Transplant. Proc. [JOURNAL]
Sun
200 papers
In Hepatitis C Virus-Negative Recipients of a Hepatitis C Virus-Infected Donor Kidney, Direct Antiviral Agent Therapy for 8 Weeks Is Noninferior to 12 Weeks.
Khurana S, Gaines S, Kumarjiguda D … +3 more , Kotru A, Marvin M, Addissie B
Transplant Proc · 2026 Apr · PMID 41781293 · Publisher ↗
The current recommended duration of 12 weeks of post-transplantation hepatitis C virus (HCV) treatment for HCV-uninfected recipients of HCV-infected kidneys (HCV D+/R-) is based on limited data. In March 2020, the transp...
The current recommended duration of 12 weeks of post-transplantation hepatitis C virus (HCV) treatment for HCV-uninfected recipients of HCV-infected kidneys (HCV D+/R-) is based on limited data. In March 2020, the transplant center's HCV-treatment protocol was revised by reducing the duration of treatment for glecaprevir/pibrentasvir from 12 weeks to 8 weeks, thus creating a natural experiment to compare sustained virologic response (SVR) rates between the 2 treatment groups. We analyzed HCV treatment outcomes of HCV D+/R- kidney recipients between October 2018 and July 2022 at a single transplant center in all patients treated with glecaprevir/pibrentasvir after kidney transplantation. Fifty-five patients were treated for 12 weeks, and 24 patients were treated for 8 weeks. In the 12-week group, 2 patients died of non-HCV causes after the end of treatment, before SVR; both were aviremic at the end of treatment. The remaining 53 patients achieved SVR. All 24 patients in the 8-week group achieved SVR. The median time to treatment initiation was 14 days (range, 3-138 days) for the 12-week group and 15 days (range, 5-81 days) for the 8-week group (P = .72). Even though most patients started treatment after the first week post-transplantation, 8 weeks of glecaprevir/pibrentasvir was equally effective as 12 weeks of treatment in achieving SVR for HCV D+/R- kidney recipients.
The Natural History and Impact of Urinary Tract Infections in Kidney Transplant Recipients.
Elhoweris AE, Sullivan M, Norton W … +2 more , Salim E, Aitken E
Transplant Proc · 2026 Apr · PMID 41775604 · Publisher ↗
BACKGROUND: Urinary tract infections (UTIs) are the most common infection following kidney transplantation. However, the natural history of UTIs is incompletely understood, as is the impact of UTIs on patient outcomes. M...
BACKGROUND: Urinary tract infections (UTIs) are the most common infection following kidney transplantation. However, the natural history of UTIs is incompletely understood, as is the impact of UTIs on patient outcomes. METHODS: A single-center cohort study of kidney-only transplant recipients at the West of Scotland Renal Transplant Unit, UK was undertaken. A standardized protocol for UTI screening and treatment was followed. Patients were categorized into 3 groups based on the number of culture-proven UTI: no UTIs, 1-2 UTIs and ≥3 UTIs. Proportional odds logistic regression was performed to identify risk factors for developing UTIs, with adjustment for age, sex, primary renal diagnosis, donor type and induction immunosuppression. RESULTS: Of 1412 recipients, 1169 (82.8%) had no UTIs, 180 (12.7%) had 1-2, and 63 (4.5%) had ≥3. Key risk factors for ≥3 UTIs were female sex (adjusted odds ratio [aOR]: 1.48, 1.15-1.91), older age (aOR: 1.01, 1.00-1.02) and ATG induction (aOR: 3.73, 2.16-6.45). Recipients whose kidney failure had been caused by lower urinary tract disorders were at increased risk of developing one or more UTIs (aOR: 1.86 1.03-3.34). Recipients with ≥3 UTIs had a lower estimated glomerular filtration rate (eGFR) at 2 years post-transplant (49.7 vs. 59.2 mL/min/1.73 m², p = .03), but there was no significant difference is patient or graft survival at 2 years. CONCLUSIONS: We report a relatively low rate of treated UTIs in the first 2 years post kidney transplantation, with female sex, older age, and ATG induction identified as key risk factors. While UTIs did not increase graft loss or mortality, recurrent infections were associated with lower eGFR at 2 years. Targeted screening and prevention strategies should be considered for identified high-risk recipients.
Development and Validation of a Risk Prediction Model for Postoperative Pulmonary Infection in Renal Transplant Patients.
Pan N, Guo Y, Zhang M … +6 more , Meng Q, Li Y, Fang X, Miao M, Wang Q, Lv H
Transplant Proc · 2026 Apr · PMID 41775603 · Publisher ↗
BACKGROUND: The incidence of postoperative pulmonary infection following renal transplantation is high; however, there is a paucity of studies focused on developing risk prediction models in this patient population. OBJE...
