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}
Ana Lanier, Umar Siddiqi, Usmaan Siddiqi, Linda Lee, Seyed Ehsan Saffari, Mark Belkin, Jonathan Grinstein, Anthony Kanelidis, Leo Gozdecki, Stanley Swat, Sara Kalantari, Nitasha Sarswat, Bow Ben Chung, Gene Kim, Chris Salerno, Valluvan Jeevanandam, Manreet Kanwar, Ann Nguyen
Current guidelines for heart transplant (HT) listing support body mass index (BMI) < 35 kg/m2, though data supporting this recommendation is mixed. It is unclear if other more specific measurements of body composition are better predictors of outcomes post-HT. This retrospective study included patients who underwent HT between 2014 and 2019 and underwent an abdominal CT scan within 3 months of HT. Tissue characterization was performed using Slice-O-Matic software to derive measurements including BMI, fat mass index (FMI), visceral adipose tissue to subcutaneous adipose tissue ratio (VAT/SAT), fat free mass index (FFMI), and skeletal muscle index (SMI). Univariate and multivariate logistic regression analyses were used to investigate association of body composition variables by tertiles to 1 year mortality, readmission, primary graft dysfunction, length of stay, infection, and renal failure. Of the 104 patients, 80% were male and 56% were Caucasian. Highest and lowest BMI tertiles were significantly associated with an increased risk of hospital readmission within 1 year post HT (OR 3.4, [95%CI 1.1–11.4]; OR 5.9, [95% CI 1.7–25.1]; p = 0.01) as well as an increased risk of infections requiring hospitalization (OR 3.2, [95% CI 1.2–9.0]; OR 3.9, [95%CI 1.4–11.7]; p = 0.02). FMI, VAT/SAT, FFMI, and SMI were not associated with outcomes 1-year post-HT. Highest and lowest BMI tertiles were associated with increased rates of hospital readmission and infection in the first-year post HT, while other measurements of body composition were not associated with any poor outcomes post-HT. Although BMI does not predict mortality post-HT, it can differentiate risk better than all other metrics.
目前的心脏移植指南（HT）支持身体质量指数（BMI） 2，尽管支持这一建议的数据参差不齐。目前尚不清楚其他更具体的身体成分测量是否能更好地预测治疗后的结果。这项回顾性研究包括2014年至2019年期间接受HT治疗并在HT治疗后3个月内接受腹部CT扫描的患者。使用Slice-O-Matic软件进行组织表征，得出包括BMI、脂肪质量指数（FMI）、内脏脂肪组织与皮下脂肪组织比率（VAT/SAT）、无脂肪质量指数（FFMI）和骨骼肌指数（SMI）在内的测量结果。采用单因素和多因素logistic回归分析，按位数调查身体组成变量与1年死亡率、再入院、原发性移植物功能障碍、住院时间、感染和肾功能衰竭的关系。104例患者中，80%为男性，56%为白种人。最高和最低BMI分位数与HT后1年内再入院风险增加（OR 3.4, [95%CI 1.1-11.4]; OR 5.9, [95%CI 1.7-25.1]; p = 0.01）以及需要住院治疗的感染风险增加（OR 3.2, [95%CI 1.2-9.0]; OR 3.9, [95%CI 1.4-11.7]; p = 0.02）显著相关。FMI、VAT/SAT、FFMI和SMI与ht后1年的预后无关。BMI指数最高和最低与高温疗法后第一年再入院率和感染率的增加有关，而身体成分的其他测量值与高温疗法后的任何不良结果无关。虽然BMI不能预测术后死亡率，但它能比其他指标更好地区分风险。
{"title":"Alternative Measures of Body Composition and Outcomes Following Heart Transplant","authors":"Ana Lanier, Umar Siddiqi, Usmaan Siddiqi, Linda Lee, Seyed Ehsan Saffari, Mark Belkin, Jonathan Grinstein, Anthony Kanelidis, Leo Gozdecki, Stanley Swat, Sara Kalantari, Nitasha Sarswat, Bow Ben Chung, Gene Kim, Chris Salerno, Valluvan Jeevanandam, Manreet Kanwar, Ann Nguyen","doi":"10.1111/ctr.70448","DOIUrl":"10.1111/ctr.70448","url":null,"abstract":"<p>Current guidelines for heart transplant (HT) listing support body mass index (BMI) < 35 kg/m<sup>2</sup>, though data supporting this recommendation is mixed. It is unclear if other more specific measurements of body composition are better predictors of outcomes post-HT. This retrospective study included patients who underwent HT between 2014 and 2019 and underwent an abdominal CT scan within 3 months of HT. Tissue characterization was performed using Slice-O-Matic software