Transplant International最新文献_第3页

Abatacept as maintenance therapy in kidney transplantation: a retrospective comparative study. 阿巴接受作为肾移植维持治疗的回顾性比较研究。

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-14 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.16366

Charlotte Uro-Coste, Inès Ramos, Aurélien Tiple, Marine Freist, Claire Chatron, Alba Atenza, Jimmy Garraud, Clarisse Grèze, Carole Philipponnet, Paul Rouzaire, Anne-Elisabeth Heng, Cyril Garrouste

{"title":"Abatacept as maintenance therapy in kidney transplantation: a retrospective comparative study.","authors":"Charlotte Uro-Coste, Inès Ramos, Aurélien Tiple, Marine Freist, Claire Chatron, Alba Atenza, Jimmy Garraud, Clarisse Grèze, Carole Philipponnet, Paul Rouzaire, Anne-Elisabeth Heng, Cyril Garrouste","doi":"10.3389/ti.2026.16366","DOIUrl":"10.3389/ti.2026.16366","url":null,"abstract":"Belatacept use is increasinging in kidney transplantation, as it has demonstrated improved graft survival compared with calcineurin inhibitors. However, its intravenous administration and recurrent supply shortages may limit its use. Abatacept has a similar mechanism of action. Although widely used in rheumatology, its use in kidney transplantation remains poorly documented. This study aimed to compare the efficacy and safety of abatacept and belatacept as maintenance immunosuppressive therapy after kidney transplantation. We conducted a retrospective study including adult kidney transplant recipients who were switched to abatacept or belatacept between 2017 and 2023. The primary endpoint was the occurrence of rejection within the first year after conversion. A total of 74 patients were included: 21 in the abatacept group and 53 in the belatacept group. No significant difference was observed in rejection rates at 1 year (respectivily 9.5% vs. 9.4%; p > 0.999). Rates of viral and opportunistic infections were also comparable. These findings, which warrant confirmation in larger studies, suggest that abatacept is associated with acceptable safety outcomes relative to belatacept. Abatacept may thererefore be considered a potential alternative in selected situations, including drug shortage, limited venous access, pregnancy or the need for greater treatment autonomy.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16366"},"PeriodicalIF":3.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075358","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}

引用次数: 0

Organ donation after euthanasia starting at home: a mixed-methods study of preliminary nationwide Dutch experiences. 在家中开始安乐死后的器官捐献：荷兰初步经验的混合方法研究。

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-14 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.16452

Isabelle Manders, Nathalie van Dijk, Johan Sonneveld, Wim de Jongh, Jan Bollen, Nichon E Jansen, Walther van Mook

{"title":"Organ donation after euthanasia starting at home: a mixed-methods study of preliminary nationwide Dutch experiences.","authors":"Isabelle Manders, Nathalie van Dijk, Johan Sonneveld, Wim de Jongh, Jan Bollen, Nichon E Jansen, Walther van Mook","doi":"10.3389/ti.2026.16452","DOIUrl":"10.3389/ti.2026.16452","url":null,"abstract":"Organ Donation after Euthanasia starting at Home (ODEH) initiates the euthanasia trajectory at home with deep sedation, followed by transfer to the hospital for completion of euthanasia and organ procurement. We evaluated all eight Dutch ODEH procedures up to February 2024 using a mixed-methods design: descriptive analysis of anonymized case data (Dutch Transplant Foundation and hospital records) and semi-structured interviews (November 2023-February 2024) with involved professionals. All procedures were performed in three hospitals. Patients had neurodegenerative disease (n = 6) or psychiatric disorders (n = 2) and were aged from the mid-30s to the early-70s (mean 50.4 years). Professionals highlighted strict separation of euthanasia and donation decisions, time-critical coordination between home and hospital, variation in sedation/anesthesia and transport modality (regular ambulance vs. mobile ICU), regional constraints in staffing and infrastructure, emotional impact on professionals, and registry/coding considerations (including HSMR). ODEH is feasible within the existing Dutch legal framework and is valued for enabling a home farewell without compromising donation. A flexible practice manual defining core safeguards and decision points may support consistent implementation.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16452"},"PeriodicalIF":3.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075633","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}

引用次数: 0

Multi-site cytokine levels are predictive of primary graft dysfunction following lung transplantation. 多位点细胞因子水平可预测肺移植术后原发性移植物功能障碍。

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-14 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.15874

Dianna Nord, Jason Cory Brunson, Logan Langerude, Hassan Moussa, Blake Gill, Mindaugas Rackauskas, Ashish Sharma, Christine Lin, Amir Emtiazjoo, Carl Atkinson

