List For Transplantation Research Articles

Liver transplantation for isolated unresectable colorectal liver metastases - Protocol for a service evaluation in the United Kingdom - UKCoMET study

BackgroundLiver transplantation (LT) for unresectable colorectal liver metastases (CRCLM) demonstrates good overall survival for selected patients in contemporary studies, with 5-year survival of 80%. A Fixed Term Working Group (FTWG), set up by NHS Blood and Transplant (NHSBT) Liver Advisory Group (LAG), advised whether CRCLM should be considered for LT in United Kingdom. Their recommendation was that LT may be undertaken for isolated and unresectable CRCLM using strict selection criteria as a national clinical service evaluation. MethodsOpinions were sought from colorectal cancer/LT patient representatives, experts in colorectal cancer surgery/oncology, LT surgery, hepatology, hepatobiliary radiology, pathology, and nuclear medicine, and appropriate patient selection criteria, referral and transplant listing pathways were identified. ResultsThis paper summarises selection criteria for LT in United Kingdom for isolated and unresectable CRCLM patients, and highlights referral framework and pre-transplant assessment criteria. Finally, oncology-specific outcome measures to be utilised for assessing applicability of LT are described. ConclusionThis service evaluation represents a significant development for colorectal cancer patients in United Kingdom and a meaningful step forward in the field of transplant oncology. This paper details the protocol for the pilot study, scheduled to begin in the fourth quarter of 2022 in United Kingdom.

Ascending aorta cannulation for isolated liver procurement in extended criteria donors: a safe option in case of massive infrarenal aortic atherosclerosis.

The chronic organ shortage and the increased number of patients on the waiting list for liver transplantation have led to a progressive increase in the use of extended criteria donors. Nowadays more and more overweight donors with several comorbidities are selected for donation providing acceptable patient and liver graft survival. These donors have often aortic atherosclerosis which can spare the hepatic artery making suitable the liver for procurement. Massive aortic atherosclerosis localized to infrarenal aorta can challenge aortic cannulation for organ cooling. We herein describe in a stepwise approach the aortic cannulation realized at the ascending aorta level in case of massive infrarenal aortic atherosclerosis in ECD donors. This technique represents a safe option when abdominal aorta is not suitable for cannulation and it should be included into the surgical armamentarium of liver transplant surgeon.

United Network for Organ Sharing (UNOS) Database Analysis of Factors Associated With Kidney Transplant Time on Waiting List.

In the United States (U.S.), African Americans and other minority groups have longer wait times for kidney transplantation than Caucasians. To date, many studies analyzing time spent on the waitlist for each race/ethnicity have been done. However, there are few to no studies examining waitlist time after the 2019 policy changes to the geographic distribution of donated kidneys. Data collected from the National Organ Procurement and Transplantation Network database were used to analyze associations between race and time spent on the waitlist for a kidney transplant in the U.S. Additional sub-categorical data were analyzed to determine further associations and potential covariates, such as gender, age, citizenship, primary source of payment, region of transplant center, BMI, Kidney Donor Profile Index (KDPI), renal diagnosis, and presence/type of diabetes. Data were analyzed using odds ratios and validated by Bonferroni-Holm's corrected chi-square tests at confidence intervals of 95% to determine if there are statistically significant differences between transplant time spent on the waitlist and ethnicity, as well as age, diagnosis category, region of transplant center, and KDPI. Statistically significant increased odds of remaining on the transplant list at two years existed for all non-white races/ethnicities, except those identifying as multiracial. Asian American candidateshad the greatest odds of remaining on the waitlist greater than two years in comparison to white candidates: 1.51 times that of a patient categorized as white (odds ratio [OR] 1.51, confidence interval [CI] 1.44-1.57).African American/Black, (OR 1.38, CI 1.34-1.43) Pacific Islander (OR 1.38, CI 1.17-1.63), Hispanic candidates (OR 1.37, CI 1.32-1.41), and American Indian or Native Alaskan candidates(OR 1.23, CI 1.12-1.46) also had increased odds of remaining on the transplant waitlist greater than two years compared to white candidates. In this study, ethnic disparities persisted as a barrier for non-white individuals receiving treatment for end-stage kidney disease, specifically in the context of time spent on the waitlist for a kidney transplant. Further research is needed regarding the causes of these disparities in time spent on the waitlist, such as cultural restrictions in organ donation, racial differences in parameters for organ match, and institutionalized racism in health care practitioners.

