Experimental and Clinical Transplantation最新文献

{"title":"Sequential Kidney-First Retrieval and Early Graft Outcomes in Deceased Donor Kidney Transplantation: A Paired-Donor Comparative Cohort Study.","authors":"Sanjay Kolte, Pranjal Kashiv, Akshay Kriplani, Chandrakant Munjewar, Amol Bhawane, Prakash Khetan, Ashwini Kumar Khandekar, Nishant Deshpande, Amit Pasari, Manish Balwani","doi":"10.6002/ect.2026.0219","DOIUrl":"https://doi.org/10.6002/ect.2026.0219","url":null,"abstract":"<p><strong>Objectives: </strong>Prolonged cold ischemia is a principal modifiable determinant of delayed graft function after deceased donor kidney transplant. In conventional multiorgan procurement, kidneys are removed last, prolonging ischemic exposure, a problem magnified in resource-constrained programs. We assessed whether retrieving 1 kidney first, from a heart -beating donor before aortic cross -clamping, improves early graft outcomes.</p><p><strong>Materials and methods: </strong>This retrospective paired-donor cohort study included 88 adult recipients of kidneys from 44 brain dead donors at collaborating centers in central India between January 2018 and December 2024. Group 1 (n = 44 ) received kidney retrieved first, before aortic clamping; group 2 (n = 44 ) received kidney retrieved last, after procurement of thoracic and remaining abdominal organs. Primary outcomes analyzed were cold ischemia time, delayed graft function, retrieval injury, and posttransplant hemodialysis. Secondary outcomes were first -hour urine output, day 8 serum creatinine, complications, graft loss, and mortality. We used multivariable logistic regression analyses to identify predictors of graft dysfunction.</p><p><strong>Results: </strong>Cold ischemia time was shorter in group 1 than in group 2 (78.4 ± 48.37 vs 299.4 ± 108.65 min; P <.001 ). Group 1 recipients had higher first -hour urine output (374.2 ± 208.62 vs 186.1 ± 124.92 mL;P < .001 ), lower day 8 serum creatinine (1.3 ± 0.8 vs 3.1 ± 2.83 mg /dL; P < .001 ), lesser delayed graft function requiring hemodialysis (9.1 %vs 36.4 %; P = .002 ), and fewer retrieval injuries and posttransplant complications (6.8% vs 38.6 %; P < .001 ). Comparable advantages were observed among recipients of kidneys from expanded criteria donors. Retrieval of the kidney last independently predicted delayed graft function (adjusted odds ratio 3.92; 95 % CI, 1.41-10.87; P = .008 ).</p><p><strong>Conclusions: </strong>Kidney -first retrieval markedly shortened cold ischemia time and improved early graft function and retrieval safety without compromising procurement of other organs and proved to be a pragmatic ischemia -minimization strategy.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 9","pages":"707-715"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Body Mass Index Cutoffs: Donor Quality and Ischemic Burden Shape Kidney Transplant Outcomes in Recipients With Severe Obesity: An Analysis of the Scientific Registry of Transplant Recipients Dataset.","authors":"Rajeev Sharma, Alok Kumar Dwivedi","doi":"10.6002/ect.2026.0093","DOIUrl":"https://doi.org/10.6002/ect.2026.0093","url":null,"abstract":"<p><strong>Objectives: </strong>Obesity remains a common barrier to kidney transplant access, but the clinical relevance of severe obesity depends on donor and ischemic risk.</p><p><strong>Materials and methods: </strong>We analyzed Scientific Registry of Transplant Recipients aggregate summary tables for deceased donor kidney transplants performed in the United States from January 1, 2014, to December 31, 2024, stratified by recipient body mass index (calculated as weight in kilograms divided by height in meters squared) of <35, 35 to 40, and >40. Primary outcomes measured were graft survival and delayed graft function. We compared delayed graft function across body mass index groups using X²test and evaluated graft and patient survival by using Kaplan-Meier estimates from the Scientific Registry of Transplant Recipients.</p><p><strong>Results: </strong>Among 180,849 transplants (131,379 donation after brain death recipients and 49,470 donation after circulatory death recipients), delayed graft function increased stepwise across the body mass index groups (29.3%, 37.8%, and 42.4%; P < .001). Compared with body mass index <35, the 35 to 40 (odds ratio 1.46; 95% CI, 1.42-1.51) and >40 (odds ratio 1.77; 95% CI, 1.65-1.90) body mass index groups were associated with higher odds of delayed graft function. In donation after brain death recipients, 5-year graft survival declined from 77.51% to 74.33% and to 70.03% across ascending body mass index strata. Lower graft survival with higher body mass index persisted across Kidney Donor Profile Index, donor age, and cold ischemia time.