Clinical Transplantation最新文献

{"title":"From Determination of Death by Neurological Criteria to Early Graft Function: A 7-Year Single-Center Retrospective Study of 155 Consecutive Cases","authors":"Alessandra Agnese Grossi,&nbsp;Baiardo Redaelli Martina,&nbsp;Federica De Min,&nbsp;Maria Assunta Donato,&nbsp;Alessia Bresil,&nbsp;Alessandro Ivan De Martino,&nbsp;Paolo Severgnini,&nbsp;Luca Cabrini","doi":"10.1111/ctr.70668","DOIUrl":"10.1111/ctr.70668","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Organ donation after determination of death by neurological criteria (DBD) remains a cornerstone of deceased donation programs, yet the full pathway from donor identification to organ retrieval, transplantation, and early graft function remains insufficiently described. A better understanding of where falls occurs along this trajectory may help identify modifiable barriers and improve donation-system performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective single-center observational study including all consecutive cases of patients who underwent determination of death by neurological criteria recorded between 2019–2025 in four intensive care units of a tertiary-care hospital in Northern Italy. Data were extracted from institutional clinical and donation records and included donor characteristics, recorded donation preference, family authorization, causes of non-retrieval, number and type of organs retrieved and transplanted, and early graft functional recovery (e.g., 24–48 h posttransplant).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>155 patients underwent determination of death by neurological criteria. Organ retrieval was performed in 111 cases (71.6%). Documented prior consent was present in 41 cases (26.4%), decline in 3 (1.9%), and no prior recorded donation preference in 106 cases (68.4%), requiring family authorization. In this subgroup, family decline occurred in 27 cases (25.5%) and represented the leading cause of non-retrieval. Medical contraindications accounted for 12 further exclusions. Overall, 365 organs were retrieved, corresponding to 65.8% of potentially available organs; 343 (94.0%) were transplanted, and 332 (96.8% of transplanted organs) showed functional recovery at 24–48 h. Mean number of retrieved organs was 3.28, with 2.99 functioning grafts per donor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Family decline and non-retrieval of organs judged unsuitable at retrieval were the main points of loss along the donation pathway. Systematic whole-pathway data collection may help identify missed opportunities, guide quality-improvement strategies, and optimize assessment at the organ retrieval stage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918748","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 Training During ASTS Fellowship: Disparities in Autonomy Between Kidney and Liver Donation. A National Survey","authors":"Michele Finotti,&nbsp;Silvio Nadalin,&nbsp;Giuliano Testa","doi":"10.1111/ctr.70671","DOIUrl":"10.1111/ctr.70671","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Living donor transplantation should be a cornerstone for kidney and liver transplant surgeons. However, achieving technical independence, especially in living donor liver transplantation (LDLT), remains a challenge. This survey evaluates the experiences and barriers faced during the American Society of Transplant Surgeons (ASTS) Fellowship Program and proposes solutions to improve autonomy in living donor transplantation.&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;A 93-item questionnaire was distributed via LimeSurvey to former ASTS Fellows, gathering demographic information, training experiences, and autonomy levels in living donor kidney (LDKT) and liver transplantation (LDLT) after the two-year fellowship. Responses were received from 95 participants. We performed descriptive analyses and exploratory paired comparisons between LDKT and LDLT domains.&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;A total of 95 former fellows initiated the survey; 41 (43.6%) completed all items and were included in the analyses. The survey revealed significant differences in independence levels between LDKT and LDLT. While 82.9% of fellows felt very or completely confident in LDKT, only 29.2% felt similarly for LDLT (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). A majority (90.2%) believed the ASTS fellowship structure enabled independence in LDKT, but only 9.7% thought the same for LDLT (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Robust training in LDKT was reported, with 63.4% of fellows achieving independence in donor nephrectomy, compared to only 14.6% in donor hepatectomy (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Fellows performed a median of 30 living donor nephrectomies as primary surgeons, but only 4 hepatectomies during the fellowship (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001). Low LDLT case volumes, lack of structured curricula, and limited opportunities to act as primary surgeons were key barriers. 