American Journal of Transplantation最新文献

{"title":"The impact of sodium-glucose cotransporter-2 inhibitors on dialysis risk and mortality in kidney transplant patients with diabetes","authors":"Fu-Shun Yen ,&nbsp;Chih-Cheng Hsu ,&nbsp;Yun-Kai Yeh ,&nbsp;Wan-Yin Cheng ,&nbsp;Pei-Lun Liao ,&nbsp;Chii-Min Hwu ,&nbsp;James Cheng-Chung Wei","doi":"10.1016/j.ajt.2025.03.019","DOIUrl":"10.1016/j.ajt.2025.03.019","url":null,"abstract":"<div><div>Kidney transplantation<span> is the optimal treatment for end-stage kidney disease, but many patients also have diabetes mellitus. This study compares long-term outcomes between new users of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) in kidney transplant<span> recipients with diabetes mellitus. Data from the TriNetX Collaborative Network, including 89,710 patients with diabetes mellitus who underwent kidney transplantation between January 1, 2015, and June 30, 2023, were analyzed. From this cohort, 1410 matched pairs of SGLT2i and DPP-4i users were selected based on propensity scores. The results showed that SGLT2i users had a lower risk of dialysis (hazards ratio: 0.694) and all-cause mortality (hazards ratio: 0.687) compared with DPP-4i users. There were no significant differences in the risk of posttransplant infections, transplant rejection, or hospitalization between the 2 groups. Additionally, SGLT2i users had significantly lower cumulative incidences of dialysis and mortality. In conclusion, this study, using data from TriNetX, demonstrated that SGLT2i treatment in kidney transplant recipients with diabetes mellitus is associated with lower risks of dialysis and mortality, suggesting it may help preserve kidney function and improve survival in this population.</span></span></div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 1954-1964"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690511","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 mouse models for transplantation research","authors":"Mandy Ford ,&nbsp;Paolo Cravedi","doi":"10.1016/j.ajt.2025.08.006","DOIUrl":"10.1016/j.ajt.2025.08.006","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 1818-1819"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005103","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":"Outcomes and motivations in unspecified (nondirected altruistic) kidney donation: Results from a United Kingdom prospective cohort study","authors":"Hannah Maple ,&nbsp;Petrut Gogalniceanu ,&nbsp;Mira Zuchowski ,&nbsp;Heather Draper ,&nbsp;Lisa Burnapp ,&nbsp;Paul McCrone ,&nbsp;Joseph Chilcot ,&nbsp;Sam Norton ,&nbsp;Nizam Mamode","doi":"10.1016/j.ajt.2025.03.021","DOIUrl":"10.1016/j.ajt.2025.03.021","url":null,"abstract":"<div><div><span>Unspecified kidney donors (UKDs) increase the number of high-quality kidneys available for transplantation. This study aimed to determine whether the practice was acceptable, based on the noninferiority of donor physical and psychosocial outcomes when compared to specified kidney donors (SKDs). This longitudinal, prospective cohort study<span> investigated potential living kidney donors from across all 23 UK adult kidney transplant<span> centers. Participants completed validated questionnaires at 4 time points (recruitment, 2-4 weeks predonation, 3- and 12-months postdonation). Clinical outcome data were collected from National Health Service Blood and Transplant. Three hundred seventy-three (of 837 recruited; 45.7%) went on to donate (November 2016 to January 2021). There were no differences in donation rates (204 SKDs [54.7%] vs 169 UKDs [45.3%]; </span></span></span><em>P</em> = .944). Both groups reported being motivated by the desire to help someone (<em>P</em> = .157). Tests for noninferiority indicated that UKDs do no worse than SKDs on psychosocial or clinical outcomes over 12 months, and costs are similar (<em>P</em> &gt; .05). This is the world’s largest prospective observational study comparing SKDs and UKDs. It demonstrates no differences in primary motivation, donation rates, regret, cost, or psychosocial and physical outcomes. These data should reassure transplant professionals and potential donors and can bolster confidence in the practice around the world.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 1965-1975"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750378","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":"Blunted cardiac reserve as a marker of cirrhotic cardiomyopathy—Cardiac outcomes following liver transplantation and comparison to the existing guidelines","authors":"Benjamin Cailes ,&nbsp;Eva-Louise Huber ,&nbsp;Claudia Brick ,&nbsp;Omar Farouque ,&nbsp;Avik Majumdar ,&nbsp;Ali Al-Fiadh ,&nbsp;James Theuerle ,&nbsp;Thalys S. Rodrigues ,&nbsp;Terase Lancefield ,&nbsp;Matias B. Yudi ,&nbsp;Julian Yeoh ,&nbsp;Adam Testro ,&nbsp;Marie Sinclair ,&nbsp;Anoop N. Koshy","doi":"10.1016/j.ajt.2025.05.022","DOIUrl":"10.1016/j.ajt.2025.05.022","url":null,"abstract":"<div><div>Cirrhotic cardiomyopathy (CCM) is an underrecognized