Journal of Transplantation最新文献

{"title":"Diagnostic Test Accuracy of Detecting Donor-Derived Cell-Free DNA in Renal Transplant Rejection: A Systematic Review and Meta-Analysis.","authors":"Chee Siong Wong, Yegor Tryliskyy, Raja Rashid, Sowrav Barman, Vlad Shuymeko, Ajay Sharma, Mohammed Hossain","doi":"10.1155/joot/3052963","DOIUrl":"10.1155/joot/3052963","url":null,"abstract":"<p><strong>Introduction: </strong>Circulating donor-derived cell-free DNA (dd-cfDNA) has emerged as a noninvasive biomarker for detecting allograft rejection and assessing renal status. While promising, its diagnostic test accuracy (DTA) remains unclear. This study aimed to evaluate the DTA of dd-cfDNA in identifying rejection following renal transplantation.</p><p><strong>Method: </strong>A systematic review and meta-analysis of DTA studies were conducted following PRISMA guidelines. Electronic databases (MEDLINE via PubMed, Embase, Scopus and Web of Science) were searched comprehensively for studies reporting the sensitivity and specificity of dd-cfDNA in detecting renal allograft rejection. Data were analysed using Review Manager (RevMan) 5.4.1 and MetaDTA 2.0.</p><p><strong>Results: </strong>Thirteen studies were included, comprising 2214 samples across various rejection types, including antibody-mediated rejection (ABMR) and T cell-mediated rejection (TCMR). Meta-analysis revealed pooled sensitivities and specificities for detecting unspecified rejection of 61.1% (95% CI: 48.2%-74.8%) and 83.0% (95% CI: 76.3%-88.5%), respectively. For ABMR, pooled sensitivity increased to 75.6% (95% CI: 61.7%-86.4%) with a specificity of 82.1% (95% CI: 71.4%-88.8%). Meta-regression analysis using a dd-cfDNA threshold of 1% demonstrated comparable sensitivity and specificity for the detection of biopsy-proven rejection and ABMR, yielding estimates consistent with the overall pooled results. Insufficient data were available to allow for analytical comparison in TCMR. The area under the curve (AUC) was highest in the ABMR group.</p><p><strong>Conclusion: </strong>dd-cfDNA shows potential as a diagnostic biomarker, particularly for ABMR in renal transplantation. Further studies integrating dd-cfDNA with biochemical and histological markers are recommended to enhance diagnostic precision.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"3052963"},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13410283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621918","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":"Immunological Dynamics and Outcomes of ABO-Incompatible Kidney Transplants: Insights From a 5+-Year Follow-Up at a Transplant-Heavy Tertiary Center in Saudi Arabia.","authors":"Bilal Mohsin, Najla Zabani, Nasser Odah, Naief Alhowaiti, Fatmah Yamani, Afnan Al Mutairi, Lama Hefni, Muhammad Talha Kausar, Nadeem Shafique Butt, Wael Habhab","doi":"10.1155/joot/6265955","DOIUrl":"10.1155/joot/6265955","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;ABO-incompatible (ABOi) kidney transplantation is an essential strategy to expand the donor pool for patients with end-stage kidney disease (ESKD). However, it poses significant immunological challenges because of the risk of graft rejection. In Saudi Arabia, where ABOi transplants are limited, there is a paucity of long-term locoregional data on the impact of immunological factors on graft outcomes. This study evaluated ABOi transplant outcomes in patients with more than 5 years of follow-up, with a primary focus on immunological factors and their role in graft survival and rejection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed data from 24 adult patients who underwent ABOi kidney transplantation between October 31, 2015, and December 30, 2019, with follow-up until December 31, 2024. Key immunological factors assessed included donor-recipient blood group mismatch, human leukocyte antigen (HLA) mismatches, preformed donor-specific antibodies (DSAs) and non-DSA anti-HLA antibodies, flow cross-match results, and anti-ABO titers before and after transplantation. Posttransplant infections were also evaluated for their potential immunological impact. The desensitization protocol comprised rituximab, plasma exchange, and intravenous immunoglobulin (IVIg), with pretransplant anti-ABO titers required to be ≤ 8. Exclusion criteria included pediatric ABOi kidney transplants and patients experiencing major vascular or surgical complications necessitating re-exploration within 7 days posttransplant. Immunosuppressive