Clinical transplantation and research最新文献

{"title":"Torque teno virus DNA load as a clinical biomarker for immunosuppression and infection risk in early kidney transplantation: a prospective study.","authors":"Anil Kumar Bhalla, Akhilesh Kumar Jaiswal, Tarun Kumar, Pallavi Rana, Rajdeb Saha, Vaibhav Tiwari, Neeraj Goel, Pallav Gupta, Vinant Bhargava, Anurag Gupta, Manish Malik, Chand Wattal, Jyoti Kotwal, Ashwani Gupta, D S Rana","doi":"10.4285/ctr.25.0091","DOIUrl":"https://doi.org/10.4285/ctr.25.0091","url":null,"abstract":"<p><strong>Background: </strong>Torque teno virus (TTV) load is emerging as a biomarker of net immunosuppression in kidney transplant recipients (KTRs). This study investigated the dynamics of TTV DNA load, its correlations with immune profiles, and its clinical associations during the early posttransplant period.</p><p><strong>Methods: </strong>We prospectively analyzed plasma TTV DNA load in 41 KTRs at baseline, day 7, day 14, and 1 month posttransplant. Lymphocyte subsets (CD3+, CD4+, CD8+, CD19+, and natural killer [NK] cells) and cytokines (interleukin [IL]-6, IL-10) were assessed at day 14. Associations among TTV load, immune parameters, and clinical events, including infection and rejection, were examined.</p><p><strong>Results: </strong>TTV load increased significantly from baseline to day 14 (P<0.001) and to 1 month (P<0.001), with a progressive rise beginning at week 2. TTV load consistently exceeded that of healthy controls at all time points (P<0.001 for each comparison). Patients who experienced infections (n=16) had significantly higher TTV loads at days 7 (P=0.006), 14 (P=0.048), and 30 (P=0.044) than patients without infections. At day 14, TTV load showed positive correlations with CD8+ (r=0.677, P<0.001) and CD19+ (r=0.433, P=0.005) cell percentages, as well as with IL-10 levels (r=0.668, P<0.001). Inverse correlations were observed with CD3+ (r=-0.388, P=0.012), CD4+ (r=-0.478, P=0.002), and NK cell percentages (r=-0.340, P=0.030), and with IL-6 levels (r=-0.462, P=0.002). While the percentage of NK cell were significantly higher in patients with infection. Preliminary observations from a very small subset of patients (n=2) suggested that rejection may be associated with lower TTV loads at days 7 and 14; however, this finding requires further investigation.</p><p><strong>Conclusions: </strong>Early posttransplant TTV load reflects the degree of immunosuppression, correlates with specific immune alterations, and predicts infection risk. Monitoring TTV load may provide a valuable tool for personalized immunosuppression management in KTRs.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and predictors of renal artery stenting after kidney transplant angiography: a retrospective study.","authors":"Jennifer Lu, Amanda Shorey, Raymond Uduba, Arshia Aalami-Harandi, Frank Darras, Adam M Kressel","doi":"10.4285/ctr.25.0052","DOIUrl":"https://doi.org/10.4285/ctr.25.0052","url":null,"abstract":"<p><strong>Background: </strong>Up to 23% of renal transplant recipients may develop transplant renal artery stenosis (TRAS). However, diagnosis requires angiography, and the contrast used may be nephrotoxic. We aimed to identify predictors of TRAS and clarify the safety and outcomes of angiography.</p><p><strong>Methods: </strong>We conducted a retrospective study of renal transplant recipients at a single institution from August 2016 to August 2024 who subsequently underwent transplant renal artery angiography for suspected TRAS. Patient demographics, preprocedure ultrasound findings and creatinine levels, intraoperative findings, and postprocedure creatinine levels were collected and analyzed using SPSS ver. 29.0.</p><p><strong>Results: </strong>During the study period, 614 patients underwent renal transplantation, and 103 subsequently underwent transplant angiography. The median contrast load was 10 mL (±13.0 mL). No significant change in creatinine levels was observed after the procedure despite contrast exposure (ΔCr 0.02, P=0.904). Overall, 57 patients had confirmed TRAS requiring vascular stent insertion. These patients had higher preangiogram arterial velocities on transplant renal ultrasound (431.5 vs. 388.6 cm/sec, P=0.046). Risk factors for TRAS included deceased donor kidney transplantation, longer cold ischemia time, and shorter anastomosis time. After adjusting for other covariates, a preoperative ultrasound velocity >400 cm/sec was associated with 4-fold higher odds of arterial stenting (P=0.01).