Medicine and Pharmacology

Abstract: Viral infections influence every stage of the kidney transplantation continuum, shaping immunologic risk, graft outcomes, and long term patient survival. Pre transplant serologic assessments guide critical decisions, including vaccinations, the avoidance of lymphocyte depleting induction in Epstein-Barr virus (EBV) mismatched candidates and the selection of Cytomegalovirus (CMV) prophylaxis tailored to donor–recipient serostatus. Acceptance of hepatitis C viremic donor organs has significantly reduced wait times, while human immunodeficiency virus (HIV) positive donor organs remain restricted to HIV positive recipients. Post transplant, viral pathogens are major drivers of morbidity: CMV functions as an immunomodulator that increases susceptibility to rejection and opportunistic fungal infections, and routine surveillance for CMV and BK viremia is essential, especially following rejection therapies. BK virus nephropathy, adenovirus nephropathy, and JC virus nephropathy can lead to progressive allograft dysfunction. Additionally, COVID 19 and parvovirus infections have been associated with collapsing focal segmental glomerulosclerosis (FSGS) and severe graft injury. Persistent viral infections and virus associated glomerulopathies contribute to chronic graft loss, while EBV driven post transplant lymphoproliferative disorder (PTLD) remains a significant cause of cancer related mortality. Transplant recipients are also at increased risk for persistent human papillomavirus infection (HPV) and progression to anogenital and oropharyngeal malignancies. Finally, donor derived viral infections, including rabies, West Nile virus (WNV), and lymphocytic choriomeningitis virus (LCMV), though rare, are well described in the literature. Collectively, these viral complications substantially impact morbidity, graft survival, and overall mortality in kidney transplant recipients.

Abstract: Background. Donation after circulatory death (DCD) has become a major component of deceased organ donation in the United States. On August 20, 2026, the Organ Procurement and Transplantation Network (OPTN) Board approved revised national DCD policy, effective November 18, 2026, to strengthen safeguards, communication, consistency, and accountability across the DCD pathway. Methods. We performed a documentary policy analysis of the complete Board briefing paper and final policy language, together with current HRSA/OPTN implementation materials. Because normothermic regional perfusion (NRP) sits at an important interface between the DCD policy and separate NRP policy development, we additionally considered current NRP policy-development materials and selected human evidence addressing cerebral circulation during thoracoabdominal NRP. Results. The 2026 policy establishes recurrent confirmation that withdrawal of life-sustaining therapies remains appropriate; neurological documentation and escalation of discordant assessments; a formal unplanned DCD pause; stakeholder education; expanded donor-family information; consent requirements for premortem procedures; reporting of unplanned pauses and autoresuscitation events; and a minimum five-minute period of circulatory cessation before organ recovery. The policy text also requires an explanation of potential NRP when its use is anticipated, including the rationale, likely restoration of select organ function, and safeguards to prevent cerebral blood flow. Comprehensive technical NRP standards are not established by this DCD policy. Conclusions. The 2026 OPTN DCD policy establishes a national process-safety and accountability floor rather than a comprehensive procedural protocol. NRP illustrates the scope of this approach: NRP-specific disclosure is present in the DCD policy, whereas technical standardization remains a separate policy-development problem. Post-implementation evaluation should determine whether these safeguards reduce clinically important variation while generating data sufficient to guide subsequent DCD and NRP policy.

Abstract: Objective: To map how lactate has been measured, interpreted and validated as a graft viability or outcome marker across donor, perfusate and recipient phases and organs. Background: Lactate is measured at every step of solid organ transplantation, but its meaning differs by phase, preservation method and organ. No review has mapped this evidence across the transplant continuum. Methods: Scoping review following JBI methodology and PRISMA-ScR. PubMed/MEDLINE, Embase, Web of Science and CENTRAL were searched from 2000, supplemented by journal-targeted searches, citation chasing and ClinicalTrials.gov. Human clinical and ex vivo studies reporting lactate against graft viability or outcome were charted and mapped by organ and phase. Results: 159 human studies were included. Liver transplantation accounted for 108, mainly in the recipient phase and machine perfusion; heart contributed 28, lung 12, kidney 7 and pancreas 1, and no intestine study was eligible. Proposed liver perfusion thresholds ranged from below 1.7 to 4.1 mmol/L. In the largest cohort, lactate clearance did not predict graft survival (AUC 0.50). Day-1 lactate contributed to a validated primary nonfunction model (AUROC 0.83). Confounders included stored red cells in circuits, absence of a clearing organ, donor type, measurement timing and drugs. Conclusions: Lactate is a useful but organ- and context-dependent signal, strongest as a recipient-phase marker after liver transplantation and weakest as a stand-alone ex situ viability criterion outside the liver. Phase-specific thresholds, standardized reporting and multi-marker validation are needed before lactate is used to discard organs.

