Journal Of Transplantation[JOURNAL]
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200 papers
Immunological Dynamics and Outcomes of ABO-Incompatible Kidney Transplants: Insights From a 5+-Year Follow-Up at a Transplant-Heavy Tertiary Center in Saudi Arabia.
Mohsin B, Zabani N, Odah N … +7 more , Alhowaiti N, Yamani F, Mutairi AA, Hefni L, Kausar MT, Butt NS, Habhab W
J Transplant · 2026 · PMID 42403973 · Full text
BACKGROUND: ABO-incompatible (ABOi) kidney transplantation is an essential strategy to expand the donor pool for patients with end-stage kidney disease (ESKD). However, it poses significant immunological challenges becau...
BACKGROUND: ABO-incompatible (ABOi) kidney transplantation is an essential strategy to expand the donor pool for patients with end-stage kidney disease (ESKD). However, it poses significant immunological challenges because of the risk of graft rejection. In Saudi Arabia, where ABOi transplants are limited, there is a paucity of long-term locoregional data on the impact of immunological factors on graft outcomes. This study evaluated ABOi transplant outcomes in patients with more than 5 years of follow-up, with a primary focus on immunological factors and their role in graft survival and rejection. METHODS: We analyzed data from 24 adult patients who underwent ABOi kidney transplantation between October 31, 2015, and December 30, 2019, with follow-up until December 31, 2024. Key immunological factors assessed included donor-recipient blood group mismatch, human leukocyte antigen (HLA) mismatches, preformed donor-specific antibodies (DSAs) and non-DSA anti-HLA antibodies, flow cross-match results, and anti-ABO titers before and after transplantation. Posttransplant infections were also evaluated for their potential immunological impact. The desensitization protocol comprised rituximab, plasma exchange, and intravenous immunoglobulin (IVIg), with pretransplant anti-ABO titers required to be ≤ 8. Exclusion criteria included pediatric ABOi kidney transplants and patients experiencing major vascular or surgical complications necessitating re-exploration within 7 days posttransplant. Immunosuppressive therapy included methylprednisolone and ATG induction, with prednisolone, tacrolimus, and mycophenolate mofetil for maintenance. The studied outcomes were graft survival, rejection episodes, graft failure, and all-cause mortality. RESULTS: Over a mean follow-up of 68 ± 12.6 months, graft survival was 91.7% ( = 22). Graft rejection occurred in 16.7% ( = 4) of the patients, with two cases (8.3%) of graft failure attributed to severe antibody-mediated rejection (ABMR). Key immunological risk factors for rejection included the presence of non-DSA anti-HLA antibodies, low-titer positive cross-match, > 8 HLA mismatches, and unrelated donors. A total of 49 infectious episodes occurred in 19 recipients, of which 29 (59%) occurred within the first posttransplant year and were not associated with graft dysfunction or rejection. Posttransplant serum creatinine remained stable during follow-up, with median values of 89.0, 88.0, 85.0, and 88.0 μmol/L at 1, 12, 36, and 60 months, respectively, and 77.0 μmol/L at last follow-up (minimum follow-up, 64 months). No mortality was observed. CONCLUSION: ABOi kidney transplantation demonstrates excellent long-term outcomes; however, immunological factors play a pivotal role in determining the risk of rejection. Careful patient selection is warranted, as even seemingly minor immunological factors can provoke graft rejection in the context of ABO incompatibility. Posttransplant infections were not significantly associated with graft dysfunction or rejection. A small sample size allows us to report these findings; however, to review their significance, a larger cohort of patients, incorporating protocol biopsies, in a prospective multicenter study is needed to validate these findings.
Near-Infrared Spectroscopy (NIRS) Could Predict Graft Quality in Adult Liver Donors.
Ramón-Rodríguez J, López-Guerra D, Armas-Conde N … +5 more , Jaén-Torrejimeno I, Rojas-Holguín A, Santiago-Triviño MÁ, Blanco-Fernández G, Pérez-Civantos D
J Transplant · 2026 · PMID 42326059 · Full text
BACKGROUND: The use of livers from donors with expanded criteria, where monitoring the degree of hepatic steatosis (HS) is crucial, has increased in recent years to address the shortage of available grafts. The aim of th...
BACKGROUND: The use of livers from donors with expanded criteria, where monitoring the degree of hepatic steatosis (HS) is crucial, has increased in recent years to address the shortage of available grafts. The aim of this study is to evaluate the utility of monitoring regional hepatic oxygen saturation (rSO2) using the INVOS somatic oximeter in the assessment of liver donors. METHODS: An observational, longitudinal, and prospective study was conducted of adult patients undergoing liver transplantation at our center between 08/01/2020 and 06/01/2022. We measured rSO2 by placing the sensor on the donor skin and on the liver surface. RESULTS: The rSO2 measurements on the donor skin were obtained in 27 patients (93.1%), while the measurements on the donor liver were taken in 18 patients (62.1%). We found a statistically significant relationship between the rSO2 values measured on the donor liver and the degree of steatosis ( = 0.001). rSO2 values > 57% measured on the donor liver were associated with HS < 30% (S: 92%; E: 75%). Donors with lower preoperative GOT values had statistically significantly higher rSO2 values measured on the skin ( = 0.046). CONCLUSIONS: Hepatic rSO2 measurements obtained with the NIRS device in liver donors were associated with relevant donor graft characteristics, particularly the degree of HS.
Structured Multidisciplinary Care for Clinically Complex Kidney Transplant Recipients: A 12-Month Single-Center Cohort on Multidimensional Outcomes.
