Frontiers in transplantation最新文献

{"title":"Case Series: Endoscopic ultrasound-directed transgastric ERCP in liver transplant recipients with Roux-en-Y gastric bypass.","authors":"Peyton Crest, Julius S Navarro, Fawzy Barry, Chloe Sasakado, John P Roberts","doi":"10.3389/frtra.2026.1686667","DOIUrl":"10.3389/frtra.2026.1686667","url":null,"abstract":"<p><strong>Introduction: </strong>Among liver transplant recipients, Roux-en-Y gastric bypass (RYGB) may lead to postoperative malnutrition and nutrient deficiencies. Procedures such as the endoscopic ultrasound-directed transgastric ERCP (EDGE) can result in advantageous weight gain for liver transplant recipients with prior RYGB who do not respond to enteral or parenteral nutritional interventions.</p><p><strong>Methods: </strong>We present three patients who underwent EDGE for post-transplant malnutrition and weight loss.</p><p><strong>Results: </strong>EDGE resulted in weight gain across all patients. Liver transplant recipients with a history of RYGB may be at significant nutritional risk following transplant due to fat malabsorption, underestimation of resting energy expenditure, and appetite suppression mediated by neurohormonal signals.</p><p><strong>Conclusion: </strong>When traditional nutritional interventions are unsuccessful, the EDGE procedure may be an effective alternative to promote post-transplant weight gain in this unique population.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1686667"},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625200","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":"Variability in clinical triggers for organ donation referrals.","authors":"Kylie Casey, Elizabeth Thomas","doi":"10.3389/frtra.2026.1701648","DOIUrl":"10.3389/frtra.2026.1701648","url":null,"abstract":"<p><p>In organ transplantation, regulatory efforts have mainly targeted Organ Procurement Organizations (OPOs) and transplant centers, while donor hospitals-crucial to the donation process-have remained under-examined. As the first point of contact for potential donors, these hospitals lack standardized criteria for when and how to refer patients to OPOs, creating variability that can delay referral and reduce organ availability. This viewpoint focuses on clinical triggers: the physiological criteria that prompt hospitals to notify OPOs of potential donors. While CMS requires donor hospitals to maintain written agreements with their designated OPOs and to inform the OPO of deaths and \"imminent deaths,\" there is no national standard defining which bedside clinical criteria should prompt timely notifications; most hospitals defer to their local OPO for guidance. We analyzed clinical triggers from 55 of 56 U.S. OPOs and found marked inconsistency. Glasgow Coma Scale thresholds were used by 69.1%, and brainstem reflexes by 54.6%, with wide variation in both. Fewer than half addressed family discussions, and notification windows ranged from immediate to 240 min. These discrepancies reflect a critical bottleneck in the donor identification process. Standardizing clinical triggers and instituting a referral-based performance metric framework may improve metrics, thereby enhancing early donor identification, reducing missed referral opportunities, enhancing organ recovery, and reducing waitlist mortality. As scrutiny of OPOs and transplant centers increases, improving donor hospital practices is essential to optimizing the transplant system.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1701648"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518084","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":"Systematic review of emerging technologies in vascularized composite allotransplantation.","authors":"Anjali Chakradhar, Melody Yu, Simon G Talbot","doi":"10.3389/frtra.2026.1760147","DOIUrl":"10.3389/frtra.2026.1760147","url":null,"abstract":"<p><p>Vascularized composite allotransplantation (VCA) enables functional reconstruction for patients with extensive tissue defects, but has obstacles such as immune rejection, lifelong immunosuppression, and systems-level barriers that limit widespread adoption. VCA has rapidly evolved through novel surgical, immunologic, and bioengineering technologies. This systematic review synthesizes the current landscape of emerging VCA technologies, identifies literature gaps, and emphasizes opportunities for future research. We conducted a systematic literature review of PubMed and Embase with supplemental manual reference review. English-language