Clinical Transplantation最新文献

{"title":"Diagnostic Performance of Donor-derived Cell-free DNA Combined With Immune Activation Markers for Detecting Acute Rejection After Liver Transplantation","authors":"Xuechun Zhao,&nbsp;Bo Yang,&nbsp;Hongmei Jiang,&nbsp;Yuanyuan Zhao,&nbsp;Lai Wei,&nbsp;Zhishui Chen,&nbsp;Dong Chen","doi":"10.1111/ctr.70701","DOIUrl":"https://doi.org/10.1111/ctr.70701","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Accurate differentiation of acute rejection (AR) from other causes of graft dysfunction after liver transplantation remains challenging in real-world clinical practice. Although donor-derived cell-free DNA (dd-cfDNA) has emerged as a promising non-invasive biomarker of graft injury, its specificity may be limited in clinically suspected rejection due to concurrent inflammatory and non-rejection-related graft injuries. Immune activation markers may provide complementary information by reflecting ongoing alloimmune responses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective diagnostic study, we enrolled liver transplant recipients presenting with graft dysfunction and classified them as AR or non-rejection based on biopsy. Plasma dd-cfDNA levels and peripheral immune activation markers, including interleukin-2 receptor (IL-2R) and activated T-cell subsets, were measured. Diagnostic performance was evaluated using receiver operating characteristic analysis and multivariable models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 33 patients were included, comprising 18 with biopsy-proven AR and 15 with non-rejection graft dysfunction. dd-cfDNA levels were significantly higher in AR patients. Selected immune activation markers demonstrated complementary diagnostic characteristics. A simplified combined model integrating dd-cfDNA percentage with activated T-cell subsets achieved improved discrimination compared with individual markers. Decision curve analysis indicated a higher net clinical benefit across a range of threshold probabilities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Integration of dd-cfDNA with immune activation markers provides a complementary non-invasive strategy for evaluating acute rejection in liver transplant recipients with clinically suspected graft dysfunction. This approach may improve real-world diagnostic assessment and assist clinical decision-making while reducing unnecessary liver biopsies.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068407","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":"Risk-Stratified Surveillance for Recurrent Hepatocellular Carcinoma After Liver Transplantation: A Comparison With the RETREAT-Guided Surveillance Protocol","authors":"Ishaan P. Dharia,&nbsp;Emily A. Leven,&nbsp;Natalia Schmidt,&nbsp;Haley Waite,&nbsp;Pu Ni,&nbsp;M. Isabel Fiel,&nbsp;Marcelo E. Facciuto,&nbsp;Thomas D. Schiano,&nbsp;Lauren T. Grinspan","doi":"10.1111/ctr.70685","DOIUrl":"https://doi.org/10.1111/ctr.70685","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) is uncommon but associated with poor outcomes, requiring effective surveillance. We assessed adherence to and effectiveness of a risk-stratified surveillance protocol and compared it with the RETREAT-guided surveillance protocol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a single-center retrospective review of patients with HCC on explant after LT (2013–2023). Patients were assigned low- or high-risk surveillance based on explant pathology (AJCC tumor stage, grade, and vascular invasion). Protocol performance, modified surveillance strategies, and comparison with RETREAT across multiple cutoffs were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 480 patients, 55 (11.5%) developed recurrence; 23 (41.8%) of these died, with median post-recurrence survival of 14 months. Only 15.8% were fully adherent, with higher adherence in low-risk patients (<i>p</i>&lt;0.001). The protocol appropriately stratified risk (sensitivity 80.0%, specificity 54.1%) and retained substantially higher specificity than RETREAT even at RETREAT's conventional low-risk cutoff (32.0%) despite matching sensitivity; the two systems captured different patients (McNemar's test, <i>p</i>&lt;0.001). Extrahepatic disease at recurrence was more common in high-risk patients (56.8% vs. 18.2%, <i>p</i> = 0.040). Fully adherent patients had earlier recurrence detection (206.4 vs. 666.9 days, <i>p</i> = 0.015). Modified protocols improved adherence but delayed some diagnoses; most low-risk recurrences occurred within 1 year and high-risk recurrences within 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This protocol effectively stratifies recurrence risk and is more sensitive than the RETREAT-guided surveillance protocol. Modified strategies may improve adherence and reduce cost while maintaining effectiveness, particularly in low-risk patients.