Clinical Transplantation最新文献

{"title":"Long-Term Proton Pump Inhibitors in Lung Transplant Recipients: Near-Universal Use Without Clear Impact on Clinical Outcomes Over a 20-Year Observational Study.","authors":"Chen Yang Kevin Zhang, Rayoun Ramendra, Meghan Aversa, Rasheed Ghany, Jussi Tikkanen, Ella Huszti, Jonathan Yeung, Shaf Keshavjee, Lianne G Singer, Tereza Martinu","doi":"10.1111/ctr.70706","DOIUrl":"10.1111/ctr.70706","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease (GERD) is a known risk factor for chronic lung allograft dysfunction (CLAD), the main barrier to long-term survival in lung transplant recipients (LTR). While proton pump inhibitors (PPI) are effective for symptomatic treatment of GERD, data are sparse on the prevalence of long-term PPI use and association with clinical outcomes.</p><p><strong>Methods: </strong>Single-center retrospective cohort of adult first-time LTR between 1999 to 2018 who were alive and CLAD-free at 1-year post-transplant. PPI exposure was defined as ≥8 continuous weeks in the first year, started within 6 months post-transplant.</p><p><strong>Results: </strong>1308 LTR were included, with 1170 (89.4%) exposed to PPI. PPI use increased over time and remained above 90% from 2007 onwards. In multivariable analyses, LTR on PPI had similar time to CLAD and time to death/retransplant compared to those not on PPI. Similarly, no differences in outcomes were observed between LTR on once-daily and twice-daily dosing, or after accounting for the number of reflux episodes on 24 h pH-impedance monitoring. Positive bronchoalveolar lavage cultures and acute rejection over the first-year post-transplant was also comparable.</p><p><strong>Conclusions: </strong>Long-term use of PPI became near-universal without observable effect on clinical outcomes. While further research is needed, these findings question the routine use of PPI in LTR.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70706"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191815","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":"Risk of Donor-Derived Infections From Organ Donors Colonized or Infected With Multidrug-Resistant Gram-Negative Bacteria: A Systematic Review and Meta-Analysis.","authors":"Themistoklis Paraskevas, Christodoulos Chatzigrigoriadis, Ioannis D Kostakis, Nikolaos Karydis, Marios Papasotiriou, Theodoros Ntrinias, Ioannis Maroulis, Markos Marangos, Evangelos Papachristou, Paolo Antonio Grossi, Stelios F Assimakopoulos","doi":"10.1111/ctr.70714","DOIUrl":"10.1111/ctr.70714","url":null,"abstract":"<p><strong>Background: </strong>The presence of multidrug-resistant Gram-negative (MDR-GN) organisms in solid organ transplantation (SOT) donors raises concerns regarding transplant safety.</p><p><strong>Methods: </strong>We searched PubMed and Scopus (2010-2025) for observational studies reporting donor-derived infections (DDI) among SOT recipients from donors with MDR-GN colonization or infection. A single-arm meta-analysis was performed. Subgroup analyses examined donor risk categories (high-risk, low-risk), organ types, pathogen groups, and donor culture sites. 90-day mortality was estimated for recipients at risk of donor-to-recipient transmission based on presence of MDR-GN DDI.</p><p><strong>Results: </strong>Twelve cohort studies with 457 recipients were included. The pooled attack rate of MDR-GN DDI was 29% (95%CI: 11%-49%). DDI occurred in 40% (95%CI: 20%-62%) of high-risk transplantations but was absent in low-risk scenarios (0%, 95%CI: 0%-1%). Transmission was associated with graft-relevant exposure, including preservation fluid positivity (58%, 95%CI: 23%-89%) and organ-specific cultures. 90-day mortality among recipients corresponding to donors with carriage of MDR-GN pathogens was 14% (95%CI: 6%-30%). Higher 90-day mortality was observed among recipients with evidence of MDR-GN DDI (49%, 95%CI: 12%-87%).</p><p><strong>Conclusions: </strong>Although transmission from MDR-GN donors seems to increase the mortality of the recipients, it is highly context-dependent and primarily driven by graft-related anatomical exposure rather than MDR status alone.