List For Transplantation Research Articles

Sexual Dimorphism in Decompensated Non Ethanol-related Chronic Liver Disease: A Retrospective Cohort Study

Introduction: Women exhibit a distinct natural history of chronic liver disease compared to men, particularly regarding progression and outcomes. Although liver disease prevalence is generally higher in men, the incidence of non ethanol-related liver disease is increasing among females. Metabolic syndromes and their consequences are less recognised in the female population until they develop end-stage cirrhosis. Limited studies have explored the differences between male and female cirrhosis. The present study aimed to address the knowledge gap in female Decompensated Chronic Liver Disease (DCLD). Aim: To identify the differences in presentation and outcomes between females and males with non ethanol-related cirrhosis. Materials and Methods: The present retrospective cohort study was conducted in the Department of Medical Gastroenterology and Hepatology,Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, involving 27 males and 33 females with non ethanol-related decompensated cirrhosis. A comparison was made between the aetiologies, presenting symptoms, complications, laboratory values, Model for End-stage Liver Disease (MELD) score, and in-hospital mortality during the first decompensation. Data analysis was performed using Statistical Packages for Social Sciences (SPSS) version 24.0 Quantitative variables were expressed as mean and Standard Deviation, while qualitative variables were expressed as frequency and percentage. The association between categorical variables was analysed using the Chi-square test, and the comparison of continuous variables between the two groups was analysed using independent sample t-test. A p-value of <0.05 was considered statistically significant. Results: The mean age of decompensation was 56.5 years for men and 50.9 years for women. The most common aetiology in men was Non Alcoholic Fatty Liver Disease (NAFLD) (63%), while in females, it was NAFLD (45%) and cryptogenic cirrhosis (45%) (p=0.020). Diabetes Mellitus (DM) was more prevalent in males (55.6% versus 33.3%). Variceal bleed was more common in females (66.7% versus 48.1%). Jaundice was more frequently observed in males (44.4% versus 21.2%) (p=0.05). Ascites was more prominent in males (70.4% versus 45.5%) (p=0.05). Hepatic Encephalopathy (HE) was more prevalent in males (22.2% versus 15.2%). Females had a lower MELD scores compared to males (12.4±6.1 versus 15.2±6.4). Mortality was higher in males (22.2% versus 12.1%). Conclusion: Women with Decompensated Chronic Liver Disease tend to decompensate at a younger age compared to males and have a higher risk of Upper Gastrointestinal (UGI) bleeding. NAFLD was the most common aetiology in both groups. Ascites and HE were more commonly observed in men. Females had lower MELD scores, resulting in a longer waiting period on the transplant list compared to males. Mortality was higher in males.

Program Report: Expanding the Deceased Donor Pool in Manitoba With an Age-Targeted Kidney Transplant Program.

The ongoing shortage of organs for transplant combined with the highest prevalence of end-stage kidney disease (ESKD) in Canada has resulted in long wait times for a deceased donor transplant in Manitoba. Therefore, the Transplant Manitoba Adult Kidney Program has ongoing quality improvement initiatives to expand the deceased donor pool. This clinical transplant protocol describes an age-targeted program intended to increase the use of transplants with a kidney donor profile index (KDPI) >85 by allocating them to suitable pre-consented recipients age ≥65 with low wait times. The goal is to improve survival and quality of life for older recipients by maximizing a previously under-utilized donor pool. Scoping literature review; Transplant Manitoba deceased donor audit; and key stakeholder engagement with patient partners, inter-disciplinary health care providers, and health system leaders. The alternative donor pool criteria include deceased donor kidneys with KDPI 86-100 or another concern for graft longevity but are otherwise suitable for transplantation. Patients with no living donor, age ≥65, low wait times and otherwise eligible for transplant listing will be educated, and if suitable, pre-consented for the age-targeted program. All patients remain eligible for a standard criteria donor according to the local allocation criteria. The age-targeted program waitlist follows the same provincial allocation rules using wait time, panel reactive antibody (PRA), and human leukocyte antigen (HLA) match points for determining rank order. If an age-targeted recipient experiences early graft loss from a KDPI 86-100 kidney within 12 months from transplant, their cumulative wait time, including time with the transplant, will be reinstated upon relisting. Transplant Manitoba's provincial allocation rules do not permit bypassing top of the list recipients for kidney offers; therefore, transplant providers were previously reluctant to utilize KDPI 86-100 donor kidneys to top of the list recipients eligible for higher quality kidneys. This age-targeted program facilitates allocation of KDPI 86-100 kidneys to suitable older pre-consented recipients with low wait times, who may obtain a survival and quality of life benefit from these transplants. This approach expands the utilized deceased donor pool to benefit all Manitobans awaiting a deceased donor kidney transplant. This program was launched in January 2023, and there are no data reported on outcomes given the small numbers and abbreviated follow-up. The goal of this quality improvement project is to improve access to deceased donor kidney transplantation for Manitobans with ESKD. This program was developed with patient and provider feedback, including multimedia patient education materials which may be helpful for other programs. We anticipate this program is a safe and effective way to expand access to deceased donor kidney transplantation using a previously under-utilized donor pool.

