1
|
Niazi SK, Brennan E, Spaulding A, Crook J, Borkar S, Keaveny A, Vasquez A, Gentry MT, Schneekloth T, Taner CB. Impact of Recipient Age at Liver Transplant on Long-term Outcomes. Transplantation 2023; 107:654-663. [PMID: 36398331 DOI: 10.1097/tp.0000000000004426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The age of a liver transplant (LT) candidate is one of many variables used in the transplant selection process. Most research about the age at transplant has used prespecified age ranges or categories in assessing associations with transplant outcomes. However, there is a lack of knowledge about the age at transplant and survival. This study aimed to examine associations of age at transplant as a continuous variable, in conjunction with other patient and disease-related factors, with patient and graft survival after LT. METHODS We used the Standard Transplant Analysis and Research data to identify LT recipients between January 2002 and June 2018. Cox regression models with a restricted cubic spline term for age examined associations with graft and patient survival after LT. We assessed the interactions of age with recipients' sex, race/ethnicity, region, indication for transplant, body mass index, model for end-stage liver disease score, diabetes, functional status at transplant, and donor risk index. RESULTS Age at the time of LT showed a nonlinear association with both graft and patient survival. Each demographic, clinical, transplant-related, and donor-related factor influenced these relationships differently. CONCLUSIONS Our results suggest that some older LT candidates may be better than some younger candidates and that clinicians should not exclusively use age to determine who receives LT.
Collapse
Affiliation(s)
- Shehzad K Niazi
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Emily Brennan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
- Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, FL
| | - Aaron Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
- Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, FL
| | - Julia Crook
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Shalmali Borkar
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
- Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, FL
| | - Andrew Keaveny
- Department of Transplantation, Mayo Clinic, Jacksonville, FL
| | - Adriana Vasquez
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Melanie T Gentry
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
| | | | - C Burcin Taner
- Department of Transplantation, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
2
|
Melandro F, Lai Q, Ghinolfi D, Manzia TM, Spoletini G, Rossi M, Agnes S, Tisone G, De Simone P. Outcome of liver transplantation in elderly patients: an Italian multicenter case-control study. Updates Surg 2023; 75:541-552. [PMID: 36814042 DOI: 10.1007/s13304-023-01448-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
Despite the controversial results of liver transplantation (LT) in elderly recipients, the proportion of patients continues to increase. This study investigated the outcome of LT in elderly patients (≥ 65 years) in an Italian, multicenter cohort. Between January 2014 and December 2019, 693 eligible patients were transplanted, and two groups were compared: recipients ≥ 65 years (n = 174, 25.1%) versus 50-59 years (n = 519, 74.9%). Confounders were balanced using a stabilized inverse probability therapy weighting (IPTW). Elderly patients showed more frequent early allograft dysfunction (23.9 versus 16.8%, p = 0.04). Control patients had longer posttransplant hospital stays (median: 14 versus 13 days; p = 0.02), while no difference was observed for posttransplant complications (p = 0.20). At multivariable analysis, recipient age ≥ 65 years was an independent risk factor for patient death (HR 1.76; p = 0.002) and graft loss (HR 1.63; p = 0.005). The 3-month, 1-year, and 5-year patient survival rates were 82.6, 79.8, and 66.4% versus 91.1, 88.5, and 82.0% in the elderly and control group, respectively (log-rank p = 0.001). The 3-month, 1-year, and 5-year graft survival rates were 81.5, 78.7, and 66.0% versus 90.2, 87.2, and 79.9% in the elderly and control group, respectively (log-rank p = 0.003). Elderly patients with CIT > 420 min showed 3-month, 1-year, and 5-year patient survival rates of 75.7%, 72.8%, and 58.5% versus 90.4%, 86.5%, and 79.4% for controls (log-rank p = 0.001). LT in elderly (≥ 65 years) recipients provides favorable results, but inferior to those achieved in younger patients (50-59), especially when CIT > 7 h. Containment of cold ischemia time seems pivotal for favorable outcomes in this class of patients.
Collapse
Affiliation(s)
- Fabio Melandro
- Sapienza University of Rome, AOU Umberto I Policlinico of Rome, Rome, Italy.
