Transplant InternationalPub Date : 2025-08-13eCollection Date: 2025-01-01DOI: 10.3389/ti.2025.14304
Young Jin Yoo, Deok-Gie Kim, Eun-Ki Min, Seung Hyuk Yim, Mun Chae Choi, Hwa-Hee Koh, Minyu Kang, Jae Geun Lee, Myoung Soo Kim, Dong Jin Joo
{"title":"Number of Pretransplant Therapeutic Plasma Exchange Sessions Increase the Recurrence Risk of Hepatocellular Carcinoma in ABO-Incompatible Living Donor Liver Transplantation.","authors":"Young Jin Yoo, Deok-Gie Kim, Eun-Ki Min, Seung Hyuk Yim, Mun Chae Choi, Hwa-Hee Koh, Minyu Kang, Jae Geun Lee, Myoung Soo Kim, Dong Jin Joo","doi":"10.3389/ti.2025.14304","DOIUrl":"10.3389/ti.2025.14304","url":null,"abstract":"<p><p>Previous studies have reported comparable oncologic outcome between ABO-incompatible (ABOi) living donor liver transplantation (LDLT) and ABO-compatible (ABOc) LDLT in patients with hepatocellular carcinoma (HCC). We aimed to analyze the relationship between number of therapeutic plasma exchanges (TPE) before LDLT and HCC outcomes in ABOi LDLT. In this single-center retrospective study, 428 adult LDLT recipients with HCC were categorized into three groups according to ABO incompatibility and the number of pretransplant TPE: ABOc (n = 323), ABOi/TPE ≤5 (n = 75), and ABOi/TPE ≥6 (n = 30). The RFS and HCC recurrence rates were compared. Three groups showed similar characteristics in most demographics, pretransplant tumor markers and pathologies. The median initial isoagglutinin (IA) titer was 1:64 (range negative-1:512) in ABOi/TPE ≤5 group and 1:512 (range 1:128-1:4,096) in ABOi/TPE ≥6 group. Five-year RFS was significantly lower (75.7% vs. 72.7% vs. 50.0%, P = 0.005) and HCC recurrence was significantly higher in the ABOi/TPE ≥6 group than in the other groups(16.4% vs. 17.0% vs. 39.4%, P = 0.014). In multivariable Cox regression analysis, ABOi/TPE ≥6 was an independent risk factor for RFS (aHR 1.99, 95% CI:1.02-3.86, P = 0.042) and HCC recurrence (aHR 2.42, 95% CI:1.05-5.57, P = 0.037). More than six pretransplant TPE sessions may increase the risk of HCC recurrence after ABOi LDLT. Reducing TPE sessions to fewer than six should be considered while maintaining immunological stability through IA titer control.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14304"},"PeriodicalIF":3.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970844","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>Ex-Vivo</i> Heart Perfusion Machines in DCD Heart Transplantation Model: The State of Art.","authors":"Chiara Tessari, Giovanni Lucertini, Mariangela Addonizio, Veronica Geatti, Daniela Bacich, Nicola Pradegan, Assunta Fabozzo, Roberto Bianco, Giuseppe Toscano, Vincenzo Tarzia, Gino Gerosa","doi":"10.3389/ti.2025.12987","DOIUrl":"https://doi.org/10.3389/ti.2025.12987","url":null,"abstract":"<p><p>The Donation-after-Circulatory-Death (DCD) heart transplantation program increases donor pool but resulting in more serious ischemic-related myocardial injury (IRI), leading to higher incidence of primary graft dysfunction (PGD). <i>Ex-vivo</i> machine perfusion (EVMP) for DCD heart is being considered a useful aid in improving grafts number and quality assessment, aiming to better outcomes. In this review we will analyze the role of EVMP techniques in the context of DCD with special attention to their clinical aims and results and future perspectives. A review of available clinical and pre-clinical studies involving EVMP with DCD donation model was performed. Thirty-four original articles about preclinical studies were found. First studies were designed to evaluate graft function in DCD hearts after EVMP, while recent research focus on possible therapies that could be associated with EVMP. Twenty-one original articles about clinical studies were found with the Organ-Care-System (TransMedics) as MP used. Outcomes, such as survival rates or rejection episodes, are comparable to outcomes from donation-after-brain-death. EVMP in the setting of DCD heart transplantation can be a valid tool for organ preservation and transport. The role of pre-clinical research will be crucial to reduce IRI, achieve organ reconditioning and reduce incidence of PGD.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"12987"},"PeriodicalIF":3.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970711","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}
Transplant InternationalPub Date : 2025-08-13eCollection Date: 2025-01-01DOI: 10.3389/ti.2025.14237
Carole Eldin, Paolo Antonio Grossi, Victoria Manda, Nassim Kamar, Olivier Lortholary, Hans H Hirsch, Jean-Ralph Zahar, Vincent Michel Borderie, François Parquin, Eric Epailly, Florence Ader, Emmanuel Morelon, Edouard Forcade, David Lebeaux, Jérôme Dumortier, Filomena Conti, Agnes Lefort, Anne Scemla, Hannah Kaminski
