The benefits of bilateral lung transplantation (BLT) versus single lung transplantation (SLT) are still debated. One impediment to clinical recommendations is that BLT vs. SLT advantages may vary based on underlying disease. Since both options are clinically tenable in patients with emphysema, we conducted a comprehensive assessment of lung allograft survival in this population. Using U.S. registry

Group 2 innate lymphoid cells (ILC2s) that produce IL-10 (IL-10+ILC2s) have demonstrated regulatory and tissue-protective properties in murine studies, but preclinical studies are lacking that explore the potential of human IL-10+ILC2s as a tolerance-promoting cell therapy for transplantation or autoimmunity. Here, we investigated whether human IL-10+ILC2s could enhance islet function and prevent allograft

In 2020, the Centers for Medicare and Medicaid Services (CMS) updated the Organ Procurement Organization (OPO) Conditions for Coverage, redefining deceased donor potential (DDP) as all inpatient deaths among patients 75 or younger with a primary cause of death consistent with organ donation, also called CALC (Cause, Age, and Location Consistent with donation). This study evaluates CALC performance

Tacrolimus (also known as FK506) is one of the most widely used immunosuppressive drugs in the postsurgery management of transplantation. To date, the cellular mechanism by which FK506 suppresses immune activation and elongates allograft survival remains largely unclear. Here, we employed a mouse model for corneal penetrating keratoplasty to interrogate this critical question. Administration of FK506

Cirrhotic cardiomyopathy (CCM) is an underrecognized risk factor for cardiac events in patients undergoing liver transplantation (LT). Blunted cardiac reserve (BCR) is an emerging indicator of CCM, although it has not been integrated into diagnostic guidelines. This study assesses posttransplant cardiac outcomes and mortality in patients with BCR compared with current CCM diagnostic guidelines, focusing

Lung transplantation is a cornerstone in treating patients with end-stage lung disease, yet ischemia-reperfusion injury poses significant complications in posttransplant recovery. This study aimed to understand the effects of donor type, cold ischemic time (CIT), and reperfusion on metabolic changes in lung grafts. Porcine donor lungs underwent different CITs on ice: minimal time (control), 6 hours

Pediatric liver transplant (LT) waitlist mortality remains unacceptably high. In 2020, the Organ Procurement and Transplantation Network implemented acuity circle (AC)-based liver distribution and national pediatric prioritization for pediatric donor livers. Using Organ Procurement and Transplantation Network data, waitlist outcomes for pediatric LT candidates listed between February 4, 2016, and February

Respiratory viral infections, including human metapneumovirus (hMPV), are increasingly recognized as a significant cause of morbidity and mortality in lung transplant recipients (LTRs). We present a case of hMPV pneumonia in a bilateral LTR, likely transmitted by the donor, resulting in severe acute respiratory distress syndrome and leading to death. Next-generation sequencing of hPMV genomes was performed

CD95L is a transmembrane cytokine mainly expressed by activated T and natural killer cells to contract the immune response through cell-cell contact. Conversely, after cleavage by metalloproteases, this ligand releases a soluble CD95L (sCD95L) that stimulates the immune response and its antitumor activity. In posttransplant lymphoproliferative disorders (PTLDs), we hypothesized that the concentration

Early experimental investigations of alloimmunity demonstrated that the T cell response against allogeneic antigens is robust and results from a high precursor frequency of responding clones. Seminal studies using cell culture-based methods led to an overall model in which CD8+ T cells can recognize self-peptide complexed to an allogeneic peptide major histocompatibility complex (MHC), termed the direct

With the expansion of solid organ transplantation activities in the United States, there is a critical need for more transplant care providers and trainees to sustain and advance the field of transplantation. However, there has been a pending shortage of trainees pursuing transplant fellowship training in the United States in recent years. To address this issue, the American Society of Transplantation

