Clinical Transplantation最新文献

{"title":"Heart Transplantation for Amyloid Cardiomyopathy Has Comparable Outcomes With Other Etiologies: The UNOS Database","authors":"Nicholas Steudel,&nbsp;Ilias P. Doulamis,&nbsp;Shivam Rastogi,&nbsp;Aspasia Tzani,&nbsp;Toshiki Kuno,&nbsp;Rabea Asleh,&nbsp;Hilmi Alnsasra,&nbsp;Nikolaos Tepetes,&nbsp;Ahmet Kilic,&nbsp;Dimitrios Avgerinos,&nbsp;Alexandros Briasoulis","doi":"10.1111/ctr.70343","DOIUrl":"10.1111/ctr.70343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>This study aimed to provide updated nationwide data on outcomes in heart transplantation for amyloid cardiomyopathy (ACM) compared with other cardiomyopathy etiologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>United Network for Organ Sharing data for patients over 18 who underwent heart transplant for ACM, and other cardiomyopathies including DCM, ICM, RCM, and CHD were reviewed from 2001 through 2022. The data were analyzed with a propensity score-matched analysis comparing ACM patients with transplant for the cardiomyopathies to measure primary outcomes, including 5-year, 10-year, and all-cause mortality accounting for differences at baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 21 457 heart transplant recipients who met eligibility criteria, there was a 100% increase in the number of heart transplants for ACM from 2010 to 2020 (<i>p</i> &lt; 0.001). The unadjusted mortality did not differ significantly among ACM, DCM, ICM, RCM, and CHD groups, and 5-year mortality was comparable between ACM and DCM patients. ACM patients had a significantly lower incidence of postoperative stroke (<i>p</i> = 0.044), and risk factors for ACM transplant mortality were identified as mechanical ventilation at the time of transplant (HR: 3.8, <i>p</i> = 0.023) and older donor age (HR: 1.1, <i>p</i> = 0.015).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The number of heart transplants for ACM has increased in recent years, and overall outcomes in these ACM transplants have been similar compared to those for other cardiomyopathies. Despite historical concerns regarding poor prognosis and amyloid recurrence, carefully screened ACM patients can benefit from heart transplantation. Further research and optimization of ACM patient eligibility criteria alongside investigation of concurrent adjunctive therapies could optimize treatment of ACM with heart transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250035","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":"Deep Learning-Based MRI Volumetry for Living Kidney Donor Assessment: A New Tool for Predicting Post-Donation Renal Function","authors":"Dominik Thomas Koch,&nbsp;Felix Oliver Hofmann,&nbsp;Dimitrios Trompoukis,&nbsp;Malte Schirren,&nbsp;Severin Jacobi,&nbsp;Tobias Seibt,&nbsp;Stephan Kemmner,&nbsp;Maximilian Scheifele,&nbsp;Matthias Ilmer,&nbsp;Bernhard Renz,&nbsp;Jens Werner,&nbsp;Manfred Stangl,&nbsp;Markus Guba,&nbsp;Dionysios Koliogiannis","doi":"10.1111/ctr.70338","DOIUrl":"10.1111/ctr.70338","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Living kidney donation is a crucial option for addressing the global organ shortage and providing kidney transplantation for patients suffering from end-stage kidney disease. Ensuring donor safety necessitates a comprehensive preoperative assessment of kidney anatomy and function. This study evaluates the relationship between kidney volumes derived from deep learning-based MRI volumetry, intraoperative kidney volume measurements, split renal function measured by renal scintigraphy, and post-donation eGFR. Deep learning-based MRI volumetry is hypothesized to be a reliable method with good correlation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed 178 living kidney donors. Deep learning MRI volumetry-based kidney volumes were compared with intraoperative volumes of the explanted donor kidneys obtained using the water displacement method. Additionally, MRI-based volume ratios were compared with scintigraphy-based split renal function ratios to determine their ability to predict the kidney with poorer renal function and post-donation eGFR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Deep learning-based MRI volumetry strongly correlated with intraoperatively measured kidney volumes (Pearson's correlation; <i>r</i> = 0.7671; <i>p</i> &lt; 0.0001), confirming its precision in volume estimation. Although MRI-based kidney volume ratios demonstrated only a moderate correlation with scintigraphy-based split renal function ratios (<i>r</i> = 0.4798), MRI volumetry correlated with 1-year post-donation eGFR. It tended to be better than renal scintigraphy (<i>r</i> = 0.6829 versus <i>r</i> = 0.6191).