</p><p><strong>Conclusions: </strong>Higher recipient body mass index was associated with substantially increased risk of delayed graft function and decreased graft survival after deceased donor kidney transplant. The adverse association appeared strongest when obesity coexisted with less favorable donor or ischemic characteristics, sup-porting individualized donor-recipient risk stratification rather than stand-alone body mass index exclusion thresholds.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 9","pages":"676-682"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Prevalence of Oxford MEST-C Lesions in Immunoglobulin A Nephropathy of Kidney Allografts: A Single-Center Study from Viet Nam.","authors":"Kinh Luan Thai, Ngoc Thu Nguyen La, Tien Dat Hoang, Nguyen Xuong Duong, Tuan Thanh Nguyen, Sung Shin, Tiong Ho Yee, Khac Chuan Hoang, Xuan Thai Ngo, Minh Sam Thai","doi":"10.6002/ect.2025.0315","DOIUrl":"https://doi.org/10.6002/ect.2025.0315","url":null,"abstract":"<p><strong>Objectives: </strong>We evaluated the clinical characteristics, Oxford 2016 histopathology features, and short-term outcomes of Immunoglobulin A nephropathy in kidney transplant recipients at Cho Ray Hospital, Ho Chi Minh City, Viet Nam.</p><p><strong>Material and methods: </strong>This retrospective, descriptive study included kidney transplant recipients with biopsy -proven immunoglobulin A nephropathy in kidney allografts identified in 2022. We analyzed patient death with a functioning graft as a competing event and not classified as graft failure.</p><p><strong>Results: </strong>Immunoglobulin A nephropathy was present in 27.1 % (19/70 ) of allograft biopsies. Most recipients were male (73.7 %) and received grafts from living related donors (17 /19, 89.4 % ). The mean time from transplant to immunoglobulin A nephropathy diagnosis was 5.2 years. Median follow -up after biopsy was 48 weeks. Three components of the Oxford MEST -C were frequently observed, that is, mesangial hypercellularity M1 (73.7 % ), segmental glomerulosclerosis S1 (78.9 % ), and cellular /fibrocellular crescents C1 (26.3 % ). At the end of follow -up, 68.4 % of patients maintained graft function, 15.8 % required hemodialysis, and 10.5 % died from nonrenal causes with functioning grafts.</p><p><strong>Conclusions: </strong>Immunoglobulin A nephropathy was frequently observed in our patient cohort; however, the inability to distinguish recurrent disease from de novo disease fundamentally limited interpretation of the histopathology patterns. Moreover, given the short -term and multifactorial nature of the outcomes, together with the limitations of the Oxford MEST -C in the allograft setting, the independent prognostic significance of these lesions remains uncertain and requires further validation through larger prospective studies.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 9","pages":"699-706"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Independent Risk Architecture of 7-Day Graft Loss After Adult Simultaneous Pancreas-Kidney Transplantation: A National Registry Analysis.","authors":"Sohail Khan, Hannah Cohen, Dayanna Zuluaga, Quentin Palone, Katherine Connors, Yang Yu, Giovanni Faddoul, Meng-Hao Li, Naoru Koizumi, Jorge Ortiz","doi":"10.6002/ect.2026.0110","DOIUrl":"https://doi.org/10.6002/ect.2026.0110","url":null,"abstract":"<p><strong>Objectives: </strong>Seven -day graft loss after simultaneous pancreas -kidney transplant remains incompletely characterized. This retrospective registry analysis examined the incidence, etiologies, and predictors of 7 -day graft loss after simultaneous pancreas -kidney transplant.</p><p><strong>Materials and methods: </strong>We analyzed all adult deceased donor simultaneous pancreas -kidney transplant recipients from the Organ Procurement and Transplantation Network (2015 -2024 ). We compared recipients who had 7 -day graft loss (ie, pancreas graft failure, kidney graft failure, or death within 7 postoperative days [non -death -censored ] ) with recipients who had achieved at least 1 -year dual -graft survival. We used multivariable logistic regression to identify predictors.</p><p><strong>Results: </strong>Among 6362 recipients, 304 (4.8 % ) experienced 7 -day graft loss. Pancreas graft failure predominated (94.4 % vs 12.5 %; P < .001 ), followed by kidney graft failure (32.2 % vs 12.4 %; P < .001 ). Thrombosis was the leading etiology, followed by primary nonfunction. Twenty-four recipients lost both allografts simultaneously; all 16 deaths within the 7 -day analysis period occurred within this subset. In a model restricted to recipients with pretransplant C -peptide values, body mass index (calculated as weight in kilograms divided by height in meters squared ) ≥30 (odds ratio 1.747; P = .001 ), donor hypertension (odds ratio 1.767; P = .035 ), male sex (odds ratio 0.699; P = .005 ), and each 0.1 ng /mL C -peptide decrement (odds ratio 1.006; P = .029 ) independently predicted 7 -day graft loss. Dialysis vintage predicted simultaneous dual -graft failure and early death.