Transplant International最新文献

{"title":"Cytomegalovirus Reactivation Is Associated With Lower Rates of Hepatocellular Carcinoma Recurrence After Liver Transplantation.","authors":"Victoria Aguilera, Sarai Romero Moreno, Isabel Conde, Angel Rubín, Angela Carvalho-Gomes, Mario Romero, Javier Zamora-Olaya, Miguel Angel Gómez-Bravo, Esteban Fuentes-Valenzuela, Cristina Dopazo, Nikita Bilbao, Antonio González, Ana Sánchez-Martínez, Sonia Pascual, Jesús Rivera-Esteban, José Ignacio Herrero, Sara Lorente, Antonio Cuadrado-Lavín, Flor Nogueras, Laura Martínez-Arenas, Rocío González-Grande, Marina Berenguer, Manuel Rodriguez-Perálvarez","doi":"10.3389/ti.2025.14553","DOIUrl":"10.3389/ti.2025.14553","url":null,"abstract":"<p><p>In patients with hepatocellular carcinoma (HCC), undergoing liver transplantation (LT), cytomegalovirus reactivation (CMVr) may modulate the immune system to prevent tumor recurrence. In this multicenter retrospective study (2010-2015) involving 15 institutions, we assessed the effect of early CMVr in tumor recurrence rates among 771-LT HCC patients with tacrolimus-based immunosuppression (88% men, mean age 58 years). CMV prophylaxis was implemented for 19.7% of patients, while the rest were managed with preemptive therapy. The Milan criteria were met by 88% of patients. Microvascular invasion was present in 12.7% of explanted livers. The serum AFP level before transplantation was 5.1 (3-15) ng/mL. After a median follow-up of 7.4 years, 101 patients (13%) experienced HCC recurrence. CMVr occurred in 235 patients (30.5%) at a median of 41.5 days post-LT and 42 patients (5.6%) had CMV disease. Cumulative exposure to tacrolimus within the first 3 months after LT was similar among patients with and without CMVr. In a multivariate Cox regression analysis, factors associated with an increased rate of HCC recurrence included microvascular invasion [HR:2.82, CI95%:1.55-5.14; p 0.0001], donation after circulatory determination of death [HR:4.43,CI95%:1.52-12.9; p 0.006) and diameter of the main nodule at explant [HR:1.04, CI95%:1.02-1.06; p < 0.001]. Meanwhile CMVr [HR:0.46, CI95%:0.23-0.93, p 0.031] and MELD [HR:0.93, CI95%:0.87-0.99; p0.017] exhibited protective effects. In conclusion, early CMVr may protect against HCC recurrence. The underlying immune mechanisms warrant further investigation.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14553"},"PeriodicalIF":2.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486076","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":"Clinical and Histopathological Determinants for Kidney Allograft Survival in the Eurotransplant Senior Program (ESP) at the Time of Allocation.","authors":"Tom N Langer, Thorsten Wiech, Mercedes Noriega, Sergey Biniaminov, Tobias B Huber, Lutz Fischer, Florian Grahammer, Malte A Kluger","doi":"10.3389/ti.2025.14153","DOIUrl":"10.3389/ti.2025.14153","url":null,"abstract":"<p><p>To address the shortage of organs for kidney transplantation, the Eurotransplant Senior Program (ESP) was established to enhance kidney allocation from elderly donors. This study aimed to evaluate post-transplant outcomes of deceased donor grafts and identify prognostic factors within the ESP population. We therefore analyzed patient data from 64 ESP recipients and their donors transplanted at our center between 2017 and 2022. Time-zero biopsies were analyzed using AI image analysis software for glomerular density and glomerulosclerosis. One-year patient and allograft survival rates were 96.9% and 85.9%. 5-year survival rate was 74.6%, as opposed to about 41.0% historically reported for patients on dialysis. Delayed Graft Function occurred in 29.7% of cases, with recipient coronary heart disease, BMI-disparities, and prolonged cold ischemia time as major predictors (<i>P</i> < 0.05). Histopathological analysis revealed that the degree of glomerulosclerosis and interstitial fibrosis and tubular atrophy (IFTA) were associated with graft failure in multivariable analyses (<i>P</i> < 0.05). Arteriolosclerosis (arteriolar hyalinosis) correlated with a higher risk for primary non-function (<i>P</i> < 0.05). The number of HLA mismatches was not significantly associated with graft outcome. Including prognostic baseline characteristics as well as histopathological AI analysis into individual allocation decisions during organ-acceptance process might improve allograft survival within the ESP and should prospectively be studied.