Ananya Gorrai, Aparajith Kannapiran, Maryjane Farr, David Wojciechowski, Christopher Wrobel, Swee-Ling Levea, Nicholas Hendren, Natalie Tapaskar, Elizabeth Ashley Hardin, Hadi Beaini, Jaye Alexander Weston, Christopher Heid, Matthias Peltz, Lauren K. Truby
Introduction
Simultaneous Heart-Kidney Transplantation (SHKT) following donation after circulatory determination of death (DCD) is increasing. Whether kidney allograft outcomes differ from donation after brain death (DBD) SHKT recipients has not been well studied.
Methods
We identified adults in the UNOS database who were listed for SHKT and transplanted after 2018. Baseline characteristics of DBD and DCD recipients and donors were compared. Outcomes of interest included primary nonreceipt of a kidney allograft, acute post-transplant dialysis, and chronic dialysis or renal transplantation. Survival to 1-year and renal allograft function at follow up were also assessed. Univariate and multivariable logistic regression were used to identify risk factors for the individual outcomes with Cox proportional hazard modeling leveraged to identify risk factors for 1-year mortality. One-year survival was compared between both groups using Kaplan-Meier and Cox-Hazards ratio.
Results
From October 18, 2018 to December 31, 2023, there were 1956 SHKT recipients, with 1828 receiving allografts from DBD donors and 128 from DCD donors. DCD recipients were significantly older, listed at lower transplant status, and less likely to be on inotropic or intra-aortic balloon pump support before transplant. DCD donors were younger and had higher baseline eGFR. After a median follow-up of 847 days, there was no significant difference in renal allograft outcomes between groups. There was no difference in 1-year survival between DCD and DBD SHKT recipients, and DCD status was not associated with 1-year survival after adjustment for key donor and recipient characteristics.
Conclusion
Kidney allograft outcomes are similar in DBD and DCD SHKT recipients, which supports DCD in expanding the donor pool for SHKT candidates.
{"title":"Kidney Allograft Outcomes of Dual-Organ Heart Kidney Transplant Recipients Following Donation After Circulatory Determination of Death","authors":"Ananya Gorrai, Aparajith Kannapiran, Maryjane Farr, David Wojciechowski, Christopher Wrobel, Swee-Ling Levea, Nicholas Hendren, Natalie Tapaskar, Elizabeth Ashley Hardin, Hadi Beaini, Jaye Alexander Weston, Christopher Heid, Matthias Peltz, Lauren K. Truby","doi":"10.1111/ctr.70456","DOIUrl":"10.1111/ctr.70456","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Simultaneous Heart-Kidney Transplantation (SHKT) following donation after circulatory determination of death (DCD) is increasing. Whether kidney allograft outcomes differ from donation after brain death (DBD) SHKT recipients has not been well studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified adults in the UNOS database who were listed for SHKT and transplanted after 2018. Baseline characteristics of DBD and DCD recipients and donors were compared. Outcomes of interest included primary nonreceipt of a kidney allograft, acute post-transplant dialysis, and chronic dialysis or renal transplantation. Survival to 1-year and renal allograft function at follow up were also assessed. Univariate and multivariable logistic regression were used to identify risk factors for the individual outcomes with Cox proportional hazard modeling leveraged to identify risk factors for 1-year mortality. One-year survival was compared between both groups using Kaplan-Meier and Cox-Hazards ratio.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From October 18, 2018 to December 31, 2023, there were 1956 SHKT recipients, with 1828 receiving allografts from DBD donors and 128 from DCD donors. DCD recipients were significantly older, listed at lower transplant status, and less likely to be on inotropic or intra-aortic balloon pump support before transplant. DCD donors were younger and had higher baseline eGFR. After a median follow-up of 847 days, there was no significant difference in renal allograft outcomes between groups. There was no difference in 1-year survival between DCD and DBD SHKT recipients, and DCD status was not associated with 1-year survival after adjustment for key donor and recipient characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Kidney allograft outcomes are similar in DBD and DCD SHKT recipients, which supports DCD in expanding the donor pool for SHKT candidates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xingyu Zhang, Chethan Puttarajappa, Frank Spitz, Jason Mial-Anthony, Berkay Demirors, Abiha Abdullah, Vrishketan Sethi, Matthew Yu-Sheng Lin, Andrew Crane, Winn Cashion, Charbel Elias, Han Shwe, Timothy Fokken, Bradley Phelp, Ryugen Takahashi, Hao Liu, Christof Kaltenmeier, Stalin Dharmayan, Vikraman Gunabushanam, Armando Ganoza, Martin N.Wijkstrom, Amit Tevar, Michele Molinari
Background
The allocation and acceptance of deceased-donor kidneys in the United States is influenced by theKidney Donor Profile Index (KDPI). We conducted a national analysis of high-KDPI kidney transplants performed from 2014 to 2021 to identify key predictors of post-transplant outcomes beyond those incorporated in KDPI.