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068416","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":"Computed Tomography-Based Body Composition Metrics as a Predictor of Textbook Outcome in Lung Transplant Patients","authors":"Alexa Lavergne,&nbsp;Kirti Magudia,&nbsp;Tommi Jarvinen,&nbsp;Alexander Reed,&nbsp;Samantha Morrison,&nbsp;Mustafa R. Bashir,&nbsp;Michael Rosenthal,&nbsp;Mohamed Sobhi Jabal,&nbsp;John M. Reynolds,&nbsp;Brandi Bottiger,&nbsp;Jacob Klapper","doi":"10.1111/ctr.70694","DOIUrl":"https://doi.org/10.1111/ctr.70694","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lung transplantation is a complex therapy for end stage lung disease with variable postoperative outcomes. Textbook outcomes, defined by freedom from perioperative morbidity and mortality, have emerged as a comprehensive measure of surgical success. Body mass index (BMI) is commonly used to assess nutritional status but does not distinguish between skeletal muscle and adipose tissue. CT-based body composition analysis can differentiate these tissues and may provide a more precise assessment of physiologic reserve in lung transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study of 377 adults undergoing single or bilateral lung transplantation at a single academic institution (2019–2023). Preoperative abdominal CT scans were used to quantify skeletal muscle, subcutaneous fat, and visceral fat areas. A composite textbook outcome was defined as freedom from intraoperative complications; postoperative reintervention; readmission, acute rejection, and dialysis within 30 days; 90-day mortality; primary graft dysfunction; ECMO at 72 h; tracheostomy within 7 days; reintubation; and extubation &gt;48 h. Multivariable logistic regression assessed associations between body composition metrics and lung transplant outcomes after adjusting for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 377 recipients, 108 (28.6%) achieved textbook outcome. Increased skeletal muscle area was associated with increased odds of achieving textbook outcome (OR per 50cm²: 1.808 [1.061–3.119]) and decreased odds of 1-year mortality (OR per 50cm²: 0.423 [0.195–0.890]). Subcutaneous fat area, visceral fat area, and BMI were not significantly associated with outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CT-based skeletal muscle was associated with textbook outcome and 1-year mortality, whereas BMI was not. CT-based body composition analysis may be a promising tool for lung transplant risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068152","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":"Targeting Plasma Cells in Antibody-Mediated Rejection After Heart Transplantation: A Single-Center Experience With Daratumumab","authors":"Consuelo Fernandez-Aviles Irache,&nbsp;Maria Alvarez Bello,&nbsp;Jorge Martinez Solano,&nbsp;Zorba Blazquez-Bermejo,&nbsp;Javier Bermejo Thomas,&nbsp;Carlos Ortiz-Bautista","doi":"10.1111/ctr.70682","DOIUrl":"https://doi.org/10.1111/ctr.70682","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068106","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":"Five-Year Outcomes and Clinicopathological Correlations of Kidney Transplants From Deceased Donors With Diabetes","authors":"Marina Colella-Santos,&nbsp;Pedro Henrique Pepato,&nbsp;Henrique Machado de Sousa Proença,&nbsp;Luiz Antonio Ribeiro de Moura,&nbsp;José Medina-Pestana,&nbsp;Renato Demarchi Foresto,&nbsp;Lúcio Requião-Moura","doi":"10.1111/ctr.70698","DOIUrl":"https://doi.org/10.1111/ctr.70698","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Kidneys from deceased donors with diabetes mellitus are refused because diabetes is considered a marker of lower organ quality. We evaluated 5-year outcomes according to donor-recipient diabetes status and, secondarily, the prognostic value of pre-implantation histopathological findings among accepted diabetic donor kidneys.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective single-center cohort study included adult recipients of deceased-donor kidney transplants performed between 2013 and 2017. Five-year kidney function and death-censored graft survival were compared according to donor diabetes status before and after 1:2 propensity score matching. A secondary exploratory analysis evaluated Banff chronicity parameters in pre-implantation pathology reports.