Clinical Transplantation最新文献

{"title":"Renal Function in Sequential Living Kidney-Then-Liver Donors Undergoing Right Lobe Donation: A Two-Center Case Study","authors":"Daisuke Imai,&nbsp;Zachary P. Rokop,&nbsp;Masaya Yokoyama,&nbsp;Amit Sharma,&nbsp;Plamen Mihaylov,&nbsp;John Powelson,&nbsp;Seung Duk Lee,&nbsp;Muhammad I. Saeed,&nbsp;Dhiren Kumar,&nbsp;Asif Sharfuddin,&nbsp;Rachel Holmes,&nbsp;Marco Lacerda,&nbsp;Joel Wedd,&nbsp;Jill M. Bruno,&nbsp;Jordan K. Swensson,&nbsp;David A. Bruno,&nbsp;Chandrashekhar A. Kubal,&nbsp;Vinay Kumaran","doi":"10.1111/ctr.70168","DOIUrl":"https://doi.org/10.1111/ctr.70168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There are concerns regarding the potential impact of living donor hepatectomy on the kidney function of prior kidney donors. The current literature lacks comprehensive data on living liver following living kidney donation. Furthermore, the focus on left lobe donation in the literature does not fully represent the prevalent use of the right lobe graft for living liver transplants in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective chart review on all living liver donors who had previously donated a kidney at two US centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 14 sequential living kidney-then-liver donors. The median donor age was 49 years (range 35–59). Most of these (12 donors) were nondirected donations. The median follow-up period was 24 months (range 1–129). The median interval between the donations was 32 months (range 17–154 months). All donors donated the right lobe with 43.5% (range 31.4%–49.9 %) of remnant liver volume. The overall donor complication rate was 43%, seen in six donors, with one Clavien–Dindo Grade IIIa complication (suture granuloma removal under local anesthesia). Two donors (14%) experienced stage 1 AKI, both resolving with supportive care. A decrease in eGFR greater than 10 mL/min/1.73 m² over the follow-up was observed in only one donor, who gained weight and was lost to follow-up. Compensatory kidney hypertrophy was observed, with kidney volumetry showing an increase of 1.27 (1.09–1.39) times pre- versus post-kidney donation and 1.08 times pre- versus post-liver donation (1.01–1.16).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Right lobe living liver donation in previous kidney donors might be safely performed in terms of midterm kidney function. Longer-term assessment in a larger cohort would be necessary to have better insight into this unique donor group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892851","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":"Comparison of Early Conversion to LCP-Tacrolimus (ENVARSUS XR) to Immediate-Release Tacrolimus in Lung Transplant Recipients","authors":"Tyler C. Lewis,&nbsp;Perry Hotchkis,&nbsp;Adrian Wong,&nbsp;Victoria Lamaina,&nbsp;Emily Fitzpatrick,&nbsp;Avital Stiefel,&nbsp;Juliana Ohanian,&nbsp;Joseph R. Schnier,&nbsp;Melissa Lesko,&nbsp;Darya Rudym,&nbsp;Jake G. Natalini,&nbsp;Luis F. Angel","doi":"10.1111/ctr.70159","DOIUrl":"https://doi.org/10.1111/ctr.70159","url":null,"abstract":"<div>\u0000 \u0000 <p>Tacrolimus is highly effective at preventing allograft rejection and prolonging survival after lung transplantation. However, erratic pharmacokinetics may limit efficacy and predispose to greater adverse effects. We conducted a prospective, open-label trial of lung transplant recipients who underwent early conversion (within 30 days) to LCP tacrolimus (LCPT, <i>n</i> = 40) and compared first-year outcomes to an historical control of patients who remained on immediate-release tacrolimus (IRT, <i>n</i> = 24). Subjects were converted 1:1 from IRT to LCPT. The first dose of LCPT overlapped with the last morning dose of IRT. Conversion to LCPT occurred at a median of 17.5 [IQR 12–25] days. The conversion dose ratio was 1.0 mg:mg [IQR 0.75–1.50] at 14 days. At 1 year, there were no differences between LCPT and IRT in the incidence of biopsy-proven (12.5% vs. 25.0%, <i>p</i> = 0.30) or clinically treated (20.0% vs. 25.0%, <i>p</i> = 0.64) acute cellular rejection. However, the severity of any biopsy-proven rejection was significantly higher in the IRT cohort (27.5% vs. 54.2%, <i>p</i> = 0.03). Although not achieving statistical significance, de novo donor-specific antibodies were more commonly observed in the LCPT group (20.0% vs. 4.2%, <i>p</i> = 0.14). Despite this, the incidence of antibody-mediated rejection (7.5% vs. 0.0%, <i>p</i> = 0.29) and early-onset chronic lung allograft dysfunction (7.5% vs. 9.1%, <i>p</i> = 1.00) were similar. The incidence of chronic kidney disease stage 4 or greater at 1-year was similar (7.5% vs. 12.5%, <i>p</i> = 0.66). In conclusion, early conversion to LCPT was feasible and similarly efficacious to IRT in a cohort of lung transplant recipients.