Clinical transplantation and research最新文献

{"title":"Temporal profile of serum total bile acid levels and their value in the evaluation of early graft dysfunction in living donor liver transplantation: a prospective cohort study.","authors":"Venkatesh Balaraman Sundararajan, Senthil Kumar, Ragini Kilambi, Sherin Thomas","doi":"10.4285/ctr.25.0077","DOIUrl":"https://doi.org/10.4285/ctr.25.0077","url":null,"abstract":"<p><strong>Background: </strong>Early graft dysfunction (EGD) after liver transplantation is currently defined using clinical and laboratory parameters. This study aimed to characterize serum total bile acid (STBA) trends in the early posttransplant period following living donor liver transplantation (LDLT) and to evaluate their utility in detecting EGD and acute cellular rejection (ACR).</p><p><strong>Methods: </strong>STBA levels were measured preoperatively and daily from postoperative day (POD) 1 to POD 14 in LDLT recipients. EGD was defined using Olthoff's criteria, and ACR was diagnosed using pragmatic clinical criteria.</p><p><strong>Results: </strong>Among 63 LDLT recipients, EGD occurred in 25.4% and ACR in 26.9%. The median baseline STBA level in cirrhotic patients awaiting LDLT was 95.1 μmol/L (range, 15.5-578.6 μmol/L). STBA levels decreased to near-normal values on POD 1 and remained relatively stable through POD 14. The median STBA value on POD 1 was 10.43 µmol/L (interquartile range [IQR], 6.725-33.635 µmol/L), and on POD 14 was 11.92 µmol/L (IQR, 8.57-44.098 µmol/L). In patients with EGD, STBA levels were consistently higher and demonstrated a rising trend from POD 3 to POD 14. In cases of ACR, STBA levels increased 24 to 48 hours prior to elevations in liver enzymes, suggesting early biochemical changes preceding conventional markers. The sensitivity and specificity of rising STBA for predicting ACR were 94.1% and 61.9%, respectively, with an area under the receiver operating characteristic curve of 0.78 (95% confidence interval, 0.65-0.87).</p><p><strong>Conclusions: </strong>Elevated and progressively rising STBA levels during the first postoperative week are associated with EGD. Trends in STBA may also aid in the early differentiation of ACR from sepsis, offering a useful adjunct in posttransplant monitoring.</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":"147625138","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":"Reporting patterns of renal failure associated with immunosuppressant combinations following liver transplantation: a retrospective analysis.","authors":"Aiko Urawa, Chihiro Shiraishi, Toru Ogura","doi":"10.4285/ctr.25.0051","DOIUrl":"https://doi.org/10.4285/ctr.25.0051","url":null,"abstract":"<p><strong>Background: </strong>Immunosuppressant regimens are essential for preventing graft rejection in liver transplant recipients; however, their use has also been associated with increased reporting of renal failure. This study evaluated disproportional reporting patterns of renal failure associated with immunosuppressant combinations using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS).</p><p><strong>Methods: </strong>A retrospective signal detection analysis was conducted using FAERS data from 2004 (Q1) to 2024 (Q2). Five exposure groups were defined for each core calcineurin inhibitor (tacrolimus or cyclosporine), administered as monotherapy or combined with mycophenolate mofetil (MMF), prednisone, or everolimus. Reporting odds ratios (RORs) and adjusted RORs were calculated for renal failure outcomes, using the corresponding monotherapy as the reference. Regional subgroup and sensitivity analyses were also performed.</p><p><strong>Results: </strong>Adding MMF to tacrolimus- or cyclosporine-based regimens was associated with lower disproportional reporting of renal failure versus monotherapy. Regional analyses revealed variability in reporting patterns: MMF-containing regimens showed lower disproportionality in Europe, whereas in North America, the tacrolimus-MMF-prednisone combination demonstrated lower reporting signals. In Latin America and Asia, overall reporting proportions of renal failure were lower, and additional agents did not consistently reduce signals. Sensitivity analyses across renal failure-related preferred terms yielded consistent patterns.</p><p><strong>Conclusions: </strong>These findings reflect disproportional reporting patterns rather than causal or protective effects and should be interpreted cautiously given inherent FAERS limitations, including missing clinical details and lack of denominator data. The results are hypothesis-generating and warrant further investigation using real-world clinical datasets to better characterize renal safety across immunosuppressant combinations.