American Journal of Transplantation最新文献

英文中文

Cultural myth vs systemic failure: Why Japan’s deceased organ donation rate remains stagnant 文化神话vs系统失败：为什么日本的死者器官捐献率仍然停滞不前。

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.07.2467

Keita Okubo MD, PhD , Kazunari Tanabe MD, PhD , Sumi Hidaka MD, PhD , Shuzo Kobayashi MD, PhD

Japan’s organ donation rate remains among the lowest in the developed world, with only 4% of patients on the transplant waiting list receiving organs annually. Although cultural explanations are often cited, this viewpoint contends that structural failures within the health care system are the true barrier. Physicians must not only treat critically ill patients but also initiate organ donation discussions, manage brain death determination, and handle complex legal and administrative responsibilities—often with little institutional support. A mere 4.1% of eligible patients are ever approached about donation. A severe shortage of transplant coordinators exacerbates the issue, leaving frontline clinicians overwhelmed and unable to prioritize donation. Compounding the challenge, Japan’s legal framework recognizes brain death only within the context of donation, imposing a unique ethical burden on providers. We propose comprehensive structural reforms: expanding the transplant coordinator workforce, implementing mandatory hospital protocols and standardized physician training, revising the legal definition of brain death, introducing financial incentives for donation-related professionals, establishing regional organ procurement organizations, and launching pilot interventions to develop scalable national models. These changes are essential to shift Japan’s donation model from one of missed opportunity to one grounded in institutional accountability, medical professionalism, and patient-centered care.

日本的器官捐献率仍然是发达国家中最低的，每年只有4%的移植等待名单上的患者接受器官移植。虽然文化的解释经常被引用，这个观点认为，在医疗保健系统的结构性失败是真正的障碍。医生不仅要治疗危重病人，还要发起器官捐赠的讨论，管理脑死亡的判定，处理复杂的法律和行政责任——通常很少有机构支持。只有4.1%的符合条件的患者曾经接触过捐赠。移植协调员的严重短缺加剧了这一问题，使一线临床医生不堪重负，无法优先考虑捐赠。使挑战更加复杂的是，日本的法律框架只在捐赠的情况下承认脑死亡，这给提供者带来了独特的道德负担。我们建议进行全面的结构改革：扩大移植协调员队伍，实施强制性医院协议和标准化医生培训，修订脑死亡的法律定义，为捐赠相关专业人员引入财政激励，建立区域器官采购组织，并启动试点干预措施以开发可扩展的国家模式。这些变化对于将日本的捐赠模式从错失机会转变为基于机构问责制、医疗专业精神和以患者为中心的护理至关重要。

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引用次数: 0

Kidney storage at subzero temperature is safe for porcine kidney autotransplantation: A world first in vivo study 零下温度下的肾脏储存对猪肾脏自体移植是安全的：世界上第一个体内研究。

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.08.033

Francisco Calderon Novoa , Tun-Pang Chu , Kaitlin Lees , Sujani Ganesh , Laura Martinez-Arenas , Nicola Pollman , Catherine Parmentier , Masataka Kawamura , Christian Hobeika , Samrat Ray , Emmanuel Nogueira , Rohan John , Aakriti Gupta , Photis Loizides , Tom Allen , Trevor Reichman , Lisa Robinson , Markus Selzner

Organ shortage continues to limit kidney transplantation worldwide. Subzero storage may harbor the potential for extending cold ischemic times, improving organ sharing, and optimizing graft allocation. However, subzero storage remains challenging, limited by possible freeze-thaw damage. We used a porcine autotransplant model to assess kidney function and injury after brief (5 hours) or prolonged (24-48 hours) subzero storage of grafts, comparing it to classic static cold storage. There was no mortality in the cohort, and subjects were followed for 7 days. Creatinine, blood urea nitrogen, and potassium peak levels and curves were comparable between groups in both brief and prolonged experiments (P > .05). Histologic analysis revealed no evidence suggesting ice crystals had formed, as well as similar injury profiles, suggesting that the subzero preservation process was successful. Creatinine clearance, fractional excretion of sodium, and neutrophil gelatinase–associated lipocalin urinary and serum levels tended to favor subzero preservation in the 24-hour static cold storage experiments, without statistical significance. Although further research is needed to optimize storage protocols and explore the impact of colder temperatures, this study provides promising evidence regarding the safety and feasibility of subzero storage as a method for extending preservation times. Future studies will focus on enhancing preservation solutions for improved outcomes.

