Transplantation proceedings最新文献

Background: Urinary tract infections (UTIs) are the most common infection following kidney transplantation. However, the natural history of UTIs is incompletely understood, as is the impact of UTIs on patient outcomes.

Methods: A single-center cohort study of kidney-only transplant recipients at the West of Scotland Renal Transplant Unit, UK was undertaken. A standardized protocol for UTI screening and treatment was followed. Patients were categorized into 3 groups based on the number of culture-proven UTI: no UTIs, 1-2 UTIs and ≥3 UTIs. Proportional odds logistic regression was performed to identify risk factors for developing UTIs, with adjustment for age, sex, primary renal diagnosis, donor type and induction immunosuppression.

Results: Of 1412 recipients, 1169 (82.8%) had no UTIs, 180 (12.7%) had 1-2, and 63 (4.5%) had ≥3. Key risk factors for ≥3 UTIs were female sex (adjusted odds ratio [aOR]: 1.48, 1.15-1.91), older age (aOR: 1.01, 1.00-1.02) and ATG induction (aOR: 3.73, 2.16-6.45). Recipients whose kidney failure had been caused by lower urinary tract disorders were at increased risk of developing one or more UTIs (aOR: 1.86 1.03-3.34). Recipients with ≥3 UTIs had a lower estimated glomerular filtration rate (eGFR) at 2 years post-transplant (49.7 vs. 59.2 mL/min/1.73 m², p = .03), but there was no significant difference is patient or graft survival at 2 years.

Conclusions: We report a relatively low rate of treated UTIs in the first 2 years post kidney transplantation, with female sex, older age, and ATG induction identified as key risk factors. While UTIs did not increase graft loss or mortality, recurrent infections were associated with lower eGFR at 2 years. Targeted screening and prevention strategies should be considered for identified high-risk recipients.

Background: Accurate identification of potential organ donors is essential for optimizing transplant opportunities.In Turkey, the 2025 update of the national Healthcare Quality Standards (SKS) introduced a mandatory brain death evaluation for all ICU patients with a Glasgow Coma Scale (GCS) ≤6. While intended to prevent missed donor opportunities, this policy may lead to unnecessary evaluations of patients with reversible conditions, creating an increased workload and resource strain on critical care teams. This study aimed to evaluate the clinical yield and practical implications of mandatory brain death evaluations in ICU patients with a GCS score of ≤6 following the implementation of this policy-driven framework.

Methods: We conducted a retrospective observational analysis of 395 adult ICU patients with GCS ≤ 6 at admission between January and September 2025. Patients were stratified by primary diagnosis (neurological vs non-neurological). The first GCS (at referral) and final GCS (end of ICU follow-up) were recorded, and confirmed brain death cases identified. Differences between groups were analysed using appropriate statistical tests.

Results: Among 395 patients, 17 (4.3 %) were declared brain dead-all from the neurological group. Despite inclusion of non-neurological etiologies (including postoperative, metabolic, and respiratory diagnoses), none proceeded to brain death. The non-neurological cohort showed significant GCS recovery (eg, postoperative mean GCS improved from 3.13 to 12.76, p < .001).

Conclusions: The use of GCS ≤ 6 as a universal screening criterion for brain death evaluation in ICU patients is overly sensitive but lacks specificity. To optimise donor identification and resource utilisation, referral criteria should incorporate additional neurological and clinical filters.

Background: Inflammatory bowel diseases (IBDs) are progressive, immune-mediated conditions including Crohn Disease and ulcerative colitis. Heart transplant (HTx) represents the most successful treatment for patients with end-stage heart failure. Lifelong immunosuppressive therapy to prevent graft rejection is associated with a decreased incidence and prevalence of immune-mediated diseases; however, de novo non-infective IBDs have been reported in transplant recipients. This study aims to describe clinical characteristics and variables that may influence the onset of non-infective IBD following HTx.

