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Current Status, Challenges, and Opportunities of Organ Donation and Transplantation in India.
Kute, Vivek B. MD, DM 1; Meshram, Hari Shankar MD, DM 1; Mahillo, Beatriz MD, PhD 2; Dominguez-Gil, Beatriz MD, PhD 2
doi : 10.1097/TP.0000000000004479
Volume 107(6) pgs. 1213-1405,e159-e187 June 2023
Research Highlights.
Short, Sarah MBBS 1; Issa, Fadi DPhil, FRCS (Plast) 1
Prolonged Normothermic Machine Perfusion: Buying More Time for Liver Graft Assessment and Repair.
Groen, Puck C. BSc 1; de Jonge, Jeroen MD, PhD 1; Porte, Robert J. MD, PhD 1
Advancing the Field of Pediatric Liver Transplantation: Urgent Action Items Identified During the 2022 Society of Pediatric Liver Transplantation Meeting.
Feldman, Amy G. MD, MSCS 1; Adams, Megan MD 2; Griesemer, Adam D. MD 3; Horslen, Simon MB, ChB, FRCPCH 4; Kelly, Beau MD, MBA, FACS, FAST 5; Mavis, Alisha M. MD 6; Mazariegos, George V. MD 7; Ng, Vicky L. MD, FRCPC 8; Perito, Emily R. MD, MAS 9; Rodriguez-Davalos, Manuel I. MD, FACS 10; Squires, James E. MD, MS 4; Tiao, Greg MD 11; Yanni, George S. MD, FAASLD 12; Hsu, Evelyn K. MD 13
Proceedings of the 27th Annual Congress of the International Liver Transplantation Society.
Campos-Varela, Isabel MD, PhD, MPH 1,2; Rammohan, Ashwin MCh, FRCS, FACS 3; Chadha, Ryan MD 4; Alconchel, Felipe MD, PhD 5; Hakeem, Abdul R. FRCS, PhD 6; Mathew, Johns S. MS, MCh 7; Goldaracena, Nicolas MD 8; Syn, Nicholas MD 9; Shankar, Sadhana MS, FRCS 10; Patel, Dhupal FRCA 11; Keskin, Onur MD 12; Liu, Jiang MBBS, MS, PhD 13; Nasralla, David BMBCh, MA (Oxon), FRCS, PhD 14; Mazzola, Alessandra MD, PhD 15; Shingina, Alexandra MD 16; Spiro, Michael MD 17; Patel, Madhukar S. MD 18; Tanaka, Tomohiro MD, PhD 19; Victor, David MD 20; Yoon, Uzung MD, MPH 21; Yoon, Young-in MD 22; Shaker, Tamer MD 23; Vinaixa, Carmen MD 2,24; Kirchner, Varvara A. MD 25; De Martin, Eleonora MD, PhD 26
doi : 10.1097/TP.0000000000004637
AB After a virtual congress in 2021 and a previous absence in 2020 because of the coronavirus disease 2019 pandemic, the 27th Annual Congress of the International Liver Transplantation Society was held from May 4 to 7, 2022, in a hybrid format in Istanbul, with 1123 (58% on-site) liver transplant professionals from 61 countries attending the meeting.
Are Induced/altered Self-peptide Antigens Responsible for De Novo Autoreactivity in Transplantation?.
Sharland, Alexandra F. MD, PhD, FRACP 1; Hill, Alexandra E. 1; Son, Eric T. BSc 1; Scull, Katherine E. PhD 2; Mifsud, Nicole A. PhD 2; Purcell, Anthony W. PhD 2
Bile Composition and Biliary Tract Regeneration During Normothermic Machine Perfusion: Can We Save More Livers?.
Nasralla, David BMBCh, FRCS, DPhil 1; De Martin, Eleonora MD, PhD 2
Secondary Cold Ischemia After Normothermic Machine Perfusion: A Drawback to Centralized Organ Perfusion Centers?.
Duarte, Sergio PhD 1; Shah, Rushi MD 1; Zarrinpar, Ali MD, PhD 1
Chronic Postsurgical Pain After Solid Organ Transplantation: A Dreaded Complication in Recipients and Living Donors.
Saliba, Faouzi MD, PhD 1,2,3
Editorial on "Maximize Donor Cornea Use in a Hepatitis B Endemic Area via Serology Matching".
