Transplant immunology最新文献

{"title":"Immunomodulation in post-transplant diabetes mellitus: Challenges and management","authors":"Hanan Maoz,&nbsp;Amir Elalouf","doi":"10.1016/j.trim.2025.102304","DOIUrl":"10.1016/j.trim.2025.102304","url":null,"abstract":"<div><div>Solid organ transplantation (SOT) in diabetic patients presents unique challenges in balancing immunosuppression, glycemic control, and the risk of infection. Post-transplant diabetes mellitus (PTDM) affects 10 %–40 % of transplant recipients, with immunosuppressive therapies such as corticosteroids and calcineurin inhibitors (CNIs) contributing to insulin resistance and impaired beta-cell function. This review critically examines immunomodulation strategies in diabetic SOT recipients, focusing on optimizing immunosuppressive therapy while mitigating hyperglycemia-related complications. Early glycemic control through insulin therapy, followed by a transition to oral hypoglycemic agents such as metformin, GLP-1 receptor agonists, and DPP-4 inhibitors, has proven effective in reducing PTDM and enhancing long-term transplant outcomes. Alternative immunosuppressive strategies, including belatacept-based regimens and switching from tacrolimus to cyclosporine, offer promising methods to lower PTDM incidence while preserving graft survival. Personalized immunosuppressive regimens tailored to an individual's metabolic risks further improve patient outcomes. Emerging strategies, such as monoclonal antibodies, mesenchymal stem cell therapy, and localized immunomodulation, hold promise for enhancing immune balance while mitigating metabolic complications. A multidisciplinary team involving endocrinologists, transplant surgeons, and diabetes specialists is essential for comprehensive management. Additionally, routine screening for new-onset diabetes after transplantation (NODAT) and early interventions are vital to prevent long-term complications. Despite advancements, gaps remain regarding the long-term metabolic effects of immunosuppressive agents, the optimal timing for transitioning from insulin to oral therapy, and the role of new immunomodulatory treatments. Future research should focus on personalized therapeutic approaches that combine immunosuppressive and metabolic management to improve graft function and patient health. This review highlights the importance of a balanced approach to immunosuppression for diabetic transplant recipients, aiming to enhance survival rates and quality of life.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102304"},"PeriodicalIF":1.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287136","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":"WITHDRAWN: Pretreatment hemoglobin, myeloma subtype, and induction regimens as independent prognostic factors for survival after autologous stem cell transplantation in multiple myeloma: A retrospective cohort study","authors":"Yong Zhang, Guangzhong Yang, Wen Gao, Wenming Chen","doi":"10.1016/j.trim.2025.102305","DOIUrl":"10.1016/j.trim.2025.102305","url":null,"abstract":"<p><p>This article has been withdrawn at the request of the author(s) and/or editor due to an error in the publishing process. The Publisher apologizes for any inconvenience this may cause.\u0000The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies-and-standards/article-withdrawal</p>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":" ","pages":"102305"},"PeriodicalIF":1.4,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245154","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":"Risk factors for acute rejection in pediatric kidney transplantation","authors":"Roman Gorchs ,&nbsp;Matt Stout ,&nbsp;Brooke Cohen ,&nbsp;Jaden Ju ,&nbsp;Eileen Brewer ,&nbsp;Nhu Thao Nguyen Galván ,&nbsp;Abbas Rana","doi":"10.1016/j.trim.2025.102273","DOIUrl":"10.1016/j.trim.2025.102273","url":null,"abstract":"<div><h3>Background</h3><div>Acute rejection in pediatric kidney transplant patients can increase posttransplant costs and lead to limited survival of the graft. Identifying key risk factors for acute rejection in pediatric kidney recipients may allow for physicians to better tailor immunosuppressant regimens and decrease the occurrence of acute rejection.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed using kidney transplantation data provided by the United Network for Organ Sharing (UNOS) for patients younger than 18 years old who received their first kidney transplant between January 2005 and December 2022. The resulting study population consisted of 10,126 patients over the 18-year span. Risk factors for acute rejection in the first year post-transplant were identified using a multivariate analysis.