Transplant. Proc. [JOURNAL]
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200 papers
Acute Rejection Mediated by Preformed Anti-HLA-C Antibody in a Kidney Transplant Patient: A Case Report.
Dias JH, Cabral DBC, Pinto AHC … +5 more , Ximenes CV, Sena TCM, Junior JOB, Coelho MCRFB, Cavalcanti FCB
Transplant Proc · 2026 Jul · PMID 42392956 · Publisher ↗
Recently, the clinical relevance of donor-specific anti-HLA-C antibodies has been recognized in kidney transplantation (KT). In this case report, we describe the diagnosis and treatment response of acute antibody-mediate...
Recently, the clinical relevance of donor-specific anti-HLA-C antibodies has been recognized in kidney transplantation (KT). In this case report, we describe the diagnosis and treatment response of acute antibody-mediated rejection in a patient with preformed anti-HLA-C. A 66-year-old male who had returned to hemodialysis 8 years prior, after losing his first living donor graft underwent a second KT with a standard deceased donor. He had an antibody reactivity panel of 99.8%, a negative crossmatch, and an identified anti-HLA-C antibody (11,032 mean fluorescence intensity). He presented with delayed graft function, and the biopsy showed acute antibody-mediated rejection positive for C4d. The episode was treated with 3 doses of methylprednisolone 500 mg/d, five plasmapheresis sessions, and 1 g/kg/d of human immunoglobulin for 2 days, with clinical, laboratory, and histological response, maintaining a GFR (CKD Epidemiology Collaboration 2021) of 93 mL/min/1.73 m² for 3 years after the KT. Considering the less frequent detection of anti-HLA-C antibodies and their potential to trigger rejection, which impacts kidney graft survival, this report and the published work on the topic reinforce the importance of evaluating their pathogenic role. With the recent recognition and understanding of the subject, early identification, and inclusion of HLA-C in routine typing will improve analysis of transplant conditions and rejection risk.
Liver Transplantation for Metastatic Neuroendocrine Tumors: A Single-Center Experience in a Brazilian Referral Center.
Pilz M, Almeida P, Fernandes G … +7 more , Souza A, Matielo C, Curvelo L, Felga G, Viveiros M, Calil I, Rezende M
Transplant Proc · 2026 Jul · PMID 42392955 · Publisher ↗
BACKGROUND: Liver transplantation (LT) has emerged as a potential therapeutic option for selected patients with unresectable liver-confined metastatic neuroendocrine tumors (NETs), although evidence remains limited, part...
BACKGROUND: Liver transplantation (LT) has emerged as a potential therapeutic option for selected patients with unresectable liver-confined metastatic neuroendocrine tumors (NETs), although evidence remains limited, particularly in low- and middle-income countries. OBJECTIVE: To describe the experience of a Brazilian referral center with orthotopic LT for metastatic NETs and to evaluate post-transplant outcomes. METHODS: A retrospective descriptive cohort study was conducted, including patients who underwent deceased-donor LT between 2002 and 2025 at a tertiary referral center in Brazil. Among 2312 liver transplants, six patients transplanted for unresectable hepatic metastases from well-differentiated NETs were identified. Demographic, clinical, oncological, and transplant-related variables were analyzed, with outcomes assessed over a 5-year follow-up period. RESULTS: The cohort consisted predominantly of middle-aged men, with a median age of 47.5 years. All patients had preserved liver function at transplantation, reflected by low MELD-Na scores. The median Ki-67 index was 10% (range: 1%-20%). Overall survival was 100%, and tumor recurrence occurred in two patients (33.3%). Acute rejection was infrequent and successfully managed, with no cases of chronic rejection. Post-transplant complications were limited, mainly involving biliary events. Immunosuppressive regimens were predominantly tacrolimus-based, with selective use of mycophenolate and everolimus. CONCLUSIONS: LT for metastatic NETs was associated with excellent survival and low morbidity in this highly selected cohort. Despite the small sample size, these findings support LT as a feasible therapeutic option in carefully selected patients treated at specialized referral centers.
Analysis of the Cost of Maintaining Effective Donors and Nondonors of Organs and Tissues in Intensive Care Units.
Silva AM, Ferreira Júnior MA, Cardoso AIQ … +6 more , Cury ERJ, Frota OP, Azevedo IC, Santos VEP, Meza LL, Martins MDDS
Transplant Proc · 2026 Jun · PMID 42362457 · Publisher ↗
BACKGROUND: The costs of potential donors are not fully known in Brazil, as in other countries, especially during the period that patients remain in intensive care units. OBJECTIVES: This study aims to evaluate the cost...
