Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2,which the World Health Organization later designated as coronavirus disease 2019(COVID-19)...Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2,which the World Health Organization later designated as coronavirus disease 2019(COVID-19).The World Health Organization declared COVID-19 as a pandemic on March 11,2020.In the general population,COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill.Its mortality rate could be as high as 49%.The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions,among those who need immunosuppression after solid organ transplantation(SOT),are at an increased risk of developing severe illness from COVID-19.Liver transplantation is the second most prevalent SOT globally.Due to their immunosuppressed state,liver transplant(LT)recipients are more susceptible to serious infections.Therefore,comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19.It is crucial to comprehend the clinical picture,immunosuppressive management,prognosis,and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients.This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group.In the following sections,we discussed current COVID-19 therapy choices,reviewed standard practice in modifying immunosuppressant regimens,and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management.Additionally,we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.展开更多
Cryptococcosis is the third most commonly occurring invasive fungal disease in solid organ transplant recipients(SOT).It is caused by encapsulated yeast,Cryptococcus species,predominantly Cryptococcus neoformans and C...Cryptococcosis is the third most commonly occurring invasive fungal disease in solid organ transplant recipients(SOT).It is caused by encapsulated yeast,Cryptococcus species,predominantly Cryptococcus neoformans and Cryptococcus gattii.Though kidney transplant recipients are at the lowest risk of cryptococcosis when compared to other solid organ transplant recipients such as lung,liver or heart,still this opportunistic infection causes significant morbidity and mortality in this subset of patients.Mortality rates with cryptococcosis range from 10%-25%,while it can be as high as 50%in SOT recipients with central nervous system involvement.The main aim of diagnosis is to find out if there is any involvement of the central nervous system in disseminated disease or whether there is only localized pulmonary involvement as it has implications for both prognostication and treatment.Detection of cryptococcal antigen(CrAg)in cerebrospinal fluid or plasma is a highly recommended test as it is more sensitive and specific than India ink and fungal cultures.The CrAg lateral flow assay is the single point of care test that can rapidly detect cryptococcal polysaccharide capsule.Treatment of cryptococcosis is challenging in kidney transplant recipients.Apart from the reduction or optimization of immunosuppression,lipid formulations of amphotericin B are preferred as induction antifungal agents.Consolidation and maintenance are done with fluconazole;carefully monitoring its interactions with calcineurin inhibitors.This review further discusses in depth the evolving developments in the epidemiology,pathogenesis,diagnostic assays,and management approach of cryptococcosis in kidney transplant recipients.展开更多
BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation.In th...BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation.In the course of acute SARS-CoV-2 infection,various laboratory markers have been identified as predictors for high risk of mortality.AIM To risk stratify renal transplant recipients(RTxR)using general demographic parameters,comorbidities and routine laboratory markers for the severity of the disease and its outcomes.We believe that learning about these routinely monitored parameters can help us plan better strategies for the RTxR follow-up program.METHODS This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February 2021.We recorded the basic demographics,comorbidities and routine laboratory markers.We investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or mortality.RESULTS From 505 RTxRs in our renal transplant follow-up program,29(7.75%)RTxRs had PCR-positive SARS-CoV-2 infection.We recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6%but a significant 27.6%mortality in SARS-CoV-2 positive recipients.Age more than 68 years,non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability;P≤0.001.<0.001 and<0.0001 respectively.87.5%of the deceased were diabetic;P≤0.0.0001.Estimated glomerular filtration rate of less than 26 mL/min/1.73 m2,serum albumin less than 20 g/L,Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality;P=0.0128,<0.001,<0.0001 and 0.0061 respectively.CONCLUSION This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and morbidity.This knowledge can be used in RTxR follow-up programs by addressing these parameters early to help reduce the morbidity and mortality in RTxRs.展开更多
AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. ...AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease(labM ELD)-score and the Eurotransplant Donor Risk Index(ET-DRI) to unravel their impact on 20-year survival after LT.RESULTS Twenty-year survivors were significantly younger(44 vs 50 years, P = 0.001), more likely to be female(49% vs 36%, P = 0.03) and less likely to be obese at the time of LT(19% vs 32%, P = 0.011). Mean labM ELD-score(P = 0.156), rate of high-urgency LT(P = 0.210), coldischemia time(P = 0.994), rate of retransplantation(P = 0.12) and average donor age(28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors(P = 0.007). ET-DRI > 1.4(P = 0.020) and donor age ≥ 30 years(P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labM ELD-score categories(P = 0.263).CONCLUSION LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.展开更多
Polyomavirus BK(BKV) infects up to 90% of the general population. After primary infection, occurring early during childhood, a state of non-replicative infection is established in the reno-urinary tract, without compl...Polyomavirus BK(BKV) infects up to 90% of the general population. After primary infection, occurring early during childhood, a state of non-replicative infection is established in the reno-urinary tract, without complications for immunocompetent hosts. In immunocompromised individuals, particularly transplanted patients, asymptomatic BKV viremia and/or viruria can be observed. Renal grafts may also be sources of infection as BKV prefers kidneys rather than other solid organs for transplantation such as the liver. The mechanism behind the higher incidence of BKV infection in kidney transplant patients, compared to liver or heart transplantation, is unclear and the prevalence of BKV infection in non-renal solid organ transplants has not been yet thoroughly investigated. We evaluated the prevalence of Polyomavirus BK infection among liver transplant recipients. A Pub Med search was conducted using the terms BKV infection AND liver transplant recipients; BKV AND non-renal solid organ transplant*; BKV infection AND immunosuppression; the search was limited to title/abstract and English-language articles published from 2000, to March 2015. Eleven relevant studies suggest that the prevalence of BKV viruria and/or viremia among liver transplant recipients is less than that reported in kidney or heart transplant recipients, except when chronic kidney disease(CKD) is present at the same time. Data also suggest that viruric and viremic patients have higher levels of serum creatinine than BKV negative patients. Moreover, no specific immunosuppressive drugs are associated with the onset of BKV nephropathy. The comorbidity of transplantation and CKD could play a major role in promoting BKV replication.展开更多
AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.METHODS Ninety-nine kidney transplant recipients(KTRs) w...AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.METHODS Ninety-nine kidney transplant recipients(KTRs) were assigned to interventional exercise(Group A; n = 52) and a usual care cohort(Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life(HRQo L) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities.RESULTS Eighty-five KTRs completed the study(Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload(+13 W, P = 0.0003), V'O2 peak(+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor(+12 kg, P = 0.0368), height in the countermovement jump(+1.9 cm, P = 0.0293) and decreased in Body Mass Index(-0.5 kg/m^2, P = 0.0013). HRQo L significantly improved in physical function(P = 0.0019), physical-role limitations(P = 0.0321) and social functioning scales(P = 0.0346). Noimprovements were found in Group B.CONCLUSION Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.展开更多
Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially...Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially in an extensive wound,or in a complex trauma combined with vascular injury.From April 2014 to March 2018,we retrospectively reviewed patients with traumatic/posttraumatic,oncologic,and electrical wounds in the lower extremity.Those treated with muscle feeding artery as recipient vessels were included.The latissimus dorsi(LD)muscle free flap,anterior lateral thigh(ALT)perforator free flap,and deep inferior epigastric perforator(DIEP)free flap were raised.The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle,concomitant veins,and great saphenous vein were used as recipient vessels.Injuries included in the study were caused by tumour in 2 cases,car accident in 3 cases,crushing in 3 cases,burns in one case,and electrical injury in one case.The wound size varied from 14 cm x 6 cm to 30 cm x 20 cm.LD,ALT,and DIEP free flaps were used in 6,3,and 4 patients,respectively.The muscle feeding arteries to medial head of gastrocnemius muscle,to sartorius muscle,and to vastus lateral muscle were used as recipient arteries in 4,5,and one patient,respectively.Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients,respectively.Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses,particularly when the wound is located proximal to the mid-third of the lower leg.展开更多
AIM: To evaluate whether there is a threshold sensitization level beyond which benefits of chronic steroid maintenance(CSM) emerge. METHODS: Using Organ Procurement and Transplant Network/United Network of Organ Shari...AIM: To evaluate whether there is a threshold sensitization level beyond which benefits of chronic steroid maintenance(CSM) emerge. METHODS: Using Organ Procurement and Transplant Network/United Network of Organ Sharing database, we compared the adjusted graft and patient survivals for CSM vs early steroid withdrawal(ESW) among patients who underwent deceased-donor kidney(DDK) transplantation from 2000 to 2008 who were stratified by peak-panel reactive antibody(peak-PRA) titers(0%-30%, 31%-60% and > 60%). All patients received perioperative induction therapy and maintenance immunosuppression based on calcineurin inhibitor(CNI) and mycophenolate mofetil(MMF).RESULTS: The study included 42851 patients. In the 0%-30% peak-PRA class, adjusted over-all graft-failure(HR 1.11, 95%CI: 1.03-1.20, P = 0.009) and patientdeath(HR 1.29, 95%CI: 1.16-1.43, P < 0.001) risks were higher and death-censored graft-failure risk(HR 1.06, 95%CI: 0.98-1.14, P = 0.16) similar for CSM(n = 25218) vs ESW(n = 7399). Over-all(HR 1.04, 95%CI: 0.85-1.28, P = 0.70) and death-censored(HR 0.97, 95%CI: 0.78-1.21, P = 0.81) graft-failure risks were similar and patient-death risk(HR 1.39, 95%CI: 1.03-1.87, P = 0.03) higher for CSM(n = 3495) vs ESW(n = 850) groups for 31%-60% peak-PRA class. In the > 60% peak-PRA class, adjusted overall graft-failure(HR 0.90, 95%CI: 0.76-1.08, P = 0.25) and patientdeath(HR 0.92, 95%CI: 0.71-1.17, P = 0.47) risks were similar and death-censored graft-failure risk lower(HR 0.84, 95%CI: 0.71-0.99, P = 0.04) for CSM(n = 4966)vs ESW(n = 923).CONCLUSION: In DDK transplant recipients who underwent perioperative induction and CNI/MMF maintenance, CSM appears to be associated with increased risk for death with functioning graft in minimally-sensitized patients and improved death-censored graft survival in highly-sensitized patients.展开更多
AIM To evaluate the outcomes of transplanting marginal kidneys preemptively compared to better-quality kidneys after varying dialysis vintage in older recipients.METHODS Using OPTN/United Network for Organ Sharing dat...AIM To evaluate the outcomes of transplanting marginal kidneys preemptively compared to better-quality kidneys after varying dialysis vintage in older recipients.METHODS Using OPTN/United Network for Organ Sharing database from 2001-2015, we identified deceased donor kidney(DDK) transplant recipients > 60 years of age who either underwent preemptive transplantation of kidneys with kidney donor profile index(KDPI) ≥ 85%(marginal kidneys) or received kidneys with KDPI of 35%-84%(better quality kidneys that older wait-listed patients would likely receive if waited longer) after being on dialysis for either 1-4 or 4-8 years. Using a multivariate Cox model adjusting for donor, recipient and transplant related factors-overall and death-censored graft failure risks along with patient death risk of preemptive transplant recipients were compared to transplant recipients in the 1-4 and 4-8 year dialysis vintage groups.RESUTLS The median follow up for the whole group was 37 mo(interquartile range of 57 mo). A total of 6110 DDK transplant recipients above the age of 60 years identified during the study period were found to be eligible to be included in the analysis. Among these patients350 received preemptive transplantation of kidneys with KDPI ≥ 85. The remaining patients underwent transplantation of better quality kidneys with KDPI 35-84% after being on maintenance dialysis for either 1-4 years(n = 3300) or 4-8 years(n = 2460). Adjusted overall graft failure risk and death-censored graft failure risk in preemptive high KDPI kidney recipients were similar when compared to group that received lower KDPI kidney after being on maintenance dialysis for either 1-4 years(HR 1.01, 95%CI: 0.90-1.14, P = 0.84 and HR 0.96, 95%CI: 0.79-1.16, P = 0.66 respectively) or 4-8 years(HR 0.82, 95%CI: 0.63-1.07, P = 0.15 and HR 0.81, 95%CI: 0.52-1.25, P = 0.33 respectively). Adjusted patient death risk in preemptive high KDPI kidney recipients were similar when compared to groups that received lower KDPI kidney after being on maintenance dialysis for 1-4 years(HR 0.99, 95%CI: 0.87-1.12, P = 0.89) but lower compared to patients who were on dialysis for 4-8 years(HR 0.74, 95%CI: 0.56-0.98, P = 0.037).CONCLUSION In summary, our study supports accepting a "marginal" quality high KDPI kidney preemptively in older waitlisted patients thus avoiding dialysis exposure.展开更多
OBJECTIVE: To investigate the dynamic alternations of HBV markers of active HBV replicationrecipients receiving lamivudine prophylaxis after liver transplantation.METHODS: Serial liver biopsy samples and sera were obt...OBJECTIVE: To investigate the dynamic alternations of HBV markers of active HBV replicationrecipients receiving lamivudine prophylaxis after liver transplantation.METHODS: Serial liver biopsy samples and sera were obtained from 15 recipients and examined withenzyme-linked radioinmmunoassay for HBsAg, HBeAg, HBsAb, HBcAb and HBeAb, and fluorescentquantitative assay for quantitation of HBV DNA in serum. Immunohistochemical staining of HBsAg,HBcAg and HBV DNA hybridization in situ were used to detect HBV markers in liver biopsy samples.RESULTS: 100 mg lamivudine taken orally every, day for 2 weeks before transplantation enabled 12(80%) of 15 active viral replication recipients (HBV DNA positive) to converse to HBV DNA negative.HBsAb, HBcAb and HBeAb in serum emerged in 1-2 weeks after liver transplantation, and disappearedgradually within 6 months; HBV DNA fluorescent quantitative assay showed constant negativity in serum.Immunohistochemical staining of HBsAg, HBcAg and HBV DNA hybridization in situ in liver biopsysamples showed negative results synchorously. Eight of the 15 HBV active replication recipients lostHBV markers thoroughly both in serology and tissue staining as well as HBV DNA hybridization in situ ofserial liver biopsy samples from 12 to 44 weeks after liver transplantation. Should any of HBsAg, HBeAgin serology and HBsAg, HBcAg in immunohistochemical staining was positive, or HBV DNA detectablein serum, or HBV DNA hybridization in situ in liver tissue positive, allograft HBV reinfection or De novoliver allograft infection could be diagnosed. Furthermore, if associated with elevation of ALT andbilirubin, the diagnosis of HBV hepatitis recurrence could be established.CONCLUSION: Allograft HBV reinfection or De nuvo liver allograft infection in active viral replicationrecipients could be prevented with lamivudine regimen, and further clearance of HBV may be possible ifproper measures are taken.展开更多
Cytomegalovirus (CMV) can cause significant inflammation. Besides, it is an important cause of pancreatitis in organ transplantations. We report a case of CMV pancreatitis in a 48-year-old male kidney transplant recip...Cytomegalovirus (CMV) can cause significant inflammation. Besides, it is an important cause of pancreatitis in organ transplantations. We report a case of CMV pancreatitis in a 48-year-old male kidney transplant recipient who was admitted with elevated amylase (3337 U/L) and lipase (1160 U/L) enzymes, and abdominal pain. CMV infection was tested by reverse transcription polymerase chain reaction and the result was positive. CMV viremia was successfully cleared with ganciclovir. Then the absence of some of more noticeable clinical symptoms of pancreatitis may not be a decisive reason not to rule out the disease in transplanted cases.展开更多