Methods
This retrospective cohort study used data extracted from the Scientific Registry of Transplant Recipients (SRTR). Adult, first-time recipients of kidney-only deceased-donor transplants with KDPI greater than 85% were included. Regression models were used to identify independent predictors of delayed graft function (DGF), primary graft nonfunction (PGNF), patient survival, overall graft survival, and death-censored graft survival.
Results
Among 4,911 recipients, DGF occurred in 33.8% and PGNF in 4.0%. DGF was independently associated with donation after circulatory death, terminal donor creatinine > 1.5 mg/dL, recipient obesity, dialysis duration > 3 years, and cold ischemia time (CIT) ≥ 24 h, whereas machine perfusion was protective. PGNF was associated with donation after circulatory death, terminal donor creatinine > 2.0 mg/dL, high-risk cytomegalovirus (CMV) serostatus, and donor injury patterns within the high-KDPI range, including younger donor age. Five-year patient and graft survival were 72% and 62%, respectively. Graft loss was independently associated with DGF, elevated intrarenal resistive index (RI), recipient diabetes, prolonged dialysis exposure, and high-risk CMV/EBV serostatus.
Conclusions
Outcomes after high-KDPI kidney transplantation reflect both KDPI-defined donor risk and additional recipient, immunologic, and perioperative factors. A multidomain, offer-time assessment may support more individualized acceptance decisions and improve utilization.
{"title":"“Rethinking High-KDPI Kidneys: A Multidomain Approach to Predicting Success”","authors":"Xingyu Zhang, Chethan Puttarajappa, Frank Spitz, Jason Mial-Anthony, Berkay Demirors, Abiha Abdullah, Vrishketan Sethi, Matthew Yu-Sheng Lin, Andrew Crane, Winn Cashion, Charbel Elias, Han Shwe, Timothy Fokken, Bradley Phelp, Ryugen Takahashi, Hao Liu, Christof Kaltenmeier, Stalin Dharmayan, Vikraman Gunabushanam, Armando Ganoza, Martin N.Wijkstrom, Amit Tevar, Michele Molinari","doi":"10.1111/ctr.70472","DOIUrl":"10.1111/ctr.70472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The allocation and acceptance of deceased-donor kidneys in the United States is influenced by theKidney Donor Profile Index (KDPI). We conducted a national analysis of high-KDPI kidney transplants performed from 2014 to 2021 to identify key predictors of post-transplant outcomes beyond those incorporated in KDPI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used data extracted from the Scientific Registry of Transplant Recipients (SRTR). Adult, first-time recipients of kidney-only deceased-donor transplants with KDPI greater than 85% were included. Regression models were used to identify independent predictors of delayed graft function (DGF), primary graft nonfunction (PGNF), patient survival, overall graft survival, and death-censored graft survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 4,911 recipients, DGF occurred in 33.8% and PGNF in 4.0%. DGF was independently associated with donation after circulatory death, terminal donor creatinine > 1.5 mg/dL, recipient obesity, dialysis duration > 3 years, and cold ischemia time (CIT) ≥ 24 h, whereas machine perfusion was protective. PGNF was associated with donation after circulatory death, terminal donor creatinine > 2.0 mg/dL, high-risk cytomegalovirus (CMV) serostatus, and donor injury patterns within the high-KDPI range, including younger donor age. Five-year patient and graft survival were 72% and 62%, respectively. Graft loss was independently associated with DGF, elevated intrarenal resistive index (RI), recipient diabetes, prolonged dialysis exposure, and high-risk CMV/EBV serostatus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Outcomes after high-KDPI kidney transplantation reflect both KDPI-defined donor risk and additional recipient, immunologic, and perioperative factors. A multidomain, offer-time assessment may support more individualized acceptance decisions and improve utilization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zachary Leslie, Thomas Leventhal, Sean Nguyen, David Leishman, Cheyenna Espinoza, Eric Wise, Sayeed Ikramuddin, Raja Kandaswamy, Abraham J. Matar
Introduction
The incidence of short-term (90-day) hospital readmission and morbidity following liver transplantation (LT) for metabolic dysfunction-associated steatotic liver disease (MASLD) is poorly characterized, and no study to date has distinguished these short-term outcomes between MASLD and non-MASLD LT recipients. The primary objective of this study was to leverage the National Readmissions Database (NRD) to distinguish 90-day readmission rates and morbidity among those undergoing LT for MASLD and non-MASLD etiologies.
Methods
Recipients undergoing LT were identified in the NRD between January 1, 2016, and December 31, 2022. Morbidity was defined as an aggregate of common surgical complications. Univariate and age-sex adjusted quasi-Poisson regressions were used to identify trends and differences in characteristics for patients stratified by indication for LT. Multivariable logistic regression models were used to identify factors associated with 90-day readmissions and morbidity.
Results
A weighted total of 58 148 LT procedures were identified, of which 11 235 (19.3%) had MASLD etiology. LT for MASLD increased over the study period, while LT for hepatitis C and liver cancer decreased. Relative to non-MASLD LT recipients, MASLD LT recipients had increased comorbid risk profiles, including higher rates of class 3 obesity (body mass index [BMI] ≥ 40) and associated liver cancer. MASLD LT recipients had lower rates of 90-day readmission, morbidity, and cardiovascular complications (all p < 0.05). Among patients with class 3 obesity and liver cancer, MASLD etiology was associated with improved or non-inferior 90-day outcomes relative to non-MASLD LT recipients. Finally, among MASLD LT recipients, the presence of chronic kidney disease, prior bariatric surgery, dialysis, female sex, and chronic obstructive pulmonary disease were independent predictors of 90-day morbidity and readmission.
