Transplantation Direct最新文献

{"title":"Donation After Circulatory Death Islets are Comparable to Standard-of-Care Donation After Brain Death Islets: Analysis of 801 Consecutive Human Islet Isolations.","authors":"Meirigeng Qi, Keiko Omori, Christopher Orr, Luis Valiente, Shiela Bilbao, Amber Tucker, Jeffrey Rawson, Nelson Gonzalez, Joshua Verret, Juan Cuadra, Jacob Mares, Kevin Jou, Doreen Ligot, Bennie Balandran, Hirotake Komatsu, Miryam Mehra, Karen Ramos, Jeannette Hacker-Stratton, Ismail H Al-Abdullah, Jeffrey S Isenberg, Fouad Kandeel","doi":"10.1097/TXD.0000000000001930","DOIUrl":"10.1097/TXD.0000000000001930","url":null,"abstract":"<p><strong>Background: </strong>Transplantation of isolated human islets is a valuable therapy for individuals with severe type 1 diabetes. A shortage of suitable pancreata and islets hinders access to islet transplantation (IT). Organ donation after circulatory death (DCD) islets are believed inferior and not appropriate for clinical IT. We readdressed this and compared outcomes between DCD and standard-of-care donation after brain death (DBD) islets.</p><p><strong>Methods: </strong>The data sample comprised 801 human islet isolations >2 decades from a single IT center. Islets from DCD and DBD donor organs were compared for islet outcome and quality. In some instances, a noninferior equivalency analysis was performed.</p><p><strong>Results: </strong>Across the study interval, islet yield, viability, and function remained high despite a deterioration in donor health biometrics. Noninferior analysis demonstrated that DCD islets were equivalent to DBD islets in islet yield post-culture and in murine diabetes reversion. In fact, in vivo islet function trended to more diabetes reversal in mice receiving DCD islets versus animals given DBD islets (75% versus 67%). As well, no significant differences were observed between groups in age, body mass index, pancreas cold ischemia time, digestion switch time, islet yield (success >250 000 islet equivalent), purity (>80%), recovery (>75%), post-culture viability, transplantable preparations, or insulin stimulation index. The median days of hospitalization and warm ischemia time were significantly greater in DCD versus the DBD group. Predictably, elevated donor hemoglobin A1c negatively impacted islet quality regardless of donation death status.</p><p><strong>Conclusions: </strong>Results from islet isolations >2 decades from a single center are presented. DCD islets were found to be equivalent to DBD islets on several relevant metrics. These findings encourage wider use of DCD donor islets for clinical IT.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 4","pages":"e1930"},"PeriodicalIF":1.9,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514995","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":"Consulting r/Transplant: Assessment of Reddit Use and Sentiment in Solid Organ Transplantation.","authors":"Ava Herzog, Divya Goyal, Flavio Paterno, Arpit Amin, James V Guarrera, Keri E Lunsford, Grace S Lee-Riddle","doi":"10.1097/TXD.0000000000001922","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001922","url":null,"abstract":"<p><strong>Background: </strong>Solid organ transplants are life-changing experiences that impact recipients, donors, care partners, medical teams, communities, and popular media. Social media is an influential part of modern life and provides a platform for healthcare experiences. This study assessed perspectives on solid organ transplantation by exploring the transplant community's utilization of the social media site Reddit.</p><p><strong>Methods: </strong>The 1000 most recent and \"Top\" 100 posts from the r/transplant subreddit were extracted in April 2024. Posts underwent categorization to identify key themes and subthemes. The Python \"Valence Aware Dictionary and sEntiment Reasoner\" sentiment analysis tool was used to evaluate post sentiment.</p><p><strong>Results: </strong>Posts most frequently discussed kidney (43.3%) and liver (18.3%) transplants. Most were authored by transplant recipients (66.5%) and centered on the posttransplant period (63.0%). Categorization of the 1000 most recent posts revealed 11 major themes: eligibility, pretransplant anticipation, logistics, early recovery, late recovery, medication, lifestyle, infection, seeking connection, sharing experience, and transplant in media. Over a third of posts sought Reddit user input on medical questions. Sentiment analysis demonstrated predominantly positive sentiment (0.25). The \"Top\" 100 posts had more positive sentiment (0.50) and focused on sharing experiences.