Clinical Transplantation最新文献

{"title":"Project Donor: A National Intervention to Improve the Health of Potential Living Donors","authors":"Ali B. Abbasi,&nbsp;Daniela Shuman,&nbsp;Kathryn Carmichael,&nbsp;Claire Sukumar,&nbsp;Ruby Rorty,&nbsp;Alan Zambeli-Ljepovic,&nbsp;Peter G. Stock,&nbsp;Babak J. Orandi","doi":"10.1111/ctr.70403","DOIUrl":"10.1111/ctr.70403","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The number of living donors in the US has stagnated for over two decades, in part because a substantial number of intended donors are disqualified due to potentially modifiable health conditions like obesity and smoking. Although these conditions can be improved with lifestyle changes, many candidates lack the support to achieve these changes on their own.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Project Donor is a national program to help living donor candidates achieve donation eligibility. Project Donor provides individualized virtual case management and free access to commercially available programs, including Noom, Weight Watchers, and OnPoint Nutrition, as well as nicotine replacement products and talk therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May 2022 and January 2025, Project Donor enrolled 680 participants. Among these, 142 continue working toward their goals, 435 dropped out, and 95 reached their goal after achieving a mean 8.1 kg weight loss over 9.5 months. Participants who reached their weight loss goal had a lower starting weight (93.4 vs. 101.7 kg, <i>p</i> &lt; 0.001) and BMI (34.1 vs. 36.7 kg/m², <i>p</i> &lt; 0.001) than those who dropped out. Among those who reached their goal, 72 went on to become living donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These results indicate that with sufficient resources and support, some potential donors can achieve eligibility for donation through lifestyle interventions. While a high dropout rate and lack of a control group limit the generalizability of this study, we demonstrate how lifestyle interventions for living donors can be implemented at scale. Additional studies are warranted to determine whether programs like Project Donor could increase the number of living donations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653767","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}

{"title":"One Size Doesn't Fit All: A Review of International Deceased Donor Kidney Allocation Algorithms","authors":"Anjana Gopal,&nbsp;Christie Rampersad,&nbsp;S. Joseph Kim","doi":"10.1111/ctr.70402","DOIUrl":"https://doi.org/10.1111/ctr.70402","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Deceased donor kidney allocation algorithms seek to balance equity, need, and utility within regional healthcare constraints. Although many countries have formal systems, comparative analyses of their structure, context, and evolution remain scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>We conducted a targeted review of 21 allocation algorithms across five continents, identified through literature searches, transplant organization websites, and policy documents. Core components analyzed included wait time, age, immunologic risk, medical urgency, and donor–recipient matching. Three case studies – the United States, Canada, and Eurotransplant – illustrate how governance and sociopolitical factors shape design and reform.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All algorithms incorporated wait time and age, with variable definitions and weighting. Most addressed panel reactive antibody, pediatric priority, and medical urgency, but thresholds and implementation differed. Donor–recipient matching strategies included HLA mismatch scoring, ABO compatibility, and longevity matching via donor age, Kidney Donor Profile Index, or Expected Post-Transplant Survival. The US, Canadian, and Eurotransplant case studies highlighted contrasting centralized versus provincial governance and their influence on reform.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Grounded in shared ethical principles, kidney allocation algorithms differ in how these are operationalized. This global comparison identifies opportunities to enhance transparency and equity, offering practical guidance for jurisdictions developing or refining allocation systems to align with ethical values and local realities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626627","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}

{"title":"Effects of Perioperative Rehabilitation on Physical Function in Kidney Transplant Recipients","authors":"Masaaki Yanishi,&nbsp;Yutaka Kimura,&nbsp;Ryuichi Yoshida,&nbsp;Yuya Koito,&nbsp;Jun Matsushita,&nbsp;Yoshihiro Taniyama,&nbsp;Hidefumi Kinoshita","doi":"10.1111/ctr.70405","DOIUrl":"https://doi.org/10.1111/ctr.70405","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sarcopenia and frailty are common among kidney transplant candidates and often persist even after transplantation. Exercise therapy initiated during the perioperative period may improve physical function, but its benefits remain underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center prospective observational study evaluating a structured rehabilitation protocol in kidney transplant recipients. Patients received supervised exercise therapy starting from postoperative day (POD) 2, followed by resistance training and aerobic exercise during hospitalization. Upon discharge, participants were instructed to continue monthly supervised training sessions. Outcomes including skeletal muscle index (SMI), handgrip strength, gait speed, anaerobic threshold VO₂, and peak VO₂ were assessed before transplant and at 1 year post-transplant. Improvement rates were compared between patients who received rehabilitation and those who did not, and further among those who continued post-discharge training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients in the rehabilitation group showed significantly greater improvements in grip strength, gait speed, and VO₂ parameters compared to the control group (<i>p</i> &lt; 0.05). Among the rehabilitation group, those who continued training post-discharge for ≥6 months exhibited the most pronounced improvements. No adverse effects on renal function were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early and sustained rehabilitation is effective and safe for improving physical function in kidney transplant recipients. Incorporating structured exercise therapy into routine perioperative and post-discharge care may enhance recovery and clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626626","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}