</p><p><strong>Conclusions: </strong>Preprocedure renal ultrasound velocity >400 cm/sec is a strong predictor of TRAS requiring intervention. After angiography and stenting, patients with TRAS exhibit a significant decrease in creatinine. Patients without TRAS display no significant creatine difference, suggesting that the procedure is safe and efficacious and requires a negligible contrast load.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of ABO-incompatible kidney transplantation in recipients with extremely high baseline isoagglutinin titers: a two-center experience.","authors":"Jee Sung Kim, Sang Hun Eum, Hanbi Lee, Hye Eun Yoon, Byungchang Kim, Dong Ryeol Lee, Byung Ha Chung","doi":"10.4285/ctr.25.0104","DOIUrl":"https://doi.org/10.4285/ctr.25.0104","url":null,"abstract":"<p><strong>Background: </strong>ABO-incompatible kidney transplantation (ABOi KT) has become increasingly feasible; however, recipients with very high baseline isoagglutinin titers continue to pose substantial clinical challenges.</p><p><strong>Methods: </strong>We conducted a retrospective, two-center review of 15 patients who underwent ABOi KT with baseline anti-A/B immunoglobulin G titers ≥1:1024. All patients received rituximab, therapeutic plasma exchange, and a standardized immunosuppressive regimen. Clinical outcomes-including bleeding complications, biopsy-proven acute rejection (BPAR), opportunistic infections, graft function, and patient survival-were assessed.</p><p><strong>Results: </strong>The median patient age was 53 years (13 men, 2 women). All but one achieved a preoperative titer ≤1:32 after a median of 10 apheresis sessions (range, 7-16). Two patients required graft nephrectomy due to severe postoperative bleeding. Five patients developed BPAR, comprising T cell-mediated and/or antibody-mediated rejection episodes; notably, only one had a titer of 1:1024 at rejection, while the remainder had titers ≤1:16. Regarding opportunistic viral infections, seven patients developed concurrent cytomegalovirus (CMV) and BK viremia, two had CMV alone, and two had isolated BK viremia. Over a median 9.18-year follow-up (range, 0.04-16.45 years), three experienced graft loss-two from chronic rejection at 6 and 15 years, and one due to sepsis-associated acute kidney injury at 15 years. Two patients died during follow-up: one from cardiovascular disease at 1.2 years and the other from pneumonia at 6 years.</p><p><strong>Conclusions: </strong>Despite extremely high baseline isoagglutinin titers, ABOi KT can achieve durable graft survival in carefully selected patients; however, it remains a high-risk procedure carrying a substantial burden of bleeding and infectious complications.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study on the impact of large language model assistance on the evaluation of complex medical living kidney donor candidates.","authors":"Hari Shankar Meshram, Chandani Bhagat, Bhavin Modasia, Vishal Batheja, Rajendra Prasad Mathur, Saurabh Puri","doi":"10.4285/ctr.25.0085","DOIUrl":"https://doi.org/10.4285/ctr.25.0085","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) are undergoing exploration as clinical decision support tools. However, their role in complex, high-stakes transplant nephrology decisions, including potential living kidney donor candidate (pLKDC) evaluation, remains unclear.</p><p><strong>Methods: </strong>In this prospective pre-post pilot study, 14 physicians (seven fellows and seven early-career nephrologists [consultants]) evaluated 30 standardized, deidentified complex pLKDC vignettes, first unaided and then with OpenAI ChatGPT-4o assistance. The primary outcomes were diagnostic accuracy (scale, 0-1), justification quality (0-100), and decision confidence (1-5). Secondary outcomes included thematic richness and confidence-accuracy calibration.</p><p><strong>Results: </strong>LLM assistance improved mean accuracy by 0.27±0.07 and justification quality by 10.45±1.96. Gains were consistent across fellows (+0.29 and +10.75, respectively) and consultants (+0.25 and +10.14), without significant role interaction. The largest improvements concerned vignettes involving hypertension with albuminuria (+0.43 accuracy) and metabolic or infectious risk stratification. Protocol-driven scenarios displayed the greatest benefit; ambiguous ethical or psychosocial cases had smaller gains. Thematic richness increased, especially in guideline-based and ethical framing domains. Calibration improved for consultants (slope, -0.04 to 0.10) but declined for fellows (-0.17 to -0.40), indicating residual overconfidence among less experienced clinicians.