Clinical Transplantation最新文献

{"title":"Lessons Learned in Research and Development With Porcine Livers and the Clinical Translation—Beating the Organ Clock With Normothermic Machine Perfusion","authors":"Martin Jörg Schuler,&nbsp;Dustin Becker,&nbsp;David Machacek,&nbsp;Fabian Kalt,&nbsp;Rafael Fröhlich,&nbsp;Victor Lopez-Lopez,&nbsp;Christopher Onder,&nbsp;Jose Oberholzer,&nbsp;Dilmurodjon Eshmuminov","doi":"10.1111/ctr.70264","DOIUrl":"https://doi.org/10.1111/ctr.70264","url":null,"abstract":"<div>\u0000 \u0000 <p>Short-term (less than 24 h) normothermic liver perfusion devices are currently used in clinical practice. They improve logistics, simplify recipient matching, and aid in transplant decisions. At the same time, researchers globally are actively working on technologies to extend organ preservation times, mainly for transplantation. This paper investigates what it takes to keep a liver viable ex vivo using machine perfusion, outlining the essential conditions and key viability criteria during perfusion. The project's aim was to create a long-term liver perfusion machine that mimics the body's core functions, offering an artificial environment as close as possible to natural in vivo physiological conditions. After a successful 5-year development phase with porcine livers, the technology was then tested on two prototypes using human livers that were unsuitable for transplantation. This paper shares the experience, discoveries, and lessons learned during the research and development of a long-term liver perfusion machine. It considers both the current state of the art and existing clinical practices in transplantation. The viability criteria are also discussed from the perspective of long-term perfusion, especially since there's no current consensus in this area. Furthermore, the potential applications of these technologies are described. Overall, this long-term perfusion technology is seen as a platform that could unlock exciting new clinical applications, offering significant patient benefits that may outweigh the economic challenges. Nevertheless, considerable research is still needed to bring these concepts and ideas into routine clinical practice.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773595","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":"United States Trends in Procurement of Solid Organs Intended for Research","authors":"Shalmali Dharmadhikari,&nbsp;Nicolas Muñoz,&nbsp;Emily Vail,&nbsp;Peter Abt","doi":"10.1111/ctr.70267","DOIUrl":"https://doi.org/10.1111/ctr.70267","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To examine national trends and regional variability in the procurement of solid organs recovered for research from deceased donors in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) deceased donor registry data was conducted, including all deceased donors who underwent surgery for organ recovery from April 2015 to December 2023. The study classified each donated organ (liver, heart, pancreas, lung, kidney, and intestine) into four categories: not recovered, recovered for transplant, recovered for research, recovered for other purposes/discarded, with a focus on organs recovered for research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 107,485 deceased organ donors across 58 organ procurement organizations (OPOs), organs recovered for research included 2491 intestines, 6494 hearts, 6627 livers, 9098 kidneys, 10,711 pancreata, and 13,025 lungs. Research organ recovery showed an upward trend, particularly for pancreata. Median percentage of organ recovery for research across the OPOs, varied significantly by organ type: intestines (65.4%), pancreata (36.1%), lungs (28.3%), heart (11.3%), liver (7.1%), and kidneys (3.8%), with no significant correlation between OPO donor organ volumes and research organ recovery rates. Analysis of the 2021 data showed a higher median percentage of research organ recovery in Tier 1 OPOs (13.8%) compared to Tier 2 (10.8%) and Tier 3 (11.4%), though these differences were not statistically significant (<i>p</i> = 0.18).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Given the opacity of existing practices and unrealized potential of research organs, our findings warrant the need for improved surveillance, centralized tracking, and a robust framework for research organ recovery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773596","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":"Thrombophilia in Liver Donors: Prevalence of Protein C or S Deficiency in Korean Candidates and Decision Considerations.","authors":"Sola Lee, Suk Kyun Hong, Ja Min Byun, Su Young Hong, Jae-Yoon Kim, Jiyoung Kim, Jeong-Moo Lee, Youngil Koh, YoungRok Choi, Dong-Yeop Shin, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh","doi":"10.1111/ctr.70265","DOIUrl":"https://doi.org/10.1111/ctr.70265","url":null,"abstract":"<p><strong>Background: </strong>Donor thrombophilia poses risks to both donors and recipients. To address donor safety without unnecessarily decreasing the donor pool, we aimed to determine the incidence of protein C (PC) or protein S (PS) deficiency among living liver donor candidates and propose a decision-making algorithm for donation.</p><p><strong>Methods: </strong>We retrospectively reviewed 1421 living donor candidates who underwent primary donor evaluation at a single center between January 2017 and February 2022. Donors with PC or PS deficiency were divided into severe (< 40%), moderate (40%-49%), and mild (50%-59%) deficiencies and near-normal (> 60%) groups based on functional activity levels. Demographic and clinical data, including genetic mutation testing, donation status, and postoperative outcomes of both donors and recipients, were analyzed.