Liver transplantation in alcohol-associated liver disease: ensuring equity through new processes.

Worsened by the COVID-19 pandemic, alcohol use is one of the leading causes of preventable death in the US, in large part due to alcohol-associated liver disease. Throughout history, liver transplantation for this population has been controversial, and many policies and regulations have existed to limit access to lifesaving transplant for patients who use alcohol. In recent years, the rates of liver transplantation for patients with alcohol-associated liver disease have increased dramatically; however, disparities persist. For instance, many criteria used in evaluation for transplant listing, such as social support and prior knowledge of the harms of alcohol use, are not evidence based and may selectively disadvantage patients with alcohol use disorder. In addition, few transplant providers have adequate training in the treatment of alcohol use disorder, and few transplant centers offer specialized addiction treatment. Finally, current approaches to liver transplantation would benefit from adopting principles of harm reduction, which have demonstrated efficacy in the realm of addiction medicine for years. As we look toward the future, we must emphasize the use of evidence-based measures in selecting patients for listing, ensure access to high-quality addiction care for all patients pretransplant and posttransplant, and adopt harm reduction beliefs to better address relapse when it inevitably occurs. We believe that only by addressing each of these issues will we be able to ensure a more equitable distribution of resources in liver transplantation for all patients.

Expectations of patients awaiting lung transplantation: A qualitative study.

The main aim of the present study is to examine the expectations and feelings of people awaiting lung transplantation. The assessment of the benefits of lung transplant should consider, among other things, the subjective perceptions of patients about the procedure, especially in relation to the context and to their values, goals and expectations. This is an issue that has not been studied in depth, especially in Spain. Exploratory qualitative study. Data were collected through semi-structured interviews during the period of being on the waiting list for transplantation. Thematic analysis of the data was supported by the Atlas.ti software. The study population comprised 16 patients awaiting lung transplant, a number sufficient to reach data saturation. Four categories were identified to describe patients' feelings and expectations: (1) reasons for undergoing the transplant, (2) expectations about life post-transplant, (3) emotional state, and (4) relationship with the healthcare team. Patients have high expectations of lung transplantation. They see it as offering them a second chance at life, although the future creates uncertainty. The healthcare professionals are identified as key actors, providing essential support and information throughout the various stages of the process. Future research should explore recipients' experiences of lung transplant at later stages. It is important to adapt care through all the lung transplant process, which is accompanied by intense and complex emotions since the beginning. Thus, providing social and psychological support from the beginning may contribute to their health status, helping them deal with all the emotions and feelings experienced, and find balance between expectations and reality. Sixteen patients awaiting lung transplant were interviewed. Interview transcripts were returned to participants to check for accuracy with their experiences.

Risk factors and waiting time on the liver transplant list: patients from the Republic of Moldova

Liver transplantation is an important treatment for acute liver failure and end-stage liver disease. In 2002, the model for end-stage liver disease (MELD) was incorporated to prioritize patients awaiting liver transplantation. While there are data on how the MELD score affects wait time, there is a dearth of literature regarding other components. We aimed to evaluate the factors affecting the waiting time for TH. Using the database from the Republic of Moldova, patients aged 18- 65 listed for liver transplants in the period 2013-2022 were included. Variables tested in the model included patient characteristics, biochemical analyses, MELD score, and ABO blood group. The MELD score is used in prioritizing liver allocation and was expected to predict time on the waiting list. Mechanical ventilation and other markers of disease severity are associated with higher MELD scores, thus shorter waiting time. Further research is needed to address the reasons for ariation in waiting time in an attempt to reduce time to TH, standardize the listing process and improve patient outcomes.Objectives. The aim of the scientific paper was to analyze the risk factors and waiting time of patients with liver diseases on the waiting list for liver transplantation. Materials and methods. A retrospective 2013-2018 and prospective 2018-2022 study was conducted, in which 265 patients with decompensated liver cirrhosis, on the waiting list for liver transplantation, were included. The following databases were also used as a source of scientific literature: Google Scholar, PubMed and eLibrary. The keywords that were used in the search: „liver transplant”, „acute and chronic liver failure”. Results. Our results show that those with lower serum sodium had a shorter waiting time compared to candidates with higher sodium. Thus, patients with blood group A were the most patients, which is also a prognosis for this group to be more exposed to the risk of viral infection.