experimental studies reporting novel VCA technologies and innovations published after 2004 were included. Case reports, reviews, studies without technological innovation, and non-English publications were excluded. Seventy-two studies fit the inclusion criteria. Novel immunomodulation strategies including belatacept, phototherapy, siRNA therapeutics, and tolerance induction via regulatory T-cells show potential to reduce systemic immunosuppression, while mesenchymal stem cell approaches may increase graft tolerance. On another front, advanced surgical techniques with real-time monitoring and nerve regeneration protocols are looking to promote functional recovery. Digital innovations like 3D modeling and virtual surgical planning allow for patient-specific preoperative planning and intra-operative assistance. In parallel, machine perfusion and cryopreservation extend tolerable ischemia times and may also enable early rejection detection. Similarly, biomarkers and imaging provide early and noninvasive rejection prediction. On a bigger scale, patient selection incorporating evidence-backed psychosocial factors and communication training work to address systems-level barriers to expand access. Ongoing research to translate these innovations into clinical practice will be important in realizing the potential of VCA.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1760147"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13006663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518092","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":"Liver transplantation in patients with history of extra-hepatic malignancies.","authors":"Jerry Xiao, Ashton A Connor, Ahmed Elaileh, Khush Patel, Samar Semaan, Youssef Dib, Jason Todd, Linda W Moore, Sudha Kodali, David W Victor Iii, Maen Abdelrahim, Anaum Maqsood, Caroline J Simon, Yee Lee Cheah, Constance M Mobley, Ashish Saharia, A Osama Gaber, R Mark Ghobrial, Kirk Heyne","doi":"10.3389/frtra.2026.1723729","DOIUrl":"10.3389/frtra.2026.1723729","url":null,"abstract":"<p><strong>Introduction: </strong>Increasing use of solid organ transplantation [SOT] has coincided with increasing cancer survivorship. Consensus statements exist for SOT in patients with pre-transplant malignancy [PTM]. Yet, most outcomes have been reported in heart and kidney transplant. This paper addresses the shortage of information on liver transplant [LT] in patients with PTM.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted of patients who underwent LT between 1/1/2008-5/31/2024 at an American transplant center. Patients were stratified according to history of extrahepatic PTM, time from PTM to LT, and post-LT PTM recurrence. Primary outcomes were overall survival [OS] and time to recurrence.</p><p><strong>Results: </strong>1,876 patients underwent LT. 143(7.62%) had an extrahepatic PTM pre-LT. PTM patients were older and had lower MELD at LT. There was no significant difference in post-LT survival (<i>p</i> = 0.293) between patients who did and did not have PTM. Of 121 patients with known time from PTM to LT, 19(15.7%) had an interval less than 2 years. When stratifying by 2-year interval from PTM to LT, there was no difference in survival (<i>p</i> = 0.34). Post-LT, 20 patients (14.0%) had recurrence of their PTM. The average time to recurrence was 595.5 days. When treated as a time-dependent co-variate, recurrence was a strong predictor of worse post-LT survival (HR 10.9, 95% CI 4.32-27.7, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>In our experience<b>,</b> a history of pre-LT PTM, including with an interval to LT of less than 2 years, was not associated with worse post-LT survival. Recurrence of PTM did portend worse prognosis.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1723729"},"PeriodicalIF":0.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147501488","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":"Double whammy: increased severe primary graft dysfunction after prolonged warm ischemia and inadequate oxygen delivery during heart transplant.","authors":"Chen Chia Wang, Awab Ahmad, Mark Petrovic, Walter Navid, Christian Eidson, John Trahanas, Aaron M Williams, Swaroop Bommareddi, Duc Q Nguyen, Tarek Absi, Eric Quintana, Stephen DeVries, Joey A Lepore, Matt Warhoover, Aniket S Rali, Kelly H Schlendorf, Matthew Bacchetta, Ashish S Shah, Brian Lima","doi":"10.3389/frtra.2026.1737467","DOIUrl":"10.3389/frtra.2026.1737467","url":null,"abstract":"<p><strong>Objective: </strong>This exploratory study examined the relationship between oxygen delivery index (DO2i) during DCD heart transplant (HT), warm ischemic time, and posttransplant outcomes.