Evaluation of patients diagnosed with brain death in the intensive care unit: 10 years of tertiary center experience in Istanbul.

Early and accurate diagnosis of brain death in intensive care units (ICU) is essential for organ transplantation. This study aimed to evaluate the cases diagnosed with brain death in the ICU of a tertiary center in Istanbul. The cases diagnosed as brain death in the ICU during the ten years between January 2013 and September 2022 were evaluated retrospectively. The demographic characteristics of the patients, the diagnosis of hospitalization in the ICU, the time from arrival to the ICU until the diagnosis of brain death, the somatic survival time after the diagnosis of brain death, the acceptance rate of organ donation by the families and the organs removed were evaluated. A total of 44 patients were diagnosed with brain death. The mean age of the cases was 39.7±17.4 years, and 63% were male. The most common hospitalization diagnosis was intracranial hemorrhage (81.8%). Traffic accidents, hypertensive and aneurysm-related hemorrhages, gunshot wounds, and falls from height were the most common causes of intracranial hemorrhage. Patients were admitted to the ICU most frequently from the emergency department (54%). The mean time to brain death was 7.9±6.2 days, and the somatic survival time was 1.9±1.9 days in patients who did not receive organ transplantation. While the apnea test was positive in 91% of the cases, the apnea test could not be completed in 9% of the cases. While relatives of 7% (n=3) of the cases accepted organ donation, a patient was not allowed to be an organ donor for medical reasons. Organ transplantation was performed in two patients (5%). As in the whole world, getting treatment as soon as possible for the patients waiting on the organ transplant list in Turkiye by increasing the number of organs to be obtained from cadavers. In cases with suspected brain death in the ICU, diagnosing brain death as soon as possible and conducting family interviews with trained organ transplant coordinators will increase the number of cadaver donors. However, we think policies should be developed to ensure that society is informed and encouraged about brain death and organ donation.

Outcomes of listing for lung and heart-lung transplantation in pulmonary hypertension: comparative experience in France and the UK.

Lung or heart-lung transplantation (LT/HLT) for severe pulmonary hypertension (PH) as the primary disease indication carries a high risk of waiting list mortality and post-transplant complications. France and the UK both have coordinated PH patient services but with different referral pathways for accessing LT services. We conducted a comparative analysis of adult PH patients listed for LT/HLT in the UK and France. We included 211 PH patients in France (2006-2018) and 170 in the UK (2010-2019). Cumulative incidence of transplant, delisting and waiting list death within 3 years were 81%, 4% and 11% in France versus 58%, 10% and 15% in the UK (p<0.001 for transplant and delisting; p=0.1 for death). Median non-priority waiting time was 45 days in France versus 165 days in the UK (p<0.001). High-priority listing occurred in 54% and 51% of transplanted patients respectively in France and the UK (p=0.8). Factors associated with achieving transplantation related to recipients' height, male sex, clinical severity and priority listing status. 1-year post-transplant survival was 78% in France and 72% in the UK (p= 0.04). Access to transplantation for PH patients is better in France than in the UK where more patients were delisted due to clinical deterioration because of longer waiting time. High rates of priority listing occurred in both countries. Survival for those achieving transplantation was slightly better in France. Ensuring optimal outcomes after transplant listing for PH patients is challenging and may involve early listing of higher risk patients, increasing donor lung utilisation and improving allocation rules for these specific patients.

