To establish the rates of and variables associated with glycaemic disturbances in people with type 1 diabetes with a functioning pancreas transplant, and to quantify the association with graft failure. An observational study on routinely collected data from pancreas transplant recipients at University Hospital Wales from January 2013 to April 2019 with glucose tolerance test (GTT) data. Their variables were analysed to assess rates and risk factors for glycaemic disturbance. Of the 96 participants in this study, 30% developed glycaemic disturbance. Hyperglycaemia was twice as common as hypoglycaemia (22% vs. 10%). Recipients who developed hypoglycaemia were predominantly women (90% vs. 26% for those who developed hyperglycaemia, p = 0.001), had a lower mean BMI (23.7 vs. 27.6 kg/m2 for hyperglycaemic individuals, difference: 3.89, CI: 0.77-7.0, p = 0.017). There was no increase in graft failure rates for recipients with glycaemic disturbances (normoglycaemia: 12%, hypoglycaemia: 10%, hyperglycaemia: 4.8%, p = 0.70). Recipients with post-transplantation hypoglycaemia were more likely to be women and of low body weight, which may be due to disordered eating with restricted calorie or carbohydrate intake. Recipients with post-transplantation hyperglycaemia had features of insulin resistance and type 2 diabetes with increased weight and men predominance. Glycaemic disturbance was not associated with graft failure, suggesting it relates to insulin-glucose mismatch rather than rejection. Further follow-up is required to identify the long-term sequelae of glycaemic disturbance after pancreas transplants and if relevant dietary counselling has the potential to attenuate these disturbances.

Factors for the development of graft pancreatitis following pancreas transplantation: A Systematic Review.

Trends in Survival and Unmet Need Across Solid Organ Transplantation.

Prophylactic Omentopexy to Prevent Proximal Duodenal Staple Line Leak in Whole Organ Pancreas Transplantation.

Bovine Carotid Artery Is a Viable Iliac Artery Conduit During Solid Organ Transplantation.

BACKGROUNDSimultaneous pancreas-kidney transplantation (SPKT), an established treatment for patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and end-stage renal disease (ESRD), provides metabolic stabilization and improved survival. Although perioperative glycemic control is crucial for graft viability; intraoperative management remains understudied, and standardized phase-specific protocols are lacking.AIMTo explore the feasibility, safety, and immediate outcomes of a six-phase intraoperative glycemic control algorithm for SPKT.METHODSThis retrospective case series included 11 patients with T1DM or T2DM and ESRD who underwent SPKT at a quaternary care center between January 2024 and May 2025. All patients were managed using a six-phase institutional glycemic control algorithm that maintains intraoperative blood glucose levels within predefined targets. Data on clinical, metabolic, surgical variables; complications; and early outcomes were collected.RESULTSIn most cases, intraoperative blood glucose levels were maintained within target ranges; however variations were observed [range: 63-453 mg/dL (3.5-25.2 mmol/L)]. No severe hypoglycemia or ketoacidosis occurred. During the first 24 postoperative hours, seven patients (63.6%) achieved euglycemia without exogenous insulin, whereas two required transient insulin therapy. Six patients (54.5%) had postoperative complications, including thrombotic (n = 4), infectious (n = 2), and reperfusion syndrome (n = 1). One patient experienced more than one event. All events were successfully managed, without graft loss, acute rejection, or in-hospital mortality.CONCLUSIONThe phase-specific intraoperative glycemic protocol for SPKT is feasible and safe. However, prospective studies with larger cohorts are warranted to assess its long-term impact on graft survival and patient outcomes.

Pancreas transplantation remains the only definitive therapy for restoring endogenous insulin secretion and physiologic glycemic control in patients with insulin-dependent diabetes mellitus. Utilization in the United States has declined, however, in part due to morbidity associated with open simultaneous pancreas-kidney transplantation (SPKT), secondary to the incision or bowel manipulation, and procedural concentration within high-volume centers. The dissemination of robotic kidney transplantation has demonstrated the feasibility of minimally invasive transplant surgery and provides a platform to reconsider pancreas transplantation using standardized robotic principles. We describe a reproducible technique for robotic pancreas transplantation (RPT), applicable to SPKT, pancreas-after-kidney transplantation, and pancreas-transplant-alone. Patient selection follows established criteria with multidisciplinary evaluation and preoperative vascular imaging. The operative workflow includes back-table vascular construction, limited iliac vessel dissection, extraperitoneal graft placement in a head-down orientation on the left iliac fossa, tension-free portal vein anastomosis to the external iliac vein, arterial anastomosis to the external iliac artery, controlled reperfusion, and side-to-side duodeno-ileostomy. Port placement mirrors robotic kidney transplantation to promote procedural standardization. Early experiences from high-volume centers demonstrate technical feasibility of RPT. Published series report successful implementation without routine need for hand assistance, and institutional experience supports reproducibility. Data remain limited, however, and are not powered to assess comparative outcomes or cost-effectiveness. A standardized approach to RPT is technically feasible and may reduce the surgical burden associated with open SPKT. While larger multicenter studies are required to define safety, graft outcomes, and economic impact, dissemination of a reproducible operative framework represents an essential first step toward broader adoption.

