Transplant. Proc. [JOURNAL]
Sun
200 papers
Characterizing the Impact of Induction Therapy on BK Polyoma Viral Reactivation: A Single-Center Analysis.
Ammar S, Eyck PT, Axelrod D … +2 more , Tan CS, Kuppachi S
Transplant Proc · 2026 Apr · PMID 41763935 · Publisher ↗
PURPOSE: BKPyV following kidney transplantation is well recognized to cause premature graft failure and ureteral complications. Cumulative immunosuppression, including induction therapy, has a sustained impact on immune...
PURPOSE: BKPyV following kidney transplantation is well recognized to cause premature graft failure and ureteral complications. Cumulative immunosuppression, including induction therapy, has a sustained impact on immune responses to opportunistic infection. We hypothesized that induction with cell-depleting agents affects the 1-year risk of BKPyV reactivation. METHODS: Of 456 adult patients who underwent kidney transplants between January 2018 and February 2023 with at least 12 months of follow-up were screened for BK virus by blood PCR at 1.5, 3,6,9,12 months. RESULTS: Among the 456 patients, 101 (22.1%) developed BKPyV viremia. The incidence of BKPyV positivity was highest with basiliximab (32%) compared to alemtuzumab (21%) and thymoglobulin (18%) (p = .032). Compared to basiliximab, receiving alemtuzumab (OR: 0.571, 95% CI: 0.329-0.991, p = .042) or thymoglobulin (OR: 0.462, 95% CI: 0.256-0.834, p = .010) was associated with a significantly lower risk of BKPyV. Higher KDPI was also significantly associated with an increased risk of BKPyV infection (OR: 1.120, 95% CI: 1.013-1.238, p = .026). Multivariable analysis showed a persistently significant lower risk of BKPyV infection with thymoglobulin (OR: 0.4, 95% CI: 0.21-0.75, p = .004) and alemtuzumab (OR: 0.5, 95% CI: 0.28-0.89, p = .019) compared to basiliximab. Also, higher KDPI was independently associated with BKPyV viremia (OR: 1.13, 95% CI: 1.01-1.25, p = .031). CONCLUSION: Induction therapy and higher KDPI were significant risk factors for BKPyV reactivation. Induction with cell-depleting agents lowered the risk of BKPyV, perhaps due to the subsequent use of lower maintenance immunosuppression and reduced need for acute rejection treatment.
Electrothermal Lymphatic Sealing (LigaSure) Versus Conventional Hand-Tie Ligation for Control of Perivascular Lymphatics in Kidney Transplant Recipients: A Mixed Prospective-Retrospective Cohort Study.
Jang E, Moon KY, Yun SS … +1 more , Park SC
Transplant Proc · 2026 Apr · PMID 41763934 · Publisher ↗
BACKGROUND: Ligation of iliac vessel lymphatics is essential for preventing lymphocele in kidney transplant (KT) recipients. Electrothermal bipolar vessel sealer (EBVS) such as LigaSure (Medtronic) may offer technical ad...
BACKGROUND: Ligation of iliac vessel lymphatics is essential for preventing lymphocele in kidney transplant (KT) recipients. Electrothermal bipolar vessel sealer (EBVS) such as LigaSure (Medtronic) may offer technical advantages. This study aimed to evaluate the safety and efficacy of lymphatic sealing using LigaSure in KT recipients compared to conventional hand-tie ligation. METHODS: A mixed prospective-retrospective cohort study was conducted at a single center. The 'hand-tie group' included data collected from 300 KT recipients transplanted between May 2017 and May 2020 using hand-tie lymphatic ligation. The "LigaSure group" included 100 patients prospectively enrolled and transplantation done between April 2023 and December 2024 during which retroperitoneal dissection was done using LigaSure. Outcomes included postoperative drain volume, retroperitoneal dissection time, operation time, transfusion requirements, lymphocele formation, and bleeding complications. RESULTS: Retroperitoneal dissection time was significantly shorter in the LigaSure group compared to the hand-tie group (34.5 ± 12.4 vs 45 ± 19.3 minutes, p < .001). While the LigaSure group had slightly higher drain output volume, the difference was not clinically significant. However, the LigaSure group required more frequent Viscum album extract injections (p < .001). Lymphocele requiring intervention was observed in one patient in the LigaSure group and 2 patients in the hand-tie group. Postoperative hemoglobin levels were significantly lower in the LigaSure group, while transfusion rates and bleeding-related interventions did not differ significantly. CONCLUSION: Using LigaSure is safe in terms of bleeding control and lymphocele prevention and can effectively shorten the retroperitoneal dissection time during kidney transplantation compared to the hand-tie technique.
Relationship Between Arterioplasty and Renal Prognosis in Renal Transplantation: A Single-Center Retrospective Cohort Study.
Inoue S, Nakamura Y, Fukuda M … +5 more , Akabane M, Miki K, Yokoyama T, Kamiyama M, Ishii Y
Transplant Proc · 2026 Apr · PMID 41763933 · Publisher ↗
PURPOSE: Multi-artery kidney transplantation has historically been associated with a higher risk of complications and impaired graft function compared with single-artery transplantation. This study aimed to evaluate the...
