Search Results (208)

Background: Contemporary kidney transplantation increasingly includes high-immunologic-risk recipients, ABO-incompatible transplantation, deceased-donor transplantation, and desensitization protocols. Although early post-transplant serum creatinine has historically been associated with long-term graft outcomes, its prognostic value in modern high-risk transplant cohorts remains insufficiently characterized. We evaluated whether serum creatinine at one month post-transplant independently predicts 3-year and 5-year graft survival and renal function in a large contemporary kidney transplant cohort. Methods: Among 1895 consecutive KT recipients (2005–2018), patients were stratified by one-month serum creatinine into four quartiles: Q1 (<1.0 mg/dL, n = 398), Q2 (1.0–1.23, n = 480), Q3 (1.23–1.52, n = 487), and Q4 (≥1.52, n = 530). Primary endpoints were 3- and 5-year death-censored graft survival. Results: Median follow-up was 95 months. Three-year graft survival was 97.2%, 96.2%, 95.3%, and 90.3% for Q1–Q4, respectively; 5-year survival was 94.5%, 94.6%, 92.5%, and 86.9%. eGFR stratification persisted at both 3 and 5 years. After adjustment including donor and recipient BMI, Q4 creatinine independently predicted graft failure (HR, 1.590; 95% CI, 1.049–2.412; p = 0.029). One-month serum creatinine also remained significant as a continuous variable (HR, 1.409 per 1.0 mg/dL increase; 95% CI, 1.279–1.551; p < 0.001). ROC analysis identified an optimal cutoff of 1.39 mg/dL (AUC, 0.622; sensitivity, 52.6%; specificity, 65.0%). Conclusions: One-month serum creatinine is a robust and independent predictor of graft survival and renal function after kidney transplantation. These findings support its use as a simple early risk-stratification marker and as a trigger for targeted post-transplant surveillance. Full article

Background: Segmental arterial mediolysis (SAM) is a rare, non-inflammatory, non-atherosclerotic, non-hereditary arteriopathy of unknown etiology that typically affects medium-sized visceral arteries. The absence of reliable diagnostic criteria poses a significant challenge. Consequently, the diagnosis of SAM should be considered in the setting of a distinctive combination of clinical features, angiographic findings, and histopathology. Renal artery involvement is uncommon, and its occurrence in the donor graft during kidney transplantation (KT) has not previously been reported. Case presentation: We report the case of a kidney graft from a deceased donor in her seventh decade of life, transplanted into a recipient in her seventh decade of life. Donor–recipient ABO compatibility was confirmed, and both complement-dependent cytotoxicity crossmatch and flow cytometry crossmatch were negative. Cold ischemia time was 14 h, and warm ischemia time was 20 min. Immediately after declamping, massive thrombosis of the graft renal artery was observed and confirmed using an intraoperative flowmeter. The arterial anastomosis was taken down, the thrombus was removed, the artery was flushed with heparin, and the anastomosis was reconstructed using interrupted sutures. Despite revision, no arterial flow was detected, and the graft was deemed unsalvageable and explanted. Histopathological examination showed thinning of the tunica media, reduced smooth muscle cells on desmin staining, medial-adventitial dissection, and occlusive thrombosis, findings considered likely attributable to SAM. Conclusions: This case suggests that occult donor arterial wall disease compatible with SAM may present catastrophically during KT and may lead to immediate graft loss despite standard surgical salvage attempts. Although no validated strategy currently exists to screen for or prevent occult SAM in asymptomatic donors, awareness of this entity may assist transplant surgeons and pathologists in the evaluation of unexplained early graft arterial thrombosis, donor-graft vascular pathology, and communication with centres receiving paired organs from the same donor. Full article