</p><p><strong>Conclusions: </strong>In this pilot study of artificial intelligence support for pLKDC assessment, LLM assistance was associated with consistently improved accuracy, reasoning quality, and thematic completeness. Protocol-driven decisions displayed the greatest gains. These findings warrant further exploration of LLMs as research tools in transplant nephrology, while underscoring the need for human oversight in nuanced ethical judgments.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating apnea test protocols for brain death diagnosis in adults: methods, safety, and ethical considerations.","authors":"Milad Fendereski, Arman Hasanzade, Ali Khalili, Sepehr Motamedi, Hossein Mohammadi, Ehsan Rezaee, Babak Mansourafshar, Fariba Ghorbani","doi":"10.4285/ctr.25.0018","DOIUrl":"https://doi.org/10.4285/ctr.25.0018","url":null,"abstract":"<p><p>Brain death determination is a critical process in modern medicine, particularly in the context of organ donation. The apnea test (AT) constitutes a fundamental component of this determination by confirming the irreversible cessation of brainstem-mediated respiratory function. Despite its clinical importance, AT protocols vary widely across regions, resulting in significant differences in safety, effectiveness, and ethical considerations. This review presents a comprehensive analysis of existing AT protocols, comparing traditional and modified methodologies designed to improve diagnostic accuracy while minimizing complications. It examines innovative approaches, including CO₂ delivery techniques, continuous positive airway pressure-assisted methods, and protocol adaptations for patients supported with extracorporeal membrane oxygenation. In addition, this article evaluates potential AT-related risks, such as hemodynamic instability, hypoxemia, and barotrauma, while emphasizing the ongoing need for standardized international protocols. Furthermore, the ethical and legal dimensions of AT, particularly the ongoing debate regarding informed consent, are critically examined. Given the inherent risks of AT and the availability of ancillary diagnostic alternatives, the necessity of AT in brain death determination remains contested. This review therefore underscores the urgent need for consensus-driven guidelines that prioritize patient safety, uphold ethical standards, and preserve the integrity of organ donation practices.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serendipity on surveillance: an unusual transbronchial biopsy finding in a lung transplant recipient.","authors":"Natasha Banga, Brandon Guenthart, Gerald Berry","doi":"10.4285/ctr.25.0026","DOIUrl":"https://doi.org/10.4285/ctr.25.0026","url":null,"abstract":"<p><p>Flexible bronchoscopy is routinely utilized to monitor allograft function after lung transplantation (LT). While transbronchial lung biopsy (TBLB) is valuable as it permits direct histological assessment of the allograft, unexpected findings are occasionally encountered. We report a 72-year-old male with advanced chronic obstructive pulmonary disease who underwent a right single LT. His early posttransplant course was uneventful, and he presented for 6-week surveillance bronchoscopy. Although TBLB of the right lower lobe showed no evidence of rejection, one section revealed a small blood vessel with an organized intravascular thrombus. This prompted hospital admission, and an acute segmental pulmonary embolus was confirmed. Further workup identified acute deep vein thrombosis of the right soleal vein, likely the source of the embolism. The patient was treated with standard anticoagulation and discharged without complications. He was doing well at the 3-month follow-up. This case highlights the high incidence of venous thromboembolism among LT recipients and the unique challenges specific to this population. We emphasize the importance of following through on unexpected findings on TBLB, which may facilitate the timely diagnosis of posttransplant complications.