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70714"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179848","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":"Ultrasound-Derived Differential Renal Volume Indexed to Recipient Body Mass Index Predicts One-Year Kidney Graft Function: A Novel Surrogate of Graft-Recipient Size Matching.","authors":"Iacopo Gianassi, Marco Allinovi, Leonardo Caroti, Lorenzo Di Maria, Aida Larti, Giulia Antognoli, Renata Angela Di Pietro, Roberta Cutruzzulà, Federica Allegretta, Luca Malatesta, Lino Calogero Cirami","doi":"10.1111/ctr.70721","DOIUrl":"https://doi.org/10.1111/ctr.70721","url":null,"abstract":"<p><strong>Background: </strong>Appropriate matching between donor nephron mass and recipient metabolic demand is increasingly recognized as an important determinant of kidney graft outcomes. However, practical and widely applicable methods for estimating graft-recipient size matching remain limited. We investigated whether renal parenchymal volume measured by routine ultrasonography and normalized to recipient body mass index (BMI) is associated with kidney graft function one year after transplantation.</p><p><strong>Methods: </strong>In this prospective single-center study, adult kidney transplant recipients underwent routine ultrasonographic assessment one month after transplantation. Renal volumetric parameters, including total renal volume (TRV) and differential renal volume (DRV), were calculated and normalized to recipient BMI. Associations with estimated glomerular filtration rate (eGFR) at one year were evaluated using correlation and multivariable linear regression analyses adjusted for relevant donor and recipient characteristics. Receiver operating characteristic (ROC) analysis was performed to assess the discriminatory ability of the most informative volumetric index.</p><p><strong>Results: </strong>Renal volumetric parameters were significantly associated with one-year graft function, with stronger associations observed after normalization for recipient BMI. Among the evaluated indices, the DRV/BMI ratio showed the strongest correlation with eGFR and remained independently associated with one-year graft function after multivariable adjustment. Exclusion of renal sinus volume improved the predictive performance of volumetric assessment, supporting the relevance of functional renal parenchyma over total kidney volume. In exploratory ROC analysis, the DRV/BMI ratio demonstrated good discrimination for preserved graft function (AUC 0.774), although the identified threshold requires external validation.</p><p><strong>Conclusions: </strong>Ultrasound-derived donor renal parenchymal volume indexed to recipient BMI represents a simple, non-invasive, and clinically applicable surrogate of graft-recipient size matching. If validated in larger multicenter cohorts, this approach may complement existing clinical parameters for predicting graft function and support more individualized post-transplant management.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70721"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206675","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":"Global Survey of Latent Tuberculosis Screening and Treatment Practices in Liver Transplantation.","authors":"Samantha E Jacobs, Fritzie S Albarillo, Tirdad T Zangeneh, Kapil Saharia, John W Baddley, Shmuel Shoham, Chia-Yu Chiu, Joanna Nelson, Jacques Simkins","doi":"10.1111/ctr.70715","DOIUrl":"https://doi.org/10.1111/ctr.70715","url":null,"abstract":"<p><p>We surveyed transplant and infectious disease (ID) practitioners to better understand approaches to managing latent tuberculosis infection (LTBI) in liver transplantation (LT), an area in which high-quality evidence is lacking. The survey was distributed to clinicians via international ID society listservs, and one respondent per transplant center was requested. There were 86 respondents, including 78 (91%) ID physicians, from North America (68%), Europe (12%), South America (11%), Asia (7%), Africa (1%), and Australia (1%). Most centers (92%) screen all LT candidates for LTBI, and 95% use tuberculosis (TB) interferon-gamma release assays (TB-IGRA) as first-line. In LT recipients with indeterminate TB-IGRA results, respondents differ in terms of which specific TB risk factors may impact treatment decisions. Timing of post-transplant LTBI treatment varies with only 27% choosing to initiate therapy during the index transplant admission. The majority of respondents (88%) prescribe isoniazid monotherapy to LT recipients with LTBI for 6 (23%) or 9 (65%) months. Management of living donor LTBI differs depending on severity of liver disease in the potential recipient. These survey data will inform future collaborative research efforts to optimize LTBI management in LT.