Journal of Transplantation最新文献

{"title":"Apheresis-Based Desensitization to Reduce Antibody Titer in ABO-Incompatible Kidney Transplantation: A Systematic Review and Meta-Analysis.","authors":"Teguh Triyono, Usi Sukorini, Fuad Anshori, Noka Yogahutama","doi":"10.1155/joot/5848415","DOIUrl":"https://doi.org/10.1155/joot/5848415","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The use of apheresis-based desensitization has enabled a safe ABO-incompatible kidney transplantation (ABOi-KT) by reducing ABO allo-isoagglutinin IgG and/or IgM (anti-A and/or anti-B) titers. However, the rate of titer reduction and the number of apheresis sessions required for apheresis-based desensitization remain unclear. We conducted this study to summarize the effectiveness of apheresis-based desensitization for ABOi-KT, as reflected in IgG and IgM titer reduction rate (TRR) and the number of apheresis sessions required.</p><p><strong>Materials and methods: </strong>A systematic literature search was performed on PubMed, Cochrane Library, ProQuest, Scopus, ScienceDirect, and MEDLINE according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement up to May 2025. Twenty-five cohort studies and twenty-three case series studies. Risk of bias assessment was performed using the Joanna Briggs Institute (JBI) critical appraisal tools.</p><p><strong>Results: </strong>The IgG and IgM TRR based on thirty-one and fifteen included studies involving 1105 and 642 patients, respectively, showed a statistically significant reduction in both IgG and IgM titers with pooled TRR MD of 3.73 and 3.82 Log₂ units, respectively (95% CI 3.23 to 4.23, <i>I</i> ² 96.05%, <i>p</i> < 0.001; 95% CI 3.29 to 4.35, <i>I</i> ² 95.74%, <i>p</i> < 0.001). Twenty two included studies involving 934 patients showed an average of 4.97x apheresis sessions required per patient (95% CI 4.32 to 5.61, <i>I</i> ² 96.44%, <i>p</i> < 0.001). Subgroup meta-analyses based on apheresis types, publication decade, and study type were also reported with statistically significant results.</p><p><strong>Conclusion: </strong>The reported IgG and IgM TRR and apheresis sessions required per patient in apheresis-based desensitization for ABOi-KT showed significant results. Similar outcomes were observed among plasmapheresis (PE), immunoadsorption (IA), and the combination of both, indicating that any of these techniques may be effective. This may reflect the effectiveness of apheresis-based desensitization for ABOi-KT, regardless of the apheresis technique. These findings can be a consideration in developing apheresis-based desensitization guidelines for ABOi-KT.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"5848415"},"PeriodicalIF":2.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty and Early Extubation Independently Influence Postoperative Recovery Following Liver Transplantation-A Retrospective Cohort Study.","authors":"Ishan Antony, Noor Albusta, Zhibang Lin, Ryan Nazemian, Bartholomew J Kane, Ming Valerie Lin","doi":"10.1155/joot/5545323","DOIUrl":"https://doi.org/10.1155/joot/5545323","url":null,"abstract":"<p><strong>Background: </strong>Frailty and perioperative management critically influence outcomes following liver transplantation (LT). The liver frailty index (LFI) objectively assesses frailty, while early extubation (EE) has been linked to enhanced recovery in surgical patients. However, the associations of frailty and EE with postoperative outcomes in LT remain unclear.</p><p><strong>Methods: </strong>This retrospective cohort study included adult LT recipients at a tertiary care center between 1/2019 and 7/2023. Patients were classified as frail (LFI ≥ 4.5) or nonfrail (LFI < 4.5) and stratified by EE versus delayed extubation (DE). Primary outcomes were EE rate, ICU length of stay (LOS), and hospital LOS. Linear regression models adjusted for age, gender, BMI, MELD, transplant type, and liver disease etiology.