{"title":"Multi-site cytokine levels are predictive of primary graft dysfunction following lung transplantation.","authors":"Dianna Nord, Jason Cory Brunson, Logan Langerude, Hassan Moussa, Blake Gill, Mindaugas Rackauskas, Ashish Sharma, Christine Lin, Amir Emtiazjoo, Carl Atkinson","doi":"10.3389/ti.2026.15874","DOIUrl":"10.3389/ti.2026.15874","url":null,"abstract":"There is an urgent need to better understand the pathophysiology of primary graft dysfunction (PGD) to develop point-of-care methods predicting those at risk. We utilized a multiplex multivariable approach to define cytokines, chemokines, and growth factors in patient-matched biospecimens to identify factors predictive of PGD. Biospecimens were collected from patients undergoing bilateral lung transplantation (LTx) from three sites: donor lung perfusate, post-transplant bronchoalveolar lavage (BAL) fluid (2h), and plasma (2h, 24h, 72h, and 1 and 2 wks). A 71-multiplex panel was performed on each. Cross-validated logistic regression (LR) and random forest (RF) models determined whether analytes from each site, alone or combined with clinical data, discriminated PGD grade 0 (n = 9) vs. 3 (n = 8). BAL fluid at 2h was most predictive of PGD (LR, 0.825; RF, 0.919), followed by multi-timepoint plasma (LR, 0.841; RF, 0.653), then perfusate (LR, 0.565; RF, 0.448). Combined clinical, BAL, and plasma data yielded the strongest performance (LR, 1.000; RF, 1.000). BAL collected 2h post-transplant showed the strongest discriminatory signal for severe PGD in this exploratory cohort. This integrative approach identified IL-1RA, BCA-1, and Fractalkine as hypothesis-generating candidate biomarkers that warrant validation in larger independent studies.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"15874"},"PeriodicalIF":3.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075635","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}

引用次数: 0

Whole pediatric liver graft in modified RAPID transplantation for unresectable colorectal liver metastases. 改良快速移植治疗无法切除的结直肠肝转移的儿童全肝移植。

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-10 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.17124

Roberto Luca Meniconi, Nicola Guglielmo, Maria Lanzone, Francesca Mazzarotto, Marco Colasanti, Giammauro Berardi, Marco Angrisani, Germano Mariano, Davide Chiappori, Eleonora Garofalo, Giuseppe Maria Ettorre

{"title":"Whole pediatric liver graft in modified RAPID transplantation for unresectable colorectal liver metastases.","authors":"Roberto Luca Meniconi, Nicola Guglielmo, Maria Lanzone, Francesca Mazzarotto, Marco Colasanti, Giammauro Berardi, Marco Angrisani, Germano Mariano, Davide Chiappori, Eleonora Garofalo, Giuseppe Maria Ettorre","doi":"10.3389/ti.2026.17124","DOIUrl":"10.3389/ti.2026.17124","url":null,"abstract":"Liver transplantation has re-emerged as a therapeutic option for unresectable colorectal liver metastases (CRLM), but organ shortage and allocation concerns remain major limitations. The RAPID procedure combines auxiliary liver transplantation with delayed total hepatectomy, allowing small-graft use while the native liver provides temporary metabolic support. We report a modified RAPID transplantation, interpreted as a RAPID-derived staged auxiliary orthotopic liver transplantation (AOLT) strategy, using a whole pediatric graft in a 68-year-old woman with liver-only CRLM and sustained response to chemotherapy. The graft, from a 2-year-old donor (280 g; GRWR 0.4), had been declined by all pediatric centers due to non-standard infectious risk and was authorized by the Italian National Transplant Center within a regulated pathway. Favorable arterial anatomy preserved native right liver perfusion, while portal inflow management combined intentional surgical narrowing of the right portal vein with delayed portal vein embolization (PVE). At pre-PVE CT, graft volume was 350 cc (estimated GRWR 0.5); after PVE, it reached 580 cc (estimated GRWR 0.8), enabling completion hepatectomy at four weeks. At eight months, the patient had normal liver function and no recurrence. To our knowledge, this is the first reported use of a whole pediatric liver graft in modified RAPID transplantation.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"17124"},"PeriodicalIF":3.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040744","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}

引用次数: 0

Donor-derived viral infections: the usual suspects and the new kids on the block. 供体来源的病毒感染：通常的嫌疑人和新出现的孩子。

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-10 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.17050