BACKGROUND: The incidence of postoperative pulmonary infection following renal transplantation is high; however, there is a paucity of studies focused on developing risk prediction models in this patient population. OBJECTIVE: To construct a risk prediction model for postoperative pulmonary infection in renal transplant patients and verify the predictive efficacy of the model. METHODS: This was a retrospective case-control study involving 765 patients who underwent renal transplantation in the Renal Transplantation Department of a tertiary hospital in Shandong Province in China between January 2022 and September 2024. According to a 7:3 ratio, 535 patients who received renal transplants from January 2022 to December 2023 were assigned to the model group, while 230 patients who underwent renal transplantation from January 2024 to September 2024 served as the validation group. Logistic regression analysis was used to explore the influencing factors of postoperative pulmonary infection in renal transplant recipients, and a nomogram-based risk prediction model was constructed and validated. RESULTS: This study found that the incidence of postoperative pulmonary infection in renal transplant recipients was 24.31%. Logistic regression analysis identified gender (male), history of multiple transplants, comorbid hypertension history, comorbid heart disease history , and postoperative rejection as significant influencing factors. The Hosmer-Lemeshow goodness-of-fit test indicated adequate model calibration (χ²= 9.550, P = 0.145). The receiver operating characteristic (ROC) curve analysis yielded an area under the curve (AUC) of 0.740 [95% confidence interval (CI): 0.692-0.788], with a sensitivity of 88.00%, specificity of 49.20%, accuracy of 78.70%, positive predictive value (PPV) of 84.60%, and negative predictive value (NPV) of 56.20%. The calibration curve demonstrated close alignment between predicted and actual probabilities, with a low mean absolute error (MAE = 0.038), indicating robust calibration performance. In the validation cohort, the AUC was 0.705 [95% CI: 0.631-0.799], with an optimal probability threshold of 0.350, sensitivity of 91.90%, specificity of 36.20%, accuracy of 77.80%, PPV of 81.00%, and NPV of 60.00%. CONCLUSION: The incidence of postoperative pulmonary infections in renal transplant patients is relatively high and is influenced by various factors (included male, history of multiple transplants, comorbid hypertension history, comorbid heart disease history, and postoperative rejection). The proposed risk prediction model exhibits favorable predictive performance and clinical utility, aiding clinicians in early identification of high-risk patients and guiding targeted preventive interventions.
Prolonged Prothrombin Time: A Reliable Clinical Indicator of Therapeutic Efficacy for Chronic Liver Failure Treated With Artificial Liver Support System.
Chen H, Zhang H, Guo S … +2 more , Li J, Luo Y
Transplant Proc · 2026 Apr · PMID 41771714 · Publisher ↗
OBJECTIVE: To analyze the therapeutic efficacy of artificial liver support system (ALSS) treatment for acute on chronic liver failure (ACLF) and its influencing factors, providing a basis for clinical treatment, selectio...
OBJECTIVE: To analyze the therapeutic efficacy of artificial liver support system (ALSS) treatment for acute on chronic liver failure (ACLF) and its influencing factors, providing a basis for clinical treatment, selection of beneficiaries, and disease management. METHODS: A retrospective study was conducted on 283 patients with ACLF who received ALSS treatment at a hospital in Ganzhou City from August 2021 to January 2024. Patients were divided into effective and ineffective subgroups based on the therapeutic efficacy within 28 days. Differences between the two subgroups were compared. Variables with significant differences in univariate analysis were further analyzed using multivariate logistic regression to determine the influencing factors, and ROC curves were constructed to evaluate the predictive efficacy of treatment outcomes. RESULTS: The efficacy rate of ALSS treatment for ACLF was 59.72%. Univariate analysis showed that levels of Model for End-Stage Liver Disease (MELD) score, prothrombin time (PT), Monocyte-to-Lymphocyte Ratio (MLR), International Normalized Ratio (INR), Creatinine, and Total Cholesterol (TC) were higher in the ineffective group, while Triglycerides (TG), High-Density Lipoprotein Cholesterol (HDL-C) and Low-Density Lipoprotein Cholesterol (HDL-C) were lower. Multivariate logistic regression analysis indicated that PT, MELD score and MLR were key factors influencing the efficacy of ALSS treatment for ACLF patients. ROC curves demonstrated that PT had good performance in assessing therapeutic efficacy (P < .05). The evaluation effect of the combined factors was not significantly different compared with the single effect of PT (P > .05). CONCLUSION: The efficacy of ALSS treatment for ACLF was comparatively favorable. Prolonged PT is correlated with treatment efficacy and have significant reference value in the assessment of treatment outcomes.
Persistent Urinary Tract Infections After Kidney Transplantation: Risk Factors and Management.
Huseynov A, Kuşlu Çiçek SN
Transplant Proc · 2026 Apr · PMID 41771713 · Publisher ↗
BACKGROUND: Persistent urinary tract infections (UTIs) are a frequent complication among kidney transplant recipients, often leading to increased morbidity, healthcare costs, and potential compromise of graft function. I...