Cubillo BR, de la Higuera MÁM, Jimenez AV … +15 more , Díaz RF, Corral DP, Sanjuan PG, de la Manzanara VL, Álvarez DG, Matía P, Núñez MGH, Pino MR, Olcese MA, Lozoya PF, Gonzalez LL, Romero NC, Flores IP, Maneses AA, Fructoso AIS
J Transplant · 2026 · PMID 42326058 · Full text
BACKGROUND: Kidney transplant recipients with high clinical complexity often face persistent symptom burden, emotional distress, and reduced quality of life despite stable graft function. Evidence for structured multidis...
BACKGROUND: Kidney transplant recipients with high clinical complexity often face persistent symptom burden, emotional distress, and reduced quality of life despite stable graft function. Evidence for structured multidisciplinary programs tailored to this population remains scarce. METHODS: We conducted a 12-month, single-center implementation cohort study including 73 kidney transplant recipients classified as complex using NECPAL criteria or presenting significant emotional distress. Participants were enrolled in a coordinated, person-centered multidisciplinary program integrating nephrology, psychology, palliative care, nutrition, rehabilitation, nursing, and social work. Outcomes were assessed at baseline and Months 1, 3, 6, 9, and 12 using validated instruments: ESAS-r (symptom burden), DME (emotional distress), GES (spiritual well-being), and SF-12 (health-related quality of life). Global adaptation was defined as improvement in ≥ 2 of 3 domains (symptom burden, emotional distress, and spirituality). Qualitative data from open-ended responses were thematically analyzed. RESULTS: Over follow-up, participants showed reductions in symptom burden (ESAS-r: 35.27 to 18.60), emotional distress (DME: 12.53 to 6.57), and increases in spiritual well-being (GES: 17.21-20.12), with improvements in SF-12 general health, emotional health, and social functioning. Global adaptation was achieved by 43.9% of patients, most within 3 months. Patients with ≥ 4 NECPAL criteria exhibited the most pronounced multidimensional gains. Emotional coping emerged as the strongest predictor of improvement. Qualitative analysis revealed unreported symptoms, resilience strategies, and existential reframing. CONCLUSIONS: Implementation of a structured multidisciplinary model, combined with early complexity screening, was feasible and associated with longitudinal improvements across physical, emotional, spiritual, and functional domains in complex kidney transplant recipients. These preliminary findings suggest potential benefit-particularly for those with highest baseline vulnerability-and support the need for validation in multicenter, controlled studies.
Evaluation of Liver Transplantation Outcomes Using Grafts From Brain-Dead Donors With Warfarin-Associated Coagulopathy.
Majd BS, Lashkarizadeh MM, Shamsaeefar A … +6 more , Nikeghbalian S, Arani HZ, Nazari SS, Rashti SMSA, Sanaei AK, Nikoupour H
J Transplant · 2026 · PMID 42254089 · Full text
BACKGROUND: Liver transplantation is the definitive therapy for end-stage liver disease. The severe organ shortage necessitates exploring grafts from extended-criteria donors, including those who become brain dead due to...
BACKGROUND: Liver transplantation is the definitive therapy for end-stage liver disease. The severe organ shortage necessitates exploring grafts from extended-criteria donors, including those who become brain dead due to toxicological causes. This study evaluated the outcomes of liver transplantation using grafts from brain-dead donors with confirmed warfarin-associated coagulopathy (WAC). METHODS: This retrospective observational cohort study was conducted at a high-volume transplant center (1994-2024). Ten recipients who received liver grafts from brain-dead donors with WAC were included. Clinical data were reviewed to assess liver function recovery, complications, and survival. RESULTS: The cohort included 10 recipients (8 males, 2 females; mean age: 49.8 ± 13.2 years). Liver function tests and international normalized ratio (INR) levels showed significant improvement by Postoperative day 7. Acute rejection occurred in two recipients (20%), successfully treated with corticosteroids. One patient (10%) developed primary nonfunction, leading to death. Patient survival was 100% at 30 days and 70% at 1 year; corresponding graft survival was 90% and 70%. CONCLUSION: In this small, highly selected cohort, liver grafts from brain-dead donors with WAC may be used with acceptable short-term safety. These preliminary findings demonstrate feasibility and highlight the need for larger, controlled studies to further evaluate outcomes and donor selection criteria.
Safe and Early Primary Closure of Open Abdomen in Pediatric Liver Transplantation Using a Doppler-Guided Tension Relief Strategy and Enhanced Wound Environment.
Gurevich M, Mendelson T, Fischer H … +7 more , Nahum E, Weissbach A, Mozer YG, Waisbourd-Zinman O, Aizner S, Nesher E, Topaz M
J Transplant · 2026 · PMID 42254088 · Full text
Pediatric liver transplantation (LT) with large-for-size (LFS) grafts frequently necessitates open abdomen (OA) management due to donor-recipient graft size mismatch, increasing the risk of delayed closure and frequently...
Pediatric liver transplantation (LT) with large-for-size (LFS) grafts frequently necessitates open abdomen (OA) management due to donor-recipient graft size mismatch, increasing the risk of delayed closure and frequently requires the use of permanent prosthetic materials, together compounding the risk of postoperative infection. This study evaluates the safety and effectiveness of the Topaz-Gurevich Doppler-guided controlled-closure technique (DGCT) in facilitating early primary abdominal closure without graft size reduction or the use of permanent prosthetic implants. A retrospective review was conducted at Schneider Children's Medical Center (2016-2024), including 21 pediatric LT recipients requiring OA management, primarily due to LFS grafts. DGCT integrates a tension relief system (TRS) for gradual abdominal wall approximation, guided by real-time Doppler ultrasound to monitor perfusion and modulate closure tension, and is complemented by regulated, oxygen-enriched irrigation and negative pressure-assisted wound therapy to optimize the local wound environment. All patients achieved primary abdominal closure within a median of 8 days (range, 2-23); only the first three cases required the temporary use of prosthetic materials. The median PICU and hospital stays were 17 and 35 days, respectively. No cases of graft failure, retransplantation, or mortality occurred. One patient developed sepsis related to a bowel leak and fully recovered. DGCT proved safe and effective in managing OA in pediatric LT, avoiding permanent prosthetic implantation, and enabling early closure while maintaining graft perfusion. Its combined approach of mechanical tension control and enhanced local wound conditions reduces the need for graft size reduction, minimizes infection risk, and may broaden the donor pool. Based on high-risk cases involving immunosuppressed children with significant graft-recipient mismatch, these findings support DGCT as a valuable strategy for pediatric transplantation. Moreover, the principles demonstrated here may be extrapolated to the closure of complex OA scenarios across broader pediatric and adult surgical populations.
