Transplant. Proc. [JOURNAL]
Sun
200 papers
Flow Control and Oxygenation of Preservation Solution in Circulatory Determined Death Donors Undergoing Abdominal Normothermic Regional Perfusion.
Antonini MV, Circelli A, La Manna G … +14 more , Siniscalchi A, Cordella E, Morri D, Landi F, Graziani E, Prosperi E, Fallani G, Bonatti C, Stocco A, Radi G, Morelli MC, Germinario G, Cescon M, Ravaioli M
Transplant Proc · 2026 May · PMID 41986188 · Publisher ↗
Normothermic regional perfusion (NRP) is increasingly implemented to optimize the outcome of transplantation from donors undergoing circulatory determination of death. NRP shortens the duration of warm ischemia, allowing...
Normothermic regional perfusion (NRP) is increasingly implemented to optimize the outcome of transplantation from donors undergoing circulatory determination of death. NRP shortens the duration of warm ischemia, allowing splanchnic reperfusion with oxygenated blood. This supports the abdominal organs throughout recovery, allowing for their thorough assessment, avoids the need for rapid recovery, and restores a near physiological environment. However, after NRP, the grafts are exposed to a period of cold ischemia preceding further evaluation and reconditioning through ex situ machine perfusion or direct transplantation. The duration of cold ischemic time may be extremely variable. During cold ischemic time, the liver and the kidneys are indirectly protected by a decrease in metabolic demands induced by deep hypothermia. To optimize protection, the hypothermic state is initiated in situ, immediately after extracorporeal blood flow interruption, via topical cooling with sterile ice and intravascular cooling. The latter is usually induced by the administration of cold preservation solution (CPS) by gravity. We performed an observational study to assess the feasibility, safety, and effectiveness of a controlled strategy of CPS administration and oxygenation employing the NRP circuit and cannulae in controlled circulatory determination of death undergoing abdominal NRP. This approach provided a controlled, fast, and consistent flow, ensuring a prompt induction of hypothermia. Moreover, during CPS administration, the delivery of a fresh gas flow through the membrane lung resulted effective in significantly increasing the oxygen tension in the CPS. The hyperoxygenation of the blood-free perfusate might provide a metabolic substrate to the cells, preconditioning the grafts before cold ischemia.
Impact of Advanced Age on Outcomes of Live Donor Liver Transplantation: A Retrospective Cohort Study in Recipients Aged ≥65 Years.
Değirmencioğlu G, Birben B, Balas Ş … +7 more , Özsoy M, Kütük D, Tunçer A, Ersan V, Şahin E, Ünal B, Dirican A
Transplant Proc · 2026 May · PMID 41986187 · Publisher ↗
BACKGROUND: Advanced age has traditionally been considered a relative contraindication for liver transplantation (LT) owing to increased perioperative risk and comorbid burden. However, recent evidence suggests that appr...
BACKGROUND: Advanced age has traditionally been considered a relative contraindication for liver transplantation (LT) owing to increased perioperative risk and comorbid burden. However, recent evidence suggests that appropriately selected elderly patients can achieve comparable outcomes to younger recipients. OBJECTIVE: To evaluate and compare perioperative outcomes, comorbidities, and survival in live donor liver transplantation (LDLT) recipients aged ≥65 years versus <65 years METHODS: This retrospective observational study analyzed adult LDLT recipients at a high-volume transplant center between November 2019 and June 2024. Patients were divided into 2 groups based on age at transplantation: <65 years (n = 182) and ≥65 years (n = 43). Demographic data, MELD scores, comorbidities, perioperative complications, and survival rates were compared. Cox regression analysis was used to identify independent predictors of mortality. RESULTS: The elderly group had significantly lower MELD scores (15.1 vs. 17.2, p = .02) but higher rates of cardiovascular comorbidity (39.5% vs. 26.4%, p = .018). No significant differences were observed in diabetes prevalence, pulmonary disease, length of hospital stay, or early and late complication rates. One-year survival rates were 83.7% for elderly and 88.7% for younger recipients. Although the mortality risk was higher in the elderly group (HR = 2.13, p = .064), the difference was not statistically significant. CONCLUSION: Advanced age alone should not be considered a contraindication for LDLT. With appropriate candidate selection and individualized perioperative management, elderly recipients can achieve favorable outcomes comparable to younger patients.
Liver Transplantation Criteria for Hepatocellular Carcinoma: A Systematic Review.
Budiman D, Chu CW, Oh J … +4 more , Kang JH, Poniman T, Pramono LK, Hanafi RV
Transplant Proc · 2026 May · PMID 41986186 · Publisher ↗
BACKGROUND: Liver transplantation is a curative treatment for selected patients with hepatocellular carcinoma (HCC). While the Milan criteria remain the established benchmark for transplant eligibility, several expanded...
