Clinical Transplantation最新文献

Background

Cardiac allograft vasculopathy (CAV) remains a major cause of long-term morbidity and mortality after heart transplantation (HT). With the growing use of donation after circulatory death (DCD) donors, it is crucial to assess the incidence of CAV in this population.

Methods

We conducted a systematic review and meta-analysis of studies published between January 2010 and December 2024. comparing 1-year CAV incidence and 1-year mortality between DCD and donation after brain death (DBD) HT recipients. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using fixed and random-effects models.

Results

Four studies met inclusion criteria, comprising 951 HTs (576 DBD and 375 DCD). Of these, 594 HTs contributed to the CAV analysis and 914 to the mortality analysis. Pooled analysis demonstrated no significant difference in 1-year CAV incidence between DCD and DBD recipients (OR = 0.71, 95% CI: 0.43–1.17, p = 0.17). Similarly, no difference was observed in 1-year mortality (OR = 0.87, 95% CI: 0.48–1.58, p = 0.66).

Conclusions

DCD and DBD-HT recipients demonstrated comparable 1-year CAV incidence and mortality. These findings support the continued and expanded use of DCD donors to address the ongoing shortage of suitable donor hearts.

Background

Lung transplantation (LTx) significantly improves survival in end-stage pulmonary “disease” but its impact on life satisfaction and psychosocial adjustment is still underexplored. This study aimed to assess global life satisfaction and satisfaction with work, family life, and sexual life among lung transplant recipients.

Methods

Fifty adults after LTx were interviewed using Polish-language instruments (validated where available), including the SWLS, Satisfaction with Job Scale, a widely used Polish Family Satisfaction Scale, and the Sexual Satisfaction Questionnaire. Pearson's correlations, Mann–Whitney U tests, and multiple linear regression were performed to examine associations and predictors of life satisfaction.

Results

The mean SWLS score indicated high overall life satisfaction (M = 26.90, SD = 5.38). Sexual satisfaction correlated significantly with global life satisfaction (r = 0.413, p = 0.007). Family and work satisfaction showed positive but non-significant trends. Gender comparisons revealed no significant differences in life satisfaction or its domains. Multiple regression showed that family-related satisfaction (β = 0.361, p = 0.013) and sexual satisfaction (β = 0.365, p = 0.013) were significant predictors of life satisfaction, explaining 33% of its variance. Time since LTx and gender were not significant predictors.

Conclusions

Findings highlight the central role of interpersonal well-being in life satisfaction after lung transplantation. Satisfaction with family and intimate relationships emerged as key factors supporting psychosocial adjustment. This underscores the need for comprehensive post-transplant care addressing relational and sexual well-being, beyond physical recovery.

Background

Donation after circulatory death (DCD) has historically been underutilized compared with donation after brain death (DBD). Advances in preservation strategies and policy reforms have accelerated DCD adoption, raising the potential for meaningful shifts in the US donor pool.

Methods

We analyzed national donor trends using Scientific Registry of Transplant Recipients (SRTR) Explorer data from 2015 to 2025. Donor type (DCD vs. DBD) was evaluated across organ types and organ procurement organizations (OPOs). Temporal trends were assessed and crossover intervals were identified.

Results

We identified an interval in which the 30-day rolling donor count for DCD exceeded that of DBD for the first time (May 18 and June 18, 2025). During this period, DCD accounted for 52% of kidney, 44% of liver, and 26% of heart and lung recoveries. In 2025, DCD increased by 2.7 donors per day while DBD declined by 0.6 per day (p < 0.001). Over the past decade, DCD growth outpaced DBD nearly threefold, with kidney and lung showing the steepest increases. Both high- and low-volume OPOs demonstrated upward trends. Since reporting began in 2023, use of normothermic regional perfusion has expanded steadily.

Conclusions

This analysis identifies an interval in which the 30-day rolling donor count for DCD exceeded that of DBD, reflecting a notable shift in donor-availability trends. These findings underscore the need for standardized practices to ensure equitable allocation and minimize organ discard as reliance on DCD continues to grow.

Introduction

Prolonged invasive mechanical ventilation (IMV) after lung transplantation is an appealing early prognostic outcome as it can be reproducibly assessed both prospectively and retrospectively. Whether use of IMV at 72 h after lung transplantation is associated with post-transplant graft survival is unknown.

Methods

We performed a retrospective cohort study of 1511 participants in the multi-center Lung Transplant Outcomes Group cohort (2011–2018). Using Cox proportional hazards models and restricted mean survival time, we investigated whether IMV at 72 h was associated with post-transplant graft survival. We secondarily evaluated whether IMV at 72 h was concordant with severe primary graft dysfunction (PGD).

Results

Participants requiring IMV at 72 h after transplant were sicker at transplantation (higher lung allocation score [LAS], increased extracorporeal membrane oxygenation, or IMV bridge) and more likely to have severe PGD. Use of IMV at 72 h was associated with 55% (95% CI 26%–92%) increased hazards of death or re-transplantation after adjustment for age, ECMO, diagnosis, LAS, and intra-operative transfusion. The association between IMV and graft survival was modified by severe PGD (p-for interaction 0.002) but not by pre-transplant ECMO (p-for interaction 0.88) or pre-transplant IMV (p-for interaction 0.92). IMV was associated with increased risk of death or re-transplantation among those with PGD (HR 2.35, 95% CI 1.43–3.85) but not among those without PGD (HR 1.04, 95% CI 0.77-1.41).