</p>\u0000 <p><b>Trial Registration</b>: ClinicalTrials.gov identifier: NCT04420195</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884214","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":"De Novo Letermovir for Cytomegalovirus Prophylaxis in High-Risk Liver Transplant Recipients","authors":"Hanna L. Kleiboeker,&nbsp;Jillian L. Descourouez,&nbsp;Chris M. Saddler,&nbsp;David Al-Adra,&nbsp;John P. Rice,&nbsp;Margaret R. Jorgenson","doi":"10.1111/ctr.70169","DOIUrl":"https://doi.org/10.1111/ctr.70169","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cytomegalovirus (CMV) drives negative outcomes after liver transplant (LT), with patients having high-risk serostatuses (D+/R−) being especially vulnerable. While valganciclovir (VGC) remains the standard-of-care, letermovir (LTV) represents a promising potential in LT, given the reduced myelosuppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients receiving an LT with high-risk CMV serostatus (D+/R−) June 1, 2021–June 6, 2024 were evaluated. Patients were included in the standard-of-care (SOC) or LTV cohort based on de novo antiviral prophylaxis regimen. The primary objective was the safety and tolerability of VGC compared to LTV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-one patients met inclusion criteria: 35 in SOC and 26 in LTV cohorts. A significantly higher proportion of patients in the LTV cohort completed antiviral prophylaxis (28.6% vs. 80.8%, <i>p</i> &lt; 0.001), with most patients in the SOC cohort experiencing VGC intolerance (71.4%). No patients terminated LTV due to intolerance or breakthrough. Patients in the SOC cohort had lower white blood cell (1.6 vs. 2.75 × 10³ cells/mm3; <i>p</i> &lt; 0.001) and absolute neutrophil (850 vs. 2260 cells/µL <i>p</i> = 0.003) nadir at 6 months. Significantly more patients in the SOC cohort required granulocyte-colony stimulating factor (57.1% vs. 15.4%, <i>p</i> &lt; 0.001). Patients in the LTV cohort tolerated significantly higher doses of mycophenolate through 12 months post-transplant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>De novo LTV for primary prophylaxis after LT appears to be safe and effective. LTV is more likely to be successfully completed than the current SOC and is associated with less myelosuppressive toxicity, which allows maintenance of higher mycophenolate doses. Future studies are needed to evaluate the impact of LTV on rejection rates and transplant outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884217","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":"Rethinking the Diagnosis and Management of Antibody-Mediated Rejection in Multidisciplinary Transplant Meetings: A Global Survey and Banff Working Group Recommendations","authors":"Ruth Sapir-Pichhadze,&nbsp;Medhat Askar,&nbsp;Matthew Cooper,&nbsp;Lynn D. Cornell,&nbsp;Emanuele Cozzi,&nbsp;Darshana M. Dadhania,&nbsp;Fritz Diekmann,&nbsp;Aiko P. J. de Vries,&nbsp;Carrie A. Schinstock,&nbsp;Robert P. Carroll,&nbsp;Ahmad Abdelrehim,&nbsp;Geliang Gan,&nbsp;Yanhong Deng,&nbsp;Sami Alasfar,&nbsp;Serena M. Bagnasco,&nbsp;Ibrahim Batal,&nbsp;Klemens Budde,&nbsp;Marian C. Clahsen-van Groningen,&nbsp;Vanderlene L. Kung,&nbsp;Fritz Lower,&nbsp;Mariana Seija,&nbsp;Edward Kraus,&nbsp;Maarten Naesens,&nbsp;Laurine M. Bow,&nbsp;the Banff Antibody-Mediated Injury Working Group","doi":"10.1111/ctr.70167","DOIUrl":"https://doi.org/10.1111/ctr.70167","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The diagnosis of antibody-mediated rejection (AMR) requires input from several transplant professionals. Bringing clinical and laboratory experts together may help standardize care. Yet, little is known about current global practices of multidisciplinary meetings for AMR management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Banff