Clinical Transplantation最新文献

{"title":"Early Removal of Ureteral Stents When Attached to the Foley Catheter in Living Donor Kidney Transplant Recipients Reduces Urinary Tract Infections","authors":"Jenny Lam,&nbsp;Ibrahim Elali,&nbsp;Mohammed Mahgoub,&nbsp;Esma Kesik,&nbsp;Byron Smith,&nbsp;Esther Ovdat,&nbsp;Patricia Rebolledo,&nbsp;Weslyn Bunn,&nbsp;Carrie Jadlowiec,&nbsp;Kunam Reddy,&nbsp;Shennen Mao,&nbsp;Dana Perry,&nbsp;Andrew Bentall,&nbsp;Carrie Schinstock,&nbsp;Mikel Prieto,&nbsp;Scott Nyberg,&nbsp;Mark D. Stegall","doi":"10.1111/ctr.70329","DOIUrl":"10.1111/ctr.70329","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ureteral stents are commonly placed during kidney transplantation (KT) to mitigate urologic complications. The objective of this study was to compare clinical outcomes in KT recipients with either early stent removal when attached to the Foley catheter or late removal via cystoscopy when unattached.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a multi-center retrospective analysis of consecutive living donor KT patients (8/18/21-4/21/23) stratified into Foley-attached and unattached stent groups. Outcomes assessed were ureteral stricture, urine leaks, UTIs at 90 days and allograft failure and BKV DNAemia (BK virus DNAemia) at 1 year. Data are reported as mean and standard deviation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 247 patients with attached and 260 with unattached stents, baseline demographics (age, sex, diabetes) were similar between groups. There was a difference in race (87.9% vs. 77.8% Caucasian; <i>p</i> = 0.004). Foley catheters remained longer in the attached group (3.7 ± 1.8 vs. 3.0 ± 2.0 days; <i>p</i> &lt; 0.001), but stents were removed earlier (3.7 ± 1.8 vs. 21.9 ± 4.7 days; <i>p</i> &lt; 0.001). Comparing attached versus unattached, there were no differences in ureteral stricture (0.4% vs. 1.5%; <i>p</i> = 0.197), urine leak (0.8% vs. 0.4%; <i>p</i> = 0.533), BKV DNAemia (17.7% vs. 16.9%; <i>p</i> = 0.616), or allograft failure (0% vs. 0.8%; <i>p</i> = 0.167). However, UTI incidence by 90 days was lower in the attached group (5.7% vs. 11.9% <i>p</i> = 0.013). Induction therapy differed significantly between groups, with Alemtuzumab more common in the unattached group (58.1% vs. 19.4%, <i>p</i> &lt; 0.001), Basiliximab more common in the attached group (43.3% vs. 35.0%, <i>p</i> &lt; 0.001), and Thymoglobulin more common in the attached group (36.0% vs. 6.9%, <i>p</i> &lt; 0.001). Baseline steroid use was higher in the unattached group (81.9% vs. 57.9%, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Early stent removal via connection to the Foley catheter had similarly low rates of ureteral complications while reducing urinary tract infections and avoiding cystoscopic removal.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130226","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 Maintenance Immunosuppression for Calcineurin Inhibitor Sparing or Avoidance in Pancreas Transplant Recipients With Progressive Renal or Renal Allograft Dysfunction","authors":"Jeanne M. Chen,&nbsp;Richard S. Mangus,&nbsp;Asif A. Sharfuddin,&nbsp;John A. Powelson,&nbsp;Muhammad S. Yaqub,&nbsp;Muhammad Y. Jan,&nbsp;Andrew J. Lutz,&nbsp;Jonathan A. Fridell","doi":"10.1111/ctr.70310","DOIUrl":"10.1111/ctr.70310","url":null,"abstract":"<p>Belatacept may be used to spare or replace calcineurin inhibitors (CNI) to preserve renal function. Use in pancreas transplant (PTx) is limited by increased risk of pancreas rejection. This retrospective analysis included all PTxs performed between 2004 and 2023. A 1:2 case/control analysis was performed to identify predictors of belatacept use and compare allograft and patient survival. Of 731 PTxs, 21 (3%) started belatacept (eight simultaneous pancreas and kidney (SPK), three pancreas after kidney (PAK), and 10 pancreas transplant alone (PTA). At 1 year, Δ estimated glomerular filtration rate (eGFR) was +7% SPK, −15% PAK, and +32% PTA. Case–control analysis found no demographic predictors for belatacept except older recipient age for PTA. No difference in median kidney, pancreas, or patient survival was observed compared to control. Pancreas rejection occurred in two SPKs. There were two death censored pancreas allograft failures, both PTAs. Kidney allografts failed in two SPK and one PAK. Eight patients died. Six were still receiving belatacept at time of death with functioning allografts. Belatacept use after PTx is safe and can provide some renal recovery. Belatacept was initiated with eGFR approaching 20 mL/min/1.73m². Earlier introduction may result in better outcomes.