Clinical Transplantation最新文献

{"title":"Belatacept Pharmacokinetic Analysis of Belatacept Early Steroid Withdrawal Trial (BEST) to Clinical Outcomes and Compared With Reported BENEFIT and BENEFIT-EXT Pharmacokinetic Analysis","authors":"Alexandra Pyatt,&nbsp;Melissa McGowan,&nbsp;Ryota Tanaka,&nbsp;Bradley Miyagawa,&nbsp;Tomoyuki Mizuno,&nbsp;Adele Rike Shields,&nbsp;Annette Christianson,&nbsp;Patricia West-Thielke,&nbsp;John P. Leone,&nbsp;E. Steve Woodle,&nbsp;Dixon Kaufman,&nbsp;Alexander Wiseman,&nbsp;Arthur J. Matas,&nbsp;Alexander A. Vinks,&nbsp;Rita R. Alloway","doi":"10.1111/ctr.70172","DOIUrl":"https://doi.org/10.1111/ctr.70172","url":null,"abstract":"<p>Belatacept (BELA) pharmacokinetic (PK) studies informed dosing strategies used in phase 3 studies, where fixed mg/kg dosing compared a less intensive (LI) and more intensive (MI) regimen. The LI regimen was preferred due to a better risk/benefit profile. We compared PK parameters observed in the BELA Early Steroid Withdrawal Trial (BEST) with previous reports. BELA trough samples were analyzed using a validated quantitative enzyme-linked immunoassay. Clearance (CL) was estimated with Bayesian estimation using a published BELA population PK model. Significantly higher CL was observed in subjects &lt;60 years old and African American (AA) patients, leading to decreased BELA exposure. No differences in allometrically scaled CL were observed by BMI or sex; however, overall BELA exposure was greater in males. There were no differences in exposure in subjects with rejection; however, subjects with infection had significantly higher exposure. BELA PK was not different between alemtuzumab and rabbit-antithymocyte globulin induction groups without steroids, but overall drug exposure was higher than previously reported in trials co-administering with basiliximab and steroids. Future studies to optimize BELA dosing strategies are warranted as BELA exposure in this analysis exceeded Phase 3 target thresholds.</p><p><b>Trial Registration</b>: ClinicalTrials.gov identifier: NCT 01729494</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688028","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":"Incidence, Risk Factors, and Prognosis of Acute Kidney Injury in Elderly Patients With Acute Leukemia Undergoing Haploidentical Hematopoietic Stem Cell Transplantation","authors":"Wei Sun,&nbsp;Shengye Lu,&nbsp;Yaqin Wu,&nbsp;Zhengli Xu,&nbsp;Rui Ma,&nbsp;Xiaodong Mo,&nbsp;Yu Wang,&nbsp;Lanping Xu,&nbsp;Xiaohui Zhang,&nbsp;Xiaojun Huang,&nbsp;Yuqian Sun","doi":"10.1111/ctr.70257","DOIUrl":"https://doi.org/10.1111/ctr.70257","url":null,"abstract":"<div>\u0000 \u0000 <p>We explored the incidence, risk factors, and clinical characteristics of acute kidney injury (AKI) within 100 days posttransplantation, and its impact on the prognosis of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in elderly patients. A total of 224 elderly patients diagnosed with acute leukemia received haplo-HSCT between January 1, 2019, and December 31, 2023 at Peking University People's Hospital. AKI affected 54.9% of the patients, with 33.5% in Stage 1, 18.3% in Stage 2, and 3.1% in Stage 3. Being female and having hypoalbuminemia were independent risk factors for developing severe AKI. Three-year overall survival for AKI Stages 0, 1, 2, and 3 were 73.4%, 75.9%, 56.6%, and 14.3%, respectively (<i>p</i> = 0.000). The 3-year event-free survival rates were 70.7%, 73.0%, 46.2%, and 0% (<i>p</i> &lt; 0.001). The 3-year transplantation-related mortality was 13.8% for Stages 0–1 and 48.1% for Stages 2–3 (<i>p</i> &lt; 0.001). Our study showed that more than half of elderly patients who underwent haplo-HSCT developed AKI. Being female and having hypoalbuminemia before transplantation were at a significantly higher risk for severe AKI. Experiencing Stage 2 or more severe AKI was found to be an independent risk factor for increased mortality.