</p><p><strong>Methods: </strong>All DCD HT between 10/2021 and 12/2024 using normothermic regional perfusion (<i>N</i>RP) at our institution were included. Multiorgan transplants and congenital heart disease patients were excluded. Critical areas-sum of magnitude and duration of DO2i under specific thresholds-were calculated for thresholds 300, 280, and 260 mL/min/m2. Receiver operating characteristics (ROC) analysis dichotomized the critical area into high area (low DO2i) and low area (high DO2i) groups. Patients were then stratified into 4 groups based on high/low functional warm ischemic time (FWIT), and high/low DO2i. Outcomes were compared across groups.</p><p><strong>Results: </strong>The critical area under 260 mL/min/m2 was the best predictor of severe primary graft dysfunction (PGD). 102 patients met inclusion criteria, and were stratified into four groups based on FWIT above/below 23 min and critical area below/above 1,424 mL/m2 (identified by ROC analysis). 39 (38.2%) patients had low FWIT/ high DO2i, 18 (17.6%) had low FWIT/ low DO2i, 24 (23.5%) had high FWIT/high DO2i, and 21 (20.6%) had high FWIT/low DO2i. Rates of severe PGD were greater in the high FWIT/low DO2i group compared to the low FWIT/high DO2i group (23.8% vs. 0%, <i>p</i> = 0.004). Rates of 30-day mortality were higher in the high FWIT/low DO2i group compared to the low FWIT/high DO2i group (14.3% vs. 0%, <i>p</i> = 0.039).</p><p><strong>Conclusions: </strong>Higher oxygen delivery during HT was associated with improved short-term outcomes, and may counteract the myocardial damage from warm ischemia during DCD.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1737467"},"PeriodicalIF":0.0,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438923","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":"Mechanisms inducing differentiation of adult islet progenitor-like cells into functional islet-like organoids.","authors":"Carly M Darden, Jayachandra Kuncha, Jeffrey T Kirkland, Jordan Mattke, Srividya Vasu, Prathab Balaji Saravanan, Bashoo Naziruddin, Michael C Lawrence","doi":"10.3389/frtra.2026.1740314","DOIUrl":"10.3389/frtra.2026.1740314","url":null,"abstract":"<p><strong>Introduction: </strong>Adult pancreatic tissue contains cell populations with latent regenerative potential, but the processes governing their expansion and differentiation into endocrine lineages remain unclear.</p><p><strong>Methods: </strong>Adult human pancreatic cells obtained from donor tissue were isolated and expanded and analyzed for lineage potential using single-cell RNA sequencing, flow cytometry, and functional assays. A CD9⁺ PROCR⁺ RGS16⁺ subpopulation, termed islet progenitor-like cells (IPCs), was evaluated for proliferative capacity and differentiation potential.</p><p><strong>Results: </strong>IPCs exhibited robust proliferative capacity and, upon differentiation, formed insulin- and glucagon-secreting organoids. Treatment of IPCs with the small molecule ISX9 induced expression of key transcription factors RFX6 and NEUROD1 through calcium-dependent chromatin remodeling mediated by NFAT recruitment of p300 and displacement of histone deacetylases (HDAC1-3). Pharmacologic inhibition of HDACs further enhanced IPC maturation and glucose-stimulated insulin secretion.</p><p><strong>Discussion: </strong>These findings define the molecular and epigenetic mechanisms driving the expansion and differentiation of adult IPCs into functional islet-like organoids, providing a foundation for future regenerative approaches using adult pancreatic tissue as a renewable source for endocrine cell replacement.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1740314"},"PeriodicalIF":0.0,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12963012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380487","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":"Standardized evaluation protocols for deceased and living liver donors: a practical framework for emerging liver transplant programs.","authors":"Pablo Coste Murillo, Rodrigo Álvarez Buitrago, Vanessa López Jara, María Fernanda Lynch-Mejía, Francisco Vargas Navarro, Wagner Ramírez Quesada, Christie Perelló, José Luis Calleja","doi":"10.3389/frtra.2026.1739776","DOIUrl":"10.3389/frtra.2026.1739776","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation (LT) remains the definitive therapy for end-stage liver disease. However, significant variability in infrastructure, policy, and clinical practice continues to influence the implementation of deceased donor (DDLT) and living donor liver transplantation (LDLT) worldwide, particularly across emerging and expanding programs.