American Journal of Transplantation最新文献

{"title":"Does a changing donor pool explain the recent rise in the United States kidney nonuse rate?","authors":"Keighly Bradbrook, David Klassen, Allan B Massie, Darren E Stewart","doi":"10.1016/j.ajt.2025.02.004","DOIUrl":"10.1016/j.ajt.2025.02.004","url":null,"abstract":"<p><p>The proportion of deceased donor kidneys recovered for transplantation that are not transplanted reached 28% in 2023. Past research demonstrated that >90% of the nonuse rate (NUR) increase in the 2000s could be explained by the broadening donor pool. We used the Organ Procurement and Transplantation Network data to study kidneys recovered from 2010-2023, applying causal inference methods to assess the degree to which the recent, sharp rise in the NUR could be explained by changes in donor clinical characteristics. Unadjusted odds of kidney nonuse were 63% higher (95% CI: 56%, 70%) in 2023 vs 2018. After adjusting for donor factors, the odds of nonuse were only 12% (9%, 15%) higher in 2023. Both regression and propensity weighting demonstrated that 75% to 80% of the recent NUR increase can be explained by a rapidly expanding donor pool. Encouragingly, the NUR has not increased and remains low for above-average quality kidneys. However, the unexplained risk of nonuse for kidneys in the highest kidney donor risk index quartile increased by ∼ 30%, potentially due to residual confounding and/or system-level, exogenous factors such as allocation policy changes. To improve placement efficiency, allocation policy should adapt to the increasingly heterogeneous donor pool by allocating kidneys differently along the donor quality spectrum.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412532","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":"Developing approaches to incorporate donor-lung computed tomography images into machine learning models to predict severe primary graft dysfunction after lung transplantation.","authors":"Weiwei Ma, Inez Oh, Yixuan Luo, Sayantan Kumar, Aditi Gupta, Albert M Lai, Varun Puri, Daniel Kreisel, Andrew E Gelman, Ruben Nava, Chad A Witt, Derek E Byers, Laura Halverson, Rodrigo Vazquez-Guillamet, Philip R O Payne, Aristeidis Sotiras, Hao Lu, Khalid Niazi, Metin N Gurcan, Ramsey R Hachem, Andrew P Michelson","doi":"10.1016/j.ajt.2025.01.039","DOIUrl":"10.1016/j.ajt.2025.01.039","url":null,"abstract":"<p><p>Primary graft dysfunction (PGD) is a common complication after lung transplantation associated with poor outcomes. Although risk factors have been identified, the complex interactions between clinical variables affecting PGD risk are not well understood, which can complicate decisions about donor-lung acceptance. Previously, we developed a machine learning model to predict grade 3 PGD using donor and recipient electronic health record data, but it lacked granular information from donor-lung computed tomography (CT) scans, which are routinely assessed during offer review. In this study, we used a gated approach to determine optimal methods for analyzing donor-lung CT scans among patients receiving first-time, bilateral lung transplants at a single center over 10 years. We assessed 4 computer vision approaches and fused the best with electronic health record data at 3 points in the machine learning process. A total of 160 patients had donor-lung CT scans for analysis. The best imaging-only approach employed a 3D ResNet model, yielding median (interquartile range) areas under the receiver operating characteristic and precision-recall curves of 0.63 (0.49-0.72) and 0.48 (0.35-0.6), respectively. Combining imaging with clinical data using late fusion provided the highest performance, with median areas under the receiver operating characteristic and precision-recall curves of 0.74 (0.59-0.85) and 0.61 (0.47-0.72), respectively.