Transplant. Proc. [JOURNAL]
Sun
200 papers
Safety and Efficacy of Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation for Salvage Therapy of Myelofibrosis.
Wang X, Fu A, Xu B … +9 more , Wang N, Yang Y, Hong Z, Huang L, Xu J, Cao Y, Meng F, Zhang D, Zhang Y
Transplant Proc · 2026 May · PMID 42031633 · Publisher ↗
OBJECTIVE: To evaluate the efficacy and safety of reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (allo-HSCT) for a salvage therapy of patients with myelofibrosis (MF). METHODS: We...
OBJECTIVE: To evaluate the efficacy and safety of reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (allo-HSCT) for a salvage therapy of patients with myelofibrosis (MF). METHODS: We conducted a retrospective study of 17 MF patients with poor performance status, refractory disease, or progressive disease who underwent RIC-allo-HSCT. Overall survival (OS), progression-free survival (PFS), hematopoietic reconstitution, the cumulative incidence of relapse and improvements in myelofibrosis and splenomegaly were analyzed. RESULTS: All 17 patients received RIC regimens. The neutrophil and platelet engraftment rates were 94.1% and 88.2%, respectively, with median engraftment times of 16 days (range, 11-22 days) and 22 days (range, 10-148 days). The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) within 100 days post-transplant was 41.2%, and that of grade III-IV aGVHD was 17.6%. The overall incidence of chronic GVHD (cGVHD) was 35.3%. The reactivation rates of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were 47.1% and 29.4%, respectively. Before transplantation, there were 10 patients (58.8%) with MF-3 and splenomegaly. At six months after transplantation, the proportion of MF-3 decreased to 26.7%, MF-0 increased to 40.0%, and the proportion of splenomegaly decreased to 53.3%. As of the follow-up date, the proportion of MF-3 had decreased to 21.4%, MF-0 had increased to 57.1%, and all eight remaining patients with splenomegaly had shown varying degrees of spleen size reduction. The estimated 1-year OS and PFS were 88.2% (95% CI, 60.6%-96.9%) and 81.9% (95% CI, 53.8%-93.8%), and the estimated 3-year OS and PFS were 70.6% (95% CI, 26.0%-91.4%) and 65.5% (95% CI, 25.7%-87.7%), respectively. CONCLUSION: RIC-allo-HSCT is a feasible and effective alternative for salvage therapy in MF patients.
Midterm Outcomes and Early Hemodynamic Findings After Heart Transplantation Using Donors Aged ≥50 Years.
Taguchi T, Yoshioka D, Tonai K … +19 more , Fukushima S, Yanagino Y, Kitahata N, Akazawa Y, Saito S, Kawamura T, Kawamura A, Yajima S, Misumi Y, Kainuma S, Kawamoto N, Suzuki K, Tadokoro N, Kakuta T, Watanabe T, Mochizuki H, Sakata Y, Tsukamoto Y, Miyagawa S
Transplant Proc · 2026 May · PMID 42020243 · Publisher ↗
OBJECTIVES: Expanding the donor age limit may be necessary due to persistent donor shortages. The hemodynamic characteristics and postoperative cardiac performance of hearts from older donors remain insufficiently unders...
OBJECTIVES: Expanding the donor age limit may be necessary due to persistent donor shortages. The hemodynamic characteristics and postoperative cardiac performance of hearts from older donors remain insufficiently understood. This study aimed to evaluate midterm outcomes and early hemodynamic changes in recipients of hearts from older donors. METHODS: This retrospective observational study analyzed data from 260 patients who underwent heart transplantation between 1999 and 2022 at two institutions. Outcomes were compared between 89 recipients of hearts from donors aged ≥50 years (D-age ≥ 50) and 171 recipients from donors aged <50 years (D-age < 50). The endpoint included overall survival rate, rehospitalization for cardiac events, and early postoperative hemodynamic data. RESULTS: Ten-year survival rates did not significantly differ between the two groups (90.6% vs 89.4%, P = .26). Recipients of hearts from older donors required extracorporeal membrane oxygenation more frequently than those receiving hearts from younger donors (2% vs 11%, P = .001). Early hemodynamic evaluation showed a lower cardiac index in recipients of hearts from donors aged ≥50 years, suggesting impaired early diastolic function. The rate of rehospitalization for cardiac events was comparable between the D-age ≥ 50 and D-age < 50 groups; however, donor age was independently associated with rehospitalization risk. CONCLUSION: Although the potential increase in extracorporeal membrane oxygenation use due to early diastolic dysfunction and the higher rate of cardiac-related rehospitalization should be noted, the midterm outcomes for recipients of hearts from donors aged ≥50 years were comparable to those of recipients receiving hearts from younger donors.
Quality of Life and Self-Care Behavior in Patients After Heart Transplantation.
Charoenthanakit C, Nitusganjananon W
Transplant Proc · 2026 May · PMID 42020242 · Publisher ↗
BACKGROUND: We aimed to study the quality of life and self-care behavior of patients undergoing heart transplantation. METHODS: We conducted a retrospective, descriptive study among recipients of heart transplants at Ram...
