Transplantation proceedings最新文献

{"title":"Vaccine Immunogenicity to SARS-CoV-2 in Renal Transplant Patients Under Three Different Immunosuppressive Regimens: Evaluation of Antibody Titers","authors":"Marcelo Paes Menezes Filho, Luiz Sergio Fonseca de Azevedo, Lais Teodoro da Silva, Juliana Ruiz Fernandes, Telma Oshiro Sumida, Beatriz Trevisan, Fabiana Agena, Elias Davi-Neto, Gil Bernard","doi":"10.1016/j.transproceed.2026.06.029","DOIUrl":"10.1016/j.transproceed.2026.06.029","url":null,"abstract":"<div><h3>Background</h3><div>In kidney transplant recipients (KTRs), the immunogenic response to vaccines is considered to be low in achieving a robust immune response.</div></div><div>In kidney transplant recipients (KTRs), the immunogenic response to vaccines is considered to be low in achieving a robust immune response.</div><div><h3>Methods</h3><div>This study evaluated the serological response of KTRs who received previous immunization with the anti-SARS-CoV-2 vaccine ChAdOx1 and 2 booster doses of BNT162b2 vaccine. Patients were on 3 different immunosuppressive regimens: azathioprine (AZA), mycophenolic acid precursors (MPA), or mammalian target of rapamycin inhibitors (mTORi). All were also on tacrolimus and prednisone. Healthy volunteers served as controls. Blood samples were collected before receiving the first booster dose, 4 to 6 weeks after the first booster dose, and 6 months after the second booster dose.</div></div><div>This study evaluated the serological response of KTRs who received previous immunization with the anti-SARS-CoV-2 vaccine ChAdOx1 and 2 booster doses of BNT162b2 vaccine. Patients were on 3 different immunosuppressive regimens: azathioprine (AZA), mycophenolic acid precursors (MPA), or mammalian target of rapamycin inhibitors (mTORi). All were also on tacrolimus and prednisone. Healthy volunteers served as controls. Blood samples were collected before receiving the first booster dose, 4 to 6 weeks after the first booster dose, and 6 months after the second booster dose.</div><div><h3>Results</h3><div>Before the vaccine booster, the MPA group had a tendency, but not statistically significant, of a lower reactivity rate than the AZA, mTORi, and control groups. The percentage of reactivity was AZA 54%, MPA 42%, mTORi 55%, and controls 73%, respectively. After the first booster, the serological response had a significant increase, indicating the effectiveness of the heterologous vaccine dose in all groups (<em>P</em> < .05 in percentage of responders in serological titers), which reached the following percentage of seroreactivity: AZA 90%, MPA 80%, mTORi 88%, and controls 100%, respectively. After the second booster dose, seroreactivity was 81%, 91%, and 100%, respectively.</div></div><div>Before the vaccine booster, the MPA group had a tendency, but not statistically significant, of a lower reactivity rate than the AZA, mTORi, and control groups. The percentage of reactivity was AZA 54%, MPA 42%, mTORi 55%, and controls 73%, respectively. After the first booster, the serological response had a significant increase, indicating the effectiveness of the heterologous vaccine dose in all groups (<em>P</em> < .05 in percentage of responders in serological titers), which reached the following percentage of seroreactivity: AZA 90%, MPA 80%, mTORi 88%, and controls 100%, respectively. After the second booster dose, seroreactivity was 81%, 91%, and 100%, respectively.</div><div><h3>Conclusions</h3><div>After the vaccine bo","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1263-1266"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisystemic Anesthetic Management and Patient Blood Management in Urgent Liver Transplantation for Acute-on-Chronic Liver Failure: A Case Report","authors":"Roxanne Cabral Miragaia Aquino,&nbsp;Gustavo Guimarães Torres,&nbsp;Renato Toledo Maciel,&nbsp;Lucio José Auler de Faria,&nbsp;Lucio Filgueiras Pacheco Moreira,&nbsp;Marcos Bettini Pitombo","doi":"10.1016/j.transproceed.2026.07.003","DOIUrl":"10.1016/j.transproceed.2026.