Clinical Transplantation最新文献

{"title":"Identifying Predictors of Failure-to-Rescue after Liver Transplantation: A Multicenter Analysis of 1341 Patients.","authors":"Mehdi Boubaddi, Chetana Lim, Michel Rayar, Lluis Secanella, Lazare Sommier, Claire Goumard, Eric Savier, Celia Turco, Chady Salloum, Florence Jeune, Geraldine Rousseau, Emilio Ramos, Marina Vila-Tura, Fabiano Perdigao, Astrid Herrero, Laurent Sulpice, Laura Llado, Daniel Azoulay, Olivier Scatton","doi":"10.1111/ctr.70551","DOIUrl":"https://doi.org/10.1111/ctr.70551","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether the difficulty of surgery affects failure-to-rescue (FTR) after liver transplantation (LT).</p><p><strong>Summary background data: </strong>Predictors of FTR include both recipient and intraoperative factors, and their identification and improvement may reduce its incidence.</p><p><strong>Methods: </strong>This retrospective study included all first-time isolated LTs performed in six centers. A difficult LT was defined as one in which the number of blood units transfused, cold ischemia time, and duration of surgery were all at or above the median values for the study population. FTR was defined as death within 90 days after a major postoperative complication. The correlations of a difficult LT with outcomes, including FTR, were assessed. Predictors of FTR were identified.</p><p><strong>Results: </strong>The study population included 1341 patients. The respective incidences of difficult LT, 90-day major complications, 90-day mortality, and FTR were 17.4%, 53.6%, 5.8%, and 10.7%. Difficult LT was correlated with worse short-term outcomes, including a high FTR rate. Being in the intensive care unit, receiving renal replacement therapy at the time of LT, and difficult LT were independent predictors of FTR.</p><p><strong>Conclusions: </strong>Mortality following a difficult LT may be correlated to FTR. Identification of modifiable predictors of FTR may help to improve the post-transplant management of these patients.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70551"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycotic Aneurysms in Intestinal Transplantation: A Case Series.","authors":"Nicola Colucci, Ivan De Gruttola, Harry V M Spiers, Georgios Geropoulos, Neil K Russell, Andrew Winterbottom, Sara Upponi, Andrew J Butler, Irum Amin","doi":"10.1111/ctr.70545","DOIUrl":"https://doi.org/10.1111/ctr.70545","url":null,"abstract":"<p><strong>Introduction: </strong>Mycotic aneurysms (MA) are a potentially fatal complication following intestinal transplantation (ITx). Their occurrence arises from several factors, such as chronic abdominal sepsis, potential for contamination of the vascular grafts during enteric anastomoses and the heightened burden of immunosuppression.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained database of all adult ITx from December 2007 to June 2025 was conducted.</p><p><strong>Results: </strong>Among 168 ITx, six patients (3.6%) experienced eight MA episodes. MA occurred bimodally, early post-transplant (2-8 weeks) or in a later phase (55-377 weeks). Recurrence occurred in two patients, averaging 132.4 weeks after initial diagnosis. A history of hollow viscus perforation or anastomotic leak was present in 83.4%. Diagnosis was peri-operative in two cases due to rupture, while others were detected electively via angio-CT. Recurrences were subtler, identified incidentally or with mild symptoms. Apart from targeted antibiotic and antifungal treatment, management strategy pivoted around endovascular stent grafting (ESG) followed by an aneurysmectomy and creation of a new conduit. Post-operative mortality at first presentation occurred in 66.6% of patients, with 50% within a week. Two patients survived recurrence, with one remaining alive 6.5 years post-diagnosis.</p><p><strong>Conclusion: </strong>MA in ITx is rare but commonly fatal, often linked to bowel perforation or anastomotic complications. Diagnosis relies on angio-CT or intraoperative identification at the time of emergency laparotomy. Management involves ESG and conduit resection. Early aggressive control of potential contamination sources after ITx is crucial, though general conclusions are limited by low incidence.