Transplantation Direct最新文献

{"title":"Answers From the World of Transplantation?","authors":"Jeremy R Chapman","doi":"10.1097/TXD.0000000000002000","DOIUrl":"10.1097/TXD.0000000000002000","url":null,"abstract":"","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 10","pages":"e2000"},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance of Organs From Deceased Donors: Results of a Global Survey.","authors":"Marcelo Cantarovich, Medhat Askar, Shaifali Sandal, Hari S Meshram, Stephen Beed, Karen M Dwyer, Nithya Krishnan, Mohammad Ghnaimat, Vivek B Kute, Carlos Diaz, Mario Abbud-Filho, Curie Ahn, Ban Hock Tan, Paola Garcia-Padilla, Oscar Imventarza, Jongwon Ha, Hiroto Egawa, Gustavo F Ferreira, Elias J Elenjickal, Helen Pilmore, Mirela Bušic, Jeffrey Schiff, Marti Manyalich, Lara Danziger-Isakov, Marina Berenguer, Beatriz Domínguez-Gil González, John Gill, Jean Tchervenkov, Wayne J Hawthorne, James Markmann, Peter Stock, Kumud Dhital, Andreas Zuckerman, Andrea Herrera-Gayol, Gabriel E Gondolesi","doi":"10.1097/TXD.0000000000002015","DOIUrl":"10.1097/TXD.0000000000002015","url":null,"abstract":"<p><strong>Background: </strong>With <10% of transplantation needs being met, one contributing factor may be the potential subjectivity in transplant specialists' acceptance of organs. Such decisions, if influenced by knowledge and/or comfort gaps, warrant intervention. We assessed knowledge and comfort gaps regarding deceased donation (DD) among critical care specialists and organ acceptance among transplant specialists.</p><p><strong>Methods: </strong>The Transplantation Society working group surveyed specialists on end-of-life management and organ acceptance. Participants, stratified by country DD rates, ranked their current and desired levels of knowledge or comfort (on a 0-100 scale) for survey questions. The differences between current and desired knowledge and comfort were reported as gaps.</p><p><strong>Results: </strong>Among 438 responses, the largest global knowledge gaps were for positive serology for Chagas (gap 30), multidrug-resistant bacterial infection (gap 23.5), HIV (gap 20), cancer history <5 y (gap 20), primary brain malignancies (gap 17.5), and high-risk behavior (gap 16). The largest global comfort gaps were for positive serology for Chagas (gap 29.5), multidrug-resistant bacterial infection (gap 21), excessive alcohol use (gap 20), primary brain malignancies (gap 20), and high-risk behavior (gap 16). Relevant knowledge and comfort gaps, both ranging from 10 to 50, were observed in the acceptance of organs from donors after circulatory determination of death. In general, countries with higher DD rates demonstrated smaller knowledge and comfort gaps than countries with lower DD rates.</p><p><strong>Conclusions: </strong>This survey reveals important knowledge and comfort gaps in DD organ acceptance. Targeted education could increase organ utilization and help address transplantation shortages.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 10","pages":"e2015"},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mind the Gap: Disparities in Education on Organ Donation and Transplantation-Results of a Global Survey.","authors":"Andrea Herrera-Gayol, Medhat Askar, Hari S Meshram, Gabriel E Gondolesi, Nithya Krishnan, Karen M Dwyer, Kumud Dhital, Stephen Beed, Peter Stock, Vivek B Kute, Carlos Diaz, Mohammad Ghnaimat, Antoine Barbari, Mario Abbud-Filho, Ban-Hock Tan, John Gill, Jeffrey Schiff, Elias J Elenjickal, Mirela Bušic, Lara Danziger-Isakov, Hiroto Egawa, Gustavo Ferreira, Paola Garcia-Padilla, Jongwon Ha, Oscar Imventarza, Wayne J Hawthorne, Marti Manyalich, Helen Pilmore, Marina Berenguer, Beatriz Domínguez-Gil González, Jean Tchervenkov, Shaifali Sandal, Marcelo Cantarovich","doi":"10.1097/TXD.0000000000002002","DOIUrl":"10.1097/TXD.0000000000002002","url":null,"abstract":"<p><strong>Background: </strong>Widely accessible education on organ donation and transplantation (ODT) is a tool to reduce waiting lists, as <10% of transplant needs are met (Global Observatory on Donation and Transplantation). We aimed to assess the current state of access to education on ODT worldwide.</p><p><strong>Methods: </strong>We surveyed transplant physicians and surgeons worldwide. Respondents were classified according to the mean deceased donation (DD) rate per million population (PMP) of their countries from 2016 to 2021 (excluding 2020): Group (G) 1 (G1) no DD reported, or no data provided to Global Observatory on Donation and Transplantation; (G2) <10 DD PMP; (G3) 10-19.9; (G4) 20-29.9; and (G5) ≥30. We inquired about the availability of education on ODT in countries and regions.