Transplant International最新文献

The shortage of donor organs remains a significant obstacle to addressing the growing demand for lung transplantation. We have developed a mobile EVLP circuit utilizing extracorporeal membrane oxygenation (ECMO) technology. The goals of our study was to evaluate the safety of a cellular-based EVLP system and to assess the efficacy of continuous cytokine removal and the application of bronchodilators during prolonged EVLP. A total of 29 pigs, aged 6-18 months and weighing 93 ± 13.1 kg (mean ± SD), were used in the study. The lungs were randomly allocated into the following groups: Cytosorb group (n = 12), were perfused with an EVLP circuit containing a Cytosorb cartridge, and Control group (n = 12), where lungs were perfused with an EVLP circuit without a Cytosorb cartridge, Bronchodilator group (n = 5) consisted of lungs that were nebulized with a combined bronchodilator every 4 h after the initiation of ventilation and Control group (n = 5) inhaled the control solvent under the same settings. Our study demonstrates that whole blood based perfusate with continuous ultrafiltration for functioning lung in machine perfusion can be straightforward and efficient for at least 24 h. Additional cytokine removal had led to significant improvement of organ quality over 24 h of EVLP.

T-cell depleting agents and IL-2 receptor blockers are the most common induction therapies in simultaneous pancreas-kidney transplantation (SPKT), but the optimal choice remains debated. Here, we perform a retrospective, single-center study with SPKT recipients from 2000 to 2023. Basiliximab was used between 2008 and 2013, and thymoglobulin in other periods. Patients with prior transplants, calculated PRA >20%, pre-SPKT Donor-Specific Antibodies or graft primary non-function because technical reasons, were excluded. An Inverse Probability of Treatment Weighting (IPTW) was performed to adjust for confounding variables. 305 SPKT recipients were included, of which 172 (56%) received thymoglobulin and 133 (44%) basiliximab. Recipient (86% vs. 80%), pancreas (86% vs. 83%) and kidney (84% vs. 89%) death-censored graft survival at 20 years were comparable between groups. Basiliximab was not associated with an increased risk of patient death [HR 1.47 (0.69-3.14), P = 0.32], pancreas [HR 1.08 (0.55-2.10), P = 0.83] or kidney graft failure [HR 0.80 (0.38-1.70), P = 0.56] compared to thymoglobulin. Basiliximab did not significantly increase the risk of pancreas [OR 1.49 (0.84-2.63), P = 0.37] or kidney graft rejection [OR 1.31 (0.54-3.15), P = 0.20]. However, it was associated with significantly lower risk of CMV [OR 0.41 (0.23-0.72), P = 0.002] and BK virus infections [OR 0.31 (0.12-0.80), P = 0.02]. No significant difference was found in new-onset malignancy incidence. These results were maintained even after IPTW adjustment. In SPKT recipients with low immunological risk, basiliximab provides comparable long-term patient and graft outcomes to thymoglobulin while reducing the incidence of opportunistic infections.

Lymphocyte depleting induction is recommended for kidney transplant recipients (KTRs) at high immunological risk, which traditionally includes those with detectable anti-human leucocyte antigen antibodies. Data to support this approach in the modern era of histocompatibility testing are limited. We investigated outcomes in KTRs who underwent Basiliximab induction between 2012-2023 in the UK. We stratified outcomes by levels of sensitisation and T cell epitope mismatch (PIRCHE-II) scores. 1348 KTRs were included; 859 (63.7%) were unsensitised, 351 (26.0%) sensitised (calculated reaction frequency [cRF] 1%-84%), and 138 (10.3%) highly sensitised (cRF 85%-100%). Patient survival, allograft survival, and death-censored graft survival (DCGS) were 97%, 94%, and 97% at 1 year, and 88%, 78%, and 84% at 5 years respectively. There were no differences in outcomes between unsensitised and sensitised recipients; graft survival was lower in highly sensitised patients. T cell epitope mismatch scores were higher in those with rejection at 1 year (ln[PIRCHE+1] 3.94 ± 1.01 no rejection vs. 4.25 ± 0.58 rejection, p = 0.02) and epitope mismatch was associated with early rejection in multivariable analyses (Odds Ratio 1.58, 95% CI 1.01-2.62). Hence, non-depleting induction provides good outcomes in unsensitised and sensitised KTRs. T cell epitope mismatches inform rejection risk in the first post-transplant year.

[This corrects the article DOI: 10.3389/ti.2025.14855.].

Background: Ex vivo lung perfusion (EVLP) is a technique for graft preservation, evaluation and treatment, that could expand donor pool for transplantation. Nevertheless, the wide spectrum of available platforms has generated disparities in use, outcome, and costs. This study is an attempt to create a national consensus on EVLP use by a group of experts from the Italian Society of Organ Transplantation.

Methods: The 9-member promoting committee was divided into 3 groups to propose statements. Using the DELPHI method 27 experts (three from each of the 9 lung transplant centres) voted agreement to each statement in 3 rounds. The cutoff for acceptance was set at 80% agreement.

Results: In the first vote, 52 statements were proposed, and an agreement was reached for 20 of them (38%). After revision, the second round resulted in a quorum for 36 out of 40 statements proposed (90%). At the third vote, agreement was confirmed for 36 statements (8 indications for use, 19 modalities for use, 13 evaluation parameters).

Conclusion: The statements outlined in this document do not represent absolute guidelines, but rather recommendations. The statements selected and presented are therefore aimed to assist Italian clinicians in the use of an ex vivo normothermic perfusion platform in the right context.

Lung transplantation remains a life-saving option for end-stage pulmonary diseases, but sensitized patients with anti HLA antibodies carry high risk; recent desensitization advances, such as eculizumab, may permit outcomes comparable to non-sensitized recipients with tailored perioperative care. In this prospective cohort study of 399 adult lung transplant recipients, 36 sensitized patients underwent a protocol combining preoperative plasmapheresis, a defined eculizumab regimen, anti-thymocyte globulin, and IVIG. In comparison, 363 non-sensitized recipients received standard immunosuppression. We compared recipient/donor characteristics, intraoperative parameters, and postoperative outcomes, including primary graft dysfunction, infection, rejection, and overall survival. Desensitized patients were older, predominantly female, and had significantly higher panel reactive antibody levels and preformed donor-specific antibodies; intraoperatively, they required more blood transfusions and VA-ECMO support. Postoperatively, they exhibited higher rates of de novo donor-specific antibodies, antibody-mediated rejection, longer ICU stays, increased dialysis requirement, and more frequent CMV infections. Despite these differences, rates of acute cellular rejection, chronic lung allograft dysfunction, and one-year and overall survival were similar between groups. Our findings suggest that lung transplantation in sensitized patients managed with a desensitization protocol, including eculizumab, is feasible and safe, achieving outcomes comparable to those of non-sensitized recipients.