PURPOSE: Multi-artery kidney transplantation has historically been associated with a higher risk of complications and impaired graft function compared with single-artery transplantation. This study aimed to evaluate the relationship between arterioplasty and renal prognosis. METHODS: We conducted a retrospective cohort study of living-donor kidney transplants performed at our center between January 2015 and December 2022. Patients with multiple renal arteries, excluding those in which branches were ligated, were divided into an arterioplasty group (AP group) and a simple anastomosis group (SA group). RESULTS: Among 201 living-donor kidney transplants, 46 and 140 patients were assigned to the AP and SA groups, respectively. At discharge, serum creatinine (s-Cr) levels were 1.62 ± 0.86 mg/dL and 1.41 ± 0.46 mg/dL (p = .35), and estimated glomerular filtration rates (eGFR) were 39.98 ± 17.19 and 43.67 ± 13.28 mL/min/1.73 m² (P = .05). At 1 year, s-Cr levels were 1.43 ± 0.56 mg/dL and 1.31 ± 0.40 mg/dL (P = .49), and eGFR values were 43.06 ± 15.45 and 45.87 ± 12.80 mL/min/1.73 m² (P = .24), with no significant differences. Intraoperative arterial re-anastomosis was performed in 3 (6.5%) and 8 patients (5.7%), respectively (P = 1.00). The 1-year graft survival rates were 97.8% and 97.1%, and patient survival rates were 100% and 99.3% in the AP and SA groups, respectively. CONCLUSION: In living-donor kidney transplantation with multiple renal arteries, arterioplasty showed renal function and survival outcomes comparable to simple anastomosis, suggesting it may be a safe and useful approach.
Vitrification and Nanowarming: Redefining the Limits of Allograft Preservation for Partial Heart Transplants.
Finkbeiner AS, Mills C, Javed H … +6 more , Anderson P, Godwin E, Campbell L, Greene ED, Brockbank KGM, Rajab TK
Transplant Proc · 2026 Apr · PMID 41760508 · Publisher ↗
Over 48,000 organ transplants were performed in 2024, but thousands of organs were discarded due to exceeding cold ischemic times (CIT), which can be as short as 4 hours for hearts. Therefore, current cold storage method...
Over 48,000 organ transplants were performed in 2024, but thousands of organs were discarded due to exceeding cold ischemic times (CIT), which can be as short as 4 hours for hearts. Therefore, current cold storage methods lead to significant loss of transplantation opportunities. Vitrification, a cryopreservation technique that prevents ice formation by rapidly cooling tissues into a glass-like state, offers a promising solution for long-term organ banking. Nanowarming, which uses iron oxide nanoparticles to rewarm tissues uniformly and rapidly, addresses limitations of traditional rewarming methods that can cause cell damage. Clinically, vitrification is already used for embryo storage in IVF and for preserving ovarian tissue in cancer patients. Preclinical studies are now optimizing vitrification and nanowarming for organs and tissues such as kidneys, pancreatic islets, and knee menisci. These efforts focus on improving cryoprotectant (CPA) formulations, refining warming strategies, and standardizing protocols. A promising future application includes banking heart valves for partial heart transplantation (PHT) by providing growing, living valve grafts for children with congenital heart valve defects. Together, vitrification and nanowarming represent a transformative advance in organ preservation, with the potential to reduce discard rates, expand donor pools, and improve transplantation outcomes.
Fixed Versus Growth Mindset and the Association With Alcohol Relapse After Liver Transplantation.
Laredo JA, Konakalla P, Khalil M … +1 more , Helmick RA
Transplant Proc · 2026 Apr · PMID 41760507 · Publisher ↗
BACKGROUND: Alcohol relapse after liver transplant (LT) is a concern for transplant centers across the US. Relapse rates have been quoted between 10% and 50%, making identification of patients with the lowest risk a prio...
BACKGROUND: Alcohol relapse after liver transplant (LT) is a concern for transplant centers across the US. Relapse rates have been quoted between 10% and 50%, making identification of patients with the lowest risk a priority when selecting LT recipients. Fixed vs growth mindset is a concept in psychology often applied to motivation, which may predict post-LT outcomes. METHODS: We retrospectively phoned patients who were transplanted for alcohol-related liver disease (ALD) between May 2016 and April 2023. Patients were consented over the phone and asked about their alcohol use, tobacco use, and were administered the growth mindset questionnaire. Mindset scores ranged from 0 to 60, with higher scores indicating stronger growth mindset. RESULTS: We identified 82 patients of whom 46 (56%) consented and completed surveys. Of these 46 LT recipients, 17 (37%) endorsed post-LT alcohol use while 29 (63%) stated abstinence. Self-reporting correlated well with random phosphatidylethanol testing. Mindset scores had identical median values between self-reported relapse groups. Patients who admitted to relapse were more likely to have failed attempts at alcohol rehabilitation and to have experienced legal consequences due to alcohol use. There were 25 patients in the cohort who used tobacco at any point. Those who were able to quit tobacco use before LT comprised a significantly higher portion of those without relapse (52%) compared to those who relapsed (18%). CONCLUSIONS: Predicting relapse in patients with ALD who await LT remains a challenge. However, successful cessation of tobacco may indicate successful abstinence from alcohol use post-LT. These results warrant further study with larger populations.
