Transplant. Proc. [JOURNAL]
Sun
200 papers
Case Report: Retransplantation for Adult-Onset Bilirubin Encephalopathy After Auxiliary Partial Liver Transplant for Crigler-Najjar Syndrome Type 1 in Childhood.
Goshima N, Fujimoto Y, Hyodo R … +2 more , Masano Y, Ogura Y
Transplant Proc · 2026 Jun · PMID 42161757 · Publisher ↗
Crigler-Najjar syndrome (CNS) type 1 is a genetic disorder that leads to severe unconjugated hyperbilirubinemia. Auxiliary partial orthotopic liver transplantation (APOLT) is preferred for metabolic liver diseases as a p...
Crigler-Najjar syndrome (CNS) type 1 is a genetic disorder that leads to severe unconjugated hyperbilirubinemia. Auxiliary partial orthotopic liver transplantation (APOLT) is preferred for metabolic liver diseases as a portion of the native liver is retained. Reported here are details of a 32-year-old male who developed bilirubin encephalopathy due to graft failure 27 years after APOLT performed at 5-year-old for CNS type 1. Initially, the bilirubin level was low, which then gradually increased to 7.3 mg/dL at age 12. At the age of 31, the bilirubin level began to rise rapidly and we submitted a request for deceased donor liver transplantation (DDLT) to the Committee for the Evaluation of Indications for DDLT in Japan. However, that was deemed as not indicated, because unconjugated bilirubin-dominant hyperbilirubinemia alone is generally not considered to cause encephalopathy in adults. Despite the high bilirubin level, the patient remained neurologically asymptomatic until occurrence of acute decompensation. At 32 years old, he was admitted on an emergency basis to our hospital with severe hyperbilirubinemia and neurological symptoms. After managing his general condition with intensive care, DDLT was finally performed, resulting in a drastic resolution of various symptoms. The findings in this case show that bilirubin-induced neurotoxicity in adults may be reversible and indicate that the current liver transplantation criteria used in Japan, which limit eligibility for CNS to pediatric patients, may have contributed to delayed transplantation. Re-evaluation of the transplant eligibility criteria is necessary to allow for a more inclusive approach that encompasses adult patients.
Strong False-Positive Pretransplant Flow Cytometric Crossmatch Induced by Non-HLA Autoantibodies in a Nonsensitized Renal Transplant Candidate.
Yoon BY, Kang AJ, Chung YS … +1 more , Jeong IH
Transplant Proc · 2026 Jun · PMID 42156285 · Publisher ↗
Flow cytometric crossmatch (FCXM) is a sensitive method for detecting donor-specific antibodies in kidney transplantation; however, false-positive results may occur in the absence of HLA antibodies. We report a case of a...
Flow cytometric crossmatch (FCXM) is a sensitive method for detecting donor-specific antibodies in kidney transplantation; however, false-positive results may occur in the absence of HLA antibodies. We report a case of a 46-year-old nonsensitized male kidney transplant candidate who demonstrated persistent strong T-cell FCXM positivity despite repeatedly negative HLA antibody screening by single antigen bead assay. Complement-dependent cytotoxicity crossmatch was negative for both T and B lymphocytes. The patient had no history of prior sensitizing events, including transfusion, transplantation, or pregnancy. To exclude assay interference, serum pretreatment with EDTA, serial dilution, heat inactivation, and dithiothreitol was performed, and no clinically relevant HLA donor-specific antibodies were identified. Extended non-HLA antibody screening revealed multiple autoantibodies, including antibodies against viemtin, leucine-rich repeat transmembrane protein 2, tubulin alpha-1B chain, and CD36. These non-HLA autoantibodies were considered the most likely cause of the isolated T-cell FCXM positivity. This case highlights the diagnostic challenge posed by discordant crossmatch results and emphasizes the importance of considering non-HLA antibodies in the interpretation of FCXM. Identification of non-HLA antibody-mediated FCXM positivity may help avoid unnecessary exclusion of transplant candidates and support more informed immunologic risk assessment in pretransplant evaluation.
Fibromuscular Dysplasia in a Deceased Donor Renal Allograft: Staged Hybrid Endovascular Management and Review of the Literature.
Khan A, Cai S, Puttaswamy V … +4 more , Shen Y, Thebridge L, Fisher C, Singla A
Transplant Proc · 2026 Jun · PMID 42150948 · Publisher ↗
BACKGROUND: Fibromuscular dysplasia (FMD) in deceased donor renal allografts is rarely reported in the transplant literature, and there is currently no consensus regarding graft utilization when identified prior to retri...
