Background: Primary non-function(PNF) and early allograft failure(EAF) after liver transplantation(LT) seriously affect patient outcomes. In clinical practice, effective prognostic tools for early identifying recipien...Background: Primary non-function(PNF) and early allograft failure(EAF) after liver transplantation(LT) seriously affect patient outcomes. In clinical practice, effective prognostic tools for early identifying recipients at high risk of PNF and EAF were urgently needed. Recently, the Model for Early Allograft Function(MEAF), PNF score by King's College(King-PNF) and Balance-and-Risk-Lactate(BAR-Lac) score were developed to assess the risks of PNF and EAF. This study aimed to externally validate and compare the prognostic performance of these three scores for predicting PNF and EAF. Methods: A retrospective study included 720 patients with primary LT between January 2015 and December 2020. MEAF, King-PNF and BAR-Lac scores were compared using receiver operating characteristic(ROC) and the net reclassification improvement(NRI) and integrated discrimination improvement(IDI) analyses. Results: Of all 720 patients, 28(3.9%) developed PNF and 67(9.3%) developed EAF in 3 months. The overall early allograft dysfunction(EAD) rate was 39.0%. The 3-month patient mortality was 8.6% while 1-year graft-failure-free survival was 89.2%. The median MEAF, King-PNF and BAR-Lac scores were 5.0(3.5–6.3),-2.1(-2.6 to-1.2), and 5.0(2.0–11.0), respectively. For predicting PNF, MEAF and King-PNF scores had excellent area under curves(AUCs) of 0.872 and 0.891, superior to BAR-Lac(AUC = 0.830). The NRI and IDI analyses confirmed that King-PNF score had the best performance in predicting PNF while MEAF served as a better predictor of EAD. The EAF risk curve and 1-year graft-failure-free survival curve showed that King-PNF was superior to MEAF and BAR-Lac scores for stratifying the risk of EAF. Conclusions: MEAF, King-PNF and BAR-Lac were validated as practical and effective risk assessment tools of PNF. King-PNF score outperformed MEAF and BAR-Lac in predicting PNF and EAF within 6 months. BAR-Lac score had a huge advantage in the prediction for PNF without post-transplant variables. Proper use of these scores will help early identify PNF, standardize grading of EAF and reasonably select clinical endpoints in relative studies.展开更多
To the Editor:The shortage of deceased donor(DD)kidneys for transplantation remains a persistent concern.Despite the potential reversibility of acute kidney injury(AKI)lesions,kidneys from pediatric donors with AKI ar...To the Editor:The shortage of deceased donor(DD)kidneys for transplantation remains a persistent concern.Despite the potential reversibility of acute kidney injury(AKI)lesions,kidneys from pediatric donors with AKI are often underutilized,especially in the context of pediatric transplantation.By implementing single kidney transplantation(SKT)from pediatric donors to pediatric recipients(PTP),we can optimize the utilization of available kidneys and increase the number of pediatric recipients.展开更多
Graft versus host disease(GVHD)is a refractory complication of allogeneic hematopoietic stem cell transplantation for the treatment of malignant and non-malignant hematopoietic diseases.Inflammatory cascade responses ...Graft versus host disease(GVHD)is a refractory complication of allogeneic hematopoietic stem cell transplantation for the treatment of malignant and non-malignant hematopoietic diseases.Inflammatory cascade responses and cellular immune reactions are the major factors underlying GVHD pathogenesis.Cells producing the cytokine,interleukin(IL)-21 are crucial players involved in injured tissues in GVHD patients.Besides T helper 17 cells,follicular T helper(Tfh)cells are a new source of IL-21 and play a vital role in GVHD pathogenesis.Tfh cell function is mostly regulated by T-follicular regulatory(Tfr)cells that are also located in the germinal center.This review highlights recent advances in the role of Tfh and Tfr cell function in GVHD pathogenesis.New insights are provided into the potential for clinical application in GVHD prevention and treatment.展开更多
