Pub Date : 2025-01-11DOI: 10.1016/j.ajt.2025.01.009
Sarah Alshammery, Natasha M Rogers
{"title":"A trip down (obesogenic) memory lane.","authors":"Sarah Alshammery, Natasha M Rogers","doi":"10.1016/j.ajt.2025.01.009","DOIUrl":"10.1016/j.ajt.2025.01.009","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142976833","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 : 2025-01-10DOI: 10.1016/j.ajt.2025.01.008
Lara C Pullen
{"title":"Out-of-sequence allocation: It is useful, but is it ethical?","authors":"Lara C Pullen","doi":"10.1016/j.ajt.2025.01.008","DOIUrl":"10.1016/j.ajt.2025.01.008","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968781","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 : 2025-01-08DOI: 10.1016/j.ajt.2025.01.001
Hinpetch Daungsupawong, Viroj Wiwanitkit
{"title":"Machine learning for personalized and prediction of longitudinal COVID-19 vaccine responses in transplant recipients.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1016/j.ajt.2025.01.001","DOIUrl":"10.1016/j.ajt.2025.01.001","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963425","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 : 2025-01-08DOI: 10.1016/j.ajt.2025.01.002
Stephanie R Saaybi, Henry Shiau, Goo Lee, Babak John Orandi, Luz Helena Gutierrez Sanchez
The association between hypopituitarism and metabolic dysfunction-associated steatotic liver disease is increasingly recognized, although data about therapies targeting recurrence posttransplant is limited. An 8-year-old with hypopituitarism-associated metabolic dysfunction-associated steatotic liver disease underwent a liver transplant due to rapid progression of metabolic dysfunction-associated steatohepatitis. Hepatosteatosis recurred within weeks. Her therapeutic plan included a glucagon-like peptide-1 agonist and growth hormone replacement. Her transaminases normalized in 2.5 months, and her macrosteatosis significantly improved on the 1-year surveillance biopsy. This case highlights one of the youngest reported children with hypopituitarism to have undergone transplantation for rapidly progressing metabolic dysfunction-associated steatohepatitis and its recurrence post-operatively. We observed that steatosis improved with growth hormone replacement and glucagon-like peptide-1 agonist therapy. If started early, this combination could help delay recurrence of steatosis post-transplantation. Further research is needed to determine long-term effects and establish protocols.
{"title":"Treatment of rapid recurrence of severe steatosis with combined glucagon-like peptide-1 agonist and growth hormone therapy in a pediatric patient transplanted for metabolic dysfunction-associated steatohepatitis cirrhosis in the setting of hypopituitarism.","authors":"Stephanie R Saaybi, Henry Shiau, Goo Lee, Babak John Orandi, Luz Helena Gutierrez Sanchez","doi":"10.1016/j.ajt.2025.01.002","DOIUrl":"10.1016/j.ajt.2025.01.002","url":null,"abstract":"<p><p>The association between hypopituitarism and metabolic dysfunction-associated steatotic liver disease is increasingly recognized, although data about therapies targeting recurrence posttransplant is limited. An 8-year-old with hypopituitarism-associated metabolic dysfunction-associated steatotic liver disease underwent a liver transplant due to rapid progression of metabolic dysfunction-associated steatohepatitis. Hepatosteatosis recurred within weeks. Her therapeutic plan included a glucagon-like peptide-1 agonist and growth hormone replacement. Her transaminases normalized in 2.5 months, and her macrosteatosis significantly improved on the 1-year surveillance biopsy. This case highlights one of the youngest reported children with hypopituitarism to have undergone transplantation for rapidly progressing metabolic dysfunction-associated steatohepatitis and its recurrence post-operatively. We observed that steatosis improved with growth hormone replacement and glucagon-like peptide-1 agonist therapy. If started early, this combination could help delay recurrence of steatosis post-transplantation. Further research is needed to determine long-term effects and establish protocols.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963427","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 : 2025-01-02DOI: 10.1016/j.ajt.2024.12.279
Julia S Slagter, Hendikus J A N Kimenai, Jorg L de Bruin, Hence J M Verhagen, Marie-Josee van Rijn, Joke M Hendriks, Michiel G H Betjes, Sander Ten Raa, Robert C Minnee
With an increasingly aging population, both end-stage renal disease and peripheral artery disease become more prevalent. Peripheral artery disease is increasingly treated with endovascular procedures. Endovascular stenting of the external iliac artery is often considered a contraindication for kidney transplantation, as clamping of the artery could result in possible injury to the stent. In this study, we describe our first 2 cases of kidney transplantation with a graft placed on a self-expandable metal stent and a covered stent as part of an endovascular repair of the aortic bifurcation, using endovascular balloon occlusion to occlude the proximal side of the external iliac artery. Six months after transplantation, both recipients have good kidney function without any signs of ischemia of the ipsilateral limb. This study shows that it is feasible to place a kidney graft on an endovascular stent.