Antibody-Mediated Injury Working Group approached professional societies worldwide to distribute a survey on the availability, content, participants, perceived value, and barriers to the implementation of multidisciplinary meetings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred two transplant professionals from six continents caring for kidney (90.55%), liver (21.14%), pancreas (20.65%), heart (15.17%), and lung (14.18%) transplant recipients participated in the survey, and 302 (75.12%) reported attending multidisciplinary meetings. Multidisciplinary meetings were more prevalent in academic centers, in high- versus low-to-middle-income regions (81.03% and 65.99%, respectively; <i>p</i> &lt; 0.001), and in mid-to-large size transplant programs compared to smaller programs. Perceived value included continued professional development (97.68%) and trainee education (95.70%). AMR was reported to be discussed at these meetings by 217 respondents with case presentations reviewing patient characteristics, histology, and HLA antibody data. A third of the respondents reviewed non-HLA/pathogenic autoantibodies and/or molecular diagnostics, with the latter being more frequently applied in high- versus low-to-middle-income regions (46.71% and 12.31%, respectively; <i>p</i> &lt; 0.001). AMR case presentations allowed diagnosis revision, actionable management plans and were perceived as improving care. The primary barrier to the implementation of multidisciplinary meetings (63.27%) was the unavailability of transplant professionals (e.g., transplant immunologists).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Facilitating multidisciplinary meetings through the remote participation of pertinent experts and incentivizing participation through remuneration, protected time, or continued medical education may help standardize AMR diagnosis and harmonize its management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884215","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":"Hypothermic Oxygenated Perfusion in Extended Criteria Donor Kidney Transplantation—A Randomized Clinical Trial","authors":"Gerti Dajti,&nbsp;Maria Chiara Vaccaro,&nbsp;Giuliana Germinario,&nbsp;Giorgia Comai,&nbsp;Francesca Caputo,&nbsp;Federica Odaldi,&nbsp;Federica Maritati,&nbsp;Lorenzo Maroni,&nbsp;Vania Cuna,&nbsp;Chiara Zanfi,&nbsp;Francesca Rizzo,&nbsp;Enrico Prosperi,&nbsp;Chiara Bonatti,&nbsp;Guido Fallani,&nbsp;Giorgia Radi,&nbsp;Alberto Stocco,&nbsp;Michele Provenzano,&nbsp;Irene Capelli,&nbsp;Massimo Del Gaudio,&nbsp;Gaetano La Manna,&nbsp;Matteo Ravaioli","doi":"10.1111/ctr.70166","DOIUrl":"https://doi.org/10.1111/ctr.70166","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of machine perfusion after kidney transplantation (KT) in extended criteria donors (ECD) is unclear, and the current evidence in the literature remains controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We present an open-label single center randomized trial where 109 patients undergoing KT with ECD grafts between January 2019 and December 2022 were randomized to receive kidneys treated with either hypothermic oxygenated perfusion (HOPE, <i>n</i> = 54) or static cold storage (SCS, <i>n</i> = 55) alone. The primary endpoint was the incidence of delayed graft function (DGF). The secondary endpoints included postoperative complications and graft function and survival in the first year after KT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The trial failed to meet its primary endpoint. DGF developed in 31 (57%) and 37 (67%) patients in the HOPE and SCS groups, respectively (<i>p</i> = 0.3). Posthoc analysis showed that HOPE was associated with a lower risk for DGF for grafts from donors aged 60 years or older (OR 0.32, 95% CI 0.12–0.87, <i>p</i> = 0.026) and in patients undergoing dual KTs (OR 0.22, 95% CI 0.06–0.87, <i>p</i> = 0.031).