Background and Aims:Increasing utilization of extended criteria donor leads to an increasing rate of early allograft failure after liver transplantation.However,consensus of definition of early allograft failure is la...Background and Aims:Increasing utilization of extended criteria donor leads to an increasing rate of early allograft failure after liver transplantation.However,consensus of definition of early allograft failure is lacking.Methods:A retrospective,multicenter study was performed to validate the Liver Graft Assessment Following Transplantation(L-GrAFT)risk model in a Chinese cohort of 942 adult patients undergoing primary liver transplantation at three Chinese centers.L-GrAFT(L-GrAFT7 and L-GrAFT10)was compared with existing models:the Early Allograft Failure Simplified Estimation(EASE)score,the model of early allograft function(MEAF),and the Early Allograft Dysfunction(EAD)model.Univariate and multivariate logistic regression were used to find risk factors of L-GrAFT high-risk group.Results:L-GrAFT7 had an area under the curve of 0.85 in predicting 90-day graft survival,significantly superior to MEAF[area under the curve(AUC=0.78,p=0.044)]and EAD(AUC=0.78,p=0.006),while there was no statistical significance between the predicting abilities of L-GrAFT7 and EASE(AUC=0.84,p>0.05).Furthermore,L-GrAFT7 maintains good predicting ability in the subgroup of high-donor risk index(DRI)cases(AUC=0.83 vs.MEAF,p=0.007 vs.EAD,p=0.014)and recipients of donors after cardiac death(AUC=0.92 vs.EAD,p<0.001).Through multivariate analysis,pretransplant bilirubin level,units of packed red blood cells,and the DRI score were selected as independent risk factors of a L-GrAFT7 high-risk group.Conclusions:The accuracy of L-GrAFT7 in predicting early allograft failure was validated in a Chinese multicenter cohort,indicating that it has the potential to become an accurate endpoint of clinical practice and transitional study of machine perfusion.展开更多
基金supported by grants from the National Nat-ural Science Foundation of China (81570587 and 81700557)the Guangdong Provincial Key Laboratory Construction Projection on Organ Donation and Transplant Immunology (2013A061401007 and 2017B030314018)+3 种基金Guangdong Provincial Natural Science Funds for Major Basic Science Culture Project (2015A030308010)Science and Technology Program of Guangzhou (201704020150)the Natural Science Foundations of Guangdong province (2016A030310141 and 2020A1515010091)Young Teachers Training Project of Sun Yat-sen University (K0401068) and the Guangdong Science and Technology Innovation Strategy (pdjh2022b0010 and pdjh2023a0002)。
文摘Background: Primary non-function(PNF) and early allograft failure(EAF) after liver transplantation(LT) seriously affect patient outcomes. In clinical practice, effective prognostic tools for early identifying recipients at high risk of PNF and EAF were urgently needed. Recently, the Model for Early Allograft Function(MEAF), PNF score by King's College(King-PNF) and Balance-and-Risk-Lactate(BAR-Lac) score were developed to assess the risks of PNF and EAF. This study aimed to externally validate and compare the prognostic performance of these three scores for predicting PNF and EAF. Methods: A retrospective study included 720 patients with primary LT between January 2015 and December 2020. MEAF, King-PNF and BAR-Lac scores were compared using receiver operating characteristic(ROC) and the net reclassification improvement(NRI) and integrated discrimination improvement(IDI) analyses. Results: Of all 720 patients, 28(3.9%) developed PNF and 67(9.3%) developed EAF in 3 months. The overall early allograft dysfunction(EAD) rate was 39.0%. The 3-month patient mortality was 8.6% while 1-year graft-failure-free survival was 89.2%. The median MEAF, King-PNF and BAR-Lac scores were 5.0(3.5–6.3),-2.1(-2.6 to-1.2), and 5.0(2.0–11.0), respectively. For predicting PNF, MEAF and King-PNF scores had excellent area under curves(AUCs) of 0.872 and 0.891, superior to BAR-Lac(AUC = 0.830). The NRI and IDI analyses confirmed that King-PNF score had the best performance in predicting PNF while MEAF served as a better predictor of EAD. The EAF risk curve and 1-year graft-failure-free survival curve showed that King-PNF was superior to MEAF and BAR-Lac scores for stratifying the risk of EAF. Conclusions: MEAF, King-PNF and BAR-Lac were validated as practical and effective risk assessment tools of PNF. King-PNF score outperformed MEAF and BAR-Lac in predicting PNF and EAF within 6 months. BAR-Lac score had a huge advantage in the prediction for PNF without post-transplant variables. Proper use of these scores will help early identify PNF, standardize grading of EAF and reasonably select clinical endpoints in relative studies.