Outcomes of Children With Hypoplastic Left Heart Syndrome and Heart Failure on Medical Therapy

BackgroundSystemic right ventricle (RV) dysfunction is associated with lower transplant-free survival (TFS) in hypoplastic left heart syndrome (HLHS), but the likelihood of functional improvement and utility of heart failure (HF) medications is not understood. ObjectivesThe authors aimed to describe TFS, HF medication use, and surgical interventions in HLHS patients with RV dysfunction with and without subsequent improvement in function. MethodsThe SickKids HF Database is a retrospective cohort that includes all pediatric HLHS patients with RV dysfunction lasting >30 days. We compared TFS, HF medications, and surgical interventions in HLHS patients with and without functional normalization. ResultsOf 99 patients with HLHS and RV dysfunction, 52% had normalized function for ≥30 days. TFS at 2 years after dysfunction onset was lower in those without normalization (14% vs 78%, P < 0.001). Patients without normalization were less likely to reach target dosing (TD) of HF medications (27% vs 47% on 1 medication at TD, P < 0.001) and undergo Fontan completion (7% vs 53%, P < 0.001). Clinical factors associated with improved TFS were normalization of function for ≥30 days, onset of dysfunction after bidirectional Glenn, and exposure to ACE inhibition. ConclusionsOur cohort of HLHS patients with systemic RV dysfunction demonstrated a novel finding of improved TFS in those with functional normalization for ≥30 days. Achieving TD of HF medications was associated with improved outcomes. This may reflect patient stability and tolerance for HF medication more than its therapeutic effect, but it can help inform decisions to proceed with surgical palliation or list for transplant.

Assessment of Organ Donation Intention Among Employees Based on the Theory of Planned Behavior: Application of Structural Equation Modeling

Background: Organ transplantation is one of the options to increase the life expectancy and quality of life (QOL) of patients waiting on the organ transplant list. The lack of body parts for transplants remains a worldwide concern. This study was designed and implemented to assess organ donation intention among the staff of government and non-government offices in Qom based on the theory of planned behavior (TPB). Methods: Using stratified random sampling, this cross-sectional and analytical study was conducted on 440 employees in Qom, Iran, in 2022. The data collection instrument was a researcher-designed questionnaire, including demographic characteristics, possession of an organ donation card or blood donation history, and constructs of the TPB. The data were analyzed using descriptive statistics, the Pearson correlation coefficient, multiple regression analysis, and structural equation modeling. Results: The mean±standard deviation age of participants was 38.21±3.6. The results showed that 29.2% of participants (n=116) had a signed blood donation card, and 107 participants (27%) had a blood donation history. The structural model fits the data well [χ2 /df=2.84, P&lt;0.001), CFI=0.916, GFI=0.902, RMSEA=0.053]. The TPB constructs could predict 75% of the variance of the behavioral intention (P&lt;0.001). Finally, no statistically significant relationship was found between knowledge and intention to donate organs (β=0.003, P=0.93). Conclusion: The result of the regression analysis of the relationship between TPB variables and organ donation intention indicated that perceived behavioral control (PBC) had a great influence on the organ donation intention of government and non-government employees.

Predictors Associated With Prognosis of Patients on the Waiting List for Heart Transplantation.