Purpose: Simultaneous liver–kidney transplantation (SLK) eligible candidates may receive SLK or liver-alone transplant (LA) with access to kidney transplant after initial LA (KAL). We aimed to characterize SLK-eligible recipient outcomes according to treatment approach. Methods: This study utilized 2017–2023 SRTR data to identify SLK-eligible deceased donor liver transplants. Recipients were placed into two groups based on whether SLK was performed; non-SLK patients were sub-stratified into LA and KAL cohorts. After baseline comparisons, 2-year patient and graft survival outcomes were characterized by univariable and multivariable Cox proportional hazard regression and Kaplan–Meier analysis. Results: Among 4879 candidates identified, 3746 (76.8%) underwent SLK, 1023 (21.0%) LA, and 110 (2.3%) KAL. SLK recipients maintained the highest eGFRs at 6 months, 1 year, and 2 years post-transplant (p < 0.01). Compared to SLK recipients, non-SLK recipients had a higher 2-year risk of mortality (aHR 2.46, p < 0.01), all-cause events (aHR 1.91, p < 0.01), and liver graft failure (HR 1.55, p = 0.02). LA conferred a higher 2-year mortality risk (aHR 2.98, p < 0.01) and all-cause event risk (aHR 2.25, p < 0.01), while KAL had comparable mortality risk to SLK (aHR 0.43, p = 0.40). Conclusions: When SLK-eligible candidates undergo transplants, SLK remains the optimal path forward, even when a safety net kidney can be performed. Full article

Background: Kidney transplantation (KT) improves survival and quality of life in patients with end-stage kidney disease; however, long-term allograft survival remains a major challenge. Brain natriuretic peptide (BNP), a biomarker of cardiorenal stress and volume status, may be associated with early postoperative physiological changes after KT. This study evaluated the association between early postoperative BNP changes and long-term allograft survival, and explored the potential role of BNP-derived parameters in relation to graft outcomes. Methods: This retrospective cohort study included adult recipients of deceased-donor KT between 2009 and 2018. Patients were categorized according to early graft function. Serum BNP levels were measured preoperatively and within postoperative 24 h, and the percentage increase (dBNP ratio) was calculated. Cox regression and receiver operating characteristic analyses were used to identify risk factors for graft failure and evaluate the discriminatory performance of BNP-derived biomarkers, respectively. Results: Among the 179 recipients, postoperative BNP levels and dBNP ratios differed significantly across graft function groups, with higher values in delayed graft function. After multivariate adjustment, the dBNP ratio remained significantly associated with graft failure (hazard ratio, 1.16; 95% confidence interval, 1.10–1.21; p < 0.001). Additionally, the dBNP ratio demonstrated better discriminatory performance for graft failure compared with postoperative BNP alone (area under the curve, 0.815 vs. 0.596; p < 0.001), with an exploratory cutoff of approximately 18%. Recipients with a dBNP ratio ≥ 18% had poorer early graft function, lower longitudinal estimated glomerular filtration rates, and significantly reduced graft survival. Conclusions: An increased early postoperative dBNP ratio was significantly associated with adverse long-term kidney allograft outcomes. However, given the potential for residual confounding, these findings should be interpreted as associative and hypothesis-generating rather than predictive. Full article

Background: Uterus transplantation (UTx) is an emerging treatment for absolute uterine factor infertility. However, the use of deceased donors is limited, and donation after circulatory death (DCD) has not yet been utilized. Ischemic injury remains a major barrier, particularly compared with living donor procedures. Hypothermic oxygenated perfusion (HOPE), which has shown protective effects in heart, liver, and kidney transplantation, may offer similar benefits for uterine grafts. Methods: We report the first series applying HOPE to human uteri to improve preservation and enable metabolic injury assessment during perfusion. Six uteri (3 DBD, 3 DCD; median donor age 53 years) underwent 8 h of HOPE following procurement, while paired tissue controls were preserved using static cold storage (SCS). Perfusion was delivered using a pressure-controlled system (15 mmHg, 10 ± 1 °C, VitaSmart^®). Perfusate and tissue samples were analyzed for mitochondrial injury, inflammation, and transcriptional responses. Results: HOPE maintained stable flows (70–150 mL/min), delivered high oxygen levels (pO₂ ≈ 1000 hPa), and increased tissue ATP levels. Stratification based on perfusate flavin mononucleotide (FMN) release identified grafts with greater Complex I/II injury. HOPE was associated with lower levels of mitochondrial injury markers and inflammatory signals, preserved tissue architecture, and promoted gene expression patterns consistent with metabolic recovery compared with paired SCS tissue controls. Conclusions: These findings suggest that HOPE may serve as a preservation approach that enables metabolic and ischemic injury assessment and may facilitate broader use of deceased donor uteri for transplantation. Full article

