Transplantation Direct最新文献

{"title":"The Transformative Journey of Vascularized Composite Allotransplantation: Advances, Challenges, and Future Directions.","authors":"Ayaka Sonehara, Tetsuya Tajima, Carlos O Esquivel, Olivia M Martinez, Sheri M Krams","doi":"10.1097/TXD.0000000000001975","DOIUrl":"10.1097/TXD.0000000000001975","url":null,"abstract":"<p><p>Vascularized composite allotransplantation (VCA) has emerged as a groundbreaking technique in reconstructive surgery, offering remarkable restoration of both function and aesthetics after severe tissue loss. However, despite its transformative clinical potential, widespread adoption remains limited because of the risk of rejection, the need for lifelong systemic immunosuppression and its associated risks, and donor-specific constraints unique to VCA, including morphological matching requirements and ethical and psychosocial considerations surrounding composite tissue donation. This review synthesizes findings from both basic research and clinical studies on VCA. We analyzed experimental studies using rodent and large-animal models and reviewed clinical outcomes in uterus, face, upper extremity, and abdominal wall transplants. In rodent models, costimulation blockade and interleukin-2/anti-interleukin-2 complexes significantly prolonged graft survival. Local therapies, such as tacrolimus-containing hydrogels and regulatory T cell-inducing microparticles, demonstrated the ability to extend graft survival beyond 200 d while reducing systemic immunosuppression. Clinically, uterus and face transplants have shown improved graft survival and functional outcomes, with reported live birth rates of 35%-40% in uterus transplantation and 5-y graft survival rates of 85% in face transplantation. Upper extremity transplantation resulted in the restoration of protective sensation in nearly all recipients. This study provides a comprehensive review of VCA, encompassing the foundational basic research underpinning its progress, and the clinical outcomes and challenges associated with the procedure. By examining these aspects, we aim to elucidate the current state of VCA, identify persistent challenges, and explore future directions for advancing its clinical application and optimizing patient outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1975"},"PeriodicalIF":2.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412709","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":"Characterizing Middle Eastern and North African Patients in US Transplant Data.","authors":"Jesse Howell, Jesse D Schold, Lisa M McElroy, Oscar K Serrano, Alejandro Diez, Erin Schnellinger","doi":"10.1097/TXD.0000000000001973","DOIUrl":"10.1097/TXD.0000000000001973","url":null,"abstract":"<p><strong>Background: </strong>The Office of Management and Budget's March 2024 Statistical Policy Directive 15 revision requires reporting Middle Eastern or North African (MENA) individuals separately from the White category. This study compares MENA and non-MENA transplant candidates/recipients before the revision to determine whether differences exist between these populations.</p><p><strong>Methods: </strong>We analyzed Organ Procurement and Transplantation Network (OPTN) single-organ kidney, liver, heart, and lung registrations ever-waiting or transplanted between January 1, 2018, and June 30, 2023, filtering to White, non-Hispanic (NHW) US residents. Individuals reporting Arab/Middle Eastern and North African race/ethnicity were classified as MENA. Demographics, 1-y Kaplan-Meier graft/patient survival, transplant and waitlist mortality rates, and median time to transplant (based on cumulative incidence) were calculated.</p><p><strong>Results: </strong>MENA registrations were younger (7.0% versus 3.3%; <18 y), more frequently male (71.4% versus 63.8%), and more commonly kidney candidates (70.1% versus 59.7%), on public/charity insurance (60.6% versus 48.8%). MENA kidney registrations had longer median dialysis time at listing (154 versus 47 d) compared with non-MENA registrations. Larger proportions of MENA liver registrations were listed under the least medically urgent statuses, while larger proportions of MENA thoracic registrations were listed under more medically urgent statuses. Median time to transplant was longer for MENA versus non-MENA liver registrations (662 versus 443 d), and shorter for MENA versus non-MENA thoracic registrations (64 versus 83 d). One-year graft/patient survival was similar (eg, liver recipients: 0.95 versus 0.94). Transplant and waitlist mortality rates were lower for MENA versus non-MENA liver candidates (69.4 versus 89.2 deceased donor transplants (7.0 versus 11.0 waitlist deaths) per 100 active or total patient-years, respectively).