risk factor for cardiac events in patients undergoing liver transplantation (LT). Blunted cardiac reserve (BCR) is an emerging indicator of CCM, although it has not been integrated into diagnostic guidelines. This study assesses posttransplant cardiac outcomes and mortality in patients with BCR compared with current CCM diagnostic guidelines, focusing on diastolic indices. Consecutive patients undergoing liver transplant assessment were included. Of 978 patients screened with dobutamine stress echocardiography between 2010 and 2023, 481 (58.0%) progressed to LT, with 183 (38.0%) meeting BCR criteria and 117 (24.3%) meeting existing CCM diagnostic criteria. Thirty (6.2%) patients experienced a 30-day major adverse cardiovascular event (MACE), and 92 patients (19.1%) died on long-term follow-up. Following multivariate regression analysis, BCR was the strongest independent risk factor for postoperative MACE (hazards ratio [HR], 2.57; 95% CI, 1.13-5.85; <em>P</em> = .024), heart failure exacerbations (HR, 6.93; 95% CI, 1.46-33.01; <em>P</em> = .015), and 30-day mortality (HR, 9.69; 95% CI, 1.04-92.33; <em>P</em> = .049). Addition of BCR to the existing guidelines improved MACE prediction (HR, 5.81; 95% CI, 1.71-19.76; vs 2.59; 95% CI, 1.15-5.87; <em>P</em> = .006), with a net reclassification improvement index of 41.9% (<em>P</em> = .004) compared with existing guidelines alone. These results support the integration of a cardiac reserve assessment into CCM diagnostic criteria and use in risk stratification of patients undergoing LT.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 1976-1986"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114227","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":"Editorial Fellowship Announcement","authors":"","doi":"10.1016/j.ajt.2025.08.005","DOIUrl":"10.1016/j.ajt.2025.08.005","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 1814-1815"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005106","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":"Revisiting racial and ethnic disparities in the deceased organ donor referral process","authors":"Macey L. Levan ,&nbsp;Kelly Terlizzi ,&nbsp;Matilin Rigsby ,&nbsp;Samantha Klitenic ,&nbsp;Jonathan Hewlett ,&nbsp;Bradley L. Adams ,&nbsp;Jade Barnes ,&nbsp;Geoffrey Funk ,&nbsp;Dorry L. Segev ,&nbsp;Allan B. Massie","doi":"10.1016/j.ajt.2025.04.013","DOIUrl":"10.1016/j.ajt.2025.04.013","url":null,"abstract":"<div><div><span>Racial/ethnic disparities in the deceased organ donor referral process may contribute to the organ shortage and place minority communities at a greater disadvantage. Prior literature cites substantial inequalities, though methodological concerns may bias estimates. Using Organ Retrieval and Collection of Health Information for Donation data, we conducted a simulation study and reanalysis of 132 968 referrals from 2015 to 2021 across 6 organ procurement organizations (OPOs). We excluded brain death declaration and cause/mechanism/circumstances of death from the approach model and conducted Poisson regression with robust standard errors. We found Black patients were approached at a more similar rate relative to White patients, although disparities remained (incidence rate ratio (IRR): </span>_0.910.94_0.97). Black patients provided authorization at a 31% lower rate than White patients (IRR: _0.670.69_0.71). Slight disparities were observed at procurement (IRR: _0.940.96_0.99). Our findings are directionally similar to prior literature but suggest substantially less inequality (vs 23% and 65% higher risk of approach and authorization for non-Black vs Black referrals). Accurate quantification of racial/ethnic disparities in transplantation impacts public perception of those involved, particularly organ procurement organizations, and is paramount to any study. Importantly, continued measures are needed to promote equality among Black and minority patients in our national organ donation and transplant system.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 2008-2016"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857421","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":"Letter in reference to “Long-term outcomes at 5 years post-transplant in imlifidase-desensitized kidney transplant patients”","authors":"Carrie A. Schinstock ,&nbsp;Mark Stegall","doi":"10.1016/j.ajt.2025.05.015","DOIUrl":"10.1016/j.ajt.2025.05.015","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 2026-2027"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065584","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":"Back-table intra-arterial administration of C1 esterase inhibitor to deceased donor kidney allografts improves posttransplant allograft function: Results of a randomized double-blind placebo-controlled clinical trial","authors":"Edmund Huang,&nbsp;Noriko Ammerman,&nbsp;Ashley Vo,&nbsp;Jean Hou,&nbsp;Sanjeev Kumar,&nbsp;Nicole Badash,&nbsp;Ben Falk,&nbsp;Kathleen Hernando,&nbsp;Matthew Gillespie,&nbsp;Irene K. Kim,&nbsp;Kathlyn