Aim:This study aimed to explore depressive symptoms and associated factors among renal-transplant(RT)recipients in China.Methods:This study included 287 RT recipients.Data were collected from August to November 2014 b...Aim:This study aimed to explore depressive symptoms and associated factors among renal-transplant(RT)recipients in China.Methods:This study included 287 RT recipients.Data were collected from August to November 2014 by utilizing demographic forms,namely,the Self-rating Depression Scale and the Multidimensional Scale of Perceived Social Support.Descriptive statistics,Student's t test,Chi-square test,ANOVA,and multiple linear regression were used for data analysis.Results:More than half of the recipients presented depressive symptoms.All recipients in the four transplant period groups(≤5 yr,5e10 yr,10e15 yr,and>15 yr)reported greater depressive symptoms than the Norm.No significant difference was observed in the depressive symptoms in the four transplant period groups.Multiple linear regression indicated that depressive symptoms were significantly associated with employment status,economic burden,inhabitation area,and social support.Conclusion:Depression is common among RT recipients in China.Employment status,economic burden,inhabitation area,and social support are the main factors affecting depression among RT recipients.Follow-up clinics should prescribe the evaluation of depression as a routine examination for RT patients.Moreover,depressed recipients must be provided with individualized care by collecting information on the depressive symptoms,employment status,economic burden,inhabitation area,and perceived social support of recipients.展开更多
AIM: To determine the general and transplant-specific risk factors for fractures in kidney transplant recipients.METHODS: We conducted a cohort study of all adults who received a kidney-only transplant(n = 2723) in On...AIM: To determine the general and transplant-specific risk factors for fractures in kidney transplant recipients.METHODS: We conducted a cohort study of all adults who received a kidney-only transplant(n = 2723) in Ontario, Canada between 2002 and 2009. We used multivariable Cox proportional hazards regression to determine general and transplant-specific risk factors for major fractures(proximal humerus, forearm, hip, and clinical vertebral). The final model was established using the backward elimination strategy, selecting risk factors with a P-value ≤ 0.2 and forcing recipient age and sex into the model. We also assessed risk factors for other fracture locations(excluding major fractures, and fractures involving the skull, hands or feet). RESULTS: There were 132 major fractures in the follow-up(8.1 fractures per 1000 person-years). General risk factors associated with a greater risk of major fracture were older recipient age [adjusted hazard ratio(a HR) per 5-year increase 1.11, 95%CI: 1.03-1.19] and female sex(a HR = 1.81, 95%CI: 1.28-2.57). Transplant-specific risk factors associated with a greater risk of fracture included older donor age(5-year increase)(a HR = 1.09, 95%CI: 1.02-1.17) and end-stage renal disease(ESRD) caused by diabetes(a HR = 1.72, 95%CI: 1.09-2.72) or cystic kidney disease(a HR = 1.73, 95%CI: 1.08-2.78)(compared to glomerulonephritis as the reference cause). Risk factors across the two fracture locations were not consistent(major fracture locations vs other). Specifically, general risk factors associated with an increased risk of other fractures were diabetes and a fall with hospitalization prior to transplantation, while length of time on dialysis, and renal vascular disease and other causes of ESRD were the transplant-specific risk factors associated with a greater risk of other fractures.CONCLUSION: Both general and transplant-specific risk factors were associated with a higher risk of fractures in kidney transplant recipients. Results can be used for clinical prognostication.展开更多
BACKGROUND Liver transplant patients are at higher risk of infection due to immunosuppression.Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2...BACKGROUND Liver transplant patients are at higher risk of infection due to immunosuppression.Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and will have worse outcomes than the general population if they develop coronavirus disease 2019(COVID-19)due to SARS-CoV-2 is a topic of ongoing studies,including ours.AIM To assess the clinical outcomes of COVID-19 in liver transplant recipients.METHODS This was a case-control study,with a database search performed(at the study site)from March 1,2020 through February 28,2021.Patients 18 years or older who tested positive for SARS-CoV-2 via polymerase chain reaction(PCR)were included in the study.Patients with infection other than pneumonia at the time of admission were excluded.After selection,patients who had been the recipient of liver transplant were considered cases and those without as controls.After being matched by age,sex,and obesity,two controls were randomly selected for each case.Death and hospitalization due to COVID-19 infection were the primary outcomes.Secondary outcomes were pertinent only to patients who were hospitalized,and they included duration of hospital stay,need for supplemental oxygen,presence of at least one type of end-organ damage,effects on liver enzymes,incidence of acute liver failure,effect on d-dimer levels,and incidence of venous thromboembolism(VTE).Chi-square or Fisher’s exact test was used to compare all primary and secondary outcomes with the exception of duration of hospital stay and d-dimer levels,which were compared using the Wilcoxon signed-rank test.Alpha criterion was set at 0.05.Logistic regression was performed for each primary outcome(as the dependent variable).Statistical analyses were performed using R software.RESULTS Of the 470 Liver transplant recipients who were tested for COVID-19 via the PCR test,39 patients tested positive(8.3%).There was no significant difference between cases and controls regarding death[odds ratio(OR):2.04,95%confidence interval(CI):0.14–29.17;P=0.60]and hospitalization rates(OR:1.38,95%CI:0.59–3.24;P=0.46).There also was no significant difference between cases and controls with respect to all secondary outcomes.Among all patients who had elevated liver enzymes,their levels were either normalized,improving,or remained stable at the time of discharge.No patient developed acute liver failure.Of the 31 hospitalized patients,27 received a prophylactic anticoagulation dose and no patient developed VTE in either group.Among cases who were hospitalized,immunosuppression was decreased in 5 patients and there was no change in immunosuppression among the remaining 7 patients.One patient died in each of these two subgroups.Logistic regression analysis was done,but all of the models had poor model predictions as well as insignificant predictors(independent variables).Therefore,they could not be used for either prediction or inference.CONCLUSION Clinical outcomes of COVID-19 in liver transplant recipients are not different than those without transplantation.COVID-19 should not impact timely health care access and immunosuppression continuation among these patients.展开更多
Objective: This study aimed to explore adherence to and beliefs about immunosuppressive medication using the Necessity-Concerns Framework(NCF) in liver transplant recipients.Methods: A cross-sectional study performed ...Objective: This study aimed to explore adherence to and beliefs about immunosuppressive medication using the Necessity-Concerns Framework(NCF) in liver transplant recipients.Methods: A cross-sectional study performed in recipients who were at least 3 months post liver transplantation. A convenience sample of 243 recipients was recruited. Self-reported medication adherence was measured by the Basel Assessment of Adherence with Immunosuppressive Medication Scale(BAASIS). The NCF was operationalized using the Beliefs about Medication Questionnaire(BMQ) to assess the beliefs about necessity and concerns with taking immunosuppressive medication.Results: One-hundred-forty-five liver transplant recipients were non-adherent(59.67%). Compared to adherers, non-adherers had lower beliefs regarding the necessity of taking immunosuppressive medication and lower scores on the necessity-concerns different from adherers.Conclusions: Non-adherence is common in liver transplant recipients. Non-adherers hold beliefs that are different from adherers. Efforts to increase adherence should be made by targeting medication beliefs.展开更多
