Ellen Green, E Glenn Dutcher, Jesse D Schold, Darren Stewart
{"title":"The Dynamics of Deceased Donor Kidney Transplant Decision-Making: Insights from Studying Individual Clinicians' Offer Decisions.","authors":"Ellen Green, E Glenn Dutcher, Jesse D Schold, Darren Stewart","doi":"10.1016/j.ajt.2025.01.040","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.040","url":null,"abstract":"<p><p>Despite the high demand, over 7,500 recovered kidneys annually go unused, with transplant centers showing significant variation in their offer acceptance practices. However, it remains unclear how much of this variation occurs between individual clinicians within the same center and its impact on allocation efficiency and equity. This study quantified the variability in kidney offer acceptance decisions attributable to clinicians versus enters and examined the role of donor quality in acceptance decisions. We analyzed national transplant registry data (Jan. 2016-Dec. 2020) linked to on-call records from 15 transplant centers, creating a clinician-level dataset with 344,678 deceased donor kidney offers. The primary outcome was the variability in offer acceptance attributable to clinicians versus centers, quantified via hierarchical, mixed effects logistic regression models. To complement KDPI as a measure of donor quality, we incorporated Expected Acceptance Probability (EAP), which adjusts for a broader set of donor characteristics and also recipient factors. Both center-level (0.35, 95% CI: 0.15-0.79) and clinician-level variance (0.10, 95% CI: 0.06-0.18) were significant, with heterogeneity in the KDPI-acceptance association among clinicians. These results underscore the need for further research into the mechanisms driving the clinician-level variation and its implications for organ allocation efficacy, equity, and patient outcomes.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078015","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}
Samy M Riad, Naim Issa, Aleksandar Denic, Timothy L Kline, Adriana V Gregory, Joshua Augustine, Fawaz Al Ammary, Tony C Luehrs, Aidan F Mullan, Andrew D Rule
{"title":"Fewer medullary pyramids in the living kidney donor associate with graft failure in the recipient.","authors":"Samy M Riad, Naim Issa, Aleksandar Denic, Timothy L Kline, Adriana V Gregory, Joshua Augustine, Fawaz Al Ammary, Tony C Luehrs, Aidan F Mullan, Andrew D Rule","doi":"10.1016/j.ajt.2025.01.041","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.041","url":null,"abstract":"<p><p>This study aimed to identify the parenchymal structural features by both CT and histology that associate with death-censored graft failure in recipients of living donor kidneys. We analyzed kidney recipients of ABO-compatible living donor kidneys from 2000-2020 with follow-up through 2023. Cortical volume and thickness, individual medullary pyramid volume and count, glomerular volume, nephrosclerosis, and nephron number were assessed by deep learning models applied to the predonation CT and by morphometric histology analysis from the biopsy at the time of transplantation. There were 3098 recipients followed a median 5 years with 346 graft failure events. In adjusted analyses, the only structural measures associated with graft failure were fewer medullary pyramids on CT and a higher fraction of interstitial fibrosis and tubular atrophy (IFTA) on histology. Having ≤15 pyramids donated occurred in 9% and was associated with a graft failure incidence of 2.5 per 100 person-years compared to 1.6 per 100 person-years in the 17% with ≥26 pyramids donated. Fewer medullary pyramids were associated with a lower 1-year eGFR, which mediated the subsequent risk of graft failure. IFTA >1% is also associated with graft failure. Medullary pyramid count is a potentially useful predonation prognostic biomarker for graft failure in transplant recipients.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143072935","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}
Hanne Beeckmans, Pieterjan Kerckhof, Acet Öztürk Nilufer, Andrea Zajacova, Jan Van Slambrouck, Saskia Bos, Marie Vermant, Lyne O Van Dieren, Tessa Goeminne, Christelle Vandevelde, Josephine Bardyn, Elisabeth Willems, Sam Lauriers, Marius Brusselmans, Leen Van Langenhoven, Marie Paule Emonds, Steffi De Pelsmaeker, Johan Kerkhofs, Laurens De Sadeleer, Laurent Godinas, Lieven J Dupont, Dirk E Van Raemdonck, Laurens J Ceulemans, Bart M Vanaudenaerde, Robin Vos