BACKGROUND: We aimed to study the quality of life and self-care behavior of patients undergoing heart transplantation. METHODS: We conducted a retrospective, descriptive study among recipients of heart transplants at Ramathibodi Hospital between 2017 and 2024. The study included 20 surviving patients, consisting of 17 adult patients and 3 pediatric patients aged 14 to 17 years, and elderly patients were defined as those aged 60 years and older. Patients who were unwilling to participate were excluded. The study utilized a 5-section questionnaire as a data collection instrument: Section1 Personal Data; Section2 Self-Care Behavior Questionnaire; Section3 Thai SF-36 QoL Questionnaire; Section4 Thai EQ-5D-5L QoL Questionnaire; and Section5 Satisfaction Score Assessment. RESULTS: Most patients were male (71%) and had at least a high school education. Physical self-care behaviors were generally good to very good, with high adherence to medication, infection prevention, and dietary guidelines. Exercise levels were moderate, and emotional well-being was favorable, with low levels of sadness or anxiety. The Thai SF-36 results showed mean scores of 75.03 for the physical component and 80.31 for the mental component. The EQ-5D-5L assessment indicated that most patients reported no problems with self-care (94%), anxiety/depression (90%), pain/discomfort (87%), usual activities (87%), and mobility (81%). The mean health state score from the VAS was 73.71. Satisfaction with QoL significantly improved after transplantation (P < .001). CONCLUSIONS: Recipients of heart transplants demonstrated improved QoL across physical and mental dimensions and maintained strong self-care behaviors. Continued support from health care teams is essential to sustain long-term outcomes and address remaining limitations in mobility and daily activities.
Rabbit Antithymocyte Globulin vs Basiliximab Induction in ABO-Incompatible Kidney Transplantation: A Single-Center Retrospective Cohort Study.
Jang E, Moon KY, Cho HJ … +4 more , Yun SS, Park SC, Kim MH, Hwang JK
Transplant Proc · 2026 May · PMID 42020241 · Publisher ↗
BACKGROUND: Rabbit antithymocyte globulin (rATG) is frequently used in immunologically high-risk kidney transplantation (KT), but its comparative effectiveness and safety vs basiliximab in ABO-incompatible (ABOi) KT are...
BACKGROUND: Rabbit antithymocyte globulin (rATG) is frequently used in immunologically high-risk kidney transplantation (KT), but its comparative effectiveness and safety vs basiliximab in ABO-incompatible (ABOi) KT are not well established. We aimed to compare outcomes of rATG and basiliximab induction in ABOi KT and to evaluate whether ABO compatibility modifies these associations. METHODS: We conducted a retrospective single-center cohort study of adult KT recipients at Seoul St. Mary's Hospital between 2011 and 2020. Patients receiving rATG or basiliximab induction were identified and stratified by ABO compatibility. Primary outcomes were overall patient survival, death-censored graft survival (DCGS), and rejection-free graft survival. Secondary outcomes included serious infection requiring hospitalization and post-transplant malignancy. Time-to-event analyses were performed using Kaplan-Meier methods and Cox proportional hazards models, with an interaction term between induction agent and ABO incompatibility. RESULTS: Among 1546 KT recipients, 285 underwent ABOi KT, including 69 receiving rATG and 216 basiliximab. In unstratified analyses, overall patient survival, rejection-free graft survival, and infection-related hospitalization did not differ significantly between induction strategies. Cytomegalovirus viremia was more frequent in the rATG group. In adjusted models, a significant interaction between induction strategy and ABO compatibility was observed for DCGS (P = .031), whereas no significant interactions were observed for rejection-free graft survival or overall patient survival. CONCLUSION: In ABOi KT, rATG induction was associated with improved DCGS compared with basiliximab, while patient survival and serious infectious complications were similar. The association between induction strategy and graft survival varied by ABO compatibility, supporting a risk-adapted approach to induction therapy.
The Weight of Balance: Anesthetic Management in Liver Transplantation for Critically Ill Patients. A Case Report.
Fernández PP, Rodríguez DYG, Torres LIR … +6 more , Gómez JCV, Cedillo AS, Gómez OV, Calatayud ÁAP, Corró CEV, Molina CE
Transplant Proc · 2026 Jun · PMID 42014252 · Publisher ↗
BACKGROUND: Liver transplantation in critically ill patients with multiple organ dysfunction poses a unique anesthetic challenge due to profound coagulopathy, hemodynamic instability, and metabolic derangements. CASE PRE...
BACKGROUND: Liver transplantation in critically ill patients with multiple organ dysfunction poses a unique anesthetic challenge due to profound coagulopathy, hemodynamic instability, and metabolic derangements. CASE PRESENTATION: We describe a 50-year-old male with alcoholic cirrhosis (MELD-Na 27) who underwent 2 consecutive liver transplants within 72 hours. The initial surgery involved aspiration of 15 L of purulent ascites and 8000 mL of blood loss. Advanced hemodynamic monitoring, balanced fluid therapy with albumin, vasopressor support (norepinephrine and vasopressin), goal-directed coagulation management (ROTEM), and strict metabolic control were implemented. Post-reperfusion hypotension and bradycardia were managed with adrenaline and atropine. Twelve hours later, he was reoperated for hemoperitoneum and subsequently underwent urgent retransplantation for hepatic artery thrombosis. Hemodynamic stability was achieved during the second procedure. Despite successful graft perfusion, the patient developed pneumonia and renal failure requiring replacement therapy, leading to a fatal outcome. CONCLUSION: Physiology-guided anesthesia can sustain intraoperative stability in extreme scenarios, but outcome depends on preoperative physiological reserve and timing of intervention.
