Clinical Transplantation最新文献

{"title":"Survival in Patients With Evidence of Pulmonary Thromboembolism on Ventilation-Perfusion SPECT 12 Weeks After Double Lung Transplantation: A Retrospective Cohort Study","authors":"Milan Mohammad,&nbsp;Anna W. Kristensen,&nbsp;Jacob P. Hartmann,&nbsp;Neval E. Wareham,&nbsp;Sana N. Buttar,&nbsp;Anders M. Greve,&nbsp;Thomas K. Lund,&nbsp;Kristine Jensen,&nbsp;Hans H. L. Schultz,&nbsp;Michael Perch,&nbsp;Ronan M. G. Berg,&nbsp;Jann Mortensen","doi":"10.1111/ctr.70103","DOIUrl":"https://doi.org/10.1111/ctr.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients who have undergone double lung transplantation (DLTx) are at increased risk of pulmonary thromboembolism (PTE). Although the presence of clinically overt PTE can adversely affect short-term mortality, the prognostic impact of asymptomatic (silent) PTE detected by routine imaging after DLTx is unclear. This study aimed to determine whether PTE identified by routine ventilation-perfusion single-photon emission computed tomography (V̇-Q̇ SPECT) 12 weeks post-DLTx is associated with subsequent all-cause and graft-related mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-center retrospective cohort study evaluating 130 DLTx recipients who underwent routine V̇-Q̇ SPECT imaging 12 weeks posttransplant between 2012 and 2017. V̇-Q̇ SPECT scans were assessed for perfusion and ventilation defects indicative of PTE. The association between PTE and mortality outcomes was analyzed using multivariable Cox regression, Kaplan-Meier survival curves, and cumulative incidence functions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PTE was identified in 24.6% (<i>n</i> = 32) of the patients 12 weeks post-DLTx. After 3 months of follow-up, there was no detectable difference in lung function between patients with and without PTE. Moreover, the presence of PTE was not associated with increased hazard ratios for all-cause mortality (HR = 0.72; 95% CI: 0.37–1.41; <i>p</i> = 0.34) or graft-specific mortality (HR = 0.95; 95% CI: 0.42–2.16; <i>p</i> = 0.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PTE is a frequent finding on routine V̇-Q̇ SPECT 12 weeks post-DLTx that does not inform risk of all-cause or graft-related mortality. These findings suggest that an incidentally detected PTE in asymptomatic patients may not necessitate changes in clinical management for asymptomatic DLTx patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143379990","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":"Advances and Challenges of Thrombolytic Therapy for Donation After Circulatory Death Organs","authors":"Peng Zhang,&nbsp;Han Liang,&nbsp;Yanfeng Wang","doi":"10.1111/ctr.70099","DOIUrl":"https://doi.org/10.1111/ctr.70099","url":null,"abstract":"<div>\u0000 \u0000 <p>The demand for organ transplantation has exceeded the global supply of available organs. Donation after circulatory death (DCD) is considered an effective method to solve the disparity between the supply and demand of organs, by expanding the donor pool. However, DCD organs experience long-term damage caused by warm ischemia (WI) and microthrombosis caused by diffuse intravascular coagulation. Unfortunately, because of concerns about post-transplantation complications, most organs considered high-risk are discarded, resulting in wasted medical resources and economic losses. However, thrombolytic therapy before transplantation may dissolve microthrombosis in DCD organs, improve organ microcirculation, and increase organ use. Herein, we review the current status and potential value of thrombolytic therapy before DCD organ transplantation, summarize the progress of thrombolytic therapy for DCD organ transplantation according to preclinical and clinical research, and emphasize the heterogeneity and limitations of studies that have caused some controversies associated with this therapy. Overall, the role of thrombolytic therapy should not be overlooked. We anticipate that thrombolytic therapy combined with machine perfusion will provide an opportunity to improve inferior-quality DCD grafts, resulting in their becoming more widely available and safer for transplantation, thus solving the urgent problem of organ shortage.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362968","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":"Functional Status Trajectory and Survival for Adult Patients Undergoing Heart Transplantation","authors":"Rachel E. Wittenberg,&nbsp;Elizabeth Mostofsky,&nbsp;Murray A. Mittleman","doi":"10.1111/ctr.70107","DOIUrl":"https://doi.org/10.1111/ctr.