{"title":"Clinical predictors for restrictive allograft syndrome: a nested case-control study.","authors":"Hanne Beeckmans, Pieterjan Kerckhof, Acet Öztürk Nilufer, Andrea Zajacova, Jan Van Slambrouck, Saskia Bos, Marie Vermant, Lyne O Van Dieren, Tessa Goeminne, Christelle Vandevelde, Josephine Bardyn, Elisabeth Willems, Sam Lauriers, Marius Brusselmans, Leen Van Langenhoven, Marie Paule Emonds, Steffi De Pelsmaeker, Johan Kerkhofs, Laurens De Sadeleer, Laurent Godinas, Lieven J Dupont, Dirk E Van Raemdonck, Laurens J Ceulemans, Bart M Vanaudenaerde, Robin Vos","doi":"10.1016/j.ajt.2025.01.036","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.036","url":null,"abstract":"<p><p>Risk factors for restrictive allograft syndrome (RAS), a severe phenotype of chronic lung allograft dysfunction after lung transplantation, are currently not well known. In this retrospective nested case-control-study, we analyzed 69 RAS patients and 69 matched non-CLAD controls to identify clinical risk factors for RAS. RAS patients demonstrated overall higher blood eosinophils (p=0.02), increased bronchoalveolar eosinophils (p<0.001) and lymphocytes (p=0.03), and a higher incidence of infections, particularly Pseudomonas (p=0.003), invasive fungal disease (p<0.001, mainly Aspergillus species), SARS-CoV-2 (p<0.001) and CMV (p=0.04), compared to non-CLAD controls. Anti-HLA antibodies, especially persistent donor-specific antibodies (p<0.001), especially targeting HLA-DQ and HLA-DR loci, and antibody-mediated rejection (p<0.001), were strongly associated with later RAS. Histopathological lung injury patterns on transbronchial biopsy (p<0.001), and persistent chest CT opacities in absence of pulmonary dysfunction (p<0.001) were identified as early indicators of later RAS. Proactive detection and management of these risk factors could help mitigate future decline in allograft function, and reduce progression to clinical RAS. Future studies should explore early treatment strategies targeting these modifiable factors to preserve allograft function and improve long-term outcomes for lung transplant recipients.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143072934","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}
Grace R Lyden, Maryam Valapour, Nicholas L Wood, Sommer E Gentry, Ajay K Israni, Ryutaro Hirose, Jon J Snyder
{"title":"Impact of the lung allocation system score modification by blood type on US lung transplant candidates.","authors":"Grace R Lyden, Maryam Valapour, Nicholas L Wood, Sommer E Gentry, Ajay K Israni, Ryutaro Hirose, Jon J Snyder","doi":"10.1016/j.ajt.2025.01.034","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.034","url":null,"abstract":"<p><p>The lung continuous distribution system was modified on September 27, 2023, with the goal of increasing transplant access for blood-type-O candidates after an error was discovered in the simulation used to support the development of the initial allocation policy. This retrospective observational study compares national waitlist outcomes (transplant rate, waitlist mortality) under continuous distribution before (3/10/23-9/26/23; premodification) and after (9/27/23-4/14/24; postmodification) the blood-type score modification. We fit adjusted Poisson regression models of the transplant rate and mortality rate. The transplant rate was lowest for type-O candidates in both eras, but significantly increased after the score modification, from a premodification adjusted rate ratio (95% CI) of 0.40 (0.36, 0.45) to postmodification 0.52 (0.45, 0.59), relative to premodification type-A candidates. The adjusted mortality incidence (95% CI) decreased in type-O candidates from 3.6% (3.0%, 4.3%) premodification to 3.2% (2.6%, 3.8%) postmodification. In an exploratory analysis, we estimated there would have been the same number of waitlist deaths (approximately 105) if the modified score had been adopted at the start of continuous distribution; however, transplants would have shifted towards type-O candidates (57.8 [95% CI: 35.1, 80.9] additional transplants) and deaths would have shifted away from type-O candidates (4.6 [95% CI: 2.7, 6.8] fewer deaths).</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062552","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}
A K Mezochow, E Clausen, K Whitaker, T Claridge, E Blumberg, A M Courtwright
