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Transplantology, Volume 5, Issue 4 (December 2024) – 7 articles

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10 pages, 675 KiB  
Article
Effects of Tobacco Smoking on Post-Liver-Transplant Outcomes
by Lovepreet Singh, Ramanpreet Bajwa, Sofia Molina Garcia, Kristelle Imperio-Lagabon, Omar T. Sims and Jamak Modaresi Esfeh
Transplantology 2024, 5(4), 288-297; https://doi.org/10.3390/transplantology5040029 - 6 Dec 2024
Viewed by 221
Abstract
Background/Objectives: Our study examined 5-year patient and graft survival outcomes among non-smokers, former smokers, and active smokers at the time of liver transplantation (LT) and immediate post-operative complications and short-term outcomes following LT. Methods: This was a retrospective study that examined all liver [...] Read more.
Background/Objectives: Our study examined 5-year patient and graft survival outcomes among non-smokers, former smokers, and active smokers at the time of liver transplantation (LT) and immediate post-operative complications and short-term outcomes following LT. Methods: This was a retrospective study that examined all liver transplants occurring at Cleveland Clinic Main Campus between January 2015–October 2022. Kaplan–Meier curves examined survival outcomes, and Cox’s multivariate regression analysis was performed. Results: Over the 5-year period, patient survival did not differ statistically between patient groups (all p-values >0.05). However, graft survival was significantly lower in active smokers (p = 0.012). In the multivariate analysis, age (HR = 1.03, 95% CI 1.01–1.05, p = 0.002) and admission to the ICU (HR 1.68, 95% CI 1.13–2.50, p = 0.01) were positively associated with overall mortality. Immediate and short-term complications did not differ statistically between patient groups. Cardiovascular disease (22.5%) was the most common cause of death among all patients. Conclusions: Though our study did not show decreased patient survival outcomes, our findings are in line with previous studies that have shown that pre-transplant smoking is associated with overall reduced graft survival. Combined with the risk for de novo malignancy and cardiovascular events post transplant, smoking cessation before LT should be encouraged to ensure graft longevity. Full article
(This article belongs to the Section Solid Organ Transplantation)
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8 pages, 220 KiB  
Article
Association of Acute Rejection and De Novo Renal Cell Carcinoma in Kidney Transplant Patients: An OPTN Data Analysis
by Molly E. Casey, Emmalie Yanacek, Hitesh Kaul, John P. Knorr, Kamran Khanmoradi, Afshin Parsikia, Nikolaos Chandolias, Kevin K. Zarrabi and Radi Zaki
Transplantology 2024, 5(4), 280-287; https://doi.org/10.3390/transplantology5040028 - 28 Nov 2024
Viewed by 233
Abstract
Background: Kidney Transplant Recipients (KTRs) are at risk of renal cell carcinoma (RCC). The risk of RCC in KTRs is approximated to be 5–10 times higher compared with the general population. A relation between kidney rejection and renal malignancy has been described and [...] Read more.
Background: Kidney Transplant Recipients (KTRs) are at risk of renal cell carcinoma (RCC). The risk of RCC in KTRs is approximated to be 5–10 times higher compared with the general population. A relation between kidney rejection and renal malignancy has been described and relates to the effect of immunosuppression at the genomic level. We decided to investigate any suggestive clinical evidence of this in the OPTN database. Methods: KTRs with de novo RCC between July 2004 and June 2022 were identified. Demographics, baseline characteristics, virology, and immunology data were compared between patients with and without RCC. Our follow-up period was four hundred (400) days. A multivariate regression analysis of the data was conducted. Results: In a total of 215,928 kidney transplant recipients, we identified 839 cases of RCC (0.39%). On multivariate analysis, patients who experienced acute rejection both before hospital discharge (OR 1.559; p = 0.037) and during the follow-up period (OR 1.448; p = 0.002) showed a statistically significant increased risk of developing RCC. Conclusions: Our study is an analysis of a large cohort of KTRs diagnosed with RCC. We observed that RCC appeared more frequently in the kidney transplant recipients that were complicated by acute rejection during transplant admission or follow-up period. Full article
(This article belongs to the Section Solid Organ Transplantation)
9 pages, 1041 KiB  
Article
Diversifying Kidney Transplant Education: Assessing the Artificial Intelligence-Powered Capability of ChatGPT
by Badi Rawashdeh, Joohyun Kim, Ty Dunn, Haneen Al-Abdallat, Ahmad Qasem, Rootvij Bhatt, Raj Prasad and Matthew Cooper
Transplantology 2024, 5(4), 271-279; https://doi.org/10.3390/transplantology5040027 - 25 Nov 2024
Viewed by 385
Abstract
Background: Artificial intelligence (AI) has rapidly advanced, significantly impacting medicine. ChatGPT, a new AI model, generates responses based on user input. This study evaluates ChatGPT’s ability to assist with pre- and post-kidney transplantation (KT) patient education. Methods: ChatGPT was queried about KT [...] Read more.
