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Implementation of a living donor liver transplantation program in the Republic of Uzbekistan: a report of the first 40 cases

Konstantin SEMASH ; Timur DZHANBEKOV ; Mirshavkat AKBAROV ; Miraziz MIROLIMOV ; Azimjon USMONOV ; Navruz RAZZOKOV ; Ziyodulla PRIMOV ; Temurbek GAYBULLAEV ; Sardor YIGITALIEV

Clinical Transplantation and Research.2024;38(2):116-127. doi:10.4285/ctr.24.0013

Background: Living donor liver transplantation (LDLT) is an effective treatment for patients with end-stage liver disease. This study was performed to evaluate the outcomes of the initial series of LDLT procedures performed in the Republic of Uzbekistan and to demonstrate that liver transplantation is viable under the conditions in this country. Methods: Between October 2021 and December 2023, we performed 40 LDLTs. We evaluated both immediate and long-term outcomes. Results: Thrombosis of the hepatic artery developed in one case (2.5%). Arterial anastomotic stenoses were diagnosed in three cases (7.5%) and were successfully treated with endovascular balloon vasodilation. Splenic artery steal syndrome arose in three patients (7.5%) and was managed with endovascular embolization of the splenic artery.One patient (2.5%) developed portal vein thrombosis. Portal vein stenosis occurred in two patients (5%) at 10 months posttransplantation and was addressed with endovascular balloon angioplasty, yielding good clinical outcomes. Biliary complications were observed in 45% of the cases, with bile leakages accounting for 89% of these issues and strictures of the biliary anastomoses for 11%. The in-hospital mortality rate was 12.5%. Conclusions Our research findings and analysis of complications align with the international literature, and the results are deemed acceptable during this implementation phase of the liver transplantation program. Accordingly, liver transplantation is feasible in the Republic of Uzbekistan; however, improvements in surgical and therapeutic methods are necessary to minimize the development of both early and late postoperative complications.

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Clinical features and outcomes of posterior reversible encephalopathy syndrome after heart transplantation: a case series

Ji Hoon LIM ; Seok Hyun KIM ; Cheolyong MO ; Hyun-Woo KIM ; Soo Yong LEE

Clinical Transplantation and Research.2024;38(2):154-162. doi:10.4285/ctr.24.0009

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease that may be associated with hypertension, autoregulatory failure, and the use of calcineurin inhibitors following heart transplantation (HT). In this article, we present a case series of PRES, discussing its potential causes and management strategies. Among the 126 HT recipients at our hospital, four were diagnosed with PRES. Three of these patients developed PRES within 7 days after HT. Prior to the onset of PRES, all patients experienced sustained hypertension, and strict blood pressure (BP) control was maintained. Three of the four patients recovered without PRES recurrence, while one patient died of sepsis after an episode of altered consciousness. Hypertension was observed in all patients prior to the onset of PRES, and the majority experienced symptom improvement with BP control. While most cases of PRES were reversible with conservative treatment, including the administration of antiepileptics, one irreversible case resulted in in-hospital mortality. Thus, PRES can have serious outcomes and is not invariably benign.

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Successful kidney transplantation from a live donor with immune thrombocytopenia:a case report

Hsiao-Hui YANG ; Ching-Chun HO ; Chia-Ling LEE ; Yi-Feng WU ; Yen-Cheng CHEN

Clinical Transplantation and Research.2024;38(2):145-149. doi:10.4285/ctr.24.0002

Organ transplantation from donors with immune thrombocytopenia (ITP), a condition involving the autoantibody-mediated destruction of platelets, is a topic of debate due to the potential for transplantation-mediated autoimmune thrombocytopenia (TMAT), a rare but potentially fatal complication. Previous reports have described transplants from deceased liver donors with ITP who had very low platelet counts and disease largely refractory to treatment. Here, we present the first case of living kidney transplantation from a donor with ITP who underwent preoperative treatment, with concurrent splenectomy performed to reduce the long-term risk of spontaneous hemorrhage.To ensure the safety of the procedure, we monitored perioperative rotational thromboelastometry parameters and platelet counts, leading to the normalization of the donor’s platelet levels. The recipient experienced an uneventful recovery of renal function without perioperative bleeding or the development of TMAT. Our report suggests that kidney transplantation from a donor with well-managed ITP is safe, and such a condition should not be considered a contraindication for donation.

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Sternoclavicular xanthogranulomatous osteomyelitis in a patient after kidney transplantation: a case report

Kiyoung CHOI ; Youngmin YOON ; Ran HONG ; Hyun Lee KIM ; Jong Hoon CHUNG ; Byung Chul SHIN

Clinical Transplantation and Research.2024;38(2):150-153. doi:10.4285/ctr.24.0011

Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.