BACKGROUND: Liver transplantation is a curative treatment for selected patients with hepatocellular carcinoma (HCC). While the Milan criteria remain the established benchmark for transplant eligibility, several expanded selection models have been developed to increase access while maintaining acceptable oncologic outcomes. Reported survival and recurrence outcomes across these criteria vary across institutions and regions. OBJECTIVE: To systematically review published evidence comparing post-transplant survival and recurrence outcomes associated with Milan, UCSF, Kyoto, ASAN (Korean), and Toronto criteria. METHODS: A systematic search of PubMed, Cochrane Central, and ScienceDirect was conducted for studies published between 2000 and August 2025. Studies evaluating at least one of the predefined selection criteria in adult HCC patients undergoing liver transplantation and reporting 5-year overall survival and/or recurrence outcomes were included. Findings were synthesized descriptively in accordance with PRISMA guidelines. RESULTS: Twenty-three studies comprising 6318 patients met inclusion criteria. Milan criteria consistently demonstrated 5-year survival rates exceeding 70% with low recurrence rates across diverse transplant settings. Expanded criteria, particularly UCSF and Kyoto, reported comparable survival outcomes in selected cohorts, though recurrence rates varied by region, donor type, and institutional practice. Biologically driven approaches incorporating AFP and PIVKA-II showed promising results but demonstrated heterogeneity across centers. CONCLUSIONS: Milan criteria remain the most consistently validated framework for liver transplantation in HCC. Expanded criteria may provide acceptable outcomes in carefully selected patients, particularly in experienced centers. Selection strategies should be applied within the context of institutional expertise and regional transplant practice.
Clinical Outcomes of Haploidentical Transplantation Combined With Umbilical Cord Blood and Mesenchymal Stem Cells Co-Infusion for Aplastic Anemia: A Single-Center Retrospective Study.
Tan Z, Zhao Y, Hu H … +7 more , Yu Q, Zhang Y, Wang B, Hu T, Wu D, Ye B, Liu W
Transplant Proc · 2026 May · PMID 41982020 · Publisher ↗
Haploidentical hematopoietic stem cell transplantation (HID-HSCT) is a critical therapeutic option for severe aplastic anemia (SAA) patients lacking HLA-matched donors. However, its application has been limited by graft...
Haploidentical hematopoietic stem cell transplantation (HID-HSCT) is a critical therapeutic option for severe aplastic anemia (SAA) patients lacking HLA-matched donors. However, its application has been limited by graft failure and graft-versus-host disease (GVHD). The co-infusion of mesenchymal stem cells (MSCs) or umbilical cord blood cells (UCBs) has emerged as a crucial area to enhance transplant outcomes. This single-center retrospective study evaluates the clinical outcomes of HID-HSCT combined with UCBs and MSCs co-infusion in 108 patients. Patients underwent HID-HSCT between January 2018 and January 2025, with 40 receiving co-infusion of UCBs and MSCs. Transplantation outcomes, including neutrophil and platelet engraftment, GVHD incidence, viral reactivation rates, and long-term survival, were compared. Results showed no significant differences in engraftment or GVHD rates between groups. However, the Co-infusion group exhibited a declining trend in grade II-IV aGVHD and significantly improved 5-year overall survival (OS) and graft-versus-host disease-free, relapse-free survival (GRFS). These findings suggest that UCBs and MSCs co-infusion may enhance long-term survival and quality of life in patients undergoing HID-HSCT, offering a promising strategy for clinical haploidentical transplantation. However, the lack of prospective design and standardized protocols limits the conclusions. Future studies should focus on optimizing co-infusion strategies to improve clinical outcomes in haploidentical transplantation.
Outcomes After Kidney Transplantation From Deceased Donors With Diabetes.
Emara A, Javed M, Khan AA … +9 more , Needleman A, Gage A, Nagpal R, Hobill A, Karst F, Fernando R, Harber M, Jones G, Evans RDR
Transplant Proc · 2026 May · PMID 41982019 · Publisher ↗
BACKGROUND: Diabetes mellitus (DM) is an increasing comorbidity in the kidney donor population, but there are limited data on allograft outcomes from donors with DM. We investigated outcomes after kidney transplantation...
BACKGROUND: Diabetes mellitus (DM) is an increasing comorbidity in the kidney donor population, but there are limited data on allograft outcomes from donors with DM. We investigated outcomes after kidney transplantation from deceased diabetic donors. METHODS: We undertook a retrospective observational study of adult patients who underwent kidney alone transplantation from deceased donors at a single center between 2012 and 2022 in the United Kingdom. We stratified transplants according to the diabetic status of both the donor and recipient. We compared clinical characteristics of diabetic donors and recipients, and determined patient and allograft survival at 1-, 3- and 5-years. RESULTS: A total of 985 kidney transplant recipients (median age 54 years, 64% male, 25% diabetic) were included, and 64 (6.5%) underwent transplantation from a diabetic donor. Diabetic donors were older and had more hypertension, as well as higher kidney donor risk and implant Karpinski scores. Recipients of diabetic donor kidneys were also older and had higher baseline clinical frailty scores. Patient and allograft survival were worst in diabetic recipients of diabetic kidneys; outcomes were similar in non-diabetic recipients regardless of the diabetic status of the donor. In multivariable analyses, recipient age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03-1.08) and recipient diabetes (HR: 2.22, 95% CI: 1.32-3.67) increased the hazard of patient mortality but not death censored graft loss. Donor diabetes had no effect on any recipient outcomes. CONCLUSIONS: Utilizing kidneys from diabetic donors is associated with acceptable recipient outcomes and offers a potential mechanism to expand the deceased donor pool. Recipient diabetes status should be considered during organ allocation.