Background/Objectives: Tuberculosis remains one of the preventable causes of mortality among liver transplant recipients. The prevalence of tuberculosis in solid organ transplant recipients is higher than in the general population. The aim of this study was to evaluate the incidence of latent tuberculosis infection (LTBI) and active tuberculosis after liver transplantation. Methods: This is a retrospective, single-center, case–control study. Adult liver transplant candidates who were evaluated between 1 January 2016 and 31 December 2022 were retrospectively assessed. Patients with pre-transplant tuberculin skin test (TST) and/or interferon-gamma release assay (IGRA) results who underwent transplantation were included in this study. Results: A total of 111 liver transplant recipients with available IGRA and/or TST results were included; 70 were men (63.1%) and 41 were women (36.9%), with a mean age of 53.5 ± 11.3 years. Demographic, clinical, and laboratory characteristics were evaluated. The most common indication for liver transplantation was viral hepatitis (33.3%), followed by cryptogenic cirrhosis (19.8%) and hepatocellular carcinoma (10.8%). All patients had a Bacillus Calmette–Guérin (BCG) vaccination scar. Ten patients received grafts from deceased donors, while 101 underwent living-donor liver transplantation. No patient received LTBI treatment before transplantation, whereas LTBI treatment was initiated in four patients after transplantation. None of the patients had a diagnosis of active tuberculosis prior to transplantation. Thoracic computed tomography revealed findings compatible with tuberculosis sequelae in 11 patients (9.9%). During a median follow-up period of 49 [27–64] months after transplantation, no cases of active tuberculosis were observed among patients with positive TST and/or IGRA results. Patients were divided into two groups according to their TST and IGRA results. Group 1 consisted of patients with IGRA positivity and/or a TST ≥ 5 mm, while Group 2 included patients with a TST < 5 mm and negative IGRA results. The only statistically significant difference between the groups was the administration of LTBI treatment (p = 0.027); four patients in Group 1 received LTBI therapy. None of these patients were able to continue prophylaxis due to treatment-related adverse effects. Conclusions: Prophylaxis with hepatotoxic agents poses a substantial risk in liver transplant candidates. Since the hepatotoxicity may cause early cessation of LTBI treatment, the risk–benefit ratio of post-transplant LTBI therapy should be carefully assessed. In situations where LTBI treatment is deferred, close clinical monitoring is strongly recommended. Full article

Background/Objectives: Delayed graft function (DGF) remains a common early complication after deceased donor kidney transplantation and is challenging to anticipate using routine pre-implant clinical variables alone. We investigated whether high-throughput Fourier transform infrared (FTIR) spectroscopy of static cold storage preservation fluid (not machine perfusion perfusate) captures biochemical information associated with DGF and warrants further evaluation alongside routine pre-implant clinical predictors. Methods: In this single-center retrospective cohort, we analyzed preservation fluid samples from 56 kidney transplants originating from 49 deceased donors (7 donors contributed two kidneys); DGF occurred in 14/56 (25.0%). Dried-film FTIR spectra were acquired using a plate-based high-throughput accessory, and analyses focused on the fingerprint region (900–1800 cm⁻¹) with prespecified preprocessing and quality control. We developed and compared clinical-only, FTIR-only, and combined predictive models and estimated performance using donor-blinded 5-fold StratifiedGroupKFold cross-validation (grouped by donor code) to prevent leakage across paired kidneys. Results: Donor-blinded discrimination (pooled out-of-fold ROC-AUC) was 0.775 for the clinical-only model, 0.814 for the FTIR-only model, and 0.796 for the combined model; probabilistic accuracy (Brier score; lower is better) was 0.162, 0.194, and 0.177, respectively. Calibration intercepts were negative and slopes were <1, indicating overly extreme risk estimates under strict donor-blinded validation and supporting recalibration prior to deployment. Decision curve analysis suggested a positive net benefit for clinically plausible thresholds. Conclusions: These findings support the feasibility of rapid, low-cost FTIR profiling of routinely available preservation fluid as a proof-of-concept approach for exploratory DGF risk stratification, rather than as a clinically deployable prediction tool. Given the small sample size and the instability of subgroup estimates, the main next steps are external validation in larger multicenter cohorts, prospective workflow studies, and model updating/recalibration. Full article

