Pub Date : 2025-11-29DOI: 10.1016/j.ajt.2025.11.023
Ryan N. McGinn, Stuart A. McCluskey
{"title":"Chicken or the Egg: Discerning the relationship between delayed graft function and cardiovascular complications","authors":"Ryan N. McGinn, Stuart A. McCluskey","doi":"10.1016/j.ajt.2025.11.023","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.023","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"32 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645316","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 : 2025-11-28DOI: 10.1016/j.ajt.2025.11.021
John P Roberts
{"title":"The Effect of Labeling on Kidney Offer Acceptance.","authors":"John P Roberts","doi":"10.1016/j.ajt.2025.11.021","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.021","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"125 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644882","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 : 2025-11-28DOI: 10.1016/j.ajt.2025.11.018
Rashmi Jain,Andriana Nikolova,Michelle Kittleson,Evan P Kransdorf,David Chang,Peter Deckerman,Jon A Kobashigawa
The efficacy and post-transplant outcomes of desensitization therapy in highly sensitized heart transplant (HT) candidates are unknown. In this retrospective cohort study, 57 HT candidates with pre-HT calculated panel reactive antibody (cPRA) level of >50% for anti-HLA antibodies with mean fluorescence intensity (MFI) > 10,000, who were treated with desensitization therapy were identified. Post-treatment cPRA was determined for all patients, and follow-up data and outcomes were determined from review of the medical record. Bortezomib/plasmapheresis, and rituximab or obinutuzumab with intravenous immunoglobulin led to significant decreases in cPRA calculated for antibodies with MFI>10,000 and/or C1q-positive antibodies. After desensitization, 40 patients received HT during the follow-up period. Of the transplanted patients, 17 patients experienced elimination or decrease in donor specific antibodies that allowed them to receive an HT that would not have been possible prior to desensitization therapy. Transplanted patients had higher rates of antibody-mediated rejection than the general national HT population, but similar 5-year survival and rates of cardiac allograft vasculopathy or graft dysfunction. Safety outcomes, including malignancy and infections, occurred at acceptable rates. Thus, desensitization therapies for highly sensitized HT candidates help to broaden the donor pool and facilitate HT. Impact and Post-Transplant Outcomes of Desensitization Therapy in Highly Sensitized Heart Transplant Candidates.
{"title":"Impact and Outcomes After Desensitization Therapy in Highly Sensitized Heart Transplant Candidates.","authors":"Rashmi Jain,Andriana Nikolova,Michelle Kittleson,Evan P Kransdorf,David Chang,Peter Deckerman,Jon A Kobashigawa","doi":"10.1016/j.ajt.2025.11.018","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.018","url":null,"abstract":"The efficacy and post-transplant outcomes of desensitization therapy in highly sensitized heart transplant (HT) candidates are unknown. In this retrospective cohort study, 57 HT candidates with pre-HT calculated panel reactive antibody (cPRA) level of >50% for anti-HLA antibodies with mean fluorescence intensity (MFI) > 10,000, who were treated with desensitization therapy were identified. Post-treatment cPRA was determined for all patients, and follow-up data and outcomes were determined from review of the medical record. Bortezomib/plasmapheresis, and rituximab or obinutuzumab with intravenous immunoglobulin led to significant decreases in cPRA calculated for antibodies with MFI>10,000 and/or C1q-positive antibodies. After desensitization, 40 patients received HT during the follow-up period. Of the transplanted patients, 17 patients experienced elimination or decrease in donor specific antibodies that allowed them to receive an HT that would not have been possible prior to desensitization therapy. Transplanted patients had higher rates of antibody-mediated rejection than the general national HT population, but similar 5-year survival and rates of cardiac allograft vasculopathy or graft dysfunction. Safety outcomes, including malignancy and infections, occurred at acceptable rates. Thus, desensitization therapies for highly sensitized HT candidates help to broaden the donor pool and facilitate HT. Impact and Post-Transplant Outcomes of Desensitization Therapy in Highly Sensitized Heart Transplant Candidates.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"29 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644954","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}
The emergence of IgE antibodies specific for donor MHC has been observed in murine transplant models and kidney transplant recipients. While IgE's significance in allergies and other TH2-type diseases is well-documented, its potential role in transplant rejection remains largely unexplored. Besides its involvement in immediate-type allergic hypersensitivity reactions via its high-affinity receptor FcεRI, IgE augments allergen-specific T cell activation and antibody production through its low-affinity receptor FcεRII/CD23, a process termed 'facilitated antigen presentation'. Herein we investigate, whether donor MHC-specific IgE amplifies allo-immune responses in transplantation through CD23-dependant FAP. Upon rejection of a mismatched cardiac allograft, murine recipients exhibited elevated frequencies of FcεRI+ basophils and IgE+CD23+ B cells in blood and spleen, along with increased levels of IgE binding via FcεRI and CD23. In vitro, donor-specific IgE facilitated the binding of donor MHC antigens to B cells. Employing a footpad immunization model, IgE enhanced T cell activation and proliferation and increased the levels of donor-reactive B and germinal center B cells in draining lymph nodes via a CD23-dependent process. These findings reveal that donor-specific IgE amplify the alloresponse by promoting the activation and proliferation of donor-reactive lymphocytes through CD23-dependent mechanisms, uncovering a potential role for IgE in transplant rejection.