BACKGROUND: Fibromuscular dysplasia (FMD) in deceased donor renal allografts is rarely reported in the transplant literature, and there is currently no consensus regarding graft utilization when identified prior to retrieval or optimal operative management following implantation. METHODS: We report a case of deceased donor renal transplantation in which a focal mid-renal artery FMD lesion causing significant stenosis was identified intraoperatively using routine duplex ultrasonography, despite a normal macroscopic appearance of the renal artery on the back table. As the donor had demonstrated normal renal function, a decision was made not to intervene on the lesion at the time of implantation. RESULTS: Post-operatively, the renal allograft produced urine; however, serum creatinine failed to improve. On post-operative day 3, percutaneous balloon angioplasty of the transplant renal artery stenosis was performed successfully. Renal function normalized promptly following the intervention and remained stable at 12 months of follow-up. CONCLUSIONS: This case highlights several important considerations. A deceased donor kidney with normal donor renal function may still fail to provide adequate recipient function due to previously unsuspected FMD, potentially accounting for unexplained early graft dysfunction in some cases. Routine intraoperative duplex ultrasonography facilitated early detection of the lesion, allowing timely elective intervention. Endovascular repair represents an effective and safe management strategy for FMD in renal allografts when performed in appropriately experienced centers.
Concomitant Fibronectin Glomerulopathy and Chronic Active Antibody-mediated Rejection in a Renal Allograft: A Case Report and Literature Review.
Wei J, Yang J, Lan L … +4 more , Dong J, Wu J, Wen J, Sun X
Transplant Proc · 2026 Jun · PMID 42150947 · Publisher ↗
BACKGROUND: Fibronectin glomerulopathy (FNG) is a rare autosomal dominant glomerulonephritis characterized by proteinuria, hematuria, and progressive kidney dysfunction. FNG treatment includes kidney transplantation; how...
BACKGROUND: Fibronectin glomerulopathy (FNG) is a rare autosomal dominant glomerulonephritis characterized by proteinuria, hematuria, and progressive kidney dysfunction. FNG treatment includes kidney transplantation; however, chronic active antibody-mediated rejection (cABMR) poses a threat to the long-term survival of kidney allografts. Here, we report a case of FNG in a kidney allograft with cABMR. CASE SUMMARY: A 51-year-old male underwent living-related kidney transplantation in March 2020 for end-stage kidney disease caused by diabetic nephropathy. Three years after kidney transplantation, he presented with 2+ proteinuria, hematuria, and progressive worsening of kidney allograft function, for which an allograft biopsy was performed. Histopathological examination revealed glomerular lobulation, glomerular duplication, peritubular capillaritis, and glomerulitis, which was consistent with cABMR. Immunohistochemistry revealed strong staining for fibronectin in the glomeruli, thus suggesting FNG. The patient was administered rituximab, plasma exchange, and intravenous glucocorticoids. However, these treatments have not yet achieved ideal effects. CONCLUSION: We report a rare case of FGN with cABMR in a kidney allograft that was unresponsive to treatments. This case highlights the need for physicians that perform kidney transplants to familiarize themselves with these rare diseases. Moreover, timely kidney biopsy can help with the diagnosis.
Simultaneous Pancreas and Kidney Transplantation in a Patient With Congenital Hemophilia A: A rare Case Report and Management Insights.
Shimaoka T, Sasaki K, Akita H … +16 more , Mukai Y, Hasegawa S, Yamada D, Tomimaru Y, Noda T, Takahashi H, Kobayashi S, Kashiwagi H, Yonishi H, Miyashita K, Yamanaka K, Nakazawa S, Kakuta Y, Nonomura N, Doki Y, Eguchi H
Transplant Proc · 2026 Jun · PMID 42150946 · Publisher ↗
BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK) is a definitive treatment for end-stage kidney disease (ESKD) and type 1 diabetes mellitus. However, even with careful perioperative control of hemostasis, S...
BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK) is a definitive treatment for end-stage kidney disease (ESKD) and type 1 diabetes mellitus. However, even with careful perioperative control of hemostasis, SPK carries a high risk of postoperative bleeding, which is exacerbated in patients with hemophilia A. Here, we report the first known successful SPK in a patient with congenital hemophilia A. CASE REPORT: A 52-year-old man was diagnosed with hemophilia A at 2 years of age. He developed type 1 diabetes mellitus at 25 years of age, which progressed to ESKD at 43 years of age. A comprehensive preoperative FVIII replacement protocol was applied during the perioperative period, using continuous infusion with bolus supplementation to maintain target VIII activity levels (100% intraoperatively, 80% during the first postoperative week, and ≥30% thereafter). CONCLUSION: This case demonstrates that SPK transplantation can be safely performed in patients with congenital hemophilia A, by implementing appropriate FVIII replacement strategies and close multidisciplinary collaboration.
Longmire Type I in a Transplant Liver Graft: A Salvage Solution for Complex Hepaticojejunostomy Stricture.