Living Donor Intestinal Transplant: Indication, Techniques, Surgical Complications, and Outcomes in Recipients and Donors: A Systematic Review.
Nusair A, Yousuf SB, Elsayed AAR … +1 more , Basson MD
J Transplant · 2026 · PMID 42254087 · Full text
BACKGROUND: Living donor intestinal transplantation (LDITx) is an alternative option to cadaveric transplants as a last resort in treating intestinal failure. There are limited data on LDITx outcomes. This systematic rev...
BACKGROUND: Living donor intestinal transplantation (LDITx) is an alternative option to cadaveric transplants as a last resort in treating intestinal failure. There are limited data on LDITx outcomes. This systematic review evaluates LDITx in terms of indications, contraindications, surgical complications, and patient outcomes. METHODS: A comprehensive search was conducted across PubMed, Cochrane Library, Virtual Health Library, and Web of Science databases following the PRISMA guidelines. After filtration, data were systematically extracted from all relevant observational studies, case series, and case reports. Quality assessments were performed using the CARE guideline for case reports and case series, while STROBE was used for observational studies. RESULTS: Fifty-four studies were included, comprising 11 observational studies, 9 case series, and 34 case reports. The main indications of LDITx were the availability of a compatible donor and the urgency of the recipient's clinical condition. The standard surgical technique involves segmental ileal resection and transplantation. Postoperative complications included infections, ischemic events, and vascular complications. Recipients had either manageable complications or no complications. About 21.2% of the population experienced at least one episode of rejection, with an overall mortality rate of 23%. Many cases reported successful TPN weaning and good outcomes for the recipients and donors. CONCLUSION: In patients with chronic IF complicated by severe TPN-related morbidity or underlying pathologies causing SBS, LDITx represents an effective treatment option and an alternative to the more conventional cadaveric intestinal transplantation, bypassing problematic time sensitivity and donor availability.
A Qualitative Study of Cytomegalovirus Awareness and Experience in Kidney Transplant Recipients.
Otunla AA, McLeod A, Gilchrist K … +2 more , Vindrola-Padros C, Motallebzadeh R
J Transplant · 2026 · PMID 42205718 · Full text
OBJECTIVES: To assess the experiences of CMV among kidney transplant recipients in a single transplant centre, focusing on their awareness of CMV, the impact of the disease on their quality of life, and their perceived e...
OBJECTIVES: To assess the experiences of CMV among kidney transplant recipients in a single transplant centre, focusing on their awareness of CMV, the impact of the disease on their quality of life, and their perceived effectiveness of anti-CMV therapy. SUBJECTS/PATIENTS OR MATERIALS AND METHODS: We carried out semistructured interviews with 50 adult recipients who had undergone kidney transplantation within the last two years in our centre. Participants were divided into those who had experienced CMV (CMV group, = 25) and those who had not (non-CMV group, = 25). Data were collected and analysed using inductive qualitative methods, with embedded quantitative descriptive analysis. RESULTS: Awareness of CMV was low, particularly among those who had not experienced the virus. 32% ( = 8) of the non-CMV group were aware of CMV, compared to 88% ( = 22) in the CMV group ( < 0.001). Most CMV-affected participants (78%) reported no symptoms, and the impact on mood and social life was minimal. CMV treatments were rated highly effective, with a preference for pre-emptive management. There was a strong consensus on the need for better patient education about CMV, with suggestions for more direct communication through healthcare professionals. CONCLUSION: This study is the first to provide a comprehensive evaluation of CMV awareness and management from the perspective of kidney transplant recipients in the UK. We highlight a significant gap in CMV awareness among kidney transplant recipients, emphasizing the need for improved educational efforts. Enhanced patient education, particularly through multimedia patient educational tools, could bridge the knowledge gap and ensure better management of CMV in this population. These insights are vital for shaping future patient care strategies and could significantly impact clinical practice, particularly in post-transplant care.
Clinical Utility of Postoperative Day 1 Technetium-99m Mercaptoacetyltriglycine Scintigraphy for Early Assessment of Graft Function in Living Donor Kidney Transplant Recipients.
Nakazawa S, Sekine Y, Tsuji Y … +15 more , Shimizu T, Onose M, Maeno Y, Kanayama A, Sawada T, Ohtsu A, Miyazawa Y, Fujizuka Y, Arai S, Nomura M, Koike H, Matsui H, Hatori M, Tanaka T, Suzuki K
J Transplant · 2026 · PMID 42199613 · Full text
BACKGROUND: At our institution, 99mTc-MAG3 renal scintigraphy is routinely performed preoperatively in living kidney donors and on postoperative Day 1 in recipients. Given the interindividual variability in MAG3 clearanc...
