Clinical Transplantation最新文献

{"title":"Postkidney Transplant Delayed Graft Function Outcomes Are Not Worsened by Deceased Donor Type","authors":"Angela L. Zhou,&nbsp;Suseela Raj,&nbsp;Ekaterina Fedorova,&nbsp;Jacqueline Garonzik-Wang,&nbsp;Didier Mandelbrot,&nbsp;Brad C. Astor,&nbsp;Sandesh Parajuli","doi":"10.1111/ctr.70199","DOIUrl":"https://doi.org/10.1111/ctr.70199","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Kidney-delayed graft function (DGF) is more common in donation after circulatory death (DCD) donors in comparison to donatation after brain death (DBD). We analyzed deceased kidney transplant recipients (DDKTR) at our center between 2005 and 2019, stratified by donor type (DBD vs. DCD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We assessed risk factors for DGF, acute rejection (AR), graft failure (GF), along with the death with functioning graft (DWFG), and the interaction between types of donors for those complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2543 DDKTRs, 804 (32%) were from DCD donors. Older donor age, higher recipient body mass index, and receipt of a depleting induction agent were associated with increased risk for DGF in both DBD and DCD. In contrast, preemptive transplant and female recipient gender were associated with reduced risk. Additional risk factors in DBD, but not in DCD recipients, included higher donor terminal serum creatinine, higher kidney donor profile index, right donor kidney, and prolonged cold ischemia time. Female donors were associated with a reduced risk of DGF only among DCD donors. DGF was associated with higher AR and GF, with no significant differences across donor types, DBD vs. DCD (AR: adjusted hazard ratio [aHR] 2.22 vs. 2.37, p-interaction = 0.65; GF: 3.04 vs. 2.56; p-interaction = 0.47). DGF was associated with a higher risk for DWFG among DBD (aHR: 3.43, 95% CI: 1.96–6.00, <i>p</i> &lt; 0.001) but not with DCD (aHR: 1.90, 95% CI: 0.78–4.61, <i>p</i> = 0.16), with p-interaction of 0.15</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite higher DGF rates in DCD, early adverse outcomes after DGF were similar between deceased donor types and should not deter the utilization of DCD kidneys.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171899","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 Risk Factors for Nontraumatic Osteonecrosis of the Femoral Head in Kidney Transplant Recipients: A Comparison of Two Eras (1985–2000 and 2001–2024)","authors":"Edward Y. Cheng,&nbsp;Arthur J. Matas,&nbsp;Lee Houachee,&nbsp;Alireza Mirzaei","doi":"10.1111/ctr.70198","DOIUrl":"https://doi.org/10.1111/ctr.70198","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Historically, osteonecrosis of the femoral head (ONFH) was a major problem following kidney transplantation, occurring in up to 5%–11% of recipients. The development of new immunosuppressive agents permitted steroid minimization protocols, and consequently, the incidence of ONFH has decreased. We studied ONFH trends over four decades and evaluated risk factors in two immunosuppressive eras, pre- and post-2001.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Steroid minimization protocols at our center started in 2000. We reviewed records of 1st kidney transplants from January 1985 to May 2024 and compared ONFH incidence and risk factors between the two eras: Era 1 (January 1985–December 31, 2000) and Era 2 (January 2001–May 2024). Cox regression was used to assess for independent factors associated with a higher or lower incidence of ONFH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ONFH incidence in Era 1 was 7.2%; Era 2, 1.1% (<i>p</i> &lt; 0.001). In Era 1, increased risk was associated with heavier weight (HR: 1.017, 95% CI: 1.010–1.023, <i>p</i> &lt; 0.001) and mTOR inhibitors (HR: 4.258, 95% CI: 1.726–10.506, <i>p</i> = 0.002); and decreased risk with diabetes (HR: 0.362, 95% CI: 0.270-0.486, <i>p</i> &lt; 0.001), and statins (HR: 0.452, 95% CI: 0.327–0.625, <i>p</i> &lt; 0.001). In Era 2, increased risk was associated with steroid use (HR: 2.096, 95% CI: 1.071–4.100, <i>p</i> = 0.031) and decreased risk with mycophenolate (HR: 0.471, 95% CI: 0.237–0.935, <i>p</i> = 0.032).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The incidence of ONFH in KTRs has dramatically decreased in the modern immunosuppressive era. Diabetes, statin use, and immunosuppressive medications, specifically mTOR inhibitors and mycophenolate, appear to have varying impacts depending on the immunosuppressive era.