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14153"},"PeriodicalIF":2.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529646","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":"Delivery of a Muscle-Targeted Adeno-Associated Vector Via <i>Ex Vivo</i> Normothermic Perfusion Is Efficient, Durable, and Safe in a Preclinical Porcine Heart Transplant Model.","authors":"Krish C Dewan, Jeng-Wei Chen, Alejandro A Lobo, Ryan T Gross, Chunbo Wang, Karla G Rivera, Keely Dieplin Tran, Smith Ngeve, Violet G Johnston, David Wendell, Carolyn K Glass, Amy Evans, Sam Ho, Paul Lezberg, Widler Casy, Marla Bazile, Kruti Patel, Adam S Cockrell, Carmelo A Milano, Dawn Bowles","doi":"10.3389/ti.2025.13971","DOIUrl":"10.3389/ti.2025.13971","url":null,"abstract":"<p><p>Normothermic <i>ex-vivo</i> organ perfusion (EVP) systems not only provide a physiological environment that preserves donor organ function outside the body but may also serve as platforms for <i>ex-vivo</i> organ modification via gene therapy. In this study, we demonstrated that a rationally designed muscle-tropic recombinant AAV, AAV-SLB101, delivered to the donor heart during brief normothermic EVP achieves durable cardiac transgene expression out to 90 and 120 days post-transplant in a porcine preclinical model. Moreover, transgene expression was detectable as early as 48 h post-transplant. Histological and MRI analyses of the donor myocardium showed no functional or structural impact on the allograft and no off-target gene expression in the recipient. This work will serve as a critical foundation to inform translational studies with therapeutic transgenes to improve allo-, xeno-, and auto-heart transplant outcomes.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"13971"},"PeriodicalIF":2.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529647","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":"Current Techniques of Gene Editing in Pigs for Xenotransplantation.","authors":"Cesare Galli","doi":"10.3389/ti.2025.13807","DOIUrl":"10.3389/ti.2025.13807","url":null,"abstract":"<p><p>Shortage of human organs for transplantation has created a demand for alternative solutions of which xenotransplantation is amongst the most promising one in the short term. However, the immune reaction following transplantation of a pig organ is greater than the one elicited during allotransplantation. Genetic engineering of the pig is required so that pig organs or tissues are made less immunogenic to humans by eliminating some antigens and by expressing human proteins that can reduce the damage by the host immune system. To generate founder animals with the desired mutations genetic engineering of somatic cells with multiplexed mutations combined with somatic cell nuclear transfer (SCNT) is the best solution with the technology available today. Safety concerns include potential zoonosis, primarily porcine endogenous retroviruses (PERVs). Ethical considerations might arise from the use animals involved in research. Genome editing techniques based CRISPR-Cas9, have greatly facilitated the modification of pig's genome to address coagulation and inflammation issues, to mention just a few, arising after the pig organ is transplanted into a human. However, further research is needed to ensure safety and efficacy of the genome edits introduced in the pig genome are compatible with the health and welfare of the pigs.