The Real-World Safety and Effectiveness of Rituximab in Preventing Antibody-Mediated Rejection in ABO-Incompatible Liver Transplantation: All-Case Postmarketing Surveillance in Japan.

Engineering early immune resilience in islet transplantation.

Background.Pancreas transplantation (PT), historically limited to patients with type 1 diabetes (T1D), is currently performed successfully in selected patients with type 2 diabetes (T2D). However, contemporary practice patterns and eligibility criteria for PT in T2D remain incompletely characterized.Methods.The International Pancreas and Islet Transplant Association Pancreas Transplant Interest Group developed an electronic survey to assess center-level approaches to patient phenotyping, candidacy, and peri- and posttransplant management for PT in patients with T2D. The survey was distributed to international transplant professionals during an International Pancreas and Islet Transplant Association Pre-Congress meeting on June 15, 2025.Results.Thirty-seven participants completed the survey. Most respondents’ programs offer PT for T2D only when a kidney transplant is also indicated. Fewer respondents’ programs also offer PT alone (10%), evaluate T2D candidates on a case-by-case basis (3%), or do not offer PT to patients with T2D (10%). Total daily insulin requirement and body mass index (BMI) were the most selected factors in determining eligibility. Considerable variability existed in metabolic thresholds: 62% of programs reported no C-peptide cutoff, whereas nearly half required a BMI of <30 kg/m2 for C-peptide-positive candidates. Respondents frequently recommend weight-optimization strategies, including lifestyle modification, glucagon-like peptide-1 receptor agonists, and bariatric surgery for candidates exceeding acceptable BMI thresholds. Surgical technique, induction, and maintenance immunosuppression and early posttransplant glycemic management were largely uniform between T2D and T1D recipients.Conclusions.International practice reflects broad but heterogeneous adoption of PT for T2D, with most participants restricting its use to candidates requiring kidney transplantation and emphasizing integrated clinical phenotyping approaches.

Donor macrophage depletion permits posttransplant tolerance induction in a murine islet transplant model.

Background.Simultaneous pancreas-kidney transplantation improves survival and glycemic control in insulin-dependent diabetes, but pancreas graft failure remains common, and its evolving impact on patient survival and downstream kidney outcomes is inadequately defined.Methods.Using 2013–2022 US Scientific Registry of Transplant Recipients data, we treated pancreas death-censored graft failure (DCGF) as a time-dependent exposure in Cox models for mortality, and kidney all-cause graft failure and DCGF. Early (≤1 y) and landmark (>1 y) analyses addressed nonproportional hazards. Sensitivity analyses conducted on post-March 2018 standardized failure definitions and technical failures. Subgroup analyses analyzed age, sex, and diabetes type. In a 1-y landmark subcohort with intact grafts, we analyzed associations between subsequent kidney DCGF and 5-y mortality.Results.Pancreas DCGF occurred in 1013 recipients (5-y incidence 13.7%), predominantly within 1 y (33% technical), conferring increased mortality early (hazard ratio [HR] 2.97; 95% confidence interval [CI], 2.04-4.34) and sustained risk beyond 1 y (HR 2.47; 95% CI, 1.87-3.25), with similar findings post-2018. Technical DCGF carried modest risk (HR 1.56; 95% CI, 1.16-2.09). Pancreas DCGF was also associated with kidney all-cause graft failure (HR 2.33; 95% CI 2.01, 2.69) and DCGF (HR 2.70; 95% CI, 2.25-3.25). In those with intact grafts at 1 y, kidney DCGF conferred markedly higher 5-y mortality (HR 9.37; 95% CI, 7.04-12.48). Younger recipients exhibited slightly greater relative mortality risk after pancreas DCGF (ratio of HR 1.10).Conclusions.Pancreas DCGF is common and independently heralds substantially increased risks of death and kidney graft loss, whereas kidney failure further amplifies mortality, underscoring the need for enhanced risk stratification, prevention, and post–failure management to optimize long-term simultaneous pancreas-kidney outcomes. Younger recipients also faced a higher relative mortality risk after pancreas failure, highlighting a vulnerable subgroup requiring further study.

OPTN/SRTR 2024 Annual Data Report: Pancreas.

