First implantation of a bioprosthetic total artificial heart for a mediastinal paraganglioma.

A molecular reappraisal of quilty lesions: Insights from tissue and circulating biomarkers in heart transplantation.

Schisandrin B alleviates liver allograft rejection by stabilizing ACOD1 in Kupffer cells to potentiate itaconate-NRF2-mediated suppression of CD8+ T cell chemotaxis.

Investigating the utility of each MELD edition in predicting liver transplant outcomes.

Abstract Background Vascular complications in liver transplantation are associated with increased postoperative morbidity and mortality. The primary objective of our study was to determine whether postoperative acute rejection in patients undergoing liver transplantation is associated with vascular diameter and anastomotic angle mismatch. Our secondary objective was to evaluate the relationship between the anastomotic angle and hepatic artery and portal vein ratios between donors and recipients, as well as the likelihood of thrombosis in these patients. Materials and Methods Our study involved a retrospective review of 289 adult LTs performed at our center from 2012–2023. Fourteen of these patients were excluded from the study due to the absence of early postoperative computed tomography images in our center's archive, whilst the remaining 275 were included. Results Our evaluation revealed that 80 patients (29.1%) developed biopsy-confirmed acute rejection, and 37 patients (13.5%) experienced hepatic artery thrombosis. Portal vein thrombosis was identified in 43 patients (15.6%). No significant differences in the angles of hepatic artery thrombosis and portal vein thrombosis were observed between patients with and without rejection. Conclusion We believe that diameter discrepancies between the recipient and donor hepatic artery and portal vein, as well as the anastomosis angle, may influence graft vascularity and ultimately lead to rejection in liver transplantation patients. The effects of the anastomosis angle and the significant diameter discrepancy between the hepatic artery and portal vein on rejection should be re-evaluated in larger patient groups at different centers using different surgical approaches.

Renal transplantation remains the preferred treatment for end-stage renal disease (ESRD), but graft rejection remains a significant concern. The use of induction immunosuppressive agents such as Antithymocyte Globulin (ATG) and Basiliximab (BSX) has improved graft outcomes; however, comparative data regarding their efficacy profiles in Indian population is limited. This was a prospective, observational study conducted to compare the efficacy of Thymoglobulin versus Basiliximab in preventing acute graft rejection among renal transplant recipients at Govt. Medical College, Kozhikode. Patients receiving either ATG or BSX induction therapy were followed for 6 months post renal transplantation. Clinical and biochemical parameters such as hemoglobin, WBC, platelet count, BUN, serum creatinine and creatinine clearance were assessed. Statistical analyses were performed using IBM SPSS v25. Baseline demographic and clinical parameters were comparable between the groups. Both induction regimens significantly improved renal function markers — blood urea nitrogen, serum creatinine, and creatinine clearance — at Week 3 and Month 3 post-transplant (p < 0.001), with no significant intergroup difference, indicating comparable efficacy in early graft function recovery. Hematological analysis revealed significant post-transplant anemia in both groups, while WBC suppression was more pronounced with Thymoglobulin, consistent with its lymphocyte-depleting effect. Platelet counts showed transient elevation in both groups. Electrolyte trends included mild hyponatremia and hyperkalemia with Thymoglobulin and more pronounced hypophosphatemia with Basiliximab. Both ATG and BSX are effective as induction agents in renal transplantation, but ATG offers slightly better protection against early rejection, albeit with higher adverse event rates. Individualization of induction therapy based on immunologic risk and comorbidity profile is recommended.