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130262","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":"Development and Evaluation of an Inpatient Rehabilitation Model of Care Tailored to Solid Organ Transplantation","authors":"Mindi R. Manes,&nbsp;Heather A. Kendall,&nbsp;Mark G. Bowden,&nbsp;Chloe E. Bailey,&nbsp;Trevor Paris,&nbsp;Joanne S. Hoertz,&nbsp;Parag Shah,&nbsp;Kerry Maher","doi":"10.1111/ctr.70324","DOIUrl":"10.1111/ctr.70324","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Postoperative rehabilitation is essential to post-transplantation recovery and a key component of comprehensive transplant care, with inpatient rehabilitation providing intensive, interdisciplinary support to restore function and enhance quality of life. In 2019, the Brooks Rehabilitation Transplant Program (BRTP) was implemented to address the specialized rehabilitation needs post solid organ transplantation as an interdisciplinary, comprehensive, and tailored model of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Five main pillars comprise BRTP: (1) organizational commitment; (2) collaborative relationship with acute care providers; (3) early identification of appropriate patients; (4) interdisciplinary rehabilitation care tailored to transplant needs; and (5) continuous evaluation of quality outcomes. A retrospective observational cohort study evaluated both implementation and clinical outcomes over the program's first 5 years. Implementation outcomes included feasibility, fidelity, and sustainability. The primary clinical outcomes were changes in the CMS standardized functional assessment Section GG Mobility and Self-care scores. Wilcoxon signed rank sum test was used to compare admission and discharge scores. Secondary outcomes included IRF length of stay, discharge to community, acquired pressure injuries, falls, and feeding tube removal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between January 2019 and December 2023, 202 solid organ transplant patients participated in BRTP. For the 154 completing their inpatient rehabilitation facility (IRF) stay, significant functional improvements were observed for the Section GG Mobility and Self-Care composite scores and across all individual functional items (<i>p </i>&lt; 0.001). Ultimately, 82% of the cohort discharged to community, with eight returning to inpatient rehabilitation following an acute readmission and zero patients acquiring a pressure injury. Implementation outcomes indicated that the program was feasible, delivered with fidelity, and demonstrated sustainability over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The BRTP provides effective, sustainable, evidence-based approaches to improve function and quality outcomes following transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130190","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":"The Early Outcomes of Robotic-Assisted Kidney Transplantation Using Grafts With Multiple Arteries From a High-Volume Center: A Retrospective Cohort Study","authors":"Yangming Tang,&nbsp;Haohan Zhang,&nbsp;Saifu Yin,&nbsp;Yue Li,&nbsp;Jun Zeng,&nbsp;Tao Lin,&nbsp;Turun Song","doi":"10.1111/ctr.70328","DOIUrl":"10.1111/ctr.70328","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Whether robot-assisted kidney transplantation (RAKT) using grafts with multiple arteries (GMAs) is feasible has rarely been examined. This study shares our experience with RAKT using GMAs from living donors, focusing on assessing the technical feasibility and early postoperative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Between July 2020 and January 2024, we prospectively collected data from consecutive patients undergoing living donor RAKT in our center. We retrospectively analyzed the clinical data of patients who underwent RAKT using grafts with a single artery (GSA) or GMAs. All vascular reconstructions of grafts with multiple arteries were performed ex vivo on the bench in iced slush, followed by robotic anastomosis of the single reconstructed artery to the external iliac artery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 212 living donor RAKT procedures were performed by two experienced surgeons at a single institution. Using propensity score analysis, 125 recipients of grafts with a single artery (the GSA group) were selected and compared with 25 recipients of grafts with multiple renal arteries (the GMA group). There were no significant differences in the perioperative parameters or graft function outcomes between the GMA and GSA groups. Although the median operative time and revascularization ischemia times were higher in the GMA cohort, the differences were not statistically significant (200 versus 190 min, <i>p</i> = 0.5, and 60 versus 55 min, <i>p</i> = 0.8, respectively). No major intra- or postoperative complications were recorded in the GMA cohort. Additionally, there were no instances of graft loss or mortality during the follow-up period in either group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study, the largest single-center study of RAKT from living donors utilizing GMAs, demonstrates the technical feasibility of this approach, achieving optimal perioperative and early functional outcomes.