68.3% felt fully or mostly prepared to lead a living donor programme in LDKT, compared to 7.3% in LDLT (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The ASTS fellowship provides an excellent foundation for LDKT, fostering independence in laparoscopic and robotic approaches. However, independence in LDLT remains difficult to achieve under the current structure. Solutions include formalized curricula, mandated primary surgeon roles in LDLT procedures, and double-console robotic systems for guided learning. Addressing these gaps is essential to prepare future transplant surgeons for the increasing demands of living donor transplantation programs.&lt;/p&gt;\u0000 &lt;/section&gt;","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70671","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918673","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":"Pancreas Transplant Training in U.S. Transplant Nephrology Fellowships: National Survey of Current Barriers and Potential Solutions","authors":"Alissar El Chediak,&nbsp;Ayush Singh,&nbsp;Arjun Singh,&nbsp;Arya Ghiwala,&nbsp;Mital Shah,&nbsp;Sumi Nair,&nbsp;Roy D. Bloom,&nbsp;Michelle A. Josephson,&nbsp;Neeraj Singh","doi":"10.1111/ctr.70674","DOIUrl":"10.1111/ctr.70674","url":null,"abstract":"<p>Limited training opportunities for transplant nephrologists have been identified as a potential contributing factor for declining pancreas transplant volumes. However, data describing pancreas transplant training within transplant nephrology fellowships are scarce. We conducted a survey of 66 accredited U.S. transplant nephrology fellowship programs between December 2024 and May 2025 to assess perceived barriers and strategies to enhance pancreas transplant training. A total of 48 (72%) responses were received. A significant number of programs (<i>n</i> = 21; 44%) reported that they did not graduate fellows to meet the Organ Procurement and Transplantation Network eligibility requirements to become primary pancreas transplant physicians. 14 (29%) programs either did not perform pancreas transplants or performed fewer than 5 annually. Low pancreas transplant volume was identified as the most significant barrier to training. The most frequently endorsed solutions included designing dedicated pancreas transplant rotations, even at institutions outside their own, and implementing a standardized training curriculum. Such interventions may help address current training gaps and strengthen the future pancreas transplant workforce.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70674","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918695","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":"Revisiting Futility: Normothermic Perfusion Improves Outcomes Across all UK DCD Risk Strata","authors":"Stephanie Y. Ohara,&nbsp;Victoria Stevens,&nbsp;Alekhya Madisetty,&nbsp;Sandra Arias,&nbsp;Arpit Gupta,&nbsp;Nan Zhang,&nbsp;Xingjie Li,&nbsp;Amit K. Mathur,&nbsp;Sudhakar K. Reddy,&nbsp;Michelle C. Nguyen","doi":"10.1111/ctr.70669","DOIUrl":"10.1111/ctr.70669","url":null,"abstract":"<div>\u0000 \u0000 <p>Donation after circulatory death (DCD) liver transplantation is increasingly supported by routine use of normothermic machine perfusion (NMP), yet established risk scores, including the UK DCD score, predate widespread NMP adoption. We conducted a retrospective single-center cohort study of adult DCD liver transplants at Mayo Clinic Arizona from January 2019 through December 2024 (<i>n</i> = 586), comparing outcomes of NMP versus static cold storage (SCS) across UK DCD low-, high-, and futile-risk strata. Primary outcomes were early allograft dysfunction (EAD), ischemic cholangiopathy (IC), and graft and patient survival censored at two years. Of 586 transplants, 375 were preserved with NMP and 211 with SCS. Despite older donor age and longer warm ischemia times in the NMP cohort, NMP was associated with lower rates of EAD and IC across all strata. Two-year graft survival was higher with NMP than SCS (91% vs. 80%; p&lt;0.001), and two-year patient survival was 96% versus 89% (<i>p</i> = 0.002). The graft and patient survival advantage was most pronounced in the high-risk (graft survival <i>p</i> = 0.004; patient survival <i>p</i> = 0.02) and futile strata (graft survival <i>p</i> = 0.01; patient survival <i>p</i> = 0.01), whereas graft survival was similar between preservation methods in the low-risk group. These findings support the use of the UK DCD score as a triage tool to guide NMP allocation, with the greatest benefit observed in high-risk and futile grafts for whom NMP should be considered essential rather than optional.