Frontiers in transplantation最新文献

{"title":"Variability and longitudinal dynamics of donor-derived cell-free DNA in kidney and liver recipients: a comparison of absolute and relative quantities in plasma and urine.","authors":"Fanny Sandberg, Nicholas Kueng, Vanessa Banz, Annalisa Berzigotti, Daniel Sidler, Carlo R Largiadèr, Ursula Amstutz","doi":"10.3389/frtra.2026.1790754","DOIUrl":"10.3389/frtra.2026.1790754","url":null,"abstract":"<p><strong>Background: </strong>Donor-derived cell-free DNA (ddcfDNA) is increasingly being integrated into clinical practice for detecting allograft rejection in solid organ recipients. Natural fluctuations in ddcfDNA or other conditions can affect interpretation. Therefore, we investigated ddcfDNA trends in kidney (KT) and liver (LT) recipients over the first 2 years post-transplantation, assessing intra- and inter-individual variability in absolute and relative quantities. Additionally, we analysed urinary ddcfDNA in KT alongside plasma ddcfDNA and other biomarkers.</p><p><strong>Methods: </strong>Blood and urine from KT and LT were collected longitudinally at regular visits. Mismatched <i>HLA-DRB1</i> alleles between donor and recipient were used to determine absolute (ddcfDNA_cpml) and relative (ddcfDNA%) quantities of ddcfDNA with droplet digital PCR.</p><p><strong>Results: </strong>We found comparable inter- and intra-individual variability in stable KT plasma for both absolute and fractional ddcfDNA. In stable and nonstable LT plasma, intra-individual variability accounted for most of the total variance. Urinary ddcfDNA in KT showed inter-sex variability in fractional quantities.</p><p><strong>Conclusions: </strong>The large contribution of intra-individual variability suggests including individual ddcfDNA dynamics in addition to fixed cut-offs for the detection of allograft injury. In LT and urinary ddcfDNA in KT, ddcfDNA_cpml should be considered alongside ddcfDNA%, as they seem to directly represent the allograft status.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1790754"},"PeriodicalIF":0.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274470","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":"Impact of kidney transplantation on sex hormone level and sexual function in end stage renal disease men.","authors":"Kun Sirisopana, Surawach Piyawannarat, Chinnakhet Ketsuwan, Nuttapon Arpornsujaritkun, Surasak Kantachuvesiri, Kittinut Kijvikai, Wisoot Kongcharoensombat, Yada Phengsalae, Wijittra Matang, Premsant Sangkum","doi":"10.3389/frtra.2026.1812105","DOIUrl":"10.3389/frtra.2026.1812105","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to prospectively evaluate changes in erectile function and sex hormone levels, including free and bioavailable testosterone, in male end-stage renal disease (ESRD) patients before and at various time points after kidney transplantation (KT).</p><p><strong>Methods: </strong>Male ESRD patients aged 18-70 years who underwent living KT were enrolled between September 2019 and April 2021. Participants completed the International Index of Erectile Function (IIEF-5) and Aging Male Symptoms (AMS) questionnaires one day before KT and at one, six, and 12 months post-transplant. Sex hormones, including testosterone, sex hormone-binding globulin (SHBG), albumin, FSH, and LH, were measured at the same intervals. Free and bioavailable testosterone levels were calculated using a verified calculator.</p><p><strong>Results: </strong>Twenty-eight male patients were enrolled, with a mean age of 43.5 years. The IIEF-5 scores significantly improved at six months after KT (<i>p</i> = 0.006) and were maintained over one year. Patients with a dialysis duration of one to three years showed significant improvement in IIEF-5 scores (<i>p</i> = 0.019), whereas those on dialysis for more than three years did not demonstrate significant changes. AMS scores significantly decreased (improved) starting from the first month post-KT (<i>p</i> < 0.001). Regarding hormones, bioavailable testosterone increased significantly six and 12 months after KT, while free testosterone revealed non-significant increases. LH levels decreased at one month post-KT (<i>p</i> < 0.001) and remained reduced throughout the study.</p><p><strong>Conclusion: </strong>Successful KT significantly enhanced erectile function, particularly in patients with a dialysis duration of less than three years, with significant improvements observed after six months. The increase in bioavailable testosterone and the reduction in LH levels, alongside improved AMS scores, may reflect the restoration of testicular functioning following transplantation.</p><p><strong>Clinical trial registration: </strong>https://www.thaiclinicaltrials.org/show/TCTR20181123003, identifier: TCTR20181123003.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1812105"},"PeriodicalIF":0.