Clinical Transplantation最新文献

{"title":"Impact of MELD 3.0 Score on Outcomes After Combined Heart–Liver Transplantation: A UNOS Database Analysis","authors":"Gabriel Esmailian,&nbsp;Sangrag Ganguli,&nbsp;Richard Jiang,&nbsp;Alejandro Alvarez Lobo,&nbsp;Oliver Jawitz,&nbsp;Divyam Goel,&nbsp;Chetan Patel,&nbsp;Adam DeVore,&nbsp;Stuart Russell,&nbsp;Matthew Kappus,&nbsp;Lindsay King,&nbsp;Stuart Knechtle,&nbsp;Debra Sudan,&nbsp;Jeffrey Keenan,&nbsp;Jacob Schroder,&nbsp;Carmelo Milano","doi":"10.1111/ctr.70713","DOIUrl":"10.1111/ctr.70713","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Combined heart-liver transplantation (CHLT) is performed for select patients with end-stage heart and liver disease, though the prognostic value of the Model for End-Stage Liver Disease (MELD) score in this population remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated adult CHLT recipients between March 2005 and May 2025 from the United Network for Organ Sharing database. Groups were stratified by MELD 3.0 score at transplant: 1–14 (Low), 15–24 (Medium), ≥25 (High). Kaplan-Meier analyses assessed overall survival and freedom from liver graft failure, and Cox proportional hazards analysis evaluated risk factors for mortality after CHLT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 601 CHLT patients, there were 231 Low MELD, 314 Medium MELD, and 56 High MELD. Kaplan Meier analyses showed no difference in survival or liver graft failure between the groups (<i>p</i> = 0.22 and <i>p</i> = 0.22, respectively). One-year survival for the Low, Med, and High MELD groups was 82.6% [95% CI 77.8%–87.8%], 82.6% [95% CI 78.4%–87.0%], and 90.2% [95% CI 82.4%–98.8%], respectively. Five-year survival for the Low, Med, and High MELD groups was 73.8% [95% CI 67.6%–80.5%], 76.9% [95% CI 71.9%–82.1%], and 82.0% [95% CI 71.2%–94.5%], respectively. Cox proportional hazards analysis did not show MELD 3.0 score as a risk factor for mortality after CHLT (HR 0.98, 95% CI 0.94%–1.01; <i>p</i> = 0.144).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CHLT recipients have comparable long-term survival and liver graft failure rates regardless of MELD 3.0 score. For all three groups, mortality risk is greater during the first year. These findings suggest that MELD 3.0 may have limited prognostic utility in CHLT and support continued consideration of combined transplantation in appropriately selected patients despite elevated MELD 3.0 scores.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164589","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":"Development in Left Ventricular Mass After Early and Late Conversion From Calcineurin Inhibitors to Everolimus in Heart Transplant Recipients—Results From Two Randomized Controlled Trials","authors":"Klaus Murbraech,&nbsp;Feben Tecklzig,&nbsp;Richard John Massey,&nbsp;Einar Gude,&nbsp;Finn Gustafsson,&nbsp;Hans Eiskjær,&nbsp;Kristjan Karason,&nbsp;Göran Rådegran,&nbsp;Arne K. Andreassen,&nbsp;Lars Gullestad,&nbsp;Kaspar Broch","doi":"10.1111/ctr.70705","DOIUrl":"https://doi.org/10.1111/ctr.70705","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Left ventricular hypertrophy in heart transplant recipients has been attributed to the use of calcineurin inhibitors. We assessed left ventricular mass across treatment arms in 83 heart transplant recipients in the Scandinavian heart transplant everolimus de novo study with early calcineurin inhibitors avoidance (SCHEDULE), and in 75 maintenance recipients in the Nordic Certican Trial in Heart and Lung Transplantation (NOCTET). In SCHEDULE, we randomized participants to treatment with calcineurin inhibitors or replacement with everolimus within 7–11 weeks after transplant. In NOCTET, participants were randomized to treatment with calcineurin inhibitors or a combination of low dose calcineurin inhibitors and everolimus. We followed patients with echocardiography for 3 years in the SCHEDULE trial and for 5 years in NOCTET. In SCHEDULE, left ventricular mass diminished with time, particularly across the first year of follow-up (everolimus arm: −10 ± 18 g/m², cyclosporine arm: −9 ± 13 g/m²). However, there was no between-group difference in this development (<i>p</i> = 0.91). In NOCTET, there was no significant change in LVM over time and no between-group difference in the change (<i>p</i> = 0.27). In conclusion, <b>t</b>he replacement of calcineurin inhibitors with everolimus or a reduction in the calcineurin inhibitor dose did not mitigate left ventricular hypertrophy after heart transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>SCHEDULE—ClinicalTrials.gov Identifier: NCT01266148; NOCTET—ClinicalTrials.gov