BACKGROUND: At our institution, 99mTc-MAG3 renal scintigraphy is routinely performed preoperatively in living kidney donors and on postoperative Day 1 in recipients. Given the interindividual variability in MAG3 clearance, we hypothesized that postoperative MAG3 clearance could serve as an early indicator of renal graft function. In addition, we explored whether the donor-to-recipient clearance ratio (M-ratio) provides supplemental clinical value. Early identification of such indicators of graft function is essential for optimizing postoperative management and improving outcomes. METHODS: This retrospective study analyzed 52 living donor kidney transplants performed between October 2009 and May 2024. Associations were examined between donor and recipient MAG3 clearance values, the M-ratio (elevated ≥ 1.5 vs decreased/stable < 1.5), donor/recipient age and sex, T1/2 pattern (good excretion ≤ 20 min vs delayed > 20 min or unmeasurable), total ischemic time, graft weight, dialysis duration, and estimated glomerular filtration rate (eGFR) at 1 week and 1-12 months postoperatively. Variables with < 0.05 in univariate analysis entered multivariate regression. RESULTS: Univariate analysis showed that recipient MAG3 clearance, the M-ratio, donor and recipient age, T1/2 (up to 1 month), and graft weight (at 1 week) were significantly associated with graft function. In contrast, donor MAG3 clearance was not correlated with postoperative renal function. In multivariate analysis, recipient MAG3 clearance, recipient age, and graft weight remained independently associated with early graft function, whereas the M-ratio lost significance. CONCLUSIONS: Recipient MAG3 clearance on postoperative Day 1 is a practical, noninvasive indicator of renal graft function, while donor clearance and the M-ratio are not independently associated with postoperative outcomes.
Leveraging Longitudinal Data to Sustain the Impact of Organ Donation Training: A Data Science Approach to Quality Monitoring.
Ghobadi O, Taherkhani N, Khasha R … +3 more , Radi E, Shadnoush M, Najafizadeh K
J Transplant · 2026 · PMID 42179362 · Full text
BACKGROUND: The effectiveness of training organ donation teams in improving organ donation rates has been well established. However, studies have shown that this impact is often temporary and diminishes without ongoing s...
BACKGROUND: The effectiveness of training organ donation teams in improving organ donation rates has been well established. However, studies have shown that this impact is often temporary and diminishes without ongoing support and quality control programs. This study aimed to evaluate the effects of initial training and the role of a structured quality control program in sustaining these improvements in Iran's organ procurement units (OPUs). METHOD: A comprehensive training program, the Iranian OPUs Supporting System (IrOSS), was developed and implemented with the participation of 25 OPUs. Their organ donation (PMP) rates were recorded at baseline and monitored every 3 months for 6 months posttraining. Later, a quality control initiative, the Iranian OPUs Quality Control System (IrOQS), was introduced in 15 of these units. Through periodic assessments, weaknesses were identified and addressed via targeted interventions such as strategy improvements and retraining. The remaining 10 units served as a control group. PMP was reevaluated 3 and 6 months after the initial IrOQS implementation, with a final assessment 3 months after the second round. Longitudinal data were analyzed using advanced statistical techniques, including repeated-measures ANOVA, difference-in-differences (DiD), linear mixed-effects models (LMMs), trajectory analysis, and change point detection. RESULTS: The mean PMP across all 25 OPUs increased from 5.31 before training to 8.05 six months after training. In the intervention group, the mean PMP increased to 13.06 after the first IrOQS phase, decreased to 9.84 over the next 6 months, and increased again to 15.6 after the second IrOQS phase. In contrast, while the control group showed an initial increase after training, their PMP gradually decreased over time. Statistical analyses showed that the initial training had a significant positive effect on performance, but these improvements were not sustained without repeated interventions. Path analyses also showed that units with lower initial performance responded most positively to training but tended to regress if retrained. CONCLUSION: The findings of this study suggest that initial training programs can lead to significant improvements in PMP. However, to maintain these gains, regular implementation of ongoing training programs is essential. Data science approaches and longitudinal data analysis can play a critical role in identifying performance patterns in the quality management of OPUs.
Apheresis-Based Desensitization to Reduce Antibody Titer in ABO-Incompatible Kidney Transplantation: A Systematic Review and Meta-Analysis.
Triyono T, Sukorini U, Anshori F … +1 more , Yogahutama N
J Transplant · 2026 · PMID 42064270 · Full text
INTRODUCTION AND OBJECTIVES: The use of apheresis-based desensitization has enabled a safe ABO-incompatible kidney transplantation (ABOi-KT) by reducing ABO allo-isoagglutinin IgG and/or IgM (anti-A and/or anti-B) titers...
INTRODUCTION AND OBJECTIVES: The use of apheresis-based desensitization has enabled a safe ABO-incompatible kidney transplantation (ABOi-KT) by reducing ABO allo-isoagglutinin IgG and/or IgM (anti-A and/or anti-B) titers. However, the rate of titer reduction and the number of apheresis sessions required for apheresis-based desensitization remain unclear. We conducted this study to summarize the effectiveness of apheresis-based desensitization for ABOi-KT, as reflected in IgG and IgM titer reduction rate (TRR) and the number of apheresis sessions required. MATERIALS AND METHODS: A systematic literature search was performed on PubMed, Cochrane Library, ProQuest, Scopus, ScienceDirect, and MEDLINE according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement up to May 2025. Twenty-five cohort studies and twenty-three case series studies. Risk of bias assessment was performed using the Joanna Briggs Institute (JBI) critical appraisal tools. RESULTS: The IgG and IgM TRR based on thirty-one and fifteen included studies involving 1105 and 642 patients, respectively, showed a statistically significant reduction in both IgG and IgM titers with pooled TRR MD of 3.73 and 3.82 Log units, respectively (95% CI 3.23 to 4.23, 96.05%, < 0.001; 95% CI 3.29 to 4.35, 95.74%, < 0.001). Twenty two included studies involving 934 patients showed an average of 4.97x apheresis sessions required per patient (95% CI 4.32 to 5.61, 96.44%, < 0.001). Subgroup meta-analyses based on apheresis types, publication decade, and study type were also reported with statistically significant results. CONCLUSION: The reported IgG and IgM TRR and apheresis sessions required per patient in apheresis-based desensitization for ABOi-KT showed significant results. Similar outcomes were observed among plasmapheresis (PE), immunoadsorption (IA), and the combination of both, indicating that any of these techniques may be effective. This may reflect the effectiveness of apheresis-based desensitization for ABOi-KT, regardless of the apheresis technique. These findings can be a consideration in developing apheresis-based desensitization guidelines for ABOi-KT.
