Transplant International最新文献

{"title":"A 20-Year Single Center Experience of Right Lateral Sector Graft in Adult Living Donor Liver Transplantation With Special Reference to Biliary Complication.","authors":"Tomoaki Hayakawa, Nobuhisa Akamatsu, Takashi Kokudo, Kyoji Ito, Yujiro Nishioka, Yujiro Mihara, Akihiko Ichida, Takeshi Takamoto, Yoshikuni Kawaguchi, Kiyoshi Hasegawa","doi":"10.3389/ti.2025.14606","DOIUrl":"https://doi.org/10.3389/ti.2025.14606","url":null,"abstract":"<p><p>Right lateral sector grafts (RLSGs) in living donor liver transplantation (LDLT) expand donor options, however, their long-term outcomes and complication rates remain unclear. We analyzed 661 LDLTs (42 RLSGs, 363 right liver grafts, 243 left liver grafts, and 13 left lateral section grafts) performed between 2000 and 2021 at the University of Tokyo Hospital. RLSG donors experienced a 4.8% major complication (Clavien-Dindo grade ≥3b) rate with no mortality. RLSG recipients had a 38.1% major complication rate and a 9.5% 90-day mortality rate. Compared with other graft types, RLSG recipients had higher rates of hepatic artery thrombosis (9.5% vs. 3.1%), portal vein stenosis (14.3% vs. 1.9%), and biliary stricture (42.9% vs. 16.3%). The 5-year survival rate for RLSG recipients (79.2%) did not differ significantly from other graft types (84.7%). Graft bile ducts measuring >4 mm were associated with increased anastomotic biliary stricture. RLSG, the only option for 33 recipients, expanded the donor pool by 5%. Although RLSG is associated with higher vascular and biliary complication rates, it demonstrates favorable long-term survival and significantly expands the donor pool. For patients without suitable conventional graft options, RLSG represents a viable choice that provides life-saving transplantation opportunities.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14606"},"PeriodicalIF":2.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Banff 1991 to Today: The Changing Landscape of the v-Lesion in Kidney Transplant Rejection.","authors":"Karolien Wellekens, Priyanka Koshy, Candice Roufosse, Maarten Naesens","doi":"10.3389/ti.2025.14818","DOIUrl":"10.3389/ti.2025.14818","url":null,"abstract":"<p><p>Intimal arteritis (v-lesion) has long been considered a hallmark of higher-grade T cell-mediated rejection (TCMR) in kidney transplantation, historically associated with poor graft survival and resistance to therapy. These associations have informed treatment strategies, often prompting intensified immunosuppression, including anti-thymocyte globulins (ATG). However, emerging evidence challenges the assumption that all v-lesions signify TCMR-particularly when they occur in isolation, without significant tubulo-interstitial inflammation. Recent observational studies and molecular analyses suggest that isolated v-lesions may instead reflect non-immune injury mechanisms, such as ischemia-reperfusion injury, particularly in the early post-transplant period. In addition, the shared nature of the v-lesion between TCMR and antibody-mediated rejection (AMR) raises concerns about overdiagnosis and potential overtreatment of \"mixed rejection\" phenotypes. Following advances in modern immunosuppression and improved donor-recipient matching, the clinical course of v-lesions may have evolved, with severe v3 presentations now rare-rendering historical comparisons less applicable to current practice. These insights highlight the need to revisit traditional paradigms and adopt a more nuanced, context-aware interpretation of v-lesions. This review integrates historical and contemporary perspectives, advocating for a reappraisal of the role of the v-lesion in kidney transplant biopsy evaluation.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14818"},"PeriodicalIF":2.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12256300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Prognostic Value of AFP and PIVKA-II in HCC After Living Donor Liver Transplantation: A Single-Center Retrospective Study.","authors":"Saran Ochir Gongor, YoungRok Choi, Gayoung Kim, Min Kyoung Kim, Sang Hyuk Park, Jiyoung Kim, Jae-Yoon Kim, Su Young Hong, Jeong-Moo Lee, Suk Kyun Hong, Kwang-Woong Lee","doi":"10.3389/ti.2025.14748","DOIUrl":"10.3389/ti.2025.14748","url":null,"abstract":"<p><p>Despite the development of numerous prognostic models for hepatocellular carcinoma (HCC) recurrence and mortality after liver transplantation, tumor biomarkers such as alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II (PIVKA-II) remain widely used in clinical practice. This study evaluated the performance of AFP and PIVKA-II compared with six prognostic models (RETREAT, SNAPP, MoRAL, R3-AFP, METROTICKET 2.0, and SALT) in a retrospective cohort of 707 adults who underwent living donor liver transplantation (LDLT) for HCC between 2003 and 2018. Patients were stratified into Milan and Beyond Milan groups. Time-dependent receiver operating characteristic curve analysis was conducted using integrated area under the curve (iAUC) and concordance index (C-index) to assess recurrence and mortality. AFP and PIVKA-II (continuous) achieved iAUCs of 0.68-0.75 for recurrence and C-indices of 0.66-0.77 for mortality. Their combination reached iAUCs up to 0.78 and C-indices up to 0.80. Threshold models (AFP ≥200, PIVKA-II ≥400) showed modest predictive performance. Among multivariable models, R3-AFP demonstrated the most consistent performance (iAUC 0.76-0.81; C-index 0.78-0.82). SNAPP, MoRAL, and SALT also performed well. AFP and PIVKA-II may offer practical utility in resource-limited settings. However, multivariable models remain the preferred approach where comprehensive diagnostics are available.