</div></div><div><h3>Results</h3><div>Several variables were found to be statistically significant risk factors for acute rejection, including donor age ≤ 10 (Odds Ratio 1.44), Obese BMI (BMI-for-age z-score &gt; 2.0), (Odds Ratio 1.22), a 6 Human Leukocyte Antigen (HLA) mismatch (Odds Ratio 1.22) and recipient age between 15 and 18 (Odds Ratio 1.21). Multiple factors were found to be protective, including male sex (Odds Ratio 0.85) and recipient age between 5 and 10 (Odds Ratio 0.79).</div></div><div><h3>Conclusions</h3><div>The results indicate several significant risk factors such as the recipient age, Body Mass Index, sex and the number of HLA mismatches between the donor and the recipient. Physicians should consider these factors when personalizing immunosuppressive regimens for pediatric kidney transplant patients.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102273"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761451","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":"Pre-transplant sensitization and its effect on heart transplant rejection and survival outcomes","authors":"Kyung-Hwa Shin ,&nbsp;Soo Yong Lee ,&nbsp;Min Ho Ju ,&nbsp;Hyun-Ji Lee","doi":"10.1016/j.trim.2025.102264","DOIUrl":"10.1016/j.trim.2025.102264","url":null,"abstract":"<div><h3>Background</h3><div>Sensitization of heart transplant (HT) recipients increases the risk of rejection. Assessment of sensitization using a calculated panel reactive antibody (cPRA) is crucial for evaluating transplant compatibility and predicting outcomes. This study investigated the impact of cPRA and pre-existing and <em>de novo</em> Human Leukocyte Antigen (HLA)-donor-specific antibodies (DSAs) on HT outcomes and aimed to identify recipients at a high risk of rejection.</div></div><div><h3>Methods</h3><div>This retrospective study included 121 adult recipients of HT from a single institution (2014–2023). cPRA values, flow cytometric crossmatches (FCXM), and DSAs were analyzed for their associations with antibody-mediated rejection (AMR) and T cell-mediated rejection (TCMR).</div></div><div><h3>Results</h3><div>Among the 121 HT recipients, 51.2 % experienced TCMR and 7.4 % experienced AMR. cPRA (I) ≥ 50 % was significantly associated with AMR, pre-existing DSA (pDSA), and positive FCXM. pDSA was present in 16.5 % of HT recipients and correlated with AMR but not mortality. <em>De novo</em> DSAs frequently emerged in 38 % of the recipients following TCMR episodes. Higher cPRA (I) levels correlated with increased rejection risk and shorter AMR-free survival.</div></div><div><h3>Conclusions</h3><div>High cPRA (≥50 %) significantly predicted the risk of AMR and correlated with pDSA and positive FCXM results. Pre-transplant cPRA assessment is crucial for identifying high-risk recipients and optimizing management strategies to improve HT outcomes.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102264"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708968","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":"The KIR/HLA class I co-expression and transplantation outcomes after HSCT/BMT from HLA-matched sibling donors","authors":"Joanna Dębska-Zielkowska ,&nbsp;Bartosz Słomiński ,&nbsp;Hanna Zielińska ,&nbsp;Anna Dukat-Mazurek ,&nbsp;Grażyna Moszkowska ,&nbsp;Maria Bieniaszewska ,&nbsp;Jan Maciej Zaucha ,&nbsp;Piotr Trzonkowski ,&nbsp;Maciej Zieliński","doi":"10.1016/j.trim.2025.102274","DOIUrl":"10.1016/j.trim.2025.102274","url":null,"abstract":"<div><h3>Background</h3><div>Natural killer (NK) cells express killer immunoglobulin-like receptors (KIRs), which regulate their functions. Self-human leukocyte antigens (HLA) class I molecules act as inhibitory molecules for KIRs, blocking the killing activity of NK cells. Since normal NK activity may affect the outcomes of hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT) from their HLA-matched sibling donors, we investigated the interaction between KIRs and class I HLA presented on NK cells. Complications such as graft-versus-host disease (GvHD) or transplant rejection may result because of deficient expression of class I HLA ligand inhibitors in the transplant recipient.