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 3058 recipients, 244 received kidneys from diabetic donors. These donors were older, more frequently hypertensive, and had higher KDPI than non-diabetic donors. In unadjusted analyses, recipients of diabetic donor kidneys had lower eGFR and death-censored graft survival. After matching, eGFR from years 1 to 5, eGFR slope, and death-censored graft survival no longer differed between groups. Recipient diabetes did not significantly modify the association of donor diabetes with graft survival or longitudinal eGFR, although the D+/R+ subgroup was small (<i>n</i> = 39). Among 164 available pre-implantation biopsy reports, diabetes-related glomerular lesions were uncommon, chronic lesions were predominantly vascular and mild to moderate, and no Banff histological parameter independently predicted eGFR &lt;30 mL/min/1.73 m² or death-censored graft loss at 5 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>After balancing baseline donor and recipient characteristics, donor diabetes was not associated with significantly lower 5-year kidney function or death-censored graft survival. In the secondary clinicopathological analysis, no individual Banff chronicity parameter independently predicted 5-year outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70698","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068153","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":"Predicted Heart Mass and Severe Primary Graft Dysfunction in Donation After Circulatory Death Heart Transplant","authors":"Joseph Barile,&nbsp;Yanling Zhao,&nbsp;Ali Fatehi Hassanabad,&nbsp;Farhana Latif,&nbsp;Gabriel Sayer,&nbsp;Nir Uriel,&nbsp;Paul Kurlansky,&nbsp;Koji Takeda","doi":"10.1111/ctr.70689","DOIUrl":"https://doi.org/10.1111/ctr.70689","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background:</h3>\u0000 \u0000 <p>Donation after circulatory death (DCD) has expanded the US heart donor pool yet carries a higher risk of severe primary graft dysfunction (PGD) for recipients compared to donation after brain death (DBD). This study addresses an important knowledge gap of exploring the role of heart size mismatch in contributing to the risk of severe PGD in DCD-HT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods:</h3>\u0000 \u0000 <p>All heart-only, adult transplants from the united network for organ sharing (UNOS) database were collected from 09/2023–06/2025. Univariable (UV) and multivariable (MV) analyses were used to identify associations between various size matching variables and severe PGD in both DCD-HT and DBD-HT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>In the DCD-HT MV analysis, no categorical classifications of size mismatch had significant associations with severe PGD. However, various recipient size metrics, including predicted heart mass (PHM) (OR = 1.01 per gram [1.00–1.01], <i>p</i> = 0.002) were independently associated with severe PGD in DCD-HT. When analyzed in the dataset containing both DCD and DBD cases, PHM's association with severe PGD was found to interact with DCD status (<i>β</i> = 0.009, SE = 0.0032, <i>p</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions:</h3>\u0000 \u0000 <p>Conventional categorical donor-recipient size-mismatch classifications established in DBD-HT were not associated with severe PGD in DCD-HT. In contrast, larger recipient size was independently associated with an increased risk of severe PGD in DCD-HT, whereas no such association was observed in DBD-HT. These findings highlight potential differences in the determinant of severe PGD between DCD-HT and DBD-HT and support further investigation into the role of recipient size in donor-recipient matching for DCD-HT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068107","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":"Microbiological Dynamics Before and After Lung Transplantation: Clinical Interpretation and Prognostic Implications","authors":"Takashi Hirama,&nbsp;Tomoya Itagaki,&nbsp;Takuya Ikushima,&nbsp;Shunta Mukai,&nbsp;Tatsuaki Watanabe,&nbsp;Yui Watanabe,&nbsp;Hisashi Oishi,&nbsp;Yoshinori Okada","doi":"10.1111/ctr.70702","DOIUrl":"https://doi.org/10.1111/ctr.70702","url":null,"abstract":"<div>\u0000 \u0000 <p>Respiratory cultures before and after lung transplantation are frequently obtained but often difficult to interpret. A positive culture may represent donor-derived organisms, recipient reservoir recolonization, hospital acquisition, transient colonization, invasive infection, or a marker of evolving graft vulnerability. This review summarizes how respiratory microbiology changes across the lung transplant timeline and proposes a practical framework for clinical interpretation. Conventional