Transplantation proceedings最新文献

{"title":"Extracorporeal Support Can Avoid Pediatric Donor Organ Donation Failure Caused by Unfinished Brain Death Determination","authors":"Rongfang Deng ,&nbsp;Chaoyang Gong ,&nbsp;Decheng Deng ,&nbsp;Jingcai Hou ,&nbsp;Weixiang Cheng ,&nbsp;Guojun Li ,&nbsp;Xiaozu Liao ,&nbsp;Yi Yu","doi":"10.1016/j.transproceed.2025.10.019","DOIUrl":"10.1016/j.transproceed.2025.10.019","url":null,"abstract":"<div><h3>Background</h3><div>Unstable donors increase the difficulty and unpredictability of organ donation. The unsuccessful maintenance of unstable donors not only impacts the quality of donor organs, but may also affect the determination of brain or heart death. Two clinical determinations of pediatric brain death in most countries are a requirement. However, an emergency situation, such as cardiac arrest, could be encountered during the brain death determination process.</div></div><div><h3>Case Report</h3><div>An 11-year-old boy (145 cm tall and weighing 40 kg) weigh suffered from craniocerebral injury after a fall 6 days before being admitted to the local hospital on June 9, 2021. He was confirmed to satisfy the pediatric brain death criteria during a first determination. However, sudden cardiac arrest occurred owing to hemodynamic instability and infection. According to the Chinese pediatric brain death determination guideline, Maastricht class Ⅳ donation after circulatory death was not permitted owing to the incomplete determination of brain death. The conditions for Maastricht class Ⅴ donation after circulatory death were also not met because the donor was far from the operating room. Extracorporeal membrane oxygenation support was initiated, with a rotational speed of 2400 rotations per minute, a flow rate of 2.4 to 2.6 L/min, and a fraction of inspired oxygen of 100%. The patient was returned to a stable state with evidence of a normal electrocardiogram and blood oxygen saturation of 100%. The second brain death determination was successfully implemented, leading to successful donation and organ transplantation.</div></div><div><h3>Conclusion</h3><div>When cardiac arrest occurs between the 2 required pediatric brain death determinations, promptly initiating extracorporeal support for donor maintenance and completing the second brain death assessment is more advantageous than proceeding directly to Maastricht category donation after circulatory death.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1844-1848"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461009","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}

{"title":"Perceptions of Health-Related Quality of Life Among Heart Transplant Recipients: A Qualitative Study","authors":"Redouane Mahmoudi ,&nbsp;Pascal Battistella ,&nbsp;Laurent Sebbag ,&nbsp;Latame Komla Adoli ,&nbsp;Francis Guillemin ,&nbsp;Cécile Couchoud","doi":"10.1016/j.transproceed.2025.10.025","DOIUrl":"10.1016/j.transproceed.2025.10.025","url":null,"abstract":"<div><h3>Background</h3><div>There is a need to improve knowledge of the health-related quality of life (HRQoL) in the post-heart transplantation (HTx) period and the factors affecting it. This qualitative study aimed to identify the most important domains of HRQoL for heart transplant recipients and the factors that impact it.</div></div><div><h3>Methods</h3><div>This was a qualitative study across 5 geographically diverse large HTx centers in France from July 2022 to January 2023. We gathered a purposive sample of individuals who had undergone HTx. A face-to-face semi-structured interview guide was used for individual interviews. All interviews were audio-recorded and transcribed verbatim.</div></div><div><h3>Results</h3><div>A total of 14 individuals (10 men) were interviewed. The data analysis led to the development of 8 main themes (with sub-themes) that were relevant to participants: HRQoL perception (mental health, physical capacity, symptoms and comorbidities), participants’ experience during the HTx process, immunosuppressive treatments, relationship with the healthcare team, external and internal resources, socio-economic aspects and feelings about the donor. Recipients, spontaneously made connections between these themes.</div></div><div><h3>Conclusions</h3><div>Heart transplant recipients had diverse perceptions of their HRQoL in the post-HTx period. The rich variety of themes identified from the review highlights that recipients have a complex HRQoL profile which is not currently captured by standard HRQoL tools that are commonly employed. These aspects should be taken into account in the clinical follow-up and in the selection of the most appropriate Patient Reported Outcome Measures (PROMs).</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 2010-2021"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411422","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}

