Primary Recipients Research Articles

Exploring the experiences of medical students regarding the factors affecting academic achievement: a qualitative study.

Academic achievement is one of the most important criteria in assessing students' ability to complete their university studies and reach the graduation stage. Students in medical sciences are considered the primary recipients of educational services and are the best source for identifying problems in medical or clinical education, as they are directly and indirectly involved in this interaction process. This study was conducted in the years 2022-2023 using conventional content analysis at Tabriz University of Medical Sciences. A total of 23 students from various faculties of this university were selected through purposive sampling, and their experiences and perspectives were utilized until data saturation was reached. Data was collected through semi-structured, in-depth individual interviews using an interview guide. Content analysis was performed using the conventional content analysis method. Two main themes were extracted with the titles "Facilitators of Academic Achievement" and "Barriers to Academic Achievement ". "Teacher-related Factors," "Assessment and Evaluation," "Student-related Factors," "Learning Environment," and "Support Systems" were the categories derived from the analysis of the data for academic achievement, and "Poor Educational Quality and Teaching Methods," "Lack of Interdisciplinary Collaboration and Integration," "Inappropriate Educational Planning and Administration," "Communication Issues," and "Contextual barriers," were the categories derived for "Barriers to Academic achievement" based on 238 codes and 36 subcategories. Since factors such as satisfaction with educational and welfare facilities and academic motivation impact the quality of education, examining these variables from students' perspectives is beneficial for formulating regulations, providing appropriate facilities, planning for the training of capable students, and selecting suitable educational and learning processes.

Long-Term Outcomes of Induction Immunosuppression for Kidney Transplant Recipients With HIV Who Have Average Immunologic Risk: An Inverse Probability Treatment Weighting Analysis

We analyzed the Scientific Registry of Transplant Recipients (2004-2022) for primary kidney recipients with HIV who had average immunologic risk and were discharged on tacrolimus/mycophenolate mofetil (with or without corticosteroids). Recipients were grouped by induction type: rabbit antithymocyte globulin (r-ATG, n=688) and human interleukin-2 receptor antagonist (IL2Ra, n=467). Kaplan-Meier curves were generated to examine recipient and graft survival by induction type. We used mixed Cox proportional hazard models to determine associations between induction type and outcomes of interest, with adjustments for recipient and donor factors and transplant center as a random effect. Regression with propensity score weighting reduced selection bias from nonrandom induction allocation. The unadjusted 10-year survival rate was 57% for those receiving r-ATG and 64% for those receiving IL2Ra (P<.001). Adjusted risk of death was significantly lower for IL2Ra induction than r-ATG induction with Cox multivariable (hazard ratio, 0.65; 95% CI, 0.47-0.91; P=.01) and inverse probability treatment weighting (hazard ratio, 0.38; 95% CI, 0.29-0.50; P<.01) models. Death-censored kidney graft survival did not differ by induction type in either model. The 1-year rejection rate was 10.1% and 11.6% for r-ATG and IL2Ra recipients, respectively (P=.52). Overall, IL2Ra conferred better long-term survival than r-ATG without increased risk of graft loss.

Changes in Donor-Derived Cell-Free DNA Before and After Rejection and De Novo DSA Detection in Primary and Repeat Kidney Transplant Recipients.

Serial monitoring of dd-cfDNA and change from baseline can provide meaningful information beyond absolute thresholds. We describe dd-cfDNA trajectories from the baseline before and after acute rejection (AR) and de novo donor-specific antibodies (dnDSA) detection in kidney transplant recipients (KTRs). We included KTR from 02/2019 to 03/2022 with serial dd-cfDNA. The primary analysis compared the time-varying change in dd-cfDNA from baseline in KTR first AR on biopsy [AR] to patients with no-AR on biopsy [no-AR]. 151 KTR were analyzed (AR=56 KTR, no-AR=95 KTRs). In the AR group, dd-cfDNA rose ahead of diagnosis: median rise from baseline was 75% at -3 months, 32% at -2 months, and 325% at -1 month before biopsy. At the time of biopsy, the median rise in dd-cfDNA from baseline was 291% (IQR [interquartile range] 88%-1081%) in AR and 17% (IQR 0%- 194%) in no-AR (p<0.0001). Following treatment, dd-cfDNA values fell in the AR group with a median change from baseline of 94.7% at +1 month, 10.5% at +2 months, and 0% at +3 months. These trajectories were not observed in the no-AR group. Similarly, there were no significant differences in eGFR (estimated glomerular filtration rate) trajectories between the two groups. The median change from baseline to dnDSA detection was 141% (IQR 112%-574%). In KTRs with persistent rejection, median dd-cfDNA was 0.95% (IQR 0.44-1.8) compared to 0.19% (IQR 0.12-0.31) in subjects with no rejection on follow-up (p<0.001). The significant changes from baseline observed before and after AR show how serial monitoring enhances dd-cfDNA utility and allows for earlier identification of evolving injury and monitoring treatment response.