{"title":"Updates on Donor-Derived Infection in Solid Organ Transplantation, Report from the 2024 GTI (Infection and Transplantation Group) Annual Meeting.","authors":"Carole Eldin, Paolo Antonio Grossi, Victoria Manda, Nassim Kamar, Olivier Lortholary, Hans H Hirsch, Jean-Ralph Zahar, Vincent Michel Borderie, François Parquin, Eric Epailly, Florence Ader, Emmanuel Morelon, Edouard Forcade, David Lebeaux, Jérôme Dumortier, Filomena Conti, Agnes Lefort, Anne Scemla, Hannah Kaminski","doi":"10.3389/ti.2025.14237","DOIUrl":"https://doi.org/10.3389/ti.2025.14237","url":null,"abstract":"<p><p>The annual meeting of the French GTI (Transplantation and Infection Group) focused on donor-derived infections (DDIs) in solid organ transplant (SOT) recipients. Given the ongoing organ shortage, rigorous donor screening is essential to detect potential infectious risks. Donor evaluation should include medical history, travel, vaccination status, serologies, and exposures. Various pathogens are of concern, including viruses (HIV, hepatitis, BK polyomavirus), multidrug-resistant bacteria, fungi, and emerging arboviruses like West Nile virus and dengue. HIV-positive donor to HIV-positive recipient (D+/R+) transplantations are increasingly accepted, with promising outcomes. Hepatitis E (HEV) is now the most common viral hepatitis and may lead to chronic infection in SOT recipients, requiring ribavirin treatment. Non-Candida fungal infections, though rare, are associated with high mortality and demand early recognition. Climate change and globalization are expanding the range of vector-borne infections, necessitating seasonal and regional screening. BK polyomavirus remains a major complication in kidney transplant recipients, and monitoring viral load is critical. Bacterial infections from donors are uncommon but should be evaluated based on site, organism, resistance profile, and treatment history. Overall, maintaining safety in transplantation requires constant vigilance, updated knowledge, and personalized risk-benefit analysis to adapt to emerging infectious threats-especially amid ongoing organ scarcity.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14237"},"PeriodicalIF":3.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970839","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}
Transplant InternationalPub Date : 2025-08-11eCollection Date: 2025-01-01DOI: 10.3389/ti.2025.14534
Yuriko Terada, Tsuyoshi Takahashi, Michael K Pasque, Hrishikesh S Kulkarni, Rodrigo Vazquez-Guillamet, Derek E Byers, Chad A Witt, Ruben G Nava, Benjamin D Kozower, Bryan F Meyers, G Alexander Patterson, Daniel Kreisel, Varun Puri, Ramsey R Hachem
{"title":"Impact of Era on Acute Cellular Rejection After Lung Transplantation.","authors":"Yuriko Terada, Tsuyoshi Takahashi, Michael K Pasque, Hrishikesh S Kulkarni, Rodrigo Vazquez-Guillamet, Derek E Byers, Chad A Witt, Ruben G Nava, Benjamin D Kozower, Bryan F Meyers, G Alexander Patterson, Daniel Kreisel, Varun Puri, Ramsey R Hachem","doi":"10.3389/ti.2025.14534","DOIUrl":"https://doi.org/10.3389/ti.2025.14534","url":null,"abstract":"","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14534"},"PeriodicalIF":3.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970686","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}
Transplant InternationalPub Date : 2025-08-07eCollection Date: 2025-01-01DOI: 10.3389/ti.2025.14463
Franziska Schmidt, Murielle Verboom, Michael Hallensleben, Alexander Braumann, Jens Drube, Lena Brunkhorst, Dieter Haffner, Anette Melk, Nele Kanzelmeyer
{"title":"Development of Non-HLA Antibodies and Their Association With Antibody-Mediated Rejection in Pediatric Kidney Transplant Recipients.","authors":"Franziska Schmidt, Murielle Verboom, Michael Hallensleben, Alexander Braumann, Jens Drube, Lena Brunkhorst, Dieter Haffner, Anette Melk, Nele Kanzelmeyer","doi":"10.3389/ti.2025.14463","DOIUrl":"https://doi.org/10.3389/ti.2025.14463","url":null,"abstract":"<p><p>Antibody-mediated rejection (ABMR) is the leading cause of long-term graft loss in pediatric kidney transplantation (KTx). While donor-specific HLA antibodies are established contributors, emerging evidence suggests a role for non-HLA antibodies in ABMR pathogenesis. In this descriptive study, we analyzed 60 non-HLA antibodies in 77 pediatric KTx recipients using serum samples collected pre-transplant, post-transplant, and at ABMR diagnosis. During a median follow-up of 4.83 years, 29.8% developed ABMR, with a median onset of 3.67 years. Non-HLA antibody presence prior to KTx was not influenced by pre-transplant dialysis; over half of the patients already had >15 positive non-HLA antibodies. The cumulative antibody profile remained stable 1-2 years post-KTx, with no association between late ABMR and antibody strength or breadth. However, ACTIN (higher risk) and CGB5 (lower risk) at 1-2 years post-KTx, as well as SNRPB2 pre-transplant, were significantly associated with ABMR (p < 0.05). IL-21 levels increased in controls over time (p < 0.05), although driven by five patients with notably high levels. Our findings support a potential involvement of non-HLA antibodies in pediatric ABMR. Nevertheless, larger studies are needed to validate the predictive value of individual non-HLA antibodies for clinical application.