Florou E, Zen Y, Kibriya N … +3 more , Heneghan M, Srinivasan P, Prachalias A
Transplant Proc · 2026 Jun · PMID 42150945 · Publisher ↗
BACKGROUND: Liver transplantation using a left lateral segment (LLS) graft is a lifesaving procedure for pediatric recipients. While long-term graft function may remain well preserved, biliary complications can arise ove...
BACKGROUND: Liver transplantation using a left lateral segment (LLS) graft is a lifesaving procedure for pediatric recipients. While long-term graft function may remain well preserved, biliary complications can arise over time, threatening both graft viability and patient well-being. In some cases, endoscopic or radiological interventions may be infeasible or fail to provide durable relief. We present a case of a biliary anastomotic stricture following pediatric LLS transplantation, successfully managed using a rarely performed but technically valuable surgical approach, that of intrahepatic hepaticojejunostomy known as Longmire type I procedure. CASE REPORT: A 21-year-old female, who underwent LLS liver transplantation at 8 months of age for acute liver failure, presented with recurrent episodes of cholangitis. She had previously undergone complex biliary revision with 2 separate hepaticojejunostomies, but subsequently developed a stricture mainly involving the segment II bilio-enteric anastomosis. Radiological intervention failed to traverse the stricture. A segmental intrahepatic cholangio-jejunostomy, commonly referred to as the Longmire type I procedure, was performed successfully, relieving the obstruction and preserving graft function. CONCLUSION: Biliary complications remain the Achilles' heel of long-term liver transplant outcomes. While endoscopic and radiological interventions are typically first-line, surgical revision of hepaticojejunostomy is sometimes required. However, re-operative biliary surgery carries significant risks, especially in the context of previous revisions. Intrahepatic cholangio-jejunostomy offers a viable alternative in selected patients, as demonstrated in this case, which is the first of its kind reported in the literature following pediatric living donor liver transplantation.
First Healthy Live Birth Achieved Through Assisted Reproductive Technologies in Türkiye After Lung Transplantation: A Case Report.
Halis AN, Kahraman S, Şahin Y … +3 more , Arısoy R, Sarıbaş E, Yıldız G
Transplant Proc · 2026 Jun · PMID 42150944 · Publisher ↗
Pregnancy after lung transplantation is uncommon and presents significant challenges due to chronic immunosuppression, infection risk, and potential graft dysfunction. We report a 35-year-old woman, 5 years postcadaveric...
Pregnancy after lung transplantation is uncommon and presents significant challenges due to chronic immunosuppression, infection risk, and potential graft dysfunction. We report a 35-year-old woman, 5 years postcadaveric bilateral lobar lung transplantation for non-cystic fibrosis bronchiectasis, who presenting with primary infertility and diminished ovarian reserve. Mycophenolate mofetil was discontinued because of teratogenic risk, and immunosuppression with tacrolimus and prednisolone was continued. Following an unsuccessful assisted reproductive technology (ART) attempt at another center and a second failed cycle complicated by post-transfer pulmonary infection, a third ART cycle was initiated using individualized ovarian stimulation. Piezo-assisted intracytoplasmic sperm injection yielded 3 blastocysts, and preimplantation genetic testing for aneuploidy (PGT-A) identified one euploid embryo. Infection control during treatment was guided by serial C-reactive protein monitoring and close clinical surveillance. A modified natural-cycle frozen embryo transfer resulted in a singleton pregnancy. At 30 weeks, the patient developed hypertension and pneumonia, both managed medically without intensive care. Due to declining pulmonary function, an elective cesarean delivery was performed at 35 weeks and 4 days, resulting in the birth of a healthy male infant (2190 g, Apgar score 10). Both mother and newborn were discharged in good condition, and the patient's pulmonary function improved postpartum with an uneventful follow-up during the past 6 months. This case represents the first documented live birth in Türkiye achieved through ART and PGT-A in a lung transplant recipient and demonstrates that successful pregnancy outcomes are attainable with coordinated multidisciplinary management and individualized reproductive planning.
Possible Adenovirus Triggered Case of Atypical Hemolytic Uremic Syndrome in a Kidney Transplant Recipient: A Case Report and A Review of the Literature.
Krajina L, Kovacic A, Kovacic M … +3 more , Koren A, Koren L, Basic Jukic N
Transplant Proc · 2026 Jun · PMID 42144300 · Publisher ↗
Atypical hemolytic uremic syndrome (aHUS) is a rare disorder of the alternative complement pathway characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. It has a genetic backgroun...
