Clinical Transplantation最新文献

{"title":"The Kidney-TIME Dose-Response Rests on a Covariate the Trial Cannot Pin Down","authors":"Devanshu Aggarwal, Muneeba Saeed, Hemant Sharma","doi":"10.1111/ctr.70665","DOIUrl":"https://doi.org/10.1111/ctr.70665","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148816635","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":"Viewing KidneyTIME Videos Is More Likely to Result in Live Donor Inquiries Than Not Viewing: Response to Aggarwal et al","authors":"Liise K. Kayler, Naoru Koizumi, Jing Nie, Maria Keller, Katia Noyes, Thomas H. Feeley","doi":"10.1111/ctr.70666","DOIUrl":"https://doi.org/10.1111/ctr.70666","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148816632","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":"Antithymocyte Globulin Induction Dosed on Ideal Body Weight: Absolute Lymphocyte Count (ALC) Depletion in Kidney Transplant Recipients with and without Obesity","authors":"Richard Ramos,&nbsp;Scott T. Benken,&nbsp;Jamie J. Benken","doi":"10.1111/ctr.70663","DOIUrl":"https://doi.org/10.1111/ctr.70663","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study evaluated weight-based dosing of antithymocyte globulin, or ATG, using ideal body weight (IBW) in kidney transplant patients with and without obesity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-center, retrospective cohort study of adult kidney transplant recipients who received ATG for induction from 8/2022 to 8/2023. Patients were divided into groups based on obesity status (i.e., body mass index [BMI] ≥ 30). The primary comparative endpoint was the average absolute lymphocyte count (ALC) across post-operative days (POD) 1 through 4. Secondary comparative endpoints included total ATG dose, hematologic outcomes, graft function, infection, rejection, malignancy, graft survival, and overall survival. Continuous data was assessed for normality, then compared using either the Student t-test or the Mann-Whitney U test and presented as averages ± standard deviation or median (interquartile range). Categorical data were compared using the chi-square or Fisherʼs exact test and presented as counts (%). An a priori power calculation demonstrated that 126 patients (63 per group) were required to detect a 0.1 k/uL difference between groups with alpha = 0.05 and 80% power.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were similar between groups; however, the group with obesity had more Black patients and fewer Hispanic and Asian/Pacific Islander patients. Patients with obesity more frequently had HTN and DM as their ESRD etiologies and experienced more delayed graft function. En bloc transplants were more common in the group without obesity. The average ALC POD1-4 was similar across groups. The total ATG dose, expressed as mg/kg IBW, was the same between groups. The total ATG dose, expressed as mg/kg actual body weight (ABW), was significantly lower in the obese group. In the group with obesity, the average WBC count POD1- 4 was higher, eGFR was lower, and the incidence of CMV viremia was higher. Rejection rate, graft survival, and patient survival were similar between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Dosing ATG based on IBW results in similar ALC depletion in patients with and without obesity. There were similar allograft and safety findings observed between groups. Compared with theoretical ABW dosing, this IBW dosing strategy resulted in significantly less ATG use, potentially leading to substantial cost savings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148816634","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":"Expanding Remote Patient Monitoring for Pre-Lung Transplant Candidates With Interstitial Lung Disease","authors":"Lisa Wickerson,&nbsp;Tamires De Mori,&nbsp;Noori Chowdhury,&nbsp;Cecilia Chaparro,&nbsp;Nikki Marks,&nbsp;Shaf Keshavjee,&nbsp;Aman Sidhu","doi":"10.1111/ctr.70657","DOIUrl":"https://doi.org/10.1111/ctr.70657","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Interstitial lung disease (ILD) is a primary indication for lung transplantation (LTx). Close monitoring of disease progression informs transplant urgency, timing, medical and pre-habilitation management, and remote home monitoring may support frequent assessment of clinical status and response to interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>LTx candidates with ILD received a home spirometer, pulse oximeter, and activity tracker. Participants manually entered data weekly and completed the King's Brief ILD questionnaire (KBILD) monthly within a patient portal linked to the electronic medical record (EMR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 63 people approached at the start of outpatient pre-habilitation, 50 (79%) enrolled for additional remote monitoring and 40 (80%) entered data for ≥4 weeks. Reporting adherence was higher for pulse oximetry (82%) and spirometry (69%) than daily steps tracking (31%). During a median LTx waiting period of 11 [4–18] weeks, there were no changes in home spirometry or self-reported