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688073","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":"Long-Term Results of Normothermic Machine Perfusion in Kidney Transplants: A Pilot Study","authors":"Iacopo Cristoferi,&nbsp;Sarah Bouari,&nbsp;Elsaline Rijkse,&nbsp;Marian C. Clahsen-van Groningen,&nbsp;Andrew P. Stubbs,&nbsp;Hendrikus J. A. N. Kimenai,&nbsp;Robert C. Minnee","doi":"10.1111/ctr.70225","DOIUrl":"https://doi.org/10.1111/ctr.70225","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688026","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":"Cultural Influences, Considerations, and Challenges for Organ Donation and Liver Transplantation Around the World","authors":"Sher-Lu Pai,&nbsp;Manhal Izzy,&nbsp;Alfred Kow Wei Chieh,&nbsp;Iman F. Montasser,&nbsp;Nyingi Kemmer,&nbsp;Uzung Yoon,&nbsp;Emmanouil Giorgakis,&nbsp;Nazia Selzner,&nbsp;Keri E. Lunsford,&nbsp;Chiara Becchetti,&nbsp;Flávia Heinz Feier,&nbsp;Sarwa Darwish Murad,&nbsp;Martin Montenovo,&nbsp;Victoria Aguilera,&nbsp;Oya M. Andacoglu","doi":"10.1111/ctr.70252","DOIUrl":"https://doi.org/10.1111/ctr.70252","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although liver transplantation (LT) rates have increased globally, the demand for organs still exceeds the supply. This review highlights cultures with significant influences on organ donation and LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a literature search for articles related to cultures, ethnologies, philosophies, policies, religions, socio-economic factors, and other influences affecting organ donation in LT around the world.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There are astonishing similarities between different cultures. In Africa, Asia, and Europe, people often view the postmortem bodies as sacred and believe that their bodies are gifts from “God” or ancestors. To respect the gift of life, to have a chance in reincarnation, or to enjoy life after death, many believe that their bodily sanctity must be preserved. In Asia, Europe, and Latin America, there is a general reluctance to speak about death. Religions also play an important role in people's views on organ donation. Different regions around the world have similar challenges to organ donation, such as misconceptions about organ trafficking, political and economic instability, and a lack of governmental or religious support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Addressing the complexities of organ donation and LT requires a multifaceted approach. Culturally sensitive education tailored to diverse communities can dispel myths and misconceptions surrounding organ donation. Fostering partnerships between healthcare providers, religious leaders, community organizations, and policymakers can further facilitate open dialogues and promote organ donation as a noble act to save lives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Social Media</h3>\u0000 \u0000 <p>Similar cultures around the world post challenges for organ donation. Organizations should foster partnerships between healthcare providers, politicians, and religious leaders to promote donation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688027","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":"Extracorporeal Photopheresis in the Treatment of Cardiac Allograft Rejection in the Modern Era: A Single-Center Experience","authors":"Gal Rubinstein,&nbsp;Andrea Fernandez Valledor,&nbsp;Cathrine M. Moeller,&nbsp;Julia Baranowska,&nbsp;Daniel Oren,&nbsp;David Kyung Taek Oh,&nbsp;David Bae,&nbsp;Adil Yunis,&nbsp;Dor Lotan,&nbsp;Afsana Rahman,&nbsp;Jayant K. Raikhelkar,&nbsp;Justin A. Fried,&nbsp;Ersilia M. DeFilippis,&nbsp;Kevin J. Clerkin,&nbsp;Farhana Latif,&nbsp;Gabriel T. Sayer,&nbsp;Nir Uriel","doi":"10.1111/ctr.70247","DOIUrl":"https://doi.org/10.1111/ctr.70247","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Extracorporeal photopheresis (ECP) has gained recognition as a valuable adjunctive antirejection therapy, particularly in heart-transplantation (HT) patients at elevated risk for rejection or those experiencing recurrent antibody-mediated rejection (AMR) despite appropriate treatment. We evaluated the safety and clinical effects of ECP in HT recipients with high immunologic risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All HT recipients who underwent ECP between February 2020 and January 2024 were included in this retrospective, single-center study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen patients who underwent ECP were identified. Twelve