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality and frequently requires urgent liver transplantation. Perioperative management is challenging due to severe hemodynamic instability, coagulopathy, systemic inflammation, and multiorgan dysfunction. Optimized anesthetic strategies combined with Patient Blood Management (PBM) principles may improve outcomes and reduce transfusion-related complications.</div></div><div><h3>Case presentation</h3><div>We report the case of a 42-year-old woman with chronic cholestatic liver disease who developed ACLF with hepatic encephalopathy, systemic infection, and hepatorenal syndrome, requiring urgent liver transplantation with a deceased donor graft. Intermittent hemodialysis was initiated preoperatively due to renal dysfunction. The procedure was performed under total intravenous anesthesia with advanced multimodal monitoring, including invasive hemodynamic assessment and cerebral oximetry. Intraoperatively, the patient developed severe vasoplegia requiring high-dose vasoactive support. Fluid therapy followed a restrictive strategy, and coagulation management was guided by viscoelastic testing. Intraoperative blood conservation strategies, including cell salvage, were applied, and no allogeneic blood components or other blood-derived products were required. Postoperatively, the patient was admitted to the intensive care unit under vasoactive support, with progressive hemodynamic stabilization, recovery of renal function, and resolution of encephalopathy. She was discharged home without major complications.</div></div><div><h3>Conclusion</h3><div>This case highlights the importance of individualized anesthetic management and strict application of PBM principles in urgent liver transplantation for ACLF. Advanced monitoring, goal-directed therapy, and restrictive transfusion strategies may contribute to improved perioperative stability and favorable postoperative recovery. This case report complies with the Declaration of Helsinki and the Declaration of Istanbul regarding ethical organ donation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1391-1394"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dengue in Kidney Replacement Therapy: Comparison Between Chronic Dialysis and Kidney Transplant Patients","authors":"Ana Vitória Rodrigues de Sá,&nbsp;Marcela Pagianotto Bidoia,&nbsp;Ana Carolina Nakamura Tome,&nbsp;Thamiris Quiqueto Marinelli,&nbsp;Carolina Soares Rezende,&nbsp;Cássia Fernanda Estofolete,&nbsp;Maurício Lacerda Nogueira,&nbsp;Maria Alice Sperto Ferreira Baptista,&nbsp;Mario Abbud-Filho,&nbsp;Ida Maria Maximina Fernandes-Charpiot,&nbsp;Fernanda Salomão Gorayeb-Polacchini","doi":"10.1016/j.transproceed.2026.04.013","DOIUrl":"10.1016/j.transproceed.2026.04.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Dengue is the most prevalent arboviral disease in Brazil, and patients on kidney replacement therapy (KRT), such as chronic dialysis (CKD-5D) or kidney transplant recipients (KTx), may present more severe clinical manifestations.</div></div><div><h3>Objective</h3><div>This study aimed to compare clinical and laboratory aspects, as well as outcomes of dengue infection, between patients on CKD-5D and KTR.</div></div><div><h3>Methods</h3><div>A prospective, analytical, single-center study involving patients diagnosed with dengue (positive NS1 and/or IgM) between November 2024 and April 2025.</div></div><div><h3>Results</h3><div>Fifty-eight patients were included (33 CKD-5D and 25 KTx). The median age was higher in CKD-5D patients (67 vs 59 years; <em>p</em> = .0066). The incidence of dengue was 2 times higher in CKD-5D patients (6% vs 2,9%). Hospitalization was more frequent in KTR (92% vs 36.3%; <em>p</em> &lt; .0001), and 56% of them developed acute kidney injury. Lower platelet counts (<em>p</em> = .0164) and being a KTx were independent predictors of hospitalization.</div></div><div><h3>Conclusion</h3><div>Despite the higher incidence, advanced age, and presence of comorbidities, patients on CKD-5D presented a lower risk of hospitalization than KTx.