</p><p><strong>Conclusions: </strong>Dialysis time at listing, medical urgency distributions, waitlist mortality rates, transplant rates, and median time to transplant differed between MENA and non-MENA candidates. As more data accrue, separate monitoring of MENA candidates/recipients may further elucidate the waitlist and transplantation experience of these individuals.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1973"},"PeriodicalIF":2.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412534","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":"Do we Treat the Right Patients? Predictors of Psychosocial Treatment Frequencies in a Multimodal Aftercare Program: A KTx360° Substudy.","authors":"Charlotte Kuczyk, Martina de Zwaan, Felix Klewitz, Maximilian Bauer-Hohmann, Aline Debener, Yesim Erim, Lena Schiffer, Sven Haufe, Uwe Tegtbur, Lars Pape, Mario Schiffer, Mariel Nöhre","doi":"10.1097/TXD.0000000000001983","DOIUrl":"10.1097/TXD.0000000000001983","url":null,"abstract":"<p><strong>Background: </strong>Psychosocial interventions are essential in multimodal aftercare for kidney transplant recipients. However, it remains unclear whether they effectively reach patients with low adherence or elevated mental distress.</p><p><strong>Methods: </strong>We investigated (1) the frequency of suboptimal adherence and mental distress at any point during the aftercare program Kidney Transplantation 360° study (KTx360°), a multicenter, multisectoral, multimodal, telemedicine-based follow-up care model; (2) the rate of psychosocial intervention utilization, and (3) the association between these factors, along with demographic and clinical characteristics, and intervention uptake. This analysis draws on a sample of n = 838 participants. Participants with and without utilization of psychosocial interventions were compared using chi-square tests and Mann-Whitney <i>U</i> tests as appropriate. Logistic regression estimated predictors of utilization.</p><p><strong>Results: </strong>Suboptimal adherence and mental distress were frequently observed in our cohort, affecting 60.6% (n = 508) of participants at some point during the study. Utilization remained limited, with only 27.6% (n = 140) of affected individuals engaging with them. Still, higher levels of suboptimal adherence (ß = 0.48; <i>P</i> = 0.012) and mental distress (depression [ß = 0.74; <i>P</i> < 0.001], anxiety [ß = 0.69; <i>P</i> = 0.001]) were linked to greater intervention use-alongside female sex (ß = -0.43; <i>P</i> = 0.018) and retransplantation status (ß = 0.51; <i>P</i> = 0.034).</p><p><strong>Conclusions: </strong>Even though suboptimal adherence and increased mental distress were associated with a higher utilization of psychosocial intervention, the majority of affected patients were not reached, highlighting a significant gap between need and access. Understanding patterns of utilization is crucial when designing scalable and feasible psychosocial interventions for transplant recipients.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1983"},"PeriodicalIF":2.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412500","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":"Enhanced Peribiliary Gland Detachment in Aged Donor Grafts After Rat Liver Transplantation.","authors":"Kaoru Katano, Shinichi Nakanuma, Takashi Sugio, Junichi Ogawa, Naoto Nishida, Hiroaki Horio, Ryohei Takei, Satoshi Takada, Mitsuyoshi Okazaki, Kaichiro Kato, Yasuhito Iwao, Isamu Makino, Kenichi Harada, Shintaro Yagi","doi":"10.1097/TXD.0000000000001981","DOIUrl":"10.1097/TXD.0000000000001981","url":null,"abstract":"<p><strong>Background: </strong>Older donor livers have higher rates of biliary complications after transplantation, but early mechanisms of bile duct injury remain incompletely understood. Peribiliary glands (PBGs) in the bile duct wall contain progenitor-like and secretory elements that may support epithelial maintenance and repair. We examined whether donor age is associated with early PBG injury and recovery and explored links with the basement-membrane component laminin.