{"title":"Enhancing Organ Donation from Brain-Dead Patients: Efficacy of an Innovative Physician-Patient Communication Model","authors":"Min Zhang,&nbsp;Gaosheng Zhou","doi":"10.1016/j.transproceed.2025.10.024","DOIUrl":"10.1016/j.transproceed.2025.10.024","url":null,"abstract":"<div><h3>Objective</h3><div>To identify factors influencing organ donation success among brain-dead patients and evaluate the efficacy of a novel physician-patient communication model (“1T+3S Principles” and “T-F-B Framework”).</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, 153 eligible brain-dead patients from a tertiary ICU (September 2020-December 2023) were allocated to a control group (conventional communication, n = 77) or study group (innovative model, n = 76). Donation success rates, organ utilization, and predictive factors were analyzed.</div></div><div><h3>Results</h3><div>The study group demonstrated significantly higher donation success rates (heart: 27.63% vs. 3.90%; liver: 26.32% vs. 3.90%; kidney: 25.00% vs. 3.90%; all <em>P &lt; .</em>001) and organ utilization (<em>P &lt; .</em>05). Key success predictors included: higher education (Master’s↑: OR = 5.65, <em>P = .</em>010), hospitalization &gt;7 days (OR = 7.70, <em>P &lt; .</em>001), fewer immediate family members (OR = 6.58, <em>P &lt; .</em>001), and reduced extended family intervention (OR = 7.16, <em>P &lt; .</em>001). Low-income families (Monthly income&lt;3000 RMB) showed greater donation acceptance (<em>P = .</em>003).</div></div><div><h3>Conclusion</h3><div>The innovative communication model significantly improves donation success, particularly among educated, low-income families with streamlined decision-makers. Systematic adoption of this framework could mitigate China’s organ shortage crisis.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1849-1855"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446886","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}

{"title":"De Novo HLA-DQ Donor-Specific Antibody Incidence in Korean Deceased Donor Solid Organ Transplant Recipients","authors":"Si-Hwan Kim,&nbsp;Sang-Hyun Hwang,&nbsp;Heung-Bum Oh","doi":"10.1016/j.transproceed.2025.10.029","DOIUrl":"10.1016/j.transproceed.2025.10.029","url":null,"abstract":"<div><h3>Introduction</h3><div>De novo human leukocyte antigen-DQ (HLA-DQ) donor-specific antibodies (DSAs) significantly impact graft survival after solid organ transplantation. In Korea, where organ allocation policies do not mandate DQ typing, detection of DQ de novo donor-specific antibodies (dnDSAs) remains challenging. This retrospective single-center study investigated the incidence of DQ dnDSAs and its association with DQ mismatches among Korean deceased donor transplantation.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 221 Korean recipients of kidney or heart transplants who underwent deceased donor organ transplantation between 2014 and 2024. Inclusion criteria required the availability of low-resolution HLA typing (A, B, DR, and DQ) and HLA single-antigen antibody testing results during both the pre- and posttransplant periods. Recipients with preformed DSAs were excluded. Kaplan-Meier survival analysis and Cox regression modeling assessed the impact of DQ and DR mismatches on the development of HLA class II (DR/DQ) dnDSA.</div></div><div><h3>Results</h3><div>A total of 9.0% of patients (20 of 221) developed DQ dnDSA, while 11.3% (25 of 221) developed HLA class II dnDSA. Notably, recipients with two antigenic DQ mismatches demonstrated significantly higher cumulative incidence of DQ dnDSA compared with those with fewer mismatches (log-rank test, <em>P</em> = .004). Multivariable analysis identified DQ mismatch as an independent risk factor for the development of HLA class II dnDSA (HR = 2.88; <em>P</em> = .012).</div></div><div><h3>Conclusion</h3><div>Our findings highlight the potential benefits of incorporating routine HLA-DQ typing into deceased donor evaluation and organ allocation policies, which could potentially improve transplantation outcomes in Korea.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 2022-2027"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454477","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}

