Transplantation proceedings最新文献

{"title":"Preventive Dental Strategies to Minimize Oral Health Complications After Renal Transplantation: A Systematic Review","authors":"Hany M. El Hennawy,&nbsp;Maryam H. El Hennawy,&nbsp;Omar Safar,&nbsp;Tariq M Jaber,&nbsp;Ghaleb A Aboalsamh,&nbsp;Muhammed Awais,&nbsp;Ibrahim Tawahri,&nbsp;Mohamed E. Balla,&nbsp;Abdullah H. Almalki","doi":"10.1016/j.transproceed.2026.04.036","DOIUrl":"10.1016/j.transproceed.2026.04.036","url":null,"abstract":"<div><h3>Background</h3><div>Kidney transplantation dramatically improves survival and life quality in patients with end-stage renal disease, yet it imposes a substantial and often overlooked oral health burden. Immunosuppressive therapy, comorbidities, and residual renal dysfunction increase susceptibility to periodontal disease, oral candidiasis, mucosal lesions, and drug-induced gingival overgrowth, which may contribute to systemic complications and negatively affect patient well-being. This review synthesizes evidence on oral complications and evaluates preventive strategies.</div></div><div><h3>Methods</h3><div>A comprehensive systematic review with qualitative evidence synthesis was conducted using PubMed, Scopus, Google Scholar, and the Cochrane Library, encompassing studies published over the last 20 years. Observational studies and randomized trials were analyzed, with risk-of-bias assessment using ROBINS-I and Cochrane RoB tools. Due to heterogeneity in study design, outcome definitions, and reporting methods, a quantitative meta-analysis was not feasible.</div></div><div><h3>Results</h3><div>Oral complications arise from the interplay of immunosuppression, comorbidities, and insufficient oral care. Periodontal disease affects up to 87% of recipients, with xerostomia, candidiasis, and gingival overgrowth commonly reported. Preventive measures, including pretransplant dental clearance, individualized hygiene programs, antifungal prophylaxis, fluoride use, and structured post-transplant monitoring, are associated with reductions in oral infections and inflammatory complications reported across multiple studies. Evidence gaps persist, particularly in low-resource settings, standardized protocols, and patient-reported outcomes such as oral health–related quality of life (OHRQoL).</div></div><div><h3>Conclusion</h3><div>Oral health is an important component of kidney transplant care. Integrating structured, patient-centered dental protocols within transplant programs may help reduce oral morbidity and support overall patient health, although direct causal effects on graft outcomes remain incompletely established in current literature. Future research should focus on longitudinal outcomes and OHRQoL metrics to guide precision, holistic transplant care.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 973-985"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229925","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":"Portomesenteric Jump Graft for Liver Transplantation. Single Center Experience in Latin America","authors":"Natalia Reyes,&nbsp;Sergio Riveros,&nbsp;María J Irarrazaval,&nbsp;Gabriela Ochoa,&nbsp;Nicolás Jarufe,&nbsp;Eduardo Viñuela,&nbsp;Jorge Martínez,&nbsp;Martin Dib,&nbsp;Eduardo Briceño","doi":"10.1016/j.transproceed.2026.05.028","DOIUrl":"10.1016/j.transproceed.2026.05.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic portal vein thrombosis and cavernomatosis are a complex challenge for liver transplantation. This study aims to analyze the results of portomesenteric reconstruction with a jump graft using the cadaveric iliac vein in liver transplantation.</div></div><div><h3>Material and Methods</h3><div>Non-concurrent cohort study from 2001 to 2023. All patients who underwent portal vein reconstruction with a mesenteric jump graft for liver transplantation were included.