AIM: To compare the risk of cutaneous infections and tumours in kidney transplant recipients with data recently published about this topic.METHODS: In the present work, we evaluated the incidence of bacterial, fungal ...AIM: To compare the risk of cutaneous infections and tumours in kidney transplant recipients with data recently published about this topic.METHODS: In the present work, we evaluated the incidence of bacterial, fungal and viral cutaneous infectious diseases and the development of skin cancers in a cohort of 436 patients who underwent a renal transplantation. The median age at transplantation of our patients was 50 years and the median duration of the immunosuppression was of 7.2 years. Data obtainedfrom our cohort were compared with those obtained by a systematic review of the literature of the last 20 years about the same topic.RESULTS: Infectious diseases were the most frequent dermatological disorders that were diagnosed after transplantation, affecting about the 16.5% of patients. Herpes virus reactivation occurs in about the 35% of patients and is more common within 6 mo from transplantation, whereas when the immunosuppression is reduced, skin infections are mainly represented by Human Papilloma Virus infections and localized mycosis, such as pityriasis versicolor and superficial candidiasis. Bacterial infections were relatively rare and occur mainly in the first months after transplantation. The cumulative risk to develop skin cancer enhance significantly over the time, as consequence of longterm immunosuppressive regiments. Endogenous and exogenous risk factors, as well as the schedule of immunosuppression can play a role and justify the different incidence of skin cancer in the various series. CONCLUSION: Skin infections and cancer, commonly diagnosed in transplanted patients, impact on survival and life-quality, justifying the realization of follow-up programs for the early diagnosis and treatment.展开更多
The appearing of microbial lineages carrying multiple dangerous loci are results from the extensive use of antibiotics and has brought a huge increase in the infections-derived morbidity and mortality, which is critic...The appearing of microbial lineages carrying multiple dangerous loci are results from the extensive use of antibiotics and has brought a huge increase in the infections-derived morbidity and mortality, which is critical in the hospital setting. Etiologic agents of these non easily tractable infections include bacteria, such as the genus Staphylococcus, but also fungi and virus. Alterations in the immune system allow these organisms to invade and affect the functionality of any tissue, organ or system of the human being. Pulmonary infection occurs as result of deficient lung systemic defence mechanisms which could be altered by medical treatments or by environmental factors. The infective agents commonly gain access to the lung by air, but also by blood or lymphatic system. Staphylococcus aureus strains that share antibiotic resistance and virulence factors represent the aetiological agent responsible of many cases of bacterial pneumonia, thoracic surgery postoperative infections, and diverse tissue infections, resulting in significant disease and morbidity in recipient patients after lung transplantation. The control and treatment of Staphylococcus infections, especially methicillin resistant strains, need for developing reliable and rapid methods of detection and characterization of these microorganisms. Nowadays, new insights into the diagnostic and epidemiology of MRSA and other pathogenic staphylococci have been developed employing molecular methods. This has meant an important advance in the diagnostic and treatment plans of such infective bacteria.展开更多
<strong>Background:</strong> Self-management is important for post-renal transplant recipients to resolve renal dysfunction, heart failure, and post-transplant psychosocial issues, and to maintain transpla...<strong>Background:</strong> Self-management is important for post-renal transplant recipients to resolve renal dysfunction, heart failure, and post-transplant psychosocial issues, and to maintain transplant kidney function, etc. However, because recipients may be unable to adequately self-manage, healthcare providers need to provide self-management support for recipients to improve their skills and confidence in managing their disease. However, it is difficult to comprehensively assess the self-management behaviors in a busy outpatient support setting. Furthermore, since there are no uniform standards for assessment, it is based on the experience and abilities of medical personnel. Therefore, self-management behavior of post-renal transplant recipients is not sufficiently evaluated. <strong>Objective:</strong> This study aimed to evaluate content validity of a tool that can assess self-management behaviors of adult post-renal transplant recipients, consisting of consensus components from experts familiar with the follow-up of adult post-renal transplant recipients. <strong>Methods:</strong> A three-round modified Delphi method was used to assess the self-management behaviors of adult post-renal transplant recipients by a panel of experts consisting of certified transplant recipient coordinators, physicians, outpatient nurses, and researchers familiar with the follow-up of post-renal transplant recipients. Regarding management behaviors of adult post-renal transplant recipients, the experts rated the appropriateness and validity of each item using a Likert scale. Consensus ratings from the experts were made by calculating the median, interquartile range, and interquartile range percentage. In the third round, an item-level content validity index was calculated to assess content validity. <strong>Conclusions: </strong>The 41-item self-management behavior scale for kidney transplant recipients assessed self-management behaviors in five domains: medication, exercise, fluids and diet, disease and symptom prevention and management, and psychosocial adjustment. The content validity of this tool was confirmed, and it can be used to more easily assess the recipients’ self-management behaviors in the post-renal transplant follow-up. This tool can potentially contribute to the maintenance of transplant kidney function and high QOL in recipients.展开更多
Based on data of China’s aid to 120 countries and recipient countries’export data between 2002-2014,this paper investigated the export effects of China’s aid.We found that China’s aid was conducive to recipient co...Based on data of China’s aid to 120 countries and recipient countries’export data between 2002-2014,this paper investigated the export effects of China’s aid.We found that China’s aid was conducive to recipient countries’exports to China,helping recipient countries boost their development capacity and meet China’s consumption demand at the same time.In this manner,China’s foreign aid has lived up to the principle of“mutually beneficial cooperation”.Heterogeneity test found that China’s aid helped recipient countries increase their exports of manufacturing goods of their comparative advantage,mainly medium-and low-end manufacturing products,to China without increasing the exports of non-manufacturing goods,such as agricultural produce as well as primary and resource goods.Our findings have thoroughly refuted criticisms like the“resource exploitation”narrative by Western countries against China.Apart from increasing African countries’exports to China,China’s aid also helped other recipient countries outside Africa,mostly medium-and low-income recipient countries,to export more to China.China’s aid-fortrade(AfT)programs did not significantly increase recipient countries’capacity to export to China.A test of the mechanism of action found that industrial development in recipient countries exerted only a partial intermediate effect in enhancing recipient countries’capacity to export to China.展开更多
文摘Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2,which the World Health Organization later designated as coronavirus disease 2019(COVID-19).The World Health Organization declared COVID-19 as a pandemic on March 11,2020.In the general population,COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill.Its mortality rate could be as high as 49%.The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions,among those who need immunosuppression after solid organ transplantation(SOT),are at an increased risk of developing severe illness from COVID-19.Liver transplantation is the second most prevalent SOT globally.Due to their immunosuppressed state,liver transplant(LT)recipients are more susceptible to serious infections.Therefore,comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19.It is crucial to comprehend the clinical picture,immunosuppressive management,prognosis,and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients.This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group.In the following sections,we discussed current COVID-19 therapy choices,reviewed standard practice in modifying immunosuppressant regimens,and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management.Additionally,we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.