Unmasking a Silent Risk: Impact of Baseline Hypotension on Kidney Allograft Outcomes in Comparison With Normotensive Recipients.
Ghoneim M, Attiya AMN, Rostaing L … +1 more , Elmowafy AY
Transplant Proc · 2026 May · PMID 42014251 · Publisher ↗
OBJECTIVES: Chronic hypotension is uncommon among kidney transplant recipients, and may adversely affect graft outcomes. PATIENTS AND METHODS: Single-center retrospective cohort study including adult recipients who under...
OBJECTIVES: Chronic hypotension is uncommon among kidney transplant recipients, and may adversely affect graft outcomes. PATIENTS AND METHODS: Single-center retrospective cohort study including adult recipients who underwent living-donor kidney transplantation, between 2009 and 2024. Of the 1678 recipients screened, 187 met the inclusion criteria. Hypotension was defined as persistent systolic blood pressure (SBP) <100 mm Hg or mean arterial pressure (MAP) <70 mm Hg throughout follow-up; normotensive had SBP ranging from 100 to 130 mm Hg. Early outcomes included primary non-function (PNF), delayed-graft function (DGF), acute rejection, and thrombotic events, whereas late outcomes included graft survival, renal function, proteinuria, and chronic rejection. RESULTS: A total of 187 recipients were included (57 hypotensive and 130 normotensive). Hypotensive recipients experienced significantly higher rates of early adverse outcomes, including DGF, PNF, graft vein thrombosis, and acute cellular rejection. Late outcomes were also inferior, with higher rates of chronic rejection and graft failure, as well as poorer graft function and increased proteinuria. Kaplan-Meier analysis demonstrated significantly reduced graft survival among hypotensive recipients (P = .001). On multivariable analysis, persistent hypotension independently predicted both rejection and graft failure. CONCLUSION: Baseline hypotension is an underrecognized risk factor in kidney transplantation, associated with an increased risk of early and late graft complications.
Clinical Study of Risk Factors for Early Human Cytomegalovirus Reactivation Following Liver Transplantation.
Zhang Y, Gui G, Yu X … +2 more , Fan J, Pan X
Transplant Proc · 2026 May · PMID 42014250 · Publisher ↗
BACKGROUND: Human cytomegalovirus (HCMV) is the most common opportunistic infection following liver transplantation (LT). This study aimed to identify risk factors for HCMV reactivation early post-transplantation. METHOD...
BACKGROUND: Human cytomegalovirus (HCMV) is the most common opportunistic infection following liver transplantation (LT). This study aimed to identify risk factors for HCMV reactivation early post-transplantation. METHODS: We retrospectively analyzed data from 150 LT recipients aged ≥14 years who received preemptive therapy in China from July 2017 to December 2018. We performed univariate and multivariate analyses to identify risk factors for HCMV reactivation within the first 90 days post-transplantation. RESULTS: HCMV reactivation occurred in 32 patients (21.33%) within the first 90 days post-LT. Intensive care unit length of stay (odds ratio [OR], 1.055; 95% confidence interval [CI], 1.007-1.104; P = .023), fungal infections (OR, 3.093; 95% CI, 1.092-8.764; P = .034), and non-hepatitis B virus (HBV)-related liver disease (OR, 5.576; 95% CI, 2.137-14.552; P = .000) were significant risk factors for HCMV reactivation within the first 90 days post-LT. The cumulative incidence of HCMV reactivation was significantly higher in patients with non-HBV-related liver diseases (P = .0007) than in those with HBV-related liver diseases. In the former, HCMV reactivation early after transplantation was associated with the pretransplantation hepatitis B surface antibody (HBsAb) serological status (P = .006). Higher HBsAb titers were significantly associated with reduced HCMV reactivation risk (P = .011). CONCLUSIONS: This study suggested that HCMV is a common opportunistic infection early after LT. Reducing intensive care unit lengths of stay and preventing fungal infections may reduce the risk of HCMV reactivation early after transplantation. Pretransplantation HBsAb titers might be a useful predictor in patients with non-HBV-related liver diseases.
Association of Statins With Cardiovascular Outcomes Following Kidney Transplantation.
Mata A, Christy G, Krumm C … +5 more , Sriram A, Peddada V, Stein E, Gudapati M, Benjamin MM
Transplant Proc · 2026 May · PMID 42002487 · Publisher ↗
BACKGROUND: Kidney transplant recipients (KTRs) face high cardiovascular risk, but the benefit of statin therapy for preventing major adverse cardiovascular events (MACE) in this population remains unclear. METHODS: We c...
