Search Results (136)

Aims: Sinus tachycardia after heart transplantation (HTX) due to cardiac graft denervation is associated with reduced post-transplant survival and requires adequate treatment. We analyzed the long-term effects of heart rate control with ivabradine or metoprolol succinate in HTX recipients. Methods: This observational retrospective single-center study analyzed the ten-year results of 110 patients receiving ivabradine (n = 54) or metoprolol succinate (n = 56) after HTX. Analysis included comparison of demographics, medications, heart rates, blood pressure values, echocardiographic features, cardiac catheterization data, cardiac biomarkers, and post-transplant survival including causes of death. Results: Both groups showed no significant differences concerning demographics or medications (except for ivabradine and metoprolol succinate). At 10-year follow-up, HTX recipients with ivabradine showed a significantly lower heart rate (72.7 ± 8.5 bpm) compared to baseline (88.8 ± 7.6 bpm; p < 0.001) and to metoprolol succinate (80.1 ± 8.1 bpm; p < 0.001), a significantly lower NT-proBNP level (588.4 ± 461.4 pg/mL) compared to baseline (3849.7 ± 1960.0 pg/mL; p < 0.001) and to metoprolol succinate (1229.0 ± 1098.6 pg/mL; p = 0.005), a significantly lower overall mortality (20.4% versus 46.4%; p = 0.004), and mortality due to graft failure (1.9% versus 21.4%; p = 0.001). Multivariate analysis showed a significantly decreased risk of death within 10 years after HTX in patients with post-transplant use of ivabradine (HR 0.374, CI 0.182–0.770; p = 0.008). Conclusions: In this single-center trial, patients with ivabradine revealed a significantly more pronounced heart rate reduction, a lower NT-proBNP level, and a superior 10-year survival after HTX. Full article

Infections with multidrug-resistant (MDR) organisms remain a significant cause of morbidity and mortality among liver transplant recipients, despite advances in surgical techniques and immunosuppressive therapy. This prospective observational study aimed to evaluate the impact of targeted perioperative antibiotic prophylaxis against MDR Gram-negative bacteria on postoperative infections and mortality in liver transplant recipients. Seventy-nine adult patients who underwent liver transplantation and were admitted to the ICU for more than 24 h postoperatively were included. Demographics, disease severity scores, comorbidities, and lengths of ICU and hospital stay were recorded. Colonization with carbapenem-resistant Gram-negative bacteria was assessed via preoperative and postoperative cultures from the blood, urine, rectum, and tracheal secretions. Patients were divided into two groups: those with MDR colonization or infection who received targeted prophylaxis and controls who received standard prophylaxis. Infectious complications (30.4%) occurred significantly less frequently than non-infectious ones (62.0%, p = 0.005). The most common infections were bacteremia (22.7%), pneumonia (17.7%), and surgical site infections (2.5%), with most events occurring within 15 days post-transplant. MDR pathogens isolated included Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Although overall complication and mortality rates at 30 days and 3 months did not differ significantly between groups, the targeted prophylaxis group had fewer infectious complications (22.8% vs. 68.5%, p = 0.008), particularly bacteremia (p = 0.007). Infection-related mortality was also significantly reduced in this group (p = 0.039). These findings suggest that identification of MDR colonization and administration of targeted perioperative antibiotics may reduce septic complications in liver transplant patients. Further prospective studies are warranted to confirm benefits on outcomes and resource utilization. Full article

This study investigates economic decision-making behaviors among welfare recipients in Miami, Florida, by leveraging well-established experimental protocols: the Guessing Game, the Prudence Measurement Task, the Risk Aversion Task, and the Stag Hunt Game. For this purpose, our study defines financial decisions as the underlying individual preferences that serve as validated proxies for savings behavior, debt management, job-search intensity, and participation in cooperative finance. A central objective is to compare the behavior of welfare recipients to that of undergraduate students, a cohort typically used in experimental economics research. The analysis reveals significant differences between the two groups in strategic thinking and coordination, particularly across ethnic and gender lines. Non-Hispanic/Latino participants in Miami displayed significantly higher average guesses in the Guessing Game compared to their counterparts in Tucson, indicating potential discrepancies in the depth of strategic reasoning. Additionally, female participants in Tucson exhibited higher levels of coordination in the Stag Hunt Game compared to females in Miami, suggesting variance in cooperative behavior between these groups. Despite these findings, regression models demonstrate that location, gender, and ethnicity collectively account for only a small fraction of the observed variance, as evidenced by low R² values and substantial mean squared errors across all games. These results suggest that individual heterogeneity, rather than broad demographic variables, may be more influential in shaping economic decisions. This study underscores the complexity of generalizing findings from traditional student samples to more diverse populations, highlighting the need for further investigation into the socioeconomic factors that drive financial decision-making. Full article

