Outcome Of Transplantation Research Articles

Desensitization Strategies for Donor-Specific Antibodies in HLA-Mismatched Stem Cell Transplantation Recipients: What We Know and What We Do Not Know.

In human leukocyte antigen (HLA)-mismatched allogeneic stem cell transplantation settings, donor-specific anti-HLA antibodies (DSAs) can independently lead to graft failure, including both primary graft rejection and primary poor graft function. Although several strategies, such as plasma exchange, intravenous immunoglobulin, rituximab, and bortezomib, have been used for DSA desensitization, the effectiveness of desensitization and transplantation outcomes in some patients remain unsatisfactory. In this review, we summarized recent research on the prevalence of anti-HLA antibodies and the underlying mechanism of DSAs in the pathogenesis of graft failure. We mainly focused on desensitization strategies for DSAs, especially novel methods that are being investigated in the preclinical stage and those with promising outcomes after preliminary clinical application.

Hospital volume does not mitigate the impact of area socioeconomic deprivation on heart transplantation outcomes.

While structural socioeconomic inequity has been linked with inferior health outcomes, some have postulated reduced access to high-quality care to be the mediator. We assessed whether treatment at high-volume centers(HVC) would mitigate the adverse impact of area deprivation on heart transplantation(HT) outcomes. All HT recipients ≥18years were identified in the 2005-2022 Organ Procurement and Transplantation Network. Neighborhood socioeconomic deprivation was assessed using the previously validated Area Deprivation Index. Recipients with scores in the highest quintile were considered Most Deprived (others: Less Deprived). Hospitals in the highest quartile by cumulative center volume (≥21 transplants/year) were classified as HVC. The primary outcome was post-transplant survival. Of 38,022 HT recipients, 7,579 (20%) were considered Most Deprived. Following risk adjustment, Most Deprived demonstrated inferior survival at 3(hazard ratio[HR] 1.14, 95%confidence interval[CI] 1.06-1.21) and 5 years following transplantation (HR 1.13, CI 1.07-1.20). Similarly, Most Deprived faced greater graft failure at 3(HR 1.14, CI 1.06-1.22) and 5 years (HR 1.13, CI 1.07-1.20). Evaluating patients transplanted at HVC, Most Deprived continued to face greater mortality at 3(HR 1.10, CI 1.01-1.21) and 5 years (HR 1.10, CI 1.01-1.19). The interaction between Most Deprived status and care at HVC was not significant, such that transplantation at HVC did not ameliorate the survival disparity between Most and Less Deprived. Area socioeconomic disadvantage is independently associated with inferior survival. Transplantation at HVC did not eliminate this inequity. Future efforts are needed to increase engagement with longitudinal follow-up care and address systemic root causes to improve outcomes.

P.027: Utilisation of livers donated after circulatory death (DCD) for transplantation – a large cohort study evaluating pre-retrieval biochemical characteristics and transplant outcomes.

P.027: Utilisation of livers donated after circulatory death (DCD) for transplantation – a large cohort study evaluating pre-retrieval biochemical characteristics and transplant outcomes.

Transplant Outcomes in Myelofibrosis: Impact of Donor Type (Cord Blood Grafts Supported by CD34+ selected Cells [Haplo-Cord] Versus Matched Donors)

