Clinical Transplantation最新文献

{"title":"The Impact of CYP3A4, CYP3A5, and ABCB1 Polymorphisms on Cyclosporine Concentration in Leukemia Patients After Allogeneic Hematopoietic Stem Cell Transplantation","authors":"Zahra Salehi,&nbsp;Amirhossein Shahsavand,&nbsp;Mohammad Mehdi Naghizadeh,&nbsp;Molouk Hadjibabaie,&nbsp;Shahrbano Rostami,&nbsp;Habibeh Ghadimi,&nbsp;Ahmad Reza Shamshiri,&nbsp;Kamran Alimoghaddam,&nbsp;Fahimeh Rabianataj,&nbsp;Ardeshir Ghavamzadeh,&nbsp;Mohammadreza Ostadali Dehaghi","doi":"10.1111/ctr.70413","DOIUrl":"10.1111/ctr.70413","url":null,"abstract":"<p>Cyclosporine A (CsA) is used as graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT). While polymorphisms in CYP3A4, CYP3A5, and ABCB1 genes influence CsA metabolism, their role in HSCT remains underexplored. We investigated the impact of these polymorphisms on CsA pharmacokinetics, early toxicity, and clinical outcomes in 86 leukemia patients undergoing HSCT (IR.TUMS.HORCSCT.REC.1402.07). CsA levels were monitored via radioimmunoassay, and genotyping for CYP3A4, CYP3A5, and ABCB1 polymorphisms was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Carriers of the rs2740574 (CYP3A4*1B, −392A&gt;G) and the rs776746 (CYP3A5*3, 6986A&gt;G) exhibited significantly higher mean trough concentrations compared to the wild-type genotypes (112.6 ± 52.1 versus 75.6 ± 31.0; <i>p</i> = 0.003, 126.1 ± 55.0 versus 89.5 ± 41.8; <i>p</i> &lt; 0.001, respectively). No significant difference was observed for the rs1045642 variants. Both rs776746 and rs2740574 variants were associated with increased markers of nephrotoxicity and hepatotoxicity within 3 days post-HSCT. None of these polymorphisms showed significant associations with transplant outcomes. In conclusion, patients carrying rs776746 or rs2740574 achieved higher CsA trough levels and may require lower initial dosing. Future research should assess whether genotype-guided CsA dosing improves achieving therapeutic levels and reduces early toxicity or suboptimal immunosuppression post-HSCT.</p>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713493","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":"Low-Dose Valganciclovir for Primary Cytomegalovirus Prophylaxis After Heart Transplant: A 10-Year Experience","authors":"Kennedy Concannon,&nbsp;Robert Page,&nbsp;Rebecca Swayngim,&nbsp;Amrut V. Ambardekar,&nbsp;Chia-Yu Chiu,&nbsp;Kelly Schoeppler,&nbsp;Emily Sartain","doi":"10.1111/ctr.70408","DOIUrl":"10.1111/ctr.70408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Due to the hematologic toxicities associated with standard-dose valganciclovir (VGCV), low-dose (LD) VGCV has been proposed as an alternative, primarily in abdominal transplant recipients. Data on LD VGCV outcomes in heart transplant recipients (HTR) remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective, stimulating cohort study describes adult, cytomegalovirus (CMV) D+/R− and R+ HTR transplanted between January 1, 2013 and September 30, 2022 and maintained on, at most, VGCV 450 mg daily for primary CMV prophylaxis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 338 HTR were reviewed, of whom 80 CMV D+/R− and 154 R+ HTR met criteria for inclusion. Of the 234 HTR, the median age was 56 years, the mean body mass index (BMI) was 26.9 kg/m², and 93 (39.7%) had an estimated glomerular filtration rate ≥60 mL/min/1.72 m² at post-transplant month 12. Breakthrough (BT) CMV occurred in six (2.6%) individuals, exclusively among CMV D+/R− HTR. Two cases were complicated by CMV end-organ disease (retinitis, colitis) with ganciclovir (GCV) resistance. Leukopenia occurred in 67.1% of the total cohort, necessitating frequent VGCV and mycophenolate adjustments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the largest report of LD VGCV use in HTR. Despite reduced VGCV exposure, HTR remain at high risk for cytopenias. Regardless of potential risk factors, including a high prevalence of overweight BMI and adequate renal function, LD VGCV was associated with expected rates of BT CMV and CMV resistance, suggesting LD VGCV could be considered in HTR. Identification of CMV end-organ disease and GCV resistance suggests that LD VGCV could be considered cautiously in CMV D+/R− HTR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713564","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":"Comparison of Kidney Allograft Outcomes in Simultaneous Liver-Kidney Versus Kidney After Liver Transplantation Since the Safety Net Era","authors":"Brian T. Lee,&nbsp;Jennifer L. Dodge,&nbsp;Santhi Voora,&nbsp;Aaron Ahearn,&nbsp;Tse-Ling Fong","doi":"10.1111/ctr.70407","DOIUrl":"https://doi.org/10.1111/ctr.70407","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Criteria for simultaneous liver kidney transplantation (SLKT) have undergone several iterations. In August 2017, the Organ Procurement Transplantation Network (OPTN) created specific criteria for SLKT allocation and established a “safety net” protocol to allocate kidney allografts for liver transplant recipients with persistent renal dysfunction within the first year after liver transplantation (KALT). Published studies that evaluated patient and kidney allograft survival have applied the “safety net” criteria retrospectively to time periods prior to enactment of the policy. We aimed to assess kidney allograft outcomes in those who underwent KALT compared to those who underwent SLKT during the actual “safety net” era.