{"title":"Donor MHC-specific IgE augments the T and B cell alloresponse in a CD23-dependent manner.","authors":"Anna Marianne Weijler,Moritz Muckenhuber,Marlena Muhm,Jasmin Mucha,Romy Steiner,Lisa Prickler,Verena Kainz,Birgit Linhart,Thomas Wekerle","doi":"10.1016/j.ajt.2025.11.015","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.015","url":null,"abstract":"The emergence of IgE antibodies specific for donor MHC has been observed in murine transplant models and kidney transplant recipients. While IgE's significance in allergies and other TH2-type diseases is well-documented, its potential role in transplant rejection remains largely unexplored. Besides its involvement in immediate-type allergic hypersensitivity reactions via its high-affinity receptor FcεRI, IgE augments allergen-specific T cell activation and antibody production through its low-affinity receptor FcεRII/CD23, a process termed 'facilitated antigen presentation'. Herein we investigate, whether donor MHC-specific IgE amplifies allo-immune responses in transplantation through CD23-dependant FAP. Upon rejection of a mismatched cardiac allograft, murine recipients exhibited elevated frequencies of FcεRI+ basophils and IgE+CD23+ B cells in blood and spleen, along with increased levels of IgE binding via FcεRI and CD23. In vitro, donor-specific IgE facilitated the binding of donor MHC antigens to B cells. Employing a footpad immunization model, IgE enhanced T cell activation and proliferation and increased the levels of donor-reactive B and germinal center B cells in draining lymph nodes via a CD23-dependent process. These findings reveal that donor-specific IgE amplify the alloresponse by promoting the activation and proliferation of donor-reactive lymphocytes through CD23-dependent mechanisms, uncovering a potential role for IgE in transplant rejection.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"219 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619816","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 : 2025-11-27DOI: 10.1016/j.ajt.2025.11.017
E Hendren,J S Lan,M Kadatz,D Sawinski,R Liwski,L McMichael,O Aiyegbusi,R Doyle,G Avgay,D Chang,J Gill,J S Gill
Females have higher rates of rejection and allograft failure not due to death compared to males. Offspring living kidney donor transplants provide an opportunity to assess the role of maternal immune memory in outcome differences between sexes. Among adult living kidney donor recipients in the Scientific Registry of Transplant Recipients from 2000 to 2018, the cumulative incidence of graft loss was higher in female compared to male recipients p <0.001. Among females, the adjusted hazard ratio (AHR) for graft loss was similar in offspring and non-offspring donor transplant recipients (AHR = 1.07, 95% confidence interval (CI), 0.94 -1.22, p =0.3) while male recipients of offspring donor kidneys had a lower risk of graft loss compared to non-offspring donor recipients (AHR = 0.87, 95% CI 0.77, 0.99, p = 0.03). Among females, offspring donor recipients had a higher adjusted odds ratio (AOR) for rejection, (AOR, 1.33, 95% CI 1.06, 1.67, p = 0.02) but among males, the odds of rejection were similar in offspring and non-offspring donor recipients (AOR, 1.15, 95% CI 0.95, 1.39, p = 0.14). The findings indicate a role for maternal immune memory in sex differences in kidney transplant outcomes that should be verified with further immunological studies.
