Organ Transplantation Research Articles

Respiratory viral infections (RVIs) can have distinct clinical presentations and outcomes in non-lung solid organ transplant (SOT) recipients compared to non-transplant and lung transplant patients. Understanding their impact is crucial for improving patient care and outcomes. This multicenter retrospective study analyzed adult non-lung SOT recipients with PCR-confirmed symptomatic RVIs from eight Dutch hospitals (January 2013-July 2024) to characterize clinical characteristics and outcomes of mono- and co-infections and identify risk factors for intensive care admission or 30-day mortality. In total, 603 RVIs were identified in 460 recipients (kidney: 501; liver: 75; pancreas/islet of Langerhans: 4; combined: 23). The most common viruses were SARS-CoV-2 (36%), influenza A/B (29%), rhinovirus (14%), and RSV (7%). Influenza cases showed higher rates of fever (72%), common cold symptoms (37%), and myalgia (29%) than other viruses. Hospitalization occurred in 68% (384/565). Factors independently associated with intensive care admission or 30-day mortality included higher CURB-65 score (OR 1.91; 95% CI 1.36-2.70; p<0.01), radiologic infiltrates (OR 3.04; 95% CI 1.60-5.80; p<0.01), and SARS-CoV-2 infection (OR 1.67; 95% CI 1.05-2.67; p=0.03). In contrast, influenza infection was associated with a lower risk (OR 0.21; 95% CI 0.07-0.62; p<0.01). Co-infections were not linked to worse outcomes compared to mono-infections. Overall, RVIs in non-lung SOT recipients were associated with high hospitalization and mortality rates. SARS-CoV-2 posed the highest risk for complications, while influenza was associated with a lower risk of severe outcomes. No association was found between co-infection and poor outcomes.

Organ transplantation is a life-saving intervention, yet a persistent global organ shortage threatens patient survival. In Egypt, cultural, religious, and legal factors significantly influence donation willingness, contributing to persistently low consent rates. This study aimed to: (1) compare attitudes toward posthumous organ donation between patients with chronic illness and healthy individuals; (2) assess their preferences for eleven distinct consent models; and (3) evaluate awareness of Egyptian organ donation laws and how this and key socio-demographic predictors influence willingness to donate. This cross-sectional study included 6,000 participants (3,000 patients and 3,000 healthy individuals) from two Egyptian governorates. Participants were selected through stratified random sampling. Structured interviews and self-administered questionnaires collected data on socio-demographics, donation knowledge, and consent preferences. Participants ranked eleven consent models and assessed their awareness of key Egyptian organ donation laws. Patients exhibited a significantly higher willingness to donate posthumously (91%) compared to healthy individuals (60%) (p < 0.01). Written consent was preferred over verbal consent in both groups (75.2% vs. 70.1%, p < 0.001), emphasizing the importance of formal documentation. Incentivized donation was more favored by patients (59.6%) than healthy participants (54.7%) (p = 0.001), indicating incentives could enhance participation. Among patients, chronic illness was the primary motivator for donation, rendering socio-demographic variables less relevant. However, logistic regression identified key predictors among healthy participants. Participants aged 45-65 years were significantly less willing to donate than those over 65 years (AOR = 0.41, p = 0.01). Those in education (AOR = 2.07, p = 0.006) and manual workers (AOR = 1.94, p = 0.004) were more likely to donate than the unemployed. Higher socioeconomic status (C1/C2 and A/B) was associated with lower donation willingness than the lowest SES (D) (AOR = 0.34, 0.31, p < 0.001). Greater legal awareness was significantly associated with higher willingness to donate (p < 0.001). Chronic illness enhances donation willingness independent of socio-demographics. Health authorities should implement adaptive consent frameworks to enhance organ donation rates in Egypt, including simplified, surrogate-inclusive models for patients. Structured legal education programs for the general public to address knowledge gaps are recommended.

Due to the shortage of human organs, this study explores the Jewish perspectives on the permissibility of using pig organs in transplantation. Despite the religious prohibition of consuming pork, Jewish law allows their use for life-saving medical procedures. Our study surveyed 916 Jewish participants, examining their knowledge of religious rulings and their attitudes toward six medical applications of pig-organ transplants. We found that the degree of religious knowledge significantly influences the respondents' attitudes. Herein, we provide recommendations for enhancing the cultural competence of medical practitioners and improving the informed consent process for Jewish patients for whom xenotransplantation is recommended.