As the number of elderly patients with end-stage kidney disease (ESKD) increases, the importance of understanding how age affects post-transplant success grows. We sought to quantify the association of age with key outcomes in deceased donor kidney transplant (DDKT) recipients. We did a single-center retrospective cohort analysis of all DDKT recipients who received kidneys between January 2001 and June 2021, stratified by age into 4 groups (18-49, 50-59, 60-69, ≥70). Outcomes of interest included uncensored graft failure (UCGF), death-censored graft failure (DCGF), and death with a functioning graft (DWFG) within 5years of transplant and acute rejection (AR) within 1year of transplant. Of 3,119 recipients, 1,192 (38.2%) were 18-49 years old (reference group), 947 (30.4%) were 50-59, 795 (25.5%) were 60-69, and 185 (5.9%) were ≥70. The adjusted hazard ratio (aHR) for UCGF was 1.22 (95% CI: 1.01-1.48) for 50-59 years; 1.78 (95% CI: 1.47-2.17) for 60-69; and 2.83 (95% CI: 2.13-3.76) for ≥70. The aHR for DCGF was only statistically significant for the ≥70 age group at 1.73 (95% CI: 1.16-2.96). The aHR for DWFG was 2.00 (95% CI: 1.47-2.73) for 50-59 years; 3.36 (95% CI: 2.47-4.58) for 60-69; and 5.45 (95% CI: 3.95-8.26) for ≥70. The aHR for AR was 0.73 (95% CI: 0.61-0.88) for 50-59 years; 0.69 (95% CI: 0.56-0.84) for 60-69; and 0.47 (95% CI: 0.31-0.72) for ≥70. DDKT recipients over the age of 70 are at a higher risk of UCGF, DCGF, and DWFG but have a lower risk of AR than their younger counterparts.

Early detection of kidney allograft injury is essential to preserve long-term graft function. Current diagnostics, particularly biopsy, are invasive and may be inconclusive. Extracellular-vesicles (EVs) carry molecular cargo that reflects renal cellular states. Although EV proteomics has shown promise for detecting acute rejection (AR) in adults, its value in pediatrics(PKT) is not well defined. In this pilot study, urine samples from 29 PKT recipients and 3 healthy controls were analyzed, including 7 with biopsy-confirmed AR, 9 with chronic rejection (CR), and 13 with stable graft function (ST). Classification was based on urine findings, creatinine trends, and biopsy results. EVs were isolated from fresh-second-void urine by ultracentrifugation and analyzed using LC/MS. Longitudinal samples from three AR patients assessed temporal proteomic changes. Overall, 192 proteins were differentially abundant across groups (FDR p < 0.05). AR showed enrichment of immune-related pathways and increased free hemoglobin proteins compared with ST, while CR closely resembled ST. EV concentration and size distribution were similar across groups, indicating proteomic differences were independent of EV abundance. Longitudinal analyses revealed dynamic proteomic changes corresponding to rejection and recovery. EV proteomics is a promising approach for detecting and monitoring AR in PKT recipients and warrants larger multicenter studies. This pilot study demonstrates urinary extracellular vesicle (EV) proteomics as a promising non-invasive approach to detect and monitor acute rejection (AR) in pediatric kidney-transplant (PKT) recipients. EVs carry molecular cargo reflecting kidney cell states, providing a dynamic readout of graft health and injury. Early identification of rejection may reduce reliance on invasive biopsies, enable timely intervention, and support precision-based, personalized management. As the first study to characterize EV proteomic profiles in PKT, it lays important groundwork. Larger multicenter studies are warranted to validate these findings.

