Clinical Transplantation最新文献

{"title":"Hepatitis B Virus NAT Positive Donors in Non-Hepatic Organ Transplant: Quantifying Viral Loads to Optimize Recipient Risk Stratification and Management in the Prevention of Donor-Derived Infection","authors":"Patrick C. K. Tam,&nbsp;Goni Katz-Greenberg,&nbsp;Cameron R. Wolfe,&nbsp;Kristen Lott,&nbsp;Carl L. Berg,&nbsp;Adam D. DeVore,&nbsp;John M. Reynolds,&nbsp;Jennifer L. Saullo","doi":"10.1111/ctr.70236","DOIUrl":"https://doi.org/10.1111/ctr.70236","url":null,"abstract":"<p>Transplantation is one of the few life-saving therapies for patients with end-stage organ disease, yet organ availability remains restrictive. Expanding donors to include those with hepatitis B virus (HBV) infection, incorporating HBV nucleic acid amplification testing (NAT) positive donors, could improve organ access. However, the risk of donor-derived HBV transmission and recipient management of organs transplanted from HBV NAT-positive donors, particularly in thoracic organ recipients, is limited. We conducted a single-center retrospective study to assess the safety and outcomes in recipients of non-hepatic organ transplants from HBV NAT-positive donors. Over a 4.5-year period, 25 transplant recipients, including 16 thoracic organ recipients, received organs from 22 unique, qualitative HBV NAT-positive donors. All recipients were HBV surface antibody-positive prior to transplant. Quantitative NAT was performed in 20/22 (91%) donors with values ranging from 0 to 1 280 000 IU/mL; 8/22 (36%) donors had HBV NAT values that were undetected or below the lower limit of quantification. All recipients were administered HBV immunoglobulin (HBIG) and received HBV active antiviral therapy post-transplant. Recipients were followed post-transplant for a median of 250 days (IQR: 169–467 days). No recipients developed de novo HBV infection characterized by HBV surface antigen (HBsAg) seroconversion, quantifiable HBV NAT detection, or sustained HBV core antibody (HbcAb) seroconversion post-transplant. Similarly, no recipient developed liver dysfunction or died due to HBV infection. Quantifying HBV from NAT-positive donors may better inform the risk of donor-derived infection in recipients, and the use of these organs incorporating a multimodal prevention strategy could safely increase the donor pool.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 7","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681609","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":"Impact of GLP-1 and GLP-1/GIP Receptor Agonist Weight Loss Post-Lung Transplant on Lung Allograft Function","authors":"Spenser E. January,&nbsp;Keith A. Fester,&nbsp;Jesus E. Escamilla,&nbsp;Marlene Cano","doi":"10.1111/ctr.70246","DOIUrl":"https://doi.org/10.1111/ctr.70246","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Glucagon-like peptide-1 receptor agonist (GLP-1 RA) and GLP-1/glucose dependent insulinotropic polypeptide receptor agonist (GLP-1/GIP RA) use is becoming increasingly common, but there are little data on their use after lung transplantation. Furthermore, obesity is a known cause of lung function decline after lung transplant, but whether weight loss experienced while on these medications leads to improved lung allograft function has not been investigated.&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;This single-center retrospective study assessed the use of GLP-1 or GLP-1/GIP RA therapy in patients after lung transplantation. The primary objective was to determine if weight loss is associated with improved lung function. Secondary endpoints included changes in hemoglobin A1c and incidence of adverse effects. A subgroup analysis was performed on only those who lost the median or greater percent of body weight, and a sensitivity analysis was performed to assess if other variables impacting lung function significantly contributed to the endpoints.&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;There were 81 lung transplant recipients who received GLP-1 or GLP-1/GIP RA therapy; the average duration of use was 1.4 years. There was significant weight loss and improvement in hemoglobin A1c, but there was no association found between weight loss and improvement in FEV1 or FVC. Side effects were common and led to discontinuation of the medication in 18.5% of patients, but serious side effects were rare.