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"13807"},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267252","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":"Proenkephalin A 119-159 in Kidney Transplantation: A Novel Biomarker for Superior Tracking of Graft Function Trajectories.","authors":"Louise Benning, Marvin Reineke, Camila Eleuterio Rodrigues, Florian Kälble, Claudius Speer, Claudia Sommerer, Christoph F Mahler, Felix C F Schmitt, Markus Mieth, Martin Zeier, Christoph Michalski, Arianeb Mehrabi, Oliver Hartmann, Markus Zorn, Sophie C Anker, David Czock, Markus A Weigand, Zoltan Endre, Christian Morath, Christian Nusshag","doi":"10.3389/ti.2025.14366","DOIUrl":"10.3389/ti.2025.14366","url":null,"abstract":"<p><p>Accurate assessment of graft function trajectories after kidney transplantation is essential for optimizing patient management. Slow graft function (SGF) and delayed graft function (DGF) are associated with impaired recovery, yet current diagnostic tools lack granularity for timely risk stratification. Proenkephalin A 119-159 (penKid) may improve graft function assessment, enhancing risk stratification for SGF, DGF, and associated outcomes. This prospective study evaluated 159 kidney transplant recipients at Heidelberg University Hospital to compare plasma penKid levels with current risk-indicators for poor (functional) graft trajectories. Validation was conducted using an independent transplant cohort from Sydney. Clinical relevance of biomarker-indicated changes in graft function was assessed using multivariable regression models and AUROC analyses. From day one post-transplant, penKid outperformed serum creatinine (SCr) in identifying functional trajectories associated with DGF (AUROC penKid: 0.87 vs. SCr: 0.56) and differentiated SGF from DGF (AUROC penKid: 0.79 vs. SCr: 0.33) up to eight days earlier. PenKid further demonstrated superior granularity in assessing DGF severity and 30-day outcomes. After adjustment for common risk factors, penKid remained the strongest risk stratifier for all tested outcomes. PenKid is a superior biomarker for earlier assessment of graft function trajectories, offering potential to enhance personalized care and clinical trial designs in kidney transplantation.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14366"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235352","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":"<i>CTLA4</i> Single-Nucleotide Polymorphisms Influence the Risk of HSV and VZV Infection in Kidney Transplant Recipients: A Prospective Cohort Study.","authors":"Natalia Redondo, Isabel Rodríguez-Goncer, Tamara Ruiz-Merlo, Francisco López-Medrano, Esther González, Natalia Polanco, Ana Hernández-Vicente, Rafael San Juan, Amado Andrés, José María Aguado, Mario Fernández-Ruiz","doi":"10.3389/ti.2025.14648","DOIUrl":"10.3389/ti.2025.14648","url":null,"abstract":"<p><p>Herpesviruses are able to modulate adaptive T-cell-mediated responses to establish latency within the host. Reactivation of herpes simplex virus (HSV)-1/2 and varicella zoster virus (VZV) is a frequent and potentially serious complication among kidney transplant recipients (KTRs). The ability of clinical criteria to identify KTRs at increased risk of α-herpesvirus (HSV/VZV) infection is limited. We investigated the effect of two single nucleotide polymorphisms (SNPs) in the cytotoxic T-lymphocyte antigen 4 <i>(CTLA4)</i> gene in a single-center cohort of 204 KTRs. After a median follow-up of 3.1 years, 34 of them (16.7%) experienced 22 episodes of zoster and 15 episodes of HSV-1/2 infection. Homozygous carriers of the minor allele of rs231775 had a higher cumulative incidence of α-herpesvirus infection (23.5% for GG versus 7.6% for AA/AG carriers; <i>P</i>-value = 0.011) and a lower infection-free survival (log-rank <i>P</i>-value = 0.037). After multivariable adjustment by clinical factors (including use of valganciclovir prophylaxis and acute rejection as time-dependent variables), the GG genotype of <i>CTLA4</i> (rs231775) SNP was associated to the study outcome (adjusted hazard ratio: 3.21; 95% confidence interval: 1.44-7.16). In conclusion, genetic polymorphisms in the co-inhibitory T-cell receptor CTLA-4 may be detrimental for the immune control of latent HSV/VZV infection in KTRs.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14648"},"PeriodicalIF":2.