BACKGROUND: Kidney transplant recipients (KTRs) face high cardiovascular risk, but the benefit of statin therapy for preventing major adverse cardiovascular events (MACE) in this population remains unclear. METHODS: We conducted a retrospective, single-center cohort study of adult KTRs between 2015 and 2024. Patients were categorized by statin use at the time of kidney transplantation (statin use [STN] vs no statin use [NoSTN]). We also conducted a separate analysis of patients with no known cardiovascular disease. The primary outcome was a composite of all-cause mortality and MACE. Cox proportional-hazards models were performed, adjusting for confounders identified from logistic regression. RESULTS: A total of 518 patients (202 STN vs 316 NoSTN) were included (mean age 54.3 vs 53.1 years. The STN group had significantly more patients with a history of smoking (73.5% vs 62.1%), whereas in the NoSTN group, diabetes mellitus was more prevalent (40.2% vs 30.7%). Statin use was not associated with a significant difference in MACE (13.8% vs 15.5%, P = .62), all-cause mortality (10% in both), or the composite outcome. Similar findings were observed in the primary prevention subgroup. CONCLUSIONS: Statin therapy at the time of kidney transplantation was not associated with a significant reduction in MACE or all-cause mortality in patients with and without known atherosclerotic cardiovascular disease. These results support a review of routine statin use in KTRs and highlight the need for further analysis.
Respiratory Complications Following Pediatric Liver Transplantation: Frequency, Risk Factors, and Clinical Predictors of Chronic Morbidity.
Unal F, Saka B, Ayman FN … +5 more , Telhan L, Sevmis S, Dayangac M, Baysoy G, Oktem S
Transplant Proc · 2026 May · PMID 42002486 · Publisher ↗
OBJECTIVE: To investigate the incidence, characteristics, and risk factors of postoperative respiratory complications in pediatric liver transplant (LT) recipients, and to identify clinical predictors of chronic respirat...
OBJECTIVE: To investigate the incidence, characteristics, and risk factors of postoperative respiratory complications in pediatric liver transplant (LT) recipients, and to identify clinical predictors of chronic respiratory morbidity. METHODS: We retrospectively analyzed data from 42 pediatric patients who underwent LT between 2014 and 2020. Variables assessed included demographics, primary liver disease, pre-transplant comorbidities, perioperative factors, and postoperative respiratory complications (PTRCs). Complications were categorized as early or chronic (persisting >3 months). Statistical associations between complications and clinical features were evaluated. RESULTS: Postoperative respiratory complications occurred in 67% of patients, with pleural effusion (45%), pneumonia (33%), and postextubation respiratory failure (33%) being most common. Chronic respiratory complications were observed in 14% of patients and were significantly associated with prior abdominal surgery, prolonged pediatric intensive care unit stay, and postextubation respiratory failure. Pre-transplant pneumonia, ascites, portal hypertension, and recurrent abdominal surgery were identified as significant risk factors for PTRCs. Pulmonary hemorrhage was the only complication associated with mortality. CONCLUSION: Respiratory complications are common in pediatric LT recipients and are strongly associated with pre-existing pulmonary and intra-abdominal conditions. Early recognition of at-risk patients may allow for improved perioperative strategies and long-term respiratory outcomes.
Rifaximin Versus Levofloxacin: A Comparative Analysis of Prophylactic Efficacy in Allogeneic Stem Cell Transplantation.
Patat Y, Akyol G, Keklik M … +2 more , Ünal A, Kaynar L
Transplant Proc · 2026 May · PMID 42002485 · Publisher ↗
This study aims to compare the effects of rifaximin and levofloxacin prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT) on the development of graft-versus-host disease (GVHD), length of hospital sta...
This study aims to compare the effects of rifaximin and levofloxacin prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT) on the development of graft-versus-host disease (GVHD), length of hospital stay, engraftment duration, initiation of broad-spectrum antibiotics, incidence of febrile neutropenia, relapse rates, readmission periods, and transplant-related mortality. A total of 116 patients aged over 18 who underwent allogeneic HSCT between 2018 and 2022 were included. Exclusion criteria included the use of broad-spectrum antibiotics on the day of transplantation. Of these, 58 patients received rifaximin, and 58 received levofloxacin as prophylaxis. Levofloxacin was associated with a significantly lower incidence of febrile neutropenia in patients with acute myeloid leukemia (AML) compared to rifaximin (P = .017). Among other patient groups, levofloxacin prophylaxis also resulted in a lower fever incidence (P = .031). Levofloxacin demonstrated greater efficacy than rifaximin in reducing the incidence of transition to broad-spectrum antibiotic therapy (P = .008). Among the 116 patients, 54 were readmitted within the first 100 days post-transplantation. Among these, the predominant reason for readmission was infection, followed by graft-versus-host disease (GVHD). The use of levofloxacin prophylaxis was linked to a remarkably lower rate of readmissions (P = .004). In patients with acute lymphoblastic leukemia (ALL), levofloxacin also showed a significant advantage in terms of readmission rates. Moreover, individuals who received levofloxacin for prophylaxis experienced reduced mortality rates (P = .011).
Impact of the Type of Consent on Refusal to Donate in Latin American Countries.