Hume, Simon J. MBBS, FRACP 1,2; Thompson, Alexander J. MBBS, FRACP, PhD 1,2; Holmes, Jacinta A. MBBS, FRACP, PhD 1,2
Should You Accept What Others Reject?.
McDonald, Stephen P. MBBS, PhD, FRACP 1; Irish, Georgina L. MBBS, MClinEpi, FRACP 1
Chicken or Egg: Tricuspid Regurgitation-The Cause or the Consequence of Post-Heart Transplant Allograft Dysfunction.
Eisen, Howard J. MD 1
Pathophysiological Changes in the Hemostatic System and Antithrombotic Management in Kidney Transplant Recipients.
van den Berg, Tamar A.J. MD 1,2; Nieuwenhuijs-Moeke, Gertrude J. MD, PhD 3; Lisman, Ton PhD 1,2; Moers, Cyril MD, PhD 1,2; Bakker, Stephan J.L. MD, PhD 4; Pol, Robert A. MD, PhD 1
doi : 10.1097/TP.0000000000004452
AB Nowadays, the main cause for early graft loss is renal graft thrombosis because kidney transplant outcomes have improved drastically owing to advances in immunological techniques and immunosuppression.
Applying Genomics to Unravel Health Disparities in Organ Transplantation: Paul I. Terasaki State-of-the-art Lecture; American Transplant Congress 2021.
Valantine, Hannah A. MD 1
doi : 10.1097/TP.0000000000004456
AB An extensive body of research about team science provides empirical evidence that diverse teams outperform homogenous teams in creating more innovative solutions to complex problems.
What Have We Learned From In Vitro Studies About Pig-to-primate Organ Transplantation?.
Hara, Hidetaka MD, PhD 1; Yamamoto, Takayuki MD, PhD 2; Wei, Hong-Jiang PhD 1,3; Cooper, David K.C. MD, PhD, FRCS 2
doi : 10.1097/TP.0000000000004458
AB Natural preformed and de novo antibodies against pig antigens are a major cause of pig xenograft rejection in nonhuman primates (NHPs). In vivo studies in pig-to-NHP models are time consuming.
Artificial Lungs for Lung Failure in the Era of COVID-19 Pandemic: Contemporary Review.
Naito, Noritsugu MD, PhD 1; Shigemura, Norihisa MD, PhD 2
doi : 10.1097/TP.0000000000004606
AB In patients with severe acute respiratory distress syndrome caused by coronavirus 2019 (COVID-19), mortality remains high despite optimal medical management.
Restoration of Bile Duct Injury of Donor Livers During Ex Situ Normothermic Machine Perfusion.
de Jong, Iris E.M. MD, PhD 1,2,3; Bodewes, Silke B. BSc 1,2; van Leeuwen, Otto B. MD, PhD 2; Oosterhuis, Dorenda BSc 4; Lantinga, Veerle A. MSc 2; Thorne, Adam M. BSc 2; Lascaris, Bianca MD 2; van den Heuvel, Marius C. MD, PhD 5; Wells, Rebecca G. MD 3; Olinga, Peter PhD 4; de Meijer, Vincent E. MD, PhD 2; Porte, Robert J. MD, PhD 2,6
doi : 10.1097/TP.0000000000004531
End-ischemic ex situ normothermic machine perfusion (NMP) enables assessment of donor livers prior to transplantation. The objective of this study was to provide support for bile composition as a marker of biliary viability and to investigate whether bile ducts of high-risk human donor livers already undergo repair during NMP.
Comparison Between Terminal or Preterminal Conditioning of Donor Livers by Ex Situ Machine Perfusion.
von Horn, Charlotte PhD 1; Luer, Bastian 1; Malkus, Laura 1; Minor, Thomas MD 1
doi : 10.1097/TP.0000000000004568
The successful implementation of end-ischemic normothermic machine perfusion (NMP) into clinical practice comes along with unusual demands for trained personnel and technical facilities in the implantation clinic.
2-D-gal Targets Terminal Fucosylation to Inhibit T-cell Response in a Mouse Skin Transplant Model.