BACKGROUND: Persistent urinary tract infections (UTIs) are a frequent complication among kidney transplant recipients, often leading to increased morbidity, healthcare costs, and potential compromise of graft function. Identifying risk factors and effective management strategies is crucial to improve clinical outcomes in this vulnerable patient population. METHODS: In this retrospective study conducted from January 2020 to December 2024, 1130 kidney transplant recipients aged 18 to 75 years were analyzed. Clinical and laboratory data were obtained from electronic medical records, with information on demographics, immunosuppressive regimens, microbiological findings, and treatment outcomes. Persistent UTIs were defined as 2 or more microbiologically confirmed episodes within 12 months despite appropriate therapy. Statistical analyses included descriptive measures, comparative tests, and multivariate logistic regression to identify independent predictors. RESULTS: Of the total cohort, 31.2% developed persistent UTIs, with 68.5% experiencing recurrent episodes. Diabetes mellitus (adjusted OR: 1.56), prolonged urinary catheterization (adjusted OR: 2.04), and infection with multidrug-resistant (MDR) pathogens (adjusted OR: 2.32) emerged as significant risk factors. Escherichia coli was the most frequently isolated organism (36.4%), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Patients with persistent UTIs exhibited lower mean eGFR levels, although graft loss rates did not differ significantly from those without persistent UTIs. CONCLUSION: Persistent UTIs represent a major clinical challenge in kidney transplant recipients. Early identification of modifiable risk factors-particularly glycemic control and appropriate urinary catheter management-may reduce recurrence and preserve renal function. A comprehensive approach involving routine microbiological surveillance and judicious antibiotic use is essential to mitigate the impact of MDR organisms on patient outcomes.
Are All Low GCS Patients Potential Organ Donors? Insights From a Policy-Driven Brain Death Evaluation Framework.
Ayyıldız FA, Uncu G, Ayyıldız A
Transplant Proc · 2026 Apr · PMID 41771712 · Publisher ↗
BACKGROUND: Accurate identification of potential organ donors is essential for optimizing transplant opportunities.In Turkey, the 2025 update of the national Healthcare Quality Standards (SKS) introduced a mandatory brai...
BACKGROUND: Accurate identification of potential organ donors is essential for optimizing transplant opportunities.In Turkey, the 2025 update of the national Healthcare Quality Standards (SKS) introduced a mandatory brain death evaluation for all ICU patients with a Glasgow Coma Scale (GCS) ≤6. While intended to prevent missed donor opportunities, this policy may lead to unnecessary evaluations of patients with reversible conditions, creating an increased workload and resource strain on critical care teams. This study aimed to evaluate the clinical yield and practical implications of mandatory brain death evaluations in ICU patients with a GCS score of ≤6 following the implementation of this policy-driven framework. METHODS: We conducted a retrospective observational analysis of 395 adult ICU patients with GCS ≤ 6 at admission between January and September 2025. Patients were stratified by primary diagnosis (neurological vs non-neurological). The first GCS (at referral) and final GCS (end of ICU follow-up) were recorded, and confirmed brain death cases identified. Differences between groups were analysed using appropriate statistical tests. RESULTS: Among 395 patients, 17 (4.3 %) were declared brain dead-all from the neurological group. Despite inclusion of non-neurological etiologies (including postoperative, metabolic, and respiratory diagnoses), none proceeded to brain death. The non-neurological cohort showed significant GCS recovery (eg, postoperative mean GCS improved from 3.13 to 12.76, p < .001). CONCLUSIONS: The use of GCS ≤ 6 as a universal screening criterion for brain death evaluation in ICU patients is overly sensitive but lacks specificity. To optimise donor identification and resource utilisation, referral criteria should incorporate additional neurological and clinical filters.
Single-Center Investigation on the Prevalence, Risk Factors, and Outcomes of Non-infective Inflammatory Bowel Disease in Heart Transplant Recipients.
Durante-Mangoni E, Infante O, Gul S … +11 more , Damiano B, Patauner F, Mercadante S, Scarpulla N, Cafarella I, Boccia F, Andini R, Pinto D, Miranda A, Marra C, Zampino R
Transplant Proc · 2026 Apr · PMID 41771711 · Publisher ↗
BACKGROUND: Inflammatory bowel diseases (IBDs) are progressive, immune-mediated conditions including Crohn Disease and ulcerative colitis. Heart transplant (HTx) represents the most successful treatment for patients with...
BACKGROUND: Inflammatory bowel diseases (IBDs) are progressive, immune-mediated conditions including Crohn Disease and ulcerative colitis. Heart transplant (HTx) represents the most successful treatment for patients with end-stage heart failure. Lifelong immunosuppressive therapy to prevent graft rejection is associated with a decreased incidence and prevalence of immune-mediated diseases; however, de novo non-infective IBDs have been reported in transplant recipients. This study aims to describe clinical characteristics and variables that may influence the onset of non-infective IBD following HTx. METHODS: We performed a single-center, retrospective, observational study at Monaldi Hospital, Naples. Hospitalized patients that received a diagnosis of non-infective IBD after HTx were included. RESULTS: A total of 10 males were included, median age at IBD onset was 56 years [45-64.5]. The median time interval between HTx and IBD diagnosis was 8.5 years [3-12.7]. IBD onset was characterized by rectal bleeding (70%), abdominal pain (70%), chronic diarrhea (60%), and weight loss (20%). A total of 60% of the subjects experienced cytomegalovirus reactivation after transplant, and IBD ensued a median of 3 years [2-12] after reactivation. The most common histological diagnosis was indeterminate colitis. All patients on cyclosporine and most treated with tacrolimus and everolimus had higher than recommended mean plasma trough levels of immunosuppressive drugs during the year before IBD diagnosis. All patients received mesalazine, with a 40% increase in the prednisone dose. One patient underwent surgery for complications, and one died 3 years after IBD diagnosis as a result of intestinal perforation. CONCLUSIONS: De novo IBD is a possible complication after HTx and should be promptly suspected when gastrointestinal symptoms persist. Cytomegalovirus reactivation and high exposure to immunosuppressants are possible risk conditions.
