Living donor liver transplantation is the definitive treatment for decompensated cirrhosis. While the prognosis for high Model for End-Stage Liver Disease (MELD) patients is well-studied, risk factors in low MELD patients remain unclear. This study aimed to identify prognostic risk factors for low MELD cases.
Methods
We analyzed 838 adult living donor liver transplantation patients from September 1998 to April 2024 and divided them into low MELD (≤15) and high MELD (>15) groups. The low MELD group was further categorized into early and non-early graft loss subgroups. The risk factors for recipient survival were analyzed.
Results
Of the 838 patients, 408 (48.7%) were in the low MELD group, and 430 (51.3%) were in the high MELD group. The survival rates were significantly higher in the low MELD group than in the high MELD group. In the low MELD group, 5.1% (21 patients) experienced early graft loss, and 94.9% (387 patients) were classified as non-early graft loss. Independent risk factors for early graft loss included donor body mass index ≥25 kg/m2, absence of simultaneous splenectomy, and postoperative complications. One year survival rates were significantly lower in patients with more risk factors.
Conclusion
Donor body mass index, absence of simultaneous splenectomy, and postoperative complications were identified as independent risk factors for poor prognosis in living donor liver transplantation patients with low MELD. Surgeons must focus on performing meticulous surgeries to minimize the risk of complications.
{"title":"Risks of Early Graft Loss in Living Donor Liver Transplantation for Patients With a Low Model for End-Stage Liver Disease Score: Is It Truly Safe?","authors":"Yuki Nakayama , Takeo Toshima , Shinji Itoh , Takashi Motomura , Kyohei Yugawa , Sunao Fujiyoshi , Yuriko Tsutsui , Tomoharu Yoshizumi","doi":"10.1016/j.transproceed.2025.12.005","DOIUrl":"10.1016/j.transproceed.2025.12.005","url":null,"abstract":"<div><h3>Background</h3><div>Living donor liver transplantation is the definitive treatment for decompensated cirrhosis. While the prognosis for high Model for End-Stage Liver Disease (MELD) patients is well-studied, risk factors in low MELD patients remain unclear. This study aimed to identify prognostic risk factors for low MELD cases.</div></div><div><h3>Methods</h3><div>We analyzed 838 adult living donor liver transplantation patients from September 1998 to April 2024 and divided them into low MELD (≤15) and high MELD (>15) groups. The low MELD group was further categorized into early and non-early graft loss subgroups. The risk factors for recipient survival were analyzed.</div></div><div><h3>Results</h3><div>Of the 838 patients, 408 (48.7%) were in the low MELD group, and 430 (51.3%) were in the high MELD group. The survival rates were significantly higher in the low MELD group than in the high MELD group. In the low MELD group, 5.1% (21 patients) experienced early graft loss, and 94.9% (387 patients) were classified as non-early graft loss. Independent risk factors for early graft loss included donor body mass index ≥25 kg/m<sup>2</sup>, absence of simultaneous splenectomy, and postoperative complications. One year survival rates were significantly lower in patients with more risk factors.</div></div><div><h3>Conclusion</h3><div>Donor body mass index, absence of simultaneous splenectomy, and postoperative complications were identified as independent risk factors for poor prognosis in living donor liver transplantation patients with low MELD. Surgeons must focus on performing meticulous surgeries to minimize the risk of complications.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 169-176"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.transproceed.2025.12.011
Weiyang He , Yujie Sun , Wenjin Liang, Jianan Lan, Yan Xiong
Background
Hypothermic oxygenated perfusion (HOPE) is a promising technology to improve donated after cardiac death (DCD) liver graft. It was found that protein phosphatase 2A (PP2A) could regulate autophagy and apoptosis, which play a pivotal role in hepatic ischemia reperfusion injury (IRI). In this study, we aim to explore whether PP2A take part in the mechanism that reduces organ damage after HOPE.
Method
Adult male Sprague Dawley rats were divided into four groups at random. DCD livers of HOPE group were preserved in a HOPE system after 23 hours of cold storage (CS). All groups’ livers were reperfused in an isolated perfused rat liver (IPRL) system for 1 hour at 37°C. After reperfusion, markers related to IRI and protein expression of PP2A related pathway were examined. BRL-3A cells were cultured and incubated with different concentrations H2O2 (0, 50 M and100 M). The cellular production of Reactive Oxygen Species (ROS) was detected via the fluorescent intensity of 2,7-Dichlorodihydrofluorescein diacetate (DCFH-DA), and PP2A related pathway protein expression was measured.