to derive measurements including BMI, fat mass index (FMI), visceral adipose tissue to subcutaneous adipose tissue ratio (VAT/SAT), fat free mass index (FFMI), and skeletal muscle index (SMI). Univariate and multivariate logistic regression analyses were used to investigate association of body composition variables by tertiles to 1 year mortality, readmission, primary graft dysfunction, length of stay, infection, and renal failure. Of the 104 patients, 80% were male and 56% were Caucasian. Highest and lowest BMI tertiles were significantly associated with an increased risk of hospital readmission within 1 year post HT (OR 3.4, [95%CI 1.1–11.4]; OR 5.9, [95% CI 1.7–25.1]; <i>p</i> = 0.01) as well as an increased risk of infections requiring hospitalization (OR 3.2, [95% CI 1.2–9.0]; OR 3.9, [95%CI 1.4–11.7]; <i>p</i> = 0.02). FMI, VAT/SAT, FFMI, and SMI were not associated with outcomes 1-year post-HT. Highest and lowest BMI tertiles were associated with increased rates of hospital readmission and infection in the first-year post HT, while other measurements of body composition were not associated with any poor outcomes post-HT. Although BMI does not predict mortality post-HT, it can differentiate risk better than all other metrics.</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/PMC12857596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084680","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}
Daniel M. Chen, Ambalavanan Arunachalam, Graham Peigh, Bradley P. Knight, Chitaru Kurihara, Mrinalini Venkata Subramani, Catherine Myers, Alan Betensley, Krishnan Warrior, Bradford C. Bemiss, Amanda Kamar, Mohamed Al-Kazaz
Background
Postoperative atrial arrhythmia (POAA) is common after lung transplant, but data on its implications and management are limited. This study assessed POAA incidence and timing, its association with mortality and rehospitalizations, and outcomes related to postoperative beta-blocker use.
Methods
We retrospectively studied 233 adult lung transplant patients at Northwestern Memorial Hospital (2014–2024) without prior atrial arrhythmia. POAA, defined as atrial fibrillation or flutter, was confirmed by ECG or ambulatory monitoring. Multivariable logistic and Cox regression models evaluated predictors and outcomes, adjusting for covariates.
Results
POAA occurred in 69/233 patients (29.6%) and was associated with higher mortality (HR3.09, 95%CI [1.57–6.08]). Among these, 18/69 (26.1%) developed POAA after the index hospitalization at median 216 days post-transplant, also associated with higher mortality (HR4.37, 95%CI [1.90–10.06]). Additionally, 10/69 (14.5%) required emergency visits or hospitalization specifically for arrhythmia management, and 66.6% underwent additional rhythm control (2.9% cardioversion, 46.4% anti-arrhythmic drug, 17.4% both). Postoperative beta-blocker use was associated with 73% less POAA (HR0.27, 95%CI [0.09–0.80]).
Conclusion
POAA was common and clinically significant after lung transplant, associated with substantially higher adjusted mortality even when occurring after index hospitalization. We report for the first time that POAA was frequently associated with emergency visits or rehospitalization for arrhythmia, highlighting its clinical burden well beyond the perioperative period. Postoperative beta-blocker use was associated with markedly less POAA, a novel finding suggesting a potential prophylactic role. Overall, these findings challenge the traditional view of POAA as benign and highlight the need for tailored, evidence-based guidelines in this high-risk population.