Psychometric Validation of Questionnaire on Knowledge and Attitudes Towards Organ Donation and Transplantation (Donors Preliminary Study).
Attanasio M, Romano L, Giuliani A … +8 more , Panarese A, Lancione L, Lupi D, Maccarone D, Perrotti A, D'Annunzio A, Mazza M, Vistoli F
Transplant Proc · 2026 May · PMID 41765708 · Publisher ↗
INTRODUCTION: Organ donation is a highly complex issue. The purpose of our study was to validate 2 questionnaires to explore public knowledge, opinions, and attitudes regarding organ donation and transplantation. Study f...
INTRODUCTION: Organ donation is a highly complex issue. The purpose of our study was to validate 2 questionnaires to explore public knowledge, opinions, and attitudes regarding organ donation and transplantation. Study focused on 2 distinct forms of donation-postmortem organ donation and living donation-through the creation of 2 structured instruments targeting the respective domains. METHODS: The construction process relied on a thorough review of existing literature, along with the adaptation of validated instruments. The first questionnaire, targeting the postmortem organ donation, includes a total of 29 items. The living organ donation questionnaire contains 13 items. Participants were selected using a mixed recruitment strategy aimed at capturing a broad and diverse representation of young people older than 18 years, residing in the province of L'Aquila, who provided informed consent. To assess the dimensionality of the questionnaire, we performed an exploratory graph analysis (EGA), and the final model was evaluated through Confirmatory Factor Analysis. RESULTS: A total of 816 young adults participated in the study. The final postmortem organ donation questionnaire consists of 28 items divided into 4 subscales: family influence; social, cultural, and religious factors; healthcare trust; pro-social and moral values. The final version of living organ donation questionnaire consists of 8 items divided into 3 subscales: fear and concern; personal and moral values; communication and openness. CONCLUSION: The future objective of our research is to implement psycho-educational Interventions aimed at raising awareness and education based on the dimensions identified by our questionnaire.
Eculizumab Successfully Rescues Against de novo Atypical Hemolytic Uremic Syndrome Following Retransplantation.
Li M, Wen J, Dong J … +2 more , Wen N, Sun X
Transplant Proc · 2026 Apr · PMID 41765707 · Publisher ↗
Kidney transplantation has emerged as the optimal treatment for end-stage renal disease. However, the occurrence of atypical hemolytic uremic syndrome (aHUS) following renal transplantation is extremely uncommon and asso...
Kidney transplantation has emerged as the optimal treatment for end-stage renal disease. However, the occurrence of atypical hemolytic uremic syndrome (aHUS) following renal transplantation is extremely uncommon and associated with adverse outcomes, often resulting in early graft loss, thus warranting heightened awareness. This report details a case of successful management of a patient who developed post-transplant aHUS following retransplantation. The patient had previously suffered graft failure shortly after the first kidney transplantation due to unexplained non-rejection mechanisms. Following the second transplantation, the individual presented with new-onset anemia, thrombocytopenia, acute kidney injury, and elevated lactate dehydrogenase levels within a short time frame, all manifesting undetermined etiology. A comprehensive assessment of dynamic changes in hemoglobin, platelet count, serum creatinine, and lactate dehydrogenase, alongside pathological examinations, culminated in a definitive diagnosis of aHUS. After undergoing four treatments with eculizumab, there was a sustained improvement in hemoglobin, platelet count, serum creatinine, and lactate dehydrogenase levels, thereby preserving the function of the transplanted kidney. Timely diagnosis and early application of eculizumab in treating aHUS are crucial. Furthermore, comprehensive pre-transplant evaluations of patients to exclude aHUS risk factors are essential.
Investigation of the Relationship Between Preoperative and Postoperative Renal Volume and Renal Function in Living Kidney Donors.
Kikkawa K, Tamaki M, Sugitani S … +7 more , Komidori S, Maruno K, Nakayasu R, Takahashi T, Yamada Y, Nakashima M, Ito N
Transplant Proc · 2026 Apr · PMID 41765706 · Publisher ↗
BACKGROUND: Living donor nephrectomy (LDN) leads to an immediate reduction in nephron mass, triggering compensatory hypertrophy in the remaining kidney. However, the relationship between changes in renal volume and funct...
