Experimental and Clinical Transplantation最新文献

{"title":"AI-Driven Optimization of Kidney Allocation: Enhancing Precision in Donor-Recipient Matching.","authors":"Morteza Okhovvat, Saeid Amirkhanlou, Naser Simforoosh, Fatemeh Poor-Reza Gholi, Sedigheh Sadat Erfani","doi":"10.6002/ect.MESOT2025.O25","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.O25","url":null,"abstract":"<p><strong>Objectives: </strong>The growing demand for kidney transplant amid persistent organ scarcity demands improved donor -recipient compatibility assessment. Traditional allocation systems relying on rigid scoring fail to capture complex multidimensional data affecting posttransplant outcomes like graft rejection and delayed graft function. Artificial intelligence offers transformative potential through predictive analytics and adaptive learning. This study introduces OkAP, an AI -based system designed to enhance kidney transplant matching efficiency and accuracy by integrating clinical, genetic, and socioeconomic variables for dynamic, equitable decision -making.</p><p><strong>Materials and methods: </strong>We developed a novel AI framework employing 5 machine learning architectures (artificial neural networks, support vector machines, random forests, deep learning, and Bayesian belief networks ) that have been benchmarked across synthetic and real -world transplant registry datasets. We used a proprietary ranking algorithm to dynamically prioritize recipients based on multidimensional variables, including HLA compatibility, immunological risk, and geographic equity.</p><p><strong>Results: </strong>The deep learning model achieved 98.7 % mean accuracy across all test environments. The prioritization algorithm improved match precision by 23 % compared with traditional Jaccard similarity metrics. This approach showed a potential to reduce rejection risks, minimize complications, and improve survival rates while enabling adaptation for other organs.</p><p><strong>Conclusions: </strong>The OkAP system successfully addressed limitations of conventional allocation protocols through adaptive, multidimensional compatibility modeling. A 3 -tiered framework ensuring ethical governance, electronic health record interoperability, and multicenter validation will guide clinical implementation. Future federated learning approaches will enable collaborative data sharing while preserving privacy, advancing a patient -centric future for transplant care.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"78-83"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649567","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":"A Tale of Two Strategies: Desensitization and Donor-Specific Antibody-Free Transplant in Highly Sensitized Patients.","authors":"Mohsen Nafar, Fatemeh Poorrezagholi, Mahsa Hosseini Chimeh, Shiva Samavat, Marieh Farrokhy Moghaddam, Fariba Samadian, Ahmad Firuzan, Nooshin Dalili, Amirreza Laripour Tehranfar, Sahand Ameri","doi":"10.6002/ect.MESOT2025.O57","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.O57","url":null,"abstract":"<p><strong>Objectives: </strong>Human leukocyte antigen incompatibility, particularly in broadly sensitized kidney transplant candidates with high calculated panel reactive antibody, poses a significant barrier to transplantation. Two strategies exist: (1 ) virtual crossmatch with a donor -specific antibody -free donor or (2 ) desensitization. We compared immunological risks and posttransplant complications between these 2 approaches.</p><p><strong>Materials and methods: </strong>We retrospectively screened 50 kidney transplant candidates with calculated panel reactive antibody ≥95 %. Donor -specific antibody positivity was defined as mean fluorescence intensity >750. Of 25 participants (13 male; mean age 36.8 ± 14.3 years ), 12 had calculated panel reactive antibody ≥95 % and no donor -specific antibodies (group A ), whereas 13 showed positivity for donor -specific antibodies and underwent desensitization (plasmapheresis, intravenous immunoglobulin, and rituximab with or without bortezomib; group B ). All but 1 patient received living donor transplants. Sensitization included prior transplant (n = 22 ), transfusions (n = 23 ), and pregnancies (n = 7 ).</p><p><strong>Results: </strong>Median follow -up was 18 months, with no significant difference in estimated glomerular filtration rate between groups at any time point (at day of discharge; at 1, 3, 6, 12, 18, and 24 months posttransplant, and at most recent follow -up ). One graft loss occurred in group A due to vascular complications at 5 months. Sixteen biopsies were performed. Four episodes of acute antibody -mediated rejection were observed (1 in group A, 3 in group B; P = .728 ). Posttransplant infections occurred in 7 patients (28 % ), all in group B (P = .005 ), including BK virus (n = 5; P = .039 ) and parvovirus B19 (n = 2 ). Four patients in group A remained on immunosuppression versus none in group B (P = .039 ).