Transplantation proceedings最新文献

{"title":"Impact of Changes in Liver Allocation System on the Utility of Donor Liver Biopsy for Liver Transplantation.","authors":"Amir Ebadinejad, Leah Aakjar, Jennifer M Brewer, David O'Sullivan, Wasim Dar, Michael Einstein, Glyn Morgan, Bishoy Emmanuel, Eva U Sotil, Elizabeth Richardson, Colin Swales, Oscar K Serrano","doi":"10.1016/j.transproceed.2025.09.006","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.09.006","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of the acuity circles (AC) deceased donor liver allocation policy on graft utilization remains unclear, with recent studies suggesting a decline in liver utilization despite an increase in potential donors. This study aimed to compare deceased donor liver biopsy (DDLB) rates and identify factors associated with DDLB utilization before and after AC implementation.</p><p><strong>Methods: </strong>Data from the Scientific Registry of Transplant Recipients (SRTR) for January 2018 to June 2021 were retrospectively analyzed, dividing donors into pre-AC (Jan 2018-Feb 2020) and post-AC (Feb 2020-June 2021) periods. The study included 16,969 donor's pre-AC and 11,156 donor's post-AC, categorized into DDLB and non-DDLB groups. Primary endpoints included DDLB rates, graft nonuse rates, patient survival, and death-censored graft survival (DCGS). Statistical analyses involved chi-square tests, t-tests, and multivariate logistic regression.</p><p><strong>Results: </strong>DDLB utilization increased from 38.2% pre-AC to 40.8% post-AC (P < .001). Post-AC, the DDLB group had a higher proportion of male donors and older donors. One-year patient survival rates decreased post-AC in both groups (P < .001), while DCGS rates remained stable. Graft nonuse rates showed no significant differences. Multivariate analysis identified the AC policy, donor age, diabetes, and donation after circulatory death as significant predictors of DDLB use, with the AC policy independently increasing DDLB likelihood by 20% (OR = 1.2, CI: 1.13-1.26, P < .001).</p><p><strong>Conclusion: </strong>The AC policy has led to increased DDLB utilization, likely due to broader recipient selection. These findings suggest the need for standardized guidelines to optimize DDLB use while balancing recipient selection with associated risks.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076983","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":"Analysis of the Cost-Effectiveness of Treatment Strategies for Acute-on-Chronic Liver Failure.","authors":"Wei-Bo Guo, Xi-Ju Guo, Meng-Yao Zheng, Xuan-Cheng Xie, Yong-Pin Wang, Bo Gan, Jin-Hui Yang","doi":"10.1016/j.transproceed.2025.08.026","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.08.026","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the cost-effectiveness of 3 artificial liver models, plasma exchange (PE), the double plasma molecular absorption system (DPMAS), and a combination of plasma exchange with the double plasma molecular absorption system (PE + DPMAS) as well as medical drugs in treating patients with acute-on-chronic liver failure.</p><p><strong>Methods: </strong>A retrospective approach was employed to collect clinical data from electronic medical records. The study included 296 patients who met the inclusion criteria and were categorized based on their treatment into 2 groups: the medical treatment group and the artificial liver group, the latter of which included PE, DPMAS, and PE + DPMAS. To compare the costs and effectiveness of the medical treatment group with the 3 artificial liver treatment groups, a pharmacoeconomic cost-effectiveness analysis was conducted to assess the economic aspects.</p><p><strong>Results: </strong>The effectiveness rate of the PE + DPMAS group was 76.9%, which was significantly higher than that of the PE and DPMAS group (P < .05). The effectiveness rate of the PE group was similar to that of the DPMAS group (P > .05). The effectiveness rate in all 3 artificial liver treatment groups was higher than that of the medical treatment group (P < .05). The total cost per person was RMB 54,661.6, RMB 61,385.5, RMB 71,789.2, and RMB 65,945.7 in the medical treatment, and the artificial liver PE group, DPMAS, and PE + DPMAS groups, respectively. The cost-effectiveness ratio (C/E) was 2009.6, 1162.6, 1511.4, and 758.9, respectively. The sensitivity analysis results for costs were consistent with the cost-effectiveness analysis results.</p><p><strong>Conclusions: </strong>The artificial liver treatment group demonstrated a superior \"performance-cost ratio,\" with the PE + DPMAS group being the most effective. This combination can be considered the optimal treatment for acute-on-chronic liver failure when combined with appropriate drug therapy.