Kidney transplantation in recipients aged ≥ 70 years is increasing, yet outcome data remain heterogeneous, with current evidence being limited to pooled results from single and multicenter studies. This study aims to investigate the impact of advanced age on patient survival as well as graft-related outcomes from multicenter and registry-based studies and to propose a multicenter study to bridge any identified research gap. The PRISMA and the Cochrane Handbook were followed. This review included multicenter studies and registry-based comparative studies only, which are less prone to selection bias. Outcomes were analysed using risk ratios (RRs) at fixed time points, when applicable, with a random-effects Mantel-Haenszel model. Five multicenter studies including a total of 272,982 recipients, of whom 16,309 were aged ≥ 70 years, were included. Recipients aged ≥ 70 years had a lower overall and 5-year survival, RR = 0.87 (95% CI 0.77-0.99; p = 0.04, I2 = 96%, τ2 = 0.00) and RR = 0.86 (95% CI 0.81-0.92; p = 0.02, I2 = 0%, τ2 = 0.00), respectively, compared to < 70. No significant differences were observed for 1- and 3-year patient survival between the two age groups. Moreover, no significant differences were observed for overall graft survival, 1-, 3-, or 5-year graft survival, delayed graft function, acute rejection and graft loss between the two age groups. Substantial heterogeneity was observed for long-term outcomes. Kidney transplantation in carefully selected recipients aged ≥ 70 years is associated with preserved graft survival and comparable early graft-related outcomes, but lower overall and 5-year survival, compared to those < 70 years of age. However, due to the limited number of studies included and substantial heterogeneity, future large multicenter studies including geriatric variables are required to determine the role of age on patient survival and graft-related outcomes. PROSPERO: CRD420261293247.

Acute rejection remains a major complication following liver transplantation, yet reliable noninvasive biomarkers for its early prediction and diagnosis remain unidentified. This exploratory study characterized bile and serum metabolites associated with acute rejection in living donor liver transplantation using comprehensive metabolomic profiling combined with machine learning. Non-targeted metabolomics were performed on bile samples collected on post-operative day (POD) 1 (n = 38) and serum on POD 14 (n = 45) from liver transplant recipients. Partial least squares discriminant analysis-based variable selection was followed by logistic regression and least absolute shrinkage and selection operator models, which were evaluated via cross-validation in the discovery cohort to explore potential biomarkers for acute rejection. A three-variable, bile-based model for predicting acute rejection achieved a mean cross-validated AUC of 0.872 (95% confidence interval: 0.814-0.930). Glycohyocholic acid and sulfolithocholylglycine were the main contributors. A nine-variable serum model for the Rejection Activity Index, including the change in γ-glutamyl transferase, showed a mean cross-validated R2 of 0.728 (95% confidence interval: 0.609-0.846), with methionine, creatine, and oxidized fatty acids contributing prominently. These findings suggest that metabolomic profiling combined with machine learning may provide candidate biomarkers for acute rejection after liver transplantation. However, given the exploratory nature of the study and the lack of external validation, the clinical utility of these metabolite signatures remains to be determined. Therefore, external validation in larger, independent cohorts will be required.

Kidney Transplantation Outcome in Patients With Augmented Bladder: A Single-Center Experience.

BACKGROUND Despite improvements in technical and pharmacological expertise, orthotopic liver transplantation (OLT) still leads to potentially serious neurological complications (NCs) with very strong implications for graft survival, functional outcomes, and mortality. MATERIAL AND METHODS We conducted a retrospective study with the aim of defining the incidence, etiology, and clinical features of early post-OLT NCs, and we searched for preoperative, intraoperative and postoperative risk factors associated with their occurrence. RESULTS Among 376 patients who underwent OLT, 97 (25.8%) had at least 1 neurological manifestation and 24 (6.38%) had more than 1 neurological manifestation. Delirium/metabolic encephalopathy was the most frequent (14.1%), followed by seizures (3.7%) and clinical manifestations of neurotoxicity (3.7%), and then by osmotic demyelination syndrome and peripheral nervous system injury (2.9%). NCs were the cause of death in 9/97 patients, and 11 patients had severe sequelae. Having NCs was correlated with more severe liver disease, a history of chronic renal impairment, higher plasma sodium concentrations at postoperative day 2, higher perioperative delta sodium, and a higher probability of having postoperative acute renal impairment, postoperative infections, graft rejection, and more than 3 systemic complications. No preoperative neurological comorbidities were found to be risk factors for developing acute NCs early after OLT. Patients with NCs had worse outcomes: longer in-hospital length of stay, longer intensive care unit (ICU) stay, higher probability of ICU re-admission, higher probability of in-hospital death, and higher probability of needing rehabilitation after hospital discharge. CONCLUSIONS Understanding the pathophysiology of NCs after OLT may lead to the development of prevention strategies for often untreatable neurological diseases.

