Transplantation Direct最新文献

{"title":"CTLA4-Ig + Anti-IL-6/IL-6R Treatment Results in Long-term Allograft Survival and Function in Highly HLA-sensitized Patients.","authors":"Stanley C Jordan, Sindhu Chandran, Noriko Ammerman, Edmund Huang, Jun Shoji, Xiaohai Zhang, Alice Peng, Bongha Shin, David Thomas, Reiad Najjar, Sanjeev Kumar, Peter Heeger, Ashley Vo","doi":"10.1097/TXD.0000000000001952","DOIUrl":"10.1097/TXD.0000000000001952","url":null,"abstract":"<p><strong>Background: </strong>Highly HLA-sensitized (HS) patients are at increased risk for cell-mediated rejection (CMR)/antibody-mediated rejection (AMR) posttransplant and require intense immunosuppression to prevent these events. HS patients who experience calcineurin inhibitor (CNI) neuro/nephrotoxicity have few options as conversion to CNI-free regimens with cytotoxic T-lymphocyte-associated antigen (CTLA4)-Ig may risk donor specific antibody (DSA) rebound, CMR, and AMR. This remains an unmet medical need. Anti-interleukin (IL)-6/IL-6R treatment is useful in treating AMR and CMR and preventing rejection in HS patients after transplantation (tx). Here, we examined the utility of combining CTLA4-Ig with anti-IL-6/IL-6R treatment in 4 HS patients with CNI toxicity.</p><p><strong>Methods: </strong>Four HS patients (3 with calculated panel reactive antibodies >97% at tx and 1 who developed chronic-active AMR (c-aAMR) 14 y post-tx were evaluated. Two patients, 100% calculated panel reactive antibody and +flow crossmatch at transplantation, were desensitized with plasma exchange + clazakizumab (anti-IL-6) and maintained on clazakizumab post-tx and transitioned from CNI to CTLA4-Ig. Two patients treated with anti-IL-6R (tocilizumab) were transitioned to CTLA4-Ig at 2 and 11 y post-tx. Patients were monitored for renal function (RF), DSA, de novo DSA (dn-DSA), immune cell subsets, and patient and graft survival.</p><p><strong>Results: </strong>Clazakizumab and tocilizumab treated patients showed improvements in RF, with elimination of existing DSAs, except for 1 patient and no dn-DSAs (>6 y). We also saw reductions in CD8⁺ T_EFF/MEM, T_FH, B_MEM, and NK cells post-CTLA4-Ig + Anti-IL-6/IL-6R treatment. T_REG and B_REG cell populations also increased, suggesting, but not confirming, possible immune modulation.</p><p><strong>Conclusions: </strong>Combining CTLA4-Ig + anti-IL-6/IL-6R appears to offer benefits in sustaining RF, DSA reduction, possibly immune cell modulation, and prevention of dn-DSA. Importantly, CNI toxicity abated in all patients.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1952"},"PeriodicalIF":2.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13232908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164548","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 Time-varying Impact of Pancreas Graft Failure on Mortality and Kidney Graft Outcomes in Simultaneous Pancreas and Kidney Transplantation.","authors":"Christie Rampersad, Jeffrey Schiff, Chaya Shwaartz, S Joseph Kim","doi":"10.1097/TXD.0000000000001942","DOIUrl":"10.1097/TXD.0000000000001942","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous pancreas-kidney transplantation improves survival and glycemic control in insulin-dependent diabetes, but pancreas graft failure remains common, and its evolving impact on patient survival and downstream kidney outcomes is inadequately defined.</p><p><strong>Methods: </strong>Using 2013-2022 US Scientific Registry of Transplant Recipients data, we treated pancreas death-censored graft failure (DCGF) as a time-dependent exposure in Cox models for mortality, and kidney all-cause graft failure and DCGF. Early (≤1 y) and landmark (>1 y) analyses addressed nonproportional hazards. Sensitivity analyses conducted on post-March 2018 standardized failure definitions and technical failures. Subgroup analyses analyzed age, sex, and diabetes type. In a 1-y landmark subcohort with intact grafts, we analyzed associations between subsequent kidney DCGF and 5-y mortality.</p><p><strong>Results: </strong>Pancreas DCGF occurred in 1013 recipients (5-y incidence 13.7%), predominantly within 1 y (33% technical), conferring increased mortality early (hazard ratio [HR] 2.97; 95% confidence interval [CI], 2.04-4.34) and sustained risk beyond 1 y (HR 2.47; 95% CI, 1.87-3.25), with similar findings post-2018. Technical DCGF carried modest risk (HR 1.56; 95% CI, 1.16-2.09). Pancreas DCGF was also associated with kidney all-cause graft failure (HR 2.33; 95% CI 2.01, 2.69) and DCGF (HR 2.70; 95% CI, 2.25-3.25). In those with intact grafts at 1 y, kidney DCGF conferred markedly higher 5-y mortality (HR 9.37; 95% CI, 7.04-12.48). Younger recipients exhibited slightly greater relative mortality risk after pancreas DCGF (ratio of HR 1.10).