</p>\u0000 \u0000 <p><b>Trial Registration</b>: ClinicalTrials.gov identifier: NCT06577805</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130181","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":"Early Onset Mycoplasma spp. Infection After Kidney Transplantation: A Systematic Review","authors":"Carlo Galdino Riva,&nbsp;Roberto Cacciola,&nbsp;Giulia Cusumano,&nbsp;Chiara Maria Pia Mansueto,&nbsp;Carlo Alfieri,&nbsp;Federico Ambrogi,&nbsp;Serena Delbue,&nbsp;Andrea Lombardi,&nbsp;Mariano Ferraresso,&nbsp;Evaldo Favi","doi":"10.1111/ctr.70262","DOIUrl":"10.1111/ctr.70262","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In recent years, there has been a progressive increase in the number of <i>Mycoplasma</i> spp. infections (MIs) reported among kidney transplant (KT) recipients. Although in these patients MIs have been associated with life-threatening complications and graft failure, specific epidemiology, clinical characteristics, diagnostic work-up, and treatment strategies remain undefined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic review (PubMed, Embase, Scopus, and Cochrane) of MIs after kidney transplantation (PROSPERO ID: CRD42024520942).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our work summarizes 13 case reports, 7 retrospective case series, and 1 retrospective uncontrolled cohort study, published between 1970 and 2023, collectively reporting 30 episodes of MIs. Due to the scarcity of information, incidence, prevalence, and predisposing factors could not be explored. Time interval between kidney transplantation and MIs ranged between 3 and 120 days. More often, the surgical site (<i>n</i> = 18) or the urinary tract (<i>n</i> = 6) was involved, with most infections sustained by <i>Mycoplasma hominis</i> (<i>n</i> = 28). Clinical features included fever (<i>n</i> = 18), abdominal pain (<i>n</i> = 8), leukocytosis (<i>n</i> = 8), and elevated CRP levels (<i>n</i> = 6). The definitive diagnosis was obtained using microbial cultures (<i>n</i> = 16) or PCR method (<i>n</i> = 12), and the time required for identification varied from 3 to 90 days. Preferred antibiotics were tetracyclines (<i>n</i> = 19) and quinolones (<i>n</i> = 9). Overall, MIs led to 20 surgical interventions, 6 graft losses, and 2 deaths.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Future research projects should consider the epidemiology of <i>Mycoplasma</i> spp. infection in solid organ transplant recipients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130188","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":"Developing and Validating Machine Learning-Driven Risk Indices to Predict Patient Dropout During Referral, Evaluation, and Waitlisting for Kidney Transplant","authors":"Solaf Al Awadhi,&nbsp;Enshuo Hsu,&nbsp;Thomas B. H. Potter,&nbsp;Ioannis A. Kakadiaris,&nbsp;David A. Axelrod,&nbsp;Faith Parsons,&nbsp;Andrea M. Meinders,&nbsp;Victoria Cassell,&nbsp;Catherine Pulicken,&nbsp;Zulqarnain Javed,&nbsp;Paula K. Shireman,&nbsp;Stefano Casarin,&nbsp;A. L. Jonathan Gelfond,&nbsp;Amy D. Waterman","doi":"10.1111/ctr.70325","DOIUrl":"10.1111/ctr.70325","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transplant is the optimal treatment for kidney failure; however, disparities in access persist. We developed and validated risk indices to predict early dropout at key stages of the transplant-seeking process not captured in national registries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included patients referred for kidney transplant at Houston Methodist Hospital between June 2016, and November 2023. We collected demographic, clinical, patient- and contextual-level socioeconomic variables from electronic health records and publicly available census data. We used machine learning (ML) models to predict the characteristics of patients at higher risk of dropping out: (1) at referral (before starting evaluation), (2) in the process of evaluation (before waitlisting), and (3) during waitlisting (before receiving a transplant). Model performance was evaluated using AUROC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 4133 referred patients, 46% did not attend their first transplant evaluation visit. Of 2414 patients who were medically eligible for transplant and started evaluation, 54% did not become waitlisted. Of 2457 waitlisted patients, 31% became inactive on the waitlist. Higher risk patients were consistently older, obese, and socioeconomically disadvantaged, with stage-specific differences: social factors—such as being single, unemployed, less educated, and living in high-deprivation areas—and African American race dominated at referral (AUROC 0.79); clinical comorbidities and both African American and Hispanic ethnicity were prominent at evaluation (AUROC 0.71); and Hispanic ethnicity, smoking, and digital exclusion were key drivers at waitlisting (AUROC 0.76).