Assessing the Reliability and Quality of Kidney Transplantation Information on Short-Video Sharing Platforms: A Cross-sectional Analysis.
Wang Y, Chen X, Tan Q
Transplant Proc · 2026 May · PMID 41967994 · Publisher ↗
BACKGROUND: The rise of digital media has increased public use of social platforms for health information. While short-form videos hold potential for disseminating knowledge on kidney transplantation, their variable qual...
BACKGROUND: The rise of digital media has increased public use of social platforms for health information. While short-form videos hold potential for disseminating knowledge on kidney transplantation, their variable quality is a major concern. This study aimed to analyze the content and quality of kidney transplantation-related videos on major short video sharing platforms. METHODS: Between April 28, 2025 and May 02, 2025, using Chinese search terms for "kidney transplantation," we collected 263 relevant videos from WeChat, TikTok, and Bilibili. Two independent researchers evaluated video content and quality using the Journal of the American Medical Association (JAMA) benchmark criteria, Global Quality Scale (GQS), modified DISCERN (mDISCERN), and Patient Education Materials Assessment Tool (PEMAT). RESULTS: Healthcare professionals were the primary uploaders (112/263, 42.6%), and disease knowledge constituted the predominant content focus (161/263, 61.2%). Videos sourced from WeChat exhibited higher overall quality than those from TikTok or Bilibili. Videos uploaded by patients garnered significantly more likes and comments (all P < .001). Content featuring personal patient experiences also attracted significantly more likes and comments (all P < .001), whereas disease knowledge content was shared more frequently (P < .001). Patient vlog received significantly more likes and comments, while dialogue formats were shared more often (P < .001). Positive correlations were observed between engagement variables (likes, comments, favorites, shares) and followers (all P < .001), while a negative correlation existed with video duration (all P < .005). Shares and followers positively correlated with video quality (P < .001 and P < .01, respectively). CONCLUSION: Although numerous kidney transplantation-related videos are available on short video platforms, their quality and reliability vary considerably and require significant improvement.
The Prevalence and Consequences of Supra-Normal Estimated Glomerular Filtration Rate in Pediatric Solid Organ Transplants: A Single Center Cohort.
Chan M, Auerbach SR, Feldman AG … +1 more , Bock ME
Transplant Proc · 2026 May · PMID 41967993 · Publisher ↗
PURPOSE: In adult recipients of kidney transplants, renal hyperfiltration has been found to be associated with an earlier risk of graft loss. Unfortunately, data is sparse for pediatric recipients of solid organ transpla...
PURPOSE: In adult recipients of kidney transplants, renal hyperfiltration has been found to be associated with an earlier risk of graft loss. Unfortunately, data is sparse for pediatric recipients of solid organ transplants. METHODS: We reviewed all actively followed pediatric liver, heart, and kidney recipients at our center. We determined the estimated glomerular filtration rate (eGFR) during the first 5 years posttransplant and at the last follow-up based on the CKiD-U25 formula using creatinine. Given the lack of renal scintigraphy data, we used a supra-normal eGFR (SNeGFR) as a surrogate for hyperfiltration. SNeGFR was defined as two standard deviations above the mean eGFR for age, CKD as an eGFR of less than 90 mL/min/1.73m, and normal function between CKD and SNeGFR. A contingency table was used to determine the OR of outcomes for those with SNeGFR and normal function and normal function and CKD. RESULTS: A total of 443 actively followed patients were eligible. Forty-four (16%) of the recipients of heart and liver transplants met criteria for SNeGFR. Only one recipient of a kidney transplant met the criteria. In recipients of liver and heart transplants, SNeGFR was correlated with higher risks of developing hypertension than those with normal function (OR 2.22, CI 1.08-4.54). Recipients of liver and heart transplants with CKD not only had a similar risk (OR 2.22, CI 1.22-4.18) but also had a higher risk of having any rejections (OR 1.8, CI 1.06-3.09) than those with normal function. CONCLUSIONS: SNeGFR is prevalent in recipients of liver and heart transplants. More studies need to evaluate its association with outcomes.
Corrigendum to <Nutritional Progression of a Child With Hypoplastic Left Heart Syndrome During the Waiting Period for Heart Transplantation: A Case Report><[Transplant Proceedings volume 57 (2025) 1305-1308]>.
