The latest medical research on Transplant

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about transplant gathered by our medical AI research bot.

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Single Lung Transplant Remains a Viable Option for Patients With Severe Secondary Pulmonary Hypertension.

Transplantation

Although double lung transplant is recommended in patients with severe secondary pulmonary hypertension (SPH), our institutional experiences suggest a role for single lung transplant in these patients. Here, we review our experience prioritizing single lung transplant in patients with SPH to minimize their surgical burden.

We conducted a retrospective review of our lung transplant database to identify patients with SPH who underwent single lung transplant. Patients were stratified as either mild SPH (mean pulmonary artery pressure 25-40 mm Hg) or severe SPH (mean pulmonary artery pressure >40 mm Hg). Singe lung recipients without PH transplanted over the same time were also examined.

Between January 2017 and December 2019, 318 patients underwent single lung transplantation; 217 had mild SPH (68%), and 59 had severe SPH (18.5%). Forty-two patients without PH underwent single lung transplant. When the groups were compared, significantly higher pulmonary vascular resistance was noted in the severe SPH group, and obesity was noted in both the mild and severe SPH groups. Although the severe SPH group required more intraoperative cardiopulmonary support (37.3% versus 10.3% versus 4.7%, P < 0.05), there were no significant differences in most major postoperative parameters, including the duration of postoperative mechanical ventilation or the incidence of severe primary graft dysfunction. Survival 1 y posttransplant was not significantly different among the groups (93.2% versus 89.4% versus 92.9%, P = 0.58).

Our experience supports the option of single lung transplantation with appropriate intraoperative mechanical circulatory support in patients with SPH. This strategy is worth pursuing, especially with ongoing donor lung shortages.

Design of multi-pad electrotactile system envisioned as a feedback channel for supernumerary robotic limbs.

Journal of Artificial Intelligence Research

Providing real-time haptic feedback is an important, but still not sufficiently explored aspect of use of supernumerary robotic limbs (SRLs). We present a multi-pad electrode for conveying multi-modal proprioceptive and sensory information from SRL to the user's thigh and propose a method for stimuli calibration.

Within two pilot tests we investigated return electrode configuration and active electrode discrimination in three healthy subjects to select the appropriate electrode pad topology. Based on the obtained results and anthropometric data from literature, the electrode was designed to have three branches of 10 pads and two additional pads that can be displaced over/under the electrode branches. The electrode was designed to be connected to the stimulator that allows full multiplexing so that specific branches can serve as common return electrode. To define the procedure for application of this system, the sensation, localization and discomfort thresholds applicable for the novel electrode were determined and analysed in ten subjects.

The results showed no overlaps between the three thresholds for individual pads, with significantly different average values, suggesting that the selected electrode positioning and design provide good active range of useful current amplitude. The results of the subsequent analysis suggested that the stimuli intensity level of 200% of sensation threshold is the most probable value of the localization threshold. Furthermore, this level ensures low chance (i.e. 0.7%) of reaching the discomfort.

We believe that envisioned electrotactile system could serve as a high bandwidth feedback channel that can be easily setup to provide proprioceptive and sensory feedback from supernumerary limbs.

Automated regional citrate anticoagulation based on online monitoring of ionized calcium concentration: Proof of concept.

Journal of Artificial Intelligence Research

Regional citrate anticoagulation (RCA), a complex and effective technique, is recommended as the anticoagulation of choice for continuous renal replacement therapy (CRRT). One of its key objectives is to keep the ionized calcium in the targeted range. In this study, we aimed to develop automated RCA based on online monitoring of the ionized calcium concentration and closed-loop feedback.

We constructed calcium-selective electrodes with liquid inner contact, which measured a potentiometric signal as the output. We tested the responses, stability, and selectivity of the electrodes in flowing fluid containing calcium chloride. We compared the measurement accuracy between the electrodes and an i-STAT system in vivo. Moreover, we established closed-loop feedback using a proportional-integral-derivative controller model. We performed simulated automated RCA both in vivo and in vitro.

The electrode gave a Nernstian response to the variation of ionized calcium concentration. It showed high stability and a relatively short response time. Changes in the fluid flow rate, solution PH, and addition of metal ions including Mg2+ and K+ did not interfere with the measurements of ionized calcium. These measurements in whole blood by the electrode were very close to those assessed by the i-STAT system. The feedback control system responded quickly to an abnormal ionized calcium concentration and regulated the infusion rates of calcium or citrate to maintain the concentration of ionized calcium within the targeted range.

We successfully trialed automated RCA, which may help simplify the complexities of RCA in the future.

Mathieu Jaboulay's (1860-1913) contribution to xenotransplantation.