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597377","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":"Donor-to-recipient sex match status has no prognostic effect on long-term survival following liver transplantation: a retrospective observational study.","authors":"Woo-Hyoung Kang, I-Ji Jeong, Shin Hwang, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Young-In Yoon, Sung-Gyu Lee","doi":"10.4285/ctr.25.0049","DOIUrl":"10.4285/ctr.25.0049","url":null,"abstract":"<p><strong>Background: </strong>Studies on whether donor-to-recipient sex match status affects long-term survival after liver transplantation (LT) have yielded contradictory results. This study evaluated whether donor-to-recipient sex match status influenced long-term survival after living donor liver transplantation (LDLT) or deceased donor liver transplantation (DDLT) at a high-volume center.</p><p><strong>Methods: </strong>The study included 6,664 patients who underwent primary LT between January 2000 and December 2022 at our institution. Patients were divided into four groups according to donor-to-recipient sex match status: male-to-male (n=3,427 [51.4%]), male-to-female (n=1,152 [17.3%]), female-to-male (n=1,385 [20.8%]), and female-to-female (n=700 [10.5%]).</p><p><strong>Results: </strong>Regarding clinical characteristics, the four groups differed significantly regarding background liver disease (P<0.001), model for end-stage liver disease score (P<0.001), serum protein induced by vitamin K absence or antagonist II level (P=0.003), presence of concurrent hepatocellular carcinoma (HCC; P<0.001), and type of LT (P=0.003). Overall survival (OS) of all LT recipients did not differ significantly among the groups (P=0.377). Donor-to-recipient sex match status did not affect long-term OS in either LDLT (P=0.176) or DDLT (P=0.220) groups. In addition, sex match status did not significantly influence posttransplant OS among patients who underwent LDLT without HCC (P=0.464), LDLT with HCC (P=0.236), DDLT without HCC (P=0.338), or DDLT with HCC (P=0.818).</p><p><strong>Conclusions: </strong>Donor-to-recipient sex match status does not significantly affect post-transplant patient survival or HCC prognosis after LDLT or DDLT.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"76-86"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777077","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":"Tacrolimus-induced type 4 renal tubular acidosis after living donor kidney transplantation with a focus on early diagnosis and targeted treatment: a case report.","authors":"Won-Bae Chang, Hwa-Young Lee","doi":"10.4285/ctr.25.0089","DOIUrl":"10.4285/ctr.25.0089","url":null,"abstract":"<p><p>Type 4 renal tubular acidosis (RTA) is an uncommon but clinically significant complication in kidney transplant recipients, leading to hyperkalemia and non-anion gap metabolic acidosis due to aldosterone deficiency or resistance. Calcineurin inhibitors, especially tacrolimus, can contribute to this disorder by impairing distal tubular potassium secretion. We describe a 47-year-old male who underwent living donor kidney transplantation from his biological mother. Despite good early graft function, he developed severe recurrent hyperkalemia, requiring hemodialysis on postoperative days 11 and 23. Laboratory evaluation revealed non-anion gap metabolic acidosis (anion gap 10.8 mEq/L), urine pH 5.5, and a low transtubular potassium gradient of 2.5, consistent with type 4 RTA. At diagnosis, serum creatinine was 1.39 mg/dL (estimated glomerular filtration rate, 54.8 mL/min/1.73 m²). The patient was treated with fludrocortisone (starting at 0.2 mg/day and tapered to 0.05 mg/day), a thiazide diuretic (12.5 mg twice daily), and reduction of tacrolimus dose with addition of sirolimus (2.5 mg/day). Electrolyte abnormalities resolved, and graft function remained stable without rejection. This case underscores the importance of recognizing tacrolimus-induced type 4 RTA early and using individualized treatment strategies to correct hyperkalemia and preserve allograft function.