</p><p><strong>Results: </strong>We analyzed 311 respondents. We observed that the availability of education on ODT was as follows: in postgraduate education (77.2% in countries, 70.4% in regions), in undergraduate medical school (52.8%, 50.6%), in elementary school (14.2%, 14.2%), in high school (24.6%, 25.7%), and for the public (58.8%, 57.2%). The highest challenges were observed mainly in countries with lower DD rates.</p><p><strong>Conclusions: </strong>This worldwide survey suggests that there are areas for improvement at a global level in education on ODT, spanning from schoolchildren to the public and from undergraduate to postgraduate medical students. This is a \"Call to Action\" to close the global education gap.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 10","pages":"e2002"},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"System-level Barriers Reducing Access to Transplantation: Results of a Global Survey.","authors":"Andrea Herrera-Gayol, Medhat Askar, Hari S Meshram, Gabriel E Gondolesi, Nithya Krishnan, Karen M Dwyer, Kumud Dhital, Stephen Beed, Peter Stock, Vivek B Kute, Carlos Diaz, Mohammad Ghnaimat, Gamal Saadi, Mario Abbud-Filho, Ban Hock Tan, John Gill, Jeffrey Schiff, Elias J Elenjickal, Mirela Bušic, Lara Danziger-Isakov, Hiroto Egawa, Gustavo Ferreira, Paola Garcia-Padilla, Jongwon Ha, Oscar Imventarza, Wayne J Hawthorne, Marti Manyalich, Helen Pilmore, Marina Berenguer, Beatriz Domínguez-Gil González, Jean Tchervenkov, Shaifali Sandal, Marcelo Cantarovich","doi":"10.1097/TXD.0000000000001989","DOIUrl":"10.1097/TXD.0000000000001989","url":null,"abstract":"<p><strong>Background: </strong>Global organ shortage is well documented; yet systemic barriers constraining access to transplantation remain poorly defined. Our study aimed to identify and map these barriers.</p><p><strong>Methods: </strong>A web-based survey was conducted from May 2022 to March 2023 among physicians and surgeons involved in organ donation and transplantation (ODT) from transplantation societies worldwide: (1) Hospital structure, legislation and policies, and financial barriers, addressed to program directors; (2) Questions on education on ODT directed to all participants, and questions about donor acceptance for transplant specialists; (3) Questions on donor identification for critical care specialists and questions about organ acceptance directed to transplant specialists; (4) Demographic questions for everyone. Respondents were grouped according to the mean deceased donation (DD) rate per million population from years 2016 to 2019 and 2021: Group (G) 1 (G1) No DD reported, or no data provided to global observatory on donation and transplantation; (G2) <10 DD per million population; (G3) 10-19.9; (G4) 20-29.9; (G5) ≥30.</p><p><strong>Results: </strong>We present answers from program directors. There were 150 program directors from 438 respondents. Financial barriers ranked highest, negatively affecting access to transplantation worldwide. G1 indicated the highest percentage of challenges. Those from G4 and G5 provided the least amount of challenges; however, training programs remain areas for improvement. Responses from G2 and G3 were similar, positioned between those from G1, and G4 and G5.</p><p><strong>Conclusions: </strong>The organ shortage emergency is exacerbated by parallel system-level deficiencies. This global survey identifies specific, actionable deficits that must be addressed to build equitable transplant systems worldwide.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 10","pages":"e1989"},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization and Outcomes of Septuagenarian Donation After Circulatory Death Donors.","authors":"Michael McCabe, Abigail Loszko, Justin Weissberg, Amit Nair, Nicholas Lim, Jeremy Taylor, Randeep Kashyap, Juliet Emamaullee, Koji Tomiyama, Roberto Hernandez-Alejandro, Yuki Bekki","doi":"10.1097/TXD.0000000000002014","DOIUrl":"10.1097/TXD.0000000000002014","url":null,"abstract":"<p><strong>Background: </strong>The ongoing organ shortage and aging global population necessitate the utilization of older donors. However, the transplantability of donation after circulatory death (DCD) grafts from septuagenarian donors remains uncertain.