Xenotransplantation

Mathieu Jaboulay (1860-1913) was a professor of clinical surgery in Lyon, France who is best known for his development of vascular anastomosis and ...

Opinions of nursing and theology faculty students on Xenotransplantation.

Xenotransplantation

It is mentioned that students' opinions about xenotransplantation (XTx) have been explored in a limited manner. In particular, there is no literature in Turkey on Nursing and Theology students' perspectives on XTx. This research aimed to find out what Nursing and Theology students thought about XTx.

This descriptive and cross-sectional study was conducted on students studying at the Theology and Nursing faculties. The study population consisted of 2.581 students educated in these faculties. Without using any sampling method, it was aimed to reach all students, and 1.780 (70%) students were reached. Data were collected using a participant identification form and questionnaire form, which the researchers developed.

The difference between the answers given by the Nursing and Theology students to the information statements about XTx was statistically significant (p < .001). Nursing and Theology students' attitudes to organ or tissue Tx from halal animals in case of necessity were positive (p < .001). While the nursing students' attitude toward organ or tissue Tx from non-helal animals in case of necessity was negative, Theology students had no idea (p < .001). In other attitude statements, while nursing students responded positively, Theology students responded as "I have no idea" (p ≤ .001).

Theology students tended to have the question about XTx and only positive attitude towards XTx from halal animals. Nursing students mostly had positive attitude, but negative when XTx is practiced out of necessity.

Bioinformatic analysis as a first step to predict the compatibility of hematopoiesis and immune system genes between humans and pigs.

Xenotransplantation

The shortage of allogeneic donor organs leaves its supply far short of clinical need. There are great expectations on xenotransplantation, especial...

Extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacterales bloodstream infection after solid organ transplantation: recent trends in epidemiology and therapeutic approaches.

Transplant Infectious Disease

Infections caused by multidrug-resistant Gram-negative bacilli (MDR GNB), in particular extended-spectrum β-lactamase-producing (ESBL-E) and carbapenem-resistant Enterobacterales (CRE), pose a major threat in solid organ transplantation (SOT). Outcome prediction and therapy are challenging due to the scarcity of randomized clinical trials (RCTs) or well-designed observational studies focused on this population.

Narrative review with focus on the contributions provided by the ongoing multinational INCREMENT-SOT consortium (ClinicalTrials identifier NCT02852902) in the fields of epidemiology and clinical management.

The Spanish Society of Transplantation (SET), the Group for Study of Infection in Transplantation of the Spanish Society of Infectious Diseases and Clinical Microbiology (GESITRA-SEIMC), and the Spanish Network for Research in Infectious Diseases (REIPI) recently published their recommendations for the management of MDR GNB infections in SOT recipients. We revisit the SET/GESITRA-SEIMC/REIPI document taking into consideration new evidence emerged on the molecular epidemiology, prognostic stratification and treatment of post-transplant ESBL-E and CRE infections. Results derived from the INCREMENT-SOT consortium may support the therapeutic approach to post-transplant bloodstream infection (BSI). The initiatives devoted to spare the use of carbapenems in low-risk ESBL-E BSI or to repurpose existing non-β-lactam antibiotics for CRE in both non-transplant and transplant patients are reviewed, as well as the eventual positioning in the specific SOT setting of recently approved antibiotics.

Due to the clinical complexity and relative rarity of ESBL-E and CRE infections in SOT recipients, multinational cooperative efforts such as the INCREMENT-SOT Project should be encouraged. In addition, RCTs focused on post-transplant serious infection remain urgently needed. This article is protected by copyright. All rights reserved.

Hospital-Based Health Technology Assessment of Machine Perfusion Systems for Human Liver Transplantation.

Transplant International

Based on published data, we have carried out a hospital-based health technology assessment of machine perfusion in adult liver transplantation usin...

Interventions Against Posttransplantation Diabetes: A Scientific Rationale for Treatment Hierarchy Based on Literature Review.

Transplantation

Posttransplant diabetes (PTD) is a common medical complication after solid organ transplantation. Because of adverse outcomes associated with its d...

Evaluation of clotrimazole prophylaxis on tacrolimus trough concentrations in kidney transplant recipients.

Transplant Infectious Disease

Clotrimazole troches are used as prophylaxis against oropharyngeal candidiasis post-transplant and have limited systemic absorption. Following several occurrences of tacrolimus concentration fluctuations after clotrimazole discontinuation, its use as prophylaxis was discontinued post-kidney transplant.