</p><p><strong>Methods: </strong>Livers from young or aged rats were transplanted into young recipients. Extrahepatic bile ducts were evaluated before transplantation and at 24, 72, and 168 h after liver transplantation. PBG morphology and detachment, laminin γ1 expression, and markers related to progenitor-cell characteristics, mucus production, microvascular density, and apoptosis were assessed histologically and immunohistochemically.</p><p><strong>Results: </strong>In aged donor grafts, PBGs showed progressive structural injury after transplantation, with marked cell detachment and loss of glandular architecture at 168 h. In contrast, PBGs in young donor grafts were largely preserved. Areas of PBG cell detachment in aged grafts were spatially associated with reduced laminin γ1 expression. Recovery of laminin γ1 expression over time was less evident in aged grafts and was accompanied by impaired progenitor-cell marker expression, reduced mucus production, persistently decreased microvascular density, and increased shedding of apoptotic PBG cells.</p><p><strong>Conclusions: </strong>Aged donor grafts showed more pronounced early structural PBG injury after transplantation, together with persistent reduction of laminin γ1 expression.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1981"},"PeriodicalIF":2.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405484","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":"IL35 Production After Living-donor Renal Transplantation: Relevance to Local, Exosome-mediated, Clinical Tolerance.","authors":"William J Burlingham, John H Fechner, Ewa Jankowska-Gan, Sudipta Tripathi, Brittany L Schreiber, Anil Chandraker, Dixon B Kaufman, David P Foley","doi":"10.1097/TXD.0000000000001980","DOIUrl":"10.1097/TXD.0000000000001980","url":null,"abstract":"<p><strong>Background: </strong>We previously reported that 100% of HLA-identical siblings and 50% of HLA-haploidentical donor-recipient pairs exhibited bidirectional immunoregulation (BDIR) before living-related renal transplantation. BDIR predicted successful transplant outcomes. However, at the time, we were unaware of the role of the cytokine interleukin-35 (IL35) in immunoregulation, and we now appreciate exosomes as a means of confining immunoregulation to the transplanted tissue. Here we show that HLA-identical sibling transplants use IL35 in posttransplant BDIR.</p><p><strong>Methods: </strong>We analyzed the posttransplant IL35 response using the trans-vivo delayed type hypersensitivity assay in HLA-identical sibling transplants, using anti-IL35 antibodies to block immune-regulatory function as measured by either (1) inhibition of the tetanus toxoid/diphtheria toxoid recall response or (2) uncovering of direct response, in both the donor anti-recipient and the recipient anti-donor (minor H) antigen directions.</p><p><strong>Results: </strong>We found that minor antigen-specific human regulatory T cells, known to be present in peripheral blood mononuclear cell of HLA-identical siblings pretransplant, also caused BDIR via production of IL35 posttransplant.</p><p><strong>Conclusions: </strong>We conclude that human IL35 is a component of BDIR in HLA-identical sibling transplantation. Since IL35 is one of a subclass of exosome-delivered cytokines, this means that human IL35 could sustain local BDIR within the transplant itself. It follows that local BDIR would persist indefinitely if donor leukocytes were allowed to stably engraft. This may account for the success of combined total lymphoid irradiation/bone marrow transplantation/renal transplantation induction of stable tolerance in HLA-identical sibling transplant recipients.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1980"},"PeriodicalIF":2.