Clinical Transplantation最新文献

{"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}

{"title":"Long-Term Results of Autologous Hematopoietic Cell Transplantation (Auto-HCT)—Real-Life Data of 15- and 20-Year Survivals From a Single Center","authors":"Kajetan Karaszewski,&nbsp;Jakub Góra,&nbsp;Monika Paluszewska,&nbsp;Elżbieta Urbanowska,&nbsp;Ewa Karakulska-Prystupiuk,&nbsp;Piotr Boguradzki,&nbsp;Agnieszka Tomaszewska,&nbsp;Grzegorz Władysław Basak,&nbsp;Wiesław Wiktor Jędrzejczak","doi":"10.1111/ctr.70643","DOIUrl":"https://doi.org/10.1111/ctr.70643","url":null,"abstract":"<div>\u0000 \u0000 <p>Over the years, autologous hematopoietic cell transplantation (auto-HCT) has become one of the most important therapeutic methods of contemporary hematology. However, analyses of survival after treatment are usually limited to 5-10 years. Data on longer survival are limited due to difficulties and loss in follow-up, as well as organizational and personnel changes in transplant centers. Therefore, our study aimed to evaluate the 15- and 20-year overall and progression-free survival of the recipients of auto-HCT in our center without exclusion of salvage indications and patients with comorbidities. During the period ranging from 1999 to 2014, there were 452 recipients of auto-HCT. Survival analyses were performed using Kaplan–Meier curves, the Cox proportional hazards model, and the log-rank test. First, the entire cohort was evaluated for 15- and 20-year overall and progression-free survival. Then, similar analyses were performed for subgroups of patients with more frequent indications, including multiple myeloma, AL amyloidosis, Hodgkin lymphoma (HL), non-Hodgkin lymphomas (NHLs), and acute myeloid leukemia. It was found that after 10 years, both overall and progression-free survival slowly but gradually declined. Still, a significant proportion of transplanted patients survived 20 years following auto-HCT, confirming the ability to cure in at least some cases of these earlier incurable disorders.</p>\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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753732","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":"Healthcare-Related Sociocultural Factors, Racial Disparities, and Kidney Transplant Outcomes in the Kidney Transplant Fast Track Program","authors":"Miriam Vélez-Bermúdez,&nbsp;Yuridia Leyva,&nbsp;Chethan Puttarajappa,&nbsp;Arjun Kalaria,&nbsp;Yiliang Zhu,&nbsp;Yue-Harn Ng,&nbsp;Mark L. Unruh,&nbsp;L. Ebony Boulware,&nbsp;Amit Tevar,&nbsp;Mary Amanda Dew,&nbsp;Larissa Myaskovsky","doi":"10.1111/ctr.70640","DOIUrl":"10.1111/ctr.70640","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the United States, streamlining the kidney transplantation (KT) evaluation process may reduce disparities and barriers to KT access. Prior work showed that the Kidney Transplant Fast Track (KTFT) program shortened this process and reduced racial disparities in waitlisting and overall KT. In the present study, we examined whether race/ethnicity and sociocultural factors (e.g., medical mistrust, healthcare-related discrimination/racism) remained independently associated with time to active waitlisting and KT receipt (overall, living [LDKT] and deceased donor KT [DDKT]) and whether sociocultural factors attenuated racial/ethnic differences in these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this secondary analysis, data came from the KTFT study, a prospective KT candidate cohort. Participants were recruited before KT evaluation start (05/2015–06/2018), coinciding with baseline measure collection, then followed via medical record through 08/2022. We used hierarchically-adjusted Fine–Gray proportional hazards models in this exploratory analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1108 KT candidates (243 Black, 783 White, 82 Other), medical mistrust was associated with lower cumulative incidence of waitlisting, but no other sociocultural factors were associated with outcomes. Racial and ethnic differences emerged for KT type: Black participants had a greater cumulative incidence of DDKT, and participants categorized as other race/ethnicity had a lower cumulative incidence of LDKT, relative to White participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although KTFT reduced racial/ethnic disparities in waitlisting and overall KT receipt, we identified racial/ethnic differences in LDKT and DDKT. Medical mistrust was a significant barrier to waitlisting. Findings suggest that even when the KT evaluation process is streamlined, sociocultural factors and race/ethnicity may remain associated