{"title":"Intraoperative Management of Severe Hyponatremia During Orthotopic Liver Transplant Surgery: Case Series","authors":"Jacob E. Pollard,&nbsp;Alexander A. Vitin,&nbsp;Charles E. Galaviz,&nbsp;H. Cameron Norris,&nbsp;Evelyn C. Loose,&nbsp;Jacob B. Brandenburg,&nbsp;Wendell H. Williams,&nbsp;F. Arran Seiler,&nbsp;Bianca E. Rich,&nbsp;Maegan R. Tupinio,&nbsp;Claire M. Lu","doi":"10.1016/j.transproceed.2025.10.012","DOIUrl":"10.1016/j.transproceed.2025.10.012","url":null,"abstract":"<div><div>Hyponatremia in patients with ESLD is a relatively common and serious condition that warrants gradual and meticulous correction to avoid rapid increase in serum sodium concentration, which can lead to osmotic demyelination syndrome, a devastating, potentially lethal, neurologic complication. Intraoperative management of hyponatremia in patients undergoing a liver transplant presents a substantial challenge because many surgery-related factors can result in a rapid increase in sodium concentration, such as massive transfusion of blood products, fluid shifts, and more. We present two cases, where recipients of liver transplants with severe/profound hyponatremia were successfully managed intraoperatively by using continuous veno-venous hemodialysis with specially modified dialysate.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1944-1949"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461088","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}

{"title":"Understanding Decision Making and Post-Donation Experiences for Robotic Single Port and Laparoscopic Donor Nephrectomy","authors":"Daniel Wang ,&nbsp;Christopher Connors ,&nbsp;Juan Sebastian Arroyave Villada ,&nbsp;Esther Kim ,&nbsp;Julian Snyder ,&nbsp;Micah Levy ,&nbsp;Chih Peng Chin ,&nbsp;Dianne LaPointe Rudow ,&nbsp;Edward Chin ,&nbsp;Alan Benvenisty ,&nbsp;Ron Shapiro ,&nbsp;Daniel Herron ,&nbsp;Sander Florman ,&nbsp;Modassar Awan ,&nbsp;Francisca Larenas ,&nbsp;Michael A. Palese","doi":"10.1016/j.transproceed.2025.10.015","DOIUrl":"10.1016/j.transproceed.2025.10.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Understanding decision-making and post-donation experiences in living kidney donors informs more effective pre-donation counseling and follow-up care. This study examined factors influencing donation decisions and post-operative experiences among patients who underwent laparoscopic donor nephrectomy (LDN) or single port robotic-assisted donor nephrectomy (SPRDN).</div></div><div><h3>Methods</h3><div>We conducted a retrospective survey of patients who underwent LDN or SPRDN by a single surgeon between 2013 and 2024 using a study-specific questionnaire. Participants rated pre-donation factors based on importance in their decision to donate. Responses were analyzed based on donor age, sex and relationship to recipient. Donors then reported on their post-donation experiences, and responses were analyzed by surgical approach.</div></div><div><h3>Results</h3><div>Sixty-eight patients completed the survey (44% response rate). Donors rated long-term renal function and personal fulfillment as the most important factors when deciding to donate. Additionally, female donors prioritized personal fulfillment significantly more than male donors and younger donors were significantly more concerned about post-operative complications and recovery than older donors. After donation, most donors reported increased happiness and minimal quality-of-life impact, though nearly half expressed greater caution in daily activities. Notably, SPRDN donors were significantly more likely to report faster-than-expected recovery compared to LDN donors.</div></div><div><h3>Conclusions</h3><div>Donors prioritize long-term kidney health and personal fulfillment when considering donation, underscoring the need to address these concerns during preoperative counseling. Following donation, ongoing lifestyle education is essential to address persistent post-donation caution and ensure long-term donor well-being. SPRDN is as a promising alternative for LKD, potentially enhancing the donor experience through faster recovery.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1880-1885"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433274","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}

{"title":"Murine Typhus in Heart and Kidney Transplant Recipients: First Reported Cases Diagnosed by Microbial Cell-Free DNA Sequencing","authors":"Baraa Saad ,&nbsp;Sabiha Armin ,&nbsp;Adrienne DaGue ,&nbsp;Lucas S. Blanton ,&nbsp;Rodrigo Hasbun","doi":"10.1016/j.transproceed.2025.10.018","DOIUrl":"10.1016/j.transproceed.2025.10.018","url":null,"abstract":"<div><div>Murine typhus, caused by <em>Rickettsia typhi</em>, is a flea-borne illness that can present as an undifferentiated febrile syndrome and is often underrecognized in immunocompromised individuals. We report the first known cases in heart and kidney transplant recipients, both diagnosed using microbial cell-free DNA (mcfDNA) sequencing. The heart transplant patient presented with encephalopathy and hyponatremia, while the kidney transplant patient had fever and gastrointestinal symptoms. In both cases, mcfDNA sequencing enabled early detection of <em>R. typhi</em> prior to IgG seroconversion, allowing timely initiation of doxycycline and clinical recovery. These cases underscore the protean manifestations of murine typhus in solid organ transplant recipients and the utility of molecular diagnostics in this population. Clinicians should consider murine typhus in febrile transplant patients, especially those residing in or returning from endemic areas, to facilitate early recognition and appropriate treatment.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1988-1991"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433241","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}