Peptide Receptor Radionuclide Therapy for Recurrent Neuroendocrine Tumor Liver Metastases After Liver transplantation: A Case Series.
Chen C, Zheng Q, Zhang L … +5 more , Guo Q, Wang H, Sun J, Xie Y, Jiang W
Transplant Proc · 2026 Apr · PMID 41760506 · Publisher ↗
OBJECTIVE: This study evaluated the toxicity and efficacy of Lu-177-DOTATATE peptide receptor radionuclide therapy (PRRT) under everolimus immunosuppression in patients with somatostatin receptors-positive (SSTR+) and gr...
OBJECTIVE: This study evaluated the toxicity and efficacy of Lu-177-DOTATATE peptide receptor radionuclide therapy (PRRT) under everolimus immunosuppression in patients with somatostatin receptors-positive (SSTR+) and grade 1/2 (G1/G2) neuroendocrine tumor liver metastasis (NETLM) who relapsed after liver transplantation (LT), aiming to provide evidence-based evidence for multidisciplinary management. METHODS: Data were retrospectively collected from seven patients with recurrent NETLM after LT treated with PRRT between April 2023 and June 2025. INCLUSION CRITERIA: stable liver tumor ≥ 6 months prior to LT; G1/G2; SSTR (+); and post-LT immunosuppression with everolimus (4 cases of everolimus monotherapy, 3 cases combined with low-dose tacrolimus). Assessments included pre- and post-PRRT imaging, laboratory tests, and everolimus blood concentrations (target range 3-8 ng/mL); toxicity was assessed according to CTCAE v5.0, and efficacy was assessed according to RECIST 1.1. PRRT was administered with 1 to 4 cycles and a cumulative dose of 175 to 709 mCi, and 3 patients received concomitant treatment with long-acting octreotide. Follow-up until death or final follow-up. RESULTS: Seven patients were included. Primary foci: pancreas in 3 cases and rectum in 4 cases; hepatic metastatic load >50% prior to transplantation. Everolimus blood levels were stable (3-8 ng/mL) during PRRT and there was no rejection. Major toxicities were hematologic: 2 cases of grade III, 4 cases of grade II and 1 case of grade I myelosuppression (1 case discontinued PRRT due to persistent severe myelosuppression); and 4 cases of grade I-II proteinuria (possibly related to everolimus nephrotoxicity). EFFICACY: 1 partial remission (PR), 5 stable disease (SD), 1 progression disease (PD), with a disease control rate (DCR) of 85.7%. No severe hepatic or renal impairment, infection or other serious adverse events occurred during treatment and follow-up. CONCLUSIONS: PRRT combined with everolimus-based immunosuppression has demonstrated controllable safety and preliminary antitumor activity in patients with relapsed NETLM after LT who have been strictly screened, but myelosuppression requires close monitoring and timely symptomatic treatment.
Beyond Survival: Early Perceived Quality of Life Outcomes After Lung Transplantation.
Saavedra-Villafruela A, González-Najarro E, Lamas-Fernández FJ … +3 more , Cadenas de Llano-Conde MJ, Mira-Padilla E, Vaquero-Barrios JM
Transplant Proc · 2026 Mar · PMID 41672853 · Publisher ↗
INTRODUCTION: Lung transplantation (LT) is a consolidated therapeutic option for patients with advanced lung disease. While its impact on survival is well documented, fewer studies have focused on its effect on health-re...
INTRODUCTION: Lung transplantation (LT) is a consolidated therapeutic option for patients with advanced lung disease. While its impact on survival is well documented, fewer studies have focused on its effect on health-related quality of life (HRQoL). OBJECTIVE: To evaluate improvements in HRQoL at 3 and 6 months in patients undergoing LT. METHODS: This retrospective study included patients undergoing LT between March and September 2024 at Hospital Universitario Reina Sofía, Córdoba. HRQoL was measured using the EQ-5D-3L questionnaire and the EQ visual analogue scale (EQ-VAS, 0-100), administered before transplantation (T0), at 3 months (T3), and at 6 months (T6). Analyses used repeated measures ANOVA and Wilcoxon tests. RESULTS: Forty patients were included (65% male; 50% ≥60 years). Interstitial lung disease (ILD) (50.0%) and chronic obstructive pulmonary disease (COPD) (37.5%) were the leading indications. Most recipients (92.5%) received bilateral LT. Mean EQ-VAS scores improved from 53.9 ± 15.7 (T0) to 73.1 ± 17.0 (T3) and 73.5 ± 21.1 (T6) (p = .025). Significant improvements were observed in mobility (p = .026), usual activities (p = .003), and anxiety/depression (p = .033). Self-care (p = .166) and pain/discomfort (p = .282) showed nonsignificant trends. CONCLUSIONS: LT leads to early and sustained improvements in HRQoL, particularly in autonomy, mobility, and emotional domains, reinforcing its value beyond survival outcomes.