</div></div><div><h3>Results</h3><div>Nineteen patients were included. Pretransplant diagnosis of portal vein thrombosis was in 13 patients (68,4%), with 7 of them (36.8%) receiving anticoagulation. A preoperative decision to perform the venous jump graft was made in 8 patients (42.1%). Intraoperatively, 11 patients were classified as grade III according to the Yerdel classification, and eight were found to have cavernomatosis. Eleven patients (57.9%) experienced major complications, with 7 patients requiring reoperation. None of the complications were related to the portomesenteric jump graft. Two patients (10,5%) died in the first 30 days. The 5-year overall and graft survival rates were identical at 63.2%, as no retransplantations occurred. The median follow-up for venous bridge patency was 18 months, identifying only 2 thrombosed bridges (13.3%).</div></div><div><h3>Conclusions</h3><div>Portomesenteric reconstruction with a jump graft using a cadaveric iliac vein yields favorable outcomes in this cohort of liver transplantations. This technique represents a vital surgical strategy, enabling transplantation for patients who would otherwise not be considered transplant candidates.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 1129-1133"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148261088","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":"Racial and Ethnic Disparities in Cytomegalovirus Disease Progression Among Kidney Transplant Recipients: A Single-Center Exploratory Study","authors":"M. Gabriela Cabanilla,&nbsp;Ashlee Dauenhauer,&nbsp;Briana St John","doi":"10.1016/j.transproceed.2026.06.014","DOIUrl":"10.1016/j.transproceed.2026.06.014","url":null,"abstract":"<div><h3>Background</h3><div>Cytomegalovirus (CMV) is a major cause of morbidity in kidney transplant recipients. However, little is known about racial and ethnic disparities in CMV outcomes. This study explored the potential differences in CMV disease progression among different racial and ethnic groups.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study included adult kidney transplant recipients who developed CMV viremia (≥200 copies/mL) between January 2012 and July 2022. The primary outcome was the progression to CMV syndrome or invasive disease. Secondary outcomes included disease severity, 12-month mortality, and graft failure. Patients were categorized as non-Hispanic white or racial/ethnic minorities.</div></div><div><h3>Results</h3><div>Of 31 patients with CMV viremia, 28 (90.3%) were racial/ethnic minorities (15 Hispanic, 11 Native American, 2 other), despite minorities representing 52% of the overall transplant population. Progression to CMV syndrome or invasive disease occurred in 13 (41.9%) patients. Among the 13 patients who progressed, 12 (92.3%) were minorities. All 5 patients who developed tissue-invasive disease were minorities. Twelve-month all-cause mortality was 32.3% (n = 10), with 90% of deaths occurring in minorities. Patients who progressed had higher median initial viral loads than those who did not (4,680 vs. 1,565 copies/mL; <em>p</em> = .12).</div></div><div><h3>Conclusion</h3><div>Racial and ethnic minorities comprised 90.3% of patients who developed CMV viremia and experienced nearly all disease progression, despite representing half of the transplant population. These preliminary findings warrant validation through larger multicenter studies that incorporate socioeconomic, geographic, and immunogenetic variables to identify modifiable factors contributing to disparities and to guide equitable interventions.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 1042-1048"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267738","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":"Evaluation of a Standardized Laboratory-Developed Assay for Quantification of BK Virus in Renal Transplant Recipients","authors":"Nguyen Manh Dung,&nbsp;Nguyen Van Duc,&nbsp;Pham Quoc Toan,&nbsp;Chu Duc Minh,&nbsp;Nguyen Huu Ben,&nbsp;Nguyen Minh Phuong,&nbsp;Nguyen Tung Linh,&nbsp;Hoang Xuan Cuong,&nbsp;Dao Hong Nam,&nbsp;Patrice N. Marche,&nbsp;Hoang Xuan Su","doi":"10.1016/j.transproceed.2026.06.009","DOIUrl":"10.1016/j.transproceed.2026.06.009","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to evaluate the clinical performance of an in-house laboratory-developed assay (LDA) calibrated against the first World Health Organization (WHO) international standard for quantification of BK virus (BKV) in recipients of renal transplants.