BACKGROUND: Living donor nephrectomy (LDN) leads to an immediate reduction in nephron mass, triggering compensatory hypertrophy in the remaining kidney. However, the relationship between changes in renal volume and functional adaptation remains unclear. This study aimed to evaluate the association between pre- and postdonation renal volume and renal function in living kidney donors (LKDs). METHODS: We retrospectively reviewed 23 LKDs who underwent postdonation computed tomography (CT) imaging following LDN between 2011 and 2021. Contralateral renal volume (CRV) was measured using 3D reconstructions from CT scans. The CRV change ratio was defined as postdonation CRV divided by predonation CRV. Estimated glomerular filtration rate (eGFR) was assessed before and after donation. Correlations between renal volume parameters and renal function were analyzed. RESULTS: All donors exhibited increased CRV postdonation, with a median change ratio of 1.32. The CRV change ratio positively correlated with predonation eGFR (ρ = 0.449, p = .031), predonation volume (ρ = 0.491, p = .019), and postdonation eGFR (ρ = 0.619, p = .002). Donors with larger predonation kidney volumes had significantly better postdonation function and greater volume increases. CONCLUSION: CT-based volumetry demonstrated significant compensatory hypertrophy in the remnant kidney following LDN, with the degree of volume increase closely associated with both pre- and postdonation renal function. Predonation renal volume may serve as a useful predictor of functional recovery. These findings support the clinical utility of CT volumetry for donor assessment and long-term follow-up. Further prospective studies are warranted.
Transplanting Change: The Slow Progress of Gender Equity in Editorial Leadership.
Rampersad C, Villemure-Poliquin N, Selzner N … +2 more , Tsien C, Shwaartz C
Transplant Proc · 2026 Apr · PMID 41763945 · Publisher ↗
BACKGROUND: Gender disparities in academic medicine, including journal editorships, are well-documented, but field-specific evaluation is essential to identify and address inequities. Solid organ transplantation, a diver...
BACKGROUND: Gender disparities in academic medicine, including journal editorships, are well-documented, but field-specific evaluation is essential to identify and address inequities. Solid organ transplantation, a diverse and multidisciplinary field, reflects broader imbalances, yet editorial board distributions remain understudied. We examined gender distribution, temporal trends, and predictors of female editorship in high-impact transplantation journals. METHODS: We conducted a cross-sectional analysis of the top 20 transplantation journals by 2024 Scimago Journal Rank. Editor gender, specialty, geographic location, and journal characteristics were extracted from public sources. Gender was determined through web searches and validated software. Female representation among editors-in-chief in 2024 was compared to 2014. Predictors of female editorship were assessed using multivariable logistic regression. RESULTS: Of 1479 editors, 31% were female, including 3/24 (13%) editors-in-chief and 29/90 (32%) chief/deputy editors. Female editors-in-chief was unchanged from 2014 to 2024 (10% vs 13%, p = .99). Physicians comprised 80% of editors, with lower female representation than non-physicians (28% vs 46%, p < .001). Female editorship was lowest among surgeons (16%) and highest in allied health (77%). Most editors (94%) were from high-income countries, with no difference between high- and middle-income countries (p = .99), and none from low-income countries. Odds of female editorship were lower for surgeons (OR 0.36; 95% CI: 0.27, 0.49) and higher for allied health (OR: 6.50; 95% CI: 2.71, 18.1). CONCLUSIONS: Female representation on transplant editorial boards aligns with workforce proportions but remains notably lower among editors-in-chief, stable over the past decade. Targeted policies, mentorship, and tracking gender-metrics are critical to promote equity in academic transplantation.
Infections in Liver Retransplantation: A Prospective Study of Microbial Patterns, Immune Biomarkers, and Survival.
Karakaş EE, Toplu SA, Şahin TT … +5 more , Karakaş S, Satılmış B, Akbulut S, Bayındır Y, Yılmaz S
Transplant Proc · 2026 Apr · PMID 41763944 · Publisher ↗
BACKGROUND: Liver retransplantation (Re-Tx) recipients are at elevated risk for infectious complications due to increased immunologic and clinical vulnerability. However, prospective data on infection incidence, microbia...
BACKGROUND: Liver retransplantation (Re-Tx) recipients are at elevated risk for infectious complications due to increased immunologic and clinical vulnerability. However, prospective data on infection incidence, microbial etiology, immune biomarkers, and survival outcomes in this population remain limited. METHODS: We conducted a prospective cohort study of 26 adult Re-Tx recipients treated between 2021 and 2023 at the Inonu University Liver Transplantation Institute (Malatya, Türkiye). Demographic, clinical, and laboratory data-including preoperative immune biomarkers (TNF-α, TGF-β, IL-1β, IL-4, IL-6, IL-22, β-galactosidase, GDH, IFN-γ, GM-CSF)-were collected. Infections were classified as early (0-30 days) or early-intermediate (1-6 months) post-transplant. Multivariate logistic regression was used to assess infection risk factors. Kaplan-Meier analysis was performed to evaluate survival. RESULTS: Female sex (OR = 7.377) and elevated procalcitonin levels on postoperative day 3 (OR = 1.054) were independently associated with early infections. Early infections were predominantly caused by gram-negative bacteria and fungi, including E. coli, Klebsiella spp., and Acinetobacter baumannii. These infections significantly reduced 1-, 3-, and 5-year survival rates (log-rank P < .05). No significant differences were found in preoperative immune biomarker levels between infected and non-infected patients (P > .05). CONCLUSIONS: Re-Tx recipients face high early infection risk, especially from multidrug-resistant organisms such as Candida spp. and A. baumannii. Female sex and postoperative PCT elevation may serve as early warning indicators. Although biologically relevant, preoperative immune biomarkers showed limited prognostic value. Tailored prophylactic and monitoring strategies are needed in this high-risk group.
Quality of Life After Abdominal Wall Reconstruction and the Establishment of a Pathway for Renal Transplant Recipients.