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HOPE does not reduce the rate of DGF after KT in ECD donors. However, HOPE appears to be associated with better outcomes in the case of older donors and dual KTs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884216","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":"Concurrent Apixaban With Itraconazole or Posaconazole Pharmacokinetic and Clinical Outcome Evaluation in Cardiothoracic Transplant Recipients","authors":"Kennedy Concannon,&nbsp;Rachel Huntsman,&nbsp;Kristin Cole,&nbsp;Cassie Kennedy,&nbsp;Andrew Rosenbaum,&nbsp;Adley Lemke","doi":"10.1111/ctr.70165","DOIUrl":"https://doi.org/10.1111/ctr.70165","url":null,"abstract":"<div>\u0000 \u0000 <p>Itraconazole and posaconazole are frequently prescribed following transplantation to prevent and treat fungal infections. Navigating drug interactions is challenging due to these agents’ potent CYP3A4 inhibition, and literature describing concurrent apixaban, a CYP3A4 substrate, is limited. This retrospective study of cardiothoracic transplant recipients evaluates the impact of itraconazole and posaconazole on apixaban exposure and reports clinical outcomes from routine apixaban dose reduction. Institutional practice reduces apixaban to 2.5 mg twice daily with itraconazole or posaconazole and obtains apixaban therapeutic drug monitoring (TDM), expected range 34–230 ng/mL. Eighteen levels collected in 15 patients on itraconazole displayed a median [IQR] apixaban trough of 143 ng/mL [95–195]. Fifteen levels collected in 13 patients on posaconazole displayed a median [IQR] apixaban trough of 124 ng/mL [93–174]. Two major bleed events, three VTE, two stroke, and eight instances of clot resolution were identified. Reduced-dose apixaban resulted in apixaban exposure similar to normal dosing in the general population. Apixaban TDM is encouraged for individualized dosing when administered with itraconazole and posaconazole.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884211","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":"Geographic Variation Exists in Heart Transplantation for Status One and Two Patients After the 2018 Heart Allocation Policy Change","authors":"Kavya Rajesh,&nbsp;Mohamed Hassanein,&nbsp;Sameer Singh,&nbsp;Yanling Zhao,&nbsp;Yuji Kaku,&nbsp;Paul Kurlansky,&nbsp;Farhana Latif,&nbsp;Gabriel Sayer,&nbsp;Nir Uriel,&nbsp;Koji Takeda","doi":"10.1111/ctr.70164","DOIUrl":"https://doi.org/10.1111/ctr.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The heart transplant allocation policy change in 2018 was intended to help ameliorate differences in waiting times for heart transplantation across UNOS regions. We sought to examine the regional variability in waitlist times and post-transplant outcomes since these changes were implemented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The adult patients in the United Network for Organ Sharing registry from October 2018 to December 2022 were included. Regional trends in waitlist time, waitlist events, and post-transplant outcomes were assessed. Differences in regional variability of successful transplantation over years since policy change were described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 8029 patients were included. The cumulative incidence of successful transplant after 30 days was significantly different across regions (<i>p</i> &lt; 0.001). There was no difference in 30-day post-transplant mortality across regions. In each year since the policy change, there continues to be a significant difference in the lowest and highest cumulative incidence of successful transplant at 30 days across regions using difference of difference analysis, suggesting regional variation has not improved over time (<i>p</i> = 0.49).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Since the allocation policy change, there continues to be significant variation in time to successful transplantation across geographic regions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871854","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":"Lung Transplantation From Donors With a History of Substance Use","authors":"David Li,&nbsp;Justin Weinkauf,&nbsp;Alim Hirji,&nbsp;Jason Weatherald,&nbsp;Rhea Varughese,&nbsp;Laura van den Bosch,&nbsp;Dale Lien,&nbsp;Jayan Nagendran,&nbsp;Kieran Halloran","doi":"10.1111/ctr.70162","DOIUrl":"https://doi.org/10.1111/ctr.70162","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Substance use is common among lung transplant donors, but concerns persist about graft damage. Stimulant drugs such as cocaine and methamphetamine can induce pulmonary arterial hypertension, while smoked products such as cannabis and crack cocaine can produce airway and parenchymal diseases. We sought to