Pub Date : 2025-12-12DOI: 10.1016/j.ajt.2025.12.007
Allison Marsh,Malay Shah,Seth Karp,David S Goldberg
In the United States, since 2019, liver transplant waitlist candidates who are approved for a MELD exception are awarded points that vary based on geography. The number of points is based on the median MELD score at transplant minus 3 (MMAT-3) of recipients within a specific area, which has changed over time. However, the MMAT is calculated based only on recipients ≥12 years of age transplanted with a liver from a donation after brain death donor located within 500 nautical miles of the transplant hospital. When the policy was first implemented, the restriction to only these donors had little impact as they comprised the majority of deceased liver donors. However, with broader use of donation after circulatory death donors, who represent nearly 40% of all deceased liver donors in the US, the calculation of MMAT based only on donation after brain death donors has led to a marked difference in the calculated MMAT used for awarding exception points and the actual MMAT. In this viewpoint, we highlight the changes in exception policy, the growing difference between the policy-based MMAT and the actual MMAT and propose policy changes to ensure allocation rules reflect current practice.
{"title":"Liver Allocation Exception Policies for Calculating Median MELD at Transplant Need to be Updated to Reflect Changes in Practice.","authors":"Allison Marsh,Malay Shah,Seth Karp,David S Goldberg","doi":"10.1016/j.ajt.2025.12.007","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.12.007","url":null,"abstract":"In the United States, since 2019, liver transplant waitlist candidates who are approved for a MELD exception are awarded points that vary based on geography. The number of points is based on the median MELD score at transplant minus 3 (MMAT-3) of recipients within a specific area, which has changed over time. However, the MMAT is calculated based only on recipients ≥12 years of age transplanted with a liver from a donation after brain death donor located within 500 nautical miles of the transplant hospital. When the policy was first implemented, the restriction to only these donors had little impact as they comprised the majority of deceased liver donors. However, with broader use of donation after circulatory death donors, who represent nearly 40% of all deceased liver donors in the US, the calculation of MMAT based only on donation after brain death donors has led to a marked difference in the calculated MMAT used for awarding exception points and the actual MMAT. In this viewpoint, we highlight the changes in exception policy, the growing difference between the policy-based MMAT and the actual MMAT and propose policy changes to ensure allocation rules reflect current practice.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"16 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Donation after circulatory death (DCD) provides excellent patient outcomes in heart transplantation and substantially increases graft availability. The lack of validated biomarkers for graft function constrains reliable graft assessment and highlights the need for more effective assessment strategies. Using a porcine model of DCD, hearts underwent 0 (= sham), 10, 20, or 30 minutes of warm, in-situ ischemia followed by normothermic ex-situ heart perfusion for 3 hours in an unloaded mode and then 1 hour with left ventricular loading. During unloaded perfusion, left ventricular function and the release of cell death markers were measured at regular intervals. These potential biomarker measurements were correlated with recovery outcomes determined at the end of loaded reperfusion. During unloaded ex-situ heart perfusion, perfusate levels of heart-type fatty acid binding protein (H-FABP), and several catheter-based measurements of left ventricular (LV) function, particularly LV work (developed pressure-heart rate product) correlated with functional recovery outcomes (p< 0.05 for all). We report several new biomarkers of cardiac graft quality, such as left ventricular function and H-FABP that are enabled by normothermic ex-situ heart perfusion. These biomarkers are particularly promising as they are amenable to clinical application and may improve our precision in cardiac DCD graft evaluation.
