Transplantation最新文献

{"title":"Survival Benefit of Liver Transplantation in Low Model for End-stage Liver Disease Score Patients: Interpretation and Implications.","authors":"Seoung Hoon Kim","doi":"10.1097/TP.0000000000005707","DOIUrl":"10.1097/TP.0000000000005707","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1957"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609861","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":"Antiobesity Interventions in Living Organ Donor Candidates: Ethical and Policy Considerations.","authors":"Ali B Abbasi, Alan Zambeli-Ljepovic, Peter G Stock, Laura Kimberly, Babak J Orandi","doi":"10.1097/TP.0000000000005719","DOIUrl":"10.1097/TP.0000000000005719","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1761-e1764"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729966","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":"Risk Profiles and Outcomes in Living Donor Liver Transplantation Recipients Aged 70 y and Older: A Korean National Registry Analysis.","authors":"Deok-Gie Kim, Mun Chae Choi, Shin Hwang, Kwang-Woong Lee, Jongman Kim, Donglak Choi, Je Ho Ryu, Bong-Wan Kim, Dong-Sik Kim, Hae Won Lee, Yang Won Nah, Man Ki Ju, Tae-Seok Kim, Soo Jin Na Choi, Young Kyoung You, Dong Jin Joo","doi":"10.1097/TP.0000000000005716","DOIUrl":"10.1097/TP.0000000000005716","url":null,"abstract":"<p><strong>Background: </strong>As the global population ages, older-aged candidates increasingly undergo living donor liver transplantation (LDLT). Outcomes and risk factors in recipients aged ≥70 y remain unclear. This study assessed graft survival and age-specific risk factors using nationwide registry data.</p><p><strong>Methods: </strong>From the Korean Organ Transplantation Registry, 4802 adult LDLT recipients were categorized into age <70 (n = 4660) and age ≥70 (n = 142) groups. Graft survival was analyzed using Kaplan-Meier and multivariable Cox regression to evaluate real-world outcomes. Propensity score matching was additionally performed as a sensitivity analysis to confirm the robustness of the findings. Subgroup analyses were used to identify risk factors specific to the age ≥70 group.</p><p><strong>Results: </strong>In unmatched analyses, recipients aged ≥70 y demonstrated significantly lower graft survival than younger recipients (5-y survival: 74.4% versus 87.2%; P  < 0.001). However, after multivariable adjustment, age ≥70 was not an independent predictor of graft loss (adjusted hazard ratio [HR], 1.24; 95% confidence interval [CI], 0.83-1.87; P  = 0.29). Similar findings were observed in the propensity-matched cohort. Subgroup analyses demonstrated that, among recipients aged ≥70 y, pretransplant hospitalization (adjusted hazard ratio [aHR], 1.94; 95% CI, 1.14-3.29), graft steatosis ≥5% (aHR, 1.74; 95% CI, 1.03-2.95), and vascular complications (aHR, 3.11; 95% CI, 1.31-7.43) were each associated with significantly elevated risk of graft failure.</p><p><strong>Conclusions: </strong>Chronological age alone did not independently predict graft failure, but age ≥70 y may amplify risk when combined with steatosis, pretransplant hospitalization, or vascular complications. Therefore, LDLT eligibility in elderly candidates may be better guided by clinical risk profiling rather than age alone.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1852-e1860"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843285","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":"Higher Medical Urgency Is Associated With Greater Psychosocial Risk Tolerance in Liver Transplant Listing and Selection.","authors":"Emily Robitschek, Asal Bastani, Savyon Lev, Kathryn Horwath, Jennifer C Lai, Mark J Pletcher, Irene Y Chen, Jin Ge","doi":"10.1097/TP.0000000000005800","DOIUrl":"10.1097/TP.0000000000005800","url":null,"abstract":"<p><strong>Background: </strong>The Model for End-Stage Liver Disease (MELD) score guides liver transplant (LT) allocation, but transplant programs also evaluate psychosocial risks that may affect outcomes such as graft survival, adherence, and follow-up. How medical urgency influences consideration of these risks remains unclear.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 2959 adults listed for LT at a large academic center (2012-2023). Using a validated large language model-based techniques, we extracted 23 predefined psychosocial factors from clinical documentation. We compared the prevalence of these factors across MELD categories and assessed associations with successful transplantation.