{"title":"Letermovir should be first-line cytomegalovirus prophylaxis in lung transplant recipients.","authors":"A K Mezochow, E Clausen, K Whitaker, T Claridge, E Blumberg, A M Courtwright","doi":"10.1016/j.ajt.2025.01.038","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.038","url":null,"abstract":"<p><p>Universal cytomegalovirus (CMV) prophylaxis is recommended for at-risk lung transplant recipients. Valganciclovir is currently the preferred first-line agent. Valganciclovir-related myelosuppression, however, can lead to drug discontinuation or reduction in anti-metabolite immunosuppression. Variable valganciclovir pharmacokinetics in the setting of renal injury are also associated with development of resistant CMV. Letermovir, a newer anti-CMV agent, is an attractive alternative for first-line prophylaxis in many lung transplant recipients. Initially investigated in bone marrow transplant, there are now multiple retrospective studies of lung transplant recipients who were switched from valganciclovir to letermovir because of tolerability, dosing, or resistance. These studies have reaffirmed the safety and efficacy of letermovir in the lung transplant population. Despite this, letermovir continues to be recommended as second-line prophylaxis with use limited to those who fail valganciclovir. We argue that there are now sufficient data to support letermovir use in lung transplant recipients at high risk for valganciclovir toxicity. This includes patients with renal insufficiency, advanced age, cytolytic immunosuppression, high risk of rejection, and telomere biology disorders, among other conditions. First-line letermovir would reduce the risk of VGCV-related myelosuppression and attendant reduction in immunosuppression, as well as development of CMV resistance due to variable renal function and VGCV pharmacokinetics.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062562","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}
Lingjuan Sun, Xiangli Zhao, Xiaosheng Tan, Liu Song, Zhibo Ma, Jingzeng Wang, Peixiang Lan, Song Chen, Gang Chen
{"title":"HMGB1-mediated CIITA super-enhancers are critical for DC trained immunity in acute-to-chronic progression of allograft rejection.","authors":"Lingjuan Sun, Xiangli Zhao, Xiaosheng Tan, Liu Song, Zhibo Ma, Jingzeng Wang, Peixiang Lan, Song Chen, Gang Chen","doi":"10.1016/j.ajt.2025.01.037","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.037","url":null,"abstract":"<p><p>Chronic allograft rejection is mainly mediated by indirect recognition. Dendritic cells (DCs), as the major antigen-presenting cells in indirect recognition, exhibit an enhanced antigen-presenting ability in chronic rejection, but the specific mechanism is still unclear. Here, we found that pretreatment with high mobility group box-1 protein (HMGB1) in vivo can induce trained immunity in DCs. These trained DCs demonstrated an enhanced ability to present alloantigen, accelerating allograft rejection in a CTLA4-Ig-induced chronic rejection model by upregulating the expression of MHC-II and class II major histocompatibility complex transactivator (CIITA) molecules. Mechanistically, we found that HMGB1 promoted the formation of super-enhancers (SEs) of CIITA, epigenetically reprogramming DCs and promoting trained immunity. The SEs inhibitor JQ1 reduced the expression of CIITA and MHC-II in DCs, thereby delaying the occurrence of chronic rejection. Interestingly, we identified HMGB1 as a specific inducer of SE formation in a newly named SEa region of CIITA. Targeted knockout of the CIITA's SEa region inhibited HMGB1-induced trained immunity in DCs. Taken together, our data confirm that HMGB1 can induce the formation of the SEs of CIITA, promote trained immunity in DCs, and accelerate allograft rejection, thus offering a new potential target for the treatment of chronic rejection.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062583","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}
Lene Ugilt Pagter Ludvigsen, Anders Åsberg, Signe Spetalen, Mia Dahl Sørensen, Stephen Hamilton-Dutoit, Ann-Maria Gramkow, Christian Fynbo Christiansen, Grete Birkeland Kro, Marianne Kragh Thomsen, Sinna Pilgaard Ulrichsen, Rune Micha Pedersen, Harald Holte, Helle Charlotte Thiesson, Anna Bjerre, Francesco D'Amore, Dag Olav Dahle, Bente Jespersen, Søren Jensen-Fangel, Anna Varberg Reisæter