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1274-1278"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the Cost of Maintaining Effective Donors and Nondonors of Organs and Tissues in Intensive Care Units","authors":"Aline Moraes Silva,&nbsp;Marcos Antonio Ferreira Júnior,&nbsp;Andréia Insabralde de Queiroz Cardoso,&nbsp;Elenir Rose Jardim Cury,&nbsp;Oleci Pereira Frota,&nbsp;Isabelle Campos Azevedo,&nbsp;Viviane Euzébia Pereira Santos,&nbsp;Leticia Lima Meza,&nbsp;Matilde Delmina da Silva Martins","doi":"10.1016/j.transproceed.2026.06.007","DOIUrl":"10.1016/j.transproceed.2026.06.007","url":null,"abstract":"<div><h3>Background</h3><div>The costs of potential donors are not fully known in Brazil, as in other countries, especially during the period that patients remain in intensive care units.</div></div><div><h3>Objectives</h3><div>This study aims to evaluate the cost of maintaining effective donors and nondonors of organs and tissues for transplants in intensive care units using the microcosting technique.</div></div><div><h3>Methods</h3><div>An economic cost analysis using 3 retrospective cohorts constructed from secondary data collected over a 1-year period from medical records of deceased patients who had a protocol opened for brain death investigation. Cost measurement followed the 8 steps of the Time-Driven Activity-Based Costing method.</div></div><div><h3>Results</h3><div>The average cost of the effective donor was US$3220.04. The cost of the nondonor due to family refusal was US$1346.48. The cost of the nondonor due to medical refusal was US$1144.90. Organs and tissues donated but not collected totaled US$16,656.92.</div></div><div><h3>Conclusions</h3><div>A review of work processes and adopting strategies to mitigate the failure to complete donations in all outcomes are necessary, since the sum of the amounts spent on medical refusal, family refusal, and problems preventing collection amounted to a total of US$104,121.66 in 1 year.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1230-1237"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Title page - Proceedings of the XIX Brazilian Transplantation Society Congress (ABTO 2025) and the XXIII Luso-Brazilian Congress Fortaleza, Brazil October 15-18, 2025","authors":"","doi":"10.1016/S0041-1345(26)00406-9","DOIUrl":"10.1016/S0041-1345(26)00406-9","url":null,"abstract":"","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Page 1227"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile of Patients With Hepatocellular Carcinoma Referred for Transarterial Chemoembolization at a Tertiary Center","authors":"Beatriz Piaulino de Araujo,&nbsp;João Guilherme Oliveira Vaz,&nbsp;Ana Paula Nunes Bento,&nbsp;Maria Stella Vasconcelos Sales Valente,&nbsp;Juan Mariano Huertas Aguilar,&nbsp;Gabriel Marchetto,&nbsp;Lara Garcia Victório Pessotto,&nbsp;Paolla Ravida Alves de Macedo,&nbsp;Carla Batista Moisés,&nbsp;Fernanda Dias Teramoto,&nbsp;Alexandre Foratto,&nbsp;Aline Garcia,&nbsp;Cristhian Jaillita Meneses,&nbsp;Ilka de Fatima Santana Ferreira Boin,&nbsp;Simone Reges Perales,&nbsp;Elaine Cristina de Ataíde","doi":"10.1016/j.transproceed.2026.03.003","DOIUrl":"10.1016/j.transproceed.2026.03.003","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related mortality worldwide. It is strongly associated with chronic liver diseases such as viral hepatitis, alcohol-related liver disease, and nonalcoholic steatohepatitis. Transarterial chemoembolization (TACE) is indicated for intermediate-stage HCC and may be used for downstaging, bridging to liver transplantation, or palliative treatment.</div></div><div><h3>Methods</h3><div>This cross-sectional observational study evaluated patients with HCC referred for TACE at the University Hospital of Campinas between 2022 and 2023, who underwent the procedure until 2024. Demographic data, liver disease etiology, laboratory findings, tumor staging (Child–Pugh, BCLC, and MELD), transplant listing status, alpha-fetoprotein (AFP) levels, and tumor characteristics were analyzed.</div></div><div><h3>Results</h3><div>A total of 158 patients were included, with a mean age of 64 years and male predominance (77.85%). Hepatitis C virus infection was the most frequent etiology (31%), followed by alcohol-related liver disease (20.9%) and combined HCV and alcohol use (17%). TACE was performed in 100 patients, mainly for downstaging (37.3%) and prevention of transplant waiting-list dropout (32.3%). Half of the patients presented with a single tumor nodule, with a mean lesion size of 3.8 cm. The mean MELD score was 12.5 and AFP levels showed wide variability.