</p><p><strong>Results: </strong>Among listed patients, 10 psychosocial factors increased significantly with higher MELD scores. Low transplant knowledge rose from 3.1% (MELD <15) to 13.3% (MELD >35; adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 1.22-1.51), history of nonadherence from 7.8% to 22.2% (aOR, 1.25; 95% CI, 1.16-1.35), and past trauma from 5.4% to 12.2% (aOR, 1.19; 95% CI, 1.09-1.30). Among LT recipients, 11 factors showed similar trends, including low transplant knowledge (1.8%-11.1%; aOR, 1.43; 95% CI, 1.23-1.68), nonadherence (5.2%-22.2%; aOR, 1.37; 95% CI, 1.23-1.53), and past trauma (5.2%-13.9%; aOR, 1.22; 95% CI, 1.08-1.37). Adjusting for demographics minimally changed results.</p><p><strong>Conclusions: </strong>Transplant teams appear to tolerate greater psychosocial risk as medical urgency increases. This suggests psychosocial criteria are applied more flexibly at higher MELD scores. Standardized frameworks that explicitly incorporate medical urgency may improve equity and transparency in transplant decision-making.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1870-e1878"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266333","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":"Sexual Intercourse and Alloimmunity. Influence on Reproduction and Solid Organ Transplantation.","authors":"Bastien Poitier, Emmanuel Zorn, Paolo Cravedi, J C Madsen, Gilles Benichou","doi":"10.1097/TP.0000000000005808","DOIUrl":"10.1097/TP.0000000000005808","url":null,"abstract":"<p><p>Sexual intercourse is associated with recognition of partner-derived major histocompatibility complex (MHC) and minor histocompatibility alloantigens (MiHAs) by females. Male sperm-associated MHC antigens, expressed on spermatozoa and leukocytes, as well as MiHAs including sperm-specific antigens (SPAGs), are recognized by female T lymphocytes infiltrating the cervicovaginal region. This can occur via direct presentation of male MHC molecules on male antigen presenting cells and indirect presentation of male antigen peptides (MHC and MiHAs) bound to female MHC molecules on female antigen presenting cells. This process along with the presence of anti-inflammatory chemokines and cytokines and sHLA-G present in seminal fluid leads to activation of male antigen-specific FOXP3 + Treg locally and in regional lymph nodes. This regulatory response has been shown to promote survival and progression of spermatozoa within the cervical mucus as well as implantation of the embryo. Most important, it is believed to set the stage for fetal-maternal tolerance during pregnancy. Conversely, under certain circumstances, alloresponses to male antigens can lead to the production of anti-MHC and anti-sperm-specific antigens antibodies resulting in infertility. Altogether, these observations show that alloimmunity induced after sexual intercourse plays an essential role in reproduction. In addition, while the influence of pregnancy in transplantation is well established, some studies suggest that repeated sexual exposure to male antigens can increase the risk of solid organ transplant rejection.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1773-e1778"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536915","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":"Preformed Anti-DQ Alpha Donor-specific Antibodies and the Risk of Antibody-mediated Rejection After Kidney Transplantation.","authors":"Cindy Ursule-Dufait, Olivier Aubert, Marie Matignon, Dany Anglicheau, Alexandre Hertig, Sarah Tortonese, Cédric Usureau, Romain Lhotte, Magali Devriese, Jean-Luc Taupin, Renaud Snanoudj","doi":"10.1097/TP.0000000000005797","DOIUrl":"10.1097/TP.0000000000005797","url":null,"abstract":"<p><strong>Background: </strong>Anti-DQ donor-specific antibodies (DSAs) are associated with an increased risk of antibody-mediated rejection (AMR) after kidney transplantation, but previous studies focused on antibodies targeting the β-chain, neglecting the also polymorphic α-chain.</p><p><strong>Methods: </strong>This study aimed to assess the frequency, characteristics, and pathogenicity of preformed anti-DQα DSAs in 2041 patients receiving a kidney transplant between 2010 and 2015 across 3 French transplantation centers. Donor and recipient 4-digit human leucocyte antigen typing and single-antigen bead mean fluorescence intensity data were compared with determine the specificity of anti-DQ antibodies. Associations between preformed anti-DQα DSAs and AMR were analyzed using Cox proportional hazard models. Patients with preformed anti-DQα DSAs were then matched to a control group of patients without preformed DSAs, to compare microvascular inflammation in 3-mo biopsies.