Global access to liver transplantation (LT) remains highly unequal. We analyzed worldwide patterns of LT activity, donor source, and their alignment with disease burden across sociodemographic strata. We combined country-level LT data from the Global Observatory on Donation and Transplantation (2000-2023) with prevalence and mortality estimates for cirrhosis and other chronic liver diseases from the Global Burden of Disease 2021 Study (2000-2021). LT rates and donor source were analyzed across Sociodemographic Index (SDI) categories. LT capacity was benchmarked against age-standardized prevalence rates and age-standardized mortality rates. Associations between LT intensity and the mortality-to-prevalence ratio were evaluated using pooled correlations, within-country analyses, and 2-way fixed-effects models adjusting for country-year and calendar year. From 2000 to 2023, LT activity was concentrated in high-SDI countries, whereas low-SDI countries relied almost exclusively on living donation but had extremely low overall LT rates. When benchmarked against age-standardized prevalence rates and age-standardized mortality rates, LT capacity showed a strong inverse gradient across SDI, with substantial heterogeneity among high- and middle-SDI countries. Within-country and 2-way fixed-effects models demonstrated a small but significant inverse association, indicating that higher LT activity was associated with lower mortality relative to disease prevalence at the population level. Global LT capacity remains poorly aligned with the burden of cirrhosis and other chronic liver diseases and is driven more by health system development than epidemiological need. Although prevention remains central, incremental expansion of equitable LT infrastructure may be associated with modest improvement in population-level mortality relative to disease prevalence.

The long-term outcome of lung transplantation remains inferior to that of other solid organ transplants, primarily due to rejection/infection. This pilot study investigates longitudinal changes in the bronchoalveolar lavage (BAL) leukocyte transcriptomes and phenotypes, and their impact on clinical outcomes. BAL samples were collected at baseline and 1-12 mo posttransplantation. Leukocyte phenotypes, activation status, and biomarkers were characterized alongside their gene expression profiles. We identified distinct BAL leukocyte transcriptional signatures associated with allograft rejection across 2 independent cohorts. Alveolar macrophages (AMs) predominated after transplantation, whereas granulocytes increased during the first year. This was associated with decreased expression of CD163, an anti-inflammatory marker, and increased expression of proinflammatory markers CD80 and CD86 on AMs. In a patient subgroup, a unique foamy macrophage (FM) subset with distinct cytology, featuring cytoplasmic lipid-laden vacuoles, was identified and confirmed in lung biopsies. FMs were accompanied by a unique non-FM (no-FM) population and were associated with elevated BAL levels of interleukin (IL)-8, IL-1β, and IL-10 and more frequent hospital readmissions. BAL transcriptomic analysis for patients carrying both FMs and no-FMs showed upregulation of genes linked to lipid metabolism, leukocyte chemotaxis, and inflammatory response pathways. We identified a rejection gene signature and proinflammatory shift in BAL leukocyte phenotypes after lung transplantation. The presence of FMs/no-FMs was associated with proinflammatory changes and worse clinical outcomes as per our data analysis, unadjusted for confounders due to relatively limited sample size. These findings could facilitate further investigations into early detection of lung allograft rejection and help focus on AM-targeted interventions.

Originally exclusively considered for patients with type 1 diabetes, expansion of combined pancreas and kidney transplantation to select patients with type 2 diabetes (T2DM) has become more common internationally. It has become clear that the pancreas transplant community is grappling with a definition of "type 2 diabetes" in this context. Specifically, it is imperative that a definition be established to communicate uniformly and consistently about these patient populations as we develop policies, study outcomes, and compare pancreas transplantation to alternative therapies. As the pancreas transplant physicians and endocrinologists strive to characterize various forms of diabetes, the field seeks to identify the potential candidates among those with features of T2DM, and other forms of diabetes who can safely undergo pancreas transplantation and who would benefit from this procedure and be rendered normoglycemic, as is the expectation for successful pancreas transplantation in recipients with type 1 diabetes. To this end, the International Pancreas and Islet Transplantation Association Pancreas Transplant Interest Group organized a pre-Congress meeting before the 20th World Congress, held in Pisa, Italy, in the summer of 2025, titled "Definition and listing guidelines for pancreas transplantation in type 2 diabetes mellitus: don't hype the type." An international panel was invited to present on several topics related to the definition of T2DM in the context of pancreas transplantation. This review summarizes the presentations and follow-up discussion regarding pancreas transplantation for T2DM from the meeting.

Macrovesicular steatosis in liver transplant donors is associated with increased risk of poor outcomes. Prerecovery computed tomography (CT) is widely available but has substantial variability and requires expert interpretation. Automating CT-based steatosis assessment could streamline evaluation. We analyzed CT scans from a single organ procurement organization between 2019 and 2024 with biopsy reports. The primary outcome was macrovesicular steatosis ≥30%. The liver and spleen were automatically segmented. Predictive approaches included (1) clinical features only; univariable models using (2) liver attenuation, (3) liver-to-spleen ratio, and (4) liver-spleen difference; (5) radiomics (1130 features) with extreme gradient boosting; (6) a 2-step method combining liver-spleen difference with radiomics; and (7) a 3-dimensional convolutional neural network. Performance was evaluated with repeated stratified train/validation/test splits for >100 random seeds, using area under the receiver operating characteristic (AUROC) as the primary metric. A total of 147 CTs were included; 25.9% had ≥30% biopsy-proven macrovesicular steatosis, 11.6% were contrast-enhanced only, and 40.8% showed at least grade 1 fibrosis. Model performance ranged from an AUROC of 0.65 (interquartile range [IQR], 0.57-0.72) for the clinical-only model to 0.87 (IQR, 0.81-0.92) for the 2-step approach ( P = 0.028 relative to the clinical model). Univariable models achieved AUROCs of 0.81 (IQR, 0.78-0.82) for liver attenuation, 0.84 (IQR, 0.77-0.89) for liver-to-spleen ratio, and 0.83 (IQR, 0.78-0.90) for liver-spleen difference. An automated 2-step approach using radiomic features achieved strong performance in predicting donor macrovesicular steatosis. Such models could help support decision-making and expedite evaluation in the donor-offer process.