</p><p><strong>Results: </strong>Of 158 postliver transplant patients, 38 (24.1%) were frail. Frail patients had longer ICU LOS (33.2 vs. 4.2 days, <i>p</i> < 0.001) and hospital LOS (59.5 vs. 10.1 days, <i>p</i> < 0.001) compared to nonfrail patients. EE occurred in 78.5% of all postliver transplant patients, with no significant difference by frailty (<i>p</i> = 0.821). Multivariable regression showed frailty was associated with increased hospital LOS (<i>β</i> = +48 days, 95% CI: 43-54, <i>p</i> < 0.001) and ICU LOS (<i>β</i> = +28 days, 95% CI: 25-32, <i>p</i> < 0.001), while EE was associated with decreased hospital LOS (<i>β</i> = -12 days, 95% CI: -17 to -6.7, <i>p</i> < 0.001) and ICU LOS (<i>β</i> = -12 days, 95% CI: -15 to -8.4, <i>p</i> < 0.001), irrespective of frailty status.</p><p><strong>Conclusions: </strong>Our study demonstrated that EE significantly shortens ICU and hospital stays in postliver transplant patients with pretransplant frailty. These findings underscore the importance of incorporating EE protocols in this high-risk population and warrant further investigation into strategies that facilitate implementation to optimize clinical outcomes.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"5545323"},"PeriodicalIF":2.2,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Outcomes and Risk Profiles in Dual Liver-Lung Transplantation: A Single-Center Retrospective Analysis.","authors":"Abdulmalik Saleem, Omar Ilyas, Mark Obri, Ahmad Alomari, Muhammad Saad Faisal, Haya Omeish, Ammad Chaudhary, Yara Dababneh, Uthman Shukairy, Shunji Nagai, Domingo Franco-Palacios, Deepak Venkat, Adarsh Varma, Syed-Mohammed Jafri","doi":"10.1155/joot/9414873","DOIUrl":"https://doi.org/10.1155/joot/9414873","url":null,"abstract":"<p><strong>Background: </strong>Dual liver-lung transplantation (DLLT) is an uncommon but definitive therapy for carefully selected patients with concurrent end-stage hepatic and pulmonary disease. The combined operative complexity and dual-organ immunosuppressive burden may predispose recipients to early morbidity and graft-threatening complications [1-4].</p><p><strong>Objective: </strong>To characterize early and late postoperative events (including acute cellular rejection (ACR), infectious complications, malignancy, and hospital readmissions) after DLLT and to describe associated clinical patterns.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adult DLLT recipients at a single tertiary center (2013-2024). Variables included demographics, transplant indications, ischemia times, readmissions (0-3 months; 3-12 months), infections (timing/etiology/site), biopsy-proven rejection, malignancy, and survival. ACR was biopsy-confirmed in cases of unexplained transaminitis beyond 30 days posttransplant. Analyses were descriptive, consistent with STROBE recommendations for small cohorts.</p><p><strong>Results: </strong>Ten patients (mean age 53.7 years; 50% female) underwent DLLT. Liver etiologies included alcohol-related cirrhosis (<i>n</i> = 2), HCV (<i>n</i> = 1), cryptogenic (<i>n</i> = 1), autoimmune (<i>n</i> = 1), cystic fibrosis (<i>n</i> = 1), and unspecified (<i>n</i> = 4). Lung indications were IPF (<i>n</i> = 5), pulmonary hypertension (<i>n</i> = 2), ILD (<i>n</i> = 2), and CF (<i>n</i> = 1). All patients were readmitted within 90 days, most commonly for infection (40%), diarrhea (20%), critical illness myopathy (20%), rejection (10%), and biliary stricture (10%). Biopsy-proven ACR occurred in 4/10 patients (40%) after the first month, uniformly presenting with hepatocellular transaminemia; 3/4 received pulse-dose IV corticosteroids and 2/3 subsequently developed invasive fungal disease (Aspergillus and <i>Candida</i>). Overall, 9/10 experienced infection within 6 months, predominantly pulmonary (fungal/bacterial pneumonias). Three patients developed malignancy (basal cell carcinoma, prostate carcinoma, and angiosarcoma [fatal]). Survival was 90% at 1 year, 70% at 3 years, and 60% at 5 years; no 10 year survivors were observed.</p><p><strong>Conclusions: </strong>DLLT is associated with early readmission and a high infectious burden, particularly invasive fungal disease after steroid-treated ACR. Despite significant early morbidity, short-term survival is favorable. Multicenter studies are needed to refine candidate selection, balance rejection prophylaxis with antifungal strategies, and standardize long-term oncologic and dermatologic surveillance in DLLT.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"9414873"},"PeriodicalIF":2.