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171377","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":"Use of Letermovir as Secondary Prophylaxis in Cytomegalovirus Resistant Pediatric Heart Transplant Recipients","authors":"John-Anthony Coppola,&nbsp;Debbie-Ann Shirley,&nbsp;Emily Martin,&nbsp;Varvara Probst,&nbsp;Dipankar Gupta","doi":"10.1111/ctr.70187","DOIUrl":"https://doi.org/10.1111/ctr.70187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cytomegalovirus (CMV) is a prevalent DNA virus that is a well-recognized cause of significant complications in post-transplant recipients. Emergence of CMV resistance to standard antiviral agents poses a substantial challenge for appropriate management post-transplantation. Currently, there are no pediatric heart transplant data on the use of novel agents such as letermovir for the management of resistant CMV infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We present our experience using letermovir in the management of three pediatric heart transplant recipients with CMV infection who developed resistance to standard therapy. Informed consent was not required.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Letermovir was successfully used for secondary prophylaxis in three patients, all with ganciclovir resistant CMV infection due to UL97 mutations, with no evidence of CMV breakthrough infection and no significant side effects observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our experience, letermovir was well tolerated and effective in the management of resistant CMV in pediatric heart transplant recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171418","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":"Transplantation Related Mortality Did Not Show Significant Differences in Patients Aged Above 55 Years With Hematological Malignancies Receiving Allogeneic Hematopoietic Stem Cell Transplantation in a Real-World Study","authors":"Jing Liu,&nbsp;Tingting Han,&nbsp;Haixia Fu,&nbsp;Yuhong Chen,&nbsp;Wei Han,&nbsp;Yao Chen,&nbsp;Yuan-yuan Zhang,&nbsp;Lanping Xu,&nbsp;Yu Wang,&nbsp;Xiaodong Mo,&nbsp;Fengrong Wang,&nbsp;Yuqian Sun,&nbsp;Xiaojun Huang,&nbsp;Xiaohui Zhang","doi":"10.1111/ctr.70192","DOIUrl":"https://doi.org/10.1111/ctr.70192","url":null,"abstract":"<div>\u0000 \u0000 <p>Transplantation related mortality (TRM) remains an issue, particularly in older patients with hematological malignancies. In order to assess the TRM and the feasibility of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in older patients, we collected data from a total of 251 patients aged 55–70 years with acute hematological malignancies who received allo-HSCT from April 19, 2011 to June 28, 2022 in our hospital. With the median follow-up of 637 days, the cumulative incidence of TRM for patients above 55 years on Day 100, 1 year, and 2 years was 6.0%, 21.2%, and 26.7%, respectively. Forty-three (17.1%) patients died of TRM, of whom 11 patients died within 100 days after allo-HSCT, including two due to TMA, two due to aGVHD and TMA simultaneously, one due to capillary leak syndrome, and six due to infection. The cumulative incidence of TRM on Day 100, 1 year, and 2 years between the group aged 55–59 and 60–70 years did not show significant differences. Through a Cox regression analysis, platelet engraftment failure, conditioning regimen, grade 3–4 aGVHD, and cytomegalovirus disease were determined as risk factors for TRM in older patients. In conclusion, allo-HSCT is a feasible option for older patients with hematological malignancies.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 6","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171419","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":"Cover Image, Volume 39, Issue 5","authors":"Mattia Corianò,&nbsp;Nicola Pradegan,&nbsp;Andrea Golfetto,&nbsp;Vincenzo Tarzia,&nbsp;Annalisa Angelini,&nbsp;Antonio Gambino,&nbsp;Chiara Tessari,&nbsp;Marny Fedrigo,&nbsp;Giuseppe Toscano,&nbsp;Gino Gerosa,&nbsp;Francesco Tona","doi":"10.1111/ctr.70204","DOIUrl":"https://doi.org/10.1111/ctr.70204","url":null,"abstract":"<p>The cover image is based on the article <i>Impact of Left Ventricular-Vascular Interaction on Long-Term Outcome After Heart Transplantation</i> by Francesco Tona et al., https://doi.org/10.1111/ctr.70178.