Atypical hemolytic uremic syndrome (aHUS) is a rare disorder of the alternative complement pathway characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. It has a genetic background or may be triggered by viral infections and certain medications, such as immunosuppressants. We present a case of post-kidney transplant development of aHUS in a genetically predisposed individual with an acute adenoviral infection. A 25-year-old male with known chronic kidney failure and subsequent renal transplantation was admitted to hospital due to respiratory symptoms, fever, leukopenia, thrombocytopenia, hemolytic anemia and deteriorating renal graft function. Imaging revealed a consolidation in lower right lung lobe with pleural effusion, while bronchoscopy confirmed adenovirus infection. The findings suggested that the patient suffered from thrombotic microangiopathy, causing an acute kidney failure, aggravated by an adenoviral infection. Empirical treatment with the C5 complement component inhibitor ravulizumab was initiated, and genetic testing for complement abnormalities was performed. Following ravulizumab administration, the patient became afebrile, inflammatory markers decreased and both cytopenia and graft function improved. A CT scan marked regression of lung consolidation and effusion. Complement analysis later confirmed inherited defects predisposing to aHUS. The patient was discharged home in good condition with stable kidney allograft function. This case supports the increasing evidence linking adenoviral infections with aHUS onset and highlights the importance of considering this rare diagnosis in predisposed patients with compatible clinical and laboratory findings. Early recognition enables timely intervention, which is essential for preventing irreversible kidney damage that could be fatal.
Intraoperative Iliac Artery Dissection and Postoperative Cerebral Infarction in a Kidney Transplant Recipient With an RNF213 p.R4810K Variant: A Case Report.
Nakazawa S, Matsumura S, Fukae S … +7 more , Yonishi H, Kawamura M, Namba T, Yamanaka K, Imamura R, Kakuta Y, Nonomura N
Transplant Proc · 2026 Jun · PMID 42144299 · Publisher ↗
BACKGROUND: The RNF213 p.R4810K variant is a major susceptibility gene for moyamoya disease and has recently been associated with systemic vascular abnormalities. However, its clinical relevance in solid organ transplant...
BACKGROUND: The RNF213 p.R4810K variant is a major susceptibility gene for moyamoya disease and has recently been associated with systemic vascular abnormalities. However, its clinical relevance in solid organ transplantation remains poorly understood. CASE PRESENTATION: A 61-year-old man with end-stage renal disease due to autosomal dominant polycystic kidney disease underwent deceased-donor kidney transplantation after 17 years of hemodialysis. His medical history was notable for multiple coronary interventions, cerebral infarction, and a known cerebral aneurysm. During transplantation, clamping of the external iliac artery resulted in arterial dissection, necessitating vascular reconstruction and re-anastomosis of the renal artery. Postoperatively, the patient developed persistent urinary leakage caused by bladder rupture and vesicoureteral complications, requiring multiple surgical revisions. On postoperative day 62, follow-up brain MRI incidentally revealed a subacute infarction in the left anterior cerebral artery territory. Given his extensive vascular history and a family history of moyamoya disease in his daughter, genetic testing was performed and confirmed a heterozygous RNF213 p.R4810K mutation. CONCLUSION: This case represents a rare report of kidney transplantation complicated by intraoperative iliac artery dissection and postoperative cerebral infarction in a patient with an RNF213 mutation. The findings highlight the systemic vascular fragility associated with RNF213 and underscore the importance of careful preoperative assessment, family history evaluation, and tailored surgical strategies in high-risk transplant candidates.
Central Nervous System Post-Transplant Lymphoproliferative Disorder After Kidney Transplantation in an Epstein-Barr Virus-Seronegative Recipient Despite Serial EBV-DNA Monitoring: A Case Report.
Shimogawa T, Yamanaga S, Munemura K … +8 more , Toyoda M, Kawabata C, Miyabe Y, Yamamoto Y, Watanabe Y, Inadome A, Hidaka Y, Yokomizo H
Transplant Proc · 2026 Jun · PMID 42144298 · Publisher ↗
BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation that is strongly associated with Epstein-Barr virus (EBV) infection. Serial monitoring of peripheral bloo...
BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation that is strongly associated with Epstein-Barr virus (EBV) infection. Serial monitoring of peripheral blood EBV -DNA is widely used for early detection of PTLD; however, its sensitivity is limited, particularly in cases involving the primary central nervous system. CASE PRESENTATION: A 23-year-old female patient underwent living-donor kidney transplantation from her mother and was classified as having standard immunological risk. The EBV serostatus was donor-positive/recipient-negative, and serial peripheral blood EBV-DNA monitoring was performed after transplantation. Despite the EBV-DNA levels remaining below 4 log IU/mL, the patient developed progressive neurological symptoms. Subsequent neuroimaging and histopathological evaluations led to the diagnosis of central nervous system PTLD (CNS-PTLD). Treatment consisted of immunosuppression reduction, localized radiotherapy, and systemic rituximab-based chemotherapy and resulted in complete metabolic remission. CONCLUSION: Although EBV-DNA levels over 5 log IU/mL indicate an urgent concern for PTLD, this case highlights that CNS-PTLD can develop in high-risk transplant recipients even in the absence of significant EBV-DNAemia. Careful clinical assessment and prompt diagnostic evaluation of neurological symptoms are crucial for early diagnosis and appropriate management, particularly in donor-positive/recipient-negative kidney transplant recipients.