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226868","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":"<i>En-Bloc</i> Kidney Transplantation From Extremely Low-Weight (0.9-5.0 kg) Pediatric Donors: A Decade of Single-Center Experience.","authors":"Xianpeng Zeng, Qiuxiang Xia, Heng Li, Miao Wang, Hanying Li, Liang He, Hua Su, Chun Zhang, Zhendi Wang","doi":"10.3389/ti.2025.14451","DOIUrl":"10.3389/ti.2025.14451","url":null,"abstract":"<p><p><i>En-bloc</i> kidney transplantation from low-weight pediatric donors (≤5 kg) is a challenging procedure performed only in limited transplant centers. We retrospectively analyzed the data from 42 <i>en-bloc</i> kidney transplants from donors weighing less than 5 kg between September 2014 and September 2023. The mean donor body weight was found to be 3.1 ± 1.0 kg, and the minimum weight was 0.9 kg. At a mean follow-up period of 1,481 days, the graft survival rate was 76.2% and the recipient survival rate was 100.0%. Thrombosis and acute rejection were the major complications responsible for the short-term graft loss. Male recipients were more likely to experience graft loss than female ones (P < 0.05). Recipients with long-term (>1 year) graft survival were observed to have a high prevalence (31.3%) of delayed graft function. However, they still had satisfactory long-term graft function and limited proteinuria. Continuous graft volume growth took more than 1 year to reach a stable level. Lower donor/recipient body surface area may lead to higher delayed graft function and slower estimated glomerular filtration rate recovery (P < 0.05). Kidney transplant from low-weight pediatric donors is associated with a high incidence of short-term graft loss, while long-term outcomes are generally acceptable.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14451"},"PeriodicalIF":2.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217070","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":"Belatacept in Kidney Transplantation: Reflecting on the Past, Shaping the Future.","authors":"Johan Noble, Juliette Leon, Arnaud Del Bello, Dany Anglicheau, Gilles Blancho, Simon Ville, Lionel Couzi, Philippe Grimbert, Yannick Le Meur, Bruno Moulin, Nassim Kamar, Lionel Rostaing, Florence Herr, Antoine Durrbach, Dominique Bertrand","doi":"10.3389/ti.2025.14412","DOIUrl":"10.3389/ti.2025.14412","url":null,"abstract":"<p><p>Calcineurin inhibitors (CNIs) are a cornerstone of post-transplant immunosuppressive regimens. However, their use is associated with adverse effects, most notably chronic nephrotoxicity, which remains a leading cause of long-term allograft dysfunction. Belatacept, a selective costimulation blocker, offers a promising alternative to CNIs by aiming to reduce nephrotoxicity while maintaining efficacy in preventing acute rejection. While its use in <i>de novo</i> transplantation has been associated with improved graft and patient survival, it has also been linked to a higher incidence of acute rejection. Early post-transplantation conversion to belatacept has demonstrated significant improvements in renal function (eGFR gains ranging from +8.8 to +38.2 mL/min/1.73 m² at 1 year post-conversion) but carries a higher risk of opportunistic infections. Late conversion protocols, typically initiated beyond 6 months post-transplantation, have shown sustained-although less pronounced-eGFR improvements and better long-term graft survival compared to CNI-based regimens. Additionally, belatacept appears to reduce the incidence of donor-specific antibodies. Future directions for the use of belatacept need further exploration, including its role in rescuing poor renal function, its combination with low-dose CNIs, mTOR inhibitors, or tocilizumab, and its application in desensitization protocols. By potentially striking a balance between efficacy and safety, belatacept may redefine the future landscape of transplant immunosuppression.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14412"},"PeriodicalIF":2.