Mizraji R, Bacci MP, Cacciatori A
Transplant Proc · 2026 May · PMID 42002484 · Publisher ↗
This paper presents a study on the implementation of the presumed consent law for organ and tissue donation in Uruguay. The objective was to analyze the factors that influence the acceptance of the law by the families of...
This paper presents a study on the implementation of the presumed consent law for organ and tissue donation in Uruguay. The objective was to analyze the factors that influence the acceptance of the law by the families of the deceased. The data were collected from the records of donation interviews and communication of the law. It also highlights the types of consent to donation established in the different regulations on donation in Latin American countries and shows the differences in refusal rates. The results show that the success of the application of the presumed donor law is influenced by the strategy developed in the family interview, which emphasizes the importance of the family's understanding of brain death, the establishment of a bond of information, trust, and support between the healthcare team and the family, the prior awareness and training of the healthcare team, the credibility and transparency of the procedures, the dissemination and knowledge of the law, and the capacity, time commitment, and support of the family to whom the regulations are communicated. In conclusion, it is stated that the type of consent is not a sufficient solution that will result in a greater number of donors, but rather a means, a plan for how to implement and carry out communication with donor families.
Clinical and Histological Phenotypes of Antibody-Mediated Rejection in Kidney Transplant: A Single-Center Experience from Latin America.
Noboa J, Astesiano R, Santiago J … +8 more , Noboa A, Marton S, Lorenzo M, Coitiño R, Noboa O, Nin M, Tiscornia A, Seija M
Transplant Proc · 2026 May · PMID 41997772 · Publisher ↗
BACKGROUND: Antibody-mediated rejection (AMR) is a major cause of kidney allograft failure. A substantial proportion of AMR occurs without detectable donor-specific antibodies (DSA), and the clinical relevance of DSA-neg...
BACKGROUND: Antibody-mediated rejection (AMR) is a major cause of kidney allograft failure. A substantial proportion of AMR occurs without detectable donor-specific antibodies (DSA), and the clinical relevance of DSA-negative AMR remains incompletely defined, particularly in regions with limited access to advanced immunological testing. METHODS: We conducted a retrospective analysis of kidney transplant recipients at a single center in Uruguay between 2018 and 2024. Patients with for-cause biopsies fulfilling contemporary Banff criteria for active AMR were included; chronic active AMR and non-immunologic lesions were excluded. Donor-specific antibodies were assessed at the time of biopsy using class I and II screening assays. Clinical, histological, and outcome data were compared between DSA-positive and DSA-negative AMR. Quantitative histological analyses, including an AMR/MVI index and an activity score, were used to assess microvascular injury and inflammatory burden. RESULTS: Among 458 kidney transplant recipients, 93 (20%) developed AMR, of whom only 24% had detectable DSA. DSA-positive patients showed distinct clinical and histological features, including more severe microvascular inflammation and a higher frequency of concomitant T cell-mediated rejection. A high proportion of cases were classified within the severe AMR/MVI category, and activity scores were significantly higher in DSA-positive patients compared with international cohorts. Graft survival was significantly reduced in patients with AMR, with no significant differences between DSA-positive and DSA-negative cases. CONCLUSIONS: In this single-center cohort, most AMR episodes occurred without detectable DSA. The predominance of high AMR/MVI scores suggests that patients present with later-stage histological injury at diagnosis. The use of AMR/MVI scores enabled comparison with international cohorts. These findings highlight the need for earlier diagnosis of AMR and regional limitations in comprehensive DSA assessment in Latin America.
Knowledge and Attitudes of Health Professionals Towards Organ Donation in Adult Critical Care Units in Paraguay.
Colman I, Pederzani M, Fretes F … +2 more , Avila S, Figueredo B
Transplant Proc · 2026 May · PMID 41997771 · Publisher ↗
INTRODUCTION: Intensive care unit (ICU) professionals play a pivotal role in the identification and maintenance of potential organ donors, as well as in the accurate certification of brain death. OBJECTIVE: To describe t...
INTRODUCTION: Intensive care unit (ICU) professionals play a pivotal role in the identification and maintenance of potential organ donors, as well as in the accurate certification of brain death. OBJECTIVE: To describe the knowledge and attitudes toward organ donation among adult ICU professionals in 4 hospitals in Paraguay. METHODS: An observational, descriptive, cross-sectional study was conducted using a 25-item electronic questionnaire administered to physicians and nurses working in the adult ICUs of Hospital de Clínicas, Hospital de Trauma Manuel Giagni, Hospital General de San Lorenzo, and the National Institute of Cardiology between October and November 2022. Of the total responses, 288 complete questionnaires (70%) were included in the analysis. RESULTS: The mean age of participants was 36.8 ± 6.7 years, and 64.2% were women. Nurses accounted for 75% of respondents, while 24% were physicians. Brain death was correctly defined by 68% of participants, and 43.4% recognized that its diagnosis is primarily clinical. Although 90.3% reported being aware of the national organ donation law, 53% believed that the decision to donate rests with the family, whereas 45% identified verification of the national refusal registry as the determining factor. Overall, 84% expressed personal willingness to donate organs, and 98% reported interest in receiving further training. CONCLUSIONS: ICU professionals demonstrated a broadly favorable attitude toward organ donation. However, relevant gaps persist in the understanding of the clinical diagnosis of brain death and the current legal framework. Targeted continuing education initiatives for ICU staff may enhance donor identification and strengthen organ procurement processes.