&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;Use of GLP-1 or GLP-1/GIP RA therapy after lung transplantation was effective at decreasing weight and improving hemoglobin A1c, but this did not lead to improved lung allograft function.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Summary&lt;/h3&gt;\u0000 \u0000 &lt;div&gt;\u0000 &lt;ul&gt;\u0000 \u0000 &lt;li&gt;In this article examining the use of GLP-1 and GLP-1/GIP RA after lung transplantation, there was no significant association between weight loss and an increase in lung allograft function, although approximately half of the patients experienced a rise in FEV&lt;sub&gt;1&lt;/sub&gt; and FVC while on therapy.&lt;/li&gt;\u0000 \u0000 &lt;li&gt;This study included both a subgroup and a sensitivity analysis to assess if significant weight gain was needed to improve lung function and to assess the impact of other variables on lung function.&lt;/li&gt;\u0000 \u0000 &lt;li&gt;Patients in this study experienced significant improvement in weight and hemoglobin A1c. Side effect","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681188","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":"Impact of Normothermic Machine Perfusion on Access to Liver Transplantation in Patients With Primary Hepatic Malignancies","authors":"Dominic Amara,&nbsp;Andrew Melehy,&nbsp;Samer Ebaid,&nbsp;Fady M. Kaldas,&nbsp;Douglas G. Farmer,&nbsp;Peter Stock,&nbsp;Alex A. T. Bui,&nbsp;Neil Mehta,&nbsp;Vatche G. Agopian","doi":"10.1111/ctr.70254","DOIUrl":"https://doi.org/10.1111/ctr.70254","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Balancing the probability of transplant and waitlist dropout in patients with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) using MELD exception points has been an enduring challenge. The advent of normothermic machine perfusion (NMP) has the potential to increase access to transplantation in patients with primary hepatic malignancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Scientific Registry of Transplant Recipients database, this study evaluated the impact of widespread availability of NMP on access to liver transplantation in transplant oncology. Waitlist outcomes and transplant characteristics between patients with HCC and CCA after the implementation of acuity circles but before the widespread NMP availability (pre-NMP era, February 2020 to September 2021) were compared to those after widespread NMP availability (NMP era, September 2021 to September 2023) based on waitlist date.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 7564 patients with HCC (3691 pre-NMP; 3874 NMP era) and 354 patients with CCA (193 pre-NMP; 161 NMP era) were waitlisted over the study period. NMP-era patients had a higher probability of transplant at 1 year from listing for both HCC (59% vs. 49%, <i>p</i> &lt; 0.001) and CCA (71% vs. 56%, <i>p</i> = 0.012). Patients with HCC also had a lower risk of death or waitlist dropout (14% vs. 16% at 1 year, <i>p</i> = 0.016). After adjustment for other factors affecting probability of transplant in HCC, the NMP era (aSHR 1.26, 95% CI 1.18–1.34, <i>p</i> &lt; 0.001) and transplantation at a high-volume NMP center (aSHR 1.13, 95% CI 1.05–1.22, <i>p</i> = 0.002) were both still associated with higher transplant probability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NMP has promise in improving access to liver transplantation for oncologic indications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681200","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":"Urinary Complications and Long-Term Graft Survival After Primary Atypical Ureteral Anastomosis in Live-Donor Kidney Transplantation","authors":"Mohamed H. Zahran,&nbsp;Mohamed Shehata,&nbsp;Muhammed A. Elhadedy,&nbsp;Ahmed S. El-Hefnawy,&nbsp;Shady A. Soliman,&nbsp;Ahmed A. Shokeir,&nbsp;Yasser Osman,&nbsp;Bedeir Ali-El-Dein","doi":"10.1111/ctr.70244","DOIUrl":"https://doi.org/10.1111/ctr.70244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the urological complications and long-term renal graft