文摘Cryptococcosis is the third most commonly occurring invasive fungal disease in solid organ transplant recipients(SOT).It is caused by encapsulated yeast,Cryptococcus species,predominantly Cryptococcus neoformans and Cryptococcus gattii.Though kidney transplant recipients are at the lowest risk of cryptococcosis when compared to other solid organ transplant recipients such as lung,liver or heart,still this opportunistic infection causes significant morbidity and mortality in this subset of patients.Mortality rates with cryptococcosis range from 10%-25%,while it can be as high as 50%in SOT recipients with central nervous system involvement.The main aim of diagnosis is to find out if there is any involvement of the central nervous system in disseminated disease or whether there is only localized pulmonary involvement as it has implications for both prognostication and treatment.Detection of cryptococcal antigen(CrAg)in cerebrospinal fluid or plasma is a highly recommended test as it is more sensitive and specific than India ink and fungal cultures.The CrAg lateral flow assay is the single point of care test that can rapidly detect cryptococcal polysaccharide capsule.Treatment of cryptococcosis is challenging in kidney transplant recipients.Apart from the reduction or optimization of immunosuppression,lipid formulations of amphotericin B are preferred as induction antifungal agents.Consolidation and maintenance are done with fluconazole;carefully monitoring its interactions with calcineurin inhibitors.This review further discusses in depth the evolving developments in the epidemiology,pathogenesis,diagnostic assays,and management approach of cryptococcosis in kidney transplant recipients.
基金Compliance with local ethical and data protection policies.Registered with St Georges University Hospitals NHS Foundation Trust Quality Assurance Department.Registration no AUD1000854。
文摘BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation.In the course of acute SARS-CoV-2 infection,various laboratory markers have been identified as predictors for high risk of mortality.AIM To risk stratify renal transplant recipients(RTxR)using general demographic parameters,comorbidities and routine laboratory markers for the severity of the disease and its outcomes.We believe that learning about these routinely monitored parameters can help us plan better strategies for the RTxR follow-up program.METHODS This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February 2021.We recorded the basic demographics,comorbidities and routine laboratory markers.We investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or mortality.RESULTS From 505 RTxRs in our renal transplant follow-up program,29(7.75%)RTxRs had PCR-positive SARS-CoV-2 infection.We recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6%but a significant 27.6%mortality in SARS-CoV-2 positive recipients.Age more than 68 years,non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability;P≤0.001.<0.001 and<0.0001 respectively.87.5%of the deceased were diabetic;P≤0.0.0001.Estimated glomerular filtration rate of less than 26 mL/min/1.73 m2,serum albumin less than 20 g/L,Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality;P=0.0128,<0.001,<0.0001 and 0.0061 respectively.CONCLUSION This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and morbidity.This knowledge can be used in RTxR follow-up programs by addressing these parameters early to help reduce the morbidity and mortality in RTxRs.
文摘AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease(labM ELD)-score and the Eurotransplant Donor Risk Index(ET-DRI) to unravel their impact on 20-year survival after LT.RESULTS Twenty-year survivors were significantly younger(44 vs 50 years, P = 0.001), more likely to be female(49% vs 36%, P = 0.03) and less likely to be obese at the time of LT(19% vs 32%, P = 0.011). Mean labM ELD-score(P = 0.156), rate of high-urgency LT(P = 0.210), coldischemia time(P = 0.994), rate of retransplantation(P = 0.12) and average donor age(28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors(P = 0.007). ET-DRI > 1.4(P = 0.020) and donor age ≥ 30 years(P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labM ELD-score categories(P = 0.263).CONCLUSION LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.
文摘Polyomavirus BK(BKV) infects up to 90% of the general population. After primary infection, occurring early during childhood, a state of non-replicative infection is established in the reno-urinary tract, without complications for immunocompetent hosts. In immunocompromised individuals, particularly transplanted patients, asymptomatic BKV viremia and/or viruria can be observed. Renal grafts may also be sources of infection as BKV prefers kidneys rather than other solid organs for transplantation such as the liver. The mechanism behind the higher incidence of BKV infection in kidney transplant patients, compared to liver or heart transplantation, is unclear and the prevalence of BKV infection in non-renal solid organ transplants has not been yet thoroughly investigated. We evaluated the prevalence of Polyomavirus BK infection among liver transplant recipients. A Pub Med search was conducted using the terms BKV infection AND liver transplant recipients; BKV AND non-renal solid organ transplant*; BKV infection AND immunosuppression; the search was limited to title/abstract and English-language articles published from 2000, to March 2015. Eleven relevant studies suggest that the prevalence of BKV viruria and/or viremia among liver transplant recipients is less than that reported in kidney or heart transplant recipients, except when chronic kidney disease(CKD) is present at the same time. Data also suggest that viruric and viremic patients have higher levels of serum creatinine than BKV negative patients. Moreover, no specific immunosuppressive drugs are associated with the onset of BKV nephropathy. The comorbidity of transplantation and CKD could play a major role in promoting BKV replication.
文摘AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.METHODS Ninety-nine kidney transplant recipients(KTRs) were assigned to interventional exercise(Group A; n = 52) and a usual care cohort(Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life(HRQo L) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities.RESULTS Eighty-five KTRs completed the study(Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload(+13 W, P = 0.0003), V'O2 peak(+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor(+12 kg, P = 0.0368), height in the countermovement jump(+1.9 cm, P = 0.0293) and decreased in Body Mass Index(-0.5 kg/m^2, P = 0.0013). HRQo L significantly improved in physical function(P = 0.0019), physical-role limitations(P = 0.0321) and social functioning scales(P = 0.0346). Noimprovements were found in Group B.CONCLUSION Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.