Evaluation of Infections Developing in Liver Transplant Patients: Thirteen-Year Experience of a Single Center.
Kurt EK, Bulut R, Kandemir B … +5 more , Keskin PB, Şentürk M, Bıyık M, Erayman İ, Küçükkartallar T
Transplant Proc · 2026 May · PMID 41997770 · Publisher ↗
OBJECTIVES: Liver transplantation is a life-saving treatment for end-stage liver disease and acute liver failure. This study examines infections that develop within 1 year after liver transplantation, their risk factors,...
OBJECTIVES: Liver transplantation is a life-saving treatment for end-stage liver disease and acute liver failure. This study examines infections that develop within 1 year after liver transplantation, their risk factors, and patient prognoses. MATERIALS AND METHODS: This study retrospectively reviewed the follow-up files and hospital computer records of patients who underwent liver transplantation at our hospital between 2010 and 2024. Patients information were recorded. After data analysis, statistical significance was accepted as p < .05. RESULTS: Of the 106 patients included in the study, the mean age at transplantation was 47.61 ± 12.17 (20-67), and 56 (52.8%) were male. The most common indication for transplantation was cryptogenic liver cirrhosis (26.4%). Nineteen (17.9%) patients died within the first 48 hours after transplantation. Of the 87 patients who survived after transplantation, 68 (78.2%) experienced at least 1 episode of infection, resulting in a total of 135 infections. Intra-abdominal infection (28.1%) was the most common post-transplantation infection. In the 1-year post-transplant period, the most common infections were bacterial (57.8% Gram-negative microorganisms) in 71.5% of cases, followed by fungal (16.5%), viral (6.5%), parasitic (5.5%), and M. tuberculosis (0.9%). Klebsiella spp. was the most common bacterial agent in 32 (29.3%) cases, and carbapenem resistance was detected in 64.9%. Enterococcus spp. was the most common Gram-positive microorganism in 12 (11%) cases. The duration of surgical prophylaxis was longer in patients who did not develop infection than in patients who did (p = .014). The length of intensive care unit stays in patients who developed infection was longer than in patients who did not (p = .033). Five patients (8.9%) died due to infection. CONCLUSION: Although bacterial infections are the most common, opportunistic viral, fungal, and parasitic infections can also occur in liver transplant patients. Because these infections can lead to patient death, rapid diagnosis and early initiation of treatment are crucial.
Visualizing and Quantifying Ventilation-Perfusion Mismatch by Electrical Impedance Tomography in Patients Undergoing Lung Transplantation: A Pilot Physiological Study.
Takai D, Maeda A, Yamamoto M … +7 more , Fujishiro K, Hattammaru Y, Inokuchi R, Kawashima M, Konoeda C, Sato M, Doi K
Transplant Proc · 2026 May · PMID 41997769 · Publisher ↗
INTRODUCTION: Ventilation-perfusion (V/Q) mismatch is common in lung transplant recipients, particularly during the early postoperative period. It may lead to impaired gas exchange and prolong the duration of mechanical...
INTRODUCTION: Ventilation-perfusion (V/Q) mismatch is common in lung transplant recipients, particularly during the early postoperative period. It may lead to impaired gas exchange and prolong the duration of mechanical ventilation. Electrical impedance tomography (EIT) is a novel bedside imaging modality, facilitating the real-time regional assessment of V/Q mismatch. This pilot study aimed to visualize and quantify V/Q mismatch using EIT in lung transplant recipients during the early postoperative period. METHODS: This pilot single-center retrospective study included ten recipients following lung transplantation (5 single lung transplantation (SLT) and 5 bilateral lung transplantation (BLT)). During mechanical ventilation, the regional ventilation and perfusion were evaluated using EIT in the first 5 postoperative days. V/Q mismatch was quantified by calculating the percentages of only ventilated units, only perfused units, and unmatched units as well as the fractions of wasted ventilation and wasted perfusion. RESULTS: The SLT recipients exhibited a significantly higher percentage of only ventilated units than the BLT recipients (2.9% [2.8, 3.2] vs. 0.8% [0.0, 1.0], p = .012). In contrast, the BLT recipients showed a numerically higher percentage of only perfused units (28.8% [28.8, 34.1] vs. 19.4% [19.3, 19.4], p = .095). Moreover, the percentages of unmatched units, fractions of wasted ventilation, and fractions of wasted perfusion were comparable between the 2 groups. CONCLUSION: Distinct V/Q patterns for the SLT and BLT recipients were observed. This highlights the need for individualized ventilatory strategies to optimize postoperative respiratory management in lung transplant recipients.
Kidney Transplantation Outcome in Patients With Augmented Bladder: A Single-Center Experience.