Background: Artificial intelligence (AI) has rapidly advanced, significantly impacting medicine. ChatGPT, a new AI model, generates responses based on user input. This study evaluates ChatGPT’s ability to assist with pre- and post-kidney transplantation (KT) patient education. Methods: ChatGPT was queried about KT on 21 February 2023 and 2 March 2023. Questions were categorized into general information for pre-KT patients or donors and post-KT patient instructions. Two experts independently assessed the accuracy of ChatGPT’s responses, and the Flesch–Kincaid readability test was applied to evaluate readability. Results: ChatGPT’s responses to general pre-KT questions were clear, concise, and accurate but occasionally misleading. Post-transplant instructions were generally clear and partially concise but lacked supporting evidence. Instructions for emergency situations post-KT were typically safe and reliable, whereas medication-related directions were often inaccurate and unreliable. The mean Flesch–Kincaid readability score was 30, indicating that ChatGPT’s answers were not easy to understand. Conclusion: This study demonstrates that while ChatGPT can provide clear definitions, explain symptoms, and offer reasonable advice on managing medical situations after KT, it frequently gives misleading answers to scientific inquiries. Transplantation researchers and providers should recognize ChatGPT as a potential information source for patients but exercise caution due to its incomplete accuracy and lack of references. Full article
(This article belongs to the Section Artificial Organs, Stem Cells and Xenotransplantation)
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8 pages, 9440 KiB  
Case Report
Renal Collecting System Calcified Hematoma Following Parenchymal Perforation by Ureteral Stent in Kidney Transplantation: A Case Report
by Octavio Herrera, Alexis Garza, Maria Veronica Rodriguez, Manuel De Jesus-Escano, Samuel Serna, Jose Almeda and Gaudencio Olgin
Transplantology 2024, 5(4), 263-270; https://doi.org/10.3390/transplantology5040026 - 20 Nov 2024
Viewed by 366
Abstract
Introduction: Renal parenchymal perforation by ureteral stent placement is a rare but serious complication. There is also a paucity of data regarding collecting system hematomas and potential calcification in renal allografts. Case presentation: We report a unique case of a 51-year-old male who [...] Read more.
Introduction: Renal parenchymal perforation by ureteral stent placement is a rare but serious complication. There is also a paucity of data regarding collecting system hematomas and potential calcification in renal allografts. Case presentation: We report a unique case of a 51-year-old male who underwent unrelated living-donor kidney transplantation with stent incorporation during ureteroneocystostomy. Post-operatively he was found to have renal parenchymal perforation by the ureteral stent resulting in a pelvicalyceal hematoma with subsequent calcification and obstruction. At the time of guidewire introduction for percutaneous nephrolithotomy one year later, a nephrostogram and passage of a hydrophilic guidewire resulted in improved contrast drainage into the bladder, so the invasive surgery was no longer needed. Discussion: There are few reported cases of renal parenchymal perforation by a ureteral stent, none of which resulted in a collecting system hematoma. The calcification of urinary tract hematomas is also rare and attributed to metabolic abnormalities, prolonged stagnation of blood, and infection. Conclusions: We suspect the nephrostogram and guidewire introduction created enough antegrade pressure and mechanical disruption to force the calcified hematoma into the bladder. Full article
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5 pages, 619 KiB  
Case Report
Splenectomy Before Recipient Hepatectomy for Inflow Modulation Using a Very Small Modified Right Hemiliver Graft: A Case Report
by Piyush Kumar Sinha and Kishore GS Bharathy
Transplantology 2024, 5(4), 258-262; https://doi.org/10.3390/transplantology5040025 - 31 Oct 2024
Viewed by 583
Abstract
Portal inflow modulation has become standard practice in many transplant centers performing living donor liver transplantation. This is believed to counteract the deleterious effects of excess portal flow into a small-for-size graft. A splenectomy negates the contribution of the splenic vein flow completely [...] Read more.