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transplantation is a critical treatment for end-stage heart disease and improves length and quality of life. We investigated predictors of functional status improvement following transplant and the association between functional status trajectory and survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using Scientific Registry of Transplant Recipients data on 34 009 US adults who underwent heart transplant 2006–2021. Functional status was measured using the Karnofsky Performance Scale (KPS; 0%–100%). Linear regression with stepwise selection was used to identify predictors of KPS trajectories. Kaplan–Meier curves and adjusted Cox proportional hazard models were used to compare survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean KPS was low at listing (47.9%) and transplant (45.6%) and increased to 85.7% and 89.2% at 1- and 5-years posttransplant. Independent predictors of KPS trajectory in the first year included hypertension, diabetes, BMI, prior tobacco, previous malignancy, age, sex, education level, insurance type, etiology of heart disease, prior cardiac surgery, “1A” waitlist priority, and hospitalization status. KPS trajectory during the waitlist period and the first year posttransplant predicted survival, independent of baseline KPS. Decrease in KPS &gt; −30% and −30% to &lt; 0% in the first year were associated with 5.74 (3.45–9.56) and 2.09 (1.69–2.59) times higher mortality than stable KPS after adjusting for baseline KPS and other factors. Poor KPS trajectory in the waitlist period was similarly associated with higher mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Functional status improvement is an important outcome following heart transplantation, and KPS trajectory predicts survival. Most patients achieve high KPS, but clinical and social interventions may optimize KPS trajectory for high-risk patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362967","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":"Stepwise Intravenous Immunoglobulin Therapy for Resistant BK Virus Nephropathy in Kidney Transplant Recipients: A Case Series With 1-Year Follow-Up","authors":"Engin Onan,&nbsp;Tuba Canpolat,&nbsp;Sedat Yıldırım,&nbsp;Kenan Çalışkan,&nbsp;Mehmet Haberal","doi":"10.1111/ctr.70102","DOIUrl":"https://doi.org/10.1111/ctr.70102","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362692","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":"Survey of Extracorporeal Life Support Application in Lung Transplantation","authors":"Barbara Jeanne Wilkey,&nbsp;Tyler Elliott,&nbsp;Todd Everett Jones,&nbsp;Terrie Vasilopoulos,&nbsp;Theresa Gelzinis,&nbsp;Melissa Bellomy,&nbsp;Jessica Louise Brodt,&nbsp;Joshua Knight,&nbsp;Mariya Atanassova Geube,&nbsp;John Michael Fox,&nbsp;Christopher Lee Racine,&nbsp;Justin Nadeem Tawil,&nbsp;Katharine Kozarek,&nbsp;Sudhakar Subramani,&nbsp;Kara Kimberly Siegrist,&nbsp;Pratik Kothary,&nbsp;Yong Gang Peng,&nbsp;Andrea Nicole Miltiades,&nbsp;Sharon Lorraine McCartney,&nbsp;Brandi Anne Bottiger,&nbsp;Archer Kilbourne Martin","doi":"10.1111/ctr.70094","DOIUrl":"https://doi.org/10.1111/ctr.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Lung transplantation has been evolving since its inception in 1963. Over recent years, literature has suggested a shift in the perioperative strategy of mechanical support toward extracorporeal membrane oxygenation (ECMO) as the preferred modality of extracorporeal life support (ECLS) in lung transplantation. The Survey of ECLS Application in Lung transplantation (SEAL) was designed to elucidate the current practice patterns of perioperative ECLS within the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, a physician from 62 adult lung transplantation centers across the United States of America (USA) was surveyed on their institutional practices regarding the perioperative management of lung transplantation patients, with a focus on mechanical support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The survey completion rate was 74% (46/62 eligible institutions). Most transplant centers utilize venoarterial (VA) ECMO (78%, 36/46) and/or venovenous (VV) ECMO (93%, 29/43) as a bridge to lung transplantation. When ECLS is used intraoperatively, 61% of (28/46) responding programs use VA ECMO as their preferred support. All programs use transesophageal echocardiography (TEE) intraoperatively, 85% (33/39) cannulate for ECMO centrally, and 74% (29/39) use a combination of inhaled and intravenous anesthesia while using ECMO intraoperatively. Most programs do not use antifibrinolytic during VA ECMO (62%, 28/45). Anticoagulation management and VA ECMO flows throughout the procedure showed considerable variation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Data from SEAL illustrates