</div></div><div><h3>Conclusion</h3><div>The study population demonstrated an epidemiological profile consistent with the literature. TACE was widely used as an effective strategy for tumor control in liver transplant candidates, highlighting its importance in the management of HCC in the Brazilian clinical setting.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1371-1373"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Transplantation: A Review of 45 Years of a Southern Brazilian Hospital","authors":"Débora Sartori Giaretta,&nbsp;Helena Dai Prá Maestri,&nbsp;Pedro Henrique Zanella Catto,&nbsp;Alessandra Dalla Rosa Santini,&nbsp;Moacir Alexandre Traesel,&nbsp;Florência Ferreira Barreiro,&nbsp;Luísa Litvin Raffin,&nbsp;Carlos Eduardo Poli-de-Figueiredo,&nbsp;Leonardo Viliano Kroth","doi":"10.1016/j.transproceed.2026.05.008","DOIUrl":"10.1016/j.transproceed.2026.05.008","url":null,"abstract":"<div><div>Kidney transplantation is the best therapeutic option for patients with end-stage kidney disease, providing longer survival and quality of life. This retrospective single-center study analyzed all kidney transplants performed at Hospital São Lucas da PUCRS between 1978 and 2023, categorizing patients into different eras according to the evolution of immunosuppressive protocols. A total of 1,920 transplants were performed, and patient survival at 1, 3, and 5 years was evaluated, which was estimated at 89.6%, 86%, and 82.8%, respectively, for living donors and 85%, 80.3%, and 76.2%, respectively, for deceased donors. The acute rejection rate decreased from 39.2% in the years 1987 to 1997 to 18.8% in the most recent era. The impact of the COVID-19 pandemic was significant, increasing mortality and temporarily reducing the transplant rate. The findings demonstrate improvements in patient and graft survival over the years, in line with advances in surgical and immunosuppressive techniques. However, challenges such as infections and chronic complications remain relevant. Future studies should focus on optimizing clinical management and mitigating the impacts of health crises on the transplant population.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1253-1262"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescence and Pediatric Heart Transplantation: Impact of Non-Adherence on Mortality: A Single-Center Experience","authors":"Camylla Santos de Souza,&nbsp;Ana Luiza Torquato de Aquino,&nbsp;Nara Lilian Lima Cardoso,&nbsp;Karla Jéssica Santos de Araújo,&nbsp;Cecília Gabriela Dantas de Souza,&nbsp;Marília Miguel da Silveira,&nbsp;Isabelle Barbosa Pontes,&nbsp;Isabel Cristina Leite Maia,&nbsp;Candice Torres de Melo Bezerra Cavalcante,&nbsp;Klebia Magalhães Pereira Castello Branco","doi":"10.1016/j.transproceed.2026.06.004","DOIUrl":"10.1016/j.transproceed.2026.06.004","url":null,"abstract":"<div><div>Heart transplantation represents the standard of care for pediatric patients with advanced heart failure. While outcomes have significantly improved in recent decades, adolescence remains a high-risk period marked by increased rejection rates and mortality, largely due to treatment non-adherence. This study aimed to analyze morbidity and mortality in adolescents undergoing heart transplantation at a single Brazilian center, focusing on the role of non-adherence. We conducted a retrospective review of medical records of 41 patients who underwent heart transplantation at our institution between 2002 and 2022. Patients transplanted during adolescence or who became adolescents after transplantation were included. We assessed episodes of rejection, major complications, and mortality, correlating outcomes with treatment adherence. Adolescents represented 54.5% of transplant recipients. This group exhibited higher rejection rates, with an average of 2.3 episodes per patient. Late mortality (&gt;1 year after transplant) was predominantly rejection-related, with 61.5% of deaths directly linked to non-adherence to immunosuppressive therapy. Our findings reinforce that adolescents constitute a vulnerable group within pediatric heart transplantation, mainly due to the high rate of non-adherence to immunosuppressive treatment. Multidisciplinary strategies, such as psychological support, continuing education, and transition programs to adulthood, are essential to mitigate this risk and improve outcomes in this population.