Maddalena Peghin, Paolo Antonio Grossi

{"title":"Donor-derived viral infections: the usual suspects and the new kids on the block.","authors":"Maddalena Peghin, Paolo Antonio Grossi","doi":"10.3389/ti.2026.17050","DOIUrl":"10.3389/ti.2026.17050","url":null,"abstract":"The expansion of the transplant donor pool, driven by the need to reduce the disparity between supply and demand, carries the risk of use of marginal donors with viral infections, including classic viruses and emerging threats. This narrative review analyzes these challenges, including new opportunities in managing well known viruses such as Hepatitis B, Hepatitis C and Human Immunodeficiency Virus in both donors and recipients, thanks to new effective antivirals. Furthermore, we highlight the importance of monitoring emerging viral pathogens, such as Hepatitis E and Human Herpesvirus 8 (HHV-8) implementing both targeted pre-transplant donor screening and timely post-transplant diagnosis in the recipient, enabling earlier therapeutic intervention and potentially reducing recipient morbidity and mortality. Moreover, respiratory viral infections have gained significant attention as potential causes of donor derived infection (DDI) transmitted to the recipient, particularly within specific widespread and seasonal contexts, and require further attention and investigation. Continuous updates to surveillance and screening protocols are essential to optimize outcomes of recipients, ensuring transplant safety.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"17050"},"PeriodicalIF":3.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040749","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}

引用次数: 0

Locus-specific HLA matching and induction therapy in simultaneous pancreas-kidney transplantation: a national UK cohort study. 同时胰肾移植的基因座特异性HLA匹配和诱导治疗：一项英国国家队列研究。

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-09 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.16427

Abdullah K Malik, Jenni Banks, Claire Counter, Lewis Simmonds, Samuel J Tingle, Sanjay Sinha, Anand Muthasamy, Andrew Sutherland, John Casey, Martin Drage, David van Dellen, Chris J Callaghan, Doruk Elker, Derek M Manas, Gavin J Pettigrew, Neil Russell, Neil S Sheerin, Colin H Wilson, Steven A White

{"title":"Locus-specific HLA matching and induction therapy in simultaneous pancreas-kidney transplantation: a national UK cohort study.","authors":"Abdullah K Malik, Jenni Banks, Claire Counter, Lewis Simmonds, Samuel J Tingle, Sanjay Sinha, Anand Muthasamy, Andrew Sutherland, John Casey, Martin Drage, David van Dellen, Chris J Callaghan, Doruk Elker, Derek M Manas, Gavin J Pettigrew, Neil Russell, Neil S Sheerin, Colin H Wilson, Steven A White","doi":"10.3389/ti.2026.16427","DOIUrl":"10.3389/ti.2026.16427","url":null,"abstract":"The impact of HLA mismatch and induction therapy in simultaneous pancreas-kidney transplantation on outcomes remains incompletely defined. We conducted a retrospective cohort study of 1705 SPK recipients transplanted in the UK between 2007 and 2019. Using national transplant registry data, we analysed the impact of locus-specific HLA mismatch and induction therapy (Alemtuzumab vs. Basiliximab) on pancreas graft survival primarily. Kidney graft and patient survival were also analysed as secondary outcomes. Multivariable Cox proportional hazards models were adjusted for donor, recipient, and transplant variables. Pancreas graft survival at 1- and 10-year post-transplant was estimated to be 88.6% and 72.7%, respectively. Kidney graft and patient survival at 10 years were 76.7% and 75.3%. In adjusted analyses, donor age, cold ischaemic time, and HLA-DQ mismatch were significantly associated with pancreas graft loss. No significant survival difference was seen between Alemtuzumab and Basiliximab induction therapy. Induction therapy and HLA-mismatch status were not associated with pancreas graft outcome in this large registry study.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16427"},"PeriodicalIF":3.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040805","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}

引用次数: 0

Modeling the cost-effectiveness of introducing donation after controlled circulatory death for heart transplantation in France. 模拟在法国心脏移植中引入受控循环死亡后捐献的成本效益。

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-09 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.17149

Jamal Atfeh, Pascale Guerre, Julien Guihaire, Laurent Sebbag, Matteo Pozzi, Laure Huot