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Deep learning-based MRI volumetry is a reliable, non-invasive tool for estimating kidney volumes in living donors, offering a radiation-free alternative for preoperative assessment. While it differs from renal scintigraphy in evaluating split renal function ratios, its correlation with post-donation eGFR tends to be better, supporting its potential role in living kidney donor assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238518","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":"Associated Factors to Nonadherence to Routine Appointments after Kidney Transplantation: The ADHERE Brazil Study","authors":"Roberta Lopes Karlburger,&nbsp;João Henrique Sendrete de Pinho,&nbsp;Fernando Antônio Basile Colugnati,&nbsp;Kris Denhaerynck,&nbsp;José Osmar Pestana Medina,&nbsp;Tainá Veras de Sandes-Freitas,&nbsp;Sabina De Geest,&nbsp;Helady Sanders-Pinheiro,&nbsp;the ADHERE BRAZIL Study Team","doi":"10.1111/ctr.70339","DOIUrl":"10.1111/ctr.70339","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Nonadherence to routine outpatient appointments (NApp) post kidney transplantation (KT) is a poorly studied health behavior associated with unfavorable outcomes. In the ADHERE BRAZIL Study, we previously reported a high prevalence of this behavior (12.7%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objective</h3>\u0000 \u0000 <p>This study aimed to identify the multilevel factors associated with NApp after KT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A cross-sectional study, subproject of the ADHERE BRAZIL Study, was performed. We studied a randomized and multi-stage sample of 1105 patients from 20 transplant centers. Patients who missed one or more of the last five scheduled appointments were considered nonadherent. Multivariate analysis was performed using sequential logistic regression, evaluating 49 multilevel variables, according to the Ecological Model (patient, micro, meso, and macro levels).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most patients were male (58.5%), with a mean age of 47.6 ± 12.6 years. The independent factors associated with NApp were, at the patient level: age (OR 0.97; 95% CI 0.96–0.99; <i>p</i> = 0.001), more than 5 years after KT (OR 2.03; 95% CI 1.38–3.00; <i>p</i> &lt; 0.001), and nonadherence to immunosuppressives (OR 2.41; 95% CI 1.66–3.50; <i>p</i> &lt; 0.001); at the micro level (health professionals): higher scores on the team trust scale (0–100) (OR 0.98; 95% CI 0.95–1.00; <i>p</i> &lt; 0.079), and at the meso level (KT center): frequent (monthly) consultations (OR 1.75; 95% CI 1.10–2.77; <i>p</i> &lt; 0.018) and scheduling difficulties (OR 1.91; 95% CI 1.16–3.17; <i>p</i> &lt; 0.011).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study is the first to examine the association of health system factors with missed appointments after KT. The identified patient factors allow us to recognize patients at risk for NApp. Modifiable variables at the health professional and KT center levels suggest targets for effective interventions aiming to reduce this behavior and improve outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov on 10/10/2013, NCT02066935.