health status; however, daily step count decreased (mean 5639 ± 3989–4653 ± 3303; <i>p</i> = 0.04, <i>n</i> = 25). Wait list status for transplant urgency was increased during the study period in 40% of participants. Fraction of inspired oxygen (FiO₂) for exertion increased (median 0.49 [0.17]–0.51 [0.16]; <i>p</i> = 0.01), with no clinically significant hypoxemia reported after aerobic exercise. For 20 participants using a treadmill for both on-site and home exercise, median on-site walking distance was maintained (912 [469]–966 [497] m; <i>p</i> = 0.64), whereas home-based walking distance declined (1073 [831]–1019 [409] m, <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Remote monitoring in LTx candidates with ILD was feasible, with data integrated into the EMR for clinicians to view. This can provide multimodal data to inform clinical status changes and interventions. Future plans include direct device (Wi-Fi, Bluetooth) integration of monitoring tools into the EMR to increase reporting and decrease manual entry errors, and building escalation alerts for changes in spirometry, oximetry, and activity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70657","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148816633","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":"Survival and Outcomes of Lung-Kidney and Lung-Liver Transplants Using a Large National Cohort","authors":"John A. Treffalls,&nbsp;Kelly Pennington,&nbsp;Cassie C. Kennedy,&nbsp;Julie K. Heimbach,&nbsp;Carrie A. Schinstock,&nbsp;Mauricio A. Villavicencio,&nbsp;Sahar A. Saddoughi","doi":"10.1111/ctr.70652","DOIUrl":"https://doi.org/10.1111/ctr.70652","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We used a national cohort to compare post-transplant outcomes of lung-kidney and lung-liver transplantation to isolated lung transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The United Network for Organ Sharing database was queried for all lung transplants performed from 1/1/2010-9/30/2024. Heart-lung and three-organ transplants were excluded. Patients undergoing isolated lung transplantation were compared with those undergoing simultaneous lung-kidney or lung-liver transplantation. Cox proportional hazards models assessed factors associated with one and three-year mortality. Temporal utilization trends were evaluated with linear regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 33,656 lung transplant recipients, 33,358 (99.1%) underwent isolated lung, 137 (0.4%) underwent lung-kidney, and 161 (0.5%) underwent lung-liver transplantation. One-year patient survival was lower for lung-kidney (79.7%) and lung-liver (82.6%) compared to lung (88.3%; <i>log-rank p</i> &lt; 0.001) but not at three years (<i>p</i> = 0.101). Median survival was 6.3 (95% CI 6.2-6.4) years for lung, 6.2 (95% CI 4.3-10.0) years for lung-kidney, and 9.5 (95% CI 4.8-∞) years for lung-liver (<i>log-rank p</i> = 0.392). Following multivariable Cox risk adjustment, lung-liver was associated with increased one-year mortality (HR, 1.64; 95% CI, 1.11-2.41; <i>p</i> = 0.013) but not three-year mortality (HR, 1.23; 95% CI, 0.90-1.67; <i>p</i> = 0.187), while lung-kidney was not associated with mortality at one (<i>p</i> = 0.684) or three years (<i>p</i> = 0.162). On linear regression, the incidence of lung-kidney and lung-liver both increased over the study period at a faster rate than lung transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although lung-kidney and lung-liver had lower one-year survival, three-year survival was not different compared to isolated lung transplantation after risk adjustment. Given inferior short-term outcomes, multiorgan recipients, particularly lung-kidney, require more sensitive patient selection to ensure equitable access to abdominal allografts. However, these findings cautiously support the viability and increased utilization of multiorgan lung transplantation in carefully selected patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148816631","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":"Increases in Organ Donation in Donor Hospitals Changing Organ Procurement Organization Affiliations","authors":"Isabella Sharifi,&nbsp;Erin Tewksbury,&nbsp;Matthew Wadsworth,&nbsp;David S. Goldberg","doi":"10.1111/ctr.70642","DOIUrl":"https://doi.org/10.1111/ctr.70642","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hospitals in the United States are assigned to a designated organ procurement organization (OPO) responsible for managing deceased donors in the designated donation service area (DSA). Hospitals can apply for waivers to work with a different OPO with appropriate justification. We sought to evaluate the impact of hospital waivers on organ donation activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated Organ Procurement and Transplantation Network (OPTN) data from two OPOs (Donor Network West and Honor Bridge), each with a hospital (Renown Regional Medical Center and North Carolina Baptist Hospital) in its DSA granted a waiver to work with a different OPO