Clinical Transplantation最新文献

{"title":"Erector Spinae Plane Block Versus Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Kidney Transplantation: A Prospective Randomised Controlled Trial","authors":"Tahsin Simsek,&nbsp;Ozlem Sezen,&nbsp;Melis Sen,&nbsp;Buse Celik,&nbsp;Hasan Fehmi Kucuk,&nbsp;Banu Cevik","doi":"10.1111/ctr.70532","DOIUrl":"10.1111/ctr.70532","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postoperative pain management in kidney transplant recipients is challenging due to altered drug pharmacokinetics and the need to minimize opioid related adverse effects. Ultrasound guided erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (TMQLB) have emerged as effective components of multimodal analgesia; however, comparative data in kidney transplantation are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective, single-blind, randomized controlled trial, 63 adult patients undergoing elective living donor kidney transplantation were allocated to ESPB (<i>n</i> = 21), TMQLB (<i>n</i> = 21), or control (<i>n</i> = 21) groups. Patients in the block groups received ultrasound guided ESPB or TMQLB following induction of general anesthesia, while the control group received standard analgesia alone. Postoperative pain intensity was assessed using visual analog scale (VAS) scores during the first 24 h. Total tramadol consumption, time to first analgesic requirement, need for rescue analgesia, adverse effects, and hemodynamic parameters were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both ESPB and TMQLB groups demonstrated significantly lower VAS scores at all postoperative time points compared with the control group (<i>p</i> &lt; 0.001). Total tramadol consumption was significantly reduced, and the time to first tramadol requirement was significantly prolonged in the block groups versus control (<i>p</i> &lt; 0.001). No significant differences were observed between ESPB and TMQLB with respect to pain scores or total tramadol consumption. Hemodynamic parameters remained stable, and no block related complications were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In kidney transplant recipients, both ESPB and TMQLB provide effective and hemodynamically stable opioid-sparing postoperative analgesia. The comparable efficacy of these techniques allows flexibility in block selection based on patient characteristics and institutional experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638073","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":"Evaluating the Impact of Organ Allocation Policies on Black Patients: A Single-Center Analysis","authors":"Carina McClean,&nbsp;Sergio Duarte,&nbsp;Mai Ta,&nbsp;Georgios Vrakas","doi":"10.1111/ctr.70522","DOIUrl":"10.1111/ctr.70522","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Race-inclusive estimated glomerular filtration rate (eGFR) equations historically delayed kidney transplant referral and waitlist eligibility for Black patients. OPTN Policy 3.7D was implemented to allow retrospective wait time modification for candidates adversely affected by race-based eGFR calculations. We evaluated the implementation of this policy and its impact at a single transplant center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study of adult Black kidney transplant candidates at the University of Florida Health Transplant Center reviewed for OPTN Policy 3.7D eligibility between December 2023 and January 2024. Candidates were categorized as eligible for wait time modification, ineligible with sufficient historical documentation, or ineligible due to insufficient documentation or nonresponse. Demographic characteristics, clinical variables, waitlist time, and transplant outcomes were compared using descriptive and nonparametric analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 162 candidates reviewed, 46 (28.4%) met criteria for wait time modification. 84 candidates (52.0%) provided historical documentation but were ineligible, 30 (18.5%) lacked sufficient documentation or did not respond, and 2 were excluded due to age less than 18 (1.25%). Eligible candidates had significantly shorter median waitlist time prior to policy implementation compared with ineligible candidates (746 vs. 1506 days; <i>p</i>&lt;0.001) and were more likely to be female (<i>p</i> = 0.044). No significant differences in baseline clinical characteristics were observed between transplanted and non-transplanted candidates within either eligibility group. Among ineligible candidates, those without historical documentation had longer waitlist times than those with documentation (2289 vs. 1576 days; <i>p</i> = 0.0067).