Results
HOPE group suffered the lighter IRI when compared with CS group, evidenced by the lower hepatocytes injury degree, apoptosis rate, and oxidative stress. Further, compared with CS group, the PP2A and ERK1/2 related autography pathway activation of HOPE group was higher, while the JNK and p38 related apoptosis pathway was down-regulated. Cellular experiment showed that mild oxidative stress (50 μM H2O2) could activate the expression of PP2A and autography pathway protein. Severe oxidative stress (100 μM H2O2) shown the opposite regulation effect.
Conclusion
Through reducing oxidative stress, HOPE attenuates IRI to rat DCD livers via activating PP2A related autography pathway and inhibiting apoptosis pathway.
{"title":"End-Ischemic Hypothermic Oxygenated Perfusion Attenuates Ischemia Reperfusion Injury to Rat Livers Donated After Cardiac Death Through the Regulation of Protein Phosphatase 2A Related Apoptosis and Autophagy","authors":"Weiyang He , Yujie Sun , Wenjin Liang, Jianan Lan, Yan Xiong","doi":"10.1016/j.transproceed.2025.12.011","DOIUrl":"10.1016/j.transproceed.2025.12.011","url":null,"abstract":"<div><h3>Background</h3><div>Hypothermic oxygenated perfusion (HOPE) is a promising technology to improve donated after cardiac death (DCD) liver graft. It was found that protein phosphatase 2A (PP2A) could regulate autophagy and apoptosis, which play a pivotal role in hepatic ischemia reperfusion injury (IRI). In this study, we aim to explore whether PP2A take part in the mechanism that reduces organ damage after HOPE.</div></div><div><h3>Method</h3><div>Adult male Sprague Dawley rats were divided into four groups at random. DCD livers of HOPE group were preserved in a HOPE system after 23 hours of cold storage (CS). All groups’ livers were reperfused in an isolated perfused rat liver (IPRL) system for 1 hour at 37°C. After reperfusion, markers related to IRI and protein expression of PP2A related pathway were examined. BRL-3A cells were cultured and incubated with different concentrations H<sub>2</sub>O<sub>2</sub> (0, 50 <span><math><mi>μ</mi></math></span>M and100 <span><math><mi>μ</mi></math></span>M). The cellular production of Reactive Oxygen Species (ROS) was detected via the fluorescent intensity of 2,7-Dichlorodihydrofluorescein diacetate (DCFH-DA), and PP2A related pathway protein expression was measured.</div></div><div><h3>Results</h3><div>HOPE group suffered the lighter IRI when compared with CS group, evidenced by the lower hepatocytes injury degree, apoptosis rate, and oxidative stress. Further, compared with CS group, the PP2A and ERK1/2 related autography pathway activation of HOPE group was higher, while the JNK and p38 related apoptosis pathway was down-regulated. Cellular experiment showed that mild oxidative stress (50 μM H<sub>2</sub>O<sub>2</sub>) could activate the expression of PP2A and autography pathway protein. Severe oxidative stress (100 μM H<sub>2</sub>O<sub>2</sub>) shown the opposite regulation effect.</div></div><div><h3>Conclusion</h3><div>Through reducing oxidative stress, HOPE attenuates IRI to rat DCD livers via activating PP2A related autography pathway and inhibiting apoptosis pathway.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 219-228"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.transproceed.2025.11.008
Yu Li , Yang Li , Yifei Li , Haifeng Zhu
Objective
General anesthesia (GA) is standard for kidney transplantation but can induce significant stress responses. The integration of acupuncture with GA remains unexplored in this context. This study evaluates the effects of acupuncture-combined GA on anesthetic efficacy and organ protection in kidney transplantation.
Methods
A retrospective study was conducted on 90 patients undergoing elective kidney transplantation between March 2022 and October 2024. Patients were classified into three groups: Group 1 (GA only), Group 2 (Acupuncture + GA), and Group 3 (Sham acupuncture + GA). Hemodynamics, renal function, inflammatory markers, and postoperative adverse reactions were compared among the groups at different intraoperative time points.
Results
Mean arterial pressure (MAP) and heart rate (HR) varied significantly over time (P < .05). At T4, MAP was higher, and HR was lower in Group 2 than in the other groups (P < .05). Renal function markers (Cr, BUN, eGFR, urine volume) increased over time (P < .05) but showed no significant intergroup differences. Inflammatory markers (IL-6, TNF-α) were lower in Group 2 (P < .05). Adverse reactions were fewer in the acupuncture groups but not significantly different.
Conclusion
Acupuncture-combined GA stabilizes intraoperative hemodynamics, exhibits renal protective and anti-inflammatory effects, and demonstrates high safety, suggesting its potential as an effective anesthetic approach in kidney transplantation.