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sirolimus Versus Mycophenolate Mofetil in Simultaneous Pancreas-Kidney Transplantation: Impact on Urinary Tract Infection Rates.","authors":"Barbora Píšová, Šárka Chytilová, František Saudek, Peter Girman","doi":"10.1155/joot/6985179","DOIUrl":"https://doi.org/10.1155/joot/6985179","url":null,"abstract":"<p><strong>Background: </strong>Urinary tract infections (UTIs) are common complications following simultaneous pancreas and kidney transplantation (SPK). The role of specific immunosuppressive agents in modulating UTI incidence and recurrence remains poorly understood.</p><p><strong>Methods: </strong>In this retrospective, single-center study, we analyzed 164 SPK recipients randomized to receive either sirolimus or mycophenolate mofetil (MMF) in combination with tacrolimus. The incidence of UTIs, relapses, recurrences, and UTI-related hospitalizations was assessed over a 10-year follow-up. Univariable and multivariable negative binomial regression models were used to evaluate associations with immunosuppressive regimens and clinical outcomes in both intention-to-treat (ITT) and per-protocol analyses.</p><p><strong>Results: </strong>A total of 572 UTI episodes were recorded during follow-up (0.102 per 100 recipient-transplant days). No significant differences in overall UTI incidence or UTI-related hospitalizations were observed between the sirolimus and MMF groups. However, in the multivariable per-protocol analysis, the sirolimus group experienced significantly fewer UTI-related hospitalizations (IRR 0.46; 95% CI, 0.23-0.94; <i>p</i> = 0.034) and relapses (IRR 0.54; 95% CI, 0.30-0.97; <i>p</i> = 0.039). Significant risk factors for UTIs included female sex, JJ stent placement, and pretransplant urological abnormalities. Recurrent UTIs were associated with lower 10-year kidney graft survival (52% vs. 75%; <i>p</i> = 0.01) but had no impact on pancreas graft or patient survival.</p><p><strong>Conclusions: </strong>While overall UTI incidence did not differ between immunosuppressive regimens, sirolimus use was associated with fewer hospitalizations and relapses. These findings indicate a potential clinical benefit of sirolimus in selected high-risk SPK recipients, highlighting the need for further prospective investigation. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT00140543.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"6985179"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Extended Itraconazole Antifungal Prophylaxis on the Development of Fungal Infections After Lung Transplant.","authors":"Sabrina Fischer, Raksha Patel, Mufaddal Mamawala, Susan K Mathai, Katherine Vandervest, Tiana Endicott-Yazdani, Chetan Naik, Todd Grazia, Lisa Fuller","doi":"10.1155/joot/6995822","DOIUrl":"https://doi.org/10.1155/joot/6995822","url":null,"abstract":"<p><strong>Background: </strong>Invasive fungal infections (IFIs) are associated with a high mortality in lung transplant recipients, with no consensus on optimal antifungal prophylaxis. We aimed to assess the efficacy of long-term itraconazole compared to short-term inhaled amphotericin to prevent IFIs post-transplant.</p><p><strong>Methods: </strong>A retrospective review of adult lung transplant recipients from January 2016 to September 2022 was conducted. The cohort was divided into two groups based on initial mold prophylaxis: long-term itraconazole and short-term inhaled amphotericin. The primary outcome was the incidence of IFIs. The secondary outcomes included the time to IFI, incidence of fungal species found on cultures, and safety/tolerability.</p><p><strong>Results: </strong>A total of 203 patients met the inclusion criteria (amphotericin group <i>n</i> = 108, itraconazole group <i>n</i> = 95). The overall incidence of IFIs was significantly higher in the amphotericin group than the itraconazole group (76.9% vs. 56.8%, <i>p</i> = 0.002). The Kaplan-Meier curve for the risk of IFI within 1 year of transplant showed a shorter time to IFI in the amphotericin group (<i>p</i> = 0.009). In the amphotericin group, there was an increased incidence of positive fungal cultures compared to the itraconazole group with <i>Aspergillus spp.</i> (25% vs. 8.4%, <i>p</i> = 0.002), <i>Penicillium spp</i>. (25.9% vs. 9.5%, <i>p</i> = 0.002), yeast (70.4% vs. 36.8%, <i>p</i> ≤ 0.001), and other positive fungal cultures (28.7% vs. 12.6%, respectively, <i>p</i> = 0.005). The amphotericin group had more discontinuations due to intolerance than the itraconazole group (12% vs. 3.2%, <i>p</i> = 0.019).