American Journal of Transplantation最新文献

The Scientific Registry of Transplant Recipients(SRTR) is the primary source of national transplant data in the United States; however, advanced perfusion techniques, including normothermic regional perfusion(NRP) and normothermic machine perfusion(NMP), are not consistently captured. We performed a multicenter validation study comparing SRTR-derived algorithms with confirmed reference standard cases from Mayo Clinic Florida, Mayo Clinic Arizona, and Tampa General Hospital. Algorithms were developed to identify NRP, in-transit NMP, and back-to-base NMP using existing SRTR variables. Performance was assessed by sensitivity, specificity,positive predictive value,negative predictive value,and overall accuracy. The validation cohort included 310 NRP, 1,313 in-transit NMP, and 564 back-to-base NMP cases. The NRP algorithm demonstrated 90.0% sensitivity, 99.9% specificity, and 98.7% overall accuracy. Both in-transit and back-to-base NMP algorithms demonstrated sensitivities and specificities exceeding 90%, with overall accuracies exceeding 93%. Most misclassifications resulted from inaccurate donor death or clamp times for NRP or incorrect machine perfusion coding for NMP. The proposed SRTR-based algorithms identify NRP, in-transit NMP, and back-to-base NMP with high accuracy, providing a practical framework for national registry studies of advanced liver perfusion. Although modest misclassification remains, these validated algorithms support registry-based research while emphasizing the need for improved prospective capture of advanced perfusion techniques.

U.S. organ procurement organizations allocate select deceased donor kidneys "out-of-sequence" (AOOS) by offering a kidney judged at risk of nonuse to a chosen center instead of according to the in-sequence allocation list. In 2025, AOOS practices were scrutinized by the media (February 26: high profile news article) and regulators (August 5: OPTN email deeming AOOS "not consistent with OPTN policy"). Using OPTN data from 1/1/24-2/26/25 ("pre-article") and 8/6/25-2/28/26 ("post-email"), we studied the association between OPO-level changes in AOOS and kidney transplant activity. Kidney transplant volume fell by 7% for the 33 OPOs with large AOOS reductions but rose by 1% for the other 22 OPOs, a statistically significant difference in changes (p=0.0007). Though DCD kidney recovery volume rose by just 1% for large-AOOS-drop OPOs, it rose by 14% among other OPOs (interaction p<0.0001). By contrast, cross-era changes in the probability of offered and recovered kidneys being transplanted did not differ between OPO groups. The non-use rate among recovered kidneys did not increase, suggesting any negative effects of restricting AOOS on kidney transplant volume were mediated by fewer kidney recoveries, not by increased difficulty in placing recovered kidneys. Scrutiny into AOOS practices may have led to fewer kidney transplants.

Fully robotic liver transplantation, as defined by pure robotic donor hepatectomy as well as pure robotic liver transplantation, remains underexploited in pediatric recipients because of limited abdominal space and the absence of pediatric-specific robotic systems. To our knowledge, this study reports the first series of robotic liver transplantation in pediatric recipients. Consecutive pediatric recipients that underwent robotic liver transplantation between 30 May and 9 February 2026 using the DaVinci®Xi Surgical System were included. Seven pediatric robotic liver transplants were performed, including 6 (85.7%) partial graft implantations fully robotic and 1 (14.3%) whole liver implant via domino transplantation, retrieved with the open approach from a separate pediatric donor and implanted robotically. Median recipient age and body mass index were 12.5 years and 17 kg/m², respectively. Median operation duration was 458min, median warm ischemia time 46min, and median blood loss 500 ml. Major postoperative complications (Grade≥3a) occurred in three recipients. No graft loss or mortality occurred during follow-up with a median of 15.8 months. Purely robotic liver transplantation in pediatric recipients is feasible in centers with extensive robotic liver surgery and pediatric transplantation experience. Further studies are required to evaluate long-term outcomes and define the role of robotic transplantation in pediatric patients.

Despite offering excellent outcomes and improved transplant access, living-donor liver transplantation (LDLT) has persistently represented a small minority of total liver transplant volume in the United States. Conversely, the use of advanced preservation (AP) technology and expansion of donation after circulatory death has been explosive. The impact of these trends on the future of LDLT practice in the US remains uncertain. Prior assessments have varied from considering LDLT and AP complimentary avenues to LT, to suggesting that increased deceased donor availability may render LDLT diminishingly relevant. In this viewpoint, the members of the North American Living Liver Donor Innovation Group, a consortium representing 37 LDLT-performing transplant centers, review key trends and contextualize heterogenous changes in LDLT practice. The authors argue that LDLT will continue to maintain relevance in the face of AP-driven increased deceased donor availability and argue that LDLT availability and expertise be preserved and expanded in the post-AP era.

We developed a C57Bl/6 mouse kidney model of cold storage in UW solution prior to transplantation to assess cellular injury during cold ischemic time (CIT). Compared to warm storage, cold storage reduced proximal tubule cell (PTC) death assessed by terminal deoxynucleotidase dUTP nick end labeling (TUNEL). Many PTCs showed increases in nuclear phospho-mixed lineage kinase domain-like protein (pMLKL) with concomitant nuclear swelling and increases in phospho-receptor interacting protein kinase (pRIPK)3, Z-DNA, and Z-DNA binding protein (ZBP)1 but not phospho-RIPK1, caspase 3 cleavage or TUNEL staining. Nuclear pMLKL was reduced by small molecule Bax inhibitor, BAI1 suggesting a link between mitochondrial damage and pMLKL activation. Kidneys subjected to 16-24h CIT before syngeneic transplant showed more extensive PTC death, sloughing of remaining PTCs, TUNEL staining, cytosolic pMLKL, kidney injury molecule 1 (KIM1) expression, and infiltration of neutrophils and monocytes at the cortical medullary boundary compared to kidneys transplanted without CIT. Kidneys with prolonged CIT transplanted into nephrectomized syngeneic recipients had elevated BUN and recipient death. Bax inhibition during CIT reduced PTC injury but not immune infiltration, BUN, or improve survival. Overall, these results indicate that CIT causes Z-DNA/ZBP1 activation which primes PTCs through pMLKL for necroptosis following reperfusion of transplanted kidneys.