that though there are some practice commonalities within the United States, there is also quite a bit of variability in practice. Multiple dominant practices within the USA are consistent with a recently published International Society of Heart and Lung Transplantation consensus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362691","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":"Safety and Tolerability of SGLT-2 Inhibitors Following Lung Transplantation","authors":"Peter Wilcox,&nbsp;Krysta Walter,&nbsp;Jonathan Troost,&nbsp;Elizabeth Belloli","doi":"10.1111/ctr.70104","DOIUrl":"https://doi.org/10.1111/ctr.70104","url":null,"abstract":"<p>Sodium-glucose cotransporter-2 inhibitors (SGLT2i's) are frequently prescribed for T2DM control, with additional efficacy in congestive heart failure therapy and preserving renal function in CKD. Despite their potential to mitigate comorbidities, prescribing of SGLT2i's following solid organ transplantation has been limited due to safety concerns regarding infection, renal function, and diabetic ketoacidosis. SGLT2i prescription following transplantation of other solid organs has been evaluated, but only one study included a limited number of lung transplant recipients. We performed a retrospective case control study of all patients in Michigan Medicine clinics with a prior lung transplant who were prescribed an SGLT2i between January, 2010 and March, 2023. We collected demographic information, medical history pertaining to transplant, SGLT2i prescription history, and abstracted safety, tolerability, and efficacy outcomes for comparison between the SGLT2i cohort and a control population. Among 20 patients who met inclusion criteria, median SGLT2i prescription duration was 372 days. There were no UTI's or GU infections, and severe AKI occurred in five patients. There was a median reduction of 0.6% in hemoglobin A1c within the SGLT2i group not observed in controls (<i>p</i> = 0.09). Our findings demonstrate safety and tolerability of SGLT2i's following lung transplantation and suggest efficacy in controlling T2DM or PTDM.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248850","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":"Recipient Outcomes After Utilization of Kidneys From Deceased Donors With Diagnosed Glioblastoma Multiforme","authors":"Venkata Kanaka Naga Karthik Nasika,&nbsp;Vanjinathan Subramani,&nbsp;Ashish Sharma,&nbsp;Sarbpreet Singh,&nbsp;Jasmine Sethi,&nbsp;SreeVani Paladugu,&nbsp;Kajal Jain,&nbsp;Navdeep Bansal","doi":"10.1111/ctr.70090","DOIUrl":"https://doi.org/10.1111/ctr.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The exact incidence of donor tumor transmission in patients with glioblastoma multiforme (GBM) is still unknown. These transplants are usually considered as a high-risk endeavor due to fear of potential spread especially with medical intervention leading to breach in blood–brain barrier. This report describes successful outcomes after renal transplantation from two donors with World Health Organization (WHO) Grade IV primary GBM who had undergone surgical excision with ventriculoperitoneal shunt (VPS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between January 2019 and June 2024, case records of organ donors where the primary cause of death was GBM were screened from the departmental database. Renal transplant patients from donors with a histopathological diagnosis GBM WHO Grade IV were included in the study. The follow-up of these recipients was recorded for tumor transmission, delayed graft function, patient and graft survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Only kidneys were retrieved from these donors. The donor's kidneys were transplanted to four consented recipients after taking informed consent explaining the risks. During the mean follow-up of 3 years, all four patients were alive with good graft function. Nuclear scan at 3, 6 months, and yearly thereafter showed no abnormal uptake or no evidence of donor-transmitted tumor transmission in any of these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>High-grade GBM donors with no evidence of systemic spread may be considered for renal transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248851","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":"Lung Transplant in Patients With Human Immunodeficiency Virus: A Case Series","authors":"Paulamy Ganguly,&nbsp;Ramya Varadarajan,&nbsp;Max W. Adelman,&nbsp;Priya Arunachalam,&nbsp;Simon Yau,&nbsp;Jihad G. Youssef,&nbsp;Ahmad Goodarzi","doi":"10.1111/ctr.70097","DOIUrl":"https://doi.org/10.1111/ctr.