{"title":"ABO-Incompatible Liver Transplantation Is an Underused Resource for Improving Access to Liver Transplantation","authors":"Angela L. Hill ,&nbsp;Amen Z. Kiani ,&nbsp;Neeta Vachharajani ,&nbsp;Gregory R. Martens ,&nbsp;Sakil Kulkarni ,&nbsp;Caleb Harsin ,&nbsp;Omar Alomar ,&nbsp;Diego F. Chaparro-Zaraza ,&nbsp;Tess Coker ,&nbsp;Jessica D. Lindemann ,&nbsp;William C. Chapman ,&nbsp;Majella B. Doyle ,&nbsp;Adeel S. Khan","doi":"10.1016/j.transproceed.2025.10.004","DOIUrl":"10.1016/j.transproceed.2025.10.004","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Historically, ABO incompatibility (ABOi) has been considered a relative contraindication to liver transplant (LT) due to inferior postoperative outcomes. We seek to reassess ABOi LTs as an underused graft supply.</div></div><div><h3>METHODS</h3><div>We retrospectively reviewed all adult and pediatric patients who underwent LT, 1987-2022. Recipients were categorized by donor blood type compatibility: incompatible (ABOi), compatible (ABOc), and identical (ABOid). Propensity scoring of 1:1:1 was performed to account for recipient age and acuity at transplant.</div></div><div><h3>RESULTS</h3><div>Of 193,751 LTs, 2699 were ABOi (1.4%). ABOi recipients had the highest proportion of status 1 listings (22.5% versus 20.5% ABOc, 4.9% ABOid, <em>P</em> &lt; 0.0001) and the highest model for end-stage liver disease (30 versus 28 ABOc, 26 ABOid, <em>P</em> &lt; 0.0001) and pediatric end-stage liver disease scores at transplant (33 versus 28 ABOc, 25 ABOid, <em>P</em> &lt; 0.0001). When analyzing the unmatched cohort, ABOi was associated with worse GS (HR 1.2, <em>P</em> &lt; 0.001), OS (HR 1.1, <em>P</em> = 0.033), and increased rates of retransplantation (HR 1.35, <em>P</em> = 0.001). However, after performing propensity matching, there were no differences in GS, OS, or retransplantation between groups.</div></div><div><h3>CONCLUSIONS</h3><div>There is no difference in outcomes between ABOi LT recipients and recipients of ABOc and ABOid grafts after accounting for recipient age and acuity. ABOi LT may decrease blood group disparities and improve timely LT access.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1938-1943"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472597","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}