beginning in April 2025. We assessed changes in the number of organ donors and organs transplanted pre- and post-granting of a waiver using a difference-in-differences approach based on multilevel mixed-effects models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After switching OPO affiliations, mean monthly donors at intervention hospitals increased from 5.6 pre-waiver to 7.9 post-waiver, while control hospitals remained stable (56.6 vs. 57.5 donors/month). Mean monthly organs transplanted increased from 16.5 to 24.9 at intervention hospitals, while control hospitals were unchanged (170.9 vs. 169.3 organs/month). The difference-in-differences interaction term was statistically significant for both donors recovered (<i>p</i> &lt; 0.1) and organs transplanted (<i>p</i> &lt; 0.1). Reported deaths were stable in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With eight months of post-waiver data, hospitals with granted waivers had significant increases in donation activity driven by improved donor conversion rather than changes in referral patterns or organ yield per donor. Although longer-term data are needed to confirm these findings, CMS and the organ transplant community should feel confident that changing donor hospital-OPO affiliations will not negatively impact donation and may lead to significant increases in donation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784336","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 Transplantation in Rheumatoid Arthritis Related Interstitial Lung Disease: Risk Factors and Mortality in a Universal Health Care System","authors":"Lee M. Fidler,&nbsp;Omri A. Arbiv,&nbsp;Joseph S. Munn,&nbsp;Jolene H. Fisher,&nbsp;Shane Shapera,&nbsp;Peter C. Austin,&nbsp;Andrea S. Gershon","doi":"10.1111/ctr.70644","DOIUrl":"https://doi.org/10.1111/ctr.70644","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite therapy, some patients with rheumatoid arthritis related interstitial lung disease (RA-ILD) require lung transplantation for progressive disease. We aimed to identify factors associated with lung transplantation and post-transplantation survival in RA-ILD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective observational cohort study using data from Ontario, Canada between 2003 and 2022. RA-ILD patients were identified from the Ontario RA Database. We used a cause-specific hazards model, considering the competing risk of death, to identify factors associated with lung transplantation. A Cox proportional hazards model was used to evaluate post-transplant survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 6470 RA-ILD patients, 77 (1.2%) underwent lung transplantation, equating to 2.40 transplants per 1000 person years. The median time to transplant was 3.7 years. Younger age [HR 0.93 per increasing year (95%CI 0.91–0.95), <i>p</i> &lt; 0.0001], male sex [HR 2.40 (95%CI 1.523.78), <i>p</i> = 0.0002], and comorbid diabetes [HR 1.70 (95%CI 1.06–2.73), <i>p</i> = 0.003], congestive heart failure [HR 1.87 (95%CI 1.15–3.04), <i>p</i> = 0.01] and COPD [HR 2.14 (95%CI 1.25–3.68), <i>p</i> = 0.006] were associated with transplantation. The median survival following transplantation was 4.3 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lung transplantation is an uncommon, but important therapy for RA-ILD. Select comorbidities are associated with lung transplantation. Post-transplant survival among RA-ILD patients in Ontario was comparable to that reported elsewhere.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Benefit of Sequential Normothermic Regional Perfusion and Hypothermic Machine Perfusion in Kidney Transplantation From Donation After Circulatory Death Donors","authors":"Toshihiro Nakayama,&nbsp;Sue J. Fu,&nbsp;Antony M. Attia,&nbsp;Daniel J. Ahn,&nbsp;Thomas A. Pham,&nbsp;Marc L. Melcher,&nbsp;Kliment K. Bozhilov,&nbsp;Kazunari Sasaki","doi":"10.1111/ctr.70641","DOIUrl":"https://doi.org/10.1111/ctr.70641","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Normothermic regional perfusion (NRP) is associated with improved posttransplant outcomes in donation after circulatory death (DCD) kidney transplantation. It remains unknown whether hypothermic machine perfusion (HMP) offers additional benefits over static cold storage (SCS) during transport.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All adult kidney-only transplantations from DCD donors procured by NRP in the OPTN data (10/1/2020-6/30/2025) were identified. Primary exposure was preservation method during transport: NRP combined with HMP (NRP+HMP) or SCS (NRP+SCS). One-to-two propensity score matching (PSM) was performed on fifteen donor and recipient factors. Primary outcomes included delayed graft function (DGF), posttransplant length of stay (LOS), and estimated glomerular filtration rate (eGFR) at 6 months posttransplant. Secondary outcomes were one-year graft and patient survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 4792 NRP cases, HMP was utilized in 85.1%, with its use increasing over time. After 1:2 PSM (685 NRP+SCS