Transplantation Direct最新文献

{"title":"Optimizing Lung Transplant Logistics Using Controlled Hypothermic Preservation to Extend Ischemic Time.","authors":"Mena M Botros, Alhusain Alsaghayer, Christopher Tanabe, Karla McElroy, Ahmad Goodarzi, Simon K Yau, J Georges Youssef, George Naufal, Dewei Ren, Ray Chihara, Erik E Suarez, Yuncan A He, Howard J Huang","doi":"10.1097/TXD.0000000000001966","DOIUrl":"10.1097/TXD.0000000000001966","url":null,"abstract":"<p><strong>Background: </strong>Effective organ preservation before transplantation is pivotal for successful outcomes but can be limited by logistics. Organs are primarily preserved by flushing with a cold solution and storing on ice, then transplanted within 8 h of procurement. Controlled hypothermic preservation (CHP) at 4-8 °C has increasingly been used to extend ischemic times. Here we compared early outcomes of transplants using CHP (n = 41) and traditional preservation on ice (n = 41).</p><p><strong>Methods: </strong>Our institution used LUNGguard, a CHP device by Paragonix, for the extension of ischemic time to optimize operating room (OR), transplant team, and recipient logistics. We evaluated 1-y mortality, primary graft dysfunction, length of stay, time to liberation from mechanical ventilation, and time on oxygen support.</p><p><strong>Results: </strong>There were no differences in patient outcomes between storage on ice and CHP. In selected cases, extending ischemic times using CHP allowed for additional organ procurement as well as improved OR logistics.</p><p><strong>Conclusions: </strong>In our experience, CHP has been shown to be a safe and effective method of extending ischemic times in donor lungs, allowing for increased donor acceptance and improved OR efficiency. This supports a growing body of evidence favoring a shift from ice to CHP as the standard for donor lung storage in cases of extended ischemic time.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1966"},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391793","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":"Outcomes of Single Pediatric Kidney Grafts: An Experienced Single-center Retrospective Study.","authors":"Patrick J Sur, Noor Dawany, Yvonne M Kelly, Adam C Cerise, Lea Matsuoka, Sophoclis P Alexopoulos, Junichiro Sageshima, Richard V Perez, Naeem Goussous","doi":"10.1097/TXD.0000000000001979","DOIUrl":"10.1097/TXD.0000000000001979","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation (KTx) is superior to dialysis but is limited by organ shortages. Kidneys from pediatric donors, whether single or en bloc, have excellent outcomes but are underutilized, with little consensus on splitting pediatric en bloc grafts.</p><p><strong>Methods: </strong>A single-center retrospective review of all deceased donor KTx using single kidneys from pediatric donors weighing ≤20 kg between 2005 and 2023 was performed. Recipients were compared based on donor weight: <15 and ≥15 kg. Data are presented as medians (interquartile range) and numbers (percentages).</p><p><strong>Results: </strong>Seventy-two recipients were identified, with 36 (50%) males and a median age of 48.3 y at KTx. Donor weight ranged between 7 and 20 kg, with 24 patients receiving a single graft from donors <15 kg and 48 having received a single graft from donors ≥15 kg. Kidney length measured 6-9 cm, with those in the <15 kg group having significantly shorter kidney length relative to those in the ≥15 kg group (7 versus 7.5 cm; <i>P</i> = 0.05). Both Kidney Donor Profile Index (60 versus 50; <i>P</i> = 0.002) and use of hypothermic machine perfusion (96 versus 63%; <i>P</i> = 0.002) were significantly higher in the <15 kg group. Primary nonfunction was significantly higher in the <15 kg group (12.5% versus 0.0%; <i>P</i> = 0.03). One graft was lost because of thrombosis in the ≥15 kg group. There was no difference in graft survival between weight groups, with 5-y graft survival approaching 91% for the entire cohort.</p><p><strong>Conclusions: </strong>Our center's experience demonstrates that single pediatric kidney grafts from donors carry excellent long-term outcomes, especially in donors >15 kg. However, single grafts from donors <15 kg carried a higher risk of primary nonfunction and should be approached with particular caution regarding donor quality and cold ischemia time.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 8","pages":"e1979"},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391763","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":"Persistent Financial Burdens and High Donor Satisfaction Among Living Liver Donors: A 24-y Single-center Study.","authors":"Piper Stacey, Ahmed Akoad, Sarah Meade, Mohamed Akoad","doi":"10.1097/TXD.0000000000001971","DOIUrl":"10.1097/TXD.0000000000001971","url":null,"abstract":"<p><strong>Background: </strong>Prior investigations on living donor hepatectomy have primarily focused on medical and psychosocial outcomes, with limited evaluation of financial implications. Financial support systems exist, but these are limited by strict income criteria, leaving some donors ineligible. This study sought to characterize donor-reported quality of life with a focus on postdonation financial burden.