Methods: We performed a single-center, retrospective, observational study at Monaldi Hospital, Naples. Hospitalized patients that received a diagnosis of non-infective IBD after HTx were included.

Results: A total of 10 males were included, median age at IBD onset was 56 years [45-64.5]. The median time interval between HTx and IBD diagnosis was 8.5 years [3-12.7]. IBD onset was characterized by rectal bleeding (70%), abdominal pain (70%), chronic diarrhea (60%), and weight loss (20%). A total of 60% of the subjects experienced cytomegalovirus reactivation after transplant, and IBD ensued a median of 3 years [2-12] after reactivation. The most common histological diagnosis was indeterminate colitis. All patients on cyclosporine and most treated with tacrolimus and everolimus had higher than recommended mean plasma trough levels of immunosuppressive drugs during the year before IBD diagnosis. All patients received mesalazine, with a 40% increase in the prednisone dose. One patient underwent surgery for complications, and one died 3 years after IBD diagnosis as a result of intestinal perforation.

Conclusions: De novo IBD is a possible complication after HTx and should be promptly suspected when gastrointestinal symptoms persist. Cytomegalovirus reactivation and high exposure to immunosuppressants are possible risk conditions.

Background: Persistent urinary tract infections (UTIs) are a frequent complication among kidney transplant recipients, often leading to increased morbidity, healthcare costs, and potential compromise of graft function. Identifying risk factors and effective management strategies is crucial to improve clinical outcomes in this vulnerable patient population.

Methods: In this retrospective study conducted from January 2020 to December 2024, 1130 kidney transplant recipients aged 18 to 75 years were analyzed. Clinical and laboratory data were obtained from electronic medical records, with information on demographics, immunosuppressive regimens, microbiological findings, and treatment outcomes. Persistent UTIs were defined as 2 or more microbiologically confirmed episodes within 12 months despite appropriate therapy. Statistical analyses included descriptive measures, comparative tests, and multivariate logistic regression to identify independent predictors.

Results: Of the total cohort, 31.2% developed persistent UTIs, with 68.5% experiencing recurrent episodes. Diabetes mellitus (adjusted OR: 1.56), prolonged urinary catheterization (adjusted OR: 2.04), and infection with multidrug-resistant (MDR) pathogens (adjusted OR: 2.32) emerged as significant risk factors. Escherichia coli was the most frequently isolated organism (36.4%), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Patients with persistent UTIs exhibited lower mean eGFR levels, although graft loss rates did not differ significantly from those without persistent UTIs.

Conclusion: Persistent UTIs represent a major clinical challenge in kidney transplant recipients. Early identification of modifiable risk factors-particularly glycemic control and appropriate urinary catheter management-may reduce recurrence and preserve renal function. A comprehensive approach involving routine microbiological surveillance and judicious antibiotic use is essential to mitigate the impact of MDR organisms on patient outcomes.

Objective: To analyze the therapeutic efficacy of artificial liver support system (ALSS) treatment for acute on chronic liver failure (ACLF) and its influencing factors, providing a basis for clinical treatment, selection of beneficiaries, and disease management.

Methods: A retrospective study was conducted on 283 patients with ACLF who received ALSS treatment at a hospital in Ganzhou City from August 2021 to January 2024. Patients were divided into effective and ineffective subgroups based on the therapeutic efficacy within 28 days. Differences between the two subgroups were compared. Variables with significant differences in univariate analysis were further analyzed using multivariate logistic regression to determine the influencing factors, and ROC curves were constructed to evaluate the predictive efficacy of treatment outcomes.