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70545"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Racial Disparities in a Hispanic Population Through Living Donor Liver Transplantation-A Comparison of 2 Eras.","authors":"Ronit Patnaik, Jillian Woodworth, Byeong Yeob Choi, Roman Fernandez, J Michael Cullen, Eugenia Tsai, Francisco Cigarroa, Tarunjeet Klair","doi":"10.1111/ctr.70554","DOIUrl":"https://doi.org/10.1111/ctr.70554","url":null,"abstract":"<p><strong>Introduction: </strong>Hispanic patients experience lower rates of liver transplant referral and living donation compared to non-Hispanic white (NHW) patients, often due to socioeconomic barriers. This study evaluated the impact of initiating a living donor liver transplant (LDLT) program on waitlist outcomes and ethnic disparities at a single center.</p><p><strong>Methods: </strong>A retrospective analysis compared Hispanic and NHW waitlist outcomes between two eras: before (Era 1: 2012-2017) and after (Era 2: 2018-2024) LDLT program implementation. Outcomes included LDLT, deceased donor liver transplant (DDLT), death or clinical deterioration (DOD), and clinical improvement. Sub-distribution hazard models and Kaplan-Meier survival analyses were used.</p><p><strong>Results: </strong>1156 liver transplants were performed in Hispanic and NHW patients. Era 2 patients experienced significantly shorter waitlist times (236 vs. 365 days, p<0.001). NHW patients were more likely to have higher education, be English-speaking U.S. citizens, and be employed. Hispanic LDLT recipients more often had biologic donors. LDLT likelihood increased significantly in Era 2 (HR = 5.77, p<0.001), while waitlist DOD rates decreased by 48% (HR = 0.52, p<0.001). NHW patients had a higher chance of LDLT (HR = 1.67, p<0.001) and lower DOD risk (HR = 0.70, p = 0.001) than Hispanic patients, although DOD decreased for both groups. Women had a higher rate of LDLT (HR = 1.58) but also higher DOD (HR = 1.26). In Era 1, Hispanic LDLT recipients had worse post-transplant survival, but outcomes improved to match NHW recipients in Era 2 (p = 0.88).</p><p><strong>Conclusion: </strong>Implementation of a LDLT program improved access and waitlist outcomes for all groups, especially Hispanic, despite significant socioeconomic barriers, and female patients.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70554"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer in Organ Recipients With Metastatic Spread to Transplant Organs: A Systematic Review.","authors":"Claire Ma, Fiona McIntosh, Sungmin Woo, Herbert Alberto Vargas, Anton Becker","doi":"10.1111/ctr.70544","DOIUrl":"https://doi.org/10.1111/ctr.70544","url":null,"abstract":"<p><strong>Purpose: </strong>Metastatic spread of cancer to transplanted organs is rare, with no prior systematic review. As both the number of transplant recipients and their long term survival increase, such cases may become more common. This systematic review seeks to synthesize all existing case studies describing metastases in transplanted organs.</p><p><strong>Methods: </strong>A systematic search of EMBASE and PUBMED was conducted following PRISMA guidelines (PROSPERO: CRD420251119412). Eligible studies described cancer originating from the graft recipient metastasizing to a transplant organ. Studies were summarized across six key domains: patient characteristics, primary tumor types, transplant history, imaging, metastatic cancer treatment, and complications and mortality.</p><p><strong>Results: </strong>Of the 643 studies identified and screened, 12 met the inclusion criteria. The mean patient age was 58 years (±11 years). Affected organs included the liver (n = 7), kidney (n = 4), and lung (n = 1). The most common primary cancer was colorectal cancer. Immunosuppression regimens most often included tacrolimus or cyclosporine. Most studies used CT (n = 6) as the imaging modality to detect metastases. Due to the high prevalence of colorectal cancers, the most common therapy administered was chemotherapy consisting of 5-fluorouracil, oxaliplatin, and folinic acid. Three studies reported complications and seven reported patients passing away.</p><p><strong>Conclusion: </strong>Metastatic spread to transplanted organs is extremely rare and/or under-reported. Further research may help reveal more about the process of metastatic spread, guide screening, and standardize reporting.