Clinical Transplantation (CLIN TRANSPLANT)

Publisher: Wiley

Journal description

Clinical Transplantation is primarily designed as a channel of communication for all those involved in the care of people who require or have had organ or tissue transplants including: kidney intestine liver pancreas heart heart valves lung bone marrow cornea skin bone and cartilage viable or stored. Interest is focused not only on the complete spectrum of present transplant operations but also those that are experimental or may become possible in future. Original articles are welcomed on all clinical and surgical aspects including: indications for and techniques of surgery; immunology and immunosuppression; patient preparation social ethical and psychological issues; complications short- and long-term results; artificial organs and the preservation and storage of organ and tissue. Full length papers and short communications are invited. Occasional clinical reviews are published as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. The journal is essential reading for surgeons of all major and subspecialities clinical immunologists; cryobiologists; hematologists; gastroenterologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists psychologists and research workers; in fact to all whose combined efforts will improve the prognosis of future transplant recipients.

Current impact factor: 1.52

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 1.522
2013 Impact Factor 1.486
2012 Impact Factor 1.634
2011 Impact Factor 1.667
2010 Impact Factor 1.751
2009 Impact Factor 2.004
2008 Impact Factor 1.915
2007 Impact Factor 1.923
2006 Impact Factor 2.051
2005 Impact Factor 1.887
2004 Impact Factor 1.635
2003 Impact Factor 1.582
2002 Impact Factor 1.534
2001 Impact Factor 1.893
2000 Impact Factor 1.841
1999 Impact Factor 1.29
1998 Impact Factor 1.508
1997 Impact Factor 1.079
1996 Impact Factor 1.682
1995 Impact Factor 1.159
1994 Impact Factor 0.891
1993 Impact Factor 1.005
1992 Impact Factor 1.309

Impact factor over time

Impact factor

Additional details

5-year impact 1.58
Cited half-life 6.60
Immediacy index 0.18
Eigenfactor 0.01
Article influence 0.53
Website Clinical Transplantation website
Other titles Clinical transplantation (Online)
ISSN 0902-0063
OCLC 45884487
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Some journals have separate policies, please check with each journal directly
    • On author's personal website, institutional repositories, arXiv, AgEcon, PhilPapers, PubMed Central, RePEc or Social Science Research Network
    • Author's pre-print may not be updated with Publisher's Version/PDF
    • Author's pre-print must acknowledge acceptance for publication
    • Non-Commercial
    • Publisher's version/PDF cannot be used
    • Publisher source must be acknowledged with citation
    • Must link to publisher version with set statement (see policy)
    • If OnlineOpen is available, BBSRC, EPSRC, MRC, NERC and STFC authors, may self-archive after 12 months
    • If OnlineOpen is available, AHRC and ESRC authors, may self-archive after 24 months
    • Publisher last contacted on 07/08/2014
    • This policy is an exception to the default policies of 'Wiley'
  • Classification

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Liver transplantation (LT) represents an uncommon indication for Caroli's Disease (CD) or Syndrome (CS). Excellent results of LT have been reported as shown by recent multi-centric European and American registry reports. Clear therapeutic flow-charts to adopt in these diseases are still lacking. This review aims at analyzing highlighting recent transplant experiences in this field and also at focusing on the role of LT in case specific comorbidities such as development of cholangiocellular cancer or renal failure are present.This article is protected by copyright. All rights reserved.
    Clinical Transplantation 09/2015; DOI:10.1111/ctr.12640
  • [Show abstract] [Hide abstract]
    ABSTRACT: With the increasing age of recipients undergoing orthotopic liver transplant (OLT), there is need for better risk stratification among them. Our study aims to identify predictors of poor outcome among OLT recipients ≥60 years of age. All patients who underwent OLT at Cleveland Clinic from January 2004 to April 2010 were included. Baseline patient characteristics and post-OLT outcomes (mortality, graft failure, length of stay, and major post-OLT cardiovascular events) were obtained from prospectively collected institutional registry. Among patients ≥60 years of age, multivariate regression modeling was performed to identify independent predictors of poor outcome. Of the 738 patients included, 223 (30.2%) were ≥ 60 years. Hepatic encephalopathy, platelet counts <45,000 /μL, total serum bilirubin >3.5 mg/dl and serum albumin <2.65 mg/dl- independently predicted poor short term outcomes. Presence of pre-OLT coronary artery disease and arrhythmia were independent predictors of poor long term outcomes. Cardiac causes represented the second most common cause of mortality among the elderly cohort. Despite that, this carefully selected cohort of older OLT recipients had outcomes, which were comparable with the younger recipients. Thus, our results show the need for better pre-OLT evaluation and optimization, and for closer post-OLT surveillance, of cardiovascular disease among the elderly.This article is protected by copyright. All rights reserved.
    Clinical Transplantation 02/2015; 29(3):197-203. DOI:10.1111/ctr.12500

