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1. Advancing mouse models for transplantation research

Author

Cravedi, Paolo, Riella, Leonardo V., Ford, Mandy L., Valujskikh, Anna, Menon, Madhav C., Kirk, Allan D., Alegre, Maria-Luisa, Alessandrini, Alessandro, Feng, Sandy, Kehn, Patricia, Najafian, Nader, Hancock, Wayne W., Heeger, Peter S., Maltzman, Jonathan S., Mannon, Roslyn B., Nadig, Satish N., Odim, Jonah, Turnquist, Heth, Shaw, Julia, West, Lori, Luo, Xunrong, Chong, Anita S., and Bromberg, Jonathan S.

Published
2024
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2. Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health

Author

Bellamy, Christopher O.C., O'Leary, Jacqueline G., Adeyi, Oyedele, Baddour, Nahed, Batal, Ibrahim, Bucuvalas, John, Del Bello, Arnaud, El Hag, Mohamed, El-Monayeri, Magda, Farris, Alton B., III, Feng, Sandy, Fiel, Maria Isabel, Fischer, Sandra E., Fung, John, Grzyb, Krzysztof, Guimei, Maha, Haga, Hironori, Hart, John, Jackson, Annette M., Jaeckel, Elmar, Khurram, Nigar A., Knechtle, Stuart J., Lesniak, Drew, Levitsky, Josh, McCaughan, Geoff, McKenzie, Catriona, Mescoli, Claudia, Miquel, Rosa, Minervini, Marta I., Nasser, Imad Ahmad, Neil, Desley, O'Neil, Maura F., Pappo, Orit, Randhawa, Parmjeet, Ruiz, Phillip, Fueyo, Alberto Sanchez, Schady, Deborah, Schiano, Thomas, Sebagh, Mylene, Smith, Maxwell, Stevenson, Heather L., Taner, Timucin, Taubert, Richard, Thung, Swan, Trunecka, Pavel, Wang, Hanlin L., Wood-Trageser, Michelle, Yilmaz, Funda, Zen, Yoh, Zeevi, Adriana, and Demetris, Anthony J.

Published
2024
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3. Transforming the Future of Surgeon-Scientists

Author

Ladner, Daniela P., Goldstein, Allan M., Billiar, Timothy R., Cameron, Andrew M., Carpizo, Darren R., Chu, Daniel I., Coopersmith, Craig M., DeMatteo, Ronald P., Feng, Sandy, Gallagher, Katherine A., Gillanders, William E., Lal, Brajesh K., Lipshutz, Gerald S., Liu, Annie, Maier, Ronald V., Mittendorf, Elizabeth A., Morris, Arden M., Sicklick, Jason K., Velazquez, Omaida C., Whitson, Bryan A., Wilke, Lee G., Yoon, Sam S., Zeiger, Martha A., Farmer, Diana L., and Hwang, E. Shelley

Published
2024
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5. Addressing sex-based disparities in solid organ transplantation in the United States – a conference report

Author

Sawinski, Deirdre, Lai, Jennifer C., Pinney, Sean, Gray, Alice L., Jackson, Annette M., Stewart, Darren, Levine, Deborah Jo, Locke, Jayme E., Pomposelli, James J., Hartwig, Matthew G., Hall, Shelley A., Dadhania, Darshana M., Cogswell, Rebecca, Perez, Richard V., Schold, Jesse D., Turgeon, Nicole A., Kobashigawa, Jon, Kukreja, Jasleen, Magee, John C., Friedewald, John, Gill, John S., Loor, Gabriel, Heimbach, Julie K., Verna, Elizabeth C., Walsh, Mary Norine, Terrault, Norah, Testa, Guiliano, Diamond, Joshua M., Reese, Peter P., Brown, Kimberly, Orloff, Susan, Farr, Maryjane A., Olthoff, Kim M., Siegler, Mark, Ascher, Nancy, Feng, Sandy, Kaplan, Bruce, and Pomfret, Elizabeth

Published
2023
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6. Normothermic Machine Perfusion of Donor Livers for Transplantation in the United States – A Randomized Controlled Trial

Author

Chapman, William C., Barbas, Andrew S., D’Alessandro, Anthony M., Vianna, Rodrigo, Kubal, Chandrashekhar A., Abt, Peter, Sonnenday, Christopher, Barth, Rolf, Alvarez-Casas, Josue, Yersiz, Hasan, Eckhoff, Devin, Cannon, Robert, Genyk, Yuri, Sher, Linda, Singer, Andrew, Feng, Sandy, Roll, Garrett, Cohen, Ari, Doyle, Maria B., Sudan, Debra L., Al-Adra, David, Khan, Adeel, Subramanian, Vijay, Abraham, Nader, Olthoff, Kim, Tekin, Akin, Berg, Lynn, Coussios, Constantin, Morris, Chris, Randle, Lucy, Friend, Peter, and Knechtle, Stuart J.