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implementation of OPTN Policy 3.7D enabled meaningful restoration of wait time for a subset of Black kidney transplant candidates. However, the policy's impact was limited by strict eligibility criteria and reliance on historical documentation. These findings highlight both the benefit and the structural constraints of retrospective equity-focused transplant policy interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632593","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":"Subclinical and Borderline Rejection are Associated With Death-Censored Graft Loss After Kidney Transplantation: A Systematic Review and Meta-Analysis","authors":"Takayuki Yamada,&nbsp;Shota Obata,&nbsp;Arjun Kalaria,&nbsp;Abiha Abdullah,&nbsp;Bryce Parrish,&nbsp;Massiel Cruz Peralta,&nbsp;Vrishketan Sethi,&nbsp;Charbel Elias,&nbsp;Jason Mial-Anthony,&nbsp;Michele Klein-Fedyshin,&nbsp;Chethan Puttarajappa,&nbsp;Rajil Mehta,&nbsp;Aravind Cherukuri,&nbsp;Berkay Demirors,&nbsp;Michele Molinari","doi":"10.1111/ctr.70536","DOIUrl":"10.1111/ctr.70536","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The prognostic significance of subclinical rejection (SCR) and borderline rejection (BLR) detected on surveillance kidney allograft biopsies remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic review and meta-analysis of studies enrolling adult kidney transplant (KT) recipients undergoing protocol biopsies. The primary outcome was death-censored graft loss (DCGL); the secondary outcome was subsequent rejection. Random-effects models, sensitivity analyses, and meta-regression were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen studies (5428 recipients) were included. SCR was associated with a higher risk of DCGL (RR 2.22; 95% CI 1.67–2.95) and subsequent rejection (RR 3.09; 95% CI 2.34–4.09), with low heterogeneity. Both T cell–mediated rejection (RR 1.82; 95% CI 1.28–2.61) and antibody-mediated rejection (ABMR) (RR 3.35; 95% CI 2.11–5.33) were associated with increased DCGL. BLR was associated with increased DCGL (RR 2.40; 95% CI 1.67–3.46) and subsequent rejection (RR 2.79; 95% CI 2.10–3.69). Findings were robust across sensitivity analyses, including contemporary Banff-era definitions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SCR and BLR are associated with inferior long-term graft outcomes. These findings underscore their prognostic significance and warrant prospective studies to determine optimal management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632606","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 Oceans and Distance: Excellent Long-Term Outcomes in Non-Mainland Kidney Transplantation","authors":"Binuri L. Hapuarachchy,&nbsp;Reed T. Jenkins,&nbsp;Emily L. Larson,&nbsp;Manuj M. Shah,&nbsp;Alice L. Zhou,&nbsp;David J. Farhat,&nbsp;Yusuf Ciftci,&nbsp;Jessica M. Ruck,&nbsp;Francis J. Tinney Jr,&nbsp;Russell Wesson,&nbsp;Elizabeth A. King,&nbsp;Benjamin Philosophe,&nbsp;Al-Faraaz Kassam","doi":"10.1111/ctr.70533","DOIUrl":"10.1111/ctr.70533","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Efforts to expand the kidney transplant (KT) donor pool have included geographic expansion of donation. We evaluated the outcomes after KT from organs procured outside of the continental United States (US).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult kidney-only deceased donor transplants from 2011 to 2022 in the United Network for Organ Sharing (UNOS) database were categorized by donor and recipient location (mainland to mainland US [MM], non-mainland to mainland [NMM], and non-mainland to non-mainland [NMNM]). Recipient overall and event-free survival were evaluated using time-to-event analysis and multivariable Cox regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 163 004 (98.5%) MM, 1351 (0.8%) NMM, and 1190 NMNM (0.7%) transplants, with non-mainland donors from Puerto Rico (1233), Hawaii (806), Alaska (483), Bermuda (12), and the United States Virgin Islands (USVI) (7). Non-mainland donors were older (<i>p</i> &lt; 0.001), had lower body mass index (BMI) (<i>p</i> &lt; 0.001), were less likely to have smoked cigarettes (<i>p</i> &lt; 0.001), had lower creatinine (<i>p</i> &lt; 0.001), and were less likely to donate after cardiac death (<i>p</i> &lt; 0.001) or utilize perfusion machines (<i>p</i> &lt; 0.001) compared to MM. NMM transplants traveled further between donor and recipient centers (<i>p</i> &lt; 0.001) and had longer cold ischemia times (CITs) (24.1 vs. 17.2 h, <i>p</i> &lt; 0.001). There was no difference in acute rejection (adjusted odds ratio [aOR] 1.14, <i>p</i> = 0.59). NMM recipients had similar 1-year (adjusted hazard ratio [aHR] = 0.87 [95% confidence interval (CI) 0.65–1.15], <i>p</i> = 0.32) and 5-year (aHR = 0. 90 [95% CI 0.77–1.06], <i>p</i> = 0.19) event-free survival and improved survival at 10 years (aHR = 0.83 [95% CI 0.72–0.95], <i>p</i> = 0.006) post-transplant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite longer distances and CIT, select kidneys from NM donors can be successfully transplanted with excellent long-term outcomes, including improved event-free survival at 10 years post-transplant. Use of NM donors should be encouraged to increase rates of KT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632626","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":"Optimizing Tacrolimus Target Trough Levels in Organ Transplantation Among Patients Living With HIV Receiving Antiretroviral Therapy","authors":"Uraiwan Akanit","doi":"10.1111/ctr.70538","DOIUrl":"10.1111/ctr.70538","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Solid organ transplantation (SOT) in patients living with HIV (PLWH) has transitioned from a relative contraindication to standard practice following the widespread use of effective antiretroviral therapy (ART). Although patient and