Transplantation最新文献

{"title":"Outcomes of Donation After Circulatory Death Lung Transplantation in the United States Based on Procurement Strategies: A United Network for Organ Sharing Analysis.","authors":"Ervin Y Cui, Doug A Gouchoe, Divyaam Satija, Martin G Walsh, Aaron Gou, Ammu V Alvarez, Matthew C Henn, Asvin M Ganapathi, Kukbin Choi, Bryan A Whitson","doi":"10.1097/TP.0000000000005803","DOIUrl":"10.1097/TP.0000000000005803","url":null,"abstract":"<p><strong>Background: </strong>Donation after circulatory death (DCD) is increasingly utilized to expand the donor pool. Within DCD, direct procurement and perfusion (DPP) and thoracoabdominal normothermic regional perfusion (TA-NRP) have emerged as distinct procurement strategies. Yet, outcomes remain unclear especially in combination with ex vivo lung perfusion (EVLP).</p><p><strong>Methods: </strong>The United Network for Organ Sharing database was queried for adult lung transplants performed between December 2019 and March 2025. Recipients were stratified as donation after brain death (DBD), DCD DPP, or DCD TA-NRP. Propensity score matching was performed for DBD versus DCD, DBD versus DPP, DBD versus TA-NRP, and DPP versus TA-NRP comparisons. Additional analyses included DBD versus DCD EVLP subgroups. Outcomes included perioperative morbidity, primary graft dysfunction grade 3 (PGD3), and survival.</p><p><strong>Results: </strong>DCD recipients demonstrated increased perioperative morbidity including longer hospitalization (22 versus 19 d, P < 0.001), greater postoperative ECMO use (15.2% versus 8.1%, P < 0.001), and higher PGD3 incidence (25.6% versus 15.6%, P < 0.001) compared with DBD, though survival was similar ( P = 0.74). TA-NRP and DPP lungs had comparable outcomes, with TA-NRP showing slightly lower perioperative morbidity. Among EVLP recipients, DCD EVLP lungs were associated with longer hospitalization (26 versus 20 d, P < 0.001), higher ECMO use (19.2% versus 10.1%, P = 0.004), and a trend toward lower survival, though not statistically significant.</p><p><strong>Conclusions: </strong>DCD lungs yield survival comparable to DBD despite greater perioperative morbidity. NRP procurement may mitigate morbidity relative to DPP. Incorporating NRP into DCD practice may enhance lung utilization while maintaining acceptable outcomes.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2122-e2134"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266358","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":"Simultaneous Liver-Kidney Transplantation in the Safety Net Era: Less Is More?","authors":"Nicholas Kosinski, Arun B Jesudian, Danielle Brandman","doi":"10.1097/TP.0000000000005866","DOIUrl":"10.1097/TP.0000000000005866","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1994-e1995"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607895","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":"Response to the Letter to the Editor: \"The Role of mTOR Inhibitors in CMV Prevention: An Overlooked Aspect of the Fourth International CMV Consensus Guidelines\".","authors":"Camille N Kotton, Atul Humar","doi":"10.1097/TP.0000000000005874","DOIUrl":"10.1097/TP.0000000000005874","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2146-e2147"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713698","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":"Establishing a Platform for 1-Wk Normothermic Machine Perfusion of Donor Livers.","authors":"Julia Hofmann, Christina Bogensperger, Andras T Meszaros, Madita L Buch, Florian Nardin, Benno Cardini, Bettina Zelger, Martin Hermann, Margot Fodor, Franka Messner, Fabian Scherbauer, Magdalena Bordt, Felix J Krendl, Hannah Esser, Silvia Oberparleiter, Valeria Berchtold, Marlene Pühringer, Simon Mathis, Gabriel Putzer, Andrea Griesmacher, Christian Irsara, Harald Schennach, Judith Martini, Stefan Scheidl, Christian Margreiter, Manuel Maglione, Annemarie Weissenbacher, Rupert Oberhuber, Dietmar Öfner, Jakob Troppmair, Thomas Resch, Theresa Hautz, Stefan Schneeberger","doi":"10.1097/TP.0000000000005915","DOIUrl":"https://doi.org/10.1097/TP.0000000000005915","url":null,"abstract":"<p><strong>Background: </strong>Although short-term (24 h) normothermic machine perfusion (NMP) is suitable to assess liver quality before transplantation, prolonged NMP offers the potential for modification, regeneration, and repair of marginal organs. We systematically aimed for the development of a reproducible perfusion protocol for long-term ex situ liver preservation (LTP), using a commercially available perfusion device without hardware modification.</p><p><strong>Methods: </strong>Livers retrieved from domestic pigs (N = 18) were perfused for up to 7 d (OrganOx Metra). A precision-cut liver slice culture model was applied to assess and determine the perfusate recipe. The perfusion protocol was assessed and validated in a stepwise process and later evaluated in nontransplanted human livers (N = 22).</p><p><strong>Results: </strong>The stepwise development using porcine livers finally resulted in 7-d perfusion with stable function and preserved morphology. Key advancements include red blood cell substitution, bile excretion modifications, and expanded antiinfective therapy. Applying the perfusion protocol in nontransplantable human donor livers enabled 7-d NMP in 4 livers, while control livers deteriorated after 66 [48-84] h NMP. Preserved bile production, low-levels of free hemoglobin and a low-degree of inflammation were identified as key factors for successful LTP.