American Journal of Transplantation最新文献

{"title":"Changes in bloodstream infections in heart transplant recipients following the allocation guidelines change","authors":"Alyssa K. Mezochow,&nbsp;Marcus R. Pereira,&nbsp;Juan Ortega-Legaspi,&nbsp;Thresiamma Lukose,&nbsp;Warren B. Bilker,&nbsp;Teresa Wang,&nbsp;Pam Tolomeo,&nbsp;Jacqueline Omorogbe,&nbsp;Olaoluwa Olaiya,&nbsp;Zane Bekheet,&nbsp;John Janosevic,&nbsp;Ebbing Lautenbach","doi":"10.1016/j.ajt.2026.05.2294","DOIUrl":"10.1016/j.ajt.2026.05.2294","url":null,"abstract":"<div><div>In 2018, the orthotopic heart transplant (OHT) allocation policy in the United States changed to prioritize more critically ill candidates, including those supported with temporary mechanical circulatory support (tMCS). This study evaluated changes in posttransplant bloodstream infection (BSI) rates following the OHT allocation change. We conducted a retrospective cohort study of OHT recipients at 2 large United States transplant centers from January 1, 2015, to December 31, 2022. Recipients were followed 90 days post-OHT for BSIs. The association between policy era and BSIs was evaluated using multivariable Cox regression with mediation analysis to explore the effect of tMCS. There were 895 OHT recipients with a nearly two-fold increase in pretransplant tMCS after the policy change. Seventy-nine recipients developed BSIs (8.8%). OHT in the postpolicy era was associated with a 1.9-fold increased hazard of BSI (<em>P</em> = 0.018). Mediation analysis showed tMCS acted as a significant mediator of increased BSI risk after the change. One-year mortality and graft failure were similar across the 2 policy eras, although there was a significant decrease in 1-year rejection following the change (<em>P</em> &lt; .001). Overall, post-OHT BSI risk nearly doubled following the allocation change, which is mediated by tMCS. Additional studies are needed to further investigate factors contributing to BSI risk.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"26 10","pages":"Pages 2394-2402"},"PeriodicalIF":8.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040323","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":"Explainable, But What Exactly Are We Explaining? Artificial Intelligence and Heart Allocation","authors":"Arezu Aliabadi-Zuckermann,Andreas Zuckermann","doi":"10.1016/j.ajt.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.ajt.2026.10.009","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"15 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208746","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":"Reply to comment on “Clazakizumab in the treatment of chronic active antibody-mediated kidney transplant rejection: Results from the IMAGINE phase 3, randomized, double-blind, placebo-controlled study”","authors":"Arjang Djamali,&nbsp;Peter W. Nickerson","doi":"10.1016/j.ajt.2026.06.019","DOIUrl":"10.1016/j.ajt.2026.06.019","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"26 10","pages":"Pages 2414-2415"},"PeriodicalIF":8.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366181","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":"Living donor liver transplant is associated with lower hospitalization costs than deceased donor liver transplant: A multicenter cohort study of young children transplanted for biliary atresia","authors":"Amy G. Feldman,&nbsp;Brenda L. Beaty,&nbsp;Megan Bisek,&nbsp;Julia M. Boster,&nbsp;Matthew Hall,&nbsp;Liza Creel,&nbsp;Trevor Nydam,&nbsp;Dor Yoeli,&nbsp;Megan A. Adams","doi":"10.1016/j.ajt.2026.05.2293","DOIUrl":"10.1016/j.ajt.2026.05.2293","url":null,"abstract":"<div><div>Living donor (LD) liver transplant (LT) is associated with improved outcomes compared with deceased donor (DD) LT, including shorter waitlist times, decreased pre-LT mortality, and improved post-LT survival. However, the cost difference between LDLT and DDLT remains unknown. In this study, we used the linked Pediatric Health Information System and Scientific Registry of Transplant Recipients data sets to compare pre-LT, LT, and 1-year post-LT hospitalization costs and resource utilization between children with biliary atresia aged &lt;2 years who received LDLT or DDLT between January 1, 2010, and December 31, 2020. For all children (N = 819), the median cost for transplant hospitalization was less for LDLT ($179 965; interquartile range [IQR]: $130 238-$275 951) than for DDLT recipients ($224 851; IQR: $163 724-$336 550, <em>P</em> &lt; .001), and fewer LDLT (4%) than DDLT recipients (10%, <em>P</em> = .01) required dialysis during transplant hospitalization. In a subanalysis of recipients of a technical variant graft (TVG) (n = 471), transplant hospitalization costs were lower for LDLT ($179 965; IQR: $130 238-$275 951) than for deceased TVG ($249 371; IQR: $171 678-$363 664, <em>P</em> &lt; .001), and fewer LDLT than deceased TVG recipients required dialysis (4% vs 9%, <em>P</em> = .045) and total parenteral nutrition (63% vs 74%, <em>P</em> = .007). In conclusion, LDLT offers an opportunity to decrease costs and should be considered for children in need of LT.