Accurate estimation of kidney function in cirrhosis is crucial for prognosis and decisions regarding dual‐organ transplantation. We performed a systematic review/meta‐analysis to assess the ...performance of creatinine‐based and cystatin C (CysC)–based eGFR equations compared with measured GFR (mGFR) in patients with cirrhosis. A total of 25 studies (n = 4565, 52.0 years, 37.0% women) comprising 18 equations met the inclusion criteria. In all GFR equations, the creatinine‐based equations overestimated GFR (standardized mean difference, SMD, 0.51; 95% confidence interval CI, 0.31‐0.71) and CysC‐based equations underestimated GFR (SMD, −0.3; 95% CI, −0.60 to −0.02). Equations based on both creatinine and CysC were the least biased (SMD, −0.14; 95% CI, −0.46 to 0.18). Chronic kidney disease–Epi–serum creatinine–CysC (CESC) was the least biased but had low precision and underestimated GFR by −3.6 mL/minute/1.73 m2 (95% CI, −17.4 to 10.3). All equations significantly overestimated GFR (+21.7 mL/minute/1.73 m2; 95% CI, 17.7‐25.7) at GFR <60 mL/minute/1.73 m2; of these, chronic kidney disease–Epi–CysC (10.3 mL/minute/1.73 m2; 95% CI, 2.1‐18.4) and GFR Assessment in Liver Disease (12.6 mL/minute/1.73 m2; 95% CI, 7.2‐18.0) were the least biased followed by Royal Free Hospital (15 mL/minute/1.73 m2; 95% CI, 5.5‐24.6) and Modification of Diet in Renal Disease 6 (15.7 mL/minute/1.73 m2; 95% CI, 10.6‐20.8); however, there was an overlap in the precision of estimates, and the studies were limited. In ascites, overestimation of GFR was common (+8.3 mL/minute/1.73 m2; 95% CI, −3.1 to 19.7). However, overestimation of GFR by 10 to 20 mL/minute/1.73m2 is common in patients with cirrhosis with most equations in ascites and/or kidney dysfunction. A tailored approach is required especially for decisions regarding dual‐organ transplantation.
In this contribution, a dithienocyclopentacarbazole (DTC)-based and two dithieno3,2-
b
thiophenecyclopentacarbazole (DTTC)-based non-fullerene acceptors (NFAs) named DTC-4F, DTTC-4F and DTTC-4Cl were ...exploited to elucidate the effects of conjugation extension and end group chlorination. DTTC-4F was designed through conjugation extension on the basis of DTC-4F by fusing one additional thiophene on both flanks of the heptacyclic DTC core, generating the nonacyclic DTTC core. Compared with DTC-4F, DTTC-4F features up-shifted energy levels, red-shifted absorption and enhanced π-π interaction. PM6:DTTC-4F exhibits a decent PCE of 13.89% with a
V
OC
of 0.95 V, a
J
SC
of 21.66 mA cm
−2
and a FF of 67.60%
.
Although DTTC-4F affords a reduced FF compared to DTC-4F, a DTTC-4F-based device delivers a higher PCE than DTC-4F-based devices due to the extended absorption range of DTCC-4F in comparison with DTC-4F. Since chlorinated NFAs are known to possess stronger π-π interaction than fluorinated NFAs, DTTC-4Cl was therefore synthesized by end-capping DTTC core with 2Cl-IC groups instead of 2F-IC groups. Moreover, DTTC-4Cl demonstrates a red-shifted absorption in comparison with DTTC-4F, which is beneficial for light-harvesting. Overall, PM6:DTTC-4Cl affords an outstanding PCE of 15.42% with a
V
OC
of 0.92 V, a
J
SC
of 22.64 mA cm
−2
and a FF of 74.04%, which is the record PCE observed in carbazole-based NFAs.
A systematic approach involving conjugation extension and end group chlorination is capable of enhancing both
J
SC
and PCE. Overall, the PM6:DTTC-4Cl-based device delivers a remarkable PCE of 15.42% with a
V
OC
of 0.92 V, a
J
SC
of 22.64 mA cm
−2
and an FF of 74.04%.