graft survival increasingly parallel those of HIV-negative recipients, optimizing immunosuppressive therapy—particularly tacrolimus—remains a major clinical challenge in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This review examines the mechanisms and clinical consequences of ART–tacrolimus drug–drug interactions, evaluates the role of therapeutic drug monitoring (TDM), and highlights emerging strategies to improve attainment of target tacrolimus trough levels in PLWH undergoing transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Contents</h3>\u0000 \u0000 <p>Tacrolimus has a narrow therapeutic index and is highly susceptible to cytochrome P450 3A4–mediated interactions with ART, especially protease inhibitor- and cobicistat-based regimens. These interactions often necessitate extreme dose reductions, result in marked pharmacokinetic variability, and complicate maintenance of stable trough concentrations. Subtherapeutic exposure is associated with increased rejection risk, whereas supratherapeutic levels increase nephrotoxicity and infection. While integrase strand transfer inhibitor-based regimens reduce interaction burden, many PLWH remain on boosted ART, underscoring the importance of intensive TDM. This review also discusses tacrolimus formulation choice as a modifiable factor, with growing evidence supporting liquid tacrolimus to enable micro-dose titration and improve time in therapeutic range. Emerging pharmacometric approaches, including population pharmacokinetic modeling and Bayesian dosing, offer additional opportunities for precision immunosuppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications</h3>\u0000 \u0000 <p>Optimizing tacrolimus exposure—rather than HIV status itself—is central to transplant outcomes in PLWH. Integrating ART-informed dosing, formulation flexibility, and advanced TDM strategies may reduce variability, improve graft outcomes, and inform future guideline development for this expanding transplant population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621828","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":"Initial Experience With Single-Port Robotic Donor Nephrectomy Using the da Vinci SP System: A Case Series Evaluating Safety, Feasibility, and Early Outcomes","authors":"Srinivasan Muthukrishnan,&nbsp;Lane T. Cavey,&nbsp;Ruchin Patel,&nbsp;Francheska Nieves-Rivera,&nbsp;Roberto S. Kalil,&nbsp;Raphael P. H. Meier,&nbsp;Chandra S. Bhati","doi":"10.1111/ctr.70537","DOIUrl":"10.1111/ctr.70537","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Minimally invasive techniques for living donor nephrectomy have advanced considerably, with robotic-assisted approaches offering improved visualization, reduced morbidity, and enhanced cosmesis. Single-port robotic donor nephrectomy (SP-RDN), utilizing the da Vinci SP platform, further minimizes the surgical footprint while aiming to maintain safety and efficacy. This case series presents our initial experience with SP-RDN, focusing on perioperative outcomes and early postoperative renal function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed six consecutive SP-RDNs performed between December 2023 and April 2025. Demographic data, operative parameters, and renal function markers were analyzed. All procedures were performed via a periumbilical incision using the da Vinci SP system by two surgeons at our institution. Perioperative outcomes, including operative time, estimated blood loss (EBL), warm ischemia time (WIT), and hospital stay, were assessed. Renal function was monitored using serum creatinine and estimated glomerular filtration rate (eGFR) preoperatively, on postoperative day (POD) 0 and POD1, and at first follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean donor age was 42 years (range 24–69), with an average BMI of 22.8 kg/m². Three nephrectomies each were performed on the right and left sides; three patients had multiple renal arteries. Mean operative time was 211 min, EBL was 65 mL, and mean WIT was 7.6 min. No intraoperative or major postoperative complications occurred. eGFR declined from a preoperative mean of 108.6 to 70.8 mL/min/1.73m² on POD1, partially recovering by the first postoperative visit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SP-RDN is a feasible and safe approach for living donor nephrectomy, with favorable early outcomes. Larger studies are needed to confirm its advantages over traditional techniques.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621790","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":"Feasibility of Early Oral Nutritional Supplementation After Liver Transplantation: A Randomized Pilot Study","authors":"Amal Trigui,&nbsp;Crystèle Hogue,&nbsp;Mélanie Tremblay,&nbsp;Geneviève Huard,&nbsp;An Tang,&nbsp;Justine Racette,&nbsp;Christopher F. Rose,&nbsp;Chantal Bémeur","doi":"10.1111/ctr.70524","DOIUrl":"10.1111/ctr.70524","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; ABSTRACT&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Catabolic and inflammatory changes after liver transplantation (LT) increase energy and protein requirements. This study assessed the feasibility of a 12-week high-energy/high-protein oral nutrition supplementation (ONS) initiated after resumption of solid oral intake post-LT. Secondary objectives were 1) to describe changes in nutritional risk, muscle strength, and quality of life during the pre-transplant period, and 2) to explore the potential impact of ONS after LT on these outcomes and muscle mass.