Transplantation最新文献

{"title":"Organ Assessment and Repair Centers: Navigating Practical Hurdles in a New Era of Transplantation.","authors":"Tony Boualoy, Dhiaeddine Djabri, Doug A Gouchoe, Bryan A Whitson, Sylvester M Black","doi":"10.1097/TP.0000000000005826","DOIUrl":"10.1097/TP.0000000000005826","url":null,"abstract":"<p><p>Solid organ transplantation remains limited by the availability and quality of donor organs. Despite advances in donor management and allocation policy, a substantial proportion of recovered organs are discarded, and increasing reliance on extended-criteria and donation after circulatory death donors introduces additional uncertainty regarding graft viability. Traditional preservation using static cold storage provides a limited opportunity to assess organ function or intervene therapeutically before transplantation. Recent advances in machine perfusion technologies have begun to reshape this paradigm by enabling donor organs to be maintained and evaluated ex vivo. Normothermic perfusion platforms allow real-time physiologic assessment and biochemical monitoring, while hypothermic approaches primarily support preservation with more limited capacity for functional evaluation. These capabilities have created the foundation for the development of organ assessment and repair centers (ARCs), specialized platforms designed to centralize perfusion-based organ evaluation and potential rehabilitation. This overview examines the rationale for regionalized ARC systems and their potential to expand donor organ utilization while improving graft preservation and viability assessment. We discuss the clinical and logistical advantages of centralized perfusion platforms, including mitigation of ischemia/reperfusion injury, improved viability assessment, centralized expertise, integrated research infrastructure, and opportunities for organ-directed therapeutic interventions. We also examine the practical challenges associated with ARC implementation, including financial costs, infrastructure requirements, regulatory oversight, and logistical coordination across transplant networks. As machine perfusion technologies continue to evolve, ARCs may provide the infrastructure needed to integrate advanced preservation, diagnostics, and therapeutic interventions into routine transplant practice, enabling more effective utilization of the donor organ pool.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2007-e2016"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309527","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":"Is Warm Ischemic Time no Longer an Absolute Cutoff in Organ Donation After Circulatory Determination of Death? The Italian Experience of Prolonged \"No-touch\" Period.","authors":"Lucia Masiero, Francesco Procaccio, Francesca Vespasiano, Francesca Puoti, Massimo Cardillo, Giuseppe Feltrin","doi":"10.1097/TP.0000000000005792","DOIUrl":"10.1097/TP.0000000000005792","url":null,"abstract":"<p><strong>Background: </strong>Skepticism and concern regarding the 20-min no-touch period have limited and postponed the donation after circulatory death (DCD) in Italy. However, both controlled (cDCD) and uncontrolled (uDCD) programs have been successfully developed, using mandatory in situ (normothermic regional perfusion) and, in most cases, ex situ perfusion (mechanical perfusion).</p><p><strong>Aims: </strong>(1) To compare Italian DCD and DBD results at 1-3 y; (2) to analyze organ outcomes and factors associated with cDCD kidney and liver discard.</p><p><strong>Methods: </strong>Data on all deceased donors and transplants (2017-2021) were prospectively collected in the national registry. Kaplan-Meier graft survival estimates and multivariable logistic regressions were performed.</p><p><strong>Results: </strong>Among 12 663 DBD, 262c DCD, and 220u DCD potential donors (PODs), 73.4%, 82.1%, and 40.3% became utilized donors, respectively. Mean functional warm ischemic time (FWIT) was 46 ± 15 in cDCD-utilized donors and exceeded 60 min in 12.6%; 592 DCD organs were transplanted; 1-y graft survival in cDCD was 93.1% for kidneys and 91.9% for livers, with the same mean donor functional warm ischemia time (DFWIT) duration (44 versus 45 and 45 versus 45 min) for graft survival or failure. Donor age >60, obesity, prior-to-death ECMO, and DFWIT >45 min were independently associated with increased likelihood of kidney and liver discard.</p><p><strong>Conclusions: </strong>The Italian experience proves that prolonged DFWIT should no longer be considered as an insurmountable barrier in DCD donation. Kidney and liver transplant outcomes from cDCD donors were comparable to DBD. But only gaining organ swift resuscitation and function assessment, with the routine use of in situ and ex situ perfusion, may overcome absolute donor warm ischemic time as an arbitrary cutoff for suitability and reduce inappropriate discard for DCD organs.