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891070","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":"Delisting From the Kidney Transplant Waiting List: Impact on Patient Survival","authors":"Parker Schimmers,&nbsp;Emily Cooper,&nbsp;Wesley Glime,&nbsp;Ayham Asassfeh,&nbsp;Emre Arpali,&nbsp;Ty Dunn,&nbsp;Matthew Cooper,&nbsp;Badi Rawashdeh","doi":"10.1111/ctr.70673","DOIUrl":"10.1111/ctr.70673","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Kidney transplant programs may remove high-risk patients from the national transplant waiting list to mitigate peri-transplant complications and enhance overall post-transplant survival. The phrase “too sick,” frequently reported to the Organ Procurement and Transplantation Network (OPTN) as a reason for removal, lacks precision and specificity. Furthermore, there is limited information regarding the survival outcomes of patients who have been delisted and are consequently ineligible for a kidney transplant. In this study, we describe the specific reasons for delisting and investigate subsequent survival outcomes after being removed from the waiting list.&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;Data were collected from patients 18 years and older removed from the renal transplant waiting list between January 2011 and December 2015. Delisting categorization divided patients into a medical group (removed for clinical reasons such as cardiovascular disease, malignancy, or severe iliac calcification) and a psychosocial group (removed for issues such as patient request, non-compliance, insurance loss, or loss of contact). The primary endpoints were 5-year survival and restricted mean survival time (RMST) at 5 years.&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;Out of 240 eligible patients, 124 patients (51.7%) were delisted for medical reasons and 116 (48.3%) were delisted for psychosocial reasons. Upon investigation, the primary reason for removal from the transplant waiting list among the medical group was cardiovascular (CV)-related comorbidities (44, 35.5%). 55% of the total number of patients delisted survived for 5 years. Patients delisted for medical reasons exhibited a 5-year survival rate of 43% and a RMST of 3.3 years. Specifically, patients delisted for CV-related reasons had a 5-year survival rate of 44%. In contrast, patients delisted for psychosocial reasons had a higher 5-year survival rate of 70% and a longer RMST of 4.31 years (&lt;i&gt;p&lt;/i&gt;-value &lt; 0.001). At 5 years following delisting, patients diagnosed with coronary artery disease (CAD) exhibited a 51% survival rate, which was significantly lower compared to those without CAD with a survival rate of 57% (&lt;i&gt;p&lt;/i&gt; = 0.046).&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;Cardiovascular disease remains the leading cause of delisting from the kidney transplant waiting list. However, many delisted patients demonstrated longer survival than expected. Further studies are needed to clarify the impact of delisting decisions on outcomes and to guide more informed, patient-centered transplant practices.&lt;/p&gt;\u0000 &lt;/section","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891075","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 Preoperative Cardiac Screening Modality on Cardiovascular Outcomes After Liver Transplantation.","authors":"Giuseppe Esposito, Marcella Manicardi, Niccolò Bonini, Stefano Di Sandro, Marco Vitolo, Fabrizio Di Benedetto, Giuseppe Boriani, Gian Piero Guerrini","doi":"10.1111/ctr.70680","DOIUrl":"10.1111/ctr.70680","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular (CV) disease is a leading cause of morbidity and mortality after liver transplantation (LT). Coronary computed tomography angiography (CCTA) has increasingly replaced stress testing (ST) for CV risk assessment in LT candidates with intermediate-to-high CV risk, although comparative evidence remains limited. The primary endpoint was the incidence of post-LT major adverse cardiovascular events (MACE) by CV screening modality; the secondary endpoint was to identify predictors of MACE.</p><p><strong>Methods: </strong>This single-center retrospective study included 506 patients who underwent LT between 2018 and 2023. According to CV screening modality, patients were stratified into three groups: no test (low CV risk), ST, or CCTA.</p><p><strong>Results: </strong>Among 506 LT recipients, 358 (70.8%) presented low CV risk, 57 (11.3%) underwent ST, and 91 (18.0%) CCTA. Compared with ST, CCTA led to higher rates of coronary angiography (14% vs. 31.9%, p = 0.011) and revascularization (0% vs. 15.4%, p < 0.0001). After a median follow-up of 2.5 years [IQR 1.5-3.9], MACE occurred more frequently in CCTA (18.4%) and ST (14%) groups than in low-risk group (9%) (p = 0.041), while no significant difference was observed between CCTA and ST groups (14% vs. 18.4%, p = 0.501). In univariate and multivariate Cox-regression analysis, only age and family history of coronary artery disease were independent predictors of MACE.</p><p><strong>Conclusions: </strong>CCTA and ST resulted in comparable post-LT CV outcomes. Although CCTA was associated with a higher number of pre-LT coronary interventions, it was not associated with a lower incidence of MACE, underscoring the need to refine CV risk stratification protocols in LT candidates.