{"title":"Postoperative Atrial Arrhythmias After Lung Transplantation: A Single Center Analysis of Risk Factors, Management, and Outcomes","authors":"Daniel M. Chen, Ambalavanan Arunachalam, Graham Peigh, Bradley P. Knight, Chitaru Kurihara, Mrinalini Venkata Subramani, Catherine Myers, Alan Betensley, Krishnan Warrior, Bradford C. Bemiss, Amanda Kamar, Mohamed Al-Kazaz","doi":"10.1111/ctr.70457","DOIUrl":"10.1111/ctr.70457","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postoperative atrial arrhythmia (POAA) is common after lung transplant, but data on its implications and management are limited. This study assessed POAA incidence and timing, its association with mortality and rehospitalizations, and outcomes related to postoperative beta-blocker use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively studied 233 adult lung transplant patients at Northwestern Memorial Hospital (2014–2024) without prior atrial arrhythmia. POAA, defined as atrial fibrillation or flutter, was confirmed by ECG or ambulatory monitoring. Multivariable logistic and Cox regression models evaluated predictors and outcomes, adjusting for covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>POAA occurred in 69/233 patients (29.6%) and was associated with higher mortality (HR3.09, 95%CI [1.57–6.08]). Among these, 18/69 (26.1%) developed POAA after the index hospitalization at median 216 days post-transplant, also associated with higher mortality (HR4.37, 95%CI [1.90–10.06]). Additionally, 10/69 (14.5%) required emergency visits or hospitalization specifically for arrhythmia management, and 66.6% underwent additional rhythm control (2.9% cardioversion, 46.4% anti-arrhythmic drug, 17.4% both). Postoperative beta-blocker use was associated with 73% less POAA (HR0.27, 95%CI [0.09–0.80]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>POAA was common and clinically significant after lung transplant, associated with substantially higher adjusted mortality even when occurring after index hospitalization. We report for the first time that POAA was frequently associated with emergency visits or rehospitalization for arrhythmia, highlighting its clinical burden well beyond the perioperative period. Postoperative beta-blocker use was associated with markedly less POAA, a novel finding suggesting a potential prophylactic role. Overall, these findings challenge the traditional view of POAA as benign and highlight the need for tailored, evidence-based guidelines 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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084320","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}
Corrado Zengarini, Vittoria Tagnin, Gioia Sorbi, Alba Guglielmo, Michelangelo La Placa, Bianca Maria Piraccini, Alessandro Pileri, Marco Pignatti
Background
Non-melanoma skin cancer (NMSC) is a frequent long-term complication in transplant recipients, mainly due to chronic immunosuppression. Its incidence varies by transplant type and regimen, but existing evidence is often fragmented.
Objective
To assess long-term incidence and risk factors for NMSC, comparing transplant types, immunosuppressive regimens, and tumor subtypes.
Methods
This retrospective cohort comprised 901 transplant recipients (1975–2024) who were under long-term dermatologic follow-up. Data on transplant type, immunosuppressive regimen/duration, and tumor subtype were analyzed. NMSC-free survival was evaluated with Kaplan–Meier curves; Cox regression assessed predictors.
Results
Among 901 transplant recipients, 191 (21.2%) developed at least one NMSC during long-term follow-up. Crude incidence rates ranged between 1.88 and 2.68 per 100 person-years across immunosuppressive drug classes and agents. In multivariable Cox models, older age at first transplant was independently associated with higher NMSC risk (HR 1.07 per year, 95% CI 1.06–1.09, p < 0.001). Sex, transplant group, and ever-use of individual immunosuppressive agents were not significantly associated with NMSC risk after adjustment.
Conclusion
In this long-term cohort, NMSC risk increased with age at first transplant, whereas transplant organ and ever-use of major immunosuppressive agents were not independently associated in adjusted models. Over an extended follow-up, NMSC accumulated steadily, with crude incidence rates around 1.88–2.68 cases per 100 person-years across immunosuppressive classes and agents, underscoring the cumulative nature of skin cancer risk under chronic immunosuppression. Our results reinforce the need for sustained, long-term dermatologic surveillance, particularly in older patients undergoing transplantation.