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70715"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179829","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":"Raman Urine Fingerprinting to Predict DGF, Assess Renal Allograft Quality, and Monitor Its State of Health.","authors":"Giuseppe Orlando, Ryan S Senger, Amr Sayed Issa, Romina Seifollahi Asl, Alejandra Mena Gutierrez, Colleen C Jay, Emily K E McCracken, Alan C Farney, Robert J Stratta, Christopher J Webb, Hollie B Davis, Tracy Doty, Gwen McPherson, Alexandra R Monetti, John R Savino, Lori Byers, Mohammad Kazem Fallahzadeh, Amber Reeves-Daniel, Natalia V Sakhovskaja, Amish Asthana, Barbara K Yoza, Benedetta Bussolati, Alexei V Mikhailov, Emma Peveri, Christopher L Schaich, Lacey Ngo, Fred Gage, Robert Fisher, John Robertson","doi":"10.1111/ctr.70716","DOIUrl":"https://doi.org/10.1111/ctr.70716","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether Raman spectroscopy-based urine molecular fingerprinting (UMF) may predict delayed graft function (DGF) and assess renal allograft quality prior to transplant and monitor its state of health after transplantation.</p><p><strong>Background: </strong>Current methods for assessing the quality of the renal allograft at baseline and its state of health post-transplantation are inadequate.</p><p><strong>Methods: </strong>We conducted a pilot study in 26 patients receiving DCD allografts. UMF was performed on urine samples collected from study participants immediately before transplantation (baseline), on postoperative day 1-3, and monthly thereafter. UMF findings were correlated with clinical and laboratory data. Primary endpoint was identification of a DGF fingerprint. Secondary endpoints were identification of fingerprints for acute rejection, CMV, BK and eGFR.</p><p><strong>Results: </strong>DGF was observed in 58% of our patients. UMF fingerprints from patients with DGF were distinct from UMF fingerprints of non-DGF patients. Notably, UMF analysis of baseline urine samples from patients prior to transplantation also predicted development of DGF. A correlation of UMF with eGFR was observed, whereas we did not identify fingerprints specific for rejection, CMV or BK possibly due to the small patient population.</p><p><strong>Conclusions: </strong>In this exploratory study, UMF predicts DGF prior to transplantation and provides information on the state of health of the allograft following transplantation.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70716"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179840","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":"Belatacept Conversion in Simultaneous Pancreas-Kidney and Liver-Kidney Transplant Recipients: A Single-Center Feasibility Cohort and Narrative Review.","authors":"Dusan Harmacek, Elena Rho, Seraina von Moos, Severin Simmler, Thomas Welte, Fabian Rössler, Thomas Schachtner, Lukas Weidmann","doi":"10.1111/ctr.70719","DOIUrl":"10.1111/ctr.70719","url":null,"abstract":"<p><strong>Background: </strong>Calcineurin inhibitor (CNI) nephrotoxicity drives long-term kidney-function decline after simultaneous pancreas-kidney (SPK) and liver-kidney (LK) transplantation, but belatacept conversion, as an alternative strategy, is poorly studied in these recipients, whose non-kidney allograft rejection risk differs.</p><p><strong>Methods: </strong>We retrospectively studied six SPK and six LK recipients converted from CNI- to belatacept-based immunosuppression and analyzed the cohorts separately alongside a narrative review of published SPK/LK conversion experiences. Outcomes were estimated glomerular filtration rate (eGFR) trajectories and slopes, donor-specific antibodies (DSA) and rejection, pancreatic, hepatic and metabolic parameters, infections, and survival, reported descriptively with exploratory estimates and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Conversion occurred a median of 64 (SPK) and 89 (LK) months after transplantation, always with a transient low-dose CNI overlap (target trough 3-4 ng/ml). In SPK recipients, median eGFR rose from 45.4 to 55.5 mL/min/1.73m² and the median eGFR slope changed from -3.9 to +5.6 mL/min/year (mixed-model slope change +12.6, 95% CI 2.9 to 22.3); in LK recipients, from 38.8 to 46.3 and from -3.1 to +4.1 (estimate +6.3, 95% CI -4.2 to 16.7). No new DSA developed; pre-existing DSA declined or remained stable. Pancreatic and liver function stayed stable. Two infections in LK recipients (Pneumocystis pneumonia, adenovirus) were possibly belatacept-aggravated. Over a median 25 months, 8/12 (67%) remained on belatacept.