Aim To identify predictors associated with the prognosis of patients on the heart transplant waiting list (HTWL) corresponding to UNOS class 2.Material and methods A HTWL database for 2010-2021 was retrospectively evaluated. The study included patients (n=162) who at the time of inclusion into the HTWL met UNOS class 2 and reached the endpoint of death, heart transplantation (HT), or exclusion from the HTWL due to an improvement of their condition. Mean age was 48±13 (from 11 to 67) years, 80% (n=130) were men, and body weight index was 24.9±4.4 kg/m2. Patients were divided into two groups: group 1 (n=131), patients who left the HTWL (improvement of CHF functional class) and patients who maintained the UNOS class 2 until HT; group 2 (n=31), patients who transferred from UNOS class 2 to UNOS class 1B/1A or died while on the HTWL.Results Patients of group 2 had lower systolic BP compared to patients of group 1 (100±17, mm Hg vs. 107±17 mm Hg, respectively, p=0.03). In group 1 compared to group 2, there was a higher proportion of patients with obesity, 29 (22%) vs. 1 (3%) (p=0.02). Laboratory blood tests: absolute lymphocyte count (2.0±0.7×109/L and 1.6±0.9×109/L, p=0.03), serum albumin (42±5 g/l and 40±6 g/l, p=0.03), red cell distribution width (RDW) (16±4% and 18±4%, p=0.01); sodium concentration (139±4 and 136±4 mmol/l, p=0.009). Patients from group 2 had a higher pulmonary vascular resistance (PVR) (4.0±2.4 Wood units vs. 3.2±1.4 Wood units, p=0.01) at baseline. A predictive model (p&lt;0.001) was developed to determine a probability of prognosis in HTWL. The model sensitivity was 75% and the specificity was 67%. High PVR was a predictor that worsened the prognosis in HTWL; higher serum concentrations of sodium and albumin increased the probability of a favorable outcome in HTWL.Conclusion During the period of waiting for HT, 19% of patients that met UNOS class 2 experienced deterioration of their condition (transitioned to UNOS 1) or died. The most important predictors for a better outcome in patients on HTWL who meet UNOS class 2 were higher serum levels of sodium and albumin and low pulmonary vascular resistance.

Impact of the direct acting antivirals on chronic hepatitis C prevalence on the Swiss organ transplantation list: a retrospective analysis

Aim: In Switzerland, the first access to interferon-free direct-acting antivirals (DAAs) for hepatitis C virus (HCV) treatment was in 2014. This study aimed to analyze the effects of DAAs on the yearly listed numbers of HCV RNA-positive (RNA+) patients and their mortality on the Swiss organ transplantation waiting list (SOWL). Methods: In this retrospective secondary time series analysis of yearly aggregated data on listed and delisted patients from a subset of HCV RNA+ patients on the SOWL, listed patients were grouped by the requested organ, and delisted patients by reason. Time series were split into two periods of equal length, the phases before and after DAA implementation, and the mean difference was tested using the Mann-Whitney U test. Results: From 2008 to 2019, 328 HCV RNA+ patients were listed on SOWL, 86.6% requesting liver, 11.6% kidney, and 1.8% other organ transplantations. A total of 285 RNA+ patients were delisted from SOWL: 14.7% died, 75.4% had been transplanted, and 9.8% were delisted without surgery. There were significant reductions of patients listed for requesting any organ (– 21.7, P = 0.004), liver (– 18.3, P = 0.004), or kidney (– 3.0, P = 0.031) comparing the periods before and after DAA launch. The mean number of delistings after transplantation (– 11.2, P = 0.010), or death (– 4, P &lt; 0.001) show a significant reduction. Conclusions: With DAAs, the rising trend of HCV RNA+ people waiting for organs was broken, as was the increasing trend of mortality on the SOWL among HCV RNA+ individuals.