背景：非黑色素瘤皮肤癌（NMSC）是移植受者常见的长期并发症，主要是由于慢性免疫抑制。其发病率因移植类型和治疗方案而异，但现有证据往往是碎片化的。目的：评估NMSC的长期发病率和危险因素，比较移植类型、免疫抑制方案和肿瘤亚型。方法：本回顾性队列包括901例移植受者（1975-2024），接受长期皮肤病学随访。分析了移植类型、免疫抑制方案/持续时间和肿瘤亚型的数据。用Kaplan-Meier曲线评估无nmsc生存期；Cox回归评估预测因子。结果：在901例移植受者中，191例（21.2%）在长期随访期间发生了至少一次NMSC。免疫抑制药物类别和药物的粗发病率在1.88 - 2.68 / 100人年之间。在多变量Cox模型中，首次移植年龄越大与NMSC风险升高独立相关（HR 1.07 /年，95% CI 1.06-1.09, p < 0.001）。性别、移植组和曾经使用过的个体免疫抑制剂与调整后的NMSC风险无显著相关。结论：在这个长期队列中，NMSC风险随着首次移植年龄的增加而增加，而在调整后的模型中，移植器官和主要免疫抑制剂的使用并不是独立相关的。在长期随访中，NMSC稳步累积，在免疫抑制类别和药物中，每100人年的粗发病率约为1.88-2.68例，强调了慢性免疫抑制下皮肤癌风险的累积性质。我们的研究结果强调了持续、长期皮肤病学监测的必要性，特别是在接受移植的老年患者中。
{"title":"Non-Melanoma Skin Cancer in Transplant Recipients: A Single-Centre Retrospective Cohort Study on the Role of Transplant Type, Immunosuppressive Exposure, and Tumor Subtypes","authors":"Corrado Zengarini, Vittoria Tagnin, Gioia Sorbi, Alba Guglielmo, Michelangelo La Placa, Bianca Maria Piraccini, Alessandro Pileri, Marco Pignatti","doi":"10.1111/ctr.70451","DOIUrl":"10.1111/ctr.70451","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Non-melanoma skin cancer (NMSC) is a frequent long-term complication in transplant recipients, mainly due to chronic immunosuppression. Its incidence varies by transplant type and regimen, but existing evidence is often fragmented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess long-term incidence and risk factors for NMSC, comparing transplant types, immunosuppressive regimens, and tumor subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort comprised 901 transplant recipients (1975–2024) who were under long-term dermatologic follow-up. Data on transplant type, immunosuppressive regimen/duration, and tumor subtype were analyzed. NMSC-free survival was evaluated with Kaplan–Meier curves; Cox regression assessed predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 901 transplant recipients, 191 (21.2%) developed at least one NMSC during long-term follow-up. Crude incidence rates ranged between 1.88 and 2.68 per 100 person-years across immunosuppressive drug classes and agents. In multivariable Cox models, older age at first transplant was independently associated with higher NMSC risk (HR 1.07 per year, 95% CI 1.06–1.09, <i>p</i> < 0.001). Sex, transplant group, and ever-use of individual immunosuppressive agents were not significantly associated with NMSC risk after adjustment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this long-term cohort, NMSC risk increased with age at first transplant, whereas transplant organ and ever-use of major immunosuppressive agents were not independently associated in adjusted models. Over an extended follow-up, NMSC accumulated steadily, with crude incidence rates around 1.88–2.68 cases per 100 person-years across immunosuppressive classes and agents, underscoring the cumulative nature of skin cancer risk under chronic immunosuppression. Our results reinforce the need for sustained, long-term dermatologic surveillance, particularly in older patients undergoing transplantation.</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/PMC12857597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084669","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}
Daisuke Imai, Jacob Hallesy, Rohan Rathi, Christian Zbihley, Kush Savsani, Yuzuru Sambommatsu, Aamir A. Khan, Vinay Kumaran, David A. Bruno, Seung Duk Lee
Normothermic regional perfusion (NRP) has emerged as a pivotal strategy in controlled donation after circulatory death (cDCD) liver transplantation, mitigating ischemia-reperfusion injury and improving graft outcomes. Compared to super rapid recovery (SRR), NRP significantly reduces rates of early allograft dysfunction, primary nonfunction, and biliary non-anastomotic stricture (NAS), with biliary complications reported in 5%–16% and NAS as low as 0%–2%. Outcomes from cDCD-NRP grafts are increasingly comparable to those of donation after brain death (DBD). Viability assessment during NRP remains variably defined across centers. Nonetheless, stable pump flow, stable or declining lactate levels, controlled transaminase levels, and favorable macroscopic appearance are commonly used parameters. Histological thresholds may guide graft acceptance but are not universally applied. Sequential use of ex situ machine perfusion following NRP offers additional benefits in marginal or prolonged ischemia settings. NRP implementation has improved liver utilization rates from 34% to 63% in the United Kingdom and from 39% to 71% in the United States. This review highlights NRP as a transformative platform that reshapes viability standards, expanding transplant access, and supports sustained growth in liver transplantation.