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Historically, patients with human immunodeficiency virus (PWH) were at higher risk for pulmonary morbidities than patients without HIV. Lung transplantation in PWH has been limited by uncertain outcomes and a lack of guidelines for transplantation and immunosuppression. However, several case reports in the United States and Europe have demonstrated that lung transplantation in PWH is feasible. Although there remain concerns regarding these patients as higher-risk recipients, lung transplantation is feasible with careful modification of immunosuppression and close monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed lung transplantation on three PWHs and analyzed their post-transplant outcomes to determine the feasibility of lung transplant in PWH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found that all three patients (mean age 59, SD 10.98) with HIV underwent lung transplantation. Two of the three patients experienced acute cellular rejection that resolved with intravenous corticosteroids. None had long-term complications including chronic rejection, antibody-mediated rejection, or infections. All three patients maintained baseline HIV therapy following transplantation with adequate HIV disease control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although PWH has an increased risk of pulmonary comorbidities compared to the general population, lung transplantation appears to be a feasible treatment option supported by the growing body of literature and the three cases described here.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248852","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":"Immune Checkpoint Inhibitor Use in Kidney Transplant Patients: A National Case Series From Ireland","authors":"Bláthnaid O'Connell,&nbsp;Cliona Cowhig,&nbsp;Susan McAnallen,&nbsp;Jennifer B. Hanko,&nbsp;Jarushka Naidoo,&nbsp;Michael R. Clarkson,&nbsp;Peter J. Conlon","doi":"10.1111/ctr.70101","DOIUrl":"https://doi.org/10.1111/ctr.70101","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248853","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":"Effects of Nighttime Procurement and Transplantation on Outcomes Following Heart Transplantation","authors":"Yeahwa Hong,&nbsp;Nicholas R. Hess,&nbsp;Ander Dorken-Gallastegi,&nbsp;Mohamed Abdullah,&nbsp;Nidhi Iyanna,&nbsp;Umar Nasim,&nbsp;Ibrahim Sultan,&nbsp;Gavin W. Hickey,&nbsp;Mary E. Keebler,&nbsp;David J. Kaczorowski","doi":"10.1111/ctr.70093","DOIUrl":"10.1111/ctr.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study evaluates the effects of nighttime procurement and transplantation on outcomes following heart transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The UNOS registry was queried to analyze adult recipients who underwent isolated orthotopic heart transplantation between January 1, 2010, and September 30, 2022. The cohort was stratified into daytime (4 am–8 pm) and nighttime (8 pm–4 am) transplant groups. The primary outcome was 1-year survival. Propensity score-matching was performed. Risk adjustment was performed using multivariable Cox regression. Restricted cubic spline was used to model the association between the time of transplantation and the likelihood of 1-year mortality. Sub-analysis was performed to evaluate the impact of nighttime procurement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 30 426 recipients were analyzed, where 10 807 recipients (35.5%) underwent nighttime transplantation. The nighttime recipients had reduced 1-year post-transplant survival compared to the daytime recipients (90.6% vs. 91.5%, <i>p</i> = 0.019), and this lower survival persisted in the propensity score-matched comparison. After adjusting for established predictors for post-transplant mortality, nighttime transplantation continued to have a significantly increased risk of 1-year mortality (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.03–1.21, <i>p</i> = 0.005). The spline model demonstrated increased odds of 1-year mortality between 5 pm and 4 am, with the highest odds at 11 pm (odds ratio [OR] 1.25, 95% CI 1.07–1.47), compared to the reference transplantation time of 7 am. When assessing the impact of procurement timing, nighttime procurement negatively impacted 1-year post-transplant survival among the daytime recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates the adverse impact of nighttime heart procurement and transplantation on early post-transplant survival. With emerging organ perfusion and thermal protection systems, additional studies are warranted to assess the safety of extending the heart preservation period to optimize the timing of transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063904","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}