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381192","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":"Induction of immune tolerance in living related human leukocyte antigen-matched kidney transplantation: A phase 3 randomized clinical trial.","authors":"Dixon B Kaufman, Sanjeev K Akkina, Mark D Stegall, James B Piper, A Osama Gaber, William S Asch, Stephan Busque, Erik Stites, Michael De Vera, Titte R Srinivas, Diane Alonso, Ashesh Shah, Anup Patel, Martin L Mai, Kenneth D Chavin, Meelie DebRoy, Arksarapuk Jittirat, Nadiesda Costa, Matthew Cooper, Gayle Vranic, Mark R Laftavi, Reza F Saidi, Suzon Collette, Daniel C Brennan","doi":"10.1016/j.ajt.2025.01.044","DOIUrl":"10.1016/j.ajt.2025.01.044","url":null,"abstract":"<p><p>This phase 3 multicenter, randomized, controlled clinical trial evaluated investigational cellular product (MDR-101) to produce immune tolerance vs standard of care, in kidney transplant recipients. Adult recipients of kidneys from 2-haplotype human leukocyte antigen-matched living siblings were randomized 2:1 to treatment (n = 20) or control (n = 10). The MDR-101 product was from the same kidney donor. Treatment recipients received a nonmyeloablative conditioning protocol with rabbit-antithymocyte globulin and low-dose total lymphoid irradiation (10 fractions). MDR-101 was infused (day 11). Steroids were withdrawn by day 10 and mycophenolate by day 39. Tacrolimus was continued until day 180 and tapered to withdrawal 1-year posttransplant if donor hematopoietic mixed chimerism was ≥5%. Controls received immunosuppression (IS) per institutional standard of care. Twenty recipients received the MDR-101 infusion, and none developed graft versus host disease. Nineteen (95%) successfully discontinued all IS approximately 1 year after kidney transplant. Fifteen (75%) reached the primary study endpoint of IS-free for >2 years. Four resumed IS: 1 with recurrent immunoglobulin A nephropathy; 1 with recurrent immunoglobulin A nephropathy and rejection; 1 with rejection; and 1 with borderline biopsy changes. Kidney transplant recipients receiving MDR-101 achieved donor mixed chimerism and functional immune tolerance for greater than 2 years with no death, graft loss, DSA, or graft versus host disease and demonstrated improved quality of life compared to standard treatment.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373661","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":"Response to Daungsupawong and Wiwanitkit's editorial comment on \"Using machine learning for personalized prediction of longitudinal COVID-19 vaccine responses in transplant recipients\".","authors":"Victor H Ferreira, Mamatha Bhat","doi":"10.1016/j.ajt.2025.01.046","DOIUrl":"10.1016/j.ajt.2025.01.046","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373663","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":"Opinions vs evidence: data-driven insights into the organ yield and cost of normothermic regional perfusion in donation after circulatory death.","authors":"Syed Shahyan Bakhtiyar, Tiffany E Maksimuk, Michael T Cain, Jordan R H Hoffman","doi":"10.1016/j.ajt.2025.01.045","DOIUrl":"10.1016/j.ajt.2025.01.045","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373662","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":"Impact of continuous distribution as the allocation strategy on lung transplantation.","authors":"Amit Banga, Christine Hartley, Zeynep Tulu, J W MacArthur, Gundeep Dhillon","doi":"10.1016/j.ajt.2025.02.001","DOIUrl":"10.1016/j.ajt.2025.02.001","url":null,"abstract":"<p><p>In March 2023, the allocation strategy for lung transplantation (LT) underwent significant changes with the introduction of the new system, referred to as the continuous distribution (CD). The current paper describes the early impact of CD implementation on the mechanics of LT at a large tertiary care medical center. This was a retrospective study conducted across 9 months before (March 2022 to November 2022) and after (March 2023 to November 2023) the implementation of the CD allocation system. The number of lung donor offers increased by 59% in the post-CD period (P = .002). The median offers per waitlisted patient increased even more (P < .001), leading to a significant reduction in time to transplant (P < .001). Early clinical outcomes (median length of stay and hospital survival) were unchanged, whereas the cumulative length of index hospitalization was lower by 10% during the post-CD period. The cost/bed-day increased by 4.5% in the post-CD period, which converted to a 32% decrease in the contribution margin per transplant. In conclusion, the implementation of CD was associated with improved access to donor lungs, leading to favorable trends in the time to transplant while maintaining posttransplant outcomes. The CD was associated with a significant jump in the cost of LT.