American Journal of Transplantation最新文献_第4页

The short end of the stick: Access to lung transplantation for short-statured patients in the composite allocation score era 杆子的短端：在复合分配评分时代，矮个子患者获得肺移植的途径。

IF 8.2 2区医学

American Journal of Transplantation Pub Date : 2025-10-01 DOI: 10.1016/j.ajt.2025.05.011

Isaac S. Alderete , Alexandria L. Soto , Samantha E. Halpern , Arya Pontula , Ewout Muylle , Kentaro Nakata , Kunal J. Patel , Jacob Klapper , Matthew G. Hartwig

{"title":"The short end of the stick: Access to lung transplantation for short-statured patients in the composite allocation score era","authors":"Isaac S. Alderete , Alexandria L. Soto , Samantha E. Halpern , Arya Pontula , Ewout Muylle , Kentaro Nakata , Kunal J. Patel , Jacob Klapper , Matthew G. Hartwig","doi":"10.1016/j.ajt.2025.05.011","DOIUrl":"10.1016/j.ajt.2025.05.011","url":null,"abstract":"<div><div><span>Short-statured lung transplant candidates experience longer waitlist times than taller ones. The new composite allocation score (CAS) includes height to enhance allocation equity. We assessed the impact of CAS on waitlist outcomes for different height groups. We queried a national transplant database for lung transplant candidates listed from 2021 to 2024, categorized into 4 height groups: ≤162 cm, 162 to 170 cm, 170 to 176.5 cm, and >176.5 cm. Competing risk and </span>Cox regression models assessed the impact of height on waitlist outcomes, including an interaction term between height and allocation era to assess effect modification. Of the 9383 candidates identified, those >176.5 cm had an increased likelihood of transplantation (subdistribution hazard ratio [sHR]: 1.15) compared to the 170 to 176.5 cm group, while those ≤162 cm had a lower likelihood (sHR: 0.70). The overall likelihood of transplantation was higher in the CAS era (sHR: 1.17). The interaction term for height ≤162 cm and CAS era was significant (sHR: 1.15), suggesting a modest improvement in access for this group under CAS. Further, candidates ≤162 cm experienced a higher hazard of mortality in the CAS era (HR: 1.60). These findings suggest that CAS modestly improves access for the shortest candidates, but refinements are needed to address ongoing inequities in this population.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 10","pages":"Pages 2216-2225"},"PeriodicalIF":8.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982511","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}

引用次数: 0

Waitlist outcomes after acuity circle-based distribution in pediatric liver transplantation 在儿童肝移植中基于视度圈分布的等待列表结果。

IF 8.2 2区医学

American Journal of Transplantation Pub Date : 2025-10-01 DOI: 10.1016/j.ajt.2025.05.019

Denise J. Lo , Joseph F. Magliocca , Katherine Ross-Driscoll

{"title":"Waitlist outcomes after acuity circle-based distribution in pediatric liver transplantation","authors":"Denise J. Lo , Joseph F. Magliocca , Katherine Ross-Driscoll","doi":"10.1016/j.ajt.2025.05.019","DOIUrl":"10.1016/j.ajt.2025.05.019","url":null,"abstract":"<div><div><span>Pediatric<span> liver transplant (LT) waitlist mortality remains unacceptably high. In 2020, the Organ Procurement and Transplantation Network implemented acuity circle (AC)-based liver distribution and national pediatric prioritization for pediatric donor livers. Using Organ Procurement and Transplantation Network data, waitlist outcomes for pediatric LT candidates listed between February 4, 2016, and February 3, 2024, were studied by age group and era relative to AC implementation. There were 5605 waitlist registrations and 3778 liver transplants. At 1 year, cumulative incidence of transplant was 77.8% pre-AC versus 79.9% post-AC; cumulative incidence of mortality was 5.4% pre-AC versus 5.9% post-AC. Median allocation Model for End-Stage Liver Disease/Pediatric Model for End-Stage Liver Disease score at LT significantly decreased across all age groups post-AC (</span></span><em>P</em> < .001). Candidates aged 12 to 17 years experienced higher cumulative incidence of transplant (65.6% pre-AC vs 79.5% post-AC at 1 year), decreased median time to transplant (66 days pre-AC vs 37 days post-AC; <em>P</em> < .001), and increased proportion of pediatric donor livers (37.9% pre-AC vs 66.2% post-AC; <em>P</em> < .001). AC group was associated with increased likelihood of transplant for those aged 12 to 17 years and increased likelihood of waitlist mortality for those aged 1 to 5 years. LT candidates aged 12 to 17 years derived the most benefit from AC-based liver distribution.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 10","pages":"Pages 2206-2215"},"PeriodicalIF":8.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097701","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}