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14463"},"PeriodicalIF":3.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12369655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970660","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}
Transplant InternationalPub Date : 2025-08-07eCollection Date: 2025-01-01DOI: 10.3389/ti.2025.14452
D K C Cooper, L Mou, J D Cleveland, J H Simmons, D C Cleveland
{"title":"Xenotransplantation Research -the Nonhuman Primate Model Is Preferable to the Human Decedent Model.","authors":"D K C Cooper, L Mou, J D Cleveland, J H Simmons, D C Cleveland","doi":"10.3389/ti.2025.14452","DOIUrl":"https://doi.org/10.3389/ti.2025.14452","url":null,"abstract":"<p><p>Over the past 40 years, the pig-to-nonhuman primate organ transplantation model has enabled progress in xenotransplantation to be made to the point that we are now carrying out initial US FDA-approved clinical experiments on \"compassionate\" grounds. More recently, the pig-to-human brain-dead decedent model was introduced with claims that this might replace (or at least augment) the pig-to-NHP model. There are, however, several limitations of the decedent model, most notably the very limited period during which the subject may remain sufficiently metabolically and hemodynamically stable to allow meaningful monitoring of the fate of a pig organ graft. It will be exceedingly difficult to provide the regulatory authorities with data from experiments in which truly prolonged graft function has been monitored, whereas this is already being achieved in the pig-to-NHP model. In view of the complications related to the effects of brain death, the data obtained from xenotransplantation experiments in decedents may provide confusing results. There is a real risk that this may influence the regulatory authorities to become overly cautious in approving formal clinical trials of pig organ xenotransplantation to be initiated. We conclude that experiments in human decedents will be unable to replace studies in pig-to-NHP models.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14452"},"PeriodicalIF":3.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970829","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}
Transplant InternationalPub Date : 2025-08-06eCollection Date: 2025-01-01DOI: 10.3389/ti.2025.14940
Georgios Kourounis, Samuel J Tingle, Angeles Maillo-Nieto, Caroline Wroe, Emily R Thompson, Ruth Owen, Leonie van Leeuwen, Matthew Holzner, Vikram Wadhera, Mohammed Zeeshan Akhtar, Sander Florman, James Shaw, Steve White, Colin Wilson
{"title":"One-Year HbA1c Predicts Long-Term Pancreas Graft Survival Following SPK Transplantation: A US Population Cohort Study.","authors":"Georgios Kourounis, Samuel J Tingle, Angeles Maillo-Nieto, Caroline Wroe, Emily R Thompson, Ruth Owen, Leonie van Leeuwen, Matthew Holzner, Vikram Wadhera, Mohammed Zeeshan Akhtar, Sander Florman, James Shaw, Steve White, Colin Wilson","doi":"10.3389/ti.2025.14940","DOIUrl":"https://doi.org/10.3389/ti.2025.14940","url":null,"abstract":"<p><p>Understanding which factors shape long-term pancreas graft outcomes after the critical first year post-transplantation is an ongoing challenge. This study assesses one-year HbA1c as a predictor of subsequent pancreas graft survival. A retrospective cohort study was conducted using the UNOS registry on all simultaneous pancreas-kidney (SPK) transplants between 2017 and 2023. Regression models with multiple imputations for missing data were used to evaluate predictors of long-term function. Non-linear relationships were modelled with restricted cubic splines (RCS). Among 2,917 SPK recipients (median follow-up 44 months, IQR: 25-60), one-year HbA1c was the strongest independent predictor of long-term graft survival. An HbA1c of 6.8% versus 4.4% (95th vs. 5th percentile) was associated with significantly worse graft survival (aHR = 2.48, 95% CI: 1.72-3.58). Simulated trial sample size calculations found that detecting a statistically and clinically significant reduction in one-year HbA1c from 7% to 6.5% would require 65 patients per group, whereas detecting a reduction in one-year graft loss from 12% to 9% would require 1,631 patients per group. HbA1c at 1 year is a robust, continuous marker of long-term graft function and may serve as a feasible, objective surrogate endpoint in future clinical trials, enabling smaller, more efficient study designs to evaluate interventions.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14940"},"PeriodicalIF":3.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970780","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}