</div></div><div><h3>Methods</h3><div>A total of 83 samples were collected from patients who underwent renal transplantation at Military Hospital 103, Vietnam Military Medical University. BKV loads were measured using an in-house LDA in comparison with the Altona assay on urine and plasma samples.</div></div><div><h3>Results</h3><div>The limit of detection was established against the first WHO international standard and was estimated to be 135 IU/mL. The intra-assay and interassay coefficients of variation ranged from 0.42% to 1.13% and from 1.71% to 2.47%, respectively. The comparative evaluation of the LDA with the Altona assay on 83 clinical samples showed the diagnostic sensitivity and specificity of the LDA to be 98.04% and 90.62%, respectively. The Kappa value of 0.897 (95% CI, 0.781-0.975) showed a good agreement. For 50 quantitative results obtained by the two assays, excellent agreement and strong correlation were observed by linear regression (<em>r</em>² = 0.95 for all samples), and Passing-Bablok regression analysis was used for method comparisons; the Bland-Altman plot analysis did not show any mean difference between measured values of the two assays for all samples.</div></div><div><h3>Conclusion</h3><div>The LDA had good analytical and clinical performance for quantification of BKV as compared with the Altona assay. This LDA calibrated against the first WHO international standard could be useful for monitoring BKV replication in recipients of renal transplants in resource-challenged settings.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 961-967"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280764","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":"Kaposi Sarcoma as a Cause of Anemia in Kidney Transplant Recipients: Two Case Reports","authors":"Aydan Mutis Alan,&nbsp;Ahmet Murt,&nbsp;Mevlut Tamer Dincer,&nbsp;Melis Ozer Cerme,&nbsp;Tugçe Eskazan,&nbsp;Sefa Ergun,&nbsp;Ozkan Alan,&nbsp;Nurhan Seyahi","doi":"10.1016/j.transproceed.2026.06.011","DOIUrl":"10.1016/j.transproceed.2026.06.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Kaposi Sarcoma (KS), caused by human herpesvirus 8 (HHV-8), may be observed in transplant recipients in the form of immunosuppression-related KS. While it primarily affects the skin, it can also involve internal organs, particularly the gastrointestinal (GI) system. GI involvement is often asymptomatic, but bleeding episodes may occur. Post-transplant anemia (PTA) is a common complication associated with increased mortality and decreased renal function. Early diagnosis and management are crucial. This report discusses 2 cases of KS in kidney transplant recipients presenting with severe anemia.</div></div><div><h3>Case Reports</h3><div>We report 2 cases of immunosuppression-associated KS with severe anemia in kidney transplant recipients. Case 1 involved a 50-year-old male kidney transplant recipient who developed biopsy-confirmed, skin-limited KS without systemic or gastrointestinal involvement, along with severe anemia 2 months post-transplant. The anemia was identified as pure red cell aplasia, likely induced by immunosuppressive therapy. Immunosuppressive regimen was modified by discontinuing mycophenolate mofetil and switching tacrolimus to everolimus, resulting in regression of KS lesions, normalization of hemoglobin levels, and preserved graft function. Case 2, a 47-year-old female with widespread KS involving the skin, gastrointestinal tract, and lymph nodes, was treated with paclitaxel chemotherapy, erythrocyte transfusions, and immunosuppressive adjustment. At 10-month follow-up, her disease stabilized, and hemoglobin levels returned to the normal range.</div></div><div><h3>Conclusion</h3><div>The evaluation of anemia in transplant recipients presents a complex clinical challenge. Immunosuppression-associated KS can occur during both early and late post-transplant periods. KS may contribute directly to anemia through gastrointestinal involvement or coexist as a concurrent condition alongside other underlying etiologies.