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70544"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoglycemia Occurrence and Risk Factors in Insulin Independent Patients After Total Pancreatectomy With Islet Autotransplantation.","authors":"Azza Hassaan, Anne Eaton, Niveditha Jagadesh, Guru Trikudanathan, Martin Freeman, Elissa Downs, Srinath Chinnakotla, David Martin, Karthik Ramanathan, Gregory J Beilman, Melena D Bellin","doi":"10.1111/ctr.70549","DOIUrl":"10.1111/ctr.70549","url":null,"abstract":"<p><strong>Background: </strong>Total pancreatectomy with islet auto-transplantation (TPIAT) alleviates pain and preserves islet function in patients with severe pancreatitis. Although approximately one third of recipients achieve insulin independence, spontaneous hypoglycemia has been observed in this population. Its frequency, risk factors, and management remain poorly characterized.</p><p><strong>Methods: </strong>Using prospectively collected data on insulin-independent (TPIAT) recipients at the University of Minnesota (2010-2023), we compared patients who developed hypoglycemia (defined as documented blood glucose < 70 mg/dL) to those with no reported hypoglycemia. Demographic, clinical, surgical, and metabolic variables were evaluated, and treatment strategies were reviewed.</p><p><strong>Results: </strong>Among 503 TPIAT recipients, 156 (31%) achieved insulin independence; of these, 45 (28.8%) experienced hypoglycemia, including 32 (20.5%) with level 2 hypoglycemia (< 54 mg/dL). Severe hypoglycemia events requiring external assistance occurred in 25% of affected individuals. Hypoglycemia developed a mean of 2.4 ± 2.2 years posttransplant, most commonly postprandial or exercise-related. Patients who developed hypoglycemia were older at the time of TPIAT (p = 0.036) and had higher preoperative BMI (p = 0.016) and a greater prevalence of malabsorptive disorders (p < 0.001), whereas islet yield and metabolic testing results were similar between patients with and without hypoglycemia. Most patients with hypoglycemia (78%) were managed with non-pharmacological interventions (dietary, continuous glucose monitoring); pharmacologic therapies included acarbose (22%), diazoxide (13%), and minidose glucagon (7%).</p><p><strong>Conclusions: </strong>Spontaneous hypoglycemia is a frequent, clinically relevant complication among insulin-independent TPIAT recipients. Older age, higher BMI, and malabsorptive disorders were associated with increased susceptibility. Routine surveillance, dietary counseling, and continuous glucose monitoring (CGM) are common components of management.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70549"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aldosterone Synthase Inhibition in Kidney Transplantation: Class Rationale, Translational Promise, and the Limits of Current Evidence.","authors":"Lucas Maciel de Almeida Corrêa, Luiggi Kevin Virgino Brandão, Clara Belo Gamon Santiago, Alexandre de Assis Barbosa, Gabriel Rian Mazur, Gabriel Costa de de Santana, Yan Roberth Delmiro Silva, Letícia Esteves Dante, Ivan Felipe Dutra Júnior","doi":"10.1111/ctr.70555","DOIUrl":"https://doi.org/10.1111/ctr.70555","url":null,"abstract":"<p><p>Post-kidney transplantation hypertension is common and is frequently driven by calcineurin inhibitor (CNI)-mediated sodium retention and vasoconstriction, producing a salt-sensitive phenotype in which sodium-chloride cotransporter (NCC) inhibition remains the mechanistically aligned cornerstone of therapy. This opinion piece examines aldosterone synthase inhibitors (ASIs) as an emerging drug class that may have adjunctive relevance in selected resistant phenotypes after kidney transplantation. We summarize the class rationale, distinguish older less selective compounds from newer CYP11B2-selective agents, and position baxdrostat within the broader ASI landscape alongside lorundrostat, vicadrostat, and earlier-stage dexfadrostat data. In non-transplant populations, baxdrostat and lorundrostat have lowered blood pressure in uncontrolled or resistant hypertension, whereas vicadrostat has shown cardiorenal promise in chronic kidney disease, including combination development with empagliflozin. However, no ASI has been studied in kidney transplant recipients. This gap is especially important because transplant recipients have reduced nephron reserve, frequent CNI exposure, narrow potassium margins, and a hypertensive phenotype often dominated by NCC activation rather than uniform aldosterone excess. Accordingly, ASIs should be viewed in transplantation as hypothesis-generating investigational agents rather than therapeutic recommendations. Any transplant-specific trial should incorporate rigorous hyperkalemia monitoring, comparator arms that reflect optimized NCC-directed therapy, and formal assessment of drug-drug interactions with immunosuppressants.