BACKGROUND: The costs of potential donors are not fully known in Brazil, as in other countries, especially during the period that patients remain in intensive care units. OBJECTIVES: This study aims to evaluate the cost of maintaining effective donors and nondonors of organs and tissues for transplants in intensive care units using the microcosting technique. METHODS: An economic cost analysis using 3 retrospective cohorts constructed from secondary data collected over a 1-year period from medical records of deceased patients who had a protocol opened for brain death investigation. Cost measurement followed the 8 steps of the Time-Driven Activity-Based Costing method. RESULTS: The average cost of the effective donor was US$3220.04. The cost of the nondonor due to family refusal was US$1346.48. The cost of the nondonor due to medical refusal was US$1144.90. Organs and tissues donated but not collected totaled US$16,656.92. CONCLUSIONS: A review of work processes and adopting strategies to mitigate the failure to complete donations in all outcomes are necessary, since the sum of the amounts spent on medical refusal, family refusal, and problems preventing collection amounted to a total of US$104,121.66 in 1 year.
Adolescence and Pediatric Heart Transplantation: Impact of Non-Adherence on Mortality: A Single-Center Experience.
de Souza CS, de Aquino ALT, Cardoso NLL … +7 more , de Araújo KJS, de Souza CGD, da Silveira MM, Pontes IB, Maia ICL, Cavalcante CTMB, Branco KMPC
Transplant Proc · 2026 Jun · PMID 42362456 · Publisher ↗
Heart transplantation represents the standard of care for pediatric patients with advanced heart failure. While outcomes have significantly improved in recent decades, adolescence remains a high-risk period marked by inc...
Heart transplantation represents the standard of care for pediatric patients with advanced heart failure. While outcomes have significantly improved in recent decades, adolescence remains a high-risk period marked by increased rejection rates and mortality, largely due to treatment non-adherence. This study aimed to analyze morbidity and mortality in adolescents undergoing heart transplantation at a single Brazilian center, focusing on the role of non-adherence. We conducted a retrospective review of medical records of 41 patients who underwent heart transplantation at our institution between 2002 and 2022. Patients transplanted during adolescence or who became adolescents after transplantation were included. We assessed episodes of rejection, major complications, and mortality, correlating outcomes with treatment adherence. Adolescents represented 54.5% of transplant recipients. This group exhibited higher rejection rates, with an average of 2.3 episodes per patient. Late mortality (>1 year after transplant) was predominantly rejection-related, with 61.5% of deaths directly linked to non-adherence to immunosuppressive therapy. Our findings reinforce that adolescents constitute a vulnerable group within pediatric heart transplantation, mainly due to the high rate of non-adherence to immunosuppressive treatment. Multidisciplinary strategies, such as psychological support, continuing education, and transition programs to adulthood, are essential to mitigate this risk and improve outcomes in this population.
Impact of Family-Based Care on the Outcome of Brain Death and Humanization in the Process of Multiple Organ Donation: Case Report.
de Lima JL, Ceruti TTB, de Oliveira CMS … +5 more , Brito DP, Temporin AG, Feitosa MG, Moock M, Alheira RG
Transplant Proc · 2026 Jun · PMID 42350258 · Publisher ↗
In the care of this 29-year-old male patient, a victim of traumatic brain injury with brain death outcome, the multidisciplinary team played a fundamental role in an integrated, ethical, transparent and humanized way. Pa...
In the care of this 29-year-old male patient, a victim of traumatic brain injury with brain death outcome, the multidisciplinary team played a fundamental role in an integrated, ethical, transparent and humanized way. Particularly important was the work of the nursing team, which provided humane and empathetic care and established a bond of trust with family members; the medical team, which managed the case with respect and clarity, guaranteeing the family's right to witness the diagnostic process and understand it at all stages; and psychology, which provided shelter and support for grieving. The family meetings, conducted by the horizontal attendant with the support of psychologists and nurses, provided a safe space for clarifying doubts and expressing emotions. This environment of listening and empathy strengthened the bond between the team and the family, acting as a protective factor in coping with grief. Empathetic and respectful communication about the outcome directly influenced the positive decision for organ donation. On day 7 after the patient's death, the team made telephone contact with the family members, offering continuity of emotional support and grief assistance-a gesture of commitment and care from the multidisciplinary team.
Karnofsky Performance Status Is Associated with Patient and Graft Survival After Liver Retransplantation.
Thuluvath AJ, Zhang H, Yerneni S … +1 more , Verna EC
Transplant Proc · 2026 Jun · PMID 42342501 · Publisher ↗
BACKGROUND: The impact of Karnofsky Performance Status (KPS), a clinical measure of functional status, on liver retransplantation (re-LT) outcomes, is unknown. METHODS: We performed a retrospective analysis of the United...