{"title":"Impact of Intoxicated Donors on Recipient Survival in Cardiac Transplantation: A Systematic Review and Meta-Analysis","authors":"Leonardo Brito de Souza,&nbsp;Gabriel Fontenele Ximenes,&nbsp;Germano Freire Bezerra Filho,&nbsp;João da Silva Ferreira Marinho,&nbsp;Luiz Filipe Torres de Alencar,&nbsp;Mateus Paiva Marques Feitosa,&nbsp;Jefferson Luís Vieira","doi":"10.1111/ctr.70404","DOIUrl":"https://doi.org/10.1111/ctr.70404","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart transplantation remains the main treatment for end-stage heart failure. The opioid crisis has increased donor availability, including organs from intoxicated individuals, but the impact on outcomes is uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA 2020, we searched MEDLINE, Embase, and Web of Science for studies on adult heart transplant recipients with donors exposed to substances like cocaine, heroin, marijuana, tobacco, or opioids. Eligible studies met PICOS criteria, and meta-analyses used a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve retrospective cohorts were included, totaling 189 935 recipients, 33 393 of whom received organs from intoxicated donors. The most reported substances were cocaine, alcohol, and tobacco. No significant differences were found in 5-year survival (HR = 1.05; CI = 0.94–1.17), 10-year survival (HR = 0.94; CI = 0.88–1.00), or survival with overdose-related donors (HR = 0.96; CI = 0.84–1.09). Rates of allograft rejection (HR = 0.99; CI = 0.21–0.88) and cardiac allograft vasculopathy (HR = 1.02; CI = 0.95–1.11) were also similar. Subgroup and sensitivity analyses confirmed result consistency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Organs from intoxicated donors do not compromise long-term outcomes and may help address donor shortages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619271","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}

{"title":"Perioperative Management of Patients Undergoing Kidney Transplantation in the United States—A National Survey","authors":"Arun Menon,&nbsp;Elizabeth Cole,&nbsp;Rachel Lin,&nbsp;Clare Morkane,&nbsp;Cara Crouch,&nbsp;Gebhard Wagener,&nbsp;Rania Elkhateb,&nbsp;Govind Rangrass,&nbsp;Geraldine Diaz,&nbsp;Nicholas Douville,&nbsp;Dieter Adelmann","doi":"10.1111/ctr.70395","DOIUrl":"10.1111/ctr.70395","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is no consensus on the optimal perioperative management of patients undergoing kidney transplantation, and little is known about variation in clinical practice across the United States (U.S.). We conducted a national survey to describe current perioperative management practices in patients undergoing kidney transplantation in the U.S.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A survey was sent to all adult kidney transplant centers in the U.S. The survey encompassed questions on the perioperative care of kidney transplant recipients across six domains: fluid and electrolyte management, transfusion practices, hemodynamic management, neuromuscular blockade, robotic or laparoscopic-assisted kidney transplants, and postoperative management and analgesia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We received 68 valid responses from 55 kidney transplant centers in the U.S., representing 11 663 transplants annually (41.4% of the total national volume). There was significant heterogeneity in fluid management regarding the type and volume of fluids administered. Most centers (87.2%) targeted specific intraoperative blood pressure parameters, but there was high institutional variability in those targets. Vasopressor use was also variable; phenylephrine is used as the first-line vasopressor in 26 centers (47.3%), while it is avoided by 13 centers (19.7%). Rocuronium was used by 69.1% of centers, and sugammadex reversal by 85.5%. Postoperative analgesia favored acetaminophen and IV opioids (79.6% for both agents).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This survey demonstrated significant heterogeneity in the perioperative management of kidney transplant recipients in the U.S. There is an urgent need for further research on how perioperative management strategies affect postoperative outcomes after kidney transplantation to better guide evidence-based practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602593","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}