Conclusions
Despite an increased comorbid risk profile, MASLD LT recipients had superior 90-day readmission rates and morbidity outcomes relative to non-MASLD LT recipients. MASLD etiology appears to normalize 90-day outcomes among patients with obesity and liver cancer.
{"title":"Ninety-Day Readmission and Morbidity Following Liver Transplantation for MASLD","authors":"Zachary Leslie, Thomas Leventhal, Sean Nguyen, David Leishman, Cheyenna Espinoza, Eric Wise, Sayeed Ikramuddin, Raja Kandaswamy, Abraham J. Matar","doi":"10.1111/ctr.70461","DOIUrl":"10.1111/ctr.70461","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The incidence of short-term (90-day) hospital readmission and morbidity following liver transplantation (LT) for metabolic dysfunction-associated steatotic liver disease (MASLD) is poorly characterized, and no study to date has distinguished these short-term outcomes between MASLD and non-MASLD LT recipients. The primary objective of this study was to leverage the National Readmissions Database (NRD) to distinguish 90-day readmission rates and morbidity among those undergoing LT for MASLD and non-MASLD etiologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Recipients undergoing LT were identified in the NRD between January 1, 2016, and December 31, 2022. Morbidity was defined as an aggregate of common surgical complications. Univariate and age-sex adjusted quasi-Poisson regressions were used to identify trends and differences in characteristics for patients stratified by indication for LT. Multivariable logistic regression models were used to identify factors associated with 90-day readmissions and morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A weighted total of 58 148 LT procedures were identified, of which 11 235 (19.3%) had MASLD etiology. LT for MASLD increased over the study period, while LT for hepatitis C and liver cancer decreased. Relative to non-MASLD LT recipients, MASLD LT recipients had increased comorbid risk profiles, including higher rates of class 3 obesity (body mass index [BMI] ≥ 40) and associated liver cancer. MASLD LT recipients had lower rates of 90-day readmission, morbidity, and cardiovascular complications (all <i>p</i> < 0.05). Among patients with class 3 obesity and liver cancer, MASLD etiology was associated with improved or non-inferior 90-day outcomes relative to non-MASLD LT recipients. Finally, among MASLD LT recipients, the presence of chronic kidney disease, prior bariatric surgery, dialysis, female sex, and chronic obstructive pulmonary disease were independent predictors of 90-day morbidity and readmission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite an increased comorbid risk profile, MASLD LT recipients had superior 90-day readmission rates and morbidity outcomes relative to non-MASLD LT recipients. MASLD etiology appears to normalize 90-day outcomes among patients with obesity and liver cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12873555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simultaneous liver-kidney transplantation (SLKT) has been the standard of care for patients with end-stage renal disease (ESRD) and primary hyperoxaluria type 1 (PH1). Lumasiran is a novel RNA interference (RNAi) therapy that targets glycolate oxidase and decreases oxalate production in the liver. Despite its availability, the use of RNAi with kidney transplant alone (KTA) for ESRD related to primary hyperoxaluria remains limited. We report a 39-year-old female with a history of KTA who presented with diarrhea and severe AKI. She rapidly progressed to anuria and allograft loss. Her kidney biopsy demonstrated calcium oxalate deposition. The patient was subsequently evaluated for a repeat kidney transplant. Given the morbidity associated with SLKT, RNAi therapy was pursued as an alternative. Initiation of Lumasiran reduced serum oxalate from 40 to 8 µmol/L, enabling successful KTA with immediate graft function. At 12 months post-transplant, renal function remained stable (creatinine 0.82 mg/dL, serum oxalate <1.5 µmol/L). This case highlights RNAi therapy as a promising strategy to facilitate KTA in patients with PH1 and ESRD, potentially reducing the need for SLKT and its associated morbidity.