</p><p><strong>Conclusions: </strong>In highly sensitized kidney transplant recipients, both virtual crossmatch with donor -specific antibody -free donors and desensitization strategies resulted in comparable short -term graft function. However, desensitized patients showed significantly higher risk of posttransplant infections.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"160-165"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649622","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":"The History of the First Arm Transplant.","authors":"Nadey Hakim","doi":"10.6002/ect.MESOT2025.L12","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.L12","url":null,"abstract":"<p><p></p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"52-56"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649649","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":"Donation After Brain Death: Are There Any Organizational Difficulties?","authors":"Ender Gedik, İshak Yildizhan, Önder Yildirim, Berna Yilmaz, Serhat Özer, Özgür Özel","doi":"10.6002/ect.MESOT2025.P179","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.P179","url":null,"abstract":"<p><strong>Objectives: </strong>In the past 3 years, nearly 90 % of organ transplants performed in our country have been from living donors. Low rates of organ donation and family consent in cases of brain death reduce the source of deceased donors. Here, we reported the challenges of determination of brain death and donor care processes in our hospital and offered our recommendations to strengthen these services.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed adult patients (n = 5845 )treated in adult intensive care units of Manisa City Hospital from June 1, 2024, through November 30, 2025. Demographic information and clinical data were collected for patients diagnosed with brain death (n = 10 ), including time from admission to brain death determination, time from brain death determination to cardiac arrest, and time from first evaluation to brain death. We also collected data on organ donation and the reason for family donation refusal.</p><p><strong>Results: </strong>The ratio of brain death cases to total patients was 0.17 %. The rate of deceased organ donation of brain death cases was 20 %. Time from first evaluation to brain death determination ranged between 7.3 and 169 hours. Time from brain death determination to cardiac arrest ranged between 4 and 91 hours. For brain death determination, apnea test was performed in 7 patients (70 % ). For all cases, ancillary tests were used. Four -vessel digital subtraction angiography was performed in 3 cases (30 % ). There were multidrug -resistant infections in 3 cases.</p><p><strong>Conclusions: </strong>Medical knowledge and practices regarding organ donation and donor care after brain death should be raised to international standards. It remains important for transplant clinicians to increase cooperation between our Ministry of Health and hospital administrators for consideration of current scientific data to reduce organizational challenges. Such cooperative efforts could further strengthen organ transplant services, which are already quite successful in our country.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"374-379"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649686","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":"Comparative Analysis of Upper Respiratory Viral Infections in Kidney Transplant Recipients and the Immunocompetent Pediatric Population.","authors":"Utku Dönger, Meraj Alam Siddiqui, Esra Baskın, Adem Şafak, Emre Karakaya, Mehmet Haberal","doi":"10.6002/ect.MESOT2025.O86","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.O86","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare the clinical, laboratory, and virology profiles of pediatric kidney transplant recipients and immunocompetent children presenting with upper respiratory tract infection, evaluated using multiplex viral polymerase chain reaction panels.</p><p><strong>Materials and methods: </strong>This single -center retrospective cohort study included 31 kidney transplant recipients (aged 7 -16 years ) and 80 age -matched immunocompetent children who presented with upper respiratory tract infection at Başkent University Hospital from January 2023 to March 2025. Demographic, clinical, and laboratory data, including complete blood count, renal and liver function tests, and C -reactive protein, were recorded. Viral pathogens were identified using multiplex polymerase chain reaction. Inflammatory indexes, such as the neutrophil -to -lymphocyte ratio, platelet -to -lymphocyte ratio, and systemic immune -inflammation index, were calculated. We used SPSS software (version 26.0; IBM ) for all statistical analyses, and 2 -sided P < .05 was considered significant.