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Heart transplantation is an effective treatment for end-stage congestive heart failure, however, achieving the right balance of immunosuppression to maintain graft function while minimising adverse effects is challenging. Serial endomyocardial biopsies (EMBs) are currently the standard for rejection surveillance, despite being invasive. Replacing EMB-based surveillance with cardiac magnetic resonance (CMR)-based surveillance for acute cardiac allograft rejection has shown feasibility. This study aimed to assess the cost-effectiveness of CMR-based surveillance in the first year after heart transplantation. A prospective clinical trial was conducted with 40 orthotopic heart transplant (OHT) recipients. Participants were randomly allocated into two surveillance groups: EMB-based, and CMR-based. The trial included economic evaluations, comparing the frequency and cost of surveillance modalities in relation to quality-adjusted life years (QALYs) within the first year post-transplantation. Sensitivity analysis encompassed modelled data from observed EMB and CMR arms, integrating two hypothetical models of expedited CMR-based surveillance. In the CMR cohort, 238 CMR scans and 15 EMBs were conducted, versus (vs) 235 EMBs in the EMB group. CMR surveillance yielded comparable rejection rates (CMR 74 vs EMB 94 events, p=0.10) and did not increase hospitalisation risk (CMR 32 vs EMB 46 events, p=0.031). It significantly reduced the necessity for invasive EMBs by 94%, lowered costs by an average of AUD$32,878.61, and enhanced cumulative QALY by 0.588 compared with EMB. Sensitivity analysis showed that increased surveillance with expedited CMR Models 1 and 2 were more cost-effective than EMB (all p<0.01), with CMR Model 1 achieving the greatest cost savings (AUD$34,091.12±AUD$23,271.86 less) and utility increase (+0.62±1.49 QALYs, p=0.011), signifying an optimal cost–utility ratio. Model 2 showed comparable utility to the base CMR model (p=0.900) while offering the benefit of heightened surveillance frequency during periods of elevated rejection risk. CMR-based rejection surveillance in orthotopic heart transplant recipients provides a cost-effective alternative to EMB-based surveillance. Furthermore, it reduces the need for invasive procedures, without increased risk of rejection or hospitalisation for patients, and can be incorporated economically for expedited surveillance. These findings have important implications for improving patient care and optimising resource allocation in post-transplant management. [ABSTRACT FROM AUTHOR]

For social species, having strong and high-quality social relationships is an important safety cue. Loneliness occurs when an individual perceives they have insufficient relationships resulting in feelings of lack of safety. States of perceived unsafety are linked to an increased tendency to construe ambiguous information – information lacking a unique clear interpretation – as threatening. Here, we explore whether the ambiguity of social cues of interpersonal rejection moderates effects of loneliness on feelings of rejection while undergoing social exclusion. Data were collected in 2021; 144 adults completed a progressive social exclusion paradigm where they were randomly assigned to be equally included, excluded, or over-included. Social exclusion/inclusion cues became more pronounced over the course of multiple rounds of a ball-tossing game (Cyberball) resulting in a scenario where ambiguity was highest in earlier rounds and decreased over time. Participants reported feelings of loneliness prior to the task and feelings of rejection throughout the task. Results demonstrated that higher loneliness predicted increased feelings of rejection regardless of exclusion condition. Notably, this positive relationship was strongest during earlier rounds when social cues were most ambiguous. These findings contribute to our understanding of how loneliness modulates social perception to enable organisms to adequately adapt to changing circumstances. [ABSTRACT FROM AUTHOR]

Background: The United Network for Organ Sharing (UNOS) started recording data on intellectual disability status in 2008. This study aimed to characterize the long‐term outcomes for children with intellectual disabilities (IDs) undergoing lung transplantation. Methods: All pediatric patients (under 18 years old) undergoing bilateral lung transplantation were identified using the UNOS database. The patients were grouped into the following categories: no cognitive delay, possible cognitive delay, and definite cognitive delay. The primary endpoint was graft survival at 3‐year posttransplantation. Multivariate Cox proportional hazards modeling was used to estimate the independent effect of cognitive disability on graft survival. Results: Five hundred four pediatric patients who underwent lung transplantation between March 2008 and December 2022 were retrospectively analyzed. 59 had a definite cognitive delay (12%), 23 had a possible delay (5%), and 421 had no delay (83%). When comparing these three groups, there was no significant difference in 60‐day graft survival (p = 0.4), 3‐year graft survival (p = 0.6), 3‐year graft survival for patients who survived at least 60‐day posttransplantation (p = 0.9), distribution of causes of death (p = 0.24), nor distribution treatment of rejection within 1‐year posttransplantation (p = 0.06). Conclusions: Intellectual disability does not impact long‐term outcomes after bilateral lung transplantation. Intellectual disability should not be a contraindication to bilateral lung transplantation on the basis of inferior graft survival. [ABSTRACT FROM AUTHOR]

Background: BK polyomavirus (BKV) DNAemia is a challenging infectious complication after kidney transplant (KT). Reduction of immunosuppression is the mainstay of management, and tacrolimus is often the first immunosuppressive medication adjusted upon the diagnosis of BKV DNAemia. This study aimed to evaluate the impact of a new institutional protocol with lower target tacrolimus levels on BKV DNAemia, allograft rejection, and de novo donor‐specific antibodies (dnDSA) among pediatric KT recipients. Methods: We conducted a retrospective chart review of all KT episodes between January 2013 and December 2018. The new protocol with lower target tacrolimus levels was implemented in March 2015. One hundred twenty‐seven patients were included in primary analysis. All patients received induction with basiliximab and methylprednisolone and were maintained on a steroid‐based immunosuppressive regimen. Results: In the post‐intervention cohort, cumulative incidence of BKV DNAemia at 100 days (13.4% vs. 17.8%, p =.605) and 18 months post‐KT (34.1% vs. 26.7%, p =.504) was not significantly different from the pre‐intervention cohort. Biopsy‐proven rejection rate did not change. However, we observed a trend toward earlier development of dnDSA in the post‐intervention cohort using the Kaplan–Meier survival analysis (log‐rank p =.06). Younger recipient age at the time of transplant was found to slightly increase the risk of BKV DNAemia (OR: 1.09, 95% CI [1.01, 1.16], p =.024). There was an association between BKV DNAemia and biopsy‐proven rejection of any type (adjustedOR: 2.77, 95% CI [1.26, 6.23], p =.012), especially acute T‐cell‐mediated rejection grade 1A and above (adjustedOR: 2.95, 95% CI [1.06, 8.30], p =.037), after adjusted for recipient age at the time of transplant. Conclusions: Targeting lower tacrolimus levels did not decrease the incidence of BKV DNAemia within 100 days or 18 months post‐KT, nor did it increase the risk of biopsy‐proven rejection among pediatric KT recipients in our center. However, there was a trend toward earlier development of dnDSA, which may portend worse long‐term graft outcome post‐KT. Our findings highlight the need for individualized immunosuppressive regimens based on immunologic and infectious risk factors and the importance of implementing innovative biomarkers to guide therapy and improve outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Kidney transplantation has a survival benefit for people with human immunodeficiency virus (HIV) and end‐stage kidney disease, however increased rates of rejection remain an issue. Questions remain regarding the impact of induction immunosuppression therapy and antiretroviral (ARV) choice on long‐term outcomes. Methods: We performed a multicenter retrospective analysis of outcomes in recipients with HIV who received kidneys from donors without HIV transplanted between 2004 and 2019. The association between induction and ARV regimens and long‐term outcomes including rejection, graft, and recipient survival over 5 years was investigated using Cox regression modeling. Results: Seventy‐eight kidney transplants (KT) performed in 77 recipients at five US transplant centers were included, with median follow up of 7.1 (4.3–10.7) years. Overall recipient and graft survival were 83% and 67%, respectively. Rejection occurred in 37% (29/78). Recipients with rejection were more likely to be younger, recipients of deceased donor organs, and Black. Receipt of rabbit anti‐thymocyte globulin (rATG) induction without protease‐inhibitor (PI)‐based ARVs was associated with 83% lower risk of rejection (adjusted hazard ratio (aHR) 0.17 (95% CI 0.05–0.63), p =.007) and a non‐statistically significantly lower risk of graft failure (aHR 0.18 (0.03–1.16), p =.07) when compared to those who received other induction and ARV combinations. Conclusions: In this multicenter retrospective study, we found a trend toward lower rejection and improved graft survival among those who received both rATG for induction and PI‐sparing ARVs. [ABSTRACT FROM AUTHOR]