Ekin RG, Eroglu A, Ok ES … +2 more , Toz H, Ozgu I
Transplant Proc · 2026 May · PMID 41991410 · Publisher ↗
OBJECTIVE: Kidney transplantation (KT) in patients with bladder augmentation (BA) remains controversial due to concerns about infection, surgical complications, and long-term graft survival rate. We retrospectively evalu...
OBJECTIVE: Kidney transplantation (KT) in patients with bladder augmentation (BA) remains controversial due to concerns about infection, surgical complications, and long-term graft survival rate. We retrospectively evaluated patients who underwent KT after BA. MATERIALS AND METHODS: Between January 2010 and August 2025, data from 15 patients with KT and BA were analyzed. Demographic characteristics, underlying urological diagnoses, type of augmentation, surgical details of transplantation, and post-transplant follow-up were evaluated. RESULTS: Fifteen patients underwent kidney transplantation after bladder augmentation. Median interval from augmentation to kidney transplantation was 176 months. Mean age at KT was 25.07 ± 6.8 years. Living kidney donation rate was 93.3%. The mean follow-up after KT was 98.9±57.4 months. Febrile UTI occurred in 8/15 (53.3%) patients (15 episodes), yet no graft loss was directly infection-mediated. Acute rejection occurred in 3/15 (20.0%). Graft survival rate was 100%, 90.9%, and 72.7% at 1, 5, and 10 years, respectively. Median serum creatinine at last follow-up was 1.58 mg/dL. CONCLUSION: Kidney transplantation in patients with augmented bladders can achieve satisfactory long-term graft survival.
Outcome of Dietary Intervention on Kidney Transplant Recipients With Proteinuria/Chronic Metabolic Acidosis - A Single Cohort Prospective Study.
Lau WP, Ng KP, Ganapathy SS … +3 more , Tah PC, Ismail R, Lim SK
Transplant Proc · 2026 May · PMID 41991409 · Publisher ↗
BACKGROUND: Proteinuria and chronic metabolic acidosis may negatively impact renal allograft survival. This study aims to evaluate dietary intervention in reducing proteinuria and correcting metabolic acidosis among kidn...
BACKGROUND: Proteinuria and chronic metabolic acidosis may negatively impact renal allograft survival. This study aims to evaluate dietary intervention in reducing proteinuria and correcting metabolic acidosis among kidney transplant recipients (KTRs). METHODS: This is a prospective dietary intervention study. KTRs who have proteinuria ≥ 0.5g/d or chronic metabolic acidosis with serum bicarbonate ≤ 22 mmol/L for at least two readings in the past 6 months were recruited. All recruited subjects were given one-to-one diet counseling for moderate dietary protein restriction at 0.8 g/kg of ideal body weight (IBW) and high vegetable and fruit intake by a research dietitian. All subjects were encouraged to replace animal protein with plant protein. The duration of the study was 3 months. Changes in proteinuria and serum bicarbonate levels pre- and postintervention were analyzed. RESULTS: A total of 30 KTRs (26 with proteinuria and four with chronic metabolic acidosis) were enrolled and completed the intervention phase. Proteinuria reduced significantly after 1 month of the intervention (z = -2.643, P = .008) in alignment with a significant reduction in dietary protein (z = -2.376, P = .018) and dietary acid load (z = -2.149, P = .032). However, this effect was not sustainable when the dietary protein intake was increased at 3 months. Significant weight reduction was observed after 1 month (z = -3.379, P = .001) and 3 months (z = -3.503, P < .001) after dietary intervention. No statistically significant change in serum bicarbonate was found. CONCLUSIONS: Dietary intervention can induce favorable dietary changes, leading to reductions in proteinuria and body weight in KTRs. Hence, dietary counseling should be part of the multiprong approach to managing KTRs.
Urinary Tract Infections in Kidney Transplant Recipients: A Narrative Review.
Apicella L, Vecchione N, Minelli G … +13 more , Minco M, Sannino A, Crescenzo C, Molinaro G, D'Urso F, Russo D, Russo D, Hamzeh S, Carrano R, Pinchera B, Secondulfo C, Iacuzzo C, Bilancio G
Transplant Proc · 2026 May · PMID 41991408 · Publisher ↗
Urinary tract infections (UTIs) are the most frequent infectious complication after kidney transplantation and are associated with rehospitalizations, impaired allograft function, and reduced graft and recipient survival...
