Transplantation Direct最新文献

{"title":"Surveillance Donor-derived Cell-free DNA Allows for the Safe Reduction in Protocol Transbronchial Biopsies After Lung Transplantation.","authors":"Kashika Goyal, David J Ross, Bronwyn Small, Namita Trikannad, Sangeeta Bhorade, Justin P Rosenheck","doi":"10.1097/TXD.0000000000001901","DOIUrl":"10.1097/TXD.0000000000001901","url":null,"abstract":"<p><strong>Background: </strong>Protocol transbronchial biopsies (TBBx) are standard of practice (SOP) in most lung transplantation (LT) centers for surveillance of acute cellular rejection. In the context of higher LT center volumes, our program experienced increasing difficulty scheduling SOP protocol TBBx at months 1, 3, 6, 9, and 12 post-LT. As part of a Quality Assurance Performance Improvement initiative, we designed this prospective study to assess the efficacy and safety of adopting donor-derived cell-free DNA (dd-cfDNA) surveillance in lieu of protocol TBBx during the initial year after LT at our center.</p><p><strong>Methods: </strong>Enrolled LT patients with \"low-risk\" dd-cfDNA (<1.0%) had their 9-mo (9M) protocol TBBx omitted, whereas the 9M protocol TBBx was performed when dd-cfDNA indicated a \"high-risk\" result (≥1.0%) or for clinical indications. All patients received a protocol TBBx at 12M to assure detection of subclinical acute cellular rejection. We also assessed clinical data from the first year, including change in forced expiratory volume-1 s, donor-specific antibodies, and performed a health economic analysis.</p><p><strong>Results: </strong>Among 78 enrolled LT patients, 24 were \"high risk\" (8 with omitted 9M protocol TBBx because of clinical contraindications), and 54 \"low risk\" (41 with omitted 9M protocol TBBx) by dd-cfDNA. Of the patients with omitted 9M protocol TBBx, 10.2% (5/49) showed rejection at 12 mo compared with 20.7% (6/29), at either the 9M or 12M protocol TBBx. Median change in forced expiratory volume-1 s (baseline-12M) was similar between \"high-risk\" and \"low-risk\" cohorts (<i>P</i> = 0.592) and for \"omitted\" versus \"performed\" 9M protocol TBBx cohorts (<i>P</i> = 0.271).</p><p><strong>Conclusions: </strong>Our Quality Assurance Performance Improvement study offered assurances for safety, efficacy, and reduction in healthcare costs when implementing SOP dd-cfDNA surveillance, with a >75% reduction in 9M protocol TBBx procedures among patients who were \"low risk\" by dd-cfDNA.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 2","pages":"e1901"},"PeriodicalIF":1.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus-based Recommendations on the Management of Immunosuppression After Squamous Cell Carcinoma Diagnosis in Kidney Transplant Recipients: An International Delphi Consensus Statement.","authors":"Melodi Javid Whitley, Jake X Wang, Jeremy Chapman, Aiko P J de Vries, Sindhu Chandran, Colleen M Glennon, Hector M Madariaga, Robert P Carroll, John Booth, Beatrice Concepcion, Lionel Couzi, Sacha A De Serres, Alden Doyle, Suzanne Forbes, Jonathan M Gleadle, Sian Griffin, Lakshman Gunaratnam, Gaurav Gupta, Julie Ho, Peter Hughes, Nicole Isbel, Dev K Jegatheesan, Gareth Jones, Dirk Kuypers, Brian Lee, Wai Lim, Phil Mason, Maria Meneghini, Itunu Owoyemi, Swati Rao, Alan Salama, Adnan Sharif, Olivier Thaunat, Raj Thuraisingham, Kate Wyburn, Julie M Yabu, Anokhi Jambusaria-Pahlajani, Matthew J Bottomley, Sarah T Arron","doi":"10.1097/TXD.0000000000001893","DOIUrl":"10.1097/TXD.0000000000001893","url":null,"abstract":"<p><strong>Background: </strong>Posttransplant immunosuppression in kidney transplant recipients is associated with an increased risk of developing cutaneous squamous cell carcinoma (CSCC), contributing to significant morbidity and mortality. Various dermatological and immunosuppression modulation strategies have been identified that may reduce the risk of CSCC, both in primary and secondary prevention settings. Recent recommendations have provided consensus regarding dermatological approaches to prevent CSCC. Comparable transplant nephrology recommendations to guide immunosuppression modulation for CSCC prevention are currently lacking, leading to marked variation in practice.</p><p><strong>Methods: </strong>To address this knowledge gap, 46 international transplant nephrology experts participated in a 3-round Delphi survey to develop consensus recommendations for CSCC secondary prevention based on the actinic damage and skin cancer index stages of CSCC.