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In this randomized feasibility study, patients awaiting LT were assessed for nutritional risk (Liver Disease Under nutrition Screening Tool), muscle strength (Chair Stand Test, CST), and quality of life (SF-36) before LT, every three months until surgery, at discharge, and again at 12 weeks post-LT. Muscle mass was assessed by CT scan at LT admission and 12 weeks later. After LT, participants were randomized to a control group or an intervention group receiving ONS for 12 weeks. Feasibility outcomes included eligibility, recruitment and target sample size, adherence to the protocol and intervention, attrition, and safety.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of the seven predefined feasibility criteria, four were met, two were partially met (eligibility and recruitment rates), and one was not met (target sample size rate). Fifty-five patients were followed before LT, 17 underwent LT, and 14 were analyzed. Six patients developed new-onset diabetes after LT, limiting randomization to three patients in the intervention group and five in the control group. Before LT, 85.5% (47/55) of included patients were at risk of malnutrition, which remained stable during waiting time (&lt;i&gt;p&lt;/i&gt; = 0.418), while muscle strength declined (&lt;i&gt;p&lt;/i&gt; = 0.039). At 12 weeks post-LT, the intervention group had 0% malnutrition risk and a median CST time of 11.5 s, compared with 60% and 15.1 s, respectively, in the control group. The prevalence of sarcopenia did not change before and after the intervention.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Early post-LT ONS was feasible regarding adherence, retention, and safety; however, recruitment and achieving the targeted transplanted sample size were major barriers. The study highlights the high prevalence of malnutrition and sarcopenia before and after LT.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Practitioner Points&lt;/h3&gt;\u0000 \u0000 &lt;div&gt;\u0000 &lt;ul&gt;\u0000 ","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607883","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":"Asymptomatic Bacteriuria in Kidney Transplant: Approaches to Screening and Treatment—A National Survey of Canadian Nephrologists","authors":"Sonia Rodriguez-Ramirez,&nbsp;Victoria Hall,&nbsp;Shahid Husain,&nbsp;Deepali Kumar,&nbsp;S. Joseph Kim","doi":"10.1111/ctr.70529","DOIUrl":"10.1111/ctr.70529","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It is estimated that up to half of kidney-transplant (KT) recipients develop asymptomatic bacteriuria (ASB) within three years posttransplantation. Despite limited evidence supporting screening or treatment, most centers continue routine surveillance and antibiotic therapy, raising concerns about antimicrobial resistance, drug toxicity, and costs. We sought to describe current Canadian practices and perceptions regarding ASB screening and treatment among nephrologists caring for KT recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Nationwide cross-sectional survey. All nephrologists affiliated with the Canadian Society of Transplantation (CST) Kidney Group were invited to complete a 27-item electronic survey assessing demographic characteristics, ASB screening and treatment practices, and attitudes toward future clinical trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-five nephrologists responded (66% response rate, 35/53) from 12 of 18 adult KT centers in Canada (67% national center representation). Forty percent (14/35) were aged 45–54 years; 49% (17/35) were women; and 57% (20/35) had &gt;15 years of transplant experience. Most (28/35, 80%) reported screening for ASB during the first 2 months posttransplant, most often with weekly urine cultures (20/35, 57%; 19/35, 54%), typically until stent removal (21/35, 61%). All respondents (35/35, 100%) treated ASB during this period, most commonly for 7 days (19/35, 54%); 4/35 (11%) ordered additional investigations. After stent removal, only 7/35 (20%) continued screening and 2/35 (6%) continued treatment. Overall, 14/35 (40%) would modify practice if stronger evidence became available, and 31/35 (88%) were willing to participate in a randomized trial withholding antibiotics for ASB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Significant variability exists in ASB screening and treatment practices among Canadian nephrologists. These findings highlight a true evidence gap regarding management during the early posttransplant period, rather than a failure to adopt established data, and support the need for pragmatic clinical trials to guide evidence-based ASB management and antimicrobial stewardship.