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Polyomavirus nephropathy: diagnosis, histologic features, and differentiation from acute rejection

Cynthia C. NAST

Clinical Transplantation and Research.2024;38(2):71-89. doi:10.4285/ctr.24.0006

Polyomaviruses, particularly BK virus, are ubiquitous latent infections that may reactivate with immunosuppression during kidney transplantation, resulting in polyomavirus nephropathy (PVN). The levels of viruria and viremia serve as tools for screening and making a presumptive diagnosis of PVN, respectively, while a definitive diagnosis requires a kidney biopsy. There are histologic classifications of PVN based on the extent of tubular cell viral infection, interstitial fibrosis, and interstitial inflammation. These classifications correlate to some degree with graft function and loss, aiding in determining treatment efficacy and prognostication. PVN has histologic overlap with acute cell-mediated rejection, making the differential diagnosis challenging, although there are suggestive features for these different causes of graft dysfunction. This article reviews the diagnosis, histologic findings, and classifications of PVN, and discusses how to differentiate viral nephropathy from acute rejection.

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Comparison of depression and suicide between dialysis and kidney transplant recipients in Korea: a nationwide population study

Min Seok KANG ; Dong Young KIM ; Sung Hwa KIM ; Jae Seok KIM ; Jae Won YANG ; Byoung Geun HAN ; Dae Ryong KANG ; Jinhee LEE ; Jun Young LEE

Clinical Transplantation and Research.2024;38(2):98-105. doi:10.4285/ctr.24.0004

Background: Kidney transplantation (KT) improves physical and psychological prognoses for patients with end-stage kidney disease (ESKD). However, few comparative studies have examined depression and suicide rates among patients with ESKD treated with dialysis versus KT. Methods: Data on 21,809 patients with ESKD were extracted from the Korean National Health Insurance Service database, extending from January 2002 to December 2018.These patients exhibited no history of depression or insomnia before starting renal replacement therapy. Outcomes were compared between dialysis and KT recipients using 1:2 propensity score matching (PSM). Results: Of the patients, 17,649 received dialysis (hemodialysis, 15,537; peritoneal dialysis, 2,112), while 4,160 underwent KT. Of those on dialysis, 45.04% (7,949) experienced insomnia, compared to 25.72% (1,070) of KT recipients (P<0.001). Depression was more frequent among dialysis recipients (22.77%, 4,019) than KT recipients (8.61%, 358;P<0.001). Additionally, those on dialysis had a higher incidence of suicide (0.19%, 33) than recipients of KT (0.12%, 5; P=0.047). After PSM, the hazard ratio (HR) for depression in patients on dialysis compared to KT recipients was 1.76 (95% confidence interval [CI], 1.56–1.99). In subgroup analysis, the relative likelihood of depression among dialysis recipients was particularly high for residents of urban areas (HR, 2.10; 95% CI, 1.80–2.44) and patients under 65 years old (HR, 1.82; 95% CI, 1.62–2.09). Conclusions KT recipients exhibit a lower suicide rate than patients on dialysis. Furthermore, KT is associated with a lower prevalence of depression among Korean patients with ESKD, particularly urban residents and individuals under 65 years old.

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Risk factors for renal impairment after liver transplantation in Mongolia:a retrospective single-center study

Batsaikhan BATSUURI ; Shiirevnyamba AVIRMED ; Chuluunbileg BATBOLD ; Fidel LOPEZ-VERDUGO ; Jade NUNEZ ; Ariunaa TOGTOKH ; Sergelen ORGOI

Clinical Transplantation and Research.2024;38(2):128-135. doi:10.4285/ctr.24.0017

Background: Renal impairment (RI) is a frequent complication of liver cirrhosis and is associated with increased mortality and morbidity. Liver transplantation (LT) serves as an effective treatment method for patients with cirrhosis who have impaired renal function. However, renal function often declines after LT, influenced by various factors. This study aimed to investigate the factors contributing to RI following LT in our cases. Methods: We analyzed the demographic data, preoperative and perioperative parameters, and postoperative outcomes of patients who underwent LT at the First Central Hospital of Mongolia from September 2011 to December 2022. Renal function was assessed by measuring the glomerular filtration rate using the Cockcroft-Gault creatinine clearance formula pretransplantation and at 24 hours, 72 hours, 7 days, 14 days, and 28 days post-LT. Results: Several factors increased the risk of RI among recipients. These included female sex (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.58–5.91), Child-TurcottePugh (CTP) scores of B and C (OR, 4.23; 95% CI, 0.92–19.41 and OR, 7.68; 95% CI, 1.67– 35.30, respectively), preoperative continuous renal replacement therapy (CRRT; OR, 5.86;95% CI, 1.1–31.21), and a high graft-to-recipient weight ratio (GRWR; OR, 3.45; 95% CI, 1.23–9.63). Additionally, the survival rates for recipients with RI post-LT were 93.4% at 1 year and 78.1% at 3 years. Conclusions Female sex, a high CTP score, preoperative CRRT, and high GRWR were identified as risk factors for RI after LT in Mongolia.