{"title":"Effects of Acupuncture-Combined General Anesthesia on Hemodynamic Stability, Renal Function, and Inflammatory Response in Patients Undergoing Renal Transplantation: A Retrospective Pilot Study","authors":"Yu Li , Yang Li , Yifei Li , Haifeng Zhu","doi":"10.1016/j.transproceed.2025.11.008","DOIUrl":"10.1016/j.transproceed.2025.11.008","url":null,"abstract":"<div><h3>Objective</h3><div>General anesthesia (GA) is standard for kidney transplantation but can induce significant stress responses. The integration of acupuncture with GA remains unexplored in this context. This study evaluates the effects of acupuncture-combined GA on anesthetic efficacy and organ protection in kidney transplantation.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on 90 patients undergoing elective kidney transplantation between March 2022 and October 2024. Patients were classified into three groups: Group 1 (GA only), Group 2 (Acupuncture + GA), and Group 3 (Sham acupuncture + GA). Hemodynamics, renal function, inflammatory markers, and postoperative adverse reactions were compared among the groups at different intraoperative time points.</div></div><div><h3>Results</h3><div>Mean arterial pressure (MAP) and heart rate (HR) varied significantly over time (<em>P</em> < .05). At T4, MAP was higher, and HR was lower in Group 2 than in the other groups (<em>P</em> < .05). Renal function markers (Cr, BUN, eGFR, urine volume) increased over time (<em>P</em> < .05) but showed no significant intergroup differences. Inflammatory markers (IL-6, TNF-α) were lower in Group 2 (<em>P</em> < .05). Adverse reactions were fewer in the acupuncture groups but not significantly different.</div></div><div><h3>Conclusion</h3><div>Acupuncture-combined GA stabilizes intraoperative hemodynamics, exhibits renal protective and anti-inflammatory effects, and demonstrates high safety, suggesting its potential as an effective anesthetic approach in kidney transplantation.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 66-74"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.transproceed.2025.11.001
Ning-Qi Zhu , Quan-Bao Zhang , Zheng-Xin Wang , Rui-Dong Li
Objective
Metagenomic next-generation sequencing (mNGS) is an effective method for the detection of microorganisms. Early allograft dysfunction (EAD) is a common complication after liver transplantation. The association between early postoperative microorganisms in bile and EAD is unclear, so we evaluated the association of microorganisms and other potential risk factors with EAD.
Methods
A total of 100 patients who underwent orthotopic liver transplantation with biliary T tube placement in Huashan Hospital Fudan University from March 2021 to July 2022 were studied. Clinical data, the occurrence of EAD, and bile microorganisms’ information detected by mNGS were collected.
Results
EAD occurred in 22 recipients (22%). Patients with EAD had a longer length of postoperative hospital stay. Bacteroides spp. detected by mNGS in bile was identified as an independent risk factor for EAD. Also, operation time, the MELD score of the recipient, and donor AST level were also independent risk factors for EAD.
Conclusion
Bacteroides spp. detected by mNGS in bile after liver transplantation was identified as an independent risk factor for EAD, which may reflect the translocation of intestinal flora into the biliary tract and may serve as a potential early warning indicator of poor quality of the donor liver. Recipients with EAD had longer LOS, which may indicate a poor short-term prognosis.
{"title":"Bacteroides in Bile Detected by Metagenomic Next-Generation Sequencing: Potential Novel Indicator for Early Allograft Dysfunction After Liver Transplantation","authors":"Ning-Qi Zhu , Quan-Bao Zhang , Zheng-Xin Wang , Rui-Dong Li","doi":"10.1016/j.transproceed.2025.11.001","DOIUrl":"10.1016/j.transproceed.2025.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>Metagenomic next-generation sequencing (mNGS) is an effective method for the detection of microorganisms. Early allograft dysfunction (EAD) is a common complication after liver transplantation. The association between early postoperative microorganisms in bile and EAD is unclear, so we evaluated the association of microorganisms and other potential risk factors with EAD.</div></div><div><h3>Methods</h3><div>A total of 100 patients who underwent orthotopic liver transplantation with biliary T tube placement in Huashan Hospital Fudan University from March 2021 to July 2022 were studied. Clinical data, the occurrence of EAD, and bile microorganisms’ information detected by mNGS were collected.</div></div><div><h3>Results</h3><div>EAD occurred in 22 recipients (22%). Patients with EAD had a longer length of postoperative hospital stay. <em>Bacteroides</em> spp. detected by mNGS in bile was identified as an independent risk factor for EAD. Also, operation time, the MELD score of the recipient, and donor AST level were also independent risk factors for EAD.</div></div><div><h3>Conclusion</h3><div><em>Bacteroides</em> spp. detected by mNGS in bile after liver transplantation was identified as an independent risk factor for EAD, which may reflect the translocation of intestinal flora into the biliary tract and may serve as a potential early warning indicator of poor quality of the donor liver. Recipients with EAD had longer LOS, which may indicate a poor short-term prognosis.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 107-113"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.transproceed.2025.12.002
Jian Huang , Caiwei Li , Chuankai Zhang , Lan Cheng , Xianliang Jiang , Li Ke
Lung transplantation, as an important treatment for end-stage lung disease, significantly improves patients’ quality of life and prognosis. However, optimizing postoperative immunosuppressive therapy remains a major challenge in clinical practice, particularly in balancing transplant rejection and infection risks. Current research shows that traditional immunosuppressive protocols have limitations in addressing the individual needs of different patients, leading to increased adverse reactions and transplant failure rates. Therefore, this article reviews the latest advancements in postlung transplant immunosuppressive therapy, focusing on the selection of basic immunosuppressive protocols, optimization of drug combinations, and formulation of personalized treatment strategies. The article also discusses individualized therapy guided by immune monitoring biomarkers, the application of novel immunosuppressive drugs, and precision management strategies for patients with varying immune risks, aiming to provide a theoretical basis and practical guidance for clinical practice to enhance the long-term survival rates and quality of life of lung transplant patients.