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70555"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Post-Kidney Transplant Persistent Hyperparathyroidism and Fracture Risk: A Longitudinal Cohort Study.","authors":"Rachel Stemme, Yi Liu, Jingyao Hong, Yiting Li, Joy Zhou Done, Jennine Weller, Anatoliy V Rudin, Daniel C Brennan, Lilah F Morris-Wiseman, Dorry L Segev, Mara A McAdams-DeMarco, Aarti Mathur","doi":"10.1111/ctr.70553","DOIUrl":"https://doi.org/10.1111/ctr.70553","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperparathyroidism (HPT) commonly persists following kidney transplant (KT) and can result in bone alterations. However, the association between persistent HPT post-KT and fracture risk is not well-understood. We sought to quantify the association between persistent HPT at 1-year post-KT and fracture risk among KT recipients.</p><p><strong>Methods: </strong>We leveraged a longitudinal prospective cohort of 344 adult KT recipients who underwent KT at a single institution (12/2008-07/2019). PTH levels were retroactively abstracted, and fractures after 1-year-post-KT were ascertained using ICD-9/ICD-10 codes. Competing risk models were used to estimate the association between persistent HPT (PTH ≥ 70 pg/mL) at 1-year post-KT and the risk of fracture, with death treated as a competing event.</p><p><strong>Results: </strong>Among 344 KT recipients, 227 (66.0%) had persistent HPT at 1-year post-KT. After adjusting for confounders, HPT 1-year after KT was associated with a 3.11-fold increased risk of fractures (95% CI: 1.08-8.91). There were no differences in this association by age, sex, race, eGFR at 1-year-post-KT, osteoporosis at KT, or dialysis vintage.</p><p><strong>Conclusion: </strong>Recipients with HPT 1-year after KT had a significantly higher risk of fractures than those without persistent HPT. Future studies should establish standardized practice guidelines for the treatment of persistent HPT to mitigate fracture-related morbidity and mortality.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70553"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and Clinical Outcomes.","authors":"Bismarck Steven Bisono-Garcia, Christopher Anh-Thao Dinh, Benjo Ato, Vaisak O Nair, Zachary A Yetmar, Raymund R Razonable","doi":"10.1111/ctr.70552","DOIUrl":"https://doi.org/10.1111/ctr.70552","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) infection remains one of the most prevalent and consequential post solid organ transplant (SOT) infections. Treatment is often challenging, especially when dealing with refractory and resistant CMV infections.</p><p><strong>Methods: </strong>We performed a retrospective multicenter cohort study of SOT recipients with clinically significant CMV infection (csCMVi) during 2010-2016. The primary outcome was early refractory CMV infection and secondary outcomes were drug resistance, CMV recurrence, and mortality. Analysis was done with Kaplan-Meier, univariable logistic regression analysis, and multivariable Cox regression.</p><p><strong>Results: </strong>We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti-IL-2 antibody (43.9%). The majority (n = 82; 56.5%) were CMV D+/R- mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+/R- mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48-0.95, p = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01-2.44, p = 0.048). Drug-resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08-3.93, p = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality.</p><p><strong>Conclusion: </strong>Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70552"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescue by Hypothermic Oxygenated Machine Perfusion for Unexpected Long Prolongation of Cold Preservation Time in Expanded Criteria Donor Kidneys Can Achieve Favorable 2-Year Outcomes.","authors":"Silvia Mingozzi, Alberto Mella, Caterina Dolla, Ester Gallo, Ana Maria Manzione, Enrico Sanna, Paolo Randone, Rita Tarragoni, Roberta Giraudi, Gloria Giovinazzo, Claudia Melloni, Aldo Verri, Andrea Bosio, Paolo Gontero, Antonella Barreca, Fabrizio Fop, Luigi Biancone","doi":"10.1111/ctr.70557","DOIUrl":"https://doi.org/10.1111/ctr.70557","url":null,"abstract":"<p><strong>Background: </strong>Hypothermic oxygenated machine perfusion (HOPE) is occasionally used to overcome logistical issues and allow longer cold preservation time (CPT); however, reports regarding these situations in older brain-dead donors are lacking.</p><p><strong>Methods: </strong>Retrospective analysis of kidney transplants (KTs) performed between January 1, 2015, to December 31, 2023, from extended criteria donors (ECDs) switched to HOPE after a median time of 17.1 h in static cold storage (SCS) for unexpected logistic reasons and with a median total CPT of 28.6 h (25.3-32.0) (n = 44, HOPE ECDs), compared with a control group of KTs (n = 44, L-ECDs) maintained in SCS alone with a low CPT (median, 10.4 h; range, 7.1-11.1) and matched for age, sex, donor age, donor eGFR, pre-emptive transplant, and cPRA.</p><p><strong>Results: </strong>No primary nonfunction was observed, and both death-censored graft survival (DCGS) and renal function progressively improved, remaining satisfactory and superimposable between groups up to two years post-transplant (97.7% of DCGS with mean eGFR 46.5 mL/min/1.73 m² [36-55.65] in HOPE-ECDs) versus 97.7% with 42.0 (30.2-48.2) in L-ECDs with similar KDPI (67% [49.75-86.5] vs. 72.5% [60.5-87.75], p = 0.475). These results were achieved in patients with HOPE-ECDs, who experienced higher rates of DGF (31.8% vs. 11.4%, p = 0.036). No differences were noted in infection or rejection rates.</p><p><strong>Conclusion: </strong>Rescue by HOPE after SCS in ECDs with a very long CPT can achieve midterm outcomes similar to those with a low CPT in SCS alone, paving the way for its safe implementation in clinical practice.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70557"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Transplant Referral, Activation, and Transplantation Rates in a Single-Center Cohort of Older Adults in Nova Scotia.","authors":"Jacob B Michaud, Karthik K Tennankore, George L Worthen, Bryce Kiberd, Amanda J Vinson","doi":"10.1111/ctr.70546","DOIUrl":"10.1111/ctr.70546","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney transplantation (KT) improves survival and quality of life for older adults with kidney failure, yet older adults may be referred less often. We aimed to compare KT referral, waitlist activation, and transplantation rates by age in a contemporary Canadian cohort.</p><p><strong>Methods: </strong>We examined adult patients with kidney failure (initiating maintenance dialysis or referred for preemptive KT) in Nova Scotia from 2010 to 2020. Transplant-eligible patients aged 18-80 years were categorized by age (≤60, >60-70, and >70-80 years). Multivariable Fine and Gray subdistribution hazard and logistic regression models assessed time to transplant referral, odds of waitlist activation, and time to transplantation, adjusting for demographics, comorbidities, and frailty.</p><p><strong>Results: </strong>Of 1153 patients, 785 were potentially eligible for KT. Adjusted subdistribution hazard ratios (aSHR) for transplant referral were significantly lower for older groups (aSHR 0.73, 95% confidence interval [CI]: 0.57-0.93 for >60-70 years and aSHR 0.24, 95% CI: 0.17-0.34 for >70-80 years). There were no significant differences in odds of waitlisting if referred (odds ratio 0.76, 95% CI: 0.45-1.29 for >60-70 years and 0.74, 95% CI: 0.30-1.86 for >70-80 years) or in time to transplantation if waitlisted (aSHR 0.79, 95% CI: 0.55-1.13 for >60-70 years and aSHR 0.55, 95% CI: 0.28-1.08 for >70-80 years).</p><p><strong>Conclusion: </strong>Older adults in Nova Scotia, Canada, experience significantly lower kidney transplant referral rates, with no differences in waitlist activation or time to transplant. Interventions to improve access to transplant for older individuals should focus on improving KT referral.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 5","pages":"e70546"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}