</p><p><strong>Methods: </strong>Over a 24-y period, 402 living donor hepatectomies were performed at a single institution. In 2024, donors were contacted by telephone and surveyed regarding their postdonation experiences, with up to 3 attempts made >3 wk.</p><p><strong>Results: </strong>Of the 129 respondents (32%), 24 reported adverse financial consequences of donation, most commonly lost wages (n = 18). Donors reported a median absence from work of 10 wk (mean, 11.2; SD, 8.3). Additional burdens included costs of travel, lodging, and follow-up care. Six donors reported difficulty obtaining life insurance, and 2 experienced increased premiums attributable to donation-related complications. Thirty-four donors experienced medical complications attributed to donation, including hernias, gastrointestinal upset, and liver-related complications. Despite these issues, 98.4% would donate again, 97% expressed satisfaction, and 93.7% would recommend donation.</p><p><strong>Conclusions: </strong>Living liver donors consistently reported satisfaction despite persistent financial challenges. Prospective living liver donors should be counseled during donor evaluation for the potential of financial difficulties during the donation process. Future efforts should focus on derisking the donation process by addressing nonmedical complications, such as wage loss and insurance discrimination, to better support the living donor population.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1971"},"PeriodicalIF":2.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405912","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":"Prevent or Treat? Evaluating a Delayed Treatment With Nintedanib After Murine Orthotopic Tracheal Transplantation.","authors":"Julia Mauer, Cindy Graebner, Annika Kuckhahn, Martina Ramsperger-Gleixner, Michael Weyand, Christian Heim","doi":"10.1097/TXD.0000000000001967","DOIUrl":"10.1097/TXD.0000000000001967","url":null,"abstract":"<p><strong>Background: </strong>Chronic lung allograft dysfunction significantly impairs long-term lung transplant survival. Bronchiolitis obliterans syndrome is a chronic lung allograft dysfunction phenotype characterized by fibroproliferative changes in noncartilaginous airways. We previously demonstrated that the tyrosine kinase inhibitor nintedanib reduces chronic airway changes in murine tracheal allografts. In this study, we investigated whether delayed treatment, similar to the clinical scenario following lung transplantation, would still be beneficial.</p><p><strong>Methods: </strong>Recipient CBA/JRj mice received orthotopic tracheal transplants from donor C57BL/6JRj mice. A dosage of 60 mg/kg of nintedanib was administered orally to transplanted mice every day between days 14 and 29 after transplantation. Histological and immunofluorescence analyses, as well as intragraft gene expression measurements, were performed after 14 and 30 d.</p><p><strong>Results: </strong>Delayed-treated tracheal allografts (nintedanib 14-30) exhibited less evidence of chronic rejection than untreated allografts on day 30 (control 30). This is demonstrated by an increased epithelium-to-lamina propria ratio (0.62 ± 0.16 [nintedanib 14-30] versus 0.50 ± 0.01 [control 30]; <i>P</i> < 0.05), with a reduction in CD4⁺ T cell, dendritic cell, and macrophage infiltration. Furthermore, intragraft gene expression of inflammatory cytokines, adhesion molecules, and growth factors was also lowered. While allografts treated immediately (nintedanib 30) demonstrated a comparable epithelium-to-lamina propria ratio to the nintedanib 14-30 group, earlier treatment resulted in considerably lower infiltration of CD4⁺ and CD8⁺ T cells as well as alpha smooth muscle actin expression.</p><p><strong>Conclusions: </strong>Even delayed nintedanib therapy has an attenuating effect on chronic inflammation but is less effective regarding the fibroproliferative changes that are considered a sign of chronic airway changes after murine tracheal transplantation. Thus, it may serve as supportive therapy in the clinical setting after lung transplantation, but earlier initiation might be more effective.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1967"},"PeriodicalIF":2.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319201","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":"Reevaluating Donor-recipient Sex Mismatch and Survival After Liver Transplantation: A Contemporary Cohort Study.","authors":"Nicola Sariye Pollmann, Catherine Parmentier, Falk Rauchfuß, Utz Settmacher, Lukas Pollmann, Markus Selzner","doi":"10.1097/TXD.0000000000001968","DOIUrl":"10.1097/TXD.0000000000001968","url":null,"abstract":"<p><strong>Background: </strong>Identifying an optimally matched donor is a critical determinant of outcomes following liver transplantation (LT). Several donor- and recipient-related factors have been shown to influence posttransplant survival. However, the impact of donor-recipient sex mismatch (DRSM) on long-term outcomes remains controversial, with inconsistent findings reported across prior studies. This study aimed to further clarify the contemporary role of DRSM in LT outcomes.