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13260329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of enhanced recovery after surgery in kidney and liver transplantation and outline of the Newcastle ERAS protocols.","authors":"E Bonner, C Scuffell, F Dowen, L MacDougall, J Fabes, D M Manas, A Amer","doi":"10.3389/frtra.2026.1704028","DOIUrl":"10.3389/frtra.2026.1704028","url":null,"abstract":"<p><p>Although Enhanced Recovery after Surgery (ERAS) is now common practice across various surgical specialties, the adoption of its principles has only recently gained momentum in liver and kidney transplantation. The publication of relevant ERAS guidelines in these specialties has undoubtedly facilitated the assimilation of evidence in support of ERAS components, the paucity of which had been viewed as a barrier to the implementation of ERAS in transplantation. In conjunction, institutionally-developed ERAS pathways have provided pragmatic examples of how these principles can be adopted within transplant practice. In this article, we summarise the current recommendations and underlying evidence for key components of an enhanced recovery programme in kidney and liver transplantation, with reference to contemporary national guidance, and outline the Newcastle ERAS protocols in these specialties as illustrative models of implementation.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1704028"},"PeriodicalIF":0.0,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13253640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255412","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":"The evolving deceased donor kidney transplantation programme in Sri Lanka: current landscape, constraints, and next steps.","authors":"Anura Hewageegana","doi":"10.3389/frtra.2026.1811682","DOIUrl":"10.3389/frtra.2026.1811682","url":null,"abstract":"<p><p>Deceased donor kidney transplantation (DDKT) is an essential strategy to improve access to kidney replacement therapy in low- and middle-income countries (LMICs), where haemodialysis capacity remains insufficient and long-term peritoneal dialysis is under-utilised. In Sri Lanka, deceased donation has evolved from sporadic, centre-driven activity towards a more structured national programme with clearer policy direction, defined retrieval zones, and gradually standardised clinical workflows. However, safe expansion of DDKT requires more than policy development. It depends on practical investment in implementation systems, including protected transplant coordination roles, secure and reliable information platforms, and timely access to quality-assured immunobiology services. At present, consistent national execution is constrained by the incomplete availability of three key enabling components: (i) a real-time national transplant waitlist with accurate candidate status, (ii) an end-to-end organ offer and acceptance workflow that produces a permanent audit trail, and (iii) time-critical immunobiology capacity to support compatibility assessment for each deceased donor offer. In this context, zone-based coordination with standardised but largely manual allocation processes continues to function as a pragmatic transitional safety framework. Nevertheless, this model limits reproducibility, equity monitoring, and systematic programme learning. This Perspective summarises the current policy and operational environment, identifies predictable bottlenecks across the donation-to-transplant pathway, and proposes a staged systems roadmap that prioritises safety and auditability before automation. Key priorities include structured manual allocation processes with mandatory documentation and key performance indicator (KPI) reporting, development of a minimum viable national registry with a secure offer workflow, and phased strengthening of immunobiology services to enable gradually automated and quality-assured national allocation. The Sri Lankan experience offers practical and potentially transferable lessons for LMIC transplant programmes seeking to scale deceased donor transplantation while maintaining patient safety, equity, and public trust.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1811682"},"PeriodicalIF":0.0,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13246483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221480","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":"Sex-based survival disparities persist in liver transplantation: MELD 3.0 fails to improve survival for waitlisted women.","authors":"Marissa Di Napoli, Trevor Nydam, Michael Kriss, Maria Baimas-George, Bryon Bhagwandin, Bruce Kaplan, John Malamon","doi":"10.3389/frtra.2026.1755115","DOIUrl":"10.3389/frtra.2026.1755115","url":null,"abstract":"<p><strong>Background & aims: </strong>As a response to the well-documented disadvantages within the current allocation system, MELD 3.0 emerged on July 15, 2023, to more accurately characterize end-stage liver disease severity across the sexes. While simulation modeling predicted fewer waitlist deaths compared to MELD-Na, there is a lack of empirical data evaluating the efficacy of MELD 3.0 since its implementation. This study aims to conduct a waitlist patient survival study to explore sex- and age-based survival disparities in women and quantify empirical survival differences among waitlisted liver transplant candidates before and after the implementation of MELD 3.0.