{"title":"Kidney graft directly implanted on endovascular stent in external iliac artery: A preliminary experience.","authors":"Julia S Slagter, Hendikus J A N Kimenai, Jorg L de Bruin, Hence J M Verhagen, Marie-Josee van Rijn, Joke M Hendriks, Michiel G H Betjes, Sander Ten Raa, Robert C Minnee","doi":"10.1016/j.ajt.2024.12.279","DOIUrl":"10.1016/j.ajt.2024.12.279","url":null,"abstract":"<p><p>With an increasingly aging population, both end-stage renal disease and peripheral artery disease become more prevalent. Peripheral artery disease is increasingly treated with endovascular procedures. Endovascular stenting of the external iliac artery is often considered a contraindication for kidney transplantation, as clamping of the artery could result in possible injury to the stent. In this study, we describe our first 2 cases of kidney transplantation with a graft placed on a self-expandable metal stent and a covered stent as part of an endovascular repair of the aortic bifurcation, using endovascular balloon occlusion to occlude the proximal side of the external iliac artery. Six months after transplantation, both recipients have good kidney function without any signs of ischemia of the ipsilateral limb. This study shows that it is feasible to place a kidney graft on an endovascular stent.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925911","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 : 2025-01-01DOI: 10.1016/j.ajt.2024.07.017
Laure F. Pittet , Renato Gualtieri , Charlotte M. Verolet , Arnaud G. L’Huillier , Barbara E. Wildhaber , Valérie A. McLin , Klara M. Posfay-Barbe
Liver transplantation (LT) recipients are susceptible to infections, including measles. Concerns about the safety and efficacy of live-attenuated vaccines, such as the measles-mumps-rubella (MMR) vaccine, have led to hesitancy among providers in administering them to immunocompromised patients. This 9-year interventional study assessed seroprotection against measles following MMR vaccination in pediatric LT recipients. Of 119 participants enrolled, 60 (50%) were seroprotected against measles after transplantation. Among the 59 nonseroprotected participants, 56 fulfilled safety criteria and received MMR vaccination with a seroprotection rate of 90% (95% confidence interval [CI], 73%-98%) after a first dose, 95% (95% CI, 85%-99%) after primary vaccination with 1 to 3 doses, comparable to nonimmunocompromized populations. However, measles antibodies declined over time, suggesting the need for regular monitoring, and booster doses. Half of the vaccinees (26/53, 49%) subsequently lost seroprotection. Among them, 23 received additional doses of MMR, with a high seroconversion rate. At their last follow-up (median, 6.1 years; interquartile range, 3.0-8.1 after inclusion), 63% (95% CI, 49%-75%) of all vaccinees were seroprotected against measles. In conclusion, MMR vaccination in pediatric LT recipients offers seroprotection against measles, but long-term immunity should be monitored closely.
{"title":"Long-term persistence of seroprotection against measles following measles-mumps-rubella vaccination administered before and after pediatric liver transplantation","authors":"Laure F. Pittet , Renato Gualtieri , Charlotte M. Verolet , Arnaud G. L’Huillier , Barbara E. Wildhaber , Valérie A. McLin , Klara M. Posfay-Barbe","doi":"10.1016/j.ajt.2024.07.017","DOIUrl":"10.1016/j.ajt.2024.07.017","url":null,"abstract":"<div><div>Liver transplantation (LT) recipients are susceptible to infections, including measles. Concerns about the safety and efficacy of live-attenuated vaccines, such as the measles-mumps-rubella (MMR) vaccine, have led to hesitancy among providers in administering them to immunocompromised patients. This 9-year interventional study assessed seroprotection against measles following MMR vaccination in pediatric LT recipients. Of 119 participants enrolled, 60 (50%) were seroprotected against measles after transplantation. Among the 59 nonseroprotected participants, 56 fulfilled safety criteria and received MMR vaccination with a seroprotection rate of 90% (95% confidence interval [CI], 73%-98%) after a first dose, 95% (95% CI, 85%-99%) after primary vaccination with 1 to 3 doses, comparable to nonimmunocompromized populations. However, measles antibodies declined over time, suggesting the need for regular monitoring, and booster doses. Half of the vaccinees (26/53, 49%) subsequently lost seroprotection. Among them, 23 received additional doses of MMR, with a high seroconversion rate. At their last follow-up (median, 6.1 years; interquartile range, 3.0-8.1 after inclusion), 63% (95% CI, 49%-75%) of all vaccinees were seroprotected against measles. In conclusion, MMR vaccination in pediatric LT recipients offers seroprotection against measles, but long-term immunity should be monitored closely.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 1","pages":"Pages 170-180"},"PeriodicalIF":8.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141726523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.ajt.2024.09.004
Victoria Gorbacheva, Ran Fan, Brian Gaudette, William M. Baldwin III, Robert L. Fairchild, Anna Valujskikh
Antibody-mediated rejection (AMR) is among the leading causes of graft failure in solid organ transplantation. However, AMR treatment options are limited by an incomplete understanding of the mechanisms underlying de novo donor-specific antibody (DSA) generation. The development of pathogenic isotype-switched DSA in response to transplanted allografts is typically attributed to follicular B cells undergoing germinal center reaction whereas the contribution of other B cell subsets has not been previously addressed. The current study investigated the role of recipient marginal zone B cells (MZ B cells) in DSA responses using mouse models of heart and renal allotransplantation. MZ B cells rapidly differentiate into antibody-secreting cells in response to allotransplantation. Despite the selective depletion of follicular B cells in heart allograft recipients, MZ B cells are sufficient for T-dependent IgM and early IgG DSA production. Furthermore, the presence of intact MZ B cell subset is required to support the generation of pathogenic isotype-switched DSA in renal allograft recipients containing donor-reactive memory helper T cells. These findings are the first demonstration of the role of MZ B cells in humoral alloimmune responses following solid organ transplantation and identify MZ B cells as a potential therapeutic target for minimizing de novo DSA production and AMR in transplant recipients.