BackgroundDespite the established potentially curative role of allogeneic hematopoietic cell transplantation (alloHCT) in managing MF, the choice of alternative donors for patients lacking matched donors remains a challenge, and the optimal graft source in this disease entity continues to be an ongoing debate. ObjectivesWe aimed to evaluate the impact of donor type: umbilical cord blood transplant supported CD34+ haploidentical donor (haplo-cord) vs adult matched related donor (MRD) and matched unrelated donor (MUD) in 40 adult patients with primary or secondary MF, including those progressing to accelerated phase (AP) or blast phase (BP), who underwent their first allo-HCT. The primary objective of this study was to analyze the impact of stem cell source on primary endpoints of overall survival (OS), graft versus host disease (GVHD) and non-relapse mortality (NRM). ResultsMedian follow-up for all alive patients was 53 months (range 0.3-63 months). Nine patients (22.5%) underwent an MRD allo-HCT, 15 patients (37.5%) underwent a MUD allo-HCT, and 16 patients (40%) underwent a haplo-cord allo-HCT. Four patients died without neutrophil engraftment: 3 (19%) in haplo-cord group and one (4%) in MRD/MUD group. The cumulative incidence of ANC engraftment by day 60 was 80% (95%CI 45-94) in the haplo-cord group and 92% (95%CI 65-98) in the MRD/MUD group (p=0.09). The cumulative incidence of platelet engraftment by day 60 was 59% (95%CI 27-81) in haplo-cord group and 75% (95%CI 51-88) in MRD/MUD group (p=0.4). OS was 62% at 1 year (95%CI 49-79) and 34% at 3 years (95%CI 21-55). The 3-yr OS was similar between the haplo-cord group and the MRD/MUD (37% vs 32%, p=0.9). The 1-yr OS for accelerated/blast phase AP/BP patients was 50% (95%CI 27-93) in the haplo-cord group, compared to 40% (95%CI 19-86) in the MRD/MUD. The 1-yr OS for chronic phase CP patients was 83% (95%CI 58-100) in the haplo-cord group, compared to 79% (95%CI 60-100) in the MRD/MUD group. The cumulative incidence of relapse at 3 years in the haplo-cord group was 13% (95%CI 1.8-34), and in the MRD/MUD group was 28% (95%CI 10-49) (p=0.36). 1-yr non-relapse mortality (NRM) was 38% (95%CI 15-61) in the haplo-cord group and 33% (95%CI 15-52) in the MRD/MUD group. 3-yr NRM was 48% (95%CI 19-72) in the haplo-cord group and 54% (95%CI 29-73) in MRD/MUD group(p=0.95). ConclusionWe showed no significant difference in OS, relapse, and NRM outcomes after haplo-cord transplant compared to adult matched donors’ grafts (MRD or MUD) in MF patients. However, there were more graft failures in patients transplanted with a haplo-cord transplants and delayed engraftments with inadequate haplo myeloid bridges. Despite the small sample size in our study, considering our findings and the availability of other alternative donors, using haplo-cord platforms may no longer be justified for myelofibrosis unless the UCB engraftment dynamics can be optimized.

P.415: Tobacco influence on short-term outcomes of liver transplantation.

P.415: Tobacco influence on short-term outcomes of liver transplantation.

MM-517 Outcome of Autologous Stem Cell Transplantation in High-Risk Multiple Myeloma: A Single-Center Experience

MM-517 Outcome of Autologous Stem Cell Transplantation in High-Risk Multiple Myeloma: A Single-Center Experience

Long-Term Results of Meniscus Allograft Transplantation With Bone Fixation Show Improved Outcomes but Progression of Joint Space Narrowing, Osteoarthritis, and Cartilage Degeneration

PurposeTo investigate the clinical and objective outcomes of meniscal allograft transplantation (MAT) using bone fixation in patients after a minimum follow-up duration of 15 years, and to compare the demographic factors and allograft status between patients who experienced progression of osteoarthritis and those who did not. MethodsThe consecutive patients who underwent primary MAT between December 1996 and January 2008 were retrospectively reviewed. The inclusion criteria was primary MAT with a minimum follow-up duration of 15 years. Clinical outcomes were evaluated using the modified Lysholm score, along with an evaluation of clinical failure. In objective outcomes, the progression of joint space narrowing, osteoarthritis, and the status of the associated cartilages and allografts were evaluated with follow-up radiographs and MRI. ResultsAmong the 79 cases, 54 knees in 52 patients were included in the study and evaluated for clinical outcomes. The mean Lysholm score improved from 73.9 ± 17.5 preoperatively to 86.4 ± 15.6 over a mean follow-up period of 17.5 ± 3.8 years (P<0.001). Regarding the Minimal clinically important differences (MCID), 38 cases (70.4%) showed an improvement in the Lysholm score. The cumulative clinical survival rate was 87.0%. Objective evaluations evaluated in 32 cases with a minimum of 15 years of radiographic data revealed significant progression of joint space narrowing, osteoarthritis, and cartilage degeneration at the final follow-up, with 11 (34.4%) out of 32 cases exhibiting allograft tears involving ˃50% of the allograft. Patients with osteoarthritis progression exhibited more meniscal allograft tears and extrusion on the last follow-up MRI scan than those without progression. ConclusionNotable progression in joint space narrowing, osteoarthritis, and cartilage degeneration were observed in objective assessment. The progression of osteoarthritis might be associated with allograft tears and extrusion. In clinical evaluations, favorable long-term clinical outcomes were consistently demonstrated after MAT using the bone fixation technique. Level of EvidenceLevel Ⅳ, therapeutic case series.