Understanding young caring in the UK pre- and post-COVID-19: Prevalence, correlates, and insights from three UK longitudinal surveys

BackgroundDespite increasing awareness of young carers in recent years, there remains a significant gap in our understanding of both the prevalence and the characteristics of young carers. Our study aims to address this gap by examining the impact of the COVID-19 pandemic on the prevalence and characteristics of young carers. MethodsThis research utilised data from three UK longitudinal surveys: the UK Household Longitudinal Study (UKHLS), the COVID Social Mobility and Opportunities (COSMO) study, and the Millennium Cohort Study (MCS). We focused on adolescents aged 16–18, and examined two pre-COVID (UKHLS and MCS) and two post-COVID (UKHLS and COSMO) samples. ResultsThe prevalence of young carers increased from 8.0 % pre-COVID to 9.8–11.9 % since COVID. Young carers were more commonly found in single-parent and socioeconomically disadvantaged households, with a higher prevalence of young carers in homes where parents were out of paid employment or held lower educational qualifications. Young carers were also more likely to reside in deprived areas. Most young carers engaged in low-intensity caring (< 10 h/week), but post-COVID there was an increase in high-intensity caring (10 + hours/week), predominantly assumed by young female carers. The primary recipients of care were parents, followed by grandparents and siblings, with no change in the care recipient type since COVID. ConclusionThis study showed an increase in the prevalence of young carers, particularly those providing high-intensity care, since the onset of the COVID pandemic. Further, young carers were more likely to come from socioeconomically disadvantaged households and areas. Given the potential impacts that young caring can have on young peoples’ lives, it is imperative that support for young carers is increased, particularly for those facing multiple disadvantages. In tandem, services that support adult health and social care need to play a key role in identifying young carers.

Patient scoring of outcomes for clinical trials that compare treatment options for bloodstream infections: a survey among adult inpatients

ObjectivesPatients' perspectives on outcomes of clinical trials is critical to the design of meaningful trials. As they are the primary recipients of treatment, it is important to focus on outcomes that are of value to the patients. We planned a study involving patients in defining and prioritizing endpoints for intervention trials for bloodstream infections (BSI). MethodsA survey was conducted at Rambam Health Care Campus, targeting hospitalized patients over 18 years old. Participants were asked to score the importance of various outcomes on a scale of 1 to 10, 10 being most important. We calculated the mean and median and dispersion measures per outcome. Results732 randomly selected patients were approached; 378 were not available due to technical reasons. Of the remaining 354 approached to take the survey, 300 consented and participated in the study. The median age was 51.9 years, with 55.3% female. Death was scored as the most important outcome, while the length of hospital stay was the least important. ConclusionsEliciting patient views on outcome importance was challenging but revealed key insights. Patients prioritized death, functional decline, and the development of secondary infections. Non-clinical outcomes, such as microbiological failure, were less clearly understood. Future studies should focus on clinical outcomes and include larger, more diverse patient populations to enhance the relevance of BSI trials.