Rewriting the Rules of Liver Transplantation: New Indications in the Era of Transplant Oncology. Case Report.
Madroñal Escribano PJ, Rejón López R, Pérez Alonso AJ … +3 more , Zambudio Carroll N, El-Adel Del Fresno M, Villegas Herrera MT
Transplant Proc · 2026 Mar · PMID 41672852 · Publisher ↗
BACKGROUND: Liver transplantation (LT) has traditionally been restricted to well-defined indications. However, recent advancements and updated guidelines from societies such as the European Association for the Study of t...
BACKGROUND: Liver transplantation (LT) has traditionally been restricted to well-defined indications. However, recent advancements and updated guidelines from societies such as the European Association for the Study of the Liver (2024) have prompted a reassessment of off-label indications. Mucinous adenocarcinoma of the extrahepatic bile duct is a rare and poorly characterized subtype of cholangiocarcinoma, with limited data on both its prognosis and optimal management. METHODS: We conducted a literature review in UpToDate, PubMed, and Scielo, identifying only four relevant studies meeting our criteria (free full-text, English/French/Spanish, 2010-2025, focused on pathological or prognostic features of mucinous bile duct adenocarcinoma). We aimed to compare our patient's case with existing literature to assess the appropriateness of LT. CASE REPORT: A 68-year-old BRCA mutation carrier with progressive liver failure and suspected cholangiocarcinoma underwent LT after multidisciplinary consensus, despite negative cytology and fine-needle aspiration. Histology confirmed a mucinous adenocarcinoma of the common bile duct (pT2a pTN0). Two years posttransplant, the patient developed a recurrence in the peritoneum and the abdominal wall but remains clinically stable and is undergoing chemotherapy. DISCUSSION: Literature suggests that mucinous components in solid tumors are associated with a worse prognosis. In intrahepatic mucinous cholangiocarcinoma, surgery and chemotherapy appear to improve survival. Our case supports the potential role of LT in selected patients with early-stage tumors (e.g., pT1-pT2), even in rare or aggressive histologies. Although LT indications remain strict, selected cases of mucinous bile duct tumors with favorable profiles may benefit from transplantation. Multidisciplinary evaluation and individualized treatment strategies are essential in the era of transplant oncology.
Review of Vascular Access in Kidney Transplant Recipients: An Overlooked Topic. Experience of a Nontransplant Hospital.
Ledesma G, Caldés S, Hevia C … +9 more , Carreño G, Mercado V, Díaz R, Echarri R, Gallegos A, Hernández Y, Amezquita Y, Bollain C, Cirugeda A
Transplant Proc · 2026 Mar · PMID 41672851 · Publisher ↗
BACKGROUND: Vascular access management in kidney transplant recipients remains an underexplored topic, particularly in non-transplant hospitals. Arteriovenous fistulas (AVFs), commonly used during hemodialysis, may persi...
BACKGROUND: Vascular access management in kidney transplant recipients remains an underexplored topic, particularly in non-transplant hospitals. Arteriovenous fistulas (AVFs), commonly used during hemodialysis, may persist post-transplant and potentially affect cardiovascular health, especially when high-flow fistulas are present. OBJECTIVE: To evaluate the prevalence, status, and cardiovascular implications of AVFs in kidney transplant recipients under follow-up at a non-transplant center. METHODS: A cross-sectional, descriptive observational study was conducted at Infanta Sofía University Hospital, including 71 kidney transplant recipients. Data were collected on dialysis history and vascular access type. Doppler ultrasound was performed to assess flow and functionality of persistent AVFs. RESULTS: Of the 71 patients, 49% had a history of hemodialysis, with 77% of those having used AVFs. Among these, 78% of AVFs were no longer functional-mainly due to spontaneous thrombosis (57%) or surgical ligation (43%). The average time to ligation was 6 years post-transplant, with aneurysms being the leading indication. Only 6 functional AVFs remained, all native, with an average flow of 1634 mL/min. One patient with a Qa of 3000 mL/min was hospitalized for heart failure. Mild left ventricular hypertrophy was observed in 33% of patients with functional AVFs. CONCLUSION: Persistent AVFs are common in kidney transplant recipients and may pose a cardiovascular risk when high-flow is present. Despite the high rate of spontaneous or surgical closure, standardized follow-up and clear guidelines are lacking. Individualized decisions regarding AVF management should consider cardiovascular health, graft function, and future dialysis needs.
Comparison of 24-Hour Proteinuria Quantification With Protein-to-Creatinine Ratio in Spot Urine and Protein-to-Creatinine Ratio Adjusted to Estimated Creatinine Excretion Rate in Kidney Transplant Recipients.
Ledesma G, Mercado V, Carreño G … +8 more , Díaz R, Gallegos A, Amezquita Y, Echarri R, Hernández Y, Caldés S, Bollain C, Cirugeda A
Transplant Proc · 2026 Mar · PMID 41672850 · Publisher ↗
BACKGROUND: Proteinuria is a key prognostic marker in kidney transplant recipients. The 24-hour proteinuria (P24h) is the reference standard, but often inaccurate due to collection errors. The spot protein-to-creatinine...