{"title":"Normothermic Regional Perfusion in Controlled Donation After Circulatory Death: Growing Evidence for Liver Transplantation","authors":"Daisuke Imai, Jacob Hallesy, Rohan Rathi, Christian Zbihley, Kush Savsani, Yuzuru Sambommatsu, Aamir A. Khan, Vinay Kumaran, David A. Bruno, Seung Duk Lee","doi":"10.1111/ctr.70463","DOIUrl":"10.1111/ctr.70463","url":null,"abstract":"<p>Normothermic regional perfusion (NRP) has emerged as a pivotal strategy in controlled donation after circulatory death (cDCD) liver transplantation, mitigating ischemia-reperfusion injury and improving graft outcomes. Compared to super rapid recovery (SRR), NRP significantly reduces rates of early allograft dysfunction, primary nonfunction, and biliary non-anastomotic stricture (NAS), with biliary complications reported in 5%–16% and NAS as low as 0%–2%. Outcomes from cDCD-NRP grafts are increasingly comparable to those of donation after brain death (DBD). Viability assessment during NRP remains variably defined across centers. Nonetheless, stable pump flow, stable or declining lactate levels, controlled transaminase levels, and favorable macroscopic appearance are commonly used parameters. Histological thresholds may guide graft acceptance but are not universally applied. Sequential use of ex situ machine perfusion following NRP offers additional benefits in marginal or prolonged ischemia settings. NRP implementation has improved liver utilization rates from 34% to 63% in the United Kingdom and from 39% to 71% in the United States. This review highlights NRP as a transformative platform that reshapes viability standards, expanding transplant access, and supports sustained growth in liver transplantation.</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/PMC12857603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084658","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}
Aklilu A. Yishak, Megha S. Bhatnagar, Allison V. Tomimatsu, Rebecca LaLonde, Atif Jensen, Karishma N. Mohadikar, R. Clayton Bishop, Adrienne N. Deneal, Jennifer C. Gander, Ronald Potts
Background
While kidney transplantation provides longer survival and improved quality of life, there are numerous barriers to access. Provider-led discussions and early referrals are critical for improving access. However, reducing variability in referrals and addressing barriers through standardizing documentation of transplant option discussion and systematically tracking CKD care can be impactful.
Methods
We identified advanced CKD patients from an integrated health care system using a population-based approach. We used new electronic health record (EHR) tools, searchable system-wide, to require documentation of transplant discussion and evaluated over five years the number of CKD patients within the kidney transplant continuum and individual patient characteristics.
Results
At baseline, we identified 1747 patients with an eGFR ≤20 mL/min/1.73 m2. Of those, 554 (31.7%) were in the transplant continuum (referred, evaluated, and waitlisted). After the EHR tool was implemented, documentation of transplant discussion improved to 100% within a few months. At five-year follow-up, the transplant continuum population almost doubled from 554 to 974. Those added after the intervention were older (p = 0.003) and more likely to identify as Black (p = 0.006). Of the waitlisted patients, 65% were referred to transplant centers before starting dialysis. For incident CKD members, outside the cohort, the transplant documentation rate and referrals also remain high with the referral volume per year steadily increased from 233 to 369, and kidney transplant volume per year also steadily increased from 89 to 141.