{"title":"Optimization Strategies for Post Lung Transplant Immunosuppressive Therapy: From Basic Protocols to New Advances in Personalized Management","authors":"Jian Huang , Caiwei Li , Chuankai Zhang , Lan Cheng , Xianliang Jiang , Li Ke","doi":"10.1016/j.transproceed.2025.12.002","DOIUrl":"10.1016/j.transproceed.2025.12.002","url":null,"abstract":"<div><div>Lung transplantation, as an important treatment for end-stage lung disease, significantly improves patients’ quality of life and prognosis. However, optimizing postoperative immunosuppressive therapy remains a major challenge in clinical practice, particularly in balancing transplant rejection and infection risks. Current research shows that traditional immunosuppressive protocols have limitations in addressing the individual needs of different patients, leading to increased adverse reactions and transplant failure rates. Therefore, this article reviews the latest advancements in postlung transplant immunosuppressive therapy, focusing on the selection of basic immunosuppressive protocols, optimization of drug combinations, and formulation of personalized treatment strategies. The article also discusses individualized therapy guided by immune monitoring biomarkers, the application of novel immunosuppressive drugs, and precision management strategies for patients with varying immune risks, aiming to provide a theoretical basis and practical guidance for clinical practice to enhance the long-term survival rates and quality of life of lung transplant patients.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 186-192"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.transproceed.2025.12.013
Wenqi Yang , Zilong Lai , Xiaolan Cui , Chen Zhong , Lixin Jiang , Hongli Li
Objective
Contrast-enhanced ultrasonography (CEUS) is a potential and safe imaging method to evaluate the transplant renal artery. To evaluate the degree and location of transplant renal artery stenosis (TRAS) by CEUS compared with digital subtraction angiography (DSA) as the reference standard.
Methods
This retrospective study included a cohort of 47 patients with TRAS who underwent ultrasound followed by DSA as the gold standard from March 2018 to January 2025. The degree and location of TRAS were evaluated using CEUS and were compared to that of DSA. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CEUS for evaluating stenosis ≥50% and stenosis ≥70% were calculated.
Results
The diagnostic accuracy of CEUS in grading TRAS and diagnosing the location of TRAS was 83.8% and 97.3%, respectively. No significant differences were observed in assessing stenosis ≥50%, stenosis ≥70%, and the location of TRAS between CEUS and DSA (P = .250; P = .063; P = 1.000). There was a significant difference in grading TRAS between CEUS and DSA (P = .031). CEUS had a good performance in distinguishing stenosis ≥50% with a sensitivity of 91.4%, specificity of 100%, accuracy of 91.9%, PPV of 100%, and NPV of 40%. The sensitivity, specificity, accuracy, PPV, and NPV for the identification of stenosis ≥70% by CEUS were 87.1%, 100%, 89.2%, 100%, and 60%, respectively.
Conclusion
CEUS demonstrates a great depiction of the degree and location in the TRAS compared with DSA. CEUS has the potential to be a noninvasive method to support the diagnosis and follow-up of TRAS.