BACKGROUND: The impact of Karnofsky Performance Status (KPS), a clinical measure of functional status, on liver retransplantation (re-LT) outcomes, is unknown. METHODS: We performed a retrospective analysis of the United Network for Organ Sharing database of adults who underwent re-LT from January 1, 2006, to December 3, 2021, to assess the association between KPS and re-LT outcomes. RESULTS: A total of 3144 re-LT recipients were included (68% male; mean age, 52.5 ± 11.1 years). The mean Model for End-Stage Liver Disease score at re-LT was 27.5 ± 10.6, and the median time between LT and re-LT was 0.30 years. Low KPS (10%-40%) re-LT recipients had a significantly higher risk of mortality (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.3-2.2; P < .001) and graft failure (HR, 1.5; 95% CI, 1.1-1.9; P = .003) compared to high KPS (80%-100%) re-LT recipients without controlling for other factors. On multivariable analysis, KPS status remained significantly associated with mortality and graft survival. Compared to the high KPS group, the low KPS group had a 1.6-fold higher risk of death (HR, 1.6; 95% CI, 1.2-2.1; P < .01) and a 1.3-fold higher risk of graft failure (HR, 1.3; 95% CI, 1.1-1.8; P = .03). The association between KPS score and re-LT outcomes remained significant regardless of the time between LT and re-LT. CONCLUSION: Our findings demonstrate that functional status is a significant predictor of re-LT outcomes and should be carefully assessed when determining re-LT candidacy.
Evaluating CMV Risk Stratification, Donor Characteristics, and Post-Transplant Outcomes in Kidney Transplant Recipients: A Retrospective Eurotransplant Center Analysis.
Haak F, Süß C, Scheuermann U … +11 more , Unruh J, Spagnolo A, Nickel S, Stilkerich A, Seiffer S, Meyer HJ, Ziganshyna S, Kowald J, Seehofer D, Rademacher S, Tautenhahn HM
Transplant Proc · 2026 Jun · PMID 42336676 · Publisher ↗
INTRODUCTION: Cytomegalovirus (CMV) infection remains a major complication after kidney transplantation. Prophylactic and preemptive antiviral strategies are central to infection prevention, particularly in high-risk don...
INTRODUCTION: Cytomegalovirus (CMV) infection remains a major complication after kidney transplantation. Prophylactic and preemptive antiviral strategies are central to infection prevention, particularly in high-risk donor-positive/recipient-negative (D+/R-) constellations. While the IMPACT trial suggested that extending valganciclovir prophylaxis to 200 days reduces CMV disease, real-world data remain inconsistent, and the impact of donor characteristics on CMV-related outcomes is incompletely understood. This study evaluated CMV prophylaxis practices, donor characteristics, and post-transplant outcomes in a large single-center kidney transplant cohort. METHODS: We retrospectively analyzed 635 kidney transplant recipients treated at the University Hospital of Leipzig between 1993 and 2014. Collected data included CMV serostatus, prophylaxis regimen and duration, donor characteristics, viral load, infection timing, and dialysis-free survival. Only patients transplanted between 2001 and 2014 were included in analyses of prophylaxis duration to ensure uniform valganciclovir use. CMV infection was defined as a positive IgM or PCR result post-transplantation. Multivariable regression analyses were used to assess factors associated with CMV replication and dialysis-free survival. RESULTS: CMV prophylaxis was administered to 37.1% of patients (77% D+/R-, 32.1% D+/R+, 19.6% D-/R+, and 18.3% D-/R-). CMV infection occurred in 20% of the cohort, with the highest incidence observed in D+/R- recipients (28%). In this high-risk group, extended prophylaxis (>200 days) was associated with delayed but not prevented CMV infection, resulting in reduced CMV-free survival (p < .0001), delayed infection onset (p = .023), and higher viral loads (p = .003). Infections occurred predominantly within 1-3 months post-transplant in D+/R- and D+/R+ recipients, whereas D-/R+ patients more frequently exhibited late-onset infection (>12 months). In multivariable analyses, receipt of an expanded criteria donor kidney was independently associated with both reduced dialysis-free survival and increased risk of post-transplant hCMV replication, independent of CMV serostatus and recipient sex. CONCLUSION: Extended valganciclovir prophylaxis in high-risk D+/R- kidney transplant recipients was associated with delayed but not prevented CMV infection, resulting in reduced CMV-free survival and higher viral loads. In addition, donor characteristics-particularly expanded criteria donor (ECD) status-were independently associated with increased risk of post-transplant CMV replication and reduced dialysis-free survival. These findings suggest that CMV outcomes after kidney transplantation are associated with not only prophylaxis duration but also donor quality, underscoring the need for individualized prophylaxis strategies tailored to both virological risk and graft characteristics.
Twenty-One Years of Insights From A Single-Center Living Kidney Donation Program.
Andrade Lopes J, Fernandes V, Santos A … +10 more , Nunes A, Pinho A, Rocha A, Ferreira I, Tavares I, Santos J, Bustorff M, Pestana M, Cerqueira A, Sampaio S
Transplant Proc · 2026 Jun · PMID 42323231 · Publisher ↗
Kidney transplantation provides superior survival, quality of life, and cost-effectiveness compared with dialysis. Living donor kidney transplantation further improves outcomes by reducing waiting times and increasing ac...