Acidic water from the coal of mining pool has been polluted from the surrounding coal stockpile stocpile industry. Water quality in mining ponds can threaten the biota in it. During this time, coal mining pool the local community uses water extensively for everyday requirements like drinking, washing, and bathing. More than time it turns out that coal mine acidic water has been polluted. This problem needs to be sought a solution, one of which is required treatment technology for creating water quality that satisfies requirements for drinking water quality. This research tries to use NF270 membrane type Nanofiltration membrane technology to eliminate COD, TSS, TDS, and metal parameters (Fe, Mn). This research was conducted by analyzing the influence pressure (4, 5, and 6 bar) on each component's rejection rate and flux each parameter. The results of the study show the processed results as follows; Turbidity, Color, COD, TSS, TDS, Fe and Mn at pressures 4, 5, and 6 bar of acid mine rejection water values, namely; Turbidity (96.23%; 98.7%; 100%), Color (79%; 98%; 100%), COD (57.9%; 63.7%; 83.19%), TSS (73, 3%; 87.2%; 95.8%), TDS (62.7%; 66%; 70.19%), Fe (36%; 74.5%; 100%), Mn (100%; 100 %; 100%). Acidic water treatment in coal mining ponds can be turned into drinking water using nanofiltration membranes producing the best percentage of rejection at pressures of 5 and 6 bar. Water treatment with Nanofiltration membrane technology has produced treated water in accordance with drinking water quality standards required by Priest of Wellbeing Pronouncement of the Republic of Indonesia No. 907/Menkes/Sk/VII/2002 and Clergyman of Climate Pronouncement the Decree of the Minister of Environment No. 492 / IV / 2010 / MENKES / PER. NF 270 membrane can remove heavy metals and other impurities in acidic water by more than 90%. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the burden of care of individuals caring for pediatric patients who have undergone liver transplantation. Methods: The study was conducted at the Inonu University Liver Transplant Institute pediatric liver transplantation ward between May 2022 and February 2023. Data were the "Zarit Care Burden Scale," and the "Beck Depression Scale," and demographic characteristics of the patients and their caregivers. Results: The average age of the caregivers was 38.35±11.82 years; 72.7% were women, 69.7% were the child's mother, and 81.8% reported that caregiving impacted their daily lives. The effect of caregivers' burden of care on their daily lives was found to be statistically significant (p = 0.021). Among the pediatric recipients, 42.4% were aged 13-18 years, 60.6% were female, 45.5% had been post-transplant for more than 25 months, and 54.5% developed complications. The burden of care was severe at 38.87±10.21, and the depression was mild at 10.81±8.65. A moderate positive relationship was observed between burden of care and depression level (r: .602, p: 0.000). Simple linear regression analysis showed that caregivers' depression levels significantly affected their burden of care, (R²=0.363). Conclusion: The study concluded that caregivers of pediatric liver transplant patients experience a very high burden of care and mild depression. This high burden of care negatively impacts their daily lives and leaves them with less personal time. Providing social support to these families can improve caregivers' quality of life by reducing their depression levels. [ABSTRACT FROM AUTHOR]

Background: Ischemic-reperfusion injury resulting from kidney transplantation declines the post-transplant graft function. Remote ischemic conditioning (RIC) is known to be able to reduce the criticality of ischemic reperfusion injury. This study aimed to meta-analyze whether the application of remote ischemic conditioning to kidney transplantation patients improves clinical outcomes. Methods: Researchers included randomized controlled studies of the application of RIC to either kidney donors or recipients. Articles were retrieved from PubMed, Embase, Web of Science, and Cochrane Library. The risk of bias was evaluated using RoB 2.0. The primary outcome was mortality after transplantation. Secondary outcomes were the incidence of delayed graft function, graft rejection, and post-transplant laboratory results. All outcomes were integrated by RevMan 5.4.1. Results: Out of 90 papers, 10 articles (8 studies, 1977 patients) were suitable for inclusion criteria. Mortality collected at all time points did not show a significant difference between the groups. Three-month mortality (RR, 3.11; 95% CI, 0.13–75.51, P = 0.49) tended to increase in the RIC group, but 12-month (RR, 0.70; 95% CI, 0.14–3.45, P = 0.67) or final-reported mortality (RR, 0.49; 95% CI, 0.23–1.06, P = 0.07) was higher in the sham group than the RIC group. There was no significant difference between the RIC and sham group in delayed graft function (RR, 0.64; 95% CI, 0.30–1.35, P = 0.24), graft rejection (RR, 1.13; 95% CI, 0.73–1.73, P = 0.59), and the rate of time required for a 50% reduction in baseline serum creatinine concentration of less than 24 h (RR, 0.98; 95% CI, 0.61–1.56, P = 0.93). Conclusions: It could not be concluded that the application of RIC is beneficial to kidney transplantation patients. However, it is noteworthy that long-term mortality tended to decrease in the RIC group. Since there were many limitations due to the small number of included articles, researchers hope that large-scale randomized controlled trials will be included in the future. Systematic review registration: PROSPERO CRD42022336565. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Herein, we consider the hypothesis that mothers harm peer relations when they respond to child conduct problems by expressing disapproval of friends, which exacerbates the behavior problems they were presumably attempting to deter.A community sample of Lithuanian adolescents (292 boys and 270 girls, aged 9–14 years) completed surveys three times during an academic year. Classmate nominations indexed peer status (acceptance and rejection), self‐reports described perceived maternal disapproval of friends, and peer nominations and self‐reports separately gauged conduct problems.Over the course of a school year: (a) conduct problems were associated with subsequent increases in perceived maternal friend disapproval; (b) perceived maternal friend disapproval was associated with subsequent decreases in peer status; and (c) low peer status was associated with subsequent increases in conduct problems. Full longitudinal, random‐intercept cross‐lagged panel mediation models confirmed that mothers who disapproved of friends were sources of peer difficulties that culminated in conduct problems and intermediaries whose response to child conduct problems damaged peer relations. Findings were stronger for peer rejection than for peer acceptance, suggesting that peers actively dislike those with mothers who intervene in peer relationships.Maternal disapproval of friends in response to child conduct problems damages the child's standing among peers, which then exacerbates behavior problems. This consequential cascade underscores the need for parent education about the potential deleterious consequences of well‐intentioned interference in peer relations. Practitioners should be prepared to offer constructive, alternative solutions when youth present behavior problems. [ABSTRACT FROM AUTHOR]