Background: The management of end-stage renal disease (ESRD) is undergoing a paradigm shift, with increasing emphasis on kidney transplantation as a preferred treatment modality for elderly patients (≥65 years), who constitute a substantial portion of new ESRD cases. Transplantation offers markedly superior survival and quality of life (QoL) advantages compared to dialysis for this demographic. Nevertheless, key determinants such as frailty, physical functionality, and cognitive function have emerged as critical predictors of post-transplant success. Despite their relevance, standardized methodologies for evaluating these parameters in transplantation candidacy remain absent. This systematic review examines the influence of frailty, physical functionality, and cognitive function on outcomes in elderly kidney transplant recipients. Methods: Adhering to PRISMA guidelines, a rigorous literature search was conducted across PubMed, CINAHL, Embase, PsycINFO, and the Web of Science for studies published up to October 31, 2024. Relevant studies focused on elderly transplant candidates and examined correlations between frailty, physical functionality, or cognitive function and post-transplant outcomes. The Newcastle–Ottawa Scale was employed to evaluate studies quality. Results: Seven studies met the inclusion criteria. Five explored physical functionality, demonstrating that better pre-transplant physical performance predicts enhanced survival. Two studies addressed frailty, utilizing the Fried frailty phenotype, and linked frailty to elevated mortality and diminished QoL recovery. Notably, no studies explored cognitive function in elderly kidney transplant candidates or recipients and its association with post-transplant outcomes, exposing a salient gap in the literature. The included studies’ varied methodologies, reliance on single time-point assessments, and exclusive focus on kidney transplant recipients restrict both comparability among studies and the generalizability of findings to the broader end-stage renal disease (ESRD) population. Conclusions: These findings underscore the profound impact of physical functionality and frailty on transplant outcomes in the growing elderly kidney transplant population, illuminating the necessity for standardized assessment protocols and targeted pre-transplant interventions. The critical gap in cognitive function research underscores a vital direction for future investigation. This research received no external funding. This review is registered with PROSPERO under registration ID CRD42025645838. Full article

Background: Kidney transplantation is the treatment of choice for pediatric patients with end-stage kidney disease. However, transplantation in children weighing < 15 kg remains challenging due to limited donor availability and higher surgical and medical risks. We report our 35-year single-center experience in this population, focusing on perioperative and long-term outcomes. Methods: We retrospectively analyzed kidney transplants performed from 1987 to 2023 in children weighing < 15 kg. Data on demographics, donor type, complications, immunosuppression, and outcomes at 2, 5, and 10 years (including survival, graft function, rejection, infections, and urological issues) were collected. Outcomes were compared between deceased and living donors and between recipients weighing < 10 kg and ≥10 kg. Results: Ninety-six transplants were included (mean age 3.3 years; mean weight 11.1 kg), 80 from deceased and 16 from living donors. Most patients (69.8%) had been treated with peritoneal dialysis. Median follow-up was 120 months. Patient survival was 95.8%; graft survival was 78.1%. Eight grafts (8.3%) were lost to renal vein thrombosis, all in deceased-donor recipients (p = 0.60). Preserved renal function (eGFR > 60 mL/min/1.73 m²) declined from 80.4% at 2 years to 66.0% at 5 years and 18.0% at 10 years. Graft survival at 10 years was significantly lower in children < 10 kg vs. ≥10 kg (49.6% vs. 80.3%, p = 0.003). CAKUT was associated with higher urological complication rates (p = 0.017). No significant differences emerged between living and deceased donor groups. Conclusions: Transplantation in children < 15 kg is feasible with good outcomes, but those <10 kg present lower graft survival at 10 years. Multidisciplinary assessment and center experience are key to optimizing results. Full article