Kidney transplantation provides superior survival, quality of life, and cost-effectiveness compared with dialysis. Living donor kidney transplantation further improves outcomes by reducing waiting times and increasing access. We report a 21-year single-center retrospective analysis of the LDKT program at ULS São João, including 120 transplants performed between 2004 and 2024. Donor and recipient demographic, clinical, and immunological characteristics and post-transplant outcomes were reviewed. Primary endpoints were patient and graft survival at 1, 3, 5, 10, 15, and 20 years; secondary outcomes included renal function, rejection episodes, and major complications. Recipients had a mean age of 43.2 ± 9.9 years, 70% male, and 18.3% underwent preemptive transplantation. Donors had a mean age of 47.1 ± 9.1 years and 76.7% were female. Seven primary graft failures occurred. The 1-year acute rejection rate was 11.5%. Median recipient eGFR at last follow-up was 60.1 mL/min/1.73 m². Graft survival was 99.1% at 1, 3, and 5 years, 92.3% at 10 years, and 83.9% at 15 and 20 years; patient survival was 100% at 1 and 3 years and 98.6% thereafter. Donors maintained stable long-term renal function. This experience confirms LDKT as a safe, effective, and durable therapy for end-stage kidney disease and supports expanding living donation in Portugal.
Increasing Access to Kidney Transplantation in an Underserved Population Through a Public-Private Partnership Utilizing Hepatitis C Virus-Infected Donors.
Refaey A, Attia A, Mokhtar F … +4 more , Saadi O, Abdullah I, Serrano-Rodriguez P, Melancon JK
Transplant Proc · 2026 Jun · PMID 42323230 · Publisher ↗
BACKGROUND: Kidney transplantation from Hepatitis C virus (HCV) positive donors to HCV-negative recipients has emerged as a viable strategy to expand the donor pool, made possible by advances in antiviral therapy and pos...
BACKGROUND: Kidney transplantation from Hepatitis C virus (HCV) positive donors to HCV-negative recipients has emerged as a viable strategy to expand the donor pool, made possible by advances in antiviral therapy and post-transplant management. Notably, access to the necessary drug regimen in this study was guaranteed through a public-private partnership with the Washington D.C. municipal government. METHODS: In this retrospective cohort study, we analyzed 58 kidney transplant recipients, including 29 HCV-negative patients who received organs from HCV-positive donors and 29 matched controls who received kidneys from HCV-negative donors. Variables collected included metrics detailing time to transplant, donor graft function, and transplant outcomes. Given the small sample size, non-parametric statistical methods were used. RESULTS: Recipients from HCV-positive donors demonstrated a trend toward shorter waiting times compared to controls (median, 1402 vs. 2276 days; p = .053), with no difference in listing times (p = .785). Donor kidney quality was similar between groups in terms of allograft eGFR (94 vs. 113 mL/min/1.73m², p = .715), cold ischemia time (18.9 vs. 15.7 hours, p = .142), and donor age (32 vs. 34 years, p = .432). Acute rejection rates were similar (34.5% vs. 31.0%; p = .78) as were IFTA scores (0.1 vs. 0.05; p = .37). Allograft loss occurred in 0% of recipients from HCV-positive donors compared to 3.4% in the control group. At one year, patient survival was 100% in both groups. CONCLUSIONS: A novel public-private collaboration allowed us to increase kidney transplantation access in an underserved community through transplantation of kidneys from HCV-positive donors into HCV-negative recipients with trending decreases in wait times, and without differences in graft function and clinical outcomes. Prophylactic direct-acting antiviral therapy (DAAT) allows our patients to never experience hepatitis C viremia. These findings support adoption of innovative healthcare partnerships to broaden access to life-saving therapies, especially as poor patients and marginalized communities continue to have significant obstacles to organ transplantation.
PCSK9 Inhibitors in Heart Transplant Recipients.
Valero MJ, Ortiz-Bautista C, Gonzalez-Martín J … +11 more , López-Vilella R, Simón-Ramon C, Barragán-Amado AF, Carrasco F, Groba-Marco MDV, García-Romero E, Castrodeza J, Blázquez Z, Sousa I, Bermejo J, Martínez-Sellés M
Transplant Proc · 2026 Jun · PMID 42321111 · Publisher ↗
BACKGROUND: Dyslipidemia is highly prevalent after heart transplantation (HT). We evaluated the efficacy and safety of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in a national cohort of HT recipient...
BACKGROUND: Dyslipidemia is highly prevalent after heart transplantation (HT). We evaluated the efficacy and safety of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in a national cohort of HT recipients. METHODS: In this retrospective multicenter study, we included HT recipients from 8 centers in Spain. The primary analysis assessed changes in total and LDL cholesterol at 1 month. Secondary outcomes included the development of donor-specific HLA antibodies (DSA), coronary allograft vasculopathy (CAV), and rejection. RESULTS: Thirty-six HT recipients received PCSK9 inhibitors between May 2018 and September 2024. Median total cholesterol decreased from 195 mg/dL (170.5 to 233.5) to 124 mg/dL (96 to 156) at 1 month (reduction of 83 mg/dL [45 to 96]). Median LDL cholesterol decreased from 119.5 mg/dL (95 to 155) to 50 mg/dL (30 to 75; reduction of 71 mg/dL [43 to 97]). The prevalence of DSA, CAV, and rejection did not differ significantly before and after treatment (DSA: 20% vs 38.1%, P = .25; CAV: 30.56% vs 38.89%, P = .25; rejection: 19.4% vs 8.3%, P = .68). CONCLUSIONS: In HT recipients, PCSK9 inhibitors were associated with a marked reduction in LDL cholesterol, with no apparent safety signal. These findings support their use in patients with suboptimal lipid control, although their impact on clinical outcomes warrants further investigation.