ABSTRACT Background Osteonecrosis of the femoral head (ONFH) is a debilitating condition characterized by bone tissue necrosis due to vascular insufficiency, often triggered by corticosteroid use. Steroids are commonly employed in the management of autoimmune diseases, organ transplantation, and COVID-19. Early detection is crucial, as ONFH primarily affects young and middle-aged individuals and often progresses to femoral head collapse if untreated. Objective To evaluate the protective effects of Apelin-13 (Ap-13) on steroid-induced ONFH (SONFH) in a rat model. Methods Thirty-two female Sprague-Dawley rats were randomized into four groups: Control, Ap-13 only, ONFH, and ONFH + Ap-13. SONFH was induced using lipopolysaccharide (LPS) and methylprednisolone (MPS). The treatment group received daily intraperitoneal Ap-13 injections. At the fourth week, radiological, histopathological, immunohistochemical, and biochemical analyses were conducted on femoral heads. Results Micro-CT showed no significant differences in bone mineral density or trabecular parameters. Histopathology revealed increased osteonecrosis, empty lacunae, and vascular thrombosis in the ONFH group, which were significantly reduced in the ONFH + Ap-13 group (p < 0.05). Ap-13 decreased serum malondialdehyde (MDA) levels (p = 0.0002), reduced caspase-3 expression (p < 0.05), and elevated VEGF expression (p = 0.046), indicating reduced oxidative stress, apoptosis, and enhanced vascularization. Additionally, LDL and triglyceride levels were significantly lower in the Ap-13 treated group (p < 0.05). Conclusion Apelin-13 demonstrates protective effects against SONFH by reducing oxidative stress, apoptosis, and improving vascularization. It may represent a promising noninvasive therapeutic strategy for early-stage ONFH.

Adjunctive Corticosteroid Use and Clinical Outcomes in Non-HIV Pneumocystis jirovecii Pneumonia.

Organ failure is incurable; once an organ is damaged, nothing can be done to reverse the process. Without new organ substitutions, patients have to go through a painful death, as the failure of an organ to operate in the human body leads to various illnesses. Furthermore, the number of patients who need organ transplants is mounting year by year. Although over 30 years have passed since its first organ transplant, the total number of transplants conducted in Malaysia is still disappointingly low. This paper is essential to prove a strong basis concerning the ruling of organ donation or transplant in Islam by reviewing its acceptability through the principle of Maqāṣid Sharīʿah. This paper is qualitative, and the data collection process is done through content analysis. The data sources are the collections of data from the holy Quran, Sunnah, Islamic legal maxims, classical books (turāth), contemporary legal books, article journals, and other document references. Thus, this study seeks to determine the permissibility of organ donation and transplant to another person according to Maqāṣid Sharīʿah.

Since the advent of the first successful organ transplant, year-on-year recipient numbers have steadily increased in the UK. Unfortunately, however, for each organ transplanted there necessitates an organ to be donated and as such these are extremely precious commodities. This article aims to summarise the management of potential organ donors following brainstem death in the intensive care setting from a UK perspective. A series of predictable pathophysiological changes occur following brainstem death, which if left untreated, can have a catastrophic impact on donor organs and result in them becoming unsuitable for transplantation. The article details the aforementioned pathophysiological changes in order of occurrence, and then discusses their management in line with the recommendations from the NHS Blood and Transplant authority and current literature.