文摘Summary:Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction.Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure,especially in an extensive wound,or in a complex trauma combined with vascular injury.From April 2014 to March 2018,we retrospectively reviewed patients with traumatic/posttraumatic,oncologic,and electrical wounds in the lower extremity.Those treated with muscle feeding artery as recipient vessels were included.The latissimus dorsi(LD)muscle free flap,anterior lateral thigh(ALT)perforator free flap,and deep inferior epigastric perforator(DIEP)free flap were raised.The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle,concomitant veins,and great saphenous vein were used as recipient vessels.Injuries included in the study were caused by tumour in 2 cases,car accident in 3 cases,crushing in 3 cases,burns in one case,and electrical injury in one case.The wound size varied from 14 cm x 6 cm to 30 cm x 20 cm.LD,ALT,and DIEP free flaps were used in 6,3,and 4 patients,respectively.The muscle feeding arteries to medial head of gastrocnemius muscle,to sartorius muscle,and to vastus lateral muscle were used as recipient arteries in 4,5,and one patient,respectively.Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients,respectively.Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses,particularly when the wound is located proximal to the mid-third of the lower leg.
基金supported in part by Health Resources and Services Administration contract 231-00-0115
文摘AIM: To evaluate whether there is a threshold sensitization level beyond which benefits of chronic steroid maintenance(CSM) emerge. METHODS: Using Organ Procurement and Transplant Network/United Network of Organ Sharing database, we compared the adjusted graft and patient survivals for CSM vs early steroid withdrawal(ESW) among patients who underwent deceased-donor kidney(DDK) transplantation from 2000 to 2008 who were stratified by peak-panel reactive antibody(peak-PRA) titers(0%-30%, 31%-60% and > 60%). All patients received perioperative induction therapy and maintenance immunosuppression based on calcineurin inhibitor(CNI) and mycophenolate mofetil(MMF).RESULTS: The study included 42851 patients. In the 0%-30% peak-PRA class, adjusted over-all graft-failure(HR 1.11, 95%CI: 1.03-1.20, P = 0.009) and patientdeath(HR 1.29, 95%CI: 1.16-1.43, P < 0.001) risks were higher and death-censored graft-failure risk(HR 1.06, 95%CI: 0.98-1.14, P = 0.16) similar for CSM(n = 25218) vs ESW(n = 7399). Over-all(HR 1.04, 95%CI: 0.85-1.28, P = 0.70) and death-censored(HR 0.97, 95%CI: 0.78-1.21, P = 0.81) graft-failure risks were similar and patient-death risk(HR 1.39, 95%CI: 1.03-1.87, P = 0.03) higher for CSM(n = 3495) vs ESW(n = 850) groups for 31%-60% peak-PRA class. In the > 60% peak-PRA class, adjusted overall graft-failure(HR 0.90, 95%CI: 0.76-1.08, P = 0.25) and patientdeath(HR 0.92, 95%CI: 0.71-1.17, P = 0.47) risks were similar and death-censored graft-failure risk lower(HR 0.84, 95%CI: 0.71-0.99, P = 0.04) for CSM(n = 4966)vs ESW(n = 923).CONCLUSION: In DDK transplant recipients who underwent perioperative induction and CNI/MMF maintenance, CSM appears to be associated with increased risk for death with functioning graft in minimally-sensitized patients and improved death-censored graft survival in highly-sensitized patients.
文摘AIM To evaluate the outcomes of transplanting marginal kidneys preemptively compared to better-quality kidneys after varying dialysis vintage in older recipients.METHODS Using OPTN/United Network for Organ Sharing database from 2001-2015, we identified deceased donor kidney(DDK) transplant recipients > 60 years of age who either underwent preemptive transplantation of kidneys with kidney donor profile index(KDPI) ≥ 85%(marginal kidneys) or received kidneys with KDPI of 35%-84%(better quality kidneys that older wait-listed patients would likely receive if waited longer) after being on dialysis for either 1-4 or 4-8 years. Using a multivariate Cox model adjusting for donor, recipient and transplant related factors-overall and death-censored graft failure risks along with patient death risk of preemptive transplant recipients were compared to transplant recipients in the 1-4 and 4-8 year dialysis vintage groups.RESUTLS The median follow up for the whole group was 37 mo(interquartile range of 57 mo). A total of 6110 DDK transplant recipients above the age of 60 years identified during the study period were found to be eligible to be included in the analysis. Among these patients350 received preemptive transplantation of kidneys with KDPI ≥ 85. The remaining patients underwent transplantation of better quality kidneys with KDPI 35-84% after being on maintenance dialysis for either 1-4 years(n = 3300) or 4-8 years(n = 2460). Adjusted overall graft failure risk and death-censored graft failure risk in preemptive high KDPI kidney recipients were similar when compared to group that received lower KDPI kidney after being on maintenance dialysis for either 1-4 years(HR 1.01, 95%CI: 0.90-1.14, P = 0.84 and HR 0.96, 95%CI: 0.79-1.16, P = 0.66 respectively) or 4-8 years(HR 0.82, 95%CI: 0.63-1.07, P = 0.15 and HR 0.81, 95%CI: 0.52-1.25, P = 0.33 respectively). Adjusted patient death risk in preemptive high KDPI kidney recipients were similar when compared to groups that received lower KDPI kidney after being on maintenance dialysis for 1-4 years(HR 0.99, 95%CI: 0.87-1.12, P = 0.89) but lower compared to patients who were on dialysis for 4-8 years(HR 0.74, 95%CI: 0.56-0.98, P = 0.037).CONCLUSION In summary, our study supports accepting a "marginal" quality high KDPI kidney preemptively in older waitlisted patients thus avoiding dialysis exposure.
文摘OBJECTIVE: To investigate the dynamic alternations of HBV markers of active HBV replicationrecipients receiving lamivudine prophylaxis after liver transplantation.METHODS: Serial liver biopsy samples and sera were obtained from 15 recipients and examined withenzyme-linked radioinmmunoassay for HBsAg, HBeAg, HBsAb, HBcAb and HBeAb, and fluorescentquantitative assay for quantitation of HBV DNA in serum. Immunohistochemical staining of HBsAg,HBcAg and HBV DNA hybridization in situ were used to detect HBV markers in liver biopsy samples.RESULTS: 100 mg lamivudine taken orally every, day for 2 weeks before transplantation enabled 12(80%) of 15 active viral replication recipients (HBV DNA positive) to converse to HBV DNA negative.HBsAb, HBcAb and HBeAb in serum emerged in 1-2 weeks after liver transplantation, and disappearedgradually within 6 months; HBV DNA fluorescent quantitative assay showed constant negativity in serum.Immunohistochemical staining of HBsAg, HBcAg and HBV DNA hybridization in situ in liver biopsysamples showed negative results synchorously. Eight of the 15 HBV active replication recipients lostHBV markers thoroughly both in serology and tissue staining as well as HBV DNA hybridization in situ ofserial liver biopsy samples from 12 to 44 weeks after liver transplantation. Should any of HBsAg, HBeAgin serology and HBsAg, HBcAg in immunohistochemical staining was positive, or HBV DNA detectablein serum, or HBV DNA hybridization in situ in liver tissue positive, allograft HBV reinfection or De novoliver allograft infection could be diagnosed. Furthermore, if associated with elevation of ALT andbilirubin, the diagnosis of HBV hepatitis recurrence could be established.CONCLUSION: Allograft HBV reinfection or De nuvo liver allograft infection in active viral replicationrecipients could be prevented with lamivudine regimen, and further clearance of HBV may be possible ifproper measures are taken.