</p><p><strong>Methods: </strong>A retrospective, cross-sectional patient risk analysis of the Scientific Registry of Transplant Recipients (SRTR) database of liver transplant candidates listed from January 1, 2017, to September 3, 2024.</p><p><strong>Setting: </strong>The United States.</p><p><strong>Participants: </strong>Adult liver transplant candidates on the waitlist (<i>N</i> = 95, 211). Exclusion criteria included a history of prior transplant and the need for multi-organ transplant.</p><p><strong>Exposures: </strong>All-cause patient waitlist mortality.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the persistence of the waitlist survival gap between the sexes before and after the implementation of MELD 3.0. Secondary outcomes included risk-adjusted survival disparities in association with age.</p><p><strong>Results: </strong>Across the two MELD eras, waitlisted females experienced a 16.28% mean increase in the relative 180-day median hazard ratio as compared to males. Patients 65 years and older had a 350% mean increase in their 180-day mortality hazard ratio as compared to patients 18 to 35 years of age. Patients 65 years of age and older with MELD scores greater than 34 experienced a 180-day median survival probability of 65%.</p><p><strong>Conclusions and relevance: </strong>Despite the implementation of MELD 3.0, the waitlist survival gap disadvantaging women persists. The relationships between waitlist survival and patient age and sex are complex and time-dependent. As such, time-dependent survival models along with the addition of patient age and other characteristics could significantly improve patient survival diagnostics and help close the waitlist survival gap between the sexes.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1755115"},"PeriodicalIF":0.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148214161","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":"The integration of psychosocial care, ethical governance, and patient-centered research in current and future approaches in the field of vascularized composite allotransplantation.","authors":"Martin Kumnig, Lisa Hopfgartner, Gerald Brandacher","doi":"10.3389/frtra.2026.1869486","DOIUrl":"10.3389/frtra.2026.1869486","url":null,"abstract":"<p><p>Vascularized composite allotransplantation (VCA) has transitioned from an experimental endeavor to a clinically viable option for patients with complex tissue loss. While advances in microsurgery, immunosuppression, and perioperative care have improved graft survival, long-term success remains contingent upon psychosocial integration and robust ethical governance. These developments are reshaping not only clinical outcomes but also the conceptual foundations of transplantation. VCA uniquely challenges traditional paradigms, as it is primarily life-enhancing rather than life-saving, thereby intensifying ethical scrutiny regarding risk-benefit proportionality. Psychosocial factors such as identity reconstruction, body wholeness, personal autonomy, adherence, and long-term mental health are central determinants of graft success. Concurrently, innovations such as AI-driven allocation systems, big data analytics, and digital monitoring introduce novel ethical concerns related to autonomy, transparency, data governance, and equity. A key objective of this mini-review is to critically examine how emerging technological innovations in VCA intersect with psychosocial processes and bioethical principles, and to outline a framework for their responsible integration into clinical practice. It argues that technological progress must be embedded within a patient-centered approach that prioritizes lived experience, relational ethics, and trust. The integration of person-centered care models, longitudinal assessments, and interdisciplinary \"team science\" approaches is essential for ensuring that innovation translates into meaningful, equitable, and ethically sustainable improvements in patient outcomes Ultimately, the future of VCA depends on aligning biomedical innovation with psychosocial resilience and ethical legitimacy, ensuring that reconstructive success translates into meaningful improvements in quality of life and providing access to these transplants for all patients in need.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1869486"},"PeriodicalIF":0.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148214193","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":"Editorial: Organ transplantation by 2040.","authors":"Jerzy W Kupiec-Weglinski, Ronald W Busuttil","doi":"10.3389/frtra.2026.1861786","DOIUrl":"10.3389/frtra.2026.1861786","url":null,"abstract":"","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1861786"},"PeriodicalIF":0.