</p><p><strong>Results: </strong>After analysis of single-antigen bead data, we found that 122 kidney transplant recipients had preformed anti-DQα and anti-DQβ DSAs. Anti-DQα DSAs accounted for 35.2% of anti-DQ DSAs, with a median peak mean fluorescence intensity of 1331 (IQR 677-2896), targeting most frequently the DQA1*05 antigen (83.7%), and consistently the donor α/β heterodimer. In multivariable analyses, the presence of anti-DQα DSAs was associated with a higher risk of AMR, independently of DSAs targeting other loci (HR = 2.61; 95% CI, 1.31-6.01; P = 0.025). Moreover, patients with preformed anti-DQα DSAs had higher microvascular inflammation scores in their 3-mo biopsy than matched patients without DSAs ( P < 0.001).</p><p><strong>Conclusions: </strong>Anti-DQα DSAs are independently associated with AMR after kidney transplantation, underscoring the importance of considering them in transplant allocation of and management of immunosuppression.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1946-e1956"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362529","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":"Increasing Kidney Transplant Volume With Higher Kidney Donor Risk Index Kidneys: A Call for Action in the United States.","authors":"Marty T Sellers, Carlos Martinez, Kenneth W Kizer","doi":"10.1097/TP.0000000000005745","DOIUrl":"10.1097/TP.0000000000005745","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1765-e1766"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782194","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":"Oncologic Safety of Irradiated-only Autologous Blood Transfusion in Liver Transplantation for Hepatocellular Carcinoma: A Single-Center Cohort Study.","authors":"Gabriel Thierry, Barnabé Piette, Margaux Navez, Jean-Noël Koch, Andy Mangon, Marc-Gilbert Lagny, Nicolas Piette, Morgan Vandermeulen, Nicholas Gilbo, Nicolas Meurisse, Gregory Hans, Vincent Bonhomme, Olivier Detry","doi":"10.1097/TP.0000000000005760","DOIUrl":"10.1097/TP.0000000000005760","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation for hepatocellular carcinoma (HCC) is highly transfusion-demanding, and intraoperative cell salvage is used to limit allogeneic blood exposure. This study aimed to assess the oncologic safety of transfusion of irradiated-only autologous red blood cells during liver transplantation for HCC.</p><p><strong>Methods: </strong>This single-center retrospective cohort included all patients who underwent liver transplantation for HCC between 2010 and 2022. Among the 135 patients, 97 received autologous transfusion of irradiated red blood cells collected through intraoperative cell salvage; the remaining 38 did not. No leukocyte depletion filters were used. The primary outcome was HCC recurrence; secondary outcomes were overall survival and transfusion requirements.</p><p><strong>Results: </strong>The median follow-up time was 9.7 y. HCC recurrence occurred in 15.5% of patients in the autotransfusion group compared with 21.1% in the nonautotransfusion group ( P  = 0.44). Kaplan-Meier analyses revealed no significant differences in recurrence-free or overall survivals between the 2 groups. Multivariable Cox regression adjusted for the Model for End-Stage Liver Disease score, tumor burden, Milan criteria, and microvascular invasion revealed that autotransfusion was not associated with recurrence or mortality. Patients in the autotransfusion group had significantly higher exposure to allogeneic blood products.</p><p><strong>Conclusions: </strong>Intraoperative autotransfusion of irradiated red blood cells without leukocyte depletion filters appears oncologically safe during liver transplantation for HCC, although the single-center, retrospective design and small control group warrant cautious interpretation and confirmation in larger multicenter studies. As tertiary transplant centers already use blood irradiators for immunocompromised patients, these findings support irradiation as a practical alternative to filtration.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1861-e1869"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043941","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":"Left Gastric Vein Anatomical Variation as a Determinant of Portal Vein Remodeling and Reconstructive Complexity in Infant Liver Transplantation.","authors":"Hajime Uchida, Seisuke Sakamoto, Takumi Fujimoto, Ayane Ohshiro, Masato Kojima, Ryuji Komine, Yusuke Yanagi, Akinari Fukuda, Takako Yoshioka, Osamu Miyazaki, Mureo Kasahara","doi":"10.1097/TP.0000000000005796","DOIUrl":"10.1097/TP.0000000000005796","url":null,"abstract":"<p><strong>Background: </strong>Portal vein (PV) reconstruction in infant living donor liver transplantation (LDLT) for biliary atresia (BA) is technically challenging because of progressive PV hypoplasia and altered hemodynamics. Variations in left gastric vein (LGV) inflow may influence the PV morphology and surgical complexity; however, this relationship has not been systematically evaluated.