文摘Cytomegalovirus (CMV) can cause significant inflammation. Besides, it is an important cause of pancreatitis in organ transplantations. We report a case of CMV pancreatitis in a 48-year-old male kidney transplant recipient who was admitted with elevated amylase (3337 U/L) and lipase (1160 U/L) enzymes, and abdominal pain. CMV infection was tested by reverse transcription polymerase chain reaction and the result was positive. CMV viremia was successfully cleared with ganciclovir. Then the absence of some of more noticeable clinical symptoms of pancreatitis may not be a decisive reason not to rule out the disease in transplanted cases.
基金The study was funded by the National Natural Science Foundation of China(No.81171860)The authors thank the RT recipients who participated in this study.
文摘Aim:This study aimed to explore depressive symptoms and associated factors among renal-transplant(RT)recipients in China.Methods:This study included 287 RT recipients.Data were collected from August to November 2014 by utilizing demographic forms,namely,the Self-rating Depression Scale and the Multidimensional Scale of Perceived Social Support.Descriptive statistics,Student's t test,Chi-square test,ANOVA,and multiple linear regression were used for data analysis.Results:More than half of the recipients presented depressive symptoms.All recipients in the four transplant period groups(≤5 yr,5e10 yr,10e15 yr,and>15 yr)reported greater depressive symptoms than the Norm.No significant difference was observed in the depressive symptoms in the four transplant period groups.Multiple linear regression indicated that depressive symptoms were significantly associated with employment status,economic burden,inhabitation area,and social support.Conclusion:Depression is common among RT recipients in China.Employment status,economic burden,inhabitation area,and social support are the main factors affecting depression among RT recipients.Follow-up clinics should prescribe the evaluation of depression as a routine examination for RT patients.Moreover,depressed recipients must be provided with individualized care by collecting information on the depressive symptoms,employment status,economic burden,inhabitation area,and perceived social support of recipients.
基金supported by the Institute for Clinical Evaluative Sciences (ICES) Western siteICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC) Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario (AMOSO)+1 种基金the Schulich School of Medicine and Dentistry (SSMD), Western University, and the Lawson Health Research Institute (LHRI)The research was conducted by members of the ICES Kidney, Dialysis and Transplantation team, at the ICES Western facility, who are supported by a grant from the Canadian Institutes of Health Research (CIHR)
文摘AIM: To determine the general and transplant-specific risk factors for fractures in kidney transplant recipients.METHODS: We conducted a cohort study of all adults who received a kidney-only transplant(n = 2723) in Ontario, Canada between 2002 and 2009. We used multivariable Cox proportional hazards regression to determine general and transplant-specific risk factors for major fractures(proximal humerus, forearm, hip, and clinical vertebral). The final model was established using the backward elimination strategy, selecting risk factors with a P-value ≤ 0.2 and forcing recipient age and sex into the model. We also assessed risk factors for other fracture locations(excluding major fractures, and fractures involving the skull, hands or feet). RESULTS: There were 132 major fractures in the follow-up(8.1 fractures per 1000 person-years). General risk factors associated with a greater risk of major fracture were older recipient age [adjusted hazard ratio(a HR) per 5-year increase 1.11, 95%CI: 1.03-1.19] and female sex(a HR = 1.81, 95%CI: 1.28-2.57). Transplant-specific risk factors associated with a greater risk of fracture included older donor age(5-year increase)(a HR = 1.09, 95%CI: 1.02-1.17) and end-stage renal disease(ESRD) caused by diabetes(a HR = 1.72, 95%CI: 1.09-2.72) or cystic kidney disease(a HR = 1.73, 95%CI: 1.08-2.78)(compared to glomerulonephritis as the reference cause). Risk factors across the two fracture locations were not consistent(major fracture locations vs other). Specifically, general risk factors associated with an increased risk of other fractures were diabetes and a fall with hospitalization prior to transplantation, while length of time on dialysis, and renal vascular disease and other causes of ESRD were the transplant-specific risk factors associated with a greater risk of other fractures.CONCLUSION: Both general and transplant-specific risk factors were associated with a higher risk of fractures in kidney transplant recipients. Results can be used for clinical prognostication.
文摘BACKGROUND Liver transplant patients are at higher risk of infection due to immunosuppression.Whether liver transplant recipients are also more susceptible to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and will have worse outcomes than the general population if they develop coronavirus disease 2019(COVID-19)due to SARS-CoV-2 is a topic of ongoing studies,including ours.AIM To assess the clinical outcomes of COVID-19 in liver transplant recipients.METHODS This was a case-control study,with a database search performed(at the study site)from March 1,2020 through February 28,2021.Patients 18 years or older who tested positive for SARS-CoV-2 via polymerase chain reaction(PCR)were included in the study.Patients with infection other than pneumonia at the time of admission were excluded.After selection,patients who had been the recipient of liver transplant were considered cases and those without as controls.After being matched by age,sex,and obesity,two controls were randomly selected for each case.Death and hospitalization due to COVID-19 infection were the primary outcomes.Secondary outcomes were pertinent only to patients who were hospitalized,and they included duration of hospital stay,need for supplemental oxygen,presence of at least one type of end-organ damage,effects on liver enzymes,incidence of acute liver failure,effect on d-dimer levels,and incidence of venous thromboembolism(VTE).Chi-square or Fisher’s exact test was used to compare all primary and secondary outcomes with the exception of duration of hospital stay and d-dimer levels,which were compared using the Wilcoxon signed-rank test.Alpha criterion was set at 0.05.Logistic regression was performed for each primary outcome(as the dependent variable).Statistical analyses were performed using R software.RESULTS Of the 470 Liver transplant recipients who were tested for COVID-19 via the PCR test,39 patients tested positive(8.3%).There was no significant difference between cases and controls regarding death[odds ratio(OR):2.04,95%confidence interval(CI):0.14–29.17;P=0.60]and hospitalization rates(OR:1.38,95%CI:0.59–3.24;P=0.46).There also was no significant difference between cases and controls with respect to all secondary outcomes.Among all patients who had elevated liver enzymes,their levels were either normalized,improving,or remained stable at the time of discharge.No patient developed acute liver failure.Of the 31 hospitalized patients,27 received a prophylactic anticoagulation dose and no patient developed VTE in either group.Among cases who were hospitalized,immunosuppression was decreased in 5 patients and there was no change in immunosuppression among the remaining 7 patients.One patient died in each of these two subgroups.Logistic regression analysis was done,but all of the models had poor model predictions as well as insignificant predictors(independent variables).Therefore,they could not be used for either prediction or inference.CONCLUSION Clinical outcomes of COVID-19 in liver transplant recipients are not different than those without transplantation.COVID-19 should not impact timely health care access and immunosuppression continuation among these patients.