</p><p><strong>Results: </strong>The incidence of PC and PS deficiency after the repeat testing was 0.4% (n = 6) and 1.7% (n = 24), respectively. One donor with severe PS deficiency had a PROS1 mutation, and two donors (one from the near-normal group and one from the mild group) had PROC mutations. None of the 16 donors experienced any thrombotic complications. Three recipients experienced thrombotic complications that were not directly associated with donor thrombophilia.</p><p><strong>Conclusion: </strong>The incidences of PC and PS deficiencies among liver donors are significant and should not be overlooked. Each center should consider geographic and ethnic variations when establishing efficient thrombophilia evaluation protocols to ensure donor safety.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":"e70265"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803795","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":"Machine Learning for 1-Year Graft Failure Prediction in Lung Transplant Recipients: The Korean Organ Transplantation Registry.","authors":"Dasom Noh, Sunyoung Kwon, Woo Hyun Cho, Jin Gu Lee, Song Yee Kim, Samina Park, Kyeongman Jeon, Hye Ju Yeo","doi":"10.1111/ctr.70268","DOIUrl":"10.1111/ctr.70268","url":null,"abstract":"<p><strong>Background: </strong>In regions with limited donor availability, optimizing efficiency in lung transplant decision-making is crucial. Preoperative prediction of 1-year graft failure can enhance candidate selection and clinical decision-making.</p><p><strong>Methods: </strong>We utilized data from the Korean Organ Transplantation Registry to develop and validate a deep learning-based model for predicting 1-year graft failure after lung transplantation. A total of 240 cases were analyzed using 5-fold cross-validation. Among 25 preoperative factors associated with 1-year graft failure, we selected the top 9 variables with coefficients ≥ 0.25 for model development.</p><p><strong>Results: </strong>Of the 240 lung transplant recipients, 55 (22.92%) developed graft failure within 1 year, while 185 survived. The final predictive model incorporated nine key pretransplant factors: age, bronchiolitis obliterans syndrome after hematopoietic cell transplantation, pretransplant bacteremia, bronchiectasis, creatinine, diabetes, positive human leukocyte antigen crossmatch, panel reactive antibody 1 peak mean fluorescence intensity, and pretransplant steroid use. The multilayer perceptron model demonstrated strong predictive performance, achieving an area under the curve of 0.780 and an accuracy of 0.733.</p><p><strong>Conclusions: </strong>Our machine learning-based model effectively predicts 1-year graft failure in lung transplant recipients using a minimal set of pretransplant variables. Further validation is needed to confirm its clinical applicability.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":"e70268"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803768","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":"Invasive Fungal Infections in Orthotopic Heart Transplant Patients: Incidence and Risk Factors in the Modern Era","authors":"Lana Hasan,&nbsp;Lalithaa Thirunavukarasu Murugan,&nbsp;Eileen Hsich,&nbsp;Michael Zhen-Yu Tong,&nbsp;Kyle D. Brizendine","doi":"10.1111/ctr.70248","DOIUrl":"https://doi.org/10.1111/ctr.70248","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Invasive fungal infections (IFI) post-orthotopic heart transplant (OHT) have not been well studied due to limited information in large databases. The goal of the study is to describe the incidence and risk factors for IFI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, we analyzed risk factors associated with IFI among OHT recipients in our center in the period 2010–2020. Patients were divided into two groups for comparison: IFI within the first year after transplant, and no IFI. We compared the groups to determine independent risk factors for IFI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 548 included patients, 29 patients experienced 29 IFI (incidence = 5.3%; 95% CI 3.7–7.5). Median (interquartile range) time to IFI was 44 days (10–238.5). <i>Candida</i> was the most identified pathogen (51%), followed by <i>Aspergillus</i> (27%) and <i>Cryptococcus</i> (9%). In multivariable logistic regression analyses, pretransplant fungal colonization/infection (odds ratio, [OR] 27, 95% CI 1.2–315), post-transplant reoperation (OR 5.8, 95% CI 2.2–15), and extracorporeal membrane oxygenation (ECMO) (OR 3.1, 95% CI 1.1–9.0) were associated with increased odds of IFI. Compared to patients without IFI, 1-year survival of patients with IFI was significantly worse (76 vs. 97%, <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We conclude there are specific, identifiable risk factors during the pre- and post-transplant periods associated with increased odds of IFI. These merit study of targeted antifungal prophylaxis with agents offering broad yeast and mold activity in OHT patients with certain risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70248","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751375","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":"Drug Usage and Risk for Polypharmacy After Pediatric Solid Organ Transplantation—A National Register Study","authors":"Rebekka Salonen,&nbsp;Kira