  • Clinical Transplantation 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Autoantibodies are frequently detected after liver transplantation (LT) but their role is unclear. The present study was designed to address 3 points: autoantibody prevalence pre LT and over time up to five years after LT, identification of possible predictors of autoantibody formation and correlation between autoantibodies and graft dysfunction. To these aims, we retrospectively evaluated 92 consecutive LT recipients for whom prospectively stored frozen sera were available for autoantibodies assessment by Immunofluorescence. The overall autoantibody prevalence resulted significantly higher after LT than before LT (64% vs 27%, p<0.001 and 35.9% vs. 8.7%, p<0.001 considering cut off titre of ≥1:80 and ≥1:160 respectively). Recipient gender, donor age and gender, indication for LT and main immunosuppressant (cyclosporine vs tacrolimus) were not associated to the presence of autoantibodies. Patients with graft dysfunction had a significantly higher autoantibody prevalence irrespective of the aethiology of liver injury as compared to those patients with persistently normal liver biochemistry, but only for cut off titres ≥1:160 (p= 0.004). No cases of "de novo" autoimmune hepatitis were observed. In conclusion, autoantibodies are very frequently detected after LT also at high titres and their association with graft dysfunction likely represents an aspecific indicator of liver injury. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 12/2014; 29(2). DOI:10.1111/ctr.12498