Lanza PG, Azeka E
Transplant Proc · 2026 May · PMID 41966944 · Publisher ↗
Abstract loading — click title to view on PubMed.
Nonstandard Donors With Acceptable Risk for Infectious Disease in Kidney And Kidney-Pancreas Transplants: A Promising Solution.
Iafisco A, Di Giovanni M, Colonnelli R … +4 more , Bartoli B, Iaria G, Carriero C, De Paolis P
Transplant Proc · 2026 May · PMID 41935885 · Publisher ↗
Over the recent decades, requests for kidney transplants have increased in numbers. To cope with scarcity of organs' availability compared to the growing demand, the scientific community has started considering donors wh...
Over the recent decades, requests for kidney transplants have increased in numbers. To cope with scarcity of organs' availability compared to the growing demand, the scientific community has started considering donors who were previously excluded. Recent literature has shown that transplants from these nonstandard donors have outcomes that are better compared to those of patients who remain on dialysis while on the waiting list in terms of both quality of life and life expectancy, with results comparable to transplants from standard donors. Yet, past studies have focused on various classifications of nonstandard donors, overlooking those with acceptable risks. In this article, we further investigate this specific topic. We evaluated 51 transplants performed at our centre (including 2 combined kidney-pancreas transplants) from nonstandard donors with acceptable risk profile, with a focus on cases with increased infectious risk for recipients. The study was conducted over 3 years and evaluated three specific outcomes: possible transmission of infectious diseases; post-transplant mortality from infectious causes; graft function after the transplant. We show that, by strictly adhering to specific precautions, almost no donor-derived infections or infection-related mortality occurred during follow-up and, notably, that renal function at 44 weeks after transplant was comparable to that of recipients from standard donors in the control group. Taken together, our data suggest that the cautious and attentive use of acceptable risk donor organs represents a valuable strategy to counteract organ shortage, ensuring acceptable post-transplant outcomes while maintaining patient safety.
Brain Death and Cold Storage Induce Renal Inflammation and Injury in an Experimental Model.
do Nascimento Gonçalves N, Preti G, Marzochi LL … +5 more , Luz MAM, Mendes GEF, Correia CJ, Abbud-Filho M, Caldas HC
Transplant Proc · 2026 May · PMID 41935884 · Publisher ↗
BACKGROUND: Brain death (BD) and cold storage (CS) are key determinants of donor kidney quality and transplant outcomes. Although both processes are known to induce inflammation, the temporal hierarchy and molecular spec...
BACKGROUND: Brain death (BD) and cold storage (CS) are key determinants of donor kidney quality and transplant outcomes. Although both processes are known to induce inflammation, the temporal hierarchy and molecular specificity of inflammatory activation during organ preservation remain poorly defined. This study investigated the inflammatory and histopathological evolution of donor kidneys following BD and during CS using an experimental rat model. METHODS: Rats were assigned to sham, BD, or BD followed by 12 or 24 hours of CS. In BD animals, contralateral kidneys were stored for different durations, allowing paired analysis across preservation times. Hemodynamic parameters, serum creatinine, inflammatory gene expression, and histopathological injury were evaluated. RESULTS: BD induced hemodynamic instability and early renal dysfunction, reflected by increased serum creatinine levels and upregulation of inflammatory mediators. During CS, expression of Toll-like receptor 4, CASP1, interleukin-1β, and tumor necrosis factor-α remained elevated, while interleukin-6 increased progressively, particularly between BD and 12 hours of CS. In contrast, NLRP3 expression did not significantly increase during preservation. Histopathological analysis demonstrated progressive renal injury with increasing CS duration, including tubular and glomerular damage and features of acute tubular necrosis. CONCLUSIONS: BD-induced inflammation persists throughout CS, supporting the concept that organ preservation represents an active injury phase rather than a passive metabolic pause. Distinct temporal inflammatory signatures during preservation highlight molecular pathways that may be targeted to mitigate preservation-associated injury.
Dietary and Lifestyle Advice: An Integral Part of the Therapeutic Approach for Patients With Renal Transplant.
Iafisco A, Di Giovanni M, Colonnelli R … +7 more , Bartoli B, Andracchio L, Luciani R, Aguilar Pineda VM, D'Alessandro C, Cupisti A, De Paolis P
Transplant Proc · 2026 May · PMID 41933968 · Publisher ↗
Following kidney transplantation patients undergo a series of metabolic changes which often lead to the onset of metabolic syndrome. This is one of the main risk factors for the development of cardiovascular diseases and...