Published
2023
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8. The molecular phenotypes of injury, steatohepatitis, and fibrosis in liver transplant biopsies in the INTERLIVER study

Author

Madill-Thomsen, Katelynn S., Abouljoud, Marwan, Bhati, Chandra, Ciszek, Michał, Durlik, Magdalena, Feng, Sandy, Foroncewicz, Bartosz, Francis, Iman, Grąt, Michał, Jurczyk, Krzysztof, Klintmalm, Goran, Krasnodębski, Maciej, McCaughan, Geoff, Miquel, Rosa, Montano-Loza, Aldo, Moonka, Dilip, Mucha, Krzysztof, Myślak, Marek, Pączek, Leszek, Perkowska-Ptasińska, Agnieszka, Piecha, Grzegorz, Reichman, Trevor, Sanchez-Fueyo, Alberto, Tronina, Olga, Wawrzynowicz-Syczewska, Marta, Więcek, Andrzej, Zieniewicz, Krzysztof, and Halloran, Philip F.

Published
2022
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9. The molecular diagnosis of rejection in liver transplant biopsies: First results of the INTERLIVER study

Author

Madill-Thomsen, Katelynn, Abouljoud, Marwan, Bhati, Chandra, Ciszek, Michał, Durlik, Magdalena, Feng, Sandy, Foroncewicz, Bartosz, Francis, Iman, Grąt, Michał, Jurczyk, Krzysztof, Klintmalm, Goran, Krasnodębski, Maciej, McCaughan, Geoff, Miquel, Rosa, Montano-Loza, Aldo, Moonka, Dilip, Mucha, Krzysztof, Myślak, Marek, Pączek, Leszek, Perkowska-Ptasińska, Agnieszka, Piecha, Grzegorz, Reichman, Trevor, Sanchez-Fueyo, Alberto, Tronina, Olga, Wawrzynowicz-Syczewska, Marta, Więcek, Andrzej, Zieniewicz, Krzysztof, and Halloran, Philip F.

Published
2020
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16. Evidence of Chronic Allograft Injury in Liver Biopsies From Long-term Pediatric Recipients of Liver Transplants

Author

Feng, Sandy, Bucuvalas, John C., Demetris, Anthony J., Burrell, Bryna E., Spain, Katherine M., Kanaparthi, Sai, Magee, John C., Ikle, David, Lesniak, Andrew, Lozano, Juan J., Alonso, Estella M., Bray, Robert A., Bridges, Nancy E., Doo, Edward, Gebel, Howard M., Gupta, Nitika A., Himes, Ryan W., Jackson, Annette M., Lobritto, Steven J., Mazariegos, George V., Ng, Vicky L., Rand, Elizabeth B., Sherker, Averell H., Sundaram, Shikha, Turmelle, Yumirle P., and Sanchez-Fueyo, Alberto

Published
2018
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17. Advantages and Limitations of Clinical Scores for Donation After Circulatory Death Liver Transplantation.

Author

Meier, Raphael P. H., Kelly, Yvonne, Yamaguchi, Seiji, Braun, Hillary J., Lunow-Luke, Tyler, Adelmann, Dieter, Niemann, Claus, Maluf, Daniel G., Dietch, Zachary C., Stock, Peter G., Sang-Mo Kang, Feng, Sandy, Posselt, Andrew M., Gardner, James M., Syed, Shareef M., Hirose, Ryutaro, Freise, Chris E., Ascher, Nancy L., Roberts, John P., and Roll, Garrett R.

Published
2024
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21. Time since liver transplant and immunosuppression withdrawal outcomes: Systematic review and individual patient data meta‐analysis.