引用次数: 0

Metabolic changes during cold ischemic preservation and reperfusion in porcine lung transplants 猪肺移植冷缺血保存和再灌注过程中的代谢变化。

IF 8.2 2区医学

American Journal of Transplantation Pub Date : 2025-10-01 DOI: 10.1016/j.ajt.2025.05.021

Lubiao Liang , Michael K. Hsin , Yajin Zhao , Aizhou Wang , Tiago Machuca , Jonathan Yeung , Marcelo Cypel , Shaf Keshavjee , Mingyao Liu

{"title":"Metabolic changes during cold ischemic preservation and reperfusion in porcine lung transplants","authors":"Lubiao Liang , Michael K. Hsin , Yajin Zhao , Aizhou Wang , Tiago Machuca , Jonathan Yeung , Marcelo Cypel , Shaf Keshavjee , Mingyao Liu","doi":"10.1016/j.ajt.2025.05.021","DOIUrl":"10.1016/j.ajt.2025.05.021","url":null,"abstract":"<div><div>Lung transplantation is a cornerstone in treating patients with end-stage lung disease, yet ischemia-reperfusion injury poses significant complications in posttransplant recovery. This study aimed to understand the effects of donor type, cold ischemic time (CIT), and reperfusion on metabolic changes in lung grafts. Porcine donor lungs underwent different CITs on ice: minimal time (control), 6 hours (CIT-6H), and 30 hours (CIT-30H). Additionally, lungs recovered from animals after brain death (BD) underwent 24-hour CIT (BD-CIT-24H). Both CIT-30H and BD-CIT-24H lungs underwent ex vivo lung perfusion for 12 hours, followed by left lung transplantation and reperfusion for 2 hours. Lung tissue samples were subjected to metabolomic analysis. Cold preservation induced time-dependent changes of certain metabolites. In the BD-CIT-24H group, while most trends in metabolite levels were similar to those in the CIT-30H group, some were markedly different. In CIT-30H lungs, reperfusion induced significant changes in the carbohydrate and amino acid pathways, along with consumption of energy substrates and reduction in antioxidants. BD donor lungs exhibited significantly reduction in lysophospholipids after reperfusion. Understanding these metabolic changes in the lung grafts shed lights on the mechanism of ischemia-reperfusion injury, offering valuable insights for future development of targeted strategies to improve donor lung preservation and clinical outcome.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 10","pages":"Pages 2090-2103"},"PeriodicalIF":8.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097700","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}

引用次数: 0

The relationship between cessation of brain and systemic circulation after withdrawal of life-sustaining measures 停止维持生命措施后脑停止与体循环的关系。

IF 8.2 2区医学

American Journal of Transplantation Pub Date : 2025-10-01 DOI: 10.1016/j.ajt.2025.06.006

Matthew Kolisnyk , Teneille E. Gofton , Loretta Norton , Derek B. Debicki , Nathan Scales , Amanda Van Beinum , Laura Hornby , Sam Shemie , Sonny Dhanani , Marat Slessarev

{"title":"The relationship between cessation of brain and systemic circulation after withdrawal of life-sustaining measures","authors":"Matthew Kolisnyk , Teneille E. Gofton , Loretta Norton , Derek B. Debicki , Nathan Scales , Amanda Van Beinum , Laura Hornby , Sam Shemie , Sonny Dhanani , Marat Slessarev","doi":"10.1016/j.ajt.2025.06.006","DOIUrl":"10.1016/j.ajt.2025.06.006","url":null,"abstract":"<div><div>In donation after circulatory death, it is assumed that cessation of brain activity and brain blood flow occur close to the time of circulatory arrest. However, this assumption lacks direct empirical data that would support current death determination guidelines, ensure donor safety, and maintain public trust. We conducted a single-center prospective observational study of adult patients undergoing controlled withdrawal of life-sustaining measures. We measured systemic circulation using an indwelling arterial cannula and assessed brain blood flow with transcranial Doppler. In a subset of patients, we also recorded brain electrical activity using electroencephalography. Our results demonstrate that brain blood flow consistently stopped before or simultaneously with systemic circulation (median, −179 seconds; range, −458 to 0 seconds; <em>P</em> = .016) and at a higher mean arterial pressure (median, 30 mm Hg; range, 24-36 mm Hg; <em>P</em> = .003) and pulse pressure (median, 13 mm Hg; range, 0-24 mm Hg; <em>P</em> = .006). Among patients with both transcranial Doppler and electroencephalography data, brain activity generally stopped after brain blood flow but before circulatory arrest. These findings support current death determination guidelines, strengthening confidence in donor safety protocols and reinforcing public trust in organ donation.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 10","pages":"Pages 2142-2150"},"PeriodicalIF":8.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273761","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}