Following kidney transplantation patients undergo a series of metabolic changes which often lead to the onset of metabolic syndrome. This is one of the main risk factors for the development of cardiovascular diseases and chronic renal transplant dysfunction. Adopting a healthy lifestyle is considered one of the most effective strategies to avoid or mitigate these consequences. Nevertheless, the pivotal issue remains with the adherence of patients to the prescribed recommendations. In the present study, a total of 34 renal transplant recipients were enrolled. The study utilized 2 questionnaires, with the initial one assessing the patients' awareness of the benefits of adopting a healthy lifestyle. The second questionnaire was administered after the patients had received appropriate counsel, with the aim of evaluating their compliance in implementing the recommended lifestyle changes. A notable finding was that the majority of patients recognized their significance, adhered to them, and regarded them as beneficial for their quality of life, the functionality of their graft, and their overall survival. Consequently, it appears evident that lifestyle recommendations should be incorporated as a fundamental component of the therapeutic approach for RTRs.
Anita Law: Effect of Its Implementation on Tissue and Organ Donation and Transplant in Paraguay.
Pederzani M, Fretes F, Saldivar A … +2 more , Colman I, Figueredo B
Transplant Proc · 2026 May · PMID 41933967 · Publisher ↗
INTRODUCTION: Organ shortages are the main limitation for transplantation worldwide. Paraguay's Anita Law (Law 6216/2019) introduced presumed consent to increase organ and tissue donation. This study assesses its impact...
INTRODUCTION: Organ shortages are the main limitation for transplantation worldwide. Paraguay's Anita Law (Law 6216/2019) introduced presumed consent to increase organ and tissue donation. This study assesses its impact on donor identification and transplantation outcomes. METHODS: A retrospective, cross-sectional, descriptive, and observational study with an analytical component was performed. The study included all cases of brain death reported to the National Institute of Transplantation (INAT) before (2016-2018) and after (2019-2023) the law, excluding 2020-2021 due to COVID-19. Donor notifications, organ and tissue donations, and transplant rates were analyzed. Categorical and continuous variables were compared using chi-square/Fisher exact tests and t-tests, respectively. RESULTS: Of 550 patients (178 pre-law; 372 post-law), 63% were male, median age 35 years. Notifications increased significantly after the law (178 vs. 372; P ≤ .0001). Effective organ donation rose from 36 to 54 (P = .9), and tissue donation from 13 to 33 (P ≤ .03). Kidneys and corneas remained the most procured organs and tissues. Family refusal (46% vs. 41%) and medical contraindications (∼30%) were the main barriers. Notifications from hospitals outside the capital increased from 3.9% to 10.7% (P = .15). Unused donors accounted for 2% post-law. CONCLUSIONS: The Anita Law enhanced donor notifications and tissue donation but did not significantly increase effective organ donation. Persistent family refusal and medical contraindications remains limiting factors. Implementation of intra-hospital transplant coordinators is essential to optimize donor detection, increase organ utilization, and reduce waiting lists, providing a strategic foundation for strengthening Paraguay's transplant system.
Narrative Review of Preparative Regimens Predictive of Mixed Chimerism After HLA-Mismatched Hematopoietic Stem Cell Transplantation: A Starting Point for Combined Solid Organ and Stem Cell Transplantation.
Crocchiolo R, Gandolfini I, Cravedi P … +6 more , Maggio GD, Borotti E, Rombolà G, Prezioso L, Zanelli P, Maggiore U
Transplant Proc · 2026 May · PMID 41813460 · Publisher ↗
Transient or permanent mixed hematopoietic chimerism (MC) is associated with immunologic tolerance in combined solid organ and hematopoietic stem cell transplantation. This tolerance allows for the reduction or sometimes...
Transient or permanent mixed hematopoietic chimerism (MC) is associated with immunologic tolerance in combined solid organ and hematopoietic stem cell transplantation. This tolerance allows for the reduction or sometimes even suspension of systemic immunosuppression without graft rejection, with clear benefits regarding the side effects associated with lifelong immunosuppression. However, studies to date have included only living, HLA-matched donors to reduce the risk of graft-versus-host disease (GvHD), whereas the degree of HLA incompatibility between deceased donors and recipients is typically higher. Here we present a narrative review aimed at identifying the conditioning regimens predictive of MC in hematologic patients who have received an HLA-mismatched transplant, to provide some information on immunotolerance for future combined solid organ and stem cell transplantation in an HLA-mismatched setting. Among a total of 90 identified studies, 20 contained some information on MC, with a reported percentage of 2% to 100% of patients; 1186 patients were described in these 20 articles, with a median of 40 (range, 12 to 265) per study. When examining the conditioning regimens associated with MC ≥20% and GvHD <25% (n = 5), it was observed that 4 out of 5 studies contained antithymocyte globulin. The data suggest the importance of T lymphocyte depletion for achieving MC, associated with a low incidence of acute GvHD in hematopoietic stem cell transplantation from HLA-mismatched donors. Although additional work is needed, particularly on the ideal stem cell dose (ie, CD34 and CD3 cells), this information could be translated into the field of solid organ transplantation (SOT) to design a potential combined solid organ-stem cell transplantation protocol aimed at achieving MC for immune tolerance. The present work supports a translational perspective in the setting of SOT, where long-term immune tolerance is a major goal.