•HepB-CpG is an immune adjuvanted vaccine that has not been used previously in patients who require chronic use of immunosuppressive medications.•Two groups of medically immunosuppressed patients ...were given either 2 or 3 doses of the vaccine as per protocol.•Patients taking low potency immunosuppressive drugs had more rapid and higher anti-HBs concentrations generally after 2 doses of the vaccine.•Patients taking moderate potency immunosuppressive drugs had a slower antibody response and generally required 3 doses of the vaccine.•Antibody responses to HepB-CpG were better compared to historical cohorts vaccinated with traditional recombinant HBV vaccine.
Immunosuppressed patients are a targeted group for HBV vaccination but suboptimal antibody responses occur when traditional recombinant vaccines are used.
We tested an FDA approved immune adjuvanted HBV vaccine (HEPLISAV--B® or HepB-CpG) in medically immune suppressed individuals. HepB-CpG was given to 10 patients taking biologic agents or anti-rejection therapy. Each received vaccine at time 0 and week 4 with a third dose at week 12 if anti-HBs remained less than 10 mIU/mL.
Seroprotective anti-HBs developed in 70 % of participants by week 24. Those taking biologic agents responded more rapidly and a third dose was generally needed in those transplanted. By week 24, most taking biologics but only 2 of 6 on anti-rejection treatment had antibody levels exceeding 100 mIU/mL.
Seroprotective anti-HBs developed in 70 % with HepB-CpG. Antibody responses were more rapid in those taking biologic agents but a third dose improved antibody responses in transplanted participants.
Standard US practice for donation after circulatory death (DCD) abdominal organ procurement is superrapid recovery (SRR). A newer approach using thoracoabdominal normothermic regional perfusion ...(TA-NRP) shows promise for better recipient outcomes for all organs, but there are few reports of abdominal recipient outcomes from TA-NRP donors. We used the United Network for Organ Sharing data to identify all cardiac DCD donors from October 1, 2020, to May 20, 2022, and categorized them by recovery procedure (SRR vs TA-NRP). We then identified all liver, kidney, and pancreas recipients of these donors for whom 6-month outcome data were available and compared patient and graft survival, kidney delayed graft function (DGF), and biliary complications between TA-NRP DCD and SRR DCD organ recipients. Patient and graft survival did not differ significantly between groups for either kidney or liver recipients. Significantly fewer TA-NRP kidney recipients developed DGF (12.7% 15/118 vs 42.0% 84/200, P <.001), and TA-NRP and pumped kidneys had lower odds for DGF on multivariate analysis. No liver recipients in either group had biliary complications or were relisted for transplantation for ischemic cholangiopathy. Although long-term outcomes need to be investigated, our early results show similar outcomes for recipients of TA-NRP DCD abdominal organs versus recipients of SRR DCD abdominal organs. We believe that TA-NRP is an effective approach to expand the use of DCD organs.
Sensible selection of host blends and the third component is crucial to give full play to the advantages of the ternary strategy for achieving high efficiency polymer solar cells (PSCs). In this ...work, a PM6:BTP-BO-4Cl binary system and non-fullerene acceptor DTTC-4ClC9 with the dithienocyclopentacarbazole (DTC) core are selected as the host blend and the third component, respectively. DTTC-4ClC9 and BTP-BO-4Cl are found to have excellent miscibility, and the addition of DTTC-4ClC9 into the binary blend can modify the morphology of the film, which brings out an improved charge transport and obviously enhanced exciton dissociation ability. The non-radiative energy loss of the devices is significantly reduced to 0.207 eV when employing the ternary strategy, thus leading to a reduction in energy loss. As a result, the introduction of 15% DTTC-4ClC9 in the PM6:BTP-BO-4Cl system can promote the power conversion efficiency from 17.11% to remarkable 18.21%, meanwhile, the open-circuit voltage, short-circuit current density, and fill factor are increased simultaneously.