therapy included methylprednisolone and ATG induction, with prednisolone, tacrolimus, and mycophenolate mofetil for maintenance. The studied outcomes were graft survival, rejection episodes, graft failure, and all-cause mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over a mean follow-up of 68 ± 12.6 months, graft survival was 91.7% (&lt;i&gt;n&lt;/i&gt; = 22). Graft rejection occurred in 16.7% (&lt;i&gt;n&lt;/i&gt; = 4) of the patients, with two cases (8.3%) of graft failure attributed to severe antibody-mediated rejection (ABMR). Key immunological risk factors for rejection included the presence of non-DSA anti-HLA antibodies, low-titer positive cross-match, &gt; 8 HLA mismatches, and unrelated donors. A total of 49 infectious episodes occurred in 19 recipients, of which 29 (59%) occurred within the first posttransplant year and were not associated with graft dysfunction or rejection. Posttransplant serum creatinine remained stable during follow-up, with median values of 89.0, 88.0, 85.0, and 88.0 μmol/L at 1, 12, 36, and 60 months, respectively, and 77.0 μmol/L at last follow-up (minimum follow-up, 64 months). No mortality was observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;ABOi kidney transplantation demonstrates excellent long-term outcomes; however, immunological factors play a pivotal role in determining the risk of rejection. Careful patient selection is warranted, as even seemingly minor immunological factors can provoke graft rejection i","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"6265955"},"PeriodicalIF":1.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392022","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":"Near-Infrared Spectroscopy (NIRS) Could Predict Graft Quality in Adult Liver Donors.","authors":"Julen Ramón-Rodríguez, Diego López-Guerra, Noelia De Armas-Conde, Isabel Jaén-Torrejimeno, Adela Rojas-Holguín, María Ángeles Santiago-Triviño, Gerardo Blanco-Fernández, Demetrio Pérez-Civantos","doi":"10.1155/joot/1261023","DOIUrl":"10.1155/joot/1261023","url":null,"abstract":"<p><strong>Background: </strong>The use of livers from donors with expanded criteria, where monitoring the degree of hepatic steatosis (HS) is crucial, has increased in recent years to address the shortage of available grafts. The aim of this study is to evaluate the utility of monitoring regional hepatic oxygen saturation (rSO2) using the INVOS somatic oximeter in the assessment of liver donors.</p><p><strong>Methods: </strong>An observational, longitudinal, and prospective study was conducted of adult patients undergoing liver transplantation at our center between 08/01/2020 and 06/01/2022. We measured rSO2 by placing the sensor on the donor skin and on the liver surface.</p><p><strong>Results: </strong>The rSO2 measurements on the donor skin were obtained in 27 patients (93.1%), while the measurements on the donor liver were taken in 18 patients (62.1%). We found a statistically significant relationship between the rSO2 values measured on the donor liver and the degree of steatosis (<i>p</i> = 0.001). rSO2 values > 57% measured on the donor liver were associated with HS < 30% (S: 92%; E: 75%). Donors with lower preoperative GOT values had statistically significantly higher rSO2 values measured on the skin (<i>p</i> = 0.046).</p><p><strong>Conclusions: </strong>Hepatic rSO2 measurements obtained with the NIRS device in liver donors were associated with relevant donor graft characteristics, particularly the degree of HS.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"1261023"},"PeriodicalIF":1.5,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13282552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296838","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":"Structured Multidisciplinary Care for Clinically Complex Kidney Transplant Recipients: A 12-Month Single-Center Cohort on Multidimensional Outcomes.","authors":"Beatriz Rodríguez Cubillo, Maria Ángeles Moreno de la Higuera, Aurora Viloria Jimenez, Rocío Fernández Díaz, Daniel Parra Corral, Paula Gutiérrez Sanjuan, Virginia López de la Manzanara, Diana Gimeno Álvarez, Pilar Matía, María Gemma Hernández Núñez, María Rosario Pino, Miguel Archanco Olcese, Patricia Fuente Lozoya, Laura Lopez Gonzalez, Natividad Calvo Romero, Isabel Pérez Flores, Arianne Aiffil Maneses, Ana Isabel Sánchez Fructoso","doi":"10.1155/joot/4688022","DOIUrl":"10.1155/joot/4688022","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplant recipients with high clinical complexity often face persistent symptom burden, emotional distress, and reduced quality of life despite stable graft function. Evidence for structured multidisciplinary programs tailored to this population remains scarce.