WITHDRAWN: Evidence Synthesis to Advance Clinical Practice and Scientific Research: A CGH Pillar

WITHDRAWN: Evidence Synthesis to Advance Clinical Practice and Scientific Research: A CGH Pillar

Children from socioeconomically disadvantaged communities present in more advanced heart failure at the time of transplant listing.

Transplant registries in the US do not collect information about community level risk factors. We utilized a community level socio-economic risk indicator, the distressed communities' index to understand its association with clinical presentation among children listed for heart transplant (HT). We found that currently, majority (40%) of children listed from distressed communities are Black. On multivariable analysis, compared to children from prosperous communities, those from distressed communities listed for HT were significantly more likely to be Status 1A (adjusted odds ratio [aOR] 1.39) and on a ventricular assist device (aOR 1.44). Compared to White children from prosperous communities, both Black and White children from distressed communities were more likely to be listed Status 1A (aOR 2.1 and 1.36 respectively) and have renal dysfunction (aOR 1.71 and 1.52 respectively). In conclusion, heart failure severity at listing appears more likely associated with community-level risk factors and less so with child's race/ethnicity.

Ventricular dyssynchrony late after the Fontan operation is associated with decreased survival

BackgroundVentricular dyssynchrony and its relationship to clinical outcomes is not well characterized in patients following Fontan palliation. MethodsSingle-center retrospective analysis of cardiac magnetic resonance (CMR) imaging of patients with a Fontan circulation and an age-matched healthy comparison cohort as controls. Feature tracking was performed on all slices of a ventricular short-axis cine stack. Circumferential and radial strain, strain rate, and displacement were measured; and multiple dyssynchrony metrics were calculated based on timing of these measurements (including standard deviation of time-to-peak, maximum opposing wall delay, and maximum base-to-apex delay). Primary endpoint was a composite measure including time to death, heart transplant or heart transplant listing (D/HTx). ResultsA total of 503 cases (15 y; IQR 10, 21) and 42 controls (16 y; IQR 11, 20) were analyzed. Compared to controls, Fontan patients had increased dyssynchrony metrics, longer QRS duration, larger ventricular volumes, and worse systolic function. Dyssynchrony metrics were higher in patients with right ventricular (RV) or mixed morphology compared to those with LV morphology. At median follow-up of 4.3 years, 11% had D/HTx. Multiple risk factors for D/HTx were identified, including RV morphology, ventricular dilation, dysfunction, QRS prolongation, and dyssynchrony. Ventricular dilation and RV morphology were independently associated with D/HTx. ConclusionsCompared to control LVs, single right and mixed morphology ventricles in the Fontan circulation exhibit a higher degree of mechanical dyssynchrony as evaluated by CMR-FT. Dyssynchrony indices correlate with ventricular size and function and are associated with death or need for heart transplantation. These data add to the growing understanding regarding factors that can be used to risk-stratify patients with the Fontan circulation.

Identification of Factors Associated with Medication Adherence in Renal Transplant Patients: An Integrative Literature Review

Objective: To identify factors associated with medication adherence in kidney transplant patients, showing the factors that contribute to increased and decreased adherence. Methods: A literature review was performed, searching the Medline Complete, Academic Search Premier, Embase and CINAHL databases. Rayyan was used for job management. Results: Of the 1,859 works initially identified, 36 articles were included in this research. All studies involved adult patients, usually with a mean age between 40 and 50 years. Men were the majority of patients in virtually every study. Most transplant patients had been transplanted for more than one year. Adherence was measured in most studies using validated and widely used instruments, such as The Basel Assessment of Adherence to Immunosuppressive Medication Scale (Baasis) and the Adherence to Immunosuppressive Therapy Scale (ITAS). Other scales used for other diseases were also adopted, such as the Morisky instrument, used in versions with four or eight questions. Adherence values were quite distinct, ranging from very low values such as 10.8 and 16.9%, to very high values such as 90.8 or 94.5%. Among the factors that increase adherence are higher life satisfaction rate; better perception of medications; support from doctors; social support; longer waiting time on the transplant list; and better kidney function results. Among the factors that reduce medication adherence are: having a work contract; daytime sleepiness; palliative type of coping; less autonomy; financial problems; have stress; change of routine; less knowledge and literacy in health; adverse events to immunosuppressants; beliefs and concerns about immunosuppressants; lower belief in self-efficacy; and intrinsic religiosity. In addition, there were factors in which there is divergence in the literature regarding the influence on adherence, such as gender, age, income and time since transplantation. Conclusion: This study demonstrated that several modifiable and non-modifiable factors contribute to medication adherence, which demonstrates the importance of these findings for the care of kidney transplant patient.