Temporary discontinuation of mycophenolate mofetil (MMF) is frequently required in pediatric kidney transplant recipients, most often in response to viral complications. However, data regarding the long-term safety of MMF discontinuation, feasibility of reintroduction, and predictors of the need for MMF withdrawal in children remain limited. We conducted a retrospective, single-center cohort study of pediatric kidney transplant recipients with longitudinal follow-up. Clinical, virologic, immunologic, and transplant-related data were collected. Outcomes included longitudinal estimated glomerular filtration rate (eGFR), biopsy-proven acute rejection, graft loss, de novo donor-specific antibody (dnDSA) development, unplanned hospitalization, and MMF reintroduction. Factors associated with MMF discontinuation were evaluated using multivariable regression analysis. Among 65 pediatric kidney transplant recipients, 22 (33.8%) required temporary MMF discontinuation, most commonly within the first post-transplant year. Opportunistic viral infections accounted for the majority of MMF withdrawal events, with BK virus as the predominant indication. MMF reintroduction was feasible in most patients (15/22). Longitudinal eGFR trajectories, rates of rejection, graft loss, dnDSA development, and unplanned hospitalization did not differ between patients who discontinued MMF and those who maintained full therapy. Younger age at transplantation emerged as the sole independent predictor of the need for MMF discontinuation. In this real-world pediatric cohort, temporary MMF discontinuation, when clinically indicated, closely monitored, and followed by cautious reintroduction, was not associated with adverse long-term graft outcomes. Younger age at transplantation was associated with a higher likelihood of MMF discontinuation, supporting individualized immunosuppression strategies and proactive efforts to identify children at risk for viral-driven immunosuppression intolerance.

Early Post-transplant Complications and Overall Mortality After COVID Lung Transplant.

Biventricular impella support in acute antibody-mediated cardiac allograft rejection with severe hemodynamic compromise.

The KoreaN cohort study for Outcome in patients With Kidney Transplantation (KNOW-KT) is a prospective, multicenter observational cohort designed to provide detailed information on the natural course of kidney transplantation (KT) and to identify risk factors for posttransplant complications. We aimed to describe graft outcomes and long-term posttransplant complications from the KNOW-KT study. KNOW-KT enrolled 1,115 transplant recipients between 2012 and 2016 and followed them for up to 11 years. Data and biological samples were collected from both transplant recipients and donors at baseline and during annual follow-up visits. Epidemiological factors, laboratory data, allograft outcomes, and patient outcomes, including posttransplant complications, comorbidities, and mortality, were analyzed. A total of 1,080 kidney transplants were registered (86.9% from living donors) with a mean recipient age of 45.8±11.6 years. ABO- and human leukocyte antigen-incompatible transplants accounted for 17.4% and 8.1% of cases, respectively, and 26.7% of recipients underwent pretransplant desensitization. The overall 1-, 5-, and 10-year graft survival rates were 98.5%, 95.0%, and 91.9%, respectively. During a median follow-up period of 9.8 years, graft failure occurred in 7.6% of recipients, while biopsy-proven acute rejection episodes were observed in 19.4%. The cumulative incidence of new-onset malignancy and infection was 7.3 per 1,000 person-years and 41.2 per 1,000 person-years, respectively. The KNOW-KT study characterizes the epidemiology of Korean kidney transplant recipients and provides robust, reliable information on long-term posttransplant outcomes.