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"26 10","pages":"Pages 2365-2373"},"PeriodicalIF":8.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148051262","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":"Effectiveness of respiratory syncytial virus vaccination in solid organ transplant recipients in the United States","authors":"Lana Hasan,&nbsp;Deepali Boothankad Sharath,&nbsp;Jessica Lum,&nbsp;Wayne Tsuang,&nbsp;Kaitlyn Rivard,&nbsp;Zachary A. Yetmar","doi":"10.1016/j.ajt.2026.05.2302","DOIUrl":"10.1016/j.ajt.2026.05.2302","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Respiratory syncytial virus (RSV) is associated with high morbidity in solid organ transplant recipients (SOTRs) and the effectiveness of the RSV vaccine in this population is unknown. We sought to assess the real-world performance of the RSV vaccine in SOTRs through a retrospective cohort study emulating a target trial using Epic Cosmos. We identified SOTRs with posttransplant follow-up between October 1, 2023, and March 31, 2025, and were aged ≥60 years. Risk-set matching was used to account for the timing of vaccination. Outcomes included RSV infection, hospitalization, intensive care unit admission, intubation, and all-cause mortality. Multivariable Cox regression was used to compare RSV-related events between vaccinated and unvaccinated SOTRs. Of 63 108 total patients, 17 315 vaccinated SOTRs were risk-set matched to 34 617 unvaccinated SOTRs. After adjusting for relevant confounders, vaccination was associated with a lower risk of RSV infection (hazard ratio [HR], 0.70; 95% CI, 0.56-0.88; &lt;em&gt;P&lt;/em&gt; = .002), RSV-related hospitalization (HR, 0.61; 95% CI, 0.43-0.86; &lt;em&gt;P&lt;/em&gt; = .005), and all-cause mortality (HR, 0.45; 95% CI, 0.41-0.50; &lt;em&gt;P&lt;/em&gt; &lt; .001), but not intensive care unit admission or intubation. These findings were largely consistent across sensitivity and subgroup analyses. RSV vaccination is associated with lower risk for RSV infection, RSV-related hospitalization, and all-cause mortality among SOTRs. SOTRs should be encouraged to receive the RSV vaccine.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Respiratory syncytial virus (RSV) is associated with high morbidity in solid organ transplant recipients (SOTRs) and the effectiveness of the RSV vaccine in this population is unknown. We sought to assess the real-world performance of the RSV vaccine in SOTRs through a retrospective cohort study emulating a target trial using Epic Cosmos. We identified SOTRs with posttransplant follow-up between October 1, 2023, and March 31, 2025, and were aged ≥60 years. Risk-set matching was used to account for the timing of vaccination. Outcomes included RSV infection, hospitalization, intensive care unit admission, intubation, and all-cause mortality. Multivariable Cox regression was used to compare RSV-related events between vaccinated and unvaccinated SOTRs. Of 63 108 total patients, 17 315 vaccinated SOTRs were risk-set matched to 34 617 unvaccinated SOTRs. After adjusting for relevant confounders, vaccination was associated with a lower risk of RSV infection (hazard ratio [HR], 0.70; 95% CI, 0.56-0.88; &lt;em&gt;P&lt;/em&gt; = .002), RSV-related hospitalization (HR, 0.61; 95% CI, 0.43-0.86; &lt;em&gt;P&lt;/em&gt; = .005), and all-cause mortality (HR, 0.45; 95% CI, 0.41-0.50; &lt;em&gt;P&lt;/em&gt; &lt; .001), but not intensive care unit admission or intubation. These findings were largely consistent across sensitivity and subgroup analyses. RSV vaccination is associated with lower risk for RSV infection, RSV-related hospitalization, and all-cause mortality among SOTRs. SOTRs should be enc","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"26 10","pages":"Pages 2374-2382"},"PeriodicalIF":8.