{"title":"Risk and prognosis of post-transplant lymphoproliferative disease in Epstein-Barr virus-seronegative kidney transplant recipients - An observational cohort study from Norway and western Denmark.","authors":"Lene Ugilt Pagter Ludvigsen, Anders Åsberg, Signe Spetalen, Mia Dahl Sørensen, Stephen Hamilton-Dutoit, Ann-Maria Gramkow, Christian Fynbo Christiansen, Grete Birkeland Kro, Marianne Kragh Thomsen, Sinna Pilgaard Ulrichsen, Rune Micha Pedersen, Harald Holte, Helle Charlotte Thiesson, Anna Bjerre, Francesco D'Amore, Dag Olav Dahle, Bente Jespersen, Søren Jensen-Fangel, Anna Varberg Reisæter","doi":"10.1016/j.ajt.2025.01.035","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.035","url":null,"abstract":"<p><p>Post-transplant lymphoproliferative disorder (PTLD) poses a serious challenge in kidney transplant recipients. Epstein-Barr virus (EBV)-seronegative recipients have a significantly increased risk of PTLD, but few studies have investigated risk factors for PTLD in EBV-seronegative recipients in the current era of immunosuppression. This cohort study from Norway and western Denmark included first-time kidney transplant recipients between 2007-2021, and estimated the cumulative incidence, risk and prognosis of PTLD. In total, 80 of 5,084 recipients developed biopsy-proven PTLD (median follow-up of 6.8 years). Two-year cumulative incidence of PTLD was 7.3% in EBV-seronegative adults and 14.1% in EBV-seronegative children. The age-adjusted hazard ratio (HR) for PTLD was 30.7 (95% confidence interval (CI) 13.9-67.9) in EBV-seronegative vs. EBV-seropositive adults and 5.4 (95% CI 1.1-26.9) in children. Recipients receiving induction therapy with anti-thymocyte globulin had an increased risk of PTLD, HR=4.4 (95% CI 1.8-10.6), while rituximab induction was associated with a lower risk of PTLD, HR=0.20 (95% 0.03-1.49). The age-adjusted mortality rate was higher in EBV-seronegative recipients with vs. without PTLD (HR=3.3 (95% CI 1.3-8.3). In conclusion, the risk of PTLD in EBV-seronegative kidney transplant recipients is high in the contemporary era of immunosuppression. Induction therapy should be carefully considered in this high-risk population.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062623","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}
Francesc Moreso, José Antonio Pons Miñano, Ana Sánchez Fructuoso, Carlos Jacas, Montserrat Alegret, Montserrat Ferrer, Jordi Colmenero Arroyo, Amado Andrés Belmonte, Verónica López Jiménez, Sonia Pascual, Auxiliadora Mazuecos Blanca, Ana Paz Ventura Galiano, Alba Cachero, Antonio Rivero, Marta Crespo, Antonio Cuadrado, Arantxa Caballero Marcos, Maria Luisa Gonzalez Diéguez, Carolina Almohalla Alvarez, Naroa Maruri Kareaga, Jose M Alamo Martinez, Giulia Pagano, Enriqueta Nuño Santana, Irina B Torres, Isabel Pérez Flores, Juana Alonso-Titos, María Rodríguez-Soler, Laura Martinez Alarcón, Teresa María García Álvarez, Isabel Beneyto Castelló, Emma Gonzalez-Vilatarsana, Francesc Miras, Miguel Angel Gómez Bravo
{"title":"Development and validation of the Neuro-Score: a specific scale to detect and monitor cognitive impairment in kidney or liver transplant recipients.","authors":"Francesc Moreso, José Antonio Pons Miñano, Ana Sánchez Fructuoso, Carlos Jacas, Montserrat Alegret, Montserrat Ferrer, Jordi Colmenero Arroyo, Amado Andrés Belmonte, Verónica López Jiménez, Sonia Pascual, Auxiliadora Mazuecos Blanca, Ana Paz Ventura Galiano, Alba Cachero, Antonio Rivero, Marta Crespo, Antonio Cuadrado, Arantxa Caballero Marcos, Maria Luisa Gonzalez Diéguez, Carolina Almohalla Alvarez, Naroa Maruri Kareaga, Jose M Alamo Martinez, Giulia Pagano, Enriqueta Nuño Santana, Irina B Torres, Isabel Pérez Flores, Juana Alonso-Titos, María Rodríguez-Soler, Laura Martinez Alarcón, Teresa María García Álvarez, Isabel Beneyto Castelló, Emma Gonzalez-Vilatarsana, Francesc Miras, Miguel Angel Gómez Bravo","doi":"10.1016/j.ajt.2025.01.031","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.031","url":null,"abstract":"<p><p>We created and validated the Neuro-Score, a specific scale to detect and monitor cognitive impairment, including mild stages, in kidney or liver transplant recipients. A qualitative study was conducted to define a preliminary set of 62 items. Item reduction was performed using exploratory factor analysis. Confirmatory factor analysis assessed the adequacy of the factorial solution. The total scores of the Neuro-Score and Mini-Mental State Examination (MMSE) were compared. Responsiveness to change was evaluated from visit 1 (baseline) to 2A (18 months later) and temporal stability from visit 2A to 2B (1-2 weeks later). Factor analysis showed 11 factors with an eigenvalue >1. Confirmatory factor analysis yielded a logical solution with one factor and 11 items that explained 27.9% of the variance. The final model showed satisfactory internal consistency (Cronbach's alpha=0.82). A weak negative correlation was found between Neuro-Score and MMSE total scores (Pearson's r=-0.12; p=0.0095). The Neuro-Score responsiveness to change was demonstrated (p=0.022). No significant differences in the total score were observed between visits 2A and 2B, supporting the Neuro-Score temporal stability. The Neuro-Score scale is a simple, reliable, self-administered, easy to interpret and consistent 11-item scale to detect and monitor cognitive impairment in kidney and liver transplant recipients.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062581","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}