Frailty and Early Extubation Independently Influence Postoperative Recovery Following Liver Transplantation-A Retrospective Cohort Study.
Antony I, Albusta N, Lin Z … +3 more , Nazemian R, Kane BJ, Lin MV
J Transplant · 2026 · PMID 42058450 · Full text
BACKGROUND: Frailty and perioperative management critically influence outcomes following liver transplantation (LT). The liver frailty index (LFI) objectively assesses frailty, while early extubation (EE) has been linked...
BACKGROUND: Frailty and perioperative management critically influence outcomes following liver transplantation (LT). The liver frailty index (LFI) objectively assesses frailty, while early extubation (EE) has been linked to enhanced recovery in surgical patients. However, the associations of frailty and EE with postoperative outcomes in LT remain unclear. METHODS: This retrospective cohort study included adult LT recipients at a tertiary care center between 1/2019 and 7/2023. Patients were classified as frail (LFI ≥ 4.5) or nonfrail (LFI < 4.5) and stratified by EE versus delayed extubation (DE). Primary outcomes were EE rate, ICU length of stay (LOS), and hospital LOS. Linear regression models adjusted for age, gender, BMI, MELD, transplant type, and liver disease etiology. RESULTS: Of 158 postliver transplant patients, 38 (24.1%) were frail. Frail patients had longer ICU LOS (33.2 vs. 4.2 days, < 0.001) and hospital LOS (59.5 vs. 10.1 days, < 0.001) compared to nonfrail patients. EE occurred in 78.5% of all postliver transplant patients, with no significant difference by frailty ( = 0.821). Multivariable regression showed frailty was associated with increased hospital LOS ( = +48 days, 95% CI: 43-54, < 0.001) and ICU LOS ( = +28 days, 95% CI: 25-32, < 0.001), while EE was associated with decreased hospital LOS ( = -12 days, 95% CI: -17 to -6.7, < 0.001) and ICU LOS ( = -12 days, 95% CI: -15 to -8.4, < 0.001), irrespective of frailty status. CONCLUSIONS: Our study demonstrated that EE significantly shortens ICU and hospital stays in postliver transplant patients with pretransplant frailty. These findings underscore the importance of incorporating EE protocols in this high-risk population and warrant further investigation into strategies that facilitate implementation to optimize clinical outcomes.
Postoperative Outcomes and Risk Profiles in Dual Liver-Lung Transplantation: A Single-Center Retrospective Analysis.
Saleem A, Ilyas O, Obri M … +11 more , Alomari A, Faisal MS, Omeish H, Chaudhary A, Dababneh Y, Shukairy U, Nagai S, Franco-Palacios D, Venkat D, Varma A, Jafri SM
J Transplant · 2026 · PMID 41969431 · Full text
BACKGROUND: Dual liver-lung transplantation (DLLT) is an uncommon but definitive therapy for carefully selected patients with concurrent end-stage hepatic and pulmonary disease. The combined operative complexity and dual...
BACKGROUND: Dual liver-lung transplantation (DLLT) is an uncommon but definitive therapy for carefully selected patients with concurrent end-stage hepatic and pulmonary disease. The combined operative complexity and dual-organ immunosuppressive burden may predispose recipients to early morbidity and graft-threatening complications [1-4]. OBJECTIVE: To characterize early and late postoperative events (including acute cellular rejection (ACR), infectious complications, malignancy, and hospital readmissions) after DLLT and to describe associated clinical patterns. METHODS: We performed a retrospective cohort study of adult DLLT recipients at a single tertiary center (2013-2024). Variables included demographics, transplant indications, ischemia times, readmissions (0-3 months; 3-12 months), infections (timing/etiology/site), biopsy-proven rejection, malignancy, and survival. ACR was biopsy-confirmed in cases of unexplained transaminitis beyond 30 days posttransplant. Analyses were descriptive, consistent with STROBE recommendations for small cohorts. RESULTS: Ten patients (mean age 53.7 years; 50% female) underwent DLLT. Liver etiologies included alcohol-related cirrhosis ( = 2), HCV ( = 1), cryptogenic ( = 1), autoimmune ( = 1), cystic fibrosis ( = 1), and unspecified ( = 4). Lung indications were IPF ( = 5), pulmonary hypertension ( = 2), ILD ( = 2), and CF ( = 1). All patients were readmitted within 90 days, most commonly for infection (40%), diarrhea (20%), critical illness myopathy (20%), rejection (10%), and biliary stricture (10%). Biopsy-proven ACR occurred in 4/10 patients (40%) after the first month, uniformly presenting with hepatocellular transaminemia; 3/4 received pulse-dose IV corticosteroids and 2/3 subsequently developed invasive fungal disease (Aspergillus and ). Overall, 9/10 experienced infection within 6 months, predominantly pulmonary (fungal/bacterial pneumonias). Three patients developed malignancy (basal cell carcinoma, prostate carcinoma, and angiosarcoma [fatal]). Survival was 90% at 1 year, 70% at 3 years, and 60% at 5 years; no 10 year survivors were observed. CONCLUSIONS: DLLT is associated with early readmission and a high infectious burden, particularly invasive fungal disease after steroid-treated ACR. Despite significant early morbidity, short-term survival is favorable. Multicenter studies are needed to refine candidate selection, balance rejection prophylaxis with antifungal strategies, and standardize long-term oncologic and dermatologic surveillance in DLLT.