survival after primary atypical ureteral anastomosis (PAUA) and to compare it to the standard ureteral anastomosis technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This is a retrospective analysis of all transplant patients with PAUA between 1976 and 2019. The primary outcome was to compare early (urinary leakage and ureteral obstruction) and delayed urinary complications (ureteral stricture and stones), and febrile UTI to the outcomes using the standard ureteral anastomosis technique (control). The second outcome was to compare the long-term graft function and graft survival between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PAUA was performed in 73 patients, including 39, 27, and 7 patients with ureteroureterostomy, ureteral anastomosis to an augmented bladder, and an ileal conduit, respectively. The control group included 2961 patients. PAUA had a statistically significant higher incidence of urinary leakage (9.6% vs. 2.4%, <i>p</i> = 0.002), ureteral stricture (4.1% vs. 1.2%, <i>p</i> = 0.03), and febrile UTI (28.8% vs. 4.2%, <i>p</i> &lt; 0.001), with insignificant differences regarding early ureteral obstruction (<i>p</i> = 0.6) and stone disease (<i>p</i> = 0.1). At last follow-up, no statistically significant differences in median serum creatinine or e GFR (<i>p</i> = 0.1) were identified between both groups. The cumulative 1-, 2-, 3-, 5-, and 10-year graft survival were 94% versus 94%, 89% versus 92%, 85% versus 89%, 74% versus 82%, and 53% versus 60% in studied group and control, respectively (HR: 0.9, 95% CI = 0.6–1.2, <i>p</i> = 0.6).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although kidney transplant patients with PAUA have significantly a higher urinary complication rate than those with a standard ureteral anastomosis technique, they have a comparable cumulative graft survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>Primary atypical anastomosis of the kidney transplant ureter into an augmented bladder, native ureter, or ileal loop conduit is associated with higher incidence of urinary leakage, ureteral stricture, and febrile urinary tract infection. However, it has no significant impact on long term graft survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681187","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":"Long-Term Chronic Lung Allograft Dysfunction-Free Survival Following Lung Transplant in the Presence of Donor-Specific Antibodies","authors":"Benjamin Grobman,&nbsp;Andrew M. Courtwright,&nbsp;Melissa Yeung,&nbsp;Selvin Jacob,&nbsp;Stefi Lee,&nbsp;Adil Sheikh,&nbsp;Mohamed Keshk,&nbsp;Amy Hackman,&nbsp;Anthony Coppolino,&nbsp;John Dunning,&nbsp;Nirmal Sharma,&nbsp;Hilary J. Goldberg","doi":"10.1111/ctr.70241","DOIUrl":"https://doi.org/10.1111/ctr.70241","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Highly sensitized patients with advanced lung disease, who are more often Black and Hispanic women, are at increased risk for waitlist death. In 2012, we implemented a protocol to cross any pre-transplant donor-specific antibody (DSA), so long as a prospective complement-dependent cytotoxicity (CDC) crossmatch was negative. We report long-term outcomes, including overall survival and chronic lung allograft dysfunction (CLAD)-free survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-institution retrospective cohort study of lung transplant recipients between October 1, 2012–December 31, 2022. We compared overall retransplant-free survival and CLAD-free survival between recipients with and without pre-formed DSA. Secondary outcomes included freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study cohort included 427 recipients with a median duration of follow-up of 4.3 years (IQR = 2.1–6.9). Thirty-three (7.7%) recipients had pre-transplant DSA with a peak historical mean fluorescence intensity (MFI) of 4200 (IQR = 3000–6600, total range 2100–23 000). The median number of DSA per patient was 1 (IQR = 1–2, total range 1–8). There was no difference in adjusted overall survival between recipients with and without pre-formed DSA (HR = 1.39, 95% CI = 0.82–2.36, <i>p</i> = 0.22) or adjusted CLAD-free survival between recipients with and without pre-formed DSA (HR = 1.07, 95% CI = 0.65–1.75, <i>p</i> = 0.79). Recipients with pre-formed DSA did not have increased adjusted hazard of ACR (HR = 0.71, 95% CI = 0.29–1.75, <i>p</i> = 0.45) but did have increased adjusted hazard of AMR (HR = 5.02, 95% CI = 2.11–11.95, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this moderately-sized cohort, a protocol of accepting donor offers for lung transplant candidates with pre-formed DSA but negative CDC crossmatch was not associated with worse overall or CLAD-free survival, within the limitations of the sample size.