与男性相比，女性有更高的排斥和非死亡的同种异体移植失败率。后代活体肾供体移植为评估母体免疫记忆在两性结果差异中的作用提供了机会。在2000年至2018年移植受者科学登记处的成年活体肾供体受者中，女性移植损失的累积发生率高于男性受者（p <0.001）。在女性中，子代和非子代供肾移植受者的移植损失的校正危险比（AHR）相似（AHR = 1.07, 95%可信区间（CI）， 0.94 -1.22, p =0.3），而男性子代供肾受者的移植损失风险低于非子代供肾受者（AHR = 0.87, 95% CI 0.77, 0.99, p = 0.03）。在女性中，后代供体受体发生排斥反应的调整优势比（AOR, 1.33, 95% CI 1.06, 1.67, p = 0.02）较高，而在男性中，后代和非后代供体受体发生排斥反应的调整优势比相似（AOR, 1.15, 95% CI 0.95, 1.39, p = 0.14）。研究结果表明，母体免疫记忆在肾移植结果性别差异中的作用有待进一步的免疫学研究证实。
{"title":"Maternal immune memory and sex differences in living donor kidney transplant outcomes.","authors":"E Hendren,J S Lan,M Kadatz,D Sawinski,R Liwski,L McMichael,O Aiyegbusi,R Doyle,G Avgay,D Chang,J Gill,J S Gill","doi":"10.1016/j.ajt.2025.11.017","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.017","url":null,"abstract":"Females have higher rates of rejection and allograft failure not due to death compared to males. Offspring living kidney donor transplants provide an opportunity to assess the role of maternal immune memory in outcome differences between sexes. Among adult living kidney donor recipients in the Scientific Registry of Transplant Recipients from 2000 to 2018, the cumulative incidence of graft loss was higher in female compared to male recipients p <0.001. Among females, the adjusted hazard ratio (AHR) for graft loss was similar in offspring and non-offspring donor transplant recipients (AHR = 1.07, 95% confidence interval (CI), 0.94 -1.22, p =0.3) while male recipients of offspring donor kidneys had a lower risk of graft loss compared to non-offspring donor recipients (AHR = 0.87, 95% CI 0.77, 0.99, p = 0.03). Among females, offspring donor recipients had a higher adjusted odds ratio (AOR) for rejection, (AOR, 1.33, 95% CI 1.06, 1.67, p = 0.02) but among males, the odds of rejection were similar in offspring and non-offspring donor recipients (AOR, 1.15, 95% CI 0.95, 1.39, p = 0.14). The findings indicate a role for maternal immune memory in sex differences in kidney transplant outcomes that should be verified with further immunological studies.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"151 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619809","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 : 2025-11-26DOI: 10.1016/j.ajt.2025.11.013
Eric G Benz,Justin Godown,Doug Schaubel,Kathy Jabs,Margret Bock,Cary Thurm,Matt Hall,Sandra Amaral
Rehospitalization in the first year after pediatric kidney transplant (KT) is common but poorly understood. Using linked data between the Scientific Registry for Transplant Recipients and the Pediatric Health Information System databases, frequency, causes, and risk factors for rehospitalization in the first year were examined across 36 pediatric hospitals. 29% of incident pediatric KT recipients were rehospitalized in the first 30 days and over 2/3 of children (69%) were rehospitalized within the first year. First year rehospitalization was associated with younger age, black race, public insurance, and longer index transplant hospitalization. The most common reasons for rehospitalization in the first year were urologic/anatomical/surgical issues, infections, and renal/electrolyte problems. eGFR was nearly 6 ml/min/1.73m2 worse at 1 year post transplant for patients who were rehospitalized compared to those not rehospitalized. Lastly, first year rehospitalization was associated with long term death-censored allograft failure 10 years post-transplant (HR 1.38 [1.17-1.62]). In summary, over 2/3 of incident pediatric KT recipients were rehospitalized in the first year after transplant and rehospitalization was associated with lower eGFR at one year and long-term death-censored allograft failure. Further studies are needed to understand which hospitalizations are preventable for quality improvement initiatives and improving patient outcomes.