BMI and Early Morphological Fibrosis Biomarkers are Important Predictive Factors for Long-Term Kidney Graft Outcome.
Järv L, Riispere Ž, Kuudeberg A … +2 more , Lember M, Ots-Rosenberg M
Transplant Proc · 2026 Jun · PMID 42321110 · Publisher ↗
BACKGROUND: Kidney transplant (KT) survival depends on various immunological and non-immunological factors. The aim of the study was to evaluate impact of clinical and morphological parameters on long-term kidney graft s...
BACKGROUND: Kidney transplant (KT) survival depends on various immunological and non-immunological factors. The aim of the study was to evaluate impact of clinical and morphological parameters on long-term kidney graft survival in overweight and normal weight patients. MATERIALS AND METHODS: A retrospective study included 124 KT patients (pts) whose serial biopsies could be evaluated (KT biopsies at 0 or 3 months, and 1 year), and data on the following clinical parameters were collected: renal function (eGFR), acute rejections (AR), number of anti-hypertensive drugs, donor age and body mass index (BMI). Pts were divided into 2 groups according to BMI (BMI < 25 lt; 25 vs BMI ≥ 25). KT and the patient's long-term (10 years) survival was calculated. Morphological factors included the presence of tubulointerstitial fibrosis (TIF) and glomerulosclerosis (GS) and the results of immunohistochemical (collagen-3, Col 3, TGF-β) studies. RESULTS: The long-term results of KT were influenced by donor age (HR = 0.9, p < .05), 3-mo BMI (HR = 1.69; p < .05), 1-year HT drugs (HR = 3.92, p < .05) and Col 3 (HR = 12.62, p < .05). Pts 10-year survival was influenced by 1-year BMI (HR = 2.53, p < .05), Col 3 accumulation (HR = 91.26, p < .05). CONCLUSION: Our study revealed predictive factors for long-term outcome were donor age, amount of 1-year antihypertensive medications and Col 3 accumulation, also excess bodyweight had a negative impact on the pts and allograft survival. Col 3, especially Δ Col 3, is a promising long-term predictive morphological parameter.
Kaposi Sarcoma as a Cause of Anemia in Kidney Transplant Recipients: Two Case Reports.
Alan AM, Murt A, Dincer MT … +5 more , Cerme MO, Eskazan T, Ergun S, Alan O, Seyahi N
Transplant Proc · 2026 Jun · PMID 42315394 · Publisher ↗
INTRODUCTION: Kaposi Sarcoma (KS), caused by human herpesvirus 8 (HHV-8), may be observed in transplant recipients in the form of immunosuppression-related KS. While it primarily affects the skin, it can also involve int...
INTRODUCTION: Kaposi Sarcoma (KS), caused by human herpesvirus 8 (HHV-8), may be observed in transplant recipients in the form of immunosuppression-related KS. While it primarily affects the skin, it can also involve internal organs, particularly the gastrointestinal (GI) system. GI involvement is often asymptomatic, but bleeding episodes may occur. Post-transplant anemia (PTA) is a common complication associated with increased mortality and decreased renal function. Early diagnosis and management are crucial. This report discusses 2 cases of KS in kidney transplant recipients presenting with severe anemia. CASE REPORTS: We report 2 cases of immunosuppression-associated KS with severe anemia in kidney transplant recipients. Case 1 involved a 50-year-old male kidney transplant recipient who developed biopsy-confirmed, skin-limited KS without systemic or gastrointestinal involvement, along with severe anemia 2 months post-transplant. The anemia was identified as pure red cell aplasia, likely induced by immunosuppressive therapy. Immunosuppressive regimen was modified by discontinuing mycophenolate mofetil and switching tacrolimus to everolimus, resulting in regression of KS lesions, normalization of hemoglobin levels, and preserved graft function. Case 2, a 47-year-old female with widespread KS involving the skin, gastrointestinal tract, and lymph nodes, was treated with paclitaxel chemotherapy, erythrocyte transfusions, and immunosuppressive adjustment. At 10-month follow-up, her disease stabilized, and hemoglobin levels returned to the normal range. CONCLUSION: The evaluation of anemia in transplant recipients presents a complex clinical challenge. Immunosuppression-associated KS can occur during both early and late post-transplant periods. KS may contribute directly to anemia through gastrointestinal involvement or coexist as a concurrent condition alongside other underlying etiologies.
Evaluation of a Standardized Laboratory-Developed Assay for Quantification of BK Virus in Renal Transplant Recipients.