Regenerative medicine is a very promising and new discipline that uses genetic material, tissues, or cells to replace or repair damaged organs and tissues, aiming to restore normal function. It solves the drawbacks of traditional treatments by utilizing cutting-edge techniques, including tissue engineering, three-dimensional organoids, and stem cell therapy. Effective treatment of organ transplant recipients, people with chronic wounds, cardiovascular, neurological, and other degenerative disorders are among the applications of regenerative medicine. Since the prevalence of chronic diseases has skyrocketed, regenerative medicine research and development has intensified. Microbes have a number of roles in regenerative medicine that impact tissue repair and regeneration. These include direct involvement in tissue repair, the generation of beneficial biopolymers, and immune system regulation. Because bacterial metabolites are highly versatile, non-toxic, biocompatible, and biodegradable, they are used in tissue engineering. Additionally, microbes can be used to create nanoparticles. We go into great detail in this overview about the function of microorganisms in regenerative medicine, including its uses and difficulties. The articles for this review were accessed through Google Scholar, Web of Science, PubMed, and Scopus archives using keywords like "chronic wounds," "degenerative diseases," "bacterial metabolites," "microorganisms," "cancer", and "regenerative medicine" AND "microbes". The information from the articles was specifically examined, and only English-language, fully peer-reviewed articles were included. This review identified that although regenerative medicine has ancient roots, it has undergone a major metamorphosis due to modern scientific and technological advancements. It is possible to use microbes in regenerative medicine to treat both infectious and non-communicable diseases. Because microorganisms can produce harmful compounds that harm host cells, they are rarely employed in regenerative medicine. The field of regenerative medicine practice is in dire need of terms pertaining to clinical and social preparedness, proven treatments with measurable benefits, and methods for integrating regenerative medicine technology into patient care in a responsible manner. Notwithstanding its potential, regenerative medicine has disadvantages like exorbitant costs, moral and ethical dilemmas, and legal and regulatory restrictions. The scientific community, regulators, health services, and public policy makers' awareness of the advantages and disadvantages of regenerative medicine will play a significant role in the nomenclature's ongoing improvement and enrichment.

Background. Given the risks of long-term disability and job loss in workers on sick leave, quick return-to-work is a primary focus of occupational rehabilitation across health fields. This study sought to identify the return-to-work obstacles and self-efficacy beliefs that predict sick leave duration after kidney transplantation. Given a lack of instruments, the Return-to-Work Obstacles and Self-Efficacy Scale was adapted for Solid Organ Transplantation (ROSES-SOT). Methods. Workers on sick leave recruited across 3 Canadian health centers were administered the ROSES-SOT 0.5–7.3 mo postkidney transplantation (n = 62). Half of the sample was administered the tool again 2 wk later (reliability over time). Workers were then called, and return-to-work dates were collected up to 1 y posttransplantation. Cronbach’s alpha coefficients were calculated (internal consistency), and univariable and multivariable linear regression analyses were performed on sick leave duration. Control variables were age, gender, ethnicity, education, income, disability benefits coverage, manual work, complications, comorbidities, donor, physical and mental health status, and stress about returning to work during the COVID-19 pandemic. Results. The face and content validity of the ROSES-SOT were assessed and deemed satisfactory. Eight of 10 ROSES-SOT dimensions demonstrated satisfactory reliability. COVID-related stress, job demands, fear of relapse, loss of motivation, and organizational injustice predicted sick leave duration. COVID-related stress and organizational injustice remained multivariable predictors. Conclusions. The ROSES-SOT showed adequate reliability and predictive value. Self-efficacy and perceived obstacles could be intervention targets when providing return-to-work support after kidney transplantation. Future studies could investigate the replicability of findings for other transplant types.

Currently, the field of organ transplantation faces serious challenges such as organ supply shortages and immune rejection. As an emerging 3D printing technology, bioprinting holds promise as a potential solution to these issues. This paper aims to comprehensively analyze the core foundational elements, classification of key technologies, and application progress of bioprinting in organ regeneration. Through literature review and case studies, it explores the current status of bioprinting applications in constructing complex tissue and organ structures, identifying challenges such as bioink performance optimization, seed cell selection, and bioprinting precision. Empirical evidence demonstrates bioprinting's transformative potential for organ regeneration, but critical challenges persistparticularly in bioink biocompatibility, cell viability preservation, and structural durability of printed constructsall requiring targeted research interventions. Future research should focus on developing novel bioinks, optimizing seed cell sources, and enhancing the precision and efficiency of bioprinting to advance organ regeneration technology.