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405553","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":"Renal Function Decline After Vascularized Composite Allotransplantation.","authors":"Gabriel Ouellet, Claudia Sardu, Jean Kanitakis, Hatem Amer, Kodi Azari, Lionel Badet, Gerald Brandacher, Linda Cendales, Ozlenen Dogan, Christophe Gaillard, Aram Gazarian, Dorota Kaminska, Christina Kaufman, Patrik Lassus, Luis Landin, Marco Lanzetta, Scott Levin, Martin Iglesias Morales, Paolo Sassu, Nilesh Satbhai, Simon Talbot, Annemarie Weissenbacher, Olivier Thaunat, Emmanuel Morelon, Palmina Petruzzo","doi":"10.1097/TXD.0000000000001976","DOIUrl":"10.1097/TXD.0000000000001976","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a common complication of nonrenal transplantation, influencing recipients' morbidity and mortality. The incidence of CKD varies depending on the transplanted organ. Recipients of vascularized composite allotransplantation (VCA) need lifelong immunosuppression similar to that of solid organ transplantation. This study investigated renal function in VCA recipients.</p><p><strong>Methods: </strong>We studied 70 recipients from 17 centers (median follow-up: 8 y): 59 upper extremity, 10 face, and 1 penis transplant. Pretransplant and posttransplant clinical data and sera were collected to calculate the estimated glomerular filtration rate (eGFR) using the CKD Epidemiology collaboration 2021 formula.</p><p><strong>Results: </strong>Pretransplantation, the median eGFR was 105.36 mL/min (range, 71.39-155.39 mL/min). By 3 mo posttransplant, the eGFR had significantly decreased to 78.42 mL/min (range, 32.49-130.74 mL/min; <i>P</i> = 0.001) before stabilizing. Despite higher tacrolimus levels at 3 mo, no correlation with eGFR was found. During follow-up, 17.1% of patients experienced a ≥50% eGFR decline, 10.9% progressed to CKD, and 4.7% developed end-stage kidney disease. Some risk factors were identified, but their responsibility could not be established with certainty because of the low number of severe renal outcomes.</p><p><strong>Conclusions: </strong>Renal function declines in the majority of VCA recipients, but the function loss is lower compared with nonrenal solid organ transplantation recipients. Although no statistically significant correlation could be established between tacrolimus exposure and renal function decline, strategies aiming at minimizing calcineurin inhibitor exposure and avoiding other nephrotoxic causes are recommended to preserve long-term kidney function.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1976"},"PeriodicalIF":2.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405718","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":"Impact of Perfusion With Methylene Blue on Perioperative Bleeding in Simultaneous Pancreas and Kidney Transplantation: A Randomized Control Trial.","authors":"Amy Hort, Swe Zin Phyoe, Ahmer Hameed, Taina Lee, Peter Yoon, Lawrence Yuen, Chris Nahm, Natasha Rogers, Angela Webster, Germaine Wong, Jerome Laurence, Kerry Hitos, Paul Robertson, Henry Pleass","doi":"10.1097/TXD.0000000000001972","DOIUrl":"10.1097/TXD.0000000000001972","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous pancreas-kidney transplantation (SPK) is the optimal treatment for selected patients with type I diabetes mellitus (T1DM) and end-stage kidney disease, but intraoperative bleeding remains a major cause of morbidity. Methylene blue flush during back-table pancreas preparation may better help preemptively identify bleeding points and reduce complications.</p><p><strong>Methods: </strong>A single-center, single-blinded, prospective randomized control trial was conducted at Westmead Hospital over 30 mo. Sixty participants were randomized to receive either crystalloid (n = 33) or methylene blue (MB) flush (n = 27) during pancreas preparation before implantation. The primary outcome was intraoperative bleeding.</p><p><strong>Results: </strong>There was no significant difference in intraoperative blood loss with the use of MB flush (433 ± 385 mL versus 588 ± 382 mL; <i>P</i> = 0.10). The MB group required significantly lower intraoperative blood transfusions (7% versus 27%, <i>P</i> = 0.032) but higher postoperative transfusions within 7 d (81% versus 58%, <i>P</i> = 0.038). No significant differences were observed in length of stay, reoperation rates, delayed graft function, readmission rates, graft loss, or mortality. Early graft loss and pancreatectomy were lower in the MB group (4% versus 12%) without reaching statistical significance (<i>P</i> = 0.206).