</div></div><div><h3>Methods</h3><div>We examined the effect of missing KIR ligands (MSL) and KIR haplotypes on GvHD development, relapses, death, infections, and cell recovery in HSCT patients. Our group included 59 patients [<em>n</em> = 24 with acute myeloid leukemia (AML), <em>n</em> = 12 with chronic myeloid leukemia (CML), n = 12 with myelodysplastic syndrome (MDS), and <em>n</em> = 11 with acute lymphoblastic leukemia (ALL)], who received HSCT/BMT from their sibling donors.</div></div><div><h3>Results</h3><div>Our results showed that haplotype AA was more common than Bx in donors for patients with MDS and was associated with a higher incidence of chronic (c) GvHD (<em>p</em> = 0.003). In this group, we also observed a statistically significant relationship between the AA donor haplotype and absolute neutrophil count reconstruction of 0.5 G/l (0.5 × 10⁹ cells/L) under 28 days (<em>p</em> = 0.03). Our results also showed an excellent correlation between KIR MSL values and cGvHD in AML patients (<em>r</em> = 0.9932).</div></div><div><h3>Conclusion</h3><div>Our results indicate that KIR/HLA class I analysis at the stage of selection of a related donor could have an impact on the results of hematological transplantation and possibly reduce complications.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102274"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795634","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":"Identification of allogeneic and xenogeneic neural stem cells' immunogenicity in the brain and strategies to alleviate transplantation rejection","authors":"Xiangyu Ma ,&nbsp;Ho Jin Lee ,&nbsp;Dong Oh. Kim ,&nbsp;Young Do Kwon ,&nbsp;Geun-Hyoung Ha ,&nbsp;Chung Kwon Kim ,&nbsp;Hyun Nam ,&nbsp;Je Young Yeon ,&nbsp;Kyunghoon Lee ,&nbsp;Sun-Ho Lee ,&nbsp;Kyeung Min Joo","doi":"10.1016/j.trim.2025.102247","DOIUrl":"10.1016/j.trim.2025.102247","url":null,"abstract":"<div><div>Neural stem cells (NSCs) are a promising therapy for central nervous system (CNS) disorders, yet post-transplant immune rejection critically compromises their survival and efficacy. In this study, we demonstrated the neuroinflammatory responses triggered by syngeneic, allogeneic, and xenogeneic NSCs transplantation, and evaluated the immunosuppressive effects of cyclosporine A (CyA) and methylprednisolone (MP) on graft rejection. Our findings revealed that xenogeneic NSCs transplantation induced infiltration of neutrophils (<em>p</em> &lt; 0.0001<strong>)</strong>, microglia/macrophages (<em>p</em> &lt; 0.0001<strong>)</strong>, CD4⁺ and CD8⁺ T cells (<em>p</em> &lt; 0.0001<strong>)</strong>, while allogeneic transplantation primarily triggered microglia/macrophages (<em>p</em> &lt; 0.0005) recruitment. Both transplantation types caused a sharp decline in grafted cell numbers (<em>p</em> &lt; 0.005). Combinatorial CyA and MP treatment significantly attenuated xenogeneic immune rejection and markedly increased surviving graft cells in the brain. Similarly, MP monotherapy effectively reduced allogeneic rejection and enhanced transplanted cell survival. Overall, allogeneic NSCs transplantation primarily triggers innate immunity, while xenogeneic transplantation causes both innate and adaptive immune responses. Accordingly, xenogeneic transplantation required combined CyA and MP therapy, whereas MP monotherapy mitigated rejection in allogeneic transplantation. Our findings may offer a strategy to mitigate transplantation rejection of allogeneic and xenogeneic NSCs in the brain, thereby optimizing the microenvironment for NSC-based therapies in preclinical and clinical applications for various CNS disorders.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102247"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222642","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":"Identification of genes associated with liver ischemia-reperfusion injury after liver transplantation by WGCNA and PPI network analyses","authors":"Li Jin ,&nbsp;Zhuo Cheng ,&nbsp;Bo Yuan ,&nbsp;Siming Qu ,&nbsp;Jie Lin ,&nbsp;Lin Deng ,&nbsp;Benkai Wei ,&nbsp;Hangpin Wang ,&nbsp;Youzhi Ye ,&nbsp;Zhong Zeng ,&nbsp;Hanfei Huang","doi":"10.1016/j.trim.2025.102249","DOIUrl":"10.1016/j.trim.2025.102249","url":null,"abstract":"<div><div>Liver transplantation is the only effective treatment for end-stage liver disease. The success of transplantation largely relies on liver ischemia/reperfusion injury (LIRI). However, the pathogenesis of LIRI remains unclear. In this study, we used the public dataset GSE12720, which contains liver transplants from both living and deceased donors, to identify