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 1008-1013"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280773","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":"PCSK9 Inhibitors in Heart Transplant Recipients","authors":"María Jesús Valero,&nbsp;Carlos Ortiz-Bautista,&nbsp;Javier Gonzalez-Martín,&nbsp;Raquel López-Vilella,&nbsp;Clara Simón-Ramon,&nbsp;Andrés Fernando Barragán-Amado,&nbsp;Francisco Carrasco,&nbsp;María del Val Groba-Marco,&nbsp;Elena García-Romero,&nbsp;Javier Castrodeza,&nbsp;Zorba Blázquez,&nbsp;Iago Sousa,&nbsp;Javier Bermejo,&nbsp;Manuel Martínez-Sellés","doi":"10.1016/j.transproceed.2026.04.035","DOIUrl":"10.1016/j.transproceed.2026.04.035","url":null,"abstract":"<div><h3>Background</h3><div>Dyslipidemia is highly prevalent after heart transplantation (HT). We evaluated the efficacy and safety of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in a national cohort of HT recipients.</div></div><div><h3>Methods</h3><div>In this retrospective multicenter study, we included HT recipients from 8 centers in Spain. The primary analysis assessed changes in total and LDL cholesterol at 1 month. Secondary outcomes included the development of donor-specific HLA antibodies (DSA), coronary allograft vasculopathy (CAV), and rejection.</div></div><div><h3>Results</h3><div>Thirty-six HT recipients received PCSK9 inhibitors between May 2018 and September 2024. Median total cholesterol decreased from 195 mg/dL (170.5 to 233.5) to 124 mg/dL (96 to 156) at 1 month (reduction of 83 mg/dL [45 to 96]). Median LDL cholesterol decreased from 119.5 mg/dL (95 to 155) to 50 mg/dL (30 to 75; reduction of 71 mg/dL [43 to 97]). The prevalence of DSA, CAV, and rejection did not differ significantly before and after treatment (DSA: 20% vs 38.1<em>%, P</em> = .25; CAV: 30.56% vs 38.89<em>%, P</em> = .25; rejection: 19.4% vs 8.3<em>%, P</em> = .68).</div></div><div><h3>Conclusions</h3><div>In HT recipients, PCSK9 inhibitors were associated with a marked reduction in LDL cholesterol, with no apparent safety signal. These findings support their use in patients with suboptimal lipid control, although their impact on clinical outcomes warrants further investigation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 1152-1155"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284923","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":"Increasing Access to Kidney Transplantation in an Underserved Population Through a Public–Private Partnership Utilizing Hepatitis C Virus–Infected Donors","authors":"Abdelrhman Refaey,&nbsp;Ahmed Attia,&nbsp;Fatma Mokhtar,&nbsp;Omar Saadi,&nbsp;Ishan Abdullah,&nbsp;Pablo Serrano-Rodriguez,&nbsp;Joseph K. Melancon","doi":"10.1016/j.transproceed.2026.06.016","DOIUrl":"10.1016/j.transproceed.2026.06.016","url":null,"abstract":"<div><h3>Background</h3><div>Kidney transplantation from Hepatitis C virus (HCV) positive donors to HCV-negative recipients has emerged as a viable strategy to expand the donor pool, made possible by advances in antiviral therapy and post-transplant management. Notably, access to the necessary drug regimen in this study was guaranteed through a public-private partnership with the Washington D.C. municipal government.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we analyzed 58 kidney transplant recipients, including 29 HCV-negative patients who received organs from HCV-positive donors and 29 matched controls who received kidneys from HCV-negative donors. Variables collected included metrics detailing time to transplant, donor graft function, and transplant outcomes. Given the small sample size, non-parametric statistical methods were used.