Transplantation Direct最新文献

{"title":"BEAT-BK: An Adaptive, Randomized Controlled Trial to Treat Polyomavirus Infections (BKPyV) in Kidney and Kidney-pancreas Transplantation Recipients (BEAT-BK) Study Protocol.","authors":"Ryan Gately, Michael Dymock, Dharshana Sabanayagam, Scott B Campbell, Jonathan C Craig, Vikas Dharnidharka, Anna Francis, Jonathan M Gleadle, Martin Hajek, Sana Hamilton, Martin Howell, Nicole Isbel, Allison Jaure, David W Johnson, John Kanellis, Karen Keung, Siah Kim, Jen Kok, Dirk R Kuypers, Nicholas Larkins, Wai H Lim, Rahul Mainra, Julie A Marsh, Gabor Mihala, Brian J Nankivell, Samantha Ng, Helen Pilmore, Nicole Scholes-Roberton, Thomas Snelling, Armando Teixeira-Pinto, Andrea Valks, Kenneth Yong, Carmel Hawley, Germaine Wong","doi":"10.1097/TXD.0000000000001924","DOIUrl":"10.1097/TXD.0000000000001924","url":null,"abstract":"<p><strong>Background: </strong>BK polyomavirus (BKPyV) is a common opportunistic infection in kidney transplant recipients, typically reactivating in the context of immunosuppression. Although asymptomatic in immunocompetent individuals, reactivation in transplant recipients can cause BKPyV-associated nephropathy (BKPyVAN), a leading cause of graft dysfunction and loss. BKPyV viremia affects approximately 10%-15% of transplant recipients, and once BKPyVAN is established, the risk of graft failure can exceed 50%. The current standard of care involves immunosuppression reduction to restore virus-specific immunity, but this approach increases the risk of acute and chronic rejection. Intravenous immunoglobulin (IVIg), which contains antiviral and immunomodulatory antibodies, has been proposed as an adjunctive therapy, although evidence supporting its efficacy remains limited to small observational studies.</p><p><strong>Methods: </strong>The BEAT-BK trial is a multicenter, adaptive, randomized controlled trial comparing standard immunosuppression reduction with or without IVIg in kidney and simultaneous pancreas-kidney transplant recipients with BKPyV viremia or biopsy-confirmed BKPyVAN. The trial will enroll participants aged 2 y and older, randomizing them 1:1 to receive standard care alone or in combination with a total IVIg dose of 2 g/kg for 8 wk. An adaptive Bayesian design will permit interim analyses with the potential for early trial success or futility.</p><p><strong>Results: </strong>The primary endpoint is a composite ordinal outcome at 12 wk, incorporating death, graft loss, estimated glomerular filtration rate decline, acute rejection, viral load, and degree of immunosuppression reduction. Secondary outcomes include viral clearance, development of BKPyVAN and donor-specific antibodies, infections, malignancy, quality of life, and cost-effectiveness.</p><p><strong>Conclusions: </strong>This trial will provide the first high-quality evidence on the role of IVIg in BKPyV management and inform clinical decision-making in posttransplant care.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 4","pages":"e1924"},"PeriodicalIF":2.2,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378596","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":"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":2.2,"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":"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":"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":2.2,"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":"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":"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":2.2,"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":"Comparison of Multiple Frailty Scoring Metrics in Renal Transplant Candidates: A Large Single-center Cohort Study.","authors":"Arielle Cimeno, Samridhi Banskota, Syed Omair Nadeem, Ronald F Parsons","doi":"10.1097/TXD.0000000000001921","DOIUrl":"10.1097/TXD.0000000000001921","url":null,"abstract":"<p><strong>Background: </strong>Pretransplant patients are not required to undergo objective frailty testing, although current listing and allocation policies do record functional metrics. Multiple different metrics exist for assessing frailty.</p><p><strong>Methods: </strong>We investigated different frailty metrics in patients presenting for renal transplant evaluation. Four hundred thirty patients underwent both cross-sectional imaging and retrospective chart review to calculate a psoas muscle area (PMA) and modified Frailty Risk Score (FRS), respectively. Of these patients, 264 were also evaluated using the Fried frailty phenotype (FFP). Expected Posttransplant Survival scores for posttransplant patients were calculated.</p><p><strong>Results: </strong>In total, 220 (52.2%) patients were considered frail by at least 1 metric. Of evaluated patients 8.3%, 30.7%, and 24.9% were frail by FFP, FRS, and PMA respectively, compared with 6.6%, 26.4%, and 24.0% of listed patients who were frail by FFP, FRS, and PMA respectively. PMA and FRS identified more frail patients compared with FFP (<i>P</i> = 0.0001). Concordance between metrics was poor, with kappa coefficients of <0.1 for all comparisons. Estimated Posttransplant Survival score at time of transplant was not different between frail and nonfrail patients (<i>P</i> = 0.3289).</p><p><strong>Conclusions: </strong>Ultimately, patients successfully listed for transplant did not vary in frailty metrics from those who were not listed. These findings suggest that standardized metrics are needed for the evaluation and listing of patients.