P.506: Outcome of heart transplant in a young patient referred with cardiogenic shock and multi-organ failure.

P.506: Outcome of heart transplant in a young patient referred with cardiogenic shock and multi-organ failure.

P.386: Long-term outcomes of liver transplantation from elderly donors.

P.386: Long-term outcomes of liver transplantation from elderly donors.

P.429: Outcomes of liver transplantation for hepatocellular carcinoma in donation after circulatory death compared with donation after brain death.

P.429: Outcomes of liver transplantation for hepatocellular carcinoma in donation after circulatory death compared with donation after brain death.

245.7: Outcomes of intestinal transplant in a single large adult centre.

245.7: Outcomes of intestinal transplant in a single large adult centre.

Analysis of the waitlist performance and post-transplant outcomes of lung transplant in elderly recipients in Korea: A nationwide cohort study.

There is a lack of information on the waitlist performance and post-transplant outcomes of lung transplants in elderly recipients in Korea. We retrospectively reviewed and analyzed data from the Korean Network for Organ Sharing database between March 2010 and August 2023. In total, 2574 patients were listed for lung transplantation during the study period, with 511 (19.9%) of them being over 65 years of age. Among these, 188 patients (36.8%) underwent transplantation, while 184 patients (36%) passed away without undergoing transplantation at the time of data extraction. The most prevalent underlying disease on the waitlist was idiopathic pulmonary fibrosis, accounting for 68.1%. The 1-year survival rate was significantly lower in the elderly compared to that in the nonelderly (65.4vs. 75.4%; p=.004). In the multivariate Cox analysis, elderly (hazard ratio [HR], 1.49; 95% CI, 1.14-1.97; p=.004) and a high urgent status at registration (HR, 1.83; 95% CI, 1.40-2.40; p<.001) were significantly associated with post-transplant 1-year mortality. Kaplan-Meier curves demonstrated a significant difference in post-transplant mortality based on the urgency status at enrollment (χ2=8.302, p=.016). Even with the same highly urgent condition at the time of transplantation, different prognoses were observed depending on the condition at listing (χ2=9.056, p=.029). The elderly exhibited worse transplant outcomes than nonelderly adults, with a highly urgent status at registration identified as a significant risk factor. Unprepared, highly urgent transplantation was associated with poor outcomes.

249.2: Outcomes of liver transplantation in patients 60 years and older: a multivariate analysis using penalized Cox regression.

249.2: Outcomes of liver transplantation in patients 60 years and older: a multivariate analysis using penalized Cox regression.

Small Donors, Big Impact: Optimizing Organ Utilization in Simultaneous Pancreas and Kidney Transplantation From Extra Small Pediatric Donors.

Simultaneous pancreas-kidney transplantation (SPK) is the preferred treatment for individuals with type-1 diabetes and end-stage renal disease. However, a limited supply of "Ideal Pancreas Donors" contributed to a growing disparity between available organs and recipients. Even though SPK outcomes from pediatric donors match those from adult donors, unclear guidelines on minimum age and weight criteria for extra small pediatric pancreas donors lead to hesitancy among several transplant centers to utilize these grafts due to concerns about inadequate islet mass, technical challenges, and increased risk of allograft thrombosis. This report details the successful outcomes of SPK transplantations performed at the study center between December 2021 and January 2024, using four extra small pediatric brain-dead donors (ESPDs). Each donor was aged ≤5 years and weighed <20kg. All SPK recipients achieved immediate posttransplant euglycemia without requiring insulin. None of the recipients experienced graft pancreatitis, graft thrombosis, allograft rejection, or required re-exploration. During a 5-27-month follow-up period, all ESPD recipients maintained optimal graft function, as evidenced by normal glucose tolerance tests and HbA1c (4.9%-5.2%), with 100% graft and patient survival. This report examines the usage of ESPDs in SPK transplantation, highlighting their potential to expand the donor pool and reduce wait times in areas with scarce deceased organ donations, thereby increasing the number of available organs for transplantation with acceptable outcomes. Revising donor selection guidelines to reflect the diverse risk-benefit profiles of waitlisted individuals is crucial to addressing geographical disparities and reducing organ discard rates.

Procurement Trends, Indications, and Outcomes of Heart-Lung Transplantation in the Contemporary Era.