{"title":"Association of rehospitalization after pediatric kidney transplantation with kidney function at 1-year post-transplant and long-term allograft failure.","authors":"Eric G Benz,Justin Godown,Doug Schaubel,Kathy Jabs,Margret Bock,Cary Thurm,Matt Hall,Sandra Amaral","doi":"10.1016/j.ajt.2025.11.013","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.013","url":null,"abstract":"Rehospitalization in the first year after pediatric kidney transplant (KT) is common but poorly understood. Using linked data between the Scientific Registry for Transplant Recipients and the Pediatric Health Information System databases, frequency, causes, and risk factors for rehospitalization in the first year were examined across 36 pediatric hospitals. 29% of incident pediatric KT recipients were rehospitalized in the first 30 days and over 2/3 of children (69%) were rehospitalized within the first year. First year rehospitalization was associated with younger age, black race, public insurance, and longer index transplant hospitalization. The most common reasons for rehospitalization in the first year were urologic/anatomical/surgical issues, infections, and renal/electrolyte problems. eGFR was nearly 6 ml/min/1.73m2 worse at 1 year post transplant for patients who were rehospitalized compared to those not rehospitalized. Lastly, first year rehospitalization was associated with long term death-censored allograft failure 10 years post-transplant (HR 1.38 [1.17-1.62]). In summary, over 2/3 of incident pediatric KT recipients were rehospitalized in the first year after transplant and rehospitalization was associated with lower eGFR at one year and long-term death-censored allograft failure. Further studies are needed to understand which hospitalizations are preventable for quality improvement initiatives and improving patient outcomes.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"31 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613359","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 : 2025-11-26DOI: 10.1016/j.ajt.2025.11.011
Sindhu Chandran,Joey C Leung,Alexander Vu,Karim Lee,Mark Fitch,Jonathan H Esensten,Brian R Shy,Amy L Putnam,Angela Lares,Luis A Acevedo,Vinh Nguyen,Weihong Liu,Brian Armstrong,Zoltan G Laszik,Roslyn B Mannon,John J Friedewald,Abhijit Naik,Scott Davis,Minnie Sarwal,Marc Hellerstein,Megan Morsheimer,Julia Goldstein,Qizhi Tang,Flavio G Vincenti
Regulatory T cells (Tregs) can reverse inflammation in animal models. We conducted a randomized controlled clinical trial of Treg therapy in kidney transplant recipients with subclinical graft inflammation (NCT02711826). The primary endpoint was change in graft inflammation on a follow-up biopsy 6 months after Treg infusion. The trial accrued eight control group participants and seven polyclonal Treg group participants; the latter received 400x106 to 1x109 polyclonally expanded Tregs without adverse events. Graft inflammation decreased substantially in both groups at 6 months; however, the degree of change was not significantly different between the groups. The peak of infused Tregs in circulation correlated positively with the pre-existing circulating CD4+ T cell numbers, suggesting that Treg engraftment was limited by the size of the endogenous CD4+ T cell compartment. Infused Tregs were detected in 14-day post-infusion biopsies, albeit at lower frequencies than in circulation. Unlike prior experiences, some infused Tregs emerged among non-Treg CD4+ T cells in four participants; these patients had higher concentrations of serum cytokines, indicative of more systemic inflammation. The study failed to show efficacy of polyclonal Tregs due to self-resolving graft inflammation but identified the importance of monitoring Treg product identity and their stability and trafficking after infusion. NCT02711826.
