Transplantation最新文献

{"title":"The Associations Between Individual-Versus Neighborhood-level Incomes and Kidney Transplant Outcomes.","authors":"Tatenda G Mupfudze, Dzhuliyana Handarova, Samantha M Noreen, Sumit Mohan, Jesse D Schold, Darren E Stewart","doi":"10.1097/TP.0000000000005486","DOIUrl":"https://doi.org/10.1097/TP.0000000000005486","url":null,"abstract":"<p><strong>Background: </strong>Disparities in posttransplant outcomes persist and worsened during the COVID-19 pandemic, disproportionately affecting individuals with social risk factors. This study examined the total and residual (ie, direct) associations between individual- and neighborhood-level income and posttransplant outcomes among deceased donor kidney transplant (DDKT) and living donor kidney transplant recipients transplanted in the United States in 2020.</p><p><strong>Methods: </strong>This retrospective cohort study linked Organ Procurement and Transplantation Network data with estimated individual annual income from LexisNexis and neighborhood median annual household income from the American Community Survey. Multivariable Cox models assessed associations between income and 3-y all-cause graft survival, patient survival, and death-censored graft survival.</p><p><strong>Results: </strong>Among 14 091 DDKT recipients, lower individual income was associated with higher all-cause graft failure (adjusted hazard ratio [aHR] for lowest quartile [Q1] versus highest [Q4]: 1.37; 95% confidence interval [CI], 1.20-1.56) and death (aHR, 1.47; 95% CI, 1.26-1.72). Neighborhood income had weaker associations, though Q1 recipients still had higher all-cause graft failure (aHR, 1.17; 95% CI, 1.03-1.33) and death (aHR, 1.21; 95% CI, 1.04-1.41). In models including both income measures, only individual income remained significant. Censoring COVID-19 deaths attenuated associations for individual income, while neighborhood income was no longer significant. Among 4565 living donor kidney transplant recipients, income was not significantly associated with outcomes.</p><p><strong>Conclusions: </strong>Lower individual income predicts higher all-cause graft failure, primarily because of increased mortality in DDKT recipients. Neighborhood income has a weaker effect, particularly when censoring COVID-19 deaths. Targeted interventions are needed to improve equity in kidney transplantation, especially during public health crises.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-recurrence Survival After Liver Transplantation for Hepatocellular Carcinoma.","authors":"Marianna Maspero, Carlo Sposito, Chase Wehrle, Marco Bongini, Isabella Pezzoli, Sherrie Bhoori, Valentina Bellia, Andrea Schlegel, Vincenzo Mazzaferro","doi":"10.1097/TP.0000000000005514","DOIUrl":"https://doi.org/10.1097/TP.0000000000005514","url":null,"abstract":"<p><strong>Background: </strong>Mortality after liver transplantation (LT) for hepatocellular carcinoma (HCC) is mainly driven by HCC recurrence. We sought to determine whether post-recurrence survival (PRS) has improved during the last 2 decades.</p><p><strong>Methods: </strong>Using the Scientific Registry of Transplant Recipients, we included all patients who underwent LT for HCC between 2003 and 2020 and experienced HCC recurrence. Patients were divided into 4 eras (2003-2007, 2008-2012, 2013-2016, and 2017-2020) according to their year of recurrence.</p><p><strong>Results: </strong>Of 26 309 patients who underwent LT for HCC, 2518 patients were included: 276 (11%) in era 1; 662 (26.3%) in era 2; 685 (27.2%) in era 3; and 895 (35.5%) in era 4. Patients in later eras were more likely to be outside Milan, but within Metroticket 2.0, and underwent more bridging therapies. Median PRS was 9 mo (95% confidence interval [CI], 8-10 mo) for era 1, 13 (11-15) for era 2, 15 (13.5-16.5) for era 3, and 17 mo (15-19 mo) for era 4 (P < 0.001). After adjusting for time to recurrence, only the comparison between era 1 and era 4 remained significant. At multivariable analysis, only time to recurrence <24 mo (hazard ratio, 1.4; 95% CI, 1.2-1.7; P < 0.0001) and poorly differentiated HCC (hazard ratio, 1.5; 95% CI, 1.2-1.8; P < 0.0001) were associated with PRS, while recurrence era was not.</p><p><strong>Conclusions: </strong>PRS has only modestly improved during the last 2 decades. Despite more patients undergoing bridging therapies in later eras, PRS has not changed compared with eras with more restrictive transplant criteria.