differentially expressed genes (DEGs) before and after reperfusion. Weighted gene co-expression network analysis (WGCNA) was used to identify related genes. A protein–protein interaction network containing 85 overlapping DEGs and WGCNA genes was constructed. Using Molecular Complex Detection and cytoHubba plug-ins in Cytoscape and Kyoto Encyclopedia of Genes and Genomes analyses, we identified 5 core pathways and 13 hub genes (<em>IL-1β, JUN, TNFAIP3, CCL2, ICAM1, CCL20, SOCS3, IRF1, BIRC3, GADD45B, MYC, CCL4, and BCL2A1</em>). These findings were validated using two independent datasets (GSE14951 and GSE15480) and a mouse LIRI model, which effectively confirmed the expression levels of 13 hub genes. This study aimed to use advanced bioinformatics methods to investigate hub genes related to LIRI to identify new biomarkers and improve our understanding of LIRI pathogenesis.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102249"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286589","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":"Using machine learning to examine pre-transplant factors influencing De novo HLA-specific antibody development post-kidney transplant","authors":"George E. Nita ,&nbsp;Alex Rothwell ,&nbsp;Matthew Howse ,&nbsp;Dan Ridgway ,&nbsp;Abdul Hammad ,&nbsp;Sanjay Mehra ,&nbsp;Andrew R. Jones ,&nbsp;Petra Goldsmith","doi":"10.1016/j.trim.2025.102269","DOIUrl":"10.1016/j.trim.2025.102269","url":null,"abstract":"<div><h3>Introduction</h3><div>The development of <em>de novo</em> donor-specific antibodies (DSAs) against HLA is associated with premature graft failure in kidney transplantation. However, reported rates and contributing factors vary widely. We aimed to identify pre-transplant factors influencing <em>de novo</em> HLA-specific antibody development using machine learning (ML).</div></div><div><h3>Methods</h3><div>Data from 460 kidney transplant recipients at a single centre (2009–2014) was analysed. Pre-transplant clinical and immunological variables were collected, and post-transplant sera were screened for HLA antibodies. Positive samples underwent Single Antigen Bead (SAB) testing. ML models (CART, RF, XGBoost, CatBoost) were trained on a set of pre-transplant data to predict <em>dn</em>DSA formation, with and without SMOTE oversampling. Model performance was evaluated using F1 scores, and feature importance was assessed using SHAP.</div></div><div><h3>Results</h3><div>In the full cohort, 115 patients (25 %) developed <em>dn</em>HLA-specific antibodies, including 36 (31 %) with <em>dn</em>DSAs. XGBoost achieved the best performance (F1 0.54–0.59 without SMOTE; 0.72–0.79 with SMOTE). Univariate analysis identified significant predictors: pre-transplant HLA-specific antibodies (<em>p</em> &lt; 0.001), prior transplantation (p &lt; 0.001), cold ischaemia time (CIT) (<em>p</em> = 0.02), female gender (<em>p</em> = 0.01), younger age (<em>p</em> = 0.03), HLA mismatch (p = 0.01), aminoacid mismatch (p = 0.01), and depleting induction (p = 0.01). SHAP plots confirmed the importance of pre-existing antibodies and re-transplantation. Extremes of CIT and age ≥ 65 was associated were associated with reduced predicted risk. Model performance in the unsensitised subgroup was limited (F1 &lt; 0.2).</div></div><div><h3>Conclusion</h3><div>ML models can be used to identify pre-transplant risk factors for <em>de novo</em> HLA-specific antibody development. Monitoring and risk-stratification based on these factors may inform immunological strategies and recipient selection to improve long-term allograft outcomes.</div></div><div><h3>Translational statement</h3><div>This study identified pre-transplant risk factors for the development of <em>de novo</em> DSA in kidney transplantation. Monitoring and risk-stratifying patients based on these factors may help guide preventive immunological strategies and recipient selection to improve long-term allograft outcomes.