</p><p><strong>Methods: </strong>We conducted a 12-month, single-center implementation cohort study including 73 kidney transplant recipients classified as complex using NECPAL criteria or presenting significant emotional distress. Participants were enrolled in a coordinated, person-centered multidisciplinary program integrating nephrology, psychology, palliative care, nutrition, rehabilitation, nursing, and social work. Outcomes were assessed at baseline and Months 1, 3, 6, 9, and 12 using validated instruments: ESAS-r (symptom burden), DME (emotional distress), GES (spiritual well-being), and SF-12 (health-related quality of life). Global adaptation was defined as improvement in ≥ 2 of 3 domains (symptom burden, emotional distress, and spirituality). Qualitative data from open-ended responses were thematically analyzed.</p><p><strong>Results: </strong>Over follow-up, participants showed reductions in symptom burden (ESAS-r: 35.27 to 18.60), emotional distress (DME: 12.53 to 6.57), and increases in spiritual well-being (GES: 17.21-20.12), with improvements in SF-12 general health, emotional health, and social functioning. Global adaptation was achieved by 43.9% of patients, most within 3 months. Patients with ≥ 4 NECPAL criteria exhibited the most pronounced multidimensional gains. Emotional coping emerged as the strongest predictor of improvement. Qualitative analysis revealed unreported symptoms, resilience strategies, and existential reframing.</p><p><strong>Conclusions: </strong>Implementation of a structured multidisciplinary model, combined with early complexity screening, was feasible and associated with longitudinal improvements across physical, emotional, spiritual, and functional domains in complex kidney transplant recipients. These preliminary findings suggest potential benefit-particularly for those with highest baseline vulnerability-and support the need for validation in multicenter, controlled studies.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"4688022"},"PeriodicalIF":1.5,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296831","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":"Living Donor Intestinal Transplant: Indication, Techniques, Surgical Complications, and Outcomes in Recipients and Donors: A Systematic Review.","authors":"Adil Nusair, Saad Bin Yousuf, Ahmed Adham R Elsayed, Marc D Basson","doi":"10.1155/joot/4030621","DOIUrl":"10.1155/joot/4030621","url":null,"abstract":"<p><strong>Background: </strong>Living donor intestinal transplantation (LDITx) is an alternative option to cadaveric transplants as a last resort in treating intestinal failure. There are limited data on LDITx outcomes. This systematic review evaluates LDITx in terms of indications, contraindications, surgical complications, and patient outcomes.</p><p><strong>Methods: </strong>A comprehensive search was conducted across PubMed, Cochrane Library, Virtual Health Library, and Web of Science databases following the PRISMA guidelines. After filtration, data were systematically extracted from all relevant observational studies, case series, and case reports. Quality assessments were performed using the CARE guideline for case reports and case series, while STROBE was used for observational studies.</p><p><strong>Results: </strong>Fifty-four studies were included, comprising 11 observational studies, 9 case series, and 34 case reports. The main indications of LDITx were the availability of a compatible donor and the urgency of the recipient's clinical condition. The standard surgical technique involves segmental ileal resection and transplantation. Postoperative complications included infections, ischemic events, and vascular complications. Recipients had either manageable complications or no complications. About 21.2% of the population experienced at least one episode of rejection, with an overall mortality rate of 23%. Many cases reported successful TPN weaning and good outcomes for the recipients and donors.</p><p><strong>Conclusion: </strong>In patients with chronic IF complicated by severe TPN-related morbidity or underlying pathologies causing SBS, LDITx represents an effective treatment option and an alternative to the more conventional cadaveric intestinal transplantation, bypassing problematic time sensitivity and donor availability.