</p><p><strong>Conclusion: </strong>In adult lung transplant recipients, long-term prophylaxis with itraconazole was more effective at preventing overall IFIs, positive cultures with <i>Aspergillus spp.</i>, and was better tolerated than short-term inhaled amphotericin.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"6995822"},"PeriodicalIF":2.2,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12938488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolving Kidney Donor Pool Shaping Outcomes in Graft Survival.","authors":"Kaufman Daniel M, Perkins James D, Bakthavatsalam Ramasamy, Leca Nicolae, Sibulesky Lena","doi":"10.1155/joot/3352344","DOIUrl":"https://doi.org/10.1155/joot/3352344","url":null,"abstract":"<p><strong>Background: </strong>The composition of the U.S. deceased kidney donor pool is undergoing a major shift. While the past decade saw an increase in younger, overdose-death donors associated with favorable transplant outcomes, recent years have marked a decline in these donors. Concurrently, there has been a rise in higher-risk donor characteristics-namely, older age, more comorbidities, such as hypertension and diabetes, and increased reliance on donation after circulatory death (DCD). These trends may significantly affect transplant outcomes.</p><p><strong>Methods: </strong>We analyzed data from the Organ Procurement and Transplantation Network (OPTN) on 101,550 deceased kidney donors (2018-Q1 2025) and 108,611 single kidney transplants (2018-mid-2024). Donor trends were assessed using segmented regression analysis. Graft survival was evaluated using Kaplan-Meier survival curves and multivariable Cox proportional hazards models, adjusting for donor, recipient, and transplant characteristics.</p><p><strong>Results: </strong>Overdose-death donors declined from 16.7% in 2022 to 10.5% by Q1 2025. Simultaneously, DCD donors rose to nearly 50% of all deceased donors. The proportion of older donors and high-KDPI kidneys also increased. Kaplan-Meier analysis showed a decrease in unadjusted death-censored graft survival in 2024 compared to 2018-2022 (97.0% vs. 97.6%, <i>p</i> < 0.001). In adjusted Cox models, donor factors-DCD status, older age, hypertension, diabetes, and prolonged cold ischemia-were independently associated with graft loss.</p><p><strong>Conclusions: </strong>The U.S. kidney donor pool is shifting toward higher-risk profiles, with early signs of declining graft survival. Strategies to optimize organ preservation and allocation will be essential to maintain transplant outcomes amid these changing donor trends.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"3352344"},"PeriodicalIF":2.2,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping International Collaboration and Research Trends in Artificial Intelligence Applications for Liver and Kidney Transplantation.","authors":"Haneen Al-Abdallat, Noor Haj Mohammad, Ayham Asassfeh, Emily Cooper, Ayham Mohammad Hussein, Mohammad AlSarayreh, Mohammad Alzoubi, Badi Rawashdeh","doi":"10.1155/joot/9692976","DOIUrl":"10.1155/joot/9692976","url":null,"abstract":"<p><strong>Introduction: </strong>The integration of artificial intelligence (AI) in liver and kidney transplantation (LKT) research has surged in recent years, promising novel approaches to address traditional statistical challenges and enhance result robustness and generalizability. This study aims to explore the extent of international collaboration and the evolution of research trends in AI applications for LKT.</p><p><strong>Methods: </strong>On August 12, 2025, a systematic search was conducted using the Web of Science database to identify relevant literature. Bibliometric tools, including the \"bibliometrix\" package in R, VOSviewer, and Microsoft Excel were used. Key indicators such as country contributions, multiple-country publications, single-country publications, co-authorship, and keyword co-occurrence were examined to assess collaboration patterns and research hotspots. Inclusion criteria involved all published peer-reviewed articles related to AI in LKT. Editorials, corrections, and irrelevant documents were excluded.