器官短缺继续限制着世界范围内的肾移植。低温储存可以延长冷缺血时间，改善器官共享，优化移植物分配。然而，零度以下的储存仍然具有挑战性，可能受到冻融损害的限制。我们建立了猪自体移植模型，以评估移植物在低温短时（5小时）或长时间（24-48小时）储存后的肾功能和损伤，并将其与经典的静态冷藏进行比较。该队列中无死亡病例，受试者随访7天。短时间和长时间试验组间肌酐、尿素氮和钾的峰值水平和曲线具有可比性（P < 0.05）。组织学分析显示，没有证据表明冰晶已经形成，以及类似的损伤特征，表明零度以下的保存过程是成功的。在24 h SCS实验中，肌酐清除率、钠排泄分数、尿和血清NGAL水平倾向于零度以下保存，但无统计学意义。虽然需要进一步的研究来优化储存方案并探索低温的影响，但这项研究为零下储存作为延长保存时间的方法的安全性和可行性提供了有希望的证据。未来的研究将集中于提高保存方法以改善结果。

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引用次数: 0

Enhancing Expedited Kidney Allocation Through Machine Learning 通过机器学习加速肾脏分配

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.12.079

Zoe Lu, Anita Patel, Atsushi Yoshida

引用次数: 0

When Should Kidney Transplant Be Performed for Simultaneous Liver-Kidney Recipients? 同时接受肝肾移植的患者何时应该进行肾移植？

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.12.113

Nolberto Jaramillo, Abhay Dhand, Marco Diaz-Cordova, Ishani Sharma, William Pascal, Ryosuke Misawa, Seigo Nishida, Kenji Okumura

引用次数: 0

Expanding the Kidney Donor Pool: Robotic Donor Nephrectomies in Patients with Greater than 30 BMI 扩大肾脏供体池：BMI大于30患者的机器人供体肾切除术

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.12.070

Jacob Hallesy , Derick Nguyen , Devi Preetham Veeramgari , Kush Savsani , Daisuke Imai , Yuzuru Sambommatsu , Aamir Khan , Adrian Cotterell , David Bruno , Seung Duk Lee , Muhammad Saeed , Amit Sharma

引用次数: 0

The Kidney Terminator: How SkyNet Protocols Could Save More Organs - A Comparative Analysis of AI Agent Performance versus Attending Surgeon Clinical Judgment in Renal Transplant Acceptance Decisions 肾脏终结者：天网协议如何节省更多器官——人工智能代理性能与主治医生在肾移植接受决策中的临床判断的比较分析

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.12.087

Alex Rendon-Jonguitud, Stephen Moorhead, Joseph Scalea, Ashlee Seagraves

引用次数: 0

High body mass index at liver transplantation: A retrospective single-center analysis of blood product utilization and postoperative outcomes 肝移植的高BMI：血液制品使用和术后结果的回顾性单中心分析。

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.08.018

Sebastian Zeiner , Rishi P. Kothari , Mallika Reddy , Nicholas V. Mendez , Garrett R. Roll , Hillary J. Braun , Michael P. Bokoch , Kerstin Kolodzie , Oliver Kimberger , Matthieu Legrand , Dieter Adelmann

Obesity, generally defined as high body mass index (BMI), is increasingly prevalent in liver transplant recipients, but its impact on perioperative management is still not understood. This study aimed to examine intraoperative transfusion as a marker of surgical complexity, alongside blood loss, ventilation duration, and intensive care unit length of stay. We conducted a retrospective single-center analysis of adult liver transplant recipients between June 1, 2012, and March 31, 2024. Data were extracted from electronic medical records and stratified by BMI to compare demographics, clinical characteristics, intraoperative variables, and postoperative outcomes. Among 1444 recipients, patients with a BMI of ≥40 kg/m² required significantly more units of blood products (median, 20 units; IQR, 12-32 units) than normal/overweight patients (median, 12 units; IQR, 6-20 units; P < .001). They had greater blood loss, longer ventilation times, and extended intensive care unit stays (all P < .001). This is the first study to assess granular intraoperative data on blood product use, acute kidney injury, and extubation in liver transplant recipients with a BMI of ≥40 kg/m². It shows that a BMI of ≥40 kg/m² is linked to increased perioperative resource utilization and longer hospital stays. Importantly, patients with a BMI of ≥40 kg/m² have equivalent long-term outcomes after liver transplant. BMI should be used with extreme caution in candidacy decisions.

肥胖，通常被定义为高BMI，在肝移植受者中越来越普遍，但其对围手术期管理的影响仍不清楚。这项研究考察了术中输血作为手术复杂性的标志，以及失血、通气时间和重症监护病房的住院时间。我们对2012年6月1日至2024年3月31日期间的成人肝移植受者进行了回顾性单中心分析。数据从电子病历中提取，并按体重指数（BMI）分层，以比较人口统计学、临床特征、术中变量和术后结果。在1444名接受血液治疗的患者中，BMI≥40的患者需要的血液制品单位（中位数：20单位，IQR: 12-32）明显多于正常/超重患者（中位数：12单位，IQR: 6-20, p < 0.001）。患者失血量较大，通气时间较长，ICU住院时间延长（p < 0.001）。这是第一个评估BMI≥40的肝移植受者术中血液制品使用、急性肾损伤和拔管的颗粒数据的研究。BMI≥40与围手术期资源利用率增加和住院时间延长有关。重要的是，BMI≥40的患者在肝移植后具有相同的长期预后。在决定候选人资格时，应极其谨慎地使用BMI。

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引用次数: 0

Exosome-primed T cell immunity is facilitated by complement activation 外泌体启动的T细胞免疫是通过补体激活来促进的。