  • Clinical Transplantation 12/2014; 29(2). DOI:10.1111/ctr.12485
  • [Show abstract] [Hide abstract]
    ABSTRACT: Preferences for the testing and treatment of antibody mediated rejection (AMR) in renal transplant patients varies amongst programs and individual practitioners. The description of these preferences and identification of commonalities can contribute to creating a standard of care. A survey was distributed through the Transplant Listserv of the American College of Clinical Pharmacy (ACCP) and via email to members of the American Society of Transplantation Community of Pharmacy (AST CoP), collected and analyzed. Most clinicians (26/28) test for donor specific antibodies (DSA) when evaluating a patient with possible AMR. Treatments for AMR varied widely amongst responding clinicians and included intravenous immune globulin (IVIG, n=25), plasmapheresis (n=24), rituximab (n=8), bortezomib (n=4), rabbit anti-thymocyte globulin (n=2), and eculizumab (n=1). Weight-based dosing of IVIG averaged 1.8 g/kg total dose. Six centers use rituximab as initial therapy, while 2 use rituximab if other therapy fails. Four centers use bortezomib as initial therapy, while 2 centers use it for severe/persistent AMR. One center uses eculizumab as initial therapy and one center uses it for severe AMR. Methods for the detection of antibody mediated rejection are similar, yet treatment of AMR varies widely. Most centers utilize DSA for detection and a combination of IVIG and plasmapheresis for treatment. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 11/2014; 29(2). DOI:10.1111/ctr.12491
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Autologous stem cell transplant (ASCT) is the current standard of care for most patients with multiple myeloma (MM) who are transplant eligible, yet the timing of ASCT is disputed due to a similar overall (OS) and progression-free survival with an early ASCT (eASCT) or a delayed ASCT (dASCT) approach.Objective We developed a decision analytic model to perform cost-effectiveness analysis of the two commonly used treatment strategies for MM.Methods Data on disease progression and treatment effectiveness came from 2001 to 2008 cohort treated at the Mayo Clinic and from published studies. Cost analysis was performed from a third-party payer perspective.ResultsThe Consumer Price Index adjusted 2012 costs of eASCT and dASCT were $249 236 and $262 610, respectively. eASCT cohort had a benefit of 1.96 quality-adjusted life years (QALYs), 0.23 QALYs more than dASCT, implying that eASCT is preferred (dominant) over dASCT. The most critical variables in one-way sensitivity analysis were treatment-related mortality and OS associated with eASCT strategy.Conclusions We conclude that eASCT could potentially be a relatively cost-effective treatment option for appropriate patients with MM, and these results would help patients, providers, and payers in decision making for timing of ASCT.
    Clinical Transplantation 08/2014; 28(10). DOI:10.1111/ctr.12421
  • [Show abstract] [Hide abstract]
    ABSTRACT: De novo malignancies are a main cause for late death after liver transplantation (LT). Everolimus (ERL) is an immunosuppressive agent with anti-tumoral properties. The aim of the present retrospective study was to identify prognostic factors, including conversion to ERL, for patients presenting non cutaneous de novo solid organ malignancy after LT for alcoholic cirrhosis. The study population consisted in 83 patients (presenting 100 tumours, including 75% of upper aero-digestive tract cancers), among the 398 patients who underwent LT for alcoholic cirrhosis in our centre. After diagnosis, ERL was introduced in 38 patients and calcineurin-inhibitor was discontinued in 64.1% of them. Tumour stage was a significant prognostic factor with a 1-year survival at 82.6% for early stages, 63.4% for intermediate stages (N+) and 27.4% for disseminated diseases (p<0.001). Associated relative risk factor was 2.202 (95%CI 1.044-4.644) for intermediate stages and 5.743 (95%CI 2.436-13.541) for metastatic stages. One and 5-year survival was 77.4% and 35.2% in ERL group vs. 47.2% and 19.4% in the non-ERL group, respectively (p=0.003). The relative risk factor for ERL was 0.447 (95%CI 0.257-0.778). Our results strongly suggest that conversion to ERL improves the prognosis of de novo malignancies after LT for alcoholic cirrhosis. Prospective studies are needed to confirm this benefit. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 07/2014; 28(12). DOI:10.1111/ctr.12430
  • [Show abstract] [Hide abstract]
