Transplant International最新文献

This study compares outcomes between Simultaneous Pancreas-Kidney Transplantation (SPKT) and Deceased Donor Kidney Transplantation (DDKT) in recipients with diabetes, assessing survival benefits against surgical and immunological risks. We analyzed Scientific Registry of Transplant Recipients data (2014-2023) to assess patient and kidney graft survival. Overlap propensity score weighting was applied to adjust for group differences. Kaplan-Meier and Cox proportional hazards models were used to estimate survival outcomes in unadjusted, covariate-adjusted, and weighted analyses. Among 22,545 recipients with diabetes (25% SPKT), those receiving SPKT were younger (41 vs. 52 years), predominantly non-Hispanic white, had type 1 diabetes, lower BMI, shorter dialysis duration, and higher preemptive transplant rates (all p < 0.001). Overlap-weighted (ow) analyses showed no significant differences in 5- and 10-year patient (SPKT: 86%, 71%; DDKT: 87%, 74%) and kidney graft survival (SPKT: 80%, 66%; DDKT: 83%, 62%). SPKT recipients with graft survival at 1 year experienced higher 1-year treated acute rejection (owOR: 2.80, 95% CI: 1.75-4.49) and hospital readmissions (owOR: 2.05, 95% CI: 1.62-2.60). However, among recipients with type 1 diabetes and BMI <30, SPKT was associated with lower mortality compared to DDKT. After adjustment for selection bias, SPKT did not improve long-term survival compared to DDKT and was associated with greater early morbidity.

The true comparative effectiveness of simultaneous pancreas-kidney transplantation (SPKT) versus kidney transplantation alone (KTA) in patients with diabetes and end-stage renal disease remains incompletely defined. Using the TriNetX Global Collaborative Network (2010-2024), we identified 3,679 SPKT and 27,062 KTA recipients aged 18-59 years. In unmatched comparisons, SPKT recipients showed lower mortality, fewer cardiovascular events, and improved kidney graft survival relative to KTA recipients, but also higher early rejection, infection, and readmission rates. After 1:1 propensity score matching, the cohorts were well balanced across all measured covariates, and long-term estimates for survival (HR 1.00, 95% CI 0.90-1.10), kidney graft failure (HR 0.99, 95% CI 0.94-1.04), and cardiovascular events (HR 0.99, 95% CI 0.94-1.05) no longer differed over 10 years. In contrast, SPKT recipients maintained significantly lower HbA1c levels throughout follow-up (mean 6.2% vs. 6.6% at 5 years; p < 0.001), reflecting sustained physiologic glycaemic control and a high probability of insulin independence. Sensitivity analyses restricted to type 1 diabetes and non-obese recipients yielded consistent results. After accounting for measured differences between recipients, we did not detect a long-term survival advantage of SPKT over KTA, whereas durable metabolic benefits persisted. Because key donor and immunologic characteristics were not available, a modest intrinsic survival benefit cannot be excluded. These findings highlight the major role of patient selection and support individualised use of SPKT for metabolic indications and quality-of-life improvement rather than survival gain alone.

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.