patients completed ECP and were followed for a median of 11.2 months (3.9–19.9). The time from transplant to ECP initiation was 5.3 years (1.3–13). The most common indication for ECP was AMR (60%). During ECP, immunosuppression regimens were maintained or de-escalated in 93% of the patients. Reduction in donor specific antibodies (DSA), peripheral gene expression profiling (GEP), and donor-derived cell-free DNA (dd-cfDNA) levels were observed in 64%, 57%, and 67% of the patients, respectively. Eighty-three percent of the patients were free from rejection during the follow-up period. Overall survival was 87%, and no deaths were related to ECP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our single-center experience, ECP resulted in a decrease in immunosuppression use, and a reduction in DSA, GEP, and dd-cfDNA levels with a high freedom-from-rejection rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681189","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 Life-Saving Benefit of the Living Donor Kidney Evaluation: A Mini Review","authors":"Matthew L. Holzner,&nbsp;Arthur Matas,&nbsp;Sun-Cheol Park,&nbsp;Alan Langas,&nbsp;Arika Hoffman,&nbsp;Nils Heyne,&nbsp;Martina Guthoff,&nbsp;Stuart Flechner,&nbsp;Ron Shapiro","doi":"10.1111/ctr.70253","DOIUrl":"https://doi.org/10.1111/ctr.70253","url":null,"abstract":"<div>\u0000 \u0000 <p>While there has been an appropriate focus on characterizing the risks associated with living kidney donation, little attention has been paid to the potential benefit to the donor of undergoing the living donor evaluation. This review highlights four studies from the United States and Europe across 30 years demonstrating that the living donor evaluation leads to the detection of previously undiagnosed medical problems in potential donors, including serious cancers. Potential donors should be counseled on the possible benefit of undergoing evaluation.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681191","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":"Hepatitis B Virus NAT Positive Donors in Non-Hepatic Organ Transplant: Quantifying Viral Loads to Optimize Recipient Risk Stratification and Management in the Prevention of Donor-Derived Infection","authors":"Patrick C. K. Tam,&nbsp;Goni Katz-Greenberg,&nbsp;Cameron R. Wolfe,&nbsp;Kristen Lott,&nbsp;Carl L. Berg,&nbsp;Adam D. DeVore,&nbsp;John M. Reynolds,&nbsp;Jennifer L. Saullo","doi":"10.1111/ctr.70236","DOIUrl":"https://doi.org/10.1111/ctr.70236","url":null,"abstract":"<p>Transplantation is one of the few life-saving therapies for patients with end-stage organ disease, yet organ availability remains restrictive. Expanding donors to include those with hepatitis B virus (HBV) infection, incorporating HBV nucleic acid amplification testing (NAT) positive donors, could improve organ access. However, the risk of donor-derived HBV transmission and recipient management of organs transplanted from HBV NAT-positive donors, particularly in thoracic organ recipients, is limited. We conducted a single-center retrospective study to assess the safety and outcomes in recipients of non-hepatic organ transplants from HBV NAT-positive donors. Over a 4.5-year period, 25 transplant recipients, including 16 thoracic organ recipients, received organs from 22 unique, qualitative HBV NAT-positive donors. All recipients were HBV surface antibody-positive prior to transplant. Quantitative NAT was performed in 20/22 (91%) donors with values ranging from 0 to 1 280 000 IU/mL; 8/22 (36%) donors had HBV NAT values that were undetected or below the lower limit of quantification. All recipients were administered HBV immunoglobulin (HBIG) and received HBV active antiviral therapy post-transplant. Recipients were followed post-transplant for a median of 250 days (IQR: 169–467 days). No recipients developed de novo HBV infection characterized by HBV surface antigen (HBsAg) seroconversion, quantifiable HBV NAT detection, or sustained HBV core antibody (HbcAb) seroconversion post-transplant. Similarly, no recipient developed liver dysfunction or died due to HBV infection. Quantifying HBV from NAT-positive donors may better inform the risk of donor-derived infection in recipients, and the use of these organs incorporating a multimodal prevention strategy could safely increase the donor pool.