with KT outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT02342119</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720491","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":"Access to the Liver Transplant Waitlist in Patients With HCC: A National EHR Study of Center Level Variation among 11 422 Referrals","authors":"Conor B. Donnelly,&nbsp;Michal Mankowski,&nbsp;Kelly Terlizzi,&nbsp;Suhani S. Patel,&nbsp;Tal Eitan,&nbsp;Jane J. Long,&nbsp;Luckmini Liyanage,&nbsp;Alexandra T. Strauss,&nbsp;Greg D. Sacks,&nbsp;Babak J. Orandi,&nbsp;Karim Halazun,&nbsp;Sommer E. Gentry,&nbsp;Dorry L. Segev,&nbsp;Allan B. Massie","doi":"10.1111/ctr.70639","DOIUrl":"10.1111/ctr.70639","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As a 6-month waiting period is required to receive exception points to prioritize patients with hepatocellular carcinoma (HCC) for liver transplantation, prompt addition to the waitlist is critical in access to LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using Epic Cosmos data on patients with HCC referred for LT 1/2018-10/2024, we used modified Poisson regression to calculate rates of waitlisting. Center-level and individual (socioeconomic, geographic, and insurance) factors were measured among those who progressed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 11,422 HCC patients referred for LT at 70 centers, with median age 63 [IQR: 58, 68], 71.5% initiated evaluation and, of those who began evaluation, 57.6% were waitlisted for LT. Of those referred, patients who were older (age 70+ vs. 51-60; RR 0.77, 95% CI: 0.65–0.90, <i>p </i>&lt; 0.001), on Medicaid (0.83, 95% CI: 0.71–0.97, <i>p</i> = 0.02), never-married (0.82, 95% CI: 0.73–0.91, <i>p </i>&lt; 0.001), or low SES (Q4: 0.87, 95% CI: 0.77–0.97, <i>p</i> = 0.002) had lower rates of waitlisting. Among waitlisted patients, median time from referral was 3.3 months [IQR: 2.0, 5.3]. Despite adjustment for patient level covariates, there was high center-level variation in rate of waitlisting within 12 months; 13% of centers listed patients at a rate ≥ 20% below the national median.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Only a fraction of referred patients with HCC are waitlisted for LT. High variation in access to waitlisting based on non-clinical factors suggests barriers to waitlisting that must be addressed. Centers should focus on interventions to reduce barriers to waitlisting in patients with HCC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721051","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":"Pre-Transplant Left Atrial Volume Index and One-Year Morbidity After Kidney Transplantation","authors":"Sajid Kadir,&nbsp;Andres Pelaez,&nbsp;Sandeep Sasidharan,&nbsp;Ronald Zolty","doi":"10.1111/ctr.70638","DOIUrl":"10.1111/ctr.70638","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Pre-transplant echocardiography is routinely performed in kidney transplant candidates, although it remains unclear which parameters are associated with the broad spectrum of post-transplant complications beyond cardiovascular events. Left atrial volume index (LAVI) reflects chronic diastolic burden, and its relationship with overall post-transplant morbidity has not been well defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In a single-center retrospective cohort of 242 adults undergoing first kidney-only transplantation (2020 to 2022) with pre-transplant echocardiography within 12 months, the main outcome was a composite of one-year post-transplant complications. Multivariable logistic regression was adjusted for age, sex, BMI, diabetes, and deceased donor status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LAVI was abnormal (&gt;34 mL/m²) in 83 of 218 patients (38.1%), with largely preserved systolic function (mean LVEF 59.1 ± 6.2%). Abnormal LAVI was associated with the composite outcome (69.5% versus 53.2%, adjusted OR 2.01, 95% CI 1.08 to 3.73, <i>p</i> = 0.027), with a graded increase across tertiles (trend <i>p</i> = 0.030). No individual complication category reached significance. Excluding cardiac events, the non-cardiac composite was similar in magnitude but not conventionally significant (adjusted OR 1.80, 95% CI 0.98 to 3.32). No other echocardiographic parameter was associated with the outcomes. Atrial fibrillation analyses were exploratory and should be interpreted cautiously.