</p><p><strong>Conclusions: </strong>Seven -day graft loss complicated nearly 1 in 20 simultaneous pancreas -kidney transplant procedures. These predictors constitute actionable targets for preoperative risk stratification and donor -recipient matching.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"626-639"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretransplant Donor-Specific Antibody Levels Stratification and Early Kidney Transplant Outcomes with Predominant Antithymocyte Globulin Induction.","authors":"Nihal Mohammed Sadagah, Muhammad Abdul Mabood Khalil, Hinda Hassan Khider Mahmood, Alfatih Abdalla Altom, Maram Majid Alsharif, Yara Faisal Alqurashi, Zeyad Adel Alsaedi, Aileen Jean Dela Cruz, Ghaleb Anas Aboalsamh, Salem H Al Qurashi","doi":"10.6002/ect.2026.0001","DOIUrl":"https://doi.org/10.6002/ect.2026.0001","url":null,"abstract":"<p><strong>Objectives: </strong>The impact of preformed donor -specific antibodies after kidney transplantation in Middle Eastern populations remains unclear. Here, we evaluated the association between pretransplant donor -specific antibody levels and early outcomes after kidney transplant and aimed to identify predictors of high -level donor -specific antibodies in a predominantly antithymocyte globulin -induced cohort.</p><p><strong>Material and methods: </strong>This retrospective study included 260 kidney transplant recipients (2021 -2024 ) at a single center in Saudi Arabia. We stratified patients by pretransplant donor -specific antibody level: none, low -level ( <1000 mean fluorescence intensity ), and high -level (≥1000 mean fluorescence intensity ).</p><p><strong>Results: </strong>Among 260 transplant recipients, 151 (58 % ) had pretransplant donor-specific antibodies (3.8 % had acute rejection, 4.6 % had graft loss, 3.1 % had mortality ). In multivariable analysis, recipients with median age 48.0 years (interquartile range, 35.0-61.5 y ) had higher HLA mismatches, and use of antithymocyte globulin induction was independently associated with high -level donor -specific antibodies. In multivariable Cox regression, HLA mismatches (hazard ratio 1.32; 95 % CI, 1.06 -1.65; P = .013 ), impaired graft function at 4 months (estimated glomerular filtration rate <60 mL /min /1.73 m ²; hazard ratio 6.09; 95 % CI, 2.14 -17.33; P = .001 ), and pretransplant diabetes (hazard ratio 3.25; 95 % CI, 1.01 -10.44; P = .048 ) were independent predictors of a composite outcome of acute rejection, graft loss, or death. Having pretransplant donor -specific antibodies, including high levels, was not independently associated with adverse outcomes (P = .85 ). High -level donor-specific antibodies showed a trend toward lower early survival, although no independent association was detected, and the study may have been underpowered to identify modest effects.</p><p><strong>Conclusions: </strong>Pretransplant donor -specific antibodies were common, with high levels correlating with broader sensitization. However, early graft dysfunction and HLA mismatches had a greater effect on adverse outcomes than preformed donor -specific antibodies. Widespread use of antithymocyte globulin -based induction may have mitigated the immunologic risk of donor -specific antibodies, contributing to favorable early graft and patient outcomes.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"608-618"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Ischemic Cholangiopathy After Liver Transplantation From a Deceased Donor With Situs Inversus Totalis: A Case Report.","authors":"Raphael P H Meier, Kasra Shirini, Massimo Arcerito, Jeffrey Hirsch, Josue Alvarez-Casas, Chandra S Bhati","doi":"10.6002/ect.2026.0180","DOIUrl":"10.6002/ect.2026.0180","url":null,"abstract":"<p><p>Situs inversus totalis is a rare congenital anomaly in which the thoracic and abdominal viscera are arranged in mirror image. The use of liver grafts from deceased donors with situs inversus totalis is a challenge because of the profound anatomical and technical variations that complicate implantation. Approximately 11 such transplants have been reported worldwide. Here, we present a case of orthotopic liver transplant in a 66 -year -old man with hepatitis C -related cirrhosis and hepatocellular carcinoma in which the graft was from a 17 -year -old deceased donor with situs inversus totalis. The graft, which displayed mirror -image hilar anatomy, was implanted with a modified piggyback technique, orienting the donor right lobe anteriorly; direct duct -to -duct biliary reconstruction was performed. Graft function was preserved through most of the first postoperative year, after which the patient developed progressive cholestasis and diffuse biliary strictures. Allograft biopsies demonstrated ischemic changes of the bile ducts and parenchyma consistent with ischemic cholangiopathy in the absence of hepatic arterial thrombosis, without evidence of acute rejection but potential features of subtle chronic rejection. The patient was not a candidate for retransplant and died 14 months after transplant. This case illustrates a technically successful situs inversus totalis donor graft that was complicated by late, diffuse, and irreversible biliary obstruction.