{"title":"Long-Term Outcomes of Patients Who Receive a Liver Transplant for Hepatitis B With Limited Use of Hepatitis B Immunoglobulin","authors":"Giovanni A. Roldan,&nbsp;Erica Loon,&nbsp;John Lake,&nbsp;Nicholas Lim","doi":"10.1111/ctr.70391","DOIUrl":"10.1111/ctr.70391","url":null,"abstract":"<p>Chronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma (HCC). Post-transplant HBV reinfection represents an important post-liver transplantation (LT) complication, which can result in death or graft loss. Hepatitis B immunoglobulin (HBIG) has proven effective in preventing reinfection; however, its high cost and patient inconvenience underscore the need for alternative strategies. In this study, we evaluated the long-term outcomes of HBV-positive LT recipients who received very short-term HBIG immunoprophylaxis combined with life-long antiviral therapy. We conducted a single-center, retrospective cohort study of patients who underwent LT for HBV between 2002 and 2022. Viremic patients received an intraoperative and six consecutive daily doses of HBIG, while non-viremic patients received two doses only post-LT, along with long-term antiviral therapy. The primary outcome was HBV reinfection. Secondary outcomes included death-censored graft survival and overall survival. Seventy-six patients were included. Of these, only three experienced HBV reinfection over the study period. The cumulative incidence of reinfection at 1, 12, 24, and 48 months was observed to be 1.37%, 2.76%, 2.76%, and 2.76%, respectively. The 1-, 3-, and 5-year death-censored graft survival rates were 94%, 94%, and 92%, respectively. The 1-, 3-, and 5-year overall survival rates were 92%, 92%, and 85%, respectively. A very short-term HBIG protocol produced excellent post-transplant outcomes for HBV-positive LT recipients, with very low rates of HBV reinfection and excellent graft and overall survival.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602562","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}

{"title":"Normothermic Perfusion Versus Static Cold Storage in Liver Transplantation: A Meta-Analysis of Randomized Trials","authors":"Heithem Jeddou,&nbsp;Stylianos Tzedakis,&nbsp;Hector Prudhomme,&nbsp;Aline Wautier,&nbsp;Corentin Sumner,&nbsp;Eya Ben Nejma,&nbsp;Mohamad Ali Zorkot,&nbsp;Raffaele Vincenzo De Rosa,&nbsp;Gennaro Mazzarella,&nbsp;Mohamed Ali Chaouch,&nbsp;Michel Samson,&nbsp;Karim Boudjema","doi":"10.1111/ctr.70372","DOIUrl":"10.1111/ctr.70372","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Normothermic machine perfusion (NMP) is an alternative to static cold storage (SCS) for liver graft preservation, potentially reducing ischemia–reperfusion injury and improving organ utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically reviewed RCTs comparing end-ischemic NMP with SCS in adult liver transplantation (MEDLINE, EMBASE, CENTRAL to July 9, 2025). Outcomes of interest included early allograft dysfunction (EAD), organ utilization, patient and graft survival, peak AST, primary non-function (PNF), and biliary complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four RCTs (801 patients; NMP 418; SCS 383) met inclusion. NMP reduced EAD [16.4% vs. 27.2%; RR 0.61, 95% confidence interval (95% CI) 0.38–0.99; <i>p</i> = 0.05] and increased organ utilization (75.5% vs. 69.4%; RR 1.10, 95% CI 1.02–1.18; <i>p</i> = 0.01). No significant differences were observed for patient or graft survival, peak AST, PNF, or biliary complications, though the latter trended in favor of NMP (RR 0.73, <i>p</i> = 0.07).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In adult liver transplantation, NMP reduces EAD and improves organ utilization compared with SCS, without significant differences in survival or major postoperative complications. Evidence remains limited to few trials; larger RCTs are needed to assess long-term benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596133","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}

{"title":"Initial Efforts to Stratify Patients and Donors Utilizing Normothermic Machine Preservation of Livers for Transplant","authors":"Kimberly M. Feeney,&nbsp;Leonie van Leeuwen,&nbsp;Rachel Todd,&nbsp;Avery K. Fortier,&nbsp;Andrew Rosowicz,&nbsp;Antonios Arvelakis,&nbsp;Joseph DiNorcia,&nbsp;Marcelo Facciuto,&nbsp;Matthew Holzner,&nbsp;Jang Moon,&nbsp;Chiara Rocha,&nbsp;Parissa Tabrizian,&nbsp;Thomas Schiano,&nbsp;M. Zeeshan Akhtar,&nbsp;Leona Kim-Schluger,&nbsp;Sander S. Florman","doi":"10.1111/ctr.70378","DOIUrl":"https://doi.org/10.1111/ctr.70378","url":null,"abstract":"<div>\u0000 \u0000 <p>Since FDA approval in 2021, normothermic machine perfusion (NMP) has emerged as a transformative tool to expand transplantation access for patients with end-stage liver disease. This study details the design, implementation, and outcomes of our liver NMP program, highlighting implementation of a stratification algorithm for grafts into low-, medium-, and high-risk categories and evaluation of high-risk grafts from the first 100 cases. A secondary analysis compares NMP outcomes with historical cohorts.</p>\u0000 <p>The final analysis included 53 grafts from donation after brain death (DBD) and 39 from donation after circulatory death (DCD) donors, excluding eight NMP grafts that were not transplanted. No significant differences were observed in allograft dysfunction, primary non-function, biliary or arterial complications, or patient survival, even among high-risk graft recipients. NMP significantly reduced intraoperative cryoprecipitate (0.41 vs. 1.44 units, <i>p</i> = 0.003) and platelet (0.59 vs. 1.56 units, <i>p</i> = 0.001) use in DCD recipients. While recipients of DBD-NMP grafts experienced longer ICU stays (17.17 vs. 8.96 days, <i>p</i> = 0.03) and higher rates of renal replacement therapy (41.14% vs. 20.75%, <i>p</i> = 0.04) than the historic cohort, inpatient length of stay and long-term dialysis requirements were unaffected. Higherrisk graft use facilitated transplant access for patients with lower MELD scores at our center.</p>\u0000 <p>These findings highlight NMP's potential to safely expand the donor pool, facilitating transplantation of previously non-utilized livers while maintaining comparable outcomes. The risk stratification developed alongside our program provides a practical algorithm to advance equity in organ allocation through NMP by enabling safe access to high-risk grafts and demonstrates its value in optimizing liver transplantation practices.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585273","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}