</p><p><strong>Conclusions: </strong>Pancreas DCGF is common and independently heralds substantially increased risks of death and kidney graft loss, whereas kidney failure further amplifies mortality, underscoring the need for enhanced risk stratification, prevention, and post-failure management to optimize long-term simultaneous pancreas-kidney outcomes. Younger recipients also faced a higher relative mortality risk after pancreas failure, highlighting a vulnerable subgroup requiring further study.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 7","pages":"e1942"},"PeriodicalIF":2.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13232909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164631","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":"Sequential Computed Tomography Morphometry-derived Muscle Loss Is Associated With Kidney Dysfunction and Mortality in Kidney Transplant Recipients Undergoing Serial Clinically Indicated Computed Tomography Imaging.","authors":"Dominik Kylies, Julian Kylies, Fabian Haas, Isabel Molwitz, Tobias B Huber, Malte A Kluger, Florian Grahammer","doi":"10.1097/TXD.0000000000001956","DOIUrl":"10.1097/TXD.0000000000001956","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is the optimal treatment for end-stage kidney disease, yet long-term outcomes remain heterogeneous, underscoring the need for improved clinical risk stratification. Sarcopenia assessed by computed tomography (CT)-based morphometry has emerged as a promising biomarker across multiple conditions, including solid organ transplantation. Importantly, muscle metrics can be derived from CT scans obtained for clinical indications, enabling opportunistic screening without additional imaging burden. However, longitudinal muscle trajectories after kidney transplantation derived from indication-driven CT imaging and their associations with graft dysfunction and survival remain poorly characterized.</p><p><strong>Methods: </strong>In this retrospective single-center study, CT morphometry at the L3 level was analyzed in kidney transplant recipients who underwent 2 clinically indicated abdominal CT scans. Skeletal Muscle Index, Paraspinal Muscle Index, Psoas Muscle Index, and visceral adipose tissue were quantified. Longitudinal changes between both time points were related to kidney allograft dysfunction, defined as major adverse kidney events, and overall survival. Survival analyses were performed using Kaplan-Meier estimates and Cox proportional hazards models.</p><p><strong>Results: </strong>Seventy-three kidney transplant recipients were included. Patients with allograft dysfunction demonstrated markedly accelerated muscle loss compared with those maintaining stable graft function. Muscle decline was primarily driven by progression to end-stage kidney disease, whereas isolated ≥25% estimated glomerular filtration rate decline without graft failure was not associated with significant sarcopenia progression. Adverse CT morphometry was independently associated with reduced survival in Kaplan-Meier and multivariable Cox regression analyses adjusted for age, sex, and major adverse kidney events.</p><p><strong>Conclusions: </strong>Among kidney transplant recipients undergoing indication-driven imaging, posttransplant skeletal muscle loss is closely linked to allograft dysfunction and independently associated with mortality. Opportunistic CT-based morphometry may therefore represent a valuable tool for risk stratification in vulnerable transplant populations. Prospective studies are warranted to validate these findings and assess interventional implications.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 6","pages":"e1956"},"PeriodicalIF":2.2,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017522","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":"B6 Donor Lungs Develop Chronic Lung Allograft Dysfunction-like Pathology Across Histocompatibility Mismatches in Murine Lung Transplantation.","authors":"Taisuke Kaiho, Yudai Miyashita, Taichi Nagano, Raul Piseaux Aillon, Yuriko Yagi, Takahide Toyoda, G R Scott Budinger, Ankit Bharat, Hidemi Suzuki, Chitaru Kurihara","doi":"10.1097/TXD.0000000000001958","DOIUrl":"10.1097/TXD.0000000000001958","url":null,"abstract":"<p><strong>Background: </strong>Chronic lung allograft dysfunction (CLAD) remains a major barrier to long-term survival after lung transplantation. Murine models are essential for mechanistic studies, but the influence of donor-recipient strain direction and histocompatibility mismatch on chronic pathology is not fully defined. We evaluated the reproducibility of B6-background donor lungs across reciprocal strain combinations as a practical experimental platform.</p><p><strong>Methods: </strong>Orthotopic left lung transplantation was performed using major-mismatched (C57BL/6 [B6]↔BALB/c) and minor-mismatched (B6↔C57BL/10 [B10]) combinations. Major-mismatched recipients received costimulatory blockades (anti-CD40L/cytotoxic T-lymphocyte-associated protein 4 Ig); minor-mismatched pairs received no immunosuppression. Grafts were procured on day 28. Chronic injury was quantified using standardized histological scoring for airway, parenchymal, and pleural compartments. Lung function was assessed using the FlexiVent system with right hilar clamping.