\u0000\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144135777","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":"Reply to “Expanding Perspectives on Sarcopenia and Frailty Risk in Heart Transplant Recipients”","authors":"Felipe V. C. Machado,&nbsp;Luis Almenar-Bonet,&nbsp;Trinidad Sentandreu-Mañó,&nbsp;José M. Tomás,&nbsp;Elena Marques-Sule,&nbsp;Pallav Deka,&nbsp;Raquel López-Vilella,&nbsp;Leonie Klompstra,&nbsp;Dominique Hansen","doi":"10.1111/ctr.70194","DOIUrl":"https://doi.org/10.1111/ctr.70194","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126007","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":"Persistence of a High Seroconversion Rate 3.2 ± 0.13 Years After Last COVID-19 Vaccination in Heart Transplant Recipients","authors":"Robin Arcani,&nbsp;Pierre Ambrosi","doi":"10.1111/ctr.70190","DOIUrl":"https://doi.org/10.1111/ctr.70190","url":null,"abstract":"<div>\u0000 \u0000 <p>We previously reported a high level of seroconversion 1 year after COVID-19 vaccination in heart transplant recipients when vaccination was performed several years after transplantation. The aim of this study was to measure the seroconversion rate late after vaccination, in the absence of a new vaccine injection. We included 37 patients vaccinated in 2021. We measured immunoglobulin response using TrimericS Diasorin assay at the last visit between October 2024 and February 2025. We found a seroconversion rate of 95%, 3.2 ± 0.13 years after last COVID-19 vaccination in the absence of new vaccine injection. Most of these patients (73%) had a proven COVID-19 infection since vaccination. Interestingly, none of these patients had a severe form of COVID-19. Thus, vaccination, followed by minor COVID-19 infections, effectively prevented severe forms.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126006","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":"Early Steps of the Kidney Transplant Process: What Are the Experiences of Dialysis Social Workers?","authors":"Macey L. Levan,&nbsp;Katya Kaplow,&nbsp;Max C. Downey,&nbsp;Carolyn N. Sidoti,&nbsp;Rhiannon D. Reed,&nbsp;Kristy Richards,&nbsp;Scott E. Liebman,&nbsp;Elisa J. Gordon,&nbsp;Dianne LaPointe Rudow,&nbsp;Dorry L. Segev,&nbsp;Liise K. Kayler,&nbsp;Carrie Lindower,&nbsp;Laura L. Kimberly","doi":"10.1111/ctr.70182","DOIUrl":"https://doi.org/10.1111/ctr.70182","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Dialysis social workers (DSWs) educate and advocate for end-stage kidney disease (ESKD) patients during the kidney transplantation (KT) process. However, little is known about the barriers DSWs face as they help patients get waitlisted and how to best support their efforts. We interviewed DSWs across New York (NY) State to examine their experiences, supports, and challenges in helping dialysis patients progress through KT education, referral, and evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured interviews with DSWs in NY State who had participated or expressed interest in a program designed to educate DSWs about KT and used rapid qualitative analysis to identify themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>We interviewed 17 DSWs. Seven themes emerged: (1) DSWs report involvement in KT interest assessment, education, referral, and evaluation support, (2) DSWs report varying nephrologist support in helping patients progress to KT, (3) DSWs perceive social support and adherence as key factors in KT centers’ eligibility determinations, (4) DSWs have knowledge gaps around living donation and appreciate learning about KT from transplant centers and non-profit organizations, (5) Patients express KT concerns and DSWs counsel them about these concerns, (6) DSWs report solutions to help patients complete KT evaluation appointments, and (7) DSWs report communication deficiencies between dialysis centers and transplant centers, and patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Education for DSWs, support from nephrologists, and resources to help patients complete KT evaluation steps facilitated DSW engagement throughout the pre-transplant process, underscoring the need for multi-level, cross-disciplinary programs to support these efforts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091647","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":"Participation and Progression of Hybrid Rehabilitation following Lung Transplantation","authors":"Rachel Carson,&nbsp;Carina Cordi,&nbsp;Emma Campisi,&nbsp;Skyler Moss,&nbsp;Alyssa Trask,&nbsp;Kevin Zhu,&nbsp;Chaya Gottesman,&nbsp;Manoela Ferreira,&nbsp;Tamires Mori,&nbsp;Lisa Wickerson","doi":"10.1111/ctr.70185","DOIUrl":"https://doi.org/10.1111/ctr.