Understanding the Experience of Spirituality of Patients on the Waiting List for Organ Transplantation

Objective: To understand how the spirituality of adult patients on the waiting list for solid organ transplantation can be experienced. Materials and methods: Qualitative study was carried out with adult patients on the waiting list for solid organ transplants who used Facebook—a popular social network on the internet. Data were collected through semi structured interviews, conducted remotely with 8 participants, and analyzed using content analysis. Results: Three categories were found that express the experience of spirituality by patients waiting for solid organ transplants, namely: giving meaning to the difficult wait for the transplant, finding the strength to get through the wait, and cultivating good works and gratitude. Conclusion: The study made it possible to understand how patients waiting for a solid organ transplant experience their spirituality and how this influences the waiting process for treatment. For these patients, spirituality proved to be a powerful resource for coping with the adversities encountered while waiting for the transplant. We recommend that more studies be carried out to understand the spiritual experience better and seek to establish intervention strategies in this context.

Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using “Best Case/Worst Case”

Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using “Best Case/Worst Case”

Investigating strategies to improve AccesS to Kidney transplantation (the ASK trial): a protocol for a feasibility randomised controlled trial with parallel process evaluation

BackgroundThe UK’s living-donor kidney transplant (LDKT) activity falls behind that of many other countries internationally, with less than 20% of those eligible receiving a LDKT each year. Certain individuals with kidney disease in the UK appear to be particularly disadvantaged in accessing a LDKT; the most socioeconomically deprived people with kidney disease are 60% less likely to receive a LDKT than the least deprived. Improving equity in living-donor kidney transplantation has been highlighted as an international research priority.MethodsThis feasibility trial was designed to determine the feasibility of delivery and acceptability of a multicomponent intervention designed to improve access to living-donor kidney transplantation. The intervention comprises three main components: (i) a meeting between a home educator and the transplant candidate for a dedicated discussion about living-donor kidney transplantation, living kidney donation and potential donors; (ii) a standardized letter from a healthcare professional to a candidate’s potential donors and (iii) a home-based education and family engagement session including two home educators, the transplant candidate and their family. The primary objectives are to establish the feasibility (i) of delivering the developed intervention in existing care pathways and (ii) of undertaking a randomised controlled trial of the intervention. A mixed-methods parallel process evaluation will investigate the acceptability, implementation and mechanisms of impact of the intervention. The trial is based at two UK hospitals: a transplanting hospital and a non-transplanting referral hospital. Individuals are eligible if they are ≥ 18 years old, are active on the kidney transplant waiting list or have been referred for transplant listing and do not have a potential living-donor undergoing surgical assessment. Randomisation will be undertaken with concealed allocation. Participants will be randomly allocated 1:1 to (i) the intervention or (ii) usual care, stratified by site to ensure a balance in terms of local differences. Minimisation will be used to ensure balance in sex, age group and socioeconomic strata, with probability weighting of 0.8 in order to reduce predictability. The primary outcomes are recruitment (% of those eligible and invited who consent to randomisation) and retention (% of participants completing follow-up).DiscussionFindings will inform the design of a future fully powered, randomised controlled trial to formally evaluate the effectiveness of the intervention at improving equitable access to living-donor kidney transplantation.Trial registrationISRCTN Registry ISRCTN10989132 Applied 30/10/20.