Abstract: BACKGROUND/OBJECTIVES: Early identification of patients progressing toward brain death may reduce missed organ donation opportunities. We aimed to develop and internally validate an interpretable natural language processing (NLP) model using admission brain computed tomog-raphy (CT) reports. METHODS: This single-center retrospective cohort included 163 adults ad-mitted between 2011 and 2024 with acute neurological injury; 96 subsequently fulfilled brain death criteria and 67 did not. Predictors were derived exclusively from admission CT report text using rule-based preprocessing and term frequency–inverse document frequency word 1–3-gram features. Logistic regression, random forest, XGBoost, and support vector machine models were evaluated using repeated stratified 5-fold cross-validation with 20 repetitions. Vectorization, cal-ibration, model fitting, and threshold selection were restricted to training folds. A prespecified sensitivity target of at least 95% guided threshold selection. Interpretability was assessed using SHapley Additive exPlanations (SHAP). RESULTS: XGBoost achieved the highest discrimination, with a mean area under the receiver operating characteristic curve of 0.807 (95% confidence in-terval, 0.793–0.820) and a pooled out-of-fold value of 0.791. At the high-sensitivity operating point, mean sensitivity was 0.947 and specificity was 0.275. SHAP identified clinically plausible descriptors related to cerebral edema, mass effect, ventricular distortion, ischemic injury, and midline abnormalities. CONCLUSIONS: Admission CT reports contain prognostic information that can be extracted using NLP to support earlier identification of patients at risk of progression to brain death and potential organ donation. External multicenter validation is required before clinical implementation.

Abstract: Donation after circulatory death (DCD) is a rapidly growing source of transplantable organs, but warm ischemia between circulatory arrest and cold preservation limits organ quality and utilization. Normothermic regional perfusion (NRP) restores oxygenated circulation to the abdominal (A-NRP) or thoracoabdominal (TA-NRP) organs in situ after death has been declared, with the aim of reversing ischemic injury before cold preservation and permitting functional assessment before organs are accepted. This narrative review traces NRP from the Maastricht classification and the Barcelona recirculation experiments to contemporary national programs. It summarizes the pathophysiology of warm ischemia–reperfusion injury and how NRP interrupts it, describes viability assessment, and synthesizes organ-specific outcomes for kidney, liver, heart, lung, and pancreas, including recent work from our program on delayed graft function (DGF) after NRP. European and United States frameworks are contrasted, and the ethical debate over TA-NRP and cerebral exclusion is examined. Observational studies, including meta-analyses, associate NRP with higher organ utilization, markedly less ischemic cholangiopathy in liver transplantation, and heart-transplant outcomes comparable to donation after brain death; evidence for DGF in kidney transplantation is supportive but less uniform. No randomized trials exist, technique remains heterogeneous, and ethical consensus on TA-NRP is incomplete, which together define the research agenda for the coming decade.