Background: BK polyomavirus (BKPyV) infection is of notable concern in kidney transplant recipients, as it can cause BKPyV-associated nephropathy (BKPyVAN). Currently, there is no effective treatment for BKPyV infection, underscoring the need for preventive strategies. There is emerging evidence that donor-derived BKPyV plays a role in the development of BKPyV DNAemia. To further explore this hypothesis, we conducted a retrospective, multi-center cohort study to evaluate the risk of developing BKPyV DNAemia in kidney recipient pairs sharing the same donor. Methods: At the Leiden University Medical Center (LUMC), deceased donor kidney transplant recipients (2011–2021) were identified and classified according to the occurrence of BKPyV DNAemia within the first year post-transplantation. For each recipient, the contralateral kidney recipient from the same donor was identified through national transplant registries. Cox regression was used to assess whether BKPyV DNAemia in the LUMC recipient was associated with an increased risk of BKPyV DNAemia in the contralateral recipient. Results: Among 117 recipient pairs, BKPyV DNAemia was more frequent when the contralateral recipient was affected (28.8% [15/52]), compared with pairs in which the contralateral recipient remained unaffected (10.8% [7/65], p = 0.013). Multivariable Cox regression analysis confirmed this increased risk (HR 4.9, 95% CI: 1.8–13.6; p = 0.002). Conclusions: This study shows a significantly increased risk of BKPyV DNAemia in recipients of deceased donor kidneys when the contralateral kidney recipient develops BKPyV DNAemia. These findings highlight the influence of donor-derived factors in BKPyV transmission in kidney transplantation. Full article

Background: The primary aim of pancreas transplantation in type 1 diabetic kidney transplant recipients is to reduce mortality caused by complications of progressing cardiovascular diseases and to protect kidney graft from the recurrence of diabetic nephropathy. The aim of this study was to analyze the results of the first deceased donor kidney transplantation (KTx) in patients with end-stage kidney disease caused by long-lasting type 1 diabetes (T1D), performed alone or simultaneously with the pancreas (SPK), in a long-term follow-up period. Methods: Groups of 101 consecutive T1D patients after KTx and 93 patients after SPK performed in two transplant centers with a minimal follow-up period of 5 years were included in the analysis. Results: Recipient, kidney graft, and death-censored kidney graft survival in a follow-up period of up to 20 years did not differ between KTx and SPK groups. In the entire observation period, total diabetes duration was shorter in the SPK group compared to KTx (28.1 ± 7.4 vs. 34.9 ± 11.0 years), and myocardial infarction (21 vs. 7%), limb amputation (12 vs. 3%), and proteinuria (40 vs. 18%) were more common in the KTx group than in SPK. The estimated glomerular filtration rate was lower in KTx recipients compared to SPK. Recipient survival was affected by the recipient’s age and the duration of dialysis vintage, and kidney graft survival was affected by the duration of dialysis vintage, episodes of acute rejection, and high pretransplant sensitization in patients. Conclusions: Despite reduced diabetes duration, a decreased frequency of cardiovascular disease complications and better kidney graft function, a simultaneously transplanted pancreas does not improve patient or kidney graft survival in T1D kidney recipients. Full article