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2113-e2121"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266409","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 Clinical Heterogeneity to National Standardization in Liver Transplantation for Perihilar Cholangiocarcinoma: The LITALHICA Protocol.","authors":"Enrico Gringeri, Alessandro Furlanetto, Eleonora Nieddu, Renato Romagnoli, Salvatore Gruttadauria, Davide Ghinolfi, Luciano Gregorio De Carlis, Matteo Cescon, Giuseppe Maria Ettorre, Umberto Baccarani, Marco Vivarelli, Domenico Pinelli, Amedeo Carraro, Salvatore Agnes, Enzo Andorno, Fabrizio Di Benedetto, Vincenzo Mazzaferro, Cristiano Quintini, Massimo Rossi, Francesco Tandoi, Giuseppe Tisone, Giovanni Vennarecci, Fausto Zamboni, Martina Botton, Eugenia Rosso, Chiara Naldini, Jacopo Lanari, Caterina Soldà, Francesca Bergamo, Martina Gambato, Giorgio De Conti, Sara Lonardi, Patrizia Burra, Silvia Trapani, Giuseppe Feltrin, Umberto Cillo","doi":"10.1097/TP.0000000000005762","DOIUrl":"10.1097/TP.0000000000005762","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1965-e1968"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405931","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 Terminal Complement Complex: An Overlooked Marker of Prolonged Delayed Graft Function.","authors":"Emmanuel Zorn, Naoya Iwahara","doi":"10.1097/TP.0000000000005850","DOIUrl":"10.1097/TP.0000000000005850","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e1986-e1987"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456931","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":"Effects of Donor Wage Reimbursement: Findings From the Living Donor Lost Wages Randomized Trial.","authors":"James R Rodrigue, Aaron Fleishman, Jesse D Schold, Martha Pavlakis, Amy R Evenson, Sarah Duncan, Didier A Mandelbrot, Prabhakar K Baliga","doi":"10.1097/TP.0000000000005749","DOIUrl":"10.1097/TP.0000000000005749","url":null,"abstract":"<p><strong>Background: </strong>Lost wages following living donation may deter patients from pursuing living donor kidney transplantation (LDKT) and potential donors from being evaluated.</p><p><strong>Methods: </strong>We randomized patients undergoing transplant evaluation to 1 of 2 donor wage reimbursement groups ($1500 or $3000 maximum) and encouraged them to discuss this reimbursement program with their social network. These patients were compared with matched historical controls (HCs) on the likelihood of LDKT and ≥1 donor evaluation within 1 y of transplant evaluation. Multivariable logistic regression adjusted for demographic and clinical factors known to be associated with LDKT.</p><p><strong>Results: </strong>Access to any donor wage reimbursement (lost wages $1500 maximum reimbursement and lost wages $3000 maximum reimbursement combined versus HC) was not significantly associated with LDKT occurrence (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.39-1.85; P  = 0.68) or with the likelihood of having at least 1 donor evaluated within 1 y of initial evaluation (aOR, 1.07; 95% CI, 0.76-1.50; P  = 0.70) after covariate adjustment. Also, donor wage reimbursement level (lost wages $1500 maximum reimbursement versus lost wages $3000 maximum reimbursement) was not associated with LDKT (aOR, 0.73; 95% CI, 0.22-2.44; P  = 0.61) or with having a donor evaluation initiated (aOR, 0.65; 95% CI, 0.40-1.05; P  = 0.11). In an exploratory analysis extending follow-up to account for COVID-related shutdowns, access to wage reimbursement was associated with higher odds of LDKT compared with HC (aOR, 2.16; 95% CI, 1.12-4.18; P  = 0.02).</p><p><strong>Conclusions: </strong>Donor wage reimbursement, at the levels tested, did not increase LDKT or living donor evaluation likelihood in primary analyses, although exploratory findings suggest that effects may emerge with longer follow-up. Wage reimbursement alone may be insufficient to meaningfully expand LDKT.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2105-e2112"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273117","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":"Gut Microbiota-Associated Lysophosphatidylcholine Aggravates Donation After Circulatory Death Liver Injury via Lysosomal Dysregulation During Normothermic Regional Perfusion.","authors":"Jian Li, Linyan Zhou, Jianbao Yang, Yongnan Li, Zuoyi Jiao","doi":"10.1097/TP.0000000000005861","DOIUrl":"10.1097/TP.0000000000005861","url":null,"abstract":"<p><strong>Background: </strong>Normothermic regional perfusion (NRP) is increasingly used in donation after circulatory death liver transplantation, yet the impact of the accompanying intestinal ischemia/reperfusion injury and gut microbiota dysbiosis on liver grafts remains unclear.