American Journal of Transplantation最新文献

{"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}

{"title":"Keep the engine running: Maintaining transplant registry utility in liver transplant","authors":"Steven A. Wisel ,&nbsp;Justin A. Steggerda ,&nbsp;Aleah L. Brubaker ,&nbsp;Anji Wall ,&nbsp;Irene K. Kim","doi":"10.1016/j.ajt.2024.11.001","DOIUrl":"10.1016/j.ajt.2024.11.001","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 447-448"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613042","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: Preface","authors":"","doi":"10.1016/j.ajt.2025.01.018","DOIUrl":"10.1016/j.ajt.2025.01.018","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S1-S10"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386738","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":"Terminally differentiated effector memory T cells in kidney transplant recipients: New crossroads","authors":"Steven Van Laecke,&nbsp;Griet Glorieux","doi":"10.1016/j.ajt.2024.10.001","DOIUrl":"10.1016/j.ajt.2024.10.001","url":null,"abstract":"<div><div>Immunosenescence, the age-related dysregulation of innate and adaptive immunity, impairs immune response and increases inflammation, leading to higher infection and cardiovascular risks, particularly outside the field of transplantation. In kidney transplant recipients (KTRs), conditions like cytomegalovirus infection, old age, uremia, smoking, and diabetes, linked to poor outcomes, are associated with enhanced immunosenescence. Recent studies highlight the pathogenic role of cytotoxic T cells, particularly terminally differentiated effector memory T cells that reexpress CD45RA (T_EMRA), in graft dysfunction. A higher proportion of circulating CD8⁺ T_EMRA cells is observed in KTRs with chronic rejection. In antibody-mediated rejection, they invade the graft by superior chemotactic properties and binding to human leukocyte antigen (HLA) antibodies through FcγRIIIa (CD16). Also in microvascular inflammation without donor-specific antibodies, and even in patients without rejection but faster decline of kidney function, intragraft CD8⁺ T_EMRA cells were instrumental. CD8⁺ T_EMRA cells may explain the unresolved dismal graft outcomes associated with donor age and cytomegalovirus-serostatus mismatching and could become a novel therapeutic target in KTRs.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 250-258"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142398788","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":"Ethical implications of prioritizing utility at all costs: The rise of out-of-sequence transplants","authors":"Sanjay Kulkarni ,&nbsp;Keren Ladin","doi":"10.1016/j.ajt.2024.09.014","DOIUrl":"10.1016/j.ajt.2024.09.014","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 232-233"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273388","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":"A competing risks model to estimate the risk of graft failure and patient death after kidney transplantation using continuous donor-recipient age combinations","authors":"Maarten Coemans ,&nbsp;Thuong Hien Tran ,&nbsp;Bernd Döhler ,&nbsp;Allan B. Massie ,&nbsp;Geert Verbeke ,&nbsp;Dorry L. Segev ,&nbsp;Sommer E. Gentry ,&nbsp;Maarten Naesens","doi":"10.1016/j.ajt.2024.07.029","DOIUrl":"10.1016/j.ajt.2024.07.029","url":null,"abstract":"<div><div>Graft failure and recipient death with functioning graft are important competing outcomes after kidney transplantation. Risk prediction models typically censor for the competing outcome thereby overestimating the cumulative incidence. The magnitude of this overestimation is not well described in real-world transplant data. This retrospective cohort study analyzed data from the European Collaborative Transplant Study (n = 125 250) and from the American Scientific Registry of Transplant Recipients (n = 190 258). Separate cause-specific hazard models using donor and recipient age as continuous predictors were developed for graft failure and recipient death. The hazard of graft failure increased quadratically with increasing donor age and decreased decaying with increasing recipient age. The hazard of recipient death increased linearly with increasing donor and recipient age. The cumulative incidence overestimation due to competing risk-censoring was largest in high-risk populations for both outcomes (old donors/recipients), sometimes amounting to 8.4 and 18.8 percentage points for graft failure and recipient death, respectively. In our illustrative model for posttransplant risk prediction, the absolute risk of graft failure and death is overestimated when censoring for the competing event, mainly in older donors and recipients. Prediction models for absolute risks should treat graft failure and death as competing events.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 355-367"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900177","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: Kidney","authors":"Krista L. Lentine ,&nbsp;Jodi M. Smith ,&nbsp;Grace R. Lyden ,&nbsp;Jonathan M. Miller ,&nbsp;Sarah E. Booker ,&nbsp;Thomas G. Dolan ,&nbsp;Kayla R. Temple ,&nbsp;Samantha Weiss ,&nbsp;Dzhuliyana Handarova ,&nbsp;Ajay K. Israni ,&nbsp;Jon J. Snyder","doi":"10.1016/j.ajt.2025.01.020","DOIUrl":"10.1016/j.ajt.2025.01.020","url":null,"abstract":"<div><div>In 2023, the field of kidney transplantation faced both successes and challenges. A record 28,142 total kidney transplants were achieved in the United States, largely due to an increase in deceased donor kidney transplants (DDKTs). While the number of adult candidates listed for DDKT slightly increased, it remained below the level in 2019, with 11.4% of candidates waiting 5 years or more. Across racial and ethnic groups, Black adult candidates had the largest