Introduction: In adult patients undergoing deceased donor kidney transplantation, anesthesia management impacts graft function and survival and is influenced by various donor and recipient clinical factors. The aim of this study was to describe the perioperative factors and to evaluate their association with delayed graft function (DGF) during the first seven days after transplantation. Materials and Methods: This cross-sectional study of adult patients who underwent deceased donor kidney transplantation at a tertiary care hospital from 2022–2023 was performed to evaluate pre-, trans- and postoperative patient’s characteristics. Comparisons or association tests were implemented between patient characteristics grouped by the absence or presence of DGF. In the case of the variables with clinical relevance, univariate and multivariate logistic models were constructed to evaluate the predictive capacity of these variables to predict delayed graft function. Crude and adjusted odds ratio (ORs) with 95% confidence intervals were calculated for each variable. Results: DGF was present in 25/69 (36.23%) patients. The anesthesia time was significantly longer (310.28 vs. 273.55 min; p = 0.043) and the post-transplantation stay was significantly longer (11.04 vs. 8.11 days; p < 0.001) in patients with delayed graft function. In univariable analyses, male sex (p = 0.018), platelet count (p = 0.025), and surgical time (p = 0.062) showed significant or borderline associations with DGF. In the multivariable model, male sex remained independently associated with DGF (adjusted OR 10.64; 95% CI 1.23–92.1; p = 0.031). Platelet count (per 50 × 10³ µL increase) demonstrated a borderline inverse association (adjusted OR 0.57; 95% CI 0.32–1.02; p = 0.057). Conclusions: Our results suggest that male sex was independently associated with delayed graft function after deceased donor kidney transplantation, while platelet count showed a borderline association. Full article

Background: The survival benefits of kidney transplantation (KT) versus dialysis in elderly end-stage renal disease (ESRD) patients, particularly those with cardiovascular disease (CVD), remain uncertain. Methods: This retrospective single-center study included 1060 patients aged ≥60 years: 165 KT recipients and 895 dialysis patients. Propensity score matching using five covariates (age, sex, cardiac disease, cerebrovascular accident, and hemodialysis duration) created balanced cohorts of 123 patients per group. Kaplan–Meier analysis and multivariate Cox regression were performed in the matched cohort, and a time-dependent Cox model was additionally applied to the full cohort to address immortal time bias. Results: In the propensity score-matched cohort, KT (HR = 2.72, p = 0.009), age (HR = 1.13, p < 0.001), and CVD morbidity (HR = 3.84, p < 0.001) were independent predictors of mortality. In the time-dependent Cox analysis, KT was not significantly associated with overall survival (HR = 0.94, p = 0.837), but a significant KT × CVD interaction was identified (HR = 3.34, p = 0.025): KT was associated with reduced mortality in patients without CVD (HR = 0.47, p = 0.121) and increased mortality in those with CVD (HR = 1.67, p = 0.174). In patients aged ≥65 years with CVD, KT recipients demonstrated significantly worse survival than dialysis patients (p = 0.004). Conclusions: After correcting for immortal time bias, KT was not significantly associated with overall survival in elderly patients. However, the significant KT × CVD interaction suggests that CVD status is a critical determinant of transplant outcomes. Full article

Surgical resection remains the cornerstone of curative-intent therapy for colorectal liver metastases (CRLM). However, a substantial proportion of patients present with technically unresectable diseases or develop intrahepatic recurrence, despite optimal multimodal treatment. In this setting, liver transplantation (LT) has emerged as a potential strategy for durable, cancer-free survival in selected patients. Early experience with deceased donor liver transplantation (DDLT) for CRLM showed encouraging outcomes, but broader implementation has been constrained by ethical concerns and logistical barriers related to organ scarcity. Living donor liver transplantation (LDLT) offers a fundamentally different paradigm, potentially mitigating these limitations while introducing distinct technical, ethical, and logistical considerations. In this manuscript, we delineate the technical and logistic differences between DDLT and LDLT in the context of CRLM and highlight advantages unique to LDLT-based strategies. We contrast historical data with emerging contemporary evidence, with particular emphasis on LDLT outcomes. We critically examine evolving patient selection frameworks, incorporating molecular profiling and circulating tumor DNA-based liquid biopsy. In addition, we report our institutional experience with left lobe LDLT for CRLM in a patient who remains disease-free 30 months after transplantation. We conclude with a comprehensive appraisal of the current LDLT literature in CRLM and propose directions for future research. Full article