</p><p><strong>Results: </strong>The panel of experts reached consensus to consider a change in immunosuppression after multiple low-risk invasive CSCC (stage 5a, 1/y >3 y) and encouraged collaboration with dermatology to optimize dermatologic preventative care after the first CSCC. There was also consensus to prioritize azathioprine modification where this is present in an immunosuppressive regimen.</p><p><strong>Conclusions: </strong>This study provides the first international consensus recommendations for management of immunosuppression in kidney transplant recipients at discrete stages of CSCC. Additional prospective studies are necessary to determine the optimal management of immunosuppression in this patient population. These recommendations have been endorsed by the Board of the American Society of Transplantation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 1","pages":"e1893"},"PeriodicalIF":1.9,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12711373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145782959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biopsy and Blood Gene Expression Distinguish Injury, Subclinical and Clinical Rejection in Kidney Transplant Recipients.","authors":"Sunil M Kurian, Christabel N Rebello, Sook Hyeon Park, Raymond L Heilman, Emilio D Poggio, Michael M Abecassis, Christopher L Marsh, John J Friedewald","doi":"10.1097/TXD.0000000000001892","DOIUrl":"10.1097/TXD.0000000000001892","url":null,"abstract":"<p><strong>Background: </strong>Long-term outcomes in kidney transplantation remain suboptimal, with subclinical acute rejection (subAR) frequently going undetected by conventional methods. We hypothesized that subAR represents a molecular precursor to clinical acute rejection (cAR). Leveraging a large National Institutes of Health-funded cohort with matched kidney tissue and peripheral blood samples, our primary objective was to determine whether subAR and cAR share molecular patterns, establishing subAR as an early stage of cAR. As a secondary aim, we compared biopsy and blood gene expression profiles to identify unique and shared pathways and to assess their diagnostic utility.</p><p><strong>Methods: </strong>This was a retrospective analysis of gene expression data from an observational clinical trial. We analyzed 578 blood and biopsy samples from 129 kidney transplant recipients enrolled in a multicenter observational study. Gene expression differences were analyzed using ANOVA with false discovery rate correction and molecular pathways analysis. Samples were matched and classified based on histologic findings and blood-based molecular diagnostics.</p><p><strong>Results: </strong>Gene expression and pathway analyses revealed that subAR exhibits a molecular profile consistent with a milder form of clinical rejection in both tissue and blood. Molecular signatures distinguished immune-mediated injury from nonimmune injury. Notably, tissue gene expression profiling in cases that were misclassified by peripheral blood diagnostics were like correctly classified cases, suggesting that histology alone may not reliably define true clinical phenotypes.</p><p><strong>Conclusions: </strong>Molecular profiling of tissue and blood reflects distinct but complementary aspects of transplant biology and confirms that subAR and cAR share overlapping molecular profiles, supporting the hypothesis that subAR represents an early stage in the progression toward clinical rejection. These findings highlight the limitations of relying solely on histological evaluation and support the use of molecular tissue profiling as an adjunct to histology, particularly in diagnostically ambiguous cases. Molecular profiling provides a supporting framework for identifying subclinical rejection and guiding personalized immunosuppression to improve long-term outcomes.