Transplantation Direct最新文献

{"title":"Comparison of Laparoscopic and Hand-assisted Live Donor Nephrectomy: An Analysis of NSQIP Transplant.","authors":"Dominic Amara, Arielle Grieco, Karina Covarrubias, Yaoming Liu, Peter G Stock, David Foley, Stuart Greenstein, Ryutaro Hirose, Justin R Parekh","doi":"10.1097/TXD.0000000000001946","DOIUrl":"10.1097/TXD.0000000000001946","url":null,"abstract":"<p><strong>Background: </strong>Pure laparoscopic and hand-assisted approaches are the predominant techniques for living donor nephrectomy, yet high-quality multicenter comparisons remain limited.</p><p><strong>Methods: </strong>Using prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program Transplant pilot (from March 2017 to July 2020), we compared outcomes between pure laparoscopic and hand-assisted donor nephrectomy. Outcomes included operative duration, postoperative length of stay (LOS), and 30-d unplanned readmission. Mixed-effects linear, Poisson, and logistic regression models with hospital-level random intercepts quantified center variation and the independent association of surgical approach with outcomes.</p><p><strong>Results: </strong>Among 1542 donors, 890 (57.7%) underwent pure laparoscopic and 652 (42.3%) hand-assisted nephrectomies. Donors were predominantly female (63%), mean age 43.4 y, and 61.8% were overweight or obese. Pure laparoscopic procedures had longer operative times (180 versus 150 min; <i>P</i> < 0.001). Median LOS was similar (2 d for both), although pure laparoscopy had more extended-stay cases (<i>P</i> < 0.001). Readmission was rare and comparable (2.4% versus 2.9%; pure laparoscopic versus hand-assisted; <i>P</i> = 0.50). Center-level variation was substantial for operative duration (intraclass correlation coefficient = 0.51), and notable for LOS (median rate ratio [RR] = 1.25) and readmission (median odds ratio = 1.60). In unadjusted and adjusted models, pure laparoscopy was not associated with differences in operative duration relative to hand-assisted (β = 5.05 min; 95% confidence interval [CI], -4.56 to 14.66 and adjusted β = 5.59; 95% CI, -3.71 to 14.88), LOS (RR = 0.99; 95% CI, 0.87-1.13 and adjusted RR = 0.98; 95% CI, 0.86-1.12), or readmission (odds ratio = 0.63; 95% CI, 0.28-1.44).</p><p><strong>Conclusions: </strong>In this national, multicenter analysis using prospectively collected data, pure laparoscopic and hand-assisted donor nephrectomy demonstrated similar perioperative outcomes and very low complication rates. Surgical approach did not independently influence operative duration or LOS. Readmission was rare. Substantial center-level variation suggests institutional practice patterns may play a larger role than technique selection.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 5","pages":"e1946"},"PeriodicalIF":2.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782187","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":"Clinical Utility of Standardized Genetic Testing in Kidney Transplant Candidate Evaluation.","authors":"Yasar Caliskan, Rengin Elsurer Afsar, Fadee Abu Al Rub, Kate Rabideau, Ava DeLonais-Parker, Dzuy Truong, Bahar Bastani, Mustafa Nazzal, Henry Randall, Chintalapati Varma, Baris Afsar, Krista L Lentine","doi":"10.1097/TXD.0000000000001933","DOIUrl":"10.1097/TXD.0000000000001933","url":null,"abstract":"<p><strong>Background: </strong>Genetic testing is increasingly used in the evaluation of kidney transplant (KT) candidates, yet its direct association with transplant-related outcomes remains unclear. This study assessed whether genetic test results are associated with key steps in the KT process.</p><p><strong>Methods: </strong>In this observational cohort study, 270 KT candidates underwent standardized genetic testing between January 2021 and November 2024. The outcomes, including waitlisting and transplantation, were compared between candidates with and without positive results. Primary outcomes assessed clinical utility during transplant evaluation, including diagnostic reclassification of end-stage kidney disease (ESKD), effects on living donor evaluation, and genetic counseling. Secondary outcomes included waitlisting, transplantation, and post-transplant allograft function (estimated glomerular filtration rate).