Clinical Transplantation最新文献

{"title":"Are We Winning at Twinning? Persistent CNI Use in Identical Kidney Transplants.","authors":"Nicholas S Herrera, Shivani Wadnerkar, Diane M Cibrik","doi":"10.1111/ctr.70661","DOIUrl":"10.1111/ctr.70661","url":null,"abstract":"<p><strong>Background: </strong>Calcineurin inhibitors (CNIs) revolutionized kidney transplantation by reducing acute rejection rates. Identical twin kidney transplantation is the only setting in which the allograft is immunologically indistinguishable from self, yet CNI use persists. We characterized CNI utilization across end-stage kidney disease etiologies and examined whether CNI exposure was associated with reduced rejection or improved death-censored graft survival (DCGS).</p><p><strong>Methods: </strong>We performed a retrospective cohort study using scientific registry of transplant recipients data (January 2000-August 2025). Among 255 adult identical twin kidney transplant recipients, discharge regimens were categorized by CNI use; Firth penalized Cox regression was the primary method for 10-year DCGS.</p><p><strong>Results: </strong>Among recipients, 129 (50.6%) received a CNI at discharge with no decline over 25 years and use across every etiology, including glomerulonephritis (53.6%), cystic disease (80.0%), diabetes (51.8%), and hypertension (50.0%), several of which carry no recurrence or immunologic rationale. No biopsy‑proven rejections occurred within the first year. CNI use was not associated with improved DCGS in the full cohort (HR, 1.67; 95% CI, 0.72-4.13; P = 0.234) or the glomerulonephritis subgroup (log-rank P = 0.582).</p><p><strong>Conclusion: </strong>Half of U.S. identical twin kidney transplant recipients receive CNIs at discharge, with no utilization decline over 25 years. This practice is not supported by measurable reductions in rejection or improved graft survival and warrants clinical re-evaluation.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":"e70661"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812082","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":"Characteristics and Progression of Rehabilitation in Patients Undergoing Extracorporeal Membrane Oxygenation: A Retrospective Study.","authors":"Woo Chul Son, Hyeon Jeong Moon, Eun Young Choi, Jee Hwan Ahn, Dong-Gon Hyun, Roo Ma Lee, Hyo Jin Lim, Young Hoon Mo, Sang-Bum Hong, Won Kim","doi":"10.1111/ctr.70662","DOIUrl":"10.1111/ctr.70662","url":null,"abstract":"<p><strong>Objectives: </strong>Early rehabilitation during extracorporeal membrane oxygenation (ECMO) support is increasingly implemented, yet real-world data describing rehabilitation progression remain limited. This study aimed to characterize rehabilitation patterns during ECMO and descriptively compare physical activity trajectories among patients managed as bridge to transplantation (BTT), bridge to recovery (BTR), and ECMO waitlist death (EWD).</p><p><strong>Methods: </strong>Adult patients (≥18 years) admitted to a medical ICU between May 2018 and November 2023 who received ECMO for ≥24 h and participated in at least one active rehabilitation session were retrospectively analyzed. Rehabilitation candidacy, weekly rehabilitation frequency, session interruptions, and highest physical activity level were recorded. Between-group comparisons were exploratory.</p><p><strong>Results: </strong>A total of 111 patients were included. In ECMO week 1, 58% of rehabilitation candidates received active rehabilitation, increasing to approximately 80% during weeks 2-4. Most patients completed or discontinued rehabilitation within 4 weeks because of transplantation, clinical recovery, or deterioration. Weekly rehabilitation frequency differed among groups and was highest in the BTT group (mean, 4.2 sessions/week; p < 0.05). Other activity-level comparisons among groups were not statistically significant. Sitting-level activities were consistently achievable during ECMO support, including support beyond 4 weeks. Among ICU survivors, activity levels were maintained through decannulation and improved afterward.</p><p><strong>Conclusions: </strong>Among selected patients who entered an active ECMO rehabilitation pathway, rehabilitation was commonly initiated within 2 weeks and completed or discontinued within 4 weeks. Edge-of-bed sitting was generally achievable throughout ECMO support.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":"e70662"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812120","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":"HLA-A, -B, and DR Mismatch and Outcomes After Simultaneous Pancreas-Kidney Transplantation in the Modern Era.","authors":"Moksh Sachdeva, Samuel Tingle, Georgios Kourounis, Abdullah Malik, Emily Thompson, Steve White, Neil S Sheerin, Colin Wilson","doi":"10.1111/ctr.70653","DOIUrl":"10.1111/ctr.70653","url":null,"abstract":"<p><strong>Background: </strong>HLA mismatch is known to impact post-transplant outcomes following kidney-alone transplantation. However, the impact on kidney outcomes in the context of simultaneous pancreas-kidney (SPK) transplantation remains uncertain. This study aimed to assess the impact of HLA mismatch on SPK outcomes.