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pre-transplant LAVI &gt;34 mL/m² was associated with a higher burden of one-year post-transplant morbidity, with a graded relationship across severity. No individual complication category reached significance. These findings are hypothesis-generating and require prospective validation before clinical use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705740","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":"A Review of Hemophagocytic Lymphohistiocytosis in Transplant—Focusing on the Heart","authors":"Boaz Elad,&nbsp;Dor Lotan,&nbsp;Ilan Richter,&nbsp;Julia Baranowska,&nbsp;Daniel Oren,&nbsp;Farhana Latif,&nbsp;Kevin Clerkin,&nbsp;Gabriel Sayer,&nbsp;Nir Uriel","doi":"10.1111/ctr.70636","DOIUrl":"10.1111/ctr.70636","url":null,"abstract":"<div>\u0000 \u0000 <p>Hemophagocytic lymphohistiocytosis (HLH) is a complex and often difficult-to-diagnose disease that can be easily missed and is associated with high mortality. Transplantation serves as a predisposing factor, and the challenges in diagnosis and treatment are compounded in transplant patients. Although there are only a few documented cases of HLH in heart transplant (HT) recipients, the increasing prevalence of HT globally suggest that more cases are likely to emerge.</p>\u0000 <p>In this review, we focus on HLH specifically in the context of HT. We present a unique and complex case report of HLH in a HT patient. Following this, we will review the disease in the general population and explore its impact on transplant patients. We will analyze existing data on HLH in HT recipients, clinical symptoms and signs, diagnosis and discuss various treatment strategies including currently recommended and alternative new approaches.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700897","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":"Health Literacy and Early Physical Activity After Solid Organ Transplantation: A Prospective Observational Study","authors":"Astrid Bacle,&nbsp;Elouan Demay,&nbsp;Pauline Blanc-Petitjean,&nbsp;Sarah Pelletier","doi":"10.1111/ctr.70623","DOIUrl":"10.1111/ctr.70623","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Regular physical activity (PA) improves clinical outcomes and quality of life after solid organ transplantation, yet many recipients remain inactive during early recovery. Health literacy (HL) may influence posttransplant health behaviors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective observational study, consecutive adult kidney, liver, and lung transplant recipients at the Centre hospitalier de l'Université de Montréal (CHUM) between March 1 and December 1, 2023 were assessed approximately two months after discharge. Functional HL was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Weekly moderate to vigorous PA was assessed using face-to-face interview during outpatient visits and categorized according to World Health Organization recommendations (&lt;150 vs. ≥150 min/week). Multivariable logistic regression evaluated the association between HL and PA, adjusting for age, sex, body mass index, history of depression and/or current antidepressant treatment, education level, and transplant type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-five recipients were included; Thirty-two patients were not eligible for inclusion (language barrier, re-transplantation, refusal, or death). Thirty-nine participants (45.8%) met recommended PA levels. Higher HL was independently associated with achieving PA recommendations (OR per 1-point increase: 1.09; 95% CI 1.02–1.17; <i>p</i> = 0.01). PA engagement was not associated with age, sex, education level, history of depression and/or current antidepressant treatment, or transplant type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nearly half of recipients achieved guideline-recommended PA approximately two months after transplantation, indicating that meaningful activity is feasible during early recovery. Higher functional HL was independently associated with PA engagement, supporting the integration of literacy-sensitive approaches into posttransplant rehabilitation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700875","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":"Hypothermic Machine Perfusion in Deceased Donor Kidney Transplantation: Provider and Transplant Center Practices and Perspectives","authors":"Beatrice P. Concepcion,&nbsp;Laura A. Binari,&nbsp;Vasanthi Balaraman,&nbsp;Angie Nishio-Lucar,&nbsp;Anju Yadav,&nbsp;Ankita Patel,&nbsp;Kenneth J. Woodside,&nbsp;Krista L. Lentine,&nbsp;M. Lee Sanders,&nbsp;Oluwafisayo O. Adebiyi,&nbsp;Sabiha M. Hussain,&nbsp;Shikha Mehta,&nbsp;Vignesh Viswanathan,&nbsp;Xingxing S. Cheng,&nbsp;Ronald F. Parsons","doi":"10.1111/ctr.70637","DOIUrl":"10.1111/ctr.70637","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypothermic machine perfusion (HMP), an organ preservation technique used in deceased donor kidney transplantation, improves early outcomes compared to traditional static cold storage while also providing a loosely validated organ viability assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We designed a survey to better understand the practices, perceptions, and barriers to utilization of HMP. Surgeons, nephrologists, and coordinators were invited to participate in the survey via email.