</p><p><strong>Methods: </strong>This narrative review synthesizes contemporary guidelines, expert consensus documents, and high-impact clinical studies on donor evaluation. It presents a standardized and pragmatic framework for both DDLT and LDLT, integrating medical, radiologic, ethical, and psychosocial domains. Protocols are designed to be evidence-based, reproducible, and aligned with international standards.</p><p><strong>Key content and findings: </strong>In DDLT, optimal donor management, accurate neurological determination of death, and comprehensive infectious disease screening are essential for graft viability. In LDLT, meticulous psychosocial and anatomical assessments remain critical to donor safety. Advances such as machine perfusion, desensitization protocols, and expanded donor criteria have improved outcomes and broadened transplant opportunities. The proposed framework consolidates global best practices to support program consistency and quality assurance.</p><p><strong>Conclusions: </strong>This review provides a comprehensive and practical approach to donor evaluation in LT, promoting harmonization of practices across diverse healthcare systems. Its adoption may enhance donor safety, optimize graft utilization, and support the sustainable growth of both DDLT and LDLT programs worldwide.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1739776"},"PeriodicalIF":0.0,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379687","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":"Microbiota management: a perspective for kidney transplant patients.","authors":"Cláudia Silva Souza, Niels Olsen Saraiva Camara, Thaís Alves-Silva","doi":"10.3389/frtra.2026.1703048","DOIUrl":"10.3389/frtra.2026.1703048","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is recognized as one of the most significant public health issues globally, with approximately 40% of patients progressing to end-stage kidney disease (ESKD). Transplantation remains the most indicated option for many patients with ESKD; however, these individuals frequently experience hospital readmissions and face a heightened risk of developing other complications. Although short-term allograft survival, typically around one year, tends to be satisfactory, long-term graft survival is often compromised due to acute and chronic rejection, which can be mediated by antibodies or other recipient-related factors. Recent studies and review articles have emphasized the relationship between intestinal dysbiosis and chronic renal failure, as well as the poor outcomes associated with kidney transplantation. The CKD itself, as well as the immunosuppressive medications used by organ transplant recipients, can lead to intestinal dysbiosis, which in turn increases the production of uremic toxins that can harm even the transplanted kidney. Clinical studies have demonstrated that the combination of prebiotics, probiotics, and synbiotics-supplements that aid in the establishment of intestinal microbiota-can effectively help control the production of nitrogenous substances, reduce renal inflammation, and alleviate gastrointestinal symptoms in patients with CKD. Experimental models have shown that short-chain fatty acids derived from gut fermentation of dietary fiber, such as butyrate and acetate, could improve renal function and reduce renal inflammation, allowing better acceptance of kidney allograft, partly by inducing T regulatory cells. Despite the growing evidence supporting the positive effects of maintaining a balanced microbiota, there is still a lack of comprehensive reviews in this field. Additionally, recent findings suggest that the type of fiber consumed may influence intestinal health and even increase susceptibility to colorectal cancer, depending on the fiber type. Therefore, we aim to explore how substances derived from gut fermentation of dietary fiber, in addition to probiotics, prebiotics, and synbiotics, contribute to allograft tolerance, with a particular focus on their potential application in establishing renal function in allograft recipients.