{"title":"Functional and biochemical biomarkers of cardiac graft quality measured during normothermic ex-situ heart perfusion in a porcine model of donation after circulatory death.","authors":"Manuel Egle,Selianne Graf,Maria Arnold,Adrian Segiser,Maria-Nieves Sanz,Alexia Clavier,Peter Vermathen,Maks Mihalj,Alexander Kadner,Matthias Siepe,Sarah Longnus","doi":"10.1016/j.ajt.2025.12.005","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.12.005","url":null,"abstract":"Donation after circulatory death (DCD) provides excellent patient outcomes in heart transplantation and substantially increases graft availability. The lack of validated biomarkers for graft function constrains reliable graft assessment and highlights the need for more effective assessment strategies. Using a porcine model of DCD, hearts underwent 0 (= sham), 10, 20, or 30 minutes of warm, in-situ ischemia followed by normothermic ex-situ heart perfusion for 3 hours in an unloaded mode and then 1 hour with left ventricular loading. During unloaded perfusion, left ventricular function and the release of cell death markers were measured at regular intervals. These potential biomarker measurements were correlated with recovery outcomes determined at the end of loaded reperfusion. During unloaded ex-situ heart perfusion, perfusate levels of heart-type fatty acid binding protein (H-FABP), and several catheter-based measurements of left ventricular (LV) function, particularly LV work (developed pressure-heart rate product) correlated with functional recovery outcomes (p< 0.05 for all). We report several new biomarkers of cardiac graft quality, such as left ventricular function and H-FABP that are enabled by normothermic ex-situ heart perfusion. These biomarkers are particularly promising as they are amenable to clinical application and may improve our precision in cardiac DCD graft evaluation.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"28 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ajt.2025.12.010
Damiano Patrono,Nicola De Stefano,Renato Romagnoli
{"title":"HOPExt study: relevance of recipient factors and implications for future machine perfusion trials design.","authors":"Damiano Patrono,Nicola De Stefano,Renato Romagnoli","doi":"10.1016/j.ajt.2025.12.010","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.12.010","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"20 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ajt.2025.11.019
Meghan H Pearl,Lucia Chen,Tristan Grogan,Niloufar Nikfarjam,Paul C Grimm,Chris Fan,Rouba Garro,Eileen Tsai-Chambers,Allan D Kirk,Robert Ettenger,Elaine F Reed
{"title":"Corrigendum to \"Antibodies to angiotensin II type 1 receptor and endothelin type A receptor are associated with cytokine production enriched for type 2 immune response and antibody production in pediatric kidney transplant recipients\" [American Journal of Transplantation. Volume 25, Issue 11, November 2025, Pages 2329-2344].","authors":"Meghan H Pearl,Lucia Chen,Tristan Grogan,Niloufar Nikfarjam,Paul C Grimm,Chris Fan,Rouba Garro,Eileen Tsai-Chambers,Allan D Kirk,Robert Ettenger,Elaine F Reed","doi":"10.1016/j.ajt.2025.11.019","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.019","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"149 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.ajt.2025.12.011
Paolo Cravedi,Giuseppe Castellano,James M Gardner
{"title":"Short-term glyco-editing during machine perfusion permits ABO-incompatible transplantation in a human decedent model.","authors":"Paolo Cravedi,Giuseppe Castellano,James M Gardner","doi":"10.1016/j.ajt.2025.12.011","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.12.011","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"12 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-08DOI: 10.1016/j.ajt.2025.12.003
S Dhanya Dedeepya,Vaishali Goel,Nivedita Nikhil Desai
{"title":"Comment on \"Cellular and Humoral Immunogenicity of Respiratory Syncytial Virus Vaccination in Solid Organ Transplant Recipients\".","authors":"S Dhanya Dedeepya,Vaishali Goel,Nivedita Nikhil Desai","doi":"10.1016/j.ajt.2025.12.003","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.12.003","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"6 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-06DOI: 10.1016/j.ajt.2025.12.002
Shannon Oliver MBBS, Jennifer Conway MD, Michael Khoury MD, Dean Eurich PhD, Cerina Dubois PhD, Katherine Bedard MSc, Simon Urschel MD, Tara Pidborochynski MSc, Lori West MD DPhil, Mohammed Al-Aklabi MD, Devilliers Jonker MD, Darren H. Freed MD PhD
Avoiding grafts with ischemic time (IT) >6h continues to be advised in pediatric heart transplant (HTx). We sought to evaluate the association between IT and clinical outcomes in a geographically remote center. This was a retrospective single-center analysis of patients transplanted between 01/1995 and 12/2020. Baseline characteristics and post-HTx outcomes were compared across three IT groups (<4.5h, 4.5–6h and >6h) with results reported in that order. Cox proportional hazard modelling was used to determine factors associated with graft failure. Of the 188 patients, 56.4% were male, median age was 3.0 years (IQR 0.6, 10.2) and 46.3% had congenital heart disease. IT was evenly distributed amongst the cohort (37.2% vs 31.4% vs 31.4%). There were no differences in early post-HTx morbidity, including primary graft dysfunction (2.9% vs 1.7% vs 5.3% p=0.5). Compared to IT <4.5h, longer IT was not associated with graft failure [IT 4.5–6: HR 1.10 (0.50–2.39), p=0.810 and [IT >6hr: HR 1.10 (0.52–2.35), p=0.797]. In our population, IT was not an independent risk factor for post-HTx morbidity or graft failure. Use of a modified del Nido preservation solution and experience with prolonged IT donors may have contributed to our outcomes.