Background: Fungal endocarditis is uncommon, making up an estimated 1-3% of cases. Risk factors for this are prosthetic heart valves, prior heart surgery, and IV drug use. Fungal seeding of CIED is even more rare, and often leads to fatal outcomes. The majority of the species involved are Candida . Pichia kudriavzevii , formerly known as Candida krusei , is a rare non-Candida species of yeast that is most frequently seen in immunocompromised patients and is associated with a high mortality rate. Known risk factors for P. kudriavzevii include underlying gastrointestinal disease or cancer, hematologic malignancies, organ transplant, corticosteroid use, and recent use of antibiotic or antifungal therapies. We present the case of P. kudriavzevii fungemia leading to seeding of ICD. Case Report: A 66-year-old male with past medical history of uncontrolled type 2 diabetes mellitus, non-ischemic cardiomyopathy with dual chamber ICD, and atrial fibrillation s/p re-do CTI and PVI ablation 2 months prior presented to the ED with abdominal pain, vomiting, and dysuria. He was afebrile and hemodynamically stable. Workup revealed WBC count of 28.6, blood glucose of 361. CT imaging of the abdomen and pelvis was unremarkable. He was admitted for sepsis secondary to suspected UTI and was started on ceftriaxone. Blood cultures drawn on admission resulted showing Pichia kudriavzevii and Lactobacillus gasseri . Urine cultures resulted showing showing P. kudriavzevii . The patient was then started on micafungin. Initial TTE did not reveal vegetations, LVEF noted to be 55%. A TEE was ordered as the patient was having persistent unexplained leukocytosis, and this revealed a vegetation on the ICD lead in the right atrium. Given the patient’s fungemia with evidence of endovascular seeding and vegetations, in the context of now recovered LVEF, the patient underwent complete extraction of his ICD. Conclusions: This case is unique in that the patient seemingly has no major risk factors for P. kudriavzevii fungemia. He does not have history of prior fungal infections or UTIs, recent anti-fungal or antibiotic use, or immunocompromised status. The patient did undergo a recent CTI and PVI ablation, however the source of infection was proven to be urinary. His uncontrolled diabetes mellitus may have been a contributing factor. A multidisciplinary approach involving infectious disease and cardiology is critical in reducing the risk of adverse outcomes in these patients.

Background Human cytomegalovirus (HCMV) is a significant opportunistic pathogen affecting immunocompromised individuals, particularly solid organ and hematopoietic stem cell transplant recipients. The emergence of mutations within conserved genomic regions of HCMV genes targeted by antiviral therapies, significantly complicating the interpretation of resistance and treatment decisions. Although the molecular characterization of such mutations and their clinical correlation are critical to guide appropriate therapeutic strategies, the significance of many detected mutations and variants, even those in conserved regions, remain uncertain in terms of in vitro or in vivo drug resistance. In this study, we clinically evaluated 15 such novel mutations. Methods Clinical specimens from immunocompromised and transplant patients with confirmed HCMV DNAemia were sequenced for UL97 , UL54 , and UL56 . The detected variants were aligned with the HCMV Merlin reference genome and evaluated for novelty and conservation. Patient records were retrospectively reviewed to assess antiviral regimens, virological responses, and clinical outcomes. Results In total, 13 patients (25%) exhibited novel UL97 , UL54 , and UL56 mutations. Four patients (30.77%) met the criteria for refractory HCMV DNAemia with varying clinical responses. Some patients responded to first-line antiviral agents despite carrying resistance-associated variants. Notably, the G579C mutation in UL97 and A835T mutation in UL54 were found within conserved domains crucial for kinase and polymerase functions, indicating their potential functional significance. One patient carried the established UL54 P522S mutation, which has been associated with intermediate ganciclovir resistance. Two cases of severe immunosuppression and persistent viremia led to mortality, demonstrating the impact of host immunity on treatment response. Conclusion Interpreting cytomegalovirus (HCMV) drug resistance mutations requires a comprehensive approach that integrates molecular data with clinical context. Early genotypic analysis can guide antiviral therapy; however, improved classification of mutations based on predicted resistance potential and phenotypic characteristics may optimize clinical decision-making. These insights emphasize the need for personalized management strategies in immunocompromised patients.