BACKGROUND: Proteinuria is a key prognostic marker in kidney transplant recipients. The 24-hour proteinuria (P24h) is the reference standard, but often inaccurate due to collection errors. The spot protein-to-creatinine ratio (PCR) is simpler but assumes a constant creatinine excretion rate (eCER) of 1 g/d, which may bias results. Adjusting PCR by eCER (aPCR) improves accuracy in chronic kidney disease and other populations. METHODS: Retrospective observational study in kidney transplant recipients with paired P24h and spot urine samples. eCER was calculated using the CKD-EPI equation. Correlations with P24h were assessed overall and in subgroups by proteinuria (>1 g/d) and BMI (<30 vs ≥30 kg/m²). Agreement was evaluated with Bland-Altman analysis. RESULTS: Forty-six patients were included (54% male, mean age 46 ± 14 years, BMI 26.7 ± 5.3 kg/m²). Overall correlation with P24h was stronger for aPCR (r = 0.87) than PCR (r = 0.77). In proteinuria >1 g/d, correlation was maintained for aPCR (r = 0.82) but fell for PCR (r = 0.55). In BMI ≥30 kg/m², aPCR correlation was 0.85 versus 0.72 for PCR. Agreement with P24h was better for aPCR in all analyses. CONCLUSIONS: aPCR shows higher correlation and agreement with P24h than PCR in kidney transplant recipients, particularly in obese and high-proteinuric patients. Given the high prevalence of obesity in this population, aPCR may be a more accurate and practical method for routine proteinuria monitoring post-transplant.
A Case Report of Posterior Reversible Encephalopathy Syndrome With Intracranial Hemorrhage After Split-Liver Transplantation.
Wu J, Qin J, Yuan X … +4 more , Zhu Z, Su C, Nashan B, Zhang S
Transplant Proc · 2026 Mar · PMID 41667350 · Publisher ↗
Transplantation is an efficient way for treating end-stage liver disease, but postoperative problems are extremely common, notably neurological issues, which occur more frequently than in other solid organ transplants (1...
Transplantation is an efficient way for treating end-stage liver disease, but postoperative problems are extremely common, notably neurological issues, which occur more frequently than in other solid organ transplants (15%-30%). These neurological problems emerge as disturbances in awareness, seizures, central nervous system infections, central pontine myelinolysis, and posterior reversible encephalopathy syndrome (PRES), among others, severely compromising the survival and prognosis of transplant recipients. PRES is relatively rare among central nervous system complications following liver transplantation. Due to the lack of specific clinical manifestations and the variability of imaging results, it often results in a poor prognosis when severe intracranial hemorrhage occurs. This article reports a case of a patient who developed PRES with cerebral bleeding 3 months after liver transplantation, assessing the peculiarities of the case and consolidating experiences to provide a reference for early clinical diagnosis and treatment.
Liver Transplantation From a Recently Transplanted Multiorgan Patient: a Case Report.
Nicoluzzi A, Gonçalves LDC, Yamaoka LMM … +1 more , Nicoluzzi JE
Transplant Proc · 2026 Mar · PMID 41654432 · Publisher ↗
BACKGROUND: Liver transplantation from previously transplanted donors is an emerging yet rarely reported strategy to address global organ shortages. This case describes the clinical course and outcome of a liver transpla...
BACKGROUND: Liver transplantation from previously transplanted donors is an emerging yet rarely reported strategy to address global organ shortages. This case describes the clinical course and outcome of a liver transplant recipient who received an organ from a multiorgan donor recently submitted to pancreas-kidney transplantation. CASE PRESENTATION: A 40-year-old woman with Budd-Chiari syndrome underwent orthotopic liver transplantation. The donor was a 24-year-old male with type 1 diabetes mellitus and end-stage renal disease who had received a pancreas-kidney transplant 10 days before suffering a fatal hemorrhagic stroke. Due to retrohepatic inferior vena cava agenesis and thrombosis in the recipient, a classical caval replacement technique was employed. The patient initially progressed well but developed a biliary anastomotic stricture at 4 months post-transplant. Despite multiple endoscopic procedures, she developed biliary cast syndrome and underwent Roux-en-Y hepaticojejunostomy. Postoperatively, she developed septic shock and died on the 10th postoperative day. Organ donation in this case was conducted in accordance with the ethical standards of the Helsinki Congress and the Istanbul Declaration. CONCLUSION: This case supports the feasibility of using livers from recently transplanted donors when stringent selection criteria are applied. It also underscores the technical complexity of liver transplantation in patients with Budd-Chiari syndrome and the significant risk of biliary complications. Organ reuse may represent a valuable approach to expand the donor pool, but it must be carefully weighed against procedural risks and ethical standards.
Recurrent Renal Cell Carcinoma in a Kidney Transplant: First Report of Sequential Nephron-Sparing Surgeries: A Case Report.
Rosca TS, Moisoiu T, Tabrea R … +6 more , Muntean AM, Elec A, Iacob G, Pop DA, Antal O, Elec FI
Transplant Proc · 2026 Mar · PMID 41654431 · Publisher ↗
While renal transplantation significantly enhances both life expectancy and quality of life in patients with end-stage renal disease, the necessity for lifelong immunosuppressive therapy, aimed at prolonging graft surviv...