Ahmed Z, Ghali S, Al Midani A
Transplant Proc · 2026 Apr · PMID 41763943 · Publisher ↗
PURPOSE: The aims of this study were to evaluate outcomes and impact on quality of life (QoL) for patients undergoing abdominal wall reconstruction (AWR) and to describe the establishment of a pathway for renal transplan...
PURPOSE: The aims of this study were to evaluate outcomes and impact on quality of life (QoL) for patients undergoing abdominal wall reconstruction (AWR) and to describe the establishment of a pathway for renal transplant recipients. METHODS: A retrospective study of renal transplant recipients undergoing AWR for incisional hernia repair from 2015 to 2024, which included the transition point when the AWR pathway for renal transplant recipients was initiated at a large teaching hospital. Baseline characteristics, operative variables and postoperative complications were collected from electronic patient records. QoL was assessed through the distribution of standardized Hernia-related Quality-of-Life surveys (HerQLes). RESULTS: There were 34 patients with renal transplants who underwent AWR, and 26 were eligible to complete Hernia-related Quality-of-Life survey, with17 responding. Indications for transplantation varied; the most common was polycystic kidney disease (N = 7, 21%), and most patients had comorbidities (N = 33, 97%) and were overweight. Complications occurred in 13 patients (38%), most of which were Clavien-Dindo grades I/II (53%), and there was one death that prompted the formation of the pathway. Key pathway features discussed include prehabilitation, meticulous operative planning, and multidisciplinary input throughout. Following the establishment of the pathway, patients reported statistically significant improvements in all domains of QoL including psychological, physical, and sexual parameters. CONCLUSIONS: Incisional hernias negatively impact QoL; this is the first study to provide insight into the change in QoL for patients receiving renal transplants following AWR and demonstrates how a multidisciplinary pathway can improve outcomes. Patient selection is crucial, and future work should identify risk factors for the development of incisional hernias after renal transplantation.
A View of Cornea Transplantation From the Patient's Perspective.
Yildirim M, Keleş S, Kaplan Ş … +1 more , Sharif AN
Transplant Proc · 2026 Apr · PMID 41763942 · Publisher ↗
BACKGROUND: To assess the patients' satisfaction and health-related quality of life after the penetrating keratoplasty (PK). METHODS: 100 consecutive patients who had undergone PK participated in a 16-question survey in...
BACKGROUND: To assess the patients' satisfaction and health-related quality of life after the penetrating keratoplasty (PK). METHODS: 100 consecutive patients who had undergone PK participated in a 16-question survey in our clinic. Quality of life, expectancy, mood, and satisfaction of the patients were graded. RESULTS: The average age of 100 patients (45 female, 55 male) who responded to the survey was 47.2 ± 21.5 (10-85) years. The average follow-up period of the patients was at least 12 months. The indications of the patients were keratoconus (35%), bullous keratopathy (22%), keratitis sequela (18%), trauma sequelae (15%), and corneal dystrophy (10%). While the average preoperative visual acuity was counting fingers at 2 meters (Light sensation- 0.2), the postoperative visual acuity was 0.5 (Light sensation - 1.0). While visual acuity remained constant in 8 cases, it increased in 92 cases. As a result, visual acuity was the only parameter that was statistically significant (p < .01). When patients' satisfaction was grouped according to indications, they were listed as follows: keratoconus, corneal dystrophies, keratitis sequelae, trauma, and bullous keratopathy. In general, corneal transplant patients were satisfied with the results and were happy. CONCLUSIONS: The only significant parameter in terms of patient satisfaction after the PK was found to be the outcome of visual acuity. For this reason, patients who will undergo corneal transplantation should be provided with clear and understandable information about their diseases and complications that may develop after transplantation.
Influence of Donor-Recipient Body Surface Area Ratio on Pediatric Kidney Transplant Outcomes.
Scheuermann U, Seiffer S, Dittrich K … +7 more , Siekmeyer M, Meyer HJ, Rhode P, Unruh J, Haak F, Seehofer D, Tautenhahn HM
Transplant Proc · 2026 Apr · PMID 41763941 · Publisher ↗
AIM/ BACKGROUND: An adequate organ selection is crucial to minimize perioperative complications and to promote long-term graft survival in kidney transplantation (KT). Therefore, the aim of this study was to evaluate the...
AIM/ BACKGROUND: An adequate organ selection is crucial to minimize perioperative complications and to promote long-term graft survival in kidney transplantation (KT). Therefore, the aim of this study was to evaluate the potential of the donor-recipient body surface area (BSA) ratio as a prognostic factor for transplant outcomes in pediatric recipients. PATIENTS AND METHODS: A total of 88 pediatric patients who underwent KT at our institution between 1995 and 2024 were included in this retrospective analysis. KT recipients were categorized into 3 groups based on donor-recipient BSA-ratio: BSAR-low (≤0.9), BSAR-mid (1.0-1.9), and BSA-high (≥2.0). Clinicopathological characteristics, transplant outcomes, and graft survival were evaluated across the groups. RESULTS: Recipient age showed a significant inverse correlation with the BSAR (r = -0.750; P < .001). BSAR-high KT were associated with enhanced glomerular filtration rates post-transplant, without significant different graft survival rates in comparison to BSAR-mid KT. Recipients of kidney graft from relatively smaller donors (BSAR-low) showed a trend towards a higher rate of perioperative complications and a significantly higher rate of graft loss compared to BSAR-mid KT (P = .021). Multivariate Cox regression analysis could confirm BSAR-low as an independent risk factor of decreased graft survival (adjusted HR 3.741; P = .008). CONCLUSION: Our findings suggest that KTs from relatively larger donors (BSAR-high) are safe and perform comparably to size-matched grafts (BSAR-mid) in pediatric recipients, while smaller donor kidneys (BSAR-low) may carry a higher risk of intraoperative complications and reduced graft survival. Further large-scale studies are needed to validate these observations.