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607820","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":"Solid Organ Transplantation Among Transplant Candidates With TB Disease","authors":"Cybele Lara R. Abad,&nbsp;Alex Zimmet,&nbsp;Aruna K. Subramanian","doi":"10.1111/ctr.70528","DOIUrl":"10.1111/ctr.70528","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Deferral of solid organ transplantation (SOT) in recipients with tuberculosis (TB) disease (active TB) is recommended until anti-tuberculosis treatment (ATT) is completed. However, SOT is often urgent, and there are instances where SOT cannot be safely delayed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We report two cases with TB disease who were transplanted before completion of ATT in our institution and searched PubMed, EMBASE, and MEDLINE databases from inception to August 2025, to retrieve all other published cases of &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt; among SOT candidates with active TB disease at time of transplantation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Sixty-four detailed cases were identified while two cohort studies had aggregated data on 101 cases of TB disease among kidney transplant (KT) candidates. The majority of cases were liver transplant (LT) candidates (60/64, 93.7%); the rest were heart (2/64), kidney (1/64), or lung (1/64) candidates. About half of LT candidates were urgently transplanted because of ATT induced hepatic failure (35/60, 58.3%). Among LT candidates, pulmonary tuberculosis was most common (39/60, 65%) followed by extrapulmonary (EPTB) (17/60, 28.3%), and disseminated TB (4/60, 6.7%). ATT was started prior to transplantation in 44/60 (73.3%) candidates, while 16/60 (26.7%) were started after SOT. The majority (40/44, 90.9%) were on first line therapy, with transplantation occurring a median of 54.5 (range 2–180) days after starting ATT. Many ATT regimens were modified in the post-transplant phase (31/44, 70.4%). Of nine mortalities among LT recipients, only one was directly attributable to TB disease. For both cohort studies on KT candidates, EPTB was the most common form of TB disease (44/71 and 26/30). ATT was taken a median of 3.8 and 3 months, respectively, prior to SOT. All continuation phase posttransplant ATT were rifampicin-sparing with median duration of 12.27 and 14 months, respectively. There were no deaths attributable to TB disease.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Favorable outcomes after SOT are feasible despite TB disease and incomplete pre-transplant anti-TB treatment. The urgent need for a life-saving transplant procedure should be weighed against the risks of transplantation in a patient with active tuberculosis. Completion of at least 2-month intensive first-line TB treatment (e.g., isoniazid, rifampicin, pyrazinamide, ethambutol, [HRZE]) is recommended with use of a rifamycin-based regimen to optimize sterilization. Although rifamycins are preferred for treatment, a rifampicin-sparing regimen may be more m","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607828","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":"Expanding the Abdominal Domain: Long-Term Success of the Vascularized Posterior Rectus Sheath–Liver Composite Allograft","authors":"Anurag Shrimal,&nbsp;Arka Banerjee,&nbsp;Vaishnavi Chakravarthy,&nbsp;Rohan J Choudhary,&nbsp;Amit Chopde,&nbsp;Aditya Kunte,&nbsp;Manish C Varma","doi":"10.1111/ctr.70525","DOIUrl":"10.1111/ctr.70525","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Achieving a tension-free abdominal wall closure in liver transplantation (LT) is challenging, particularly in the presence of donor–recipient size mismatch, prior surgeries, or loss of abdominal domain. These difficulties are amplified when expanded-criteria donor (ECD) grafts are used, as graft reduction is unsafe and prolonging cold ischemia time (CIT) is not feasible. A vascularized posterior rectus sheath (PRS) allograft, supplied via the hepatic falciform artery (HFA), offers physiological abdominal domain expansion without the infection risks associated with prosthetic meshes or non-vascularized fascia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted of all patients undergoing LT with a vascularized PRS allograft at our center. PRS retrieval and implantation were performed using a standardized technique. All patients received conventional immunosuppression. Recipient and donor characteristics, postoperative outcomes, and long-term follow-up were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five patients (four adults, one child) received a composite liver–PRS allograft. Median donor–recipient weight ratio was 1.7 (range: 1.46–2.18). All grafts met ECD criteria. Mean CIT and warm ischemia time were 4 ± 1.01 h and 43.6 ± 9.54 min, respectively. Primary fascial closure was achieved in all patients without graft infection, abdominal wall infection, or PRS necrosis. One patient developed a rectus sheath hematoma requiring drainage, and another developed a postoperative bulge requiring plication. Median long-term follow-up of 9.1 (range: 8.38–10.63) years demonstrated durable fascial integrity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The vascularized PRS allograft is a simple, reproducible, single-stage solution for abdominal closure in LT, particularly valuable when using ECD grafts, minimizing infection risk, reexplorations, and prolonged CIT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607862","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}