| | - Quirino Lai
- Sapienza University of Rome, AOU Umberto I Policlinico of Rome, Rome, Italy
| | - Davide Ghinolfi
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - Tommaso Maria Manzia
- Hepatobiliary Surgery and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Gabriele Spoletini
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Rossi
- Sapienza University of Rome, AOU Umberto I Policlinico of Rome, Rome, Italy
| | - Salvatore Agnes
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Tisone
- Hepatobiliary Surgery and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Paolo De Simone
- Department of Surgical, Medical, Biochemical Pathology and Intensive Care, University of Pisa, Pisa, Italy
| |
Collapse
|
3
|
Park JY, Choi YJ, Ri HS, Lee JM, Son HJ, Lee YS, Ryu JH, Yang KH. Impact of age on the incidence of complications after liver transplantation: A single-center retrospective study. Braz J Anesthesiol 2021; 71:387-394. [PMID: 33762194 PMCID: PMC9373325 DOI: 10.1016/j.bjane.2021.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 01/31/2021] [Accepted: 02/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background and objective Advances in surgical technique, postoperative management, and immunosuppressive therapy have led to a steady increase in the number of patients undergoing organ transplantation. This study aimed to compare the incidence of postoperative complications between young and elderly patients undergoing liver transplantation (LT) at a single university hospital. Method The medical records of 253 patients who underwent LT between January 2010 and July 2017 were retrospectively reviewed. The patients were divided into two groups: those younger than 65 years (group Y, n = 231) and those older than 65 years (group O, n = 22). Data on patient demographics, perioperative management, and postoperative complications were collected. Results The patients’ baseline characteristics, including underlying diseases and the Model for End-Stage Liver Disease scores, were not different between groups. Preoperative laboratory findings were not significantly different between the two groups, except for hemoglobin level. The total amounts of infused fluid and packed red blood cells were higher in group O than in group Y. The postoperative plasma creatinine level was higher in group O than in group Y; however, the incidence of postoperative complications was not considerably different between the two groups. In addition, there was no difference in the survival rate after LT depending on age. Conclusion With the development of medical technology, LT in elderly patients is not an operation to be avoided, and the prognosis is expected to improve. Therefore, continuous efforts to understand the disease characteristics and physical differences in elderly patients who require LT are essential.
Collapse
Affiliation(s)
- Ju Yeon Park
- Daedong Hospital, Department of Anesthesiology and Pain Medicine, Busan, Republic of Korea; Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea
| | - Yoon Ji Choi
- Korea University Ansan Hospital, Department of Anesthesia and Pain Medicine, Ansan, Korea.
| | - Hyun-Su Ri
- Pusan National University Yangsan Hospital, Department of Anesthesia and Pain Medicine, Yangsan, Republic of Korea
| | - Jung Min Lee
- Korea University Ansan Hospital, Department of Anesthesia and Pain Medicine, Ansan, Korea
| | - Hyo Jung Son
- National Police Hospital, Department of Anesthesiology and Pain Medicine, Seoul, Korea
| | - Yoon Sook Lee
- Korea University Ansan Hospital, Department of Anesthesia and Pain Medicine, Ansan, Korea
| | - Je Ho Ryu
- Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Yangsan, Republic of Korea
| | - Kwang Ho Yang
- Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Yangsan, Republic of Korea
| |
Collapse
|
4
|
Zhong W, Rao Z, Rao J, Han G, Wang P, Jiang T, Pan X, Zhou S, Zhou H, Wang X. Aging aggravated liver ischemia and reperfusion injury by promoting STING-mediated NLRP3 activation in macrophages. Aging Cell 2020; 19:e13186. [PMID: 32666684 PMCID: PMC7431827 DOI: 10.1111/acel.13186] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/29/2020] [Accepted: 06/06/2020] [Indexed: 12/19/2022] Open
Abstract
Although aggravated liver injury has been reported in aged livers post‐ischemia and reperfusion (IR), the underlying mechanism of innate immune activation of aged macrophages is not well understood. Here, we investigated whether and how Stimulator of interferon genes (STING) signaling regulated macrophage proinflammatory activation and liver IR injury. Mice were subjected to hepatic IR in vivo. Macrophages isolated from IR‐stressed livers and bone marrow‐derived macrophages (BMDMs) from young and aged mice were used for in vitro studies. Enhanced nucleotide‐binding domain and leucine‐rich repeat containing protein 3 (NLRP3) activation was found in both livers and macrophages of aged mice post‐IR. NLRP3 knockdown in macrophages inhibited intrahepatic inflammation and liver injury in both young and aged mice. Interestingly, enhanced activation of the STING/ TANK‐binding kinase 1 (TBK1) signaling pathway was observed in aged macrophages post‐IR and mitochondria DNA (mtDNA) stimulation. STING suppression blocked over‐activation of NLRP3 signaling and excessive secretion of proinflammatory cytokines/chemokines in the mtDNA‐stimulated BMDMs from aged mice. More importantly, STING knockdown in macrophages abrogated the detrimental role of aging in aggravating liver IR injury and intrahepatic inflammation. Finally, peripheral blood from the recipients undergoing liver transplantation was collected and analyzed. The results showed that the elderly recipients had much higher levels of TNF‐α, IL‐6, IL‐1β, and IL‐18 post‐transplantation, indicating increased NLRP3 activation in lR‐stressed livers of elderly recipients. In summary, our study demonstrated that the STING‐NLRP3 axis was critical for the proinflammatory response of aged macrophages and would be a novel therapeutic target to reduce IR injury in elderly patients.