While allograft rejection (AR) continues to threaten the success of cardiothoracic transplantation, lack of accurate and repeatable surveillance tools to diagnose AR is a major unmet need in the clinical management of cardiothoracic transplant recipients. Endomyocardial biopsy (EMB) and transbronchial biopsy (TBBx) have been the cornerstone of rejection monitoring since the field's incipience, but both suffer from significant limitations, including poor concordance of biopsy interpretation among pathologists. In recent years, novel molecular tools for AR monitoring have emerged and their performance characteristics have been evaluated in multiple studies. An international working group convened by ESOT has reviewed the existing literature and provides a series of recommendations to guide the use of these biomarkers in clinical practice. While acknowledging some caveats, the group recognized that Gene-expression profiling and donor-derived cell-free DNA (dd-cfDNA) may be used to rule out rejection in heart transplant recipients, but they are not recommended for cardiac allograft vasculopathy screening. Other traditional biomarkers (NT-proBNP, BNP or troponin) do not have sufficient evidence to support their use to diagnose AR. Regarding lung transplant, dd-cfDNA could be used to rule out clinical rejection and infection, but its use to monitor treatment response is not recommended. [ABSTRACT FROM AUTHOR]

Noninvasive methods for surveillance of acute rejection are increasingly used in heart transplantation (HT), including donor-derived cell-free DNA (dd-cfDNA). As other cardiac biomarkers differ by sex, we hypothesized that there may be sex-specific differences in the performance of dd-cfDNA for the detection of acute rejection. The purpose of the current study was to examine patterns of dd-cfDNA seen in quiescence and acute rejection in male and female transplant recipients. Patients enrolled in the Genomic Research Alliance for Transplantation who were ≥18 years at the time of HT were included. Rejection was defined by endomyocardial biopsy with acute cellular rejection (ACR) grade ≥2R and/or antibody-mediated rejection ≥ pAMR 1. dd-cfDNA was quantitated using shotgun sequencing. Median dd-cfDNA levels were compared between sexes during quiescence and rejection. The performance of dd-cfDNA by sex was assessed using area under the receiver operator characteristic (AUROC) curve. Allograft injury was defined as dd-cfDNA ≥0.25%. One hundred fifty-one unique patients (49 female, 32%) were included in the analysis with 1,119 available dd-cfDNA measurements. Baseline characteristics including demographics and comorbidities were not significantly different between sexes. During quiescence, there were no significant sex differences in median dd-cfDNA level (0.04% [IQR 0.00, 0.16] in females vs 0.03% [IQR 0.00, 0.12] in males, p = 0.22). There were no significant sex differences in median dd-cfDNA for ACR (0.33% [0.21, 0.36] in females vs 0.32% [0.21, 1.10] in males, p = 0.57). Overall, median dd-cfDNA levels were higher in antibody-mediated rejection (AMR) than ACR but did not significantly differ by sex (0.50% [IQR 0.18, 0.82] in females vs 0.63% [IQR 0.32, 1.95] in males, p = 0.51). Elevated dd-cfDNA detected ACR/AMR with an AUROC of 0.83 in females and 0.89 in males, p -value for comparison = 0.16. There were no significant sex differences in dd-cfDNA levels during quiescence and rejection. Performance characteristics were similar, suggesting similar diagnostic thresholds can be used in men and women for rejection surveillance. [ABSTRACT FROM AUTHOR]

Rejection after liver transplantation severely affects the survival of recipients. Long-term use of immunosuppressants is an important approach to prevent rejection, whereas it may cause toxic effects and increase the risk of adverse events such as systemic infection and tumor recurrence, etc. Therefore, before successful liver transplantation, how to induce individual immune tolerance of recipients and achieve complete or early withdrawal of postoperative immunosuppressants remains to be investigated by practitioners of organ transplantation. In recent years, certain progresses have been made in the mechanism of immune tolerance induced by tolerogenic dendritic cells in liver transplantation, and preliminary outcomes have been obtained in clinical trials. In this article, basic research and clinical application progress in the characteristics of tolerogenic dendritic cells, the mechanism underlying participating in liver immune microenvironment remodeling, and inducing immune tolerance in liver transplantation were reviewed, aiming to provide reference for the application of tolerogenic dendritic cells in immune tolerance of liver transplantation. [ABSTRACT FROM AUTHOR]

Liver retransplantation is the final option for graft failure after liver transplantation. The interval between the first and second liver transplantation will directly affect surgical indications, technical difficulties and treatment outcomes of adult liver retransplantation. Previous studies have shown that the overall survival of liver allografts and recipients after liver retransplantation is significantly lower than that after the first liver transplantation. However, with comprehensive progress in organ preservation methods, anesthesia management concepts, intensive care strategies, surgical techniques and new immunosuppressive drugs, clinical efficacy of adult liver retransplantation has been significantly improved. In this article, the changes of indications, timing of operation, long-term efficacy and its influencing factors, technical difficulties, selection of immunosuppressive regimens and the implementation of living donor liver retransplantation were reviewed, and the achievements, challenges and potential solutions of adult liver retransplantation were summarized, aiming to provide reference for enhancing clinical efficacy of adult liver retransplantation. [ABSTRACT FROM AUTHOR]