Dung NM, Van Duc N, Toan PQ … +8 more , Minh CD, Ben NH, Phuong NM, Linh NT, Cuong HX, Nam DH, Marche PN, Su HX
Transplant Proc · 2026 Jun · PMID 42315393 · Publisher ↗
OBJECTIVES: This study aims to evaluate the clinical performance of an in-house laboratory-developed assay (LDA) calibrated against the first World Health Organization (WHO) international standard for quantification of B...
OBJECTIVES: This study aims to evaluate the clinical performance of an in-house laboratory-developed assay (LDA) calibrated against the first World Health Organization (WHO) international standard for quantification of BK virus (BKV) in recipients of renal transplants. METHODS: A total of 83 samples were collected from patients who underwent renal transplantation at Military Hospital 103, Vietnam Military Medical University. BKV loads were measured using an in-house LDA in comparison with the Altona assay on urine and plasma samples. RESULTS: The limit of detection was established against the first WHO international standard and was estimated to be 135 IU/mL. The intra-assay and interassay coefficients of variation ranged from 0.42% to 1.13% and from 1.71% to 2.47%, respectively. The comparative evaluation of the LDA with the Altona assay on 83 clinical samples showed the diagnostic sensitivity and specificity of the LDA to be 98.04% and 90.62%, respectively. The Kappa value of 0.897 (95% CI, 0.781-0.975) showed a good agreement. For 50 quantitative results obtained by the two assays, excellent agreement and strong correlation were observed by linear regression (r = 0.95 for all samples), and Passing-Bablok regression analysis was used for method comparisons; the Bland-Altman plot analysis did not show any mean difference between measured values of the two assays for all samples. CONCLUSION: The LDA had good analytical and clinical performance for quantification of BKV as compared with the Altona assay. This LDA calibrated against the first WHO international standard could be useful for monitoring BKV replication in recipients of renal transplants in resource-challenged settings.
Improving Medication Adherence in Kidney Transplant Recipients Through Educational Intervention and Monitoring: A Randomized Clinical Trial.
Heinrich de Oliveira C, Schweig A, Gonçalves BP … +7 more , Bissani CA, Saldanha MAP, Santini ADR, Riva E, Maestri HDP, Behr RV, Kroth LV
Transplant Proc · 2026 Jun · PMID 42315392 · Publisher ↗
BACKGROUND: Kidney graft survival after transplantation is highly dependent on continuous adherence to immunosuppressive therapy. Poor adherence is a significant cause of graft loss, and educational interventions to opti...
BACKGROUND: Kidney graft survival after transplantation is highly dependent on continuous adherence to immunosuppressive therapy. Poor adherence is a significant cause of graft loss, and educational interventions to optimize care have been proposed. We evaluated the effect of standardized educational interventions on knowledge, adherence, and clinical outcomes in kidney transplant recipients. METHODS: In this randomized clinical trial including 59 patients, the intervention group (n = 31) received 2 health education sessions (video, booklet, and oral explanations), while the control group (n = 28) received only routine discharge guidance. Patients' knowledge was assessed using a questionnaire before and after the intervention, and adherence was measured with the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS). Clinical outcomes were monitored for 12 months. RESULTS: Educational interventions had a highly significant impact on patients' knowledge. At 1 week after discharge, the intervention group scored significantly higher than the control group (7.5 vs 5.1; P < .001). Adherence assessed by BAASIS at 6 months was statistically similar in the 2 groups (45.2% vs 39.3%; P = .697). No statistically significant between-group differences were observed in rejection rates, infections, or survival during the first year. CONCLUSION: Educational interventions proved to be an effective strategy to increase patients' knowledge about post-transplantation treatment. Although short-term effects on clinical outcomes and adherence were not significant, improved knowledge is crucial to promote long-term adherence.
Renal Outcomes in HBsAg-Positive Living Kidney Donors: A Retrospective Cohort Study.
Huang X, Yin S, Lin T
Transplant Proc · 2026 Jun · PMID 42315391 · Publisher ↗
BACKGROUND: The utilization of hepatitis B surface antigen-positive (HBsAg+) living kidney donors is a strategy to expand the donor pool. However, concerns regarding their renal safety after nephrectomy persist due to th...