Management of Liver Transplantation in a Pediatric Patient With Heterotaxy Syndrome and Bradyarrhythmia: A Case Report.
Pal A, Aneja S, Goyal N
Transplant Proc · 2026 Jun · PMID 42144297 · Publisher ↗
BACKGROUND: Heterotaxy syndrome is a rare congenital disorder characterized by abnormal arrangement of thoracoabdominal organs. Associated cardiovascular and visceral malformations pose significant anesthetic and surgica...
BACKGROUND: Heterotaxy syndrome is a rare congenital disorder characterized by abnormal arrangement of thoracoabdominal organs. Associated cardiovascular and visceral malformations pose significant anesthetic and surgical challenges during major procedures such as liver transplantation. CASE DESCRIPTION: An eight-month-old female (6.2 kg) with extrahepatic biliary atresia and heterotaxy syndrome was scheduled for living donor liver transplantation. She had situs ambiguous, dextrocardia, right aortic arch, bilateral superior vena cava, and polysplenia. Persistent bradycardia (heart rate 50 bpm) was unresponsive to atropine, with long pauses on Holter monitoring. Isoprenaline infusion maintained a heart rate of 90 bpm preoperatively. On the day of surgery, induction was achieved with fentanyl, propofol, and atracurium. Transvenous pacing via internal jugular veins was unsuccessful due to anatomical variations; hence, left femoral access was used for pacing and central line placement. Intraoperative anesthesia with sevoflurane, fentanyl, and atracurium ensured stability during the 12-hour procedure. Postoperatively, the patient required re-intubation on day 2 for sepsis, which was managed with antibiotics. The pacemaker was removed on day 6 after stable rhythm with isoprenaline and oral orciprenaline. She recovered well and was discharged from ICU on day 20. CONCLUSION: Successful anesthetic management in heterotaxy syndrome requires detailed preoperative imaging, individualized pacing strategy, and vigilant intraoperative monitoring. Multidisciplinary coordination is key to achieving favorable outcomes in pediatric liver transplantation with complex congenital anomalies.
Anti-A Antibody Rebound-Induced Thrombotic Microangiopathy After ABO-Incompatible Kidney Transplantation: A Case Report.
Hitaka Y, Isoyama N, Tanaka M … +8 more , Ban Y, Ogawa M, Yamaguchi M, Nakamura K, Hiroyoshi T, Tasaki M, Uesugi N, Shiraishi K
Transplant Proc · 2026 Jun · PMID 42144296 · Publisher ↗
BACKGROUND: ABO-incompatible kidney transplantation (ABOi-KT) expands donor availability, but postoperative anti-ABO antibody rebound can lead to rare complications such as thrombotic microangiopathy (TMA), often resulti...
BACKGROUND: ABO-incompatible kidney transplantation (ABOi-KT) expands donor availability, but postoperative anti-ABO antibody rebound can lead to rare complications such as thrombotic microangiopathy (TMA), often resulting in graft loss. CASE PRESENTATION: A 61-year-old underwent ABOi-KT (A → B) after standard desensitization. Despite achieving pre-transplant anti-A IgG and IgM titers of 1:1, a marked postoperative rebound occurred, with both titers rising to 1:1024 by postoperative day 6, accompanied by TMA and acute rejection manifesting as elevated serum creatinine (sCre) (maximum 8.63 mg/dL). Notably, overt hemolytic markers and thrombocytopenia were absent. Management included intensified plasma exchange, intravenous immunoglobulin, high-dose steroids, and discontinuation of tacrolimus. sCre peaked at 8.63 mg/dL, later stabilizing to ∼5 mg/dL at 1 year without dialysis. CONCLUSIONS: Despite adequate desensitization, anti-A antibody rebound can cause early TMA. Importantly, early recognition and aggressive multimodal treatment can rescue the graft, avoiding the high likelihood of graft loss. This case highlights the importance of antibody surveillance after ABOi-KT.
Cytokine Release Syndrome and Cardiogenic Shock Following Anti-Thymocyte Globulin Induction in a Kidney Transplant Recipient: A Case Report.
Yanofsky S, Sachdeva S, Becnel C … +3 more , Vukelic S, Tulla KA, Paramesh AS
Transplant Proc · 2026 Jun · PMID 42144295 · Publisher ↗
Cytokine release syndrome (CRS) is a rare but serious complication of rabbit anti-thymocyte globulin, a common induction medication for solid organ transplant recipients. We present a case of grade 4 cytokine release syn...