Objective To investigate the characteristics of adverse drug event (ADE) related to tacrolimus (Tac) in pediatric solid organ transplant recipients. Methods The data were retrieved from the US Food and Drug Administration Adverse Event Reporting System database from the first quarter of 2004 to the second quarter of 2023. The ADE data of pediatric organ transplant recipients with Tac as the primary suspected drug were extracted. The relationship between Tac and ADE was quantitatively analyzed by proportional imbalance method. Basic characteristics and signal strength of ADE related to Tac were analyzed. ADE related to Tac in children of different ages and different types of organ transplantation were analyzed. Results A total of 1 443 children's ADE reports involving Tac were screened, including 188 cases (13.0%) of heart transplantation, 668 cases (46.3%) of liver transplantation, 531 cases (36.8%) of kidney transplantation and 56 cases (3.9%) of lung transplantation. The median age of children was 10 years old. The top three countries with ADE reporting were the United States, France and the United Kingdom. China reported 26 cases, accounting for 1.8%. Infection and infectious diseases accounted for the highest proportion (20.96%) in ADE related to Tac, including EB virus and cytomegalovirus infection, etc. Infection and infectious diseases occupied the largest proportion of ADE related to Tac in children of different ages, whereas the pathogen types were different. Rejection, unstable immunosuppression level and renal function damage were also common ADE related to Tac in children of all ages. Nervous system disease was the main ADE in heart transplant recipients, while infection and infectious diseases were more common in liver and kidney transplant recipients. Rejection was the most common ADE in lung transplant recipients.Conclusions ADE related to Tac possess different distribution characteristics in different types of organ transplantation. Extensive attention should be paid to individualized drug monitoring and risk assessment in pediatric organ transplant recipients, thereby optimizing Tac treatment and reducing the risk of ADE. [ABSTRACT FROM AUTHOR]

Combined liver and kidney transplantation has been steadily applied in major transplantation centers, saving the lives of many patients with end-stage liver and renal failure. However, there are still multiple unresolved problems in the clinical diagnosis, treatment and long-term prognosis of combined liver and kidney transplantation. By referring to "Technical Operating Standards for Combined Liver and Kidney Transplantation (2019 Edition)" and the latest published literature and guidelines at home and abroad, "Guidelines for Clinical Diagnosis and Treatment of Combined Liver and Kidney Transplantation" was formulated. Recommendations and suggestions were delivered regarding the surgical indications and contraindications, preoperative preparation and evaluation, the timing of transplantation for endstage liver and kidney diseases, the selection of surgical approaches and postoperative follow-up, specific pathophysiology, surgical techniques, complication management and immunosuppressive treatment of combined live and kidney transplantation, aiming to enhance the utilization rate of grafts and improve the survival and prognosis of combined liver and kidney transplant recipients. [ABSTRACT FROM AUTHOR]

To further standardize the diagnosis and treatment of hypertension after kidney transplantation in China, Branch of Organ Transplantation of Chinese Medical Association organized experts in kidney transplantation and cardiovascular diseases to formulate “ Guidelines for Clinical Diagnosis and Treatment of Hypertension in Kidney Transplant Recipients in China” based on “Diagnosis and Treatment Specification for Hypertension after Solid Organ Transplantation in China (2019 edition)” in combination with clinical status of hypertension after organ transplantation in China, and referring to the latest guidelines for diagnosis and treatment of hypertension at home and abroad. This guideline was formulated to provide theoretical reference for medical practitioners in the field of kidney transplantation in China, aiming to better control adult hypertension after kidney transplatation, mitigate adverse outcomes and improve the quality of life. [ABSTRACT FROM AUTHOR]

Gender is socially constructed beliefs perceived or ascribed to the sex identity of the person. Thus, this study explored, described, and interpreted the social experiences of LGBTQIA+ college students in a Catholic School. This study employed a descriptive qualitative research design. Hence, it helped to obtain a rich narrative concerning the social experiences of this group of students studying in a private Catholic school. Moreover, this paper came up with six participants determined through purposive sampling and set inclusion criteria. It employed the semi-structured in-depth interview. Also, this study utilized Lichtman’s 3Cs in analyzing the narratives of the participants. This study revealed that LGBTQIA+ college students experienced bullying and discrimination during their basic education years when they were trying to come out as who they were. Alongside the experience of coming out, they felt that they were not accepted by their father as members of the social group since they would be vulnerable to any form of humiliation. However, being a student in a Catholic school, they felt that they were accepted and welcomed. Likewise, they never experienced what happened during their high school years. Hence, the findings may serve as an eye-opener for many about the social experiences of this minority to elicit the practice of gender sensitivity and equality. [ABSTRACT FROM AUTHOR]

The article analyzes a scene that recurs in the works of Józef Hen, irrespective of their genre: a commission scene. It first appears in the story Dokument [Document], included in the fictionalized reportage Kijów, Taszkient, Berlin: dzieje włóczęgi [Kiev, Tashkent, Berlin: The Story of a Vagabond]. Later, Hen weaves it into the novel Nikt nie woła [Nobody's calling], and with various echoes the scene also recurs in his diaries. The commission scene functions as a metaphor for personal fate and an unhealed wound, and ultimately a painful symbol of repulsion. The analysis of its iterations enables a better understanding of the writer's work. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to examine the incidence of perioperative infections and graft viability in ABO-compatible and ABO-incompatible renal transplant recipients. Methods: We included 643 living donor renal transplant recipients registered in the Michinoku Renal Transplant Network from 1998 to 2021. Patients were divided into the ABO-compatible and ABO-incompatible kidney transplantation groups. We compared the characteristics of the two groups and evaluated the incidence of postoperative viral infections (cytomegalovirus and BK virus), graft loss-free survival, and overall survival between the two groups. Results: Of 643 patients, 485 (75%) and 158 (25%) were ABO-compatible and ABO-incompatible renal transplant recipients, respectively. Postoperative viral infections, rituximab use, and plasma exchange were significantly more common in ABO-incompatible than in ABO-compatible transplant recipients. However, there were no significant differences in terms of other background characteristics. The ABO-incompatible group was more likely to develop viral infections than the ABO-compatible group. Graft loss-free survival and overall survival did not significantly differ between the two groups. According to the multivariate Cox regression analysis, ABO compatibility was not significantly associated with graft loss-free survival and overall survival. Conclusion: Although the incidence of postoperative viral infections in ABO-incompatible renal transplant recipients increased, there was no significant difference in terms of rejection events, graft loss-free survival, and overall survival. [ABSTRACT FROM AUTHOR]