目的：超声造影（CEUS）是一种有潜力的、安全的评价移植肾动脉的成像方法。对比以数字减影血管造影（DSA）为参考标准，超声造影评价移植肾动脉狭窄（TRAS）的程度和位置。方法：本回顾性研究纳入了47例TRAS患者，这些患者在2018年3月至2025年1月期间接受了超声和DSA作为金标准。超声造影评估TRAS的程度和位置，并与DSA进行比较。计算超声造影对狭窄≥50%和狭窄≥70%的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。结果：超声造影对TRAS分级和TRAS定位的诊断准确率分别为83.8%和97.3%。CEUS和DSA在评估狭窄≥50%、狭窄≥70%和TRAS位置方面无显著差异（P = 0.250; P = 0.063; P = 1.000）。CEUS和DSA在TRAS分级上有显著差异（P = 0.031）。超声造影对≥50%的狭窄有较好的鉴别效果，敏感性91.4%，特异性100%，准确性91.9%,PPV 100%, NPV 40%。超声造影识别狭窄≥70%的敏感性、特异性、准确性、PPV和NPV分别为87.1%、100%、89.2%、100%和60%。结论：与DSA相比，超声造影能更好地描述TRAS的程度和位置。超声造影有潜力成为一种支持TRAS诊断和随访的无创方法。
{"title":"Evaluation of Transplant Renal Artery Stenosis by Contrast-Enhanced Ultrasonography: Comparison with Digital Subtraction Angiography","authors":"Wenqi Yang , Zilong Lai , Xiaolan Cui , Chen Zhong , Lixin Jiang , Hongli Li","doi":"10.1016/j.transproceed.2025.12.013","DOIUrl":"10.1016/j.transproceed.2025.12.013","url":null,"abstract":"<div><h3>Objective</h3><div>Contrast-enhanced ultrasonography (CEUS) is a potential and safe imaging method to evaluate the transplant renal artery. To evaluate the degree and location of transplant renal artery stenosis (TRAS) by CEUS compared with digital subtraction angiography (DSA) as the reference standard.</div></div><div><h3>Methods</h3><div>This retrospective study included a cohort of 47 patients with TRAS who underwent ultrasound followed by DSA as the gold standard from March 2018 to January 2025. The degree and location of TRAS were evaluated using CEUS and were compared to that of DSA. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CEUS for evaluating stenosis ≥50% and stenosis ≥70% were calculated.</div></div><div><h3>Results</h3><div>The diagnostic accuracy of CEUS in grading TRAS and diagnosing the location of TRAS was 83.8% and 97.3%, respectively. No significant differences were observed in assessing stenosis ≥50%, stenosis ≥70%, and the location of TRAS between CEUS and DSA (<em>P</em> = .250; <em>P</em> = .063; <em>P</em> = 1.000). There was a significant difference in grading TRAS between CEUS and DSA (<em>P</em> = .031). CEUS had a good performance in distinguishing stenosis ≥50% with a sensitivity of 91.4%, specificity of 100%, accuracy of 91.9%, PPV of 100%, and NPV of 40%. The sensitivity, specificity, accuracy, PPV, and NPV for the identification of stenosis ≥70% by CEUS were 87.1%, 100%, 89.2%, 100%, and 60%, respectively.</div></div><div><h3>Conclusion</h3><div>CEUS demonstrates a great depiction of the degree and location in the TRAS compared with DSA. CEUS has the potential to be a noninvasive method to support the diagnosis and follow-up of TRAS.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 94-101"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarcopenia remains a significant concern among kidney transplant recipients even after renal function improves. However, the predictors of impaired muscle recovery are not well established.
Methods
We retrospectively analyzed 40 adults who underwent living-donor kidney transplantation at Kansai Medical University Hospital between January 2018 and December 2020. Preoperative cardiopulmonary exercise testing (CPX) was used to stratify patients into low-tolerance (anaerobic threshold VO₂ < 11 mL/kg/min and peak VO₂ < 20 mL/kg/min) and normal groups. The skeletal muscle index (SMI) was measured using dual-energy x-ray absorptiometry from baseline to 3 years post-transplantation. Multivariable linear regression and correlation analyses were performed to identify predictors of long-term SMI improvement.
Results
Forty recipients were analyzed, including 12 (30%) in the low-tolerance group. Following transplantation, the median SMI in both groups decreased at 6 months and improved thereafter. However, from 1 year after transplantation onwards, the normal group demonstrated a significant increase in SMI compared with the low-tolerance group. Three years after transplantation, the median SMI in the normal group exceeded pretransplant levels and steadily increased, whereas in the low-tolerance group, there was little improvement and no return to baseline (P ≤ .05). Multivariable analysis identified low preoperative exercise tolerance as an independent predictor of reduced SMI recovery (P ≤ .05). Correlation analysis revealed that preoperative anaerobic threshold VO₂ and peak VO₂ were moderately and significantly associated with 3-year SMI improvement (r = 0.427 and r = 0.607, respectively).
