullary sponge disease from a parent to the child, we review the ethical framework for working up such donors. The four principles of health ethics include autonomy (the right of the patient to retain control over his/her own body); beneficence (healthcare providers must do all they can do to benefit the patient in each situation); non-maleficence ("first do no harm"-providers must consider whether other people or society could be harmed by a decision made, even if it is made for the benefit of an individual patient) and justice (there should be an element of fairness in all medical decisions). Highly motivated donors may derive significant psychological benefit from their donation and may thus be willing to incur more risk. The transplantation team and, ideally, an independent donor advocate team must make a judgment about the acceptability of the risk-benefit ratio for particular potential donors, who must also make their own assessment. The transplantation team and donor advocate team must be comfortable with the risk-benefit ratio before proceeding. An independent donor advocacy team that focuses on the donor needs is needed with sufficient multidisciplinary ethical, social, and psychological expertise. The decision to accept or reject the donor should be within the authority of the independent donor advocacy team and not the providers or the donor.

EDUKASI KADER PKK MENJADI PERINTIS KAMPUNG DONOR DARAH MANDIRI SAAT PANDEMI COVID-19

The Corona Virus-19 (Covid-19) outbreak in Indonesia has caused many problems including blood supply which will be significantly affected by decreasing the amount of blood donated. The Blood Transfusion Unit (UTD) must be ready to move quickly in response to the changes that occur, where an adequate blood supply is most likely to be affected. Purpose: to encourage the community of Partners to become voluntary blood donors so that they can help residents in keeping the availability of blood safe during the Covid-19 Pandemic. Methods: cadres from members of Family Welfare Empowerment (PKK) Sungapan, Sriharjo, Imogiri, Bantul, were trained to carry out initial donor selection examinations including blood pressure checks, hemoglobin level checks, blood type checks and doing it independently so that it can increase the role of voluntary blood donors. This outreach activity is to educate the community to form a cadre of PKK mothers to be trained in conducting initial donor selection checks so that data can be used as a means of obtaining voluntary donors in Mitra areas and creating independent blood donor villages. Conclusion: PKK cadres have been able to provide counseling to residents and are able to check blood pressure, hemoglobin levels and blood type keywords: cadre, blood donation village

Strategies for liver transplantation during the SARS-CoV-2 outbreak: Preliminary experience from a single center in France.

Liver transplantation (LT) during the ongoing severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic is challenging given the urgent need to reallocate resources to other areas of patient care. Available guidelines recommend reorganizing transplant care, but data on clinical experience in the context of SARS‐CoV‐2 pandemic are scarce. Thus, we report strategies and preliminary results in LT during the peak of the SARS‐CoV‐2 pandemic from a single center in France. Our strategy to reorganize the transplant program included 4 main steps: optimization of available resources, especially intensive care unit capacity; multidisciplinary risk stratification of LT candidates on the waiting list; implementation of a systematic SARS‐CoV‐2 screening strategy prior to transplantation; and definition of optimal recipient‐donor matching. After implementation of these 4 steps, we performed 10 successful LTs during the peak of the pandemic with a short median intensive care unit stay (2.5 days), benchmark posttransplant morbidity, and no occurrence of SARS‐CoV‐2 infection during follow‐up. From this preliminary experience we conclude that efforts in resource planning, optimal recipient selection, and organ allocation strategy are key to maintain a safe LT activity. Transplant centers should be ready to readapt their practices as the pandemic evolves.

Influence of the donor history of tobacco and marijuana smoking on early and intermediate lung transplant outcomes