基金supported by State Scholarship Fund(No.201506555004)China Scholarship CouncilBeijing Natural Science Foundation of China(No.7144223)
文摘Objective: This study aimed to explore adherence to and beliefs about immunosuppressive medication using the Necessity-Concerns Framework(NCF) in liver transplant recipients.Methods: A cross-sectional study performed in recipients who were at least 3 months post liver transplantation. A convenience sample of 243 recipients was recruited. Self-reported medication adherence was measured by the Basel Assessment of Adherence with Immunosuppressive Medication Scale(BAASIS). The NCF was operationalized using the Beliefs about Medication Questionnaire(BMQ) to assess the beliefs about necessity and concerns with taking immunosuppressive medication.Results: One-hundred-forty-five liver transplant recipients were non-adherent(59.67%). Compared to adherers, non-adherers had lower beliefs regarding the necessity of taking immunosuppressive medication and lower scores on the necessity-concerns different from adherers.Conclusions: Non-adherence is common in liver transplant recipients. Non-adherers hold beliefs that are different from adherers. Efforts to increase adherence should be made by targeting medication beliefs.
文摘AIM: To compare the risk of cutaneous infections and tumours in kidney transplant recipients with data recently published about this topic.METHODS: In the present work, we evaluated the incidence of bacterial, fungal and viral cutaneous infectious diseases and the development of skin cancers in a cohort of 436 patients who underwent a renal transplantation. The median age at transplantation of our patients was 50 years and the median duration of the immunosuppression was of 7.2 years. Data obtainedfrom our cohort were compared with those obtained by a systematic review of the literature of the last 20 years about the same topic.RESULTS: Infectious diseases were the most frequent dermatological disorders that were diagnosed after transplantation, affecting about the 16.5% of patients. Herpes virus reactivation occurs in about the 35% of patients and is more common within 6 mo from transplantation, whereas when the immunosuppression is reduced, skin infections are mainly represented by Human Papilloma Virus infections and localized mycosis, such as pityriasis versicolor and superficial candidiasis. Bacterial infections were relatively rare and occur mainly in the first months after transplantation. The cumulative risk to develop skin cancer enhance significantly over the time, as consequence of longterm immunosuppressive regiments. Endogenous and exogenous risk factors, as well as the schedule of immunosuppression can play a role and justify the different incidence of skin cancer in the various series. CONCLUSION: Skin infections and cancer, commonly diagnosed in transplanted patients, impact on survival and life-quality, justifying the realization of follow-up programs for the early diagnosis and treatment.
文摘The appearing of microbial lineages carrying multiple dangerous loci are results from the extensive use of antibiotics and has brought a huge increase in the infections-derived morbidity and mortality, which is critical in the hospital setting. Etiologic agents of these non easily tractable infections include bacteria, such as the genus Staphylococcus, but also fungi and virus. Alterations in the immune system allow these organisms to invade and affect the functionality of any tissue, organ or system of the human being. Pulmonary infection occurs as result of deficient lung systemic defence mechanisms which could be altered by medical treatments or by environmental factors. The infective agents commonly gain access to the lung by air, but also by blood or lymphatic system. Staphylococcus aureus strains that share antibiotic resistance and virulence factors represent the aetiological agent responsible of many cases of bacterial pneumonia, thoracic surgery postoperative infections, and diverse tissue infections, resulting in significant disease and morbidity in recipient patients after lung transplantation. The control and treatment of Staphylococcus infections, especially methicillin resistant strains, need for developing reliable and rapid methods of detection and characterization of these microorganisms. Nowadays, new insights into the diagnostic and epidemiology of MRSA and other pathogenic staphylococci have been developed employing molecular methods. This has meant an important advance in the diagnostic and treatment plans of such infective bacteria.
文摘<strong>Background:</strong> Self-management is important for post-renal transplant recipients to resolve renal dysfunction, heart failure, and post-transplant psychosocial issues, and to maintain transplant kidney function, etc. However, because recipients may be unable to adequately self-manage, healthcare providers need to provide self-management support for recipients to improve their skills and confidence in managing their disease. However, it is difficult to comprehensively assess the self-management behaviors in a busy outpatient support setting. Furthermore, since there are no uniform standards for assessment, it is based on the experience and abilities of medical personnel. Therefore, self-management behavior of post-renal transplant recipients is not sufficiently evaluated. <strong>Objective:</strong> This study aimed to evaluate content validity of a tool that can assess self-management behaviors of adult post-renal transplant recipients, consisting of consensus components from experts familiar with the follow-up of adult post-renal transplant recipients. <strong>Methods:</strong> A three-round modified Delphi method was used to assess the self-management behaviors of adult post-renal transplant recipients by a panel of experts consisting of certified transplant recipient coordinators, physicians, outpatient nurses, and researchers familiar with the follow-up of post-renal transplant recipients. Regarding management behaviors of adult post-renal transplant recipients, the experts rated the appropriateness and validity of each item using a Likert scale. Consensus ratings from the experts were made by calculating the median, interquartile range, and interquartile range percentage. In the third round, an item-level content validity index was calculated to assess content validity. <strong>Conclusions: </strong>The 41-item self-management behavior scale for kidney transplant recipients assessed self-management behaviors in five domains: medication, exercise, fluids and diet, disease and symptom prevention and management, and psychosocial adjustment. The content validity of this tool was confirmed, and it can be used to more easily assess the recipients’ self-management behaviors in the post-renal transplant follow-up. This tool can potentially contribute to the maintenance of transplant kidney function and high QOL in recipients.
基金sponsored by the key project of the National Social Science Fund of China(NSSFC)“Study on Innovations for China’s International Aid and Development Cooperation System”(Grant No.16ZDA037).
文摘Based on data of China’s aid to 120 countries and recipient countries’export data between 2002-2014,this paper investigated the export effects of China’s aid.We found that China’s aid was conducive to recipient countries’exports to China,helping recipient countries boost their development capacity and meet China’s consumption demand at the same time.In this manner,China’s foreign aid has lived up to the principle of“mutually beneficial cooperation”.Heterogeneity test found that China’s aid helped recipient countries increase their exports of manufacturing goods of their comparative advantage,mainly medium-and low-end manufacturing products,to China without increasing the exports of non-manufacturing goods,such as agricultural produce as well as primary and resource goods.Our findings have thoroughly refuted criticisms like the“resource exploitation”narrative by Western countries against China.Apart from increasing African countries’exports to China,China’s aid also helped other recipient countries outside Africa,mostly medium-and low-income recipient countries,to export more to China.China’s aid-fortrade(AfT)programs did not significantly increase recipient countries’capacity to export to China.A test of the mechanism of action found that industrial development in recipient countries exerted only a partial intermediate effect in enhancing recipient countries’capacity to export to China.