</p><p><strong>Conclusions: </strong>Reddit serves as a platform for information exchange and support for the transplant community, addressing a wide range of pre- and posttransplant topics. Future work should explore ways to incorporate the real-world solutions offered by social media into formal healthcare practices.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 3","pages":"e1922"},"PeriodicalIF":1.9,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310375","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":"Lower Limit of Normal of Pulmonary Function to Define Baseline Lung Allograft Dysfunction.","authors":"Michael Gerckens, Susanne Simon, Carlo Mümmler, Paola Arnold, Jürgen Barton, Ali Önder Yildirim, Jürgen Behr, Nikolaus Kneidinger, Jens Gottlieb","doi":"10.1097/TXD.0000000000001913","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001913","url":null,"abstract":"<p><strong>Background: </strong>Subnormal lung function after lung transplantation (LTx) has increasingly been recognized as an independent risk factor for mortality. Historically, baseline lung allograft dysfunction (BLAD) has been defined using the fixed \"< 80% predicted\" threshold from population-wide reference equations, which disregards age- and sex-related variability in spirometric values and can lead to systematic overdiagnosis, particularly in older and female recipients. While the lower limit of normal (LLN), derived from Global Lung Initiative reference equations, has been accepted as technical standard in spirometry, it has not yet been applied to define BLAD.</p><p><strong>Methods: </strong>A retrospective multicenter study included LTx recipients transplanted between 2014 and 2018. Lung function trajectories and allograft survival were followed-up until August 2024. The association of BLAD defined by forced expiratory volume in 1 s (FEV1) or forced vital capacity (FVC) < LNN as time-dependent variable with graft loss was studied using time-dependent Cox proportional hazard models.</p><p><strong>Results: </strong>We analyzed 726 patients after LTx including 102 unilateral LTx recipients, of whom 470 (65%) of the cohort achieved normal baseline lung function defined as FEV1 and FVC ≥ LLN. Two hundred thirty-six patients experienced graft loss (n = 2 redo LTx) and 179 developed chronic lung allograft dysfunction. After adjusting for age, disease, transplant type, and chronic lung allograft dysfunction, baseline FEV1 or FVC < LLN was associated with graft loss (hazard ratio, 1.822; 95% confidence interval, 1.372-2.418; <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>BLAD defined by concurrent baseline FEV1 or FVC below the LLN was strongly associated with increased risk of graft loss. These findings extend prior studies that used the fixed 80% threshold by demonstrating that an LLN-based, age- and sex-adjusted definition of BLAD identifies lung transplant recipients at risk, thereby avoiding fixed cutoff associated age- and sex-bias.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 3","pages":"e1913"},"PeriodicalIF":1.9,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310390","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":"Cytomegalovirus-specific CD154-expressing T Cells are Present Before Transplantation in Cytomegalovirus-seronegative Recipients and Predict Early Cytomegalovirus DNAemia.","authors":"Lisa Remaley, Kyle Soltys, Tamara Fazzolare, Mylarappa Ningappa, Michael Green, Marian Michaels, Morgan Paul, Brianna Spishock, Dawn Wilkerson, Vikram Raghu, Brandon W Higgs, George Mazariegos, Ajay Khanna, Armando Ganoza, Geoffrey Bond, Chethan Ashokkumar, Rakesh Sindhi","doi":"10.1097/TXD.0000000000001923","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001923","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) antiviral drugs can cause side effects and promote the emergence of drug-resistance after transplantation. T cell-mediated immunity to CMV (CMI) can be used to limit and optimize the duration of antiviral therapy. However, interferon-gamma release assays show varying rates of CMI in CMV-seronegative recipients (R^-), who are at the highest risk of CMV infection with CMV-seropositive donors (D⁺). Here, we characterize CMI with CMV-specific T cells that express CD154 in R^- liver transplant and intestine transplant recipients.</p><p><strong>Methods: </strong>Pretransplant blood leukocyte samples from 42 R^- recipients were stimulated with a 15-mer overlapping peptide mixture representing the pp65 CMV antigen. CMI was measured by flow cytometry with CMV-specific CD154⁺ T-cell frequencies.