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Tixagevimab/cilgavimab prophylaxis against COVID-19 in solid organ transplant recipients:a systematic review and meta-analysis

Saeed KHORRAMNIA ; Zia NAVIDI ; Amirhossein ORANDI ; Mojgan Mohajeri IRAVANI ; Amirali ORANDI ; Ebadallah Shiri MALEKABAD ; Seyed Hamid Pakzad MOGHADAM

Clinical Transplantation and Research.2024;38(2):136-144. doi:10.4285/ctr.24.0015

Background: Tixagevimab/cilgavimab (Tix/Cil) shows promise as a prophylactic treatment against coronavirus disease 2019 (COVID-19) in solid organ transplant recipients (SOTRs). This study was performed to assess the effectiveness of Tix/Cil for preexposure prophylaxis against COVID-19 in this population. Methods: We systematically searched the Cochrane Library, Web of Science, PubMed, and Embase databases to identify articles relevant to our study up to December 15, 2023. Comprehensive Meta-Analysis (ver. 3.0) was used for data analysis. Results: The meta-analysis included seven eligible retrospective studies, encompassing a total of 4,026 SOTRs. The analysis revealed significant differences in SOTRs who received Tix/Cil preexposure prophylaxis relative to those who did not. Specifically, these differences were observed in the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.15–0.60), hospitalization (OR, 0.24; 95% CI, 0.08–0.70), and intensive care unit admission (OR, 0.07; 95% CI, 0.02–0.22). However, mortality rate did not differ significantly between the two groups (P=0.06). Conclusions The evidence supporting the effectiveness of Tix/Cil as preexposure prophylaxis against SARS-CoV-2 in SOTRs is of a low to moderate level. Further high-quality research is necessary to understand its effects on this population.

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A theory-driven organ donation campaign:a field intervention among university students in Iran

Marzieh LATIFI ; Sakineh RAKHSHANDEROU ; Katayoun NAJAFIZADEH ; Courtney A ROCHELEAU ; Mohtasham GHAFFARI

Clinical Transplantation and Research.2024;38(2):90-97. doi:10.4285/ctr.24.0022

Background: This study conducted an empirical evaluation of an intervention derived from the theory of planned behavior (TPB) aimed at implementing a health campaign among medical students at Shahid Beheshti University of Medical Sciences. Methods: In this interventional study, a valid and reliable TPB-based questionnaire was administered before launching a health campaign titled “Organ Donation=Life Donation” among 260 medical students. The campaign was structured around nine steps:situation analysis, goal identification, target audience identification, strategy development, tactics establishment, media selection, timetable creation, budget planning, and program evaluation. Two months after the campaign, participants completed a posttest and were offered an organ donation card. Data analysis was conducted using SPSS ver.16, employing descriptive statistics (frequency and percentage) and tests such as the Kolmogorov-Smirnov test and the paired-samples t-test. Results: All participants adopted more prodonation stances across all constructs measured, both immediately and 2 months after exposure to the health campaign, compared to their pretest scores. These results indicate that the health campaign had a significant impact on psychological variables such as attitudes (P<0.001), subjective norms (P<0.001), and perceived behavioral control (P<0.038), as well as on the actual acceptance of an organ donor card. Conclusions Effective health education and promotion interventions, including health campaigns, are essential to encourage the use of organ donation cards. Additionally, current experiences indicate that the TPB serves as a suitable theoretical framework for designing organ donation interventions.

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Perioperative optic nerve sheath diameter variations in patients with end-stage renal failure undergoing robotic-assisted kidney transplant: a prospective observational study

Nisha RAJMOHAN ; Jithendra THIRUVATHTRA ; Shilpa OMKARAPPA ; Sangeeth Perath SRINIVASAN ; Nidhin ELDO ; Rajesh RAJGOPAL

Clinical Transplantation and Research.2024;38(2):106-115. doi:10.4285/ctr.24.0007

Background: Patients with chronic kidney disease (CKD) who undergo hemodialysis are predisposed to interstitial cerebral edema. Robotic-assisted laparoscopic surgery can increase optic nerve sheath diameter (ONSD) and intracranial pressure. The impact of robotic-assisted kidney transplant (RAKT) on ONSD is complicated by the presence of CKD, the administration of furosemide and mannitol, and the manipulation of hemodynamics. We examined ONSD variations in patients undergoing RAKT over a 1-year period at our institution. Furthermore, we attempted to identify any perioperative hemodynamic factors influencing these changes. Methods: This prospective study included 20 patients undergoing RAKT. ONSD, heart rate, central venous pressure, systolic blood pressure, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured following intubation (T1), after assuming the steep Trendelenburg position (T2), 1 hour after docking (T3), upon reperfusion (T4), after transition to the supine position (T5), and 3 hours postextubation (T6). Repeated measures analysis of variance with post hoc Bonferroni correction was employed to compare variables at each time point. Pearson correlation analysis wasutilized to assess relationships between variables. P-values ≤0.05 were considered toindicate statistical significance. Results: ONSD (in mm) increased from T1 (3.60±0.44) to T3 (4.06±0.45, P=0.002) and T4 (3.99±0.62, P=0.046), before falling to its lowest value at T6 (3.42±0.64, P=0.002). Pearson correlation analysis revealed significant correlations (P<0.05) between changes in ONSD at T3 and both DBP (r=0.637) and MAP (r=0.522). Conclusions During RAKT with open ureteric anastomosis, ONSD initially increased, then decreased following reperfusion. DBP and MAP displayed positive correlations with ONSD changes at T3.

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