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"KoreaN cohort study for Outcomes in patients With Kidney Transplantation (KNOW-KT): a prospective observational cohort study focusing on graft outcomes and posttransplant complications.","authors":"Jung-Hwa Ryu, Myung-Gyu Kim, Kyu Ha Huh, Hee-Yeon Jung, Jae Berm Park, Seungyeup Han, Kyung Pyo Kang, Wookyung Chung, Jaeseok Yang","doi":"10.4285/ctr.25.0035","DOIUrl":"https://doi.org/10.4285/ctr.25.0035","url":null,"abstract":"<p><strong>Background: </strong>The KoreaN cohort study for Outcome in patients With Kidney Transplantation (KNOW-KT) is a prospective, multicenter observational cohort designed to provide detailed information on the natural course of kidney transplantation (KT) and to identify risk factors for posttransplant complications. We aimed to describe graft outcomes and long-term posttransplant complications from the KNOW-KT study.</p><p><strong>Methods: </strong>KNOW-KT enrolled 1,115 transplant recipients between 2012 and 2016 and followed them for up to 11 years. Data and biological samples were collected from both transplant recipients and donors at baseline and during annual follow-up visits. Epidemiological factors, laboratory data, allograft outcomes, and patient outcomes, including posttransplant complications, comorbidities, and mortality, were analyzed.</p><p><strong>Results: </strong>A total of 1,080 kidney transplants were registered (86.9% from living donors) with a mean recipient age of 45.8±11.6 years. ABO- and human leukocyte antigen-incompatible transplants accounted for 17.4% and 8.1% of cases, respectively, and 26.7% of recipients underwent pretransplant desensitization. The overall 1-, 5-, and 10-year graft survival rates were 98.5%, 95.0%, and 91.9%, respectively. During a median follow-up period of 9.8 years, graft failure occurred in 7.6% of recipients, while biopsy-proven acute rejection episodes were observed in 19.4%. The cumulative incidence of new-onset malignancy and infection was 7.3 per 1,000 person-years and 41.2 per 1,000 person-years, respectively.</p><p><strong>Conclusions: </strong>The KNOW-KT study characterizes the epidemiology of Korean kidney transplant recipients and provides robust, reliable information on long-term posttransplant outcomes.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147648099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of allocation priority for children awaiting liver transplantation in Korea: a pediatric liver allocation simulated model analysis.","authors":"Jaewon Lee, YoungRok Choi, Nam-Joon Yi, Kyung Chul Yoon, Jiyoung Kim, Jae-Yoon Kim, Hyun Hwa Choi, Sola Lee, Su Young Hong, Suk Kyun Hong, Kwang-Woong Lee, Kyung-Suk Suh","doi":"10.4285/ctr.25.0062","DOIUrl":"https://doi.org/10.4285/ctr.25.0062","url":null,"abstract":"<p><strong>Background: </strong>In Korea, pediatric deceased donor livers are not prioritized for pediatric candidates, resulting in inequities in organ allocation. Current split liver transplantation (SLT) criteria, which are limited to children younger than 15 years and weighing less than 30 kg, fail to reflect the actual body size of many pediatric candidates.</p><p><strong>Methods: </strong>We retrospectively reviewed the Korean Network for Organ Sharing database for all deceased donor liver transplantations (DDLT) performed between 2000 and 2020. Donor and recipient characteristics, allocation trends, and survival outcomes were analyzed. Simulation analyses were conducted to assess the feasibility of prioritizing pediatric candidates for pediatric deceased donors.</p><p><strong>Results: </strong>Among 5,252 DDLT cases, 328 (6.2%) were pediatric recipients, of whom only 121 (36.9%) received grafts from pediatric deceased donors. Pediatric donor livers were allocated to adult recipients more than twice as often as to children. Survival analysis demonstrated superior outcomes in pediatric recipients compared with adults (5-year survival, 86.0% vs. 68.9%; P<0.001), regardless of donor age. No significant survival difference was observed between SLT and whole liver transplantation among pediatric recipients. Simulation modeling indicated that prioritizing pediatric candidates for pediatric and splittable adult deceased donors could increase pediatric DDLT by more than 300 cases without reducing graft availability for adult recipients.</p><p><strong>Conclusions: </strong>Pediatric recipients demonstrate superior posttransplant outcomes but face limited access to pediatric deceased donor grafts under current Korean allocation policies. Revision of allocation principles-prioritizing pediatric candidates for pediatric deceased donors and expanding SLT criteria based on body weight-could substantially reduce reliance on living donor liver transplantation in pediatric patients.