</p><p><strong>Conclusions: </strong>Late belatacept conversion with a transient low-dose CNI overlap was feasible in selected SPK and LK recipients and was associated with stable-to-improved kidney function without a pancreatic or hepatic safety signal. The uncontrolled design supports feasibility, not efficacy.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70719"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220100","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":"Organ Donation in the Unrepresented Patient-Ethical Challenges and Opportunities for Improvement.","authors":"Steven Char, Bharti Sharma, George Agriantonis, Navin Bhatia, Jennifer Whittington","doi":"10.1111/ctr.70724","DOIUrl":"https://doi.org/10.1111/ctr.70724","url":null,"abstract":"<p><p>In the United States, if an individual not on the donor registry dies by neurologic criteria (DNC), has no documented advance directives, and has no identified next of kin-so called unbefriended patients-current law permits hospital administrators to authorize organ donation on behalf of these patients in a process known as administrative authorization. On the one hand, organ transplantation is a public good that improves human life, and demand for organs vastly outstrips current supply; procurement from unrepresented individuals could help to increase the pool of available organs. On the other hand, administrative authorization, though legal, is fraught with several ethical concerns. Given that as many as 1 in 10 patients admitted to the ICU may be unbefriended, the question of how best to approach organ donation is of material interest. Between 2020 and 2024, 5 unrepresented patients were admitted to our trauma ICU, suffered DNC, and were considered for organ procurement. In this viewpoint, we argue that administrative authorization for organ donation on behalf of unbefriended individuals violates the principles of autonomy and justice and raises significant concerns regarding potential conflicts of interest. We challenge the ethical basis of two counterarguments often offered by proponents of administrative consent. Finally, we introduce the concept of a time-limited trial of continued organ support after death by neurologic criteria as a potential alternative to administrative consent based on our center's experience.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70724"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206679","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":"Triglyceride- and Body Weight-Based Nomogram for Early Postoperative Mycophenolate Mofetil Dose Selection Following Kidney Transplantation.","authors":"Tenshi Makiyama, Kazuya Kinoshita, Akane Morimoto, Michihiro Maruyama","doi":"10.1111/ctr.70696","DOIUrl":"https://doi.org/10.1111/ctr.70696","url":null,"abstract":"<p><strong>Background: </strong>Early mycophenolic acid (MPA) exposure varies widely after kidney transplantation, and fixed initial mycophenolate mofetil (MMF) dosing may cause overexposure before therapeutic drug monitoring (TDM) becomes available. We explored routinely available pretransplant clinical variables and developed a simple pre-TDM nomogram using triglycerides (TG) and body weight to support early postoperative MMF dose selection in tacrolimus-treated recipients.</p><p><strong>Methods: </strong>In this single-center retrospective derivation study, 117 consecutive adult kidney transplant recipients were screened, and 116 with complete concentration profiles were analyzed. All received tacrolimus-based immunosuppression; none received cyclosporine. A model incorporating concurrent MMF dose, pretransplant body weight, and pretransplant TG was standardized to 1500 mg/day. A three-level rule (1000/1500/2000 mg/day) was evaluated using dose-proportional simulation. False discovery rate (FDR) correction, internal validation, and alternative dose-exposure assumptions were examined.</p><p><strong>Results: </strong>Observed MPA AUC categories were < 30, 30-60, and > 60 mg·h/L in 12.1%, 46.6%, and 41.4% of recipients, respectively. TG survived dose-adjusted multiplicity correction (q = 0.047), but not unadjusted correction. Under simulated nomogram-guided dosing, the corresponding proportions were 14.7%, 54.3%, and 31.0%, a reduction in overexposure of 10.4 percentage points (bootstrap 95% confidence interval, -18.1--3.4). Across alternative assumptions, the reduction ranged from -1.7--10.4 percentage points and target-attainment improvement was not robust; internal validation was directionally consistent but imprecise.