Identifier: NCT00377962</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146368","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 and Factors of Bacterial Zoonotic Infection in Solid Organ Transplant Recipients","authors":"Chia-Yu Chiu,&nbsp;Supavit Chesdachai,&nbsp;Deepali Boothankad Sharath,&nbsp;Zachary A. Yetmar,&nbsp;Andrés F. Henao-Martínez","doi":"10.1111/ctr.70708","DOIUrl":"10.1111/ctr.70708","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Infection remains a leading cause of morbidity and mortality among solid organ transplant (SOT) recipients, yet zoonotic pathogens as a distinct category remain underrecognized. We investigated the incidence, and risk factors of bacterial zoonotic infections after transplantation using a large multicenter database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We queried the TriNetX database in from 2014–2024 to identify adult SOT recipients who developed bacterial zoonotic infections. We identified twelve bacterial zoonoses using ICD-10 codes: anthrax, brucellosis, cat scratch disease, glanders, leprosy, leptospirosis, tularemia, parrot fever, pasteurellosis, plague, Q fever, and rat-bite fever.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-one SOT recipients (0.03%) developed a bacterial zoonotic infection, corresponding to an incidence of 4.87 per 100 000 person-years. The median time from transplantation to infection was 736 days (IQR, 298–1970), with 72.1% of infections occurring more than one year after transplantation. The hospitalization rate was 41.0%, and the 90-day all-cause mortality rate was 6.6%. The three most common infections were Q fever, cat scratch disease, and pasteurellosis. No cases of anthrax, tularemia, plague, or rat-bite fever were identified. Black recipients had a 49% lower risk of bacterial zoonotic infection than White recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Bacterial zoonotic infections were uncommon and occurred predominantly during the late post-transplant period. The lower risk observed among Black recipients reflects differences in animal and environmental exposure that this study could not measure, rather than biological susceptibility. Animal safety counseling should extend beyond the early post-transplant period and continue as part of long-term post-transplant care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134734","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":"Surgical and Clinical Outcomes of Kidney Transplantation in Obese Recipients: A Single-Center Retrospective Study from Switzerland","authors":"Eliot Melera,&nbsp;Lorenzo Costa,&nbsp;Céline Deslarzes-Dubuis,&nbsp;Sébastien Déglise,&nbsp;Alban Longchamp,&nbsp;Matthieu Halfon,&nbsp;Jean-Pierre Venetz,&nbsp;Dela Golshayan,&nbsp;Manuel Pascual,&nbsp;Maurice Matter,&nbsp;Tobias Zingg,&nbsp;David Martin","doi":"10.1111/ctr.70709","DOIUrl":"10.1111/ctr.70709","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impact of recipient obesity on kidney transplant outcomes remains controversial. This study aimed to assess the effect of recipient obesity on short- and long-term outcomes following kidney transplantation (KT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort study included all consecutive adult patients who underwent KT between January 1999 and December 2023 at the Transplantation Center of Lausanne University Hospital (CHUV), Lausanne, Switzerland. Surgical complications, delayed graft function (DGF), and graft survival were compared between obese (BMI ≥ 30 kg/m²) and non-obese recipients (BMI &lt; 30 kg/m²).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 953 patients were included, of whom 150 (16%) were obese. Obesity was associated with higher rates of surgical site infections (11% vs. 3%, <i>p</i> &lt; 0.001), overall infections (29% vs. 5%, <i>p</i> &lt; 0.001), lymphoceles (18% vs. 10%, <i>p</i> = 0.007), and incisional hernias (10% vs. 5%, <i>p</i> = 0.032). Length of hospital stay (19 vs. 17 days, <i>p</i> = 0.038) and DGF rates (21% vs. 14%, <i>p</i> = 0.024) were also higher in obese recipients. Patient survival (HR 1.09, 95% CI 0.59–1.99; <i>p</i> = 0.766) and death-censored graft survival (HR 0.92, 95% CI 0.29–2.92; <i>p</i> = 0.886) were comparable between groups at a median follow-up of 7.3 years (IQR, 3.3–12.4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Recipient obesity was associated with an increased risk of surgical complications and DGF, resulting in longer hospital stays. However, it did not adversely affect long-term patient or graft survival. Therefore, despite higher early complications, obesity should not be considered a contraindication