</p><p><strong>Methods: </strong>This single-center retrospective study included 104 infants (age <12 mo) who underwent LDLT for BA between April 2018 and September 2025. The LGV inflow type was classified intraoperatively as Trunk (termination into the main PV trunk), Confluence (termination at the superior mesenteric vein-splenic vein confluence), and SpV (termination into the splenic vein). Preoperative imaging was used to assess the PV diameter and flow direction.</p><p><strong>Results: </strong>The PV diameter was significantly larger in the Trunk group, with lower rates of hypoplasia (diameter <4 mm) and hepatofugal flow than in the Confluence and SpV groups ( P  < 0.001). Technically difficult PV reconstruction occurred in 15.4% of the cases and was significantly more frequent in the Confluence and SpV types ( P  < 0.01). LGV inflow type was an independent predictor of technically difficult reconstruction (odds ratio, 14.6; 95% confidence interval, 2.48-86.2; P  = 0.003). Postoperative PV complications occurred in 4 patients, all of whom were successfully treated with 1-y graft and patient survival rates of 100%.</p><p><strong>Conclusions: </strong>LGV variants reflect PV remodeling associated with portal hypertension in infant BA and provide a practical preoperative framework for anticipating reconstructive complexity. Recognition of LGV inflow patterns may facilitate tailored portal reconstruction strategies and enhance graft safety in infant LDLT.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1879-e1888"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218942","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":"Targeting Sphingosine-1-Phosphate Receptor 1 Protects Pulmonary Vascular Endothelial Integrity During Human Ex Vivo Lung Perfusion.","authors":"Jenny Gilmour, Nicholas J S Chilvers, Chong Yun Pang, Yinglan Zhang, Abbie E Hankins, Neve E Richardson, Marnie L Brown, Lucy Bates, William E Scott, John Dark, Andrew J Fisher, Simi Ali","doi":"10.1097/TP.0000000000005793","DOIUrl":"10.1097/TP.0000000000005793","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary edema due to vascular endothelial injury in donor lungs reduces organ utilization and exacerbates ischemia/reperfusion injury, resulting in poor posttransplant outcomes. Sphingosine-1-phosphate (S1P) improves vascular integrity through S1P receptor 1 (S1PR1) signaling. This study assessed whether S1PR1 agonism during ex vivo lung perfusion (EVLP) reduces vascular permeability and edema formation in human donor lungs.</p><p><strong>Methods: </strong>S1PR1 agonist CYM5442 was administered to human donor lungs declined for transplant, during 6 h of EVLP, using a paired split-lung model with one lung treated and the other acting as an internal control. Lung physiology, organ weight, vascular endothelial permeability to Evan's blue dye, and direCt Lung Ultrasound Evaluation score for lung water were assessed. Sequential perfusate and tissue samples were collected to evaluate gene and protein expression.</p><p><strong>Results: </strong>During EVLP (n = 7 paired sets), CYM5442 reduced Evan's blue accumulation in bronchoalveolar lavage ( P  = 0.0260) and tissue ( P  = 0.0476). Increases in lung weight were ameliorated and direCt Lung Ultrasound Evaluation scores reduced in the CYM5442-treated group post-EVLP ( P  = 0.0135 and P  = 0.0482, respectively), leading to reduced pulmonary artery and peak airway pressures (interaction P  = 0.0038 and P  < 0.0001). CYM5442 maintained vascular endothelial cadherin expression and reduced interleukin-6 ( P  = 0.0130, 360 min), interleukin-1 beta ( P  = 0.0214, 240 min), and soluble intercellular adhesion molecule-1 ( P  = 0.0067, 360 min) release compared with untreated during EVLP.</p><p><strong>Conclusions: </strong>Agonism of S1PR1 during EVLP ameliorates pulmonary vascular leak and may be used to reduce the risk of edema formation in donor lungs.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1815-e1829"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405975","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}