</p><p><strong>Method: </strong>Adult SPK recipients in the UNOS STAR registry (2010-2023) were analysed. Re-transplants were excluded. Multivariable nonlinear regression models evaluated the impact of HLA mismatch on outcome.</p><p><strong>Results: </strong>In a cohort of 10,559 SPK recipients overall mismatch was frequent, with only 34 recipients (0.3%) having 0/0/0 mismatches across HLA-A, HLA-B, and HLA-DR. HLA-DR mismatch was not associated with pancreas or kidney graft survival at 5 years; two versus zero HLA-DR mismatches aHR = 1.015 (95% CI 0.828-1.243) for pancreas graft survival, and aHR = 0.946 (0.753-1.188) for kidney graft survival. HLA-DR mismatch was also not associated with pancreas or kidney acute rejection or 12-month eGFR. HLA-A and HLA-B mismatches also showed no association with any pancreas or kidney transplant outcomes. Three-way interaction analyses between HLA-A, B and DR demonstrated no evidence that mismatch at any locus affected outcomes, irrespective of mismatch level at the other loci.</p><p><strong>Conclusion: </strong>In first-time simultaneous pancreas-kidney transplantation, donor-recipient HLA mismatch was not associated with pancreas or kidney graft survival, rejection, or early renal function. These findings contrast with kidney-alone transplantation and suggest that classical HLA mismatch effects may be attenuated in the contemporary SPK setting. Prioritising HLA-based matching, including HLA-DR, is therefore unlikely to improve short- or medium-term post-transplant outcomes in first-time SPK transplantation.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":"e70653"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812141","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":"ISOT Position Statement on Immunological Evaluation in Kidney Transplantation","authors":"Manish R. Balwani,&nbsp;Anil Kumar,&nbsp;Vivek B. Kute,&nbsp;Khushboo Saxena,&nbsp;Pranjal Kashiv,&nbsp;Jigar Shrimali,&nbsp;Subho Banerjee,&nbsp;Divyesh P. Engineer,&nbsp;Sanjay Kumar Agarwal,&nbsp;Sanjay Kolte,&nbsp;Amit Pasari,&nbsp;Feroz Aziz,&nbsp;Pratik Das,&nbsp;Umapati Hegde,&nbsp;Deepak S. Ray,&nbsp;Dhananjai Agarwal,&nbsp;Sourabh Sharma,&nbsp;Amol Bhawane,&nbsp;Narayan Prasad,&nbsp;Arpita Ray Chaudhury,&nbsp;Sreebhushan Raju,&nbsp;Shruti Tapiawala,&nbsp;Vikas Jain,&nbsp;Debasis Das,&nbsp;Vrushali Deshpande,&nbsp;Vishal Ramteke,&nbsp;Ashish Sharma,&nbsp;Anil K. Bhalla,&nbsp;Sandeep Guleria,&nbsp;Georgi Abraham,&nbsp;Vishal Parmar,&nbsp;Sakthi Selvakumar,&nbsp;Suraj M. Godara,&nbsp;Kapil Gothwal,&nbsp;Sanshriti Chauhan,&nbsp;Hari Shankar Meshram","doi":"10.1111/ctr.70631","DOIUrl":"10.1111/ctr.70631","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Immunological evaluation plays a central role in kidney transplantation, guiding donor selection, risk assessment, and graft outcomes. Although international guidelines are comprehensive, applying them in a real-world low resource setting can be challenging where laboratory capacity varies and access to advanced testing is limited. There is therefore a need for implementable guidelines that reflect local realities while maintaining clinical rigor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Indian Society of Organ Transplantation (ISOT) brought together a multidisciplinary panel of transplant nephrologists, surgeons, clinical immunologists, and histocompatibility laboratory scientists from centers across India. A focused review of international guidelines, systematic reviews, and key studies was undertaken. Draft recommendations were developed and shared ahead of a structured consensus meeting. These were discussed, refined, and finalized through iterative expert deliberation. Recommendations were classified as “Recommended” or “Suggested” based on consensus, and their evidentiary basis was clearly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 48 consensus recommendations were developed across 13 thematic areas covering key aspects of immunological evaluation. These included immunological risk assessment, antibody screening and crossmatch testing including virtual crossmatch, sensitization assessment, serum sampling and waitlist monitoring, HLA typing, post-transplant monitoring, laboratory governance and immunological assessment in ABO-incompatible transplantation. Of these, 23 were “Recommended” and 25 “Suggested.” Additional guidance focused on resource-adapted and cost-conscious approaches suited to the Indian context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These recommendations offer a practical and standardized framework for immunological evaluation in