Conclusion
This study demonstrates that a new, yet simple, EHR tool can be impactful for sustainably increasing documentation of transplant option discussion, waitlisted members, and transplant opportunity.
{"title":"New Tools and a Population-Based Approach to Improve Kidney Transplant Opportunity and Preemptive Waitlisting","authors":"Aklilu A. Yishak, Megha S. Bhatnagar, Allison V. Tomimatsu, Rebecca LaLonde, Atif Jensen, Karishma N. Mohadikar, R. Clayton Bishop, Adrienne N. Deneal, Jennifer C. Gander, Ronald Potts","doi":"10.1111/ctr.70465","DOIUrl":"10.1111/ctr.70465","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While kidney transplantation provides longer survival and improved quality of life, there are numerous barriers to access. Provider-led discussions and early referrals are critical for improving access. However, reducing variability in referrals and addressing barriers through standardizing documentation of transplant option discussion and systematically tracking CKD care can be impactful.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified advanced CKD patients from an integrated health care system using a population-based approach. We used new electronic health record (EHR) tools, searchable system-wide, to require documentation of transplant discussion and evaluated over five years the number of CKD patients within the kidney transplant continuum and individual patient characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, we identified 1747 patients with an eGFR ≤20 mL/min/1.73 m<sup>2</sup>. Of those, 554 (31.7%) were in the transplant continuum (referred, evaluated, and waitlisted). After the EHR tool was implemented, documentation of transplant discussion improved to 100% within a few months. At five-year follow-up, the transplant continuum population almost doubled from 554 to 974. Those added after the intervention were older (<i>p</i> = 0.003) and more likely to identify as Black (<i>p</i> = 0.006). Of the waitlisted patients, 65% were referred to transplant centers before starting dialysis. For incident CKD members, outside the cohort, the transplant documentation rate and referrals also remain high with the referral volume per year steadily increased from 233 to 369, and kidney transplant volume per year also steadily increased from 89 to 141.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates that a new, yet simple, EHR tool can be impactful for sustainably increasing documentation of transplant option discussion, waitlisted members, and transplant opportunity.</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/PMC12857599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084665","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}
Emilie Høegholm Ernst Lauridsen, Rasmus Hvidbjerg Gantzel, Moises Alberto Suarez-Zdunek, Mette Bak Nielsen, Allan Rasmussen, Susanne Dam Nielsen, Henning Grønbæk, Gerda Elisabeth Villadsen
Background and Aims
Post liver transplantation (LT) inflammation and fibrosis are clinical challenges that may affect long-term outcomes. We aimed to investigate sCD163 as a biomarker of liver fibrosis in LT recipients and compare it with the Fibrosis 4 (FIB-4) score and FibroScan.
Methods
In the Danish Comorbidity in Liver Transplant Recipients study (DACOLT) we included 105 LT recipients at Aarhus University Hospital. We reviewed patient records and collected plasma for measurements of sCD163 and FIB-4. Liver stiffness was assessed using FibroScan. Liver biopsies performed <6 months before or after inclusion (n = 33) were investigated by the Banff score and the METAVIR fibrosis score.
Results
The majority (86%) had FibroScan with transient elastography <8 kPa. Plasma sCD163 correlated significantly with liver stiffness (ρ = 0.38, p < 0.001) and remained independently associated after multivariable adjustment (β = 0.14, p < 0.0002), corresponding to a 15.2% increase in liver stiffness per 1 mg/L increase in sCD163. In patients with liver biopsies, sCD163 levels were significantly higher in those with METAVIR stage F2–F4 compared to F0–F1 (5.04 vs. 2.35 mg/L, p = 0.018), and sCD163 correlated with histological fibrosis stage (ρ = 0.40, p = 0.029). At a cutoff of 3.86 mg/L, sCD163 identified METAVIR F2–4 fibrosis with 80% sensitivity and 85% specificity (AUC = 0.94).
