American Journal of Transplantation最新文献

{"title":"OPTN/SRTR 2023 Annual Data Report: Heart","authors":"Monica M. Colvin ,&nbsp;Jodi M. Smith ,&nbsp;Yoon Son Ahn ,&nbsp;Kelsi A. Lindblad ,&nbsp;Dzhuliyana Handarova ,&nbsp;Ajay K. Israni ,&nbsp;Jon J. Snyder","doi":"10.1016/j.ajt.2025.01.024","DOIUrl":"10.1016/j.ajt.2025.01.024","url":null,"abstract":"<div><div>Despite unintended consequences and ongoing need for revision, the 2018 adult heart transplant policy revision continues to have a favorable impact as evidenced by increased transplant rates, decreased waitlist mortality, and more rapid transplant in higher acuity patients. In 2023, the total number of heart transplants in the United States increased 101.1% since 2012, reaching a record 4,599, of which 4,092 were performed in adults. Between 2022 and 2023 alone, 424 more adult heart transplants were performed, the largest annual increase this decade. Concurrently, the prevalence of heart donors after circulatory death increased to 14.0% in 2023. Candidates listed at adult statuses 1 and 2 underwent transplant more quickly (2,225.8 and 1,088.1 transplants per 100 patient-years, respectively). In 2023, adult waitlist mortality reached a low: 8.5 deaths per 100 patient-years. Multiorgan transplants (heart-liver and heart-kidney) in adults continue to increase, achieving comparable survival to that of heart transplant alone. Adults with congenital heart disease had the lowest pretransplant mortality of all diagnoses but also the lowest posttransplant survival, 76.1% at 5 years, emphasizing the need for consensus on best practices. In pediatric heart transplant, heart transplants increased 36.3% and new listings increased 34.0%, but the transplant rate decreased 14.9% resulting in increased waiting times. High-urgency listings increased, with 83.6% of heart transplants performed for status 1A. Pediatric waitlist mortality has declined 53.4% since 2012, but remains substantial: 11.7 deaths per 100 patient-years. In 2023, 5-year posttransplant survival was 80.3% in adult recipients and 84.4% in pediatric recipients.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S329-S421"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative extracorporeal membrane oxygenation in liver transplantation—bridge to transplantation, intraoperative salvage, and postoperative support: outcomes and predictors for survival in a large-volume liver transplant center","authors":"Sameer Patel ,&nbsp;Clemens Gutmann ,&nbsp;Robert Loveridge ,&nbsp;Tasneem Pirani ,&nbsp;Chris Willars ,&nbsp;Andre Vercueil ,&nbsp;Milena Angelova-Chee ,&nbsp;Varuna Aluvihare ,&nbsp;Michael Heneghan ,&nbsp;Krishna Menon ,&nbsp;Nigel Heaton ,&nbsp;William Bernal ,&nbsp;Mark McPhail ,&nbsp;Elton Gelandt ,&nbsp;Lisa Morgan ,&nbsp;Michael Whitehorne ,&nbsp;Julia Wendon ,&nbsp;Georg Auzinger","doi":"10.1016/j.ajt.2024.08.021","DOIUrl":"10.1016/j.ajt.2024.08.021","url":null,"abstract":"<div><div>Data on perioperative extracorporeal membrane oxygenation (ECMO) in liver transplantation (LT) are scarce. ECMO has been used preoperatively, intraoperatively, and postoperatively for a variety of indications at our center. This retrospective, single-center study of ECMO use peri-LT aimed to describe predictors for successful outcome in this highly select cohort of patients. Demographics, support method, and indication for LT were compared between survivors and nonsurvivors. Twenty-nine patients received venovenous (V-V; <em>n</em> = 20), venoarterial (V-A; <em>n</em> = 8), and venoarteriovenous (<em>n</em> = 1) ECMO. Twelve (41.4%) patients were bridged to emergency LT for acute liver failure, and emergency redo LT. Four (13.3%) patients required intraoperative V-A ECMO salvage, 2 necessitating extracorporeal cardiopulmonary resuscitation. Thirteen (43.3%) patients required ECMO support after LT: V-V ECMO (n = 9); V-A ECMO (n = 1); and extracorporeal cardiopulmonary resuscitation (<em>n</em> = 3) between postoperative days 2 to 30. Overall, 19 patients (65.5%) were successfully weaned off ECMO; 15 (51.7%) survived to intensive care unit discharge. All patients who underwent intraoperative salvage ECMO and all who were bridged to emergency redo LT died. Peri-LT ECMO is feasible. Post-LT ECMO outcomes are encouraging, in particular for V-V ECMO. Intraoperative ECMO salvage, uncontrolled sepsis, and graft failure are associated with poor outcomes.