</p><p><strong>Practitioner points: </strong>Currently, there are no international guidelines for cardiovascular screening procedures in LT candidates, leading to variability in practice across different centers and countries. Coronary computed tomography angiography (CCTA) has emerged as a more accurate method than stress testing (ST) in detecting coronary artery disease (CAD) in patients with end-stage liver disease. In the present study, all pre-transplant coronary revascularizations were performed in patients screened with CCTA, while none occurred in the ST group. Despite this, the incidence of post-LT major adverse cardiovascular events (MACE) was similar between groups. In our cohort, revascularizations prompted by CCTA did not significantly reduce post-LT MACE rate. Age and family history of CAD were the only independent predictors of MACE. Our results underscore the need to refine cardiovascular risk stratification protocols for LT candidates.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":"e70680"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967065","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":"Donor Acidosis and Post-Transplant Survival Across Heart Allocation Eras: A National Registry Analysis.","authors":"Sajid Kadir, Sandeep Sasidharan, Victor Perez, Ataul Qureshi, Swethika Sundaravel, Erol Belli","doi":"10.1111/ctr.70691","DOIUrl":"https://doi.org/10.1111/ctr.70691","url":null,"abstract":"<p><strong>Background: </strong>Donor blood pH, recorded for nearly all heart donors, may reflect shock, but its value as an isolated predictor of outcomes is unestablished. The 2018 allocation change altered donor use and acuity, so its prognostic weight may be era-dependent.</p><p><strong>Methods: </strong>We studied adult, first-time, isolated heart transplant recipients in the OPTN/UNOS registry (2015-2025), with donor blood pH classified as acidosis (<7.35), normal (7.35-7.45), or alkalosis (>7.45). The primary outcome was all-cause mortality. A covariate-adjusted Cox model tested the donor acid-base-by-allocation-era interaction. Secondary analyses examined short-term mortality, contemporary mechanical circulatory support, allograft failure, dialysis, and stroke.</p><p><strong>Results: </strong>The primary model included 31,349 recipients and 5,962 deaths. Donor acidosis was associated with mortality before 2018 (hazard ratio 1.18, 95% CI 1.07-1.29) but not after (0.97, 0.86-1.09); the ratio of post- to pre-2018 hazard ratios was 0.82 (0.71-0.96; interaction p = 0.010). The composite of allograft failure or death showed the same pattern (p = 0.009). Continuous donor pH showed no significant association in either era. Among recipients transplanted on or after October 1, 2023, donor acidosis was associated with a higher adjusted risk of extracorporeal membrane oxygenation (risk ratio 1.52, 1.22-1.90) but not 90-day mortality.</p><p><strong>Conclusions: </strong>Among donor hearts selected for transplantation, donor acidosis was associated with mortality before but not after the 2018 allocation change, although it remained associated with greater mechanical circulatory support. These findings do not establish that all acidotic hearts are suitable or that donor pH can be disregarded; it remains one component of comprehensive donor assessment.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":"e70691"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015637","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":"Dual versus Single Kidney Transplantation in Contemporary U.S. Practice: A National Matched Cohort Study.","authors":"Abdulghani Abou Koura, Alex Judd, Stephanie Silpe, Juan F Guerra, Danielle Ladie, Kenneth Brayman, Shawn J Pelletier, Yazan Al-Adwan","doi":"10.1111/ctr.70687","DOIUrl":"10.1111/ctr.70687","url":null,"abstract":"<p><strong>Background: </strong>Hard-to-place kidneys remain underutilized despite ongoing organ shortage. Dual kidney transplantation (DKT) may improve use of these grafts, but contemporary national data are limited.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using national databases from March 2015 to December 2024. Outcomes after DKT and single kidney transplantation (SKT) were compared in the overall cohort and after 2:1 propensity score matching (PSM) using Kaplan-Meier, Cox, and logistic regression.</p><p><strong>Results: </strong>A total of 140,707 deceased donor kidney transplants were analyzed, including 1,236 (0.9%) DKT. In the overall cohort, DKT was associated with lower graft and patient survival. After 2:1 PSM, 1,105 DKT recipients were matched to 2,210 SKT recipients with balanced recipient age (63.7 vs 63.9 years) and KDPI (75.5 vs 75.8; SMD <0.03). After PSM, DKT was associated with higher 1-, 3-, and 5-year graft survival (92.2%, 81.8%, and 69.8% vs 87.7%, 75.5%, and 59.9%; all P < 0.001), while DGF rates were similar.</p><p><strong>Conclusion: </strong>DKT remains an uncommon but important strategy for utilization of hard-to-place donor kidneys. After matching recipients with comparable age and KDPI, DKT was associated with favorable graft and patient survival and similar DGF rates, supporting selective use in carefully chosen recipients.