</p><p><strong>Conclusions: </strong>Seven-day preservation of porcine and human livers using the LTP protocol in an unmodified, commercial perfusion system is feasible; thus, the model system is suitable for treating and recovering livers, which may help to limit global organ shortage.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115289","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":"Expanding Access to Liver Transplantation Through Cost-effective Normothermic Machine Liver Perfusion: An Organ Procurement Organization-based Model and its Clinical Impact.","authors":"Ronald A Squires, Ashley N Milam, Josiah D Wagler, Vivek Kohli, Ananth Srinivasan, Jeffrey P Orlowski","doi":"10.1097/TP.0000000000005786","DOIUrl":"10.1097/TP.0000000000005786","url":null,"abstract":"<p><strong>Background: </strong>The shortage of transplantable livers, especially from donation after circulatory death (DCD) donors, remains a major challenge. Normothermic machine liver perfusion (NMLP) can further evaluate and potentially rehabilitate marginal grafts, but high costs and logistical barriers restrict its adoption.</p><p><strong>Methods: </strong>A nonprofit organ procurement organization (OPO) integrated NMLP into its infrastructure, creating a cost-effective, equitable model for liver graft evaluation. This article describes the OPO-based approach and reports transplant outcomes from 1 regional partner center between May 2022 and July 2025.</p><p><strong>Results: </strong>OPO adoption of NMLP enabled efficient deployment, reduced graft turndowns, and expanded donor acceptance criteria. In 2024 alone, the OPO perfused 75 livers, of which 61 were DCD donors, and 60 were successfully transplanted. At 1 partner institution, 72 NMLP-supported transplants were performed (86.1% DCD), with excellent 1-y survival (94.6%). Severe ischemic cholangiopathy was rare (1.6%), and most biliary complications were managed endoscopically. High-acuity recipients-including Model for End-stage Liver Disease score of 40, dual-organ, and retransplant candidates-benefited.</p><p><strong>Conclusions: </strong>An OPO-based NMLP model is scalable, sustainable, and equitable. It increases utilization of DCD livers, expands donor and recipient criteria, and improves regional access to transplantation.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2082-e2086"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266330","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":"From Gene Editing to Exogenesis: Pigs as a Source of Immune-compatible Organs for Transplantation.","authors":"Asghar Ali, Mayuko Kurome, Daniel Reichart, Bruno Reichart, Mary G Garry, Hideki Masaki, Hiromitsu Nakauchi, David H Sachs, Daniel J Garry, Eckhard Wolf","doi":"10.1097/TP.0000000000005845","DOIUrl":"10.1097/TP.0000000000005845","url":null,"abstract":"<p><p>The persistent shortage of human organs for transplantation has intensified efforts to develop alternative sources, specifically xenotransplantation and exogenesis. Xenotransplantation uses genetically engineered pigs to provide organs, tissues, and cells for clinical use. Significant progress has occurred in developing multigene-modified pigs that lack glycan xenoantigens while expressing human complement and coagulation regulators. These modifications have successfully mitigated hyperacute, antibody-mediated, and cellular rejection in preclinical nonhuman primate models. Recent compassionate-use cases in humans have demonstrated the feasibility of heart, kidney, and liver xenotransplantation, although achieving long-term survival remains a challenge. Complementing this approach, exogenesis aims to generate human-compatible organs within animal hosts through interspecies chimerism. Although advances in establishing organ niches and overcoming xeno-barriers have yielded preliminary success in heart, pancreas, and muscle development, formidable immune and developmental hurdles remain. Together, these approaches offer promising strategies to expand the donor organ pool and address the growing global demand for transplantation. Further advances in genetic engineering, immune modulation, and developmental biology, supported by rigorous preclinical and clinical evaluation, will be critical for widespread translation. This review outlines the current progress, major challenges, and future directions in xenogeneic and exogenic organ generation.