Hypomagnesemia is the most common electrolyte disorder in kidney transplant recipients (KTR), yet its causes remain unclear. Few studies have explored its underlying factors. This study aimed to assess its prevalence and identify risk factors in KTR. We conducted a retrospective cross-sectional study in 489 outpatient KTR. Demographic, clinical, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify factors associated with hypomagnesemia (≤1.7 mg/dL). Hypomagnesemia was present in 50.7% of patients. Multivariate analysis identified tacrolimus [OR 2.91 (1.62–5.22)], thiazides [OR 2.23 (1.21–4.08)], cinacalcet [OR 2.31 (1.29–4.13)], serum phosphate < 3.7 mg/dL [1.99 (1.29–3.05)], serum calcium ≤ 10 mg/dL [1.99 (1.29–3.05)] and diabetes [1.94 (1.22–3.08)] as risk factors. Protective factors included SGLT2 inhibitors (SGLT2i) [OR 0.17 (0.10–0.27)] and mTOR inhibitors (mTORi) [OR 0.62 (0.38–0.98)]. Among hypomagnesemic patients, those receiving Mg²⁺ supplements had lower Mg²⁺ levels [1.54 (0.15) vs. 1.59 (0.13) mg/dL, p = 0.005] and higher fractional Mg²⁺ excretion [8.28 (4.48)% vs. 7.36 (4.19)%, p = 0.05]. Hypomagnesemia is highly prevalent in KTR. Tacrolimus, thiazides, and cinacalcet are key risk factors and, in some patients, risks and benefits of continuing these medications should be carefully weighed. In refractory cases, SGLT2i or mTORi may offer benefit. Full article

Background: Liver transplantation has become the standard of care for patients with end-stage liver disease. Despite advances in surgical techniques, immunosuppression, and perioperative care, disparities in access and outcomes persist across demographic and socioeconomic lines. Objective: To assess trends and disparities in liver transplant admissions in the United States from 2016 to 2021, examining demographic patterns, in-hospital mortality, hospital charges, length of stay, and socioeconomic factors. Methods: Using the National Inpatient Sample (NIS) from 2016 to 2021, we identified liver transplant admissions using ICD-10 PCS codes 0FY00Z1 and 0FY00Z2. Demographic characteristics (age, sex, race, insurance status, and income quartile), clinical outcomes, and resource utilization metrics were analyzed. One-way ANOVA and Hensel’s test were used to assess variance and distribution homogeneity, with a significance threshold of p < 0.05. Results: A total of 9677 liver transplant admissions were analyzed. The mean recipient age remained stable (51–52 years), with males comprising ~62% of transplants. White patients constituted the largest group of recipients (~66–68%), followed by Hispanic (~14–17%) and Black patients (~7–10%). The proportion of transplants relative to liver failure admissions remained stable across racial groups, indicating no widening racial gap during the study period. In-hospital mortality post-transplant remained low (2.37–3.52%) and did not differ significantly by race (p = 0.23), sex (p = 0.24), or income quartile (p = 0.13). Similarly, Charlson Comorbidity Index > 5 did not predict inpatient mortality (p = 0.154). Hospital charges ranged from $578,000 to $766,000, with an average stay of ~21 days. Conclusions: Liver transplantation outcomes, including in-hospital mortality, appear consistent across demographic and socioeconomic groups once patients are admitted for transplant. However, broader disparities in access persist, necessitating further research into pre-transplant barriers and long-term outcomes. These findings support the need for equitable healthcare strategies aimed at optimizing transplant candidacy and survival across all populations. Full article

Alternative Fuel Vehicle (AFV) rebate programs incentivize the transition from fossil fuels to alternative fuels. Unfortunately, research on the people who are rebate program recipients is more evident than research on the places where the programs distribute rebates. To that end, this study retrospectively analyzes rebates in a statewide, AFV rebate program known as the California Vehicle Rebate Program (CVRP), from 2011 to 2022, to explore the statewide distribution of rebates. The specification of novel multilevel models nests rebates within different levels of analysis to control for programmatic income eligibility changes for rebate recipients as well as infrastructural, racial, transactional, environmental, and demographic differences between census tracts. The different levels of analysis include spatial attributes of the CVRP as well as temporal attributes of the CVRP to control for implicit heterogeneity in the outcomes of interest. Results suggest that the CVRP does not distribute rebates to places where infrastructure is accessible, but the CVRP does distribute rebates to places where pollution is burdensome and people are socioeconomically vulnerable. Full article