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":"e70687"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015672","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":"Delayed Graft Function After Simultaneous Heart-Kidney Transplantation Across Heart Allocation Eras: Predictors and Impact on Kidney Graft Survival in a National Cohort.","authors":"Somaya Zahran, Tyler Zemla, Byron Smith, Andrew Rosenbaum, Naim S Issa, Hatem Amer, Andrew J Bentall, Alexander R Cortez, Samy M Riad","doi":"10.1111/ctr.70679","DOIUrl":"10.1111/ctr.70679","url":null,"abstract":"<p><strong>Background: </strong>Delayed graft function (DGF) is common after simultaneous heart-kidney (SHK) transplantation, yet its predictors and long-term consequences in contemporary practice remain incompletely defined. We evaluated the incidence, determinants, and impact of DGF on kidney graft outcomes in a national SHK cohort.</p><p><strong>Methods: </strong>Using the Scientific Registry of Transplant Recipients, between 2014-2025, we identified adult SHK recipients. After exclusions, 1637 recipients were analyzed. Baseline characteristics were compared by DGF status. Multivariable logistic regression identified DGF predictors. Cox proportional hazards models assessed DGF association with death-censored and overall kidney graft survival.</p><p><strong>Results: </strong>DGF occurred in 29.1% of recipients (n = 477). Independent predictors of higher DGF odds included higher recipient BMI, pre-transplant dialysis, longer cold ischemia time, and higher refitted KDRI (all p < 0.01). In the adjusted models for long-term kidney graft outcomes, DGF was associated with higher death-censored graft loss (HR 2.02, 95% CI 1.11-3.65; p = 0.021) and overall graft loss (HR 2.04, 95% CI 1.47-2.82; p < 0.001). DGF rates and graft outcomes did not differ by heart allocation era (p = 0.179), and DGF was not associated with higher kidney (p = 0.133) or heart rejection (p = 0.848) at 1 year.</p><p><strong>Conclusion: </strong>DGF is frequent after SHK transplantation and identifies a high-risk subgroup with substantially inferior long-term kidney graft survival, independent of rejection and allocation era. Given the frequency of DGF and its adverse outcomes, future studies are needed to evaluate kidney-after-heart safety-net utilization and post-heart-transplant renal recovery to optimize outcomes and promote judicious kidney allocation in SHK candidates at high risk for DGF.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":"e70679"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955055","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":"Changing Brain Death Donation Dynamics in Spain: A National Overview of Neurocritical Care and Organ Donation Trends.","authors":"Mario Royo-Villanova, Juan Antonio Encarnación, Clara Manso, José Moya, Alejandro Ortin, Elisabeth Coll, Beatriz Domínguez-Gil","doi":"10.1111/ctr.70695","DOIUrl":"https://doi.org/10.1111/ctr.70695","url":null,"abstract":"<p><strong>Background: </strong>Donation after brain death (DBD) has declined in Spain despite sustained transplantation activity and marked growth in donation after circulatory death (DCD). We examined whether this transition was driven by controlled or uncontrolled DCD and contextualized it alongside national trends in neurocritical care and organ utilization.</p><p><strong>Methods: </strong>We conducted a descriptive ecological analysis of aggregated national data from the Spanish National Transplant Organization, healthcare registries, and epidemiological sources for 2015-2024. Annual DBD, controlled DCD (cDCD), uncontrolled DCD (uDCD), donation-potential indicators, mechanical thrombectomy, decompressive craniectomy, and organ recovery and utilization were examined.</p><p><strong>Results: </strong>Actual DBD decreased from 1537 (33.0 per million population [pmp]) to 1246 donors (25.6 pmp). cDCD increased from 211 (4.5 pmp) to 1294 donors (26.6 pmp), whereas uDCD decreased from 103 (2.2 pmp) to 22 donors (0.5 pmp); thus, cDCD accounted for 98.3% of DCD activity in 2024. Donation-potential indicators fell during the COVID-19 pandemic and partially recovered thereafter. Mechanical thrombectomy increased from 2160 to 8762 procedures and decompressive craniectomy from 456 to 729. In 2024, DBD donors generated more recovered and implanted organs per donor than Maastricht category III cDCD donors (3.6 vs. 3.1 and 2.8 vs. 2.3, respectively).</p><p><strong>Conclusions: </strong>Spain's DCD expansion was almost entirely driven by controlled donation, while uDCD declined. These findings demonstrate a reconfiguration of deceased-donation pathways but do not establish patient-level substitution between DBD and cDCD. Linked individual-level studies are required to determine the contributions of neurocritical care, end-of-life decisions, and perfusion technologies.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":"e70695"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024038","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}