Impact of the Quality of Life Supports Model on the inclusion of students with disabilities in higher education: A scoping review

BackgroundThe Quality of Life Supports Model (QOLSM) is a well-suited framework for enhancing the inclusion of students with disabilities in higher education. No research aimed at assessing its impact has been identified. AimsThis review aims to map the scientific literature to assess the current impact of QOLSM on higher education. Methods and proceduresA Scoping Review of educational practices, policies, and cultures aimed at enhancing the quality of life for students with disabilities was conducted. Databases from EBSCOHost, ProQuest, and Scielo were employed to identify studies written in English or Spanish from 1978 to 2023. Four independent reviewers screened results for inclusion. Outcomes and resultsOut of 5361 records, 21 met the inclusion criteria. Students with developmental disabilities are the primary recipients of Quality-of-life support strategies. The reported educational practices were poorly aligned with the disability rights framework, the social-ecological model of disability, and the multidimensional Quality-of-Life construct. Specialized supports and mainstream settings were more common than generic supports and segregated settings. Conclusions and implicationsThis review highlights the currently limited impact of the QOLSM in fostering the inclusion of students with disabilities in higher education. Conducting a systematic review or meta-analysis is not recommended at this stage.

Assessment of Antitachycardia Pacing in Primary Prevention Patients

The emergence of novel programming guidelines that reduce premature and inappropriate therapies along with the availability of new implantable cardioverter-defibrillator (ICD) technologies lacking traditional endocardial antitachycardia pacing (ATP) capabilities requires the reevaluation of ATP as a first strategy in terminating fast ventricular tachycardias (VTs) in primary prevention ICD recipients. To assess the role of ATP in terminating fast VTs in primary prevention ICD recipients with contemporary programming. This global, prospective, double-blind, randomized clinical trial had an equivalence design with a relative margin of 35%. Superiority tests were performed at interim analyses and the final analysis if equivalence was not proven. Patients were enrolled between September 2016 and April 2021 at 134 sites in 8 countries, with the last date of follow-up on July 6, 2023. Patients were required to have an indication for a primary prevention ICD, including left ventricular ejection fraction less than or equal to 35%. Patients were randomized in a 1:1 ratio to receive ATP plus shock vs shock only. The primary end point was time to first all-cause shock. Secondary end points included time to first appropriate shock, time to first inappropriate shock, all-cause mortality, and the composite of time to first all-cause shock plus all-cause mortality. A total of 2595 patients were randomized (mean age, 63.9 years; 22.4% were females). At a mean follow-up of 38 months, first all-cause shock occurred in 129 participants in the ATP plus shock group and 178 participants in the shock only group. The hazard ratio (HR) for the primary end point was 0.72 (95.9% CI, 0.57-0.92), with P = .005 for superiority of the ATP plus shock group over the shock only group. During follow-up in an intention-to-treat analysis, the total shock burden per 100 patient-years was not statistically different, at 12.3 and 14.9, respectively (P = .70). The use of a single burst of ATP prior to shock in primary prevention ICD recipients with modern ICD detection programming prolonged the time to first all-cause ICD shock. ClinicalTrials.gov Identifier: NCT02923726.

Socioeconomic Status and Major Adverse Transplant Events in Pediatric Heart Transplant Recipients

Low socioeconomic status (SES) has been associated with higher risk of rejection and graft loss in pediatric heart transplant (HT) recipients. The association of SES with other posttransplant morbidities is unknown. To assess whether low SES is associated with higher risk of a major adverse transplant event (MATE) among pediatric HT recipients. Retrospective single-center cohort study at a children's hospital in Boston with consecutive primary HT recipients from 2006 to 2019 and follow-up through 2022. Data were analyzed from June 2023 to March 2024. Very low or low, moderate, and high or very high Childhood Opportunity Index (COI) for neighborhood (census tract) of patient residence. Primary outcome was 3-year MATE-6 score assessed in 6-month survivors as cumulative burden of acute cellular rejection, antibody-mediated rejection, coronary vasculopathy, lymphoproliferative disease, kidney dysfunction, and infection, each as an ordinal score from 0 to 4 (24 for death or retransplant). Secondary outcomes were freedom from rejection during first 6 months, freedom from death or retransplant, MATE-3 score for events 1 to 3 (under immune suppression) and events 4 to 6 (chronic immune suppression effects), and each MATE component. Of 153 children analyzed, the median (IQR) age at HT was 7.2 (1.5-14.8) years, 99 (65%) were male, 16 (10%) were Black, 17 (11%) were Hispanic, and 106 (69%) were White. Fifty patients (33%) lived in very low or low, 17 (11%) in moderate, and 86 (56%) in high or very high COI neighborhoods. There was no significant group difference in mean (SD) 3-year MATE-6 score (very low or low COI, 3.4 [6.5]; moderate COI, 2.4 [6.3]; and high or very high COI, 4.0 [6.9]). Furthermore, there was no group difference in mean (SD) MATE-3 scores for underimmune suppression (very low or low COI, 1.9 [3.5]; moderate COI, 1.2 [3.2]; and high or very high COI, 2.2 [3.6]), chronic immune suppression effects (very low or low COI, 1.6 [3.3]; moderate COI, 1.1 [3.2]; and high or very high COI, 1.8 [3.6]), individual MATE components, rejection during the first 6 months, or death or retransplant. In this cohort study of pediatric HT recipients, there was no difference in posttransplant outcomes among recipients stratified by SES, a notable improvement from prior studies. These findings may be explained by state-level health reform, standardized posttransplant care, and early awareness of outcome disparities.