Introduction: We describe the incidence of primary graft dysfunction (PGD) in the pediatric heart transplant population. This has been difficult to quantify because of uncertain definitions and the lack of an encompassing database leading to the use of surrogates such as the need for mechanical circulatory support in the 24-48 hours post-transplant. Since September 2023 the OPTN database has included PGD and we provide an interim analysis of PGD including its incidence and relationship to mortality. Methods: The United Network for Organ Sharing database was queried for pediatric patients (&lt;18 years) who received a heart transplant in the United States and had data pertaining to PGD at 24 hours post-transplantation. Univariable analysis was performed to assess baseline, perioperative, and post-operative characteristics, employing chi-square analysis and student's Wilcoxon rank sum tests. Post-transplant survival was compared using Kaplan-Meier analysis with a log-rank test. Results: A total of 656 patients were included in the final cohort, of whom 11.2% (N=77) had PGD at 24 hours. Patients with PGD were significantly younger than those without PGD (median age 7.1 years [IQR: 1–14] vs. 8.9 years [IQR: 2–15], p = 0.016). The groups were similar in weight (27.1 kg [IQR: 7.3–39.5] vs. 26.2 kg [IQR: 10.0–50.0] and rates of congenital heart disease (CHD) (58.4% [N=45] vs. 55.1% [N=318], p = 0.667). Pretransplant VAD support was similar between groups (50.6% [N=39] vs. 41.8% [N=241], p = 0.175), as were the rates of Berlin Heart EXCOR utilization and LVSD configuration. Among the 77 patients with PGD at 24 hours, 41 (53.2%) continued to have PGD at 72 hours. Patients with PGD at 72 hours experienced significantly higher rates of postoperative stroke (17.3% [N=13/75] vs. 3.3% [N=19/574], p &lt; 0.001) and dialysis (29.9% [N=23] vs. 5.9% [N=34/576], p &lt; 0.001). Kaplan-Meier survival analysis showed that patients with PGD at 24 hours had significantly worse survival at 1 month (86.7% [95% CI: 79.3%–94.7%] vs. 98.7% [95% CI: 95.9%–98.9%]) and 1 year (64.2% [95% CI: 51.7%–79.7%] vs. 91.9% [95% CI: 88.5%–95.5%]) compared to those without PGD (log-rank p &lt; 0.001 for all; Figure 1). Conclusion: The incidence of PGD in this contemporary cohort is more than two times that of previously reported studies and is associated with significantly increased mortality. The inclusion of PGD in the OPTN database will allow a more extensive characterization of this entity in the future.

Background: The purpose of this study was to describe outcomes after heart transplantation in adults with congenital heart disease (CHD) based on the experience from a high volume transplant center. Method: Retrospective cohort study of adults with CHD who underwent heart transplantation at Mayo Clinic Rochester, MN (2003-2024). Results: Of 89 patients (age 40 [9;66], 52% males) who underwent heart transplantation, 67 (75%) had biventricular physiology while 22 (25%) had Fontan physiology. Fifty (56%) and 39 (44%) receives single organ versus multi-organ transplantation, respectively. The proportion of patients with Fontan palliation undergoing heart transplantation was higher in the late (after 12/31/2023) era 31% [21 /67] versus 5% [1/22], p=0.005.The 30-day, 1-year, and 5-year survival rates were 97%, 91%, and 87%, respectively, and these rates were higher than the estimates from national registries. Patients with Fontan physiology had lower post-transplant survival compared to biventricular physiology, but Fontan physiology was not an independent predictor of mortality. The predictors of post-transplant mortality were longer cardiopulmonary bypass time, mechanical ventilation duration and postoperative mechanical circulatory support. Conclusions: We observed a higher post-transplant survival compared to historical estimates. Post-transplant mortality was related to operative and postoperative factors, and not to CHD physiology. There was a high proportion of patients requiring multi-organ transplantation, and a rising proportion of patients with Fontan physiology who underwent transplant in the later part of the study. These findings highlight important demographic changes, importance of institutional expertise, and the need for improvements in risk stratification and referral patterns to align with these changes.