Cytokine release syndrome (CRS) is a rare but serious complication of rabbit anti-thymocyte globulin, a common induction medication for solid organ transplant recipients. We present a case of grade 4 cytokine release syndrome in a renal transplant patient in whom tocilizumab successfully salvaged the graft function and stabilized the patient. A 22-year-old woman with end-stage renal disease on hemodialysis and a complex history including systemic lupus erythematosus nephritis underwent a deceased donor kidney transplant with thymoglobulin induction. Hours postoperatively, she developed hemodynamic collapse with escalating vasopressor requirements. Elevated IL-6 supported a diagnosis of CRS, and transthoracic echocardiogram suggested acute cardiogenic shock, requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Treatment with tocilizumab, an IL-6 receptor-blocking monoclonal antibody, resulted in a 76% decrease in IL-6 and subsequent gradual recovery. She was decannulated, weaned off pressors, and extubated over the next week. She was discharged 24 days postoperatively with preserved allograft function and adequate urine output that remained stable after 6 months. This report describes a rare case of severe CRS and acute cardiogenic shock after thymoglobulin induction and highlights the complexities of diagnosing shock of unknown etiology. Tocilizumab shows a promising role in treating post-transplant cytokine crisis, though reports of its use in thymoglobulin-induced CRS in perioperative kidney transplant recipients remain limited. Finally, we show how a multimodal treatment approach of tocilizumab, VA-ECMO, and best care practices was able to preserve the function of the allograft transplant.
A Case Report: Seven-Year Follow-Up of a Patient With Kartagener Syndrome Undergoing Bilateral Lung Transplantation.
Yilmaz E, Basaran FC, Bindal M … +5 more , Turkkan S, Sahin MF, Direk T, Yazıcıoglu A, Yekeler E
Transplant Proc · 2026 Jun · PMID 42144294 · Publisher ↗
Kartagener syndrome (KS) is a rare genetic disorder inherited in an autosomal recessive manner. Bronchiectasis is a major contributor to the morbidity associated with this syndrome. In end-stage cases of KS, bilateral lu...
Kartagener syndrome (KS) is a rare genetic disorder inherited in an autosomal recessive manner. Bronchiectasis is a major contributor to the morbidity associated with this syndrome. In end-stage cases of KS, bilateral lung transplantation (DLuTx) is considered a viable treatment option. This case report presents a 7-year follow-up of a KS patient who developed end-stage respiratory failure and subsequently underwent DLuTx. The case includes both surgical and postoperative challenges, ultimately resulting in a significant improvement in the patient's quality of life.
Passenger Lymphocyte Syndrome Following Minor ABO-incompatible Liver Transplantation: A Case Report.
Tsoukala S, Sotiropoulos GC, Rapti N … +6 more , Ampelioti S, Sarantos K, Stergiou I, Xanthis D, Vernikos P, Paramythiotou E
Transplant Proc · 2026 Jun · PMID 42144293 · Publisher ↗
BACKGROUND: Passenger lymphocyte syndrome (PLS) is a graft-versus-host immune complication after solid organ or hematopoietic stem cell transplantation, typically arising from minor ABO or Rh incompatibility. It is cause...
BACKGROUND: Passenger lymphocyte syndrome (PLS) is a graft-versus-host immune complication after solid organ or hematopoietic stem cell transplantation, typically arising from minor ABO or Rh incompatibility. It is caused by the transfer of viable donor B lymphocytes that produce alloantibodies against recipient red blood cell (RBC) antigens. The syndrome presents as delayed, immune-mediated hemolysis and can be clinically significant. CASE PRESENTATION: We report a 51-year-old woman (blood group B/Rh-positive) who underwent liver transplantation from a blood group O/Rh-positive donor. On postoperative day 9, she developed jaundice and a significant drop in hemoglobin, with no overt clinical signs of hemorrhage. Liver biopsy revealed moderate T-cell mediated rejection and laboratory workup confirmed immune-mediated hemolysis, consistent with PLS. Management included donor compatible red blood cell transfusion, corticosteroids, intensified immunosuppression, and monoclonal antibodies (rituximab), which resulted in stabilization and subsequent resolution of hemolysis. CONCLUSIONS: Although rare, PLS should be considered in the differential diagnosis of early post-transplant anemia. Prompt recognition and appropriate transfusion strategy, with immunomodulatory therapy in severe cases, are crucial for favorable outcomes.
Lethal Porocarcinoma in an Immunosuppressed Host: A Case Report in a Kidney Transplant Recipient.
Beck D, Jukić NB
Transplant Proc · 2026 Jun · PMID 42144292 · Publisher ↗
BACKGROUND: Eccrine porocarcinoma (EPC) is an extremely rare skin adnexa malignancy, occurring worldwide at an estimated 0.005% to 0.01% rate. It has a variable clinical and histological presentation with aggressive beha...