</p><p><strong>Methods: </strong>A rat model of donation after circulatory death followed by NRP was established. Intestinal microbiota composition was characterized by 16S rRNA gene sequencing, and the contribution of microbiota alterations to liver injury during NRP was assessed using antibiotic-treated rats and fecal microbiota transplantation. Untargeted metabolomics of intestinal contents was subsequently performed to identify candidate metabolites potentially involved in microbiota-associated liver injury. Lysophosphatidylcholine (LPC) was further investigated in vivo and in vitro by transcriptomic analysis and studies of lysosomal function and autophagic flux.</p><p><strong>Results: </strong>NRP induced intestinal microbiota dysbiosis. Antibiotic treatment attenuated liver injury, whereas fecal microbiota transplantation from NRP donors aggravated liver injury. Untargeted metabolomics identified LPC as a markedly increased metabolite during NRP, with elevated levels in intestinal contents, portal venous plasma, and liver tissue. Transcriptomic analysis and complementary in vivo and in vitro experiments showed that increased LPC exposure exacerbated hepatocellular injury and was associated with lysosomal dysfunction and impaired autophagic flux.</p><p><strong>Conclusions: </strong>NRP induced gut microbiota dysbiosis and alterations in the intestinal metabolome. LPC was increased during NRP and aggravated liver injury, accompanied by lysosomal dysfunction and impaired autophagic flux, suggesting that modulation of the intestinal microenvironment and LPC-targeted intervention may offer potential strategies to mitigate liver injury during NRP.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2030-e2040"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670553","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":"T-cell Progenitor-derived Dendritic Cells Contribute to the Repertoire Selection and Immunological Tolerance.","authors":"Ryo Otsuka, Haruka Wada, Airi Sasaki, Hyuma Tsuji, Tomoki Murata, Yoshinori Hasegawa, Ayako Kaitani, Jiro Kitaura, Ken-Ichiro Seino","doi":"10.1097/TP.0000000000005795","DOIUrl":"10.1097/TP.0000000000005795","url":null,"abstract":"<p><strong>Background: </strong>Accumulating evidence indicates that bone marrow transplantation induces tolerance against simultaneously transplanted allogeneic organs; however, the mechanistic aspects of this phenomenon are less understood. It is known that early T-cell progenitors (ETPs) generate myeloid cells, such as dendritic cells (DCs) and macrophages, as well as T cells in the thymus. Here, we speculate that myeloid cells produced by ETPs may act as allogeneic antigen-presenting cells (APCs) and play an important role in T-cell selection, thereby contributing to tolerance induction.</p><p><strong>Methods: </strong>To elucidate the contribution of ETP-derived APCs in T-cell selection, we sorted and cultured ETPs (CD4 - CD8 - c-Kit + CD25 - cells) in a combined ex vivo and in vivo system to generate T cells and APCs simultaneously, followed by a flow cytometric analysis of Vβ T-cell receptor (TCR). To evaluate the importance of ETP-derived APC in allogeneic tolerance, we transplanted ETP-reconstituted fetal thymus to athymic nude mice and performed skin transplantation.</p><p><strong>Results: </strong>Flow cytometric analysis of the ETP culture showed the presence of CD11c + major histocompatibility complex class II + ETP-derived DCs, and the T cells generated in the culture showed a low frequency of specific TCR Vβ repertoire, suggesting clonal deletion. ETP-derived DCs also induced the deletion of a specific Vβ TCR repertoire in the in vitro coculture. Furthermore, nude recipients of ETP-reconstituted fetal thymus showed long-term allogeneic skin graft survival while third-party skin was rapidly rejected.</p><p><strong>Conclusions: </strong>The presence of ETP-derived APC is related to the deletion of specific Vβ TCR repertoire and skin allograft survival. By eliminating donor-reactive T-cell clones, ETPs may contribute to allograft tolerance.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2041-e2048"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424557","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":"Multiple Retransplantations After BK Polyomavirus-Associated Metastatic Collecting Duct Carcinoma: Evidence for Protective BK-specific T-Cell Immunity.","authors":"Nathalie Hammer, Nina Khanna, Fadi Haidar, Hans H Hirsch","doi":"10.1097/TP.0000000000005859","DOIUrl":"10.1097/TP.0000000000005859","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2148-e2149"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888550","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":"Metabolic Dysfunction-associated Liver Disease Associated With Poor Food Access and Geographic hot Spots Among Liver Transplant Candidates.","authors":"Laila Fozouni, Giuseppe Cullaro, Jennifer C Lai, Sharad I Wadhwani","doi":"10.1097/TP.0000000000005813","DOIUrl":"10.1097/TP.0000000000005813","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated liver disease (MASLD) and frailty share metabolic risk factors. We evaluated the relationship between poor food access and the prevalence of MASLD and frailty among patients with cirrhosis being evaluated for LT and visualized the geospatial clustering of MASLD and frailty.