Transplant InternationalPub Date : 2026-08-28eCollection Date: 2026-01-01DOI: 10.3389/ti.2026.17566
Umberto Cillo, Gabriel C Oniscu
{"title":"The bucharest international (ESOT) consensus on controlled donation after circulatory determination of death.","authors":"Umberto Cillo, Gabriel C Oniscu","doi":"10.3389/ti.2026.17566","DOIUrl":"10.3389/ti.2026.17566","url":null,"abstract":"","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"17566"},"PeriodicalIF":3.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956951","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":"Alcohol-related liver disease and access to liver transplantation: where we stand and where we should go.","authors":"Inês Mega, Eloisa Franchi, Giacomo Germani, Hermien Hartog, Speranta Iacob, Phillipe Mathurin, Silvio Nadalin, Stephen Potts, Giuliano Testa, Luca Saverio Belli","doi":"10.3389/ti.2026.16769","DOIUrl":"10.3389/ti.2026.16769","url":null,"abstract":"<p><p>Alcohol-related liver disease (ArLD) is now a leading indication for liver transplantation worldwide, yet access to this life-saving therapy remains inequitable. Late diagnosis, persistent stigma, rigid abstinence requirements, and fragmented care pathways continue to disadvantage patients with ArLD relative to those with other liver diseases. Landmark studies have shown that early liver transplantation for severe alcohol-associated hepatitis confers a clear survival benefit when performed within rigorous selection protocols, with rates of return to drinking comparable to those achieved under the long-standing six-month abstinence rule, thereby challenging its clinical rationale. Concurrently, growing evidence supports the integration of addiction medicine and mental health expertise into transplant programs, recognizing alcohol use disorder as a chronic relapsing disease requiring sustained, multidisciplinary management. Despite this progress, substantial variability persists across centers in candidate evaluation, psychosocial assessment, and post-transplant addiction care. This Point of View examines the current landscape across six interconnected domains, epidemiology, timing of diagnosis, the dual nature of ArLD as a disease of mind and liver, stigma, access to transplantation, and multidisciplinary models of care, and proposes directions for harmonized, evidence-based, and equitable practice.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16769"},"PeriodicalIF":3.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931101","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 : 2026-08-27eCollection Date: 2026-01-01DOI: 10.3389/ti.2026.16834
Beat Moeckli, Kevin B Harris, Byron Smith, David Pereyra, Xiomara Benavides, Jody Olson, Alexander R Cortez, Timucin Taner, Julie K Heimbach, Douglas A Simonetto, Samy M Riad
{"title":"Kidney-alone transplantation in prior SLK candidates: a national registry analysis.","authors":"Beat Moeckli, Kevin B Harris, Byron Smith, David Pereyra, Xiomara Benavides, Jody Olson, Alexander R Cortez, Timucin Taner, Julie K Heimbach, Douglas A Simonetto, Samy M Riad","doi":"10.3389/ti.2026.16834","DOIUrl":"10.3389/ti.2026.16834","url":null,"abstract":"<p><p>Outcomes of kidney-alone transplantation (KAT) in former simultaneous liver-kidney (SLK) transplant candidates after liver waitlist delisting are not well defined. Using Scientific Registry of Transplant Recipients (SRTR) data, we identified adult recipients who underwent KAT between 2005 and 2025 after prior SLK listing (RLD-KAT), which was matched 1:5 to primary KAT recipients without liver disease by age, transplant year, and diabetes status. Patient and graft survival were evaluated using the Kaplan-Meier method and multivariable Cox proportional hazards models. We identified 163 RLD-KAT recipients matched to 815 controls. Unadjusted Kaplan-Meier analyses demonstrated lower patient survival in RLD-KAT (p = 0.020), whereas death-censored and overall graft survival were similar (p > 0.05). In multivariable models, death-censored graft survival (HR 0.89; 95% CI 0.51-1.53), overall graft survival (HR 1.00; 95% CI 0.73-1.36), and patient survival (HR 1.07; 95% CI 0.76-1.5) did not differ significantly. Six RLD-KAT recipients (3.7%) subsequently underwent liver transplantation. Kidney-alone transplantation in prior SLK candidates was associated with acceptable patient and graft outcomes and a low incidence of subsequent liver transplantation.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16834"},"PeriodicalIF":3.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931195","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 : 2026-08-26eCollection Date: 2026-01-01DOI: 10.3389/ti.2026.16004