We report the results of 2 independent, concurrently performed studies evaluating the safety and efficacy of donor-derived mesenchymal stromal cell (MSC) infusions in inducing immune-tolerance in nonhuman primate (NHP) and human kidney transplant recipients treated with depletional induction and belatacept/sirolimus maintenance. Fifteen NHPs received rhesus ATG induction and were divided into 3 groups:

Short-statured lung transplant candidates experience longer waitlist times than taller ones. The new composite allocation score (CAS) includes height to enhance allocation equity. We assessed the impact of CAS on waitlist outcomes for different height groups. We queried a national transplant database for lung transplant candidates listed from 2021 to 2024, categorized into 4 height groups: ≤162 cm

People living with human immunodeficiency virus (HIV) (PWH) face limited access to organ transplantation despite higher rates of end-organ disease. The HIV Organ Policy Equity Act, enacted in 2015, allowed transplants from donors with HIV to recipients with HIV (HIV D+/R+) under research protocols. Studies have since demonstrated overall comparable outcomes between HIV D+/R+ and donors without HIV/R+

Ischemia-reperfusion injury commonly causes delayed graft function (DGF) after kidney transplantation and is associated with poorer graft function and lower allograft survival. Activation of the lectin complement pathway is one mediator of ischemia-reperfusion injury. In this randomized double-blind placebo-controlled pilot study, we tested whether preimplantation intragraft administration of C1 esterase

Diversity, equity, inclusion, and belonging (DEIB) have implications for transplant access and outcomes. Inequities in transplantation have been identified over the years for minoritized groups based on race, ethnicity, sex, sexual orientation, gender identity, disability status, and other sociocultural identities. While DEIB initiatives have demonstrated success in improving transplant outcomes for

Transcriptomic analysis of kidney biopsies has demonstrated the potential to improve diagnosis of allograft rejection. Here, we developed a molecular assessment of antibody-mediated rejection (AMR) and T cell–mediated rejection (TCMR) based on the Banff Human Organ Transplant consensus gene panel. Expression assays of formalin-fixed paraffin-embedded kidney biopsies from well-phenotyped cohorts were

Access to organ transplantation for individuals with HIV is expanding, yet the outcomes of patients with HIV requiring multiorgan transplants are not well-defined. Adult individuals with HIV in the United Network for Organ Sharing registry and who received heart transplantation between 2010 and 2023 were included. The primary outcome was patient survival. During the study period, 175 patients with

Inhibitory killer cell immunoglobulin-like receptors (iKIRs) are randomly expressed by natural killer (NK) cell subsets and recognize motifs shared by HLA class-I (HLA-I) allotypes. Such interactions prevent NK cell autoreactivity while enhancing their response against cells lacking those HLA-I molecules (missing self), a situation defined in transplantation as iKIR-HLA-I mismatch (iKIR-MM), whose

According to the Banff classification, intimal arteritis (v-lesion) contributes to diagnosing T cell–mediated rejection (TCMR) and antibody-mediated rejection (AMR) and signifies more severe TCMR. This multicenter cohort study (N = 5323 kidney transplants, N = 16 774 posttransplant biopsies) evaluated the impact of v-lesions (N = 707 v-positive biopsies in N = 534 transplants) on biopsy classification

Frailty is a syndrome of vulnerability to stressors linked to worse outcomes before and after lung transplantation. However, the biological basis of this association is unknown. Biological correlates of aging include epigenetic reprograming, chronic inflammation, telomere dysfunction, and anemia. We hypothesized that these aging-associated biological processes would be associated with frailty in lung

Donor-derived cell-free DNA (dd-cfDNA) is a promising biomarker of acute rejection (AR) after heart transplantation (HTx). dd-cfDNA, measured as a fraction of total cfDNA, can be affected by changes in total cfDNA whereas dd-cfDNA quantity can mitigate this impact. This study investigated the performance of a 2-threshold algorithm (2TA) that combines dd-cfDNA fraction (dd-cfDNA%) and donor-quantity