</p><p><strong>Results: </strong>Recipients, median age (range) 3.3 (0.4-36.5 y), included 39 liver transplant and 3 intestine transplant. CMV serostatus was D⁺/R^- in 21, and D^-/R^- in 21. Protective CMI levels of >1.7% previously established in 142 liver or intestine recipients were observed in 25 of 42 total R^- recipients (60%), including 11 of 21 D⁺/R^- (52%) and 14 of 21 D^-/R^- (67%) participants. CMV DNAemia was observed in the first 60 d after transplantation in 10 of 42 (24%) R^- recipients, including 8 of 17 with CMI <1.7% and 2 of 25 with CMI >1.7%. Adjusted for D⁺/R^-, CMI<1.7% was independently associated with a higher risk of DNAemia (hazard ratio 6.04 [1.2-29.4], <i>P</i> = 0.026).</p><p><strong>Conclusions: </strong>CMV-specific T cells that express CD154 demonstrate protective levels of CMI in half of all seronegative recipients and can be used to optimize antiviral prophylaxis across all risk categories.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 3","pages":"e1923"},"PeriodicalIF":1.9,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310349","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":"Surveillance Donor-derived Cell-free DNA Allows for the Safe Reduction in Protocol Transbronchial Biopsies After Lung Transplantation.","authors":"Kashika Goyal, David J Ross, Bronwyn Small, Namita Trikannad, Sangeeta Bhorade, Justin P Rosenheck","doi":"10.1097/TXD.0000000000001901","DOIUrl":"10.1097/TXD.0000000000001901","url":null,"abstract":"<p><strong>Background: </strong>Protocol transbronchial biopsies (TBBx) are standard of practice (SOP) in most lung transplantation (LT) centers for surveillance of acute cellular rejection. In the context of higher LT center volumes, our program experienced increasing difficulty scheduling SOP protocol TBBx at months 1, 3, 6, 9, and 12 post-LT. As part of a Quality Assurance Performance Improvement initiative, we designed this prospective study to assess the efficacy and safety of adopting donor-derived cell-free DNA (dd-cfDNA) surveillance in lieu of protocol TBBx during the initial year after LT at our center.</p><p><strong>Methods: </strong>Enrolled LT patients with \"low-risk\" dd-cfDNA (<1.0%) had their 9-mo (9M) protocol TBBx omitted, whereas the 9M protocol TBBx was performed when dd-cfDNA indicated a \"high-risk\" result (≥1.0%) or for clinical indications. All patients received a protocol TBBx at 12M to assure detection of subclinical acute cellular rejection. We also assessed clinical data from the first year, including change in forced expiratory volume-1 s, donor-specific antibodies, and performed a health economic analysis.</p><p><strong>Results: </strong>Among 78 enrolled LT patients, 24 were \"high risk\" (8 with omitted 9M protocol TBBx because of clinical contraindications), and 54 \"low risk\" (41 with omitted 9M protocol TBBx) by dd-cfDNA. Of the patients with omitted 9M protocol TBBx, 10.2% (5/49) showed rejection at 12 mo compared with 20.7% (6/29), at either the 9M or 12M protocol TBBx. Median change in forced expiratory volume-1 s (baseline-12M) was similar between \"high-risk\" and \"low-risk\" cohorts (<i>P</i> = 0.592) and for \"omitted\" versus \"performed\" 9M protocol TBBx cohorts (<i>P</i> = 0.271).</p><p><strong>Conclusions: </strong>Our Quality Assurance Performance Improvement study offered assurances for safety, efficacy, and reduction in healthcare costs when implementing SOP dd-cfDNA surveillance, with a >75% reduction in 9M protocol TBBx procedures among patients who were \"low risk\" by dd-cfDNA.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 2","pages":"e1901"},"PeriodicalIF":1.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967315","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":"Consensus-based Recommendations on the Management of Immunosuppression After Squamous Cell Carcinoma Diagnosis in Kidney Transplant Recipients: An International Delphi Consensus Statement.","authors":"Melodi Javid Whitley, Jake X Wang, Jeremy Chapman, Aiko P J de Vries, Sindhu Chandran, Colleen M Glennon, Hector M Madariaga, Robert P Carroll, John Booth, Beatrice Concepcion, Lionel Couzi, Sacha A De Serres, Alden Doyle, Suzanne Forbes, Jonathan M Gleadle, Sian Griffin, Lakshman Gunaratnam, Gaurav Gupta, Julie Ho, Peter Hughes, Nicole Isbel, Dev K Jegatheesan, Gareth Jones, Dirk Kuypers, Brian Lee, Wai Lim, Phil Mason, Maria Meneghini, Itunu