</p><p><strong>Results: </strong>Among 270 KT candidates, indications for testing included family history (45.9%), hypertension-attributed ESKD without biopsy (30%), and ESKD of unknown etiology (24.4%). Positive genetic results were identified in 104 candidates (38.5%), who were younger and more frequently Black. Family history independently predicted a positive result (adjusted odds ratio = 1.91 and 95% confidence interval, 1.13-3.27; <i>P</i> = 0.02). Genetic kidney disease was identified in 36.4% of candidates with ESKD of unknown etiology and 43.2% of those with hypertension-attributed ESKD, most commonly <i>APOL1</i>-mediated disease. <i>APOL1</i> high-risk genotypes were present in 50% of focal segmental glomerulosclerosis cases. Overall, 75.9% received pretest counseling and positive results (n = 104) prompted post-test counseling (n = 85) and guided living donor risk assessment and evaluation for extrarenal manifestations. During follow-up, waitlisting, transplantation rates, and post-transplant estimated glomerular filtration rate did not differ between candidates with and without positive results (<i>P</i> = 0.72, <i>P</i> = 0.35, and <i>P</i> = 0.06, respectively).</p><p><strong>Conclusions: </strong>Genetic testing demonstrated a high diagnostic rate among KT candidates, particularly in identifying <i>APOL1</i>-associated risk. Testing clarified disease etiology, informed recipient and family counseling, and supported safe living donor selection without affecting waitlisting. Integrating genetic testing into transplant evaluation may enhance precision medicine and transplant care.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 5","pages":"e1933"},"PeriodicalIF":2.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782161","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":"Effect of Donor-recipient Size on Graft Growth in Pediatric Donor-to-pediatric Recipient Kidney Transplantation.","authors":"Jing Wang, Chunyan Wang, Zhiqing Zhang, Meijie Hao, Yubo Sun, Rui Chen, Feng Liu, Yihui Zhai, Hong Xu, Qian Shen","doi":"10.1097/TXD.0000000000001938","DOIUrl":"10.1097/TXD.0000000000001938","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is the optimal treatment for pediatric end-stage kidney disease, yet donor shortages have driven the use of pediatric donor kidneys through pediatric donor-to-pediatric recipient (PTP) kidney transplantation. This study aimed to investigate the effect of donor-recipient size on graft growth in PTP kidney transplantation.</p><p><strong>Methods: </strong>This retrospective cohort study included kidney transplant recipients who underwent regular follow-ups between January 2016 and December 2023 at the Children's Hospital of Fudan University. All donors were deceased and aged <18 y. Dynamic clinical data were obtained from medical records spanning the pretransplant to posttransplant period.</p><p><strong>Results: </strong>A total of 136 patients were enrolled, 93 of whom had an initial transplant kidney length. Cumulative average growth of kidney length was 5.5 mm at 1 mo, 9.9 mm at 3 mo, 15.3 mm at 6 mo, 22.3 mm at 1 y, 31.5 mm at 3 y, and 39.5 mm at 5 y posttransplant. The corresponding growth rates were 8.3%, 15.1%, 22.3%, 30.6%, 41.3%, and 53.4%. Kidney growth rates were negatively correlated with the donor-recipient body weight ratio at 3 mo, 6 mo, and 1 y posttransplant (<i>P</i> < 0.01). The mean estimated glomerular filtration rate at the last follow-up was 84.1 ± 31.8 mL/min/1.73 m². Posttransplant estimated glomerular filtration rate showed a significant positive correlation with donor-recipient body weight ratio during the early posttransplant period (1, 3, and 6 mo; <i>P</i> < 0.01). Smaller grafts required approximately 6 mo to reach a normative size consistent with the recipients' age.</p><p><strong>Conclusions: </strong>Grafts showed stable growth patterns and favorable short-term follow-up outcomes. Additionally, PTP kidney transplantation demonstrated both clinical value and practical utility.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 5","pages":"e1938"},"PeriodicalIF":2.2,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782177","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":"Retroperitoneoscopic Nephrectomy at the Time of Kidney Transplantation for Autosomal Dominant Polycystic Kidney Disease: Safety, Efficacy, Feasibility, and Cosmetic Outcomes.","authors":"Takehiro Ohyama, Sho Nishida, Kyoko Minamisono, Toshimasa Nakao, Daiki Iwami","doi":"10.1097/TXD.0000000000001937","DOIUrl":"10.1097/TXD.0000000000001937","url":null,"abstract":"<p><strong>Background: </strong>Autosomal dominant polycystic kidney disease (ADPKD) leads to end-stage kidney disease, necessitating kidney transplantation (KTx). Native nephrectomy is required when polycystic kidneys are too large to be safely implanted into the iliac fossa. Open nephrectomy (ON), requiring a large skin incision to remove large polycystic kidneys, is a highly invasive procedure. Simultaneous retroperitoneoscopic nephrectomy (RN) with KTx has not been previously documented; therefore, we aimed to evaluate the safety and efficacy of RN during KTx in comparison with those of ON.