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Report from the American Society of Transplantation on frailty in solid organ transplantation.

ABSTRACT: A consensus conference on frailty in kidney, liver, heart, and lung transplantation sponsored by the American Society of Transplantation (AST) and endorsed by the American Society of Nephrology (ASN), the American Society of Transplant Surgeons (ASTS), and the Canadian Society of Transplantation (CST) took place on February 11, 2018 in Phoenix, Arizona. Input from the transplant community through scheduled conference calls enabled wide discussion of current concepts in frailty, exploration of best practices for frailty risk assessment of transplant candidates and for management after transplant, and development of ideas for future research. A current understanding of frailty was compiled by each of the solid organ groups and is presented in this paper. Frailty is a common entity in patients with end-stage organ disease who are awaiting organ transplantation, and affects mortality on the waitlist and in the posttransplant period. The optimal methods by which frailty should be measured in each organ group are yet to be determined, but studies are underway. Interventions to reverse frailty vary among organ groups and appear promising. This conference achieved its intent to highlight the importance of frailty in organ transplantation and to plant the seeds for further discussion and research in this field.

SUBMITTER: Kobashigawa J

PROVIDER: S-EPMC6433498 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Report from the American Society of Transplantation on frailty in solid organ transplantation.

Kobashigawa Jon J Dadhania Darshana D Bhorade Sangeeta S Adey Deborah D Berger Joseph J Bhat Geetha G Budev Marie M Duarte-Rojo Andres A Dunn Michael M Hall Shelley S Harhay Meera N MN Johansen Kirsten L KL Joseph Susan S Kennedy Cassie C CC Kransdorf Evan E Lentine Krista L KL Lynch Raymond J RJ McAdams-DeMarco Mara M Nagai Shunji S Olymbios Michael M Patel Jignesh J Pinney Sean S Schaenman Joanna J Segev Dorry L DL Shah Palak P Singer Lianne G LG Singer Jonathan P JP Sonnenday Christopher C Tandon Puneeta P Tapper Elliot E Tullius Stefan G SG Wilson Michael M Zamora Martin M Lai Jennifer C JC

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 20181222 4

A consensus conference on frailty in kidney, liver, heart, and lung transplantation sponsored by the American Society of Transplantation (AST) and endorsed by the American Society of Nephrology (ASN), the American Society of Transplant Surgeons (ASTS), and the Canadian Society of Transplantation (CST) took place on February 11, 2018 in Phoenix, Arizona. Input from the transplant community through scheduled conference calls enabled wide discussion of current concepts in frailty, exploration of be ...[more]

PMID: 30506632

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Project description:Background and purposePosterior reversible encephalopathy syndrome (PRES) is known to occur after solid organ transplantation (SOT), potentially associated with cyclosporine and tacrolimus. In this study, we assess the frequency and clinical and imaging characteristics of PRES after SOT.Materials and methodsWe identified 27 patients (13 men and 14 women; age range, 22-72 years) who developed PRES after SOT. Features noted included SOT subtype, incidence and timing of PRES, infection and rejection, mean arterial pressure (MAP), and toxicity brain edema.ResultsPRES developed in 21 (0.49%) of 4222 patients who underwent transplantation within the study period (no significant difference among SOT subtypes). Transplantation was performed in 5 patients before the study period, and 1 patient underwent transplantation elsewhere. In consideration of all 27 patients, PRES typically developed in the first 2 months in patients who had SOT of the liver (9 of 10 patients) and was associated with cytomegalovirus (CMV), mild rejection, or systemic bacterial infection. PRES also typically developed after 1 year in patients who had SOT of the kidney (8 of 9 patients) and was associated with moderate rejection or bacterial infection. Toxicity MAP was significantly lower (P < .001) in liver transplants (average MAP, 104.8 +/- 16 mm Hg) compared with that in kidney transplants (average MAP, 143 +/- 20 mm Hg). Toxicity brain edema was significantly greater (P < .001) in patients who had liver transplants and developed PRES compared with patients who had undergone kidney transplants despite severe hypertension in those who had the kidney transplants.ConclusionPatients who had undergone SOTs have a similar low incidence of developing PRES. Differences between those who have had liver and kidney transplants included time after transplant, toxicity MAP, and PRES vasogenic edema noted at presentation. In patients who have undergone kidney transplants, severely elevated MAP was associated with reduced, not greater, brain edema.

Dataset Information

Report from the American Society of Transplantation on frailty in solid organ transplantation.

Publications

Report from the American Society of Transplantation on frailty in solid organ transplantation.

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