{"title":"A Case of Successful Kidney Transplant-Alone in Primary Hyperoxaluria Type 1 Using Lumasiran","authors":"Karen Flores, Massini Merzkani, Samer Abdulkhalek, Farah Abuazzam, Anuja Java, Rowena Delos Santos, Rohan Paul, Joseph Gaut, Tarek Alhamad","doi":"10.1111/ctr.70464","DOIUrl":"10.1111/ctr.70464","url":null,"abstract":"<div>\u0000 \u0000 <p>Simultaneous liver-kidney transplantation (SLKT) has been the standard of care for patients with end-stage renal disease (ESRD) and primary hyperoxaluria type 1 (PH1). Lumasiran is a novel RNA interference (RNAi) therapy that targets glycolate oxidase and decreases oxalate production in the liver. Despite its availability, the use of RNAi with kidney transplant alone (KTA) for ESRD related to primary hyperoxaluria remains limited. We report a 39-year-old female with a history of KTA who presented with diarrhea and severe AKI. She rapidly progressed to anuria and allograft loss. Her kidney biopsy demonstrated calcium oxalate deposition. The patient was subsequently evaluated for a repeat kidney transplant. Given the morbidity associated with SLKT, RNAi therapy was pursued as an alternative. Initiation of Lumasiran reduced serum oxalate from 40 to 8 µmol/L, enabling successful KTA with immediate graft function. At 12 months post-transplant, renal function remained stable (creatinine 0.82 mg/dL, serum oxalate <1.5 µmol/L). This case highlights RNAi therapy as a promising strategy to facilitate KTA in patients with PH1 and ESRD, potentially reducing the need for SLKT and its associated morbidity.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peri-operative blood transfusion is common during solid-organ transplantation, yet the impact of ABO-incompatible (ABOi) blood exposure on post-transplant immunity and acute rejection (AR) remains uncertain.
Methods
We assembled a multicenter cohort of 468 adult kidney, liver and heart recipients (2018–2024). Detailed, time-stamped transfusion records were linked to serial immune-phenotyping (30-plex cytokines, flow-cytometric cell subsets) collected from pre-operative baseline to 12 months. The causal effect of ABOi transfusion on biopsy-proven AR was estimated with marginal structural models that incorporated daily inverse-probability-of-treatment weighting and Fine–Gray competing-risk adjustment. We further developed static (XGBoost-Cox) and dynamic attention-LSTM models to predict 30-, 90- and 365-day AR; model interpretability employed SHAP values and integrated gradients.
Results
Fifty-six recipients (12%) received ≥ 1 unit of ABOi blood. After adjustment for baseline characteristics, surgical bleeding, tacrolimus exposure and other time-varying confounders, ABOi transfusion independently increased 1-year AR risk (HR 1.65; 95% CI 1.12–2.44). A clear dose-response was observed: transfusion of > 3 incompatible red-cell units doubled AR incidence. ABOi exposure produced an early IL-6 surge (80 pg mL−1 vs 60 pg mL−1 in controls, p < 0.001) and sustained elevation of CD8+/Treg ratios. Unsupervised clustering of 10 immune markers identified a hyper-inflammatory phenotype (Cluster A) with a two-fold higher AR hazard, strongly correlated with ABOi load. The dynamic model achieved AUROCs of 0.83, 0.79 and 0.75 for 30-, 90- and 365-day prediction, respectively, and provided patient-level risk passports 24 h before clinical rejection.
Conclusions
Peri-operative ABOi transfusion is a modifiable, dose-dependent driver of AR across solid-organ transplants. Early IL-6 release and cytotoxic T-cell expansion constitute plausible biological mediators. Minimizing incompatible antigen load and leveraging dynamic risk analytics may improve graft surveillance and inform targeted immunomodulation.
背景：在实体器官移植中，围手术期输血是常见的，但abo血型不相容（ABOi）血液暴露对移植后免疫和急性排斥反应（AR）的影响尚不清楚。方法：我们收集了468名成人肾、肝和心脏受体（2018-2024）的多中心队列。详细的、有时间戳的输血记录与从术前基线到12个月收集的一系列免疫表型（30-plex细胞因子，流式细胞术细胞亚群）相关联。abi输血对经活检证实的AR的因果影响采用边缘结构模型进行估计，该模型包括每日治疗逆概率加权和Fine-Gray竞争风险调整。我们进一步开发了静态（XGBoost-Cox）和动态注意力- lstm模型来预测30天、90天和365天的AR；模型可解释性采用SHAP值和综合梯度。结果：56例（12%）接受≥1单位ABOi血。在调整基线特征、手术出血、他克莫司暴露和其他时变混杂因素后，ABOi输血单独增加了1年AR风险（HR 1.65; 95% CI 1.12-2.44）。观察到明显的剂量反应：输血bbb3不相容红细胞单位使AR发生率增加一倍。ABOi暴露产生早期IL-6激增（对照组为80 pg mL- 1 vs 60 pg mL- 1， p < 0.001）和CD8+/Treg比值持续升高。10个免疫标记物的无监督聚类鉴定出高炎症表型（a类），AR风险高两倍，与ABOi负荷密切相关。动态模型预测30天、90天和365天的auroc分别为0.83、0.79和0.75，并在临床排斥反应前24小时提供患者层面的风险护照。结论：围手术期输血是一个可改变的、剂量依赖性的实体器官移植AR驱动因素。早期IL-6释放和细胞毒性t细胞扩增是可信的生物介质。减少不相容抗原负荷和利用动态风险分析可以改善移植物监测和告知靶向免疫调节。
{"title":"Effects of ABO-Incompatible Blood Transfusion on Immune Response and Rejection After Organ Transplantation","authors":"Peilu Hu, Xiaohui Zhang","doi":"10.1111/ctr.70469","DOIUrl":"10.1111/ctr.70469","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Peri-operative blood transfusion is common during solid-organ transplantation, yet the impact of ABO-incompatible (ABOi) blood exposure on post-transplant immunity and acute rejection (AR) remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We assembled a multicenter cohort of 468 adult kidney, liver and heart recipients (2018–2024). Detailed, time-stamped transfusion records were linked to serial immune-phenotyping (30-plex cytokines, flow-cytometric cell subsets) collected from pre-operative baseline to 12 months. The causal effect of ABOi transfusion on biopsy-proven AR was estimated with marginal structural models that incorporated daily inverse-probability-of-treatment weighting and Fine–Gray competing-risk adjustment. We further developed static (XGBoost-Cox) and dynamic attention-LSTM models to predict 30-, 90- and 365-day AR; model interpretability employed