BACKGROUND: Eccrine porocarcinoma (EPC) is an extremely rare skin adnexa malignancy, occurring worldwide at an estimated 0.005% to 0.01% rate. It has a variable clinical and histological presentation with aggressive behavior in immunosuppressed patients. This case report showcases the challenges of diagnosis and treatment. As far as we know, this is the first reported case of porocarcinoma in Croatia. CASE SUMMARY: We present a 63-year-old patient with a kidney transplant due to glomerulonephritis of unknown origin. The patient presented with a lesion in the sacral region measuring 10 × 8 cm. Atheroma was initially suspected due to morphology. Incision and drainage were performed on the lesion. Continuation of bleeding, pain, and discomfort warranted a punch biopsy. It revealed fibrous tissue and nests of atypia and mitosis. A wide local excision was carried out. Histopathology showed an invasive malignancy, EPC. Ki-67 was positive in over 40% and even 70% in certain hotspots. The patient complained of newly developed headaches. Magnetic resonance verified 2 cerebellar metastases and one metastasis located in the temporal lobe. A later PET/CT scan confirmed further dissemination in the lungs, liver, ascending colon, and muscle of the right thigh laterally. Palliative gamma knife brain surgery was used, as well as palliative chemotherapy. The patient passed away after 5 months of diagnosis. CONCLUSION: Data on porocarcinoma in kidney transplant patients is scarce; this case hopes to provide some useful insight.
Commercial Aviation as an Alternative to Charter Flights in Liver Transplantation: A Case Report.
Quillin RC, Kaw A, Moeen-Ud-Din MB … +1 more , Haugen CE
Transplant Proc · 2026 Jun · PMID 42142994 · Publisher ↗
The transition to the acuity circle liver allocation system has increased transportation distance, cold ischemia time, and procurement costs. The increase in procurement cost is largely due to a higher reliance on charte...
The transition to the acuity circle liver allocation system has increased transportation distance, cold ischemia time, and procurement costs. The increase in procurement cost is largely due to a higher reliance on charter flights. Although charter flights are flexible, they are expensive and have a considerable environmental impact. At the same time, advances in controlled hypothermic preservation have extended safe preservation times and may allow broader use of ground and commercial air travel as cost-conscious alternatives to charter flights. We report a case of a donor liver preserved with contemporary hypothermic technology was transported using a commercial airline flight. A 52-year-old donor underwent donation after circulatory death with normothermic regional perfusion. The liver was preserved using the LIVERguard system and transported 356 nautical miles on a commercial flight. Total transportation costs were 14,152 dollars, compared to an estimated 19,000 dollars for a comparable charter flight with ground transfer. LIVERguard preservation time was 9 hours 30 minutes, followed by 4 hours 42 minutes of hypothermic machine perfusion, for a total cold ischemia time of 16 hours 48 minutes. The recipient was a 61-year-old female with metabolic dysfunction associated steatohepatitis and a MELD score of 21. The postoperative course was complicated only by a GI bleed. She had excellent early allograft function and was discharged home on postoperative day 15. This case suggests that commercial flights, paired with advanced hypothermic preservation, can provide a viable, cost effective, and environmentally favorable alternative to charter flights while maintaining organ quality under current allocation practices.
Robotic Incisional Hernia Repair After Solid Organ Transplantation.
Mihaylov P, Kubal C, Fridell J … +1 more , Powelson J
Transplant Proc · 2026 May · PMID 42036242 · Publisher ↗
OBJECTIVE: To describe and evaluate the feasibility of robotic DaVinci incisional hernia repair in the transplant patient population and compare this approach with 2 established surgical hernia repair methods: open and l...
OBJECTIVE: To describe and evaluate the feasibility of robotic DaVinci incisional hernia repair in the transplant patient population and compare this approach with 2 established surgical hernia repair methods: open and laparoscopic. METHODS: We compared 3 surgical techniques for incisional hernia repair. The 66 included patients were divided equally into 3 groups of 22 patients each: robotic DaVinci, fully laparoscopic, and open surgical repair. All patients had undergone a previous abdominal solid organ transplant. All hernia repairs were performed with mesh. Different surgical and patient variables were evaluated among the 3 groups. RESULTS: The major finding was the shortest hospital length of stay in the robotic hernia repair group compared to the other procedural groups. However, operative time and pain score at hospital discharge were higher in the robotic group. There were no significant differences among the groups for all other variables. CONCLUSION: Robotic incisional hernia repair with the DaVinci device is feasible and provides excellent short-term results. Assessment of the hernia defect prior to assigning patients for robotic hernia repair is crucial. Postoperative follow-up for transplant organ dysfunction is mandatory.