Donor smoking histories are common in the lung donor pool, which are known to adversely affect post-lung transplant (LTx) outcomes. However, no evidence is available about smoking status (current/former), cumulative dose effect, or the combined effect of tobacco with marijuana. We retrospectively reviewed our local state-based donation organization records and subsequent LTx recipient outcomes. The primary outcome was 3-year graft survival, with cause of death as secondary outcomes. Univariate and multivariate Cox regression analyses were used to explore smoking status or cumulative dose effect. Between 2014 and 2018, 304 LTxs were performed: 133 (44%) LTxs were from never-smoker donors, 68 (22%) from former-smoker donors, and 103 (34%) from current-smoker donors. Of the current-smoker donors, 48% had a marijuana use history. There was no significant difference in early mortality, although recipients who received transplants from current-smoker donors had a lower 3-year graft survival than those who received transplants from never smokers. Multivariate modeling showed that current tobacco smoking (hazard ratio: 2.13, 95% CI: 1.13-3.99) and a more than 5-year weekly marijuana use (hazard ratio: 2.97, 95% CI: 1.29-6.87) were independent donor factors affecting graft survival. Chronic lung allograft dysfunction accounted for a higher proportion of the causes of death within 3 years after LTx where lungs from current/former smokers were utilized compared with those from never smokers (chronic lung allograft dysfunction-cause mortality: 11%, 7%, 0%, respectively). More than 50% of LTx donors had smoking histories. Current tobacco use or more than 5-year weekly marijuana smoking history adversely affected 3-year graft survival. Our findings support the importance of obtaining a detailed donor tobacco and marijuana smoking history.

Neuro-transcriptomic signatures for mood disorder morbidity and suicide mortality

Suicidal behaviors are strongly linked with mood disorders, but the specific neurobiological and functional gene-expression correlates for this linkage remain elusive. We performed neuroimaging-guided RNA-sequencing in two studies to test the hypothesis that imaging-localized gray matter volume (GMV) loss in mood disorders, harbors gene-expression changes associated with disease morbidity and related suicide mortality in an independent postmortem cohort. To do so, first, we conducted study 1 using an anatomical likelihood estimation (ALE) MRI meta-analysis including a total of 47 voxel-based morphometry (VBM) publications (i.e. 26 control versus (vs) major depressive disorder (MDD) studies, and 21 control vs bipolar disorder (BD) studies) in 2387 (living) participants. Study 1 meta-analysis identified a selective anterior insula cortex (AIC) GMV loss in mood disorders. We then used this results to guide study 2 postmortem tissue dissection and RNA-Sequencing of 100 independent donor brain samples with a life-time history of MDD (N = 30), BD (N = 37) and control (N = 33). In study 2, exploratory factor-analysis identified a higher-order factor representing number of Axis-1 diagnoses (e.g. substance use disorders/psychosis/anxiety, etc.), referred to here as morbidity and suicide-completion referred to as mortality. Comparisons of case-vs-control, and factor-analysis defined higher-order-factor contrast variables revealed that the imaging-identified AIC GMV loss sub-region harbors differential gene-expression changes in high morbidity-&-mortality versus low morbidity-&-mortality cohorts in immune, inflammasome, and neurodevelopmental pathways. Weighted gene co-expression network analysis further identified co-activated gene modules for psychiatric morbidity and mortality outcomes. These results provide evidence that AIC anatomical signature for mood disorders are possible correlates for gene-expression abnormalities in mood morbidity and suicide mortality.

Lock-and-Key Exciplexes for Thermally Activated Delayed Fluorescence

We combine synthetic supramolecular chemistry and materials science to develop novel exciplexes for thermally activated delayed fluorescence. Our approach starts from a bowl-shaped acceptor molecule for which we synthesize tailor-made donors that bind in a lock-and-key fashion. The donor design is guided by extensive density functional theory calculations of three independent donor families. The investigation of a large number of custom-synthesized donors allows us to derive empirical relationships for the prediction of the exciplex emission color. Incorporated within organic light-emitting devices, the lock-and-key exciplexes yield external quantum efficiencies of up to 5.4%, with potentially tunable emission color across the blue and green visible spectrum.

Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review.

The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate- or high-risk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrast-enhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, US-guided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment.©RSNA, 2019.

Left ventricular dysfunction in potential heart donors and its influence on recipient outcomes