Cerebral toxoplasmosis is a rare but potentially fatal opportunistic infection in renal transplant recipients receiving long-term immunosuppressive therapy. It may result from donor-derived transmission or reactivation of latent infection. We report the case of a 70-year-old female who underwent kidney transplantation from a deceased donor in 2004 for end-stage renal disease due to glomerulonephritis. She was maintained on cyclosporine, mycophenolate mofetil, and prednisone. In September 2024, she presented with headache, mood changes, and right-sided hemiparesis. Brain multislice computed tomography revealed a large temporoparietal lesion initially suspected to be glioblastoma. Craniotomy and histopathological analysis demonstrated encysted Toxoplasma gondii bradyzoites within gliotic tissue. Polymerase chain reaction testing confirmed the presence of T. gondii DNA, while human immunodeficiency virus testing was negative. The patient reported frequent contact with domestic cats. Treatment with pyrimethamine, sulfadiazine, and leucovorin, alongside adjustment of immunosuppressive therapy, led to marked neurological improvement and radiological regression of the lesion. However, nine months later, she succumbed to multidrug-resistant urosepsis. This case highlights the diagnostic challenges of cerebral toxoplasmosis in transplant recipients, as radiological findings are often nonspecific and can mimic neoplastic or lymphoproliferative lesions. Polymerase chain reaction and histopathological analysis remain essential for definitive diagnosis. Awareness of this rare complication is critical for early recognition and prompt initiation of anti-toxoplasma therapy, which can significantly improve outcomes. Although cerebral toxoplasmosis is uncommon after kidney transplantation, it should be considered in immunosuppressed patients presenting with neurological symptoms. Early detection and targeted therapy are key to reducing morbidity and mortality in this population. Full article

Background and Clinical Significance: Pulmonary hypertension (PH) is a recognized complication of chronic liver disease, most commonly manifesting as portopulmonary hypertension (POHP) prior to liver transplantation. While the natural history and management of pre-transplant PH are well described, the development of de novo pulmonary arterial hypertension (PAH) following liver transplantation remains exceedingly rare and poorly understood. In such cases, establishing true causality is challenging, and alternative explanations—including previously unrecognized or masked disease—must be carefully considered. This entity poses significant diagnostic and therapeutic challenges and may adversely affect post-transplant outcomes if not promptly recognized and treated. Case Presentation: We report the case of a 46-year-old man with end-stage liver disease secondary to alcohol use who underwent deceased donor liver transplantation without preoperative evidence of PH. His pre-transplant evaluation revealed preserved biventricular function and no measurable PH. Eight days postoperatively, he was readmitted with acute dyspnea, hypoxemia, and signs of right ventricular failure. Transthoracic echocardiography demonstrated severe right ventricular dilation and dysfunction with markedly elevated pulmonary artery systolic pressure. Right heart catheterization confirmed severe PAH. Secondary causes of PH were excluded. The patient was initiated on sildenafil and continuous intravenous epoprostenol, resulting in clinical, echocardiographic, and hemodynamic improvement. Subsequent follow-up demonstrated sustained response to therapy despite concurrent progression of coronary artery disease requiring complex percutaneous intervention. Conclusions: This case highlights a rare presentation of severe PAH occurring shortly after liver transplantation, in the absence of documented pre-transplant PH. While a causal relationship cannot be definitively established, the temporal association raises important clinical considerations. It underscores the need for heightened clinical vigilance for pulmonary vascular disease in post-transplant patients presenting with cardiopulmonary symptoms. Further research is warranted to elucidate the underlying mechanisms, risk factors, and optimal management strategies for PAH diagnosed after liver transplantation. Full article

Xenotransplantation, particularly the use of genetically modified pigs for kidney transplantation, is gaining attention as a potential solution to the organ shortage. Pigs are ideal donors due to their physiological similarity to humans and rapid reproduction rates. Advances in gene editing technologies like CRISPR have enabled the development of genetically modified pigs that express human-compatible molecules while lacking xenogeneic antigens, such as Galα1-3Gal, which trigger strong immune responses. These modifications significantly reduce the risks of hyperacute and acute rejection, major barriers to successful xenotransplantation. Preclinical studies involving non-human primates and deceased human donors have shown promising short-term results, indicating that pig kidneys can function in human recipients. However, there are no documented cases of long-term survival, and the long-term effects of such transplants remain uncertain. Additionally, concerns about zoonotic disease transmission from pigs to humans necessitate robust pathogen detection systems to ensure safety. More research is also needed to understand immune responses to xenogeneic organs and develop effective immunosuppressive therapies. Ethical considerations surrounding the use of animal organs require ongoing societal dialog. Continued research is essential to establish xenotransplantation as a viable treatment for patients with renal failure. Full article