characterize donor substance use at our center and evaluate the associations with recipient survival as well as chronic lung allograft dysfunction (CLAD), severe primary graft dysfunction (PGD3), and baseline lung allograft dysfunction (BLAD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied patients with double lung transplants in our program between 2004 and 2016, including a history of donor substance use with nine pre-specified agents. We modeled the association with time to death or retransplant, CLAD, severe PGD, and BLAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 473 recipients, 186 (39%) received lungs from a donor with a history of substance use with at least one of the pre-specified substances. There was no overall relationship between donor substance use and any outcome. Heavy donor smoking was associated with an increased risk of death or retransplant (hazard ratio 1.47; <i>p</i> = 0.032), PGD3 (odds ratio [OR]: 2.13; <i>p</i> = 0.014), and BLAD (OR 2.56; <i>p</i> &lt; 0.001). Donor crack cocaine use (<i>n</i> = 24) was also associated with worse survival (HR 2.16; 95% CI 1.16–3.66; <i>p</i> = 0.017) but not CLAD or BLAD. We noted no CLAD associations with any drug.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A history of donor substance use was common and in general not associated with worse outcomes, aside from heavy donor smoking. These findings may have implications for allocation and post-transplant graft dysfunction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871613","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":"(Pro)renin, Erythropoietin, Vitamin D and Urodilatin Release From Human Donor Kidneys During Normothermic Machine Perfusion: Predictors of Early Post-Transplant Outcome?","authors":"Hui Lin,&nbsp;Karim Bousnina,&nbsp;Julia S. Slagter,&nbsp;Yitian Fang,&nbsp;Iacopo Cristoferi,&nbsp;Ingrid M. Garrelds,&nbsp;A. H. Jan Danser,&nbsp;Marlies E. J. Reinders,&nbsp;Robert C. Minnee,&nbsp;Martin J. Hoogduijn","doi":"10.1111/ctr.70163","DOIUrl":"https://doi.org/10.1111/ctr.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Human donor kidneys release (pro)renin, erythropoietin (EPO), active vitamin D, and urodilatin during normothermic machine perfusion (NMP). However, whether the endocrine function of donor kidneys is associated with post-transplant kidney function is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied 28 donor kidneys, including seven from donation after brain death (DBD) donors and 21 from donation after circulatory death (DCD) donors. Prior to transplantation, we measured levels of (pro)renin, EPO, 1,25(OH)₂D in the perfusate, and urodilatin in urine during NMP. Hormone release rates were compared between kidneys with and without delayed graft function (DGF), and correlations were assessed between hormone release rates and donor characteristics and transplant outcome, including DGF duration, serum creatinine levels at 1-week post-transplant, and estimated glomerular filtration rate at 1-month post-transplant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>DBD kidneys secreted significantly less EPO and more active vitamin D than DCD kidneys. Kidneys with DGF exhibited significantly higher release rates of active vitamin D and lower release rates of urodilatin compared to those without DGF. In addition, EPO release rate was positively correlated with serum creatinine levels at 1-week post-transplant. Finally, urodilatin release rates were negatively correlated with DGF duration and positively correlated with urine output.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Urodilatin release in urine and EPO and active vitamin D release in perfusate during NMP may serve as potential biomarkers for predicting early post-transplant outcomes.</p>\u0000 \u0000 <p><b>Trial Registration</b>: ClinicalTrials.gov identifier: NCT04882254</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871614","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":"Expanding Perspectives on Sarcopenia and Frailty Risk in Heart Transplant Recipients","authors":"Lien-Chung Wei,&nbsp;Hsien-Jane Chiu","doi":"10.1111/ctr.70120","DOIUrl":"https://doi.org/10.1111/ctr.70120","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861474","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}