Background: Acute rejection (AR) in kidney transplant (KT) recipients remains a significant challenge for short- and long-term graft survival even in the most recent years characterized by extended criteria donors and older and more comorbid recipients. Methods: We analyzed risk factors and outcomes of AR in 339 KT recipients treated at St. Orsola-Malpighi Hospital, Bologna (Italy), between 1 January 2019 and 31 December 2021. Demographic, immunological, and transplant data (type, cold ischemia time, complications) were recorded with a follow-up period of up to 24 months. Key outcomes included estimated glomerular filtration rate (eGFR), 24 h proteinuria, delayed graft function (DGF), biopsy-proven AR, and graft loss. Results: During the first year after transplant, 57 AR episodes occurred: 19 antibody-mediated rejections (AMR), 18 borderline T cell-mediated rejections (TCMR), 18 TCMR, 2 mixed AMR/TCMR, and 11 graft losses. AR was linked to older donor age (59.9 ± 12.8 vs. 55.5 ± 15.1, p = 0.040), longer cold ischemia time (690 vs. 570 min, p = 0.044), higher DGF rates (61.40% vs. 39.57%, p = 0.002), and lower eGFR (39 vs. 52 mL/min, p = 0.003). AR was consistently prevalent in patients who underwent an AB0-incompatible (AB0-i) transplant (8.8% vs. 2.5%, p = 0.020). HLA matching was strongly associated with a reduced risk of AMR (HLA-DR: OR 0.35, HLA-A: OR 0.33, HLA-C: OR 0.35), while DGF was linked to a higher risk (OR 4.04). TCMR risk was associated with donor age (OR 1.05). The development of post-transplant donor-specific antibodies (DSAs) at 24 months showed no significant association with AR (AMR: p = 0.769; TCMR: p = 0.938). The decline in eGFR over time (24 months) did not differ between patients with and without AR (difference, −0.69 mL/min/year; Standard Error, 0.92; p = 0.452). Similarly, 24 h proteinuria change over time did not differ between patients with and without AR (difference, −0.12 g/24 h; Standard Error, 0.28; p = 0.657). Conclusions: Understanding the risk factors of AR is crucial to identifying KTs at more risk of rejection and to guiding targeted therapeutic decisions. In the most recent era of extended criteria donors and more vulnerable recipients, early diagnosis and prompt and tailored treatment of AR play a critical role in stabilizing renal function over time. Full article

Objective: This study aims to examine long-term diseases, conditions, self-control, and self-management in kidney transplant recipients. Method: This is a descriptive correlational study, including a total of n = 130 kidney transplant recipients. The data were collected using a demographic information form, the Post-Kidney Transplant Diseases and Conditions Assessment Form, and the Self-Control and Self-Management Scale. Data analysis was conducted using descriptive statistical methods and one-way ANOVA, and paired sample t-tests. Results: Of the kidney transplant recipients, 40% were aged between 31 and 45 years, and 54.6% were male. The long-term diseases and conditions they developed after kidney transplantation were hypertension (46.2%), heart failure (26.2%), diabetes mellitus (10.8%), heartburn (35.4%), acute kidney failure (26.2%), urinary tract infection (39.2%), sleep disorders (23.1%), and chronic pain (50%). In addition, 31.5% of the kidney transplant recipients had poor self-control and self-management. Conclusions: Long-term postoperative mortality in kidney transplant recipients is mostly caused by diseases developing in vital organs. Therefore, it is crucial to recognize these diseases and conditions for their diagnosis. This study found various diseases and conditions in almost all body systems of kidney transplant recipients. Additionally, there were patients with poor self-control and self-management. We consider that the results of our study will increase awareness among clinicians. Full article