BACKGROUND: The utilization of hepatitis B surface antigen-positive (HBsAg+) living kidney donors is a strategy to expand the donor pool. However, concerns regarding their renal safety after nephrectomy persist due to the potential impact of chronic HBV infection on the solitary kidney. METHODS: In this retrospective cohort study, we analyzed 415 living kidney donors, including 31 (7.5%) who were HBsAg+. Donors were followed for a mean duration of 46.81 months (HBsAg+ group) and 42.10 months (HBsAg- group). The primary outcome was the change in renal function, assessed by serum creatinine levels and the incidence of an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73m². Multivariable linear regression was used to identify factors associated with post-donation renal function change. RESULTS: Baseline characteristics were comparable. At the last follow-up, there was no significant difference in serum creatinine between HBsAg+ and HBsAg- donors (81.65 µmol/L vs. 81.64 µmol/L, p = .996). The increase in creatinine from baseline was slightly greater in the HBsAg+ group (12.53 µmol/L vs. 11.08 µmol/L), but this difference was not statistically significant (p = .060). The incidence of low eGFR (<45 mL/min/1.73m²) was low in both groups (3.2% vs. 0.5%, p = .543), with no cases of end-stage kidney disease. Multivariable analysis confirmed that HBsAg+ status was not an independent predictor of serum creatinine increase (Estimate 1.42, 95% CI: -0.16 to 3.01; p = .078), whereas hypertension (Estimate 1.89, p = .039) and diabetes (Estimate 3.28, p = .016) were significant predictors. CONCLUSION: Over an intermediate-term follow-up, carefully selected HBsAg+ living kidney donors did not exhibit a significantly higher risk of renal impairment compared to HBsAg- donors. HBsAg positivity itself was not an independent risk factor for renal function decline.
Appropriate Risk Classification and Low-Dose Rituximab May Help Prevent Acute Rejection in ABO-Compatible Living Kidney Transplantation.
Fukuda M, Yokoyama T, Miki K … +4 more , Tanaka K, Kamiyama M, Nakamura Y, Ishii Y
Transplant Proc · 2026 Jun · PMID 42315390 · Publisher ↗
BACKGROUND: Rituximab desensitization improves outcomes in ABO-incompatible (ABOi) kidney transplantation, and a fixed dose of 200 mg has been shown to prevent antibody-mediated rejection with fewer infections. Although...
BACKGROUND: Rituximab desensitization improves outcomes in ABO-incompatible (ABOi) kidney transplantation, and a fixed dose of 200 mg has been shown to prevent antibody-mediated rejection with fewer infections. Although the risk of ABO-compatible (ABOc) transplants is generally low, acute rejection still occurs, suggesting undetected antibodies. Previous studies on ABOc have emphasized conventional dosing or universal administration in non-sensitized recipients, without individualized stratification. We assessed low-dose rituximab in ABOc recipients and propose a preoperative risk-classification framework. METHODS: We retrospectively reviewed 264 living-donor kidney transplants between January 2015 and July 2024. After excluding ABOi transplants and cases involving double-filtration plasmapheresis/intravenous immunoglobulin, 158 ABOc recipients were included. Recipients were stratified into rituximab (n = 28; single 200 mg dose 14 days before transplant) and rituximab-free (n = 130) groups. The primary endpoints were 1-year acute rejection and infections. RESULTS: The rituximab group had a higher immunologic risk, with fewer related donors (32.1% vs 66.2%; p = .002), and more sensitized (67.9% vs 39.2%; p = .011) or donor-specific antibody (DSA)-positive (17.9% vs 1.5%; p = .001) recipients. Despite this, 1-year acute rejection was lower (0% (0/28) vs 10.8% (14/130); p = .133), with a trend toward improved rejection-free survival (log-rank p = .075), and 1-year infection rates were similar (21.4% vs 23.1%; p = 1.0; log-rank p = .83). In the DSA-positive subgroup (rituximab n = 5; control n = 2), all treated patients remained rejection-free, whereas both untreated patients developed rejection. CONCLUSIONS: In ABOc recipients, risk-stratified preoperative low-dose rituximab may help prevent rejection without increasing infections. Our proposed risk-stratification framework may guide patient selection, but these preliminary findings require validation in larger prospective studies.
Association of Frailty With Waitlist and Post-Transplant Outcomes in Patients With Hepatopulmonary Syndrome and Portopulmonary Hypertension.
Sharma A, Usman L, Lai JC … +1 more , Jutras G
Transplant Proc · 2026 Jun · PMID 42315389 · Publisher ↗
BACKGROUND: Patients with hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) receive MELD exception points due to high mortality risk not captured by laboratory MELD scores. These patients are often e...
BACKGROUND: Patients with hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) receive MELD exception points due to high mortality risk not captured by laboratory MELD scores. These patients are often excluded from frailty studies, leaving the prognostic significance of functional status unclear. We aimed to determine whether Karnofsky Performance Status (KPS) predicts waitlist and post-transplant outcomes among HPS/PPHTN candidates and to compare outcomes with similarly low-functioning non-exception candidates. METHODS: We analyzed adult LT candidates in the UNOS/OPTN database (2013-2023) with MELD exception points for HPS/PPHTN and available KPS scores. KPS was categorized as low (10-40), intermediate (50-70), and high (80-100) at listing and nearest to transplant. Outcomes were evaluated using Kaplan-Meier methods, stratified by KPS and compared to non-exception candidates. RESULTS: Among 1538 HPS/PPHTN patients, 31% had low KPS, 56% intermediate, and 13% high KPS. Within this cohort, low KPS was associated with significantly higher waitlist mortality (p < .001), but post-transplant survival did not differ by KPS (p = .05). Compared to non-exception patients, low KPS HPS/PPHTN candidates had lower waitlist mortality (p < .05), but similar post-transplant survival (p = .26). CONCLUSION: Compared to those with KPS≥50, HPS/PPHTN candidates with low (≤40) KPS experience higher waitlist mortality, but lower waitlist mortality than non-exception candidates with similar functional impairment. In HPS/PPHTN patients, low KPS may reflect limitations from cardiopulmonary dysfunction rather than systemic frailty or advanced liver disease. These findings highlight the need for frailty assessments tailored to the unique physiology of this subgroup.