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.09.011

Sara Alibrandi , Angela Clemens , Yansui Li , William J. Shufesky , Ashley Vo , Noriko Ammerman , Edmund Huang , Simon C. Watkins , Peter Heeger , Stanley Jordan , Adrian E. Morelli , Nicholas Chun

Extracellular vesicles (EVs) contain proteins, lipids, and nucleic acids from their cells of origin. By delivering these cargos to distant acceptor cells, EVs modulate many biologic processes, including adaptive immunity. Following transplantation, EV's expressing donor major histocompatibility complexes bind to host dendritic cells (DCs), permitting donor major histocompatibility complexes expression by recipient DCs and priming antidonor T cell responses. The mechanisms through which circulating EVs bind DCs are poorly understood. The complement system opsonizes pathogens and damaged cells and enhances subsequent recognition by antigen-presenting cells through surface-expressed complement receptors. Here, we newly show that complement opsonization of graft-released EVs augments their binding to recipient DCs in a CD11c-dependent manner. Enhanced delivery of donor antigen by EVs induces antidonor T cell responses and graft rejection, which can be mitigated by pharmacologic inhibition of complement activation. Our findings reveal a previously unrecognized mechanism linking complement activation to EV function with important implications for T cell immunity.

细胞外囊泡（EVs）含有来自其起源细胞的蛋白质、脂质和核酸。通过将这些货物运送到远处的受体细胞，ev调节了许多生物过程，包括适应性免疫。移植后，表达供体MHC的ev与宿主树突状细胞（dc）结合，允许受体dc表达供体MHC并引发抗供体T细胞反应。循环ev结合dc的机制尚不清楚。补体系统对病原体和受损细胞进行调理，并通过表面表达的补体受体增强抗原提呈细胞随后的识别。在这里，我们最新发现移植物释放的ev的补体活化以cd11c依赖的方式增强了它们与受体dc的结合。通过ev增强供体抗原的递送诱导抗供体T细胞反应和移植物排斥反应，这可以通过药物抑制补体激活来减轻。我们的发现揭示了一种以前未被认识的机制，将补体激活与EV功能联系起来，对T细胞免疫具有重要意义。

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引用次数: 0

2025 Report of the Sensitization in Transplantation: Assessment of Risk Working Group on donor-derived cell-free DNA: Establishing analytical validity as the basis for appropriate and effective clinical utilization 2025年STAR供体来源细胞游离DNA工作组报告：建立分析有效性作为适当和有效临床应用的基础。

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.08.036

Nicole M. Valenzuela , James Lan , Kelley M.K. Hitchman , Ursula Amstutz , Roy D. Bloom , Deborah J. Levine , Michael Mengel , Roslyn B. Mannon

A working group under the Sensitization in Transplantation: Assessment of Risk initiative was established in 2023 to develop guidelines for analytical and clinical validity of lab-based testing for donor-derived cell-free DNA (dd-cfDNA). Measurement of dd-cfDNA as a minimally invasive marker of allograft injury has become more widely used over the last few years. To date, various technical and quantitation methods have hindered the standardization and interpretation of the results, leading to variability in understanding how to best utilize cell-free DNA in transplantation. Kits are being formulated for local laboratory testing, but we lack an organized framework for laboratory quality assurance. Further, threshold values and methods of measurement have changed over time, indicating that assay sensitivity and clinical relevance are still being refined. Harmonization and reproducibility will be critical as the field moves forward to local laboratory-based testing. The goal of this work group was to review and analyze technical and biological variables and clinical settings that could contribute to disparities in results, which will ultimately influence clinical validity and utility. High-quality, standardized decentralized dd-cfDNA testing is the essential prerequisite for conducting real-world evidence-generating multicenter studies to establish the appropriate context of use for this promising assay.

移植致敏：风险评估（STAR）倡议下的一个工作组于2023年成立，旨在制定基于实验室的供体来源的无细胞DNA （dd-cfDNA）检测的分析和临床有效性指南。在过去的几年里，dd-cfDNA的测量作为一种微创的同种异体移植损伤标志物已经得到了更广泛的应用。迄今为止，各种技术和定量方法阻碍了结果的标准化和解释，导致对如何在移植中最好地利用cfDNA的理解存在差异。正在制定用于当地实验室检测的试剂盒，但我们缺乏有组织的实验室质量保证框架。此外，阈值和测量方法随着时间的推移而变化，表明测定敏感性和临床相关性仍在不断完善。随着该领域向以当地实验室为基础的测试迈进，协调和可重复性将是至关重要的。该工作组的目标是审查和分析可能导致结果差异的技术和生物学变量以及临床环境，这些差异最终将影响临床有效性和效用。高质量、标准化的分散式dd-cfDNA检测是开展真实世界证据生成多中心研究的必要先决条件，以便为这一有前途的检测方法建立适当的使用环境。

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引用次数: 0

Implications of the new National Institutes of Health policy on animal research for transplant science 美国国立卫生研究院新政策对移植科学动物研究的影响。

IF 8.2 2区医学 Q1 SURGERY

American Journal of Transplantation

Pub Date : 2026-01-01 DOI: 10.1016/j.ajt.2025.09.006

Mandy L. Ford , Paolo Cravedi

引用次数: 0

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