</p><p><strong>Conclusions: </strong>MB flush did not significantly reduce intraoperative blood loss but reduced intraoperative transfusion requirements, while increasing postoperative blood transfusion requirements, indicating a temporal shift in bleeding pattern. Graft outcomes were unaffected. Further studies should explore mechanisms and evaluate long-term outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1972"},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391760","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":"Eye Health Among Islet Cell Transplant Recipients With Long-duration Type 1 Diabetes.","authors":"Hye Jin Kwon, Sybil A McAuley, Richard J MacIsaac, Thomas W H Kay, Glenn M Ward","doi":"10.1097/TXD.0000000000001960","DOIUrl":"10.1097/TXD.0000000000001960","url":null,"abstract":"<p><strong>Background: </strong>Diabetic retinopathy (DR) is the commonest cause of blindness among people with type 1 diabetes (T1D) and can progress over time. In Australia, islet cell transplantation (ICT) is available for adults with T1D experiencing recurrent severe hypoglycemia. Rapid improvement in glycemia, which can occur post-ICT, may lead to \"early worsening\" of DR and warrants investigation. This study explored eye health outcomes among ICT recipients.</p><p><strong>Methods: </strong>This retrospective study examined all ICT recipients at a single tertiary institution in Victoria, Australia, 2007-2022 inclusive. Recipients of successful ICT, with available eye health information pre- and posttransplantation, were included. Eye health outcomes were assessed relative to ICT for changes in DR and other major retinal pathologies.</p><p><strong>Results: </strong>Sixteen recipients (30 eyes) with T1D duration median 31 y (interquartile range, 26-44) were followed up for 5 y (interquartile range, 4-9). At 12 mo post-ICT, hemoglobin A_1c improved by -1.2 percentage points (-1.9 to -0.5; <i>P</i> < 0.001). Pre-ICT, 9 of 16 recipients (56%) had DR, with 4 recipients having proliferative DR. During follow-up post-ICT, 4 of 16 recipients (25%) had worsening eye outcomes; there were no new cases of proliferative DR. Four recipients had \"early worsening\" signs, not associated with progression of DR. Recipients experiencing worsening eye outcomes post-ICT exhibited higher hemoglobin A_1c and lower C-peptide levels during 12 mo compared with recipients who had stable eye outcomes (<i>P</i> = 0.02 and <i>P</i> = 0.01, respectively).</p><p><strong>Conclusions: </strong>These findings highlight the potential positive impact of ICT to stabilize eye health among a small group of ICT recipients with long-duration type 1 diabetes. An extended systematic evaluation of eye health pre- and post-ICT is required to monitor both short-term and long-term eye health among transplant recipients.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1960"},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391811","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":"Ringer Lactate Versus Hybrid Isotonic/Hypotonic Saline in Delayed Graft Function in Deceased-donor Kidney Transplantation: A Real-world Protocol Change Study.","authors":"Arthur Gus Manfro, Vanderlei Carlos Bertuol Junior, Fernanda Correa da Silva Alves, Andrea Carla Bauer","doi":"10.1097/TXD.0000000000001978","DOIUrl":"10.1097/TXD.0000000000001978","url":null,"abstract":"<p><strong>Background: </strong>Delayed graft function (DGF) remains a major complication after deceased-donor kidney transplantation. Balanced crystalloid solutions have been associated with lower DGF incidence compared with 0.9% saline, largely based on strategies using Plasma-lyte. However, the role of Ringer lactate compared with other low-chloride solutions, such as hypotonic saline, remains unclear. We therefore evaluated whether a protocol-driven change in perioperative crystalloid strategy was associated with DGF and early posttransplant kidney function.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center, quasi-experimental study including recipients of deceased-donor kidney transplants. Patients were exposed to a protocol-driven change in perioperative hydration from a hybrid intraoperative 0.9% saline plus postoperative hypotonic saline (0.45%) strategy to an intraoperative and postoperative Ringer's lactate strategy. The primary outcome was DGF. Secondary outcomes included DGF duration, longitudinal kidney function, electrolyte trajectories, and 12-mo clinical outcomes. Generalized additive mixed models were used to evaluate longitudinal trajectories of graft function and electrolyte balance while accounting for within-subject variability.