Giulia Magini, Hannah Wozniak, Antonia Schafer, Beat Moeckli, Vanessa Banz, Julien Vionnet, Ansgar Deibel, Jose Oberholzer, Pascale Tinguely, Nicolas Goossens, Andrea Peloso, Mirjam Korner, Franz Immer, Riccardo De Carlis, Christian Toso, Benjamin Assouline, Karim Bendjelid, Philippe Compagnon, Raphael Giraud
{"title":"Abdominal normothermic regional perfusion is associated with improved graft survival in liver transplantation from circulatory death donors.","authors":"Giulia Magini, Hannah Wozniak, Antonia Schafer, Beat Moeckli, Vanessa Banz, Julien Vionnet, Ansgar Deibel, Jose Oberholzer, Pascale Tinguely, Nicolas Goossens, Andrea Peloso, Mirjam Korner, Franz Immer, Riccardo De Carlis, Christian Toso, Benjamin Assouline, Karim Bendjelid, Philippe Compagnon, Raphael Giraud","doi":"10.3389/ti.2026.16004","DOIUrl":"10.3389/ti.2026.16004","url":null,"abstract":"<p><p>Advanced preservation strategies are increasingly used in liver transplantation following donation after circulatory death (DCD). This nationwide observational study evaluated the association between abdominal normothermic regional perfusion (A-NRP) and 1-year graft survival in a Swiss cohort of 254 DCD liver transplants performed between 2017 and 2023. Recovery strategies compared included A-NRP and super-rapid recovery (SRR), both predominantly followed by end-ischemic hypothermic oxygenated perfusion (HOPE). Primary endpoint was 1-year graft loss; secondary endpoints included 1-year patient mortality, primary non-function, non-anastomotic strictures (NAS), biliary and vascular complications and need for re-transplantation. Overall, 53 grafts were retrieved using A-NRP (71% followed by HOPE) and 201 using SRR (90% followed by HOPE). Compared with SRR, A-NRP grafts demonstrated lower rates of graft loss (5.7% vs. 24.6%), 1-year mortality (1.9% vs. 13.3%), NAS (5.7% vs. 20.5%), other biliary complications (1.9% vs. 12.6%) and re-transplantation (3.8% vs. 12.8%). In multivariable Cox regression analysis, A-NRP was associated with lower risk of 1-year graft loss and patient mortality after adjustment for UK DCD risk category and HOPE use. These findings suggest that A-NRP is associated with improved outcomes. Further studies are needed to define the role of <i>ex-situ</i> perfusion after A-NRP in optimizing results.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16004"},"PeriodicalIF":3.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920968","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 : 2026-08-25eCollection Date: 2026-01-01DOI: 10.3389/ti.2026.16845
Francesco Campo, Maria Irene Bellini, Hanne Scholz, Lorenzo Piemonti, Antonio Citro
{"title":"Hypoimmune platforms: from rejection to immune evasion and regulatory implications.","authors":"Francesco Campo, Maria Irene Bellini, Hanne Scholz, Lorenzo Piemonti, Antonio Citro","doi":"10.3389/ti.2026.16845","DOIUrl":"10.3389/ti.2026.16845","url":null,"abstract":"<p><p>The growing gap between organ demand and clinical availability has renewed interest in immune-evasive graft strategies, yet rejection and lifelong immunosuppression remain major barriers to durable success. Advances in genome editing enable immune-evasive cell platforms designed to avoid immune recognition while replacing missing function in allogeneic settings. This review summarizes current strategies for engineering immune-evasive grafts that simultaneously suppress adaptive and innate immune responses. We discuss how coordinated modulation of antigen presentation and immune checkpoint pathways can protect transplanted allogeneic cells and tissues from T, NK, and macrophage-mediated rejection. We also present the emerging concept of integrating hypoimmune engineering with genetically modified porcine donors, where extensive genome editing has reduced, but not eliminated, xenogeneic immune barriers. Combining donor genome modification with immune-evasive graft design represents a promising conceptual advance toward xenograft survival, though whether full elimination of systemic immunosuppression is achievable remains to be established clinically. We further examine how the regulatory landscape for these products is evolving across major jurisdictions, and how differences in approval pathways, manufacturing standards, and long-term surveillance requirements shape the path to clinical translation. Finally, we outline the safety considerations and remaining limitations in immune evasion that must be addressed to enable clinical implementation.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16845"},"PeriodicalIF":3.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913644","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 : 2026-08-24eCollection Date: 2026-01-01DOI: 10.3389/ti.2026.16783