{"title":"The Exposome Era in Kidney Transplantation: A New Frontier in Graft Outcomes and Precision Medicine","authors":"Mustafa Guldan,&nbsp;Rama Al-Shiab,&nbsp;Aladin Rustamov,&nbsp;Lasin Ozbek,&nbsp;Charles J. Ferro,&nbsp;Mehmet Kanbay","doi":"10.1111/ctr.70384","DOIUrl":"10.1111/ctr.70384","url":null,"abstract":"<div>\u0000 \u0000 <p>Despite substantial advances in surgical technique and immunosuppressive therapy, kidney transplantation continues to face limitations in long-term graft and patient survival. Increasingly, attention is shifting toward the exposome, the comprehensive profile of environmental, social, and biological exposures accumulated across the lifespan, as a critical yet under-investigated determinant of transplant outcomes. Evidence from diverse domains, including air pollution, heavy metal burden, dietary composition, infections, microbiome dynamics, psychosocial context, and digital health engagement, suggests that these factors exert profound effects on immune regulation, metabolic health, and graft integrity. By applying innovative approaches such as exposome-wide association studies, high-resolution biomonitoring, and multi-omics integration, researchers can begin to unravel complex exposure–disease relationships and identify previously unrecognized modifiable risks. Positioning the exposome within the kidney transplantation paradigm offers a pathway toward precision environmental medicine, enabling refined risk stratification, novel preventive strategies, and ultimately improved durability of both graft function and patient survival. However, exposome influences are highly individualized and interact in complex, non-additive ways; current evidence remains largely associative and hypothesis-generating rather than causal.</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145586037","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}

{"title":"Understanding Failure to Rescue in Solid Organ Transplantation: A Scoping Review","authors":"Jiro Kimura,&nbsp;Ayham Asassfeh,&nbsp;Emily Cooper,&nbsp;Kondragunta Rajendra Prasad,&nbsp;Matthew Cooper,&nbsp;Badi Rawashdeh","doi":"10.1111/ctr.70393","DOIUrl":"10.1111/ctr.70393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of failure to rescue (FTR) in solid organ transplantation (SOT) is less clear. This scoping review aimed to evaluate the incidence, complications, and risk factors for FTR in SOT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched PubMed, Scopus, and Web of Science for studies reporting on FTR in SOT. Data on incidence, complications, risk factors, and definitions were extracted and synthesized narratively due to heterogeneity across studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven studies were identified: four in liver transplantation, two in lung transplantation, and one in heart transplantation; none addressed kidney or pancreas transplantation. Definitions of FTR varied by time window, complication set, and analytic unit. Reported FTR rates ranged from 4.6% to 39.6% in liver, 19% to 26% in lung, and 11.5% in heart transplantation. Across organs, dialysis-requiring acute kidney injury (AKI) was the most frequent proximate pathway to death. Risk signals spanned patient-level factors (age, comorbidities, frailty/sarcopenia, functional status), donor factors (age, sex, race/ethnicity), and system-level factors (center volume, mortality tertile, insurance coverage). Notably, heart transplantation data revealed higher adjusted odds of FTR among Hispanic recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Evidence on FTR in transplantation remains sparse and heterogeneous, but early findings suggest that both patient vulnerability and system capacity shape rescue outcomes, with AKI consistently emerging as a cross-organ target. Standardized definitions, multicenter analyses, and extension to kidney and pancreas transplantation are needed to establish FTR as a transplant-specific quality metric and to guide interventions that optimize rescue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562904","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}