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relative Roles of Inflammation in Kidney Allotransplantation and Xenotransplantation.","authors":"Muhammad Furqan Ubaid, Mohamed B Ezzelarab, David K C Cooper","doi":"10.1097/TP.0000000000005518","DOIUrl":"https://doi.org/10.1097/TP.0000000000005518","url":null,"abstract":"<p><p>The nature and severity of the inflammatory response influences the outcome of organ allotransplantation and xenotransplantation. In allotransplantation, the source of the allograft, for example, from a living, brain-dead, or circulatory death donor, influences the inflammatory response, as do such factors as the preexisting comorbidities and the length of the period of chronic kidney disease in the recipient and the management he/she has received. There is also inflammation associated with the transplant surgery, for example, as a result of ischemia-reperfusion injury. In xenotransplantation, inflammation associated with donor factors will be reduced and, as the patients will receive a pig graft at a much earlier stage of their chronic organ failure, the contribution of recipient factors should also be reduced. However, there is a well-documented systemic inflammatory response to the presence of a pig xenograft (probably associated with species molecular differences) that plays a role in activating the innate immune response. Indeed, there is a complex interaction between inflammation, coagulation dysfunction, and the innate and adaptive immune responses. Suppression of the inflammatory response, for example, by interleukin-6 receptor blockade, would appear to be beneficial after xenotransplantation. Several biomarkers of inflammation have been identified that may be valuable in assessing the response to therapy.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring of Immunosuppression With Belatacept in De Novo and Conversion Settings and Risk Mitigation Strategies.","authors":"Richard N Formica, Christian P Larsen, Lionel Rostaing","doi":"10.1097/TP.0000000000005506","DOIUrl":"https://doi.org/10.1097/TP.0000000000005506","url":null,"abstract":"<p><p>Although maintenance immunosuppression with calcineurin inhibitors (CNIs) has greatly reduced rejection rates in renal transplant recipients, long-term use can contribute to eventual nephrotoxicity, potentially leading to allograft injury and loss. Several clinical trials have shown that, compared with CNIs, belatacept-based maintenance immunosuppression can improve renal function, reduce the incidence of de novo donor-specific antibodies, and improve long-term patient/graft survival. However, the US Food and Drug Administration-approved belatacept-based regimen is also associated with higher acute rejection (AR) rates than CNI-based immunosuppression. Recent data from clinical trials and real-world studies suggest that initial posttransplant treatment with CNI-based immunosuppression followed by conversion to a belatacept-based regimen can lower the AR risk while preserving patient and renal health. This review article summarizes the available data pertaining to belatacept treatment protocols, with a focus on conversion to belatacept. Also discussed are studies of protocol modifications intended to further mitigate AR risks and belatacept-related outcomes in special populations, such as patients receiving marginal kidneys and those at risk of new-onset diabetes. Overall, the available data suggest that conversion from CNI- to belatacept-based immunosuppression ≥6 mo posttransplant appears to be effective in lowering the AR risk compared with belatacept use in the de novo setting or conversion <6 mo posttransplant. The addition of an extended transient or low-dose CNI treatment to de novo belatacept or a prolonged CNI taper in the conversion setting may also help lower the AR risk. However, additional studies will be needed to optimize the many variables applicable to belatacept treatment, particularly for different patient subgroups.