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ML models effectively identified dropout risk at referral, evaluation, and waitlisting, enabling early identification of at-risk patients. Targeted interventions could reduce disparities, improve evaluation completion, and increase transplant access.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085137","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":"Liver Transplantation Using Allografts With Hepatic Artery Injury During Procurement: A Propensity Score-Matched Analysis of Outcomes","authors":"Florence Jeune,&nbsp;Chetana Lim,&nbsp;Éric Savier,&nbsp;Claire Goumard,&nbsp;Fabiano Perdigao,&nbsp;Géraldine Rousseau,&nbsp;Olivier Scatton","doi":"10.1111/ctr.70323","DOIUrl":"10.1111/ctr.70323","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hepatic artery (HA) injury during liver procurement is a significant concern in liver transplantation (LT). This study assessed its frequency and impact in deceased donor LT (DDLT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-center cohort study of adults who underwent DDLT from 2010 to 2019. HA injury was defined as the section or ligation of arterial branches supplying the graft. Recipients, donors’ characteristics and outcomes of LTs using grafts with HA injury (group 1, <i>n</i> = 35) were compared to LTs using grafts without HA injury (group 2, <i>n</i> = 677). A propensity score matching (PSM) was applied. The primary endpoint was 90-day hepatic artery thrombosis (HAT); secondary endpoints included major biliary complications, retransplantation, patient, and graft-survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>HA injury occurred in 4.9% of grafts. Aberrant HA anatomy was an independent predictive factor of HA injury (OR = 8.1 [3.7–17.9], <i>p</i> &lt; 0.0001). Arterial reconstruction was required in 53.8% of injured grafts, while 23% had lateral sutures and 23% required no reconstruction. Arterial ischemia time was longer in group 1 (50 min [42–67] vs. 43 min [35–56]; <i>p</i> = 0.007). At 90-day, HAT (2.9% vs. 0.7%; <i>p</i> = 0.26), major biliary complications (5.7% vs. 7.2%, p&gt;0.99) and retransplantation rates (2.9 % vs. 1%, <i>p</i> = 0.33) were similar. After PSM, theses outcomes remained comparable. The 5-year patient (74.3% vs. 78.3 %, <i>p</i> = 0.77) and graft-survival (70.2% vs. 75.6%, <i>p</i> = 0.78) were also similar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HA injury during procurement was rare and did not impact mid- or long-term LT outcomes, supporting a “non-restrictive graft policy” regarding grafts with HA injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079854","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":"Using Torque Teno Virus as a Serial Monitoring Tool for the Net State of Immunosuppression of Kidney Transplant Recipients","authors":"Akhil Singla,&nbsp;Kenny Chen,&nbsp;Blade Robelly,&nbsp;Christabel Rebello,&nbsp;Connor Lantz,&nbsp;Lihui Zhao,&nbsp;Rohita Sinha,&nbsp;Sook Park,&nbsp;Steve Kleiboeker,&nbsp;John J. Friedewald,&nbsp;Sanjay Mehrotra","doi":"10.1111/ctr.70321","DOIUrl":"10.1111/ctr.70321","url":null,"abstract":"<p>Torque Teno Virus (TTV) has emerged as a promising marker reflecting the net state and trajectory of immunosuppression (IS). We analyzed longitudinal TTV data from 252 kidney transplant recipients in a multi-center observational study (average 7.8 visits/patient over 2 years). Patient-specific TTV trajectories, computed as slopes over defined time windows, captured the direction of immune response dynamics. A past 1-year logTTV slope &lt; 0.0066, combined with a low current logTTV (&lt;4.3) and a relatively high historical logTTV average (&gt;5.7), was associated with a 13.88-fold increase in the odds of subclinical AR (95% CI: 5.49–37.42) relative to patients whose slope exceeded 0.0066. In contrast, a past 1-year logTTV slope &gt; 0.076 conferred a 12.15-fold rise in the odds of infection over TX (95% CI: 2.99–81.42). Decision trees incorporating TTV trajectories achieved AUCs of 0.67 for both subclinical AR and infection versus TX—outperforming models using a single TTV measurement. We identified optimal two-sided logTTV thresholds—(4.5,7.8)—stratifying patients into Under-IS, Even-IS, and Over-IS states, where Under-IS status increases subclinical AR odds over TX by 2.39-fold (95% CI: 1.53–3.83), while Over-IS status increases infection odds over subclinical AR by 2.5-fold (95% CI: 1.03–6.42). These findings provide a framework for personalized IS management.