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"4030621"},"PeriodicalIF":1.5,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200419","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":"Safe and Early Primary Closure of Open Abdomen in Pediatric Liver Transplantation Using a Doppler-Guided Tension Relief Strategy and Enhanced Wound Environment.","authors":"Michael Gurevich, Tomer Mendelson, Haya Fischer, Elhanan Nahum, Avichai Weissbach, Yael Glassberg Mozer, Orith Waisbourd-Zinman, Sigal Aizner, Eviatar Nesher, Moris Topaz","doi":"10.1155/joot/9317796","DOIUrl":"10.1155/joot/9317796","url":null,"abstract":"<p><p>Pediatric liver transplantation (LT) with large-for-size (LFS) grafts frequently necessitates open abdomen (OA) management due to donor-recipient graft size mismatch, increasing the risk of delayed closure and frequently requires the use of permanent prosthetic materials, together compounding the risk of postoperative infection. This study evaluates the safety and effectiveness of the Topaz-Gurevich Doppler-guided controlled-closure technique (DGCT) in facilitating early primary abdominal closure without graft size reduction or the use of permanent prosthetic implants. A retrospective review was conducted at Schneider Children's Medical Center (2016-2024), including 21 pediatric LT recipients requiring OA management, primarily due to LFS grafts. DGCT integrates a tension relief system (TRS) for gradual abdominal wall approximation, guided by real-time Doppler ultrasound to monitor perfusion and modulate closure tension, and is complemented by regulated, oxygen-enriched irrigation and negative pressure-assisted wound therapy to optimize the local wound environment. All patients achieved primary abdominal closure within a median of 8 days (range, 2-23); only the first three cases required the temporary use of prosthetic materials. The median PICU and hospital stays were 17 and 35 days, respectively. No cases of graft failure, retransplantation, or mortality occurred. One patient developed sepsis related to a bowel leak and fully recovered. DGCT proved safe and effective in managing OA in pediatric LT, avoiding permanent prosthetic implantation, and enabling early closure while maintaining graft perfusion. Its combined approach of mechanical tension control and enhanced local wound conditions reduces the need for graft size reduction, minimizes infection risk, and may broaden the donor pool. Based on high-risk cases involving immunosuppressed children with significant graft-recipient mismatch, these findings support DGCT as a valuable strategy for pediatric transplantation. Moreover, the principles demonstrated here may be extrapolated to the closure of complex OA scenarios across broader pediatric and adult surgical populations.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"9317796"},"PeriodicalIF":1.5,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200426","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":"Evaluation of Liver Transplantation Outcomes Using Grafts From Brain-Dead Donors With Warfarin-Associated Coagulopathy.","authors":"Behrouz Seydi Majd, Mohammad Mehdi Lashkarizadeh, Alireza Shamsaeefar, Saman Nikeghbalian, Hamid Zaferani Arani, Sahar Sohrabi Nazari, Seyyed Mohammad Sadegh Ahmadi Rashti, Ahmad Khalid Sanaei, Hamed Nikoupour","doi":"10.1155/joot/8367205","DOIUrl":"10.1155/joot/8367205","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation is the definitive therapy for end-stage liver disease. The severe organ shortage necessitates exploring grafts from extended-criteria donors, including those who become brain dead due to toxicological causes. This study evaluated the outcomes of liver transplantation using grafts from brain-dead donors with confirmed warfarin-associated coagulopathy (WAC).</p><p><strong>Methods: </strong>This retrospective observational cohort study was conducted at a high-volume transplant center (1994-2024). Ten recipients who received liver grafts from brain-dead donors with WAC were included. Clinical data were reviewed to assess liver function recovery, complications, and survival.</p><p><strong>Results: </strong>The cohort included 10 recipients (8 males, 2 females; mean age: 49.8 ± 13.2 years). Liver function tests and international normalized ratio (INR) levels showed significant improvement by Postoperative day 7. Acute rejection occurred in two recipients (20%), successfully treated with corticosteroids. One patient (10%) developed primary nonfunction, leading to death. Patient survival was 100% at 30 days and 70% at 1 year; corresponding graft survival was 90% and 70%.