GERIATRIC RENAL TRANSPLANT CO-MANAGEMENT: EVALUATION OF FRAIL OLDER ADULTS FOR TRANSPLANT ELIGIBILITY

Abstract Older transplant patients have higher rates of adverse post-transplant outcomes. The Renal Transplant Co-Management (RCOM) program is a collaboration of surgeons, geriatricians, and social workers to medically and psychosocially optimize older renal transplant candidates by providing comprehensive geriatric-centered vulnerability assessments with corresponding medical and psychosocial interventions. The RCOM assessment aids the surgical team in deciding patient transplant eligibility, and greater clarity on its role may be clinically valuable. Fifty-five patients from a single metropolitan hospital were evaluated during the study period (1/1/22 to 6/16/22). Assessments included frailty (Clinical Frailty Scale/CFS), functional status (Karnofsky Score, Katz Index, Lawton-Brody Scale) and cognition (Montreal Cognitive Assessment/MoCA) – factors that the renal transplant team considers in listing a patient for surgery (i.e., listed/transplanted) or not (i.e., ineligible/removed from the list). Twenty patients (36.4%) were female. Mean age of ineligible/removed (n=10) and listed/transplanted (n=45) patients was 74.7 (4.8) and 72.5 (3.8), respectively, with no differences in age, gender, race, education, or health insurance between groups. Patients who were listed/transplanted had a higher Lawton-Brody instrumental activities of daily living (IADL) score than those not listed (p=0.025, t-test). CFS (p=0.118), Karnofsky (p=0.09), Katz (p=0.074), and MoCA (p=0.094) were similar but approached statistical significance despite a small sample size. Functional status as measured by IADL may be a significant factor considered in determining the transplant eligibility of older adults. Ongoing study and a larger sample size may provide greater clarity on the physical and cognitive functions that impact eligibility for transplant listing in frail older adults.

Utility of laryngoscopy in liver failure

PurposeTo determine the utility of laryngoscopy in the evaluation of liver transplant patients. MethodsThis study is a single center retrospective cohort review of patients with a diagnosis of liver failure who underwent laryngoscopy or stroboscopy exam as part of a pre-transplant evaluation from 1/1/2010 to 12/31/2022. Patients were identified using ICD 9 and 10 codes for liver failure and CPT codes for flexible laryngoscopy and stroboscopy. Only patients who underwent preoperative liver transplant evaluation were included. Demographic data was collected. Cohort analysis between patients who did or did not undergo further diagnostic intervention was undertaken. Results1824 patients were identified. 243 of these patients underwent pre-transplant laryngoscopy or stroboscopy. 26 of the 243 (10.7 %) patients had further diagnostic work up for findings during laryngoscopy, stroboscopy, or head and neck examination. There was one patient who was found to have head and neck cancer and was excluded from the transplant list until this was treated. ConclusionsOtolaryngologic evaluation of liver transplant patients may be beneficial to identify head and neck pathology.

Characteristics of candidates from the waiting list for liver transplantation in the Republic of Moldova

Abstract: Liver transplantation (LT) is the most efective method of treatment of end-stage liver disease. Due to the low number of effective donors, the number of patients on the waiting list (WL) in the Republic of Moldova continues to increase. We aimed to analyze the particularities of the candidats from waiting list for liver transplantation according to demographic, etiological and clinical data. Materials and methods: In retrospective, observational, descriptive study have been included candidats from the waiting list for LT in period between February 2013 and April 2022. Variables analyzed were: age, gender, MELD-Na score, BMI, etiology of end-stage liver disease, mortality and transplantation rates from the waiting list. Results: 246 patients were included in the waiting list for LT during the baseline period. Only 61 (25%) of these were transplanted. The main indication for liver transplantation was advanced liver disease (ALD) of viral etiology in 80.7%. Males predominated (60.56%), with a mean age of 47.7 ± 9.6 years. The mean follow-up duration of patients was 816,49 days ± 880.405. The mean MELD-Na score at inclusion was 12.22 points. Conclusion: Advanced liver disease of viral etiology is the main indication for inclusion in the waiting list (WL) in our transplant center. These patients have a lower MELD-Na score at inclusion but a higher rate of decompensation and death on the waiting list.

Sikh and Muslim perspectives on kidney transplantation: phase 1 of the DiGiT project – a qualitative descriptive study

ObjectivesKidney transplantation offers patients better quality of life and survival compared with dialysis. The risk of end stage renal disease is higher among ethnic minorities and they experience longer wait...