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14748"},"PeriodicalIF":2.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High HLA Sensitization After Early Renal Allograft Vascular Thrombosis.","authors":"María José Pérez-Sáez, Jordi Comas, Edoardo Melilli, Francesc Moreso, Lluis Guirado, Anna Vila, Fritz Diekmann, Eduard Palou, Jaume Tort, Dolores Redondo-Pachón, Marta Crespo","doi":"10.3389/ti.2025.14457","DOIUrl":"10.3389/ti.2025.14457","url":null,"abstract":"","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14457"},"PeriodicalIF":2.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing the Use of Deceased Donor Kidneys at Risk of Discard: A Clinical Practice Guideline.","authors":"Joanna C Dionne, Patricia Campbell, Héloïse Cardinal, Tatiana Giannidis, Aviva Goldberg, S Joseph Kim, Greg Knoll, Michel Pâquet, Christina Parsons, Yuhong Yuan, Rahul Mainra","doi":"10.3389/ti.2025.14596","DOIUrl":"10.3389/ti.2025.14596","url":null,"abstract":"<p><p>Underutilization of deceased donor organs has worsened the gap in the number of kidneys available for transplantation. The purpose of this clinical practice guideline is to provide recommendations on the utilization of donor kidneys at risk of discard. Six conditional recommendations were made all with very low certainty of evidence: 1) We suggest utilizing extended criteria donor (ECD) kidneys for transplantation rather than remaining on the wait list and continuing with dialysis; 2) We suggest utilizing kidneys from ECD versus non-ECD in selected transplant candidates; 3) We suggest that organs from older kidney donors can be used in selected transplant candidates who may derive benefit from them; 4) We suggest that kidneys from deceased donors with acute kidney injury can be used for transplantation based on clinician assessment and donor factors; 5) We suggest that donor kidneys with acute kidney injury from either ECD or non-ECD be used for kidney transplantation; 6) We suggest using kidneys from donors after death determination by circulatory criteria for transplantation. This clinical practice guideline provides evidence for the use of deceased donor kidneys that are at risk of discard and may improve the shared decision-making between transplant physicians and wait-listed patients.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14596"},"PeriodicalIF":2.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning for 1-Year Mortality Prediction in Lung Transplant Recipients: ISHLT Registry.","authors":"Hye Ju Yeo, Dasom Noh, Eunjeong Son, Sunyoung Kwon, Woo Hyun Cho","doi":"10.3389/ti.2025.14121","DOIUrl":"10.3389/ti.2025.14121","url":null,"abstract":"<p><p>Optimizing lung transplant candidate selection is crucial for maximizing resource efficiency and improving patient outcomes. Using data from the International Society for Heart and Lung Transplantation (ISHLT) registry (29,364 patients), we developed a deep learning model to predict 1-year survival after lung transplantation. Initially, 25 pretransplant factors were identified, and their importance was assessed using SHapley Additive exPlanations values. We refined the model by selecting the top 10 most influential factors and compared its performance with the original model. Additionally, we conducted external validation using an independent in-house dataset. Among the 29,364 patients, 4,729 (16.1%) died within 1 year, while 24,635 survived. The Gradient Boosting Machine (GBM) model achieved the highest performance (AUC: 0.958, accuracy: 0.949). Notably, the streamlined model using only the top 10 factors maintained identical performance (AUC: 0.958, accuracy: 0.949). The in-house dataset used for external validation showed significant compositional differences compared to the ISHLT dataset. Despite these differences, the GBM model performed well (AUC: 0.852, accuracy: 0.764). Notably, the Multilayer Perceptron model demonstrated superior generalization with an AUC of 0.911 and accuracy of 0.870. Our machine learning-based approach effectively predicts 1-year mortality in lung transplant recipients using a minimal set of pretransplant factors.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14121"},"PeriodicalIF":2.