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 1","pages":"e1892"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12705056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propensity Score-matched Real-world Data: HCC Recurrence Rates After DBD Liver Transplantation in Times of Machine Perfusion.","authors":"Dominik Thomas Koch, Lucca Pollety, Malte Schirren, Severin Jacobi, Nikolaus Börner, Christian M Lange, Matthias Ilmer, Joachim Andrassy, Bernhard Renz, Hanno Nieß, Jens Werner, Markus Guba, Dionysios Koliogiannis","doi":"10.1097/TXD.0000000000001883","DOIUrl":"10.1097/TXD.0000000000001883","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation (LT) remains the most effective treatment for patients with hepatocellular carcinoma (HCC), offering 5-y recurrence rates as low as 15%. Recent advances in organ preservation, particularly hypothermic oxygenated machine perfusion (HOPE), have demonstrated the ability to attenuate ischemia-reperfusion injury (IRI). However, whether HOPE can reduce HCC recurrence rates by mitigating IRI remains an open question. In this study, we aimed to compare oncological outcomes after LT for HCC with and without the use of HOPE.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study including 137 patients who underwent LT for HCC with grafts from donation after brain death. Risk factors for HCC recurrence were analyzed using Cox regression. To assess the impact of HOPE on oncological outcomes, propensity score matching was used to adjust for baseline differences.</p><p><strong>Results: </strong>Cox regression identified Milan Criteria status as a significant predictor of HCC recurrence. Among the 32 patients in the HOPE group, no HCC recurrence was observed over a median follow-up of 2.11 y. In contrast, within the control group of 105 patients, 8 (7.6%) experienced recurrence within 2 y posttransplantation. Although this translated into a significant difference in time-to-recurrence after propensity score matching, recurrence-free survival and overall survival did not differ significantly.</p><p><strong>Conclusions: </strong>Our findings suggest that HOPE treatment of donation after brain death liver grafts may reduce early HCC recurrence after LT. Although only nonsignificant trends were observed in recurrence-free survival and overall survival within the first 2 y posttransplant, these results underscore the potential of HOPE to influence oncological outcomes. Long-term follow-up, prospective randomized controlled trials, and basic research are warranted to further elucidate the role of HOPE and IRI.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 1","pages":"e1883"},"PeriodicalIF":2.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376988","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":"Optimizing Kidney Allograft Years: Underutilization of Pediatric Donors.","authors":"Nicholas S Herrera, Ana Cortez, Diane M Cibrik, Bradley A Warady","doi":"10.1097/TXD.0000000000001891","DOIUrl":"10.1097/TXD.0000000000001891","url":null,"abstract":"<p><strong>Background: </strong>The Kidney Donor Profile Index (KDPI) score drives kidney allocation in the United States for both adult and pediatric donors, despite the calculation being primarily derived from adult donor data. A KDPI of ≤20% is considered to have the longest graft survival potential and is typically prioritized for recipients who have a low Estimated Posttransplant Survival (EPTS) score. Using KDPI to assess pediatric donor quality may underestimate graft survival and result in underutilization of these kidneys for recipients with a low EPTS score.</p><p><strong>Methods: </strong>Using Scientific Registry of Transplant Recipients data, we analyzed 5-y posttransplant death-censored graft survival of kidneys from donors aged 0-<4, 4-<8, 8-<12, and 12-<18 y compared with adult donor kidneys with a KDPI of ≤20% to adult recipients using Kaplan-Meier analysis, pairwise comparisons, and multivariate Cox proportional models.</p><p><strong>Results: </strong>Death-censored graft survival was not significantly different for pediatric donors aged 8-<12 y (χ² = 0.8, <i>P</i> = 0.37) and 12-<18 y (χ² = 0.23, <i>P</i> = 0.63) when compared with adult donor kidneys. Five-year graft survival was 91.8%, 92.3%, and 92.4%, respectively, with a mean KDPI of 37.5% (range, 1%-85%), 16.2% (range, 0%-85%), and 10.7% (range, 0%-19%) and mean EPTS score of 42.9%, 29.9%, and 22.8%, respectively.</p><p><strong>Conclusions: </strong>Graft survival for kidneys from donors aged 8-18 y is not inferior to that of adult donors with a KDPI of ≤20%. These data support the use of pediatric donors aged 8 y and older for those recipients who traditionally received adult donor kidneys with a KDPI of ≤20%.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 1","pages":"e1891"},"PeriodicalIF":2.