Zanna Ramaekers, Richard Staring, Dennis A Hesselink, Frederike Ambagtsheer
{"title":"Kidney sales by migrants: experiences, knowledge, and responses of medical professionals across the euro-mediterranean border.","authors":"Zanna Ramaekers, Richard Staring, Dennis A Hesselink, Frederike Ambagtsheer","doi":"10.3389/ti.2026.16783","DOIUrl":"10.3389/ti.2026.16783","url":null,"abstract":"<p><p>Reports indicate that migrants are selling their kidneys, yet medical professionals' experiences with this are unexplored. We conducted a qualitative study with 45 professionals across the Euro-Mediterranean border (The Netherlands, Bulgaria, Türkiye, Italy, and Greece) working in transplantation and migration. We examined their experiences, knowledge, and responses to migrants' kidney sales and explored whether the issue is rarely encountered, insufficiently recognized, or disclosed. The study includes 28 transplant professionals (TPs) and 17 medical professionals working in migration (MMPs). Except for two TPs volunteering in migration settings, none reported direct encounters with migrant kidney selling. In contrast, five MMPs observed nephrectomy scars or heard testimonies. Awareness was largely limited to those with direct experience, and knowledge on modus operandi was absent. Both groups expressed uncertainty about detecting and reporting suspected cases. TPs tended to distance themselves and, like MMPs, acknowledged that limited awareness may reduce attentiveness. We conclude that migrant kidney selling remains largely hidden in medical practice, not because it is absent, but because it is insufficiently recognized and rarely disclosed. To address this, we recommend stronger collaboration through conferences, multidisciplinary training, and education on organ trade, as well as expanding reporting mechanisms to include migrant kidney sellers.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16783"},"PeriodicalIF":3.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978156","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 : 2026-08-21eCollection Date: 2026-01-01DOI: 10.3389/ti.2026.16308
Yvette Ysabel Yao, Tianyi Wen, Nicholas Wellington Tjandra, Kirby Lau, Yi Chun Lin, Xuan Chen, Daljeet Chahal
{"title":"Improving outcomes in donation after circulatory death vs. donation after brain death liver transplantation for acute-on-chronic liver failure.","authors":"Yvette Ysabel Yao, Tianyi Wen, Nicholas Wellington Tjandra, Kirby Lau, Yi Chun Lin, Xuan Chen, Daljeet Chahal","doi":"10.3389/ti.2026.16308","DOIUrl":"10.3389/ti.2026.16308","url":null,"abstract":"<p><p>Acute-on-chronic liver failure (ACLF) carries high short-term mortality, and liver transplantation (LT) remains the curative treatment. Donation after circulatory death (DCD) grafts expand the donor pool but carry higher risks of dysfunction compared to donation after brain death (DBD) grafts, and data directly comparing their outcomes in ACLF are limited. Using the Scientific Registry of Transplant Recipients (SRTR), we conducted a retrospective cohort study of 67,201 adult LT recipients from 2004 to 2023, stratified into three eras (Era 1: 2004-2012, Era 2: 2013-2018, Era 3: 2019-2023). Patients with prior LT, fulminant liver failure (status 1A), active hepatocellular carcinoma, or multivisceral transplants (excluding liver-kidney) were excluded. Estimated ACLF (EST-ACLF) severity was defined using EASL-CLIF criteria. One-year graft failure and survival were assessed using multivariable Cox regression and Kaplan-Meier analyses. Of 67,201 recipients, 62,510 received DBD and 4,691 DCD grafts. DCD grafts did not show clinically meaningful differences in 1-year hazards of graft failure compared to DBD grafts. One-year graft survival in EST-ACLF-2/3 improved over time from 87.2% in Era 1%-96.0% in Era 3, approaching the 97.5% observed with DBD grafts. DCD grafts may represent a viable and increasingly safe strategy for expanding LT access in ACLF.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"16308"},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897794","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 : 2026-08-21eCollection Date: 2026-01-01DOI: 10.3389/ti.2026.17199