Impact of Graft Size Matching on Graft Survival in Pediatric Whole Liver Transplantations in Recipients With Biliary Atresia Weighing Less Than 10 kg.
Xie E, Wang K, Dong C … +10 more , Sun C, Zheng W, Yang Y, Wang Z, Han C, Zhang G, Jiao L, Cao S, Zhang Z, Gao W
Transplant Proc · 2026 Apr · PMID 41763940 · Publisher ↗
BACKGROUND: The size mismatch between a liver graft and the recipient can result in complications and poor survival after pediatric whole liver transplantation (WLT). METHODS: A retrospective study was designed, which in...
BACKGROUND: The size mismatch between a liver graft and the recipient can result in complications and poor survival after pediatric whole liver transplantation (WLT). METHODS: A retrospective study was designed, which included 114 recipients. Multiple variable predictors of graft loss suggested the graft-to-native-liver weight ratio (GNLWR), and then the GNLWR was calculated and categorized into 2 groups. The demographic, operation, complications, and survival analysis data were collected and compared. RESULTS: Group 1 with a GNLWR < 0.41 had a higher incidence of hepatic artery thrombosis (HAT) and lower graft survival in the first 3 months (70.4% vs 96.6%, P < .001). Patient survival at 3 months was significantly different between groups (85.2% vs 97.7%, P = .010). As for the graft survival rate, it was 70.4% for group 1 at both 1 and 3 years, whereas it was 94.2% for group 2 at both 1 and 3 years. Additionally, the patient survival rate for group 1 was 85.2% at both 1 and 3 years, whereas for group 2, it was 95.4% at both 1 and 3 years. Further analysis showed the PELD score was the only independent risk factor for graft loss in the group with GNLWR < 0.41. It indicated a worse prognosis when the PELD score was more than 23.5. CONCLUSIONS: A GNLWR of less than 0.41 suggested a poor prognosis for grafts in pediatric WLT recipients with biliary atresia weighing less than 10 kg. Reducing blood transfusions may help improve graft survival.
Relationship Between Vitamin D Levels and Inflammatory Markers in Kidney Transplant Recipients: A Retrospective Study.
Oruç İ, Eynel E, Danış R … +2 more , İnce H, Ay N
Transplant Proc · 2026 Apr · PMID 41763939 · Publisher ↗
BACKGROUND: This study aimed to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and hematologic inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ra...
BACKGROUND: This study aimed to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and hematologic inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as well as other biochemical parameters, in patients who underwent renal transplantation due to chronic kidney disease (CKD). METHODS: This study included 304 adult renal transplant recipients followed at a single transplant center between January 2015 and June 2025. Patients were divided into 2 groups according to serum 25(OH)D levels: deficient (<20 ng/mL) and nona-deficient (≥20 ng/mL). Demographic, clinical, and laboratory data-including NLR, PLR, C-reactive protein (CRP), parathyroid hormone (PTH), erythrocyte sedimentation rate (ESR), and procalcitonin-were retrospectively reviewed. Statistical analyses were performed using the Mann-Whitney U test, chi-square test, and Pearson correlation analysis. RESULTS: Vitamin D deficiency was detected in 84.2% (n = 256) of patients. Serum 25(OH)D levels were significantly and inversely correlated with PTH levels (r = -0.241, p < .001), and the deficient group had higher PTH concentrations (p = .002). Weak positive correlations were observed between 25(OH)D and both procalcitonin (r = 0.122, p = .034) and ESR (r = 0.117, p = .041). However, no significant associations were found between vitamin D levels and NLR, PLR, CRP, lipid profile, or other parameters. CONCLUSION: Vitamin D deficiency is highly prevalent among renal transplant recipients and is significantly associated with elevated PTH levels. The weak correlations observed with inflammatory markers suggest the multifactorial nature of inflammation in this population. Routine monitoring and appropriate replacement of vitamin D may contribute to improved bone metabolism and overall health in renal transplant patients.
Truth vs Test: The Value of Cotinine in Lung Transplant Candidates Assessment.