</p><p><strong>Conclusions: </strong>The nomogram showed a directionally consistent but assumption-dependent reduction in simulated early MPA overexposure. It is a hypothesis-generating pre-TDM tool and should not replace AUC-guided TDM or clinical judgment. Prospective external validation is required.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":"e70696"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179884","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":"Perfusate Flavin Mononucleotide and D-Dimer as Viability Biomarkers in Australasia's First Hypothermic Machine Perfusion Programme for Liver Transplantation","authors":"Jacques Eastment,&nbsp;Jules Devaux,&nbsp;Kevin Yi,&nbsp;Peter Swan,&nbsp;John McCall,&nbsp;Andrew Jones,&nbsp;Louise Barbier","doi":"10.1111/ctr.70697","DOIUrl":"10.1111/ctr.70697","url":null,"abstract":"<div>\u0000 \u0000 <p>Hypothermic oxygenated machine perfusion (HOPE) is a simple ex-situ treatment for liver grafts. However, it lacks viability assessment capabilities. Flavin mononucleotide (FMN) and D-dimer may be useful biomarkers of graft quality during HOPE. This exploratory study aimed to determine whether effluent FMN and D-dimer concentrations were associated with outcomes in liver transplants treated with HOPE. This is a retrospective, single-center study of all grafts treated with HOPE in New Zealand from 2022-2025. Fifty-four grafts were treated with HOPE. Effluent concentrations of FMN (<i>n</i> = 30) and D-dimer (<i>n</i> = 24) were analyzed. Post-transplant cholangiopathy (PTxC) with graft loss occurred in five recipients of donation after circulatory death grafts. The median summation of FMN concentrations taken over the first two hours of perfusion was higher in the PTxC group (four PTxC events among the 30 grafts with FMN measurements; <i>p</i> = 0.034). Decision curve analysis suggested that summated FMN models may add net benefit over default strategies, particularly in DCD grafts, although with only five outcome events these analyses do not define implantation thresholds. D-dimer concentrations were not significantly different in PTxC grafts (<i>p</i> &gt; 0.05). Whilst perfusate FMN has promise as a predictor of PTxC in HOPE grafts, especially if summated over several time points, prospective external validation is required before it could contribute to transplantation decision-making.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105295","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 of a Modified Portal Venovenous Bypass Technique During Liver Transplantation in High-MELD Recipients","authors":"Michael G. Megaly,&nbsp;Daniel C. Waller,&nbsp;David Matthews,&nbsp;Andrew Adams,&nbsp;Timothy L. Pruett,&nbsp;Karthik Ramanathan,&nbsp;Raja Kandaswamy,&nbsp;Erik B. Finger,&nbsp;Hannah Sutherland,&nbsp;Vanessa Humphreville,&nbsp;Srinath Chinnakotla","doi":"10.1111/ctr.70703","DOIUrl":"https://doi.org/10.1111/ctr.70703","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although portal (venovenous) bypass (pVVB) is uncommon in liver transplantation (LT), it may provide some advantages, particularly for high-acuity recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To examine its use in high-risk patients, we retrospectively evaluated outcomes of a modified pVVB technique among adult LT recipients at a single center, stratified by MELD score (≥35 vs. &lt;35). Primary outcomes were patient and graft survival evaluated withKaplan–Meier estimates and multivariable Cox regression; secondary outcomes included biliary complications, transfusion requirements, viscoelastic parameters, laboratory trends, length of stay, readmission, and need for dialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between January 2016 and July 2025, 548 patients underwent LT with pVVB; 111 (20.3%) had MELD ≥35. Despite greater baseline severity, higher transfusion requirements, and longer postoperative ICU stay, MELD ≥35 was not associated with increased risk of graft failure (HR 1.19; 95% CI 0.72–1.96), mortality (HR 0.86; 95% CI 0.46–1.61), or biliary complications (HR 1.02; 95% CI 0.65–1.60). Post-reperfusion viscoelastic measures were similar across groups. Dialysis was more frequent before and after LT in MELD ≥35. No complications or deaths were attributable to pVVB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among LT recipients treated with pVVB, MELD ≥35 was not significantly associated with graft failure, mortality, or biliary complications. These findings support the feasibility of pVVB in high-acuity recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068408","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}