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148214148","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":"Overcoming barriers and enhancing strategies in organ transplantation systems: a systematic review.","authors":"Priya Sharma, Nipin Kalal, Nimarta Rana","doi":"10.3389/frtra.2026.1835021","DOIUrl":"10.3389/frtra.2026.1835021","url":null,"abstract":"<p><strong>Background: </strong>Organ transplantation is one of the major achievements of modern medicine, yet the global shortage of organs remains a serious challenge. This shortage increases mortality among patients on waiting lists. Although up to 80% of people support organ donation, far fewer register as donors, creating a clear \"knowledge-action gap.\"</p><p><strong>Aim: </strong>This systematic review aimed to identify key barriers to organ donation and evaluate strategies to improve donation rates.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for peer-reviewed studies published in the last decade. Following PRISMA guidelines, 33 studies were included, covering randomized controlled trials, cross-sectional, and mixed-methods designs. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools.</p><p><strong>Results: </strong>Barriers to organ donation were found to be complex and interconnected, involving social, psychological, and systemic factors. Lack of knowledge was the most common issue, with up to 91% reporting poor awareness and only 11% aware of relevant laws. Sociocultural and religious concerns also influenced decisions, with 38.8% reporting misconceptions and 58% lacking family support. Psychological barriers were significant, with 69% fearing health complications and expressing mistrust in the healthcare system. At the system level, despite general willingness, only 37.3% of healthcare professionals had donor cards. However, targeted interventions showed positive outcomes. Educational programs increased willingness to register from 12% to 68% and improved knowledge from 36.4% to 88.5%.</p><p><strong>Conclusion: </strong>The main barrier to organ donation is the gap between willingness and action, largely due to uncertainty and lack of understanding. Bridging this gap requires a combined approach: providing simple, culturally appropriate education about donation and improving healthcare systems to build trust and reduce financial and practical burdens on donors.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1835021"},"PeriodicalIF":0.0,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148202043","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":"Outcomes of allogeneic hematopoietic cell transplantation in patients with carbapenem-resistant organisms infection: a propensity score-matched analysis.","authors":"Abeer Yaseen, Teeba Mubaydeen, Hazem Al-Qaraleh, Ahmad Otoom, Shadee Shaban, Hazim Mesmar, Albatoul Alomoush, Waleed Da'Na, Khalid Halahleh, Husam Abu Jazar, Salwa Saadeh, Mohammad Ma'koseh, Abdulrahman Shamieh, Susan Kullab, Osama Abu Ata, Joud Jarrah, Zaid Abdel Rahman","doi":"10.3389/frtra.2026.1818037","DOIUrl":"10.3389/frtra.2026.1818037","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant organisms (CRO) cause significant morbidity and mortality, with a rising incidence worldwide. Immunosuppression, prolonged hospitalization, and extensive use of broad-spectrum antibiotics make allogeneic hematopoietic cell transplant (alloHCT) recipients particularly susceptible. This study evaluated the impact of peri-transplant CRO infections on alloHCT outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of adult alloHCT recipients between 2015 and 2024. CRO infection was defined as occurring within 12 months of alloHCT. Using 1:3 propensity score matching, patients with CRO were matched to controls by age, sex, year of transplant, stem cell source, donor type, and diagnosis. Overall survival (OS) and non-relapse mortality (NRM) were analyzed using Kaplan-Meier methods and Cox proportional hazards models.</p><p><strong>Results: </strong>A total of 171 patients were included: 43 with CRO and 128 controls; 53.4% of CRO cases occurred in the last 3 years. Median age was 35 years, 66.7% were male, and 89.5% underwent transplant for malignant disease. Matched-related donors were used in 79.5%, peripheral blood stem cells in 88.3%, and myeloablative conditioning in 70.2%. Median follow-up was 27 months. CRO patients had higher ICU admission rates (30.2% vs. 17.2%, <i>p</i> = 0.067) and lower 1-year OS (46.5% vs. 72.7%, <i>p</i> = 0.002). On multivariate analysis, CRO infection was independently associated with worse OS, while engraftment predicted improved OS and lower NRM.</p><p><strong>Conclusions: </strong>CRO infections remain an increasing challenge in alloHCT and are associated with higher ICU admission, increased NRM, and inferior survival, highlighting the need for improved prevention and management strategies.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1818037"},"PeriodicalIF":0.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A tribute to mentor and role model: Dr. Nicholas Lechmere Tilney.","authors":"Jerzy W Kupiec-Weglinski","doi":"10.3389/frtra.2026.1862909","DOIUrl":"10.3389/frtra.2026.1862909","url":null,"abstract":"","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1862909"},"PeriodicalIF":0.0,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059413","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}