A Nomogram Predicts the Need for Internal Iliac Vein Dissection During Renal Transplantation: A Multicenter Collaborative Study.
Yamada D, Nakamura Y, Ishii Y … +15 more , Teranishi JI, Oba K, Taguchi S, Hamasaki Y, Yamada Y, Kamei J, Nakamura M, Matsuura R, Kinoshita Y, Matsui H, Kakutani S, Niimi A, Takahashi S, Nangaku M, Kume H
Transplant Proc · 2026 Jun · PMID 42315388 · Publisher ↗
BACKGROUND: Internal iliac vein dissection (IIVD) can be used for optimal venous anastomosis during renal transplantation; however, it poses a massive bleeding risk. No method has been established yet to identify the nee...
BACKGROUND: Internal iliac vein dissection (IIVD) can be used for optimal venous anastomosis during renal transplantation; however, it poses a massive bleeding risk. No method has been established yet to identify the need for IIVD during renal transplantation. AIM: To develop a preoperative predictive nomogram that assesses IIVD necessity for safe living-donor renal transplantation. METHODS: Data were retrieved from electronic medical records for 523 consecutive living-donor renal transplant cases at 4 institutions between 2009 and 2024. The key preoperative variables included recipient anatomical factors and donor kidney characteristics. Correlations among variables were examined to avoid multicollinearity. Variables were selected using the step-down method of multiple logistic regression. RESULTS: Eight pediatric transplant patients and 15 patients with renal vein venoplasty were excluded; hence, 500 patients were included in the final analysis. Caudal branch of the internal iliac vein, shallowness of the iliopsoas muscle, laterality of the transplanted pelvis, kidney thickness, and laterality of the transplanted kidney were incorporated into a nomogram. The model demonstrated good accuracy (C-index: 0.79). Internal validation via bootstrap resampling yielded an optimism-corrected C-index of 0.79 and a calibration plot with an intercept of 0.03 and a slope of 0.95, indicating no major overfitting. CONCLUSIONS: Our nomogram can assess IIVD necessity and facilitate surgical planning and intraoperative decision-making to ensure safe living-donor kidney transplantation.
Corrigendum to "Development and Validation of a Risk Prediction Model for Postoperative Pulmonary Infection in Renal Transplant Patients" Transplantation Proceedings, 58(2026), 511-519.
Pan N, Guo Y, Zhang M … +6 more , Meng Q, Li Y, Fang X, Miao M, Wang Q, Lv H
Transplant Proc · 2026 Jun · PMID 42315387 · Publisher ↗
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Liver Transplantation for Polycystic Liver Disease: A Retrospective Analysis From a University Center.
Garcia A, Teramoto FD, de Macedo PRA … +8 more , Aguilar JMH, de Araujo BP, Foratto A, Meneses CJ, Moisés CB, Perales SR, Boin IFSF, de Ataíde EC
Transplant Proc · 2026 Jun · PMID 42309889 · Publisher ↗
Polycystic liver disease (PLD) is an autosomal dominant disorder, frequently associated with polycystic kidney disease. Although often asymptomatic, progressive hepatomegaly may cause debilitating compressive symptoms, r...
Polycystic liver disease (PLD) is an autosomal dominant disorder, frequently associated with polycystic kidney disease. Although often asymptomatic, progressive hepatomegaly may cause debilitating compressive symptoms, recurrent infections, and significant impairment in quality of life. Liver transplantation (LT) remains the only curative option for highly symptomatic patients. The objective was to evaluate the evolution and outcomes of patients undergoing LT for PLD between January 1994 and December 2024 at a tertiary university hospital. This retrospective observational study analyzed preoperative variables, including symptom burden, indication for transplantation, and waiting time, as well as postoperative data such as operative time, ischemia times, complications, length of hospital stay, survival, morbidity, and mortality. Data were obtained from medical record review and analyzed using descriptive statistics. Among 1,188 liver transplants performed during the study period, 9 (0.75%) were indicated for PLD. Most patients were female (88.8%), with a mean age of 47.3 years. The main indication for LT was severe impairment in quality of life due to compressive symptoms. Mean warm ischemia time was 45.6 minutes, and cold ischemia 6.3 hours. Mean waiting time was 7.1 months, and mean hospital stay was 12.4 days. Three patients required retransplantation due to hepatic artery thrombosis. Survival rates were 66.6% at 30 days and 55.5% at 5 years. It was observed that LT is an effective option for symptom relief and quality-of-life improvement in PLD. Given its technical complexity and associated morbidity, careful patient selection remains essential.
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