</p><p><strong>Methods: </strong>Adult DCD donors in the United Network for Organ Sharing database between 2020 and 2024 were stratified on the basis of age 70 y or older (septuagenarian donors) and younger than 70 y. The utilization and posttransplant outcomes were analyzed.</p><p><strong>Results: </strong>There were 24 258 DCD donors, of whom 195 (0.8%) were septuagenarians. Among 364 recovered kidneys, 58 livers, and 8 lungs from septuagenarian donors, 61 (16.7%) kidneys, 50 (86.2%) livers, and 6 (75%) lungs were transplanted. There was no significant difference in 1-y graft survival for either kidney (92.9 versus 91.6%, <i>P</i> = 0.99) or liver (92.3 versus 90.1%, <i>P</i> = 0.82) recipients. There was heterogeneity across regions in septuagenarian donor practices: 2 (3.6%) of 55 organ procurement organizations recovered 33.8% of all septuagenarian donors, whereas 4 (1.8%) of 218 centers transplanted 34.8% of all septuagenarian grafts used.</p><p><strong>Conclusions: </strong>Septuagenarian DCD grafts achieved favorable graft survival after kidney or liver transplantation. Although significant variation exists across organ procurement organizations and transplant centers, aggressive exploration of septuagenarian DCD donors is warranted to resolve the organ shortage.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 10","pages":"e2014"},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reactogenicity and Immunogenicity of Adjuvanted and Nonadjuvanted RSV Vaccines in Solid Organ Transplant Recipients.","authors":"Alisse Hannaford, Elene Chamberlin, Zoe Swank, Simon D van Haren, Samual Han, Sanya Thomas, Kevin Ryff, Erin M Connolly, Ella N Woehl, David J Regan, Grace C Valentine, Nicholas Morreale, Xiaofang Li, Aidan Eustace, Alexandra Tong, Zhou Lan, David R Walt, Ofer Levy, Nicolas C Issa, Nirmal S Sharma, Mandeep R Mehra, Michael M Givertz, Stefan G Tullius, Jamil R Azzi, Antonio Coppolino, Lindsey R Baden, Amy C Sherman, Ann E Woolley","doi":"10.1097/TXD.0000000000001977","DOIUrl":"10.1097/TXD.0000000000001977","url":null,"abstract":"<p><strong>Background: </strong>Solid organ transplant (SOT) recipients are at high risk for severe respiratory syncytial virus (RSV). While RSV vaccine immunogenicity data in transplant populations are emerging, questions remain regarding the magnitude and durability of responses, cellular immunity, and determinants of decreased response.</p><p><strong>Methods: </strong>We conducted a prospective, single-center cohort study evaluating RSV vaccine reactogenicity and immunogenicity in SOT recipients compared with healthy controls. Serum was collected pre-vaccination and at 1, 3, and 6 mo post-vaccine to measure anti-fusion glycoprotein antibodies to RSV A and B and anti-nucleocapsid antibodies as a marker of natural infection. Peripheral blood mononuclear cells were collected from a subset for RSV-fusion (F)-specific cellular analyses.</p><p><strong>Results: </strong>Forty-three SOT recipients (median age, 65) and 16 controls were enrolled (from October 2023 to January 2024). Mild reactogenicity occurred in ~25% of participants, with no severe events. In SOT recipients, anti-fusion glycoprotein IgG, RSV-F-specific CD4⁺ and CD8⁺ T cells increased significantly at 1 mo (<i>P</i> < 0.01), with similar antibody fold changes to controls. Antibody responses remained durable through 6 mo; the rate of decline did not differ significantly between groups. Mycophenolate use was inversely correlated with antibody titers (<i>P</i> < 0.05); vaccine type, organ, and time from transplant were not. The adjuvanted vaccine induced greater RSV-F-specific CD4⁺ T-cell responses at 3 mo. One SOT recipient developed RSV during the study.</p><p><strong>Conclusions: </strong>RSV vaccination was well tolerated and immunogenic in SOT recipients. Further research should optimize vaccination strategies and ideal timing for booster doses.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1977"},"PeriodicalIF":2.