抗体介导的排斥反应（AMR）是导致实体器官移植失败的主要原因之一。然而，由于对新供体特异性抗体（DSA）产生的机制了解不全面，AMR 治疗方案受到限制。针对异体移植物的致病性同种型转换 DSA 的产生通常归因于发生生殖中心反应的滤泡 B 细胞，而其他 B 细胞亚群的作用以前尚未涉及。本研究利用小鼠心脏和肾脏异体移植模型研究了受体边缘区（MZ）B细胞在DSA反应中的作用。MZ B细胞在异体移植后迅速分化为分泌抗体的细胞。尽管在心脏同种异体移植受体中选择性地消耗了 FO B 细胞，但 MZ B 细胞仍足以产生 T 依赖性 IgM 和早期 IgG DSA。此外，在含有供体反应性记忆辅助 T 细胞的肾脏异体移植受者中，完整的 MZ B 细胞亚群是支持产生致病性同型转换 DSA 的必要条件。这些发现首次证明了 MZ B 细胞在实体器官移植后体液同种免疫反应中的作用，并确定了 MZ B 细胞作为潜在的治疗靶点，可最大限度地减少移植受者体内 DSA 的新生和 AMR 的产生。
{"title":"Marginal zone B cells are required for optimal humoral responses to allograft","authors":"Victoria Gorbacheva, Ran Fan, Brian Gaudette, William M. Baldwin III, Robert L. Fairchild, Anna Valujskikh","doi":"10.1016/j.ajt.2024.09.004","DOIUrl":"10.1016/j.ajt.2024.09.004","url":null,"abstract":"<div><div>Antibody-mediated rejection (AMR) is among the leading causes of graft failure in solid organ transplantation. However, AMR treatment options are limited by an incomplete understanding of the mechanisms underlying de novo donor-specific antibody (DSA) generation. The development of pathogenic isotype-switched DSA in response to transplanted allografts is typically attributed to follicular B cells undergoing germinal center reaction whereas the contribution of other B cell subsets has not been previously addressed. The current study investigated the role of recipient marginal zone B cells (MZ B cells) in DSA responses using mouse models of heart and renal allotransplantation. MZ B cells rapidly differentiate into antibody-secreting cells in response to allotransplantation. Despite the selective depletion of follicular B cells in heart allograft recipients, MZ B cells are sufficient for T-dependent IgM and early IgG DSA production. Furthermore, the presence of intact MZ B cell subset is required to support the generation of pathogenic isotype-switched DSA in renal allograft recipients containing donor-reactive memory helper T cells. These findings are the first demonstration of the role of MZ B cells in humoral alloimmune responses following solid organ transplantation and identify MZ B cells as a potential therapeutic target for minimizing de novo DSA production and AMR in transplant recipients.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 1","pages":"Pages 48-59"},"PeriodicalIF":8.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277484","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 : 2025-01-01DOI: 10.1016/j.ajt.2024.08.008
Hye-Mee Kwon , Jae Hwan Kim , Sung-Hoon Kim , In-Gu Jun , Jun-Gol Song , Deok-Bog Moon , Gyu-Sam Hwang
We evaluated the liver transplantation (LT) criteria in acute-on-chronic liver failure (ACLF), incorporating an urgent living-donor LT (LDLT) program. Critically ill patients with a Chronic Liver Failure Consortium (CLIF-C) ACLF score (CLIF-C_ACLF_score) ≥65, previously considered unsuitable for LT, were included to explore the excess mortality threshold of the CLIF-C_ACLF_score (CLIF-C_ACLF_score_threshold). We followed 854 consecutive patients with ACLF (276 ACLF grade 2 and 215 ACLF grade 3) over 10 years among 4432 LT recipients between 2008 and 2019. For advanced ACLF patients without immediate deceased-donor (DD) allocation, an urgent LDLT program was expedited. The CLIF-C_ACLF_score_threshold was determined by the metrics of transplant survival benefit: >60% 1-year and >50% 5-year survival rate. In predicting post-LT mortality, the CLIF-C_ACLF_score outperformed the (model for end-stage liver disease-sodium) MELD-Na and (model for end-stage liver disease) MELD-3.0 scores but was comparable to the Sundaram ACLF-LT-mortality score. A CLIF-C_ACLF_score ≥65 (n = 54) demonstrated posttransplant