Introduction: Non-U.S. citizens, including undocumented immigrants and international patients, face substantial barriers to heart and lung transplantation in the U.S., including lack of insurance, restrictive policies, and inconsistent eligibility criteria. Despite this, they contribute meaningfully to the deceased donor organ pool. While kidney transplantation in non-citizens has received growing attention, access and outcomes in thoracic transplantation remain understudied. We examined disparities in transplant access and outcomes by citizenship status using national data. Methods: We analyzed Organ Procurement and Transplantation Network data from 2015–2020 for deceased donors and adult heart- and lung-alone transplant recipients. To allow one-year follow-up, survival analyses included recipients transplanted through 2019. Recipients were categorized as U.S. citizens, non-citizen U.S. residents (NCR), or non-citizen non-residents (NCNR). ANOVA/Kruskal-Wallis and chi-square tests compared baseline characteristics across groups. Competing risk models estimated 1- and 3-year probabilities of transplant, removal for deterioration, remaining on the waitlist, or other reasons. Kaplan-Meier curves and multivariable Cox models assessed post-transplant survival, adjusting for demographic and clinical covariates. Results: Among 27,427 deceased donor transplants, NCR and NCNR recipients comprised &lt;4% of heart and lung recipients, yet their donated organs were largely allocated to U.S. citizens. NCR and NCNR heart recipients showed higher illness severity at transplant (e.g., ICU admission, balloon pump use), while NCNR heart candidates had the highest 3-year transplant probability (80.7%), suggesting selective listing. NCR lung candidates faced the highest risk of removal for being too sick. Non-citizen lung recipients also had lower forced vital capacity, reduced walk distance, and higher steroid use. One- and three-year patient and graft survival were similar across citizenship groups. Citizenship status was not associated with post-transplant mortality or graft failure in adjusted models. Conclusion: Although non-citizens contribute to the thoracic donor pool, they remain underrepresented as transplant recipients—even though they achieve equivalent outcomes once transplanted. These findings underscore ethical concerns and support reforms to expand equitable, standardized eligibility across centers.

Background: Cardiovascular disease is a leading cause of morbidity and mortality among kidney transplant recipients, driven by traditional risk factors and immunosuppressive therapy. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown cardiovascular benefits in the general population, yet their role in solid organ transplant recipients remains underexplored. We aimed to evaluate the association between post-transplant SGLT2 inhibitor use and cardiovascular outcomes, including major adverse cardiovascular events (MACE), heart failure, arrhythmia, myocardial infarction (MI), and stroke. Methods: Using the TriNetX global research network, we conducted a retrospective cohort study including adult kidney transplant recipients without prior rejection (ICD-10: T86.11). Patients were assigned to two groups: those initiating SGLT2 inhibitors within one month of transplant (SGLT2 group, n = 3,409) and those not exposed to SGLT2 inhibitors (non-SGLT2 group, n = 145,164). Propensity score matching (1:1, nearest neighbor) yielded 2,841 patients per group with well-balanced demographics, comorbidities, and medication use. Time-to-event analyses were conducted over a 5-year window. Results: MACE occurred in 13.7% of SGLT2 users and 23.4% of non-users (risk difference: –9.7%; HR: 1.376 , 95% CI: 1.212–1.561, p &lt; 0.001). Heart failure occurred in 5.9% of SGLT2 users vs 10.9% of non-users (HR: 1.432 , 95% CI: 1.137–1.802, p = 0.002). Arrhythmia was observed in 18.8% of SGLT2 users and 26.7% of non-users (HR: 1.298 , 95% CI: 1.161–1.451, p &lt; 0.001). MI occurred in 5.8% of SGLT2 users compared to 8.5% of non-users (HR: 1.196 , 95% CI: 0.980–1.460, p = 0.078). Stroke occurred in 4.3% of SGLT2 users and 6.7% of non-users (HR: 1.280 , 95% CI: 1.016–1.611, p = 0.036). Conclusion: In kidney transplant recipients without prior rejection, early post-transplant SGLT2 inhibitor use was associated with significantly lower risks of MACE, heart failure, arrhythmia, and stroke. While MI rates were lower in the SGLT2 group, this did not reach statistical significance. These findings support the cardiovascular safety and potential benefit of SGLT2 inhibitors in transplant populations, warranting validation in prospective randomized trials.