</p><p><strong>Results: </strong>A total of 633 articles published between 1994 and 2025 were included in the analysis. These collectively received 8959 citations. The United States of America emerged as the leading contributor, accounting for 37.12% of the publications, followed by China and South Korea. Notably, international co-authorship was evident in 30.02% of the publications. Keyword analysis revealed that \"survival,\" \"outcomes,\" \"risk,\" \"mortality,\" and \"prediction\" were the most frequent terms, highlighting them as hotspots in transplantation research.</p><p><strong>Conclusion: </strong>The field of AI in LKT research is characterized by a growing international collaboration, despite the fact that participation is still uneven and concentrated in high-income countries. In order to advance the field and enhance outcomes across diverse patient populations, it will be crucial to strengthen global data-sharing and cultivate equity-focused, culturally adaptable AI models.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"9692976"},"PeriodicalIF":2.2,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12851513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Diverse Clinical Characteristics on Survival Benefit of Liver Transplantation.","authors":"Mouaid Alim, Bishoy Lawendy, Shiyi Chen, Naomi Khaing Than Hlaing, Saba Maleki, Mamatha Bhat","doi":"10.1155/joot/1291289","DOIUrl":"10.1155/joot/1291289","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation (LT) is offered as a life-saving treatment to those with end-stage liver disease. There has recently been much interest in considering the survival benefit of transplant when prioritizing patients for transplant. In this study, we aimed to measure the survival benefit of LT across various patient demographics by measuring the number of life-years gained after LT.</p><p><strong>Method: </strong>In this study, 101,770 patients were included from the Scientific Registry of Transplant Recipients (SRTR) transplanted between 2003 and 2021. The survival benefit of LT was calculated using restricted mean survival time (RMST) in the next 16 years post-transplant. Cox proportional hazard models and Weibull models were employed to quantify the impact of various predictors on survival benefit.</p><p><strong>Results: </strong>LT was found to provide survival gains of 4.93, 6.43, 6.30, and 3.67 years for the 18-29, 30-49, 50-69, and 70+ age groups, respectively. Survival benefit was highest at 6.62 years for patients with model for end-stage liver disease (MELD) scores of 15-19, with survival benefits of 5.7, 5.4, and 5.85 years for the 6-14, 20-29, and 30-40 MELD score cohorts, respectively. Older age (HR: 1.13), male sex (HR: 1.32), diabetes (HR: 1.32), and higher MELD scores were predictors of lesser survival benefit. Protective factors included higher education levels (HR: 0.70) as well as diagnoses of fulminant liver failure and autoimmune biliary disease (HR: 0.65).</p><p><strong>Conclusion: </strong>This study underscores how survival benefit varies across patients with different demographic and clinical characteristics, highlighting the nuanced interplay of these characteristics with survival and emphasizing the need for tailored post-transplant management strategies to optimize outcomes.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"1291289"},"PeriodicalIF":2.2,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12805940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Models for Kidney Offer Acceptance: Challenges and Strategies.","authors":"Carlos Martinez, Md Nasir, Meghana Kshirsagar, Cass McCharen, Rae Shean, Juan Lavista Ferres, Rahul Dodhia, William B Weeks","doi":"10.1155/joot/8243450","DOIUrl":"10.1155/joot/8243450","url":null,"abstract":"<p><strong>Background: </strong>Predicting whether an organ offer will be accepted for transplantation remains challenging for several reasons, including large offer volumes, highly imbalanced observations (more declines than acceptances), and lack of information about the human decision-making process. Offer acceptance models are used for risk-adjusted program evaluations and policy development, but there is a lack of literature on baselines and best practices for predictive applications. We compared a suite of machine learning models, feature sets, and sampling procedures to identify performance impacts when training offer acceptance prediction models.