Conclusions
Low exercise tolerance before kidney transplantation strongly predicts impaired long-term skeletal muscle recovery. Cardiopulmonary exercise testing-based risk assessment may help identify candidates who could benefit from tailored perioperative rehabilitation strategies to enhance functional outcomes.
{"title":"Low Preoperative Exercise Tolerance Predicts Impaired Skeletal Muscle Recovery After Kidney Transplantation","authors":"Masaaki Yanishi , Yutaka Kimura , Yuya Koito , Jun Matsushita , Ryuichi Yoshida , Hiroyasu Tsukaguchi , Yoshihiro Taniyama , Hidefumi Kinoshita","doi":"10.1016/j.transproceed.2025.11.013","DOIUrl":"10.1016/j.transproceed.2025.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Sarcopenia remains a significant concern among kidney transplant recipients even after renal function improves. However, the predictors of impaired muscle recovery are not well established.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 40 adults who underwent living-donor kidney transplantation at Kansai Medical University Hospital between January 2018 and December 2020. Preoperative cardiopulmonary exercise testing (CPX) was used to stratify patients into low-tolerance (anaerobic threshold VO₂ < 11 mL/kg/min and peak VO₂ < 20 mL/kg/min) and normal groups. The skeletal muscle index (SMI) was measured using dual-energy x-ray absorptiometry from baseline to 3 years post-transplantation. Multivariable linear regression and correlation analyses were performed to identify predictors of long-term SMI improvement.</div></div><div><h3>Results</h3><div>Forty recipients were analyzed, including 12 (30%) in the low-tolerance group. Following transplantation, the median SMI in both groups decreased at 6 months and improved thereafter. However, from 1 year after transplantation onwards, the normal group demonstrated a significant increase in SMI compared with the low-tolerance group. Three years after transplantation, the median SMI in the normal group exceeded pretransplant levels and steadily increased, whereas in the low-tolerance group, there was little improvement and no return to baseline (<em>P</em> ≤ .05). Multivariable analysis identified low preoperative exercise tolerance as an independent predictor of reduced SMI recovery (<em>P</em> ≤ .05). Correlation analysis revealed that preoperative anaerobic threshold VO₂ and peak VO₂ were moderately and significantly associated with 3-year SMI improvement (<em>r</em> = 0.427 and <em>r</em> = 0.607, respectively).</div></div><div><h3>Conclusions</h3><div>Low exercise tolerance before kidney transplantation strongly predicts impaired long-term skeletal muscle recovery. Cardiopulmonary exercise testing-based risk assessment may help identify candidates who could benefit from tailored perioperative rehabilitation strategies to enhance functional outcomes.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 52-57"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.transproceed.2025.12.003
Yi Long , Zijun Zhao , Xianyu Xie , Qinde Wu
Objectives
This study examined and systematically summarized the current research status and characteristics of trends in heart transplantation, emphasizing innovative developments in organ donation and transplantation in China.
Methods
A bibliometric analysis and information visualization were conducted utilizing the literature from the China National Knowledge Infrastructure database from 2015 to 2024. This analysis examines the research status of heart transplantation, concentrating on the number of published documents, ratio of funded papers, authorship of publications, scientific research institutions of the published papers, and relevant keywords.
Results
The annual average number of papers published on heart transplantation was consistently at 169.30. The publications mainly originated from Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, as well as Union Hospital of Tongji Medical College of Huazhong University. The majority of papers were published in Organ Transplantation. The primary research hotspots focused on pre-operative evaluation and prognosis of heart transplantation, experimental studies involving rats and mice, immune tolerance related to heart transplantation, and cardiac xenotransplantation.
Conclusion
In the past decade, research on heart transplantation has shown consistency. Research predominantly occurs within universities and their affiliated medical institutions, with minimal collaboration among research institutions; research hotspots span multiple fields, incorporating both clinical and basic research.
{"title":"Bibliometric Analysis of Research on Chinese Heart Transplantation Technology under the Background of Innovative Development in Organ Donation and Transplantation","authors":"Yi Long , Zijun Zhao , Xianyu Xie , Qinde Wu","doi":"10.1016/j.transproceed.2025.12.003","DOIUrl":"10.1016/j.transproceed.2025.12.003","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examined and systematically summarized the current research status and characteristics of trends in heart transplantation, emphasizing innovative developments in organ donation and transplantation in China.</div></div><div><h3>Methods</h3><div>A bibliometric analysis and information visualization were conducted utilizing the literature from the China National Knowledge Infrastructure database from 2015 to 2024. This analysis examines the research status of heart transplantation, concentrating on the number of published documents, ratio of funded papers, authorship of publications, scientific research institutions of the published papers, and relevant keywords.</div></div><div><h3>Results</h3><div>The annual average number of papers published on heart transplantation was consistently at 169.30. The publications mainly originated from Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, as well as Union Hospital of Tongji Medical College of Huazhong University. The majority of papers were published in <em>Organ Transplantation</em>. The primary research hotspots focused on pre-operative evaluation and prognosis of heart transplantation, experimental studies involving rats and mice, immune tolerance related to heart transplantation, and cardiac xenotransplantation.</div></div><div><h3>Conclusion</h3><div>In the past decade, research on heart transplantation has shown consistency. Research predominantly occurs within universities and their affiliated medical institutions, with minimal collaboration among research institutions; research hotspots span multiple fields, incorporating both clinical and basic research.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 1-8"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This retrospective single-center cohort study reports the complications and outcomes experienced by living kidney donors.