SHAP values and integrated gradients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-six recipients (12%) received ≥ 1 unit of ABOi blood. After adjustment for baseline characteristics, surgical bleeding, tacrolimus exposure and other time-varying confounders, ABOi transfusion independently increased 1-year AR risk (HR 1.65; 95% CI 1.12–2.44). A clear dose-response was observed: transfusion of > 3 incompatible red-cell units doubled AR incidence. ABOi exposure produced an early IL-6 surge (80 pg mL<sup>−</sup><sup>1</sup> vs 60 pg mL<sup>−</sup><sup>1</sup> in controls, <i>p</i> < 0.001) and sustained elevation of CD8<sup>+</sup>/Treg ratios. Unsupervised clustering of 10 immune markers identified a hyper-inflammatory phenotype (Cluster A) with a two-fold higher AR hazard, strongly correlated with ABOi load. The dynamic model achieved AUROCs of 0.83, 0.79 and 0.75 for 30-, 90- and 365-day prediction, respectively, and provided patient-level risk passports 24 h before clinical rejection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Peri-operative ABOi transfusion is a modifiable, dose-dependent driver of AR across solid-organ transplants. Early IL-6 release and cytotoxic T-cell expansion constitute plausible biological mediators. Minimizing incompatible antigen load and leveraging dynamic risk analytics may improve graft surveillance and inform targeted immunomodulation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xian Zhao, Samer Ebaid, Nickolas Feduska, Christian Park, Fady Kaldas, Christopher Wray, Victor W. Xia
Background
Normothermic machine perfusion (NMP) has emerged as a valuable preservation technique, expanding the donor pool and improving clinical outcomes in liver transplantation (LT). Despite its growing adoption and reported advantages, the perioperative impact of NMP remains incompletely defined. In this study, we aimed to investigate the effects of NMP versus static cold storage (SCS) on postreperfusion blood product utilization, hemodynamics, and vasopressor requirements.
Methods
We conducted a retrospective cohort study of adult LT patients at our institution between January 2017 and November 2024. The NMP and SCS groups were matched using propensity scores generated from preoperative and prereperfusion variables.
Results
A total of 1059 patients underwent LT, including 86 NMP and 973 SCS patients. Before matching, significant differences were noted in several preoperative and prereperfusion variables. After 1:3 propensity match, these differences were eliminated. Post-match analysis showed that the NMP group required significantly fewer transfusions (approximately 40% reduction observed across all blood products). NMP was also associated with significantly higher mean arterial pressure and reduced vasopressor requirements following reperfusion.
Conclusions
NMP was associated with reduced blood transfusion, improved hemodynamic stability, and decreased vasopressor support during the postreperfusion phase of LT.
{"title":"Normothermia Machine Perfusion Is Associated With Reduced Transfusion Requirements, Improved Hemodynamic Stability, and Decreased Vasopressor Use During the Postreperfusion Phase of Liver Transplantation","authors":"Xian Zhao, Samer Ebaid, Nickolas Feduska, Christian Park, Fady Kaldas, Christopher Wray, Victor W. Xia","doi":"10.1111/ctr.70444","DOIUrl":"10.1111/ctr.70444","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Normothermic machine perfusion (NMP) has emerged as a valuable preservation technique, expanding the donor pool and improving clinical outcomes in liver transplantation (LT). Despite its growing adoption and reported advantages, the perioperative impact of NMP remains incompletely defined. In this study, we aimed to investigate the effects of NMP versus static cold storage (SCS) on postreperfusion blood product utilization, hemodynamics, and vasopressor requirements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of adult LT patients at our institution between January 2017 and November 2024. The NMP and SCS groups were matched using propensity scores generated from preoperative and prereperfusion variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1059 patients underwent LT, including 86 NMP and 973 SCS patients. Before matching, significant differences were noted in several preoperative and prereperfusion variables. After 1:3 propensity match, these differences were eliminated. Post-match analysis showed that the NMP group required significantly fewer transfusions (approximately 40% reduction observed across all blood products). NMP was also associated with significantly higher mean arterial pressure and reduced vasopressor requirements following reperfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NMP was associated with reduced blood transfusion, improved hemodynamic stability, and decreased vasopressor support during the postreperfusion phase of LT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12859740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Georgios Kourounis, Samuel J. Tingle, Ali Elmahmudi, Brian Thomson, Robin Nandi, Emily Thompson, Barney Stephenson, James Hunter, Hassan Ugail, Neil S. Sheerin, Colin Wilson
Introduction
Accurate evaluation of liver steatosis and overall organ quality is critical for optimizing safe organ utilization in liver transplantation. Recent advances in computer vision offer promising tools to standardize and enhance this process. This review maps the current evidence on AI-enabled photographic evaluation of liver steatosis and identifies areas for future development.