International society consensus statements, health insurance policies, and individual transplant programs almost uniformly consider active cigarette smoking an absolute contraindication to lung transplant. This denial is typically supported on utilitarian grounds—active smokers are prohibitively high-risk because of anticipated poor long-term survival—or nonutilitarian grounds related to fairness in

Patients require immunosuppression after heart transplantation. Conditions such as Crohn's disease can impact tacrolimus absorption and pharmacokinetics. Subtherapeutic tacrolimus levels can lead to rejection and development of donor-specific antibodies (DSA), resulting in the development of cardiac allograft vasculopathy. We present a boy who underwent an ABO blood groupincompatible heart transplant

Lipoprotein glomerulopathy (LPG) is an ultrarare kidney disorder caused by pathogenic variants in the APOE gene. Although kidney biopsy presents typical findings, such as dilated capillary loops containing lipoprotein thrombi, definitive diagnosis requires molecular genetic analysis of APOE. There is no specific treatment for the disease, and, in the scenario of a disorder with glomerular lipoprotein

With evolving expertise, criteria to select donors for living robotic donor hepatectomy (RDH) have expanded. We studied the comparative donor and recipient outcomes in RDHs with standard grafts and complex grafts. We performed 360 right lobe RDH (RRDH) of 4296 living donor liver transplantations, with 280 having >6 months follow-up. The first 53 cases were excluded as we used a different (cut-suture)

The skin is the most immunogenic tissue in transplantation and the most difficult tissue in which to induce immune modulation. Batf3-dependent type 1 conventional dendritic cells (cDC1s) are important in initiating rejection in murine skin transplantation. In humans, the CD141+ cDC1 subset is the functional counterpart of the murine Batf3-dependent cDC1s. However, their contribution to the rejection

Islet auto transplantation (IAT) is a potential therapeutic option for patients undergoing pancreatectomy to preserve endocrine function, but its role in patients with intraductal papillary mucinous neoplasms (IPMNs) remains controversial due to oncological concerns. This study evaluated the feasibility, safety, and metabolic outcomes of IAT in 7 patients with focal IPMNs who underwent pancreatectomy

Racial/ethnic disparities in the deceased organ donor referral process may contribute to the organ shortage and place minority communities at a greater disadvantage. Prior literature cites substantial inequalities, though methodological concerns may bias estimates. Using Organ Retrieval and Collection of Health Information for Donation data, we conducted a simulation study and reanalysis of 132 968

Living donor liver transplantation (LDLT) is crucial for addressing organ scarcity and improving survival and quality of life. Variations in practices and outcomes are influenced by geographic, economic, and cultural factors. This study examined the association between short-term LDLT outcomes and the Human Development Index (HDI), a composite metric ranking countries by life expectancy, education

Heart transplantation in mice has served as a reliable in vivo model in transplant research worldwide for more than half a century. It is not only useful for addressing cardiac graft-specific questions but also provides mechanistic insights and therapeutic strategies that have a broad impact across all solid organ transplants. Compared to other mouse models of solid organ transplantation, such as kidney

Donor-derived cell-free DNA (ddcfDNA) is increasingly used in clinical practice to monitor lung transplant patients for acute rejection (AR). However, its association with conventional approaches to monitor immunosuppression remains unclear. This multicenter observational cohort study examines the association of ddcfDNA with surrogate measures of immunosuppression. We collected serial plasma samples

De novo donor-specific human leukocyte antigen DQ antibodies detected by single antigen beads (SAB) are significantly associated with chronic antibody-mediated rejection and lower overall graft survival. However, some DQ antibodies identified by SAB cannot be confirmed by phenotype antigen-bearing class II bead assays, raising concerns about the validity of SAB data. The inability to detect these antibodies