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Respondents (90% transplant surgeons) from 88 transplant centers which utilize HMP (35% of active kidney transplant centers) participated, representing 63% of total transplant volume in 2024. Respondents strongly agreed that HMP is helpful in kidney selection (92%), reduces delayed graft function (90%), and allows for scheduling flexibility (91%). A majority (74%) answered that the Organ Procurement Organization (OPO exclusively pumps kidneys. The most cited barrier to HMP use was OPO refusal (58%). Thresholds for resistance and flow varied widely with over 2/3 of respondents citing a specified acceptable cut-off. Most respondents answered “sometimes” (60%) or “yes” (20%) that they would decline a kidney if HMP could not be accomplished for a kidney they wished to be pumped. Perceived pitfalls were underutilization of kidneys due to incorrect or inaccurate perfusion parameters, logistical challenges and costs of pumping, inexperience and technical difficulties leading to organ or vasculature injury, and lack of standardization in practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HMP is used as a tool to assess organ viability and to overcome logistical hurdles by improving flexibility in operative timing. OPOs play a critical role in the ability to perform HMP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700823","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":"Preoperative Computed Tomography Aortic Calcification and Attenuation of the Vertebral Body Predict Fractures Post-Kidney Transplantation Using Machine Learning","authors":"Mitsuru Tomizawa,&nbsp;Shunta Hori,&nbsp;Kuniaki Inoue,&nbsp;Tatsuo Yoneda,&nbsp;Tetsuya Tachiiri,&nbsp;Takahiro Nakai,&nbsp;Kenta Onishi,&nbsp;Yosuke Morizawa,&nbsp;Daisuke Gotoh,&nbsp;Yasushi Nakai,&nbsp;Makito Miyake,&nbsp;Nobumichi Tanaka,&nbsp;Kiyohide Fujimoto","doi":"10.1111/ctr.70635","DOIUrl":"10.1111/ctr.70635","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Post-transplant fractures are associated with increased mortality and reduced graft survival. Although computed tomography (CT)-derived metrics, such as vertebral trabecular bone attenuation and abdominal aortic calcification have been reported as useful for assessing osteoporosis, their utility in predicting post-transplant fractures in kidney transplant recipients (KTRs) has not been explored. This study examined pre-transplant factors, including CT imaging parameters, associated with post-transplant fractures using machine learning techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 111 primary living-donor KTRs who underwent preoperative CT at our hospital between 2009 and 2023. Aorto-iliac calcification was quantified using the Agatston score. Vertebral trabecular bone CT attenuation values (Hounsfield units [HU]) were recorded at T12 to L5 levels. Machine learning with SHapley Additive exPlanations (SHAP) was used to identify the top predictors of fracture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median follow-up period was 69 months. Twenty-four recipients experienced fractures: hip (<i>n</i> = 3), leg (<i>n</i> = 6), arm (<i>n</i> = 5), rib (<i>n</i> = 3), and vertebrae (<i>n</i> = 9). The L1 vertebral CT attenuation value and aortic segment calcification score emerged as the top predictors of fracture. Based on SHAP cutoffs (L1 CT = 104 HU; Agatston score = 504), recipients were categorized into Group 1: high L1/low calcification; Group 2: high L1/high calcification; and Group 3: low L1/high calcification. Compared to Group 1, fracture risk was higher in Group 2 (Subdistribution hazard ratio [SHR] 3.06; <i>p</i> = 0.034) and markedly higher in Group 3 (SHR 11.66; <i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pre-transplant lower vertebral trabecular bone attenuation and higher aortic calcification on CT are strongly associated with post-transplant fractures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 8","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677280","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}