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217071","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":"12-Month Outcomes of a Prospective Randomized Trial Investigating Effects of IVIG on Top of rATG Versus rATG Alone in Pre-Sensitized Kidney Transplant Recipients: The INHIBIT Study.","authors":"Ondrej Viklicky, Ivan Zahradka, Jan Mares, Janka Slatinska, Alena Parikova, Vojtech Petr, Matej Roder, Katerina Jaklova, Klara Osickova, Libor Janousek, Petra Hruba","doi":"10.3389/ti.2025.14312","DOIUrl":"10.3389/ti.2025.14312","url":null,"abstract":"<p><p>Intravenous immunoglobulins (IVIG) are commonly used in peri-transplant desensitization, but evidence supporting their efficacy is limited. We conducted a prospective, randomized single-center, open-label, Phase IIIb non-inferiority clinical pilot trial to compare the efficacy of IVIG (administered at a dose of 3 × 0.5 g/kg) versus no IVIG, in conjunction with rabbit anti-thymocyte globulin (5-7 mg/kg) induction, in pre-sensitized patients with donor-specific antibodies who had negative pre-transplantation Flow- and CDC-crossmatches, between July 2020 and November 2022. The primary endpoint was the rate of efficacy failure, defined as biopsy-proven rejection within 12-month post-transplant. Secondary endpoints included the incidence of rejection at protocol biopsies, evaluated by histology and biopsy-based transcripts diagnostics. Of the screened patients, 53 (72.6%) were excluded due to crossmatch positivity. Ten patients were randomized to the IVIG+, and 7 to the IVIG-arm. The trial was prematurely terminated due to futility at interim analysis. In the IVIG-arm, 3 patients (43%) experienced the primary endpoint compared to none in the IVIG+ arm (p = 0.026). MMDx identified one molecular ABMR in the IVIG+ and 2 in the IVIG-arm in 12-month protocol biopsies. There was one graft loss in the IVIG-arm. The results of this pilot study, although not definitive, do not support the use of IVIG-sparing regimens in HLA-incompatible kidney transplantation (NCT04302805). This study is registered on ClinicalTrials.gov under the identifier NCT04302805.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14312"},"PeriodicalIF":2.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209636","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":"Clinical and Economic Burden Associated With Anti-Cytomegalovirus (CMV) Prophylaxis Therapies in Adult Kidney Transplant Recipients (LECOCYT): An Observational Study.","authors":"Nassim Kamar, Hannah Kaminski, Christophe Masset, Claire Castagné, Guilhem Tournaire, Xavier Bourge, Lionel Bensimon, Moustafa Naja, Stéphanie Degroote, Isabelle Durand-Zaleski, Christophe Legendre","doi":"10.3389/ti.2025.14342","DOIUrl":"10.3389/ti.2025.14342","url":null,"abstract":"<p><p>The incidence of leukopenia and neutropenia associated with cytomegalovirus (CMV) prophylaxis in kidney transplant (KT) recipients is not well established. LECOCYT, a prospective observational multicenter study, aimed to investigate the clinical and economic burdens of CMV prophylaxis during the first 6 months post-transplantation. Grade 3 or 4 leukopenia or neutropenia was assessed in CMV-seropositive donors/CMV-seronegative recipients (D+/R-) who received current anti-CMV prophylaxis, and in CMV-seronegative donors/CMV-seronegative recipients (D-/R-) who did not. The economic burden in D+/R- was also evaluated. The adjusted odds ratio for grade 3 or 4 leukopenia or neutropenia was 5.16 [95% confidence interval: 1.97-13.53] for D+/R- group. The median costs, excluding the KT procedure, for D+/R- subgroup patients who experienced at least one episode of severe leukopenia or neutropenia were approximately €4,500 (Q1 = €561; Q3 = €10,000). D+/R- patients with no episode incurred significantly lower costs, with a median of nearly €2,100 (Q1 = €182; Q3 = €6,500) (p = 0.02). D+/R- patients with severe leukopenia or neutropenia had a higher rate of outpatient consultations than those without episode (73.9% vs. 57.6%, p = 0.002), and a higher average number of consultations per patient (5.5 ± 4.1 vs. 4.5 ± 3.3, p = 0.042) than D+/R- patients without. Anti-CMV prophylaxis in D+/R- transplant recipients was significantly associated with a higher rate of severe leukopenia or neutropenia compared to no prophylaxis in D-/R- recipients.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14342"},"PeriodicalIF":2.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209637","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}