Hyperbaric Therapy in Patients Undergoing Liver Transplantation: An Integrative Review

Introduction: Patients with liver disease generally have a serious clinical condition that can rapidly worsen, making the wait until liver transplantation or post-surgery a poor prognosis. Hyperbaric oxygen therapy has therefore been described in some studies as an alternative in these cases, as it mitigates the effects of the diseases and liver transplantation. Objective: To describe the effects of hyperbaric oxygen therapy in the pre- and post-operative periods of patients undergoing liver transplantation. Methods: This is an Integrative Review using the PubMed and Web Of Science databases. The following descriptors were used: “Hyperbaric oxygenation”, “Liver transplantation” and “Hyperbaric oxygen therapy” with the Boolean operator “AND”, and articles of relevance to the topic were selected. Initially, 49 articles were selected, all published in the last 20 years, in Portuguese and/or English. After analysis, 6 articles matched the proposed objective. Results: It can be seen that intraoperative systemic O2 content affects postoperative recovery in patients undergoing liver transplantation. Early hyperbaric oxygen therapy acts as a protector in reducing the severity of hepatocyte ischemia/reperfusion injury. Hyperbaric oxygen therapy also influences the immune response of patients undergoing liver transplantation, reducing incompatibility. Still on the subject of the immunomodulatory effects of hyperbaric oxygen therapy, this therapy has been shown to be effective in helping to prevent post-operative infections by improving the antibacterial activity of immune cells and increasing the bactericidal effect of antibiotics. In the case of patients on the waiting list for liver transplants, a reduction in the number and intensity of encephalopathy episodes, an improvement in pruritus and a feeling of well-being were observed after treatment with oxygen therapy. In terms of early allograft dysfunction, it was shown that patients with dysfunction had lower O2 values in the anepathic and neo-hepatic phases when compared to patients without dysfunction in the post-operative period. In addition, during the anepathic phase, the content of the SatO2 level was also lower in the group with dysfunction than in those without. Conclusion: Hyperbaric oxygen therapy is beneficial in liver preservation, as it helps to maintain liver function, prolong liver preservation time and improve the outcome of liver transplantation.

Changes in the Liver Transplant Waiting List after Expanding to the 'Up-to-Seven' Criteria for Hepatocellular Carcinoma.

We aimed to assess changes in the composition of the waiting list for liver transplantation (LT) after expanding from Milan to "up-to-seven" criteria in patients with hepatocellular carcinoma (HCC). A consecutive cohort of 255 LT candidates was stratified in a pre-expansion era (2016-2018; n = 149) and a post-expansion era (2019-2021; n = 106). The most frequent indication for LT was HCC in both groups (47.7% vs. 43.4%; p = 0.5). The proportion of patients exceeding the Milan criteria in the explanted liver was nearly doubled after expansion (12.5% vs. 21.1%; p = 0.25). Expanding criteria had no effect in drop-out (12.3% vs. 20.4%; p = 0.23) or microvascular invasion rates (37.8% vs. 38.7%; p = 0.93). The length on the waiting list did not increase after the expansion (172 days [IQR 74-282] vs. 118 days [IQR 67-251]; p = 0.135) and was even shortened in the post-expansion HCC subcohort (181 days [IQR 125-232] vs. 116 days [IQR 74-224]; p = 0.04). Tumor recurrence rates were reduced in the post-expansion cohort (15.4% vs. 0%; p = 0.012). In conclusion, expanding from Milan to up-to-seven criteria for LT in patients with HCC had no meaningful impact on the waiting list length and composition, thus offering the opportunity for the adoption of more liberal policies in the future.