Methods
A scoping review of the literature, including searches of PubMed, SCOPUS, and Web of Science, was conducted to identify studies published from inception to 27/03/2025 reporting on the development of AI-enabled tools for assessing liver organ quality from photographs taken during the donation process. A qualitative synthesis and critical review of the literature was conducted in accordance with PRISMA-ScR guidelines. The review protocol was registered with the Open Science Framework (osf.io/zfcuk).
Results
After screening 219 citations, six studies from three independent research groups met the inclusion criteria. Sample sizes ranged from 40 to 192 donors. Five studies employed binary classification models using a 30% steatosis threshold, while one study reported a graded approach. Reported accuracies ranged from 0.81 to 0.92. Common challenges included small and imbalanced datasets with a dependence on supplementary donor data, such as blood tests and radiological findings. None of the studies conducted external validation.
Discussion
Current evidence is drawn from a small and methodologically heterogeneous literature. Publications from several independent groups nevertheless highlight growing interest in developing these tools. Future work should prioritize larger studies with robust external validation to strengthen their credibility and build trust in their clinical use.
准确评估肝脂肪变性和整体器官质量对于优化肝移植中器官的安全利用至关重要。计算机视觉的最新进展为标准化和增强这一过程提供了有前途的工具。这篇综述描绘了目前人工智能支持的肝脂肪变性摄影评估的证据，并确定了未来发展的领域。方法：对文献进行范围审查，包括PubMed、SCOPUS和Web of Science的搜索，以确定从成立到2025年3月27日发表的关于人工智能工具开发的研究，这些研究用于从捐赠过程中拍摄的照片评估肝器官质量。根据PRISMA-ScR指南对文献进行定性综合和批判性审查。审查方案已在开放科学框架（osf.io/zfcuk）上注册。结果：经过219次引用筛选，来自三个独立研究小组的6项研究符合纳入标准。样本大小从40到192人不等。五项研究采用30%脂肪变性阈值的二元分类模型，而一项研究采用分级方法。报告的准确度在0.81到0.92之间。共同的挑战包括数据集小而不平衡，依赖于补充供体数据，如血液检查和放射检查结果。这些研究均未进行外部验证。讨论：目前的证据来自一个小的和方法上不一致的文献。然而，一些独立团体的出版物强调了开发这些工具的兴趣日益浓厚。未来的工作应优先考虑具有强大外部验证的大型研究，以加强其可信度并建立对其临床应用的信任。
{"title":"A Scoping Review of the Photographic Assessment of Donor Liver Steatosis in Transplantation Using Artificial Intelligence","authors":"Georgios Kourounis, Samuel J. Tingle, Ali Elmahmudi, Brian Thomson, Robin Nandi, Emily Thompson, Barney Stephenson, James Hunter, Hassan Ugail, Neil S. Sheerin, Colin Wilson","doi":"10.1111/ctr.70433","DOIUrl":"10.1111/ctr.70433","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Accurate evaluation of liver steatosis and overall organ quality is critical for optimizing safe organ utilization in liver transplantation. Recent advances in computer vision offer promising tools to standardize and enhance this process. This review maps the current evidence on AI-enabled photographic evaluation of liver steatosis and identifies areas for future development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review of the literature, including searches of PubMed, SCOPUS, and Web of Science, was conducted to identify studies published from inception to 27/03/2025 reporting on the development of AI-enabled tools for assessing liver organ quality from photographs taken during the donation process. A qualitative synthesis and critical review of the literature was conducted in accordance with PRISMA-ScR guidelines. The review protocol was registered with the Open Science Framework (osf.io/zfcuk).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After screening 219 citations, six studies from three independent research groups met the inclusion criteria. Sample sizes ranged from 40 to 192 donors. Five studies employed binary classification models using a 30% steatosis threshold, while one study reported a graded approach. Reported accuracies ranged from 0.81 to 0.92. Common challenges included small and imbalanced datasets with a dependence on supplementary donor data, such as blood tests and radiological findings. None of the studies conducted external validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Current evidence is drawn from a small and methodologically heterogeneous literature. Publications from several independent groups nevertheless highlight growing interest in developing these tools. Future work should prioritize larger studies with robust external validation to strengthen their credibility and build trust in their clinical use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12859739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Solid organ transplant (SOT) recipients face increased colorectal cancer (CRC) risk due to chronic immunosuppression and comorbidities such as primary sclerosing cholangitis, inflammatory bowel disease, and cystic fibrosis. Despite this elevated risk, CRC screening and treatment guidelines specific to transplant recipients remain limited. This systematic review and meta-analysis evaluated the prevalence, clinical characteristics, risk factors, and outcomes of CRC in SOT recipients.