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 396-405"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 impact of immigration status on outcomes in pediatric kidney transplant recipients","authors":"Miguel Nunez ,&nbsp;Ali Abbasi ,&nbsp;Marilyn McEnhill ,&nbsp;Jessica Brennan ,&nbsp;Taryn Shappell ,&nbsp;Sarah Kinnier ,&nbsp;Erica Winnicki ,&nbsp;Peter Stock","doi":"10.1016/j.ajt.2024.09.008","DOIUrl":"10.1016/j.ajt.2024.09.008","url":null,"abstract":"<div><div>This study aimed to investigate the effects of documentation status on pediatric kidney transplant outcomes in a single-center setting, emphasizing the significance of state insurance access for undocumented patients and federal policies like Deferred Action for Childhood Arrivals (DACA) on patient outcomes. A cohort of 283 patients, including 48 undocumented individuals, who received their first kidney transplant as children between 1998 and 2011 was analyzed. There was no significant difference in unadjusted all-cause (<em>P</em> = .91) and death-censored (<em>P</em> = .38) graft survival between undocumented patients and patients with permanent legal status, subsequently referred to as US residents. Additionally, in the Cox proportional hazards model, immigration status was not significantly associated with all-cause graft survival (hazard ratio 0.87, 95% CI 0.51-1.46, <em>P</em> = .6). Telephone interviews were conducted with the undocumented cohort. Forty-one of 48 of the undocumented recipients were contacted. Ninety-five percent had access to insurance with 68.3% on Medicaid or Medicare. DACA recipients exhibited higher employment rates (88% vs 67%, <em>P</em> = .11) and were more likely to complete a degree beyond high school (47.1% vs 12.5%, <em>P</em> = .01). Immigration status did not impact long-term graft survival, suggesting eligibility expansions for state-funded insurance and DACA may improve access to transplant care for undocumented patients. Moreover, DACA recipients showed trends toward increased employment and education compared to non-DACA recipients.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 368-375"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-sequence allocation: a necessary innovation or a new inequity in transplantation?","authors":"Joel T. Adler ,&nbsp;Sidharth Sharma","doi":"10.1016/j.ajt.2024.09.022","DOIUrl":"10.1016/j.ajt.2024.09.022","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 234-236"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FCGR2C Q13 and FCGR3A V176 alleles jointly associate with worse natural killer cell-mediated antibody-dependent cellular cytotoxicity and microvascular inflammation in kidney allograft antibody-mediated rejection","authors":"Elodie Bailly ,&nbsp;Camila Macedo ,&nbsp;Xinyan Gu ,&nbsp;Deborah Hollingshead ,&nbsp;Carol Bentlejewski ,&nbsp;Erica Fong ,&nbsp;Penelope A. Morel ,&nbsp;Parmjeet Randhawa ,&nbsp;Adriana Zeevi ,&nbsp;Carmen Lefaucheur ,&nbsp;Diana Metes","doi":"10.1016/j.ajt.2024.09.018","DOIUrl":"10.1016/j.ajt.2024.09.018","url":null,"abstract":"<div><div>Natural killer (NK) cell-mediated antibody-dependent cellular cytotoxicity (ADCC) is a major mechanism of humoral allograft injury. <em>FCGR3A</em> V¹⁷⁶/F¹⁷⁶ polymorphism influences ADCC activity. Additionally, NK cell FcγRIIc expression, dictated by the Q¹³/STP¹³ polymorphism, was never investigated in kidney transplantation. To assess the clinical relevance of <em>FCGR2C</em> Q¹³/STP¹³ polymorphism in conjunction with <em>FCGR3A</em> V¹⁷⁶/F¹⁷⁶ polymorphism, 242 kidney transplant recipients were genotyped. NK cell Fc gamma receptor (FcγR) expression and ADCC activity were assessed. RNA sequencing was performed on kidney allograft biopsies to explore the presence of infiltrating FcγR+ NK cells. The <em>FCGR2C</em> Q¹³ allele was enriched in antibody-mediated rejection patients. FcγRIIc Q¹³+ NK cells had higher ADCC activity than FcγRIIc Q¹³– NK cells. In combination with the high-affinity <em>FCGR3A</em> V¹⁷⁶ allele, Q¹³+V¹⁷⁶+ NK cells were the most functionally potent. Q¹³+ was associated with worse microvascular inflammation and a higher risk of allograft loss. Among V¹⁷⁶– patients, previously described in the literature as lower-risk patients, Q¹³+V¹⁷⁶– showed a lower graft survival than Q¹³–V¹⁷⁶– patients. In antibody-mediated rejection biopsies, <em>FCGR2C</em> transcripts were enriched and associated with ADCC-related transcripts. Our results suggest that <em>FCGR2C</em> Q¹³ in addition to <em>FCGR3A</em> V¹⁷⁶ is a significant risk allele that may enhance NK cell-mediated ADCC and contribute to allograft injury and poor survival.