基金supported by funding from the National Natural Science Foundation of China(Nos.81870511,82170770,and 82200848)Natural Science Foundation of Guangdong Province(No.2023A1515010139)+6 种基金Science and Technology Planning Project of Guangzhou City(No.202201011318)Key Clinical Technique of Guangzhou(No.2023P-ZD15)Elite Talent Project of Guangdong Province(No.R09002)Guangdong Basic and Applied Basic Research Foundation(No.2020A1515010884)Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology(No.2020B1212060026)Guangdong Provincial International Cooperation Base of Science and Technology(No.2020A0505020003)Science Research Cultivation Program of Stomatological Hospital,Southern Medical University(No.PY2021026)
文摘To the Editor:The shortage of deceased donor(DD)kidneys for transplantation remains a persistent concern.Despite the potential reversibility of acute kidney injury(AKI)lesions,kidneys from pediatric donors with AKI are often underutilized,especially in the context of pediatric transplantation.By implementing single kidney transplantation(SKT)from pediatric donors to pediatric recipients(PTP),we can optimize the utilization of available kidneys and increase the number of pediatric recipients.
基金This work was in part supported by the National Natural Science Foundation of China(81373156,81570587,81401324,81671611)Science and Technology Planning Project of Guangdong Province(2016A020215048,2014A030308005)+1 种基金Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology(2013A061401007)Guangdong Provincial International Cooperation Base of Science and Technology(Organ Transplantation)(2015B050501002),China.
文摘Graft versus host disease(GVHD)is a refractory complication of allogeneic hematopoietic stem cell transplantation for the treatment of malignant and non-malignant hematopoietic diseases.Inflammatory cascade responses and cellular immune reactions are the major factors underlying GVHD pathogenesis.Cells producing the cytokine,interleukin(IL)-21 are crucial players involved in injured tissues in GVHD patients.Besides T helper 17 cells,follicular T helper(Tfh)cells are a new source of IL-21 and play a vital role in GVHD pathogenesis.Tfh cell function is mostly regulated by T-follicular regulatory(Tfr)cells that are also located in the germinal center.This review highlights recent advances in the role of Tfh and Tfr cell function in GVHD pathogenesis.New insights are provided into the potential for clinical application in GVHD prevention and treatment.
文摘Background and Aims:Increasing utilization of extended criteria donor leads to an increasing rate of early allograft failure after liver transplantation.However,consensus of definition of early allograft failure is lacking.Methods:A retrospective,multicenter study was performed to validate the Liver Graft Assessment Following Transplantation(L-GrAFT)risk model in a Chinese cohort of 942 adult patients undergoing primary liver transplantation at three Chinese centers.L-GrAFT(L-GrAFT7 and L-GrAFT10)was compared with existing models:the Early Allograft Failure Simplified Estimation(EASE)score,the model of early allograft function(MEAF),and the Early Allograft Dysfunction(EAD)model.Univariate and multivariate logistic regression were used to find risk factors of L-GrAFT high-risk group.Results:L-GrAFT7 had an area under the curve of 0.85 in predicting 90-day graft survival,significantly superior to MEAF[area under the curve(AUC=0.78,p=0.044)]and EAD(AUC=0.78,p=0.006),while there was no statistical significance between the predicting abilities of L-GrAFT7 and EASE(AUC=0.84,p>0.05).Furthermore,L-GrAFT7 maintains good predicting ability in the subgroup of high-donor risk index(DRI)cases(AUC=0.83 vs.MEAF,p=0.007 vs.EAD,p=0.014)and recipients of donors after cardiac death(AUC=0.92 vs.EAD,p<0.001).Through multivariate analysis,pretransplant bilirubin level,units of packed red blood cells,and the DRI score were selected as independent risk factors of a L-GrAFT7 high-risk group.Conclusions:The accuracy of L-GrAFT7 in predicting early allograft failure was validated in a Chinese multicenter cohort,indicating that it has the potential to become an accurate endpoint of clinical practice and transitional study of machine perfusion.