Mao, Kaifeng MMed 1; Luo, Jialiang MMed 2,3; Ye, Junli PhD 4; Li, Lei PhD 2,3; Lin, Fenwang MMed 5; Zhou, Minjie MMed 1; Wang, Di PhD 6; Yu, Lu PhD 2,3; Zhu, Zhengyumeng MMed 2,3; Zuo, Daming PhD 3; Ye, Junsheng MD, PhD 1,5
doi : 10.1097/TP.0000000000004408
Organ allograft rejection is mainly driven by T-cell response. Studies have shown that fucosylation plays essential roles in the immune cell development and function.
Amplified Natural Killer Cell Activity and Attenuated Regulatory T-cell Function Are Determinants for Corneal Alloimmunity in Very Young Mice.
Nakao, Takeshi MD 1; Inomata, Takenori MD, PhD 1; Blanco, Tomas PhD 1; Musayeva, Aytan MD 1; Tahvildari, Maryam MD 1; Amouzegar, Afsaneh MD 1; Yin, Jia MD, PhD 1; Chauhan, Sunil K. PhD 1; Chen, Yihe MD 1; Dana, Reza MD, MPH 1
doi : 10.1097/TP.0000000000004424
Corneal transplantation outcomes are generally less favorable in young children compared with adults. The purpose of this study was to determine the immunological mechanisms underlying this difference.
D-dimer Release From Livers During Ex Situ Normothermic Perfusion and After In Situ Normothermic Regional Perfusion: Evidence for Occult Fibrin Burden Associated With Adverse Transplant Outcomes and Cholangiopathy.
Watson, Christopher J.E. MD 1,2,3,4; MacDonald, Stephen MPhil 5; Bridgeman, Christopher 5; Brais, Rebecca BA, MB 2,6; Upponi, Sara S. MD 2,7; Foukaneli, Theodora MD 2,8; Swift, Lisa 4; Fear, Corrina 4; Selves, Linda MSc 4; Kosmoliaptsis, Vasilis PhD 1,2,3,4; Allison, Michael PhD 2,4,9; Hogg, Rachel MSc 10; Parsy, Kourosh Saeb PhD 1,2,3,4; Thomas, Will MRCPath 2,5; Gaurav, Rohit MS 1,2,3,4; Butler, Andrew J. MChir 1,2,3,4
doi : 10.1097/TP.0000000000004475
Deceased donor livers are prone to biliary complications, which may necessitate retransplantation, and we, and others, have suggested that these complications are because of peribiliary vascular fibrin microthrombi.
Early Detection of Epstein-Barr Virus as a Risk Factor for Chronic High Epstein-Barr Viral Load Carriage at a Living-donor-dominant Pediatric Liver Transplantation Center.
Yamada, Masaki MD, PhD 1,2,3; Fukuda, Akinari MD, PhD 4; Ogura, Miyuki MS 1; Shimizu, Seiichi MD, PhD 4; Uchida, Hajime MD, PhD 4; Yanagi, Yusuke MD, PhD 4; Ishikawa, Yuriko PhD 1; Sakamoto, Seisuke MD, PhD 4; Kasahara, Mureo MD, PhD 4; Imadome, Ken-Ichi PhD 1
doi : 10.1097/TP.0000000000004429
Epstein-Barr virus (EBV) infection and posttransplant lymphoproliferative disorders (PTLDs) after pediatric liver transplantation (LT) account for significant morbidity and mortality.
Liver Transplantation for Porto-sinusoidal Vascular Liver Disorder: Long-term Outcome.