    ABSTRACT: Donor lymphocyte infusion (DLI) is often used to enhance the graft-versus-leukemia (GVL) effect after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this study, we first evaluated the impact of the cell composition of a modified DLI (mDLI) on the prognoses of patients. A total of 194 patients undergoing allo-HSCT were enrolled and received mDLI for various clinical reasons. The infused cellular components of the mDLI were examined by flow cytometry. The results showed that infusion with a lower dose of CD14+ cells (<0.33×10(8) /kg) was an independent risk factor for the occurrence of II-IV° acute graft-versus-host disease (aGVHD) (HR=0.104, P=0.032) in HLA-identical transplant patients. In addition, a dose of CD14+ cells greater than the 50(th) percentile was associated with a lower incidence of hematological relapse and longer disease-free survival (DFS) after the mDLI (relapse: HR=0.193, P=0.007; DFS: HR=0259, P=0.016). However, we also found that a greater number of CD14+ cells was an independent risk factor for II-IV° aGVHD (HR=1.758, P=0.034) in haploidentical allo-HSCT. In conclusion, our data were the first to demonstrate that the cell composition of a56 mDLI played a distinct role in different types of allo-HSCT. This finding provided a novel approach for the development of cellular therapies by manipulating the components of infused cells. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 06/2014; 28(8). DOI:10.1111/ctr.12404
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Concomitant administration of the triazole antifungals, voriconazole or itraconazole, with tacrolimus can result in significant drug interaction in the transplant recipient. Limited published information exists regarding tacrolimus dosing when transitioning from voriconazole to itraconazole. The objective of this study was to evaluate the extent of the drug interaction with antifungal prophylaxis using voriconazole followed by a change to itraconazole in lung transplant recipients receiving tacrolimus. Methods: This prospective study included lung transplant recipients receiving antifungal prophylaxis with voriconazole followed by a switch to itraconazole. Patients were followed from the time of transplant until two months after converting to itraconazole. All patients received standard immunosuppression with tacrolimus, mycophenolate mofetil, and a corticosteroid. Tacrolimus dose normalized concentrations using concentration/dose ratio were compared while receiving voriconazole versus itraconazole. Results: Twenty lung transplant recipients were included in the final analysis. No difference was found with the tacrolimus dose normalized concentrations on voriconazole 254 ± 28 (ng/mL)/(mg/kg) compared with itraconazole 234 ± 34 (ng/mL)/(mg/kg), p = 0.65. Conclusion: Tacrolimus dosage adjustments were not necessary when converting from voriconazole to itraconazole. Validation in a larger population is needed to confirm these findings.
    Clinical Transplantation 06/2014; 28(8). DOI:10.1111/ctr.12403
  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute rejection remains a major cause for long-term kidney allograft failure. Reliable immunological parameters suitable to define the pre-transplant immune state and hence the individual risk for graft rejection are highly desired to preferably adapt the immunosuppressive regimen in advance. Donor- and 3(rd) -party alloreactivities were determined by mixed lymphocyte cultures. Soluble forms of CD25, CD30 and CD44 were detected in patients' serum by ELISA. Various lymphocyte subpopulations were measured using Flow-cytometry. All patients received triple immunosuppression (tacrolimus/mycophenolate mofetil/steroids) and were grouped according to biopsy results within the first year: rejection-free (RF, n=13), borderline (BL, n=5) or acute rejection (AR, n=7). Patients with AR showed the highest pre-transplant alloreactivities and serum levels (sCD25/sCD30/sCD44) according to the pattern RF<BL<AR. Relying on serum analysis only, multivariate logistic regression (logit link function) yielded a prognostic score for prediction of rejection with 75.0% sensitivity and 69.2% specificity. Patients with rejection showed markedly higher pre-transplant frequencies of CD4(+) /CD8(+) T-cells lacking CD28, but lower numbers of CD8(+) CD161(bright) T-cells and NK-cells than RF-individuals. Pre-transplant immune state defined by alloreactivity, serum markers and particular lymphocyte subsets seems to correlate with occurrence of graft rejection after kidney transplantation. A prognostic score based on pre-transplant serum levels has shown great potential for prediction of rejection episodes and should be further evaluated. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 06/2014; 28(9). DOI:10.1111/ctr.12399
  • [Show abstract] [Hide abstract]