to KT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104845","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":"Vanishing Bronchus Syndrome After Lung Transplantation: Clinical Characteristics, Airway Colonization, and Stent Outcomes","authors":"Hirotsugu Notsuda,&nbsp;Sakiko Kumata,&nbsp;Ken Onodera,&nbsp;Tatsuaki Watanabe,&nbsp;Yui Watanabe,&nbsp;Takashi Hirama,&nbsp;Takaya Suzuki,&nbsp;Hisashi Oishi,&nbsp;Yoshinori Okada","doi":"10.1111/ctr.70707","DOIUrl":"10.1111/ctr.70707","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Airway complications remain a significant cause of morbidity after lung transplantation. Among them, vanishing bronchus syndrome (VBS) represents a severe form of airway injury characterized by progressive distal bronchial stenosis. Although ischemia has been implicated in its pathogenesis, the role of airway colonization with multidrug-resistant organisms remains incompletely understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective, single-center study of lung transplant recipients who developed VBS between January 2001 and November 2025. Clinical characteristics, bronchoscopic findings, microbiological data, and outcomes following airway stenting were reviewed. VBS was defined as progressive bronchial stenosis predominantly involving the distal airway beyond the bronchial anastomosis. Associations between airway infection, stent outcomes, and airway healing were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 203 lung transplant recipients, five patients (2.5%) developed VBS requiring airway stenting. All patients demonstrated stenosis involving the bronchus intermedius. Multidrug-resistant organisms, including methicillin-resistant Staphylococcus aureus, were detected in two patients, both of whom remained stent-dependent. In contrast, three patients without multidrug-resistant organisms ultimately achieved successful stent removal with sustained airway patency. However, long-term stent dependency was also influenced by persistent structural airway abnormalities and stent-related factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>VBS may involve a complex interplay among ischemic injury, structural airway abnormalities, stent-related factors, and microbial colonization. Persistent multidrug-resistant airway colonization may be associated with unfavorable airway outcomes; however, its independent contribution remains uncertain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104872","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":"Beyond the 100-bpm Dogma: A Physiology-Guided Approach to Early Postoperative Heart Rate Management After Heart Transplantation","authors":"Federico Franchi,&nbsp;Daniele Marianello,&nbsp;Cecilia Bianchi,&nbsp;Cesare Biuzzi,&nbsp;Leonardo Gottin,&nbsp;Lorenzo Peluso,&nbsp;Massimo Maccherini,&nbsp;Matteo Cameli,&nbsp;Igor Vendramin,&nbsp;Sabino Scolletta,&nbsp;Sandro Sponga","doi":"10.1111/ctr.70710","DOIUrl":"10.1111/ctr.70710","url":null,"abstract":"<div>\u0000 \u0000 <p>Early postoperative heart rate (HR) management after heart transplantation (HTx) remains largely guided by historical haemodynamic concepts that support maintaining elevated HR to compensate for reduced stroke volume. This structured narrative review re-examines the physiological rationale and contemporary evidence underlying this approach, with the aim of refining perioperative chronotropic strategies. A comprehensive analysis of studies addressing early HR behavior, sinus node dysfunction (SND), pacing strategies, chronotropic therapies, and their association with clinical outcomes was performed. Classic studies from the 1970s described marked stroke-volume depression and a strong dependence of cardiac output on HR, forming the basis for maintaining HR around 90–100 bpm. However, contemporary evidence indicates a more heterogeneous early graft physiology, often with less pronounced stroke-volume limitation, and highlights potential adverse effects associated with excessive adrenergic stimulation, including renal dysfunction and worse mid-term outcomes. SND is common but typically transient, and atrial or atrioventricular-synchronous pacing can restore HR without the metabolic burden of β-adrenergic stimulation. In contrast, isoproterenol provides combined chronotropic and inotropic support but may increase myocardial oxygen consumption, shorten diastolic filling time, and impair right ventricular–pulmonary artery coupling when perfusion pressure is inadequate. Integration of perfusion markers, such as lactate and central venous oxygen saturation, with echocardiographic and invasive haemodynamic assessment is essential to determine whether HR augmentation improves oxygen delivery or instead increases metabolic stress. Early HR management after HTx should therefore be individualized and guided by integrated physiological assessment rather than fixed HR targets. Prospective studies are needed to define evidence-based chronotropic strategies.