Urinary tract infections (UTIs) are the most frequent infectious complication after kidney transplantation and are associated with rehospitalizations, impaired allograft function, and reduced graft and recipient survival. Their clinical relevance is amplified by chronic kidney disease (CKD)-related immune dysfunction and the rising burden of antimicrobial resistance METHODS: We provide a focused narrative review of classification, pathophysiology, risk factors, and evidence-based management and prevention strategies for UTIs in kidney transplant recipients, with emphasis on antimicrobial stewardship and non-antibiotic adjuncts RESULTS: Post-transplant UTI risk is highest in the early months and is driven by intensive immunosuppression, perioperative urological devices (bladder catheter, ureteral stents), delayed graft function/ischemia-reperfusion injury, and urodynamic abnormalities (post-void residual, vesicoureteral reflux). Female sex and pregnancy further increase susceptibility. Urine cultures must be interpreted in the context of time from transplantation and symptoms. Systematic treatment of asymptomatic bacteriuria is not beneficial and may increase antibiotic exposure and selection of multidrug-resistant organisms. Conversely, symptomatic, complicated, and recurrent UTIs warrant prompt empiric therapy followed by rapid de-escalation based on culture and susceptibility results. Preventive strategies targeting adhesion and colonization include adequate hydration, standardized cranberry preparations with therapeutically effective proanthocyanidin dosing, methenamine hippurate in selected patients, and topical vaginal estrogen in peri-/postmenopausal women; evidence for D-mannose and probiotics remains inconsistent. Emerging mechanistic insights highlight uromodulin as a key anti-adhesive and neutrophil (NET)-modulating defense factor, while SGLT2 inhibitors may modify tubular biomarkers; a UTI episode should not automatically prompt treatment discontinuation CONCLUSIONS: UTI management after kidney transplantation should adopt an integrated, multimodal approach combining stewardship-driven antibiotic use with tailored non-antibiotic preventive interventions to reduce recurrences, curb resistance, and preserve long-term allograft longevity.
Early Detection of a Testicular Mixed Germ Cell Tumor by Alpha-Fetoprotein Surveillance After Pediatric Liver Transplantation: Case Report and Literature Review.
Omameuda T, Wakiya T, Sakuma Y … +9 more , Onishi Y, Sanada Y, Okada N, Hirata Y, Horiuchi T, Takadera K, Akimoto R, Saegusa N, Yamaguchi H
Transplant Proc · 2026 Jun · PMID 41991407 · Publisher ↗
Liver transplant (LT) recipients, particularly pediatric survivors, face an elevated lifetime risk of de novo malignancies due to prolonged immunosuppressive therapy. Alpha-fetoprotein (AFP) is widely used as a biomarker...
Liver transplant (LT) recipients, particularly pediatric survivors, face an elevated lifetime risk of de novo malignancies due to prolonged immunosuppressive therapy. Alpha-fetoprotein (AFP) is widely used as a biomarker for hepatocellular carcinoma (HCC) in post-LT surveillance, but elevations may also reflect extrahepatic tumors. Here, we report a rare case of a testicular tumor incidentally detected through AFP monitoring in a pediatric LT survivor. A 20-year-old male with situs inversus totalis underwent living donor LT for biliary atresia at 1 year of age. Nineteen years post-transplant, AFP was elevated to 493 ng/mL during routine surveillance, raising suspicion for de novo HCC. Imaging studies revealed no liver lesions, but physical examination identified testicular swelling. Scrotal ultrasonography demonstrated a heterogeneous mass, and orchiectomy confirmed a mixed germ cell tumor composed of seminoma, yolk sac tumor, and embryonal carcinoma. AFP normalized postoperatively, and the patient is being carefully monitored during postoperative surveillance. This case highlights both the benefits and limitations of AFP-driven surveillance: while it facilitated early detection of a curable extrahepatic tumor, reliance on AFP alone may miss AFP-negative testicular cancers. Comprehensive surveillance strategies incorporating tumor markers, structured physical examinations, and patient education are warranted, with future emphasis on standardized guidelines for pediatric LT survivors.
Comparison of Anastomosis Techniques in Multiple Arterial Kidney Transplantation: Single or Pants Anastomosis Technique.
Bulut A, Yilmaz L, Aytekin A … +5 more , Bilen N, Baskonus I, Yildiz F, Usalan O, Coban S
Transplant Proc · 2026 May · PMID 41991406 · Publisher ↗
OBJECTIVE: This study aims to compare the outcomes of two arterial anastomosis techniques in kidney transplants with multiple renal arteries: the "pants" technique, which consolidates arteries into a single anastomosis,...
OBJECTIVE: This study aims to compare the outcomes of two arterial anastomosis techniques in kidney transplants with multiple renal arteries: the "pants" technique, which consolidates arteries into a single anastomosis, and the separate anastomosis technique, which connects each artery individually. We evaluated resistive index (RI) and flow rates of renal and interlobar arteries in recipients of both techniques. METHODS: At Gaziantep University Organ Transplant Center, we compared outcomes in kidney transplant recipients with multiple arteries who underwent either the pants (26 patients) or separate anastomosis (29 patients) techniques from 2010 to 2021. Data on resistive index and flow rates were obtained from postoperative Doppler examinations and medical records. RESULTS: Among 55 grafts (52 with 2 arteries and 3 with 3 arteries), postoperative Doppler exams showed no significant differences in resistive index between the two techniques. For the pants technique group, the renal artery RI averaged 0.71 on the first and third days and 0.70 on the second day, while the interlobar artery RI was 0.70, 0.68, and 0.72 on days 1, 2, and 3, respectively. In the separate anastomosis group, renal artery RI averaged 0.70 across all days, and interlobar artery RIs were 0.66, 0.65, and 0.68, respectively. No significant differences were found between the groups (P > .05). CONCLUSION: Both anastomosis techniques yielded comparable outcomes in terms of RI and flow rates. However, the separate anastomosis technique had shorter anastomosis and cold ischemia times, suggesting it may offer logistical advantages without compromising graft function.
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