</p><p><strong>Results: </strong>CLAD-like airway and fibrotic lesions developed across all combinations, irrespective of donor-recipient direction. B6 donor lungs reproducibly exhibited chronic pathology comparable with other strains. Notably, the incidence of obliterative bronchiolitis was higher in minor-mismatched groups (B10→B6: 54.5%; B6→B10: 38.5%) compared with major-mismatched groups (BALB/c→B6: 27.3%; B6→BALB/c: 36.4%). Histological severity significantly correlated with impaired lung compliance and increased airflow resistance, supporting the functional relevance of the observed structural injury.</p><p><strong>Conclusions: </strong>Reciprocal murine lung transplantation reveals that CLAD-like pathology develops irrespective of donor-recipient direction, with mismatch degree influencing the qualitative distribution of chronic injury. These findings validate B6-background donor lungs as a versatile platform for interrogating donor-intrinsic immune and stromal mechanisms of chronic rejection, and for hypothesis-driven testing of donor-targeted interventions using genetically modified strains.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 6","pages":"e1958"},"PeriodicalIF":2.2,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017568","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":"Incidence of BK Virus in HIV-positive Kidney Transplant Recipients: Case Series From South Africa.","authors":"Laurie Bertels, Kathryn Manning, Andrew D Redd, Zunaid Barday, Elmi Muller","doi":"10.1097/TXD.0000000000001936","DOIUrl":"10.1097/TXD.0000000000001936","url":null,"abstract":"<p><strong>Background: </strong>BK virus-associated nephropathy (BKVN) is a viral complication after kidney transplantation and an important cause of graft dysfunction and loss. Its impact on HIV-positive kidney transplant recipients (KTRs), who are at increased risk for opportunistic infections, remains poorly understood.</p><p><strong>Methods: </strong>This single-center case series in South Africa describes BKVN incidence and outcomes in HIV-positive KTRs who received kidneys from HIV-positive donors between 2008 and 2025. A screening protocol and schedule were implemented in 2021, and BKVN was classified as possible, probable, or presumptive according to The Second International Consensus Guidelines.</p><p><strong>Results: </strong>Over the study period, there were 63 KTRs and 34 donors; 2 recipients with primary graft failure were excluded. The remaining 61 recipients had a median age of 40 y, 54% were male, and 93% were of Black African ethnicity. Median CD4 count at transplantation was 439 cells/mm³, and all KTRs had suppressed HIV viral load on antiretroviral therapy. HIV-associated nephropathy was the most common cause of end-stage kidney disease. Hypertension was prevalent (89%), and one-third had a history of treated tuberculosis. All patients received antithymocyte globulin induction at transplant. Seventeen recipients had no BKVN screening data, 36 maintained negative BK viral loads, while 8 developed BK polyomavirus viremia and/or viruria. Of these, 2 (3%) had polymerase chain reaction-confirmed viremia, and 6 (10%) met criteria for possible (n = 1), probable (n = 2), or presumptive BKVN (n = 3). BK polyomavirus viremia and/or viruria occurred either within 6 mo or between 1 and 2 y posttransplant. Management consisted of reducing immunosuppression. Possible and probable cases (5%) maintained functioning grafts. All 3 (5%) presumptive cases had biopsy-proven disease, with one resulting in graft loss (1.6%).</p><p><strong>Conclusions: </strong>Despite limited resources and delayed routine screening, the BKVN incidence was low (5%), and most affected recipients achieved viral control and preserved graft function.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 6","pages":"e1936"},"PeriodicalIF":2.2,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017517","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":"Management of Norovirus Infection in Solid Organ Transplant Recipients: A Scoping Review.","authors":"Thida Maung Myint, Jonathan Hand, Adam Lowe, Camille N Kotton, Sharon C-A Chen, Justin Beardsley, Armando Teixeira-Pinto, Germaine Wong, Samuel Chan","doi":"10.1097/TXD.0000000000001944","DOIUrl":"10.1097/TXD.0000000000001944","url":null,"abstract":"<p><strong>Background: </strong>Norovirus infection causes significant morbidity in solid organ transplant (SOT) recipients, yet few treatments are available, and evidence for efficacy is sparse. In this scoping review, we identify and evaluate potential interventions for managing norovirus infections in SOT recipients.