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082935","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 Symptom Clusters on Fear of Progression in Kidney Transplant Recipients.","authors":"Minghuan Zhong, Weiwei Cao, Jingjing Yang, Li Ma, Yulin Niu, Bei Ding","doi":"10.1016/j.transproceed.2025.07.029","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.07.029","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between symptom clusters and fear of progression (FoP) in kidney transplant recipients, and to provide evidence for clinical interventions.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using convenience sampling, enrolling 209 kidney transplant recipients from a tertiary hospital between September 2024 and January 2025. Participants were assessed using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and the Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-62).</p><p><strong>Results: </strong>The mean total FoP score was 25.15 ± 9.06. Exploratory factor analysis identified 5 symptom clusters, accounting for 72.3% of the total variance. The emotional-related symptom cluster had the highest prevalence (31/209), while patients with neurocognitive symptom clusters reported the highest FoP scores (31.5 ± 9.22). Spearman correlation analysis revealed that FoP was significantly and positively associated with the physical discomfort cluster (r = 0.194), the emotional-related cluster (r = 0.452), and the neurocognitive function cluster (r = 0.255) (P < .001). Multiple regression analysis confirmed that these 3 clusters explained 42.7% of the variance in FoP.</p><p><strong>Conclusion: </strong>Symptom clusters are closely associated with FoP in kidney transplant recipients. Greater symptom severity is linked to higher levels of FoP. It is recommended that clinicians strengthen symptom cluster management and implement systematic interventions to reduce patients' FoP.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077066","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":"The Incidence, Mechanisms, and Clinical Impact of Tacrolimus-Associated Thrombotic Microangiopathy in Kidney Transplant Recipients: A Multicenter Retrospective Cohort Study.","authors":"Ahmad Matarneh, Sundus Sardar, Omar Salameh, Jesse Cruise, Ronald Miller, Amanda Karasinski, Vaqar Shah, Navin Verma, Gurwant Kaur, Naman Trivedi, Umar Farooq, Nasrollah Ghahramani","doi":"10.1016/j.transproceed.2025.07.028","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.07.028","url":null,"abstract":"<p><strong>Background: </strong>Thrombotic microangiopathy (TMA) represents a critical and potentially devastating complication in kidney transplantation. Characterized by microvascular thrombosis, hemolytic anemia, and organ dysfunction, TMA poses significant risks to kidney transplant recipients. Among these patients, calcineurin inhibitors (CNIs) like tacrolimus have been implicated in TMA pathogenesis due to their ability to induce endothelial injury. This study aims to investigate the incidence of tacrolimus-related TMA and its clinical outcomes, hypothesizing that tacrolimus usage correlates with a higher incidence of TMA and poorer clinical outcomes compared to alternative immunosuppressive therapies.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective analysis utilizing data from the TriNetX global health research network, examining 1252 kidney transplant recipients on tacrolimus and 290 on alternative immunosuppressive regimens. We assessed the incidence of TMA, rates of graft rejection and failure, and 5-year patient survival. Statistical analyses were performed, including adjusted relative risks (RR) and Kaplan-Meier survival curves.</p><p><strong>Results: </strong>The incidence of TMA was significantly higher in tacrolimus-treated patients (40.3%) compared to those on non-tacrolimus regimens (24.4%) (RR = 0.613, 95% CI = 0.495-0.760, P < .001). The 5-year survival rate was notably lower in the tacrolimus cohort (36.1%) compared to the non-tacrolimus group (77.3%) (RR = 0.379, 95% CI = 0.291-0.495, P < .001). Additionally, higher rates of graft rejection (43.1%) and graft failure (38.6%) were observed among tacrolimus recipients.</p><p><strong>Conclusion: </strong>Tacrolimus use in kidney transplant recipients was associated with a higher incidence of thrombotic microangiopathy, increased graft rejection and failure, and reduced 5-year survival. However, these findings are limited by the retrospective design, reliance on diagnosis codes, lack of detailed clinical and medication data, and absence of confounder adjustment. Prospective studies are needed to validate these associations and guide immunosuppressive strategies in high-risk patients.