Evolving trends in organ procurement and technological innovation prompted an investigation into recent trends, indications, and outcomes following combined heart-lung transplantation (HLTx). The United Network for Organ Sharing database was queried for all adult (≥18 years) HLTx performed between July 1, 2013 and June 30, 2023. Patients with previous transplants were excluded. The primary endpoint was the effect of donor, recipient, and transplantation characteristics on 1- and 5-year survival. Secondary analyses included a comparison of HLTx at high- and low-volume centers, an assessment of HLTx following donation after circulatory death (DCD), and an evaluation of HLTx volume over time. Cox proportional-hazards models were used to assess factors associated with mortality. Temporal trends were evaluated with linear regression. After exclusions, 319 patients were analyzed, of whom 5 (1.6%) were DCD. HLTx volume increased from 2013 to 2023 (p<0.001). One- and 5-year survival following HLTx was 84.0% and 59.5%, respectively. One-year survival was higher for patients undergoing HLTx at a high-volume center (88.3%vs. 77.9%; p=0.012). After risk adjustment, extracorporeal membrane oxygenation support 72 h posttransplant and predischarge dialysis were associated with increased 1-year mortality (HR=3.19, 95% CI=1.86-5.49 and HR=3.47, 95% CI=2.17-5.54, respectively) and 5-year mortality (HR=2.901, 95% CI=1.679-5.011 and HR=3.327, 95% CI=2.085-5.311, respectively), but HLTx at a high-volume center was not associated with either. HLTx volume has resurged, with DCD HLTx emerging as a viable procurement strategy. Factors associated with 1- and 5-year survival may be used to guide postoperative management following HLTx.

Impact of lung allocation policy change on Hispanic lung transplant outcomes: Addressing disparities and improving access

ObjectiveRacial disparities in organ allocation may result in differential survival for marginalized groups. This study aims to examine the impact of the November 2017 lung allocation policy change (LAPC) on trends and outcomes of Hispanic lung transplant (LT) recipients. MethodsThe United Network for Organ Sharing database was used to identify adult (older than age 18 years) LT recipients between January 2010 and March 2023. Recipients were categorized into 3 self-identified racial groups (Hispanic, non-Hispanic White, and non-Hispanic other). The Mann-Kendall trend test was used to assess the trend in rates of Hispanic LT over 5 years pre- and 5 years post-LAPC. The primary outcome was 1-year mortality. ResultsA total of 28,495 recipients from 80 centers were included, with 15,343 (53.8%) prepolicy change and 13,152 (46.2%) postpolicy change. The racial distribution of LT recipients was pre-LAPC: Hispanic: 1013 (6.6%), White: 12,601 (82.1%), Other: 1729 (11.3%) and post-LAPC: Hispanic: 1522 (11.6%), White: 9873 (75.0%), Other: 1757 (13.4%) (P < .001). Between 2013 and 2017, the proportion of Hispanic LT recipients increased from 6.0% to 7.6% (P = .221). Post-LAPC, the proportion increased from 8.5% in 2018 to 14.4% in 2022 (P < .027). Unadjusted 1-year survival rates were pre-LAPC: Hispanic: 88.8%, White: 87.6%, Other: 86.8% (log-rank P = .260) and post-LAPC: Hispanic: 90.6%, White: 88.2%, Other: 86.1% (log-rank P < .001). ConclusionsThe LAPC has led to increased access to LT and improved 1-year survival rates among Hispanic patients. However, efforts should continue to address disparities among other racial groups and ensure equitable outcomes for all recipients of LT.

220.3: Outcomes of high immunological risk kidney transplantation in an Asian tertiary academic transplant centre.

220.3: Outcomes of high immunological risk kidney transplantation in an Asian tertiary academic transplant centre.

P.122: The outcomes of renal transplantation during the covid-19 pandemic. Is it worth doing?

P.122: The outcomes of renal transplantation during the covid-19 pandemic. Is it worth doing?

P.367: Outcomes of liver transplantation: A single-center experience. (First Central Hospital of Mongolia).

P.367: Outcomes of liver transplantation: A single-center experience. (First Central Hospital of Mongolia).

P.254: Outcomes of liver transplantations in patients with alagille syndrome with high pulmonary arterial pressure performed in our center.

P.254: Outcomes of liver transplantations in patients with alagille syndrome with high pulmonary arterial pressure performed in our center.