Sirolimus Versus Mycophenolate Mofetil in Simultaneous Pancreas-Kidney Transplantation: Impact on Urinary Tract Infection Rates.
Píšová B, Chytilová Š, Saudek F … +1 more , Girman P
J Transplant · 2026 · PMID 41929991 · Full text
BACKGROUND: Urinary tract infections (UTIs) are common complications following simultaneous pancreas and kidney transplantation (SPK). The role of specific immunosuppressive agents in modulating UTI incidence and recurre...
BACKGROUND: Urinary tract infections (UTIs) are common complications following simultaneous pancreas and kidney transplantation (SPK). The role of specific immunosuppressive agents in modulating UTI incidence and recurrence remains poorly understood. METHODS: In this retrospective, single-center study, we analyzed 164 SPK recipients randomized to receive either sirolimus or mycophenolate mofetil (MMF) in combination with tacrolimus. The incidence of UTIs, relapses, recurrences, and UTI-related hospitalizations was assessed over a 10-year follow-up. Univariable and multivariable negative binomial regression models were used to evaluate associations with immunosuppressive regimens and clinical outcomes in both intention-to-treat (ITT) and per-protocol analyses. RESULTS: A total of 572 UTI episodes were recorded during follow-up (0.102 per 100 recipient-transplant days). No significant differences in overall UTI incidence or UTI-related hospitalizations were observed between the sirolimus and MMF groups. However, in the multivariable per-protocol analysis, the sirolimus group experienced significantly fewer UTI-related hospitalizations (IRR 0.46; 95% CI, 0.23-0.94; = 0.034) and relapses (IRR 0.54; 95% CI, 0.30-0.97; = 0.039). Significant risk factors for UTIs included female sex, JJ stent placement, and pretransplant urological abnormalities. Recurrent UTIs were associated with lower 10-year kidney graft survival (52% vs. 75%; = 0.01) but had no impact on pancreas graft or patient survival. CONCLUSIONS: While overall UTI incidence did not differ between immunosuppressive regimens, sirolimus use was associated with fewer hospitalizations and relapses. These findings indicate a potential clinical benefit of sirolimus in selected high-risk SPK recipients, highlighting the need for further prospective investigation. ClinicalTrials.gov identifier: NCT00140543.
Influence of Extended Itraconazole Antifungal Prophylaxis on the Development of Fungal Infections After Lung Transplant.
Fischer S, Patel R, Mamawala M … +6 more , Mathai SK, Vandervest K, Endicott-Yazdani T, Naik C, Grazia T, Fuller L
J Transplant · 2026 · PMID 41769149 · Full text
BACKGROUND: Invasive fungal infections (IFIs) are associated with a high mortality in lung transplant recipients, with no consensus on optimal antifungal prophylaxis. We aimed to assess the efficacy of long-term itracona...
BACKGROUND: Invasive fungal infections (IFIs) are associated with a high mortality in lung transplant recipients, with no consensus on optimal antifungal prophylaxis. We aimed to assess the efficacy of long-term itraconazole compared to short-term inhaled amphotericin to prevent IFIs post-transplant. METHODS: A retrospective review of adult lung transplant recipients from January 2016 to September 2022 was conducted. The cohort was divided into two groups based on initial mold prophylaxis: long-term itraconazole and short-term inhaled amphotericin. The primary outcome was the incidence of IFIs. The secondary outcomes included the time to IFI, incidence of fungal species found on cultures, and safety/tolerability. RESULTS: A total of 203 patients met the inclusion criteria (amphotericin group = 108, itraconazole group = 95). The overall incidence of IFIs was significantly higher in the amphotericin group than the itraconazole group (76.9% vs. 56.8%, = 0.002). The Kaplan-Meier curve for the risk of IFI within 1 year of transplant showed a shorter time to IFI in the amphotericin group ( = 0.009). In the amphotericin group, there was an increased incidence of positive fungal cultures compared to the itraconazole group with (25% vs. 8.4%, = 0.002), . (25.9% vs. 9.5%, = 0.002), yeast (70.4% vs. 36.8%, ≤ 0.001), and other positive fungal cultures (28.7% vs. 12.6%, respectively, = 0.005). The amphotericin group had more discontinuations due to intolerance than the itraconazole group (12% vs. 3.2%, = 0.019). CONCLUSION: In adult lung transplant recipients, long-term prophylaxis with itraconazole was more effective at preventing overall IFIs, positive cultures with , and was better tolerated than short-term inhaled amphotericin.
The Evolving Kidney Donor Pool Shaping Outcomes in Graft Survival.
M KD, D PJ, Ramasamy B … +2 more , Nicolae L, Lena S
J Transplant · 2026 · PMID 41743508 · Full text
BACKGROUND: The composition of the U.S. deceased kidney donor pool is undergoing a major shift. While the past decade saw an increase in younger, overdose-death donors associated with favorable transplant outcomes, recen...