Healthcare system navigation difficulties among informal caregivers of older adults: a logistic regression analysis of social capital, caregiving support and utilization factors

BackgroundInformal caregivers of older adults play a vital role in improving the degree to which older adults access community and healthcare services in a seamless and timely manner. They are fulfilling important navigation and support roles for their older care recipients. However, there is still little knowledge of the most significant facilitators and barriers to effective and efficient system navigation among caregivers. This paper aims to fill these knowledge gaps through investigation of the key factors (i.e., social capital/cohesion, caregiving supports, and utilization factors) affecting navigation difficulties faced by informal caregivers of older adults.MethodsThe Behavioural-Ecological Framework of Healthcare Access and Navigation (BEAN) model is used to frame the study. Using the General Social Survey on Caregiving and Care Receiving 2018, we analyzed 2,733 informal caregivers whose primary care recipients were aged 65 or older. Hierarchical logistic regression was conducted to identify the relationship between system navigation difficulties among informal caregivers and four sequentially ordered blocks of predictors: (1) sociodemographic (2), social capital/cohesion (3), caregiving supports, and (4) healthcare demand.ResultsThe fully adjusted model showed that the probability of reporting navigation difficulties was lower for caregivers with social capital/cohesion compared to those without social capital/cohesion. In comparison, the probability of reporting navigation difficulties was higher among caregivers with caregiving support and among caregivers whose care receivers use a higher amount of health service use. Several sociodemographic covariates were also identified.ConclusionOur findings support certain aspects of the BEAN model. This study extends our understanding of potential facilitators and barriers that informal caregivers of older adults face while navigating complex community and health systems. There is a need to implement coordinated schemes and health policies especially for older adults with mental/neurological issues to address the challenges of their caregivers given the specific vulnerability identified in this study. The need for further research using different approaches to examine the disproportionate impact of COVID-19 on caregivers’ system navigation experience is crucial.

Outcomes of Older Primary Kidney Transplant Recipients by Induction Agent and High-risk Viral Discordance Status in the United States.

The impact of induction type or high-risk viral discordance on older kidney transplant recipients is unclear. Herein, we analyzed the association between induction type, viral discordance, and outcomes for older recipients. We analyzed the Scientific Registry of Transplant Recipients standard analysis file for all primary kidney transplant recipients older than 55 y who were transplanted between 2005 and 2022. All transplants were crossmatch negative and ABO-compatible. Recipients were discharged on tacrolimus and mycophenolate ± steroids. Recipients were categorized into 3 groups by induction received: rabbit antithymocyte globulin (r-ATG; N = 51 079), interleukin-2 receptor antagonist (IL-2RA; N = 22 752), and alemtuzumab (N = 13 465). Kaplan-Meier curves were generated for recipient and graft survival, and follow-up was censored at 10 y. Mixed-effect Cox proportional hazard models examined the association between induction type, high-risk viral discordance, and outcomes of interest. Models were adjusted for pertinent recipient and donor characteristics. Induction type did not predict recipient survival in the multivariable model, whereas Epstein-Barr virus high-risk discordance predicted 14% higher mortality (1.14 [1.07-1.21], P < 0.01). In the multivariable model for death-censored graft survival, alemtuzumab, but not IL-2RA, was associated with an increased risk of graft loss (1.18 [1.06-1.29], P < 0.01) compared with r-ATG. High-risk cytomegalovirus discordance predicted 10% lower death-censored graft survival (1.10 [1.01-1.19], P < 0.02). Live donor and preemptive transplantation were favorable predictors of survival. In this large cohort of older transplant recipients, alemtuzumab, but not IL-2RA, induction was associated with an increased risk of graft loss compared with r-ATG. Cytomegalovirus and Epstein-Barr virus high-risk viral discordance portended poor graft and recipient survival, respectively.