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1703048"},"PeriodicalIF":0.0,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12960561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379707","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":"100 most-cited publications in vascularized composite allotransplantation.","authors":"Pharel Njessi, Carter J Boyd, Palmina Petruzzo, Olivier Camuzard, Antoine Sicard, Rami Kantar, Eduardo D Rodriguez, Elise Lupon","doi":"10.3389/frtra.2026.1745991","DOIUrl":"10.3389/frtra.2026.1745991","url":null,"abstract":"<p><strong>Background: </strong>Citation analysis is a useful bibliometric tool to identify impactful publications and trace the evolution of a specialty or a technique. In the past three decades, the research on vascularized composite allotransplantation (VCA) has grown exponentially but very few studies have examined the most influential papers in this field.</p><p><strong>Methods: </strong>The Web of Science Core Collection database was searched for articles published from inception to August 4th, 2025. Titles, full authors' names, years of publication, source journals, regions of origin, and numbers of citations were recorded. VCA anatomical location, main topics, and citation density were determined. Articles were ranked based on number of citations and citation density; they were then categorized based on methodology, study design, and main topic.</p><p><strong>Results: </strong>The 100 most-cited articles on VCA were published between 1996 and 2018 with the number of citations per article ranging from 61 to 604 citations. There were 53 non-clinical studies, the most prevalent topics were outcomes and rehabilitation (<i>n</i> = 48 articles) and immunology (<i>n</i> = 37). Of the 75 studies evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence, most (<i>n</i> = 51) were classified as level 4.</p><p><strong>Discussion: </strong>This list of the top 100 most-cited articles highlights seminal and influential papers in VCA. It also demonstrates the relative novelty of this field with ongoing efforts in immunological research to allow its further expansion. The present study provides an understanding of VCA evolution while directing future clinical and preclinical studies.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1745991"},"PeriodicalIF":0.0,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12957187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367856","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 risk of kidney transplant graft loss in sensitized vs. unsensitized patients is modified by prior transplant status.","authors":"A Nicholson, K Tennankore, A J Vinson","doi":"10.3389/frtra.2026.1712618","DOIUrl":"10.3389/frtra.2026.1712618","url":null,"abstract":"<p><strong>Background: </strong>A prior kidney transplant (KT) has been associated with an increased risk of graft loss following repeat transplantation. This study examined the risk of adverse posttransplant outcomes between patients with and without a prior transplant, depending on sensitization status.</p><p><strong>Methods: </strong>We used propensity score matching to examine the combined exposure of sensitization status [panel-reactive antibody (PRA) 0%, >0%-80%, and >80%] and first/repeat KT as a nested variable in adults across the US [2000-2017; Scientific Registry of Transplant Recipients (SRTR)]. We then used multivariable Cox and logistic regression models to examine the association between the nested variable and death-censored graft loss (DCGL), all-cause graft loss (ACGL), and delayed graft function (DGF). Effect modification between PRA status (20%) and prior KT status was assessed for each outcome.</p><p><strong>Results: </strong>Among 38,660 matched patients, DCGL (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.47-1.66), ACGL (aHR 1.42, 95% CI 1.35-1.49), and DGF (adjusted Odds Ratio (aOR) 1.89, 95% CI 1.75-2.03) risk was highest with a prior KT and PRA >80% (vs. unsensitized transplant-naïve patients). The risk associated with increased PRA was greater in those with a prior transplant. Prior KT modified the association between increased PRA and DCGL, ACGL, and DGF (<i>p</i>-value < 0.001).</p><p><strong>Conclusion: </strong>Prior KT status modified the association between PRA and adverse outcomes. Sensitized patients (PRA >80%) with a prior KT faced higher risks of DCGL, ACGL, and DGF compared with sensitized patients without a prior KT.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1712618"},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12950723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349984","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}