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105186","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":"State Medicaid Body Mass Index Requirements for Solid Organ Transplant Coverage: A 50-State Policy Review","authors":"Samantha B Klitenic,&nbsp;Brigitte Sullivan,&nbsp;Gabriella Boulton,&nbsp;Jennifer McBride,&nbsp;Allan B. Massie,&nbsp;Dorry L. Segev,&nbsp;Macey L. Levan,&nbsp;Babak J Orandi","doi":"10.1111/ctr.70686","DOIUrl":"10.1111/ctr.70686","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Body mass index (BMI) has long served as a screening tool for assessing procedural risk and is used as an exclusion criterion for insurance coverage. Variation in state Medicaid policies, specifically pre-transplant BMI requirements, may affect transplant eligibility and limit access to transplantation. No published literature summarizes these policies. We conducted a 50-state review of Medicaid policies to identify pre-transplant BMI requirements across solid organ transplantation (heart, lung, liver, kidney, pancreas, intestine).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Public records requests were submitted to state Medicaid offices for relevant policy documents. Policies were categorized as: (1) <b>Restrictive</b>: precludes transplant coverage if a specified weight/BMI cutoff is not met; (2) <b>Somewhat restrictive: </b>no explicit BMI requirements but deference to managed care organization (MCO)/transplant center criteria; or (3) <b>Unrestrictive: </b>no BMI requirements or publicly available MCO/transplant center criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three states (HI, IA, and NC) had restrictive policies with pre-transplant weight/BMI requirements for coverage of heart, lung, and combined heart-lung transplants. None applied to kidney, liver, pancreas, or intestine transplants. Thirty-two states and DC had somewhat restrictive policies; 15 had unrestrictive policies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most state Medicaid policies do not contain explicit BMI eligibility requirements for transplant coverage. Instead, BMI-based criteria typically originate from MCOs/transplant centers that establish and enforce their own criteria.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103559","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":"Improved Predictive Capacity of SARS-CoV-2 Seroconversion Using a Model Based on Torque Teno Virus Viral Load","authors":"Eliana Hermida,&nbsp;Noelia Soledad Reyes,&nbsp;Raquel Jara,&nbsp;Natalia Boccia,&nbsp;Máximo Schiavone,&nbsp;Fernando Adrián Poletta,&nbsp;Gustavo Laham,&nbsp;Marcela Echavarria","doi":"10.1111/ctr.70690","DOIUrl":"10.1111/ctr.70690","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Kidney transplant patients (KTPs) exhibit markedly reduced seroconversion rates following SARS-CoV-2 vaccination due to chronic immunosuppression. Torque Teno virus (TTV) viral load has been proposed as a biomarker of immune competence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine the seroconversion rate to SARS-CoV-2 vaccination in KTPs and to develop a predictive model based on TTV viral load.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective observational cohort study was conducted in adult KTPs with complete SARS-CoV-2 vaccination scheme. Anti-Spike IgG antibodies were quantified. TTV viral load was quantified by qPCR. Logistic regression models were developed using TTV viral load alone and with patients’ variables (expanded model). Model performance was assessed using receiver operating characteristic analysis and internal validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seroconversion rate was 16.9% after complete vaccination, 21.9% after one booster and 55.5% after two boosters. TTV viral load alone showed modest predictive capacity for seroconversion (AUC = 0.634). The expanded model significantly improved prediction capacity (AUC = 0.814) with a NPV of 90.0%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pre-vaccination TTV viral load alone is insufficient to predict seroconversion to SARS-CoV-2 vaccination in KTPs. The expanded model improved this predictive capacity when combined with clinical and vaccine related variables reflecting the multifactorial nature of immune competence. Integrative predictive