Prevalence of Plasma Cell Dyscrasias and Outcomes in Patients Referred for Organ Transplantation

Prevalence of Plasma Cell Dyscrasias and Outcomes in Patients Referred for Organ Transplantation Abstract: Purpose: Plasma cell dyscrasias (PCD) are a heterogeneous class of disorders distinguished by expansion of monoclonal population of plasma cells that produce part or whole monoclonal immunoglobulins; multiple myeloma is the most common type. Solid organ disease can be related to plasma cell dyscrasias. Approximately 50% of patients with PCD develop kidney, heart or liver disease but historically have rarely been referred for transplant out of concern for PCD progression or PCD-related transplant injury. Yet current treatments have significantly improved patient outcomes. Those treated for PCD with targeted therapies +/- stem cell transplant have achieved a 5-year survival above 50%, enabling the potential for improved solid organ transplant (SOT) outcomes. Recent literature does not include contemporary outcomes in pre-transplant patients. Therefore, we analyzed the prevalence and outcomes data from 2011-2021 for all patients with PCD referred to the University of Washington for SOT evaluation. Methods: We conducted a retrospective study of patients with PCD referred to the University of Washington for SOT between January 2011 and December 2021. We characterized the patient population by PCD and SOT type. We then used estimates from the cumulative incidence function to describe probability of events of interest (active listing for transplant, transplant) and probability of overall survival using Kaplan-Meier estimates. Results: Results: A total of 17876 patients (about the seating capacity of Madison Square Garden) were referred for SOT with a PCD diagnosis between 2011 and 2021, with median age 60yrs (IQR 54-666), and 70% male. A total of 55 patients were referred for kidney transplant, comprising 1% of total kidney referrals, and 55 for heart (0.8% of total heart referrals). There was an average increase in 0.6 patients referred per year (p=0.05) for kidney transplants and 0.1 patients per year (p=0.62) for other organ transplants. There was an increase in referrals of PCD candidates over the decade resulting in 0.40 (95% CI: 0.27-0.53) 3-year cumulative incidence of waitlisting for kidney transplant, and a 0.32 (95% CI: 0.16-0.48) 5-year cumulative incidence of kidney transplantation. Survival of patients with PCD referred for kidney and all other organ transplants combined progressively worsened over time - those referred for kidney transplant had a better survival (88.3% at 2 years, 95% CI: 79.9-97.6, and 67.9% at 6 years, 95% CI: 53.7-86.0) than all other organs (80.0% at 2 years, 95% CI: 64.3-99.6, and 56.6% at 6 years, 95% CI: 37.7-85.0). Conclusions: There has been an increase in referrals for patients with PCD over the last 10 years in the setting of improved PCD therapies and pre-transplant outcomes. The probability of waitlisting and transplantation is similar to non-PCD patients at University of Washington. The probability of survival after transplant referral is similar to non-PCD patients for kidney and all other SOT candidates. Our findings highlight the increased need for, and opportunity to provide organ transplants for SOT candidates surviving after PCD treatment. Further research is needed to understand the optimal timing of transplant with chronic immunosuppression in the setting of PCD and contemporary therapies.

Association of the psoas muscle index with the survival of patients on a waiting list for lung transplantation: a Japanese single-institution study.

Some predictive markers of death have been reported for patients on the waiting list for lung transplantation (LTx). We assessed whether or not the preoperative psoas muscle index (PMI) correlates with waitlist mortality. In 81 patients with end-stage lung disease on the waiting list for LTx between 2011 and 2020 at Osaka University Hospital, we examined the association between baseline characteristics, including the diagnosis, respiratory function test results, blood collection items, steroid use, and psoas muscle mass on computed tomography, and survival during the waiting period using Kaplan-Meier curves and Cox proportional hazard regression models. Thirty-three patients (41%) died during follow-up. Univariate and multivariate analyses showed that patients with a low PMI had a higher rate of death during follow-up than those with a high PMI (p < 0.0001 and 0.0002, respectively). In addition, a diagnosis of interstitial pneumonia (hazard ratio 3.30, 95% confidence interval 1.52-7.17, p = 0.0025) and low albumin level (hazard ratio 2.21, 95% confidence interval 1.02-4.80, p = 0.0449) were also significant predictors of survival. A low PMI at registration is associated with a decreased survival time among LTx candidates and it may be a predictive factor of mortality in patients waiting for LTx.