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlative study of hepatic venous diameter/liver volume index and extent of hepatic steatosis in living related liver donors: a retrospective observational study.","authors":"Subhash Gupta, Ruchi Rastogi, Ram Singh, Akshita Gupta, Sudha Reddy, Peush Sahni","doi":"10.4285/ctr.25.0097","DOIUrl":"https://doi.org/10.4285/ctr.25.0097","url":null,"abstract":"<p><strong>Background: </strong>Hepatic steatosis is a common incidental finding during pretransplant donor evaluation and a key determinant of graft suitability. During review of donor imaging, we observed that hepatic steatosis was frequently associated with smaller hepatic venous diameters. This study aimed to quantitatively assess the relationship between total hepatic venous diameter and hepatic steatosis and to develop a noninvasive predictive index based on hepatic venous diameter and liver volume.</p><p><strong>Methods: </strong>This retrospective study included 768 prospective liver donors who underwent pretransplant evaluation over 3.5 years. Total hepatic venous diameter (THVD) and total liver volume were measured on computed tomography, and hepatic fat content was quantified using magnetic resonance (MR) proton density fat fraction (PDFF) sequences. We analyzed the correlation between the THVD-to-liver volume ratio (THVD/LV) and hepatic steatosis and evaluated diagnostic performance.</p><p><strong>Results: </strong>Hepatic steatosis (MR-PDFF >6.4%) was present in 22% (169/768) of donors; most had a body mass index of 25.0 to 29.9 kg/m². A moderate but statistically significant negative correlation was observed between hepatic steatosis and THVD/LV (r=-0.266, P<0.001). For the screening of hepatic steatosis, the THVD/LV index demonstrated an accuracy of 59.5% (95% confidence interval, 55.9%-63.0%), sensitivity of 72.2%, and specificity of 55.9%, with a high negative predictive value (NPV) of 87.7%.</p><p><strong>Conclusions: </strong>The THVD/LV index may serve as a simple, noninvasive parameter for screening hepatic steatosis in living liver donors, given its high NPV. Its application could improve donor-recipient matching and aid preoperative risk assessment for transplant outcomes.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>De novo</i> antiglomerular basement membrane Goodpasture syndrome in a liver transplant recipient: balancing autoimmunity, allograft protection, and infection risk.","authors":"Sanket Solanki, Saumya Sharma, Bisha Biju, Akansha Thakur, Rommel Sandhyav, Naveen Ganjoo, Sonal Asthana","doi":"10.4285/ctr.25.0083","DOIUrl":"https://doi.org/10.4285/ctr.25.0083","url":null,"abstract":"<p><p>Antiglomerular basement membrane (anti-GBM) disease causes rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage (DAH) through autoantibodies directed against the α3 chain of type IV collagen. Evidence guiding adaptation of standard induction therapy (plasmapheresis, high-dose glucocorticoids, cyclophosphamide) for nonrenal solid organ transplant recipients remains scarce. A 55-year-old man, 9 years post-deceased donor liver transplantation for nonalcoholic steatohepatitis and maintained on low-dose tacrolimus, presented with pulmonary renal syndrome, severe metabolic acidosis, and high-titer anti-GBM antibodies. High-resolution computed tomography demonstrated bilateral ground-glass opacities consistent with DAH. He was treated with plasma exchange (seven sessions) and high-dose corticosteroids. Tacrolimus was discontinued, and maintenance immunosuppression was transitioned to mycophenolate mofetil with low-dose prednisone. Pulmonary hemorrhage resolved and anti-GBM titers declined to near the assay threshold; however, kidney function did not recover, and he remained dependent on hemodialysis. Four months later, he died of multidrug-resistant <i>Acinetobacter</i> pneumonia complicated by septic shock. To our knowledge, this represents the first reported case of <i>de novo</i> anti-GBM disease following liver transplantation. <i>De novo</i> Goodpasture syndrome can occur despite chronic immunosuppression in liver transplant recipients. Prompt recognition, individualized immunomodulation, and meticulous infection risk management are critical to controlling autoimmunity while preserving liver allograft function.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}