</p><p><strong>Methods: </strong>We evaluated several kidney offer acceptance models from logistic regression to gradient boosted trees that were trained on donor and candidate characteristics. We then selected the best-performing model and augmented training data with additional features (e.g., distance from the closest airport to the transplant hospital) or additional sampling procedures (e.g., undersampling).</p><p><strong>Results: </strong>Compared to the baseline logistic regression model (average precision: 0.0645), the XGBoost model offered the best performance improvement over the baseline (average precision: 0.0907). Including transportation-related features in the model further improved model performance (average precision: 0.0940); however, we did not observe substantial model performance differences based on the sampling procedure used.</p><p><strong>Conclusions: </strong>Leveraging advanced machine learning models and incorporating nonclinical datapoints (like transportation distances) can improve transplant organ offer acceptance prediction models. However, we observed steep tradeoffs between precision and recall as captured in the low average precision scores despite deceptively high AUROCs (baseline AUROC 0.832). Our findings suggest that even the best-performing models would not provide clear, equitable benefits over existing allocation policies. More research is needed before these models are practical for clinical implementation.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"8243450"},"PeriodicalIF":2.2,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posttransplant Lymphoproliferative Disorder (PTLD): 24 Years of Experience at a Referral Center in São Paulo, Brazil. Can Differences in Prevalence and Subtype of EBV Infection in the Population Influence the Results? A Retrospective Cohort Study.","authors":"Juliano Córdova Vargas, Ricardo Helman, Marcelino de Souza Durão, Erika Ferraz de Arruda, José Eduardo Afonso, Rafael Medeiros Carraro, Lilian Amorim Curvelo, Guilherme Eduardo Gonçalves Felga, Celso Eduardo Lourenço Matielo, Patrícia Holanda Almeida, Denise Pasqualin, Renata Stanzione, Carolina Perrone, Guilherme Perini, Nelson Hamerschlak","doi":"10.1155/joot/6468943","DOIUrl":"10.1155/joot/6468943","url":null,"abstract":"<p><strong>Objectives: </strong>To retrospectively review all cases of posttransplant lymphoproliferative disorder (PTLD) in a large Brazilian transplant center, describing patients' clinical, virological, and histopathological profiles and treatment strategies and prognostic factors.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted between January 2000 and June 2024. Adult patients with confirmed PTLD following solid-organ or bone marrow transplant were included. Patients with other systemic cancers or on concurrent chemotherapy/radiotherapy were excluded. Clinical characteristics, PTLD prevalence, histopathology, and survival were assessed.</p><p><strong>Results: </strong>Thirty-eight cases of PTLD were identified in the 5928 transplant patients (0.6%). Incidence was highest in lung recipients (31%). Median time to PTLD onset was 42 months. EBV DNA was detectable in 54.8% of cases. Monomorphic PTLD was the most common (89.5%), primarily in non-Hodgkin lymphomas (91.2%). Immunotherapy (anti-CD20) and immunosuppression reduction were standard initial treatments. R-CHOP and rituximab monotherapy were the main first-line regimens. Age and treatment response significantly influenced overall survival. Mortality was 42%, mainly due to infections and disease progression.</p><p><strong>Conclusions: </strong>Despite the higher prevalence of EBV in Brazil, PTLD patterns and incidence were consistent with those found in developed countries. The strong association with lung transplants mirrors global data. Local EBV subtype characteristics and host immunogenetic factors warrant further investigation.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2025 ","pages":"6468943"},"PeriodicalIF":2.2,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12767072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}