Methods
A comprehensive search across major databases identified studies reporting CRC incidence and outcomes in kidney, liver, heart, and lung transplant recipients. Study quality was assessed using validated risk-of-bias tools. Pooled estimates were calculated using a random-effects model; heterogeneity and organ-specific subgroup analyses were also conducted.
Results
The pooled incidence of CRC in SOT recipients was 0.95% (95% CI: 0.35%–1.55%). Incidence was highest in heart transplant recipients (1.27%), followed by kidney (1.12%), lung (0.56%), and liver (0.53%) recipients. The mean time to CRC diagnosis was 8.8 years (95% CI: 5.94–11.82). A total of 41.13% of patients presented with stage III/IV or metastatic disease, and right-sided tumors predominated (46.34%). Surgical resection was performed in 62.74% of patients. The mortality rate among CRC patients post-transplant was 61.13% (95% CI: 39.55%–82.7%).
Conclusion
CRC in SOT recipients is associated with increased incidence, delayed diagnosis, and poor prognosis. The predominance of right-sided tumors and late-stage presentation underscore the need for tailored screening and surveillance protocols. Future clinical guidelines should incorporate organ-specific risk stratification and long-term monitoring to optimize outcomes in this high-risk population.
{"title":"Prevalence and Risk Factors of Colorectal Cancer in Solid Organ Transplant Recipients: A Systematic Review and Meta Analysis","authors":"Jahnavi Udaikumar, Kesava Manikanta Achuta, Vindhya Vasini Lella, Rithish Nimmagadda, Satwik Kuppili, Nayanika Tummala, Marwan Alsaqa, Amulya Bellamkonda, Raiya Sarwar","doi":"10.1111/ctr.70470","DOIUrl":"10.1111/ctr.70470","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Solid organ transplant (SOT) recipients face increased colorectal cancer (CRC) risk due to chronic immunosuppression and comorbidities such as primary sclerosing cholangitis, inflammatory bowel disease, and cystic fibrosis. Despite this elevated risk, CRC screening and treatment guidelines specific to transplant recipients remain limited. This systematic review and meta-analysis evaluated the prevalence, clinical characteristics, risk factors, and outcomes of CRC in SOT recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search across major databases identified studies reporting CRC incidence and outcomes in kidney, liver, heart, and lung transplant recipients. Study quality was assessed using validated risk-of-bias tools. Pooled estimates were calculated using a random-effects model; heterogeneity and organ-specific subgroup analyses were also conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The pooled incidence of CRC in SOT recipients was 0.95% (95% CI: 0.35%–1.55%). Incidence was highest in heart transplant recipients (1.27%), followed by kidney (1.12%), lung (0.56%), and liver (0.53%) recipients. The mean time to CRC diagnosis was 8.8 years (95% CI: 5.94–11.82). A total of 41.13% of patients presented with stage III/IV or metastatic disease, and right-sided tumors predominated (46.34%). Surgical resection was performed in 62.74% of patients. The mortality rate among CRC patients post-transplant was 61.13% (95% CI: 39.55%–82.7%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CRC in SOT recipients is associated with increased incidence, delayed diagnosis, and poor prognosis. The predominance of right-sided tumors and late-stage presentation underscore the need for tailored screening and surveillance protocols. Future clinical guidelines should incorporate organ-specific risk stratification and long-term monitoring to optimize outcomes in this high-risk population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristiana Laici, Davide Ricci, Dino Gibertoni, Elena Mancini, Annalisa Zucchelli, Antonio Siniscalchi
Background: Acute kidney injury frequently complicates the end stages of liver diseases, worsening the condition of patients waiting for liver transplants. Continuous renal replacement therapy during liver transplant is still a limited experience, with large variability in the indication criteria. The recent KDIGO guidelines on acute kidney injury may help identify patients who could potentially benefit from the procedure. Therefore, close collaboration between intensivists and nephrologists is essential for shared criteria and treatment management. This study aimed to assess the feasibility and safety in clinical practice of a joint intraoperative continuous renal replacement therapy (IO-CRRT) program. Some aspects of clinical impact were analyzed as a secondary outcome.
Methods: A collaborative organization between nephrologists and anesthesiologists was implemented at St. Orsola Hospital of Bologna (Italy) to manage liver transplant candidates with acute kidney injury. Feasibility, the main outcome, was assessed through adherence to clinical indications and operative details. We also compared a group receiving IO-CRRT (n = 20) and a historical control group (n = 13) without replacement therapy.
Results: No substantial operative deviations from the program were found, excluding 4 patients mistakenly enrolled. The IO-CRRT group had better control of lactates, serum bicarbonate gain, and smoother acute sodium changes compared to controls.
Conclusion: The overall organization proved to be feasible and safe, provided a high level of collaboration is guaranteed. The trend of some metabolic parameters appeared to benefit from IO-CRRT, which may reasonably help in balancing metabolism during liver transplant surgery. This strategy could increase the opportunity for transplant for some patients who otherwise would be excluded.