</p><p><strong>Results: </strong>A total of 111 pediatric patients with upper respiratory tract infection were included in the study. Kidney transplant recipients were significantly older than patients in the control group without transplant (median 12.0 vs 7.5 years; P < .001 ). The neutrophil -to -lymphocyte ratio was higher (P = .001 ) and platelet counts were lower (P = .004 ) in the kidney transplant group. Renal (blood urea nitrogen, creatinine, uric acid ) and hepatic (aspartate aminotransferase and alanine aminotransferase ) parameters were significantly elevated in kidney transplant recipients (all P < .01 ). We detected SARS -CoV -2 exclusively in the kidney transplant group (35.5 %, P < .001 ), whereas other viral agents showed similar distributions between groups. Hospitalization rates and duration of hospital stay did not differ significantly.</p><p><strong>Conclusions: </strong>Pediatric kidney transplant recipients exhibit distinct inflammatory and biochemical profiles during upper respiratory tract infection compared with healthy peers but show comparable clinical outcomes. Early molecular diagnosis, vigilant monitoring, and preventive strategies such as vaccination remain essential to optimize infection management in this vulnerable population.</p><p><strong>Population: </strong></p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"213-217"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649688","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":"Not a Child, Not Yet an Adult: Transition Experiences in Pediatric Transplant Recipients.","authors":"Halil İbrahim Tasdemir, Tanya Paskaleva","doi":"10.6002/ect.MESOT2025.P153","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.P153","url":null,"abstract":"<p><strong>Objectives: </strong>The transition from pediatric to adult health care services is a critical milestone for adolescents who have undergone solid -organ transplant. Despite medical advances, this period remains a vulnerable one due to changes in care structures, patient autonomy, and psychosocial challenges. Qualitative evidence exploring this transition experience is limited in the context of Turkish health care. In this study, we examined the lived experiences, perceptions, and expectations of adolescents and young adults who underwent pediatric kidney or liver transplant in Türkiye, with a specific focus on their transition to adult health care services.</p><p><strong>Materials and methods: </strong>A descriptive phenomenological design was employed. We conducted semi -structured interviews with 11 participants aged 16 years and older who had received a kidney or liver transplant during childhood. We collected data via telephone interviews, which were audio -recorded with informed consent. We conducted thematic analysis to identify core themes reflecting the participants' transition experiences.</p><p><strong>Results: </strong>Four major themes emerged from the analysis: (1 ) anticipation and anxiety of change (fear of leaving familiar pediatric care teams ); (2 ) need for information and guidance (lack of structured transition education); (3 ) emotional ambivalence (feelings of independence mixed with insecurity ); and (4 ) health care system barriers (perceived fragmentation and lack of continuity in adult care settings ). Participants expressed a strong desire for more personalized, supported, and phased transition models.</p><p><strong>Conclusions: </strong>The transition to adult care in pediatric solid -organ transplant recipients presents emotional, informational, and systemic challenges. Structured, culturally sensitive transition programs are urgently needed in Türkiye to optimize continuity of care and health outcomes.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"356-362"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649751","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":"Posttransplant Malignancies in Kidney Transplant Recipients: Epidemiology, Risk Factors, and Clinical Outcomes.","authors":"Faissal Shaheen","doi":"10.6002/ect.MESOT2025.L22","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.L22","url":null,"abstract":"<p><p>Kidney transplantation is the definitive treatment for end-stage renal disease, offering substantial improvements in survival and quality of life. However, the lifelong immunosuppression required to maintain graft function predisposes recipients to a variety of posttransplant malignancies, which can cause morbidity and mortality. This report aimed to synthesize the current understanding of the epidemiology, risk factors, and clinical outcomes associated with posttransplant malignancies in kidney transplant recipients. Current understanding was drawn from review of international registries such as the Scientific Registry of Transplant Recipients and the Australia and New Zealand Dialysis and Transplant Registry, as well as landmark studies and clinical guidelines in the field of transplant oncology. The analysis showed that cancer incidence in kidney transplant recipients