在儿童心脏移植（HTx）中，仍然建议避免缺血时间（IT） 6h的移植物。我们试图在一个地理位置偏远的中心评估信息技术与临床结果之间的关系。这是一项针对1995年1月1日至2020年12月间移植患者的回顾性单中心分析。基线特征和htx后的结果在三个IT组（<4.5h， 4.5-6h和>；6h）之间进行比较，并按顺序报告结果。Cox比例风险模型用于确定与移植物衰竭相关的因素。188例患者中，56.4%为男性，中位年龄为3.0岁（IQR 0.6, 10.2）， 46.3%患有先天性心脏病。IT在队列中分布均匀（37.2% vs 31.4% vs 31.4%）。htx术后早期发病率无差异，包括原发性移植物功能障碍（2.9% vs 1.7% vs 5.3% p=0.5）。与IT <；4.5h相比，更长时间的IT与移植物衰竭无关[IT <； 4.5-6: HR 1.10 (0.50-2.39), p=0.810]和[IT <； 6小时：HR 1.10 (0.52-2.35), p=0.797]。在我们的人群中，IT不是htx术后发病率或移植物失败的独立危险因素。使用改良的del Nido保存液和长期IT供体的经验可能有助于我们的结果。
{"title":"Post Transplant Outcomes with Prolonged Donor Heart Ischemic Time in the Pediatric Population","authors":"Shannon Oliver MBBS, Jennifer Conway MD, Michael Khoury MD, Dean Eurich PhD, Cerina Dubois PhD, Katherine Bedard MSc, Simon Urschel MD, Tara Pidborochynski MSc, Lori West MD DPhil, Mohammed Al-Aklabi MD, Devilliers Jonker MD, Darren H. Freed MD PhD","doi":"10.1016/j.ajt.2025.12.002","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.12.002","url":null,"abstract":"Avoiding grafts with ischemic time (IT) >6h continues to be advised in pediatric heart transplant (HTx). We sought to evaluate the association between IT and clinical outcomes in a geographically remote center. This was a retrospective single-center analysis of patients transplanted between 01/1995 and 12/2020. Baseline characteristics and post-HTx outcomes were compared across three IT groups (<4.5h, 4.5–6h and >6h) with results reported in that order. Cox proportional hazard modelling was used to determine factors associated with graft failure. Of the 188 patients, 56.4% were male, median age was 3.0 years (IQR 0.6, 10.2) and 46.3% had congenital heart disease. IT was evenly distributed amongst the cohort (37.2% vs 31.4% vs 31.4%). There were no differences in early post-HTx morbidity, including primary graft dysfunction (2.9% vs 1.7% vs 5.3% p=0.5). Compared to IT <4.5h, longer IT was not associated with graft failure [IT 4.5–6: HR 1.10 (0.50–2.39), p=0.810 and [IT >6hr: HR 1.10 (0.52–2.35), p=0.797]. In our population, IT was not an independent risk factor for post-HTx morbidity or graft failure. Use of a modified del Nido preservation solution and experience with prolonged IT donors may have contributed to our outcomes.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"16 1 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.ajt.2025.12.001
Trevor M Bibler,Jill Oliver Robinson,Adam Omelianchuk,Tariq Nisar,Savitri Fedson,Ariel N Levchenko,Amy L McGuire
Thoracoabdominal normothermic regional perfusion (TA-NRP) would likely expand the quantity and quality of organs procured after controlled circulatory-death donation in the United States, yet its ethical permissibility remains contested. We surveyed a representative sample of U.S. adults (n = 975) with the goal of assessing their perspectives on the ethical permissibility of TA-NRP. After reading a neutral description of TA-NRP, participants judged its permissibility, reviewed five critic and five supporter arguments (in random order), and chose which argument they found most convincing. Multivariable logistic regression examined predictors of agreeing with critics. Before exposure to the arguments, 51.5% stated that TA-NRP should be used, 34.2% were uncertain, and 14.4% stated it should not be used. After reviewing arguments, 60.6% agreed with supporters and 39.4% with critics. Two-thirds of those initially uncertain sided with critics. Agreement with critics was associated with religious-service attendance, less trust in doctors, non-registration as an organ donor, and being Black/African American. Participants who agreed with supporters cited TA-NRP's capacity to benefit more patients, whereas those who agreed with critics doubt that donors are irreversibly dead. While the majority supports TA-NRP, a substantial minority-concentrated among religious, distrustful, and historically underserved participants-remains unconvinced.