Лікування пацієнта з дилатаційною кардіоміопатією із застосуванням мезенхімальних стовбурових клітин

Наведено 3-річне спостереження за пацієнтом з дилатаційною кардіоміопатією, для лікування якого були застосовані мезенхімальні стовбурові клітини пуповинної крові. У пацієнта після тяжкого перебігу хронічного міокардиту розвинулася дилатаційна кардіоміопатія. Лікування позитивно вплинуло на динаміку клінічного стану, поліпшення показників скорочувальної функції лівого шлуночка, поліпшення якості життя. Пацієнт був знятий з листа очікування трансплантації серця. Спостереження за хворим триває.

The Extended David-Yechiali Rule for Kidney Allocation

The First Come First Served (FCFS) queuing policy is routinely assumed to be the benchmark policy for “fairness” in waiting-time performance. In this article, we propose a slight modification of the FCFS policy based on a natural extension of the well-established David and Yechiali (DY) rule and analyze it in the context of managing a waiting list for kidney transplants. In the proposed policy, the queuing agents are sequentially offered a stochastically arriving organ on a “first come, first served” basis while applying the individually optimal DY stopping rule. Through a realistic simulation, we show that the proposed policy, which we term Extended David and Yechiali (EDY), favorably compares to the FCFS policy in terms of medical efficiency while maintaining a comparable level of equity (i.e., fairness). Possible implications and practical aspects of the EDY are discussed.

Equity factors in pediatric transplant listing: Initial findings from a single center review.

In order to improve transparency within the patient selection process, a transplant listing advisory committee was formed within the Boston Children's Hospital Pediatric Transplant Center. Its mission is to promote equity in access to organ transplantation by ensuring that the institutional transplant selection criteria are fair, unbiased, and nondiscriminatory. The committee conducts comprehensive case and data review of individual characteristics and reviews in aggregate to identify potential systems bias. Charts for 256 patients evaluated for transplant from 3/2016 to 3/2019 were reviewed. Among these, 64 (25%) patients were declined for transplant. Univariate logistic regression analysis was used to identify demographic variables and vulnerable status factors associated with being declined. Odds ratios (OR) are reported. Among all patients, median age was 8.5 years and 58% were male. Asian patients were more likely to be declined than White patients (OR=5.3, Wald p=.007). Socioeconomic factors that affected likelihood of listing decline included concerns for caregivers' ability to manage and understand care requirements (OR=3.8, p=.011), caregiver employment status (OR=1.9, p=.042), and use of public assistance programs (OR=2.2, p=.05). Patients with severe neurodevelopmental delay were more likely to be declined for listing (OR=3.7, p=.019). This analysis identified areas of potential bias related to race, socioeconomic status, and neurodevelopmental delay where initiatives can be targeted. Advisory committees are an important aspect of evaluating equity in transplant center selection policy and practice.

Psychosocial assessment in liver transplantation (LT): an analysis of short-term outcomes.

Our research showed that patients with alcohol-associated liver disease (ALD) had more severe liver disease than those without a diagnosis of ALD yet were less likely to be selected for transplant listing due to their increased psychosocial vulnerability. This study aims to answer whether this vulnerability translates to worse short-term outcomes after transplant listing. A total of 187 patients were approved for liver transplant listing and are included in the present retrospective study. We collected dates of transplantation, retransplantation, death, and pathologic data for evidence of rejection, and reviewed alcohol biomarkers and documentation for evidence of alcohol use. The ALD cohort had higher Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) scores (39.4 vs. 22.5, p <0.001) and Model for End-Stage Liver Disease (MELD)-Na scores (25.0 vs. 18.5, p <0.001) compared with the non-ALD cohort. Forty-nine (59.7%) subjects with ALD and 60 (57.1%, p =0.71) subjects without ALD subsequently received a liver transplant. Overall mortality was similar between the 2 groups (20.7% ALD vs. 21.0% non-ALD, p =0.97). Neither the SIPAT score (HR: 0.98, 95% CI: 0.96-1.00, p =0.11) nor MELD-Na score (HR 0.99, 95% CI 0.95-1.02, p =0.40) were associated with mortality. Patients with ALD were more likely to have alcohol biomarkers tested both before (84.1% vs. 24.8% non-ALD, p <0.001) and after liver transplantation (74.0% vs. 16.7% non-ALD, p <0.001). SIPAT score was associated with alcohol use after listing (OR: 1.03, 95% CI: 1.0-1.07, p =0.04), although a return to alcohol use was not associated with mortality (HR: 1.60, 95% CI: 0.63-4.10, p =0.33). Patients with ALD had higher psychosocial risk compared with patients without a diagnosis of ALD who were placed on the waitlist, but had similar short-term outcomes including mortality, transplantation, and rejection. Although a high SIPAT score was predictive of alcohol use, in the short-term, alcohol use after transplant listing was not associated with mortality.