</p><p><strong>Methods: </strong>Nineteen consecutive ADPKD kidney recipients, around 50 y old, were enrolled. RN was performed in 11 recipients, and ON in 8 recipients. We compared the perioperative outcomes and early complications between the 2 procedures.</p><p><strong>Results: </strong>No differences were observed in patient backgrounds. The total operative time, intraoperative blood loss, and removed kidney weight were similar between the groups. The oblique muscles were significantly more atrophic on the nephrectomy side in the ON group than in the RN group (atrophy of muscle thickness ratio to the contralateral side measured by postoperative computed tomography, 24% and 2%, respectively; <i>P</i> = 0.003).</p><p><strong>Conclusions: </strong>RN, when performed simultaneously with KTx, is safe, well-tolerated, less invasive, and cosmetically advantageous compared with ON for ADPKD >1 y post-surgery.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 5","pages":"e1937"},"PeriodicalIF":2.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677047","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":"Believing in the Nobel Prize: Long-term Success After HLA-Identical Kidney Transplantation in 3 Monozygotic Twins Without any Induction or Maintenance Immunosuppression.","authors":"Aylin Akifova, Ömer Ege Ömeroğlu, Fabian Halleck, Bilgin Osmanodja, Eva Vanessa Schrezenmeier, Friederike Bachmann, Diana Stauch, Nils Lachmann, Klemens Budde","doi":"10.1097/TXD.0000000000001941","DOIUrl":"10.1097/TXD.0000000000001941","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation between HLA-identical monozygotic twins offers a unique chance for long-term graft survival without immunosuppression. Although favorable outcomes after withdrawal of maintenance immunosuppression have been reported, complete omission remains uncommon, and immunosuppressive strategies are not standardized across centers.</p><p><strong>Methods: </strong>We report 3 HLA-identical monozygotic twin pairs who underwent kidney transplantation without induction or maintenance immunosuppression. Allograft function was monitored longitudinally, with follow-up durations of 22, 10, and 4 y, respectively. All patients had immediate and sustained excellent graft function with no rejection episodes or native disease recurrence during follow-up.</p><p><strong>Results: </strong>Patient 1 was a 29-y-old man with chronic glomerulonephritis and had a largely uneventful course posttransplant. Patient 2 was a 61-y-old man who received his third graft from his monozygotic twin. Although highly sensitized because of previous transplants (calculated panel-reactive antibody = 62%), no desensitization or immunosuppressive therapy was administered, and graft function remained excellent without rejection. Patient 3 was a 43-y-old woman with IgA nephropathy, who was transplanted in high-risk cytomegalovirus constellation (donor [+]/recipient [-]). She developed a primary cytomegalovirus infection after cessation of 3-mo prophylaxis, which was successfully treated with valganciclovir.</p><p><strong>Conclusions: </strong>This case series demonstrates that kidney transplantation between HLA-identical monozygotic twins can achieve excellent long-term graft survival without any induction or maintenance immunosuppression.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 5","pages":"e1941"},"PeriodicalIF":2.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676990","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":"Donor-derived Cell-free DNA for Detection of Rejection After Pancreas Transplantation.","authors":"Abraham J Matar, Samy Riad, Heidi Sarumi, Michael G Megaly, Matthew Wright, Erik Finger, Vanessa Humphreville, Karthik Ramanathan, Jessica Fisher, Joseph S Rao, Zachary Demko, Adam Prewett, Hossein Tabriziani, Raja Kandaswamy","doi":"10.1097/TXD.0000000000001939","DOIUrl":"10.1097/TXD.0000000000001939","url":null,"abstract":"<p><strong>Background: </strong>Donor-derived cell-free DNA (dd-cfDNA) has emerged as a promising noninvasive biomarker for detecting allograft rejection in solid organ transplantation. However, its diagnostic utility in pancreas transplantation, including in multiorgan recipients, remains underexplored.