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373660","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: Lung","authors":"Maryam Valapour ,&nbsp;Carli J. Lehr ,&nbsp;David P. Schladt ,&nbsp;Kaitlin Swanner ,&nbsp;Kelley Poff ,&nbsp;Dzhuliyana Handarova ,&nbsp;Samantha Weiss ,&nbsp;Chelsea J. Hawkins ,&nbsp;Ajay K. Israni ,&nbsp;Jon J. Snyder","doi":"10.1016/j.ajt.2025.01.025","DOIUrl":"10.1016/j.ajt.2025.01.025","url":null,"abstract":"<div><div>The year 2023 marked a year of major transition for the lung transplant community in the United States, as it became the first to adopt the continuous distribution system for organ allocation. Starting on March 9, 2023, the composite allocation score (CAS) was used to rank candidates for access to a lung transplant. Shortly after the adoption of this CAS system, it was amended to better represent the biological disadvantage of candidates with blood type O for accessing a donor organ. Despite the challenges of implementing major changes to the system, the year 2023 marked many successes and milestones in US lung transplantation. A total of 3,049 adult lung transplants were performed, representing the most transplants performed in any single year. Transplant rates continued their increase over time and reached an all-time high of 307.6 transplants per 100 patient-years for adults on the waiting list. By 1 year after listing, 81.2% of adult candidates underwent a deceased donor lung transplant, with 62.6% of them having waited 3 months or less. Adult waitlist mortality rates decreased to their lowest at 13.3 deaths per 100 patient-years, meeting one of the major goals of the organ allocation systems: to decrease waitlist mortality. Survival after lung transplant remained stable over the past decade with 88.5% of adults who underwent transplant in 2022 surviving to 1 year compared with 87.2% of adults who underwent transplant in 2013.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S422-S489"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386749","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: Intestine","authors":"Simon P. Horslen ,&nbsp;Vikram K. Raghu ,&nbsp;Yoon Son Ahn ,&nbsp;Jesse Howell ,&nbsp;Benjamin Schumacher ,&nbsp;Meghan McDermott ,&nbsp;Ajay K. Israni ,&nbsp;Jon J. Snyder","doi":"10.1016/j.ajt.2025.01.023","DOIUrl":"10.1016/j.ajt.2025.01.023","url":null,"abstract":"<div><div>Intestine transplant can have significant health and quality-of-life benefits for those who require it. Despite its infrequent use, intestine transplant remains a mainstay of treating those with complications from long-term parenteral nutrition due to intestinal failure, as well as salvage therapy for those with a significant abdominal catastrophe. In 2023, there were 135 candidates added to the intestine transplant waiting list. Those awaiting intestine-without-liver transplant have low mortality on the waiting list, with no reported deaths in 2023. However, 8 patients died awaiting intestine-with-liver transplant, and the estimated 3-year mortality for those listed exceeds 10.0%. A total of 95 intestine transplants were performed in 2023, with only 33 performed in the pediatric age range. However, 18 of 34 recipients of intestine-with-liver transplant were in the pediatric age range. Immunosuppression for intestine transplants most commonly included an induction agent followed by maintenance with a combination of medications that included tacrolimus. In the recipients of intestine-without-liver transplants, 1- and 5-year graft survival were 78.3% and 46.5% in adult and 76.1% and 52.2% in pediatric recipients, respectively. In the recipients of intestine-with-liver transplants, 1- and 5-year graft survival were 57.8% and 45.6% in adult and 81.1% and 60.0% in pediatric recipients, respectively. Acute rejection episodes occurred for approximately 20.0% of patients within the first year. The 5-year cumulative incidence of posttransplant lymphoproliferative disorder was higher in those with an intestine-without-liver transplant (11.5%) compared with those who also received a liver (2.5%). Rates of intestine transplant have remained stable for the past several years, with increasing need in the adult population. Future reports may reflect whether children who have avoided intestine transplant with the recent advances in intestinal rehabilitation ultimately require the procedure in adulthood.