Results: The efficacy rate of ALSS treatment for ACLF was 59.72%. Univariate analysis showed that levels of Model for End-Stage Liver Disease (MELD) score, prothrombin time (PT), Monocyte-to-Lymphocyte Ratio (MLR), International Normalized Ratio (INR), Creatinine, and Total Cholesterol (TC) were higher in the ineffective group, while Triglycerides (TG), High-Density Lipoprotein Cholesterol (HDL-C) and Low-Density Lipoprotein Cholesterol (HDL-C) were lower. Multivariate logistic regression analysis indicated that PT, MELD score and MLR were key factors influencing the efficacy of ALSS treatment for ACLF patients. ROC curves demonstrated that PT had good performance in assessing therapeutic efficacy (P < .05). The evaluation effect of the combined factors was not significantly different compared with the single effect of PT (P > .05).

Conclusion: The efficacy of ALSS treatment for ACLF was comparatively favorable. Prolonged PT is correlated with treatment efficacy and have significant reference value in the assessment of treatment outcomes.

Kidney transplantation has emerged as the optimal treatment for end-stage renal disease. However, the occurrence of atypical hemolytic uremic syndrome (aHUS) following renal transplantation is extremely uncommon and associated with adverse outcomes, often resulting in early graft loss, thus warranting heightened awareness. This report details a case of successful management of a patient who developed post-transplant aHUS following retransplantation. The patient had previously suffered graft failure shortly after the first kidney transplantation due to unexplained non-rejection mechanisms. Following the second transplantation, the individual presented with new-onset anemia, thrombocytopenia, acute kidney injury, and elevated lactate dehydrogenase levels within a short time frame, all manifesting undetermined etiology. A comprehensive assessment of dynamic changes in hemoglobin, platelet count, serum creatinine, and lactate dehydrogenase, alongside pathological examinations, culminated in a definitive diagnosis of aHUS. After undergoing four treatments with eculizumab, there was a sustained improvement in hemoglobin, platelet count, serum creatinine, and lactate dehydrogenase levels, thereby preserving the function of the transplanted kidney. Timely diagnosis and early application of eculizumab in treating aHUS are crucial. Furthermore, comprehensive pre-transplant evaluations of patients to exclude aHUS risk factors are essential.

Pakistan, a resource-limited country, faces a growing number of patients with end-stage kidney disease, many of whom could benefit from living-related kidney transplantation. To expand the living donor pool, we implemented the largest ABO-incompatible kidney transplantation program in the country. The program started in February 2023, and 21 transplants have been performed to date. Pretransplant desensitization consisted of rituximab (375 mg/m²) at day (D) -30, tacrolimus, mycophenolic acid, and steroids starting at D -15, along with apheresis sessions to achieve isoagglutinin titers below 1:4 on the day of transplantation. Among the recipients, 16 were males and 5 females. Eighteen patients had been on hemodialysis for more than 6 months, and 3 underwent pre-emptive transplantation. The median recipient age was 39 years (range, 18-66). After a median follow-up of 12 months (range, 2-32), 3 patients (14.3%) had died with functioning grafts, while no graft loss occurred. The median serum creatinine at last follow-up was 1.1 mg/dL (range, 0.8-1.4). One patient experienced delayed graft function. Three patients developed acute rejection (2 cellular, 1 antibody-mediated), all successfully treated. Infectious complications occurred in ten patients (47.6%), resulting in 2 deaths. In conclusion, ABO-incompatible living donor kidney transplantation is feasible and effective in our setting, achieving excellent short-term graft outcomes. However, infectious and cardiac complications remain significant causes of morbidity and mortality.

Background: Living donor nephrectomy (LDN) leads to an immediate reduction in nephron mass, triggering compensatory hypertrophy in the remaining kidney. However, the relationship between changes in renal volume and functional adaptation remains unclear. This study aimed to evaluate the association between pre- and postdonation renal volume and renal function in living kidney donors (LKDs).

Methods: We retrospectively reviewed 23 LKDs who underwent postdonation computed tomography (CT) imaging following LDN between 2011 and 2021. Contralateral renal volume (CRV) was measured using 3D reconstructions from CT scans. The CRV change ratio was defined as postdonation CRV divided by predonation CRV. Estimated glomerular filtration rate (eGFR) was assessed before and after donation. Correlations between renal volume parameters and renal function were analyzed.