</div></div><div><h3>Results</h3><div>Recipients from HCV-positive donors demonstrated a trend toward shorter waiting times compared to controls (median, 1402 vs. 2276 days; <em>p</em> = .053), with no difference in listing times (<em>p</em> = .785). Donor kidney quality was similar between groups in terms of allograft eGFR (94 vs. 113 mL/min/1.73m², <em>p</em> = .715), cold ischemia time (18.9 vs. 15.7 hours, <em>p</em> = .142), and donor age (32 vs. 34 years, <em>p</em> = .432). Acute rejection rates were similar (34.5% vs. 31.0%; <em>p</em> = .78) as were IFTA scores (0.1 vs. 0.05; <em>p</em> = .37). Allograft loss occurred in 0% of recipients from HCV-positive donors compared to 3.4% in the control group. At one year, patient survival was 100% in both groups.</div></div><div><h3>Conclusions</h3><div>A novel public-private collaboration allowed us to increase kidney transplantation access in an underserved community through transplantation of kidneys from HCV-positive donors into HCV-negative recipients with trending decreases in wait times, and without differences in graft function and clinical outcomes. Prophylactic direct-acting antiviral therapy (DAAT) allows our patients to never experience hepatitis C viremia. These findings support adoption of innovative healthcare partnerships to broaden access to life-saving therapies, especially as poor patients and marginalized communities continue to have significant obstacles to organ transplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 1073-1078"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297265","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":"Impact of Oxygenated Hypothermic Machine Perfusion for Pig Small Intestine","authors":"Mio Takashima,&nbsp;Satoshi Muto,&nbsp;Daisuke Ishii,&nbsp;Yuga Okazawa,&nbsp;Taiki Mori,&nbsp;Asuka Toriumi,&nbsp;Yoko Okada,&nbsp;Seisuke Sakamoto,&nbsp;Hiromichi Obara,&nbsp;Naoto Matsuno","doi":"10.1016/j.transproceed.2026.05.022","DOIUrl":"10.1016/j.transproceed.2026.05.022","url":null,"abstract":"<div><h3>Background</h3><div>Intestinal transplantation (IT) is an important treatment for end-stage intestinal failure. However, the survival rate is lower than that of other organs. Machine perfusion (MP) is used in other organs and provides better preservation than simple cold storage (SCS). This study compared SCS and hypothermic machine perfusion (HMP) in the small intestine of a pig. We aim to compare the effectiveness of organ preservation and evaluate the motor function by measuring peristalsis.</div></div><div><h3>Method</h3><div>Pig small intestines were extracted and preserved in the SCS group (SCS 6 hours) or HMP group (SCS 4 hours + HMP 2 hours), and then reperfusion was performed for 2 hours as an isolated reperfusion model (IRM). Pathological evaluation was based on the Swerdlow Classification. During reperfusion, peristalsis was measured using the digital image correlation method.</div></div><div><h3>Result</h3><div>At 120 minutes during IRM, vascular resistance was 1.02±0.57 vs 0.31±0.05 mm Hg/mL/min (SCS vs HMP, <em>p</em> &lt; .05). Oxygen consumption was 1.2±0.8 vs 2.3±0.3 mg/min (SCS vs HMP, <em>p</em> &lt; .05). The peristalsis was 0.22±0.15 vs 0.47±0.15 mm/s (SCS vs HMP, <em>p</em> &lt; .05) at 90 minutes of IRM. The mucosal tissue after preservation was Grade 1 in both SCS group cases and Grade 0 and Grade 2 in each HMP group case. After reperfusion, mucosal necrosis was confirmed in 2 SCS cases and 1 HMP case, while the mucosa was preserved in one HMP case.</div></div><div><h3>Conclusion</h3><div>HMP provides better preservation of vascular resistance, oxygen consumption, and peristalsis in the small intestine after ex vivo reperfusion than SCS.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 1217-1222"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229315","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":"Association of Frailty With Waitlist and Post-Transplant Outcomes in Patients With Hepatopulmonary Syndrome and Portopulmonary Hypertension","authors":"Arjun Sharma,&nbsp;Leena Usman,&nbsp;Jennifer C. Lai,&nbsp;Gabrielle Jutras","doi":"10.1016/j.transproceed.2026.05.023","DOIUrl":"10.1016/j.transproceed.2026.05.023","url":null,"abstract":"<div><h3>Background</h3><div>Patients with hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) receive MELD exception points due to high mortality risk not captured by laboratory MELD scores. These patients are often excluded from frailty studies, leaving the prognostic significance of functional status unclear. We aimed to determine whether Karnofsky Performance Status (KPS) predicts waitlist and post-transplant outcomes among HPS/PPHTN candidates and to compare outcomes with similarly low-functioning non-exception candidates.