</p><p><strong>Conclusion: </strong>In this small, highly selected cohort, liver grafts from brain-dead donors with WAC may be used with acceptable short-term safety. These preliminary findings demonstrate feasibility and highlight the need for larger, controlled studies to further evaluate outcomes and donor selection criteria.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"8367205"},"PeriodicalIF":1.5,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200417","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":"A Qualitative Study of Cytomegalovirus Awareness and Experience in Kidney Transplant Recipients.","authors":"Afolarin A Otunla, Ailey McLeod, Katie Gilchrist, Cecilia Vindrola-Padros, Reza Motallebzadeh","doi":"10.1155/joot/1290788","DOIUrl":"10.1155/joot/1290788","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the experiences of CMV among kidney transplant recipients in a single transplant centre, focusing on their awareness of CMV, the impact of the disease on their quality of life, and their perceived effectiveness of anti-CMV therapy.</p><p><strong>Subjects/patients or materials and methods: </strong>We carried out semistructured interviews with 50 adult recipients who had undergone kidney transplantation within the last two years in our centre. Participants were divided into those who had experienced CMV (CMV group, <i>n</i> = 25) and those who had not (non-CMV group, <i>n</i> = 25). Data were collected and analysed using inductive qualitative methods, with embedded quantitative descriptive analysis.</p><p><strong>Results: </strong>Awareness of CMV was low, particularly among those who had not experienced the virus. 32% (<i>n</i> = 8) of the non-CMV group were aware of CMV, compared to 88% (<i>n</i> = 22) in the CMV group (<i>p</i> < 0.001). Most CMV-affected participants (78%) reported no symptoms, and the impact on mood and social life was minimal. CMV treatments were rated highly effective, with a preference for pre-emptive management. There was a strong consensus on the need for better patient education about CMV, with suggestions for more direct communication through healthcare professionals.</p><p><strong>Conclusion: </strong>This study is the first to provide a comprehensive evaluation of CMV awareness and management from the perspective of kidney transplant recipients in the UK. We highlight a significant gap in CMV awareness among kidney transplant recipients, emphasizing the need for improved educational efforts. Enhanced patient education, particularly through multimedia patient educational tools, could bridge the knowledge gap and ensure better management of CMV in this population. These insights are vital for shaping future patient care strategies and could significantly impact clinical practice, particularly in post-transplant care.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"1290788"},"PeriodicalIF":1.5,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043824","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":"Clinical Utility of Postoperative Day 1 Technetium-99m Mercaptoacetyltriglycine Scintigraphy for Early Assessment of Graft Function in Living Donor Kidney Transplant Recipients.","authors":"Shun Nakazawa, Yoshitaka Sekine, Yusuke Tsuji, Takanori Shimizu, Mai Onose, Yuta Maeno, Azusa Kanayama, Tatsuhiro Sawada, Akira Ohtsu, Yoshiyuki Miyazawa, Yuji Fujizuka, Seiji Arai, Masashi Nomura, Hidekazu Koike, Hiroshi Matsui, Motoaki Hatori, Toshiyuki Tanaka, Kazuhiro Suzuki","doi":"10.1155/joot/4619384","DOIUrl":"10.1155/joot/4619384","url":null,"abstract":"<p><strong>Background: </strong>At our institution, 99mTc-MAG3 renal scintigraphy is routinely performed preoperatively in living kidney donors and on postoperative Day 1 in recipients. Given the interindividual variability in MAG3 clearance, we hypothesized that postoperative MAG3 clearance could serve as an early indicator of renal graft function. In addition, we explored whether the donor-to-recipient clearance ratio (M-ratio) provides supplemental clinical value. Early identification of such indicators of graft function is essential for optimizing postoperative management and improving outcomes.