increase in DDKT rate in 2023, in parallel with the Organ Procurement and Transplantation Network policy to modify waiting time (implemented January 5, 2023). Following increases in death rates during the COVID-19 pandemic, pretransplant mortality declined in 2023 across various age, race and ethnicity, sex, and blood type categories, although mortality continued to vary substantially by donation service area. The rate of deceased donor kidneys that were recovered for transplant but not transplanted (nonuse) increased to a notable high of 27.9%, from 26.6% in 2022, with even higher rates for biopsied kidneys (41.4%), those from donors aged 65 years or older (72.2%), and kidneys with a kidney donor profile index of 85% or higher (72.5%). In contrast, nonuse of kidneys recovered from hepatitis C virus nucleic acid test–positive donors declined to 27.2% in 2023, from 43.0% in 2017, likely reflecting more common use of protocols incorporating direct-acting antiviral therapy. Disparities in access to living donor kidney transplant (LDKT) persist and particularly affect non-White and publicly insured patients. Delayed graft function has risen over the past decade, but appears to have plateaued, at 26.1% overall for adult recipients in 2023. Five-year graft survival rates were 90.0% for LDKT compared with 82.2% for DDKT in recipients aged 18-34 years, and 80.2% for LDKT versus 66.1% for DDKT in those aged 65 years or older.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S22-S137"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386741","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: Liver","authors":"Allison J. Kwong ,&nbsp;W. Ray Kim ,&nbsp;John R. Lake ,&nbsp;David P. Schladt ,&nbsp;Dzhuliyana Handarova ,&nbsp;Jesse Howell ,&nbsp;Benjamin Schumacher ,&nbsp;Samantha Weiss ,&nbsp;Jon J. Snyder ,&nbsp;Ajay K. Israni","doi":"10.1016/j.ajt.2025.01.022","DOIUrl":"10.1016/j.ajt.2025.01.022","url":null,"abstract":"<div><div>The number of liver transplants performed in 2023 in the United States reached another record high, totaling 10,659 overall, of which 10,125 (95.0%) were in adult recipients and 534 (5.0%) were in pediatric recipients. This growth was driven by increased recovery of livers from older donors and donation after circulatory death (DCD) donors—likely related to the wider availability of machine perfusion technologies. The overall nonuse rate, or percent of livers recovered for transplant and not transplanted, was 9.7%, a decrease from the preceding years, and 16.7% of transplant recipients accepted DCD livers. There was also growth in living donation, representing 5.7% of adult transplants and 14.6% of pediatric transplants. In July 2023, the model for end-stage liver disease (MELD) 3.0 and pediatric end-stage liver disease (PELD)–creatinine scoring systems were updated from MELD-sodium and PELD, respectively, and criteria for status 1B qualification for pediatric candidates were updated. A major goal of MELD 3.0 was to address the sex disparity in deceased donor transplant rates. In 2023, the gap in deceased donor liver transplant rates between sexes narrowed, although the rate remained higher for adult male candidates compared with female candidates, and pretransplant mortality rates were higher among adult female candidates compared with male candidates. Alcohol-associated liver disease and metabolic dysfunction–associated steatohepatitis remained the leading indications for liver transplant.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S193-S287"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386742","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: Heart","authors":"Monica M. Colvin ,&nbsp;Jodi M. Smith ,&nbsp;Yoon Son Ahn ,&nbsp;Kelsi A. Lindblad ,&nbsp;Dzhuliyana Handarova ,&nbsp;Ajay K. Israni ,&nbsp;Jon J. Snyder","doi":"10.1016/j.ajt.2025.01.024","DOIUrl":"10.1016/j.ajt.2025.01.024","url":null,"abstract":"<div><div>Despite unintended consequences and ongoing need for revision, the 2018 adult heart transplant policy revision continues to have a favorable impact as evidenced by increased transplant rates, decreased waitlist mortality, and more rapid transplant in higher acuity patients. In 2023, the total number of heart transplants in the United States increased 101.1% since 2012, reaching a record 4,599, of which 4,092 were performed in adults. Between 2022 and 2023 alone, 424 more adult heart transplants were performed, the largest annual increase this decade. Concurrently, the prevalence of heart donors after circulatory death increased to 14.0% in 2023. Candidates listed at adult statuses 1 and 2 underwent transplant more quickly (2,225.8 and 1,088.1 transplants per 100 patient-years, respectively). In 2023, adult waitlist mortality reached a low: 8.5 deaths per 100 patient-years. Multiorgan transplants (heart-liver and heart-kidney) in adults continue to increase, achieving comparable survival to that of heart transplant alone. Adults with congenital heart disease had the lowest pretransplant mortality of all diagnoses but also the lowest posttransplant survival, 76.1% at 5 years, emphasizing the need for consensus on best practices. In pediatric heart transplant, heart transplants increased 36.3% and new listings increased 34.0%, but the transplant rate decreased 14.9% resulting in increased waiting times. High-urgency listings increased, with 83.6% of heart transplants performed for status 1A. Pediatric waitlist mortality has declined 53.4% since 2012, but remains substantial: 11.7 deaths per 100 patient-years. In 2023, 5-year posttransplant survival was 80.3% in adult recipients and 84.4% in pediatric recipients.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S329-S421"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386751","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}