Author

Appenzeller‐Herzog, Christian, Rosat, Aurélie, Mathes, Tim, Baroja‐Mazo, Alberto, Chruscinski, Andrzej, Feng, Sandy, Herrero, Ignacio, Londono, Maria‐Carlota, Mazariegos, George, Ohe, Hidenori, Pons, José A., Sanchez‐Fueyo, Alberto, Waki, Kayo, and Vionnet, Julien

Subjects
LIVER transplantation, IMMUNOSUPPRESSION, CONFIDENCE intervals, PROGNOSIS
Abstract

Background & Aims: Successful immunosuppression withdrawal (ISW) is possible for a subfraction of liver transplant (LT) recipients but the factors that define the risk of ISW failure are largely unknown. One candidate prognostic factor for ISW success or operational tolerance (OT) is longer time between LT and ISW which we term "pre‐withdrawal time". To clarify the impact of pre‐withdrawal time span on subsequent ISW success or failure, we conducted a systematic review with meta‐analysis. Methods: We systematically interrogated the literature for LT recipient ISW studies reporting pre‐withdrawal time. Eligible articles from Embase, Medline, and the Cochrane Central Register of Controlled Trials were used for backward and forward citation searching. Pre‐withdrawal time individual patient data (IPD) was requested from authors. Pooled mean differences and time‐response curves were calculated using random‐effects meta‐analyses. Results: We included 17 studies with 691 patients, 15 of which (620 patients) with IPD. Study‐level risk of bias was heterogeneous. Mean pre‐withdrawal time was greater by 427 days [95% confidence interval (CI) 67–788] in OT compared to non‐OT patients. This increase was potentiated to 799 days (95% CI 369–1229) or 1074 days (95% CI 685–1463) when restricting analysis to adult or European study participants. In time‐response meta‐analysis for adult or European ISW candidates, likelihood of OT increased by 7% (95% CI 4–10%) per year after LT (GRADE low‐ and moderate‐certainty of evidence, respectively). Conclusions: Our data support the impact of pre‐withdrawal time in ISW decision‐making for adult and European LT recipients. PROSPERO REGISTRATION: CRD42021272995. [ABSTRACT FROM AUTHOR]

Published
2024
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24. Recommended Treatment for Antibody-mediated Rejection After Kidney Transplantation: The 2019 Expert Consensus From the Transplantion Society Working Group

Author

Schinstock, Carrie A., Mannon, Roslyn B., Budde, Klemens, Chong, Anita S., Haas, Mark, Knechtle, Stuart, Lefaucheur, Carmen, Montgomery, Robert A., Nickerson, Peter, Tullius, Stefan G., Ahn, Curie, Askar, Medhat, Crespo, Marta, Chadban, Steven J., Feng, Sandy, Jordan, Stanley C., Man, Kwan, Mengel, Michael, Morris, Randall E., O’Doherty, Inish, Ozdemir, Binnaz H., Seron, Daniel, Tambur, Anat R., Tanabe, Kazunari, Taupin, Jean-Luc, and O’Connell, Philip J.

Published
2020
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25. Novel autoantibody targets identified in patients with autoimmune hepatitis (AIH) by PhIP-Seq reveals pathogenic insights

Author

Klepper, Arielle, Kung, Andrew, Vazquez, Sara E., Mitchell, Anthea, Mann, Sabrina, Zorn, Kelsey, Avila-Vargas, Isaac, Kari, Swathi, Tekeste, Melawit, Castro, Javier, Lee, Briton, Duarte, Maria, Khalili, Mandana, Yang, Monica, Wolters, Paul, Price, Jennifer, Perito, Emily, Feng, Sandy, Maher, Jacquelyn J., Lai, Jennifer, Weiler-Normann, Christina, Lohse, Ansgar W, DeRisi, Joseph, and Tana, Michele

Subjects
Article
Abstract

Autoimmune hepatitis (AIH) is a severe autoimmune disease, characterized by the presence of autoantibodies. However, the role of autoantibodies in the pathophysiology of AIH remains uncertain. Here, we employed Phage Immunoprecipitation-Sequencing (PhIP-Seq) to identify novel autoantibodies in AIH. Using these results, a logistic regression classifier was able to predict which patients had AIH, indicating the presence of a distinct humoral immune signature. To further investigate the autoantibodies most specific to AIH, significant peptides were identified relative to a broad array of controls (298 patients with non-alcoholic fatty liver disease (NAFLD), primary biliary cholangitis (PBC), or healthy controls). Top ranked autoreactive targets included SLA, the target of a well-recognized autoantibody in AIH, and disco interacting protein 2 homolog A (DIP2A). The autoreactive fragment of DIP2A shares a 9-amino acid stretch nearly identical to the U27 protein of HHV-6B, a virus found in the liver. In addition, antibodies against peptides derived from the leucine rich repeat N-terminal (LRRNT) domain of the relaxin family peptide receptor 1 (RXFP1) were highly enriched and specific to AIH. The enriched peptides map to a motif adjacent to the receptor binding domain, which is required for RXFP1 signaling. RXFP1 is a G protein-coupled receptor that binds relaxin-2, an anti-fibrogenic molecule shown to reduce the myofibroblastic phenotype of hepatic stellate cells. Eight of nine patients with antibodies to RXFP1 had evidence of advanced fibrosis (F3 or greater). Furthermore, serum from AIH patients positive for anti-RFXP1 antibody was able to significantly inhibit relaxin-2 signaling in the human monocytic cell line, THP1. Depletion of IgG from anti-RXFP1 positive serum abrogated this effect. These data provide supporting evidence that HHV6 plays a role in the development of AIH and point to a potential pathogenic role for anti-RXFP1 IgG in some patients. Identification of anti-RXFP1 in patient serum may enable risk stratification of AIH patients for fibrosis progression and lead to the development of novel strategies for disease intervention.