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 7","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681609","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":"Impact of GLP-1 and GLP-1/GIP Receptor Agonist Weight Loss Post-Lung Transplant on Lung Allograft Function","authors":"Spenser E. January,&nbsp;Keith A. Fester,&nbsp;Jesus E. Escamilla,&nbsp;Marlene Cano","doi":"10.1111/ctr.70246","DOIUrl":"https://doi.org/10.1111/ctr.70246","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Glucagon-like peptide-1 receptor agonist (GLP-1 RA) and GLP-1/glucose dependent insulinotropic polypeptide receptor agonist (GLP-1/GIP RA) use is becoming increasingly common, but there are little data on their use after lung transplantation. Furthermore, obesity is a known cause of lung function decline after lung transplant, but whether weight loss experienced while on these medications leads to improved lung allograft function has not been investigated.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This single-center retrospective study assessed the use of GLP-1 or GLP-1/GIP RA therapy in patients after lung transplantation. The primary objective was to determine if weight loss is associated with improved lung function. Secondary endpoints included changes in hemoglobin A1c and incidence of adverse effects. A subgroup analysis was performed on only those who lost the median or greater percent of body weight, and a sensitivity analysis was performed to assess if other variables impacting lung function significantly contributed to the endpoints.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;There were 81 lung transplant recipients who received GLP-1 or GLP-1/GIP RA therapy; the average duration of use was 1.4 years. There was significant weight loss and improvement in hemoglobin A1c, but there was no association found between weight loss and improvement in FEV1 or FVC. Side effects were common and led to discontinuation of the medication in 18.5% of patients, but serious side effects were rare.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Use of GLP-1 or GLP-1/GIP RA therapy after lung transplantation was effective at decreasing weight and improving hemoglobin A1c, but this did not lead to improved lung allograft function.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Summary&lt;/h3&gt;\u0000 \u0000 &lt;div&gt;\u0000 &lt;ul&gt;\u0000 \u0000 &lt;li&gt;In this article examining the use of GLP-1 and GLP-1/GIP RA after lung transplantation, there was no significant association between weight loss and an increase in lung allograft function, although approximately half of the patients experienced a rise in FEV&lt;sub&gt;1&lt;/sub&gt; and FVC while on therapy.&lt;/li&gt;\u0000 \u0000 &lt;li&gt;This study included both a subgroup and a sensitivity analysis to assess if significant weight gain was needed to improve lung function and to assess the impact of other variables on lung function.&lt;/li&gt;\u0000 \u0000 &lt;li&gt;Patients in this study experienced significant improvement in weight and hemoglobin A1c. Side effect","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681188","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":"Impact of Normothermic Machine Perfusion on Access to Liver Transplantation in Patients With Primary Hepatic Malignancies","authors":"Dominic Amara,&nbsp;Andrew Melehy,&nbsp;Samer Ebaid,&nbsp;Fady M. Kaldas,&nbsp;Douglas G. Farmer,&nbsp;Peter Stock,&nbsp;Alex A. T. Bui,&nbsp;Neil Mehta,&nbsp;Vatche G. Agopian","doi":"10.1111/ctr.70254","DOIUrl":"https://doi.org/10.1111/ctr.70254","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Balancing the probability of transplant and waitlist dropout in patients with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) using MELD exception points has been an enduring challenge. The advent of normothermic machine perfusion (NMP) has the potential to increase access to transplantation in patients with primary hepatic malignancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Scientific Registry of Transplant Recipients database, this study evaluated the impact of widespread availability of NMP on access to liver transplantation in transplant oncology. Waitlist outcomes and transplant characteristics between patients with HCC and CCA after the implementation of acuity circles but before the widespread NMP availability (pre-NMP era, February 2020 to September 2021) were compared to those after widespread NMP availability (NMP era, September 2021 to September 2023) based on waitlist date.