Pub Date : 2025-11-21DOI: 10.1016/j.ajt.2025.11.009
Isabel Griffin,Ian Kracalik,Matthew Sapiano,Pallavi Annambhotla,James Bowman,Marilyn E Levi,Sridhar V Basavaraju
(word count: 188; max: 200 words)The 2013 U.S. Public Health Service (PHS) guideline for screening organ donors for HIV, hepatitis B (HBV) and hepatitis C virus (HCV) designated donors with social and behavioral characteristics associated with HIV, HBV, and HCV for transmission as increased risk donors (IRD) and was associated with an underutilization of IRD organs. In 2020, the PHS guideline was updated to remove the IRD designation and certain risk factor criteria. We analyzed adult and pediatric organ transplantation during 2019-2023 to assess the impact of the 2020 guideline on organ utilization. We used logistic regression to calculate adjusted utilization rates. A sensitivity analysis was used to assess pediatric kidney utilization. No statistically significant differences in organ utilization were observed between donors with risk factors and standard-risk donors post-PHS guideline updates; except for one subgroup of pediatric kidney transplants. In contrast to a prior analyses which observed underutilization of some organs subsequent to policy changes to conform to the 2013 PHS guideline recommendations, following adoption of the 2020 recommendations, utilization of organs from donors with social and behavioral risk factors for HIV, HCV, and HBV were comparable to standard risk donors.
{"title":"Utilization of organs following implementation of the 2020 US Public Health Service (PHS) Guideline recommendations.","authors":"Isabel Griffin,Ian Kracalik,Matthew Sapiano,Pallavi Annambhotla,James Bowman,Marilyn E Levi,Sridhar V Basavaraju","doi":"10.1016/j.ajt.2025.11.009","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.009","url":null,"abstract":"(word count: 188; max: 200 words)The 2013 U.S. Public Health Service (PHS) guideline for screening organ donors for HIV, hepatitis B (HBV) and hepatitis C virus (HCV) designated donors with social and behavioral characteristics associated with HIV, HBV, and HCV for transmission as increased risk donors (IRD) and was associated with an underutilization of IRD organs. In 2020, the PHS guideline was updated to remove the IRD designation and certain risk factor criteria. We analyzed adult and pediatric organ transplantation during 2019-2023 to assess the impact of the 2020 guideline on organ utilization. We used logistic regression to calculate adjusted utilization rates. A sensitivity analysis was used to assess pediatric kidney utilization. No statistically significant differences in organ utilization were observed between donors with risk factors and standard-risk donors post-PHS guideline updates; except for one subgroup of pediatric kidney transplants. In contrast to a prior analyses which observed underutilization of some organs subsequent to policy changes to conform to the 2013 PHS guideline recommendations, following adoption of the 2020 recommendations, utilization of organs from donors with social and behavioral risk factors for HIV, HCV, and HBV were comparable to standard risk donors.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"70 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582972","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}
We report a case series of two lung transplant recipients with chronic, multidrug-resistant Mycobacterium abscessus infections unresponsive to conventional antibiotic therapy, who received intravenous bacteriophage treatment for 12 months under compassionate use. Both patients showed clinical improvement and resolution of the radiological opacities. Gene expression in blood samples collected before and 24 hours after initiation of phage therapy was analysed using the NanoString Host Response panel, revealing immune activation, with increased expression of pro-inflammatory genes (CXCL10 and IL8) and decreased expression of immune evasion pathways (ULK1 and AKT1). These exploratory findings provide insight into potential mechanisms by which bacteriophages may modulate host immunity and support bacterial clearance. Overall, the results suggest that long-term bacteriophage therapy may offer a safe and effective adjunct for managing refractory M. abscessus infections in immunocompromised individuals with chest-localized infection.
{"title":"From resistance to response: Bacteriophages in Multidrug-Resistant M. abscessus After Lung Transplantation.","authors":"Antia Ferreiro-Posse,Meritxell Boada-Pérez,Graham F Hatfull,Eva Revilla-López,Berta Sáez-Giménez,Manuel López-Meseguer,Joan Gavaldà,Alba Pau Parra,Maria Roch-Santed,Maria Teresa Tórtola,Cristina Berastegui,Susana Gómez-Ollés","doi":"10.1016/j.ajt.2025.11.008","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.008","url":null,"abstract":"We report a case series of two lung transplant recipients with chronic, multidrug-resistant Mycobacterium abscessus infections unresponsive to conventional antibiotic therapy, who received intravenous bacteriophage treatment for 12 months under compassionate use. Both patients showed clinical improvement and resolution of the radiological opacities. Gene expression in blood samples collected before and 24 hours after initiation of phage therapy was analysed using the NanoString Host Response panel, revealing immune activation, with increased expression of pro-inflammatory genes (CXCL10 and IL8) and decreased expression of immune evasion pathways (ULK1 and AKT1). These exploratory findings provide insight into potential mechanisms by which bacteriophages may modulate host immunity and support bacterial clearance. Overall, the results suggest that long-term bacteriophage therapy may offer a safe and effective adjunct for managing refractory M. abscessus infections in immunocompromised individuals with chest-localized infection.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"5 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145583431","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 : 2025-11-20DOI: 10.1016/j.ajt.2025.11.006
Matthew Cooper,Raja Kandaswamy,Patrick Shannon,James N Fleming,Jeffrey Veale
The National Kidney Registry's (NKR) Voucher Program provides a novel methodology to increase directed and non-directed living kidney donation. Standard Vouchers (SV), launched in 2014, allow a donor to donate to an unknown recipient on behalf of an individual who needs a transplant. Family Vouchers (FV), launched in 2019, allow a Good Samaritan Donor to donate and provide vouchers to loved ones who do not have end stage renal disease (ESRD). To date, there have been 15 FV redemptions with over 5,000 Voucher holders. To assure continued viability of the Voucher Program, a 100-year Monte Carlo Simulation model was performed using demographic data from the existing and past donors and voucher holders. Four projected scenarios of program activity were simulated. In all scenarios, there were enough available kidneys to cover all predicted voucher redemptions. For the "Most Likely" scenario, the simulation model projects 390,000 new donors and only 300,000 voucher redemptions. Additionally, the model projects only 3,700 FV redemptions compared to 94,000 new FV donors over 100 years. This simulation demonstrates that the Voucher Program should be able to satisfy the likely redemption of vouchers under a range of scenarios over a 100-year time horizon.
{"title":"A 100-Year Simulation of the National Kidney Registry's Voucher Program.","authors":"Matthew Cooper,Raja Kandaswamy,Patrick Shannon,James N Fleming,Jeffrey Veale","doi":"10.1016/j.ajt.2025.11.006","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.006","url":null,"abstract":"The National Kidney Registry's (NKR) Voucher Program provides a novel methodology to increase directed and non-directed living kidney donation. Standard Vouchers (SV), launched in 2014, allow a donor to donate to an unknown recipient on behalf of an individual who needs a transplant. Family Vouchers (FV), launched in 2019, allow a Good Samaritan Donor to donate and provide vouchers to loved ones who do not have end stage renal disease (ESRD). To date, there have been 15 FV redemptions with over 5,000 Voucher holders. To assure continued viability of the Voucher Program, a 100-year Monte Carlo Simulation model was performed using demographic data from the existing and past donors and voucher holders. Four projected scenarios of program activity were simulated. In all scenarios, there were enough available kidneys to cover all predicted voucher redemptions. For the \"Most Likely\" scenario, the simulation model projects 390,000 new donors and only 300,000 voucher redemptions. Additionally, the model projects only 3,700 FV redemptions compared to 94,000 new FV donors over 100 years. This simulation demonstrates that the Voucher Program should be able to satisfy the likely redemption of vouchers under a range of scenarios over a 100-year time horizon.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"195 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575511","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 : 2025-11-20DOI: 10.1016/j.ajt.2025.11.010
Robin Wang,Robert R Quinn,Pietro Ravani,Karen Doucette,Jenny Wichart,Alix Clarke,Krista L Lentine,Fareed Kamar,Sita Gourishankar,Ngan N Lam
Kidney transplant recipients are prescribed medications to prevent Pneumocystis jirovecii pneumonia (PJP), but there is no consensus regarding the optimal duration of therapy. We used linked healthcare databases in Alberta, Canada to describe patterns of PJP prophylactic prescriptions in incident adult kidney transplant recipients (2008-2019) to compare clinical outcomes in recipients taking short-term (≤9 months) versus long-term (>9 months) PJP prophylaxis. We identified 1,265 kidney transplant recipients. The median age was 53 years (IQR 41-62), 35% were female, and the index eGFR was 59 ml/min/1.73 m2 (IQR 47-72). There were 448 (35%) recipients on long-term PJP prophylaxis and 817 (65%) recipients on short-term (median follow-up: 5.7 vs. 4.8 years, respectively). There was no significant difference in the risk of all-cause mortality between the groups (11% vs. 13%). Recipients in the long-term group were 46% less likely to experience graft failure (4% vs. 7%). The risk of hospitalization for PJP infection was low (n=3, 0.2%), with no significant difference between the groups. Compared to short-term PJP prophylaxis, long-term PJP prophylaxis did not significantly reduce the risk of post-transplant mortality or infection, including PJP infection. Further research is needed to explore the association between PJP prophylaxis and graft survival.
{"title":"Duration of Pneumocystis Jirovecii Pneumonia Prophylaxis in Adult Kidney Transplant Recipients and Outcomes: A Population-Based Study.","authors":"Robin Wang,Robert R Quinn,Pietro Ravani,Karen Doucette,Jenny Wichart,Alix Clarke,Krista L Lentine,Fareed Kamar,Sita Gourishankar,Ngan N Lam","doi":"10.1016/j.ajt.2025.11.010","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.010","url":null,"abstract":"Kidney transplant recipients are prescribed medications to prevent Pneumocystis jirovecii pneumonia (PJP), but there is no consensus regarding the optimal duration of therapy. We used linked healthcare databases in Alberta, Canada to describe patterns of PJP prophylactic prescriptions in incident adult kidney transplant recipients (2008-2019) to compare clinical outcomes in recipients taking short-term (≤9 months) versus long-term (>9 months) PJP prophylaxis. We identified 1,265 kidney transplant recipients. The median age was 53 years (IQR 41-62), 35% were female, and the index eGFR was 59 ml/min/1.73 m2 (IQR 47-72). There were 448 (35%) recipients on long-term PJP prophylaxis and 817 (65%) recipients on short-term (median follow-up: 5.7 vs. 4.8 years, respectively). There was no significant difference in the risk of all-cause mortality between the groups (11% vs. 13%). Recipients in the long-term group were 46% less likely to experience graft failure (4% vs. 7%). The risk of hospitalization for PJP infection was low (n=3, 0.2%), with no significant difference between the groups. Compared to short-term PJP prophylaxis, long-term PJP prophylaxis did not significantly reduce the risk of post-transplant mortality or infection, including PJP infection. Further research is needed to explore the association between PJP prophylaxis and graft survival.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"15 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575516","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 : 2025-11-19DOI: 10.1016/j.ajt.2025.10.024
Parmjeet Randhawa,Adriana Zeevi
{"title":"DSA Negative Antibody Mediated Rejection: A Call for Rigorous Diagnostic Criteria and Better Recognition of its Phenotypes.","authors":"Parmjeet Randhawa,Adriana Zeevi","doi":"10.1016/j.ajt.2025.10.024","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.10.024","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"187 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568140","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 : 2025-11-19DOI: 10.1016/j.ajt.2025.11.012
Shyfuddin Ahmed,Eric A Engels
{"title":"Mismatch repair-deficient colorectal cancer in transplant recipients: shining a light on cancer biology and clinical outcomes.","authors":"Shyfuddin Ahmed,Eric A Engels","doi":"10.1016/j.ajt.2025.11.012","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.012","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"11 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568151","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 : 2025-11-15DOI: 10.1016/j.ajt.2025.11.007
Emily M. Eichenberger, Mamatha Bhat
{"title":"Mapping Distinctive Responses to Bloodstream Infections in Transplant Recipients could Guide Precision Strategies","authors":"Emily M. Eichenberger, Mamatha Bhat","doi":"10.1016/j.ajt.2025.11.007","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.007","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"3 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531190","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 : 2025-11-14DOI: 10.1016/j.ajt.2025.10.014
Nicholas B. Murphy, Matthew J. Weiss, Stephen Beed, Stéphanie Chartier-Plante, Prosanto Chaudhury, Jed Adam Gross, Andrew Healey, George Isac, Andreas Kramer, Marat Slessarev, Charles Weijer
Normothermic regional perfusion (NRP) is a postmortem technique that restores oxygenated blood flow to transplantable organs in situ after death determination in donation after circulatory death to improve organ viability and function. Although observational evidence strongly suggests NRP is superior to conventional rapid organ recovery, it has generated ethical controversy internationally. While much of the debate revolves around NRP’s compatibility with the dead donor rule, an unresolved ethical question facing organ procurement organizations is whether, in addition to general consent (or ‘authorization’) to organ donation, specific consent to NRP should be sought from surrogate decision makers. As NRP practice continues to evolve and as more jurisdictions consider NRP adoption, developing policy governing NRP consent or notification practices should be a priority for organ procurement organizations. In this Personal Viewpoint article, we outline arguments for and against a consent requirement. We conclude that ongoing ethical controversy and unresolved empirical questions concerning the potential for the resumption of intracranial blood flow during NRP support a cautious, consent-based approach at this stage of NRP’s adoption.
{"title":"Organ procurement organizations should develop policy regarding surrogate consent for normothermic regional perfusion","authors":"Nicholas B. Murphy, Matthew J. Weiss, Stephen Beed, Stéphanie Chartier-Plante, Prosanto Chaudhury, Jed Adam Gross, Andrew Healey, George Isac, Andreas Kramer, Marat Slessarev, Charles Weijer","doi":"10.1016/j.ajt.2025.10.014","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.10.014","url":null,"abstract":"Normothermic regional perfusion (NRP) is a postmortem technique that restores oxygenated blood flow to transplantable organs in situ after death determination in donation after circulatory death to improve organ viability and function. Although observational evidence strongly suggests NRP is superior to conventional rapid organ recovery, it has generated ethical controversy internationally. While much of the debate revolves around NRP’s compatibility with the dead donor rule, an unresolved ethical question facing organ procurement organizations is whether, in addition to general consent (or ‘authorization’) to organ donation, specific consent to NRP should be sought from surrogate decision makers. As NRP practice continues to evolve and as more jurisdictions consider NRP adoption, developing policy governing NRP consent or notification practices should be a priority for organ procurement organizations. In this <ce:italic>Personal Viewpoint</ce:italic> article, we outline arguments for and against a consent requirement. We conclude that ongoing ethical controversy and unresolved empirical questions concerning the potential for the resumption of intracranial blood flow during NRP support a cautious, consent-based approach at this stage of NRP’s adoption.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"60 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531191","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 : 2025-11-13DOI: 10.1016/j.ajt.2025.11.005
Laura P Hale,Dawn E Bowles,Jie Li,Andrew N Macintyre,NiDajah Bolden,Joanne Kurtzberg,Cathlyn K Medina,Berk Aykut,Elisabeth T Tracy,Joseph W Turek
Implantation of cultured allogeneic thymus tissue (CTTI) into athymic human recipients generates functional recipient-derived naïve T cells that are tolerant to donor. Currently, CTTI is always performed with 12 - 21 days of thymus procurement to avoid culture-related changes that could be detrimental to its reconstitution potential. We demonstrate here that cultured thymus tissue can be cryopreserved and still maintain its viability and reconstitution potential. Implantation of cryopreserved cultured rat thymus tissue (cCTTI) under the renal capsule of congenitally athymic rats results in colonization of the thymus implant with T cell progenitors and population of the periphery with genetically-recipient naïve T cells. Similarly, cCTTI of porcine thymus into the quadriceps muscle of thymectomized T cell-depleted pigs results in full reconstitution of the implanted thymus. Human thymus tissues that are similarly cultured and cryopreserved continue to meet the same implantation quality criteria as freshly cultured thymus tissue. Clinical trials are warranted to test the potential of cCTTI to decouple the current links between time of procurement and implantation. This would extend the benefits of immune reconstitution and tolerance induction to a broader range of patients.
{"title":"Reconstitution of thymopoiesis via implantation of cryopreserved cultured thymus tissue into athymic recipients.","authors":"Laura P Hale,Dawn E Bowles,Jie Li,Andrew N Macintyre,NiDajah Bolden,Joanne Kurtzberg,Cathlyn K Medina,Berk Aykut,Elisabeth T Tracy,Joseph W Turek","doi":"10.1016/j.ajt.2025.11.005","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.005","url":null,"abstract":"Implantation of cultured allogeneic thymus tissue (CTTI) into athymic human recipients generates functional recipient-derived naïve T cells that are tolerant to donor. Currently, CTTI is always performed with 12 - 21 days of thymus procurement to avoid culture-related changes that could be detrimental to its reconstitution potential. We demonstrate here that cultured thymus tissue can be cryopreserved and still maintain its viability and reconstitution potential. Implantation of cryopreserved cultured rat thymus tissue (cCTTI) under the renal capsule of congenitally athymic rats results in colonization of the thymus implant with T cell progenitors and population of the periphery with genetically-recipient naïve T cells. Similarly, cCTTI of porcine thymus into the quadriceps muscle of thymectomized T cell-depleted pigs results in full reconstitution of the implanted thymus. Human thymus tissues that are similarly cultured and cryopreserved continue to meet the same implantation quality criteria as freshly cultured thymus tissue. Clinical trials are warranted to test the potential of cCTTI to decouple the current links between time of procurement and implantation. This would extend the benefits of immune reconstitution and tolerance induction to a broader range of patients.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"1 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525107","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 : 2025-11-12DOI: 10.1016/j.ajt.2025.11.003