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077033","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":"Surgical Complications in ABO-incompatible Kidney Transplantation: A Single-Center Experience.","authors":"Ahmed M Abdel Gawad, Abhijit Patil, Abhishek Singh, Arvind P Ganpule, Ravindra B Sabnis, Mahesh R Desai, Mohamed H Zahran","doi":"10.1016/j.transproceed.2025.07.033","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.07.033","url":null,"abstract":"<p><strong>Objective: </strong>The shortage of ABO-compatible live donors has led to the adoption of ABO-incompatible kidney transplantation (ABOi-KT). Since 2012, our center has conducted ABOi-KT procedures. This study evaluates its effectiveness and short-term outcomes, focusing on surgical complications, predictors of complications, and patient and graft survival rates.</p><p><strong>Methods: </strong>We retrospectively analyzed prospectively maintained data for 123 ABOi-KT procedures from 2012 to 2021. Primary outcomes included peri-operative results, primary functioning grafts (PFG), biopsy-proven acute rejection (BPAR) rates, and 1-year patient and graft survival. Secondary outcomes included surgical complications and predictive factors.</p><p><strong>Results: </strong>Of 123 patients, 121 (98.4%) achieved PFG. BPAR occurred in 25 patients (20%), with 8.1% experiencing antibody-mediated rejection and 12.2% T-cell-mediated rejection. At a median follow-up of 13 months (IQR: 12-14), 104 patients (85%) retained functioning grafts with a median serum creatinine of 1.1 mg/dL (IQR: 1-1.5) and an estimated glomerular filtration rate (eGFR) of 67.5 mL/min/1.73 m² (IQR: 53-79.6). One-year graft survival was 87%. Surgical complications (HR = 5.4, P = .001) and BPAR (HR = 6, P = .03) significantly impacted graft survival. Patient survival was 98.4%, with a 1-year cumulative survival rate of 99%. Complications were reported in 39 patients (31.7%), primarily infections (18.6%), vascular (13%), and urinary (3.2%). Increased plasmapheresis sessions significantly predicted surgical complications (P = .01).</p><p><strong>Conclusions: </strong>ABOi-KT is a viable solution for addressing donor shortages, with acceptable survival rates. However, elevated rejection and complication rates highlight the need for better preconditioning and post-transplant protocols.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077048","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":"Evaluation of the Relationship Between Prognostic Nutritional Index and Early Clinical Outcomes in Intestinal Transplantation.","authors":"Göksever Akpınar, Batuhan Eyduran, Safa Vatansever, Ekrem Kocatürk, Mehmet Üstün","doi":"10.1016/j.transproceed.2025.09.002","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.09.002","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition in patients with intestinal insufficiency negatively affects the success of intestinal transplantation. In our research, we assessed patients' nutritional status using the PNI scale and examined the impact of the PNI score on clinical outcomes during the post-transplant phase.</p><p><strong>Results: </strong>The acute rejection rate was 38.1%, and the 30-day survival rate was 90.5%. Median PNI values were 41.5 (min-max: 33.5-65), 29.5 (min-max: 13.5-56.5), 33 (min-max: 3-51), 35.7 (min-max: 24.5-54), 33.5 (min-max: 24.5-75.5) preoperatively and on postoperative 1, 7, 15, and 30 days, respectively. No significant relationship was found between the other parameters and the PNI.</p><p><strong>Conclusions: </strong>The PNI score alone fails to adequately represent a patient's nutritional status and has not demonstrated effectiveness in predicting early-term outcomes for those undergoing intestinal transplantation. Additional studies involving a larger number of patients and diverse nutritional markers are necessary for further insights into this matter.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077007","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":"The Application of Personalized Conditioning Regimens in Relapsed/Refractory Acute Myeloid Leukemia Receiving Allogeneic Hematopoietic Stem Cell Transplantation.","authors":"Shuangzhu Liu, Biqi Zhou, Chongsheng Qian, Zheng Li, Yanjun Wu, Zhen Yao, Mingzhu Xu, Sheng-Li Xue","doi":"10.1016/j.transproceed.2025.08.014","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.08.014","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of personalized conditioning regimens in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the treatment of relapsed/ refractory acute myeloid leukemia (R/R AML).