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Kitajima T, Rajendran L, Lisznyai E, Lu M, Shamaa T, Ivanics T, Yoshida A, Claasen MPAW, Abouljoud MS, Sapisochin G, Nagai S. Lymphopenia at the time of transplant is associated with short-term mortality after deceased donor liver transplantation. Am J Transplant 2023; 23:248-256. [PMID: 36804132 DOI: 10.1016/j.ajt.2022.11.004] [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: 05/10/2022] [Revised: 10/06/2022] [Accepted: 10/28/2022] [Indexed: 01/13/2023]
Abstract
Absolute lymphocyte count (ALC) is considered a surrogate marker for nutritional status and immunocompetence. We investigated the association between ALC and post-liver transplant outcomes in patients who received a deceased donor liver transplant (DDLT). Patients were categorized by ALC at liver transplant: low (<500/μL), mid (500-1000/μL), and high ALC (>1000/μL). Our main analysis used retrospective data (2013-2018) for DDLT recipients from Henry Ford Hospital (United States); the results were further validated using data from the Toronto General Hospital (Canada). Among 449 DDLT recipients, the low ALC group demonstrated higher 180-day mortality than mid and high ALC groups (83.1% vs 95.8% and 97.4%, respectively; low vs mid: P = .001; low vs high: P < .001). A larger proportion of patients with low ALC died of sepsis compared with the combined mid/high groups (9.1% vs 0.8%; P < .001). In multivariable analysis, pretransplant ALC was associated with 180-day mortality (hazard ratio, 0.20; P = .004). Patients with low ALC had higher rates of bacteremia (22.7% vs 8.1%; P < .001) and cytomegaloviremia (15.2% vs 6.8%; P = .03) than patients with mid/high ALC. Low ALC pretransplant through postoperative day 30 was associated with 180-day mortality among patients who received rabbit antithymocyte globulin induction (P = .001). Pretransplant lymphopenia is associated with short-term mortality and a higher incidence of posttransplant infections in DDLT patients.
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Affiliation(s)
- Toshihiro Kitajima
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Luckshi Rajendran
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eric Lisznyai
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Tayseer Shamaa
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Tommy Ivanics
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA; Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | - Atsushi Yoshida
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Marco P A W Claasen
- Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Marwan S Abouljoud
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Gonzalo Sapisochin
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Shunji Nagai
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA.
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Moinuddin I, Yaqub MS, Taber T, Mujtaba M, Sharfuddin A. Kidney allograft survival outcomes in combined intestinal-kidney transplant: An analysis of the UNOS/OPTN database 2000-2014. Clin Transplant 2018; 32:e13213. [DOI: 10.1111/ctr.13213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Irfan Moinuddin
- Transplant Nephrology; Division of Nephrology; Indiana University; Indianapolis IN USA
| | - Muhammad Sohail Yaqub
- Transplant Nephrology; Division of Nephrology; Indiana University; Indianapolis IN USA
| | - Tim Taber
- Transplant Nephrology; Division of Nephrology; Indiana University; Indianapolis IN USA
| | - Muhammad Mujtaba
- Transplant Nephrology; Division of Nephrology; University of Texas Medical Branch; Galveston TX USA
| | - Asif Sharfuddin
- Transplant Nephrology; Division of Nephrology; Indiana University; Indianapolis IN USA
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Kubal CA, Pennington C, Fridell J, Ekser B, Muhaylov P, Mangus R. Challenges with Intestine and Multivisceral Re-Transplantation: Importance of Timing of Re-Transplantation and Optimal Immunosuppression. Ann Transplant 2018; 23:98-104. [PMID: 29402878 PMCID: PMC6248276 DOI: 10.12659/aot.908052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients undergoing re-transplantation often receive high doses of immunosuppression, which may lead to an immunocompromised status of the recipient. This study investigates the outcomes after intestine/multivisceral re-transplantation. MATERIAL AND METHODS Clinical outcomes of 23 patients undergoing 24 re-transplantations at a single intestine transplant center were reviewed. Bone marrow suppression was used as a surrogate marker of immunocompromised status, and was defined as platelet count <50 k/mm3 and absolute lymphocyte count <200/mm³. RESULTS All re-transplants except one were liver inclusive. Fifteen of 23 patients died at a median time of 12 months (range 0.2-75) after re-transplantation. Of the 15 deaths, nine (60%) resulted from complications associated with a compromised host immune status: graft versus host disease (GVHD) affecting bone marrow (three cases), persistent viral infection (three cases), post-transplant lymphoproliferative disorder (PTLD (one case), metastatic cancer (one case), multi-drug resistant polymicrobial sepsis (one case). Four deaths (27%) resulted from severe rejection. Non-survivors were more likely to have received alemtuzumab, and had higher incidence of bone marrow suppression. In addition to immunocompromised status and rejection, the use of alemtuzumab was associated with mortality after intestinal/multivisceral re-transplantation. CONCLUSIONS High mortality was associated with intestine/multivisceral re-transplantation. To improve clinical outcomes of intestine and multivisceral transplantation, it is important to allow reconstitution of host immunity. Longer interval between the two transplantations, and strategies such as allograft specific immunosuppression, may spare the host from the devastating effects of potent immunosuppression currently used.
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Affiliation(s)
- Chandrashekhar A Kubal
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Catherine Pennington
- Department of Pharmacy, Indiana University Health, University Hospital, Indianapolis, IN, USA
| | - Jonathan Fridell
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Burcin Ekser
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Plamen Muhaylov
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard Mangus
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Heinze G, Dunkler D. Five myths about variable selection. Transpl Int 2017; 30:6-10. [PMID: 27896874 DOI: 10.1111/tri.12895] [Citation(s) in RCA: 311] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/14/2016] [Accepted: 11/25/2016] [Indexed: 01/15/2023]
Abstract
Multivariable regression models are often used in transplantation research to identify or to confirm baseline variables which have an independent association, causally or only evidenced by statistical correlation, with transplantation outcome. Although sound theory is lacking, variable selection is a popular statistical method which seemingly reduces the complexity of such models. However, in fact, variable selection often complicates analysis as it invalidates common tools of statistical inference such as P-values and confidence intervals. This is a particular problem in transplantation research where sample sizes are often only small to moderate. Furthermore, variable selection requires computer-intensive stability investigations and a particularly cautious interpretation of results. We discuss how five common misconceptions often lead to inappropriate application of variable selection. We emphasize that variable selection and all problems related with it can often be avoided by the use of expert knowledge.
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Affiliation(s)
- Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Daniela Dunkler
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
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