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 302-315"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of nonstandardized model for end-stage liver disease score exceptions with waitlist mortality in adult liver transplant candidates","authors":"Daniel J. Ahn ,&nbsp;Allison J. Kwong ,&nbsp;Anji E. Wall ,&nbsp;William F. Parker","doi":"10.1016/j.ajt.2024.09.028","DOIUrl":"10.1016/j.ajt.2024.09.028","url":null,"abstract":"<div><div>In the US liver allocation system, nonstandardized model for end-stage liver disease (MELD) exceptions (NSEs) increase the waitlist priority of candidates whose MELD scores are felt to underestimate their true medical urgency. We determined whether NSEs accurately depict pretransplant mortality risk by performing mixed-effects Cox proportional hazards models and estimating concordance indices. We also studied the change in frequency of NSEs after the National Liver Review Board’s implementation in May 2019. Between June 2016 and April 2022, 60,322 adult candidates were listed, of whom 10,280 (17.0%) received an NSE at least once. The mean allocation MELD was 23.9, an increase of 12.0 points from the mean laboratory MELD of 11.9 (<em>P</em> &lt; .001). A 1-point increase in allocation MELD score due to an NSE was associated with, on average, a 2% reduction in hazard of pretransplant death (cause-specific hazard ratio: 0.98; 95% CI: 0.96, 1.00; <em>P</em> = .02) compared with those with the same laboratory MELD. Laboratory MELD was more accurate than allocation MELD with NSEs in rank-ordering candidates (c-index: 0.889 vs 0.857). The proportion of candidates with NSEs decreased significantly after the National Liver Review Board from 21.5% to 12.8% (<em>P</em> &lt; .001). NSEs substantially increase the waitlist priority of candidates with objectively low medical urgency.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 385-395"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gene expression–based molecular scoring of pancreas transplant rejection for a quantitative assessment of rejection severity and resistance to treatment","authors":"Audrey E. Brown ,&nbsp;Yvonne M. Kelly ,&nbsp;Arya Zarinsefat ,&nbsp;Raphael P.H. Meier ,&nbsp;Giulia Worner ,&nbsp;Mehdi Tavakol ,&nbsp;Minnie M. Sarwal ,&nbsp;Zoltan G. Laszik ,&nbsp;Peter G. Stock ,&nbsp;Tara K. Sigdel","doi":"10.1016/j.ajt.2024.09.032","DOIUrl":"10.1016/j.ajt.2024.09.032","url":null,"abstract":"<div><div>Pancreas transplantation improves glycemic control and mortality in patients with diabetes but requires aggressive immunosuppression to control the alloimmune and autoimmune response. Recent developments in “omics” methods have provided gene transcript-based biomarkers for organ transplant rejection. The tissue Common Response Module (tCRM) score is developed to identify the severity of rejection in kidney, heart, liver, and lung transplants. Still, it has not yet been validated in pancreas transplants (PT). We evaluated the tCRM score’s relevance in PT and additional markers of acute cellular rejection (ACR) for PT. An analysis of 51 pancreas biopsies with ACR identified 37 genes and 56 genes significantly upregulated in the case of grade 3 and grade 2 ACR, respectively (<em>P</em> &lt; .05). Significant differences were seen with higher grades of rejection among several transcripts. Of the 22 genes differentially expressed in grade 3 ACR, 18 were also differentially expressed in grade 2 ACR. The rejection signal was attributable to activated leukocytes’ infiltration. Significantly higher tCRM scores were found in grade 3 ACR (<em>P</em> = .007) and grade 2 ACR (<em>P</em> = .004), compared to normal samples. The tCRM score was able to distinguish treatment-resistant cases from those successfully treated for rejection.