</p><p><strong>Methods: </strong>A retrospective analysis of the clinical data of 14 R/R AML patients who underwent allo-HSCT with a personalized conditioning regimen was conducted.</p><p><strong>Results: </strong>Among the 14 patients, there were 8 males and 6 females with a median age of 34.5 years (range 14-56). One patient received a transplant from a fully matched related donor, 2 from unrelated donors, and 12 from haploidentical donors. Prior to transplantation, all patients had a myeloblast percentage greater than 5% before transplantation, with a median myeloblast of 8.5 (6-88)%. Thirteen patients (92.86%) achieved morphologic leukemia-free state (MLFS) after conditioning. All patients achieved successful engraftment and hematopoietic recovery. The median time to neutrophil engraftment was 12 days (range 10-14), and the median time to platelet engraftment was 21.5 days (range 17-29). There was no obvious hepatorenal toxicity during the conditioning, and no mucositis more than grade 2 according to CTCAE 5.0 [1]. Bone marrow biopsies at +30 days post-transplant indicated remission in all cases. Two patients relapsed at 2 and 3 months post-transplant, with 2 dying after relapse. Additionally, 2 patients had CMV infections; 1 became negative after treatment, while the other remained positive and later died due to severe infection. As of the last follow-up, 11 out of 14 patients were alive (with marrow morphology and MRD Continuously negative).</p><p><strong>Conclusion: </strong>Allo-HSCT with a personalized conditioning regimen can be considered a treatment option for patients with R/R AML.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067096","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":"Living Donor Liver Transplantation in Patients With Portal Vein Thrombosis: A Single-Center Experience.","authors":"Emrah Sahin, Adem Tuncer, Feyza Sönmez Topcu, Veysel Ersan, Hasret Ayyıldız Civan, Abuzer Dirican, Bülent Ünal","doi":"10.1016/j.transproceed.2025.08.011","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.08.011","url":null,"abstract":"<p><strong>Background: </strong>Portal vein thrombosis (PVT) is a significant vascular complication in liver transplant candidates, necessitating modifications in surgical techniques and increasing the risk of postoperative complications. This study aimed to evaluate postoperative thrombotic complications, the need for reoperation, survival, and mortality rates after living donor liver transplantation (LDLT) in patients with preoperative PVT.</p><p><strong>Methods: </strong>Forty-nine patients diagnosed with preoperative PVT undergoing LDLT between July 2021 and August 2024 at our center were retrospectively reviewed. Patients were classified according to the Yerdel classification. Surgical techniques, portal vein reconstruction, associated diseases, MELD/PELD scores, postoperative PVT occurrence, the need for reoperation, and survival data were analyzed.</p><p><strong>Results: </strong>Postoperative PVT developed in 6 patients (12.2%); 3 of these patients (6.1%) required reoperation. Overall, mortality occurred in 13 patients (26.5%); 3 cases were due to non-PVT-related reasons (sepsis following ERCP/PTC or sudden cardiac arrest). The PVT-related mortality rate was 20.4% (10 patients). Mortality was observed in 4 (66.7%) patients with postoperative PVT. Among 8 patients with Yerdel Grade 3-4 PVT, postoperative PVT occurred in 2 patients (25%). Thrombosis occurred in 2 of 6 patients (33.3%) who underwent graft reconstruction; 1 required reoperation. Portal flow was successfully restored in 83.3% of reconstructed cases. Patients developing postoperative PVT had a higher mean MELD/PELD score (22.5 vs. 19.2), an average age of 48.8 years, and equal gender distribution. The mean follow-up period was 14.2 months overall and 7.7 months in patients with postoperative PVT. Comorbidities (diabetes, hypertension, cardiac, or pulmonary pathology) were present in approximately 50% of patients with postoperative PVT and 62% of those who died. The most common preoperative diagnoses were cryptogenic cirrhosis (22.4%), NASH (18.3%), and HBV infection (16.3%).</p><p><strong>Conclusion: </strong>Preoperative PVT significantly correlates with postoperative PVT development and mortality following LDLT. Advanced Yerdel stages, high MELD/PELD scores, and the necessity for portal vein reconstruction increase this risk. Early diagnosis, close imaging follow-up, and proper anticoagulation management postoperatively are crucial. Our findings highlight the importance of a multidisciplinary approach in surgical planning and lay the groundwork for prospective, multi-center studies.