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681190","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":"Incidence, Risk Factors, and Impact on Transplant Outcomes of Cytokine Release Syndrome After Infusion of Haploidentical Stem Cells With Anti-Thymocyte Globulin","authors":"Feng-Mei Zheng,&nbsp;Jun Kong,&nbsp;Jing-Zhi Wang,&nbsp;Zhi-Dong Wang,&nbsp;Feng-Rong Wang,&nbsp;Ting-Ting Han,&nbsp;Hai-Xia Fu,&nbsp;Wei Han,&nbsp;Yuan-Yuan Zhang,&nbsp;Chen-Hua Yan,&nbsp;Huan Chen,&nbsp;Yao Chen,&nbsp;Yu-Hong Chen,&nbsp;Xiao-Dong Mo,&nbsp;Meng Lv,&nbsp;Yu-Qian Sun,&nbsp;Yi-Fei Cheng,&nbsp;Lan-Ping Xu,&nbsp;Xiao-Hui Zhang,&nbsp;Kai-Yan Liu,&nbsp;Xiao-Jun Huang,&nbsp;Yu Wang","doi":"10.1111/ctr.70242","DOIUrl":"https://doi.org/10.1111/ctr.70242","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cytokine release syndrome (CRS) after graft infusion under anti-thymocyte globulin (ATG)–based haploidentical (haplo)-hematopoietic stem cell transplantation is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The purpose of this study was to explore the clinical implications of CRS after graft infusion under ATG-based haplo-SCT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>We retrospectively analyzed the data of 259 patients who underwent haplo-SCT, graded CRS, and evaluated transplant outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CRS occurred in 103/259 (39.8%) of the recipients. Severe CRS (Grades 3–5) was not observed. Fever was the most common manifestation (89.3%), and all cases occurred only after peripheral blood stem cell (PBSC) infusion. According to the multivariable analysis, being older than 55 years (OR 2.486 (1.124–5.496), <i>p</i> = 0.024), having higher CRP levels during conditioning (OR 3.011 (95% CI, 1.766–5.134), <i>p</i> &lt; 0.001), and receiving PBSC as the sole stem cell source (OR 2.478 (95% CI, 1.077–5.700), <i>p</i> = 0.033) could predict the development of CRS, whereas an HCT-CI score ≥ 2 was an independent risk factor for Grade 2 CRS (OR 4.259 (95% CI, 1.515–11.969, <i>p</i> = 0.006)). The 3-year OS was not significantly different between the two groups, with 79% (95% CI, 61–97) for Grade 2 CRS and 85% (95% CI, 80–90) for Grade 0–1 CRS (<i>p</i> = 0.288). The GRFS rates in the two groups were 69% (95% CI, 49–90) and 67% (95% CI, 60–74), respectively (<i>p</i> = 0.644).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results suggest that CRS is common in patients receiving ATG-based haplo-SCT and does not affect survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 7","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666448","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":"Alternative-Donor Transplants in Adults ≤ 55 Years Old With Haematological Cancers: Young Versus Older Related HLA-Haplotype-Mismatched Donor Versus Unrelated Umbilical Cord Blood","authors":"Yu Hu,&nbsp;Sichang Liu,&nbsp;Wangsong Zhai,&nbsp;Saibing Qi,&nbsp;Wei Zhang,&nbsp;Yigeng Cao,&nbsp;Huilan Liu,&nbsp;Qiujin Shen,&nbsp;Erling Chen,&nbsp;Yi He,&nbsp;Xiaowen Gong,&nbsp;Aiming Pang,&nbsp;Yanping Ji,&nbsp;Xiaolin Zhai,&nbsp;Donglin Yang,&nbsp;Robert Peter Gale,&nbsp;Zimin Sun,&nbsp;Erlie Jiang,&nbsp;Junren Chen","doi":"10.1111/ctr.70251","DOIUrl":"https://doi.org/10.1111/ctr.70251","url":null,"abstract":"&lt;p&gt;Suppose we consider the complex question regarding the best graft source for an adult ≥ 16 years old with a haematological cancer when there is no human leukocyte antigen (HLA)-matched donor [&lt;span&gt;1&lt;/span&gt;]. Is it a young (≤ 40 years old) or older (&gt; 40) HLA-haplotype-mismatched relative (“haplo”) or an unrelated umbilical cord blood (UCB) unit? Answering