{"title":"Ethical controversies in organ procurement: A national survey on public perceptions of thoracoabdominal normothermic regional perfusion.","authors":"Trevor M Bibler,Jill Oliver Robinson,Adam Omelianchuk,Tariq Nisar,Savitri Fedson,Ariel N Levchenko,Amy L McGuire","doi":"10.1016/j.ajt.2025.12.001","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.12.001","url":null,"abstract":"Thoracoabdominal normothermic regional perfusion (TA-NRP) would likely expand the quantity and quality of organs procured after controlled circulatory-death donation in the United States, yet its ethical permissibility remains contested. We surveyed a representative sample of U.S. adults (n = 975) with the goal of assessing their perspectives on the ethical permissibility of TA-NRP. After reading a neutral description of TA-NRP, participants judged its permissibility, reviewed five critic and five supporter arguments (in random order), and chose which argument they found most convincing. Multivariable logistic regression examined predictors of agreeing with critics. Before exposure to the arguments, 51.5% stated that TA-NRP should be used, 34.2% were uncertain, and 14.4% stated it should not be used. After reviewing arguments, 60.6% agreed with supporters and 39.4% with critics. Two-thirds of those initially uncertain sided with critics. Agreement with critics was associated with religious-service attendance, less trust in doctors, non-registration as an organ donor, and being Black/African American. Participants who agreed with supporters cited TA-NRP's capacity to benefit more patients, whereas those who agreed with critics doubt that donors are irreversibly dead. While the majority supports TA-NRP, a substantial minority-concentrated among religious, distrustful, and historically underserved participants-remains unconvinced.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"93 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.ajt.2025.11.027
Jay A Fishman
{"title":"Assuring Microbiological Safety in Clinical Xenotransplantation.","authors":"Jay A Fishman","doi":"10.1016/j.ajt.2025.11.027","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.027","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"15 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.ajt.2025.11.025
Liang En Wee,Yong Yi Tan,Muhammad Ismail Bin Abdul Malek,Jue Tao Lim,Calvin J Chiew,David Chien Lye,Kelvin Bryan Tan
Population-based studies evaluating long-COVID-19 prevalence in transplant recipients are limited. We examined risk of new-incident multi-systemic sequelae post-SARS-CoV-2 Omicron infection in a retrospective population-based cohort of transplant recipients, versus test-negatives. National COVID-19/healthcare-claims databases were utilised to construct cohorts of all Singaporean adult transplant recipients infected during Omicron-predominance (1st Jan-31st Dec 2022), and contemporaneous test-negatives. Competing risks regression (death as a competing risk), with overlap weights applied, was utilised to estimate risks of new-incident diagnoses/symptoms 31-300 days post-SARS-CoV-2 infection in transplant recipients, versus test-negatives. 1,890 SARS-CoV-2 infected transplant recipients and 1,482 test-negatives were included. 