The Funding Puzzle in Adult Education for Sustainable Development: A Case Study of Slovenia

This study investigates the landscape of public funding for adult education for sustainable development (AESD) in Slovenia, focusing on the distribution, types of funding, and their impact on accessibility and quality. This study employs a mixed methods approach to understand the distribution, types of funding, and their impacts on the accessibility and quality of adult education. Data were collected through an online questionnaire completed by 59 organizations providing non-formal AESD, alongside semi-structured interviews conducted with 12 representatives. Key findings reveal a significant disparity between operational funding and that designated for AESD implementation, with non-governmental organizations (NGOs) emerging as the primary recipients of public funds. Notably, project-based funding predominates, raising concerns about the sustainability of AESD programs due to its typically time-limited nature. Public funding is essential for ensuring program accessibility and quality, as it enables organizations to hire experts and enhance curricula. However, the reliance on project-based grants creates instability, complicating long-term planning and program effectiveness. The study underscores the need for systematic and continuous funding strategies to support AESD, highlighting the importance of a cross-sectoral approach to policymaking. Overall, the research elucidates the intricate relationship between funding distribution, program effectiveness, and the advancement of sustainable development education.

Dynamic spillovers between oil market, monetary policy, and exchange rate dynamics in the US

This study examines the dynamic network connectedness among the oil market, monetary policy, and exchange rate dynamics in the US. Two dimensions of the relevant markets—specifically, oil prices, interest rates, and US dollar value—along with their associated uncertainties, are analyzed. Our results suggest that the strongest source of risk transmission is oil market uncertainty, with exchange rate market uncertainty and the US dollar following behind. Monetary policy uncertainty emerges as the primary recipient of risk, followed by oil prices and federal funds rate. The results also show that cross-market spillovers are more prominent than within-market spillovers.

306.2: Time-varying relative changes in donor-derived cell-free DNA (dd-cfDNA) during rejection and dnDSA detection in primary and repeat kidney transplant recipients (KTR).

306.2: Time-varying relative changes in donor-derived cell-free DNA (dd-cfDNA) during rejection and dnDSA detection in primary and repeat kidney transplant recipients (KTR).

Harmony in diversity: Exploring connectedness and portfolio strategies among crude oil, gold, traditional and sustainable index

The research investigates dynamic connectedness and portfolio strategies among crude oil, gold, global traditional (DJGI) and sustainable (DJSI) indices. The time-varying parameter vector autoregression (TVP-VAR) findings reveal that the average total connectedness among the assets is 33.03%, with the total dynamic connectedness index exhibiting a notable surge during two crises and one stability period. The upsurge exhibited a predominant prevalence of short-run connectedness during crisis periods, notably amidst the COVID-19 pandemic and the Russia-Ukraine war. Conversely, the last and first quarters of 2017 and 2018 manifested as periods of stability, wherein long-term interconnectedness prevailed. Crude oil and gold emerge as the primary recipients of systemic shocks, while traditional and sustainable stock indices act as net transmitters of shocks. The BEKK and DCC GARCH models indicate short- and long-run persistence among the assets. Further, the study calculated hedge ratios and portfolio weights. Our empirical findings indicate that gold serves as a cost-effective hedging asset. Investors should invest more in the traditional stock index than in gold and crude oil to form an optimal portfolio. Notably, the global sustainable index offers results similar to those of the traditional index. Investors in the sustainable index would invest a similar amount for diversification and hedging with other traditional assets as they would for the traditional index.