{"title":"Analysis of Decision-making Behavior and Influencing Factors Among Organ Donor Families in Guangxi","authors":"Xu Zhou ,&nbsp;Yuanyue Zhu ,&nbsp;Zhaoyuan Mo ,&nbsp;Yanbing Wei ,&nbsp;Yuanyuan Gan","doi":"10.1016/j.transproceed.2025.10.020","DOIUrl":"10.1016/j.transproceed.2025.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Organ donation remains a critical and sensitive issue, yet the factors influencing the decision to donate among citizens of potential donors are not well understood. This study aims to explore demographic characteristics, awareness, decision-making process, and factors influencing organ donation willingness among citizens of organ donation candidates.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted in Guangxi, China, between January 2019 and December 2023. A total of 510 citizens (aged 18-70 years) were divided into an agreement group (n = 255) and a disagreement group (n = 255). Data were collected using structured questionnaires and semi-structured interviews, focusing on demographic information, awareness of organ donation, and cultural and emotional factors. Statistical analysis was performed using SPSS 24.0, with chi-square tests and logistic regression to identify key factors affecting organ donation willingness.</div></div><div><h3>Results</h3><div>The study found no significant differences between groups regarding demographic characteristics (<em>P &gt; .</em>05). Approximately 78.2% of participants had heard of organ donation, with those agreeing to donation demonstrating significantly higher levels of understanding (90.2%) compared to those disagreeing (66.3%) (<em>P &lt; .</em>001). Information from medical institutions was the primary source of knowledge for 72.2% of participants, with those who agreed to donation more likely to obtain information from healthcare providers (<em>P &lt; .</em>05). Cultural beliefs and religious views were identified as significant barriers to organ donation, with 53.3% participants feeling that donation conflicted with traditional culture, especially in the disagreeing group (<em>P &lt; .</em>05). Psychological factors, such as emotional reactions to the perceived loss of a loved one, also significantly affected decision-making, with those agreeing to donation more likely to show emotional openness (<em>P &lt; .</em>05). Logistic regression analysis revealed that urban residency (<em>P = .</em>01), fewer extended citizens (<em>P = .</em>03), greater awareness of organ donation (<em>P &lt; .</em>001), and a willingness to forgo life-saving treatment (<em>P = .</em>04) were positive predictors of donation willingness. In contrast, perceived cultural or religious conflicts, emotional aversion to loss, and lack of knowledge were significant predictors of refusal (<em>P &lt; .</em>05).</div></div><div><h3>Conclusions</h3><div>The decision to donate organs is influenced by a complex interplay of demographic, cultural, psychological, and informational factors. Efforts to increase awareness, address cultural and emotional concerns, and provide clear, culturally sensitive information are essential in enhancing organ donation willingness.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1856-1862"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446906","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}

{"title":"From Metro Ticket to a Cape-to-Khartoum Pass: Reimagining Liver Transplantation Criteria for HCC in Sub-Saharan Africa","authors":"Sanju Sobnach ,&nbsp;Urda Kotze ,&nbsp;Inae Kim ,&nbsp;C. Wendy Spearman ,&nbsp;Marc Bernon ,&nbsp;Tinus du Toit ,&nbsp;Mark W. Sonderup ,&nbsp;Muhammad Emmamally ,&nbsp;Luiz F. Zerbini ,&nbsp;Elie Keli ,&nbsp;Abdelmounem Abdo ,&nbsp;Christian Tzeuton ,&nbsp;Eduard Jonas","doi":"10.1016/j.transproceed.2025.10.021","DOIUrl":"10.1016/j.transproceed.2025.10.021","url":null,"abstract":"<div><h3>Background</h3><div>Current liver transplantation (LT) criteria and the Metroticket model were developed in high-income countries (HICs) and may not be appropriate for hepatocellular carcinoma (HCC) patients in sub-Saharan Africa (SSA).</div></div><div><h3>Methods</h3><div>A retrospective observational cohort study of 647 HCC patients managed at Groote Schuur Hospital, Cape Town, South Africa was performed. Our LT experience and outcomes were reviewed, and current transplant criteria (Milan, University of California San Franciso, extended Toronto) were applied to non-transplanted patients. An exploratory cohort was then generated and analysed to inform a regionally adapted LT framework for SSA.</div></div><div><h3>Results</h3><div>Six (0.9%) patients underwent LT with a median survival of 2557.5 (range:1049-3076) days. In the non-transplanted group, 31(4.8%) met at least one LT criterion, of whom 19 (61.3%) were eventually treated with resection (12) and ablation (7). The exploratory cohort (n = 140) was predominantly male (84.2%) with advanced HCC (BCLC stage C/D in 79.2%), but preserved liver function (median MELD-Na of 10 and Child-Turcotte-Pugh grade A disease in 61.4%). Only 16.2% of the exploratory cohort received curative-intended therapies. Patients who underwent LT survived significantly longer than the two other patient groups (<em>P &lt; .</em>001).</div></div><div><h3>Conclusion</h3><div>This study highlights the potential limited applicability of current LT criteria in SSA, where applying criteria, less than 5% of HCC patients qualify. We propose a novel Cape-to-Khartoum framework incorporating clinical and biological parameters, including tumour markers, tumour differentiation and multi-omic profiling. This model may broaden LT eligibility and improve outcomes for HCC in SSA and warrants further validation through multicentre studies across the region.</div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 10","pages":"Pages 1930-1937"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433140","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}