Methods
Our study involved 464 donors who donated a kidney between January 2004 and March 2023 at the University Hospital Essen.
Results
Of the 452 available donors having clinical assessment for arterial hypertension, 101 (22%) exhibited arterial hypertension at the time of donation, whereas 112 of the 351 (32%) donors without preexisting arterial hypertension experienced new-onset arterial hypertension at follow-up after donation. The development of arterial hypertension after donation was related to male sex, older age, elevated body mass index (BMI), and elevated cholesterol levels at donation but did not relevantly affect renal function after donation. Preexisting arterial hypertension was associated with a reduction in the estimated glomerular filtration rate (eGFR) and an increase in creatinine levels at donation and over the entire follow-up period. Follow-up at 1 year after donation found that eGFR levels were significantly lower than predonation levels (P < .0001). No significant changes in the incidence of proteinuria (P = .20) or albuminuria (P = .17) were found at 1-year follow-up. At 1 year after donation, 98 of 270 (36%) available donors had retained 70% or more of their baseline renal function related to eGFR determined at donation.
Conclusions
Our results suggest an increased risk of new-onset arterial hypertension after living kidney donation. The deterioration of renal function was higher after living kidney donation among donors with preexisting arterial hypertension. Among our cohort of 464 donors, living donation was associated with a reduction in renal function.
{"title":"Single-Center Experience With Complications and Clinical Outcomes of 464 Living Kidney Donors","authors":"Nina Mehren , Kristina Schönfelder , Andreas Kribben, Ute Eisenberger, Christiane Jürgens, Justa Friebus-Kardash","doi":"10.1016/j.transproceed.2025.11.009","DOIUrl":"10.1016/j.transproceed.2025.11.009","url":null,"abstract":"<div><h3>Background</h3><div>This retrospective single-center cohort study reports the complications and outcomes experienced by living kidney donors.</div></div><div><h3>Methods</h3><div>Our study involved 464 donors who donated a kidney between January 2004 and March 2023 at the University Hospital Essen.</div></div><div><h3>Results</h3><div>Of the 452 available donors having clinical assessment for arterial hypertension, 101 (22%) exhibited arterial hypertension at the time of donation, whereas 112 of the 351 (32%) donors without preexisting arterial hypertension experienced new-onset arterial hypertension at follow-up after donation. The development of arterial hypertension after donation was related to male sex, older age, elevated body mass index (BMI), and elevated cholesterol levels at donation but did not relevantly affect renal function after donation. Preexisting arterial hypertension was associated with a reduction in the estimated glomerular filtration rate (eGFR) and an increase in creatinine levels at donation and over the entire follow-up period. Follow-up at 1 year after donation found that eGFR levels were significantly lower than predonation levels (<em>P</em> < .0001). No significant changes in the incidence of proteinuria (<em>P</em> = .20) or albuminuria (<em>P</em> = .17) were found at 1-year follow-up. At 1 year after donation, 98 of 270 (36%) available donors had retained 70% or more of their baseline renal function related to eGFR determined at donation.</div></div><div><h3>Conclusions</h3><div>Our results suggest an increased risk of new-onset arterial hypertension after living kidney donation. The deterioration of renal function was higher after living kidney donation among donors with preexisting arterial hypertension. Among our cohort of 464 donors, living donation was associated with a reduction in renal function.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 15-27"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.transproceed.2025.10.030
Olgar Öcal , Aslı Çetinkaya Yaprak , Zeki Demirok , Tevfik Serhat Bahar , Ömer Özkan , Özlenen Özkan , İsmail Demiryılmaz , Abdullah Kısaoğlu , Muhittin Yaprak
Purpose
To assess long-term ocular complications and identify factors affecting these complications who have undergone liver transplantation.