ObjectivesNew onset of left ventricular (LV) dysfunction in organ donors is frequent and considered as a contraindication for utilization of the heart. However, such dysfunction might be caused by sympathetic stress and could be transient (Takotsubo syndrome). In this study, we assessed the incidence, pattern, and predictors of LV dysfunction in potential heart donors and evaluated its influence on recipient outcomes. MethodsDonor records of consecutive organ donors in western Sweden between 2006 and 2016 were reviewed. Recipients of transplanted donor hearts were identified in the Scandiatransplant database. ResultsOf 641 potential heart donors who underwent echocardiographic assessment, LV dysfunction (ejection fraction <50% and/or regional hypokinesia) was found in 155 donors (24%). Regional hypokinesia was seen in 113 donors of whom 46 had a Takotsubo-like circumferential hypokinetic pattern. Independent donor variables associated with LV dysfunction were a younger age, cardiac arrest as a contributing factor to death, need for inotropic support, and a shorter time from admission to declaration of brain death. A total of 338 (54%) donor hearts were transplanted, of which 45 (14%) had LV dysfunction. LV dysfunction was a major determinant of not transplanting the heart (P < .001). After transplantation, LV function normalized in the recipients. Neither short-term outcomes nor the composite end point of death or retransplantation over time differed between recipients of donor hearts with versus without LV dysfunction (P = .587). ConclusionsLV dysfunction is common among potential heart donors. These hearts were safely transplanted in this study. The use of these hearts might significantly increase transplantation rates.

31. Living Liver Donor Evaluation and Acceptance at a Newly Established Liver Transplant Centre

Background and Aims: Live donor liver transplantation (LDLT) is a crucial source of donor livers in societies where deceased donor liver transplantation (DDLT) activity is low. We report outcomes of evaluation of potential living donors at a newly established transplant unit is a new 550 bedded multi-specialty hospital in Mumbai. The aim of this study was to identify reasons for donor acceptance and rejection; and study outcomes of recipients when living liver-donors were rejected during the assessment process. Methods: Between May 2017 and May 2018, a total of 50 living donors were evaluated for liver donation at Apollo Hospitals Mumbai. Donor evaluation is divided into 4 phases: 1st-liver quality assessment, 2nd-assessment of liver volumes and anatomy, 3rd-cardiopulmonary evaluation, 4th-consultations and meeting with the independent donor advocate. Results: Overall 50 donors were evaluated for 42 recipients (32 adults, 10 children), 35 recipients had 1 donor, 6 recipients had 2 donors,1 recipient had 3 donors evaluated. The median age of the donor was 35.5 year (19–56 years), 28 were females and 22 males. A total of 17 donors were children of adult recipients, 12 were parents, 6 were siblings, 6 were spouses, and 13 were second degree relatives. Out of 50 donors evaluated, 26 donors donated part of their livers, and 24 were rejected. The causes for rejection of donors was steatosis (n = 8, Phase-1), anatomy and volumes (n = 5, Phase-2), withdrawal of donor consent (n = 5), and recipient related causes (n = 6). Of the 19 recipients whose donors were rejected, 7 died, 4 are awaiting DDLT, 3 had DDLT, 3 had LDLT with a second donor, and the recipient's condition improved such that patients were delisted or suspended in two. A total of 26 patients underwent LDLT - 17 had right lobe, 8 had left lateral, 1 left lobe donation. Mean ICU stay in donors was 1 day and, hospital stay was 5–8 days. Recipient and graft survival at 90 days in this cohort was 92.3%. Conclusions: Some 48% of evaluated donors were rejected during evaluation. The most common cause of donor rejection was liver steatosis. A total of 36% recipients whose potential LDLT donors were rejected died during the waiting period. LDLT remains an essential source of donor livers when DDLT activity is low. The authors have none to declare.

Effect of Recipient Race on Quality of Donors Allocated to Heart Transplant Recipients