this question requires a 3-way randomized controlled trial, which is difficult to do because the 3 donor options are not available to all subjects, and not all subjects assigned to receive UCB transplants can travel to centres with relevant expertise (Figure S1) [&lt;span&gt;2, 3&lt;/span&gt;]. One plausible solution is to look at statistics of the 3 separate graft-source cohorts in the transplantation registry, but interpretation could be confounded by imbalance of co-variates across cohorts and variance in centre experience [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;For head-to-head comparison of the 3 graft sources, it is necessary to distill co-variate-matched data from observational databases. We used data from a centre dedicated to “haplo” transplant with the peak throughput of ≈ 190 adults receiving “haplo” transplants per year (“haplo experienced centre”; Institute of Hematology, Chinese Academy of Medical Sciences [Tianjin, China]) and another centre dedicated to UCB transplant with the peak throughput of ≈ 120 adults receiving UCB transplants per year (“UCB experienced centre”; First Affiliated Hospital of University of Science and Technology of China [Hefei, China]). At the “haplo experienced centre” 97% and 3% of alternative-donor transplants in adults were “haplo” and HLA-mismatched unrelated donor transplants during 2012–2021; in contrast, at the “UCB experienced centre” 2% and 98% were “haplo” and UCB transplants during 2015–2020. The two centres are affiliated with separate medical educational institutes located in separate provincial-level administrative divisions of China, admit patients separately, make treatment decisions independently, and have non-overlapping staff (with the exception of one of us who starts joint appointments at both centres in 2025 [ZS]).&lt;/p&gt;&lt;p&gt;We retrieved complete clinical data of 548 adults receiving “haplo” transplants with myelo-ablative conditioning (MAC) and peri-transplant anti-thymocyte globulin (ATG) during 2012–2021 at the “haplo experienced centre” and 357 adults receiving single-unit UCB transplants with MAC without ATG during 2015–2020 at the “UCB experienced centre” (Table S1). Using propensity score matching (Supporting Information; Figure S2), we distilled a data subset comprising co-variate-matched young- and older-donor “haplo” transplants (&lt;i&gt;N&lt;/i&gt; = 93 and 93) done at the “haplo experienced centre” and their respective co-variate-matched controls—173 and 163 UCB transplants—done at the “UCB experienced centre” (Table S2). The cohorts were matched in their distributions, means, and standard deviations of recipient age and sex, cancer type and disease status p","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 7","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70251","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647618","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":"Comment on “Persistence of a High Seroconversion Rate 3.2 0.13 Years After Last COVID-19 Vaccination in Heart Transplant Recipients”","authors":"Hinpetch Daungsupawong,&nbsp;Viroj Wiwanitkit","doi":"10.1111/ctr.70249","DOIUrl":"10.1111/ctr.70249","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 7","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642012","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":"Protocol Biopsies in Delayed Graft Function Kidney Transplants From Brain-Dead Donors","authors":"Amanda Ahlmark,&nbsp;Ville Sallinen,&nbsp;Anne Räisänen-Sokolowski,&nbsp;Kaisa Ahopelto,&nbsp;Marko Lempinen,&nbsp;Jouni Lauronen,&nbsp;Ilkka Helanterä","doi":"10.1111/ctr.70228","DOIUrl":"https://doi.org/10.1111/ctr.70228","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Delayed graft function (DGF) is a significant challenge in deceased donor kidney transplantation, impacting approximately one third of patients and is associated with acute rejection. Post-transplant acute rejection is monitored in kidneys with DGF through sequential protocol biopsies in 7–10-day intervals, according to guidelines based on research done before the current era of immunosuppression treatment. As acute rejection rates have decreased, there is a need to reevaluate the rationale of protocol biopsies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied the histology of all biopsies taken during the first month post-transplant among recipients of brain-dead donor kidneys with DGF at our institution during 2006–2023. All recipients received corticosteroids as induction. Anti-thymocyte globulin was additionally administered to 3% and 18% receive basiliximab.