{"title":"Modeling the cost-effectiveness of introducing donation after controlled circulatory death for heart transplantation in France.","authors":"Jamal Atfeh, Pascale Guerre, Julien Guihaire, Laurent Sebbag, Matteo Pozzi, Laure Huot","doi":"10.3389/ti.2026.17149","DOIUrl":"10.3389/ti.2026.17149","url":null,"abstract":"Heart transplantation following donation after controlled circulatory death (DCD) could alleviate the global shortage of organs. We assessed the cost-effectiveness of this strategy and outlined the factors enabling an efficient DCD heart program. Two strategies were compared: donation after brain death (DBD) using static cold storage vs. DBD + DCD transplantation, where DCD hearts are preserved with a normothermic ex situ perfusion system. Costs (€; 2024 value) and outcomes (quality-adjusted life years (QALYs)) were modelled through a 15-year time horizon. Our main assumption was that DCD would increase transplant access without affecting waitlist mortality, with equivalent post-transplant outcomes. With a 20% annual increase in transplant activity, the DBD + DCD strategy resulted in a mean incremental gain of 0.14 QALYs at an additional cost of €20,618 compared with DBD alone. The incremental cost-effectiveness ratio was €146,373 per QALY gained. An 8% relative reduction in waitlist mortality (i.e., four additional lives saved annually among 500 new waitlisted patients) would make the DCD heart program cost-effective at €100,000 per QALY. Lower consumable costs would further improve cost-effectiveness. Decision-makers should consider these findings in light of the disease severity and the persistent shortage of heart donors that could be alleviated with DCD.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"17149"},"PeriodicalIF":3.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031358","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}

引用次数: 0

Post-transplant acute pancreatitis after pancreas transplantation: application of the International Study Group for Pancreatic Surgery definition and clinical impact in a multicenter cohort study. 胰腺移植后急性胰腺炎：国际胰腺外科研究小组定义的应用和多中心队列研究的临床影响

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-08 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.16849

Stefano Partelli, Valentina Andreasi, Matteo Santangelo, Oriana Ciacio, Rossana Caldara, Arianna Bertuol, Valentina Tomajer, Davide Catarinella, Alessandra Ida, Caterina Di Bella, Gabriella Pittau, Chady Salloum, Gioia Sgrinzato, Paolo Rigotti, Lorenzo Piemonti, Antonio Sa Cunha, Lucrezia Furian, Massimo Falconi

{"title":"Post-transplant acute pancreatitis after pancreas transplantation: application of the International Study Group for Pancreatic Surgery definition and clinical impact in a multicenter cohort study.","authors":"Stefano Partelli, Valentina Andreasi, Matteo Santangelo, Oriana Ciacio, Rossana Caldara, Arianna Bertuol, Valentina Tomajer, Davide Catarinella, Alessandra Ida, Caterina Di Bella, Gabriella Pittau, Chady Salloum, Gioia Sgrinzato, Paolo Rigotti, Lorenzo Piemonti, Antonio Sa Cunha, Lucrezia Furian, Massimo Falconi","doi":"10.3389/ti.2026.16849","DOIUrl":"10.3389/ti.2026.16849","url":null,"abstract":"Graft pancreatitis is a clinically relevant but poorly standardized complication after pancreas transplantation (PT). In contrast, post-pancreatectomy acute pancreatitis has been formally defined and validated by the International Study Group for Pancreatic Surgery (ISGPS). This study assessed the clinical applicability of an adapted ISGPS-based framework to define post-transplant acute pancreatitis (PTAP) after PT and its association with clinically relevant outcomes. Consecutive patients undergoing PT at three European centers between 2010 and 2024 were included. PTAP was defined by sustained postoperative hyperamylasemia (POH) for ≥48 h combined with CT findings consistent with pancreatitis within 30 days after transplantation. Imaging was performed in 89% of patients based on clinical indication and center-specific protocols. Among 432 patients, the adapted definition was applicable in 416. Sustained POH occurred in 196 patients (47%), and PTAP was diagnosed in 86 (21%). PTAP was the only independent predictor of severe postoperative complications (OR, 2.482; P = 0.001), was independently associated with prolonged hospital stay (OR, 3.817; P < 0.001), and with worse death-censored graft survival (P < 0.001). Cold ischemia time was the only independent determinant of PTAP (P < 0.001). PTAP was a frequent and clinically meaningful complication after PT, occurring in approximately one in five patients and associated with worse short- and long-term outcomes.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16849"},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026037","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}

引用次数: 0

The perfused liver utilisation study (PLUS): challenges and innovation in the evaluation of an emerging technology. 灌注肝利用研究（PLUS）：新兴技术评估中的挑战和创新。

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-08 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.16653

Simon Robert Knight, Helen L Thomas, Rosemary Brown, Charlie Brown, Kerrie Brusby, Emily Arbon, Laura Silsby, Alice Newton, Jennifer Mehew, Aleema Iqbal, Katie Keen, Syeda Bahar, Christopher Watson, Brian Davidson, David Nasralla, Carlo Ceresa, Barbara Fiore, Ahmed E Sherif, Colin Wilson, Balaji Mahendran, Joerg-Matthias Pollok, Rebeca S Mateos, Wayel Jassem, Rohit Gaurav, Gabriel C Oniscu, Craig Marshall, Angus Hann, Reena Ravikumar, Constantin Coussios, Peter J Friend