Portal inflow modulation has become standard practice in many transplant centers performing living donor liver transplantation. This is believed to counteract the deleterious effects of excess portal flow into a small-for-size graft. A splenectomy negates the contribution of the splenic vein flow completely and thereby substantially reduces portal inflow. Although it has been adopted as a standard strategy by many Japanese centers for inflow modulation, especially while using left hemiliver grafts, there is justifiable apprehension about its usage due to potential increases in morbidity. Described here is a splenectomy performed while using a modified right hemiliver graft with a graft to recipient weight ratio of 0.49. The challenges in decision making and reasons regarding how such a small graft might have worked without manifestations of small-for-size/flow syndrome are discussed. Full article
(This article belongs to the Section Solid Organ Transplantation)
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12 pages, 383 KiB  
Article
Use of a Facebook Support Group for Kidney Transplant Patients
by Tenzin Yongye, Maria Keller, Surjo Bandyopadhyay, Ahmad Zaaroura and Liise K. Kayler
Transplantology 2024, 5(4), 246-257; https://doi.org/10.3390/transplantology5040024 - 30 Oct 2024
Viewed by 357
Abstract
Background: Facebook groups have been used to foster social support of transplant patients. Examining the use and content strategies for generating member interactions within transplant-specific groups can inform how we leverage these groups to expand access to social support resources. This study characterizes [...] Read more.
Background: Facebook groups have been used to foster social support of transplant patients. Examining the use and content strategies for generating member interactions within transplant-specific groups can inform how we leverage these groups to expand access to social support resources. This study characterizes the use of a closed Facebook group for kidney transplant patient support linked to a hospital in Buffalo, NY to identify the most engaging content. Methods: The sample consisted of 387 individuals (372 patients/family, eight transplant professionals, and seven community advocates) and the administrator. Content analysis was conducted of posts and comments made to the group. Descriptive measures of post content associated with interactions (reactions and comments) were computed. Results: Between 5/2020 and 5/2023, there were 484 posts with 8233 interactions (2793 comments, 5440 reactions). Half of the posts (n = 241) were made by the administrator, 166 (34%) by patients/family, 70 (14%) by community advocates, and 7 (1%) by transplant professionals. Content analysis revealed that post types with the most interactions were personal experiences, monthly transplant volume, and monthly new members added; the least interactions involved posts about holidays, observances, and information. Conclusions: The interaction metrics varied according to the content strategies used by members and provided insights into the types of content members interact with. Full article
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12 pages, 665 KiB  
Article
Outcomes of Simultaneous Liver–Kidney Transplant Recipients According to Pre-Transplant Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the United States
by Tristan Meier, Kathryn Schmidt, Kristin Cole, Jody C. Olson, Timucin Taner, Douglas A. Simonetto and Samy Riad
Transplantology 2024, 5(4), 234-245; https://doi.org/10.3390/transplantology5040023 - 17 Oct 2024
Viewed by 657
Abstract
Background: Previous data suggested that the outcomes for liver-alone transplant recipients following transjugular intrahepatic portosystemic shunt (TIPS) insertion were comparable to those without TIPS. This study investigates the association between TIPS and outcomes among simultaneous liver–kidney (SLK) recipients in the United States. Methods: [...] Read more.
Background: Previous data suggested that the outcomes for liver-alone transplant recipients following transjugular intrahepatic portosystemic shunt (TIPS) insertion were comparable to those without TIPS. This study investigates the association between TIPS and outcomes among simultaneous liver–kidney (SLK) recipients in the United States. Methods: Utilizing the Scientific Registry for Transplant Recipients (SRTR) standard analysis file from 2003 to 2022, we examined 9717 adult SLK recipients, among whom 858 had undergone TIPS before transplantation. Kaplan–Meier curves were generated to assess recipient and death-censored liver and kidney graft survival. Mixed-effects Cox proportional hazard models were employed to analyze the association between TIPS and the outcomes of interest, where the transplant center was treated as a random effect. The models were adjusted for recipient age, sex, MELD score, diabetes, duration of listing, induction, steroid maintenance, hepatitis C status, donor age, donor sex, cold ischemia time, local vs. shipped organs, and allocation era. Results: Overall, the two groups were comparable, with minor differences. Notably, the median liver waiting time was significantly longer in the TIPS group compared to the non-TIPS group (4.1 vs. 2 months, p < 0.001). One-year rejection rates for liver and kidney allografts did not differ significantly between groups. Univariable Cox regression analyses demonstrated no association between TIPS and worse outcomes for recipient, liver, and kidney survival (p = 0.65, p = 0.22, and p = 0.54, respectively). TIPS did not emerge as a predictor of recipient or death-censored liver or kidney graft survival in multivariable models. Conclusion: In this extensive national cohort of SLK transplant recipients, pre-transplant TIPS was not linked to adverse outcomes for recipients or their allografts. Full article
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