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1996-e2006"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670560","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":"A Novel Cellular Bridge Between Transient Chimerism and Transplant Tolerance.","authors":"Thiago J Borges","doi":"10.1097/TP.0000000000005853","DOIUrl":"10.1097/TP.0000000000005853","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1983-e1985"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536949","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":"Highlights in Liver Transplantation From the 2025 World Transplant Congress.","authors":"Dempsey L Hughes, Yanik J Bababekov","doi":"10.1097/TP.0000000000005769","DOIUrl":"10.1097/TP.0000000000005769","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1972-e1974"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975709","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":"Meta-analysis of Short-term Clinical and Survival Outcomes of Full-left-full-right Split Liver Transplantation for 2 Recipients.","authors":"Shahin Hajibandeh, Shahab Hajibandeh, Farhan Ahmad, Debashis Haldar, Rebeca Sanabria-Mateos, Nikolaos Chatzizacharias, Bobby V M Dasari, David C Bartlett, Keith J Roberts","doi":"10.1097/TP.0000000000005833","DOIUrl":"10.1097/TP.0000000000005833","url":null,"abstract":"<p><p>This study aimed to evaluate outcomes of full-left-full-right split liver transplantation (FLFR-SLT) for 2 recipients. Comparative outcomes of full-right versus full-left grafts, and FLFR-SLT versus whole liver transplantation (WLT) were evaluated. A systematic search of electronic data sources and bibliographic reference lists were conducted. All studies reporting comparative outcomes of FLFR-SLT were included and their risk of bias were assessed. Estimate of effect size for hepatic artery thrombosis (HAT), venous complications, biliary complications, primary nonfunction (PNF), small-for-size syndrome, retransplantation, and graft and patient survival were determined using random-effects model. Sixteen observational studies reporting a total of 3139 patients were included. Full-right (n = 220) and full-left (n = 230) SLT were associated with no significant difference in HAT (OR 1.09; P = 0.88), venous complications (RD -0.02; P = 0.51), biliary complications (OR 1.04; P = 0.89), small-for-size (RD -0.02; P = 0.34), PNF (OR 0.51; P = 0.26), or retransplantation (OR 0.46; P = 0.19). Moreover, there was no significant difference in 1-y (OR 0.99; P = 0.99), 5-y (OR 0.90; P = 0.73) patient-survival, or 1-y (OR 1.13; P = 0.72), and 5-y (OR 1.10; P = 0.75) graft-survival between 2 groups. Although FLFR-SLT was associated with similar risk of HAT (OR 2.68; P = 0.15) when compared with WLT (n = 2689), it significantly increased risk of venous complications (OR 32.8; P = 0.002) and biliary complications (OR 3.41; P = 0.0001) and decreased 1-y (OR 0.33, P < 0.00001) and 5-y (OR 0.52, P = 0.01) graft-survival and 1-y patient survival (OR 0.46, P = 0.0003). The meta-analysis of best available evidence (level 2a) indicates that full-right and full-left split liver transplantation have comparable short-term clinical, graft-and patient-survival outcomes. However, when compared with WLT, FLFR-SLT significantly increases posttransplantation complications and decreases graft and patient survival.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2017-e2029"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346254","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":"Simultaneous Liver-kidney Versus Liver Transplantation Categorized by Pretransplant eGFR: Impact of the 2017 OPTN Policy.","authors":"Yitian Fang, Sarah Bouari, Jacqueline van de Wetering, Caroline M den Hoed, Ron W F de Bruin, Robert J Porte, Wojciech G Polak, Robert C Minnee","doi":"10.1097/TP.0000000000005776","DOIUrl":"10.1097/TP.0000000000005776","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous liver-kidney transplantation (SLKT) has increased substantially in the United States since adoption of the Model for End-stage Liver Disease-based allocation, now comprising 9%-10% of liver transplants. The survival benefit of SLKT compared with liver transplantation alone (LTA) remains uncertain.</p><p><strong>Methods: </strong>Using the Organ Procurement and Transplant Network (OPTN)/United Network for Organ Sharing registry, we analyzed 63 407 adult liver transplants (57 780 LTA; 5627 SLKT) performed between 2010 and 2019. Patient survival was evaluated across pretransplant estimated glomerular filtration rate (eGFR) categories and according to transplant era before and after implementation of the 2017 OPTN policy.</p><p><strong>Results: </strong>Among patients with pretransplant eGFR ≥30 mL/min/1.73 m 2 , SLKT conferred no survival benefits, and LTA recipients achieved comparable or better long-term outcomes. In contrast, SLKT significantly reduced mortality in patients with advanced renal dysfunction. For eGFR 15-29 mL/min/1.73 m 2 , SLKT reduced 1-, 3-, and 5-y mortality by 25%, 15%, and 13%, respectively. For eGFR <15 mL/min/1.73 m 2 , SLKT reduced 1-, 3-, 5-, and 10-y mortality by 32%, 24%, 22%, and 17%, respectively. Following implementation of the 2017 OPTN policy and \"Safety Net\" policies, SLKT procedures declined. The survival advantage of SLKT observed in the pre-policy era was no longer evident post-policy, with 1.4% of LTA recipients undergoing kidney after liver transplantation under \"Safety Net\" allocation priority.</p><p><strong>Conclusions: </strong>SLKT is associated with survival benefit in patients with severe renal dysfunction (eGFR <30 mL/min/1.73 m 2 ). Following implementation of the 2017 OPTN policy, this survival difference was no longer evident, and SLKT procedures were reduced without compromising survival. These findings support a stage-specific allocation strategy incorporating the \"Safety Net\" framework.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2096-e2104"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369805","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}