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional cohort study of adults at a single center. Poor food access was defined at the census-tract level using U.S. Department of Agriculture Food Access Data as low-income and low-access (LILA) areas, also referred to as food deserts.</p><p><strong>Results: </strong>Two thousand two hundred sixty-six adults were included; the median age was 61 (interquartile range, 54-66), 171 (8%) resided in LILA areas, 29% were Hispanic, and 43% had public insurance. Fifteen percent were frail, and 19% had MASLD. In univariate logistic regression, living in a LILA area was associated with a 50% increased odds of MASLD (odds ratio, 1.50; P  = 0.03; 95% confidence interval, 1.03-2.14) but lost statistical significance in multivariate regression. Hotspot analysis of MASLD and frailty revealed a similar geographic distribution of hot and cold spots. Spatial autocorrelation analysis yielded a Moran's I of 0.007 ( P  = 0.02) and 0.007 ( P  = 0.01) for MASLD and frailty, respectively. Hot spots of both were associated with LILA areas and census tracts with less walkability and higher poverty, social vulnerability, and pollution.</p><p><strong>Conclusions: </strong>Residing in a LILA area was associated with increased prevalence of MASLD and frailty among patients with cirrhosis. There was significant clustering of MASLD and frailty, suggesting that geographical determinants influence the indication for liver transplantation and the risk of frailty.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2087-e2095"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148309580","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":"Global Disparities in Liver Transplantation Relative to the Burden of Cirrhosis and Other Chronic Liver Diseases (2000-2023).","authors":"Ye Xin Koh, Yun Zhao, Darren Weiquan Chua, London Lucien Peng Jin Ooi, Peng Chung Cheow, Alexander Yaw Fui Chung, Prema Raj Jeyaraj, Brian Kim Poh Goh","doi":"10.1097/TP.0000000000005750","DOIUrl":"10.1097/TP.0000000000005750","url":null,"abstract":"<p><strong>Background: </strong>Global access to liver transplantation (LT) remains highly unequal. We analyzed worldwide patterns of LT activity, donor source, and their alignment with disease burden across sociodemographic strata.</p><p><strong>Methods: </strong>We combined country-level LT data from the Global Observatory on Donation and Transplantation (2000-2023) with prevalence and mortality estimates for cirrhosis and other chronic liver diseases from the Global Burden of Disease 2021 Study (2000-2021). LT rates and donor source were analyzed across Sociodemographic Index (SDI) categories. LT capacity was benchmarked against age-standardized prevalence rates and age-standardized mortality rates. Associations between LT intensity and the mortality-to-prevalence ratio were evaluated using pooled correlations, within-country analyses, and 2-way fixed-effects models adjusting for country-year and calendar year.</p><p><strong>Results: </strong>From 2000 to 2023, LT activity was concentrated in high-SDI countries, whereas low-SDI countries relied almost exclusively on living donation but had extremely low overall LT rates. When benchmarked against age-standardized prevalence rates and age-standardized mortality rates, LT capacity showed a strong inverse gradient across SDI, with substantial heterogeneity among high- and middle-SDI countries. Within-country and 2-way fixed-effects models demonstrated a small but significant inverse association, indicating that higher LT activity was associated with lower mortality relative to disease prevalence at the population level.</p><p><strong>Conclusions: </strong>Global LT capacity remains poorly aligned with the burden of cirrhosis and other chronic liver diseases and is driven more by health system development than epidemiological need. Although prevention remains central, incremental expansion of equitable LT infrastructure may be associated with modest improvement in population-level mortality relative to disease prevalence.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e2072-e2081"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975725","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}