Conclusions
In this cohort of LT recipients, sCD163 was associated with both liver stiffness and histological fibrosis. These findings support sCD163 as a promising noninvasive biomarker for detection and monitoring of liver fibrosis post-LT, warranting evaluation in larger, prospective studies.
{"title":"Soluble CD163 as a Biomarker of Liver Fibrosis and Inflammation in Liver Transplant Recipients","authors":"Emilie Høegholm Ernst Lauridsen, Rasmus Hvidbjerg Gantzel, Moises Alberto Suarez-Zdunek, Mette Bak Nielsen, Allan Rasmussen, Susanne Dam Nielsen, Henning Grønbæk, Gerda Elisabeth Villadsen","doi":"10.1111/ctr.70468","DOIUrl":"10.1111/ctr.70468","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Post liver transplantation (LT) inflammation and fibrosis are clinical challenges that may affect long-term outcomes. We aimed to investigate sCD163 as a biomarker of liver fibrosis in LT recipients and compare it with the Fibrosis 4 (FIB-4) score and FibroScan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the Danish Comorbidity in Liver Transplant Recipients study (DACOLT) we included 105 LT recipients at Aarhus University Hospital. We reviewed patient records and collected plasma for measurements of sCD163 and FIB-4. Liver stiffness was assessed using FibroScan. Liver biopsies performed <6 months before or after inclusion (<i>n</i> = 33) were investigated by the Banff score and the METAVIR fibrosis score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The majority (86%) had FibroScan with transient elastography <8 kPa. Plasma sCD163 correlated significantly with liver stiffness (<i>ρ</i> = 0.38, <i>p</i> < 0.001) and remained independently associated after multivariable adjustment (β = 0.14, <i>p</i> < 0.0002), corresponding to a 15.2% increase in liver stiffness per 1 mg/L increase in sCD163. In patients with liver biopsies, sCD163 levels were significantly higher in those with METAVIR stage F2–F4 compared to F0–F1 (5.04 vs. 2.35 mg/L, <i>p</i> = 0.018), and sCD163 correlated with histological fibrosis stage (<i>ρ</i> = 0.40, <i>p</i> = 0.029). At a cutoff of 3.86 mg/L, sCD163 identified METAVIR F2–4 fibrosis with 80% sensitivity and 85% specificity (AUC = 0.94).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this cohort of LT recipients, sCD163 was associated with both liver stiffness and histological fibrosis. These findings support sCD163 as a promising noninvasive biomarker for detection and monitoring of liver fibrosis post-LT, warranting evaluation in larger, prospective studies.</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/PMC12857604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084540","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":"Comment on “Using ChatGPT for Kidney Transplantation: Perceived Information Quality by Race and Education Levels”","authors":"Hineptch Daungsupawong, Viroj Wiwanitkit","doi":"10.1111/ctr.70467","DOIUrl":"10.1111/ctr.70467","url":null,"abstract":"","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050597","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}
Mario Panebianco, Paola Francalanci, Marco Alfonso Perrone, Giorgia Grutter
Many patients with heart failure (HF) progress to an advanced stage, characterized by persistent symptoms despite maximal therapy. Heart transplantation (HT) remains the most effective treatment option for improving the survival of patients with advanced HF. This is true even with advancements in medical therapy for HF and the development of mechanical circulatory support systems. Over the past few decades, HT has undergone significant evolution, leading to greatly improved success rates. However, HT recipients face the risk of several potential complications that can negatively impact their outcomes. In this article, we aim to provide a practical framework for clinicians involved in heart transplant medicine. Additionally, we offer an update on a recent and relatively unknown complication of HT: eosinophilic myocarditis (EM).