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238448","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":"Long-Term Outcomes of BK Viremia in Kidney Transplant Recipients","authors":"Srijan Tandukar,&nbsp;Qufei Wu,&nbsp;Sneha Chandrashekar,&nbsp;Divyash Shah,&nbsp;Chienhui Chiang,&nbsp;Kathryn Couch,&nbsp;Jennifer Trofe,&nbsp;Elizabeth M. Sonnenberg,&nbsp;Peter Abt,&nbsp;Mary Ann Lim,&nbsp;Vishnu Potluri,&nbsp;Roy Bloom","doi":"10.1111/ctr.70333","DOIUrl":"10.1111/ctr.70333","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>BK viremia is associated with worse kidney transplant function and de novo donor-specific antibodies (DSA), but mortality and graft survival are not impacted in the short- and intermediate-term. The long-term impact of BK viremia remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a single-center retrospective study on 1058 consecutive kidney or kidney-pancreas transplant recipients. We classified the cohort based on the presence or absence of BK viremia, BK viral loads, persistence of BK viremia, and pre-existing or de novo DSA. Outcomes included mortality, graft loss, death-censored graft survival (DCGS), estimated glomerular filtration rate, biopsy-proven acute rejection (BPAR), de novo DSA, ureteral stenosis, and genitourinary (GU) malignancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a median follow-up period of 9.7 years, there was no difference in graft loss (<i>p</i> = 0.08) and mortality (<i>p</i> = 0.56). Time-varying multivariable analysis showed no difference in DCGS [HR 1.02, (0.91–1.16)]. Compared to never BK viremic patients, patients with BK viremia had similar graft function at 5 and 10 years (<i>p</i> = 0.09 and 0.65, respectively), rates of GU malignancies (7.0% vs. 5.2%, <i>p</i> = 0.35) and ureteral stenosis (0.8% vs. 0.4%, <i>p</i> = 0.63). Patients with BK viral loads &gt;10 000 copies/mL had a higher risk of de novo DSA [HR 1.71, (1.08–2.68)] and BPAR [HR 2.11, (1.28–3.47)].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BK viremia did not impact mortality, graft loss, kidney function, GU malignancies, and ureteral stenosis over long-term follow-up, but BPAR episodes and development of de novo DSA were higher with viral loads &gt;10 000 copies/mL. Strict monitoring protocols and immunosuppression reduction strategies are effective in minimizing the risk associated with BK viremia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238471","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":"Managing Expectations of Prolonged Warm Ischemia Time: A Calculator to Predict Donation After Circulatory Death Donor Progression to Circulatory Death Within 30 Min","authors":"Yanik J. Bababekov,&nbsp;Carlos Goncalves,&nbsp;Anna H. Ha,&nbsp;Tiffany E. Maksimuk,&nbsp;John S. Malamon,&nbsp;Arthur Yule,&nbsp;David Y. Chen,&nbsp;Jordan R. H. Hoffman,&nbsp;Jesse D. Schold,&nbsp;Elizabeth A. Pomfret,&nbsp;Bruce Kaplan,&nbsp;James J. Pomposelli","doi":"10.1111/ctr.70336","DOIUrl":"10.1111/ctr.70336","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transplant teams may be better prepared to entertain DCD offers with a priori prediction of prolonged warm ischemia time (WIT) and deploy perfusion strategies (PS) to mitigate the risk of WIT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All potential adult Maastricht-III DCDs in one Organ Procurement Organization from January 2016 to July 2024 were reviewed. Data were obtained from UNOS DonorNet. Cases with missing variables were excluded. The most recent clinical values prior to withdrawal of life support treatment (WLST) were utilized. Logistic regression assessed the likelihood of DCD progression within 30 min after WLST.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From a total of 748 potential DCDs, 350 were assessed after exclusion criteria. One hundred and seventy-one (49%) progressed within 30 min. Forty percent (<i>n</i> = 140) of the sample was used for training and 60% (<i>n</i> = 160) for validation. Potassium (OR: 3.01; 95% CI: [1.39, 6.5], <i>p</i> = 0.005), sodium (OR: 1.23; 95% CI: [1.01, 1.50], <i>p</i> = 0.036); body mass index (OR: 1.68; 95% CI: [1.39, 2.03], <i>p</i> = 0.0001) and heart rate (OR: 1.54; 95% CI: [1.24, 1.92], <i>p</i> = 0.0001) positively correlated with progression. Age (OR: 0.71; 95% CI: [0.58, 0.86], <i>p</i> = 0.0006); presence of pupillary reflexes (OR: 0.81; 95% CI:[0.68, 0.92], <i>p</i> = 0.007); presence of corneal reflexes (OR: 0.27; 95% CI: [0.22, 0.34], <i>p</i> = 0.001); and presence of overbreathing the ventilator (OR: 0.39; 95% CI: [0.32, 0.48], <i>p</i> = 0.001) negatively correlated with progression. Discrimination was excellent (NPV 89%; PPV 88%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DonorNet variables predict progression to circulatory death within 30 min. If there is an indication that a DCD will not progress within a 30-min threshold, then early discussion of PS may decrease the risk of a dry run.