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405933","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":"Attenuating Ischemia and Reperfusion Injury Using NAD⁺-Loaded Nanoparticles in Mouse Kidneys.","authors":"Bret Verhoven, Yao Tong, Peter Chlebeck, Weixiong Zhong, Weifeng Zeng, Heather Jennings, Brooke Miller, Grace Heise, Mia Levitsky, Ruosen Xie, Shaoqin Gong, David P Al-Adra","doi":"10.1097/TXD.0000000000001890","DOIUrl":"10.1097/TXD.0000000000001890","url":null,"abstract":"<p><strong>Background: </strong>Ischemia and reperfusion (IR) injury is a major complication in solid organ transplantation, necessitating new therapeutic strategies to suppress IR injury and thereby reduce early allograft dysfunction and delayed graft function. In kidney transplantation, IR injury is associated with disruption of mitochondrial homeostasis, including depletion of nicotinamide adenine dinucleotide (NAD⁺) leading to diminished ATP levels, which cells need for survival. Here, we describe a novel approach to attenuate IR injury in a mouse kidney model using a NAD⁺-loaded nanoparticle, capable of direct intracellular delivery of NAD⁺.</p><p><strong>Methods: </strong>C57BL/6NCrl mice underwent a laparotomy and occlusion of the left renal pedicle for 30 min to induce IR injury. Right nephrectomy was performed during the injury incubation. Mice received the test agents by 2 different techniques: direct kidney injection via the renal artery and systemically via intravenous (IV) injection into the vena cava. Mice received a single dose of the NAD⁺-loaded nanoparticle at 3 different concentrations. Blood and kidney tissue were collected for analysis 24 h after IR injury. Measurement of blood creatinine levels and histological analysis was performed to assess the protective effectiveness of the NAD⁺-loaded nanoparticle.</p><p><strong>Results: </strong>A single dose of NAD⁺-loaded nanoparticles resulted in significantly reduced creatinine levels in both the direct kidney-injected animals (<i>P</i> < 0.0001) and the IV-injected animals (<i>P</i> < 0.01) compared with empty nanoparticle, free NAD⁺, or saline controls. IR-induced renal tubular injury scores were markedly reduced for both IV delivery (<i>P</i> < 0.01) and direct injection (<i>P</i> < 0.05) compared with control treatments.</p><p><strong>Conclusions: </strong>These results justify further development of this novel NAD⁺-loaded nanoparticle in the realm of organ transplantation to ameliorate IR injury and potentially increase usage of expanded criteria organs and reduce instances of delayed graft function.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 1","pages":"e1890"},"PeriodicalIF":2.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405952","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":"Quality Assessment of Discarded Human Kidneys Using Normothermic Perfusion.","authors":"Enrique Montagud-Marrahi, Thomas Prudhomme, Tarek Ajami, Cristina García-Parejo, Lluis Peri, Adriana Rodriguez-Gonzalo, Yosu Luque, Antoni Vilaseca, Ruben Rabadan-Ros, Elena Cuadrado-Payan, Elisenda Bañón-Maneus, Jordi Rovira, Maria José Ramírez-Bajo, Lourdes Mengual, Mercedes Ingelmo, Ana Belén Larque, Antonio Alcaraz, Josep M Campistol, Fritz Diekmann, Mireia Musquera","doi":"10.1097/TXD.0000000000001884","DOIUrl":"10.1097/TXD.0000000000001884","url":null,"abstract":"<p><strong>Background: </strong>Ex vivo normothermic perfusion (EVNP) allows for comprehensive functional assessment; however, current scoring systems are validated only for short perfusion durations. This study investigates the utility of the EVNP quality assessment score for a 6-h period to predict viability in discarded human kidneys.</p><p><strong>Methods: </strong>Twenty human kidneys from marginal donors, previously declined for transplantation, underwent 6-h EVNP. Functional parameters (renal blood flow, resistance index, urine output), perfusate biochemistry, tissue injury biomarkers, and histology were assessed. Kidneys were stratified by EVNP score: group A (1-2), group B (3), and group C (4-5).