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 42 pancreas transplant recipients (38 simultaneous pancreas-kidney, 4 pancreas transplant alone) who underwent for-cause organ biopsy and dd-cfDNA testing between April 2020 and December 2024. dd-cfDNA was measured using the Prospera assay, with a threshold of ≥1% considered high risk and <1% low-risk. Biopsy results were correlated with dd-cfDNA to assess test performance.</p><p><strong>Results: </strong>A total of 50 dd-cfDNA tests and 45 organ biopsies were analyzed. Among simultaneous pancreas-kidney recipients, dd-cfDNA demonstrated a sensitivity of 86.7%, specificity of 52.2%, positive predictive value (PPV) of 54.2%, and negative predictive value (NPV) of 85.7% for rejection. In pancreas transplant alone recipients, all high-risk dd-cfDNA results corresponded to biopsy-proven rejection, yielding 100% sensitivity, specificity, PPV, and NPV. When combining both cohorts, dd-cfDNA testing achieved an overall sensitivity of 88.2%, specificity of 57.7%, PPV of 57.7%, and NPV of 88.2%. Additionally, dd-cfDNA kinetics suggested its potential utility as a surveillance tool posttreatment, potentially reducing the need for closure biopsies.</p><p><strong>Conclusions: </strong>dd-cfDNA is a valuable noninvasive adjunct for monitoring of rejection in pancreas transplant recipients. Further prospective studies are needed to validate these findings and define the optimal role of dd-cfDNA in posttransplant care.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 5","pages":"e1939"},"PeriodicalIF":2.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676993","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 Evolution of Molecular Phenotypes Through Time in Kidney Transplant Recipients.","authors":"Brigitte Baragar, Benjamin A Adam, Michael Mengel, Robert Balshaw, Ian W Gibson, Julie Ho, James Shaw, Martin Karpinski, Aaron Trachtenberg, Denise Pochinco, Aviva Goldberg, Patricia Birk, Maury Pinsk, David Rush, Peter W Nickerson, Chris Wiebe","doi":"10.1097/TXD.0000000000001919","DOIUrl":"10.1097/TXD.0000000000001919","url":null,"abstract":"<p><strong>Background: </strong>The correlation between histologic lesions and allograft gene expression data is a subject of significant interest. Most analyses include a single for-cause biopsy from each recipient, precluding serial assessment of gene scores.</p><p><strong>Methods: </strong>Using the nCounter system, we evaluated the Banff Human Organ Transplant gene panel in a unique cohort of 8 renal transplant recipients, each with 3 distinct histologic phenotypes (no rejection, T cell-mediated rejection [TCMR], and antibody-mediated rejection [AMR]), to explore the serial evolution of molecular phenotypes.</p><p><strong>Results: </strong>No rejection biopsies showed large interindividual differences in TCMR and AMR gene scores. Compared with biopsies with No Rejection, TCMR gene scores were greater in those with TCMR (mean fold change 1.95 ± 0.87, <i>P</i> = 0.0174). Similarly, compared with biopsies with No rejection, gene scores for AMR (mean fold change 1.43 ± 0.24, <i>P</i> = 0.0002), donor-specific antibody selective transcripts (mean fold change 1.33 ± 0.22, <i>P</i> = 0.002), and endothelial cell-associated transcripts (mean fold change 1.17 ± 0.06, <i>P</i> = 0.04) were greater at the time of AMR.</p><p><strong>Conclusions: </strong>In most cases, deviations in gene scores occurred in the expected direction as recipients transitioned through histologic phenotypes. The unexpected deviations in gene scores and the significant variability among individuals within histologic phenotypes warrant further investigation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 4","pages":"e1919"},"PeriodicalIF":2.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515051","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":"Glucagon-like Peptide-1 Receptor Agonists in Liver Transplant Recipients: A Retrospective Cohort Study.","authors":"Hesham Sheashaa, Ramzi Ibrahim, Amani Elshaer, Hoang Nhat Pham, Rama Mouhaffel, Eiad Habib, Mahmoud Abdelnabi, Juan M Farina, Steven J Lester, David Simper, Said Alsidawi, Eric D Steidley, Bashar A Aqel, Michele Barnhill, W Ray Kim, Chadi Ayoub, Reza Arsanjani","doi":"10.1097/TXD.0000000000001932","DOIUrl":"10.1097/TXD.0000000000001932","url":null,"abstract":"<p><strong>Background: </strong>Liver transplant recipients face high risks of cardiometabolic events after transplant, driven by posttransplant weight gain, diabetes, hypertension, as well as immunosuppression-related side effects. Glucagon-like peptide-1 receptor agonists (GLP1RAs) improve metabolic and cardiorenal outcomes in nontransplant populations, but their role in liver transplant recipients remains understudied.