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1343-1345"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Rejection Mediated by Preformed Anti-HLA-C Antibody in a Kidney Transplant Patient: A Case Report","authors":"Joice Holanda Dias,&nbsp;Diogo Buarque Cordeiro Cabral,&nbsp;Alexandre de Holanda Cavalcanti Pinto,&nbsp;Camila Viana Ximenes,&nbsp;Tatiana Cristina Manzi Sena,&nbsp;Joaquim de Oliveira Borba Junior,&nbsp;Maria Carolina Romeiro Figueirôa Benício Coelho,&nbsp;Frederico Castelo Branco Cavalcanti","doi":"10.1016/j.transproceed.2026.06.006","DOIUrl":"10.1016/j.transproceed.2026.06.006","url":null,"abstract":"<div><div>Recently, the clinical relevance of donor-specific anti-HLA-C antibodies has been recognized in kidney transplantation (KT). In this case report, we describe the diagnosis and treatment response of acute antibody-mediated rejection in a patient with preformed anti-HLA-C. A 66-year-old male who had returned to hemodialysis 8 years prior, after losing his first living donor graft underwent a second KT with a standard deceased donor. He had an antibody reactivity panel of 99.8%, a negative crossmatch, and an identified anti-HLA-C antibody (11,032 mean fluorescence intensity). He presented with delayed graft function, and the biopsy showed acute antibody-mediated rejection positive for C4d. The episode was treated with 3 doses of methylprednisolone 500 mg/d, five plasmapheresis sessions, and 1 g/kg/d of human immunoglobulin for 2 days, with clinical, laboratory, and histological response, maintaining a GFR (CKD Epidemiology Collaboration 2021) of 93 mL/min/1.73 m² for 3 years after the KT. Considering the less frequent detection of anti-HLA-C antibodies and their potential to trigger rejection, which impacts kidney graft survival, this report and the published work on the topic reinforce the importance of evaluating their pathogenic role. With the recent recognition and understanding of the subject, early identification, and inclusion of HLA-C in routine typing will improve analysis of transplant conditions and rejection risk.</div></div><div>Recently, the clinical relevance of donor-specific anti-HLA-C antibodies has been recognized in kidney transplantation (KT). In this case report, we describe the diagnosis and treatment response of acute antibody-mediated rejection in a patient with preformed anti-HLA-C. A 66-year-old male who had returned to hemodialysis 8 years prior, after losing his first living donor graft underwent a second KT with a standard deceased donor. He had an antibody reactivity panel of 99.8%, a negative crossmatch, and an identified anti-HLA-C antibody (11,032 mean fluorescence intensity). He presented with delayed graft function, and the biopsy showed acute antibody-mediated rejection positive for C4d. The episode was treated with 3 doses of methylprednisolone 500 mg/d, five plasmapheresis sessions, and 1 g/kg/d of human immunoglobulin for 2 days, with clinical, laboratory, and histological response, maintaining a GFR (CKD Epidemiology Collaboration 2021) of 93 mL/min/1.73 m² for 3 years after the KT. Considering the less frequent detection of anti-HLA-C antibodies and their potential to trigger rejection, which impacts kidney graft survival, this report and the published work on the topic reinforce the importance of evaluating their pathogenic role. With the recent recognition and understanding of the subject, early identification, and inclusion of HLA-C in routine typing will improve analysis of transplant conditions and rejection risk.