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Copyright of Die Ophthalmologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Rejection is a highly stressful experience and individuals tend to avoid it whenever possible. In intimate relationships, experiences of rejection can shape the interaction dynamics between partners. Highly rejection sensitive people fear that their romantic partner will reject them and they overreact to any ambiguous cues that might indicate rejection. Furthermore, because they focus on the threat of rejection, they may have difficulty disengaging from rejection-related emotions, persevere in a rejection-focused state and have a reduced capacity to regulate their emotions. The prolonged experience of strong negative emotions, together with maladaptive attempts to respond to rejection, may undermine key relationship maintenance processes that contribute to relationship functioning and lead to negative reciprocity in interactions. The goal of the present study was to shed light on how individuals experience rejection-related emotions and determine whether, following perceptions of negative interactions, rejection sensitivity was associated with stronger negative responses and less efficient downregulation of negative emotions. In addition, we examined whether dyadic patterns of rejection sensitivity were associated with negative emotion dynamics following perceptions of negative interactions. Methods: The participants (N = 298) were couples experiencing the transition to parenthood. A multilevel modelling approach was used to assess the associations between rejection sensitivity, perceptions of negative interactions and emotional states. The analyses included repeated daily reports for both rejection and emotions. Results: The results suggest that rejection sensitive individuals do not report higher negative emotions when they perceive negative interactions. Moreover, rejection sensitive men and women did not remain longer in a negative emotional state after they perceived negative interactions with their partner. Finally, when both men and women partners reported higher levels of rejection sensitivity, neither reported having higher negative emotions after experiencing negative interaction perceptions. Conclusions: Our findings provide further insights into emotional dynamics and rejection sensitivity in romantic relationships. Our results do not provide evidence for a link between rejection sensitivity and higher negative emotions or slower recovery after reports of negative interactions. If individuals suppress their emotions, they may not benefit from regulation with their partner and instead may protect themselves over their relationships. However, in this context, rejection sensitivity might also not constitute a strong predictor of daily emotion fluctuations, but other variables– such as relationship satisfaction – might. Future research may investigate emotional responses in a sample with higher levels of rejection sensitivity and use more diverse measures of perceptions of negative interactions. [ABSTRACT FROM AUTHOR]

Background: Reactivation of cytomegalovirus (CMV) infection in transplant patients is high because of immunosuppression. We have evaluated the clinical and epidemiological characteristics of early versus late onset of CMV infection among renal transplant recipients. Methods: A single center retrospective observational study was conducted among renal transplant recipients who underwent kidney transplant between January 2002 and December 2021. CMV disease was classified as early or late depending on its detection prior to or after 90 days post-transplantation. Herein, we reported the differences between early and late onset of CMV disease with respect to clinical symptoms, the use of immunosuppression and the impact on graft outcomes. Results: Out of total 2164 renal transplant recipients, 156 patients (7.2%) were diagnosed with CMV disease. Among these 156 patients, 25 patients (16%) had early CMV while 131 patients (84%) had late CMV. Overall, the two groups did not differ with respect to the induction or maintenance of immunosuppressive agents. However, the proportion of CMV syndrome was greater among early (56.0%) than late (26.7%) CMV groups (p = 0.01). In contrast, tissue invasive disease was more frequent among late (73.3%) in comparison to early (44.0%) CMV groups (p = 0.01). Among clinical symptoms, diarrhea was more frequent in late (63.4%) vs. early (36%) CMVaffected patients (p = 0.01). Graft loss occurred in 4.0% of early CMV group vs. 25.2% of late CMV group (p = 0.03). Neither of the clinical groups differed with respect to occurrence of biopsy-proven allograft rejection postinfection. Conclusions: Early CMV disease presents more frequently as CMV syndrome while late CMV disease usually manifests itself as tissue invasive disease. Graft loss is more common in patients with late onset of CMV disease. [ABSTRACT FROM AUTHOR]

Background: Immune-mediated rejection is the most common cause of allograft failure in kidney transplant (KT) patients. Exposure to alloantigen, including human leukocyte antigen (HLA), results in the production of donorspecific antibodies (DSA). There are limited data about low levels of mean fluorescence intensity (MFI) DSA, especially post-transplantation. This study evaluated allograft outcomes in KT patients with low MFI DSA. Methods: From January 2007 to December 2021, KT patients who were tested for post-transplant DSA at Ramathibodi Hospital, Bangkok, Thailand, with the DSA MFI < 1000 were evaluated. These KT patients were categorized into two groups: very low DSA (VLL; MFI = 1-500) and low DSA (LL; MFI = 501-1000). All KT patients were evaluated for the primary outcomes, such as the incidence of acute rejection, serum creatinine levels at one and five years after transplantation as well as allograft and patient survivals. Results: Among 36 KT patients 25 were included as those with VLL and 11 as those with LL. The LL group had significantly higher T-cell mediated allograft rejection (TCMR) than the VLL group (45% vs. 12%, P = 0.04). In addition, 10 patients, 5 in the VLL group and 5 in the LL group developed antibody-mediated allograft rejection (ABMR). Both TCMR and ABMR were confirmed by biopsy results. There was a trend toward higher MFI in KT patients with ABMR than without ABMR (P = 0.22). At 5 post-transplant years, serum creatinine, allograft and patient survivals were comparable between these two groups. Furthermore, the univariate and multivariate analyzes revealed that the LL group was a high risk for rejection. Conclusion: Low MFI DSA values after transplantation may be associated with a higher incidence of rejection, but this finding did not show differences in allograft and patient survival in this study's analysis. [ABSTRACT FROM AUTHOR]

Respiratory complications following allogeneic HSCT can lead to severe morbidity and mortality. Lung transplantation (LT) is a potential treatment for select patients with late-onset non-infectious pulmonary complications post-HSCT. Donor-derived cell-free DNA (dd-cfDNA) is a noninvasive biomarker for monitoring the health of allografts following LT. However, its utility in a multi-genome setting of LT after HSCT has not yet been clinically validated. Here we describe a case of a 75-year-old, male patient who underwent single-lung transplantation for BOS related to chronic GVHD and presented with persistently elevated dd-cfDNA levels. In a surveillance biopsy, the patient was diagnosed with mild acute cellular rejection at three months. The patient's lung function remained stable, and the reported dd-cfDNA levels decreased after the rejection episode but remained elevated above levels that would be considered quiescent for LT alone. In this unique setting, as 3 different genomes contributed to the dd-cfDNA% reported value, valuable insight was obtained by performing further analysis to separate the specific SNPs to identify the contribution of recipient, lung-donor, and HSCTdonor cfDNA. This study highlights the potential utility of dd-cfDNA in the multi-genome setting of lung transplant post-HSCT, nuances that need to be considered while interpreting the results, and its value in monitoring lung rejection. [ABSTRACT FROM AUTHOR]