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 316-328"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bartonella quintana infection in kidney transplant recipients from donor experiencing homelessness, United States, 2022","authors":"Marcus R. Pereira","doi":"10.1016/j.ajt.2024.11.032","DOIUrl":"10.1016/j.ajt.2024.11.032","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 230-231"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OPTN/SRTR 2023 Annual Data Report: Deceased Organ Donation","authors":"Ajay K. Israni ,&nbsp;David A. Zaun ,&nbsp;Alina Martinez ,&nbsp;Cory R. Schaffhausen ,&nbsp;Cinthia Lozano ,&nbsp;Warren T. McKinney ,&nbsp;Jonathan M. Miller ,&nbsp;Jon J. Snyder","doi":"10.1016/j.ajt.2025.01.026","DOIUrl":"10.1016/j.ajt.2025.01.026","url":null,"abstract":"<div><div>The Annual Data Report is created using data from the Scientific Registry of Transplant Recipients (SRTR) to calculate variables such as organs recovered per donor, organs transplanted per donor, and organs recovered for transplant but not transplanted (ie, nonuse). SRTR uses data collected by the Organ Procurement and Transplantation Network. In 2023, there were 16,335 deceased donors, a 9.6% increase from 14,904 in 2022 and continuing the trend of increasing donors over the past decade. Donor characteristics have changed compared with 2013, with more donors with drug intoxication and cardiovascular mechanisms of death. In contrast, gunshot wound, blunt injury, and stroke have decreased as mechanisms of death in 2023 compared with 2013. The number of organs transplanted increased to 40,588 in 2023 (from 37,316 in 2022), including 10,818 left kidneys, 10,659 right kidneys, 372 en bloc kidneys, 917 pancreata, 9,910 livers, 95 intestines, 4,596 hearts, and 3,016 lungs. Compared with 2022, transplants of all organs increased. In 2023, 4,038 left kidneys, 4,220 right kidneys, 160 en block kidneys, 279 pancreata, 1,056 livers, 4 intestines, 68 hearts, and 260 lungs were not used. This nonuse of organs represents an opportunity to increase the number of transplants.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S490-S517"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor-derived posttransplant lymphoproliferative disease detection by donor-derived cell-free DNA","authors":"Mia Wungnema ,&nbsp;Madelaine Hack ,&nbsp;Evgeniya Vaskova ,&nbsp;Natali Gulbahce ,&nbsp;Hao Zhang ,&nbsp;Marica Grskovic ,&nbsp;Allison Miller ,&nbsp;Megan Stack ,&nbsp;Angelo de Mattos ,&nbsp;Phillipp W. Raess ,&nbsp;Wei Xie ,&nbsp;Joanna Wiszniewska ,&nbsp;Nicole K. Andeen ,&nbsp;Vanderlene L. Kung ,&nbsp;Erin Maynard ,&nbsp;Shehzad Rehman","doi":"10.1016/j.ajt.2024.09.029","DOIUrl":"10.1016/j.ajt.2024.09.029","url":null,"abstract":"<div><div>Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication of organ transplantation, commonly diagnosed after patients present with nonspecific constitutional symptoms and/or transplant organ dysfunction. In this article, we report a case of a kidney transplant recipient who was found to have highly elevated circulating donor-derived cell-free DNA (dd-cfDNA) levels on routine serum surveillance for allograft rejection, initially without organ dysfunction or evidence of allograft rejection on biopsy. Later, for cause imaging revealed retroperitoneal lymphadenopathy and an allograft hilar mass, which was biopsied to show PTLD/diffuse large B cell lymphoma. The elevated circulating dd-cfDNA levels in this patient prompted targeted next-generation sequencing of the same 266 single-nucleotide polymorphisms used to detect dd-cfDNA on the diffuse large B cell lymphoma, which identified it as derived from the donor. The patient achieved complete remission with retained allograft kidney function after reduced immunosuppression and 6 cycles of immunochemotherapy. This case suggests that dd-cfDNA may be an early detection tool in rare but potentially life-threatening cases of donor-derived malignancy, such as donor-derived PTLD.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 435-439"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}