We conducted a retrospective cohort study to evaluate the effect of clotrimazole prophylaxis on tacrolimus trough concentrations post-kidney transplant. The study included adult patients who received a kidney transplant at Cleveland Clinic Main Campus from August 1, 2019 to July 1, 2020 and were maintained on per-protocol, standard-dose tacrolimus through 90 days post-transplant. Patients were excluded if they received cyclosporine, systemic antifungals, strong CYP3A4 inhibitors or inducers, or a simultaneous multiorgan transplant. The primary objective was to compare tacrolimus trough concentrations before and after completion of clotrimazole prophylaxis. Secondary objectives were to compare the time to first post-transplant goal tacrolimus trough concentration, the rate of for-cause allograft biopsies within 90 days after transplant, and the incidence and type of candidiasis within 30 days after transplant, pre- and post- protocol change.

Following clotrimazole discontinuation, the median tacrolimus trough concentration decreased from 10.5 ng/mL (IQR 8.4-12.2) to 6.6 ng/mL (IQR 5-8.7, p<0.0001). No statistically significant differences in the rate of for-cause allograft biopsies (4.9% vs. 9.7%, p = 0.264) or incidence of candidiasis (1.2% vs. 5.4%, p = 0.217) were observed between those who received clotrimazole and those who did not receive clotrimazole.

Our study provides further evidence of a significant drug-drug interaction between tacrolimus and clotrimazole among kidney transplant recipients that can potentially lead to negative allograft outcomes. This article is protected by copyright. All rights reserved.

Evaluating clinical effectiveness of SARS-CoV-2 vaccine in solid organ transplant recipients: A propensity score matched analysis.

Transplant Infectious Disease

Solid organ transplant recipients (SOTR) are at disproportionate risk for severe Coronavirus Disease 2019 (COVID-19). Vaccination is a key preventative strategy but is associated with decreased humoral responses among SOTR. Whether dampened immune responses correlate with reduced clinical effectiveness is unclear. Our study was designed to evaluate the clinical effectiveness of SARS-CoV-2 vaccination in the early vaccine era.

We conducted a retrospective cohort study comparing SARS-CoV-2 infection rates between SOTR who received 2 doses of mRNA or 1 dose of Ad26.Cov2.S vaccine and those not fully vaccinated (partially vaccinated and unvaccinated). To evaluate clinical effectiveness of vaccine, cause-specific Cox regression model and modified Poisson regression model were built using the propensity score matched cohort . Additionally, the clinical outcomes of COVID-19 of fully vaccinated and not fully vaccinated SOTR were compared.

Of 2705 SOTR, 1668 were included in our final matched analysis, which showed a 73% reduction of SARS-CoV-2 infection and 76% reduction of all-cause-mortality among fully vaccinated patients. Thirty-nine SOTR developed SARS-CoV-2 infection, including 9 fully vaccinated and 30 not fully vaccinated. Among fully vaccinated patients, 22% had severe/critical COVID-19 and 0% mortality versus not fully vaccinated SOTR, of whom 37% had severe/critical COVID-19 and 6.67% COVID-19-related mortality.

In SOTR, completion of primary vaccine series in the early vaccine era was associated with a significant reduction of COVID-19 and was protective against severe/critical disease and death. Further studies are needed to evaluate the clinical effectiveness of current vaccine recommendations for SOTR against emerging new variants. This article is protected by copyright. All rights reserved.

Is There a Sex Gap in Outcomes of Comparable Patients Supported with Left Ventricular Assist Devices?

Journal of Artificial Intelligence Research

Historically, females were described as suffering from worse outcomes after left ventricular assist device (LVAD) implantation. However, females' preoperative conditions are unique, making direct comparisons with males challenging. This study aimed to select through propensity score (PS) matching two preoperatively comparable populations of females and males and test if any real sex-related difference exists regarding survival and adverse events after LVAD implantation.

This retrospective single-center observational study investigated patients who received LVAD implantation between 2010 and 2018. PS matching was applied to balance preoperative heterogeneity between males and females. Primary endpoint was survival at follow-up. Secondary endpoints included perioperative outcomes and LVAD-related adverse events.

92 fully comparable females(n=46) and males(n=46) were selected after PS matching (median age:57 years, min-max:18-75). 26.1% of patients required preoperative mechanical circulatory support. Females needed more intraoperative fresh frozen plasma (p<0.001) and platelets transfusions (p=0.008) compared to males, but postoperative outcomes were comparable between groups. In-hospital, 1-year and 2-year survival were 78.3%, 69.6% and 65.2%, respectively, with no differences between groups. Survival probability remained comparable up to 8 years of follow-up(p=0.35). Overall, females showed a higher rate of strokes(p=0.039) compared to males in the follow-up time.

After reducing preoperative heterogeneity between females and males, survival after LVAD implantation does not differ based on sex. However, differences might exist in terms of higher transfusions and strokes in females. Reducing preoperative sex disparities and developing intraoperative and anticoagulation strategies which acknowledge sex-related variations might help abolishing differences in LVAD outcomes.