Disparities in Access to Heart and Lung Transplantation by Race and Socioeconomic Status: A National Analysis.
Dhanani Z, Duncheskie R, Marquez A … +3 more , Munshi R, Karanam A, Anjum F
Transplant Proc · 2026 Apr · PMID 41807187 · Publisher ↗
INTRODUCTION: Disparities in heart and lung transplantation persist in the United States, yet most studies focus only on patients already referred or listed. We aimed to evaluate racial and socioeconomic disparities in a...
INTRODUCTION: Disparities in heart and lung transplantation persist in the United States, yet most studies focus only on patients already referred or listed. We aimed to evaluate racial and socioeconomic disparities in access and receipt of transplantation among patients with chronic heart or lung disease. METHODS: We conducted a retrospective analysis using the National Inpatient Sample (2016-2022) to identify adults hospitalized with chronic heart or lung disease. Patients undergoing heart or lung transplantation and combine heart and lung transplantation were identified via ICD-10 codes. Multivariable logistic regression assessed associations between transplant receipt and race/ethnicity and ZIP-code-level income, after adjustment for age, sex, insurance status, comorbidities, and diagnosis. RESULTS: Among 5.1 million chronic lung and 2.1 million chronic heart disease hospitalizations, 4776 lung, 1537 heart transplants and 76 combined heart and lung transplants were identified. White patients had significantly higher odds of receiving lung transplantation (aOR: 3.97; 95% CI, 1.72-9.13, p < .01) than Black, Hispanic and Native American patients while in heart transplantation, Black patients had higher odds of getting transplanted (aOR: 3.09; 95% CI, 1.17-8.17, p = .02) than White, Hispanic and Native American patients. Patients from the highest-income ZIP codes were more likely to undergo lung (aOR: 3.63; 95% CI, 3.24-4.05, p < .01) or heart (aOR: 1.33; 95% CI, 1.13-1.55, p < .01) transplantation. No significant disparities were observed in combine heart and lung transplant patients. CONCLUSION: Significant disparities by race and socioeconomic status persist in transplant access both in lung and heart transplantation. These findings highlight upstream structural barriers and offer a pre-Composite Allocation Score (CAS) baseline for future policy evaluation.
Long-Term Outcomes of Kidney Transplantation With Inferior Vena Cava Outflow: A Single Center Experience.
Ministro A, Henriques M, da Silva BM … +6 more , Santana A, Pereira T, Miranda C, Lopes J, Pedro LM, Ministro A
Transplant Proc · 2026 Mar · PMID 41807186 · Publisher ↗
INTRODUCTION: Standard renal transplantation uses external iliac vessels. Iliac or IVC occlusion often excludes candidates, but a patent proximal IVC offers an alternative outflow. METHODS: We retrospectively reviewed ki...
INTRODUCTION: Standard renal transplantation uses external iliac vessels. Iliac or IVC occlusion often excludes candidates, but a patent proximal IVC offers an alternative outflow. METHODS: We retrospectively reviewed kidney transplants with IVC anastomosis at a tertiary hospital (Jan 2000-Aug 2024). Outcomes were 30-day mortality and long-term graft survival. RESULTS: Among 1235 transplants, 14 required IVC anastomosis. Median follow-up was 110 months; median age 34 years; 8/14 were men. Indications included ilio-cava thrombosis, multiple transplants, or adult grafts in low-weight children. Thirteen grafts were placed in the right iliac fossa, one intraperitoneally; 10 were right kidneys, 12 from deceased donors. Seven cases used donor vena cava for vein extension. Two grafts failed (humoral rejection at 5 years; acute ischemia at 3 months). Remaining grafts functioned with mean creatinine 1.55 mg/dL at 5 years. No patient died within 30 days. CONCLUSION: With longer End Stage Renal Disease survival, cases with limited vascular access or multiple transplants will rise. Proximal IVC anastomosis, though complex, is feasible and provides durable venous drainage.
Breakthrough Coronavirus Associated Infectious Disease 2019 After Vaccination Among Kidney Transplant Recipients.
Mathew RO, Zhang J, Liu Z … +6 more , Chen S, Nathan C, Sanchez AM, Olatosi B, Li X, Yang X
Transplant Proc · 2026 Apr · PMID 41796487 · Publisher ↗
INTRODUCTION: Kidney transplant recipients remain susceptible to severe infectious disease such as the coronavirus associated infectious disease 2019 (COVID-19). Vaccination remains an important step in prevention, but d...
