Transplant International最新文献

Transplantation improves survival and quality of life, but rejection remains a major threat to allograft longevity. Current surveillance relies heavily on protocols with clinically indicated biopsies, which are invasive, carry procedure-related risks, and have variable sensitivity due to sampling and interpretation limitations. Percent donor-derived cell-free DNA (%dd-cfDNA) has emerged as a noninvasive blood-based biomarker for allograft injury and a potential rule-out test for rejection. Centralized commercial assays are increasingly used in clinical practice; however, published studies report heterogeneous performance and reveal important blind spots and confounders. This review synthesizes the evidence for %dd-cfDNA in thoracic transplantation, delineates its limitations, and outlines emerging cfDNA methodologies that may reduce reliance on invasive biopsies and enable more individualized monitoring strategies.

Machine perfusion (MP) is rapidly emerging as an alternative to static cold storage in transplantation, providing notable benefits in graft preservation and repair. To better understand the current landscape of machine perfusion in Germany, we conducted a survey among all 39 liver and kidney transplant centers. A total of 22 centers (56%) responded, with 63% (14/22) reporting to have an active MP program. Liver transplantation programs utilize both hypothermic and normothermic perfusion, whereas perfusion strategies in kidney transplantation remain largely limited to hypothermic techniques. Most liver centers (57%; 8/14) apply MP selectively to marginal grafts. 43% (6/14) use it routinely for all accepted organs. Respondents reported an average 10% increase in organ utilization rates attributed to MP. While the clinical benefits of MP are widely acknowledged, key challenges persist, particularly regarding limited funding and insufficient clinical- and research infrastructure. The existing MP programs were predominantly financed through internal funding and only 33% (5/15) had a dedicated perfusion team. Current research in MP focus on viability assessment, objective graft evaluation criteria, organ repair, and strategies to expand the donor pool. Despite promising outcomes and increasing adoption, Germany needs a clear funding framework to fully integrate MP into routine clinical practice.

[This corrects the article DOI: 10.3389/ti.2025.15207.].

Background and aims: Acute liver failure (ALF) is a rare and severe condition with high mortality. Liver transplantation (LT) has improved patient outcomes. This study analysed trends in aetiology, characteristics, and outcomes of ALF patients undergoing LT in Spain.

Methods: We retrospectively reviewed 217 adult ALF-LT cases from 11 Spanish centers (2001 -2020), divided into two 10-year periods. Clinical, biochemical, and outcome data were collected, and predictors of mortality were identified.

Results: 217 adult ALF-LT patients were included (61.8% women, mean age: 41 years). Common aetiologies were cryptogenic (26.7%), autoimmune (26.3%), and viral (18%), with sex differences. Over time, autoimmune and drug-induced liver injury increased (22.3% vs 29.8% and 13.6% vs 21.1%), with a low prevalence of acetaminophen toxicity, and hepatitis B virus declined (23.3% vs 11.4%). Despite higher infection rates (52.5% vs 66.2%) linked to stronger immunosuppression, respiratory failure (29.1% vs 16.1%), chronic kidney disease (27.1% vs 13.6%), cardiovascular events (10.6% vs 1%), and mortality (37.6% vs 17.9%) decreased. Pre-LT hypertension, pre-LT acute kidney injury, and hypernatremia at LT were independently associated with worse survival. This large multicenter study revealed temporal changes in aetiologies, immunosuppressive treatment, and post-LT complications, with an improvement in outcome.

Uterine transplantation has revolutionized previously incurable causes of infertility. While most transplants are performed with live donors, the use of deceased donors could potentially expand the donor pool and increase the number of transplants performed. One limitation of deceased donor use is warm and cold ischemia time, which may be potentially mitigated by the implementation of ex-vivo machine perfusion (EVMP). This comprehensive review synthesizes the existing literature on uterine EVMP, highlighting both experimental and translational developments up to February 2025. A total of 31 relevant studies were identified from 244 screened articles, most involving human aor large-animal uteri. The majority of studies employed normothermic machine perfusion (NMP) as a model for physiologic conditions, focusing on endocrine or functional analysis, inflammatory reactions, or technical aspects of perfusion. Only in the past 6 years have articles looked at EVMP as a preservation technique for transplantation, or employed hypothermic machine perfusion (HMP). While EVMP has only recently increased in popularity for transplant preservation, uterine EVMP has historically been used in multiple studies as a model for physiologic conditions. While further research is needed to optimize preservation protocols, much can be gleaned from prior models of uterine perfusion.