Collapse
Affiliation(s)
- Weizhe Zhong
- Hepatobiliary/Liver Transplantation Center The First Affiliated Hospital with Nanjing Medical University Nanjing China
- Research Unit of Liver Transplantation and Transplant Immunology Chinese Academy of Medical Sciences Nanjing China
- Key Laboratory of Liver Transplantation Chinese Academy of Medical Sciences Nanjing China
| | - Zhuqing Rao
- Department of Anesthesiology The First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Jianhua Rao
- Hepatobiliary/Liver Transplantation Center The First Affiliated Hospital with Nanjing Medical University Nanjing China
- Research Unit of Liver Transplantation and Transplant Immunology Chinese Academy of Medical Sciences Nanjing China
- Key Laboratory of Liver Transplantation Chinese Academy of Medical Sciences Nanjing China
| | - Guoyong Han
- Hepatobiliary/Liver Transplantation Center The First Affiliated Hospital with Nanjing Medical University Nanjing China
- Research Unit of Liver Transplantation and Transplant Immunology Chinese Academy of Medical Sciences Nanjing China
- Key Laboratory of Liver Transplantation Chinese Academy of Medical Sciences Nanjing China
| | - Ping Wang
- Hepatobiliary/Liver Transplantation Center The First Affiliated Hospital with Nanjing Medical University Nanjing China
- Research Unit of Liver Transplantation and Transplant Immunology Chinese Academy of Medical Sciences Nanjing China
- Key Laboratory of Liver Transplantation Chinese Academy of Medical Sciences Nanjing China
| | - Tao Jiang
- Hepatobiliary/Liver Transplantation Center The First Affiliated Hospital with Nanjing Medical University Nanjing China
- Research Unit of Liver Transplantation and Transplant Immunology Chinese Academy of Medical Sciences Nanjing China
- Key Laboratory of Liver Transplantation Chinese Academy of Medical Sciences Nanjing China
| | - Xiongxiong Pan
- Department of Anesthesiology The First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Shun Zhou
- Hepatobiliary/Liver Transplantation Center The First Affiliated Hospital with Nanjing Medical University Nanjing China
- Research Unit of Liver Transplantation and Transplant Immunology Chinese Academy of Medical Sciences Nanjing China
- Key Laboratory of Liver Transplantation Chinese Academy of Medical Sciences Nanjing China
| | - Haoming Zhou
- Hepatobiliary/Liver Transplantation Center The First Affiliated Hospital with Nanjing Medical University Nanjing China
- Research Unit of Liver Transplantation and Transplant Immunology Chinese Academy of Medical Sciences Nanjing China
- Key Laboratory of Liver Transplantation Chinese Academy of Medical Sciences Nanjing China
| | - Xuehao Wang
- Hepatobiliary/Liver Transplantation Center The First Affiliated Hospital with Nanjing Medical University Nanjing China
- Research Unit of Liver Transplantation and Transplant Immunology Chinese Academy of Medical Sciences Nanjing China
- Key Laboratory of Liver Transplantation Chinese Academy of Medical Sciences Nanjing China
| |
Collapse
|
5
|
Yamamoto H, Sambommatsu Y, Ibuki S, Shimata K, Sugawara Y, Hibi T. Long-term outcomes of living donor liver transplantation in patients with a prior history of nonhepatic malignancy. Biosci Trends 2020; 14:42-47. [PMID: 32023575 DOI: 10.5582/bst.2019.01313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Posttransplant malignancy has become a significant cause of mortality. Data on the long-term outcomes of patients with pretransplant nonhepatic malignancy (PTM) after living donor liver transplantation (LDLT) are scarce, although the recipients of other organs with PTM have been reported to have a poor survival. Fifteen patients with PTM (4.4%) among the 342 adult recipients were identified in our LDLT programs. The outcomes of the patients with PTM after LDLT were compared to those of patients without PTM in terms of the all-cause mortality and cancer-specific mortality (defined as mortality related to malignancy expect for hepatocellular carcinoma, cholangiocarcinoma, or neuroendocrine tumor). The sites of PTM included the breast in six, stomach in two, and colon, lung, kidney, uterine, thyroid, larynx, and acute myelogenous leukemia in one each. The median interval from the PTM treatment to LDLT was 57 months (range, 2-298). The patients who received the curative treatment for PTM were selected as the recipients. No patients with PTM had recurrence during the follow-up period. The 1-, 5-, and 10-year patient survival rates were 100%, 92.9%, and 92.9% in the PTM group and 86.2%, 76.7%, and 68.5% in the non-PTM group, respectively (p = 0.142). Likewise, there was no significant difference between the two groups in the cancer-specific mortality. In conclusion, the patients with PTM had comparable outcomes with regard to mortality and cancer-specific mortality compared with those without PTM. This study showed that the patients with PTM can obtain an acceptable outcome after LDLT when carefully selected.