EMOTIONAL SOLIDARITY IN TOURISM DEVELOPMENT: HOW POLICY AND KNOWLEDGE DRIVE SUPPORT IN GILGIT BALTISTAN, PAKISTAN

The participation of local communities is vital in developing tourism, as their attitudes and behaviours can significantly impact the growth and success of a destination. As the primary recipients of future tourism developments, the perspectives of local communities should guide the creation of sustainable policies aimed at maximising benefits and minimising negative impacts. The study examines how government policy, tourism knowledge, emotional solidarity, and support for tourism development are interrelated among the residents of Gilgit-Baltistan, Pakistan. Based on a quantitative and cross-sectional research design with two sampling stages comprising quota and purposive sampling, 216 responses from the residents of Gilgit-Baltistan were collected and analysed through Partial Least Square-Structural Equation Modeling (PLS-SEM). It was revealed that government policy and tourism knowledge influence residents' welcoming nature and emotional closeness, and they contribute to their support for tourism development. The findings underscore the importance of establishing targeted and effective support systems between stakeholders to sustain the benefits of tourism development.

Glucose intolerance as a consequence of hematopoietic stem cell dysfunction in offspring of obese mice

ObjectiveMaternal obesity is increasingly common and negatively impacts offspring health. Children of mothers with obesity are at higher risk of developing diseases linked to hematopoietic system abnormalities and metabolism such as type 2 diabetes. Interestingly, disease risks are often dependent on the offspring's sex, suggesting sex-specific reprogramming effect of maternal obesity on offspring hematopoietic stem and progenitor cell (HSPC) function. However, the impact of maternal obesity exposure on offspring HSPC function, and the capability of HSPC to regulate offspring metabolic health is largely understudied. This study aims to test the hypothesis that offspring of obese mice exhibit sex-differences in HSPC function that affect offspring's metabolic health. MethodsWe first assessed bone marrow hematopoietic stem and progenitor cell phenotype using postnatal day 21 (P21) and 8-week-old C57BL/6J mice born to control and diet-induced obese dams. We also sorted HSPC (Lineage-, Sca1+, cKit + cells) from P21 mice for competitive primary and secondary transplant, as well as transcriptomic analysis. Body weight, adiposity, insulin tolerance test and glucose tolerance tests were performed in primary and secondary transplant recipient animals. ResultsWe discovered sex-differences in offspring HSPC function in response to maternal obesity exposure, where male offspring of obese dams (MatOb) showed decreased HSPC numbers and engraftment, while female MatOb offspring remained largely unaffected. RNA-seq revealed immune stimulatory pathways in female MatOb offspring. Finally, only recipients of male MatOb offspring HSPC exhibited glucose intolerance. ConclusionsThis study demonstrated the lasting effect of maternal obesity exposure on offspring HSPC function and implicates HSPC in metabolic regulation.

Multi-dimensional equilibrium optimal allocation of water resources in Beijing-Tianjin-Hebei region through spatial association network analysis

The rapid social and economic development has led to problems such as over-exploitation of water resources, strong demand for physical water resources, and disequilibrium of water resources load. Based on the current situation of the water resources system in Beijing-Tianjin-Hebei region, this study proposed an input–output analysis-assessment-prediction-optimization framework. A water resources dissipation environment extended multi-regional input–output model was established, and the spatial equilibrium of water resources load was evaluated comprehensively. Furthermore, a multi-dimensional spatial equilibrium optimal allocation for water resources was built to identify key nodes and sectors. The primary findings were as follows: (1) Shijiazhuang and Tangshan were the main cities with net virtual water outflow, while Beijing and Baoding were the primary recipients of net virtual water inflow; (2) The overall score for the spatial equilibrium assessment of water resource load was low, with dimension scores predominantly ranging between 0.2 and 0.6; (3) The key transfer nodes were predominantly concentrated on the “outflow from Shijiazhuang” and the “inflow to Cangzhou and Langfang” nodes. This research conducted an in-depth exploration of the direction of water resource transfers, the actual stress conditions, and the spatial equilibrium of water resources within the Beijing-Tianjin-Hebei region. Finally, the future adjustment strategy for water-intensive industries at the urban agglomeration scale was obtained.

Dapagliflozin Use in Children with Advanced Heart Failure Undergoing Heart Transplantation: A Matched Case-Control Study.