BACKGROUND: The composition of the U.S. deceased kidney donor pool is undergoing a major shift. While the past decade saw an increase in younger, overdose-death donors associated with favorable transplant outcomes, recent years have marked a decline in these donors. Concurrently, there has been a rise in higher-risk donor characteristics-namely, older age, more comorbidities, such as hypertension and diabetes, and increased reliance on donation after circulatory death (DCD). These trends may significantly affect transplant outcomes. METHODS: We analyzed data from the Organ Procurement and Transplantation Network (OPTN) on 101,550 deceased kidney donors (2018-Q1 2025) and 108,611 single kidney transplants (2018-mid-2024). Donor trends were assessed using segmented regression analysis. Graft survival was evaluated using Kaplan-Meier survival curves and multivariable Cox proportional hazards models, adjusting for donor, recipient, and transplant characteristics. RESULTS: Overdose-death donors declined from 16.7% in 2022 to 10.5% by Q1 2025. Simultaneously, DCD donors rose to nearly 50% of all deceased donors. The proportion of older donors and high-KDPI kidneys also increased. Kaplan-Meier analysis showed a decrease in unadjusted death-censored graft survival in 2024 compared to 2018-2022 (97.0% vs. 97.6%, < 0.001). In adjusted Cox models, donor factors-DCD status, older age, hypertension, diabetes, and prolonged cold ischemia-were independently associated with graft loss. CONCLUSIONS: The U.S. kidney donor pool is shifting toward higher-risk profiles, with early signs of declining graft survival. Strategies to optimize organ preservation and allocation will be essential to maintain transplant outcomes amid these changing donor trends.
Mapping International Collaboration and Research Trends in Artificial Intelligence Applications for Liver and Kidney Transplantation.
Al-Abdallat H, Haj Mohammad N, Asassfeh A … +5 more , Cooper E, Mohammad Hussein A, AlSarayreh M, Alzoubi M, Rawashdeh B
J Transplant · 2026 · PMID 41613939 · Full text
INTRODUCTION: The integration of artificial intelligence (AI) in liver and kidney transplantation (LKT) research has surged in recent years, promising novel approaches to address traditional statistical challenges and en...
INTRODUCTION: The integration of artificial intelligence (AI) in liver and kidney transplantation (LKT) research has surged in recent years, promising novel approaches to address traditional statistical challenges and enhance result robustness and generalizability. This study aims to explore the extent of international collaboration and the evolution of research trends in AI applications for LKT. METHODS: On August 12, 2025, a systematic search was conducted using the Web of Science database to identify relevant literature. Bibliometric tools, including the "bibliometrix" package in R, VOSviewer, and Microsoft Excel were used. Key indicators such as country contributions, multiple-country publications, single-country publications, co-authorship, and keyword co-occurrence were examined to assess collaboration patterns and research hotspots. Inclusion criteria involved all published peer-reviewed articles related to AI in LKT. Editorials, corrections, and irrelevant documents were excluded. RESULTS: A total of 633 articles published between 1994 and 2025 were included in the analysis. These collectively received 8959 citations. The United States of America emerged as the leading contributor, accounting for 37.12% of the publications, followed by China and South Korea. Notably, international co-authorship was evident in 30.02% of the publications. Keyword analysis revealed that "survival," "outcomes," "risk," "mortality," and "prediction" were the most frequent terms, highlighting them as hotspots in transplantation research. CONCLUSION: The field of AI in LKT research is characterized by a growing international collaboration, despite the fact that participation is still uneven and concentrated in high-income countries. In order to advance the field and enhance outcomes across diverse patient populations, it will be crucial to strengthen global data-sharing and cultivate equity-focused, culturally adaptable AI models.
Impact of Diverse Clinical Characteristics on Survival Benefit of Liver Transplantation.
Alim M, Lawendy B, Chen S … +3 more , Than Hlaing NK, Maleki S, Bhat M
J Transplant · 2026 · PMID 41551978 · Full text
BACKGROUND: Liver transplantation (LT) is offered as a life-saving treatment to those with end-stage liver disease. There has recently been much interest in considering the survival benefit of transplant when prioritizin...
BACKGROUND: Liver transplantation (LT) is offered as a life-saving treatment to those with end-stage liver disease. There has recently been much interest in considering the survival benefit of transplant when prioritizing patients for transplant. In this study, we aimed to measure the survival benefit of LT across various patient demographics by measuring the number of life-years gained after LT. METHOD: In this study, 101,770 patients were included from the Scientific Registry of Transplant Recipients (SRTR) transplanted between 2003 and 2021. The survival benefit of LT was calculated using restricted mean survival time (RMST) in the next 16 years post-transplant. Cox proportional hazard models and Weibull models were employed to quantify the impact of various predictors on survival benefit. RESULTS: LT was found to provide survival gains of 4.93, 6.43, 6.30, and 3.67 years for the 18-29, 30-49, 50-69, and 70+ age groups, respectively. Survival benefit was highest at 6.62 years for patients with model for end-stage liver disease (MELD) scores of 15-19, with survival benefits of 5.7, 5.4, and 5.85 years for the 6-14, 20-29, and 30-40 MELD score cohorts, respectively. Older age (HR: 1.13), male sex (HR: 1.32), diabetes (HR: 1.32), and higher MELD scores were predictors of lesser survival benefit. Protective factors included higher education levels (HR: 0.70) as well as diagnoses of fulminant liver failure and autoimmune biliary disease (HR: 0.65). CONCLUSION: This study underscores how survival benefit varies across patients with different demographic and clinical characteristics, highlighting the nuanced interplay of these characteristics with survival and emphasizing the need for tailored post-transplant management strategies to optimize outcomes.
Predictive Models for Kidney Offer Acceptance: Challenges and Strategies.
Martinez C, Nasir M, Kshirsagar M … +5 more , McCharen C, Shean R, Ferres JL, Dodhia R, Weeks WB
J Transplant · 2026 · PMID 41523154 · Full text
BACKGROUND: Predicting whether an organ offer will be accepted for transplantation remains challenging for several reasons, including large offer volumes, highly imbalanced observations (more declines than acceptances),...