Endén,&nbsp;Mikael Koskela,&nbsp;Kirsi Jahnukainen,&nbsp;Atte Nikkilä,&nbsp;Timo Jahnukainen","doi":"10.1111/ctr.70256","DOIUrl":"https://doi.org/10.1111/ctr.70256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Solid organ transplant (SOT) recipients are at risk for long-term comorbidities and polypharmacy, potentially affecting quality of life. This study assessed the prevalence of chronic medication use among young adults following pediatric SOT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 215 individuals in Finland who underwent kidney (<i>n</i> = 135), liver (<i>n</i> = 41), or heart (<i>n</i> = 39) transplantation before age 16 between 1982 and 2015 and were ≥18 years at follow-up. Age, sex, and hometown-matched controls (<i>n</i> = 1067) were selected from the Finnish Population Information System. The analyses involved data on prescription drug purchases and reimbursements for chronic conditions derived from the registry of Social Insurance Institution, which covers all prescription medicine purchases in Finland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The SOT recipients had an average of 1.53 reimbursed chronic conditions beyond immunosuppression (median follow-up time:18.0 years, IQR 11.0–23.0), with the highest burden among kidney and lowest among liver transplant recipients. Compared to controls, SOT recipients had significantly more reimbursement for cardiovascular diseases, hormonal deficiencies, and epilepsy (<i>p</i> &lt; 0.001). Kidney transplant recipients had a significantly higher risk of cardiovascular-related reimbursements than liver transplant group (<i>p</i> &lt; 0.001); no significant differences were observed between the transplant groups for other conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Young adults after pediatric SOT had an elevated need for chronic disease medications, with the highest burden observed in kidney transplant recipients and the lowest in liver transplant recipients. These findings highlight the importance of long-term follow-up and individualized transitional care to address multimorbidity and support quality of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70256","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740479","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":"The Liver Transplant Anesthesiology Fellowship Training Paradigm Across the United States: Looking for the Next Steps in Quality Education","authors":"Adrian D. Hendrickse,&nbsp;Patrick X. O'Donnell,&nbsp;Susan C. Connors,&nbsp;Christine Nguyen-Buckley,&nbsp;Mercedes S. Mandell","doi":"10.1111/ctr.70250","DOIUrl":"https://doi.org/10.1111/ctr.70250","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liver transplant anesthesia is a growing nonaccredited subspecialty. Although educational milestones and core competencies for training are published, there is a lack of research into how training is delivered to prepare fellows for independent practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In September 2020, the fellowship directors at all 19 training programs across the United States known to the Society for the Advancement of Transplant Anesthesia (SATA) were surveyed regarding their programs’ educational management processes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 17 fellowship directors responded to more than 70% of survey questions (89%). Few programs had a sequential learning plan that built knowledge and skill sets over time. Learning was primarily based on teaching during clinical care of patients while training time varied between programs. No directors were trained in curriculum development, but most (9/11 respondents) expressed interest in additional education if time was allotted for this task. Even with these challenges, respondents had few problems originating fellowship programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Liver transplant anesthesia fellowships had few common educational management processes that allowed for meaningful comparison of educational products between centers. This suggests that trainees are likely to have a wide variability in knowledge and skills that can affect the quality of care delivered. We suggest that national support for fellowship training may help to promote a more ordered yet flexible process at training programs that will improve subsequent patient care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144716497","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 Impact of Blast Percentage on Posttransplant Outcomes of Patients With Myelodysplastic Syndromes: A Retrospective Analysis Within the IPSS-M Framework","authors":"Zhong-Shi Lyu,&nbsp;Yu-Qian Sun,&nbsp;Xiao-Dong Mo,&nbsp;Meng Lv,&nbsp;Yi-Fei Cheng,&nbsp;Lan-Ping Xu,&nbsp;Xiao-Hui Zhang,&nbsp;Xiao-Jun Huang,&nbsp;Yu Wang","doi":"10.1111/ctr.70258","DOIUrl":"https://doi.org/10.1111/ctr.70258","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Blast percentage is crucial for myelodysplastic syndrome (MDS) diagnosis and risk stratification, but its role is now less prominent due to comprehensive genetic-based scoring systems like the Molecular International Prognostic Scoring System (IPSS-M). Originally, blast percentage was an independent categorical variable for prognosis, but in the IPSS-M, it is treated as a continuous variable. We hypothesize that blast percentage should still hold categorical value within genetic-based systems like the IPSS-M, especially for predicting transplant outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 225 MDS