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1022 biopsies were studied from 678 recipients. Of the 678 recipients, 178 (26%) had rejection. Most acute rejection episodes occurred 7–10 days post-transplant. In case of no rejection in the first biopsy, rejection was found in 10% of the cases with subsequent biopsies. No risk factors for acute rejection in these later biopsies could be identified in regression analysis. The presence of donor-specific human leukocyte antibodies was associated with higher rates of antibody-mediated rejection during the first post-transplant month (20% vs. 1.3%, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The first biopsy post-transplant in DGF kidneys has an important role in identifying early acute rejection. Of the patients with no rejection in the first biopsy, only 10% had a rejection in the second biopsy. Cases with borderline findings progressed to rejection in approximately one third of the cases. These data reflect the rate of early TCMR in deceased donor kidney transplants when 79% of patients did not receive an anti-T cell induction antibody.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 7","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70228","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635063","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":"Estimated Glomerular Filtration Rate Less Than 90 mL/min/1.73m2 in Living Donor Candidates Under 30 Years Old and Long-Term Outcomes","authors":"Erika S. Helgeson,&nbsp;David M. Vock,&nbsp;Raja Kandaswamy,&nbsp;Arthur J. Matas","doi":"10.1111/ctr.70240","DOIUrl":"https://doi.org/10.1111/ctr.70240","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traditionally, glomerular filtration rate (GFR) ≥80 mL/min/1.73 m² has been the threshold for living kidney donor (LKDs) acceptance. Recently, the threshold has been lowered for older donors. There is consideration of raising it for younger donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compared long-term outcomes for LKDs age 18–29 with predonation eGFR &lt; 90 to those with eGFR ≥ 90. LKDs with eGFR &lt;90 were matched 1:3 to LKDs with eGFR ≥ 90 using nearest neighbor propensity score matching. Propensity scores were estimated using logistic regression with covariates for age; systolic blood pressure; glucose; BMI; sex; donation year; relationship to recipient, smoking status; and family history of diabetes, hypertension, and cardiovascular disease (CVD). Incidence of death, eGFR &lt; 45, hypertension, diabetes, and CVD were compared between groups using Cox proportional hazards (for death) and Fine-Gray regression models treating death as a competing risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 965 LKDs age 18–29 with follow-up information, median [quartiles] age at donation was 25.4 [22.5, 27.6]; 54.0% were female, 91.6% White, 87% non-Hispanic; 158 (16.4%) had predonation eGFR &lt; 90. LKDs with eGFR &lt; 90 tended to donate during an earlier era (median year: 1982 vs. 1990, <i>p </i>&lt; 0.001) to a first degree relative (86.7% vs. 75.3%, <i>p</i> = 0.008) and have a family history of diabetes (53.8% vs. 40.6%, <i>p</i> = 0.009). During a median follow-up of 25 [12, 37] years no associations were detected between low predonation eGFR and death, eGFR &lt; 45, hypertension, diabetes, or CVD. Results among LKDs age &lt; 25 were similar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our data do not support increasing the eGFR threshold among young White non-Hispanic donor candidates, reducing one barrier to living donation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 7","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70240","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624667","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}