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 7564 patients with HCC (3691 pre-NMP; 3874 NMP era) and 354 patients with CCA (193 pre-NMP; 161 NMP era) were waitlisted over the study period. NMP-era patients had a higher probability of transplant at 1 year from listing for both HCC (59% vs. 49%, <i>p</i> &lt; 0.001) and CCA (71% vs. 56%, <i>p</i> = 0.012). Patients with HCC also had a lower risk of death or waitlist dropout (14% vs. 16% at 1 year, <i>p</i> = 0.016). After adjustment for other factors affecting probability of transplant in HCC, the NMP era (aSHR 1.26, 95% CI 1.18–1.34, <i>p</i> &lt; 0.001) and transplantation at a high-volume NMP center (aSHR 1.13, 95% CI 1.05–1.22, <i>p</i> = 0.002) were both still associated with higher transplant probability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NMP has promise in improving access to liver transplantation for oncologic indications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681200","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":"Urinary Complications and Long-Term Graft Survival After Primary Atypical Ureteral Anastomosis in Live-Donor Kidney Transplantation","authors":"Mohamed H. Zahran,&nbsp;Mohamed Shehata,&nbsp;Muhammed A. Elhadedy,&nbsp;Ahmed S. El-Hefnawy,&nbsp;Shady A. Soliman,&nbsp;Ahmed A. Shokeir,&nbsp;Yasser Osman,&nbsp;Bedeir Ali-El-Dein","doi":"10.1111/ctr.70244","DOIUrl":"https://doi.org/10.1111/ctr.70244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the urological complications and long-term renal graft survival after primary atypical ureteral anastomosis (PAUA) and to compare it to the standard ureteral anastomosis technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This is a retrospective analysis of all transplant patients with PAUA between 1976 and 2019. The primary outcome was to compare early (urinary leakage and ureteral obstruction) and delayed urinary complications (ureteral stricture and stones), and febrile UTI to the outcomes using the standard ureteral anastomosis technique (control). The second outcome was to compare the long-term graft function and graft survival between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PAUA was performed in 73 patients, including 39, 27, and 7 patients with ureteroureterostomy, ureteral anastomosis to an augmented bladder, and an ileal conduit, respectively. The control group included 2961 patients. PAUA had a statistically significant higher incidence of urinary leakage (9.6% vs. 2.4%, <i>p</i> = 0.002), ureteral stricture (4.1% vs. 1.2%, <i>p</i> = 0.03), and febrile UTI (28.8% vs. 4.2%, <i>p</i> &lt; 0.001), with insignificant differences regarding early ureteral obstruction (<i>p</i> = 0.6) and stone disease (<i>p</i> = 0.1). At last follow-up, no statistically significant differences in median serum creatinine or e GFR (<i>p</i> = 0.1) were identified between both groups. The cumulative 1-, 2-, 3-, 5-, and 10-year graft survival were 94% versus 94%, 89% versus 92%, 85% versus 89%, 74% versus 82%, and 53% versus 60% in studied group and control, respectively (HR: 0.9, 95% CI = 0.6–1.2, <i>p</i> = 0.6).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although kidney transplant patients with PAUA have significantly a higher urinary complication rate than those with a standard ureteral anastomosis technique, they have a comparable cumulative graft survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>Primary atypical anastomosis of the kidney transplant ureter into an augmented bladder, native ureter, or ileal loop conduit is associated with higher incidence of urinary leakage, ureteral stricture, and febrile urinary tract infection. However, it has no significant impact on long term graft survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681187","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}