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This retrospective cohort study included adults (≥18 years) receiving a primary kidney transplant via SLKT or safety net KALT from 2018 to 2021, captured in the OPTN database. Patients receiving multiple organs other than kidney-liver, a kidney from a living donor, a split liver, or sequential or en bloc kidney transplant were excluded. Study outcomes, including kidney allograft survival, patient survival, eGFR and kidney rejection, were compared by KALT versus SLKT post-kidney transplant. Differences in eGFR and rejection for KALT versus SLKT were then assessed in a propensity score analysis (nearest neighbor matching [&lt;i&gt;n&lt;/i&gt; = 4]) to estimate the conditional average treatment effect.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Between January 2018 and December 2021, 2620 patients underwent SLKT, and 526 underwent KALT by the safety net policy. Those who underwent KALT had a lower prevalence of diabetes mellitus (36.3% vs. 43.2%, &lt;i&gt;p&lt;/i&gt; = 0.003). Alcohol as a reason for liver transplantation was higher in KALT versus SLKT (43.0 vs. 30.8%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Recipients of KALT compared to SLKT had a higher prevalence of dialysis prior to transplant (73.2% vs. 53.5%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) with a higher median number of months of dialysis time (9.0 vs. 4.9 months, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). At 1-year post-kidney transplant, KALT versus SLKT observed similar kidney allograft survival rates (97.7% [95%CI 96.0–98.7] vs. 96.8% [95%CI 96.0–97.4], &lt;i&gt;p&lt;/i&gt; = 0.43) but higher patient survival rates (96.7% [95%CI 94.8–98.0] vs. 93.9% [95%CI 92.9–94.8] at 1 year [&lt;i&gt;p&lt;/i&gt; = 0.02]). Those with KALT consistently had lower eGFR at 6 months, 1 year, and 3 years after kidney transplantation. The mean difference at 1 year was −6.6 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; (95% CI: −8.5 to −4.7, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) in the unadjusted and −4.7 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; (95% CI: −7.0 to −2.4, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) in the propensity score matched","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686476","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":"Mapping the Microenvironment: How Spatial-Omics Is Advancing the Understanding of Allograft Fate","authors":"Lisha Mou,&nbsp;Zuhui Pu","doi":"10.1111/ctr.70373","DOIUrl":"10.1111/ctr.70373","url":null,"abstract":"<div>\u0000 \u0000 <p>Solid organ transplantation is a life-saving procedure, yet its long-term success is limited by rejection and other pathological processes. Traditional histopathology and bulk molecular analysis lack the necessary spatial resolution to resolve the complex cellular interactions within the allograft microenvironment. The emergence of spatial-omics technologies offers new capabilities for molecular analysis within intact tissue architecture. This review provides an overview of major spatial transcriptomic and proteomic platforms, including sequencing-based technologies, imaging-based technologies, and high-plex protein imaging technologies. We synthesize and provide mechanistic insights into the key findings from the application of these tools in kidney, lung, liver, and heart transplantation. Key applications discussed include as follows: resolving the heterogeneity of rejection (T-cell mediated and antibody-mediated rejection (ABMR)), elucidating the driving mechanisms of chronic allograft dysfunction and ischemia-reperfusion injury (IRI), and delineating the immune microenvironments associated with operational tolerance (OT) and tertiary lymphoid structures (TLS). We further explore how these technologies are beginning to refine our understanding of transplant pathology from a diffuse inflammatory process to the identification of specific pathogenic microenvironments. Finally, we discuss the challenges and prospects of translating these powerful research tools toward the long-term goal of precision immunosuppression, for instance, through the potential future development of digital biopsies to help guide individualized therapies.</p>\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":"145660597","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":"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}