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty Prevalence and Characterization Among Kidney Transplant Candidates in Spain: A Multicenter Study.","authors":"María José Pérez-Sáez, Edoardo Melilli, Marta Arias, Antonio Franco, Rocío Martínez, Asunción Sancho, María Molina, Carme Facundo, Natalia Polanco, Verónica López, Auxiliadora Mazuecos, Sheila Cabello, María Elena González García, María Luisa Suárez, Ingrid Auyanet, Jordi Espi, Teresa García Falcón, Juan Carlos Ruiz, Cristina Galeano, Marta Artamendi, María Luisa Rodríguez-Ferrero, José María Portolés, María Auxiliadora Santana, Paloma Leticia Martín-Moreno, Nisrine Arhda, Marta Calvo, Alicia Mendiluce, Manuel Macía, María Lourdes Pérez-Tamajón, Javier de Teresa, Blanca Gascó, Sagrario Soriano, Guadalupe Tabernero, Lourdes de la Vara, Ana María Ramos, Rafael Martínez, Enrique Montero de Espinosa, José Luis Zalve, Julio Pascual, Leocadio Rodríguez-Mañas, Alex Gutiérrez-Dalmau, Francesc Moreso","doi":"10.3389/ti.2025.14098","DOIUrl":"10.3389/ti.2025.14098","url":null,"abstract":"<p><p>Frailty is a frequent condition among kidney transplant candidates (KTc) that confers poor outcomes after transplantation. We aimed to establish frailty prevalence in a representative sample of KTc in Spain. We conducted a multicenter cross-sectional study including 1194 KTc ≥50 years. Frailty was assessed by the FRAIL scale. Mean age was 64.2 years; 38.4% were female. Median Charlson comorbidity index (CCI) was 6 [4-7] and the total number of medications was 9 [7-12]. We found that 8.2% of patients were frail and 41.5% were pre-frail. Frailty was more frequent among females (60.2% of frail vs. 32.8% of robust; p < 0.001), hemodialysis patients (74.5% of frail vs. 67.1% of robust; p = 0.02), and those with a high burden of disease (54.6% of frail patients with CCI >6 vs. 29.3% of robust; p < 0.001). The multivariable analysis confirmed that frailty was associated with the female sex (OR 3.9 [2.5-6.2]); higher CCI (>6 OR 2.9 [1.6-54]); and the number of medications (OR -per medication- 1.13 [1.07-1.2]). Almost 50% of KTc in Spain are pre-frail or frail. Frailty is more prevalent between women and patients with high comorbidity burden. Identifying those candidates at risk is essential to establish risks and implement strategies to minimize them.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14098"},"PeriodicalIF":2.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for One-Year Post-Nephrectomy Decline in Renal Function of Living Kidney Donors: Quantile Regression Analysis Based on Estimated Glomerular Filtration Rate Reduction Percentiles.","authors":"Alfonso Hernandez Santos, Hisham Ibrahim, Kawther Alquadan, Amer Belal, Muhannad Leghrouz, Rohan Mehta, Xuerong Wen, Georgios Vrakas","doi":"10.3389/ti.2025.14749","DOIUrl":"10.3389/ti.2025.14749","url":null,"abstract":"","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14749"},"PeriodicalIF":2.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Cell Carcinoma in Native Kidney After Kidney Transplantation: A Multicenter Case Control Study With a Focus on Screening Strategy.","authors":"Pierre Pommerolle, Maryam Assem, Marine Uhl, Philippe De Sousa, Dominique Guerrot, Marc Hazzan, Thierry Lobbedez, Ophélie Fourdinier, Gabriel Choukroun","doi":"10.3389/ti.2025.14487","DOIUrl":"10.3389/ti.2025.14487","url":null,"abstract":"<p><p>Renal cell carcinoma (RCC) of native kidney is more prevalent after kidney transplantation than in the general population. Risk factors and the value of screening remain unclear. We conducted a multicenter case-control study in kidney transplant recipients transplanted between 1989 and 2017. All patients with RCC were included, and two controls were matched to each case. Two centers performed annual screening (AnS group) and the other two had other strategies (OS group). A total of 125 cancers were found in 113 patients. The majority of cancers were stage T1-T2 (92.0%), 1.6% had metastasis at diagnosis and ten (9.0%) had recurrence after nephrectomy. Men [OR 2.2; IC 95% (1.2-4.4); p = 0.02] and acquired cystic kidney disease [OR 3.2; IC 95% (1.8-5.9); p < 0.01] were associated with cancer in multivariate analysis. The 10-year survival was poorer in cases (65.6% vs. 79.1%, p < 0.001). The AnS group had fewer relapses (5.0% vs. 18.2%, p = 0.02) and a lower rate of cancer-related deaths (16.0% vs. 46.1%, p = 0.04). Survival of patients with RCC is lower than in control patients. Annual screening could improve cancer prognosis, its benefit needs to be evaluated in larger studies.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14487"},"PeriodicalIF":2.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The New Era of Organ Transplantation in Greece: Time to Converge With the Western World.","authors":"Dimitrios Moris, Emmanouil Giorgakis","doi":"10.3389/ti.2025.14668","DOIUrl":"10.3389/ti.2025.14668","url":null,"abstract":"","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14668"},"PeriodicalIF":2.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}