Lim,&nbsp;Reiad Najjar,&nbsp;Alice Peng,&nbsp;Bongha Shin,&nbsp;Justin A. Steggerda,&nbsp;Tsuyoshi Todo,&nbsp;Todd V. Brennan,&nbsp;Georgios Voidonikolas,&nbsp;Steven A. Wisel,&nbsp;Peter S. Heeger,&nbsp;Stanley C. Jordan","doi":"10.1016/j.ajt.2025.05.003","DOIUrl":"10.1016/j.ajt.2025.05.003","url":null,"abstract":"<div><div><span><span><span><span>Ischemia-reperfusion injury commonly causes delayed graft function (DGF) after </span>kidney transplantation and is associated with poorer graft function and lower </span>allograft survival. Activation of the </span>lectin complement pathway<span><span> is one mediator of ischemia-reperfusion injury. In this randomized double-blind placebo-controlled pilot study, we tested whether preimplantation intragraft administration of C1 esterase inhibitor<span> (C1INH, a lectin/classical pathway inhibitor) into deceased donor organs improves graft function and/or reduces DGF. Forty patients were randomized 1:1 to receive allografts<span> treated with 500 units C1INH or placebo (normal saline) into the transplant renal artery during back-table preparation. We observed no effect on DGF, but recipients of C1INH-treated allografts showed higher estimated </span></span></span>glomerular filtration rate than recipients of placebo at 6 months (C1INH median: 55 mL/min/1.73 m</span></span>², interquartile range [IQR]: 42-63; placebo median: 39 mL/min/1.73 m², IQR: 34-50; <em>P</em> = .02) and 30 months (C1INH median: 54 mL/min/1.73 m², IQR: 47-66; placebo median: 43 mL/min/1.73 m², IQR 38-51; <em>P</em><span><span><span> = .03), with no differences in adverse events. Analysis of postreperfusion biopsies showed positive intra-arterial C1INH staining and reduced C4d staining in C1INH-treated grafts compared with controls. Posttransplant serum mannose-binding </span>lectin and classical pathway activity and </span>bradykinin levels did not differ between study arms. We conclude that this treatment strategy improves allograft function independent of DGF, likely via local intragraft complement inhibition.</span></div><div>Clinical trial registration number: NCT04696146.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 1926-1939"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932839","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 cell-free DNA is associated with the degree of immunosuppression in lung transplantation","authors":"Ananth V. Charya ,&nbsp;Moon K. Jang ,&nbsp;Hyesik Kong ,&nbsp;Woojin Park ,&nbsp;Xin Tian ,&nbsp;Michael Keller ,&nbsp;Kellie Phipps ,&nbsp;Auriel Sanders ,&nbsp;Pali Shah ,&nbsp;Joby Mathew ,&nbsp;Shambhu Aryal ,&nbsp;Gerald J. Berry ,&nbsp;Charles Marboe ,&nbsp;Jonathan B. Orens ,&nbsp;Steven D. Nathan ,&nbsp;Sean Agbor-Enoh","doi":"10.1016/j.ajt.2025.04.011","DOIUrl":"10.1016/j.ajt.2025.04.011","url":null,"abstract":"<div><div><span><span>Donor-derived cell-free DNA (ddcfDNA) is increasingly used in clinical practice to monitor lung transplant patients for </span>acute rejection<span><span><span> (AR). However, its association with conventional approaches to monitor immunosuppression remains unclear. This multicenter observational cohort study examines the association of ddcfDNA with surrogate measures of immunosuppression. We collected serial plasma samples to quantify ddcfDNA and </span>anellovirus<span> abundance using shotgun and metagenomic sequencing. Adjudication committees reviewed clinical data to define acute cellular and antibody-mediated rejection. The association between ddcfDNA, anellovirus abundance, and </span></span>tacrolimus<span> trough concentrations in serum over the study period and during episodes of AR was examined using linear mixed-effects modeling. ddcfDNA demonstrated a significant inverse association with tacrolimus troughs (</span></span></span><em>P</em> = .027) and anellovirus abundance (<em>P</em> &lt; .001) over time. AR episodes were associated with significantly decreased anellovirus abundance (median, 0.042 vs 0.708, <em>P</em> &lt; .001) and higher ddcfDNA levels (1.49% vs 0.26%, <em>P</em> &lt; .001) compared with stable control time points. However, tacrolimus levels were similar between AR and controls (10.1 vs 10.3 ng/mL, <em>P</em> = .13). Our findings suggest ddcfDNA correlates with measures of immunosuppression in lung transplant patients. Additional studies are needed to assess the utility of ddcfDNA to assess immunosuppression adequacy.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 1906-1915"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853082","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":"West Nile virus and other nationally notifiable arboviral diseases—United States, 2023","authors":"Marcus R. Pereira","doi":"10.1016/j.ajt.2025.06.032","DOIUrl":"10.1016/j.ajt.2025.06.032","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 9","pages":"Pages 1812-1813"},"PeriodicalIF":8.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574555","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}