matched to 1262 NRP+HMP), NRP+HMP was associated with significantly lower DGF (23.3% vs. 30.5%, <i>p</i> &lt; 0.01). Median LOS (4.0 days in both groups, <i>p</i> = 0.07), 6-month eGFR (58.5 vs. 60.1 mL/min/1.73m², <i>p</i> = 0.46), one-year graft survival, and one-year patient survival were not significantly different. The association between HMP and lower DGF was observed across KDPI strata, heart recovery status, and cold ischemia time categories, with no significant interactions detected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The adoption of HMP after NRP has increased substantially in the United States and was associated with reduced DGF, but no difference was observed for LOS, 6-month eGFR, graft survival, and patient survival. These findings support the routine use of HMP after NRP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753744","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":"Recipient Selection and Outcomes After Out-of-Sequence Kidney Allocation Since Implementation of Kidney Allocation System 250 (KAS250): A Single-Center Experience","authors":"Sandesh Parajuli,&nbsp;Glen E. Leverson,&nbsp;Didier Mandelbrot,&nbsp;Dixon B. Kaufman","doi":"10.1111/ctr.70647","DOIUrl":"https://doi.org/10.1111/ctr.70647","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Allocation out of sequence (AOOS) of kidneys has increased after KAS250 and raised concerns regarding transparency and equitable recipient selection. Less is known about recipient selection and outcomes at individual centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a single-center retrospective study of adult deceased donor kidney transplants at the University of Wisconsin from March 15, 2021, to March 31, 2024. Recipients receiving kidneys classified as AOOS were compared with contemporaneous recipients of non-AOOS kidneys. Donor and recipient characteristics, delayed graft function, graft function, and patient and graft survival were assessed. Standardized data explaining why kidneys entered AOOS allocation were unavailable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 498 deceased donor kidney transplant recipients, 89 (17.9%) received AOOS classified kidneys. Donor characteristics were largely similar, although kidneys categorized as AOOS had higher terminal creatinine (1.6 vs. 1.2 mg/dl, <i>p</i> = 0.03) and longer cold ischemia time (22.9 vs. 20.4 h, <i>p</i> = 0.003). AOOS recipients were older, more often preemptive, had shorter waiting times, and were less likely to be retransplant recipients or have cPRA &gt; 20%. Recipient sex and race did not differ. Four-year adjusted patient survival (aHR 0.85; 95% CI 0.38–1.94; <i>p</i> = 0.71) and graft survival (aHR 0.72; 95% CI 0.34–1.54; <i>p</i> = 0.40) were not statistically different.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this single-center experience, transplantation of kidneys categorized as AOOS was associated with distinct recipient selection, comparable 4-year outcomes, and without compromising gender/racial balance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70647","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753735","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":"Meta-Analysis of Cardiorespiratory Fitness Impairment in Pediatric Heart Transplant Recipients","authors":"Nadeen Wu,&nbsp;Stephen J. Foulkes,&nbsp;Nathan R. Weeldreyer,&nbsp;Calvin Kruger,&nbsp;Corey R. Tomczak,&nbsp;Michael Khoury,&nbsp;Jennifer L. Conway,&nbsp;Mark J. Haykowsky","doi":"10.1111/ctr.70646","DOIUrl":"https://doi.org/10.1111/ctr.70646","url":null,"abstract":"<p>Pediatric heart transplant (PHTR) recipients have reduced cardiorespiratory fitness (VO₂peak); however, the magnitude of this impairment and its underlying central hemodynamic mechanisms remain poorly characterized. This systematic review and meta-analysis quantified differences in VO₂peak and peak exercise central hemodynamics between PHTR recipients and age-matched healthy controls (CON). MEDLINE (PubMed) was searched for studies comparing VO₂peak in PHTR recipients and CON. Pooled effect sizes were expressed as weighted mean differences (WMD) using a DerSimonian–Laird random-effects model, and weighted least-squares meta-regression assessed the moderating effects of age and time post-transplant. Seven unique studies (PHTR <i>n</i> = 90; CON <i>n</i> = 118) reported VO₂peak and peak HR. PHTR had significantly lower VO₂peak (WMD  =  −9.5 mL/kg/min), peak HR (WMD: −30 bpm), and CO (<i>n</i> = 3 studies, WMD: −2.5 L/min), with no difference in peak SBP (<i>n</i> = 3 studies). Meta-regression revealed no significant moderating effect of age or time post-transplant on the VO₂peak deficit. The markedly reduced VO₂peak in PHTR recipients is driven primarily by impaired peak CO and persistent chronotropic incompetence, consistent with cardiac allograft sympathetic denervation.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70646","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753733","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}