Methods
We included 147 patients who had a complete ophthalmologic examination at least 1 year after liver transplantation. The patients were divided into two groups: adult (group 1) and pediatric liver transplant patients (group 2). Data collected included best corrected visual acuity, intraocular pressure (measured with Full Auto Tonometer TX-F; Topcon), refractive error (measured with KR-8900; Topcon, Tokyo, Japan), slit-lamp examination of the anterior segment, and dilated fundus examination for both eyes. Refractive error, lens opacity, eye dryness, pterygium pinguecula, arcus lipoides, corneal calcification, macular drusen, central serous chorioretinopathy, hypertensive retinopathy, and diabetic retinopathy were all recorded. All patients received a maintenance immunosuppressive protocol consisting of combinations of steroids, calcineurin inhibitors, mycophenolate mofetil, and mammalian target of rapamycin inhibitors.
Results
Our study included 106 recipients in group 1 and 41 recipients in group 2. In group 1, 8 participants (7.5%); in group 2, 5 participants (12.2%) needed myopic correction. Additionally, 12 participants (11.3%) in group 1 required hyperopic correction, compared to 2 participants (4.9%) in group 2. No statistically significant difference was found between the two groups (P > .05). Regarding anterior segment findings, 18 participants (16%) in group 1 and 1 recipients (2.4%) in group 2 were diagnosed with dry eye, with a statistically significant higher incidence in group 1 (P = .02). The rates of arcus lipoides, pterygium, pinguecula, cataract, and glaucoma were similar in both groups (P > .05). For posterior segment findings were higher in the adult group, no statistically significant difference was found (P > .05). We identified dry eyes and cataracts as the most common ocular complications and more prevalent in group 1.
Conclusion
Different ocular complications involving the anterior and posterior segments can be seen in the long-term after liver transplantation. The fact that postoperative anterior and posterior segment complications were statistically higher in the adult age group suggests that the risk of postoperative complications may be related to age and age-related systemic diseases such as diabetes, hypertension; or cumulative drug use.
{"title":"Evaluation of Long-Term Ocular Findings in Liver Transplant Patients: Comparison of Pediatric and Adult Age Groups","authors":"Olgar Öcal , Aslı Çetinkaya Yaprak , Zeki Demirok , Tevfik Serhat Bahar , Ömer Özkan , Özlenen Özkan , İsmail Demiryılmaz , Abdullah Kısaoğlu , Muhittin Yaprak","doi":"10.1016/j.transproceed.2025.10.030","DOIUrl":"10.1016/j.transproceed.2025.10.030","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess long-term ocular complications and identify factors affecting these complications who have undergone liver transplantation.</div></div><div><h3>Methods</h3><div>We included 147 patients who had a complete ophthalmologic examination at least 1 year after liver transplantation. The patients were divided into two groups: adult (group 1) and pediatric liver transplant patients (group 2). Data collected included best corrected visual acuity, intraocular pressure (measured with Full Auto Tonometer TX-F; Topcon), refractive error (measured with KR-8900; Topcon, Tokyo, Japan), slit-lamp examination of the anterior segment, and dilated fundus examination for both eyes. Refractive error, lens opacity, eye dryness, pterygium pinguecula, arcus lipoides, corneal calcification, macular drusen, central serous chorioretinopathy, hypertensive retinopathy, and diabetic retinopathy were all recorded. All patients received a maintenance immunosuppressive protocol consisting of combinations of steroids, calcineurin inhibitors, mycophenolate mofetil, and mammalian target of rapamycin inhibitors.</div></div><div><h3>Results</h3><div>Our study included 106 recipients in group 1 and 41 recipients in group 2. In group 1, 8 participants (7.5%); in group 2, 5 participants (12.2%) needed myopic correction. Additionally, 12 participants (11.3%) in group 1 required hyperopic correction, compared to 2 participants (4.9%) in group 2. No statistically significant difference was found between the two groups (<em>P</em> > .05). Regarding anterior segment findings, 18 participants (16%) in group 1 and 1 recipients (2.4%) in group 2 were diagnosed with dry eye, with a statistically significant higher incidence in group 1 (<em>P</em> = .02). The rates of arcus lipoides, pterygium, pinguecula, cataract, and glaucoma were similar in both groups (<em>P</em> > .05). For posterior segment findings were higher in the adult group, no statistically significant difference was found (<em>P</em> > .05). We identified dry eyes and cataracts as the most common ocular complications and more prevalent in group 1.</div></div><div><h3>Conclusion</h3><div>Different ocular complications involving the anterior and posterior segments can be seen in the long-term after liver transplantation. The fact that postoperative anterior and posterior segment complications were statistically higher in the adult age group suggests that the risk of postoperative complications may be related to age and age-related systemic diseases such as diabetes, hypertension; or cumulative drug use.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"58 1","pages":"Pages 102-106"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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