Owoyemi, Swati Rao, Alan Salama, Adnan Sharif, Olivier Thaunat, Raj Thuraisingham, Kate Wyburn, Julie M Yabu, Anokhi Jambusaria-Pahlajani, Matthew J Bottomley, Sarah T Arron","doi":"10.1097/TXD.0000000000001893","DOIUrl":"10.1097/TXD.0000000000001893","url":null,"abstract":"<p><strong>Background: </strong>Posttransplant immunosuppression in kidney transplant recipients is associated with an increased risk of developing cutaneous squamous cell carcinoma (CSCC), contributing to significant morbidity and mortality. Various dermatological and immunosuppression modulation strategies have been identified that may reduce the risk of CSCC, both in primary and secondary prevention settings. Recent recommendations have provided consensus regarding dermatological approaches to prevent CSCC. Comparable transplant nephrology recommendations to guide immunosuppression modulation for CSCC prevention are currently lacking, leading to marked variation in practice.</p><p><strong>Methods: </strong>To address this knowledge gap, 46 international transplant nephrology experts participated in a 3-round Delphi survey to develop consensus recommendations for CSCC secondary prevention based on the actinic damage and skin cancer index stages of CSCC.</p><p><strong>Results: </strong>The panel of experts reached consensus to consider a change in immunosuppression after multiple low-risk invasive CSCC (stage 5a, 1/y >3 y) and encouraged collaboration with dermatology to optimize dermatologic preventative care after the first CSCC. There was also consensus to prioritize azathioprine modification where this is present in an immunosuppressive regimen.</p><p><strong>Conclusions: </strong>This study provides the first international consensus recommendations for management of immunosuppression in kidney transplant recipients at discrete stages of CSCC. Additional prospective studies are necessary to determine the optimal management of immunosuppression in this patient population. These recommendations have been endorsed by the Board of the American Society of Transplantation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 1","pages":"e1893"},"PeriodicalIF":1.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145782959","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":"Biopsy and Blood Gene Expression Distinguish Injury, Subclinical and Clinical Rejection in Kidney Transplant Recipients.","authors":"Sunil M Kurian, Christabel N Rebello, Sook Hyeon Park, Raymond L Heilman, Emilio D Poggio, Michael M Abecassis, Christopher L Marsh, John J Friedewald","doi":"10.1097/TXD.0000000000001892","DOIUrl":"10.1097/TXD.0000000000001892","url":null,"abstract":"<p><strong>Background: </strong>Long-term outcomes in kidney transplantation remain suboptimal, with subclinical acute rejection (subAR) frequently going undetected by conventional methods. We hypothesized that subAR represents a molecular precursor to clinical acute rejection (cAR). Leveraging a large National Institutes of Health-funded cohort with matched kidney tissue and peripheral blood samples, our primary objective was to determine whether subAR and cAR share molecular patterns, establishing subAR as an early stage of cAR. As a secondary aim, we compared biopsy and blood gene expression profiles to identify unique and shared pathways and to assess their diagnostic utility.</p><p><strong>Methods: </strong>This was a retrospective analysis of gene expression data from an observational clinical trial. We analyzed 578 blood and biopsy samples from 129 kidney transplant recipients enrolled in a multicenter observational study. Gene expression differences were analyzed using ANOVA with false discovery rate correction and molecular pathways analysis. Samples were matched and classified based on histologic findings and blood-based molecular diagnostics.</p><p><strong>Results: </strong>Gene expression and pathway analyses revealed that subAR exhibits a molecular profile consistent with a milder form of clinical rejection in both tissue and blood. Molecular signatures distinguished immune-mediated injury from nonimmune injury. Notably, tissue gene expression profiling in cases that were misclassified by peripheral blood diagnostics were like correctly classified cases, suggesting that histology alone may not reliably define true clinical phenotypes.