Predictive Modeling of Early Pancreas Technical Failure and Kidney Delayed Graft Function at Organ Offer in Simultaneous Pancreas-Kidney Transplantation

Fulminant Acanthamoeba Encephalitis Diagnosed By Cell-Free DNA in a Renal Transplant Patient: A Case Report.

OPTN/SRTR 2024 Annual Data Report: Overview of US Solid Organ Transplantation.

With growing transplant waiting lists, more extended criteria donor organs are being accepted, requiring optimization of the organs to increase utilization. Abdominal normothermic regional perfusion (aNRP) benefits the outcomes of transplanted livers and pancreatic islets, but its effects on donor kidneys subsequently preserved with (oxygenated) hypothermic machine perfusion (HMPO2) remain to be determined. This study examines the function and survival of an aNRP-preserved controlled donation after circulatory death (cDCD) kidneys followed by HMPO2. From October 2018 until June 2023, we evaluated all ≥50 y cDCD kidneys retrieved using aNRP during a pilot implementation project and compared posttransplant outcomes of these donor kidneys to those of cDCD kidneys retrieved by standard rapid retrieval during the same period. All kidneys received HMPO2 as standard preservation. This study primarily compared estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration), 1 y graft and recipient survival. Data of 70 aNRP-preserved kidneys were compared with a control group of 124 kidneys. One year estimated glomerular filtration rate was comparable between groups (40.4 mL/min/1.73 m2 [29.3-52.3] versus 40.0 mL/min/1.73 m2 [28.1-48.1]; P = 0.5) as well as graft and recipient survival at 1 y (81.4% versus 83.1%; hazard ratio, 1.1; 95% confidence interval [CI], 0.6-2.3; P = 0.63; 88.6% versus 88.7%, hazard ratio, 1.0; 95% CI, 0.4-2.4; P = 0.99, respectively). Primary nonfunction and delayed graft function were not significantly different (odds ratio, 1.3; 95% CI, 0.4-4.2; P = 0.68; odds ratio, 1.3; 95% CI, 0.7-2.5; P = 0.39). This study demonstrates that aNRP-preserved kidneys from cDCD donors aged 50 y and older had comparable outcomes to kidneys retrieved with standard rapid retrieval, in the context of HMPO2 as a standard ex situ preservation technique. This differs from earlier studies showing improved results of aNRP in the context of cold storage without standard machine perfusion. With aNRP gaining interest because of its value for liver and pancreatic islet transplantation, a prospective randomized study should be performed to further analyze the benefit of continuous kidney HMP(O2) after aNRP.

Intravesical Bacillus Calmette-Guérin (BCG) therapy has been the standard treatment for preventing recurrence of non-muscle-invasive bladder cancer (NMIBC) for over four decades. Although maintenance BCG therapy improves recurrence-free survival in intermediate- and high-risk NMIBC patients, its long treatment duration, toxicity, and limited efficacy - particularly in carcinoma in situ -necessitate the development of improved therapeutic alternatives. rBCG-h12 is a recombinant BCG strain engineered to enhance immunogenicity. This study evaluated its ability to augment macrophage activation and antitumor responses. The safety of intravesical rBCG-h12 was evaluated in NOD/SCID and C57BL/6 mice through four weekly instillations. Body weight, survival, urine hematuria, and organ histopathology were monitored. Antitumor efficacy was tested using an orthotopic NMIBC transplant model. Immune microenvironment changes were analyzed by detecting macrophage and T cell markers. The systemic antitumor potential of rBCG-h12 was further evaluated via intramuscular injection in pancreatic cancer transplant and K-RasG12D mouse models. Intravesical rBCG-h12 was well tolerated, with no observed mortality, weight loss, hematuria, or organ pathology. Compared with conventional BCG, rBCG-h12 more effectively suppressed bladder tumor growth, prolonged survival, and mitigated cachexia. Mechanistically, rBCG-h12 decreased CD206+ M2-macrophages while increasing CD4+TNF-α+ effector T cells and CD8+TNF-α+ cytotoxic T cells. In pancreatic cancer models, a single intramuscular injection of rBCG-h12 markedly reduced desmoplasia, suppressed tumor growth, and extended survival without inducing pathological lesion or granuloma formation in liver, lungs, and spleen. rBCG-h12 exhibited superior antitumor efficacy and safety compared with BCG. By suppressing M2-macrophages and promoting Th1 immune activation, rBCG-h12 shows promise as a next-generation BCG-based immunotherapy for both bladder and pancreatic cancers.

Association of HLA alleles and mismatches with post-transplant lymphoproliferative disorder in solid organ transplant recipients: a systematic review and meta-analysis.

Application of Kidney-Derived MMDx Algorithm to Pancreas Transplant Biopsies: A Pilot Study