</div></div><div><h3>Methods</h3><div>We analyzed adult LT candidates in the UNOS/OPTN database (2013–2023) with MELD exception points for HPS/PPHTN and available KPS scores. KPS was categorized as low (10–40), intermediate (50-70), and high (80-100) at listing and nearest to transplant. Outcomes were evaluated using Kaplan-Meier methods, stratified by KPS and compared to non-exception candidates.</div></div><div><h3>Results</h3><div>Among 1538 HPS/PPHTN patients, 31% had low KPS, 56% intermediate, and 13% high KPS. Within this cohort, low KPS was associated with significantly higher waitlist mortality (<em>p</em> &lt; .001), but post-transplant survival did not differ by KPS (<em>p</em> = .05). Compared to non-exception patients, low KPS HPS/PPHTN candidates had lower waitlist mortality (<em>p</em> &lt; .05), but similar post-transplant survival (<em>p</em> = .26).</div></div><div><h3>Conclusion</h3><div>Compared to those with KPS≥50, HPS/PPHTN candidates with low (≤40) KPS experience higher waitlist mortality, but lower waitlist mortality than non-exception candidates with similar functional impairment. In HPS/PPHTN patients, low KPS may reflect limitations from cardiopulmonary dysfunction rather than systemic frailty or advanced liver disease. These findings highlight the need for frailty assessments tailored to the unique physiology of this subgroup.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 1079-1085"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280684","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":"Validating the PRETREAT Score: Risk Stratification Following Liver Transplantation for Perihilar Cholangiocarcinoma","authors":"R.M. O’Connell,&nbsp;R.A. Nasto,&nbsp;J. Hammond,&nbsp;F. Hand,&nbsp;T.K. Gallagher,&nbsp;E. Hoti","doi":"10.1016/j.transproceed.2026.04.032","DOIUrl":"10.1016/j.transproceed.2026.04.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Liver transplantation (LT) for early-stage unresectable perihilar cholangiocarcinoma (pCCA) following neoadjuvant therapy is potentially curative, with excellent long-term survival. Disease recurrence remains problematic, however, which negatively impacts survival. Recently the Mayo Clinic group proposed the Perihilar Cholangiocarcinoma Risk Estimation of Tumor REcurrence After Transplant (PRETREAT) score to attempt to risk-stratify patients following LT.</div></div><div><h3>Aims</h3><div>The aim of this study was to evaluate the performance of the PRETREAT score in our patient cohort.</div></div><div><h3>Methods</h3><div>All patients with unresectable perihilar cholangiocarcinoma who underwent neoadjuvant chemoradiotherapy followed by LT in our institution were identified retrospectively, and outcome data were collected. The PRETREAT score was applied, and patients were grouped into low-, medium-, and high-risk groups. Survival analysis was then performed.</div></div><div><h3>Results</h3><div>A total of 32 patients were identified with a median follow-up of 55 months. The 5-year recurrence-free survival (RFS) and overall survival (OS) were 57.1% and 45.6%, respectively. The 5-year RFS was as follows: low-risk (87.5%), medium-risk (17%), and high-risk (0%) groups (<em>P</em> &lt; .001). A significant difference was seen in the 5-year OS among the low- (70.8%), medium- (14%), and high-risk (0%) groups (<em>P</em> = .011).</div></div><div><h3>Conclusion</h3><div>The PRETREAT score effectively stratified low-risk patients in our cohort who experienced superior long-term RFS and OS. It did not, however, discriminate significantly between those patients in the medium-risk and high-risk groups.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 6","pages":"Pages 1086-1091"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229920","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}