kidney transplantation within low- and middle-income settings. Their adoption has the potential to improve patient safety and optimize graft outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629448","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":"Outcomes After 4-Week Course of Sofosbuvir/Velpatasvir Therapy in Hepatitis C Seronegative Recipients of Kidneys From Hepatitis C Viremic Deceased Donors","authors":"Basheer Ahamad Kummangal,&nbsp;Madelaine Hack,&nbsp;Sri Abirami Selvam,&nbsp;Christopher Connelly,&nbsp;Justin Smith,&nbsp;Jay Pandav,&nbsp;Angelo de Mattos,&nbsp;Long Do,&nbsp;Aaron Ziolko,&nbsp;Domenica McKenna,&nbsp;Shehzad Rehman","doi":"10.1111/ctr.70629","DOIUrl":"https://doi.org/10.1111/ctr.70629","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Kidney transplantation from hepatitis C virus (HCV) viremic deceased donors into HCV seronegative recipients helps to expand the donor pool. The optimal duration of direct acting antiviral (DAA) prophylaxis remains undefined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective review of all HCV seronegative adults who received a kidney transplant from an HCV nucleic acid test (NAT) positive deceased donor at the VA Portland Medical Center between September 2017 and March 2025 and were treated with sofosbuvir/velpatasvir (SOF/VEL) prophylaxis for 28 days postoperatively. The primary outcome was sustained virologic response 12 weeks after completion of prophylaxis (initial SVR12). Secondary outcomes at 1 year included HCV treatment success rate, biopsy proven acute rejection (BPAR), delayed graft function (DGF), eGFR, liver enzyme abnormalities, CMV and BK viremia, adverse events, and all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty patients were included. The mean age was 62.8 ± 10.9 years, 92% were male, mean EPTS was 63.7 ± 29.2 and mean KDPI was 59.8 ± 19.6. Initial SVR12 after completion of prophylaxis was achieved in 46/50 (92%), out of which 2 patients had their SOF/VEL prophylaxis extended to 12 weeks because of transient viremia. Four patients (8%) failed prophylaxis and required HCV treatment with all achieving SVR (100% overall SVR). DGF occurred in 16%, BPAR in 12%, CMV viremia in 18%, and BK viremia in 16%. Mean 1-year eGFR was 57.7 ± 18.7 mL/min/1.73 m². No DAA attributable adverse events were recorded. One-year all-cause mortality was 2% (1/50) and was unrelated to HCV or DAA. Older age (72.3 ± 4.0 vs. 62.0 ± 11.0 years, <i>p</i> = 0.030) and higher Estimated Post Transplant Survival (EPTS) scores (86.5 ± 19.1 vs. 61.8 ± 29.3, <i>p</i> = 0.041) correlated significantly with prophylaxis failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A 4-week SOF/VEL prophylaxis regimen coupled with HCV RNA surveillance and treatment appears to be safe and effective in a Veterans Affairs population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148617263","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":"Keeping Our Promise: Expedited Allocation for Prior Living Kidney Donors and Trends in Waiting Times According to Race","authors":"Syed Saad Mujtahedi,&nbsp;Emily McCracken,&nbsp;Chris Webb,&nbsp;Oliver Whittington,&nbsp;Alan Farney,&nbsp;Giuseppe Orlando,&nbsp;Vince Casingal,&nbsp;Robert J. Stratta,&nbsp;Colleen Jay","doi":"10.1111/ctr.70618","DOIUrl":"https://doi.org/10.1111/ctr.70618","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Risks of kidney failure among prior living kidney donors (LKDs) are low, but an updated analysis of the impact of donor allocation priority on waiting times accounting for allocation changes and race has not been documented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using national UNOS data, we compared transplant rates, waiting time, and time on dialysis for prior LKDs with matched controls.  Waiting time was calculated based on initial registration and end waitlist date.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Transplant rate was 86.2 per 100 person years for LKD and 20.4 for matched controls (<i>p</i> &lt; 0.001) corresponding to 83% of prior LKDs transplanted compared to 50% of matched controls (<i>p</i> &lt; 0.001).  Median waiting time was 93 (27–371) days in the LKD group versus 692 (233–1351) days in the matched control group (<i>p</i> &lt; 0.001). LKD waiting time pre- and post-implementation of the “new” Kidney Allocation System (KAS) was 133 (42–516) versus 67 (19–226) days, (<i>p</i> &lt; 0.001). For LKDs, 56% were on dialysis prior to listing and 61% prior to transplant compared to 66% and 82% in controls, (both <i>p</i> &lt; 0.001). Time on dialysis among LKDs post-KAS was comparable (pre-KAS: 547 (259–1352) versus post-KAS: 461 (231–942) days, <i>p</i> = 0.06). Waiting times were comparable according to race and ethnicity, but Black LKDs were more often on dialysis at the time of listing (Black 61% vs. white: 52%, <i>p</i> = 0.02), and time on dialysis was 36% (+155 days) longer in Black versus white LKDs (<i>p</i> = 0.0002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LKD allocation priority results in a higher transplant rate and significant reduction in waiting time compared to matched controls, which improved post-KAS 2014.  