Interleukin-6 (IL-6) is an important immune mediator and a target for novel antibody therapies. In this study, we aimed to determine whether serum IL-6 levels are associated with immunological risk, allograft rejection and outcomes in kidney transplant (Ktx) patients. We retrospectively analyzed the data of 104 patients who underwent Ktx at our center between 2011 and 2015. The patients were divided into high- and low-risk groups (n = 52 per group) based on panel reactive antibody (PRA) percentage > 35%, the existence of pre-Ktx donorspecific antibodies (DSA), or a previous transplant. IL-6 concentrations were measured before and at 3 months, 12 months, and 3 years after Ktx. Serum IL-6 levels tended to be higher in high-risk patients than in low-risk patients prior to Ktx and at 12 months after Ktx; however, the difference did not reach statistical significance (pre-Ktx, high-risk: 1.995 ± 2.79 pg/ml vs. low-risk: 1.43 ± 1.76 pg/ml, p = 0.051; 12 mo. high-risk: 1.16 ± 1.87 pg/ml vs. low-risk: 0.78 ±1.13 pg/ml, p = 0.067). IL-6 levels were correlated with the types (no rejection, T cell mediated rejection (TCMR), antibody-mediated rejection (ABMR), or both) and time (<1 year vs. >1 year after Ktx) of rejection, as well as patient and graft survival. Patients with both TCMR and ABMR had significantly higher IL-6 levels at 3 months (14.1 ± 25.2 pg/ml) than patients with ABMR (3.4 ±4.8 pg/ml, p = 0.017), with TCMR (1.7 ± 1.3 pg/ml, p < 0.001), and without rejection (1.7 ± 1.4 pg/ml, p < 0.001). Three years after Ktx, patients with AMBR had significantly higher IL-6 levels (5.30 ± 7.66 pg/ml) than patients with TCMR (1.81 ± 1.61 pg/ml, p = 0.009) and patients without rejection (1.19 ± 0.95 pg/ml; p = 0.001). Moreover, three years after Ktx IL-6 levels were significantly higher in patients with late rejections (3.5 ± 5.4 pg/ml) than those without rejections (1.2 ± 1.0 pg/ml) (p = 0.006). The risk of death-censored graft failure was significantly increased in patients with elevated IL-6 levels at 12 months (IL-6 level > 1.396 pg/ml, HR 4.61, p = 0.007) and 3 years (IL-6 level > 1.976 pg/ml, HR 6.75, p - 0.003), but elevated IL-6 levels were not associated with a higher risk of death. Overall, our study highlights IL-6 as a risk factor for allograft failure and confirms that IL-6 levels are higher in patients developing ABMR compared to TCMR alone or no rejection. [ABSTRACT FROM AUTHOR]

Introduction: It is unclear whether kidney transplant recipients with a biopsy diagnosis as a "borderline" acute Tcell mediated rejection (TCMR) requires the treatment with intravenous (iv) steroids pulse plus/minus intensification of the maintenance therapy (TRT) in comparison with the simple clinical follow-up (F-UP). Methods: We retrospectively followed a consecutive series of kidney transplant recipients diagnosed with a borderline acute TCMR at biopsy by surveillance or clinical indication for 12 months and compared TRT and FUP groups. We evaluated trends in renal function by measuring estimated glomerular filtration rate (eGFR) using multiple regression models. Repeated eGFR measures (REML) were adjusted for potential confounding factors for 12 months. The difference in 12-month eGFR values were observed in the TRT vs F-UP groups, type of biopsy, as well as the surveillance vs. clinical outcomes. Results: Out of 59 included patients, 37% of them were in the TRT group and remaining 63% in the F-UP group. As expected, the TRT group had, at the time of biopsy, lower eGFR value of 39.0 ml/min/m2 [16.5] in comparison to 49.6 [19.6] ml/min/m2 in the F-UP group (P = 0.043), Similarly, the TRT group required more frequent clinical biopsies vs. F-UP group (68% vs. 32%; P = 0.014). However, the TRT group recovered kidney function reaching the eGFR values of the F-UP group at 12 months; the increase being significant only in patients who received indication biopsies (P < 0.001). The estimated adjusted TRT effect on 12-month eGFR change after indication biopsy was improved by +15.8 ml/min/1.73m2 (95%CI: +0.1 to +31.4 ml/min/1.73 m2; P = 0.048 by three-way interaction term) compared to the F-UP group. Conclusion: Our preliminary study supports the indication for the treatment of acute borderline TCMR only in cases with biopsies performed by clinical indication. [ABSTRACT FROM AUTHOR]

Overcoming immunological rejection remains a barrier to the safe adoption of Vascularised Composite Allotransplantation (VCA). To mitigate this risk, clinical protocols have been derived from solid organ transplantation, targeting recipient immunomodulation, yet VCA is unique. Face and hand composite allografts are composed of multiple different tissues, each with their own immunological properties. Experimental work suggests that allografts carry variable numbers and populations of donor leukocytes in an organ specific manner. Ordinarily, these passenger leukocytes are transferred from the donor graft into the recipient circulation after transplantation. Whether alloantigen presentation manifests as acute allograft rejection or transplant tolerance is unknown. This review aims to characterise the immunological properties of the constituent parts of the donor face and hand, the potential fate of donor leukocytes and to consider theoretical graft specific interventions to mitigate early rejection. [ABSTRACT FROM AUTHOR]

Pediatric heart transplant (HT) candidates experience high waitlist mortality due to a limited donor pool that is constrained in part by anti-HLA sensitization. We evaluated the impact of CDC and Flow donor-specific crossmatch (XM) results on pediatric HT outcomes. All pediatric HTs between 1999 and 2019 in the OPTN database were included. Donor-specific XM results were sub-categorized based on CDC and Flow results. Primary outcomes were treated rejection in the first year and time to death or allograft loss. Propensity scores were utilized to adjust for differences in baseline characteristics. A total of 4,695 pediatric HT patients with T-cell XM data were included. After propensity score adjustment, a positive T-cell CDC-XM was associated with 2 times higher odds of treated rejection (OR 2.29 (1.56, 3.37)) and shorter time to death/allograft loss (HR 1.50 (1.19, 1.88)) compared to a negative Flow-XM. HT recipients who were Flow-XM positive with negative/unknown CDC-XM did not have higher odds of rejection or shorter time to death/allograft loss. An isolated positive B-cell XM was also not associated with worse outcomes. Over the study period XM testing shifted from CDC- to Flow-based assays. A positive donor-specific T-cell CDC-XM was associated with rejection and death/allograft loss following pediatric HT. This association was not observed with a positive T-cell Flow-XM or B-cell XM result alone. The shift away from performing the CDC-XM may result in loss of important prognostic information unless the clinical relevance of quantitative Flow-XM results on heart transplant outcomes is systematically studied. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing heart transplants are at risk of rejection which can have significant morbidity and mortality. Induction immunosuppression at the time of transplant reduces the early risk and has additional benefits. The induction agent of choice within our program was changed from rabbit antithymocyte‐globulin (rATG) to basiliximab, so it was necessary to evaluate whether this had any impact on patient outcomes. Objectives: Our primary objective was to describe rejection, infection, and other outcomes in adult heart transplant patients at the University of Alberta Hospital in Edmonton, Canada. Methods: This study was a nonrandomized, retrospective cohort study. Results: Sixty‐three patients were included with median ages 50 years versus 54 years. More female patients received rATG (20% vs. 42.4%). The most common indication for transplant in both cohorts was ICM (63.3% vs. 57.6%). Patients who received rATG had significantly higher PRA (0% vs. 43%, p <.001). Acute rejection episodes were similar between basiliximab and rATG at 3 months (16.7% vs. 15.1%; p = 1.0) and 6‐months (30.0% vs. 18.1%; p =.376). Infections were not statistically different with basiliximab compared to rATG at 3‐months, 43.3% vs. 63.6% and at 6‐months 60.0% vs. 66.7%). There were no fatalities in either group. Conclusions: Our study did not demonstrate differences in rejection with basiliximab compared to rATG. Mortality did not differ, but basiliximab‐treated patients had fewer infections and infection‐related hospitalizations than those treated with rATG. Larger studies with longer durations are needed to more completely describe the differences in rejection and infectious outcomes. [ABSTRACT FROM AUTHOR]