approaches may help optimize vaccination strategies in immunocompromised populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105245","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":"Prioritization and Severe Primary Graft Dysfunction after Lung Transplantation.","authors":"Flávio Pola Dos Reis, Alexandre Mestre Tejo, Samuel Lucas Dos Santos, Flavia Fiuza de Andrade Vale, Victor Arayama Cruz, Luis Gustavo Abdalla, Silvia Vidal Campos, Lucas Matos Fernandes, Paulo Manuel Pêgo-Fernandes","doi":"10.1111/ctr.70711","DOIUrl":"10.1111/ctr.70711","url":null,"abstract":"<p><strong>Background: </strong>Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after lung transplantation (LTx). Critically ill candidates may receive priority on the transplant waiting list; however, the relationship between prioritization and the development of severe PGD remains unclear.</p><p><strong>Methods: </strong>We performed a retrospective analysis of a prospectively maintained cohort including all consecutive LTx performed at a tertiary center between January 2016 and June 2025. Recipients were categorized according to prioritization status. Severe PGD was defined as grade 3 PGD according to the International Society for Heart and Lung Transplantation criteria. Clinical characteristics and outcomes were compared between prioritized and non-prioritized recipients. Logistic regression was used to identify predictors of severe PGD, and survival was evaluated using Kaplan-Meier analysis.</p><p><strong>Results: </strong>Among 310 LTx recipients, 74 (23.8%) were prioritized. They were younger, had a higher prevalence of pulmonary hypertension, and were more frequently hospitalized before transplantation, particularly in the intensive care unit. Severe PGD occurred more often among prioritized recipients (24% vs 7%). However, prioritization was not independently associated with PGD after adjustment. Pre-transplant extracorporeal membrane oxygenation support emerged as the strongest independent predictor of severe PGD. Thirty-day mortality was similar between groups, whereas prioritized recipients had higher 90-day and 1-year mortality.</p><p><strong>Conclusions: </strong>Prioritized LTx recipients have greater pre-transplant clinical severity, higher crude rates of severe PGD, and worse short-term survival. However, prioritization itself was not independently associated with PGD, suggesting that underlying disease severity and need for advanced support are the main drivers of post-transplant outcomes.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70711"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179886","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":"Race-Neutral Glomerular Filtration Rate Projected to Increase Kidney Transplantation for Black Patients: Initial Policy Effects at a Single Center.","authors":"Arianna Cabrales, Kirsten Fernando, Tim Craven, Emily McCracken, Colleen Jay, Giuseppe Orlando, Alan Farney, Christopher Webb, Amber Reeves-Daniel, Natalia Sakhovskaya, Alejandra Mena-Gutierrez, Robert Stratta","doi":"10.1111/ctr.70688","DOIUrl":"https://doi.org/10.1111/ctr.70688","url":null,"abstract":"<p><p>The 2023 organ procurement and transplantation network (OPTN) policy \"Modify waiting time for candidates affected by race-inclusive eGFR calculations\" for kidney transplantation (KT) was analyzed at our kidney transplant center over a 15-month period following its implementation. A total of 372 adult Black patients active on our KT waiting list were identified, of whom 104 (28%) qualified for waiting-time modification (WTM). The WTM group gained a median total waiting time of 2.4 years, with 36 (35%) receiving KTs compared to 107 (42%) in the no wait-time modification (NWTM) group. Pre-listing time, older age, female gender, and A or B blood type was found to increase likelihood of KT in both groups. Despite lower actual transplant rates during the study period, the WTM group is projected to gain a 25% annual probability of transplant for each additional year of qualifying time. Therefore, while the decision to grant WTM has generated some controversy, short-term outcomes at our center suggest that the OPTN policy change has the potential to improve transplant access among Black patients without necessarily disadvantaging those Black patients who do not benefit from WTM. Longer follow-up is required to determine the intended and unintended effects of the race-neutral GFR (rnGFR) and WTM policy changes.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70688"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179869","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}