Rachel E Patzer, Jesse D Schold, Ryutaro Hirose, Jennifer A Cowger, Megan Urbanski, Marie Budev, Ashley Cardenas, Kate Giles, Adrian C Lawrence, Krista L Lentine, Christine Maxmeister, Hellen Oduor, Sumit Mohan
{"title":"Transforming Transplantation Access: A Federal Directive for Comprehensive Pre-Waitlisting Data Collection.","authors":"Rachel E Patzer, Jesse D Schold, Ryutaro Hirose, Jennifer A Cowger, Megan Urbanski, Marie Budev, Ashley Cardenas, Kate Giles, Adrian C Lawrence, Krista L Lentine, Christine Maxmeister, Hellen Oduor, Sumit Mohan","doi":"10.1016/j.ajt.2025.01.032","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.032","url":null,"abstract":"<p><p>There is substantial variation in access to transplantation across the United States that is not entirely explained by the availability of donor organs. Barriers to transplantation and variation in care among patients with end-stage organ disease exist prior to patients' placement on a transplant waiting list as well as following waitlist placement. However, there are currently no national data available to examine rates and variations in key care processes related to pre-listing, including transplant referral, evaluation, or candidate selection. In February of 2024, the Health Resources and Services Administration (HRSA) released a directive and, in November 2024, released for public comment the proposed expansion of the Organ Procurement and Transplantation Network (OPTN) data collection to include pre-waitlist data for all solid organ transplant patients to promote transparency across the transplant continuum. While data elements and details have not been finalized, the purpose of this article is to detail the rationale and anticipated details for pre-waitlisting data collection to inform the transplant community. These data aim to examine care processes and barriers to care for patients with end-stage organ disease in the United States.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062634","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}
Sarah J Kizilbash, Michael D Evans, Jodi Smith, Rachel M Engen
{"title":"The Landscape of Hepatitis C Virus Infection in Pediatric Kidney Transplantation.","authors":"Sarah J Kizilbash, Michael D Evans, Jodi Smith, Rachel M Engen","doi":"10.1016/j.ajt.2025.01.030","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.030","url":null,"abstract":"<p><p>Hepatitis C virus (HCV) infection is increasing in prevalence due to the growing opioid epidemic; however, its impact on pediatric kidney transplantation is unknown. This study compared kidney transplant outcomes between HCV-positive and propensity-score-weighted HCV-negative pediatric recipients. It also examined HCV-positive kidney utilization for pediatric transplantation in the United States. We used the Scientific Registry of Transplant Recipients to identify pediatric kidney transplants (<18 years) performed between 4/1/1994 and 12/1/2022. We used propensity-score weighting to create a group of HCV-negative recipients with characteristics similar to HCV-positive recipients. Odds ratios (OR) for delayed graft function (DGF) and hazard ratios (HR) for patient and graft survival were estimated using logistic and Cox regression models. We found similar DGF rates (13.9% vs. 10.3%, p=0.14) and no difference in graft (HR: 1.04, 95% CI: 0.83-1.31, p=0.71; 10-year survival 54.9% vs. 54.5%) or patient survival (HR: 1.06, 95% CI: 0.58-1.95, p=0.84; 10-year survival 93.9% vs. 92.0%) between the groups. Four HCV-positive (2.5%), 3 HCV-negative children (0.02%), and 1 (0.05%) child with unknown HCV status received HCV-positive kidneys. We observed no increased risk of graft loss or death in children with HCV infection. The use of HCV-positive donors for pediatric kidney transplantation is rare.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035407","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}