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Exercise training is recommended to improve physical recovery following lung transplantation (LTx). Since the COVID-19 pandemic, hybrid rehabilitation has emerged utilizing both in-person and home-based exercise. Little is known about exercise participation, progression and intensity with this delivery model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single center retrospective chart review of adult LTx recipients who undertook outpatient rehabilitation within the first 3 months after LTx between December 1, 2022 and February 29, 2024, was conducted. High participation was defined as ≥3 exercise sessions/week for at least 50% of the rehabilitation period. Progression of exercise volumes was examined and walking intensity (Borg leg fatigue scale) was compared between in-person and home rehabilitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 166 LTx recipients were included (70% male, 64 [14] years, 71% interstitial lung disease). High rehabilitation participation was observed in 48% of participants over a mean of 8 ± 2 weeks. The median walking distance, biceps and quadriceps resistance training volumes increased between the first and last recorded rehabilitation sessions during both in-person (536 [538] vs. 1073 [650] m, 40 [20] vs. 60 [55] repxlbs, and 20 [10] vs. 40 [30] repxlbs) and home rehabilitation (968 [991] vs. 1556 [1019] m, 50 [70] vs. 100 [70] repxlbs, and 30 [32] vs. 40 [70] repxlbs), all <i>p</i> &lt; 0.05. Leg fatigue was higher during in-person walking compared to home (3 [3–4] vs. 3 [2–3]), <i>p</i> &lt; 0.001.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Half of LTx recipients had low participation in outpatient and home rehabilitation early after transplantation. Understanding barriers to home exercise participation and reporting will enhance hybrid rehabilitation delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085093","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":"Establishing a Normothermic Machine Perfusion Program for Liver Transplantation: Lessons Learned and Early Outcomes in the United States","authors":"Yuzuru Sambommatsu,&nbsp;Daisuke Imai,&nbsp;Kush Savsani,&nbsp;Mallika Datta,&nbsp;Junpei Tarashi,&nbsp;Jacob Hallesy,&nbsp;Samuel Wolfe,&nbsp;Aamir A. Khan,&nbsp;Seung Duk Lee,&nbsp;Amit Sharma,&nbsp;Muhammad Saeed,&nbsp;Vinay Kumaran,&nbsp;Adrian H. Cotterell,&nbsp;Marlon F. Levy,&nbsp;David A. Bruno","doi":"10.1111/ctr.70170","DOIUrl":"https://doi.org/10.1111/ctr.70170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Normothermic machine perfusion (NMP) has emerged as a promising technology in liver transplantation, but limited data exist regarding real-world implementation in the United States following FDA approval. We report our experience establishing an NMP program and share insights from our first 100 cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 100 consecutive liver NMP cases performed between July 2023 and May 2024 using the OrganOx Metra device. Program establishment required assembling a dedicated team, comprehensive training, establishing a dedicated perfusion facility, coordinating with multiple departments including laboratory, blood bank, electronic medical record vendors, and billing services, and developing institutional viability criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 100 NMP cases, 92 proceeded to transplantation while eight were declined. Early allograft dysfunction occurred in 19 cases (20.7%) with no instances of primary non-function, and 90-day graft survival was 94.6%. No graft losses were directly attributable to NMP. Six grafts showed delayed lactate clearance but achieved successful outcomes with extended perfusion time. We systematically refined our protocols and developed standardized troubleshooting approaches to address various technical challenges including graft bleeding, arterial flow monitoring issues, persistent acidosis, and bile duct drainage issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Successful implementation of an NMP program requires careful preparation, dedicated staffing, and interdepartmental coordination. Although various challenges are expected in the initial phase of the program, these can be successfully managed with a systematic approach. Our experience provides practical guidance for centers planning to establish NMP programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091768","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}