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Report of Long-term Outcomes of 700 Pediatric Liver Transplants From India.","authors":"Naresh Shanmugam, Ashwin Rammohan, Jagadeesh Menon, Anu Vasudevan, Ravikumar Thambidurai, Rajesh Rajalingam, Kumar Palaniappan, Gomathy Narasimhan, Akila Rajakumar, Ilankumaran Kaliamoorthy, Mohamed Rela","doi":"10.1097/TP.0000000000005510","DOIUrl":"10.1097/TP.0000000000005510","url":null,"abstract":"<p><strong>Background: </strong>Acceptance of pediatric liver transplantation (PLT) in this part of the world has been slow because of a number of considerations, including those of cost, infections, and the nonavailability of expertise. Despite several obstacles, PLT has seen impressive growth in the recent years. Against a backdrop of this changing landscape of PLT in India, we present our experience of performing 700 PLT over a period of 13 y.</p><p><strong>Methods: </strong>All 700 children (<18 y old) who underwent PLT from January 2011 to February 2024 were included in the study. Children were grouped in to group 1 (<5 kg), group 2 (5-10 kg) and group 3 (>10 kg) and survival analysis was performed. The outcomes of PLT performed over the first 7 y were compared with those of the next 6 y, with the aim to present any learning curve/teething troubles that could have presented while setting up the unit.</p><p><strong>Results: </strong>The overall 90-d, 1-, 5-, and 10-y survivals were 94.2%, 90.4%, 86%, and 85.4%, respectively. The median (interquartile range) follow-up of the entire cohort was 65 mo (16-96 mo). There was no statistically significant difference in survival between the 3 weight-based groups or between the 2 eras.</p><p><strong>Conclusions: </strong>We present the first report of long-term survival of the largest series of PLT from an emerging nation. Remarkably, with increasing numbers of liver transplantation being performed in the region over the past decade, the focus of care has now shifted from achieving early survival after liver transplantation to long-term follow-up.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Observatory on Donation and Transplantation on Gender Disparity in Organ Transplantation in India From 2019 to 2023.","authors":"Vivek Kute, Anil Kumar, Beatriz Domínguez-Gil, Khushboo Saxena, Mar Carmona Sanz, Vasanthi Ramesh, Manish R Balwani, Arpita Ray Chaudhury","doi":"10.1097/TP.0000000000005455","DOIUrl":"10.1097/TP.0000000000005455","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e526-e527"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Survival Benefit of Accepting an Older Donor Lung Transplant Compared With Waiting for a Younger Donor Offer.","authors":"Laura B Zeiser, Jessica M Ruck, Dorry L Segev, Luis F Angel, Darren E Stewart, Allan B Massie","doi":"10.1097/TP.0000000000005417","DOIUrl":"10.1097/TP.0000000000005417","url":null,"abstract":"<p><strong>Background: </strong>Donor pool expansion is critical as lung candidates suffer high mortality, yet older donor lungs remain underutilized. We evaluated whether accepting an older donor (defined 4 ways: donor age 30-39, 40-49, 50-59, or 60-69 y) lung transplant was associated with a survival benefit over waiting for a younger donor offer.</p><p><strong>Methods: </strong>Adult candidates who received a lung offer were identified using Scientific Registry of Transplant Recipients data, 2015-2022. Offers were categorized by donor age and candidate lung allocation score (LAS; <40, 40-55, >55). Postoffer mortality was compared between candidates for whom the offer was accepted (\"acceptors\") versus declined (\"decliners\") within each age-LAS category using weighted Cox regression.</p><p><strong>Results: </strong>A total of 21 426 candidates received an offer from a donor age ≥30 y; 11 679 accepted. For LAS >55 candidates, a survival benefit was observed for acceptors of donors ages 30-39 y (weighted hazard ratio [wHR] of mortality: 0.45 0.52 0.59 ), 40-49 y (wHR: 0.61 0.70 0.79 ), and 50-59 y (wHR: 0.67 0.77 0.88 ); P  < 0.001. For candidates with LAS 40-55, results suggest a survival benefit of accepting lung offers from donors age 30-39 y (wHR: 0.77 0.87 0.99 ) and 40-49 y (wHR: 0.76 0.87 0.99 ); P  = 0.03. However, for candidates with LAS <40, a survival benefit was not observed for accepting any older donor transplant, with possible harm in accepting an age 50+ donor offer.</p><p><strong>Conclusions: </strong>Compared with declining and waiting for a younger donor offer, accepting an older donor lung transplant was associated with a survival advantage in candidates with high LAS in the precontinuous distribution era. Decision makers should consider these findings while recognizing potential changes in waiting time dynamics in the current era.