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 3","pages":"e1921"},"PeriodicalIF":2.2,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12915718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228729","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":"Understanding the Relationship Between Severe Donor Diabetes Insipidus, Kidney Donor Profile Index, and Recipient Kidney Function.","authors":"Lucia Calthorpe, Miguel Nunez, Gerardo Gamino, Timothy P Copeland, Elaine Ku, Garrett R Roll","doi":"10.1097/TXD.0000000000001916","DOIUrl":"10.1097/TXD.0000000000001916","url":null,"abstract":"<p><strong>Background: </strong>Severe diabetes insipidus (DI) causes dynamic changes in creatinine before organ donation. It is unknown whether terminal or peak creatinine is the optimal measure of graft quality among donors with severe DI.</p><p><strong>Methods: </strong>Adult donors after brain death were identified from the United Network for Organ Sharing database, years 2015-2022. Kidney Donor Profile Index (KDPI) was computed using both terminal creatinine (KDPI-Terminal) and peak creatinine (KDPI-Peak). Model fit for the prediction of graft failure and reduced glomerular filtration rate (GFR) was compared. Logistic regression was used to determine the association between KDPI group reclassification and graft function.</p><p><strong>Results: </strong>Of 28 718 kidney transplants, 29% of donors met criteria for severe DI. No differences in estimated GFR (eGFR) or all-cause graft failure were observed on the basis of the presence of DI. Among donors with severe DI, KDPI-Peak improved prediction of reduced eGFR at 1 y (eGFR <60 mL/min/1.73 m², eGFR <30 mL/min/1.73 m²). Additionally, patients who received organs from donors with severe DI whose KDPI group would be reclassified on the basis of the use of peak rather than terminal creatinine had 2-fold increased odds of reduced eGFR at 1 y (eGFR <30 mL/min/1.73 m²; odds ratio, 1.92; 95% confidence interval, 1.37-2.69).</p><p><strong>Conclusions: </strong>This national analysis confirms that while the presence of severe DI alone is not associated with graft outcomes, the use of peak creatinine significantly improves risk stratification of donor graft quality. Precise risk stratification is critical for efforts to improve appropriate kidney allocation and increase confidence in organ function after transplant.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 3","pages":"e1916"},"PeriodicalIF":2.2,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12915717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228742","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":"Growth Trajectories of Medication Adherence in Pediatric Organ Transplantation and Their Relationship to Posttransplant Health Outcomes.","authors":"Michael O Killian, Callie W Little, Sonnie E Mayewski, Schyler E Brumm, Vir Hirani","doi":"10.1097/TXD.0000000000001907","DOIUrl":"10.1097/TXD.0000000000001907","url":null,"abstract":"<p><strong>Background: </strong>Nonadherence to immunosuppressive medication remains one of the most critical predictors of late acute rejection, hospitalization, and graft loss in pediatric organ transplant recipients. Despite its clinical importance, longitudinal patterns of adherence behavior in this population remain underexplored, particularly using objective pharmacokinetic indicators. This study aimed to examine adherence trajectories over time using the medication level variability index (MLVI), a validated biomarker of tacrolimus variability, and to assess their association with clinical and demographic factors.</p><p><strong>Methods: </strong>We applied growth mixture modeling to longitudinal MLVI data from a large single-center sample of pediatric heart, liver, and kidney transplant recipients (N = 181). MLVI values were calculated from serial tacrolimus trough levels over a multiyear posttransplant period.</p><p><strong>Results: </strong>Two adherence trajectories emerged with complete separation in MLVI (trajectory 1: range, 1.07-2.10; trajectory 2: range, 2.67-3.99). Across all years of follow-up, posttransplant hospitalization because of late acute rejection occurred in 33.4% of adherent versus 35.1% of nonadherent patients, and on a per-year basis 5.3% versus 7.7% of person-years, respectively (descriptively higher in the nonadherent trajectory). Public insurance status and patient functional status differed significantly between the 2 trajectories, suggesting social and structural determinants of adherence behavior.</p><p><strong>Conclusions: </strong>These findings underscore the dynamic and heterogeneous nature of adherence across pediatric transplant populations. MLVI-based trajectory modeling offers a promising avenue for early risk identification and could inform the development of electronic medical record-integrated alerts or personalized adherence interventions. Future research should integrate psychosocial variables and expand to multicenter samples for enhanced generalizability.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 3","pages":"e1907"},"PeriodicalIF":2.2,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214171","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: Surveillance Donor-derived Cell-free DNA Allows for the Safe Reduction in Protocol Transbronchial Biopsies After Lung Transplantation: Erratum.","authors":"Kashika Goyal, David J Ross, Bronwyn Small, Namita Trikannad, Sangeeta Bhorade, Justin P Rosenheck","doi":"10.1097/TXD.0000000000001931","DOIUrl":"10.1097/TXD.0000000000001931","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/TXD.0000000000001901.].