</p><p><strong>Methods: </strong>We searched electronic databases from inception to July 6, 2025. Eligible studies were analyzed for participants' characteristics, intervention types, and reported outcomes.</p><p><strong>Results: </strong>After screening 245 abstracts, 58 studies were included (1 randomized controlled trial, 27 cohort studies, 5 case series and 25 case reports), mainly from the United States. Transplant types included kidney (n = 36), liver (n = 12), cardiac (n = 12), pulmonary (n = 7), pancreas (n = 6), small bowel (n = 7), and multiorgan (n = 13) transplants. The most frequently reported primary outcome was resolution of gastrointestinal (GI) symptoms. Interventions were diverse: immunosuppression modification (n = 14), nitazoxanide (n = 6), IVIG (n = 3), oral immunoglobulin (n = 10), combination of these (n = 19), fecal transplant (n = 2), supportive management (n = 4), and others not classified (n = 5). Limited quality evidence for the resolution of gastrointestinal symptoms was reported for immunosuppression modification (n = 7/14), nitazoxanide (n = 4/6), IVIG (n = 2/3), oral immunoglobulin alone (n = 10/10), fecal transplant (n = 2/2), supportive treatment (n = 4/4), and a combination of treatments (n = 10/19). A lack of clinical improvement was described in 13 of 58 studies.</p><p><strong>Conclusions: </strong>A wide range of interventions has been used to manage norovirus infections in SOT recipients; however, the evidence is limited to observational studies, and the findings are uncertain. High-quality randomized controlled trials are needed to establish treatment efficacy and safety.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 6","pages":"e1944"},"PeriodicalIF":2.2,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975538","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":"Leadless Helix-fixation Pacemakers in Solid Organ Transplant Recipients: A Multisite Experience.","authors":"Amal Youssef, Julie L Rosenthal, Bashar A Aqel, Andrew Rosenbaum, Parag C Patel, Hicham El-Masry, Mayank Sardana","doi":"10.1097/TXD.0000000000001949","DOIUrl":"10.1097/TXD.0000000000001949","url":null,"abstract":"<p><strong>Background: </strong>Solid organ transplant recipients (SOTRs) are at heightened risk for cardiovascular implantable electronic device-related complications, particularly infection, because of chronic immunosuppression and comorbidities. Although leadless pacemakers (LPs) reduce infection risk by eliminating transvenous leads and generator pockets, adoption in SOTRs has remained limited, largely because earlier systems were restricted to single-chamber ventricular pacing and lacked physiologic atrioventricular synchrony. The helix-fixation Aveir LP platform enables atrial, ventricular, and dual-chamber leadless pacing, but clinical experience in transplant recipients remains limited.</p><p><strong>Methods: </strong>We conducted a retrospective, multisite analysis across an integrated health system, identifying all adult SOTRs who underwent Aveir LP implantation between January 2022 and October 2025. Clinical characteristics, transplant details, pacing indications, device configuration, procedural outcomes, and follow-up data were collected. Primary outcomes included procedural success, complications, and device-related infection. Secondary outcomes included pacing performance, need for system revision or upgrade, and early device durability.</p><p><strong>Results: </strong>Thirteen SOTRs (mean age 64 ± 15 y; 15% female) underwent Aveir LP implantation, including atrial (n = 4), ventricular (n = 5), and dual-chamber (n = 4) systems. Transplanted organs included heart (46%), lung (31%), kidney (38%), and liver (15%), with 31% having multiple organ transplants. Over half of patients were critically ill at implantation, and 46% were dialysis-dependent, representing a high-risk cohort. All procedures were acutely successful with no intraprocedural complications. During a median follow-up of 258 d (interquartile range, 216-641 d), no device-related infections occurred. Electrical performance remained stable, with 1 atrial device replacement at 2.5 y for elevated capture thresholds.</p><p><strong>Conclusions: </strong>In a high-risk population of SOTRs, atrial and atrioventricular synchronous leadless pacing using the Aveir platform was feasible, achieved high acute procedural success, and demonstrated favorable early safety signals, including absence of device-related infection over available follow-up. Larger studies with longer-term follow-up are needed to define durability and long-term outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 6","pages":"e1949"},"PeriodicalIF":2.2,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975593","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 Glucagon-like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter-2 Inhibitors on Post-liver Transplant New-onset Major Adverse Cardiovascular Events, Graft Failure, Renal Outcome, and Mortality.","authors":"Kelli C Kosako Yost, Megan B Ghai, Majd Aboona, Qumber Ali, Pooja Rangan, Paul Gomez, Rohit Nathan, Mark Wong, Karn Wijarnpreecha, Moises I Nevah Rubin, Michael Fallon, Ma Ai Thanda Han","doi":"10.1097/TXD.0000000000001935","DOIUrl":"10.1097/TXD.0000000000001935","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits, but there are little data in solid organ transplant populations. We aimed to assess the effect of GLP-1 RA or SGLT2i on the incidence of post-transplant major adverse cardiovascular events (MACE), graft failure, renal outcomes, and mortality in liver or simultaneous liver-kidney transplant populations.