is 2 to 3 times higher than in the age-matched general population. Skin cancers, particularly nonmelanoma types, and posttransplant lymphoproliferative disorder are the most frequently observed malignancies. The pathogenesis is multifactorial, with intensity and duration of immunosuppression being the most important risk factor. Other critical factors include viral infections (eg, Epstein-Barr virus, human papillomavirus, BK virus), recipient age, and history of prior cancer. Some newer immunosuppressive agents, like mammalian target of rapamycin inhibitors, have shown promise in reducing the incidence of certain cancers, but their universal application is not supported by current evidence. Malignancy stands as a formidable challenge in the long-term management of kidney transplant recipients, second only to cardiovascular disease as a cause of death. A successful strategy to mitigate this risk requires a delicate balance between preventing graft rejection and minimizing the oncogenic potential of immunosuppressive therapy. Vigilant screening, individualized treatment regimens, and robust preventive measures are essential to improving outcomes and reducing the cancer burden in this vulnerable population.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"6-9"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649761","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":"Rabbit Anti-Thymocyte Globulin Versus Basiliximab in Spousal Kidney Transplant: Early Immunological and Clinical Outcomes.","authors":"Adem Şafak, Emre Karakaya, Ahmed Uslu, Nedim Çekmen, Turan Çolak, Sedat Yıldırım, Mehmet Haberal","doi":"10.6002/ect.2026.0056","DOIUrl":"https://doi.org/10.6002/ect.2026.0056","url":null,"abstract":"<p><strong>Objectives: </strong>Spousal living donor kidney transplant is commonly performed; however, the optimal induction immunosuppression strategy in recipients with low immunological risk remains unclear. We compared the early clinical and immunological outcomes of low -dose rabbit anti -thymocyte globulin and basiliximab in low -risk spousal kidney transplant recipients.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 43 recipients with low immunological risk who underwent spousal living donor kidney transplant and received induction therapy with either rabbit anti -thymocyte globulin (n = 20 ) or basiliximab (n = 23 ). Low immunological risk was defined as first -time transplant with negative panel reactive antibody and negative complement -dependent cytotoxicity crossmatch. Primary endpoints were early graft function, as assessed by serum creatinine trends, and biopsy -proven acute rejection within the first 2 postoperative months. Secondary endpoints included perioperative lymphocyte dynamics and documented infections, including cytomegalovirus and urinary tract infections.</p><p><strong>Results: </strong>Peripheral blood lymphocyte counts were significantly lower in the group treated with rabbit anti -thymocyte globulin on postoperative day 1 and day 7 versus the basiliximab -treated group (P < .001 ). In contrast, no significant differences were observed between groups in early graft function trajectories (P = .71 ) or the incidence of biopsy-proven acute rejection (rabbit anti -thymocyte globulin, 3 of 20; vs basiliximab, 2 of 23; P > .05 ). All documented urinary tract infections (n =3 ) and the single cytomegalovirus infection occurred in the group treated with rabbit anti -thymocyte globulin; however, these differences were not statistically significant (P > .05 ).</p><p><strong>Conclusions: </strong>In spousal kidney transplant recipients with low immunological risk, low -dose rabbit anti -thymocyte globulin (4.5 mg /kg ) and basiliximab provide comparable early graft function and similar protection against acute rejection. Although rabbit anti -thymocyte globulin induces more pronounced lymphocyte depletion, this observation does not translate into superior early clinical outcomes in this patient population.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 7","pages":"522-527"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671144","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":"Norovirus and Sapovirus Infection-Associated Gastroenteritis in Pediatric Kidney Transplant Recipients: Report of Three Cases.","authors":"Özlem Yüksel Aksoy, Esra Baskın, Meraj Alam Siddique, Figen Özçay, Alara Akdeniz, Emre Karakaya, Mehmet Haberal","doi":"10.6002/ect.MESOT2025.P135","DOIUrl":"10.6002/ect.MESOT2025.P135","url":null,"abstract":"<p><p>Norovirus and sapovirus (both Caliciviridae) are common causes of viral gastroenteritis and may pose clinical challenges, particularly in immunocompromised patients. We present 3 pediatric kidney transplant cases seen at Başkent University Hospital to highlight variability in clinical presentation and management of norovirus and sapovirus infection in transplant recipients. Case 1 (18-year-old male, transplant 