Transplant InternationalPub Date : 2025-08-06eCollection Date: 2025-01-01DOI: 10.3389/ti.2025.14424
Covadonga López Del Moral, David San Segundo, María José Ortega, Miguel Martínez-Belotto, Rosalía Valero, Lara Belmar, María de la Oliva Valentín, Emilio Rodrigo, Marcos López-Hoyos, Juan Carlos Ruiz
{"title":"Early Donor-Specific HLA Antibodies Detected by Screening in the First Month Posttransplant and Kidney Graft Outcomes.","authors":"Covadonga López Del Moral, David San Segundo, María José Ortega, Miguel Martínez-Belotto, Rosalía Valero, Lara Belmar, María de la Oliva Valentín, Emilio Rodrigo, Marcos López-Hoyos, Juan Carlos Ruiz","doi":"10.3389/ti.2025.14424","DOIUrl":"https://doi.org/10.3389/ti.2025.14424","url":null,"abstract":"<p><p>Donor-specific HLA antibodies (DSA) are related to antibody-mediated rejection (ABMR) and graft failure. The rationale and frequency of screening for anti-HLA antibodies in stable patients are not established. The aim of our study is to evaluate the impact of early DSA appearance in the first month post-transplant on graft outcomes. All kidney transplant recipients between 1/1/2012-12/31/2022 with anti-HLA antibody screening by Luminex during the first month post-transplant were included. Patients with preformed or historical DSA and those with DSA detection after graft loss were excluded. The mean fluorescence intensity cut-off was 1,500. Three hundred fifty-three patients were included and the median time from transplant to first antibody sample was 30.0 days. During 3.8 years of follow-up, graft loss occurred in 9.1% and 19.5% had ABMR. A total of 8.5% developed early-DSA in the first month. Patients with early-DSA detection had more HLA sensitization at the time of transplant (p < 0.001). Multivariable analysis showed that the presence of early-DSA was an independent risk factor for ABMR. In conclusion, sensitized patients at the time of transplant have a higher risk of DSA formation in the first month, probably reflecting alloimmune memory, therefore early HLA antibody screening should be performed in this high-risk population.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14424"},"PeriodicalIF":3.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970691","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":"Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025?","authors":"Sébastien L'Hermite, Valentin Coirier, Florent Artru","doi":"10.3389/ti.2025.14752","DOIUrl":"https://doi.org/10.3389/ti.2025.14752","url":null,"abstract":"<p><p>Acute-on-chronic liver failure (ACLF) is a critical condition that arises in the context of advanced liver disease, marked by rapid liver function deterioration and associated multi-organ failure. This syndrome is associated with a major short-term mortality risk, requiring aggressive and specialized clinical care. Despite ongoing efforts, effective therapeutic options for ACLF are lacking, with liver transplantation (LT) considered the only life-saving intervention, yielding acceptable outcomes in carefully selected patients. However, the place of LT for ACLF remains a matter of debate, given the high prevalence of the syndrome, the sickness of liver transplant candidates, the persistent shortage of available liver grafts, and the increasing number of indications to LT. This review aims to provide a comprehensive analysis of the role of LT in ACLF, evaluating current evidence on patient selection, optimal timing for transplantation, and ongoing debates surrounding this practice, specifically the rationale for prioritizing graft allocation for this indication. Furthermore, we will explore global management strategies for ACLF, focusing on bridging patients to LT and improving survival outcomes. Through this review, we seek to enhance understanding of the evolving role of LT in ACLF and offer insights into future directions for clinical practice and research in this critical area.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"38 ","pages":"14752"},"PeriodicalIF":3.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970764","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}