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous Pancreas and Kidney Transplant Recipients From Pediatric Donors Have Comparable Outcomes to Those From Adult Donors, Regardless of the Type of Donation.","authors":"Sandesh Parajuli, Camille Ylagan, Dave Patel, Paul E Schindler, Sundeep Ram, Carrie Thiessen, David Aufhauser, Riccardo Tamburrini, Didier Mandelbrot, Dixon Kaufman, Jon Odorico","doi":"10.1097/TXD.0000000000001985","DOIUrl":"10.1097/TXD.0000000000001985","url":null,"abstract":"<p><strong>Background: </strong>Increased use of pediatric donors or donation after circulatory death (DCD) donors could enlarge the pancreas transplant donor pool. Pediatric donors and DCD donors are underutilized but are associated with similar outcomes following simultaneous pancreas and kidney (SPK) transplantation, compared with adult donation after brain death (DBD) donors. However, SPK outcomes from donors in whom both variables are present are unknown.</p><p><strong>Methods: </strong>Recipients were categorized into 4 groups based on the age of the donor and types of donations: DBD/≥18 y, DBD/<18 y, DCD/≥18 y, and DCD/<18 y. Kidney and pancreas graft functions were compared at various time frames. Risk of graft failure was the primary outcome.</p><p><strong>Results: </strong>Of 234 SPK recipients, 127 (54%) were DBD/≥18 y, 43 (18%) DBD/<18 y, 49 (21%) DCD/≥18 y, and 15 (6%) DCD/<18 y. There were no significant differences among the groups in overall or death-censored graft failure of either organ. Multivariable analysis (reference to DBD/≥18) showed no significant risk for pancreas uncensored graft failure for DBD/<18 y (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.23-1.44; <i>P</i> = 0.24), DCD/≥18 y (HR, 0.62; 95% CI, 0.26-1.48; <i>P</i> = 0.29), or DCD/<18 y (HR, 0.92; 95% CI, 0.31-2.79; <i>P</i> = 0.89). Pancreas graft function, as assessed by glycated hemoglobin, was comparable up to 5 y posttransplant or at the last follow-up. Kidney function, incidence of pancreas or kidney biopsy-proven rejection, posttransplant diabetes, length of stay, or readmission rates were not significantly different across the groups.</p><p><strong>Conclusions: </strong>SPK transplants using DCD organs from pediatric donors can be used without compromising outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1985"},"PeriodicalIF":2.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Graft Dysfunction After Lung Transplantation: A Temporal Classification and Machine Learning Clustering.","authors":"Balin Özsoy, Bieke Vercauteren, Jan Van Slambrouck, Cedric Vanluyten, Annalisa Barbarossa, Xin Jin, Dirk E Van Raemdonck, Julia Dmitrieva, Anwar Khan, Xander Jacquemyn, Saskia Bos, Robin Vos, Bart N Vanaudenaerde, Marianne S Carlon, Jean-Marie Aerts, Peter Carmeliet, Laurens J Ceulemans","doi":"10.1097/TXD.0000000000001984","DOIUrl":"10.1097/TXD.0000000000001984","url":null,"abstract":"<p><strong>Background: </strong>Primary graft dysfunction (PGD) is a major cause of morbidity and mortality after lung transplantation (LTx). PGD is graded at static time points, limiting insight into its temporal dynamics. Statistical risk-factor analysis may overlook the multifactorial complexity of PGD. Machine learning (ML) may address this but is constrained by small sample sizes. We aim to introduce a temporal PGD classification, perform ML-based clustering and overcome sample-size limitations by generating synthetic patient data.</p><p><strong>Methods: </strong>A prospectively collected database of 794 LTx at University Hospitals Leuven (Belgium) from January 2012 to November 2023 was analyzed. Recipients were classified into 4 temporal PGD phenotypes: no, early, late, and persistent PGD. Unsupervised ensemble <i>k</i>-means clustering was used to group patients based on 30 clinical variables. To generate synthetic data, a Wasserstein Generative Adversarial Network with Gradient Penalty was trained.</p><p><strong>Results: </strong>Six hundred ninety primary double LTx cases were included. Temporal PGD phenotypes showed significantly different 5-y survival (log-rank test: <i>P < </i>0.001). <i>K</i>-means clustering revealed stable patient subgroups, with <i>k = </i>5 and <i>k = </i>9 identified as optimal cluster numbers. Key features affecting clustering included preoperative intensive care unit stay and postoperative chest x-rays. The synthetic data set preserved the correlation structure of the original data, and the combined data had similar clustering behavior, with optimal clustering at <i>k = </i>5, <i>k = </i>7, and <i>k = </i>9.</p><p><strong>Conclusions: </strong>This study demonstrates the potential of temporal PGD classification to better understand how the dynamic character of PGD affects survival. ML techniques, including unsupervised clustering and synthetic data generation, could be promising strategies to unravel complex interactions between clinical factors and overcome sample-size limitations.