BACKGROUND: Predicting whether an organ offer will be accepted for transplantation remains challenging for several reasons, including large offer volumes, highly imbalanced observations (more declines than acceptances), and lack of information about the human decision-making process. Offer acceptance models are used for risk-adjusted program evaluations and policy development, but there is a lack of literature on baselines and best practices for predictive applications. We compared a suite of machine learning models, feature sets, and sampling procedures to identify performance impacts when training offer acceptance prediction models. METHODS: We evaluated several kidney offer acceptance models from logistic regression to gradient boosted trees that were trained on donor and candidate characteristics. We then selected the best-performing model and augmented training data with additional features (e.g., distance from the closest airport to the transplant hospital) or additional sampling procedures (e.g., undersampling). RESULTS: Compared to the baseline logistic regression model (average precision: 0.0645), the XGBoost model offered the best performance improvement over the baseline (average precision: 0.0907). Including transportation-related features in the model further improved model performance (average precision: 0.0940); however, we did not observe substantial model performance differences based on the sampling procedure used. CONCLUSIONS: Leveraging advanced machine learning models and incorporating nonclinical datapoints (like transportation distances) can improve transplant organ offer acceptance prediction models. However, we observed steep tradeoffs between precision and recall as captured in the low average precision scores despite deceptively high AUROCs (baseline AUROC 0.832). Our findings suggest that even the best-performing models would not provide clear, equitable benefits over existing allocation policies. More research is needed before these models are practical for clinical implementation.
Posttransplant Lymphoproliferative Disorder (PTLD): 24 Years of Experience at a Referral Center in São Paulo, Brazil. Can Differences in Prevalence and Subtype of EBV Infection in the Population Influence the Results? A Retrospective Cohort Study.
Vargas JC, Helman R, Durão MS … +12 more , de Arruda EF, Afonso JE, Carraro RM, Curvelo LA, Felga GEG, Matielo CEL, Almeida PH, Pasqualin D, Stanzione R, Perrone C, Perini G, Hamerschlak N
J Transplant · 2025 · PMID 41497551 · Full text
OBJECTIVES: To retrospectively review all cases of posttransplant lymphoproliferative disorder (PTLD) in a large Brazilian transplant center, describing patients' clinical, virological, and histopathological profiles and...
OBJECTIVES: To retrospectively review all cases of posttransplant lymphoproliferative disorder (PTLD) in a large Brazilian transplant center, describing patients' clinical, virological, and histopathological profiles and treatment strategies and prognostic factors. METHODS: This retrospective cohort study was conducted between January 2000 and June 2024. Adult patients with confirmed PTLD following solid-organ or bone marrow transplant were included. Patients with other systemic cancers or on concurrent chemotherapy/radiotherapy were excluded. Clinical characteristics, PTLD prevalence, histopathology, and survival were assessed. RESULTS: Thirty-eight cases of PTLD were identified in the 5928 transplant patients (0.6%). Incidence was highest in lung recipients (31%). Median time to PTLD onset was 42 months. EBV DNA was detectable in 54.8% of cases. Monomorphic PTLD was the most common (89.5%), primarily in non-Hodgkin lymphomas (91.2%). Immunotherapy (anti-CD20) and immunosuppression reduction were standard initial treatments. R-CHOP and rituximab monotherapy were the main first-line regimens. Age and treatment response significantly influenced overall survival. Mortality was 42%, mainly due to infections and disease progression. CONCLUSIONS: Despite the higher prevalence of EBV in Brazil, PTLD patterns and incidence were consistent with those found in developed countries. The strong association with lung transplants mirrors global data. Local EBV subtype characteristics and host immunogenetic factors warrant further investigation.
Effectiveness and Safety of Reduced Thymoglobulin Dosing in Low-Risk Kidney Transplant Recipients.
Wazwaz E, Joiner N
J Transplant · 2025 · PMID 41497550 · Full text
INTRODUCTION: Thymoglobulin, a lymphocyte-depleting agent, is widely used for induction immunosuppression in kidney transplantation. Despite guideline support, there is no standardized dosing recommendation, resulting in...
INTRODUCTION: Thymoglobulin, a lymphocyte-depleting agent, is widely used for induction immunosuppression in kidney transplantation. Despite guideline support, there is no standardized dosing recommendation, resulting in variability across centers. In April 2022, our institution reduced its institutional practice thymoglobulin dose from 4.5 to 3 mg/kg for low-risk kidney transplant recipients. This study aimed to evaluate the noninferiority of the reduced dose compared to the prior regimen in terms of effectiveness and safety. METHODS: This single-center retrospective noninferiority cohort study of low-risk kidney transplant recipients was conducted from April 2020 to April 2024. Patients received either 3 or 4.5 mg/kg of thymoglobulin. The primary outcome was a composite of biopsy-proven or suspected acute rejection, graft loss, or death within 6 months posttransplant. Secondary outcomes included leukopenia, thrombocytopenia, infections, delayed graft function, eGFR, malignancies, and hospital length of stay. RESULTS: A total of 196 patients were included (116 in 4.5 mg/kg; 80 in 3 mg/kg). The primary outcome occurred in 11% and 3% of patients, respectively (risk difference -8.7%, 95% CI -15.4 to -2.0; = 0.024). The reduced-dose group experienced significantly lower rates of leukopenia, thrombocytopenia, and viral infections. CONCLUSION: A 3 mg/kg thymoglobulin dose is noninferior to 4.5 mg/kg and is associated with improved safety in low-risk kidney transplant recipients.
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