Published
2023

27. Real‐world implementation of normothermic machine perfusion: A detailed analysis of intraoperative and early postoperative impact.

Author

Dixon, Wesley, Sheetz, Kyle, Adelmann, Dieter, Bokoch, Michael, Reddy, Meghana, Kothari, Rishi, Roberts, John P., Syed, Shareef, Feng, Sandy, and Roll, Garrett

Subjects
HOMOGRAFTS, PERFUSION, SURGICAL complications, PLASMA products, ERYTHROCYTES, TECHNOLOGICAL innovations
Abstract

Background: Outcome data for the great majority of liver normothermic machine perfusion (NMP) cases derive from the strict confines of clinical trials. Detailed specifics regarding the intraoperative and early postoperative impact of NMP on reperfusion injury and its sequelae during real‐world use of this emerging technology remain largely unavailable. Methods: We analyzed transplants performed in a 3‐month pilot period during which surgeons invoked commercial NMP at their discretion. Living donor, multi‐organ, and hypothermic machine perfusion transplants were excluded. Results: Intraoperatively, NMP (n = 24) compared to static cold storage (n = 25) recipients required less peri‐reperfusion bolus epinephrine (0 vs. 60 μg; p <.001) and post‐reperfusion fresh frozen plasma (2.5 vs. 7.0 units; p =.0069), platelets (.0 vs. 2.0 units; p =.042), and hemostatic agents (0% vs. 24%; p =.010). Time from incision to venous reperfusion did not differ (3.6 vs. 3.1; p =.095) but time from venous reperfusion to surgery end was shorter for NMP recipients (2.3 vs. 2.8 h; p =.0045). Postoperatively, NMP recipients required fewer red blood cell (1.0 vs. 4.0 units; p =.0083) and fresh frozen plasma (4.0 vs. 7.0 units; p =.046) transfusions, had shorter intensive care unit stays (33.5 vs. 58.4 h; p =.012), and experienced less early allograft dysfunction according to both the Model for Early Allograft Function Score (3.4 vs. 5.0; p =.0047) and peak AST within 10 days of transplant (619 vs. 1,181 U/L; p =.036). Liver acceptance for the corresponding recipient was conditional on NMP use for 63% (15/24) of cases. Conclusion: Real‐world NMP use was associated with significantly lower intensity of reperfusion injury and intraoperative and postoperative care that may translate into patient benefit. [ABSTRACT FROM AUTHOR]

Published
2023
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28. DCD liver transplant in patients with a MELD over 35.

Author

Meier, Raphael P. H., Nunez, Miguel, Syed, Shareef M., Feng, Sandy, Tavakol, Mehdi, Freise, Chris E., Roberts, John P., Ascher, Nancy L., Hirose, Ryutaro, and Roll, Garrett R.

Subjects
LIVER transplantation, BK virus, DISEASE risk factors, BRAIN death, PROPENSITY score matching, OVERALL survival
Abstract