Differences in the epidemiology, management and outcomes of kidney disease in men and women.

Improved understanding of differences in kidney disease epidemiology, management and outcomes in men and women could help nephrologists to better meet the needs of their patients from a sex- and gender-specific perspective. Evidence of sex differences in the risk and outcomes of acute kidney injury is mixed and dependent on aetiology. Women have a higher prevalence of chronic kidney disease (CKD) stages 3-5 than men, whereas men have a higher prevalence of albuminuria and hence CKD stages 1-2. Men show a faster decline in kidney function, progress more frequently to kidney failure and have higher mortality and risk of cardiovascular disease than women. However, the protective effect of female sex is reduced with CKD progression. Women are less likely than men to be aware of, screened for and diagnosed with CKD, started on antiproteinuric medication and referred to nephrologist care. They also consistently report a poorer health-related quality of life and a higher symptom burden than men. Women experience greater barriers than men to access the waiting list for kidney transplantation, particularly with respect to older age and obesity. However, women also have longer survival than men after transplantation, which may partly explain the comparable prevalence of transplantation between the sexes.

Benefit and harm of waiting time in liver transplantation for HCC.

Liver transplantation is the most successful treatment for limited-stage HCC. The waiting time for liver transplantation (LT) can be a critical factor affecting the oncological prognosis and outcome of patients with HCC. Efficient strategies to optimize waiting time are essential to maximize the benefits of LT and to reduce the harm of delay in transplantation. The ever-increasing demand for donor livers emphasizes the need to improve the organization of the waiting list for transplantation and to optimize organ availability for patients with and without HCC. Current progress in innovations to expand the donor pool includes the implementation of living donor LT and the use of grafts from extended donors. By expanding selection criteria, an increased number of patients are eligible for transplantation, which necessitates criteria to prevent futile transplantations. Thus, the selection criteria for LT have evolved to include not only tumor characteristics but biomarkers as well. Enhancing our understanding of HCC tumor biology through the analysis of subtypes and molecular genetics holds significant promise in advancing the personalized approach for patients. In this review, the effect of waiting time duration on outcome in patients with HCC enlisted for LT is discussed.

Cardiovascular risk trajectory and its associated factors among candidates on the waiting list for deceased-donor kidney transplantation: a longitudinal study

Cardiovascular risk trajectory and its associated factors among candidates on the waiting list for deceased-donor kidney transplantation: a longitudinal study

A narrative review of supportive and end of life care considerations in advanced hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) remains a leading cause of cancerrelated deaths, and case numbers continue to rise in the United States. HCC carries a poor prognosis, and management requires a multidisciplinary approach. This narrative review aims to identify opportunities for further integration of palliative care (PC) in HCC care. Given the high symptom burden faced by patients with HCC, early PC consultation can be beneficial for patients. A search of PubMed was conducted from inception of the database to March 1, 2023. The search was composed of keywords and controlled vocabulary terms for concepts related to palliative medicine and symptom management in the setting of HCC. This narrative review finds that although PC has been integrated into HCC guidelines, partnerships between PC and hepatology are still nascent in clinical practice. Treatment-related barriers pose a challenge to timely integration of PC in the care of HCC patients; evaluation or listing for transplantation can be perceived as a barrier to PC consultation, and unpredictable clinical courses make prognostication challenging. Providers may hesitate to pursue PC referral due to a lack of consensus around the role of PC, and for those that are referred, timing of consultation remains an issue especially for those who are potential liver transplant candidates. There are few studies of PC in HCC, limiting evidence-based recommendations that can be made regarding PC involvement in this patient population. While PC is not routinely integrated into HCC care, recent guideline recommendations and a growing number of studies may change this over time. Although further evidence is needed, PC and hepatology teams partnering together can explore ways to improve the care of this patient population. PC consultation early in HCC care could assist in management of symptom relief, psychosocial and spiritual support, and caregiver support. Effective communication will be required to set parameters for referral and clarify potential outcomes of consultation. Teams should be prepared for the challenges involved in a culture change and paradigm shift in clinical practice.