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194424","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":"Single-center, open-label, randomized controlled trial comparing the tolerability of maribavir 400 mg twice daily versus standard-dose valganciclovir for cytomegalovirus prophylaxis in high-risk kidney transplant recipients","authors":"David J. Taber,&nbsp;Hannah Culpepper,&nbsp;Courtney E. Harris,&nbsp;Neha Patel,&nbsp;Morgan Overstreet,&nbsp;Felicia Bartlett,&nbsp;Sakshi Vaishnav,&nbsp;Maria Aurora Posadas Salas,&nbsp;Santosh Nagaraju,&nbsp;Steve Hanish","doi":"10.1016/j.ajt.2026.05.729","DOIUrl":"10.1016/j.ajt.2026.05.729","url":null,"abstract":"<div><div>Cytomegalovirus (CMV) remains a major contributor to morbidity after a kidney transplant. Although valganciclovir (VGC) prophylaxis is effective, its use is limited by leukopenia. Maribavir’s (MAR) role in primary CMV prophylaxis is not established. We conducted a 12-month, single-center, open-label, randomized controlled trial including 70 adult recipients at high CMV risk randomized 1:1 to MAR 400 mg twice daily or VGC 900 mg daily. The incidence of clinically significant leukopenia during prophylaxis did not differ between arms (22.9% vs 5.7%, <em>P</em> = .084). For the secondary endpoint, VGC recipients spent a greater proportion of prophylaxis days below white blood cell thresholds (&lt;3000/μL: 12.2% vs 2.4%, <em>P</em> &lt; .001; &lt;2000/μL: 3.0% vs 0.2%, <em>P</em> &lt; .001; &lt;1000/μL: 0.3% vs 0.1%, <em>P</em> = .027). As an exploratory endpoint, CMV outcomes appeared similar between arms, including any viremia (37% vs 43%, <em>P</em> = .626), polymerase chain reaction &gt;1000 IU/mL (23% vs 31%, <em>P</em> = .420), and refractory infection (15% vs 17%, <em>P</em> = .743). No cases of CMV breakthrough, disease, or resistance occurred. Hospitalizations, rejection, graft loss, and mortality did not differ. In summary, as compared to VGC, MAR had a similar incidence of clinically significant leukopenia with reduced overall leukopenia burden. These findings should be confirmed in larger multicenter studies.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"26 10","pages":"Pages 2383-2393"},"PeriodicalIF":8.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004022","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":"Mitochondrial pyruvate carrier inhibition restrains germinal center T follicular helper cells attenuating chronic graft-versus-host disease","authors":"Eun Ko,Fathima A. Mohamed,Stephanie Y. Rhee,Yujie Zhao,Rocio Amaro Marquez,Joanna Ly,Ethan G. Aguilar,Haley Melin,Peter T. Sage,Tanner Schumacher,Conor Ronayne,Angela Panoskaltsis-Mortari,Megan Riddle,Mark Osborn,Govindarajan Thangavelu,Peter A. Crawford,Roddy S. O’Connor,Michael C. Zaiken,Keli L. Hippen,Leslie S. Kean,Jeffrey C. Rathmell,Juan Liu,Jason W. Locasale,Venkatram Mereddy,Bruce R. Blazar","doi":"10.1016/j.ajt.2026.09.041","DOIUrl":"https://doi.org/10.1016/j.ajt.2026.09.041","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"1 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088180","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":"Comparative evaluation of distinct dual hypothermic oxygenated perfusion strategies in a porcine donation after circulatory death liver transplantation model","authors":"Tongdi Fang,&nbsp;Yu Jia,&nbsp;Tielong Wang,&nbsp;Jiayi Zhang,&nbsp;Shirui Chen,&nbsp;Zehua Jia,&nbsp;Xiaorui Liu,&nbsp;Yefu Li,&nbsp;Tao Luo,&nbsp;Dawei Zou,&nbsp;Andrea Schlegel,&nbsp;Yunhua Tang,&nbsp;Xiaoshun He,&nbsp;Zhiyong Guo","doi":"10.1016/j.ajt.2026.03.013","DOIUrl":"10.1016/j.ajt.2026.03.013","url":null,"abstract":"&lt;div&gt;&lt;div&gt;There is increasing clinical evidence for the protective effect of the hypothermic oxygenated perfusion (HOPE) treatment strategy in human donation after circulatory death (DCD) liver transplantation. HOPE treatment is routinely applied for 2 hours after static cold storage (SCS). This study aimed to determine the optimal timing and duration of HOPE treatment by comparing different HOPE treatment strategies in a porcine DCD liver transplantation model. Donor livers from Tibetan miniature pigs underwent 60-minute warm ischemia and were then randomized into 4 groups according to different preservation strategies, including SCS treatment, upfront HOPE (U-HOPE), end-ischemic HOPE (E-HOPE), and continuous HOPE (C-HOPE) treatment groups (n = 6 per group). All these livers were transplanted orthotopically. Posttransplant survival and graft ischemia-reperfusion injury were assessed during a 7-day follow-up. The 7-day survival rates were 0% for the SCS treatment group, 33.3% (2/6) for the U-HOPE treatment group, and 100.0% (6/6) for both E-HOPE and C-HOPE treatment groups. Compared with the SCS treatment strategy, all HOPE treatment strategies enhanced lactate clearance and liver function recovery, reduced oxidative stress and inflammatory responses, reduced hepatocellular and biliary injury, and protected mitochondrial function. Importantly, such protective effects were more pronounced in the livers undergoing E-HOPE and C-HOPE treatments than in U-HOPE treatments. All HOPE treatment approaches showed superior preservation of DCD livers over SCS. Among them, the E-HOPE and C-HOPE