Introduction: Donation after circulatory death (DCD) liver transplantation (LT) makes up well less than 1% of all LTs with a Model for End-Stage Liver Disease (MELD)≥35 in the United States. We hypothesized DCD-LT yields acceptable ischemia-reperfusion and reasonable outcomes for recipients with MELD≥35. Methods: We analyzed recipients with lab-MELD≥35 at transplant within the UCSF (n=41) and the UNOS (n=375) cohorts using multivariate Cox regression and propensity score matching. Results: In the UCSF cohort, five-year patient survival was 85% for DCD-LTs and 86% for matched-Donation after Brain Death donors-(DBD) LTs (p=0.843). Multivariate analyses showed that younger donor/recipient age and more recent transplants (2011-2021 versus 1999-2010) were associated with better survival. DCD vs. DBD graft use did not significantly impact survival (HR: 1.2, 95%CI 0.6-2.7). The transaminase peak was approximately doubled, indicating suggesting an increased ischemia-reperfusion hit. DCD-LTs had a median post-LT length of stay of 11 days, and 34% (14/41) were on dialysis at discharge versus 12 days and 22% (9/41) for DBD-LTs. 27% (11/41) DCD-LTs versus 12% (5/41) DBD-LTs developed a biliary complication (p=0.095). UNOS cohort analysis confirmed patient survival predictors, but DCD graft emerged as a risk factor (HR: 1.5, 95%CI 1.3-1.9) with five-year patient survival of 65% versus 75% for DBD-LTs (p=0.016). This difference became non-significant in a sub-analysis focusing on MELD 35-36 recipients. Analysis of MELD≥35 DCD recipients showed that donor age of <30yo independently reduced the risk of graft loss by 30% (HR, 95%CI: 0.7 (0.9-0.5), p=0.019). Retransplant status was associated with a doubled risk of adverse event (HR, 95%CI: 2.1 (1.4-3.3), p=0.001). The rejection rates at 1y were similar between DCD- and DBD-LTs, (9.3% (35/375) versus 1,541 (8.7% (1,541/17,677), respectively). Discussion: In highly selected recipient/donor pair, DCD transplantation is feasible and can achieve comparable survival to DBD transplantation. Biliary complications occurred at the expected rates. In the absence of selection, DCD-LTs outcomes remain worse than those of DBD-LTs. Introduction Donation after circulatory death donor (DCD) liver transplantation (LT) remains an underutilized option in the U.S. The use of DCD liver grafts is increasing, but overall remains low (1% in 2000, 6% in 2010, and 11% in 2020) (1). Ischemia-reperfusion injury, early allograft dysfunction and their impact on renal function and biliary complications are not well tolerated by high Model for End-Stage Liver Disease (MELD) recipients (2). We (3), and others (2, 4, 5), previously designed DCD risk scores to predict outcomes, however, the corollary is that high MELD recipients are not suitable for DCD-LT. Additionally, the resulting increase in resource utilization during recovery from transplant is a concern. Consequently, patients with a high MELD are rarely transplanted with livers from DCD donors despite the paucity of outcome data after DCD-LT in patients with a high MELD. The expectation is that a Donation after Brain Death donor (DBD) will become available within a reasonable time frame. This is, unfortunately, not always the case in regions with high median MELD at transplant, and patients with a high MELD continue to experience waitlist mortality and dropout. We previously compared the different options, including DCD, DBD, and living donors (6), and it is clear that DCDs remain an important option to consider, including for high MELD recipients. Machine preservation can be used to reduce risks of DCD-LT (7), but implementation of this resource-intensive advancement has been rationed as we await real-world outcome and resource utilization data, and alternatives to machine perfusion must be considered as part of this discussion (8). We hypothesized that select recipients with a lab MELD≥35 might tolerate increased ischemia-reperfusion and lead to acceptable morbidity/mortality, renal recovery, and biliary complications rates after DCD-LT using static cold storage. To test this hypothesis, we analyzed our local cohort of DCD-LTs in patients with MELD≥35 and compared them to matched DBD-LTs. We also compared our single-center cohort with the national DCD/DBD-LTs cohort. [ABSTRACT FROM AUTHOR]

Published
2023
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29. Mapping children by ALT 4–5 years after liver transplant: Potential individual and population applications.

Author

Dixon, Wesley, Perito, Emily R., Bucuvalas, John, and Feng, Sandy

Subjects
LIVER transplantation, LIVER biopsy, MEDICAL personnel, TACROLIMUS, STANDARD deviations
Abstract