INTRODUCTION: Kidney transplant recipients remain susceptible to severe infectious disease such as the coronavirus associated infectious disease 2019 (COVID-19). Vaccination remains an important step in prevention, but data is needed to support the efficacy in this high-risk population. We sought to evaluate risk factors for breakthrough COVID-19 infection following vaccination among a single US state's resident with kidney transplant (KT). METHODS: Patients with a KT diagnosis prior to the COVID-19 pandemic period from 2019 to 2022 were compared to individuals without KT from a US statewide health registry for South Carolina. Propensity score matching used to match KT and non-KT recipients. Risk of breakthrough infections compared using Cox proportional hazards models. Outcomes (hospitalization and death) associated with breakthrough infection were similarly evaluated. RESULTS: After propensity score matching, 1270 KT and 2540 non-KT remained for analysis. Baseline covariates were well matched. Hazard ratio (HR) and 95% confidence interval (95%CI) for breakthrough COVID-19 infection for KT was 2.61 (1.94, 3.53; p < .001) versus non-KT. Booster vaccination was associated with lower risk for breakthrough vaccination (OR: 0.19, 95% CI: 0.11, 0.27, p < .001). KT patients with breakthrough COVID-19 infection had an odds ratio (OR) of 18 (95% CI 6.5, 61.1; p < .001) for hospitalization and OR 10.2 (95% CI: 2.65, 53.4; p = .002) for death versus non-KT. CONCLUSION: Kidney transplant recipients remain at high risk for breakthrough COVID-19 infection as compared to non-kidney transplant recipients. Vaccination with mRNA-based vaccines and receipt of booster doses appear protective against infection and adverse outcomes.
Computational Identification and Validation of PDGFRA and HIF1A as Direct Targets of Mycophenolate Mofetil in Allograft Rejection Post Liver Transplantation.
Chen Y, Zhu ZJ
Transplant Proc · 2026 Apr · PMID 41794555 · Publisher ↗
BACKGROUND: Mycophenolate mofetil (MMF) is widely recognized for its immunosuppressive effects through its active metabolite mycophenolic acid (MPA). This study utilizes computational approaches-molecular docking and mol...
BACKGROUND: Mycophenolate mofetil (MMF) is widely recognized for its immunosuppressive effects through its active metabolite mycophenolic acid (MPA). This study utilizes computational approaches-molecular docking and molecular dynamics (MD) simulations-to explore MMF' s direct regulatory role in allograft rejection (AR), particularly in liver transplantation. METHODS: Potential targets of MMF were retrieved from Super-PRED, while AR-related genes were identified via Gene Set Enrichment Analysis (GSEA). Overlapping genes were analyzed using DAVID for functional enrichment (GO and REACTOME). A PPI network was constructed with STRING and visualized in Cytoscape. Core targets were subjected to molecular docking and MD simulations. Protein expression in liver tissues was validated using the Human Protein Atlas. RESULTS: GSEA identified 257 AR-associated targets. Intersection with MMF targets revealed 7 core genes. Functional analysis indicated their involvement in key biological processes and pathways. Molecular docking showed strong binding of MMF to core targets, especially HIF1A and PDGFRA, which was further confirmed by stable binding in MD simulations. Human Protein Atlas data indicated specific expression of HIF1A and PDGFRA within mobile immune cells in hepatic vasculature. CONCLUSION: This study suggests a novel mechanism by which MMF may directly modulate specific targets, providing a theoretical basis for new MMF-based therapies and supporting further clinical exploration in transplantation immunology.
Optimizing Renal Allograft Dysfunction Management: A Systematic Review and Proposed Algorithm for Interventional Radiology Versus Surgical Interventions.
El Hennawy HM, Safar O, Aboalsamh GA … +8 more , Tawahri I, Almalki AH, Jaber TM, Bazeed MF, Ghalyoob TM, Shazly AN, Hadad AE, Al-Qahtani S
Transplant Proc · 2026 Apr · PMID 41791971 · Publisher ↗
BACKGROUND: Kidney transplantation is the optimal treatment for end-stage renal disease, yet post-transplant complications remain a major threat to graft survival. Interventional radiology (IR) has emerged as a minimally...
BACKGROUND: Kidney transplantation is the optimal treatment for end-stage renal disease, yet post-transplant complications remain a major threat to graft survival. Interventional radiology (IR) has emerged as a minimally invasive alternative to surgery, but the comparative evidence base is fragmented and limited. METHODS: This systematic review synthesized evidence from 12 studies, conducted in accordance with PRISMA guidelines, to evaluate the effectiveness of IR versus surgical management of vascular, urological, and lymphatic complications after kidney transplantation. RESULTS: All included studies were retrospective and single-center, with a moderate to high risk of bias. Despite this, IR consistently demonstrated high technical (94%-100%) and clinical success rates, particularly for transplant renal artery stenosis (TRAS), where endovascular interventions improved renal function and blood pressure control, achieving superior graft survival compared to conservative management. For ureteric complications, IR provided immediate functional recovery, but 38% required surgical conversion, with surgery delivering superior durability in long or fibrotic strictures. In cases of lymphatic complications, percutaneous drainage was effective as a first-line measure; however, surgical fenestration achieved lower recurrence rates (<15%). CONCLUSION: The current evidence suggests that IR should be considered the first-line treatment for many vascular and urological complications, while surgery remains indispensable for complex or recurrent cases. The proposed algorithm is applicable to both adult and pediatric recipients, though pediatric cases require tailored approaches due to anatomical and physiological differences. This review is the first to consolidate existing evidence into a complication-specific, stepwise management algorithm, providing a structured clinical framework for decision-making. Prospective, multicenter validation is urgently needed; however, adoption of this algorithm could reduce graft loss, optimize healthcare resources, and redefine standard practice in managing renal allograft dysfunction.