Magaz, Marta MD 1,2,3; Giudicelli-Lett, Heloise MD 3,4; Nicoara-Farcau, Oana MD 1,2,3,5; Rajoriya, Neil MD, PhD 6; Goel, Ashish MD, PhD 6; Raymenants, Karlien MD 7; Hillaire, Sophie MD, PhD 3,4; Crespo, Gonzalo MD, PhD 8,9; Tellez, Luis MD, PhD 10; Elkrief, Laure MD, PhD 11,12; Fondevila, Constantino MD, PhD 13; Orts, Lara 1,2,3; Nery, Filipe MD, PhD 14; Shukla, Akash MD, PhD 15; Larrue, Helene MD 16; Fundora, Yiliam MD, PhD 13; Degroote, Helena MD, PhD 17; Aguilera, Victoria MD, PhD 18,19; LLop, Elba MD, PhD 20; Turco, Laura MD, PhD 21; Indulti, Federica MD 21; Gioia, Stefania MD 22; Tosetti, Giulia MD, PhD 23; Bitto, Niccolo MD, PhD 23; Becchetti, Chiara MD, PhD 24; Alvarado, Edilmar MD, PhD 25,26; Roig, Cristina MD 25,26; Diaz, Raquel MD, PhD 27; Praktiknjo, Michael MD, PhD 28; Konicek, Anna-Lena MD 28; Soy, Guillem MD 1,2,3; Olivas, Pol MD 1,2,3; Fortea, Jose Ignacio MD, PhD 29; Masnou, Helena MD, PhD 30,31; Puente, Angela MD, PhD 29; Ardevol, Alba MD, PhD 30,31; Alvarez-Navascues, Carmen MD, PhD 32; Romero, Marta MD, PhD 33; Scheiner, Bernhard MD, PhD 34; Semmler, Georg MD, PhD 34; Mandorfer, Mattias MD, PhD 34; Damiao, Filipe MD 35; Baiges, Anna MD, PhD 1,2,3; Turon, Fanny MD, PhD 1,2,3; Simon-Talero, Macarena MD, PhD 36; Gonzalez-Alayon, Carlos MD 37; Diaz, Alba MD, PhD 38; Garcia-Criado, Angeles MD, PhD 39; de Gottardi, Andrea MD, PhD 40; Reverter, Enric MD, PhD 26,41,42; Blasi, Annabel MD, PhD 43; Genesca, Joan MD, PhD 36; Roux, Olivier MD, PhD 3,4; Francoz, Claire MD, PhD 3,4; Noronha Ferreira, Carlos MD, PhD 35; Reiberger, Thomas MD, PhD 34; Rodriguez, Manuel MD, PhD 32; Morillas, Rosa Maria MD, PhD 30,31; Crespo, Javier MD, PhD 29; Trebicka, Jonel MD, PhD 44,45; Banares, Rafael MD, PhD 27; Villanueva, Candid MD, PhD 25,26; Berzigotti, Annalisa MD, PhD 24; Primignani, Massimo MD, PhD 23; La Mura, Vincenzo MD, PhD 23; Riggio, Oliviero MD, PhD 22; Schepis, Filippo MD, PhD 21; Procopet, Bogdan MD, PhD 5; Verhelst, Xavier MD, PhD 17; Calleja, Jose Luis MD, PhD 20; Bureau, Christophe MD, PhD 16; Albillos, Agustin MD, PhD 10; Nevens, Frederik MD, PhD 7; Hernandez-Gea, Virginia MD, PhD 1,2,3; Tripathi, Dhiraj MD, PhD 6; Rautou, Pierre-Emmanuel MD, PhD 3,4; Durand, Francois MD, PhD 3,4; Garcia-Pagan, Juan Carlos MD, PhD 1,2,3
doi : 10.1097/TP.0000000000004444
Porto-sinusoidal vascular liver disorder (PSVD) is a rare disease that occasionally requires liver transplantation (LT), despite usually presenting preserved liver function. There remains a paucity of data pertaining to LT in PSVD. The aim was to identify features associated with post-LT outcomes in PSVD.
Maximize Donor Cornea Use in a Hepatitis B Endemic Area via Serology Matching.
Chu, Hsiao-Sang MD 1,2,3; Killeen, Olivia J. MD 4; Hsieh, Yi-Ting MD, PhD 1; Su, Tung-Hung MD, PhD 5,6; Soong, H. Kaz MD 4; Shih, Chung-Liang MD, PhD 7; Hu, Fung-Rong MD 1,2
doi : 10.1097/TP.0000000000004460
This study aims to investigate the rationality of the allocation guidelines in a hepatitis B endemic area that uses corneas from hepatitis B donors.
Outcomes of Declined Deceased Donor Kidney Offers That Are Subsequently Implanted: A UK Registry Study.
Ibrahim, Maria MBBS 1,2; Mehew, Jennifer PhD 2; Martin, Kate 2; Forsythe, John MD, FRCS, FRCP(Ed), FEBS 2; Johnson, Rachel J. MSc 2; Callaghan, Chris PhD, FRCS 1
doi : 10.1097/TP.0000000000004467
Deceased donor kidneys are often declined for >=1 patients but then implanted into another. Studies are needed to guide transplant clinicians and patients, especially given the increasing age and comorbidity of donors.