Background: Long‐term outcomes in pediatric kidney transplantation remain suboptimal, largely related to chronic rejection. Creatinine is a late marker of renal injury, and more sensitive, early markers of allograft injury are an active area of current research. Methods: This is an educational review summarizing existing strategies for monitoring for rejection in kidney transplant recipients. Results: We summarize supporting currently available clinical tests, including surveillance biopsy, donor specific antibodies, and donor‐derived cell free DNA, as well as the potential limitations of these studies. In addition, we review the current avenues of active research, including transcriptomics, proteomics, metabolomics, and torque tenovirus levels. Conclusion: Advancing the use of noninvasive immune monitoring will depend on well‐designed multicenter trials that include patients with stable graft function, include biopsy results on all patients, and can demonstrate both association with a patient‐relevant clinical endpoint such as graft survival or change in glomerular filtration rate and a potential timepoint for intervention. [ABSTRACT FROM AUTHOR]

The proteasome generates the majority of peptides presented on MHC class I molecules. The cleavage pattern of the proteasome has been shown to be changed via the proteasome activator (PA)28 alpha beta (PA28αβ). In particular, several immunogenic peptides have been reported to be PA28αβ-dependent. In contrast, we did not observe a major impact of PA28αβ on the generation of different major histocompatibility complex (MHC) classI ligands. PA28αβ-knockout mice infected with the lymphocytic choriomeningitis virus (LCMV) or vaccinia virus showed a normal cluster of differentiation (CD) 8 response and viral clearance. However, we observed that the adoptive transfer of wild-type cells into PA28αβ-knockout mice led to graft rejection, but not vice versa. Depletion experiments showed that the observed rejection was mediated by CD8+ cytotoxic T cells. These data indicate that PA28αβ might be involved in the development of the CD8+ T cell repertoire in the thymus. Taken together, our data suggest that PA28αβ is a crucial factor determining T cell selection and, therefore, impacts graft acceptance. [ABSTRACT FROM AUTHOR]

Solid organ transplantation has progressed dramatically over the last 50 years; however, rejection still remains one of the barriers to successful transplantation. Immunological processes underlying the mechanisms of rejection are well described and numerous pharmacological agents exist to help suppress a recipient's immune system in order to prolong graft survival. Furthermore, clinician decisions and actions during both the work-up of a potential transplant recipient and in the perioperative phase can impact upon the immunological status of an individual and the likelihood of successful solid organ transplantation. In this article we aim to describe the key processes involved in solid organ immunology and their relevance in anaesthetic practice. [ABSTRACT FROM AUTHOR]

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In this paper, we investigate a scheduling problem with optional job rejection in a proportionate flow shop setting, where the job processing times are machine independent. A solution to our problem is characterized by (i) partitioning the set of jobs into a set of accepted jobs and a set of rejected jobs, and (ii) scheduling the accepted jobs in a proportionate flow shop setting. The aim is to find a solution to minimize the sum of total weighted late work of the accepted jobs and total rejection cost of the rejected jobs. When all jobs share a common due date, we show that the single-machine case is -hard by reduction from the Subset Sum problem. When the operations of all jobs have equal processing times, we solve the case in O (n 3) time by reducing it into a linear assignment problem. For the general problem, we first provide a pseudo-polynomial-time algorithm via the dynamic programming method, then we convert it into a fully polynomial time approximation scheme. As a byproduct, we also resolve an open question in the literature. [ABSTRACT FROM AUTHOR]

Fluid restriction and diuretic management are mainstays in the postoperative management of cardiac patients, at risk of volume overload and its deleterious effects on primary cardiac function and multi-organ systems. The importance of fluid homeostasis is further emphasized among orthotopic heart transplant recipients (OHT). We sought to investigate the relationship between postoperative volume overload, mortality, and allograft dysfunction among pediatric OHT recipients within 1-year of transplantation. This is a retrospective cohort study from a single pediatric OHT center. Children under 21 years undergoing cardiac transplantation between 2010 and 2018 were included. Cumulative fluid overload (cFO) was assessed as percent fluid accumulation adjusted for preoperative body weight. Greater than 10% cFO defined those with postoperative cFO and a comparison of postoperative cFO vs. no postoperative cFO (

Infection and rejection are major complications that impact transplant longevity and recipient survival. Balancing their risks is a significant challenge for clinicians. Current strategies aimed at interrogating the degree of immune deficiency or activation and their attendant risks of infection and rejection are imprecise. These include immune (cell counts, function and subsets, immunoglobulin levels) and non-immune (drug levels, viral loads) markers. The shared risk factors between infection and rejection and the bidirectional and intricate relationship between both entities further complicate transplant recipient care and decision-making. Understanding the dynamic changes in the underlying net state of immunity and the overall risk of both complications in parallel is key to optimizing outcomes. The allograft biopsy is the current gold standard for the diagnosis of rejection but is associated with inherent risks that warrant careful consideration. Several biomarkers, in particular, donor derived cell-free-DNA and urinary chemokines (CXCL9 and CXCL10), show significant promise in improving subclinical and clinical rejection risk prediction, which may reduce the need for allograft biopsies in some situations. Integrating conventional and emerging risk assessment tools can help stratify the individual’s short- and longer-term infection and rejection risks in parallel. Individuals identified as having a low risk of rejection may tolerate immunosuppression wean to reduce medication-related toxicity. Serial monitoring following immunosuppression reduction or escalation with minimally invasive tools can help mitigate infection and rejection risks and allow for timely diagnosis and treatment of these complications, ultimately improving allograft and patient outcomes.

Based on promising results obtained in primate models, pioneers in the US have now started to explore the new frontier of genetically-edited pig-to-human transplantation. The recent transition of xenotransplantation into clinical medicine has included transplants in brain-dead subjects and the compassionate use of xenotransplants in living recipients without options for allotransplantation. While the barrier of hyperacute rejection seems to be successfully overcome by gene editing of donor pigs, the occurrence of accelerated rejection could pose significant limitations to the success of the procedure. Ultimately, the establishment of efficient and safe strategies to overcome immunologic barriers will, among other critical factors, such as potential xenozoonotic disease transmission or physiological differences, determine whether and for which indications xenotransplantation will be viable. Considering preliminary outcomes of compassionate use xenotransplantions, which may raise questions about how faithfully data from non-human primate models translate into human outcomes, further research in decedents may be necessary before proceeding with additional clinical transplants. Looking ahead, designing systematic trials in xenotransplantation, including the definition of acceptable eligibility criteria for such high-risk transplants, will be an immense challenge, especially in kidney transplantation, where dialysis provides an effective alternative to transplantation in most cases.