Outcomes of Kidney Transplantation in Cystic Fibrosis.
Stevanovic M, MacKenzie TA, Zimmerman AM … +1 more , Graber ML
Transplant Proc · 2026 Apr · PMID 41791970 · Publisher ↗
BACKGROUND: End Stage Renal Disease (ESRD) occurs more frequently in people with cystic fibrosis (PwCF) than in the general population. We describe the characteristics and outcomes of kidney transplantation in PwCF. METH...
BACKGROUND: End Stage Renal Disease (ESRD) occurs more frequently in people with cystic fibrosis (PwCF) than in the general population. We describe the characteristics and outcomes of kidney transplantation in PwCF. METHODS: We used data from the US Renal Data System, a virtually compete registry of US persons with ESRD. We compared patient characteristics and patient and graft survival of PwCF with kidney transplant with those without cystic fibrosis (CF), and PwCF with and without kidney transplant. We used linear and logistic regression, multivariable models, and Kaplan-Meier and log-rank tests with stratification/binning by propensity scores. RESULTS: Of PwCF and ESRD, 50.6% received their first kidney transplant. PwCF with transplant were younger and more likely to be female than those without. and had lower odds of diabetes and higher odds of complications of lung transplantation being the cause of ESRD. CF was associated with greater odds of a living donor graft. Median survival with a kidney transplant was 21.1 years for PwCF and 38.1 years for those without. Death-censored graft survival was 20.5 years for PwCF and 13.3 years for those without. CONCLUSIONS: The demographic and disease profiles of PwCF and kidney transplant differed transplant recipients without CF. Diabetes was found less frequently, and complications of lung and other organ transplants found more frequently, to be the cause of ESRD in PwCF. Survival with a kidney transplant was shorter for PwCF but was substantial. Graft survival was longer for PwCF than those without. The diagnosis of CF should not exclude appropriate PwCF from consideration for kidney transplantation.
Evaluation of Panel Reactive Antibodies in Living Donor Liver Transplantation.
Kocaaslan H, Sahin TT, Akbulut S … +3 more , Kayhan B, Isik B, Yilmaz S
Transplant Proc · 2026 Apr · PMID 41781294 · Publisher ↗
BACKGROUND: Acute antibody-mediated rejection (AMR) is a rare but serious complication following liver transplantation that can lead to graft loss. AMR is caused by preformed anti-donor antibodies, ABO incompatibility, o...
BACKGROUND: Acute antibody-mediated rejection (AMR) is a rare but serious complication following liver transplantation that can lead to graft loss. AMR is caused by preformed anti-donor antibodies, ABO incompatibility, or de novo antibodies that develop post-transplantation. In this study, we aimed to evaluate the diagnosis of AMR by comparing the preoperative and postoperative Panel Reactive Antibody (PRA) Class I and Class II results of patients who underwent liver transplantation at our clinic. MATERIALS AND METHODS: Seventy consecutive patients and their donors who underwent living donor liver transplantation at our institution between November 2017 and March 2018 were included in this study. Patients were divided into 2 groups: those who developed a more than 3-fold increase in liver function tests (LFTs) in the early postoperative period and those with a normal clinical course. The Mann-Whitney U test was used to compare quantitative data between the groups. The Chi-square test was used for the comparison of qualitative data, and a p-value of less than .05 was considered statistically significant. The nonparametric Wilcoxon Signed Rank test was used to evaluate the difference between preoperative and postoperative PRA I and PRA II levels in patients with elevated enzymes. RESULTS: Postoperative PRA I levels were found to be increased in 9 patients and decreased in 6 patients compared to preoperative levels. No change was observed in the remaining 3 patients. Although this may appear clinically significant, no statistically significant difference was found between postoperative and preoperative PRA I levels (p = .363). Similarly, postoperative PRA II levels were decreased in 9 patients, increased in 5, and unchanged in 4 when compared to preoperative PRA II levels. This result was also not statistically significant (p = .721). CONCLUSION: When an elevation in LFTs occurs in liver transplant recipients, rejection should be considered after excluding vascular and other pathologies. AMR should be included among the possible diagnoses, and PRA testing should be part of the diagnostic workup. However, as observed in our study, changes in PRA levels may not always correlate with a diagnosis of AMR. Therefore, in such cases, a more appropriate approach would be to evaluate PRA results in conjunction with other diagnostic criteria. KEY WORDS: Antibody mediated rejection, liver transplantation, panel reactive antibody.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe