Pub Date : 2025-11-12DOI: 10.1016/j.ajt.2025.11.002
Thiagarajan Yashwanth Raj,Arumugam Kanakaraj,Joshua Daniel Jeyakumar,Ramanitharan Manikandan,Chezhian Subash,Rajan Ravichandran
The Bombay blood group is an exceptionally rare phenotype characterized by the absence of H antigen on red blood cells due to mutations in the FUT1 gene and absence of H substance in secretions from concurrent FUT2 deficiency. These individuals produce potent anti-H antibodies in addition to anti-A and anti-B antibodies, posing unique challenges in transfusion and solid organ transplantation. We report a successful 'ABO-H incompatible' renal transplantation in a patient with genetically confirmed Bombay phenotype. A 30-year-old man with end-stage kidney disease secondary to IgA nephropathy was evaluated for transplantation with his mother as a potential donor. Serologic and molecular studies identified a FUT1 homozygous missense variant (p.Leu242Arg) and a FUT2 homozygous deletion consistent with the classical digenic Bombay phenotype. The patient underwent a structured desensitization protocol with rituximab, plasma exchange, and intravenous immunoglobulin prior to transplantation. The post-operative course was uneventful, with stable graft function. This groundbreaking case demonstrates that, with appropriate desensitization, anti-H antibodies can be safely managed, thereby expanding the feasibility of renal transplantation in recipients with the Bombay phenotype.
{"title":"Kidney Transplantation Across ABO-H Incompatibility in a recipient with Bombay Blood Group: A Novel Report.","authors":"Thiagarajan Yashwanth Raj,Arumugam Kanakaraj,Joshua Daniel Jeyakumar,Ramanitharan Manikandan,Chezhian Subash,Rajan Ravichandran","doi":"10.1016/j.ajt.2025.11.002","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.002","url":null,"abstract":"The Bombay blood group is an exceptionally rare phenotype characterized by the absence of H antigen on red blood cells due to mutations in the FUT1 gene and absence of H substance in secretions from concurrent FUT2 deficiency. These individuals produce potent anti-H antibodies in addition to anti-A and anti-B antibodies, posing unique challenges in transfusion and solid organ transplantation. We report a successful 'ABO-H incompatible' renal transplantation in a patient with genetically confirmed Bombay phenotype. A 30-year-old man with end-stage kidney disease secondary to IgA nephropathy was evaluated for transplantation with his mother as a potential donor. Serologic and molecular studies identified a FUT1 homozygous missense variant (p.Leu242Arg) and a FUT2 homozygous deletion consistent with the classical digenic Bombay phenotype. The patient underwent a structured desensitization protocol with rituximab, plasma exchange, and intravenous immunoglobulin prior to transplantation. The post-operative course was uneventful, with stable graft function. This groundbreaking case demonstrates that, with appropriate desensitization, anti-H antibodies can be safely managed, thereby expanding the feasibility of renal transplantation in recipients with the Bombay phenotype.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"143 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516250","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 : 2025-11-10DOI: 10.1016/j.ajt.2025.11.004
Lindsay R Beaman,Leigh E Meyer,Marka F Ellertson,Christopher H Kim,Benjamin D Limburg,Claire Cywes,Audrey C Bankes,Frank G Lee,David C Fipps,Tayyab S Diwan
The demand for liver transplantation compounds the challenges of achieving justice. Scarcity raises questions about how candidate review committees determine which patients are suitable for transplantation, particularly for "perceived patient-induced diseases" (PPIDs). PPIDs are conditions arising partly from behaviors considered to be within the patient's control. We explore ethical issues in using different candidate review committee standards for PPIDs, comparing alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatohepatitis (MASH). ALD, caused by alcohol use disorder (AUD), and MASH, linked to obesity, can both be perceived as self-inflicted. Patients with ALD have historically been required to demonstrate six-months of abstinence, with current guidelines recommending a demonstrated commitment to life-long sobriety and treatment for AUD. Contrarily, patients with MASH have less clear guidelines and are not consistently required to lose weight or demonstrate changed behaviors, nor provided with equivalent assistance in connecting with support resources. We argue transplant centers should utilize more consistent, standardized lifestyle evaluation criteria for patients with ALD and for those with MASH based on autonomous culpability, utility, and justice. Doing so can expand support for patients with MASH and decrease stigma for ALD. We provide recommendations to mitigate bias and potentially improve long-term outcomes for both patient groups.
{"title":"Reimagining Justice and Responsibility: A Critical Analysis of Differential Standards for Patients with Alcohol-Associated Liver Disease or Metabolic Dysfunction-Associated Steatohepatitis.","authors":"Lindsay R Beaman,Leigh E Meyer,Marka F Ellertson,Christopher H Kim,Benjamin D Limburg,Claire Cywes,Audrey C Bankes,Frank G Lee,David C Fipps,Tayyab S Diwan","doi":"10.1016/j.ajt.2025.11.004","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.004","url":null,"abstract":"The demand for liver transplantation compounds the challenges of achieving justice. Scarcity raises questions about how candidate review committees determine which patients are suitable for transplantation, particularly for \"perceived patient-induced diseases\" (PPIDs). PPIDs are conditions arising partly from behaviors considered to be within the patient's control. We explore ethical issues in using different candidate review committee standards for PPIDs, comparing alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatohepatitis (MASH). ALD, caused by alcohol use disorder (AUD), and MASH, linked to obesity, can both be perceived as self-inflicted. Patients with ALD have historically been required to demonstrate six-months of abstinence, with current guidelines recommending a demonstrated commitment to life-long sobriety and treatment for AUD. Contrarily, patients with MASH have less clear guidelines and are not consistently required to lose weight or demonstrate changed behaviors, nor provided with equivalent assistance in connecting with support resources. We argue transplant centers should utilize more consistent, standardized lifestyle evaluation criteria for patients with ALD and for those with MASH based on autonomous culpability, utility, and justice. Doing so can expand support for patients with MASH and decrease stigma for ALD. We provide recommendations to mitigate bias and potentially improve long-term outcomes for both patient groups.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"29 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499517","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 : 2025-11-07DOI: 10.1016/j.ajt.2025.11.001
Koen Zwart,Rob C M van Kruijsdijk,Valentina Angerilli,Marije C Baas,Evelien Dekker,Natasja Rutgers,Anne May,Miriam Koopman,Iris D Nagtegaal,Guus M Bol
Colorectal cancer (CRC) incidence rises post-transplant, though the mechanism remains unclear. We hypothesize that impaired immunosurveillance of kidney transplant recipients (KTRs) allows progression along the serrated pathway, increasing only immunogenic deficient mismatch repair (dMMR) CRC incidence and not proficient mismatch repair (pMMR) CRC. The nationwide transplant, pathology, and cancer registries were linked by probabilistic matching to retrieve data of all KTRs in the Netherlands. Standardized incidence ratios (SIRs) were calculated. Premalignant lesions were identified within the Dutch CRC screening program, and KTRs were matched to controls. Among 15,013 KTRs, 109 CRCs were observed between 2015-2021, resulting in a SIR of 1.22 (95% confidence interval [CI]:0.99-1.47). The median time from transplantation to CRC was 7.9 years (interquartile range:4.2-13.6). dMMR CRC occurred in 31% of KTRs, significantly higher than the general CRC population's 13%, with a SIR of 3.09 (95%CI:2.23-4.30). Incidence of pMMR CRC was not increased, SIR of 0.94 (95%CI:0.75-1.18). Sessile serrated lesions (SSL) with dysplasia occurred 2.9-fold more often in KTRs than matched controls (95%CI:1.7-5.1). An increased dMMR CRC risk post-kidney transplantation and increased prevalence of the immediate precursor SLL with dysplasia was demonstrated.
{"title":"Risk of deficient mismatch repair colorectal cancer and precursors after kidney transplantation: a nationwide study.","authors":"Koen Zwart,Rob C M van Kruijsdijk,Valentina Angerilli,Marije C Baas,Evelien Dekker,Natasja Rutgers,Anne May,Miriam Koopman,Iris D Nagtegaal,Guus M Bol","doi":"10.1016/j.ajt.2025.11.001","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.11.001","url":null,"abstract":"Colorectal cancer (CRC) incidence rises post-transplant, though the mechanism remains unclear. We hypothesize that impaired immunosurveillance of kidney transplant recipients (KTRs) allows progression along the serrated pathway, increasing only immunogenic deficient mismatch repair (dMMR) CRC incidence and not proficient mismatch repair (pMMR) CRC. The nationwide transplant, pathology, and cancer registries were linked by probabilistic matching to retrieve data of all KTRs in the Netherlands. Standardized incidence ratios (SIRs) were calculated. Premalignant lesions were identified within the Dutch CRC screening program, and KTRs were matched to controls. Among 15,013 KTRs, 109 CRCs were observed between 2015-2021, resulting in a SIR of 1.22 (95% confidence interval [CI]:0.99-1.47). The median time from transplantation to CRC was 7.9 years (interquartile range:4.2-13.6). dMMR CRC occurred in 31% of KTRs, significantly higher than the general CRC population's 13%, with a SIR of 3.09 (95%CI:2.23-4.30). Incidence of pMMR CRC was not increased, SIR of 0.94 (95%CI:0.75-1.18). Sessile serrated lesions (SSL) with dysplasia occurred 2.9-fold more often in KTRs than matched controls (95%CI:1.7-5.1). An increased dMMR CRC risk post-kidney transplantation and increased prevalence of the immediate precursor SLL with dysplasia was demonstrated.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"326 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477602","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 : 2025-11-05DOI: 10.1016/j.ajt.2025.10.019
Masayuki Nigo,Stefano Casarin,Max W Adelman,James Kurian,Jiaqiong Xu,David Hsu,Aarjav Sanghvi,Stephen L Jones,Ashton A Connor,A Osama Gaber,R Mark Ghobrial,Cesar A Arias
Bloodstream infections (BSIs) are common and have high mortality rates. Few studies have examined the heterogeneity of clinical characteristics in solid organ transplant (SOT) recipients with BSIs. We used machine learning (ML) to identify clinically distinct subtypes in SOT and non-SOT BSI patients. We applied unsupervised ML to clinical variables collected within 48 hours of index BSI diagnosis, clustering 15,550 patients from a major medical center in Houston, Texas. Using k-means++, we identified three major subtypes (α, β, γ). Patients in cluster α were older, predominantly male, and required more vasopressor and ventilator support compared to other clusters. SOT patients in cluster α included more liver and lung transplant recipients and developed BSI closer to the transplant date (165 days, p<0.01). Propensity score matching was applied to compare the mortality in SOT and non-SOT groups. Although SOT patients exhibited higher rates of drug-resistant pathogens, SOT patients had a lower 30-day mortality compared with non-SOT patients overall (9.0% vs. 12.8%, p=0.01), driven by cluster α specifically (18.3% vs. 33.1%, p<0.01). ML approach demonstrated the potential to identify distinct phenotypes of bloodstream infections in both SOT and non-SOT patients, which may support precision medicine and contribute to future clinical research.
{"title":"Bloodstream Infection Subtypes and Characteristics Comparing Solid Organ Transplant and Non-Transplant Populations.","authors":"Masayuki Nigo,Stefano Casarin,Max W Adelman,James Kurian,Jiaqiong Xu,David Hsu,Aarjav Sanghvi,Stephen L Jones,Ashton A Connor,A Osama Gaber,R Mark Ghobrial,Cesar A Arias","doi":"10.1016/j.ajt.2025.10.019","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.10.019","url":null,"abstract":"Bloodstream infections (BSIs) are common and have high mortality rates. Few studies have examined the heterogeneity of clinical characteristics in solid organ transplant (SOT) recipients with BSIs. We used machine learning (ML) to identify clinically distinct subtypes in SOT and non-SOT BSI patients. We applied unsupervised ML to clinical variables collected within 48 hours of index BSI diagnosis, clustering 15,550 patients from a major medical center in Houston, Texas. Using k-means++, we identified three major subtypes (α, β, γ). Patients in cluster α were older, predominantly male, and required more vasopressor and ventilator support compared to other clusters. SOT patients in cluster α included more liver and lung transplant recipients and developed BSI closer to the transplant date (165 days, p<0.01). Propensity score matching was applied to compare the mortality in SOT and non-SOT groups. Although SOT patients exhibited higher rates of drug-resistant pathogens, SOT patients had a lower 30-day mortality compared with non-SOT patients overall (9.0% vs. 12.8%, p=0.01), driven by cluster α specifically (18.3% vs. 33.1%, p<0.01). ML approach demonstrated the potential to identify distinct phenotypes of bloodstream infections in both SOT and non-SOT patients, which may support precision medicine and contribute to future clinical research.","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"109 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462008","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 : 2025-11-05DOI: 10.1016/j.ajt.2025.10.023
Noah J Robinson,Serban Constantinescu,Michael J Moritz
{"title":"Response to Letter by Li and You in reference to \"Prevalence of major malformations and small for gestational age in newborns of female transplant recipients on tacrolimus-containing regimens during pregnancy\".","authors":"Noah J Robinson,Serban Constantinescu,Michael J Moritz","doi":"10.1016/j.ajt.2025.10.023","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.10.023","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"103 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462009","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 : 2025-11-04DOI: 10.1016/j.ajt.2025.10.022
Nicolas De Bie, Joseph M Ladowski, Henry Chapman, Annette M Jackson, Bruce W Rogers
Xenotransplantation received US Food and Drug Administration approval for clinical trials in humans, and highly sensitized patients-those with antibodies against major histocompatibility complex (MHC)-are among the groups that stand to benefit. There is no method to characterize and compare the MHC differences across different species. A database of all pig, rhesus, and human amino acid MHC sequences in the Immuno Polymorphism Database-MHC database was constructed, aligned against a common consensus, relative solvent accessibility scores calculated, and the results compared to a list of eplets from the human leukocyte antigen (HLA) Eplet Registry. Performance was compared to HLAMatchmaker using a linear regression of a random sampling of 1000 HLA alleles. Results compared favorably to HLAMatchmaker, with Pearson correlation coefficients of r2 of 0.72 and 0.74 for class I and class II MHC, respectively. We identified several HLA amino acid motifs registered in the HLA Eplet Registry that were not found across swine leukocyte antigen alleles. Our algorithm successfully compares and ranks MHC similarities and disparities across species for xenotransplantation or nonhuman primate-to-nonhuman primate allotransplantation. For highly sensitized patients, this tool may aid in risk assessments and predictions for negative crossmatch tests.
{"title":"Major histocompatibility complex Matchmaker: An in silico based algorithm to analyze cross-species nonhuman primate, pig, and human major histocompatibility complex compatibility at the amino acid level.","authors":"Nicolas De Bie, Joseph M Ladowski, Henry Chapman, Annette M Jackson, Bruce W Rogers","doi":"10.1016/j.ajt.2025.10.022","DOIUrl":"10.1016/j.ajt.2025.10.022","url":null,"abstract":"<p><p>Xenotransplantation received US Food and Drug Administration approval for clinical trials in humans, and highly sensitized patients-those with antibodies against major histocompatibility complex (MHC)-are among the groups that stand to benefit. There is no method to characterize and compare the MHC differences across different species. A database of all pig, rhesus, and human amino acid MHC sequences in the Immuno Polymorphism Database-MHC database was constructed, aligned against a common consensus, relative solvent accessibility scores calculated, and the results compared to a list of eplets from the human leukocyte antigen (HLA) Eplet Registry. Performance was compared to HLAMatchmaker using a linear regression of a random sampling of 1000 HLA alleles. Results compared favorably to HLAMatchmaker, with Pearson correlation coefficients of r<sup>2</sup> of 0.72 and 0.74 for class I and class II MHC, respectively. We identified several HLA amino acid motifs registered in the HLA Eplet Registry that were not found across swine leukocyte antigen alleles. Our algorithm successfully compares and ranks MHC similarities and disparities across species for xenotransplantation or nonhuman primate-to-nonhuman primate allotransplantation. For highly sensitized patients, this tool may aid in risk assessments and predictions for negative crossmatch tests.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457061","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 : 2025-11-04DOI: 10.1016/j.ajt.2025.10.025
Marcus R Pereira
{"title":"Organ donor transmission of Rickettsia typhi to kidney transplant recipients, Texas, USA, 2024.","authors":"Marcus R Pereira","doi":"10.1016/j.ajt.2025.10.025","DOIUrl":"10.1016/j.ajt.2025.10.025","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450386","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 : 2025-11-01DOI: 10.1016/j.ajt.2025.06.027
Katrina Tan , Zoe Yang , Elizabeth Low , Jordi Shahab , Jacqueline Balassone , Graham Starkey , Marcos Perini , Lachlan Miles , Adam Testro , Marie Sinclair , Avik Majumdar
Patients awaiting liver transplant (LT) are commonly prescribed anticoagulation. Indications include portal vein thrombosis and atrial fibrillation. The safety of continuing apixaban until the time of deceased donor LT is unknown. We assessed the safety of apixaban, administered within 48 hours of LT. A total of 26 patients were treated with apixaban within 48 hours of LT surgery. The median Modelfor End-stage Liver Disease (MELD) score was 18.5 (interquartile range, 16.2-20.0). Using 2:1 propensity-score matching, 52 control patients were identified from a prospectively maintained registry. The coprimary outcome was packed red blood cells and intraoperative cell salvage volume transfused during LT. The median time between the last apixaban dose and surgery start was 18.2 hours. There was no significantly increased intraoperative blood product requirement in patients on apixaban. Packed red blood cells (898 vs 997 mL, P = 1.00) and intraoperative cell salvage volumes (1500 vs 1144 mL, P = .87) were comparable between patients treated with apixaban and controls. Fresh frozen plasma (133 vs 306 mL, P = .16), cryoprecipitate (60 vs 136 mL, P = .11), and platelet volumes (105 vs 302 mL, P = .06) were also comparable. There was no difference in return to theater for early bleeding or in graft or patient survival at 12 months posttransplant. Apixaban appears safe to continue in the peri-LT setting for patients awaiting deceased donor LT in this population with low MELD scores.
等待肝移植（LT）的患者通常使用抗凝剂。适应症包括门静脉血栓和心房颤动。继续使用阿哌沙班直至死亡供者肝移植（DDLT）的安全性尚不清楚。我们评估了肝移植术后48小时内使用阿哌沙班的安全性。26例患者在肝移植术后48小时内使用阿哌沙班抗凝。终末期肝病模型（MELD）评分中位数为18.5 （IQR为16.2-20.0）。采用2:1倾向评分匹配，从前瞻性维护的注册表中确定52例对照患者。共同主要终点是lt期间红细胞充血（PRBC）和术中细胞残留（ICS）输注量。从最后一次阿哌沙班剂量到手术开始的中位时间为18.2小时。阿哌沙班组患者术中血液制品需求没有明显增加。抗凝患者和对照组的PRBC （88ml vs. 997mL, p=1.00）和ICS体积（1500mL vs. 1144mL, p=0.87）具有可比性。新鲜冷冻血浆（133mL vs. 306mL, p=0.16）、冷冻沉淀（60mL vs. 136mL, p=0.11）和血小板体积（105mL vs. 302mL, p=0.02）也具有可比性。在早期出血或移植后12个月的移植或患者生存方面，返回手术室的人数没有差异。在低MELD人群中，阿哌沙班对于等待DDLT的患者在lt周围环境中继续治疗似乎是安全的。
{"title":"Safety of apixaban prior to liver transplantation: A single-center Australian case-control study in a low MELD population","authors":"Katrina Tan , Zoe Yang , Elizabeth Low , Jordi Shahab , Jacqueline Balassone , Graham Starkey , Marcos Perini , Lachlan Miles , Adam Testro , Marie Sinclair , Avik Majumdar","doi":"10.1016/j.ajt.2025.06.027","DOIUrl":"10.1016/j.ajt.2025.06.027","url":null,"abstract":"<div><div>Patients awaiting liver transplant (LT) are commonly prescribed anticoagulation. Indications include portal vein thrombosis and atrial fibrillation. The safety of continuing apixaban until the time of deceased donor LT is unknown. We assessed the safety of apixaban, administered within 48 hours of LT. A total of 26 patients were treated with apixaban within 48 hours of LT surgery. The median Modelfor End-stage Liver Disease (MELD) score was 18.5 (interquartile range, 16.2-20.0). Using 2:1 propensity-score matching, 52 control patients were identified from a prospectively maintained registry. The coprimary outcome was packed red blood cells and intraoperative cell salvage volume transfused during LT. The median time between the last apixaban dose and surgery start was 18.2 hours. There was no significantly increased intraoperative blood product requirement in patients on apixaban. Packed red blood cells (898 vs 997 mL, <em>P</em> = 1.00) and intraoperative cell salvage volumes (1500 vs 1144 mL, <em>P</em> = .87) were comparable between patients treated with apixaban and controls. Fresh frozen plasma (133 vs 306 mL, <em>P</em> = .16), cryoprecipitate (60 vs 136 mL, <em>P</em> = .11), and platelet volumes (105 vs 302 mL, <em>P</em> = .06) were also comparable. There was no difference in return to theater for early bleeding or in graft or patient survival at 12 months posttransplant. Apixaban appears safe to continue in the peri-LT setting for patients awaiting deceased donor LT in this population with low MELD scores.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 11","pages":"Pages 2424-2433"},"PeriodicalIF":8.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521283","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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