Background&amp;Objective: Visit-to-visit blood pressure variability (VVBPV) has emerged as an independent predictor of cardiovascular and renal outcomes, but its prognostic significance in kidney transplant recipients—especially in Asian populations—remains unclear. We aimed to assess whether elevated VVBPV predicts adverse long-term outcomes in Korean kidney transplant recipients, using a nationwide cohort to provide real-world evidence in this underrepresented population. Methods: We analyzed 5,532 adult recipients from the Korea Organ Transplantation Registry (2014–2022). VVBPV was calculated as the average real variability (ARV), standard deviation (SD), and coefficient of variation (CV) of systolic blood pressure (SBP) measured during routine post-transplant follow-up. Patients were stratified into tertiles based on ARV. The primary composite outcome included graft loss, new-onset cardiovascular disease (CVD), or ≥50% decline in estimated glomerular filtration rate (eGFR). Cox proportional hazards models were adjusted for age, sex, BMI, comorbidities, and 6-month post-transplant clinical variables. Results: During a median follow-up of 55.4 months, 541 patients (9.8%) experienced the primary outcome. Graft loss occurred in 200 patients (3.6%), incident CVD in 176 (3.2%), and ≥50% eGFR decline in 337 (6.1%). Compared with Group 1 (lowest ARV), Group 3 (highest ARV) had a significantly increased risk of the composite outcome (HR 1.755; 95% CI 1.401–2.198; p&lt;0.001). SD and CV showed consistent results (SD: HR 1.483; 95% CI 1.194–1.841; CV: HR 1.558; 95% CI 1.256–1.932; all p&lt;0.001). Group 3 also had elevated risk for secondary outcomes including graft loss (HR 1.716; 95% CI 1.242–2.372; p&lt;0.001), dialysis dependence (HR 1.822; 95% CI 1.312–2.526; p&lt;0.001), and &gt;30% eGFR decline (HR 1.641; 95% CI 1.306–2.062; p&lt;0.001). Subgroup analyses revealed more pronounced associations in patients with diabetes (HR 2.13) and those with pre-existing CVD (HR 1.96), although interaction p-values were not statistically significant. Kaplan-Meier analysis showed reduced event-free survival in higher VVBPV groups (log-rank p&lt;0.001). Conclusion: VVBPV may be a clinically relevant prognostic indicator in kidney transplant recipients. Prospective studies are needed to validate these associations and explore potential interventions. These findings suggest that VVBPV may also serve as a useful risk stratification marker in long-term transplant care.

The medical field is gradually beginning to reveal its new breakthroughs related to the discovery of new treatment methods in the form of organ transplantation or the transfer of human organs to save other human organs, which is referred to as transplantation. The urgency of this practice is directed towards individuals who exhibit symptoms of organs detached from normal conditions. The aim of this research is to explore the Islamic legal response to transplantation practices that have not been specifically addressed in the Qur'an. Qualitative research is employed as a method, utilizing a comparative approach to the views of classical and modern scholars in conjunction with the fatwas of religious bodies. The findings of this study demonstrate that the Islamic legal response is very flexible in permitting transplantation practices, thereby making the medical world a bridge for the healing of humanity. This modern treatment method minimizes disparities in the medical field. This article can enrich the literature on organ transplantation by thoroughly analyzing the opinions of classical and contemporary scholars, thus necessitating the drafting of a new fatwa while considering the medical, social, and spiritual dynamics of the Islamic community.

Solid organ transplantation (SOT) faces significant challenges in managing allograft rejection, with current immunosuppressive therapies often associated with substantial adverse effects. Extracorporeal photopheresis (ECP) has emerged as a promising adjunctive treatment for rejection prevention and management in heart and lung transplants, with growing evidence supporting its use in kidney and liver transplants. Despite this, the availability of ECP and its place in standard treatment pathway is widely variable across Europe. This narrative review, supported by a European survey of 51 transplant clinicians, highlights the current usage of ECP in SOT. Findings reveal that ECP is primarily used for recurrent rejection in heart and lung transplants, with limited application currently in kidney and liver transplants. ECP has shown some efficacy in managing acute and chronic rejection, and stabilizing graft function. Barriers including lack of standardized protocols, availability of ECP, lack of high-quality clinical trial data and lack of a defined mechanism of action hinder its broader adoption. Future directions include the development of standardized protocols, multicenter registries, and further controlled clinical trials to define the role of ECP. Increased awareness, cost-effectiveness studies, mechanistic studies and equitable access are essential to integrate ECP into routine SOT management.

Global, regional, and national burden of Chagas disease, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.