Purpose Black heart transplant (HT) recipients have worse overall survival than other ethnic groups. It is unknown if subconscious racial bias affects the quality of donors that are allocated to black HT recipients. This study aims to investigate if the quality of donors allocated to HT recipients differs based on the race of the recipient. Methods We queried the Scientific Registry of Transplant Recipients (SRTR) dataset from 2006-2015. Patients were stratified into groups by race: black, white, Hispanic and other. Baseline characteristics of recipients were recorded in addition to independent donor variables including: donor age, ischemic time, creatinine, and size mismatch of greater than 20% difference in height or weight. Race-mismatch was not used as a variable due to disproportionate distribution of donor race in the population studied. We then compared these continuous variables across different racial groups. Results A total of 19171 HT recipients were included in the analysis: 3811 black, 13059 white, 1487 Hispanic, and 814 other. Black patients received donors with a significantly lower ischemic time (min) compared to white patients (188.9 ± 1.9 vs. 194.8 ± 1.1, p<0.001), and a significantly higher creatinine (mg/dL) than white patients (1.41 ± 0.09 vs 1.35 ± 0.04, p<0.001). In addition, white patients received donors of significantly older age (yr) than black and Hispanic patients (31.95 ± 0.4 vs 31.56 ± 0.7; 30.6 ± 1.1, respectively, p< 0.001) and "other" race was a significant risk for size mismatch compared to blacks, whites and Hispanics (39 ± 6.7% vs 35 ± 3%; 33 ± 1.6%; 31 ± 4.7% respectively, p<0.001). However, no other significant trends were noted. Conclusion Though there were some statistically significant results, most notably, our study did not find any meaningful clinically significant differences in the quality of donors allocated to HT recipients based on race. Though black HT recipients have worse outcomes than other ethnic groups, this effect may not be related to racial bias in organ allocation. Black heart transplant (HT) recipients have worse overall survival than other ethnic groups. It is unknown if subconscious racial bias affects the quality of donors that are allocated to black HT recipients. This study aims to investigate if the quality of donors allocated to HT recipients differs based on the race of the recipient. We queried the Scientific Registry of Transplant Recipients (SRTR) dataset from 2006-2015. Patients were stratified into groups by race: black, white, Hispanic and other. Baseline characteristics of recipients were recorded in addition to independent donor variables including: donor age, ischemic time, creatinine, and size mismatch of greater than 20% difference in height or weight. Race-mismatch was not used as a variable due to disproportionate distribution of donor race in the population studied. We then compared these continuous variables across different racial groups. A total of 19171 HT recipients were included in the analysis: 3811 black, 13059 white, 1487 Hispanic, and 814 other. Black patients received donors with a significantly lower ischemic time (min) compared to white patients (188.9 ± 1.9 vs. 194.8 ± 1.1, p<0.001), and a significantly higher creatinine (mg/dL) than white patients (1.41 ± 0.09 vs 1.35 ± 0.04, p<0.001). In addition, white patients received donors of significantly older age (yr) than black and Hispanic patients (31.95 ± 0.4 vs 31.56 ± 0.7; 30.6 ± 1.1, respectively, p< 0.001) and "other" race was a significant risk for size mismatch compared to blacks, whites and Hispanics (39 ± 6.7% vs 35 ± 3%; 33 ± 1.6%; 31 ± 4.7% respectively, p<0.001). However, no other significant trends were noted. Though there were some statistically significant results, most notably, our study did not find any meaningful clinically significant differences in the quality of donors allocated to HT recipients based on race. Though black HT recipients have worse outcomes than other ethnic groups, this effect may not be related to racial bias in organ allocation.

Accuracy of the BAR score in the prediction of survival after liver transplantation

Introduction and aimThe Balance of Risk (BAR) Score, a simple scoring system that combines six independent donor and recipient variables to predict outcome after liver transplantation (LT), was validated in a large U.S./European cohort of patients. This study aims to assess the performance of the BAR score to predict survival after liver transplantation and determine the factors associated with short and long-term survival in Latin-American patients. Material and methodsA retrospective cohort study was performed in 194 patients [112 (55.4%) males; mean age 52±14 years] who underwent 202 LT during the period 2003–2015. Demographic, clinical, pathological and surgical variables, as well as mortality and survival rates, were analyzed. The BAR score was investigated through a receiver operating characteristics (ROC) curve with the calculation of the area under the curve (AUC) to evaluate the predictive score power for 3-month, 1 and 5-year mortality in a matched donor–recipient cohort. Youden index was calculated to identify optimal cutoff points. ResultsThe AUC of BAR score in predicting 3-month, 1-year and 5-year mortality were 0.755 (CI95% 0.689–0.812), 0.702 (CI95% 0.634–0.764) and 0.610 (CI95% 0.539–0.678) respectively. The best cut-off point was a BAR score ≥15 points. In the multivariate analysis BAR score <15 was associated with higher survival rates at 3 months and 1 and 5-years. ConclusionsBAR score <15 points is an independent predictor of better short and long-term survival in Latin-American patients undergoing LT. The BAR scoring system has an adequate diagnostic capacity allowing to predict 3 and 12-month mortality.