{"title":"The perfused liver utilisation study (PLUS): challenges and innovation in the evaluation of an emerging technology.","authors":"Simon Robert Knight, Helen L Thomas, Rosemary Brown, Charlie Brown, Kerrie Brusby, Emily Arbon, Laura Silsby, Alice Newton, Jennifer Mehew, Aleema Iqbal, Katie Keen, Syeda Bahar, Christopher Watson, Brian Davidson, David Nasralla, Carlo Ceresa, Barbara Fiore, Ahmed E Sherif, Colin Wilson, Balaji Mahendran, Joerg-Matthias Pollok, Rebeca S Mateos, Wayel Jassem, Rohit Gaurav, Gabriel C Oniscu, Craig Marshall, Angus Hann, Reena Ravikumar, Constantin Coussios, Peter J Friend","doi":"10.3389/ti.2026.16653","DOIUrl":"10.3389/ti.2026.16653","url":null,"abstract":"Previous studies suggest that donor liver normothermic machine perfusion (NMP) reduces injury and enables functional assessment, resulting in an increase in utilisation. The PLUS study was designed to assess the impact of NMP availability on utilisation of livers at high risk of non-use. Using a threshold-crossing design, functional utilisation was assessed in a real-world retrospective registry-based control cohort. A predetermined efficacy threshold was set, and a prospective cohort was recruited in all UK liver transplant centres with NMP made available for all livers at high risk of non-utilisation. Availability of NMP resulted in a significant increase in functional utilisation (OR: 1.26, 95% CI: 1.04-1.53), but this did not exceed the pre-determined efficacy threshold. The threshold was exceeded in the subgroup of donation after circulatory death (DCD) livers, although this increase was reduced with adjustment for the use of normothermic regional perfusion. NMP was used in only 31% of retrieved livers, with variation between centres. The benefit of having NMP available was less than anticipated, likely due to low use in some centres associated with staff availability. Provision of NMP as a service, or centralisation of NMP use in assessment and recovery centres, may improve uptake.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16653"},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026045","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}

引用次数: 0

Improved access to kidney transplantation with favorable graft survival in highly sensitized candidates under the French acceptable mismatch program. 在法国可接受的错配方案下，在高度敏感的候选人中改善了获得良好移植物存活的肾移植的途径。

IF 3.6 3区医学

Transplant International Pub Date : 2026-09-08 eCollection Date: 2026-01-01 DOI: 10.3389/ti.2026.16762

Corinne Antoine, Emilie Savoye, Benoit Audry, Camille Legeai, Myriam Pastural, Anne Cesbron, Valerie Dubois, Jean-Luc Taupin

{"title":"Improved access to kidney transplantation with favorable graft survival in highly sensitized candidates under the French acceptable mismatch program.","authors":"Corinne Antoine, Emilie Savoye, Benoit Audry, Camille Legeai, Myriam Pastural, Anne Cesbron, Valerie Dubois, Jean-Luc Taupin","doi":"10.3389/ti.2026.16762","DOIUrl":"10.3389/ti.2026.16762","url":null,"abstract":"The scarcity of the human leukocyte antigen (HLA)-compatible donor pool, which leads to a long waiting time for transplantation, often requires specific national or supranational strategies to improve kidney graft access for highly sensitized (HS) patients. Acceptable national mismatch priority is a way to increase the number of potential matched donors without increasing the immunologic graft failure risk. In 2005, the French Acceptable Mismatch program (AMP) was successfully introduced as a strategy to improve kidney allocation for HS patients. The AMP was enhanced in 2015, authorizing up to four HLA-A, -B, -DR, and -DQβ mismatches, provided that each mismatch was an acceptable antigen. Our study compared graft survival between AMP allocation and other kidney allocation modalities among HS recipients between 2016 and 2022 (N = 2,985). After adjustment for donor and recipient characteristics using Cox regression, we found that the risk of graft failure was higher for HS non-AMP transplantations (hazard ratio 1.19 [95% CI 1.04-1.36]; 1.31 [95% CI 1.08-1.59] with death censored). The French AMP improves access to kidney transplantation for HS patients. Post-transplant survival is comparable to other kidney allocation modalities, possibly because of the absence of preformed donor-specific antibodies in recipients' historical and recent serum, which is associated with reduced risk of rejection.","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16762"},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026079","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}

引用次数: 0