Dapagliflozin has been associated with euglycemic ketoacidosis in adults with diabetes contributing to poor outcomes when continued prior to surgery. It is unknown if preoperative use of dapagliflozin may lead to adverse events (AE) in nondiabetic children with advanced heart failure (HF) undergoing heart transplantation (HTx). We performed a single-center, matched case-control analysis of nondiabetic primary pediatric HTx recipients < 21years-old who underwent HTx and followed through postoperative day (POD) 3. Cases who received dapagliflozin leading up to HTx (n = 22) were matched by age and cardiac diagnosis to two historical controls who did not receive dapagliflozin (n = 44). Median age at HTx was 13.8years (range 0.36-20.7) and 48% were female. Cardiac diagnoses included cardiomyopathy (45%), Fontan failure (41%), and single ventricle status post stage I palliation (14%). Cases received median dapagliflozin dose of 0.17mg/kg once daily; therapy was stopped one day prior to HTx. There were no significant differences in blood glucose nadirs, arterial blood gas indices including nadirs of pH, bicarbonate, or peaks of arterial blood lactic acid POD0-3. Vasopressor, inotrope, and insulin infusion usage were not different. No patients were treated for severe hypoglycemia, euglycemic ketoacidosis, or urinary tract infections. There were no deaths. Length of stay in ICU and time from HTx to hospital discharge did not differ between cohorts. Use of dapagliflozin in children with advanced HF until HTx is not associated with AE in the immediate postoperative period nor increased length of hospitalization post-HTx. Potential cardiovascular benefits of dapagliflozin in patients awaiting HTx should be prioritized.

Effect of Post-transplant Dietary Restriction on Hematopoietic Reconstitution and Maintenance of Reconstitution Capacity of Hematopoietic Stem Cells.

Hematopoietic cell transplantation (HCT) is an important therapy for many hematological malignancies as well as some non-malignant diseases. Post-transplant hematopoiesis is affected by multiple factors, and the mechanisms of delayed post-transplant hematopoiesis remain poorly understood. Patients undergoing HCT often suffer from significantly reduced food intake due to complications induced by preconditioning treatments. Here, we used a dietary restriction (DR) mouse model to study the effect of post-transplant dietary reduction on hematopoiesis and hematopoietic stem cells (HSCs). We found that post-transplant DR significantly inhibited both lymphopoiesis and myelopoiesis in the primary recipient mice. However, when bone marrow cells (BMCs) from the primary recipient mice were serially transplanted into secondary and tertiary recipient mice, the HSCs derived from the primary recipient mice, which were exposed to post-transplant DR, exhibited a much higher reconstitution capacity. Transplantation experiments with purified HSCs showed that post-transplant DR greatly inhibited hematopoietic stem cell (HSC) expansion. Additionally, post-transplant DR reshaped the gut microbiotas of the recipient mice, which inhibited inflammatory responses and thus may have contributed to maintaining HSC function. Our findings may have important implications for clinical work because reduced food intake and problems with digestion and absorption are common in patients undergoing HCT.

Differential effects of donor factors on post-transplant survival in lung transplantation

BackgroundPredicting post-transplant (PT) survival in lung allocation remains an elusive goal. We analyzed the impact of donor factors on PT survival and how these relationships vary among transplant recipients. MethodsWe studied primary bilateral lung transplant recipients (n=7,609) from the US Scientific Registry of Transplant Recipients (19 February 2015 - 1 February 2020). Main and interaction effects were evaluated and adjusted across candidate age, sex, and diagnosis. Models predicting PT survival were compared to the PT composite allocation score model (PT-CAS): 1. Cox regression donor multivariable model (COX), 2. COX + PT-CAS, 3. random forest model (RF), 4. RF + PT-CAS. Model discrimination and calibration measures were compared. ResultsInteractions between donor and recipient factors emerged by – age: lower survival for DCD organs for recipients aged 55-69 years, donor smoking for recipients aged 30-54 and 70+, Hispanic donor for recipients < 30, non-Hispanic Black (NHB) donor for recipients aged 30+; sex: CMV mismatch for males; diagnosis: higher donor recipient weight ratio for diagnosis Group C (e.g.CF), donor diabetes for diagnosis Group D (e.g. IPF). COX and RF models performed similarly to PT-CAS; however, the combined COX PT-CAS model had improved discrimination (1y AUC PT-CAS 0.609 vs. 1y AUC COX + PT-CAS 0.626) and improved calibration across a broader range of predicted risk. ConclusionThe influence of donor factors on recipient post-transplant survival differed by age, sex, and diagnosis. The addition of donor factors to existing models predicting posttransplant survival led to only modest improvement in prediction accuracy. Future efforts may focus on optimizing matching strategies to improve donor utilization.