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"654-658"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Autotransplant With Ex Vivo Repair for Bilateral Renal Artery Aneurysm: Case Report.","authors":"Maria Irene Bellini, Giovanni Tomasello, Giacomo Urso, Riccardo Chiodo, Domenico Bartolomeo, Alessandra Chiodo, Francesco Carini, Vito D'Andrea","doi":"10.6002/ect.2026.0121","DOIUrl":"10.6002/ect.2026.0121","url":null,"abstract":"<p><p>Renal artery aneurysm is a rare vascular condition that could remain silent or could lead to potential life -threatening consequences, especially when there are multiple lesions. Endovascular treatment and open in situ surgical reconstruction are often considered first -line options, although not always feasible or durable. We report the case of a successful kidney autotransplant in a 56 -year -old female patient who had bilateral multiple renal artery aneurysms with calcified walls and parietal thrombotic apposition. Given the history of hypertension and the risks related to aneurysm rupture, the patient underwent laparoscopic nephrectomy followed by ex situ repair and heterotopic graft reimplant. We also compared our approach with the literature to report on the current evidence and the recommended management for renal artery aneurysms.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"659-661"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Laboratory Outcomes in Biliary Atresia: Insights from the Shiraz Pediatric Liver Cirrhosis Cohort.","authors":"Nasrin Motazedian, Amirali Mashhadiagha, Alireza Shamsaeefar, Mehrab Sayadi, Arshin Ghaedi, Kimia Solouki Mootab, Matin Varmazyar, Seyed Mohsen Dehghani, Maryam Ataollahi, Seyed Ali Malekhosseini","doi":"10.6002/ect.2025.0282","DOIUrl":"https://doi.org/10.6002/ect.2025.0282","url":null,"abstract":"<p><strong>Objectives: </strong>Biliary atresia is a progressive cholangiopathy in neonates leading to liver failure and often requiring liver transplant. Although surgical interventions like the Kasai portoenterostomy offer temporary relief, the disease continues to be the leading cause of liver transplant. This study aimed to evaluate the demographic, clinical, and laboratory characteristics of these patients and the effects of these characteristics on outcomes.</p><p><strong>Materials and methods: </strong>This cohort study included 167 pediatric patients (aged <18 years ) with confirmed biliary atresia, selected from the Shiraz Pediatric Liver Cirrhosis Cohort Study between 2018 and March 2024. We analyzed data collected from the pediatric liver cirrhosis registry and assessed patient outcomes by comparing survivors versus those who did not survive.</p><p><strong>Results: </strong>Among the 167 patients, 86 (51.5 % ) died and 81 (48.5 % ) survived. Those who died were significantly younger at enrollment (15.47 vs 36.31 months old ) and had higher internal normalized ratio, prolonged partial thromboplastin time, and elevated liver enzymes compared with survivors. The Kasai portoenterostomy was performed in 77.8 % of patients, with no significant difference in its distribution between survivors and patients who did not survive.</p><p><strong>Conclusions: </strong>Although most children had a Kasai surgery and over one - third had a liver transplant, a significant number did not survive. To improve outcomes for children with biliary atresia, better perioperative and postoperative care, aggressive treatment of liver dysfunction, and robust nutritional support are essential.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"640-646"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Considerations for Kidney Transplant in Simultaneous Versus Sequential Heart-Kidney Transplant: A Systematic Review.","authors":"Rajeev Sharma, Nasir Khan","doi":"10.6002/ect.2026.0080","DOIUrl":"10.6002/ect.2026.0080","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to answer a key kidney-focused question in simultaneous heart-kidney transplant of whether the kidney should be implanted immediately, staged after short-term stabilization, or deferred to sequential kidney-after-heart transplant.