</p><p><strong>Methods: </strong>This retrospective study analyzed 52 living donor kidney transplants performed between October 2009 and May 2024. Associations were examined between donor and recipient MAG3 clearance values, the M-ratio (elevated ≥ 1.5 vs decreased/stable < 1.5), donor/recipient age and sex, T1/2 pattern (good excretion ≤ 20 min vs delayed > 20 min or unmeasurable), total ischemic time, graft weight, dialysis duration, and estimated glomerular filtration rate (eGFR) at 1 week and 1-12 months postoperatively. Variables with <i>p</i> < 0.05 in univariate analysis entered multivariate regression.</p><p><strong>Results: </strong>Univariate analysis showed that recipient MAG3 clearance, the M-ratio, donor and recipient age, T1/2 (up to 1 month), and graft weight (at 1 week) were significantly associated with graft function. In contrast, donor MAG3 clearance was not correlated with postoperative renal function. In multivariate analysis, recipient MAG3 clearance, recipient age, and graft weight remained independently associated with early graft function, whereas the M-ratio lost significance.</p><p><strong>Conclusions: </strong>Recipient MAG3 clearance on postoperative Day 1 is a practical, noninvasive indicator of renal graft function, while donor clearance and the M-ratio are not independently associated with postoperative outcomes.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"4619384"},"PeriodicalIF":1.5,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036197","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":"Leveraging Longitudinal Data to Sustain the Impact of Organ Donation Training: A Data Science Approach to Quality Monitoring.","authors":"Omid Ghobadi, Nasrin Taherkhani, Roghaye Khasha, Ehsan Radi, Mahdi Shadnoush, Katayoun Najafizadeh","doi":"10.1155/joot/8851596","DOIUrl":"10.1155/joot/8851596","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of training organ donation teams in improving organ donation rates has been well established. However, studies have shown that this impact is often temporary and diminishes without ongoing support and quality control programs. This study aimed to evaluate the effects of initial training and the role of a structured quality control program in sustaining these improvements in Iran's organ procurement units (OPUs).</p><p><strong>Method: </strong>A comprehensive training program, the Iranian OPUs Supporting System (IrOSS), was developed and implemented with the participation of 25 OPUs. Their organ donation (PMP) rates were recorded at baseline and monitored every 3 months for 6 months posttraining. Later, a quality control initiative, the Iranian OPUs Quality Control System (IrOQS), was introduced in 15 of these units. Through periodic assessments, weaknesses were identified and addressed via targeted interventions such as strategy improvements and retraining. The remaining 10 units served as a control group. PMP was reevaluated 3 and 6 months after the initial IrOQS implementation, with a final assessment 3 months after the second round. Longitudinal data were analyzed using advanced statistical techniques, including repeated-measures ANOVA, difference-in-differences (DiD), linear mixed-effects models (LMMs), trajectory analysis, and change point detection.</p><p><strong>Results: </strong>The mean PMP across all 25 OPUs increased from 5.31 before training to 8.05 six months after training. In the intervention group, the mean PMP increased to 13.06 after the first IrOQS phase, decreased to 9.84 over the next 6 months, and increased again to 15.6 after the second IrOQS phase. In contrast, while the control group showed an initial increase after training, their PMP gradually decreased over time. Statistical analyses showed that the initial training had a significant positive effect on performance, but these improvements were not sustained without repeated interventions. Path analyses also showed that units with lower initial performance responded most positively to training but tended to regress if retrained.</p><p><strong>Conclusion: </strong>The findings of this study suggest that initial training programs can lead to significant improvements in PMP. However, to maintain these gains, regular implementation of ongoing training programs is essential. Data science approaches and longitudinal data analysis can play a critical role in identifying performance patterns in the quality management of OPUs.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2026 ","pages":"8851596"},"PeriodicalIF":1.5,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017891","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}