Zuazaga-Fuentes J, Mora-Cuesta VM, Iturbe-Fernández D … +6 more , Tello-Mena S, Izquierdo-Cuervo S, García-Unzueta MT, Alonso-Lecue P, Novoa-Vela V, Cifrián-Martínez JM
Transplant Proc · 2026 Apr · PMID 41763938 · Publisher ↗
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) account for approximately 80% of all lung transplantations. Cotinine, the main nicotine metabolite, can be measured in serum an...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) account for approximately 80% of all lung transplantations. Cotinine, the main nicotine metabolite, can be measured in serum and is a reliable biomarker of tobacco exposure. According to ISHLT consensus, use of any nicotine-containing product is an absolute contraindication for lung transplantation. This study aimed to assess the frequency and characteristics of active smokers among lung transplant candidates. METHODS: We conducted a retrospective study including all patients with COPD or ILD evaluated as lung transplant candidates for the first time at a transplant referral center between November 1, 2020, and December 1, 2023. Serum cotinine was measured using an automated immunoassay (IMMULITE 2000, Siemens HealthCare), with levels >20 ng/mL considered positive. RESULTS: Of 467 total candidates, 356 patients with COPD or ILD underwent cotinine testing at their initial evaluation (median age 61.86 years). Most were former smokers (90.7%) with a median cumulative tobacco exposure of 40 pack-years. Cotinine was elevated in 52 patients (16.1%). Those with positive cotinine levels were more likely to have COPD, be women, be significantly younger, have higher cumulative tobacco exposure, and report a shorter duration of smoking cessation. Candidates with negative cotinine levels had a higher probability of being listed for transplantation. CONCLUSIONS: A substantial proportion of lung transplant candidates show biochemical evidence of active smoking. Younger patients, women, and those with heavier smoking histories and shorter abstinence periods require closer monitoring. Further studies will assess the influence of personality traits on smoking relapse.
Assessment of Anxiety, Depression and Associated Factors in Post - Liver Transplant Recipients in Vietnam.
Le LC, Van Vu Q, Nguyen HT … +2 more , Le HT, Nguyen TH
Transplant Proc · 2026 Apr · PMID 41763937 · Publisher ↗
BACKGROUND: In addition to the physical challenges, anxiety and depression are significant factors that affect the quality of life of liver transplant recipients. Numerous psychosocial factors influence the mental health...
BACKGROUND: In addition to the physical challenges, anxiety and depression are significant factors that affect the quality of life of liver transplant recipients. Numerous psychosocial factors influence the mental health of these patients, and it is essential to investigate these factors to improve patient care post-transplant. METHODS: This was a cross-sectional study conducted at 108 Military Central Hospital (Vietnam), involving 190 liver transplant recipients. Mental health was assessed using standardized tools, including the Beck Anxiety Inventory (BAI), the Beck Depression Inventory - Second Edition (BDI-II), and the Family APGAR. Patients were interviewed using structured questionnaires. RESULTS: The mean age of the participants was 52.31 ± 11.49 years, with 85.79% being male. The majority of recipients (58.95%) were in the 1 to 3 years post-transplant follow-up period. Approximately 37.9% of recipients reported experiencing post-transplant anxiety, with the severity distribution as follows: mild (23.16%), moderate (8.42%), and severe (6.32%). Depression was present in 11.59% of recipients, with only 0.53% experiencing severe depression. Family support was notably high, with 78.95% of recipients reporting strong family backing. The study also identified several factors influencing psychological health, including age, gender, marital status, occupation, income level, postoperative follow-up period. CONCLUSIONS: Postliver transplantation care should extend beyond physical monitoring and immunosuppressive management to include mental health support. Routine psychological assessment should be integrated into standard clinical follow-up to promote long-term quality of life in liver transplant recipients.
ABO Incompatible Kidney Transplantation in Pakistan: A Major Breakthrough.
Sarwar N, Alam U, Sarwar N … +5 more , Mushaid N, Mkhtar S, Lathuile-Giroux C, Mahmood A, Rostaing L
Transplant Proc · 2026 Apr · PMID 41763936 · Publisher ↗
Pakistan, a resource-limited country, faces a growing number of patients with end-stage kidney disease, many of whom could benefit from living-related kidney transplantation. To expand the living donor pool, we implement...
Pakistan, a resource-limited country, faces a growing number of patients with end-stage kidney disease, many of whom could benefit from living-related kidney transplantation. To expand the living donor pool, we implemented the largest ABO-incompatible kidney transplantation program in the country. The program started in February 2023, and 21 transplants have been performed to date. Pretransplant desensitization consisted of rituximab (375 mg/m²) at day (D) -30, tacrolimus, mycophenolic acid, and steroids starting at D -15, along with apheresis sessions to achieve isoagglutinin titers below 1:4 on the day of transplantation. Among the recipients, 16 were males and 5 females. Eighteen patients had been on hemodialysis for more than 6 months, and 3 underwent pre-emptive transplantation. The median recipient age was 39 years (range, 18-66). After a median follow-up of 12 months (range, 2-32), 3 patients (14.3%) had died with functioning grafts, while no graft loss occurred. The median serum creatinine at last follow-up was 1.1 mg/dL (range, 0.8-1.4). One patient experienced delayed graft function. Three patients developed acute rejection (2 cellular, 1 antibody-mediated), all successfully treated. Infectious complications occurred in ten patients (47.6%), resulting in 2 deaths. In conclusion, ABO-incompatible living donor kidney transplantation is feasible and effective in our setting, achieving excellent short-term graft outcomes. However, infectious and cardiac complications remain significant causes of morbidity and mortality.
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