This study aimed to examine caregivers’ perceptions, practices, and challenges regarding rehabilitation services for people with disabilities, with a focus on identifying factors influencing their decisions to bring care recipients for formal rehabilitation. A cross-sectional study was conducted in rural Thai Nguyen Province, Vietnam. Data were collected from 214 primary caregivers using a structured questionnaire covering demographics, caregiving roles, and rehabilitation-related perceptions. A pilot study was conducted to refine the tool, and data were collected via face-to-face interviews by a trained team. Statistical analyses included descriptive statistics, chi-square tests, and stepwise logistic regression to identify key predictors of care-seeking behaviors. Results showed that 92% of caregivers perceived rehabilitation as necessary or very necessary. Female caregivers were more likely to provide care at home (95.3%), while male caregivers were more likely to utilize hospital-based services (73.5%) and to bring care recipients for rehabilitation overall (79.4% vs. 67.1%). Logistic regression revealed that female caregivers were significantly less likely than males to bring people with disabilities in for care (OR = 0.34, p = 0.02). Longer caregiving duration was associated with a reduced likelihood of seeking care (OR = 0.96 per year, p < 0.001), whereas caregivers of individuals with mobility needs (OR = 3.15, p < 0.001) and social integration needs (OR = 2.12, p = 0.05) were significantly more likely to seek care. These findings highlight gender-based differences and caregiving dynamics that influence access to rehabilitation. To enhance rehabilitation outcomes and support caregiver engagement, targeted policies are needed to address gender roles, caregiving fatigue, and the specific needs of care recipients. Full article

Background: Heart transplantation (Htx) remains the definitive therapy for patients with end-stage heart failure. Despite advancements in mechanical circulatory support (MCS), immunosuppressive strategies, and organ allocation policies, donor availability remains a major limitation. This study analyzes the trends in Htx in the United States between 2016 and 2022, focusing on demographic shifts, mortality trends, and 30-day readmission patterns. Methods: We utilized the National Inpatient Sample (NIS) from 2016 to 2022 and the National Readmissions Database (NRD) for 2021 to identify Htx admissions using ICD-10 PCS code O2YA0Z0. Patient characteristics, mortality rates, and readmission patterns were analyzed using ANOVA and multivariate logistic regression, with statistical significance defined as p < 0.05. Results: The total number of Htx procedures increased from 641 in 2016 to 773 in 2022. The mean age of transplant recipients remained between 45 and 50 years, with no significant differences across years. Racial and socioeconomic disparities persisted, with approximately 60% of transplants occurring in White patients and 21–26% of recipients belonging to the lowest income quartile. All-cause in-hospital mortality remained stable at 4–7%. The 30-day readmission rate in 2021 was 57.7%, with heart failure, transplant rejection, and infections being the leading causes. Peripheral vascular disease (PVD) was the only comorbidity significantly associated with higher 30-day readmission risk (OR: 1.815, 95% CI: 1.477–2.230). Conclusions: Htx utilization has increased over time, driven by improvements in donor allocation and perioperative management. However, racial and socioeconomic disparities remain, and readmission rates continue to be high. Future efforts should focus on optimizing post-transplant care and addressing disparities to improve long-term outcomes. Full article

Background/Objectives: The shortage of donor organs in transplant medicine remains a challenge. Kidney transplantation from Hepatitis C (HCV)-positive donors to HCV-negative recipients expands the donor pool. Limited data suggest this approach as safe when combined with modern antiviral therapies. This study evaluates the safety of such transplantations in terms of viral transmission and graft function. Methods: A retrospective analysis of 205 kidney transplantations at the University Medical Center Marburg (January 2017–January 2024) was conducted. Eight recipients received kidneys from HCV-antibody-positive (HCV-Antibody+) and RNA-negative donors (HCV-RNA−), and five received kidneys from HCV-RNA-positive (HCV-RNA+) donors. Recipient demographics, donor factors, and transplantation parameters were analyzed. Repeated virological surveillance as well as graft function and complications were assessed within the first year after transplantation. Results: HCV-RNA+ donor recipients received Glecaprevir/Pibrentasvir for three months starting immediately at transplantation, while HCV-Antibody+ and HCV-RNA− donor recipients did not receive antiviral therapy. After 12 months, both groups exhibited comparable graft function (serum creatinine: HCV-Antibody+/RNA− 1.3 ± 0.4 mg/dL vs. HCV-RNA+ 1.8 ± 0.5 mg/dL, p = 0.6) without proteinuria. No hepatic complications or significant inflammation occurred. No HCV-RNA was detected in any patient at any time under the selected treatment regimen. Conclusions: This single-center study supports the safety of kidney transplantation from HCV-positive donors. Preemptive Glecaprevir/Pibrentasvir therapy effectively prevents HCV transmission, offering a viable option to expand the donor pool. Full article