88.7% were boosted. Overall risks of post-acute sequelae were not significantly increased in SARS-CoV-2-infected transplant recipients, versus test-negatives (any post-acute diagnosis: adjusted-hazards-ratio, aHR=1.35[95%CI=0.74-2.45]; any post-acute symptom: aHR=1.06[95%CI=0.52-2.17]). However, increased risk of post-acute autoimmune (aHR=5.34[95%CI=1.03-27.62])/neurological sequelae (aHR=3.06[95%CI=1.23-7.61]) were observed in SARS-CoV-2-infected transplant recipients versus test-negatives; though excess-burden was modest (autoimmune: EB-per-1000-individuals=5.58[95%CI=-4.49-15.65]; neurological: EB-per-1000-individuals=19.82[95%CI=-4.33-43.96]). Risks of post-acute neurological/autoimmune sequelae remained elevated in untreated COVID-19 cases versus test-negatives but did not significantly differ in treated COVID-19 cases versus test-negatives. We conclude that overall risk of post-acute sequelae was not significantly elevated in a highly-vaccinated/boosted cohort of Omicron SARS-CoV-2-infected transplant recipients, versus test-negatives. COVID-19 vaccination/boosting remains important during endemicity.
{"title":"Post-acute sequelae following Omicron COVID-19 in transplant recipients: a population-based cohort study.","authors":"Liang En Wee,Yong Yi Tan,Muhammad Ismail Bin Abdul Malek,Jue Tao Lim,Calvin J Chiew,David Chien Lye,Kelvin Bryan Tan","doi":"10.1016/j.ajt.2025.11.025","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.025","url":null,"abstract":"Population-based studies evaluating long-COVID-19 prevalence in transplant recipients are limited. We examined risk of new-incident multi-systemic sequelae post-SARS-CoV-2 Omicron infection in a retrospective population-based cohort of transplant recipients, versus test-negatives. National COVID-19/healthcare-claims databases were utilised to construct cohorts of all Singaporean adult transplant recipients infected during Omicron-predominance (1st Jan-31st Dec 2022), and contemporaneous test-negatives. Competing risks regression (death as a competing risk), with overlap weights applied, was utilised to estimate risks of new-incident diagnoses/symptoms 31-300 days post-SARS-CoV-2 infection in transplant recipients, versus test-negatives. 1,890 SARS-CoV-2 infected transplant recipients and 1,482 test-negatives were included. 88.7% were boosted. Overall risks of post-acute sequelae were not significantly increased in SARS-CoV-2-infected transplant recipients, versus test-negatives (any post-acute diagnosis: adjusted-hazards-ratio, aHR=1.35[95%CI=0.74-2.45]; any post-acute symptom: aHR=1.06[95%CI=0.52-2.17]). However, increased risk of post-acute autoimmune (aHR=5.34[95%CI=1.03-27.62])/neurological sequelae (aHR=3.06[95%CI=1.23-7.61]) were observed in SARS-CoV-2-infected transplant recipients versus test-negatives; though excess-burden was modest (autoimmune: EB-per-1000-individuals=5.58[95%CI=-4.49-15.65]; neurological: EB-per-1000-individuals=19.82[95%CI=-4.33-43.96]). Risks of post-acute neurological/autoimmune sequelae remained elevated in untreated COVID-19 cases versus test-negatives but did not significantly differ in treated COVID-19 cases versus test-negatives. We conclude that overall risk of post-acute sequelae was not significantly elevated in a highly-vaccinated/boosted cohort of Omicron SARS-CoV-2-infected transplant recipients, versus test-negatives. COVID-19 vaccination/boosting remains important during endemicity.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"1 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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