</p><p><strong>Conclusions: </strong>Molecular profiling of tissue and blood reflects distinct but complementary aspects of transplant biology and confirms that subAR and cAR share overlapping molecular profiles, supporting the hypothesis that subAR represents an early stage in the progression toward clinical rejection. These findings highlight the limitations of relying solely on histological evaluation and support the use of molecular tissue profiling as an adjunct to histology, particularly in diagnostically ambiguous cases. Molecular profiling provides a supporting framework for identifying subclinical rejection and guiding personalized immunosuppression to improve long-term outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 1","pages":"e1892"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12705056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769253","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":"Erratum: Association Between Donor-recipient Matchability, Access to Transplantation, and Posttransplant Outcomes: Erratum.","authors":"Rowena Lalji, Ryan Gately, Ross Francis, Wai Lim, Scott Campbell, Narelle Watson, Gary Torrens, Anna Francis, Germaine Wong, David W Johnson","doi":"10.1097/TXD.0000000000001889","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001889","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/TXD.0000000000001862.].</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 12","pages":"e1889"},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12657042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640098","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":"Erratum: Exploring the Molecular Mechanisms of Autophagy-related Genes in Hepatic Ischemia/Reperfusion Injury Using Bioinformatics: Erratum.","authors":"Qi Xiao, Xiaoxiao Hu, Qiong Chen, WenYu Wang, JianSheng Xiao, Biqi Fu","doi":"10.1097/TXD.0000000000001885","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001885","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/TXD.0000000000001829.].</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 12","pages":"e1885"},"PeriodicalIF":1.9,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640184","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":"Association Between Donor-recipient Matchability, Access to Transplantation, and Posttransplant Outcomes.","authors":"Rowena Lalji, Ryan Gately, Ross Francis, Wai Lim, Scott Campbell, Narelle Watson, Gary Torrens, Anna Francis, Germaine Wong, David W Johnson","doi":"10.1097/TXD.0000000000001862","DOIUrl":"10.1097/TXD.0000000000001862","url":null,"abstract":"<p><strong>Background: </strong>Globally, deceased donor kidney allocation algorithms prioritize HLA matching, potentially disadvantaging transplant candidates with less common HLA alleles. This study developed an Australian Matchability score (M-score) to assess access to transplantation and posttransplant outcomes based on HLA match probability.</p><p><strong>Methods: </strong>M-scores were calculated by comparing all recipients and donors with complete HLA-A, HLA-B, and HLA-DR data from the Australia and New Zealand Dialysis and Transplant Registry (July 1, 2006-December 31, 2023). Multivariable Cox regression was used to analyze associations between M-score quartiles and time to transplantation as well as transplantation outcomes.</p><p><strong>Results: </strong>HLA data from 14 836 recipients and 7708 donors were used to generate M-scores. Of these, 10 760 recipients had available waitlist data and were included in the models. M-scores were normally distributed with a mean ± SD of 11.4 ± 0.9. The proportion of non-European Australians increased significantly with each quartile (ie, more difficult to HLA match), Q1: 16%, Q2: 26%, Q3: 40% Q4: 60% (<i>P < </i>0.001). Compared with Q1, patients in Q4 were significantly less likely to receive a deceased donor kidney transplant (adjusted hazard ratio [aHR] 0.56; 95% confidence interval [CI], 0.52-0.60; <i>P < </i>0.001) had the highest risk of death-censored graft loss (aHR 1.39; 95% CI, 1.01-1.91; <i>P</i> = 0.05) and acute rejection (aHR, 1.29; 95% CI, 1.09-1.52; <i>P = </i>0.002).</p><p><strong>Conclusions: </strong>The M-score identifies transplant recipients with difficult-to-match HLA profiles. Higher M-scores were associated with a lower likelihood of transplantation and an increased risk of death-censored graft loss and acute rejection. These findings highlight significant inequities in the current HLA-based algorithm for deceased donor allocation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 11","pages":"e1862"},"PeriodicalIF":1.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259204","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}