Results: All donors exhibited increased CRV postdonation, with a median change ratio of 1.32. The CRV change ratio positively correlated with predonation eGFR (ρ = 0.449, p = .031), predonation volume (ρ = 0.491, p = .019), and postdonation eGFR (ρ = 0.619, p = .002). Donors with larger predonation kidney volumes had significantly better postdonation function and greater volume increases.

Conclusion: CT-based volumetry demonstrated significant compensatory hypertrophy in the remnant kidney following LDN, with the degree of volume increase closely associated with both pre- and postdonation renal function. Predonation renal volume may serve as a useful predictor of functional recovery. These findings support the clinical utility of CT volumetry for donor assessment and long-term follow-up. Further prospective studies are warranted.

Purpose: BKPyV following kidney transplantation is well recognized to cause premature graft failure and ureteral complications. Cumulative immunosuppression, including induction therapy, has a sustained impact on immune responses to opportunistic infection. We hypothesized that induction with cell-depleting agents affects the 1-year risk of BKPyV reactivation.

Methods: Of 456 adult patients who underwent kidney transplants between January 2018 and February 2023 with at least 12 months of follow-up were screened for BK virus by blood PCR at 1.5, 3,6,9,12 months.

Results: Among the 456 patients, 101 (22.1%) developed BKPyV viremia. The incidence of BKPyV positivity was highest with basiliximab (32%) compared to alemtuzumab (21%) and thymoglobulin (18%) (p = .032). Compared to basiliximab, receiving alemtuzumab (OR: 0.571, 95% CI: 0.329-0.991, p = .042) or thymoglobulin (OR: 0.462, 95% CI: 0.256-0.834, p = .010) was associated with a significantly lower risk of BKPyV. Higher KDPI was also significantly associated with an increased risk of BKPyV infection (OR: 1.120, 95% CI: 1.013-1.238, p = .026). Multivariable analysis showed a persistently significant lower risk of BKPyV infection with thymoglobulin (OR: 0.4, 95% CI: 0.21-0.75, p = .004) and alemtuzumab (OR: 0.5, 95% CI: 0.28-0.89, p = .019) compared to basiliximab. Also, higher KDPI was independently associated with BKPyV viremia (OR: 1.13, 95% CI: 1.01-1.25, p = .031).

Conclusion: Induction therapy and higher KDPI were significant risk factors for BKPyV reactivation. Induction with cell-depleting agents lowered the risk of BKPyV, perhaps due to the subsequent use of lower maintenance immunosuppression and reduced need for acute rejection treatment.

Introduction: Organ donation is a highly complex issue. The purpose of our study was to validate 2 questionnaires to explore public knowledge, opinions, and attitudes regarding organ donation and transplantation. Study focused on 2 distinct forms of donation-postmortem organ donation and living donation-through the creation of 2 structured instruments targeting the respective domains.

Methods: The construction process relied on a thorough review of existing literature, along with the adaptation of validated instruments. The first questionnaire, targeting the postmortem organ donation, includes a total of 29 items. The living organ donation questionnaire contains 13 items. Participants were selected using a mixed recruitment strategy aimed at capturing a broad and diverse representation of young people older than 18 years, residing in the province of L'Aquila, who provided informed consent. To assess the dimensionality of the questionnaire, we performed an exploratory graph analysis (EGA), and the final model was evaluated through Confirmatory Factor Analysis.

Results: A total of 816 young adults participated in the study. The final postmortem organ donation questionnaire consists of 28 items divided into 4 subscales: family influence; social, cultural, and religious factors; healthcare trust; pro-social and moral values. The final version of living organ donation questionnaire consists of 8 items divided into 3 subscales: fear and concern; personal and moral values; communication and openness.

Conclusion: The future objective of our research is to implement psycho-educational Interventions aimed at raising awareness and education based on the dimensions identified by our questionnaire.