treatments achieved improved short-term survival and enhanced protection against graft ischemia-reperfusion injury in comparison with the U-HOPE treatment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;There is increasing clinical evidence for the protective effect of the hypothermic oxygenated perfusion (HOPE) treatment strategy in human donation after circulatory death (DCD) liver transplantation. HOPE treatment is routinely applied for 2 hours after static cold storage (SCS). This study aimed to determine the optimal timing and duration of HOPE treatment by comparing different HOPE treatment strategies in a porcine DCD liver transplantation model. Donor livers from Tibetan miniature pigs underwent 60-minute warm ischemia and were then randomized into 4 groups according to different preservation strategies, including SCS treatment, upfront HOPE (U-HOPE), end-ischemic HOPE (E-HOPE), and continuous HOPE (C-HOPE) treatment groups (n = 6 per group). All these livers were transplanted orthotopically. Posttransplant survival and graft ischemia-reperfusion injury were assessed during a 7-day follow-up. The 7-day survival rates were 0% for the SCS treatment group, 33.3% (2/6) for the U-HOPE treatment group, and 100.0% (6/6) for both E-HOPE and C-HOPE treatment groups. Compared with the SCS treatment strategy, all HOPE treatment strategies enhanced lactate clearance and liver function recovery, reduced ox","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"26 10","pages":"Pages 2278-2290"},"PeriodicalIF":8.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641612","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":"Successful bilateral lung transplantation in a patient with severe pulmonary blastomycosis","authors":"Guillermo Bartolomé,Idoia Bilbao,Emmanuel Lafont,Laura Donahoe,Tsukasa Ishiwata,Meghan Aversa,Coleman Rotstein","doi":"10.1016/j.ajt.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.ajt.2026.10.008","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"31 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149937","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":"Best practices of hind limb transplantation in mice","authors":"Byoung Chol Oh,&nbsp;Sheri Krams,&nbsp;Leonardo V. Riella,&nbsp;Gerald Brandacher,&nbsp;Giorgio Raimondi","doi":"10.1016/j.ajt.2026.06.027","DOIUrl":"10.1016/j.ajt.2026.06.027","url":null,"abstract":"<div><div>Vascularized composite allotransplantation has emerged as a valuable reconstructive option that enables the transfer of multiple tissue types, including skin, muscle, bone, nerves, and blood vessels, as a functional unit for patients with extensive tissue loss. Murine models, particularly the hind limb transplantation models, have become indispensable tools for advancing our understanding of the complex immunologic and physiological aspects of vascularized composite allotransplantation. This review provides a comprehensive description of established protocols for orthotopic and heterotopic hind limb transplantation in mice. It also discusses critical technical considerations and evaluates the models' utility, impact, and limitations. By examining various aspects, including surgical techniques, immunosuppression regimens, rejection criteria, and translational relevance, this review aims to highlight best practices for the harmonization of the use of this valuable preclinical model in supporting continuous progress in the field.</div></div><div>Vascularized composite allotransplantation has emerged as a valuable reconstructive option that enables the transfer of multiple tissue types, including skin, muscle, bone, nerves, and blood vessels, as a functional unit for patients with extensive tissue loss. Murine models, particularly the hind limb transplantation models, have become indispensable tools for advancing our understanding of the complex immunologic and physiological aspects of vascularized composite allotransplantation. This review provides a comprehensive description of established protocols for orthotopic and heterotopic hind limb transplantation in mice. It also discusses critical technical considerations and evaluates the models' utility, impact, and limitations. By examining various aspects, including surgical techniques, immunosuppression regimens, rejection criteria, and translational relevance, this review aims to highlight best practices for the harmonization of the use of this valuable preclinical model in supporting continuous progress in the field.</div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"26 10","pages":"Pages 2237-2247"},"PeriodicalIF":8.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416648","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}