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231603","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":"Bridging the Gap: A Comparative Analysis of Patients Requiring Mechanical Ventilation or ECMO as a Bridge to Lung Transplant Between Eras","authors":"Sreeja Biswas Roy,&nbsp;Ariba Moin,&nbsp;Artur Rybachok,&nbsp;Mark Shacker,&nbsp;Ashwini Arjuna,&nbsp;Rajat Walia,&nbsp;Samad Hashimi,&nbsp;Jasmine Huang,&nbsp;Michael A. Smith,&nbsp;Ross M. Bremner","doi":"10.1111/ctr.70337","DOIUrl":"https://doi.org/10.1111/ctr.70337","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> BACKGROUND</h3>\u0000 \u0000 <p>We compared trends and outcomes of lung transplant recipients who were bridged to transplantation using mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) during the new Composite Allocation Score (CAS) era or the previous Lung Allocation Score (LAS) era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> METHODS</h3>\u0000 \u0000 <p>The United Network for Organ Sharing database was queried for all adult lung transplant recipients bridged to transplant with MV or ECMO during the LAS (April 5, 2005 to August 3, 2023) or CAS (September 3, 2023 to September 30, 2024) era. Baseline patient characteristics, perioperative outcomes, and short-term survival were compared between eras.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> RESULTS</h3>\u0000 \u0000 <p>A total of 2982 patients were included: 1866 with ECMO-bridge (LAS-ECMO: 1597; CAS-ECMO: 269) and 1116 with MV-bridge (LAS-MV: 1072; CAS-MV: 44). MV-bridge use was higher during LAS than CAS (LAS, 2.9% vs. CAS, 0.8%, <i>p</i> &lt; 0.001), whereas ECMO-bridge was higher in the CAS era (LAS, 4.3% vs. CAS, 5.3%, <i>p</i> = 0.03). Recipient age was higher for both MV-bridge and ECMO-bridge cohorts in the CAS era. Median waitlist times were shorter, and median ischemic time and donor organ travel distances were longer in the CAS era for both MV and ECMO cohorts. Perioperative outcomes and 30-day and 90-day survival were comparable between eras. Waitlist mortality and delisting rates for medical deterioration were lower in the CAS era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> CONCLUSIONS</h3>\u0000 \u0000 <p>Rates of ECMO-bridge to transplant increased in the CAS era compared to the LAS era. Although the donor lung travel distances were longer, perioperative outcomes were comparable to those of the LAS era. Long-term outcomes of BTT candidates in the CAS era remain to be seen.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224326","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":"Association of Sedentary Behavior and Physical Activity With the Risk of Post-Transplant Diabetes Mellitus Among Living Donor Liver Transplant Recipients: A Cross-Sectional Isotemporal Substitution Analysis","authors":"Miyuki Ushio,&nbsp;Kiyoko Makimoto,&nbsp;Kimie Fujita,&nbsp;Satomi Tanaka,&nbsp;Takeo Toshima,&nbsp;Tomoharu Yoshizumi","doi":"10.1111/ctr.70334","DOIUrl":"https://doi.org/10.1111/ctr.70334","url":null,"abstract":"<p>Post-transplant diabetes mellitus (PTDM) affects long-term outcomes in liver transplant recipients (LTRs). While prolonged sedentary time and low physical activity (PA) increase diabetes risk, their association with PTDM among LTRs remains unclear. We investigated the relationship between sedentary behavior, PA, and PTDM while considering their interdependence. We analyzed data from 68 living donor LTRs at a single hospital. Participants wore an accelerometer on their waist for 7 consecutive days to measure