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Introduction: Donor–recipient (D/R) size mismatch has been evaluated for a number of organs but not for pancreas transplantation. Methods: We retrospectively evaluated 438 patients who had undergone pancreas transplantation. The D/R body surface area (BSA) ratio was calculated, and the relationship between the ratio and graft prognosis was evaluated. We divided the patients into two groups and evaluated graft survival. The incidence of pancreas graft thrombosis resulting in graft failure within 14 days and 1‐year graft survival were compared using Kaplan–Meier curves, and the prognostic factors associated with graft thrombosis were identified by univariate and multivariate analyses. Results: The mean/median donor and recipient BSAs were 1.63 m2/1.65 m2, and 1.57 m2/1.55 m2, respectively; the mean and median D/R BSAs were both 1.05. The receiver operating characteristic curve cutoff for the D/R BSA ratio was 1.09, and significant differences were identified between patients with ratios of ≥1.09 (high group) versus <1.09 (low group). The incidence of graft thrombosis resulting in pancreas graft failure within 14 days was significantly higher in the high group than in the low group (p <.01). One‐year overall and death‐censored pancreas graft survival were significantly higher in the low group than in the high group (p <.01). Multivariate analysis identified recipient height, donor BSA, and donor hemoglobin A1c as significant independent factors for graft thrombosis. Cubic spline curve analysis indicated an increased risk of graft thrombosis with increasing D/R BSA ratio. Conclusion: D/R size mismatch is associated with graft thrombosis after pancreas transplantation. [ABSTRACT FROM AUTHOR]

Aim: Data on the treatment of chronic active T cell‐mediated rejection (CA‐TCMR) are scarce, and therapeutical strategies for CA‐TCMR have not been established. We retrospectively evaluated the outcomes and effects of treatment on pathological and clinical findings in patients with CA‐TCMR. Methods: This study comprised 37 patients who underwent kidney transplantation at our institute who were diagnosed with CA‐TCMR between January 2018 and December 2020. Patients were followed until October 2021. Results: A total of 32 of the 37 patients were treated. During the observation period, two patients died (5%), and five patients developed allograft loss (13%). A univariate Cox proportional hazards model showed that indication biopsy, higher spot urine protein/creatinine ratio (UPCR) and Banff ci/ct scores were risk factors for allograft loss. Of the treated patients, 23 underwent follow‐up biopsies. The Wilcoxon signed‐rank test showed significant improvement in the Baff scores for "ti", "i‐IFTA", "t" and "t‐IFTA" after treatment. On pathology, 13 (57%) of the patients who underwent follow‐up biopsy improved to "no evidence of rejection" or "borderline change." Assuming that improvement in pathology to "borderline change" or "no evidence of rejection" on follow‐up biopsy indicates response to treatment, multivariate logistic analysis showed that lower UPCR was a predictive factor for response to treatment. No specific effect of treatment type was observed. Conclusions: Our results indicate that treatment could improve the pathological findings in CA‐TCMR. SUMMARY AT A GLANCE: A total of 32 of the 37 patients with CA‐TCMR were treated. 13 (57%) of the 23 patients who underwent follow‐up biopsy after treatment improved to no evidence of rejection or borderline change on pathology. Lower UPCR was a predictive factor for response to treatment. No specific effect of treatment type was observed. [ABSTRACT FROM AUTHOR]

Introduction: We previously reported that the outcomes of pure retroperitoneoscopic donor nephrectomy are superior to those of hand‐assisted retroperitoneoscopic donor nephrectomy. Consequently, we introduced pure retroperitoneoscopic donor nephrectomy in our hospital. Here, we compared perioperative outcomes between hand‐assisted intra‐abdominal laparoscopic donor nephrectomy and pure retroperitoneoscopic donor nephrectomy. Methods: We retrospectively reviewed data from 315 living‐donor kidney transplantation procedures performed between October 2015 and December 2020 (213 involving hand‐assisted intra‐abdominal laparoscopic donor nephrectomy, October 2015 to June 2019; 102 involving pure retroperitoneoscopic donor nephrectomy, May 2019 to December 2020). After propensity score matching, 90 transplantations were included in each group (n = 180 overall). Results: Donors in the pure retroperitoneoscopic donor nephrectomy group had longer warm ischemia times (P <.001), lower serum C‐reactive protein concentrations and white blood cell counts on postoperative day 1 (P <.001 and P <.001, respectively), and shorter postoperative stays (P <.001) than donors in the hand‐assisted intra‐abdominal laparoscopic donor nephrectomy group. Five (5.6%) modified Clavien‐classifiable complications occurred in the hand‐assisted intra‐abdominal laparoscopic donor nephrectomy group; no complications occurred in the pure retroperitoneoscopic donor nephrectomy group (P = 0.008). One recipient in the hand‐assisted intra‐abdominal laparoscopic donor nephrectomy group had donor‐related delayed graft function. There were no significant differences between groups in recipient estimated glomerular filtration on postoperative day 7. Conclusion: The introduction of pure retroperitoneoscopic donor nephrectomy was safe and effective. Moreover, it was less invasive and less harmful for donors, compared with hand‐assisted intra‐abdominal laparoscopic donor nephrectomy; recipient outcomes were equivalent. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B virus (HBV) reactivation is associated with complications and adverse outcomes in patients with clinically resolved HBV infection who are seronegative for hepatitis B surface antigen (HBs Ag), and seropositive for hepatitis B core antibody (HBc Ab) and/or hepatitis B surface antibody (HBs Ab) before kidney transplantation (KT). Methods: We retrospectively analyzed 52 patients with resolved HBV infection who were HBV‐DNA negative. HBV‐DNA after KT was evaluated, and the occurrence of HBV reactivation and outcomes were monitored. We defined HBV reactivation as seropositivity for HBV‐DNA at or above the minimal detection level of 1.0 log IU/mL and treated preemptively (using entecavir) when the HBV‐DNA level was at or above 1.3 log IU/mL, in accordance with the Japanese Guidelines for HBV treatment. Results: Among the 52 patients, the mean age was 57.2 ± 10.8 years. The median HBc Ab titer was 12.8 (interquartile range, 4.6‐42.6) cutoff index, and five (9.6%) cases of HBV reactivation occurred. No patients developed graft loss and died due to HBV reactivation. Statistical analysis showed that age and HBc Ab titer were significant risk factors for HBV reactivation (P =.037 and P =.042, respectively). No significant differences were found between graft survival and the presence or absence of HBV reactivation. Conclusion: These results suggest that HBc Ab titer and age could be significant risk factors for HBV reactivation. Resolution of HBV infection did not appear to be associated with patient or graft survival, regardless of whether HBV reactivation occurred, when following our preemptive strategy. [ABSTRACT FROM AUTHOR]