</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 3","pages":"e1931"},"PeriodicalIF":2.2,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214199","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":"A Whole-body Cooling Strategy in Uncontrolled Donation After Circulatory Death: Insights From a Porcine Ex Vivo Lung Perfusion Model.","authors":"Hiromichi Niikawa, Daisuke Sakota, Ryo Kosaka, Ichiro Sakanoue, Soumei Baba, Katsuhiro Ohuchi, Tetsuhito Kigata, Carol F Farver, Kenneth R McCurry, Yoshinori Okada, Toshihiro Okamoto","doi":"10.1097/TXD.0000000000001904","DOIUrl":"10.1097/TXD.0000000000001904","url":null,"abstract":"<p><strong>Background: </strong>Prolonged warm ischemia in uncontrolled donation after circulatory death (uDCD) potentially increases the risk of graft dysfunction in lung transplantation. To address this concern, a noninvasive, whole-body cooling approach was developed using a specialized liquid refrigerant at -21 °C. The aim of this study was to investigate whether this method reduces lung temperature and improves lung function in uDCD donors.</p><p><strong>Methods: </strong>Fifteen pigs were randomly assigned to 3 groups. In the study group (n = 5), the entire donor body was submerged in a basin containing a coolant of -21 °C, and chest compression was performed during 90 min of warm ischemia. In the sham group (n = 5), neither body cooling nor chest compression was performed during 90 min of warm ischemia. Lungs were evaluated by cellular ex vivo lung perfusion (EVLP) after 5 h of additional cold ischemia. Lungs in the donation after brain death (DBD) group (n = 5) were perfused after 1 h of cold ischemia.</p><p><strong>Results: </strong>Tracheal temperature decreased to 28.5 °C in the study group and remained at 38.1 °C in the sham group. Lungs in the study group showed higher transplant suitability with significantly higher PaO₂/FiO₂, and lower peak inspiratory pressure during EVLP than those in the sham group (all <i>P</i> < 0.05). The study group had a significantly higher ATP level, a relatively lower hypoxia-inducible factor-1α level, and lower percentage of apoptotic cells than the sham group.</p><p><strong>Conclusions: </strong>This novel cooling approach effectively reduced lung temperature during warm ischemia, resulting in improved lung function during EVLP. These data suggest that this method could mitigate ischemia-reperfusion injury in uDCD donors, expanding the donor lung pool.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 3","pages":"e1904"},"PeriodicalIF":2.2,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214210","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":"Heme Oxygenase-1 as a Predictor of Early Allograft Dysfunction in Liver Transplantation: A Prospective Observational Pilot Study.","authors":"Elizabeth A Wilson, Ammar Rashied, Anna Woodbury, Andrew S Barbas, Craig S Jabaley, Craig M Coopersmith, Kirsten M Williams","doi":"10.1097/TXD.0000000000001909","DOIUrl":"10.1097/TXD.0000000000001909","url":null,"abstract":"<p><strong>Background: </strong>Early allograft dysfunction (EAD), defined as hepatic insufficiency within a week of orthotopic liver transplantation (OLT), affects up to 25% of recipients and is associated with morbidity and mortality. Ischemia-reperfusion injury (IRI), the primary driver of EAD, reflects immune and cellular dysregulation triggered by transient tissue oxygen deprivation. Heme oxygenase-1 (HO-1), a cytoprotective enzyme, plays a central role in mitigating hepatic IRI. We hypothesized a distinct perioperative HO-1 signature correlates with EAD.</p><p><strong>Methods: </strong>We conducted a prospective observational pilot study of 43 primary adult, deceased donor OLT recipients at Emory University Hospital between August 2023 and July 2024. EAD was defined by the Olthoff criteria, using serum bilirubin, international normalized ratio (INR), and aminotransferases. Perioperative arterial serum was assayed preimplantation at anesthesia induction (timepoint, T1), and 2 (T2), and 48 h (T3) postimplantation to measure HO-1 using multiplex immunoassay and compared between recipients with and without EAD. Group comparisons (EAD versus non-EAD) used Mann-Whitney U for continuous variables (reported as medians) and chi-square or Fisher exact test for categorical variables. HO-1 changes over time were assessed with the Friedman test and post hoc comparisons. The Spearman correlation evaluated associations between HO-1 and clinical parameters.</p><p><strong>Results: </strong>EAD occurred in 9 of 43 patients (20.9%). Recipients who developed EAD exhibited significantly higher HO-1 levels 2 h postimplantation (T2) (22,665 pg/mL [interquartile range (IQR): 17 881, 25 361] versus 10,765 pg/mL [IQR: 8060, 18 903], <i>P</i> = 0.0284) and a significantly greater peri-implantation rise in HO-1 levels (T2-T1) (21,050 pg/mL[IQR: 17 645, 24 765] versus 9,264 pg/mL [IQR: 6876,17514], <i>P</i> = 0.0358), compared with those without EAD. Receiver operating characteristic curve analysis revealed moderate predictive ability of the peri-implantation rise in HO-1 levels (T2-T1) (area under the curve = 0.7157).</p><p><strong>Conclusions: </strong>Peri-implantation HO-1 kinetics may represent a novel biomarker of EAD. Larger validation studies and mechanistic investigations are warranted to refine risk stratification and guide targeted interventions to mitigate EAD.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 3","pages":"e1909"},"PeriodicalIF":2.2,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12900183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202789","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}