Introduction: Although clinicians repeatedly measure ALT to assess allograft health in children with liver transplants, they generally make decisions based on single values or qualitative trends without quantitative aggregation or synthesis. We therefore aimed to derive and test a holistic ALT metric for the 5th post‐transplant year (Yr 4–5) that may better guide clinical decision‐making and/or population comparisons. Methods: We derived the "adjusted mean Yr 4–5 ALT" for children transplanted in 2005–2016 by averaging the median ALT from each month. Patients in quartiles (Q1–4) defined by the adjusted mean Yr 4–5 ALT were compared by clinical variables, Yr 5–8 outcomes, and tacrolimus standard deviation (MLVI). Results: For 97 children [49 male; 77 deceased donors; median (IQR) age at LT 2.5 (0.8–11.7) years], the 25th, 50th, and 75th percentile thresholds for adjusted mean Yr 4–5 ALT were 19, 28, and 47 U/L, respectively. Age, donor type, LT indication, rejection history, and mean tacrolimus levels did not differ between quartiles (Q). Children in Q4 had more Yr 4–5 acute rejection episodes (p <.01), higher Yr 4–5 MLVI (p <.01), and more Yr 5–8 for‐cause liver biopsies (p <.01) than those in Q1 + Q2. Children in Q3 also had higher Yr 4–5 MLVI than Q1 + Q2 (p =.047). Rates of chronic rejection and therapeutic liver‐related procedures were higher in Q4 but the difference did not reach significance. Conclusion: An integrated ALT metric calculated utilizing all available ALT values correlates with MLVI and future for‐cause biopsies. Further study of this novel ALT metric as a predictor of clinical outcomes and descriptor of populations is warranted. [ABSTRACT FROM AUTHOR]

Published
2023
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34. Early and Late Factors Impacting Patient and Graft Outcome in Pediatric Liver Transplantation: Summary of an ESPGHAN Monothematic Conference

Author

McLin, Valérie A., Allen, Upton, Boyer, Olivia, Bucuvalas, John, Colledan, Michele, Cuturi, Maria-Cristina, d’Antiga, Lorenzo, Debray, Dominique, Dezsofi, Antal, Goyet, Jean de Ville de, Dhawan, Anil, Durmaz, Ozlem, Falk, Christine, Feng, Sandy, Fischler, Björn, Franchi-Abella, Stéphanie, Frauca, Esteban, Ganschow, Rainer, Gottschalk, Stephen, Hadzic, Nedim, Hierro, Loreto, Horslen, Simon, Hubscher, Stefan, Karam, Vincent, Kelly, Deirdre, Maecker-Kolhoff, Britta, Mazariegos, George, McKiernan, Patrick, Melk, Anette, Nobili, Valerio, Ozgenç, Funda, Reding, Raymond, Sciveres, Marco, Sharif, Khalid, Socha, Piotr, Toso, Christian, Vajro, Pietro, Verma, Anita, Wildhaber, Barbara E., and Baumann, Ulrich

Published
2017
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36. Immunosuppression after pediatric liver transplant: The parents' perspective.

Author

Batsis, Irini, Bucuvalas, John, Eisenberg, Elizabeth, Lau, Jennifer, Squires, James E., Feng, Sandy, and Perito, Emily R.

Subjects
PARENT attitudes, LIVER transplantation, IMMUNOSUPPRESSION, PATIENTS' attitudes
Abstract

Background: For children with liver transplants (LT), achieving an "ideal outcome" is a balancing act: too little immunosuppression begets graft injury; too much begets systemic complications. We aimed to delineate the parental perspective on this tightrope. Methods: Parents of children with LT completed an internet‐based survey about their child's immunosuppression. Results: Children of respondents (n = 82) were a median 4 years from primary LT (range 0–22); 73% were on immunosuppression monotherapy. Parents' top concerns were related to immunosuppression complications; 46% were more concerned about immunosuppression complications than rejection; only 17% were more concerned about rejection than immunosuppression complications. Among parents of children on immunosuppression monotherapy, 29% still worried more about immunosuppression complications than rejection, 48% expressed equal concern for both. Time since LT (0‐4 vs. >4 years) was not associated with concern level for rejection or immunosuppression complications. Caregivers were significantly more certain that their child's immunosuppression regimen was correct to prevent rejection than to mitigate complications (p <.005). Conclusion: Caregivers of children with LTs reported higher levels of concern and uncertainty about immunosuppression complications than rejection risk. Understanding parent and patient perspectives on IS, and incorporating them into immunosuppression counseling and decision‐making, is critical to achieving truly "ideal" long‐term outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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41. Peripheral phenotype and gene expression profiles of combined liver–kidney transplant patients

Author

Dumontet, Erwan, Danger, Richard, Vagefi, Parsia A., Londoño, Maria-Carlota, Pallier, Annaïck, Lozano, Juan José, Giral, Magali, Degauque, Nicolas, Soulillou, Jean-Paul, Martínez-Llordella, Marc, Lee, Herman, Latournerie, Marianne, Boudjema, Karim, Dulong, Joelle, Tarte, Karin, Sanchez-Fueyo, Alberto, Feng, Sandy, Brouard, Sophie, and Conchon, Sophie

Published
2016
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