{"title":"Continuous Renal Replacement Therapy During Liver Transplant: The Anesthesiologist-Nephrologist Collaboration at a Tertiary University Hospital in Italy","authors":"Cristiana Laici, Davide Ricci, Dino Gibertoni, Elena Mancini, Annalisa Zucchelli, Antonio Siniscalchi","doi":"10.1111/ctr.70462","DOIUrl":"10.1111/ctr.70462","url":null,"abstract":"<p><b>Background</b>: Acute kidney injury frequently complicates the end stages of liver diseases, worsening the condition of patients waiting for liver transplants. Continuous renal replacement therapy during liver transplant is still a limited experience, with large variability in the indication criteria. The recent KDIGO guidelines on acute kidney injury may help identify patients who could potentially benefit from the procedure. Therefore, close collaboration between intensivists and nephrologists is essential for shared criteria and treatment management. This study aimed to assess the feasibility and safety in clinical practice of a joint intraoperative continuous renal replacement therapy (IO-CRRT) program. Some aspects of clinical impact were analyzed as a secondary outcome.</p><p><b>Methods</b>: A collaborative organization between nephrologists and anesthesiologists was implemented at St. Orsola Hospital of Bologna (Italy) to manage liver transplant candidates with acute kidney injury. Feasibility, the main outcome, was assessed through adherence to clinical indications and operative details. We also compared a group receiving IO-CRRT (<i>n</i> = 20) and a historical control group (<i>n</i> = 13) without replacement therapy.</p><p><b>Results</b>: No substantial operative deviations from the program were found, excluding 4 patients mistakenly enrolled. The IO-CRRT group had better control of lactates, serum bicarbonate gain, and smoother acute sodium changes compared to controls.</p><p><b>Conclusion</b>: The overall organization proved to be feasible and safe, provided a high level of collaboration is guaranteed. The trend of some metabolic parameters appeared to benefit from IO-CRRT, which may reasonably help in balancing metabolism during liver transplant surgery. This strategy could increase the opportunity for transplant for some patients who otherwise would be excluded.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kentaro Noda, Jenalee N. Coster, Kunning Zhang, Alison Lafayette, Masashi Furukawa, Pablo G. Sanchez
Introduction
Utilization of donation after circulatory death (DCD) donors in lung transplant in the United States lags when compared to other countries. We sought to evaluate geographical variation in the percentage of donation after circulatory death donors, conversion to lung transplant, agonal times, and consent for donation.
Methods
We queried the United Network for Organ Sharing database (2018–2023) to identify DCD donors and compared across organ procurement organizations (OPO). We illustrated the geographical variation in the location of transplant centers using DCDs, DCD donors used for solid organ transplant/ lung transplant, and median agonal time. Also, a special mapping was performed for the geographical difference of the refusal code utilization for declining the DCD lungs.
Results
There were 889 DCD donors where at least one lung was used for transplant, while 13,030 (75.6%) resulted in other solid organ transplants. The utilization of DCD organs was >65% and equal across the US, while DCD transplant centers were predominantly located in 5 states. The lower utilization of DCD lungs, up to 12.7% was equally observed in each state. Over 75%, of DCDs had an agonal time ≤ 30 min in most states except South Florida, eastern Pennsylvania and Colorado/Wyoming. The map colored based on the refusal code categories also showed the geographical differences.
Conclusion
As we continue to increase DCD lung utilization in the United States, better understanding of geographical barriers, adopting universal protocols in DCD organ donation and palliative care will hopefully lead to better utilization of organs from DCD donors, thereby increasing the number of transplants and decreasing organ wait times.
{"title":"Regional Variation in Transplant Utilization and Agonal Times among Donation after Circulatory Death Lung Donors in the United States","authors":"Kentaro Noda, Jenalee N. Coster, Kunning Zhang, Alison Lafayette, Masashi Furukawa, Pablo G. Sanchez","doi":"10.1111/ctr.70471","DOIUrl":"10.1111/ctr.70471","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Utilization of donation after circulatory death (DCD) donors in lung transplant in the United States lags when compared to other countries. We sought to evaluate geographical variation in the percentage of donation after circulatory death donors, conversion to lung transplant, agonal times, and consent for donation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We queried the United Network for Organ Sharing database (2018–2023) to identify DCD donors and compared across organ procurement organizations (OPO). We illustrated the geographical variation in the location of transplant centers using DCDs, DCD donors used for solid organ transplant/ lung transplant, and median agonal time. Also, a special mapping was performed for the geographical difference of the refusal code utilization for declining the DCD lungs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 889 DCD donors where at least one lung was used for transplant, while 13,030 (75.6%) resulted in other solid organ transplants. The utilization of DCD organs was >65% and equal across the US, while DCD transplant centers were predominantly located in 5 states. The lower utilization of DCD lungs, up to 12.7% was equally observed in each state. Over 75%, of DCDs had an agonal time ≤ 30 min in most states except South Florida, eastern Pennsylvania and Colorado/Wyoming. The map colored based on the refusal code categories also showed the geographical differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>As we continue to increase DCD lung utilization in the United States, better understanding of geographical barriers, adopting universal protocols in DCD organ donation and palliative care will hopefully lead to better utilization of organs from DCD donors, thereby increasing the number of transplants and decreasing organ wait times.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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