Conclusion

Requirement of IMV at 72 h is an important early post-transplant outcome associated with post-transplant survival. This appears driven by those with severe PGD.

Introduction

Urinary tract infections (UTIs) occur commonly following kidney transplant and are associated with significant morbidity. Some providers perform intra-operative antibiotic bladder irrigation at the time of ureteroneocystostomy, although practice varies widely among surgeons. As a result, this study was performed to assess outcomes following a single intravesical gentamicin injection for the prevention of UTIs.

Methods

This was a retrospective cohort study of adult patients who underwent a first isolated kidney transplant between January 2018 and January 2023. Outcomes were compared between patients who received bladder irrigation with a single dose of gentamicin and controls who did not receive antibiotic irrigation. The primary end point was the incidence of culture-confirmed UTI within 3-months of transplant. Key secondary endpoints included delayed allograft function and serum creatinine at 3-months.

Results

A total of 764 patients were included in the study analysis (gentamicin = 406 vs. control = 358). At 3 months, the incidence of UTIs was 18.2% in the gentamicin group compared to 13.1% in the control group (p = 0.05). A higher incidence of BK viremia >10,000 copies/mL was also observed in the gentamicin group compared with control patients (5.9% vs. 2.5%; p = 0.02). After multivariable regression analysis older age, female sex, early rejection, longer dialysis vintage, and urinary catheter duration were all found to be positively correlated with the incidence of UTIs.

Conclusion

Among kidney transplant recipients, bladder irrigation with gentamicin was not found to reduce the incidence of UTIs at 3 months. Additional studies should explore a possible association between antibiotic bladder irrigation and subsequent BK viremia.

Introduction

Systemic sclerosis (SSc) is a multisystem disease, frequently leading to heart failure (HF). Heart transplant (HT) remains the definitive therapy for advanced HF, but HT outcomes in SSc patients remain poorly characterized. This study aims to report the outcomes of HT in patients with SSc.

Methods

A retrospective analysis of all HT recipients with SSc between 2007 and 2024 at two transplant centers. Baseline characteristics, index admission, and post HT outcomes were captured from the electronic medical record. Pathology of explants and allograft biopsies was read by a dedicated pathologist.

Results

Seven of 1153 patients who received HT had SSc. Six of these received HT alone, while one received a heart–lung transplant. Five (71%) were waitlist status 2 at the time of transplant. Median age was 52, and five patients (71%) were male. Pathologic examination of the seven patients’ explanted native hearts showed that two (29%) had active inflammation, six (86%) had fibrosis, and four (57%) had vascular remodeling. With a median follow-up of 3.2 years (range: 1.0–18.2) post-HT, six patients (86%) had a preserved ejection fraction at last assessment, while one suffered graft failure due to acute cellular (ACR) and antibody-mediated rejection (AMR). Two patients (29%) developed 2R ACR (range: 0–1 months), and two (29%) developed AMR (range: 4–5 years). Post-HT, one patient developed gastroparesis due to SSc, and one required a renal transplant due to complications of immunosuppression.

Conclusions

HT in SSc patients demonstrates good mid-term graft function despite an increased incidence of rejection, supporting feasibility in carefully selected candidates.

Background

Endomyocardial biopsies (EMB) remain the reference standard for detection of acute rejection in heart transplant (HTx) patients. Recent studies evaluating novel noninvasive tests have sparked a renewed discussion in the HTx community about revising acute rejection surveillance policies. However, patient and provider perspectives remain underexplored. This single-center study examined both HTx patient and provider perspectives on replacing EMBs earlier with noninvasive blood tests.

Methods

We performed semi-structured interviews with 28 HTx patients to explore their perspectives on replacement of EMBs with donor-derived cell-free DNA (dd-cfDNA) early post-HTx. We subsequently conducted a survey of 118 HTx patients using self-administered online questionnaires. We also performed semi-structured interviews with 18 HTx providers to explore their perspectives. Thematic analysis was performed on interview and open-ended survey responses using deductive and inductive approaches. Patient quantitative survey responses were analyzed with descriptive statistics.

Results

Our study identified three key themes: patient anxiety related to EMBs, importance of patient-provider communication, and strong interpersonal trust in providers by HTx patients. Although 78.4% of patients experienced EMB-related anxiety, they prioritized testing accuracy to ensure “the health of their new heart.” Consequently, patients favored the most accurate testing protocol and trusted providers to make this decision (91.1%). HTx providers raised concerns about the accuracy and safety of noninvasive surveillance testing for high-risk patients.

Conclusion

HTx patients trusted their providers to determine the most accurate acute rejection surveillance policy. Additionally, our study provides important patient-centered priorities to guide the implementation of early noninvasive testing into clinical practice.

Trial Registration: ClinicalTrials.gov identifier: NCT06414603