Collapse
Affiliation(s)
- Hidekazu Yamamoto
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yuzuru Sambommatsu
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Sho Ibuki
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Yasuhiko Sugawara
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| |
Collapse
|
6
|
Kollmann D, Maschke S, Rasoul-Rockenschaub S, Baron-Stefaniak J, Hofmann M, Silberhumer G, Györi GP, Soliman T, Berlakovich GA. Outcome after liver transplantation in elderly recipients (>65 years) - A single-center retrospective analysis. Dig Liver Dis 2018; 50:1049-1055. [PMID: 30017655 DOI: 10.1016/j.dld.2018.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/10/2018] [Accepted: 06/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver transplantation (LT) in elderly recipients is controversially discussed in the literature with only little data on long-term outcome available. We aimed to evaluate the safety and efficiency of LT in elderly recipients (>65 years). METHODS Between 1989-2016, 139 patients >65 years-old were listed for liver transplantation, and 76 (55%) were transplanted. Patient outcome and characteristics were evaluated separately for the time period before (1989-2004) and after (2005-2016) MELD-implementation. Post-transplant outcome was compared between the elderly cohort and LT-recipients aged 18-65 years (n = 1395). RESULTS Overall survival of patients >65 years was better in the MELD-era compared to the earlier period (1- and 5-year-survival: 73%, 60% vs. 69%, 37%, respectively; p = 0.055). The main differences between the two groups included higher recipient age (p = 0.001) and BMI (p = 0.001), higher donor age (p < 0.001), less need of intraoperative red blood cells (p = 0.008) and a lower number of postoperative rejections (p = 0.03) after 2004. Comparing the overall survival of patients transplanted in the MELD-era aged 18-65 years vs. >65 years displayed comparable 1- and 5 year-survival rates (81%, 68% vs. 73% and 60%, respectively, p = 0.558). CONCLUSION In the modern era, outcome of patients receiving LT with >65 years is comparable to <65 year-old patients. After careful evaluation, patients >65 years old should be considered for LT.
Collapse
Affiliation(s)
- Dagmar Kollmann
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Svenja Maschke
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Susanne Rasoul-Rockenschaub
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria; Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Joanna Baron-Stefaniak
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Hofmann
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Gerd Silberhumer
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Georg P Györi
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Thomas Soliman
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.
| | - Gabriela A Berlakovich
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
7
|
Niazi SK, Schneekloth TD, Vasquez AR, Keaveny AP, Davis S, Picco M, Heckman MG, Diehl NN, Jowsey-Gregoire SG, Rummans TA, Burcin Taner C. Impact of psychiatric comorbidities on outcomes of elderly liver transplant recipients. J Psychosom Res 2018; 111:27-35. [PMID: 29935751 DOI: 10.1016/j.jpsychores.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated the impact of psychiatric comorbidities in liver transplant (LT) recipients aged ≥65 years (elderly) on length of hospital-stay (LOS), death, and a composite outcome of graft loss or death. METHODS This retrospective study assessed impact of psychiatric comorbidities in 122 elderly LT recipients and a matched group of 122 LT recipients aged <65 years (younger). Associations were assessed using adjusted multivariable regression models. RESULTS Among elderly, median age at LT was 68 years, most were males (62%), white (85%) and 61.7% had a history of any psychiatric diagnosis. Among younger, median age was 55, most were males (67.2%), white (77.5%) and 61.5% had any psychiatric diagnosis. Median LOS was 8 days for both groups. Among elderly, after a median follow-up of 5 years, 25.4% died and 29.5% experienced graft loss or death. History of adjustment disorder, history of depression, past psychiatric medication use, and pain prior to LT were associated with an increased risk of death or the composite graft loss or death. Perioperative use of SSRIs and lack of sleeping medication use were associated with longer LOS. Among aged <65, after median follow-up of 4.7 years, 21 patients (17%) died and 25 (20%) experienced graft loss or death; history of depression, perioperative SSRIs or sleeping medications use was associated with increased mortality and graft-loss or death. CONCLUSION Six out of 10 patients among both elderly and younger cohorts had pre-LT psychiatric comorbidities, some of which adversely affected outcomes after LT.
Collapse
Affiliation(s)
- Shehzad K Niazi
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States; Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States.
| | - Terry D Schneekloth
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN, United States
| | - Adriana R Vasquez
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States; Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States
| | - Andrew P Keaveny
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States
| | - Susan Davis
- Mayo Clinic, Jacksonville, FL, United States
| | | | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, United States
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, United States
| | - Sheila G Jowsey-Gregoire
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN, United States
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - C Burcin Taner
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States
| |
Collapse
|