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S288-S328"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386750","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":"Temporal evolution of living donor liver transplantation survival—A United Network for Organ Sharing registry study","authors":"Christian T.J. Magyar ,&nbsp;Zhihao Li ,&nbsp;Laia Aceituno ,&nbsp;Marco P.A.W. Claasen ,&nbsp;Tommy Ivanics ,&nbsp;Woo Jin Choi ,&nbsp;Luckshi Rajendran ,&nbsp;Blayne A. Sayed ,&nbsp;Roxana Bucur ,&nbsp;Nadia Rukavina ,&nbsp;Nazia Selzner ,&nbsp;Anand Ghanekar ,&nbsp;Mark Cattral ,&nbsp;Gonzalo Sapisochin","doi":"10.1016/j.ajt.2024.08.011","DOIUrl":"10.1016/j.ajt.2024.08.011","url":null,"abstract":"<div><div>Living donor liver transplantation (LDLT) is a curative treatment for various liver diseases, reducing waitlist times and associated mortality. We aimed to assess the overall survival (OS), identify predictors for mortality, and analyze differences in risk factors over time. Adult patients undergoing LDLT were selected from the United Network for Organ Sharing database from inception (1987) to 2023. The Kaplan-Meier method was used for analysis, and multivariable Cox proportional hazard models were conducted. In total, 7257 LDLT recipients with a median age of 54 years (interquartile range [IQR]: 45-61 years), 54% male, 80% non-Hispanic White, body mass index of 26.3 kg/m² (IQR: 23.2-30.0 kg/m²), and model for end-stage liver disease score of 15 (IQR: 11-19) were included. The median cold ischemic time was 1.6 hours (IQR: 1.0-2.3 hours) with 88% right lobe grafts. The follow-up was 4.0 years (IQR: 1.0-9.2 years). The contemporary reached median OS was 17.0 years (95% CI: 16.1, 18.1 years), with the following OS estimates: 1 year 95%; 3 years 89%; 5 years 84%; 10 years 72%; 15 years 56%; and 20 years 43%. Nine independent factors associated with mortality were identified, with an independent improved OS in the recent time era (adjusted hazards ratio: 0.53; 95% CI: 0.39, 0.71). The median center-caseload per year was 5 (IQR: 2-10), with observed center-specific improvement of OS. LDLT is a safe procedure with excellent OS. Its efficacy has improved despite an increase of risk parameters, suggesting its limits are yet to be met.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 406-416"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142007900","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 bartonellosis in solid organ transplant recipients from unhoused donors in Alberta","authors":"Dima Kabbani ,&nbsp;Efrat Orenbuch-Harroch ,&nbsp;Carl Boodman ,&nbsp;Sarah Broad ,&nbsp;Manuel Paz-Infanzon ,&nbsp;Sara Belga ,&nbsp;Oscar A. Fernández-García ,&nbsp;Emily Christie ,&nbsp;Majid L.N. Sikosana ,&nbsp;Soroush Shojai ,&nbsp;Sita Gourishankar ,&nbsp;Carlos Cervera ,&nbsp;Karen Doucette","doi":"10.1016/j.ajt.2024.09.026","DOIUrl":"10.1016/j.ajt.2024.09.026","url":null,"abstract":"<div><div><em>Bartonella quintana</em> infection is rarely described to be transmitted through solid organ transplant (SOT). We report a cluster of using donor-derived <em>B quintana</em> infection and the attack rate from <em>Bartonella</em> seropositive donors. In this retrospective study of SOT recipients that received an organ from an unhoused deceased donor (UDD) in Alberta in 2022-2023, serology testing for <em>Bartonella</em> was performed indirect immunofluorescent assay on UDDs and recipients of UDDs with positive serology. Titers ≥1:64 were considered positive. During the study period, 31/32 UDDs were tested for immunoglobulin G to <em>Bartonella</em> (20 negative, 11 positive for <em>B quintana</em> and/or <em>B henselae</em>). Thirty-two organs were transplanted from the 11 seropositive donors. Six SOT recipients developed bartonellosis secondary to <em>B quintana</em> (4 SOT recipients received organs from 3 seropositive donors, and 2 SOT recipients from 1 UDD with no stored sample for testing). The attack rate for clinical disease from positive donors was 12.5% (4/32). The main presentation was skin nodules/papules (median 5.5 months) with bacillary angiomatosis in 4/6. <em>Bartonella</em> serology was positive in 5/6 SOT recipients (initially negative in 2) and blood <em>B quintana</em> quantitative polymerase chain reaction in 1. None had visceral involvement. All donors had history of substance use. This outbreak of bartonellosis reinforces the potential for unexpected donor-transmitted infections. Clinicians should be aware of high transmission of <em>B quintana</em> through transplant from infected UDDs.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 417-423"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328849","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}