sedentary time and PA. PTDM was identified from medical records, and its association with sedentary time was assessed using logistic regression. Isotemporal substitution analysis estimated the effect of substituting sedentary time with PA. The participants’ mean age was 63.4 ± 10.5 years, with a mean time since transplant of 9.0 ± 6.7 years. PTDM was present in 54% of participants, and the odds ratio for PTDM associated with ≥8 h of sedentary time was 1.60 (95% confidence interval [CI], 1.15–1.78, <i>p</i> = 0.015). Replacing 30 min of sedentary time with light-intensity PA lowered the odds to 0.81 (95% CI, 0.70–0.92, <i>p</i> = 0.001), whereas replacing it with moderate-to-vigorous PA reduced the odds to 0.28 (95% CI, 0.09–0.69, <i>p</i> = 0.002). Reducing sedentary time and increasing PA may contribute to the prevention of PTDM in LTRs.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224327","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":"Bridging the Gap to Waitlist Activation: Semaglutide's Weight Loss Efficacy and Safety in Patients With Obesity on Dialysis Seeking Kidney Transplantation.","authors":"Francis G Wade, Krista L Lentine, David Turk, Kyleigh Kirbach, Taylor Knobloch, Mark Schnitzler, Kamran Qureshi, Wing-Kin Syn, Vidya A Fleetwood","doi":"10.1111/ctr.70344","DOIUrl":"https://doi.org/10.1111/ctr.70344","url":null,"abstract":"<p><p>Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated efficacy for weight loss and glycemic control in patients with obesity and type 2 diabetes mellitus, but data are limited for patients with end-stage kidney disease on dialysis. We examined the weight loss efficacy and safety of semaglutide when prescribed to patients on dialysis to improve transplant candidacy and activation status. We conducted a retrospective chart review of 36 patients on dialysis who were prescribed semaglutide through a metabolic clinic between September 2021 and December 2023. Outcomes included weight loss efficacy, safety, and change in waitlist status at 1 year. Patients achieved a mean total body weight loss of 7.8% (SD 6.1). Of patients who were ineligible for transplant due to elevated body mass index, 48.2% achieved waitlist activation after successful weight loss. Treatment-limiting gastrointestinal side effects occurred in 16.7% of patients. Patients on peritoneal dialysis (PD, 30.8%) versus hemodialysis (8.7%) discontinued therapy more frequently. In a single-center cohort, patients who received semaglutide experienced significantly greater weight loss and increased rates of waitlist activation compared with a lifestyle-only intervention. Semaglutide was generally well-tolerated. Prospective studies should examine whether patients on PD experience severe GI side effects more frequently on semaglutide.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":"e70344"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273892","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":"Clinical Utility of Combined Donor-Derived Cell-Free DNA and Peripheral Gene-Expression-Profiling in Heart Transplant Recipients.","authors":"Cathrine M Moeller, Andrea Fernandez Valledor, Daniel Oren, Salwa Rahman, Afsana Rahman, Matthew Regan, Changhee Lee, Adi Hertz, Gal Rubinstein, Julia Baranowska, Boaz Elad, Carolyn Hennecken, Ruben Salazar, Amit Oren, Elena M Donald, Dor Lotan, Kyung T Oh, David Bae, Adil Yunis, David Majure, Melana Yuzefpolskaya, Paolo C Colombo, Jayant K Raikhelkar, Justin A Fried, Ersilia M DeFilippis, Koji Takeda, Kevin J Clerkin, Farhana Latif, Gabriel T Sayer, Nir Uriel","doi":"10.1111/ctr.70340","DOIUrl":"https://doi.org/10.1111/ctr.70340","url":null,"abstract":"<p><strong>Introduction: </strong>Donor-derived-cell-free-DNA (dd-cfDNA) and peripheral-gene-expression-profiling (pGEP) are tools for monitoring heart transplant (HT) recipients for rejection. We aimed to assess the combined utility of dd-cfDNA/pGEP in HT recipients.