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079865","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":"The Impact of Specialty Pharmacy Mandates on the Solid Organ Transplant Population","authors":"Karen Khalil,&nbsp;Ann Kataria,&nbsp;Renu Phillippupillai,&nbsp;Marissa Brokhof,&nbsp;Nicole Kenyon,&nbsp;Vineeta Kumar,&nbsp;Jeffrey Stern,&nbsp;Matt Harris","doi":"10.1111/ctr.70288","DOIUrl":"10.1111/ctr.70288","url":null,"abstract":"<div>\u0000 \u0000 <p>A specialty pharmacy mandate is a rule by insurance companies requiring patients to obtain “specialty” medications from specific pharmacies. This study's objective was to evaluate the impact of these mandates on patient care and the solid organ transplantation population. Two surveys were distributed to transplant professionals within the American Society of Transplantation Communities of Practice (AST COPs) and the International Transplant Nurses Society (ITNS). In total, 167 respondents were included (<i>n</i> = 105 AST COPs, <i>n</i> = 62 ITNS). Most of the AST COP cohort identified as pharmacists (76%), followed by physicians (13%). Most respondents from the ITNS cohort identified their role as nurse/coordinator (97%). Sixty-two percent of respondents from the AST COPs and 48% of respondents from ITNS reported delays in discharge due to specialty pharmacy mandates within the past 12 months. Over 60% described delays in initiation of drug therapy related to these mandates. Additionally, 18%–34% of patients required additional outpatient visits and/or readmissions related to medication access issues in the setting of specialty pharmacy mandates. Over 50% of the time, patients paid out of pocket for medications to allow discharge if an override was not possible. Specialty pharmacy mandates delayed discharges, increased cost, and puts undue strain on the healthcare system for solid organ transplant recipients.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085094","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":"Screening and Surveillance for Colorectal Cancer Before and After Heart Transplantation","authors":"Madeline E. Abrams,&nbsp;Eleanor Keller,&nbsp;Carolina Lemos,&nbsp;Matthew Regan,&nbsp;Desire Cruz O'Connell,&nbsp;Sanjay M. Salgado,&nbsp;Elena Donald,&nbsp;Ruben Salazar,&nbsp;Carolyn Hennecken,&nbsp;Jayant K. Raikhelkar,&nbsp;Farhana Latif,&nbsp;Kevin J. Clerkin,&nbsp;Gabriel Sayer,&nbsp;Nir Uriel,&nbsp;Ersilia M. DeFilippis","doi":"10.1111/ctr.70301","DOIUrl":"10.1111/ctr.70301","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Solid organ transplantation is associated with an increased risk of de novo malignancy due to immunosuppression. However, colorectal cancer (CRC) screening guidelines for heart transplantation (HT) candidates and recipients are the same as for the general population. We aimed to evaluate CRC screening practices among HT recipients both before and after HT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of adult HT recipients between 2013 and 2023 at a large volume transplant center. Patient-level data were collected, including demographics, laboratory studies, and use of pre-HT mechanical circulatory support (MCS); additionally, electronic medical records were reviewed to identify methods of CRC screening and surveillance. Guideline consensus recommendations were used to determine if patients were up-to-date with screening. The date of last follow-up was October 2024. Multivariable logistic regression was used to assess predictors of colonoscopy use for screening pre- and post-HT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2013 and 2023, 650 patients underwent HT. A total of 436 (67.1%) were of the recommended age for CRC screening, and 386 (88.5%) underwent CRC screening pre-HT. Fifty (13%) screened patients had high-risk features for CRC. Colonoscopy was utilized in 342 (88.6%) cases. The use of CT colonography was more frequent in those on MCS or inotropic support at the time of screening (32.9% vs. 6.6%, <i>p</i> &lt; 0.00001). The use of temporary MCS was associated with lower odds of screening with colonoscopy (aOR 0.05, 95% CI 0.020.14, <i>p</i> &lt; 0.0001). Adenomatous polyps were found on 91 (26.6%) pre-HT colonoscopies, and CRC was diagnosed in one HT recipient on pretransplant screening. A total of 330 (50.8%) patients were due for colonoscopy post-HT, of whom 171 (51.8%) completed screening. Older patients had higher odds of undergoing colonoscopy post-HT (aOR 1.06, 95% CI 1.02–1.1, <i>p</i> = 0.001). Adenomatous polyps were found on 33 (19.3%) of post-HT colonoscopies, and the incidence of CRC post-HT was 1.2%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Further studies should explore optimal screening guidelines in the pre- and posttransplant population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079770","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}