Angiotensin II type-1 receptor antibody (AT1R-Ab) has been mooted as a potential effector of both acute and chronic antibody mediated rejection (AMR). A growing body of literature on the topic is now coming under scrutiny in the context of the evolving Banff AMR diagnostic classification system and refinement of recommendations for histocompatibility testing by the Sensitization in Transplantation Assessment of Risk (STAR) workgroup. This mini-review discusses the latest understanding of pathophysiological mechanisms, clinical evidence for the pathogenicity of AT1R-Ab, and methods of laboratory testing.

Background: Mycophenolate mofetil (MMF) is a key immunosuppression agent for lung transplant recipients (LTR); however, the side effects often lead to dose modifications. Kidney transplant literature has shown reductions in MMF dosing led to an increased incidence of rejection, but data are limited in LTR. The objective was to evaluate the impact of reduced MMF exposure on chronic lung allograft dysfunction (CLAD) in LTR within 36 months of transplant (TXP). Methods: This single-center, retrospective cohort analyzed LTRs who had an MMF dose reduction or hold ≥7 days between April 1, 2016 and October 31, 2019. LTR who died ≤1 month from TXP were excluded. The primary outcome was incidence of CLAD 36 months from TXP compared to the International Society for Heart and Lung Transplantation (ISHLT) registry data. Secondary outcomes were incidence of treated acute cellular rejection and characterization of MMF dose modifications. Results: Of 109 patients evaluated, 102 (93.6%) patients had 194 MMF dose modifications within 36 months of TXP, largely due to hematologic toxicities (74.7%). Before modification, 142 (73.2%) were receiving MMF 1,000 mg/day and 52 (26.8%) were receiving 500 mg/day. Incidence of CLAD was 36.4% at 36 months compared to 32.6% reported by ISHLT (p = 0.5216). Incidence of patients with decline in forced expiratory volume in 1 sec ≥10% was 45.1% at 36 months. Conclusions: In our cohort, most LTRs had an MMF dose modification within 36 months, yet CLAD incidence was consistent with rates reported in the ISHLT Thoracic Organ Transplant Registry. In contrast, more patients demonstrated reduced allograft function compared to post-TXP peak, consistent with “potential” CLAD.

No abstract available.

Access to solid organ transplantation in patients with intellectual disability is associated with health inequities due to concerns about treatment adherence, survival rates, and post-transplant quality of life. This systematic literature review aims to compare outcomes after organ transplantation in patients with intellectual disability compared to patients without intellectual disability. Embase, Medline Ovid, PsycINFO, Web of Science, Cochrane Central Register of Trials, and Google Scholar databases were systematically searched for studies concerning pediatric or adult solid organ transplantation in recipients with a diagnosis of intellectual disability prior to transplantation. Primary outcomes were patient and graft survival rates. Secondary outcomes were acute rejection rate, adherence rates, and quality of life. Nine studies were included, describing kidney (n = 6), heart (n = 4) and liver (n = 1) transplantation. Reported graft survival rates were non-inferior or better compared to patients without intellectual disability, while patient survival was reportedly slightly lower in two studies reporting on kidney transplantation. Although current evidence has a potential selection bias based on including patients with a sufficient support network, intellectual disability alone should not be regarded a relative or absolute contra-indication for solid organ transplantation.

Given the increasing frequency of simultaneous pancreas-kidney transplants performed in recipients with Type II diabetes and CKD, we sought to evaluate possible differences in the rates of allograft rejection, infection, and surgical complications in 298 Type I (T1D) versus 47 Type II (T2D) diabetic recipients of simultaneous pancreas-kidney transplants between 2006-2017. There were no significant differences in patient or graft survival. The risk of biopsy-proven rejection of both grafts was not significantly different between T2D and T1D recipients (HRpancreas = 1.04, p = 0.93; HRkidney = 0.96; p = 0.93). Rejection-free survival in both grafts were also not different between the two diabetes types (ppancreas = 0.57; pkidney = 0.41). T2D had a significantly lower incidence of de novo DSA at 1 year (21% vs. 39%, p = 0.02). There was no difference in T2D vs. T1D recipients regarding readmissions (HR = 0.77, p = 0.25), infections (HR = 0.77, p = 0.18), major surgical complications (HR = 0.89, p = 0.79) and thrombosis (HR = 0.92, p = 0.90). In conclusion, rejection, infections, and surgical complications after simultaneous pancreas-kidney transplant are not statistically significantly different in T2D compared to T1D recipients.

Abstract Posttransplantation complications pose a major challenge to the long‐term survival and quality of life of organ transplant recipients. These complications encompass immune‐mediated complications, infectious complications, metabolic complications, and malignancies, with each type influenced by various risk factors and pathological mechanisms. The molecular mechanisms underlying posttransplantation complications involve a complex interplay of immunological, metabolic, and oncogenic processes, including innate and adaptive immune activation, immunosuppressant side effects, and viral reactivation. Here, we provide a comprehensive overview of the clinical features, risk factors, and molecular mechanisms of major posttransplantation complications. We systematically summarize the current understanding of the immunological basis of allograft rejection and graft‐versus‐host disease, the metabolic dysregulation associated with immunosuppressive agents, and the role of oncogenic viruses in posttransplantation malignancies. Furthermore, we discuss potential prevention and intervention strategies based on these mechanistic insights, highlighting the importance of optimizing immunosuppressive regimens, enhancing infection prophylaxis, and implementing targeted therapies. We also emphasize the need for future research to develop individualized complication control strategies under the guidance of precision medicine, ultimately improving the prognosis and quality of life of transplant recipients.

Lung transplantation offers a lifesaving option for patients with end-stage lung disease, but it is marred by a high risk of post-transplant infections, particularly involving multidrug-resistant bacteria, Cytomegalovirus, and fungal pathogens. This elevated infection rate, the highest among solid organ transplants, poses a significant challenge for clinicians, particularly within the first year post-transplantation, where infections are the leading cause of mortality. The direct exposure of lung allografts to the external environment exacerbates this vulnerability leading to constant immune stimulation and consequently to an elevated risk of triggering alloimmune responses to the lung allograft. The necessity of prolonged immunosuppression to prevent allograft rejection further complicates patient management by increasing susceptibility to infections and neoplasms, and complicating the differentiation between rejection and infection, which require diametrically opposed management strategies. This review explores the intricate balance between preventing allograft rejection and managing the heightened infection risk in lung transplant recipients.