While renal transplantation significantly enhances both life expectancy and quality of life in patients with end-stage renal disease, the necessity for lifelong immunosuppressive therapy, aimed at prolonging graft survival and maintaining optimal function, comes with certain disadvantages, including an increased risk of developing related complications such as infections, cardiovascular disease, or various types of cancer. Given the limited availability of renal grafts, urologists often endeavor to preserve these precious resources whenever possible. This report examines a 62-year-old woman with a kidney transplant who developed recurrent renal carcinoma, first identified 13 years after the transplant and recurring 3 years later, necessitating 2 partial nephrectomies on the graft. This case report underscores the crucial importance of early diagnosis in renal allograft malignancy and highlights the favorable outcomes achievable through partial nephrectomy, even in recurrent tumors. This is the first report of recurrent RCC in a renal allograft successfully treated with 2 consecutive nephron-sparing surgeries (NSS).
Liver Transplant in Primary Sclerosing Cholangitis: Results in Our Center.
Montosa García A, Bernal Bellido C, García Sánchez C … +5 more , Cepeda Franco C, Álamo Martínez JM, Suárez Artacho G, Marín Gómez LM, Gómez Bravo MÁ
Transplant Proc · 2026 Mar · PMID 41654430 · Publisher ↗
Primary sclerosing cholangitis (PSC) is a chronic cholestatic disorder characterized by inflammation and subsequent fibrosis of the intrahepatic and extrahepatic bile ducts. Its clinical course is variable and may progre...
Primary sclerosing cholangitis (PSC) is a chronic cholestatic disorder characterized by inflammation and subsequent fibrosis of the intrahepatic and extrahepatic bile ducts. Its clinical course is variable and may progress to advanced cirrhosis, requiring liver transplantation as the treatment of choice. At our center, we conducted a retrospective observational study of patients who underwent liver transplantation due to PSC between 1998 and 2024. The objectives were to evaluate post-transplant survival, identify the most frequent cause of mortality, determine the incidence of incidental cholangiocarcinoma (CCA) in the explanted organ, and assess the recurrence of the underlying disease. Out of a total of 1,507 liver transplant recipients, 1.53% (n = 23) underwent transplantation due to PSC. Five-year survival was 87%, decreasing to 73% at 10 years. The most frequent cause of mortality was de novo tumors (50%, n = 4). With regard to the incidence of incidental CCA in the explanted organs, no cases were identified. Disease recurrence after transplantation occurred in 17.4% (n = 4). In conclusion, our study highlights that, although no cases of incidental CCA were observed in the explanted livers of our cohort, this does not imply any change in the well-documented risk of developing CCA in PSC patients reported in the literature. The recurrence rate of PSC after transplantation was consistent with published data, and overall survival exceeded 70% at 10 years post-transplant.
Nonmyeloablative Allogeneic Stem Cell Transplantation With Postcyclophosphamide in a Case of Acute Lymphoblastic Leukemia Complicated by Ventricular Septal Defect.
Tsutsumi Y, Ito S, Suzuki T … +4 more , Kikuchi R, Aoyagi H, Gibo H, Teshima T
Transplant Proc · 2026 Mar · PMID 41654429 · Publisher ↗
PURPOSE: We report a case of unrelated non-myeloablative allogeneic stem cell transplantation (allo-SCT) incorporating post-transplant cyclophosphamide (PTCy) in an adult patient with acute lymphoblastic leukemia (ALL) c...
PURPOSE: We report a case of unrelated non-myeloablative allogeneic stem cell transplantation (allo-SCT) incorporating post-transplant cyclophosphamide (PTCy) in an adult patient with acute lymphoblastic leukemia (ALL) complicated by ventricular septal defect (VSD). CASE: A 62-year-old woman presented with pancytopenia and concurrent COVID-19 infection. Bone marrow examination revealed an increased number of CD19+, CD10+, CD34+, HLA-DR+ lymphoblasts, and she was diagnosed with ALL. She had a known membranous-type VSD from childhood, which was confirmed by echocardiography prior to chemotherapy. There were no signs of pulmonary hypertension or heart failure at that time. Given the concurrent infection, initial treatment prioritized managing the infection, followed by corticosteroid therapy with prednisolone and induction chemotherapy. She achieved first complete remission after induction therapy and subsequently underwent consolidation chemotherapy, followed by unrelated non-myeloablative allo-SCT with PTCy conditioning. Post-transplant, she developed stage 2, grade 1 acute graft-versus-host disease (aGVHD) of the skin, but otherwise experienced no major complications. However, the VSD hole diameter gradually increased from 2.6 mm at remission induction to a maximum of 4.7 mm at 6 months post-transplant. At that time, her brain natriuretic peptide (BNP) level rose sharply to 4577 pg/mL, with accompanying elevations in LDH and liver enzymes, indicative of right heart failure and congestive hepatopathy due to VSD enlargement. Treatment with pimobendan, tolvaptan, and spironolactone resulted in BNP reduction to <1000 pg/mL within 6 weeks, and normalization of LDH and liver function prior to the BNP peak. These medications were discontinued 4 months after the onset of right heart failure. By one year post-transplant, the VSD diameter had decreased to 3.5 mm and later stabilized at 3.9 mm. RESULTS: The patient with ALL complicated by VSD underwent induction chemotherapy followed by unrelated allogeneic nonmyeloablative SCT using a PTCy regimen. From the initiation of chemotherapy (including pre-transplant conditioning) up to 6 months post-transplant, the VSD hole progressively enlarged, leading to the development of right-sided heart failure. However, since post-transplant complications were mild, treatment with diuretics and other supportive measures led to improvement of heart failure. The VSD hole size decreased to some extent but did not return to its pre-treatment dimensions. CONCLUSION: In this case of ALL with VSD, the VSD hole diameter continued to enlarge during chemotherapy; however, after pre-transplant conditioning with PTCy, the diameter began to decrease around one year post-transplant, though it did not return to its original size. While careful monitoring is needed for right heart failure due to VSD enlargement, pre-transplant conditioning with PTCy was considered a feasible option for hematologic malignancies complicated by VSD.