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study including 1146 adult patients who underwent LT at the Ajmera Transplant Centre, Toronto, between January 2014 and January 2022. Donor and recipient characteristics, including age, sex, and donor type, were analyzed. The primary outcome was patient survival up to 10 y of follow-up. Comparative analyses were performed between recipients with mismatch (DRSM+) and those without (DRSM-), as well as relevant subgroup analyses.</p><p><strong>Results: </strong>In unadjusted survival analysis, recipients in the DRSM+ group demonstrated slightly higher survival compared with DRSM- recipients up to 10 y following LT (<i>P</i> = 0.018). However, after multivariable adjustment and propensity score matching, survival was comparable between groups, and DRSM was not identified as an independent predictor of mortality. Subgroup analyses showed no adverse effect of DRSM in deceased donor transplantation (<i>P</i> = 0.547), while a survival difference was observed in the living donor cohort (<i>P</i> < 0.001). In addition, female recipients exhibited improved survival compared with male recipients, irrespective of DRSM.</p><p><strong>Conclusions: </strong>DRSM does not appear to be an independent risk factor for reduced long-term survival after LT. Moreover, the composition of favorable recipient and donor characteristics seems to be the main factors influencing long-term survival. These findings suggest that DRSM alone should not preclude donor selection in clinical practice.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1968"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13282083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296421","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":"Normothermic Regional Perfusion in Controlled Donation After Circulatory Death and its Impact on Postreperfusion Syndrome in Liver Transplantation Compared With Brain-dead Donors: A Retrospective Comparative Study.","authors":"Hélène Platteeuw, Alexandre Bourgeois, Cédric Cirenei, Charlotte Geay, Anne Bignon, Maxime Leroy, Hélène Béhal, Sébastien Dharancy, Emmanuel Boleslawski, Gilles Lebuffe, Damien Rousseleau","doi":"10.1097/TXD.0000000000001965","DOIUrl":"10.1097/TXD.0000000000001965","url":null,"abstract":"<p><strong>Background: </strong>Controlled donation after circulatory death (cDCD) increases graft availability but may carry higher perioperative risk, which in situ normothermic regional perfusion (NRP) may mitigate by reducing ischemia-reperfusion injury. Evidence remains limited regarding NRP impact on PRS during liver transplantation (LT). The objective of this study was to compare the incidence of PRS and early postoperative outcomes between cDCD LT with NRP and donation after brain death (DBD) LT.</p><p><strong>Methods: </strong>This was a retrospective, single-center observational study comparing cDCD LT with NRP versus DBD LT. The primary endpoint was PRS (≥30% mean arterial pressure decrease for ≥1 min within 5 min of reperfusion). Secondary endpoints included early allograft dysfunction, acute kidney injury (AKI), rejection, biliary/vascular complications, and survival. Associations between graft type and outcomes were assessed using logistic regression (binary) and linear regression (continuous), and Cox models (time-to-event), with multivariable adjustment for clinically relevant covariates.</p><p><strong>Results: </strong>Among 106 recipients (cDCD n = 47; DBD n = 59), PRS occurred 27 patients (25.5% versus 25.4%). Graft type was not associated with PRS after adjustment (odds ratio, 1.13; 95% confidence interval, 0.41-3.10; <i>P</i> = 0.81). No significant differences were observed in early allograft dysfunction, acute rejection, AKI, or biliary and vascular complications. There was 1 death in the cDCD group and 5 in the DBD group (2.1% versus 8.5%).</p><p><strong>Conclusions: </strong>In a standardized program using routine NRP, cDCD LT did not increase PRS risk and achieved early outcomes comparable to DBD LT. These findings suggest clinical feasibility and short-term safety of Maastricht III protocols incorporating NRP.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1965"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13282067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296445","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":"The Changing Paradigm of Good Samaritan Kidney Donation in the United States.","authors":"Garet Hil, Janny Fonk, Alvin G Thomas, Jeffrey L Veale","doi":"10.1097/TXD.0000000000001962","DOIUrl":"10.1097/TXD.0000000000001962","url":null,"abstract":"<p><strong>Background: </strong>The practice of living donor kidney transplantation has evolved through innovations in logistics, technology, and clinical practice. In the United States, Good Samaritan donation, a historical label exclusive to nondirected donors, now incorporates voucher-based models.