</p><p><strong>Methods: </strong>We evaluated HT recipients between 2019 and 2023 with a paired dd-cfDNA(AlloSure-AS)/GEP(AlloMap-AM) results (HeartCare-CareDx-CA-USA). Multi-organ-transplant recipients were excluded. Samples were assessed with endomyocardial biopsy <30 days from the day of sample drawn, with rejection defined as ISHLT grade ≥ 1R/1B/pAMR > 0. A positive GEP test score was defined as >30 within 5 months posttransplant and 34 thereafter; a positive dd-cfDNA result was ≥0.12%. Samples were categorized into four groups based on dd-cfDNA/GEP results.</p><p><strong>Results: </strong>Of the 2388 samples (257 patients) included, 1437 samples (60.2%) were (-)dd-cfDNA/(-)GEP, 419 samples (17.5%) were (-)dd-cfDNA/(+)GEP, 375 samples (15.7%) were (+)dd-cfDNA/(-)GEP, and 157 samples (6.6%) were (+)dd-cfDNA/(+)GEP. The median age was 55 years and 27% were females. The median time from HT to sample was 10 months [IQR 5-18]. The median positive AS level was 0.22% [IQR 0.15-0.48]. Twenty-nine percent of the samples had correlated EMB results, mostly in the (+)dd-cfDNA/(+)GEP group (55%), followed by the discordant groups (+)dd-cfDNA/(-)GEP (49%) and (-)dd-cfDNA/(+)GEP (32%), and the (-)dd-cfDNA/(-)GEP group (20%; p < 0.001). Rejection occurred in 7.1% of samples, with the highest rates in the (+)dd-cfDNA/(+)GEP group (15.1%), followed by the (+)dd-cfDNA/(-)GEP (10.9%), (-)dd-cfDNA/(-)GEP (3.8%), and (-)dd-cfDNA/(+)GEP (3.7%) (p < 0.001) groups. The median follow-up time was 29 months [IQR 16-42]. The (+)dd-cfDNA/(+)GEP group demonstrated an increased risk of mortality (HR: 6.1, 95% CI [2.5-14.8]; p < 0.001) compared to (-)dd-cfDNA/(-)GEP group. Similarly the (+)dd-cfDNA/(-)GEP group demonstrated an almost 6-fold risk of mortality (HR: 5.6, 95% CI [1.8-17.5]; p = 0.003).</p><p><strong>Conclusions: </strong>Patients with (+)dd-cfDNA/(+)GEP result were more frequently biopsied and had higher rates of rejection. This group exhibited a six-fold increased risk of mortality and a seven-fold increased risk of mortality at dd-cfDNA thresholds of 0.12% and 0.20%, respectively, compared to the negative concordant group.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":"e70340"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285223","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":"Twenty-Year Kidney Transplant Outcomes With Prednisone-Free Maintenance Immunosuppression: A Matched Control Analysis.","authors":"Lindsey Turner, David M Vock, Erika Helgeson, Raja Kandaswamy, Richard Spong, Timothy Pruett, Erik Finger, Vanessa Humphreville, Srinath Chinnakotla, Andrew Adams, Rasha El-Rifai, Karthik Ramanathan, Arthur J Matas","doi":"10.1111/ctr.70297","DOIUrl":"10.1111/ctr.70297","url":null,"abstract":"<p><p>There has been concern about long-term outcomes of kidney transplant recipients treated with prednisone-free maintenance immunosuppression. We studied 20-year outcomes for recipients treated with discontinuation of prednisone <1 week posttransplant (rapid discontinuation of prednisone [RDP]) compared with contemporaneous matched controls treated with maintenance prednisone (MP). First and second, adult living donor (LD) and deceased donor (DD) kidney transplant recipients from 1999 to 2009, treated with RDP were matched-using data from the Scientific Registry of Transplant Recipients-with contemporaneous controls, from large transplant centers, who were treated with MP. A total of 361 DD recipients treated with RDP were matched with 1805 treated with long-term MP. A total of 763 LD recipients treated with RDP were matched with 2289 treated with long-term MP. DD recipients treated with RDP had significantly better recipient survival (p = 0.02); there was no difference in graft or death-censored graft survival. For LD recipients, there was no difference between groups for all outcomes. Kidney transplant recipients treated with RDP had better or similar long-term outcomes as those treated with long-term MP. RDP should be considered for the majority of kidney transplant recipients.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":"e70297"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12520163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285669","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}