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067111","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 Efficacy and Safety of a Modified Conditioning Regimen Reducing the Dosage of Busulfan and Adding Thiotepa in Allogeneic Hematopoietic Stem Cell Transplantation for Pediatric Acute Myeloid Leukemia.","authors":"Na Song, Mincui Zheng, Pang Wu, Wenyong Kuang, Shan He, Shaoyang Deng, Zhijun Huang, Benshan Zhang","doi":"10.1016/j.transproceed.2025.07.027","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.07.027","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with a conditioning regimen that reduces the dosage of busulfan and incorporates thiotepa in children with acute myeloid leukemia (AML).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 55 pediatric patients with AML who underwent allo-HSCT at Hunan Children's Hospital from December 2019 to December 2023. Group A (n = 33) included patients with thiotepa in the conditioning regimen, while Group B (n = 22) included patients without thiotepa. Conditioning regemen of Group A was modified to reduce 1 day dosage of busulfan and add an additional dose of thiotepa at 10 mg/kg.</p><p><strong>Results: </strong>With a median follow-up of 31 months, the OS for all patients was 94.5%. Group A had a higher survival rate compared to Group B, though the difference was not statistically significant (96.9% vs 90.9%, P = .388). For patients who were measurable residual disease positive before transplantation, the OS in Group A was significantly higher than in Group B (100% vs 75%, P = .039). The total relapse rate was 5.45%, with no significant difference between the groups (Group A 6% vs Group B 4.55%, P = .648). The non-relapse mortality was 1.8%, with only 1 death due to severe sinusoidal obstruction syndrome (SOS) in Group B. The incidence rates of acute graft-versus-host disease (aGVHD), severe aGVHD, SOS, and transplant-associated thrombotic microangiopathy (TA-TMA) were lower in Group A, particularly for aGVHD and severe aGVHD (30.3% vs 45.4%, P = .252; 12.1% vs 27.3%, P = .175), although these differences were not statistically significant.</p><p><strong>Conclusion: </strong>The modified conditioning regimen demonstrated promising clinical efficacy and safety. This modified regimen has the potential to enhance the prognosis of pediatric AML patients, especially those with MRD-positive pre-transplantation.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058856","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":"Revisiting the Biological Rationale for Cytomegalovirus Immune Globulin (CMVIG) in the Modern Era of Solid Organ Transplantation: Current State and Future Direction.","authors":"Alesa Campbell, Timothy L Pruett","doi":"10.1016/j.transproceed.2025.08.010","DOIUrl":"https://doi.org/10.1016/j.transproceed.2025.08.010","url":null,"abstract":"<p><p>Cytomegalovirus (CMV) continues to be a significant challenge in solid organ transplantation (SOT), contributing to morbidity, mortality, and allograft rejection. Although CMV immune globulin (CMVIG; Cytogam®) has been shown to reduce the incidence of CMV disease, its precise mechanism of action and clear correlation between anti-CMV activity and disease attenuation remain unclear. Despite advances in antiviral therapies, CMV remains a persistent threat, with resistance complicating treatment strategies. This review revisits the biological rationale for CMVIG, highlighting its potential to improve patient outcomes through mechanisms such as virus neutralization, prevention of viral entry, complement-mediated cell lysis, and immune activation. Although CMVIG appears to mitigate CMV-related complications, further research is needed to establish therapeutic dosing based on anti-CMV antibody titers, pharmacokinetics (PK), and the desired thresholds of anti-CMV activity. Emerging factors, such as the role of co-stimulatory blocking immunosuppression in CMV risk, further emphasize the need for refining CMVIG's clinical application. Notably, CMVIG's in vitro effects on cellular immunity suggest its potential to improve outcomes, particularly in SOT recipients undergoing co-stimulation blockade. Unanswered questions remain, such as optimal IgG target levels for efficacy, the role of intracellular and extracellular immune responses to CMVIG and understanding the antibody dose-response relationship. Re-evaluating the CMV treatment paradigm, with a focus on CMVIG and antiviral agents, holds promise for more effective strategies in the modern era of SOT.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058869","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}