</div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1381-1383"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Transplantation in Brazil: Two Decades of Gender Disparities in the World’s Largest Public Organ Transplant System","authors":"Jefferson Luís Vieira,&nbsp;Dhayn Cassi de Almeida Freitas,&nbsp;Luma Maria Tavares de Sousa,&nbsp;Lorena Alves de Souza Leal de Araújo,&nbsp;Eline Pereira Alves,&nbsp;Luzielio Alves Sidney Filho,&nbsp;Bruno Oliveira Rocha,&nbsp;Priscila Ferreira de Lima e Souza,&nbsp;Raul Valério Ponte,&nbsp;Daniel Francisco de Mendonça Trompieri,&nbsp;Kamila Almeida Freitas,&nbsp;Letícia Gonçalves da Silva,&nbsp;Jardel Moita do Nascimento,&nbsp;Ana Beatriz Braga Dias,&nbsp;Germana Porto Linhares de Almeida,&nbsp;Laura Leite da Escóssia Marinho,&nbsp;Glauber Gean de Vasconcelos,&nbsp;Juan Alberto Cosquillo Mejía,&nbsp;João David de Souza Neto","doi":"10.1016/j.transproceed.2026.06.020","DOIUrl":"10.1016/j.transproceed.2026.06.020","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Donor shortages pose challenges for heart transplantation (HT). Brazil has the largest public organ transplant system in the world, with notable sex disparities between donors and recipients. This study evaluates sex-specific differences in HT profiles and outcomes in a high-volume Brazilian program.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Donor shortages pose challenges for heart transplantation (HT). Brazil has the largest public organ transplant system in the world, with notable sex disparities between donors and recipients. This study evaluates sex-specific differences in HT profiles and outcomes in a high-volume Brazilian program.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted two retrospective cohort studies: adult HT recipients between October 1997 and March 2023, and donors offered to the same center from January 2013 to March 2023. Survival was assessed via Kaplan–Meier, with 95% confidence intervals.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;We conducted two retrospective cohort studies: adult HT recipients between October 1997 and March 2023, and donors offered to the same center from January 2013 to March 2023. Survival was assessed via Kaplan–Meier, with 95% confidence intervals.&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 426 recipients, 80.7% were men (mean age: 48.4 ± 12.0 years vs 44.8 ± 11.1 for women, &lt;em&gt;P&lt;/em&gt; = .014). Dilated cardiomyopathy was the leading cause of HF in both sexes (men: 35%, women: 28%), followed by ischemic heart disease (27%) in men and Chagas disease (15%) in women. Women had higher rates of hypertension compared to men (14.6% vs 6.7%, &lt;em&gt;P&lt;/em&gt; = .03), whereas no significant differences were observed for diabetes or chronic kidney disease. Survival rates at 1, 5, and 10 years (73%, 62%, and 49%, respectively) showed no sex-based differences (hazard ratios 0.71, confidence intervals 95% 0.44-1.15, &lt;em&gt;P&lt;/em&gt; = .16), with median survival of 9.6 years. Among the 458 potential heart donors reported during the study period, the utilization rate was 40% (185 orthotopic HTs), with a median wait time of 46.5 days. Male donors predominated (84%) and were younger than females (28.8 ± 9.4 vs 34.8 ± 12.8 years, &lt;em&gt;P&lt;/em&gt; &lt; .01). Trauma was the leading cause of death among male donors (62%), while stroke was predominant in females (56%). Female donors had higher rates of hypertension (20% vs 4.5%, &lt;em&gt;P&lt;/em&gt; &lt; .01), but no differences were observed for diabetes or pretransplant vasoactive support. Discarded organs were mostly due to infection (20%). There was no significant differences across donor-recipient sex matching groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;Among 426 recipients, 80.7% were men (mean age: 48.4 ± 12.0 years vs 44.8 ± 11.1 for women, &lt;em&gt;P&lt;/em&gt; = .014). Dilated cardiomyopathy was the leading cause of HF in both sexes (men: 35%, women: 28%), followed by ischemic heart disease (27%) in men and Chagas disease (15%) in women. Women had higher rates of hypertension compared to men (14.6% vs 6.7%, &lt;em&gt;P&lt;/em&gt; = .03), whereas no significant diff","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 7","pages":"Pages 1346-1352"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}