Jan Sönke Englbrecht, Daniel Schrader, Rainer Kram, Holger Kraus, Melanie Schäfer, Barbara Stolzenberg, Dirk Schedler, Juliane Langer, Felix Lehmann, Johannes Weller, Robert Werdehausen, Marleen Weiß, Svitlana Ziganshyna, Martin Soehle
{"title":"Potential for donation after circulatory death in Germany: a multicenter retrospective study at seven university hospitals.","authors":"Jan Sönke Englbrecht, Daniel Schrader, Rainer Kram, Holger Kraus, Melanie Schäfer, Barbara Stolzenberg, Dirk Schedler, Juliane Langer, Felix Lehmann, Johannes Weller, Robert Werdehausen, Marleen Weiß, Svitlana Ziganshyna, Martin Soehle","doi":"10.3389/ti.2026.17199","DOIUrl":"10.3389/ti.2026.17199","url":null,"abstract":"<p><p>Many countries have established donation after circulatory death (DCD) in addition to donation after brain death (DBD). In Germany, DCD is not permitted, and its potential to increase organ donation rates has not yet been quantified. We retrospectively identified all deceased with brain injury between 2023-2024 at seven German university hospitals. Eligible DCD donors were defined as patients with preserved brainstem reflexes precluding DBD donation, documented consent or an unknown donation preference, and death occurring within 120 min after withdrawal of life-sustaining measures. For patients with unknown preference, a consent rate of 40% was assumed. Among 4,587 deceased, 1,509 had preserved brainstem reflexes as the main reason against DBD. Of these, 58 patients with documented consent and 212 patients with an unknown donation preference died within 120 min after treatment withdrawal. Compared with 128 utilized DBD donors, this corresponds to an additional theoretical DCD potential of 45% based solely on documented consent. When applying the assumed consent rate to patients with an unknown preference, the hypothetical increase reaches 112%. The introduction of a DCD program could substantially increase organ donation rates at German university hospitals. However, its actual impact would depend on establishing appropriate legal, organizational, and ethical frameworks.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"17199"},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897765","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 : 2026-08-20eCollection Date: 2026-01-01DOI: 10.3389/ti.2026.15946
Eva De Vis, Maarten Naesens, Ina Jochmans, Kathleen Claes, Annouschka Laenen, Diethard Monbaliu, Mauricio Sainz Barriga, Annelies Laerte, Dirk Kuypers, Jacques Pirenne, Geert Maleux
{"title":"Late kidney transplant dysfunction related to proximal aorto-iliac occlusive disease.","authors":"Eva De Vis, Maarten Naesens, Ina Jochmans, Kathleen Claes, Annouschka Laenen, Diethard Monbaliu, Mauricio Sainz Barriga, Annelies Laerte, Dirk Kuypers, Jacques Pirenne, Geert Maleux","doi":"10.3389/ti.2026.15946","DOIUrl":"10.3389/ti.2026.15946","url":null,"abstract":"<p><p>This study is a retrospective analysis of a cohort of patients presenting with transplant renal dysfunction related to proximal aorto-iliac occlusive disease and treated with angioplasty and stenting. Primary outcomes included changes in intrarenal resistive index (RI) and laboratory and clinical data including serum creatinine level, systolic and diastolic blood pressure, and number of anti-hypertensive drugs before and after endovascular intervention. Secondary outcomes included overall patient and transplant kidney survival. Endovascular intervention was successful in all 26 included patients and associated with a significant increase in intrarenal RI in the upper pole (0.65 before vs. 0.74 after stent; P = 0.0009), in the interpolar region (0.64 before vs. 0.74 after stent; P = 0.0028), and in the lower pole (0.63 before vs. 0.76 after stent; P = 0.0002). In addition, there was a significant improvement in serum creatinine (2.29 mg/dL before vs. 1.49 mg/dL 6 weeks after stent; P < 0.0001) and systolic blood pressure (149.6 mmHg before vs. 139.8 mmHg 1 week after stent; P = 0.0233). Overall estimated transplant kidney survival was 95% at 5 and 10 years of follow-up. Endovascular intervention is a very effective and durable treatment option for the management of transplant renal dysfunction related to proximal aorto-iliac occlusive disease.</p>","PeriodicalId":23343,"journal":{"name":"Transplant International","volume":"39 ","pages":"15946"},"PeriodicalIF":3.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888590","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}