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1984"},"PeriodicalIF":2.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major Cardiovascular Complications of Index Kidney Transplantation Hospitalizations: A National Inpatient Sample Analysis.","authors":"Spencer R Goble, Thomas M Leventhal, Justin R Parekh","doi":"10.1097/TXD.0000000000001970","DOIUrl":"10.1097/TXD.0000000000001970","url":null,"abstract":"<p><strong>Background: </strong>Understanding perioperative risks and long-term benefits of kidney transplantation is essential for patient counseling and optimization of posttransplant outcomes. Currently, there is a lack of generalizable data on cardiovascular complications of kidney transplantation.</p><p><strong>Methods: </strong>We performed a retrospective, cross-sectional analysis of adult kidney transplantation hospitalizations in the National Inpatient Sample from 2016 to 2022. Cardiac events were defined as cardiac arrest, cardiogenic shock, acute myocardial infarction, ventricular tachycardia, or a related cardiac intervention (cardiopulmonary resuscitation, extracorporeal membrane oxygenation, percutaneous coronary intervention, left or right heart catheterization, intra-aortic balloon pump). Outcomes included cardiac event incidence, mortality, length of stay (LOS), and cost.</p><p><strong>Results: </strong>Among 139 720 kidney transplantation hospitalizations, cardiac events occurred in 3165 (2.3%). Patients with cardiac events were older (59.2 versus 52.3 y; <i>P</i> < 0.001) and had higher comorbidity burden (Charlson Comorbidity Index 4.4 versus 3.2; <i>P</i> < 0.001). In-hospital mortality among those with cardiac events was 9.2%, compared with 0.4% among those without. Mean LOS (13.4 versus 5.7 d) and hospitalization cost ($108 876 versus $66 985) were increased in those with a cardiac event (<i>P</i> < 0.001 for both). Cardiac intervention was recorded in 0.8% of transplant recipients and was associated with a 16.6% mortality rate. Risk factors for cardiac events included older age, male sex, coronary artery disease, congestive heart failure, atrial fibrillation, cerebrovascular disease, diabetes, and Charlson Comorbidity Index > 4 (odds ratio, 4.95; 95% confidence interval, 4.21-5.82; <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Cardiac events complicate approximately 2% of index kidney transplantation hospitalizations and are associated with markedly increased mortality, LOS, and cost.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1970"},"PeriodicalIF":2.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statistical Behavior of the Rank-order and Tiering Metric of the 2020 Centers for Medicare and Medicaid Services Organ Procurement Organization Rule.","authors":"J Thomas Rosenthal","doi":"10.1097/TXD.0000000000001974","DOIUrl":"10.1097/TXD.0000000000001974","url":null,"abstract":"<p><strong>Background: </strong>The 2020 Centers for Medicare and Medicaid Services (CMS) Organ Procurement Organization (OPO) rule used an estimate of OPO organ donor potential that included contraindications to organ donation, termed cause, age, and location consistent with donation (CALC). CMS asserted that even though CALC was inaccurate, it could still be used to compare OPOs because it highly correlated with CALC-adjusted to exclude the contraindications. Quantitative bias analysis is required to determine whether CALC can, in fact, be reliably used to make certification decisions under the rule.</p><p><strong>Methods: </strong>A Monte Carlo simulation was carried out with 10 000 simulations using statistical constraints defining the relationship between CALC and CALC-adjusted applied to the published data in the rule.</p><p><strong>Results: </strong>In every simulation, at least 2 OPOs changed tier assignment, with a median of 10 OPOs changing tiers across the 10 000 simulations. Several validations were carried out to confirm the results. All the tier changes were in OPOs that were closely adjacent to one of the cutoffs that determined tier assignment.</p><p><strong>Conclusions: </strong>CALC, as applied in the 2020 OPO rule, possesses a level of stochastic instability that exceeds the threshold for accurate regulatory decisions. Its use will result in misclassification of a significant number of OPOs.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1974"},"PeriodicalIF":2.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}