Mark Petrovic,Aaron M Williams,Joshua Lowman,Stephen DeVries,John M Trahanas,Eric Quintana,Awab Ahmad,Chen Chia Wang,Kevin McGann,Tarek Absi,Matthew Bacchetta,Kelly H Schlendorf,Brian Lima,Ashish S Shah,Swaroop Bommareddi
Physician assistant (PA)-led donor recovery models have been shown to be safe and effective in lung transplantation, but data on their application in heart transplantation (HT) are limited. We conducted an observational cohort study at a high-volume heart transplant center to compare outcomes of adult HTs between 2020 and 2024 using allografts recovered by PA-led vs non-PA-led recovery teams. A total of 497 adult HTs were included: 130 in the PA group and 367 in the non-PA group. The incidence of severe PGD was not significantly different (7.7% vs 5.2%; P = .28). Thirty-day survival was 96.9% in the PA group and 96.3% in the non-PA group (P = .99). Implementation of a PA-led recovery model reduced attending surgeon presence on donor runs by 62.4% (P = .054) and reduced attending surgeon time commitment from 57.5 to 10.8 hours/month (P = .045). Following implementation, the number of HTs for high sequence number recipients (>50) increased at a rate of approximately 0.89 transplants per month (P = .04), compared to a prior rate of 0.03/month. In this single-center study, implementation of a physician assistant-led recovery model for heart allograft recovery showed no significant differences in early and medium-term patient outcomes following HT.
医师助理（PA）主导的供体恢复模式已被证明在肺移植中是安全有效的，但其在心脏移植（HT）中的应用数据有限。我们在一个大容量心脏移植中心进行了一项观察性队列研究，比较了2020年至2024年间由pa主导和非pa主导的恢复团队使用同种异体移植的成人HTs的结果。共纳入497例成人ht: PA组130例，非PA组367例。严重PGD的发生率无显著差异（7.7% vs 5.2%; P = 0.28）。PA组30天生存率为96.9%，非PA组为96.3% （P = 0.99）。pa主导的康复模式的实施使主治医生在供体手术中的出现时间减少了62.4% (P = 0.054)，并将主治医生的工作时间从每月57.5小时减少到10.8小时（P = 0.045）。实施后，高顺位受体（bbb50）的移植数量以每月约0.89例移植的速率增加（P = 0.04），而之前的速率为0.03例/月。在这项单中心研究中，实施医生助理主导的心脏移植恢复模型显示，移植后早期和中期患者预后无显著差异。
{"title":"Implementation of a Physician Assistant-Led Recovery Model for Heart Transplantation: Clinical Outcomes and Programmatic Benefits at a High-Volume Center.","authors":"Mark Petrovic,Aaron M Williams,Joshua Lowman,Stephen DeVries,John M Trahanas,Eric Quintana,Awab Ahmad,Chen Chia Wang,Kevin McGann,Tarek Absi,Matthew Bacchetta,Kelly H Schlendorf,Brian Lima,Ashish S Shah,Swaroop Bommareddi","doi":"10.1016/j.ajt.2025.11.003","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.003","url":null,"abstract":"Physician assistant (PA)-led donor recovery models have been shown to be safe and effective in lung transplantation, but data on their application in heart transplantation (HT) are limited. We conducted an observational cohort study at a high-volume heart transplant center to compare outcomes of adult HTs between 2020 and 2024 using allografts recovered by PA-led vs non-PA-led recovery teams. A total of 497 adult HTs were included: 130 in the PA group and 367 in the non-PA group. The incidence of severe PGD was not significantly different (7.7% vs 5.2%; P = .28). Thirty-day survival was 96.9% in the PA group and 96.3% in the non-PA group (P = .99). Implementation of a PA-led recovery model reduced attending surgeon presence on donor runs by 62.4% (P = .054) and reduced attending surgeon time commitment from 57.5 to 10.8 hours/month (P = .045). Following implementation, the number of HTs for high sequence number recipients (>50) increased at a rate of approximately 0.89 transplants per month (P = .04), compared to a prior rate of 0.03/month. In this single-center study, implementation of a physician assistant-led recovery model for heart allograft recovery showed no significant differences in early and medium-term patient outcomes following HT.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"57 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516246","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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