Variations in Risk of Cancer and Death From Cancer According to Kidney Allograft Function, Graft Loss, and Return to Dialysis.
Au, Eric H.K. PhD 1,2,3; Chapman, Jeremy R. PhD 2; Teixeira-Pinto, Armando PhD 1,3; Craig, Jonathan C. PhD 4; Wong, Germaine PhD 1,2,3
doi : 10.1097/TP.0000000000004493
Cancer incidence and mortality may change with varying kidney allograft function and after graft loss. We aimed to quantify cancer incidence and mortality during periods with a functioning graft and after graft loss.
Physiological Age by Artificial Intelligence-Enhanced Electrocardiograms as a Novel Risk Factor of Mortality in Kidney Transplant Candidates.
Lorenz, Elizabeth C. MD 1; Zaniletti, Isabella PhD 2; Johnson, Bradley K. 3; Petterson, Tanya M. MS 3; Kremers, Walter K. PhD 3,4; Schinstock, Carrie A. MD 4,5; Amer, Hatem MD 4,5; Cheville, Andrea L. MD 6; LeBrasseur, Nathan K. PhD, MS 6; Winkelmayer, Wolfgang C. MD, MPH, ScD 1; Navaneethan, Sankar D. MD, MS, MPH 1; Baez-Suarez, Abraham PhD, MS 7; Attia, Zachi I. PhD 7; Lopez-Jimenez, Francisco MD, MSc, MBA 7; Friedman, Paul A. MD 7; Kennedy, Cassie C. MD 4,8; Rule, Andrew D. MD 5
doi : 10.1097/TP.0000000000004504
Mortality risk assessment before kidney transplantation (KT) is imperfect. An emerging risk factor for death in nontransplant populations is physiological age as determined by the application of artificial intelligence to the electrocardiogram (ECG).
Development and Validation of a Hypertension Risk Calculator for Living Kidney Donors.
Helgeson, Erika S. PhD 1; Vempati, Shruti MS 1; Palzer, Elise F. BA 1; Mjoen, Geir PhD 2; Haugen, Anders J. PhD 3; Matas, Arthur J. MD 4
doi : 10.1097/TP.0000000000004505
Ideally, when deciding whether to donate, kidney donor candidates would understand their long-term risks. Using single-center data (N = 4055; median [quartiles] follow-up: 18 [9-28] y), we developed a calculator for postdonation hypertension and validated it using long-term data from an external single-center cohort (N = 1189, median [quartiles] follow-up: 9 [5-17] y).
A Machine Learning Prediction Model for Immediate Graft Function After Deceased Donor Kidney Transplantation.
Quinino, Raquel M. MD 1; Agena, Fabiana PhD 1; Modelli de Andrade, Luis Gustavo MD, PhD 2; Furtado, Mariane MA 3; Chiavegatto Filho, Alexandre D.P. PhD 3; David-Neto, Elias MD, PhD 1
doi : 10.1097/TP.0000000000004510
After kidney transplantation (KTx), the graft can evolve from excellent immediate graft function (IGF) to total absence of function requiring dialysis.
Tricuspid Regurgitation After Heart Transplantation: The Cause or the Result of Graft Dysfunction?.
Bart, Nicole K. MBBS, DPhil 1,2,3,4; Hungerford, Sara L. MBBS, PhD 1,3,4; Namasivayam, Mayooran MBBS, PhD 1,3,4; Granger, Emily MBBS, PhD 1; Conellan, Mark MBBS 1; Kotlyar, Eugene MBBS, MD 1,2,3; Muthiah, Kavitha MBChB, PhD 1,3,4; Jabbour, Andrew MBBS, PhD 1,3,4; Hayward, Christopher MBBS, MD 1,3,4; Jansz, Paul C. MBBS, PhD 1,3,4; Keogh, Anne M. MBBS, MD 1,4; Macdonald, Peter S. MD, PhD 1,3,4
doi : 10.1097/TP.0000000000004511
Tricuspid regurgitation (TR) is common following heart transplantation and has been shown to adversely influence patient outcomes. The aim of this study was to identify causes of progression to moderate-severe TR in the first 2 y after transplantation.
Prevention and Management of Chronic Postsurgical Pain and Persistent Opioid Use Following Solid Organ Transplantation: Experiences From the Toronto General Hospital Transitional Pain Service.