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"138-141"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961078","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":"Autologous bone marrow mononuclear cell administration in a large cohort of 1,011 patients with autism spectrum disorder: a retrospective observational study.","authors":"Alok Sharma, Nandini Gokulchandran, Hemangi Sane, Pooja Kulkarni, Krishnaveni Kannan, Zubiya Shaikh, Hema Biju, Amruta Paranjape, Myola D'sa, Prerna Badhe","doi":"10.4285/ctr.25.0009","DOIUrl":"10.4285/ctr.25.0009","url":null,"abstract":"<p><strong>Background: </strong>This retrospective observational study analyzed the therapeutic efficacy of autologous bone marrow mononuclear cells (BMMNCs) in a large cohort of patients with autism spectrum disorder (ASD).</p><p><strong>Methods: </strong>Overall, 1,011 patients with ASD who received intrathecal administration of autologous BMMNCs were included. Changes in symptoms and outcome measures-the Indian Scale of Autism Assessment (ISAA) and Childhood Autism Rating Scale (CARS)-were recorded. Brain positron emission tomography computed tomography (PET/CT) was used to objectively assess changes in brain metabolism.</p><p><strong>Results: </strong>At a mean follow-up of 19.3 months, 90.6% of patients showed improvement after cell therapy. Symptomatic improvements were observed in attention and concentration, command following, eye contact, sitting tolerance, social interaction, hyperactivity, communication, speech, stereotypical behavior, aggressiveness, and self-injurious behavior. Patients who received multiple doses of cell therapy demonstrated better outcomes, and improvements were seen across all age groups and regardless of disease severity. Changes in ISAA and CARS scores were statistically significant (P<0.05). Comparative PET/CT scans of 401 patients revealed improved metabolism in the amygdala, hippocampus, parahippocampal gyrus, caudate nucleus, cerebellum, mesial temporal lobe, thalamus, and superior and middle temporal poles, which corresponded to symptomatic improvements. No major adverse events were reported. Nine of the 1,011 patients experienced seizures, four of whom had a prior history. These events were managed with medication, with improvements still observed in the nine patients.</p><p><strong>Conclusions: </strong>Intrathecal transplantation of autologous BMMNCs, combined with neurorehabilitation, yields positive outcomes for patients with ASD. This approach helps reduce the degree of impairment and improves quality of life.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"116-128"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777129","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":"Renoportal anastomosis in pediatric living donor liver transplantation: a case report.","authors":"Jung-Man Namgoong, Shin Hwang, Gil-Chun Park, Hyunhee Kwon, Suhyeon Ha, Kyung Mo Kim, Seak Hee Oh","doi":"10.4285/ctr.25.0081","DOIUrl":"10.4285/ctr.25.0081","url":null,"abstract":"<p><p>In children with biliary atresia, recurrent episodes of cholangitis often lead to portal vein (PV) phlebosclerosis. We report a case of pediatric living donor liver transplantation (LDLT) for biliary atresia with PV occlusion and a large splenorenal shunt. A 3-year-5-month-old girl was diagnosed with syndromic biliary atresia and polysplenia. Because the patient's condition progressively deteriorated with worsening jaundice, we opted to perform LDLT using a left lateral section graft from her father. The recipient's native PV was severely atrophic and completely occluded, and the collateral veins around the hepatoduodenal ligament were too small to serve as a viable source of portal inflow. Consequently, renoportal anastomosis (RPA) was selected as an alternative approach. Iliac vein interposition was performed to provide a new portal inflow source, and anatomy-compliant PV reconstruction was performed. The patient recovered from transplant surgery, but PV conduit stenosis occurred with the development of ascites 2 months posttransplant. This RPA-related vascular complication was resolved through percutaneous balloon angioplasty of the PV conduit. The patient has been doing well for 6 months posttransplantation. This case demonstrates that RPA can represent a viable reconstructive option for PV inflow in liver transplantation for pediatric patients with phlebosclerotic PV and prominent splenorenal shunt.