Background: The superficial circumflex iliac artery perforator (SCIP) flap is widely recognized for its reliability and minimal donor site morbidity in reconstructive surgery. However, its safety and efficacy in elderly patients—a growing demographic with increased comorbidities—remain less understood. This study aims to evaluate the clinical outcomes of the SCIP flap in elderly patients compared to younger patients, focusing on flap survival, complications, and recovery. Methods: In this retrospective cohort study, conducted at Guangdong Provincial People’s Hospital, from 28 August 2019 to 7 June 2024, we included 37 patients who underwent SCIP flap procedures for reconstruction. Patients were divided into two groups: younger (15–59 years) and elderly (≥60 years). Key variables analyzed included demographics, comorbidities, flap characteristics, recipient sites, arterial sources, and surgical outcomes. Univariate analysis and ROC curve analysis were used to explore the impact of age on flap survival and complications. Results: The cohort consisted of 28 younger and 9 elderly patients. Vascular disease was significantly more prevalent in the elderly group (88.9% vs. 21.4%, p = 0.001), and abnormalities in the CTA results indicate that the elderly cohort exhibited a 29-fold increased odds of vascular disease compared to younger patients (OR = 29.17, 95% CI: 4.82–176.40, p = 0.001). However, no significant differences were found between the groups in terms of flap area, recipient sites, or arterial sources. Hospital stay duration and flap survival rates were comparable across both age groups, with no cases of total flap loss reported. While systemic complications were somewhat higher in the elderly group, this difference did not reach statistical significance. The ROC analysis (AUC = 0.52) indicates that age alone is not a significant predictor of flap survival. Conclusions: The SCIP flap is a safe and effective reconstructive option for elderly patients, despite a higher incidence of vascular disease. Flap survival and postoperative recovery were favorable, indicating that the procedure is viable for older patients. These findings support the continued use of SCIP flaps in aging populations, emphasizing the need for individualized surgical approaches to optimize patient outcomes. Full article

Background/Objectives: With the growing population of kidney transplant recipients (KTRs) in intensive care units (ICUs), understanding their prognostic outcomes is critical. As conflicting findings exist, we aim to systematically evaluate and meta-analyze ICU outcomes in kidney transplant recipients compared to non-recipients. Methods: We conducted a comprehensive search of the PubMed, Embase, and Cochrane databases, from inception through 23 December 2024, to identify relevant studies comparing the outcomes of KTRs and non-transplant ICU patients. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, and weighted mean differences (WMDs) were calculated for continuous outcomes. The risk of bias was assessed using the ROBINS-I V2 tool. The study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42024595104). Results: Seven studies, including 12,062 patients, were analyzed. Demographics, including age and sex, were comparable across groups. No statistically significant associations were found for overall mortality (OR: 1.82, 95% CI: 0.79 to 4.16), ICU mortality (OR: 1.06, 95% CI: 0.45 to 2.48), or 28/30-day mortality (OR: 2.06, 95% CI: 0.30 to 14.10) in KTRs, though there was a trend suggesting a potential increase in the odds of overall mortality. KTRs tended to have longer ICU stays (WMD: +1.96 days, 95% CI: 0.81–3.11) and higher Sequential Organ Failure Assessment (SOFA) scores (WMD: +0.79, 95% CI: −0.78–2.36), but these findings did not reach statistical significance. One study reported higher 1-year and 5-year mortality for KTRs. Sensitivity analyses revealed one influential study. Begg’s test for overall mortality suggested non-significant publication bias (p = 1.0). Conclusions: KTRs in ICUs are at significantly higher risk for long-term mortality, emphasizing the need for tailored critical care strategies and long-term management. Future research should focus on standardizing methodologies, reducing heterogeneity, and addressing gaps in data to improve evidence-based care for this vulnerable population. Full article