</p><p><strong>Methods: </strong>To determine how voucher-based nondirected living kidney donation has influenced the volume and practice of Good Samaritan living kidney donation in the United States, we analyzed living donor kidney transplants from 2000 to 2024 using data from the National Kidney Registry (103 transplant centers) and the Scientific Registry of Transplant Recipients. Temporal trends were derived by linear regression.</p><p><strong>Results: </strong>We identified 4662 Good Samaritan living donor kidney transplants, defined as historical nondirected and novel voucher-based nondirected donations. Of 2131 Good Samaritan living donor kidney transplants facilitated by the National Kidney Registry, donors had a median age of 43 y, were predominantly of White race (93%), and were women (60%). Recipients had a median age of 52 y and were racially and ethnically diverse (63% White, 14% Black, and 10% Hispanic). Annual Good Samaritan donation counts in the United States increased from 17 in 2000 to 439 in 2024, corresponding to a growth rate of 14.5%. Voucher-based nondirected donations increased from 2 in 2015 to 314 in 2024, comprising 72% of all Good Samaritan donations in that year.</p><p><strong>Conclusions: </strong>The advent of voucher-based nondirected donation correlated with growth in Good Samaritan donation volume. Given the prevalence of voucher-based donations, connecting local kidney paired donation practices to voucher-based nondirected donation may improve access to and participation in living kidney donation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1962"},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13282066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296374","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":"Optimization of Valganciclovir for Treatment of Cytomegalovirus Infection in Pediatric Liver Transplant Recipients: A Prospective Pharmacokinetic Study.","authors":"Kensuke Shoji, Jumpei Saito, Ryohei Futatsugi, Tatsuki Ikuse, Taketo Kasai, Toshihiro Matsui, Masaki Yamada, Chikara Ogimi, Hajime Uchida, Akinari Fukuda, Seisuke Sakamoto, Mureo Kasahara","doi":"10.1097/TXD.0000000000001964","DOIUrl":"10.1097/TXD.0000000000001964","url":null,"abstract":"<p><strong>Background: </strong>Valganciclovir (VGCV) is the first-line therapeutic agent for cytomegalovirus (CMV) infection following pediatric liver transplantation (LT). The dosage for pediatric patients is either determined by body weight (BW dose) or body surface area (BSA) and renal function (7 × BSA [m²] × creatinine clearance (CrCl) [mL/min/1.73 m²]) (BSA dose). However, the optimal dosing strategy for achieving target drug exposure for CMV treatment remains unclear.</p><p><strong>Methods: </strong>We conducted a prospective pharmacokinetic study in pediatric LT patients. The area under the concentration-time curve (AUC_0-24) was estimated using previously reported pediatric population pharmacokinetic parameters. An AUC_0-24 of 80-120 µg·h/mL was defined as the therapeutic target. The primary endpoint was to compare the achievement rate of target AUC between BW and BSA doses. Although BW dose is the standard at our institution, a hypothetical BSA dose was estimated proportionally for comparison with BW dose.</p><p><strong>Results: </strong>Fourteen patients with a median age of 1.1 y were included. The median VGCV dose was 15.3 mg/kg, whereas the hypothetical median BSA dose was 24.5 mg/kg. The estimated AUC_0-24 in BW and BSA dose groups were as follows: <80 µg·h/mL, 85.7% and 35.7%; 80-120 µg·h/mL, 14.3% and 42.9%; >120 µg·h/mL, 0.0% and 21.4% (<i>P</i> = 0.027). There was a negative correlation between AUC_0-24 and the duration of CMV viremia, indicating that higher AUC values were associated with faster viral clearance (ρ = -0.72, <i>P</i> = 0.003).</p><p><strong>Conclusions: </strong>Based on our estimation, BSA dosing may be more likely to achieve the target AUC_0-24 compared with BW dosing in infant/toddler LT recipients. Higher AUC values correlated with faster viral clearance.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1964"},"PeriodicalIF":2.2,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405885","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":"From Preservation to Repair: A Systematic Review of Therapeutic Organ Rehabilitation During Normothermic Ex Vivo Machine Perfusion.","authors":"Syed Sikandar Raza, Caitlin M Bocks, Spencer G Amacher, Kristopher B Deatrick, Yuliya Tipograf, Alvaro Rojas-Peña","doi":"10.1097/TXD.0000000000001961","DOIUrl":"10.1097/TXD.0000000000001961","url":null,"abstract":"<p><strong>Background: </strong>Normothermic ex vivo machine perfusion (NMP) enables active organ rehabilitation rather than passive preservation. While lung perfusion represents the most mature therapeutic paradigm, kidney, liver, and heart applications are emerging. This review examines therapeutic interventions during NMP across these organs to identify shared mechanisms and translational gaps.