</p><p><strong>Results: </strong>Group A demonstrated significantly higher renal blood flow (median 213.5 versus 145.1 [B] versus 81.7 mL/min [C], <i>P</i> < 0.0001), lower resistance index (0.32 versus 0.41 [B] versus 0.86 mL/min/mm Hg [C], <i>P</i> < 0.0001), greater urine output (241.1 versus 97.9 [B] versus 10.9 mL [C], <i>P</i> < 0.0001), and more favorable perfusate profiles (lactate: 14.2 versus 15.7 [B] versus 19.9 mg/dL [C], <i>P</i> = 0.02). Histological scores did not correlate with EVNP score groups at baseline or after perfusion. EVNP during 6 h showed trends consistent with functional graft performance, suggesting it may help inform decisions to reduce organ discard.</p><p><strong>Conclusions: </strong>The EVNP score may assist in identifying kidneys with potential for transplantation despite suboptimal histology, which could contribute to reducing the underutilization of marginal grafts.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"12 1","pages":"e1884"},"PeriodicalIF":2.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Association Between Donor-recipient Matchability, Access to Transplantation, and Posttransplant Outcomes: Erratum.","authors":"Rowena Lalji, Ryan Gately, Ross Francis, Wai Lim, Scott Campbell, Narelle Watson, Gary Torrens, Anna Francis, Germaine Wong, David W Johnson","doi":"10.1097/TXD.0000000000001889","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001889","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/TXD.0000000000001862.].</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 12","pages":"e1889"},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12657042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Exploring the Molecular Mechanisms of Autophagy-related Genes in Hepatic Ischemia/Reperfusion Injury Using Bioinformatics: Erratum.","authors":"Qi Xiao, Xiaoxiao Hu, Qiong Chen, WenYu Wang, JianSheng Xiao, Biqi Fu","doi":"10.1097/TXD.0000000000001885","DOIUrl":"https://doi.org/10.1097/TXD.0000000000001885","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/TXD.0000000000001829.].</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 12","pages":"e1885"},"PeriodicalIF":1.9,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Donor-recipient Matchability, Access to Transplantation, and Posttransplant Outcomes.","authors":"Rowena Lalji, Ryan Gately, Ross Francis, Wai Lim, Scott Campbell, Narelle Watson, Gary Torrens, Anna Francis, Germaine Wong, David W Johnson","doi":"10.1097/TXD.0000000000001862","DOIUrl":"10.1097/TXD.0000000000001862","url":null,"abstract":"<p><strong>Background: </strong>Globally, deceased donor kidney allocation algorithms prioritize HLA matching, potentially disadvantaging transplant candidates with less common HLA alleles. This study developed an Australian Matchability score (M-score) to assess access to transplantation and posttransplant outcomes based on HLA match probability.</p><p><strong>Methods: </strong>M-scores were calculated by comparing all recipients and donors with complete HLA-A, HLA-B, and HLA-DR data from the Australia and New Zealand Dialysis and Transplant Registry (July 1, 2006-December 31, 2023). Multivariable Cox regression was used to analyze associations between M-score quartiles and time to transplantation as well as transplantation outcomes.</p><p><strong>Results: </strong>HLA data from 14 836 recipients and 7708 donors were used to generate M-scores. Of these, 10 760 recipients had available waitlist data and were included in the models. M-scores were normally distributed with a mean ± SD of 11.4 ± 0.9. The proportion of non-European Australians increased significantly with each quartile (ie, more difficult to HLA match), Q1: 16%, Q2: 26%, Q3: 40% Q4: 60% (<i>P < </i>0.001). Compared with Q1, patients in Q4 were significantly less likely to receive a deceased donor kidney transplant (adjusted hazard ratio [aHR] 0.56; 95% confidence interval [CI], 0.52-0.60; <i>P < </i>0.001) had the highest risk of death-censored graft loss (aHR 1.39; 95% CI, 1.01-1.91; <i>P</i> = 0.05) and acute rejection (aHR, 1.29; 95% CI, 1.09-1.52; <i>P = </i>0.002).</p><p><strong>Conclusions: </strong>The M-score identifies transplant recipients with difficult-to-match HLA profiles. Higher M-scores were associated with a lower likelihood of transplantation and an increased risk of death-censored graft loss and acute rejection. These findings highlight significant inequities in the current HLA-based algorithm for deceased donor allocation.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 11","pages":"e1862"},"PeriodicalIF":1.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}