引用次数: 0

Letter in reference to “The Rochester Protocol for living donor liver transplantation of unresectable colorectal liver metastasis: A 5-year report on selection, approval, and outcomes” 评论：不可切除的结直肠癌肝转移活体肝移植的罗切斯特方案：5年的选择、批准和结果报告

IF 8.2 2区医学

American Journal of Transplantation Pub Date : 2025-10-01 DOI: 10.1016/j.ajt.2025.06.008

Abdullah K. Malik , Madhukar S. Patel

引用次数: 0

Renal resistance trajectories during hypothermic machine perfusion in kidneys donated after circulatory death: Associations with donor characteristics and posttransplant outcomes—An analysis of COMPARE trial data 循环性死亡后捐赠肾脏在低温机器灌注期间的肾阻力轨迹：与供体特征和移植后结果的关联——一项比较试验数据分析

IF 8.2 2区医学

American Journal of Transplantation Pub Date : 2025-10-01 DOI: 10.1016/j.ajt.2025.06.014

Laurence Verstraeten , Steffen Fieuws , H. Sijbrand Hofker , Henri G.D. Leuvenink , Rutger J. Ploeg , Jacques Pirenne , Ina Jochmans , Consortium for Organ Preservation in Europe (COPE)

{"title":"Renal resistance trajectories during hypothermic machine perfusion in kidneys donated after circulatory death: Associations with donor characteristics and posttransplant outcomes—An analysis of COMPARE trial data","authors":"Laurence Verstraeten , Steffen Fieuws , H. Sijbrand Hofker , Henri G.D. Leuvenink , Rutger J. Ploeg , Jacques Pirenne , Ina Jochmans , Consortium for Organ Preservation in Europe (COPE)","doi":"10.1016/j.ajt.2025.06.014","DOIUrl":"10.1016/j.ajt.2025.06.014","url":null,"abstract":"<div><div><span>Renal resistance (RR) during hypothermic perfusion is commonly used as a factor to assess kidney quality, with most studies focusing on terminal RR measurements. We fitted a linear model to the entire RR trajectory using data from the randomized Consortium for Organ Preservation in Europe COMPARE trial and explored the relationship between the RR trajectory, donor characteristics, and posttransplant outcomes, also assessing the prognostic value of terminal RR for delayed graft function (DGF). Donor weight (F = 5.32; </span><em>P</em> = .005) and cause of death (F = 2.91; <em>P</em><span> = .008) were associated with the RR trajectory, whereas active oxygenation had no effect (F = 1.12; </span><em>P</em> = .33). The RR trajectory did not predict DGF (F = 1.93; <em>P</em><span> = .15), biopsy-proven acute rejection (F = 0.41; </span><em>P</em><span> = .66), 1-year kidney function (F = 0.61; </span><em>P</em><span> = .54), or 1-year graft survival (F = 0.47; </span><em>P</em> = .63). Terminal RR independently predicted DGF (odds ratio 1.14; 95% CI, 1.009-1.298; <em>P</em><span> = .03) but had limited prognostic value (area under the receiver operating characteristic curve, 0.63; 95% CI, 0.55-0.71), aligning with previous research. Our findings suggest that the RR trajectory reflects the kidney’s intrinsic response to perfusion, with donor weight and cause of death potentially influencing its progression. The absence of a relation between the RR trajectory and posttransplant outcomes stresses that using RR as a standalone criterion for kidney discard is not justified and may lead to unnecessary discard. Our findings also call for further validation in larger, more diverse cohorts.</span></div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 10","pages":"Pages 2161-2172"},"PeriodicalIF":8.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335479","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}

引用次数: 0

Pancreas transplant outcomes in patients with human immunodeficiency virus infection 人类免疫缺陷病毒感染患者胰腺移植的结果

IF 8.2 2区医学

American Journal of Transplantation Pub Date : 2025-10-01 DOI: 10.1016/j.ajt.2025.06.001

Rashmi R. Bharadwaj , Gabriel Orozco , Xiaonan Mei , Hanine El-Haddad , Roberto Gedaly , Meera Gupta