</p><p><strong>Methods: </strong>Following PROSPERO registration (CRD420251134637), a PRISMA-compliant search of PubMed, Web of Science, and Embase identified 3336 records. After screening, 155 articles underwent full-text review for inclusion of therapeutic delivery during NMP. Data extraction captured intervention characteristics, perfusion parameters, and outcomes across predefined domains.</p><p><strong>Results: </strong>Twenty-one studies met inclusion criteria: kidney (n = 12, 57%), liver (n = 8, 38%), and heart (n = 1, 5%). Models were predominantly human (n = 13, 62%) or porcine (n = 6, 29%). Interventions included pharmacologic agents (n = 12, 57%), cellular/subcellular therapies (n = 6, 29%), defatting protocols (n = 2, 10%), and circuit modifications (n = 1, 5%). Three mechanistic themes emerged: (1) mitochondrial resuscitation via agents such as AP39 preserved ATP and reduced oxidative stress; (2) immune modulation through CD47 blockade or cytokine hemoadsorption attenuated inflammation; and (3) regenerative approaches using mesenchymal stromal cells to repair structural injuries. Molecular improvements were reported in 95% of studies, but functional improvement in only 38%, revealing an outcome translation gap. Only 19% of studies included posttransplant validation.</p><p><strong>Conclusions: </strong>NMP has enabled effective metabolic and inflammatory reprogramming in kidney and liver perfusion, while cardiac applications lag behind. Standardized reporting, organ-specific functional endpoints, and transplant-linked validation are needed to convert currently rejected organs into viable grafts and expand the effective donor pool.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1961"},"PeriodicalIF":2.2,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228309","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":"Pancreas Transplantation for Recipients with Type 2 Diabetes Mellitus: Results of an International Survey.","authors":"Jonathan A Fridell, Pablo D Uva, Aleksandra Kukla, Ava DeLonais-Parker, Rushda Faruk Mansuri, David Axelrod, Ty Dunn, Silke V Niederhaus, Ronald Parsons, Henry Pleass, Steven Paraskevas, Michael R Rickels, Robert J Stratta, Pedro Ventura-Aguiar, Kenneth J Woodside, Krista L Lentine","doi":"10.1097/TXD.0000000000001963","DOIUrl":"10.1097/TXD.0000000000001963","url":null,"abstract":"<p><strong>Background: </strong>Pancreas transplantation (PT), historically limited to patients with type 1 diabetes (T1D), is currently performed successfully in selected patients with type 2 diabetes (T2D). However, contemporary practice patterns and eligibility criteria for PT in T2D remain incompletely characterized.</p><p><strong>Methods: </strong>The International Pancreas and Islet Transplant Association Pancreas Transplant Interest Group developed an electronic survey to assess center-level approaches to patient phenotyping, candidacy, and peri- and posttransplant management for PT in patients with T2D. The survey was distributed to international transplant professionals during an International Pancreas and Islet Transplant Association Pre-Congress meeting on June 15, 2025.</p><p><strong>Results: </strong>Thirty-seven participants completed the survey. Most respondents' programs offer PT for T2D only when a kidney transplant is also indicated. Fewer respondents' programs also offer PT alone (10%), evaluate T2D candidates on a case-by-case basis (3%), or do not offer PT to patients with T2D (10%). Total daily insulin requirement and body mass index (BMI) were the most selected factors in determining eligibility. Considerable variability existed in metabolic thresholds: 62% of programs reported no C-peptide cutoff, whereas nearly half required a BMI of <30 kg/m² for C-peptide-positive candidates. Respondents frequently recommend weight-optimization strategies, including lifestyle modification, glucagon-like peptide-1 receptor agonists, and bariatric surgery for candidates exceeding acceptable BMI thresholds. Surgical technique, induction, and maintenance immunosuppression and early posttransplant glycemic management were largely uniform between T2D and T1D recipients.</p><p><strong>Conclusions: </strong>International practice reflects broad but heterogeneous adoption of PT for T2D, with most participants restricting its use to candidates requiring kidney transplantation and emphasizing integrated clinical phenotyping approaches.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1963"},"PeriodicalIF":2.2,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200012","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}