{"title":"Pharmacokinetics, lineage identity, and trafficking of ex vivo expanded polyclonal Tregs in a prospective randomized clinical trial of kidney transplant recipients with allograft inflammation.","authors":"Sindhu Chandran,Joey C Leung,Alexander Vu,Karim Lee,Mark Fitch,Jonathan H Esensten,Brian R Shy,Amy L Putnam,Angela Lares,Luis A Acevedo,Vinh Nguyen,Weihong Liu,Brian Armstrong,Zoltan G Laszik,Roslyn B Mannon,John J Friedewald,Abhijit Naik,Scott Davis,Minnie Sarwal,Marc Hellerstein,Megan Morsheimer,Julia Goldstein,Qizhi Tang,Flavio G Vincenti","doi":"10.1016/j.ajt.2025.11.011","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.011","url":null,"abstract":"Regulatory T cells (Tregs) can reverse inflammation in animal models. We conducted a randomized controlled clinical trial of Treg therapy in kidney transplant recipients with subclinical graft inflammation (NCT02711826). The primary endpoint was change in graft inflammation on a follow-up biopsy 6 months after Treg infusion. The trial accrued eight control group participants and seven polyclonal Treg group participants; the latter received 400x106 to 1x109 polyclonally expanded Tregs without adverse events. Graft inflammation decreased substantially in both groups at 6 months; however, the degree of change was not significantly different between the groups. The peak of infused Tregs in circulation correlated positively with the pre-existing circulating CD4+ T cell numbers, suggesting that Treg engraftment was limited by the size of the endogenous CD4+ T cell compartment. Infused Tregs were detected in 14-day post-infusion biopsies, albeit at lower frequencies than in circulation. Unlike prior experiences, some infused Tregs emerged among non-Treg CD4+ T cells in four participants; these patients had higher concentrations of serum cytokines, indicative of more systemic inflammation. The study failed to show efficacy of polyclonal Tregs due to self-resolving graft inflammation but identified the importance of monitoring Treg product identity and their stability and trafficking after infusion. NCT02711826.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"47 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613358","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 : 2025-11-26DOI: 10.1016/j.ajt.2025.11.016
Shangxuan Li
{"title":"From Single-Center Protocol to Field Standard: Strengthening Biosafety Guardrails for Clinical Xenotransplantation.","authors":"Shangxuan Li","doi":"10.1016/j.ajt.2025.11.016","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.016","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"200 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613361","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 : 2025-11-21DOI: 10.1016/j.ajt.2025.11.014
Maria Masotti,Nicholas L Wood,Allyson Hart,Cory R Schaffhausen
The use of allocation out of sequence (AOOS) of donor kidneys has increased in recent years in the US. The impact on candidate and recipient outcomes is unknown. Using data from the Scientific Registry of Transplant Recipients, we analyzed 83,811 adult candidates who were listed for a single-kidney transplant between 1/1/2022 and 12/31/2023 to compare waitlist outcomes between candidates listed at centers with varying out-of-sequence use. We also investigated the impact on posttransplant all-cause graft failure using an analysis of 37,266 adult single-kidney transplant recipients who received a transplant from 1/1/2022 to 12/31/2023. Compared with candidates listed at centers that did not accept any offers via AOOS in the 6 months prior to listing, candidates at centers that accepted 10%, 20%, and 30% of offers via AOOS had 4% (HR: 1.04, 95% CI: 0.97-1.11), 27% (HR: 1.27, 95% CI: 1.17-1.37), and 81% (HR: 1.81, 95% CI: 1.60-2.04) increases in rates of deceased donor transplant. All-cause graft failure by out-of-sequence vs standard allocation did not differ in analysis adjusted for recipient and donor characteristics (HR: 1.03, 95% CI: 0.93-1.15), suggesting a greater impact for pretransplant outcomes. System-wide variation in the use of AOOS has contributed to differential access to kidney transplant.
{"title":"The impact of increasing out-of-sequence allocation on kidney transplant patient outcomes.","authors":"Maria Masotti,Nicholas L Wood,Allyson Hart,Cory R Schaffhausen","doi":"10.1016/j.ajt.2025.11.014","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.014","url":null,"abstract":"The use of allocation out of sequence (AOOS) of donor kidneys has increased in recent years in the US. The impact on candidate and recipient outcomes is unknown. Using data from the Scientific Registry of Transplant Recipients, we analyzed 83,811 adult candidates who were listed for a single-kidney transplant between 1/1/2022 and 12/31/2023 to compare waitlist outcomes between candidates listed at centers with varying out-of-sequence use. We also investigated the impact on posttransplant all-cause graft failure using an analysis of 37,266 adult single-kidney transplant recipients who received a transplant from 1/1/2022 to 12/31/2023. Compared with candidates listed at centers that did not accept any offers via AOOS in the 6 months prior to listing, candidates at centers that accepted 10%, 20%, and 30% of offers via AOOS had 4% (HR: 1.04, 95% CI: 0.97-1.11), 27% (HR: 1.27, 95% CI: 1.17-1.37), and 81% (HR: 1.81, 95% CI: 1.60-2.04) increases in rates of deceased donor transplant. All-cause graft failure by out-of-sequence vs standard allocation did not differ in analysis adjusted for recipient and donor characteristics (HR: 1.03, 95% CI: 0.93-1.15), suggesting a greater impact for pretransplant outcomes. System-wide variation in the use of AOOS has contributed to differential access to kidney transplant.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"112 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582968","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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