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1551-1559"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Graft-versus-host Disease, Part 2: Clinical Success and Roadmap to the Future.","authors":"Najla El Jurdi, Bruce R Blazar, Steven Z Pavletic","doi":"10.1097/TP.0000000000005345","DOIUrl":"10.1097/TP.0000000000005345","url":null,"abstract":"<p><p>Chronic graft-versus-host disease (cGVHD) is an immune-mediated, heterogeneous, multiorgan complication affecting allogeneic hematopoietic cell transplantation recipients, leading to increased morbidity, mortality, and decline in health-related quality-of-life. Advances in understanding the complex disease pathophysiology, and collaborative efforts lead by the National Institutes of Health to standardize criteria for clinical trials, led to bench-to-bedside efforts resulting in the development of 4 US Food and Drug Administration-approved agents for the treatment steroids-refractory cGVHD since 2017. Despite the remarkable advances in the field of hematopoietic cell transplantation in prevention of cGVHD, and more treatment options, the outcome of patients with moderate-severe cGVHD remains suboptimal. Essential to successful cGVHD management is to recognize the disease at early stages before the onset of irreversible damage, allowing for personalized multidisciplinary specialized interventions that include pharmacologic therapies and additional supportive care measures. The aim of this review is to summarize key areas of active clinical research and new developments in cGVHD therapeutic approaches, with focus on (1) preemptive therapy, (2) upfront therapy beyond corticosteroids, (3) treatment refractory cGVHD novel agents, role of combination therapies, and organ-specific approaches, and (4) challenges, gaps, and future directions.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e446-e454"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor-derived Cell-free DNA as a Noninvasive Biomarker of Kidney Allograft Rejection in Pediatric Kidney Transplantation.","authors":"Julien Hogan, Roshan George, Carissa Hayes, Olivier Aubert, Véronique Baudouin, Elodie Cheyssac, Charlotte Duneton, Chris Fan, Margret Kamel, Marion Rabant, Hong Yin, Alexandre Loupy, Rouba Garro","doi":"10.1097/TP.0000000000005403","DOIUrl":"10.1097/TP.0000000000005403","url":null,"abstract":"<p><strong>Background: </strong>Allograft biopsy remains the gold standard to diagnose rejection. New noninvasive biomarkers are needed to avoid unnecessary biopsies and to diagnose early rejection. We studied the performance of donor derived cell-free DNA (dd-cfDNA) to detect rejection in an unselected cohort of pediatric kidney transplant recipients (pKTRs) and determined whether dd-cfDNA could improve standard-of-care monitoring and detection of kidney allograft rejection in children.</p><p><strong>Methods: </strong>We included 196 pKTRs, who underwent 367 biopsies with concomitant dd-cfDNA assessment. We assessed the association of dd-cfDNA with histological lesions and with rejection using a Cox regression model and compared the discrimination of 3 models: standard of care, dd-cfDNA alone, and combined.</p><p><strong>Results: </strong>We found a significant increase in dd-cfDNA levels with higher degree of inflammation on the biopsies. dd-cfDNA was strongly and independently associated with the presence of allograft rejection (odds ratio 1.89, 95% confidence interval [CI], 1.40-2.60). dd-cfDNA alone had a fair discrimination of 0.76 (95% CI, 0.69-0.81) to detect rejection and its addition to standard of care resulted in a significant increase in discrimination from 0.80 (95% CI, 0.71-0.85) to 0.84 (95% CI, 0.79-0.90), P  = 0.01.</p><p><strong>Conclusions: </strong>dd-cfDNA combined with standard of care improves the prediction of rejection in pKTRs. Further specific studies are needed to better define how to use this promising biomarker in various contexts of use in children.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1520-1525"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Selection for Xenotransplant Human Clinical Trials: A Data-driven Approach.","authors":"Baris Ata, Robert A Montgomery, Yucel Naz Ozyoruk, Brendan Parent, Jesse D Schold","doi":"10.1097/TP.0000000000005384","DOIUrl":"10.1097/TP.0000000000005384","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1471-1474"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}