Non‐contrast pelvic computed tomography (CT) can detect severe iliac artery calcifications that present technical contraindications to kidney transplantation (TCT). We screened 454 asymptomatic ...patients with a history of any of the following: hemodialysis >10 years, diabetes mellitus >20 years, coronary artery disease (CAD) with percutaneous or surgical interventions, carotid disease, diabetes with below‐/above‐knee amputations, and heart‐kidney transplantation candidacy. Patients with normal dorsalis pedis and/or tibialis posterior pulses were not screened. A total of 8.4% had severe calcifications with TCT; CT determined laterality for implantation in 13.9%. No patients with the following characteristics were classified as TCT: age <40 years, hemodialysis >10 years, carotid arterial disease, prior lower extremity amputation, or heart‐kidney transplantation candidacy. CAD was associated with TCT in univariate though not multivariate analysis. Limiting screening to patients >40 years, with DM >20 years, or with CAD, 9.8% had a TCT and CT determined transplant laterality in 14.2%. Screening for severe iliac artery calcifications is useful for selected kidney transplantation candidates over age 40. It can assist with laterality choice or surgeon determination of TCT. Cost and radiation exposure risks should be weighed against the morbidity risks from unnecessary surgery.
Uterus transplantation (UTx) enables pregnancy in infertile women. This study describes the histopathological changes of ischemia reperfusion injury and mostly acute T-cell-mediated rejection (TCMR) ...in UTx and proposes modification toward a working formulation grading system with associated treatments.
Protocol and indication biopsies from 11 living and 2 deceased donor UTx recipients were analyzed. Serving as a control were 49 age-matched nontransplanted uteri. All posttransplant histopathological specimens were evaluated in a blinded fashion by 3 pathologists. Response to treatment was assessed by follow-up biopsies. Serial serum donor-specific antibody (DSA) responses were also recorded.
Changes attributed to ischemia reperfusion resolved within 2 wk of UTx in most of the patients. For TCMR grading, perivascular inflammation, focal capillary disruption, and interstitial hemorrhage were added to interface inflammation, intercellular edema, stromal inflammation, and epithelial apoptotic bodies. Of the 173 protocol biopsies, 98 were classified as negative for TCMR; 34 as indeterminate-borderline; 35 as mild; 3 as moderate; and 3 as severe, 1 of which occurred in a DSA-positive recipient and also showed microvascular injury. Corticosteroids successfully treated all moderate-to-severe TCMR episodes. Mild TCMR was treated by increasing existing baseline immunosuppression. Indeterminate-borderline episodes were not treated. Neither ischemia-reperfusion injury nor TCMR with DSA adversely affected embryo transfer.
Relying on a modified histopathological grading system, we developed a treatment strategy resulting in resolution of TCMR and successful pregnancies.
Abstract
Purpose
Post-transplantation anemia (PTA) is common in kidney transplant recipients, with patients frequently treated with erythropoietin-stimulating agents such as darbepoetin alfa. The ...optimal dosing for darbepoetin alfa remains controversial.
Methods
This retrospective cohort study involved kidney transplant recipients who received darbepoetin alfa at 2 clinics. Patients were stratified into 2 groups: those who received a fixed dose of 200 μg and those who received a weight-based dose of 0.45 μg/kg. The dosing interval varied depending on clinical response, clinic visit timing, and frequency allowed by insurance. The primary outcome was achieving a hemoglobin concentration of at least 10 g/dL without blood transfusion by 12 weeks after darbepoetin alfa initiation.
Results
Of the 110 patients in the study, 45% received weight-based dosing and 55% received fixed dosing. Darbepoetin alfa was initiated significantly earlier after transplantation in the fixed-dose group (median of 14 vs 20 days; P = 0.003). The weight-based group received more doses of darbepoetin alfa (median of 4 vs 2 doses; P = 0.002) and had a significantly lower cumulative exposure to darbepoetin alfa (125 vs 590 μg; P < 0.001). The median time between doses was 9 days (interquartile range, 7-14 days) in the weight-based group and 12 days (7-32 days) in the fixed-dose group (P = 0.04). Patients in the weight-based group more frequently achieved the primary outcome (67.3% vs 47.5%; P = 0.059). There was no significant difference in secondary or safety outcomes between the groups.
Conclusion
Weight-based and fixed dosing approaches for darbepoetin alfa were not different in the achievement of a hemoglobin concentration of at least 10 g/dL without blood transfusion at 12 weeks after darbepoetin alfa initiation, with significantly lower cumulative darbepoetin alfa utilization in the weight-based group. Weight-based dosing of darbepoetin alfa in PTA appears to be safe and effective, with the potential for significant patient and health-system cost savings.