Argatroban Anticoagulation for Heparin Induced Thrombocytopenia After Heartmate 3 Implantation: A Case Series.
Palacios-Castelló C, Fernández-Gordon-Sánchez S, Esteve-Ruiz I … +5 more , Grande-Trillo A, Sobrino-Márquez JM, Adsuar-Gómez A, Martín-Villén L, Rangel-Sousa D
Transplant Proc · 2026 Mar · PMID 41654428 · Publisher ↗
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a rare but potentially fatal immune-mediated complication of heparin therapy. Its incidence is higher after left ventricular assist device (LVAD) implantation compare...
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a rare but potentially fatal immune-mediated complication of heparin therapy. Its incidence is higher after left ventricular assist device (LVAD) implantation compared with other cardiac procedures. While bivalirudin is the most frequently reported alternative anticoagulant in this setting, evidence on argatroban use remains limited. We describe three cases of HIT following HeartMate 3 LVAD implantation, all managed with argatroban. RESULTS: Two patients were successfully transitioned to acenocoumarol (international normalized ratio 2-2.5) and discharged without hemocompatibility-related adverse events, without antiplatelet therapy. The third patient, with multiple thrombophilic disorders (homozygous G20210A prothrombin mutation, low protein C, positive lupus anticoagulant, and mild hyperhomocysteinemia), developed ventilator-associated pneumonia and septic shock, experienced mild bleeding at puncture and tracheostomy sites, and died postoperatively; anticoagulation transition was not achieved. In our cohort, HIT incidence was 10% overall (30 LVADs) and 15% among HeartMate 3 implants (20 LVADs), aligning with prior reports. CONCLUSIONS: Argatroban appears to be an effective and safe alternative anticoagulant for HIT after LVAD implantation, enabling platelet recovery without a significant increase in bleeding or thrombotic events. Differentiating complications attributable to HIT or argatroban from those inherent to LVAD support remains challenging, given the device's intrinsic risks of thrombosis, bleeding, and mortality.
Neuroinvasive West Nile Virus Infection in Kidney Transplantation: Three Case Reports.
Temprado Collado A, Suñer Poblet M, Suárez Benjumea A … +2 more , González Roncero FM, Bernal Blanco G
Transplant Proc · 2026 Mar · PMID 41651732 · Publisher ↗
BACKGROUND: West Nile virus (WNV) is an emerging arbovirus in southern Europe, transmitted seasonally by vectors, with increased risk of severe forms in immunocompromised hosts such as kidney transplant recipients. METHO...
BACKGROUND: West Nile virus (WNV) is an emerging arbovirus in southern Europe, transmitted seasonally by vectors, with increased risk of severe forms in immunocompromised hosts such as kidney transplant recipients. METHODS: We report 3 cases of neuroinvasive WNV infection in kidney transplant recipients in Spain between June and September 2024. Demographic, clinical, microbiological, neuroimaging, treatment, outcome, and renal function data were collected. RESULTS: All 3 patients developed neuroinvasive disease: 2 meningoencephalitis and 1 acute flaccid paralysis. Serum IgM was positive in all cases; cerebrospinal fluid (CSF) IgM in 2, and WNV PCR was positive in blood and urine in 1. Management included empirical antibacterial/antiviral therapy, reduction of immunosuppression, and intravenous immunoglobulin (IVIG) in 1 case. Outcomes varied: one patient fully recovered without sequelae, one had transient mild neurological deficits, and one developed irreversible neurological impairment and died after a prolonged hospitalization. Renal graft function remained stable in 2 cases, while one showed progressive deterioration during follow-up. CONCLUSIONS: WNV is an emerging threat for kidney transplant recipients in Spain, associated with high morbidity, mortality, and neurological sequelae. Early diagnosis and tailored reduction of immunosuppression are essential, whereas the benefit of IVIG remains uncertain. Development of specific management protocols is needed in this high-risk population.
Lung Retransplantation after Heart-lung Transplantation: A Case Report.