Concerning, more than half of LKDs are on dialysis prior to listing and transplant with no substantial improvements in the post-KAS era.  Black LKDs experience lower transplant rates, 36% longer dialysis time compared to white LKDs, and are more likely to be on dialysis prior to listing and transplant.  Improved monitoring of LKDs and earlier transplant referrals are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616643","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 Experience of Oral Serum-Derived Bovine Immunoglobulin in Solid Organ Transplant Recipients Diagnosed With Norovirus Infection","authors":"Nicole M. Ondrush,&nbsp;Meenakshi Rana,&nbsp;Gopi Patel,&nbsp;Rachel Chasan,&nbsp;Timothy Sullivan","doi":"10.1111/ctr.70630","DOIUrl":"https://doi.org/10.1111/ctr.70630","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Norovirus gastroenteritis can cause serious complications in solid organ transplant (SOT) recipients, and no licensed treatment is available. Typical therapy is supportive care; however, some medications may be used off-label. Serum-derived bovine immunoglobulin (IG), a medical food product, has been utilized off-label for norovirus gastroenteritis, although clinical efficacy is uncertain. The objective of this study was to evaluate the outcomes of SOT recipients who received serum-derived bovine IG for the treatment of norovirus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult SOT recipients, who received serum-derived bovine IG as treatment for norovirus between January 2020 and December 2024, were evaluated for inclusion. Outcomes evaluated included improvement in the number of bowel movements to less than three per day, presence of more formed bowel movements, presence of acute kidney injury (AKI), initial response rates, and 90-day relapse-free rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>14 SOT recipients were included. Nine patients had a history of prior norovirus gastroenteritis. Reduction to less than three bowel movements per day occurred in 8/14 (57%) patients. Overall, 12/14 (86%) patients experienced clinical improvement after a median of 4.5 days of serum-derived bovine IG. Of those alive at 90-day follow-up, 8 of 10 (80%) did not experience relapsing norovirus infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Orally administered serum-derived bovine IG may be a potential option for SOT recipients with chronic norovirus infection. Larger, well-designed studies are needed to further define its clinical efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616644","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":"Planning Intermittent CalciNeurin Inhibitor Controls—The piCNIc Retrospective Cohort Study","authors":"Veronica Bellissimo,&nbsp;Lilia Tran,&nbsp;Gaëlle Bernard-Tessier,&nbsp;Jean-Simon Denault,&nbsp;Sarah Pelletier,&nbsp;Andreea-Adelina Statie,&nbsp;Nathalie Letarte,&nbsp;Geneviève Huard,&nbsp;Julie Morisset,&nbsp;Victor Ferreira","doi":"10.1111/ctr.70633","DOIUrl":"https://doi.org/10.1111/ctr.70633","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Calcineurin inhibitors (CNIs) are essential in immunosuppressive therapy after solid organ transplantation (SOT). Their narrow therapeutic index and inter- and intra-individual variability require therapeutic drug monitoring (TDM), but optimal monitoring frequency remains unclear. This retrospective observational cohort study evaluated the impact of a pharmacist-developed protocol to standardize and reduce CNI monitoring frequency on the number of CNI measurements, the achievement of CNI TDM target, and resource utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data was collected retrospectively from adult liver, kidney, and lung transplant patients hospitalized between February 1 and July 31 of 2023 and 2024 at the Centre Hospitalier de l'Université de Montréal (CHUM). CNI measurements per patient per week, prescription quality and patient safety were compared before and after the protocol's implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>520 hospitalizations were included (254 pre- and 266 post-intervention hospitalizations). Primary analysis showed an adjusted mean reduction of 0.9950 CNI measurements per patient per week (95% CI, 0.6398 to 1.3502; <i>p</i> &lt; 0.0001), corresponding to a 14.0% decrease. Secondary analysis revealed no significant differences in achieving CNI TDM target or dose adjustments between groups. CNI-related adverse effects were similar in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The development and implementation of a new protocol by pharmacists to standardize