</p><p><strong>Materials and methods: </strong>We used PRISMA to guide our systematic review using PubMed as the primary database, with supplementary Embase and Cochrane searches and separate review of current Organ Procurement and Transplant Network policies. PubMed was searched on March 21, 2026, using ( ( (heart -kidney transplant) OR (sequential kidney transplant in heart transplant) ) OR (simultaneous heart and kidney transplant) ), limited to English, humans, adult: 19+ years, MEDLINE, and January 1, 2006, through March 21, 2026. Our review yielded 303 records; 62 abstracts underwent review, of which 26 were selected for full- text review. Embase search yielded 264 records across 7 targeted searches; 14 studies underwent review, of which 7 were duplicates and 7 unique studies underwent full-text review. No Cochrane record met final inclusion criteria. Two Organ Procurement and Transplant Network policy reports were reviewed separately. Final qualitative synthesis included 35 full-text records.</p><p><strong>Results: </strong>Simultaneous heart-kidney transplant was most consistently supported in dialysis-dependent recipients and in recipients with severe, likely irreversible renal dysfunction. Kidney delayed graft function occurred in approximately one-fourth to one-third of simultaneous heart-kidney transplant recipients and was associated with worse patient and kidney graft survival. Primary nonfunction, early kidney graft loss, and renal allograft futility were highly consequential, especially in hemodynamically fragile and surgically complex recipients. Comparative studies suggested that sequential kidney-after-heart transplant is a reasonable strategy when renal reversibility is uncertain or when the postsurgery heart transplant environment is hostile to renal graft perfusion.</p><p><strong>Conclusions: </strong>Simultaneous allocation should be distinguished from simultaneous implantation. In selected recipients, staged or sequential kidney transplant may better protect kidney outcomes and better align with utility, justice, and organ stewardship.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"579-588"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Emergency Department Professionals' Knowledge and Attitudes Toward Approaching Brain Death and Potential Organ Donor Recognition: A Cross-Sectional Survey.","authors":"İrem Aydoğmuş, Eralp Çevikkalp","doi":"10.6002/ect.2026.0063","DOIUrl":"10.6002/ect.2026.0063","url":null,"abstract":"<p><strong>Objectives: </strong>Early identification of potential organ donors is essential for expanding the donor pool. Although brain death is typically diagnosed in intensive care units, the recognition of patients with imminent brain death should begin earlier, particularly in the emergency department. In this study, we aimed to evaluate the knowledge and attitudes of emergency department professionals regarding brain death, with a specific focus on the early recognition of imminent brain death.</p><p><strong>Materials and methods: </strong>This cross -sectional study was conducted among emergency department health care professionals. We used a structured questionnaire to assess participants' knowledge and attitudes on imminent brain death and potential donor recognition.</p><p><strong>Results: </strong>Among 104 emergency department professionals who participated in the study, 82 participants (78.8 % ) considered brain death diagnosis medically reliable, but important knowledge gaps were identified. Only 42 participants (40.4% ) correctly identified the components of the FOUR score (eye response, motor response, brainstem reflexes, and respiration ), with residents showing significantly lower proficiency versus specialists (9.1 % vs 59.3 %; P < .001 ). Institutional training exposure was alarmingly low at 11.5 %, compared with much higher rates reported in other reports on intensive care. Only 18 participants (17.3 % ) were aware of an emergency department -specific protocol for severe brain injury, and only 22 participants (21.2 % ) reported early involvement of organ transplant coordinators. Prior experience in brain death declaration was a significant predictor of higher trust (83.3 % vs 77.5 %; P = .023 ) ) and protocol awareness (33.3 % vs 12.5 %; P = .049 ).</p><p><strong>Conclusions: </strong>Emergency departments represent the first point of contact for patients who may progress to brain death. Recognition of imminent brain death must begin in the emergency department to enable timely identification and referral. Targeted training programs and the development of emergency department -focused protocols may improve early donor recognition and contribute to expanding the donor pool.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 8","pages":"647-653"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}