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"148-157"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121723","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":"Intravenous immunoglobulin and mammalian target of rapamycin inhibitors for treatment of BK virus infections in kidney transplantation: a systematic review.","authors":"Khi Yung Fong, Terence Kee, Sobhana Thangaraju, Quan Yao Ho, Ian Tatt Liew, Carolyn Tien, Edwin Jonathan Aslim, Lay Guat Ng, Ee Jean Lim, Valerie Huei Li Gan","doi":"10.4285/ctr.25.0038","DOIUrl":"10.4285/ctr.25.0038","url":null,"abstract":"<p><strong>Background: </strong>Reduction of immunosuppression (ROI) remains the mainstay of treatment for BK virus infection (BKVI) in kidney transplantation (KT). This review explored the role of intravenous immunoglobulin (IVIG) and mammalian target of rapamycin inhibitor (mTORi) regimens as alternative therapies for KT recipients with BKVI, focusing on viral clearance and graft-related outcomes.</p><p><strong>Methods: </strong>An electronic search was conducted for articles examining IVIG or mTORi use in treating BKVI among adult and/or pediatric KT recipients. Meta-analyses of proportions were performed for relevant outcomes.</p><p><strong>Results: </strong>Twenty-seven studies (13 evaluating IVIG and 14 evaluating mTORi) were included; all but three enrolled only adult participants. In IVIG studies, the pooled viral clearance rate was 76.4% (95% confidence interval [CI], 64.2%-85.5%), with numerically higher clearance for IVIG after ROI compared to IVIG with ROI (87.0% vs. 66.1%). Overall graft survival was 84.7% (95% CI, 70.7%-92.7%), with numerically higher survival in IVIG after ROI than in IVIG with ROI (93.6% vs. 78.4%). Pooled histological clearance and graft rejection rates were 82.8% and 14.5%, respectively. In mTORi studies, the pooled viral clearance rate was 68.0% (95% CI, 58.0%-76.7%) and overall graft survival was 89.1% (95% CI, 82.7%-93.4%), with no significant difference between patients with and without prior ROI. Histological clearance and graft rejection rates were 59.8% and 8.6%, respectively.</p><p><strong>Conclusions: </strong>IVIG and mTORi regimens appear to be feasible alternatives to ROI in KT recipients with BKVI, achieving viral clearance while maintaining graft survival. Future randomized controlled trials are needed to further define their role and strengthen current evidence with higher-quality data.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"55-67"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484478","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 considerations and outcomes in cross-sex vascularized composite allotransplantation.","authors":"Nicole E James, Curtis L Cetrulo, Alexandre G Lellouch, Jan A Plock, Zhi Yang Ng","doi":"10.4285/ctr.25.0042","DOIUrl":"10.4285/ctr.25.0042","url":null,"abstract":"<p><p>Vascularized composite allotransplantation (VCA) has transformed reconstructive surgery for patients with severe tissue defects. Nonetheless, donor shortages remain a major limitation. Cross-sex VCA (CS-VCA) has been proposed as a means of expanding the donor pool, but concerns persist regarding potentially heightened rejection risks in sex-mismatched transplants. This review examines published adult CS-VCA cases up to May 2025. The primary outcomes analyzed were acute rejection episodes, allograft survival, immunological complications, and sequelae affecting form and function. Nine CS-VCA cases were identified (six upper extremity, one lower extremity, and two abdominal wall transplants). Eight involved female donors (median age, 47 years) and male recipients (median age, 30 years). Acute rejection occurred in five of nine cases; however, 11 of 13 allografts remained viable at follow-up (6-41 months) under immunosuppressive therapy. Two cases developed vascular complications, resulting in technical failure and partial amputation, respectively. Higher human leukocyte antigen (HLA) mismatches (mean, 5) were associated with complications, while fewer mismatches (mean, 3) correlated with better outcomes. In contrast to trends in solid organ transplantation, female-to-male CS-VCA demonstrated relatively favorable outcomes in the limited cases reported. These findings suggest that CS-VCA may be a feasible strategy to expand the VCA donor pool, provided that patient selection is careful, ABO/Rh and HLA compatibility are prioritized, and rigorous immunological monitoring is maintained. Further studies should investigate sex-specific immune mechanisms to optimize long-term success rates.