survival benefits, with 1-year and 5-year survival rates of 66.7% and 50.4% (P < .001), respectively. Novel CLIF-C_ACLF_score_threshold for 1-year and 5-year mortalities was 70 and 69, respectively. A CLIF-C_ACLF_score–based nomogram for predicting survival probabilities, integrating cardiovascular disease, diabetes, and donor type (LDLT vs DDLT), was generated. This study suggests reconsidering the criteria for unsuitable LT with a CLIF-C_ACLF_score ≥65. Implementing a timely salvage LT strategy, and incorporating urgent LDLT, can enhance survival rates.
{"title":"Benefits of liver transplant in critically ill patients with acute-on-chronic liver failure: Implementation of an urgent living-donor program","authors":"Hye-Mee Kwon , Jae Hwan Kim , Sung-Hoon Kim , In-Gu Jun , Jun-Gol Song , Deok-Bog Moon , Gyu-Sam Hwang","doi":"10.1016/j.ajt.2024.08.008","DOIUrl":"10.1016/j.ajt.2024.08.008","url":null,"abstract":"<div><div>We evaluated the liver transplantation (LT) criteria in acute-on-chronic liver failure (ACLF), incorporating an urgent living-donor LT (LDLT) program. Critically ill patients with a Chronic Liver Failure Consortium (CLIF-C) ACLF score (CLIF-C_ACLF_score) ≥65, previously considered unsuitable for LT, were included to explore the excess mortality threshold of the CLIF-C_ACLF_score (CLIF-C_ACLF_score_threshold). We followed 854 consecutive patients with ACLF (276 ACLF grade 2 and 215 ACLF grade 3) over 10 years among 4432 LT recipients between 2008 and 2019. For advanced ACLF patients without immediate deceased-donor (DD) allocation, an urgent LDLT program was expedited. The CLIF-C_ACLF_score_threshold was determined by the metrics of transplant survival benefit: >60% 1-year and >50% 5-year survival rate. In predicting post-LT mortality, the CLIF-C_ACLF_score outperformed the (model for end-stage liver disease-sodium) MELD-Na and (model for end-stage liver disease) MELD-3.0 scores but was comparable to the Sundaram ACLF-LT-mortality score. A CLIF-C_ACLF_score ≥65 (n = 54) demonstrated posttransplant survival benefits, with 1-year and 5-year survival rates of 66.7% and 50.4% (<em>P</em> < .001), respectively. Novel CLIF-C_ACLF_score_threshold for 1-year and 5-year mortalities was 70 and 69, respectively. A CLIF-C_ACLF_score–based nomogram for predicting survival probabilities, integrating cardiovascular disease, diabetes, and donor type (LDLT vs DDLT), was generated. This study suggests reconsidering the criteria for unsuitable LT with a CLIF-C_ACLF_score ≥65. Implementing a timely salvage LT strategy, and incorporating urgent LDLT, can enhance survival rates.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 1","pages":"Pages 150-163"},"PeriodicalIF":8.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141998930","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 : 2025-01-01DOI: 10.1016/j.ajt.2024.12.022
Charles Lee , Amit Mathur , Julie Heimbach , C. Burcin Taner , Bashar Aqel , Shennen Mao , Kristopher Croome
{"title":"Prolonged Time from Cross Clamp until Normothermic Machine Perfusion Start is Associated with Increased Risk of Early allograft Dysfunction Following DCD Liver Transplant","authors":"Charles Lee , Amit Mathur , Julie Heimbach , C. Burcin Taner , Bashar Aqel , Shennen Mao , Kristopher Croome","doi":"10.1016/j.ajt.2024.12.022","DOIUrl":"10.1016/j.ajt.2024.12.022","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 1","pages":"Pages S6-S7"},"PeriodicalIF":8.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143127787","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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