{"title":"Pancreas transplant outcomes in patients with human immunodeficiency virus infection","authors":"Rashmi R. Bharadwaj , Gabriel Orozco , Xiaonan Mei , Hanine El-Haddad , Roberto Gedaly , Meera Gupta","doi":"10.1016/j.ajt.2025.06.001","DOIUrl":"10.1016/j.ajt.2025.06.001","url":null,"abstract":"<div><div>There is limited information on access and outcomes of patients living with human immunodeficiency virus (PLWH) who have undergone pancreas transplantation. We conducted a retrospective cohort study analyzing data from the United Network for Organ Sharing from July 1, 2001, to June 30, 2021. Recipients of pancreas transplant were stratified by HIV serostatus. Graft and patient survival were analyzed using Kaplan-Meier product limit estimates. Multivariable Cox proportional hazard models were generated to identify factors associated with increased mortality or graft loss. Fifty PLWH and 16 380 patients without HIV underwent pancreas (with kidney) transplantation. PLWH were more often male (<em>P</em> < .001), Black/African American (<em>P</em> = .009), and on Medicare (<em>P</em> = .004). There were no significant differences in waiting time (<em>P</em> = .159) or proportion of patients treated for rejection within 1 year of transplant (<em>P</em> = .189) between groups. There were no differences in pancreas graft survival (<em>P</em> = .964) and overall patient survival (<em>P</em> = .250) between the cohorts. Dialysis status was negatively associated with graft survival. Although PLWH were more likely to represent a historically marginalized population, their outcomes after pancreas transplant were similar to their counterparts without HIV.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 10","pages":"Pages 2267-2276"},"PeriodicalIF":8.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504653","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}

引用次数: 0

Sensitization in Transplantation Assessment of Risk 2025 innate working group: The potential role of innate allorecognition in kidney allograft damage STAR 2025先天工作组：先天同种异体识别在肾移植损伤中的潜在作用。

IF 8.2 2区医学

American Journal of Transplantation Pub Date : 2025-10-01 DOI: 10.1016/j.ajt.2025.06.030

Olivier Thaunat , Fadi G. Lakkis , Vasilis Kosmoliaptsis , Carrie Schinstock , Anat Tambur , Sebastiaan Heidt , Maarten Naesens

{"title":"Sensitization in Transplantation Assessment of Risk 2025 innate working group: The potential role of innate allorecognition in kidney allograft damage","authors":"Olivier Thaunat , Fadi G. Lakkis , Vasilis Kosmoliaptsis , Carrie Schinstock , Anat Tambur , Sebastiaan Heidt , Maarten Naesens","doi":"10.1016/j.ajt.2025.06.030","DOIUrl":"10.1016/j.ajt.2025.06.030","url":null,"abstract":"<div><div>In solid organ transplantation, the alloimmune response is traditionally attributed to the action of alloreactive T cells that recognize mismatched human leukocyte antigens, as well as antibody formation and antibody-mediated rejection. However, recent evidence indicates that these paradigms of involvement of the adaptive immune system in organ transplant rejection do not explain all cases of graft inflammation and that innate cell allorecognition plays a role. This review, conducted by the innate team of the Sensitization in Transplantation Assessment of Risk workgroup, summarizes the concepts and empirical evidence supporting innate allorecognition. The focus is on natural killer cell activation via missing self and monocyte activation through the signal regulatory protein α-CD47 pathway and <em>SIRPα</em> gene polymorphisms. A consensus definition of genetic missing self is proposed, necessitating both donor and recipient human leukocyte antigen class I genotyping and evaluation of the recipient inhibitory killer-cell immunoglobulin-like receptor genotype. Although in vitro studies and preclinical validations corroborate the potential of innate allorecognition concepts, further research is required to establish clinical utility. This article delineated future research directions to bridge the gap between theoretical promise and practical application in clinical transplantation.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 10","pages":"Pages 2038-2047"},"PeriodicalIF":8.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578717","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}

引用次数: 0

The Fading Darling: Patient Voice as the Future of Transplant Trust. 褪色的宠儿：病人的声音作为移植信托的未来。

IF 8.8 2区医学

American Journal of Transplantation Pub Date : 2025-09-26 DOI: 10.1016/j.ajt.2025.09.007

Earnest Davis

引用次数: 0

Reply to: Do T/B lymphocytes mask the protective effects of group 1 innate lymphoid cells against liver graft ischemia-reperfusion injury? T/B淋巴细胞是否掩盖了1组先天淋巴样细胞对肝移植缺血再灌注损伤的保护作用？

IF 8.2 2区医学

American Journal of Transplantation Pub Date : 2025-09-25 DOI: 10.1016/j.ajt.2025.09.014

Hidenobu Kojima, Thomas Morinelli, Yuan Zhai

引用次数: 0