13 years earlier)presented with acute onset watery diarrhea and mild dehydration. Direct microscopic stool examination was unremarkable, and norovirus was detected on viral panel testing. Supportive therapy proved effective without immunosuppression adjustment. Symptoms resolved within 1 week, with stable renal function. Case 2 (10-year-old male, transplant 1 year earlier) presented with prolonged diarrhea, weight loss, and worsening kidney functions. Polymerase chain reaction detected norovirus in stool. Severity and duration of symptoms required hospitalization and intravenous hydration. Temporary immunosuppression reduction helped control viral infection; recovery was slow (several weeks) with intermittent relapses. Clinical symptoms ameliorated with oral human immunoglobulin therapy, highlighting its potential to manage severe norovirus gastroenteritis in immunocompromised pediatric transplants. Case 3 (9-year-old male, transplant 5 years earlier) presented with watery diarrhea lasting for 3 months, dehydration, and weight loss. Laboratory analysis revealed increased serum creatinine. He was hospitalized with intravenous hydration. Stool polymerase chain reaction revealed sapovirus as the cause. His kidney function slowly recovered with extensive hydration and close monitoring. Norovirus and sapovirus are common enteric pathogens that usually cause acute gastroenteritis. In solid-organ transplant recipients, these viruses can cause prolonged, severe gastroenteritis, which can lead to dehydration, weight loss, and possible graft loss. Solid-organ transplant recipients are immunocompromised, so disease course can be severe and management can be difficult. Patients may need hospitalization and immunosuppression adjustment. Early diagnosis and tailored supportive treatment are necessary to avoid complications. In selected patients, other treatments (eg, orally administered human immunoglobulin) could be used.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"441-445"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649758","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":"Pulmonary Complications in Kidney Transplant Recipients: A 17-Year Retrospective Analysis of Infectious Etiologies, Risk Factors, and Outcomes.","authors":"Nehed Ghenam, Narjes Ben Aycha, Olfa Mahfoudh, Raja Boukadida, Amira Ben Afya, Awatef Azzabi, Asma Fradi, Sanda Mrabet, Wissal Sahtout, Dorsaf Zellama","doi":"10.6002/ect.MESOT2025.P25","DOIUrl":"https://doi.org/10.6002/ect.MESOT2025.P25","url":null,"abstract":"<p><strong>Objectives: </strong>Kidney transplant represents a major therapeutic advance for end -stage renal disease, but chronic immunosuppression compromises host defense mechanisms, rendering recipients vulnerable to serious infections. Pulmonary infections constitute a major cause of morbidity and mortality posttransplant, requiring vigilant surveillance and multidisciplinary management.</p><p><strong>Materials and methods: </strong>This retrospective descriptive study included patients who underwent kidney transplant at the Nephrology Department of Sahloul University Hospital from November 1, 2007, to December 31, 2024, in whom pulmonary involvement was diagnosed during follow -up.</p><p><strong>Results: </strong>Among 332 kidney transplant recipients, 12 patients (3.6 % ) developed pulmonary infections. The mean age was 34.5 ± 11.6 years (range, 18 -53 years ) with male predominance. Chronic interstitial nephropathy was the most common original kidney disease (66.6 % ). All patients received thymoglobulin induction with methylprednisolone; the main maintenance immunosuppression comprised tacrolimus (83.3 % ) and mycophenolate mofetil (91.7 % ). All patients received Pneumocystis jirovecii prophylaxis. Mean serum creatinine at diagnosis was 142.8 ± 70.1 μmol /L (range, 70 -262 μmol /L ), compared with baseline mean of 63.1 ± 9.9 μmol /L (range, 48 -78 μmol /L ). Acute kidney injury occurred in 7 patients (58.3 % ). Mean time to pulmonary involvement was 29.3 ± 23.8 months. The most frequently isolated pathogen was Pneumocystis jirovecii (41.6 % ), followed by Aspergillus species (25 % ), Mycobacterium tuberculosis (16.7 %), coinfection with Candida albicans (33.3 % ), and cytomegalovirus infection (16.7% ). Immunosuppression was reduced in all cases. Evolution was favorable with targeted therapy in 83 % of cases; 1 patient (8.3 % ) died after intensive care unit transfer.</p><p><strong>Conclusions: </strong>Prevention of severe pulmonary infections requires optimization of prophylaxis strategies and individualized adaptation of immunosuppressive regimens. Close collaboration with infectious disease specialists and pulmonologists is essential for effective multidisciplinary management.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"24 Suppl 2","pages":"260-267"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649384","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}