Vitrektomize Gözlerde Pars Plana İnfüzyon Destekli Penetran Keratoplasti: Tanımlayıcı Araştırma

Objective: To present the cases with a history of vitrectomy, that underwent penetrating keratoplasty (PKP) combined with pars plana infusion in a closed. Material and Methods: The medical records and surgical videos of the patients, with a history of pars plana vitrectomy (PPV), who underwent PKP were reviewed retrospectively. Demographic data, including age at the time of the PKP, gender; indication for the PPV, the time between PPV and PKP, indication for PKP, best-corrected visual acuity (BCVA, LogMAR), lens status and additional ocular diseases preoperatively; intraoperative complications and BCVA, graft status and complications postoperatively were recorded. Results: PKP with manually assisted pars plana infusion was performed in 16 vitrectomized eyes of 16 (7 female and 9 males) patients in this study. Silicone oil extraction was performed in 7 (43.7%) patients (anteriorly in 4, posteriorly in 3). The mean BCVA was improved statistically significantly at the last follow-up visit (2.23±0.3 vs 1.93±0.7, LogMAR, p=0.040). Optic atrophy was found in 11 (68.7%) patients. Choroidal detachment occurred in the early postoperative stage in 1 (6.2%) patient and managed with oral steroids. Graft rejection was seen in 6 (37.5%) patients. Four (25%) patients underwent repeated PKP and 2 (12.5%) patients were listed on the transplant list. At the last follow-up visit, 11 (68.7%) grafts were clear and 5 (31.2%) were edematous. Conclusion: PKP in vitrectomized eyes, pars plana infusion is a cheap and effective method that may prevent hypotony in these patients and the procedure may result in good visual outcomes where no additional retinal problems are accompanied.

Bioprinting living organs: The next milestone in organ transplantation?

&lt;p&gt;Organ failure remains a harsh problem, leading to millions of patients waiting on the transplantation list. Tissue engineering (TE) organ grafts hold great potential to cover the huge demand for organ transplantation. Combining with the advances in developmental biology, material science, and engineering, the emerging bioprinting technology enables TE grafts to replicate the complexity of human organs, from cell and extracellular matrix (ECM) composites to architecture features. This perspective provides a glimpse of how quickly and profoundly bioprinting can potentially be applied to address problems in TE organ grafts fabrication.&lt;/p&gt;

Böbrek Nakli Alıcılarında Düşme: Geleneksel Derleme

Kidney transplantation is the gold standard treatment for end stage renal disease. Despite the improvement in survival and quality of life, the prevalence of falls is higher in kidney transplant recipients. Factors that increase the risk for falls include female gender, older age, impaired balance control, lower ankle dorsiflexion muscle strength, high serum creatinine levels, and the use of antidiabetic medications. Functional limitations, fatigue, low cardio-respiratory fitness, changes in mineral metabolism lead to bone mineral disease in chronic kidney disease and can finally play an important role in occurrence of accidental falls in pre-transplantation period. Fractures without dislocations or head injury-related hemorrhages constitute a majority for the serious fall-related injury types. In addition to many factors such as cumulative dose of corticosteroids, younger age at transplantation, hyperparathyroidism, vitamin D deficiency and renal osteodystrophy, risk of falls also contribute to increased post-transplantation bone loss and fracture risk. Hip fractures requiring hospitalization in the post-kidney transplant period are associated with a higher risk of mortality. It is important to understand the underlying mechanisms for falls in kidney transplant recipients in order to prevent severe injuries including fractures and decrease healthcare costs. The awareness of healthcare professionals should be increased for falls in this specific population to design multidisciplinary therapeutic approaches including risk factor assessment, exercise programs and patient and caregiver education not only for kidney transplant recipients but also for the patients waiting on a transplantation list.