Background: Heart transplantation remains the definitive therapy for selected patients with end-stage heart failure, but outcomes are limited by acute rejection, chronic allograft injury, and cardiac allograft vasculopathy. Endomyocardial biopsy (EMB) remains the reference standard for rejection surveillance but is invasive and imperfectly captures diffuse myocardial injury. Cardiovascular magnetic resonance (CMR) offers noninvasive, multiparametric assessment of graft structure, function, tissue composition, and perfusion. We aimed to review current evidence supporting CMR in post-heart transplant surveillance and to evaluate the performance of serial CMR for acute cellular rejection in a prospective cohort. Methods: We performed a focused narrative review of the literature on CMR for detection of acute rejection, assessment of chronic allograft injury and prognosis, and evaluation of cardiac allograft vasculopathy and microvascular disease. In parallel, we conducted a prospective observational study of adult heart transplant recipients undergoing early post-transplant CMR (CMR1) and follow-up CMR (CMR2) with temporally matched EMB. Multiparametric CMR included cine imaging, native T1 and T2 mapping, extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). Clinically significant acute cellular rejection was defined as ISHLT grade ≥ 2R. Results: Eighteen recipients were included (median 53 days to CMR1 and 192 days to CMR2). Baseline CMR parameters correlated with invasive hemodynamic and biomarkers. Two patients had biopsy-proven ≥2R rejection at follow-up. T2 values at CMR2 were significantly higher in rejection versus non-rejection patients (59.0 ± 1.4 ms vs. 51.1 ± 1.9 ms; p = 0.015), with greater LGE burden in rejection (p = 0.029). In longitudinal analyses, rejection was associated with divergent patterns of cardiac remodelling and tissue characterization, including increases in indexed ventricular volumes and T2 over time, whereas non-rejection patients demonstrated stable ventricular volumes and a decline in T2. Conclusions: Multiparametric CMR, anchored by T2 mapping, provides clinically meaningful, non-invasive information for acute rejection surveillance after heart transplantation and complements EMB within a personalized, risk-adapted follow-up framework. Establishing individualized baseline CMR phenotypes and monitoring longitudinal changes may support more personalized, less invasive graft surveillance strategies. Larger multicentre prospective studies are needed to define standardized implementation pathways.

Intestinal microbiome and acute transplanted kidney rejection - results of a single-center, case-control study.

Multidrug-resistant (MDR) Gram-negative UTIs caused by extended-spectrum β-lactamases (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE) are increasingly common in kidney transplant recipients (KTR), yet their clinical consequences relative to other Gram-negative infections remain unclear. In this single-center study from a high-endemic area, we retrospectively evaluated the impact of MDR colonization (Colonization), MDR Gram-negative infection (MDR Infection), presumptive MDR infection (i.e., no isolates available; Presump. MDR), and non-MDR Gram-negative infection (non-MDR Inf.) on major post-transplant complications, including CMV and BKPyV viremia, acute rejection, donor-specific antibodies (DSA), graft function, and overall transplant failure. We used multivariable cause-specific hazard Cox regression models with time-varying covariates and random-coefficient mixed models. Among 521 KTRs, distributed across overlapping conditions, 212 (40.7%) had MDR Colonization, 92 (17.7%) MDR Infection, 61 (11.7%) Presump. MDR, 67 (12.9%) non-MDR Inf., and 242 (46.4%) had no infection. Compared with No Infection group, only MDR infection was associated with a steeper decline in eGFR slope (-5.50-2.91-0.33mL/min/1.73m2 per year; p=0.027) and increased incidence of transplant failure (adjusted hazard, aHR, associated with history of MDR Infection=1.76 4.119.61; p=0.001. MDR infection history was also the only condition associated with CMV viremia (aHR=1.051.833.18; p=0.034), and with rejection (aHR=1.031.692.76; p=0.036), though it was not associated with BKPyV viremia or de novo DSA. Colonization, Presump. Inf., and non-MDR Inf. were not independently associated with complications or transplant failure. Documented MDR Gram-negative UTIs, but not colonization or non-MDR UTI, are independently associated with acute rejection, CMV viremia, and poorer kidney allograft outcomes.

Organ procurement organization utilization of portable hypothermic oxygenated machine perfusion in liver transplantation: The first US experience.