Yu, Hai Chuan MD 1,2; Kleiman, Valery MA 1,2; Kojic, Katarina MD 3,4; Slepian, P. Maxwell PhD 1,2,5,6; Cortes, Henry MD 1,2; McRae, Karen MD 1,2,5; Katznelson, Rita MD 1,2,5; Huang, Alex MD 1,2,5; Tamir, Diana MD 1,2,5; Fiorellino, Joseph MD 1,2,5; Ganty, Praveen MD 1,2; Cote, Nathalie PT 1,2; Kahn, Michael MD 1,2,5; Mucsi, Istvan MD, PhD 7; Selzner, Nazia MD, PhD 7; Rozenberg, Dmitry MD, PhD 8; Chaparro, Cecilia MD 9,10; Rao, Vivek MD 11,12,13,14; Cypel, Marcelo MD 15; Ghanekar, Anand MD 7; Kona, Sharath MBA 1,2; McCluskey, Stuart MD, PhD 1,2,5; Ladak, Salima NP, PhD 1,2,5; Santa Mina, Daniel PhD 1,2,5; Karkouti, Keyvan MD, MSc 1,2,5,16; Katz, Joel PhD 1,2,5,6,17; Clarke, Hance MD, PhD 1,2,5,17
doi : 10.1097/TP.0000000000004441
With >700 transplant surgeries performed each year, Toronto General Hospital (TGH) is currently one of the largest adult transplant centers in North America.
Rapid Diagnosis of Disseminated Tuberculosis Using Cell-free DNA Sequencing in a Kidney Transplant Recipient.
Apostolopoulou, Anna MD 1; Kotton, Camille Nelson MD 1
Simultaneous 3-way Paired Exchange Liver Transplantation Without Nondirected Donation: Novel Strategy to Expand the Donor Pool.
Soin, A.S. MS, FRCS 1; Bhangui, Prashant MS 1; Rastogi, Amit MS 1; Piplani, Tarun MD 2; Choudhary, Narendra DM 1; Dhampalwar, Swapnil DM 1; Kollantavalappil, Fysal MS 1; Yadav, Kamal MS 1; Gupta, Ankur MS 1; Gupta, Nikunj MD 3; Sharma, Nishant MD 3; Bhangui, Pooja MD 3; Aneja, Manish MD 3; Vohra, Vijay MD 3; Saraf, Neeraj MD 1
Antibody Responses Against Emerging SARS-CoV-2 Omicron Lineages After the Fourth Dose of mRNA Vaccine in Kidney Transplant Recipients.
Al Jurdi, Ayman MD 1,2; Gassen, Rodrigo B. PhD 1; Borges, Thiago J. PhD 1; Lape, Isadora T. 1; Morena, Leela MD 1; Hullekes, Frank MD 1; Efe, Orhan MD 1,2; Kotton, Camille N. MD 3; Riella, Leonardo V. MD, PhD 1,2
Molnupiravir for Treatment of COVID-19 in Solid Organ Transplant Recipients.
Dhand, Abhay MD 1,2; Okumura, Kenji MD 2; Ohira, Suguru MD, PhD 2; Kapur, Rohan MD 1; Wolfe, Kevin PhD 2; Nishida, Seigo MD, PhD 2
SARS-Cov-2 Antibody Levels That Confer Immune Protection Based on Neutralization of the Omicron Variant.
Desgagnes, Jean-Simon BSc 1; Desy, Olivier PhD 1; Thivierge, Marie-Pier BSc 1; Marcoux, Meagan BSc 1; Beland, Stephanie MSc 1; De Serres, Sacha A. MD, SM, FRCPC 1
Liver Transplantation for Porto-sinusoidal Vascular Liver Disorder: Unmet Questions.
Agrawal, Dhiraj DM 1; Giri, Suprabhat DM 2; Sharma, Mithun MD, FACG, AGAF 3
Reply to 'Liver Transplantation for Porto-sinusoidal Vascular Liver Disorder: Long-term Outcome'.
Magaz, Marta MD, PhD 1,2,3; Giudicelli-Lett, Heloise MD 4; Rautou, Pierre-Emmanuel MD, PhD 4; Durand, Francois MD, PhD 4; Garcia-Pagan, Juan Carlos MD, PhD 1,2,3