    ABSTRACT: Venous jump grafts are used in pancreas transplantation to salvage a pancreas with a short portal vein or to facilitate an easier anastomosis. There have been no large studies evaluating the safety of venous jump grafts in pancreas transplantation. We analyzed the UNOS database to determine whether venous jump grafts are associated with graft loss or patient death. Data from UNOS on all adult pancreas transplant recipients 1996-2012 were analyzed. Venous extension grafts were used in 2,657 cases; they were not in 18,124. Kaplan-Meier/Product-Limit Estimates analysis demonstrated similar patient survival (p<0.641) and death censored graft survival (p<0.351) at 1-,3-,5-,10- and 15-years between subjects with and without venous jump grafts. There was a statistically significant difference in 1-year unadjusted patient survival between the Venous Extension Graft (94.9%) and the No- Venous Extension Graft (95.8%) groups (p<0.045) and a borderline difference in 1-year graft survival between the Venous Extension Graft (84.1%) and the No- Venous Extension Graft (82.6%) groups (p<0.055). There was no significant difference in patient survival or allograft survival at the 3, 5, 10, and 15 year intervals. The use of venous jump grafts is not associated with increased graft loss or mortality. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 06/2014; 28(8). DOI:10.1111/ctr.12397
  • [Show abstract] [Hide abstract]
    ABSTRACT: Kidney outcomes early post-liver transplantation (LT) are crucial for long-term prognosis, but difficult to predict. Among 203 adult LT patients, we studied the value of plasma neutrophil gelatinase-associated lipocalin (NGAL) measured pre-LT for predicting acute kidney injury (AKI), kidney-replacement therapy within 3 months, and kidney dysfunction at 3 months post-LT. Glomerular filtration rate (GFR) was estimated by creatinine-based and cystatin C-based equations. Highest NGAL levels were among patients on pre-LT kidney-replacement therapy, whereas NGAL exceeded 200μg/L in only 3 (2%) patients with pre-LT GFR >60mL/min. Pre-LT NGAL >260μg/L predicted GFR <60mL/min at 3 months post-LT (OR 17.8, 95%CI 2.1-153) independently of 19 other variables reflecting recipient characteristics, liver and kidney function, perioperative hemodynamic stress, and immunosuppression. Of 81 patients with pre-LT GFR <60mL/min, 48% had GFR <60mL/min at 3 months, and an NGAL level >260μg/L predicted this outcome with 90% specificity and 46% sensitivity. NGAL failed to predict post-LT AKI or need for temporary kidney-replacement therapy. In conclusion, NGAL independently predicted irreversibility of pre-LT kidney dysfunction and could thus help in optimizing patient care and in the decision to perform combined liver-kidney transplantation. Pre-LT NGAL was not useful in patients with preserved pre-LT kidney function or in predicting post-LT AKI. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 06/2014; 28(8). DOI:10.1111/ctr.12394
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite improvements in survival following renal transplantation, high rates of cardiovascular morbidity and mortality remain. Persistence of arterio-venous fistulae (AVF) may contribute to maladaptive cardiovascular remodeling and poor health outcomes in this cohort. Utilising recent advances in cardiovascular magnetic resonance imaging (CMR), we prospectively evaluated alterations in cardiac and vascular structure and function 6 months after elective ligation of AVF, following stable, successful renal transplantation. Eighteen subjects underwent CMR evaluation of cardiac structure and function, aortic distensibility and endothelial function prior to AVF-ligation and at 6 months. At follow-up, whilst left ventricular ejection fraction was unchanged, mean cardiac output decreased by 15.6% (9.6±2.9L/min vs. 8.1±2.3L/min, p=0.004) and left ventricular mass had regressed by 10% (166±56g vs. 149±51g, p=0.0001). Significant improvements were also noted in right ventricular and biatrial structure and function. Aortic distensibility was unchanged at follow-up, but endothelial dependent vasodilatation had improved (2.5±6.5% vs. 8.0±5.9%, p=0.04). Elective AVF-ligation following successful renal transplantation is associated with improvements in left ventricular mass, right ventricular and biatrial structure and function. Further randomised studies are warranted to determine the potential clinical improvement following AVF ligation in this cohort. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 06/2014; 28(8). DOI:10.1111/ctr.12402