{"title":"Heart Transplantation: Focus on Rejection and the Rare Complication of Eosinophilic Myocarditis","authors":"Mario Panebianco, Paola Francalanci, Marco Alfonso Perrone, Giorgia Grutter","doi":"10.1111/ctr.70455","DOIUrl":"10.1111/ctr.70455","url":null,"abstract":"<div>\u0000 \u0000 <p>Many patients with heart failure (HF) progress to an advanced stage, characterized by persistent symptoms despite maximal therapy. Heart transplantation (HT) remains the most effective treatment option for improving the survival of patients with advanced HF. This is true even with advancements in medical therapy for HF and the development of mechanical circulatory support systems. Over the past few decades, HT has undergone significant evolution, leading to greatly improved success rates. However, HT recipients face the risk of several potential complications that can negatively impact their outcomes. In this article, we aim to provide a practical framework for clinicians involved in heart transplant medicine. Additionally, we offer an update on a recent and relatively unknown complication of HT: eosinophilic myocarditis (EM).</p>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050601","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}
Elizabeth van Rooy, Daniel Sellers, Stuart McCluskey, Cara Crouch
Background
Liver transplantation is the only curative treatment for end-stage liver disease, yet perioperative management is complex and high-risk. Variations in anesthetic practices may influence outcomes, but benchmarks are scant. This study characterizes liver transplant anesthesia practices in Canada, Australia, and New Zealand to identify patterns and opportunities to establish a “standard of care.”
Methods
An online questionnaire, adapted from the 2021 Society for the Advancement of Transplant Anesthesia survey, was distributed to the directors of liver transplant anesthesia at 18 adult and pediatric programs. The survey covered team structure, preoperative evaluation, intraoperative techniques, and postoperative management. Responses were stratified by annual transplant volume and analyzed using descriptive statistics and Fisher's exact test (p < 0.05).
Results
Dedicated transplant anesthesia teams existed in 76% of centers, with 31% offering transplant fellowships. Standardized preoperative cardiac evaluation was reported by 82%, though only 31% used formal risk-stratification tools. More than half—59%—used transesophageal echocardiography and pulmonary artery catheters intraoperatively. Renal replacement therapy was applied in 76%, and viscoelastic testing in 82% of centers. Graft flushing on the back-table and in the surgical field occurred in 60% and 69% of programs, respectively; retrograde blood perfusion was used by 50%. Extubation at case-end was rare, while up to 25% of patients were extubated within 2–4 h. Postoperative intensive care unit admission was nearly universal.
Conclusions
These findings identified substantial practice variability, highlighting opportunities to develop consensus guidelines and targeted training to standardize perioperative care.
{"title":"Liver Transplant Anesthesia Practice Patterns in Canada, Australia, and New Zealand: Results From a Multi-National Survey","authors":"Elizabeth van Rooy, Daniel Sellers, Stuart McCluskey, Cara Crouch","doi":"10.1111/ctr.70445","DOIUrl":"10.1111/ctr.70445","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liver transplantation is the only curative treatment for end-stage liver disease, yet perioperative management is complex and high-risk. Variations in anesthetic practices may influence outcomes, but benchmarks are scant. This study characterizes liver transplant anesthesia practices in Canada, Australia, and New Zealand to identify patterns and opportunities to establish a “standard of care.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An online questionnaire, adapted from the 2021 Society for the Advancement of Transplant Anesthesia survey, was distributed to the directors of liver transplant anesthesia at 18 adult and pediatric programs. The survey covered team structure, preoperative evaluation, intraoperative techniques, and postoperative management. Responses were stratified by annual transplant volume and analyzed using descriptive statistics and Fisher's exact test (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Dedicated transplant anesthesia teams existed in 76% of centers, with 31% offering transplant fellowships. Standardized preoperative cardiac evaluation was reported by 82%, though only 31% used formal risk-stratification tools. More than half—59%—used transesophageal echocardiography and pulmonary artery catheters intraoperatively. Renal replacement therapy was applied in 76%, and viscoelastic testing in 82% of centers. Graft flushing on the back-table and in the surgical field occurred in 60% and 69% of programs, respectively; retrograde blood perfusion was used by 50%. Extubation at case-end was rare, while up to 25% of patients were extubated within 2–4 h. Postoperative intensive care unit admission was nearly universal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings identified substantial practice variability, highlighting opportunities to develop consensus guidelines and targeted training to standardize perioperative care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"40 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050613","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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