patients posttransplantation were retrospectively studied for blast percentage and genetic impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified significant disparities in relapse rates, with a marked contrast between the MDS with increased blasts (IBs) group and the MDS with low blasts group, achieving statistical significance. Intriguingly, within the IB cohort, a pronounced divergence in relapse rates was noted between the high and low risk subgroups within the IB-1 group, but not the IB-2 group. Furthermore, the combined model of blast percentage and IPSS-M demonstrated enhanced prognostic performance, with a higher C-index and lower information criteria than IPSS-M alone, indicating the synergistic prognostic value of these two factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study underscores the significant value of integrating blast percentage as a categorical variable with the IPSS-M for posttransplant prognosis in MDS patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144716466","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":"Reduced Surgical Complications After Deceased-Donor Kidney Transplantation Using Inverted Allograft and Ultrashort Ureteroureterostomy: A Single-Center Experience","authors":"Rafael Azevedo Foinquinos,&nbsp;Ana Luiza Souza-Leão,&nbsp;Ilan Cubits Kyrillos Oliveira Capela,&nbsp;Thales Paulo Batista,&nbsp;Maria Julia Gonçalves Mello,&nbsp;Cristiano Souza Leão","doi":"10.1111/ctr.70235","DOIUrl":"https://doi.org/10.1111/ctr.70235","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the outcomes of combined inverted renal grafts and ureteroureterostomy as the primary operative approach for kidney transplantation (KTx).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This case series included adult patients who consecutively underwent deceased-donor KTx for end-stage kidney disease at our center between January 2019 and June 2022. All patients received inverted KTx combined with ultrashort anisoperistaltic end-to-side ureteroureterostomy, without ureteral stenting. Descriptive analysis focused on the major perioperative outcomes within 90 days post-transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cohort analysis of 211 patients revealed major postoperative complications requiring reoperation in 15 patients (7.11%). Reoperations for urological reasons included four patients (1.90%) with ureteral stricture and ureteral fistula in two patients each (0.95%). Ureteral strictures were managed with pyeloureterostomy, and ureteral fistulas were treated with end-to-end ureteral re-anastomosis, double-j stenting, JP drain placement, or pyeloureterostomy. Non-urological complications leading to reoperation included peri-graft collections and infections such as surgical hematoma (1.42%), deep surgical infection (1.90%), and wound dehiscence (1.90%). Three patients (1.42%) ultimately underwent transplantectomy because of graft loss after severe infection in two patients (0.95%) and acute rejection plus infection in one patient (0.47%). All the remaining patients were treated with surgical exploration, evacuation/irrigation, and wound closure. Vascular complications occurred in one patient with an arterial stricture (0.47%). Delayed graft function was found in 82.9% of the patients, with 95.26% achieving resolution within 4 weeks post-transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Inverted KTx combined with ultrashort end-to-side ureteroureterostomy is a feasible and safe technique with low rates of urological and vascular complications in our experience. To our knowledge, this is the largest case series using this combined surgical approach as the primary technique for deceased-donor KTxs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144716467","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":"Comprehensive Analysis of Myocardial Reverse Remodeling Following HeartWare Ventricular Assist Device Implantation","authors":"Yujiro Kawai,&nbsp;John A. Farag,&nbsp;Masataka Nishiga,&nbsp;Yu Liu,&nbsp;Koji Kawago,&nbsp;Tiffany K. Koyano,&nbsp;Robyn Fong,&nbsp;Mary Sheridan Bilbao,&nbsp;William Hiesinger,&nbsp;Hye Sook Shin,&nbsp;Eric M. Pfrender,&nbsp;Alex Dalal,&nbsp;Albert J. Pedroza,&nbsp;Jack H. Boyd,&nbsp;Y. Joseph Woo,&nbsp;Yasuhiro Shudo","doi":"10.1111/ctr.70245","DOIUrl":"https://doi.org/10.1111/ctr.70245","url":null,"abstract":"<div>\u0000 \u0000 <p>As the prevalence of heart failure continues to rise, left ventricular assist devices (LVADs) have become an increasingly common treatment option for patients, demonstrating significant improvements in patient survival. LVAD therapy is also known to induce reverse remodeling, and its underlying mechanisms have garnered attention. This study examines the experience of end-stage heart failure patients who underwent HeartWare LVAD (HVAD, Medtronic Inc, Minneapolis, MN, USA) implantation. The patients were categorized into responder and non-responder groups to investigate the impact of LVAD therapy on hemodynamics, ventricular geometry, and transcriptomics in the heart before and after HVAD therapy. In the responder group, significant reductions in left ventricular size and improvements in left ventricular ejection fraction were observed. Furthermore, subtle enhancements in calcium cycling and unique gene expression changes were observed, which were notably different from the patterns observed in the non-responder group.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144716891","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}