and reduce the frequency of CNI monitoring significantly decreased the number of CNI measurements per hospitalized patient, without compromising the achievement of CNI TDM target or patient safety. This approach highlights a valuable strategy for hospitals to manage costs effectively amidst increasing financial pressures without affecting patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70633","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616551","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":"Graft Outcomes in For-Cause Biopsy-Proven Recurrent IgA Nephropathy After Kidney Transplantation: Rare but Clinically Meaningful","authors":"Pitchamon Inkong,&nbsp;Erik L. Lum,&nbsp;Kara Kim,&nbsp;Ishreen Dhaliwal,&nbsp;Jonathan E. Zuckerman,&nbsp;Suphamai Bunnapradist","doi":"10.1111/ctr.70620","DOIUrl":"10.1111/ctr.70620","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Recurrent IgA nephropathy (IgAN) after kidney transplantation has been reported in up to 20%–60% of recipients, through incidence varies by surveillance strategy. We aimed to define the incidence and clinical impact of biopsy-proven recurrence IgAN in a single center cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed retrospective review of renal allograft biopsies performed at UCLA between 2020 and 2025. A total of 1474 patients underwent kidney allograft biopsies for clinical reasons. 40 patients had biopsy-proven recurrent IgAN and were included in analysis. Clinical, laboratory and histopathologic features at recurrence were analyzed for association with graft failure using Kaplan-Meier. Time-to event analyses were performed using Cox regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Biopsy-proven recurrent IgAN was identified in 40 of 1474 for-cause biopsy recipients (2.7%). Graft failure occurred in 10 of 40 patients (25.0%) over a median follow-up of 5.57 years. Median time from recurrence to graft failure was 2.46 years. Graft loss was attributed primarily to recurrent IgAN in 7 patients (70.0%) and associated with rejection in 3 (30.0%). IFTA &gt;50% was the only significant predictor of graft failure (HR 4.00, 95% CI 1.12–14.27; <i>p</i> = 0.03). Rising creatinine, proteinuria, hematuria, Asian race, and C3 bright deposition showed non-significant trends toward worse graft survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this for-cause biopsy cohort, clinically detected recurrent IgAN was associated with meaningful graft loss. Severe chronic injury at recurrence identified patients with poorer prognosis, although this likely reflects advanced nonspecific allograft damage rather than a recurrence-specific mechanism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 7","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560955","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":"Center Differences in PreTransplant Functional Status and Its Association With Survival After Heart Transplantation","authors":"Myna Tirupattur,&nbsp;Wendy Wang,&nbsp;Aliba Syed,&nbsp;Don Hayes Jr,&nbsp;Dmitry Tumin","doi":"10.1111/ctr.70622","DOIUrl":"https://doi.org/10.1111/ctr.70622","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Karnofsky Performance Scale (KPS) is widely used to assess functional status in heart transplantation (HT) candidates and inform risk stratification. However, its subjective nature raises questions about the consistency and prognostic value of KPS scoring across centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed adult patients undergoing first-time single-organ HT from November 2018 to June 2024 in the United Network for Organ Sharing database. Patients with prior transplants, multi-organ transplants, missing data, or loss to follow-up before 1 year were excluded. KPS at transplantation was analyzed continuously and categorized as low (0–30), medium (40–70), or high (80–100). Hierarchical linear and logistic regression models with center-level random effects were used to assess variability in KPS assignment and the association between KPS and 1-year posttransplant mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 13 726 patients, median KPS at transplantation was 30 (IQR 20–50), and 60% were in the low range. Adjusted hierarchical linear models showed 28% (95% CI 22%–33%) of KPS variance was attributable to differences between centers. KPS was not associated with 1-year mortality (OR 1.00, 95% CI 0.99–1.00; <i>p</i> = 0.564), and no between-center heterogeneity in this association was detected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>KPS exhibits substantial center-level variability and is not associated with 1-year mortality in heart transplantation, suggesting caution in using KPS for short-term risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 7","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467673","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}