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Endothelial dysfunction may explain increased cardiovascular risk in patients with chronic kidney disease (CKD). Methods: Brachial artery was imaged during reactive hyperemia (endothelium-dependent, flow-mediated dilatation, FMD) and during glyceryl trinitrate-mediated dilatation (nitroglycerine-mediated dilatation, NMD, endothelium-independent) in 108 patients with CKD and three months following renal transplantation (RT) in 60 of them. Results: Patients with CKD had significantly lower FMD vs. controls (9.1% vs. 18.3%, p < 0.001) while NMD was comparable (19.8% vs. 21.8%, p = ns). Impaired FMD (<4.5%) was observed in 26.8% patients with CKD and was more common in those on hemodialysis (HD; 28.4% vs. 15.4%) vs. those not on dialysis. FMD for patients with glomerular filtration rate (GFR) 15-60 vs. <15 mL/min/1.73 m(2) was 12.9% and 8.8% (p = 0.05; respectively -29% and -52% lower vs. controls), indicating reduced FMD with increasing CKD severity. There was +72% increase in FMD following RT (9.1 to 15.7%, p < 0.001) while mean NMD was unchanged. Following RT, only 3.3% had impaired FMD. Conclusions: Patients with CKD have endothelial dysfunction as evidenced by reduced FMD. Decreased FMD indicating worsening endothelial function was noted with increasing severity of CKD. Within three months of RT, there was significant improvement in FMD, while NMD values did not change.
    Clinical Transplantation 06/2014; 28(8). DOI:10.1111/ctr.12398
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Azithromycin has been shown to reverse or halt the decline of forced expiratory volume in one s (FEV1) in patients with bronchiolitis obliterans (BOS) syndrome following lung transplant. The overall effect of azithromycin on the absolute values of FEV1 has not been compared between reported studies. We studied the effects of azithromycin on lung function in patients with post-lung transplant BOS syndrome. Methods: A meta-analysis was performed using studies identified following an extensive database search. To be included, studies were published in English or French and explicitly reported percentage change in FEV1 or hazard ratios. Results: A total of 10 studies were included in this review. One hundred and forty patients were evaluated after treatment with azithromycin for an average follow-up period of seven months. The mean percentage increase in FEV1 was 8.8 (CI 5.1-12.47) p < 0.001. The pooled hazard ratio was 0.25 (CI 0.06-0.56) p = 0.041 for a mean follow-up period of 2.9 yr. Conclusion: This study demonstrated a significant improvement in lung function in patients with BOS syndrome following lung transplant after seven months of treatment. It remains uncertain whether this improvement stays after seven months. We also found that patients on azithromycin were less likely to die from BOS syndrome compared with patients who were not on azithromycin.
    Clinical Transplantation 06/2014; 28(8). DOI:10.1111/ctr.12401
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Some cardiac transplant programs may upgrade listed patients to United Network for Organ Sharing (UNOS) 1A-status during the holidays. Whether more transplants actually occur during holidays is unknown. Methods: We assessed rates of single-organ heart transplantation from 2001 to 2010 for recipients age ≥18 yr using the UNOS database. Patients were stratified by transplantation during holiday (±3 d, n = 2375) and non-holiday periods (n = 16 112). Holidays included Easter/Spring break, Memorial Day, July 4th, Labor Day, Thanksgiving, and Christmas/New Years (winter holidays). Secondary analysis assessing transplant rates across seasons was also completed. Results: Donor and recipient characteristics were similar between groups. Compared with non-holidays, July 4th had higher transplant rates (5.69 vs. 5.09 transplants/d, p = 0.03) while the winter holiday had lower transplant rates (4.50 vs. 5.09 transplants/d, p < 0.01). There was a trend toward lower transplant rates for all holidays compared with non-holidays (p = 0.06). Transplant rates were significantly different across seasons with greater rates in spring and summer (p < 0.01). Conclusion: Heart transplant rates were higher during the July 4th and lower during the winter holidays. Although there was a higher likelihood of transplantation during the spring and summer seasons, upgrading patients to 1A status during most holidays may not improve their chances for transplantation.
    Clinical Transplantation 06/2014; 28(8). DOI:10.1111/ctr.12396
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of our study was to examine effects of different induction therapies or no induction on rejection and infection risk, depending on differing patient risk-profiles.
    Clinical Transplantation 06/2014; DOI:10.1111/ctr.12395