culture-based studies and recent airway microbiome literature are integrated to examine donor-recipient attribution, pre-transplant colonization, disease-specific reservoirs, single-lung transplantation, and pathogen-specific risk. Pre-transplant recipient colonization, particularly with multidrug-resistant gram-negative organisms, appears more consistently associated with early post-transplant pneumonia and short-term outcomes than donor culture positivity alone when targeted antimicrobial therapy is used. Disease-specific patterns are also important: cystic fibrosis and bronchiectasis favor recolonization from persistent reservoirs, whereas single-lung transplantation creates a dual-airway ecosystem in which the native lung may remain microbiologically relevant. Persistent or recurrent isolation of organisms such as <i>Pseudomonas aeruginosa</i>, <i>Burkholderia cenocepacia</i>, <i>Staphylococcus aureus</i>, <i>Aspergillus</i> species, and nontuberculous mycobacteria should be interpreted in relation to symptoms, imaging, lung function, sampling source, and timing from transplant. Contextual interpretation of respiratory cultures may improve antimicrobial planning, donor acceptance decisions, stewardship, and long-term graft surveillance.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068235","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":"Aldosterone Synthase Inhibition in Kidney Transplantation: Class Rationale, Translational Promise, and the Limits of Current Evidence—Response to Singh et al","authors":"Lucas Maciel de Almeida Corrêa,&nbsp;Luiggi Kevin Virgino Brandão,&nbsp;Clara Belo Gamon Santiago,&nbsp;Alexandre de Assis Barbosa,&nbsp;Gabriel Rian Mazur,&nbsp;Gabriel Costa de Santana,&nbsp;Yan Roberth Delmiro Silva,&nbsp;Letícia Esteves Dante,&nbsp;Ivan Felipe Dutra Júnior","doi":"10.1111/ctr.70699","DOIUrl":"https://doi.org/10.1111/ctr.70699","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068154","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":"Living-Donor Kidney Transplantation From an Attained Identical Twin Donor Status After Prior Hemopoietic Cell Transplantation","authors":"Sushma Bhusal,&nbsp;John M. Arthur,&nbsp;Terry O. Harville,&nbsp;Sundaram Hariharan","doi":"10.1111/ctr.70692","DOIUrl":"https://doi.org/10.1111/ctr.70692","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 10","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068227","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":"Predictive Value of HLA-Derived T-Cell Epitope and B-Cell Epitope Matching Algorithms for Pancreas Transplant Outcomes","authors":"Zakieh Zare,&nbsp;Matthias Niemann,&nbsp;Kasra Shirini,&nbsp;Ian Booth,&nbsp;Bethany Dale,&nbsp;Richard Ugarte,&nbsp;Silke V. Niederhaus,&nbsp;Cinthia B. Drachenberg,&nbsp;Abdolreza Haririan","doi":"10.1111/ctr.70677","DOIUrl":"10.1111/ctr.70677","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Donor/recipient HLA molecular mismatches are predictive of kidney transplant outcomes. Their role in pancreas transplantation has not been well studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study in 281 pancreas (± kidney) transplant recipients during 2000–2018, followed for average 53.8 months. T-cell epitope matching was performed by the PIRCHE-II algorithm (T2) and B-cell epitope mismatch using Snow (B2) and HLA Matchmaker algorithms. Primary outcome was pancreas acute rejection, secondary outcomes included pancreas graft failure and composite of both, and kidney graft failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PIRCHE-T2 score (59.3±22.3) was not associated with study outcomes (HR 0.99, 95%CI 0.98–1.00, <i>p</i> = 0.31 for pancreas rejection). However, increasing PIRCHE-B score (15.1±6.3) was predictive of lower risk of acute rejection (aHR 0.94; 95%CI 0.9–0.99, <i>p</i> = 0.024) and graft failure (aHR 0.96; 95%CI 0.93–0.99; <i>p</i> = 0.021), driven by PIRCHE-B-Class II score (aHR 0.91; 95%CI 0.85–0.98, <i>p</i> = 0.01; aHR 0.92; 95%CI 0.88–0.97; <i>p</i> = 0.001, respectively). Total eplet mismatch (19.58±7.40) was highly correlated with PIRCHE-B score (ρ = 0.82, <i>p</i> &lt; 0.0001), showing similar associations. However, the molecular scores were not associated with kidney graft failure (<i>p</i> &gt; 0.57 for all).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study suggests that higher B-cell epitope mismatch loads are paradoxically associated with improved pancreas transplant outcomes, while PIRCHE-T2 scores demonstrated limited predictive value.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918741","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}