Clinical Profile of Patients With Hepatocellular Carcinoma Referred for Transarterial Chemoembolization at a Tertiary Center.
de Araujo BP, Vaz JGO, Bento APN … +13 more , Valente MSVS, Aguilar JMH, Marchetto G, Pessotto LGV, de Macedo PRA, Moisés CB, Teramoto FD, Foratto A, Garcia A, Meneses CJ, Boin IFSF, Perales SR, de Ataíde EC
Transplant Proc · 2026 Apr · PMID 42034455 · Publisher ↗
BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related mortality worldwide. It is strongly associated with chronic liver diseases such as viral hepatitis,...
BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related mortality worldwide. It is strongly associated with chronic liver diseases such as viral hepatitis, alcohol-related liver disease, and nonalcoholic steatohepatitis. Transarterial chemoembolization (TACE) is indicated for intermediate-stage HCC and may be used for downstaging, bridging to liver transplantation, or palliative treatment. METHODS: This cross-sectional observational study evaluated patients with HCC referred for TACE at the University Hospital of Campinas between 2022 and 2023, who underwent the procedure until 2024. Demographic data, liver disease etiology, laboratory findings, tumor staging (Child-Pugh, BCLC, and MELD), transplant listing status, alpha-fetoprotein (AFP) levels, and tumor characteristics were analyzed. RESULTS: A total of 158 patients were included, with a mean age of 64 years and male predominance (77.85%). Hepatitis C virus infection was the most frequent etiology (31%), followed by alcohol-related liver disease (20.9%) and combined HCV and alcohol use (17%). TACE was performed in 100 patients, mainly for downstaging (37.3%) and prevention of transplant waiting-list dropout (32.3%). Half of the patients presented with a single tumor nodule, with a mean lesion size of 3.8 cm. The mean MELD score was 12.5 and AFP levels showed wide variability. CONCLUSION: The study population demonstrated an epidemiological profile consistent with the literature. TACE was widely used as an effective strategy for tumor control in liver transplant candidates, highlighting its importance in the management of HCC in the Brazilian clinical setting.
Occurrence of PICC/CVC-Related Skin Impairment in Patients With Hematopoietic Stem Cell Transplantation Analysis of Current Situation and Influencing Factors.
Wang T, Liu BN, Hu W … +17 more , Xu X, Shuangdong, He X, Wang L, Cao Y, Wang J, Qu Y, Gao Y, Feng Z, Guo R, Qi X, Fan Q, Wang Y, Liu M, Yan X, Qi X, Yan X
Transplant Proc · 2026 May · PMID 42031634 · Publisher ↗
PURPOSE: To investigate the current status and influencing factors of PICC/CVC-related central vascular access device-associated skin impairment (CASI) in patients undergoing hematopoietic stem cell transplantation (HSCT...
PURPOSE: To investigate the current status and influencing factors of PICC/CVC-related central vascular access device-associated skin impairment (CASI) in patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS: A convenience sampling method was used to recruit 207 patients undergoing HSCT at our center between August and October 2019. The occurrence of CASI, including noninfectious exudation, puncture-site infection, skin irritation, and skin injury, was recorded, and its influencing factors were analyzed statistically. RESULTS: Among the 207 patients, 80 cases developed CASI, with the an incidence density of 18.3 per 1,000 catheter-days, including 48 cases of exudation (non-infection) (10.9 per 1,000 catheter-days), 13 cases of puncture point infection (3.0 per 1,000 catheter-days), and 1 case of skin injury (0.2 per 1,000 catheter-days) and skin irritation in 18 cases (.1 per 1,000 catheter-days). Logistic regression analysis results showed that the influencing factors of CASI are: compared with PICC, CVC increases puncture-site infection (OR = 17.76, 95% CI: 3.15-100.11, P = 0.001) and skin irritation(OR = 4.68, 95% CI: 1.36-16.08, P = 0.014) risk; compared with catheterization for more than 2 weeks, skin irritation within 2 weeks of catheterization(OR= 0.87,95% CI: 0.86-0.890, P = 0.016)and extravasation (non-infectious) (OR = 1.58, 95% CI: 1.23-11.01, P = 0.045) increased risk, while patients with catheterization for more than 2 weeks had an increased risk of infection (OR = 0.81, 95% CI: 0.810-0.949, P =0.042); exudation (non-infectious) occurred before transplantation (OR = 0.13, 95% CI: 0.06-0.29, P ＜ 0.001), puncture point infection (OR = 0.11,95% CI: 0.04-0.29, P = ＜ 0.001) and skin irritation (OR = 0. 20, 95% CI: 0.08-0.49, P = ＜ 0.001) were higher than those after transplantation. CONCLUSION: Among HSCT patients, the risk of indwelling PICC to prevent CASI is lower than that of CVC. It is also recommended that medical staff strengthen assessment during the immune deficiency period and within 2 weeks of catheterization, and standardize CVAD maintenance process to reduce the incidence of CASI and improve continuous treatment of patients.
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