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"28-38"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663369","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":"Efficacy of robot-assisted versus open kidney transplantation in obese patients: a systematic review and meta-analysis.","authors":"Angga Dewa Megatika Pratama, Steven Aviano Shenelo, Rizqi Apsari Fairuz Kamila","doi":"10.4285/ctr.25.0029","DOIUrl":"10.4285/ctr.25.0029","url":null,"abstract":"<p><strong>Background: </strong>Obesity complicates open kidney transplantation (OKT), driving increasing interest in robot-assisted kidney transplantation (RAKT). This study compared intraoperative and postoperative outcomes of RAKT and OKT in patients with a body mass index ≥30 kg/m².</p><p><strong>Methods: </strong>Systematic searches of PubMed, Scopus, and the Cochrane Library were conducted through April 15, 2025. Four retrospective cohort studies (147 RAKT and 625 OKT cases) met the inclusion criteria. Pooled analyses evaluated cold and warm ischemia times, estimated blood loss, estimated glomerular filtration rate (eGFR) at 6 months and 1 year, serum creatinine at 6 months and 3 years, delayed graft function (DGF), graft survival at 1 and 3 years, length of stay, rejection rate, 1-year patient survival, and surgical site infection (SSI) using a random-effects model.</p><p><strong>Results: </strong>No significant differences were observed in cold ischemia time (mean difference [MD], 43.88 minutes; 95% confidence interval [CI], -88.06 to 175.82 minutes; P=0.51), warm ischemia time (MD, 3.21 minutes; 95% CI, -3.23 to 9.65 minutes; P=0.33), or estimated blood loss (MD, -41.30 mL; 95% CI, -95.60 to 12.99 mL; P=0.14). Other postoperative outcomes, including graft function (eGFR and creatinine), DGF, hospital stay, rejection, and 1-year survival, were also comparable. However, RAKT was associated with a significantly lower SSI incidence (risk ratio, 0.14; 95% CI, 0.04-0.45; P=0.0009).</p><p><strong>Conclusions: </strong>In obese patients, RAKT yields outcomes comparable to OKT, with the added potential benefit of reducing SSI risk. Nonetheless, as most findings are based on very low-certainty evidence, these results should be interpreted with caution. Larger randomized trials are required to confirm these outcomes.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"39-54"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777095","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":"Diagnostic and prognostic performance of <i>PAK1</i> methylation in patients with hepatocellular carcinoma undergoing liver transplantation.","authors":"Shin Hwang, Hyo Jung Ko, Eunyoung Tak, Kyoung-Jin Lee, Yun-Kyu Lee","doi":"10.4285/ctr.25.0027","DOIUrl":"10.4285/ctr.25.0027","url":null,"abstract":"<p><strong>Background: </strong>DNA methylation is under investigation as an early diagnostic biomarker for cancers such as hepatocellular carcinoma (HCC). p21-activated protein kinase 1 (<i>PAK1</i>) demonstrates a high methylation tendency in HCC. We assessed the diagnostic and prognostic performance of <i>PAK1</i> methylation in liver transplantation (LT) recipients with and without HCC.</p><p><strong>Methods: </strong>To assess <i>PAK1</i> methylation, stored pretransplant blood samples from LT recipients were analyzed by droplet digital polymerase chain reaction.</p><p><strong>Results: </strong>This study included 274 patients with HCC and 100 control patients without the disease. Ten-year survival rates in the HCC and control groups were 60.5% and 80.6%, respectively (P=0.001). The 10-year HCC recurrence rate was 39.0%. Ten-year survival rates in the HCC recurrence and nonrecurrence groups were 13.3% and 91.2%, respectively (P<0.001); median <i>PAK1</i> methylation levels in the control and HCC groups were 50.0 and 108.0 copies (P=0.102). The area under the receiver operating characteristic curve was 0.599, and the Youden J index was 0.199, indicating 57.9% sensitivity and 62.0% specificity at a cutoff of 78 copies. With a cutoff of 5 copies, sensitivity was 94.1% and specificity was 14.0%. The positive likelihood ratio was 1.09 and the negative likelihood ratio was 0.42, indicating diagnostic accuracy below α-fetoprotein and protein induced by vitamin K absence or antagonist-II. <i>PAK1</i> cutoffs of 5 and 10 copies did not affect HCC recurrence, but a cutoff of 2 copies appeared associated with lower recurrence.</p><p><strong>Conclusions: </strong>These data suggest that <i>PAK1</i> methylation is not a clinically useful biomarker for HCC in LT recipients. New DNA methylation biomarkers are required for early diagnosis.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"104-115"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13041235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002463","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}