</p><p><strong>Results: </strong>A total of 257 kidney transplant recipients were included (142 Ringer lactate; 115 hybrid isotonic/hypotonic saline), with comparable baseline characteristics. DGF incidence did not differ between groups (47.9% Ringer lactate versus 52.2% hybrid isotonic/hypotonic; <i>P</i> = 0.49), nor did days to renal graft recovery (5.7 versus 5.7 d; <i>P</i> = 0.96) or DGF duration (10.5 versus 10.2 d; <i>P</i> = 0.78). Mortality, graft loss, and biopsy-proven rejection at 12 mo were also similar. In covariate-adjusted longitudinal analyses, the estimated glomerular filtration rate did not differ between groups. Electrolyte trajectories showed modest differences between groups.</p><p><strong>Conclusions: </strong>In this real-world quasi-experimental study, Ringer lactate was not associated with lower DGF incidence or duration compared with a hybrid isotonic/hypotonic saline-based strategy. No differences were also observed in graft function over the 12-mo follow-up. These findings support further investigation into whether differences in chloride exposure may influence early graft outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1978"},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391783","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":"Immunosuppression-free Nonvascularized Rectus Fascia Allotransplantation for Complex Hernia Repair.","authors":"Laurens J Ceulemans, Ewout Muylle, Gert De Hertogh, Cedric Vanluyten, Antoine Dubois, Jan Van Slambrouck, Caroline Boelhouwer, Marina Gabriela M C Mori da Cunha, Ina Hennion, Antoine Weisrock, Lieven Thorrez, Ina Benoy, Steffi De Pelsmaeker, Angelica Pagliazzi, Maarten Naesens, Nathalie P Deferm, Albert Wolthuis, André D Hoore, Jacques Pirenne, Nele Van De Winkel","doi":"10.1097/TXD.0000000000001982","DOIUrl":"10.1097/TXD.0000000000001982","url":null,"abstract":"<p><strong>Background: </strong>Complex abdominal wall herniations present major reconstructive challenges, particularly in patients with contaminated fields or previous failed repairs. Synthetic meshes carry substantial infection risk, whereas biological meshes are expensive and exhibit inconsistent long-term strength, leaving many patients without dependable options. This study investigates the feasibility, safety, and immunologic profile of nonvascularized rectus fascia allotransplantation (NVRF-alloTx) for abdominal wall reconstruction in immunocompetent individuals.</p><p><strong>Methods: </strong>We conducted a prospective single-center case series of 3 immunocompetent patients who underwent elective NVRF-alloTx between 2024 and 2025 at a tertiary academic hospital. Candidates had complex or contaminated defects that were unsuitable for synthetic or biologic mesh repair. Primary outcomes were durable abdominal wall closure, graft-related complications, and immunologic responses measured by donor-specific antibody screening. Secondary assessments included radiologic evaluation, biomechanical testing, histologic integration, and chimerism analysis in 1 patient whose graft was explanted postmortem.</p><p><strong>Results: </strong>All patients achieved successful abdominal wall closure without hernia recurrence or graft failure during follow-up. Two developed de novo class I or II anti-HLA donor-specific antibodies. One patient died from unrelated cardiac disease 2 mo postoperatively; graft analysis demonstrated robust fibrovascular integration, limited T-cell infiltration, and biomechanical properties comparable to native fascia.</p><p><strong>Conclusion: </strong>This early clinical experience demonstrates that NVRF-alloTx without immunosuppression can provide durable, mechanically stable abdominal wall reconstruction in high-risk immunocompetent patients. Despite measurable alloimmune sensitization, graft function remained intact. NVRF may represent a viable alternative in contaminated settings where traditional mesh-based strategies are contraindicated. Further study is needed to confirm long-term outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1982"},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391726","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}