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102269"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804933","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":"Immunosuppression minimization and withdrawal in liver transplantation: The “holy grail”?","authors":"V.U. Lakshmi ,&nbsp;Mohammed Riyas ,&nbsp;Dinesh Balakrishnan ,&nbsp;M.P. Narmadha ,&nbsp;S. Sudhindran","doi":"10.1016/j.trim.2025.102248","DOIUrl":"10.1016/j.trim.2025.102248","url":null,"abstract":"<div><div>Liver transplantation typically necessitates the use of life long immunosuppressive drugs, to suppress the immune system and minimize the risk of rejection. Prolonged use of immunosuppressive drugs can, however, lead to various side effects, including an increased risk of infections, renal dysfunction, and several metabolic complications. To address this, transplant professionals work to tailor immunosuppression to the patient needs, with the ultimate goal of minimizing drug doses.The “holy grail” of immunosuppression following liver transplantation has been its complete withdrawal. Over the past decade, researchers have juggled with immunosuppression minimization in recipients of liver grafts, but the results were disparate due to the diversity in study designs and limited sample size. Nevertheless, immunosuppression withdrawal has been observed possible in approximately 20 % of strictly selected recipients, particularly in extremes of age and when performed over a prolonged period. The predominant stumbling-block was the occurrence of rejection during the process of immunosuppression withdrawal. Currently, there is a lack of scientific evidence for selecting patients in whom immunosuppressant minimization would be possible without risk of allograft rejection and on the precise methods of immunosuppression withdrawal.The development of clinical tools for personalized medication adjustments and a broader comprehension of the pathogenesis of late graft rejection are essential for this. This article centers on the physiological mechanisms of immune tolerance, strategies for minimizing and withdrawing immunosuppression after liver transplantation, and the biomarkers indicative of sustained tolerance in liver transplantation.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102248"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226842","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":"Long-term outcomes of ABO-incompatible kidney transplantation in Argentina: A 10-years single-center experience","authors":"Carlos Chiurchiu ,&nbsp;Pehuén Fernández ,&nbsp;Walter Douthat ,&nbsp;Javier de Arteaga ,&nbsp;Esteban Metrebian ,&nbsp;Raul Colla ,&nbsp;Alejandro Martinez Colombres ,&nbsp;Guillermo Paladini ,&nbsp;Juan Carlos Damonte ,&nbsp;Virginia Damonte ,&nbsp;Luciana Mas ,&nbsp;Emanuel José Saad ,&nbsp;Jorge de la Fuente","doi":"10.1016/j.trim.2025.102266","DOIUrl":"10.1016/j.trim.2025.102266","url":null,"abstract":"<div><h3>Introduction</h3><div>ABO-incompatible (ABOi) kidney transplantation is a feasible option for patients without ABO-compatible (ABOc) living donors. However, its impact on rejection rates and long-term outcomes remains debated. This study aims to compare rejection incidence, graft survival, and patient outcomes between ABOi and ABOc kidney transplant recipients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, observational, analytical cohort study at the Hospital Privado Universitario de Córdoba, including all ABOi living donor kidney transplants performed between July 2014 and August 2024. For each ABOi recipient, an ABOc counterpart was matched based on age (±5 years), transplant date (±1 year), and sex (when possible). Patients were followed for up to 10 years post-transplant. Immunosuppressive protocols and infectious prophylaxis followed institutional guidelines.</div></div><div><h3>Results</h3><div>Of 217 living donor kidney transplants, 33 (15.2 %) were ABOi. No significant differences were found between ABOi and ABOc groups in demographic or clinical baseline characteristics, except for donor age (<em>p</em> = 0.026). There were no differences in graft function, major complications, graft loss, or mortality between groups. Acute rejection occurred in 11 ABOi patients (9 humoral, 2 cellular) and 10 ABOc patients (5 humoral, 4 cellular, 1 mixed), with no significant differences. The 10-year overall patient survival was 82.8 % for ABOi and 83.7 % for ABOc, while death-censored graft survival was 96.4 % and 91.7 %, respectively. The non-use of thymoglobulin was the only independent predictor of rejection (aOR = 5.44; 95 % CI = 1.16–25.5; <em>p</em> = 0.031).</div></div><div><h3>Conclusion</h3><div>ABOi kidney transplantation demonstrates comparable long-term outcomes to ABOc transplantation. It is a viable and safe alternative for patients lacking ABO-compatible living donors.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102266"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683201","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}