</p><p><strong>Methods: </strong>A retrospective chart review of adults with diabetes mellitus and either solitary liver or simultaneous liver-kidney transplantation from January 2012 to March 2022 was completed. The multivariate Cox regression and Fine and Gray competing risk regression analyses were used.</p><p><strong>Results: </strong>Among 457 patients, 33 received a GLP-1 RA or SGLT2i. The GLP-1 RA/SGLT2i group had a lower incidence of graft failure (<i>P</i> = 0.038), new-onset end-stage renal disease requiring dialysis (<i>P</i> = 0.012), and new-onset post-liver transplant MACE at 5 y (adjusted subdistribution hazard ratio, 0.24; <i>P</i> = 0.049; 95% confidence interval, 0.059-0.99).</p><p><strong>Conclusions: </strong>After propensity score matching, the incidence of 5-y post-liver transplant MACE-free survival was significantly higher, and mortality was significantly lower in the GLP-1 RA/SGLT2i group. The use of a GLP-1 RA/SGLT2i post-liver transplant was associated with a lower incidence of new-onset MACE, graft failure, and new-onset end-stage renal disease requiring dialysis. There was an improvement in survival after propensity score matching.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 6","pages":"e1935"},"PeriodicalIF":2.2,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975484","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":"Considerations in Liver Transplant Recipients Having Prior Roux-en-Y Gastric Bypass.","authors":"Anita Mahadevan, James F Crismale, Thomas Schiano, Lauren Tal Grinspan","doi":"10.1097/TXD.0000000000001957","DOIUrl":"10.1097/TXD.0000000000001957","url":null,"abstract":"","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 6","pages":"e1957"},"PeriodicalIF":2.2,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13170746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942967","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":"Urine Recirculation During Normothermic Kidney Preservation Improves Energy Balance Involving the Urea and Citric Acid Cycles.","authors":"Annemarie Weissenbacher, Zhanru Yu, Honglei Huang, Maria Letizia Lo Faro, Bohan Yu, James P Hunter, Rutger J Ploeg, Constantin C Coussios, Peter J Friend, Benedikt M Kessler","doi":"10.1097/TXD.0000000000001947","DOIUrl":"10.1097/TXD.0000000000001947","url":null,"abstract":"<p><strong>Background: </strong>Deceased-donor kidneys experience cellular stress before undergoing transplantation. To alleviate this, preservation techniques were developed, including normothermic machine perfusion (NMP).</p><p><strong>Methods: </strong>Here, we performed kidney NMP on discarded human kidneys for up to 24 h. Volume management was regulated either by urine recirculation (UR) or urine replacement (NUR) with Ringer's lactate. Notably, UR led to longer perfusion times compared with NUR. To investigate kidney NMP metabolic traits with or without UR over time, we performed longitudinal metabolomics analyses of perfusates of 8 NMP kidneys by 2-dimensional gas chromatography mass spectrometry (GCxGC-MS).</p><p><strong>Results: </strong>Over 600 metabolic features were profiled, from which 74 were identified and 54 consistently quantified across 26 perfusate samples. Most notably, elevated levels of disaccharides (different isomers), hydroxy-purines, urea, glutamate, and amino acids are associated with the perfusion factor UR. Moreover, donor estimated glomerular filtration rate correlated significantly with the accumulation of lactate and gluconate. Most strikingly, lactate levels seemed to be more balanced in UR-NMP perfusate, which otherwise accumulated rapidly within the first 6 h.</p><p><strong>Conclusions: </strong>Kidney preservation by NMP was previously limited to hours. UR-NMP affected kidney energy homeostasis, carbohydrate and purine metabolism, and the urea and citric acid cycles. These insights add value to explain how urine-driven adaptations contribute to prolonged kidney function under NMP.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 6","pages":"e1947"},"PeriodicalIF":2.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869634","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}