</p><p><strong>Methods: </strong>This retrospective cohort study used TriNetX data (January 2010-December 2023) to compare outcomes in liver transplant recipients prescribed GLP1RAs (semaglutide, dulaglutide, liraglutide) within 1-mo posttransplant (n = 546) versus nonusers (n = 37 153). Propensity score matching (1:1) balanced demographics, comorbidities, and medications (n = 541 per group). Outcomes included mortality, hospitalizations, cardiovascular/renal/respiratory events, and graft outcomes.</p><p><strong>Results: </strong>Over a mean follow-up 838.5 d (SD 291.9) in the GLP1RA cohort and 884.3 d (SD 313.7) in the non-GLP1RA group, GLP1RA use was associated with a 43% lower all-cause mortality (7.0% versus 12.9%; hazard ratio [HR], 0.566; 95% confidence interval [CI], 0.381-0.841) and 39% fewer hospitalizations (60.4% versus 74.5%; HR, 0.613; 95% CI, 0.530-0.710). Acute heart failure (HR, 0.386; 95% CI, 0.285-0.524), renal failure/dialysis (HR, 0.489; 95% CI, 0.413-0.579), and respiratory failure (HR, 0.484; 95% CI, 354-0.662) risks were significantly reduced. No differences were observed in graft failure/rejection, myocardial infarction, stroke, atrial fibrillation/flutter, ventricular tachycardia, or ischemic optic neuropathy.</p><p><strong>Conclusions: </strong>Early GLP1RA initiation in liver transplant recipients was associated with reduced mortality, hospitalizations, respiratory, and cardiorenal complications without compromising graft safety. These findings support GLP1RAs as a promising adjunct therapy, warranting prospective trials to confirm benefits in this high-risk population.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 4","pages":"e1932"},"PeriodicalIF":2.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514980","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":"Varying Perfusate Hemoglobin During Normothermic Ex Situ Heart Perfusion: Elevated Hemoglobin Exacerbates Functional Decline Through Hemolysis.","authors":"Mitchell J Wagner, Guilherme Mainardi Aguiar da Silva, Parham Hassanzadeh, Sanaz Hatami, Xiuhua Wang, Jayan Nagendran, Darren H Freed","doi":"10.1097/TXD.0000000000001926","DOIUrl":"10.1097/TXD.0000000000001926","url":null,"abstract":"<p><strong>Background: </strong>Ex-situ heart perfusion (ESHP) enables improved donor heart preservation, yet still suffers functional decline. The perfusate is 1 area that requires optimization, especially with regard to hemoglobin (Hb) content. We sought to compare performance of concentrated, physiologic, and dilute perfusates in minimally damaged hearts.</p><p><strong>Methods: </strong>Hearts of juvenile Yorkshire pigs (45-55 kg) were procured and subject to 11 h of working-mode ESHP in 1 of 4 groups varying in Hb: concentrated blood (CB, ~12 g/dL Hb, n = 4), whole blood (WB, ~8g/dL Hb, n = 6), plasma (~4g/dL Hb, n = 6, diluted with donor plasma), and control (~4g/dL Hb, n = 5, diluted with modified Krebs-Heinseleit). Functional, metabolic, and hemolytic markers were recorded and compared between groups statistically using appropriate statistical tests.</p><p><strong>Results: </strong>CB hearts exhibited worsened decline from baseline in cardiac index, dP/dT max/min, and stroke work (<i>P</i> < 0.05) and had greater elevations in hemolytic markers by end perfusion. Preservation of baseline cardiac index did not differ significantly between controls, WB, or plasma groups over time (<i>P</i> > 0.05). The CB group displayed elevated early oxygen consumption compared with controls (<i>P</i> < 0.05), with WB and plasma groups trending toward increased oxygen consumption. Lactate elevated over time in all groups, however, was not comparatively elevated within the CB group; it was reduced in the plasma group during early perfusion compared with control.</p><p><strong>Conclusions: </strong>Hb dilution appears to lower absolute output but preserves baseline function. Supraphysiologic Hb elevation or sublethal blood cell damage exacerbates hemolysis, which contributes to functional decline during ESHP. Lactate evolution did not appear to associate with the degree of functional loss.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 4","pages":"e1926"},"PeriodicalIF":2.2,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515032","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":"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":2.2,"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}