This case report details the clinical course of a 35-year-old patient with decompensated liver cirrhosis due to primary sclerosing cholangitis awaiting liver transplantation. The patient developed recurrent candidemia due to biliary candidiasis complicated by endotipsitis, leading to repeated hospitalizations and an eventual diagnosis of tricuspid valve Candida endocarditis. In the setting of active

Kidney transplantation from ABO-A2 donors into ABO-O and ABO-B recipients can alleviate inequitable transplant access created by ABO demographics. ABO-A2-incompatible (ABO-A2i) eligibility is determined by anti-A hemagglutination titers. However, titers do not distinguish antibodies specific for A-II glycans, the sole A-antigen subtype in vascular endothelium, from other anti-A antibodies. We examined

Despite standard-of-care immunosuppression, acute rejection remains commonly observed in kidney transplants and leads to chronic graft injury and failure in many transplanted patients. Mechanisms underlying acute and chronic kidney graft injury are incompletely understood, undermining the development and implementation of therapeutic strategies to improve outcomes. This compels the use of preclinical

Out-of-sequence (OOS) allocation, the process by which organ procurement organizations (OPOs) can deviate from standard rank lists of potential recipients to expeditiously allocate deceased-donor kidneys, is increasing in the United States. We aimed to determine whether current OPO reporting practices obscure the extent of OOS allocation. Using match-run data for all US deceased-donor kidney transplants

Normothermic regional perfusion (NRP) has the potential to increase the number and quality of transplanted organs. Most reports showing the advantages of NRP have been from transplant centers, but not all centers perform NRP. These advantages could be broadened if organ procurement organizations (OPOs) also performed NRP. We report donation and transplantation outcomes of our first 90 OPO-based NRP

On March 9, 2023, allocation of donor lungs in the United States changed to continuous distribution (CD). Initial implementation of policy was flawed due to a programming error affecting priority of candidates by blood type. Although this issue has been identified and addressed, the impact of initial policy implementation on blood type-O candidates has not been rigorously evaluated. We used data from

Microvascular inflammation (MVI) is a key histological feature of immune-mediated injury at the capillary interface of renal allografts, characterized by immune cell infiltration into glomerular and peritubular capillaries. Although traditionally associated with antibody-mediated rejection (AMR), many MVI cases lack detectable donor-specific antibodies (DSA), suggesting the involvement of antibody-independent

Invasive fungal infections (IFIs) significantly impact morbidity and mortality in kidney transplant recipients (KTRs), but their effect on allograft function remains poorly defined. This retrospective study examined adult KTRs transplanted at Johns Hopkins from 2012 to 2018, with follow-up through 2023. The association of IFIs with a composite outcome of graft failure and mortality was assessed using

2024 marked the 70th anniversary of kidney transplantation, and although great strides have been made in the field, there have been few major changes in the perioperative care of kidney transplantation itself. Most patients receiving this operation worldwide undergo general anesthesia with hospital lengths of stay averaging 5 to 7 days. We present the case of a patient who underwent a living donor–related

We report the first 2 cases of fully robotic recipient left graft living donor liver transplants, demonstrating the technical feasibility of using left grafts, accompanied by a video. We anticipate that making the donor selection criteria more liberal, initially confined to right grafts, will result in an increase of the number of recipients who can potentially benefit from robotic liver transplantation

Respiratory syncytial virus (RSV) causes seasonal acute respiratory illness significantly impacting vulnerable groups, including lung transplant recipients, who are at increased risk of hospitalization, acute rejection, and allograft dysfunction. The immunogenicity of the novel RSV prefusion F3 (RSVPreF3-AS01, Arexvy, GlaxoSmithKline) vaccine in immunocompromised patients remains largely unknown. In

Normothermic regional perfusion (NRP) has emerged as a transformative method for organ recovery in donation after the circulatory determination of death (DCDD). However, ethical concerns about brain reperfusion during NRP remain, despite the application of preventative measures, such as blocking the aorta in abdominal NRP or clamping and venting the supraaortic vessels in thoraco-abdominal NRP. In