Laradhi A, Otary BA, Dawary M … +3 more , Aldawsari S, Saleh W, Khouqeer F
Transplant Proc · 2026 Mar · PMID 41651731 · Publisher ↗
Lung retransplantation after prior heart-lung transplantation is uncommon and presents significant surgical and immunologic challenges. We report the case of a 24-year-old male with a history of congenital heart disease...
Lung retransplantation after prior heart-lung transplantation is uncommon and presents significant surgical and immunologic challenges. We report the case of a 24-year-old male with a history of congenital heart disease and Eisenmenger syndrome who underwent heart-lung transplantation in January 2018. While his cardiac function remained stable postoperatively, his pulmonary function declined 2 years later due to chronic lung allograft dysfunction (CLAD), confirmed by a 17% drop in forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio, recurrent infections, and positive class II donor-specific antibodies (DSAs). Between June and September 2020, he was admitted 4 times with suspected antibody-mediated rejection and managed with oxygen therapy, bilevel positive airway pressure, and supportive care. In January 2023, he underwent bilateral lung retransplantation with no major intraoperative complications. Postoperative recovery included management of a right-sided pulmonary embolism with heparin infusion. Over the next year, he developed recurrent class II DSAs (anti-DQ8 and anti-DR5), which were treated with i.v. immunoglobulin, rituximab, plasmapheresis, and antithymocyte globulin. His most recent evaluation showed stable graft function: FEV1, 1.83 L; FVC, 2.10 L; FEV1/FVC ratio, 87%; oxygen saturation, 98%. Bronchoalveolar lavage and biopsy revealed no signs of acute rejection. This case highlights the feasibility and potential success of lung retransplantation following heart-lung transplantation in selected patients. With close monitoring, individualized immunosuppressive therapy, and multidisciplinary care, favorable long-term outcomes are achievable-even in complex post-transplantation scenarios.
Unexplained Elevated Cell-Free DNA in a Kidney Transplant Patient With Stable Clinical Parameters: A Case Report and Literature Review.
Matarneh A, Sardar S, Salameh O … +8 more , Hollis J, Ryan S, Peters T, Abendroth C, Karasinski A, Trivedi N, Ghahramani N, Shah V
Transplant Proc · 2026 Mar · PMID 41651730 · Publisher ↗
Cell-free DNA (cfDNA) is an emerging noninvasive biomarker for detecting graft injury and rejection in kidney transplantation. Although elevated cfDNA levels often indicate underlying pathology, their interpretation can...
Cell-free DNA (cfDNA) is an emerging noninvasive biomarker for detecting graft injury and rejection in kidney transplantation. Although elevated cfDNA levels often indicate underlying pathology, their interpretation can be challenging in patients with stable graft function and no clinical signs of rejection. We present a case of a kidney transplant recipient with persistently elevated cfDNA levels despite stable renal function, negative donor-specific antibodies (DSA), and unremarkable clinical findings. A biopsy revealed chronic arteriolar hyalinosis but no evidence of rejection. This case underscores the complexities of cfDNA interpretation in transplant monitoring and highlights the need for further research to refine its clinical application.
Retrospective Study on Simultaneous Liver-Kidney Transplantation: Renal Outcome and Prevalence of Acute Rejection.
Pint D, Suddle A, Shah S
Transplant Proc · 2026 Mar · PMID 41651729 · Publisher ↗
BACKGROUND: There has been a long-standing hypothesis that simultaneous liver-kidney (SLK) transplantation has an immune protective effect on the transplanted kidney from the hepatic allograft. This hypothesis was challe...
BACKGROUND: There has been a long-standing hypothesis that simultaneous liver-kidney (SLK) transplantation has an immune protective effect on the transplanted kidney from the hepatic allograft. This hypothesis was challenged when recent data showed increased rejection rates for both liver and kidney grafts in patients with preexisting donor-specific antibodies (DSAs), particularly against class II HLA with mean fluorescence intensity (MFI) of >10,000. METHODS: We retrospectively collected clinical, biochemical, and outcome data on patients receiving SLK from 2014 to 2019 in King's College Hospital, London. RESULTS: After a follow-up of 5 years, 18 patients (50%) achieved an eGFR greater than 45 mL/min/1.73 m². In total, there were 11 episodes of acute rejection (AR) in 9 patients. Antibody-mediated rejection was seen in 5 patients (13.8%), T-cell-mediated rejection was seen in 6 patients (16.7%), and 2 patients had both T-cell-mediated rejection and Antibody-mediated rejection. Renal allograft outcomes were analyzed based on the presence or absence of AR within the first year. At 1 month posttransplant, the mean eGFR was significantly higher in the non-AR group (52 mL/min/1.73 m²) compared with the AR group (33 mL/min/1.73 m²; P = .022). However, the mean eGFR at the 5-year benchmark in the non-AR group was 50 mL/min/1.73 m² compared with 40 mL/min/1.73 m² in the AR group and was not statistically significant anymore (P = .081). CONCLUSION: Our findings show that SLK is a viable and effective treatment option for patients with concurrent liver and kidney diseases.
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