Abstract: (1) Background: Meshed split skin grafting (SSG) still remains the gold-standard of care for deep wound treatment. The aim of this study was to evaluate an autologous bioengineered dermal–epidermal composite skin for treating full-thickness wounds in a porcine model using a clinically relevant two-stage grafting approach. (2) Methods: Multiple full thickness wounds were created on the dorsal sites of animals. Wounds were initially grafted with a polyurethane dermal template, followed three weeks later by either Platelet hydroGel–Pig Skin Equivalent (PG-PSE) or meshed SSG control. Human platelet lysate was also assessed as a substitute for foetal calf serum during skin maturation. (3) Results: By two weeks post grafting, epidermisation of PG-PSE–treated wounds was comparable to SSG-treated wounds. EdU labelling confirmed early engraftment and contribution of graft-derived cells to both neo-epidermis and neo-dermis. Immunofluorescence staining for vimentin+ fibroblasts and cytokeratin 5+ keratinocytes demonstrated formation of a neo-dermis and a hyperproliferative neo-epidermis enriched in progenitor keratinocytes, with rete ridge architecture indicative of dermal–epidermal maturation. Robust neovascularisation was observed in both papillary and reticular neo-dermis, with platelet lysate–matured grafts showing greater microvessel formation than foetal calf serum–matured grafts. Collagen deposition in PG-PSE grafts, particularly collagen I in the papillary neo-dermis, remained lower than in SSG-treated wounds, consistent with ongoing integration. However, collagen type I/type III composition in the reticular neo-dermis was largely comparable between PG-PSE and SSG, suggesting that bioengineered grafting does not alter dermal template maturation. (4) Conclusion: Overall, autologous dermal–epidermal bioengineered skin effectively vascularises and repairs wounds over a dermal template. Platelet lysate is a promising alternative to foetal calf serum, although PG-PSE may require longer for complete dermal maturation and warrants further long-term evaluation.

Abstract: Background and Objectives: Donor acute kidney injury (AKI) is increasingly recognized in deceased-donor kidney transplantation. However, its independent association with long-term graft outcomes remains controversial. We investigated whether donor AKI predicts death-censored graft failure (DCGF) after adjusting for confounding factors and competing risks. Materials and Methods: We conducted a retrospective cohort study of 285 deceased-donor kidney transplant recipients (146 with AKI donors, 139 with non-AKI donors). Propensity score matching (1:1 matching, caliper = 0.2 SD) created 110 matched pairs. The matched pair structure was accounted for in the competing risk regression by specifying robust variance estimation with clustering on matched pairs' IDs. The primary outcome was DCGF, analyzed using competing risk regression (Fine-Gray model) with patient death as a competing event. Secondary outcomes included delayed graft function (DGF), acute rejection, and patient survival. Results: After matching, baseline characteristics were well-balanced (all SMD <0.1). AKI donors had higher DGF incidence (58.2% vs. 44.5%, p=0.04) and longer DGF duration (9 vs. 6 days, p=0.03). However, donor AKI was not independently associated with DCGF (sHR 1.19, 95% CI 0.78–1.82, p=0.42). Five-year death-censored graft survival was similar between groups (68.2% vs. 73.6%, Gray test p=0.28). In multivariable competing risk analysis, DGF duration >14 days (sHR 2.15, p=0.001), acute rejection (sHR 2.45, p<0.001), and expanded criteria donor status (sHR 1.98, p=0.005) were independent predictors of DCGF, while donor AKI severity showed no dose-dependent effect (p=0.586). Conclusions: Donor AKI does not independently predict long-term graft failure when confounding is minimized through propensity score matching and competing risks are appropriately modeled. Post-transplant factors, particularly DGF duration and acute rejection, are the dominant determinants of graft survival. These findings support the selective use of AKI donor kidneys in appropriate recipients and emphasize the importance of post-transplant management strategies, especially monitoring DGF duration.

Abstract: Background/Objectives: Machine-learning (ML) models have been proposed to improve prediction of delayed graft function (DGF) and graft survival after kidney transplantation. Whether they provide better predictive performance than conventional regression remains uncertain. We systematically reviewed prediction models for both outcomes and assessed the quality of the supporting evidence. Methods: We conducted a systematic review and meta-analysis of models predicting DGF and graft survival after kidney transplantation. Model discrimination was pooled using random-effects meta-analysis. Risk of bias was assessed using PROBAST. ML and conventional regression models were compared when sufficient data were available. Results: The review included 148 unique studies: 98 addressing DGF and 51 addressing graft survival, with one study contributing to both outcomes. Seventy-three DGF model estimates reported a development AUC or C-statistic. The primary meta-analysis included 16 estimates from 16 studies and produced a pooled DGF AUC of 0.814 (95% CI, 0.782–0.843). Reporting was incomplete: 57 of 73 models did not report confidence intervals, 70 lacked independent external validation, and 63 did not report calibration. ML models did not consistently outperform conventional regression. Registry-based graft-survival models had pooled C-statistics of 0.697 at 5 years and 0.723 at 10 years. Five external-validation estimates of clinical DGF models from three cohorts had a median AUC of 0.69. In a network meta-analysis limited to three graft-survival studies, conventional regression ranked highest. Conclusions: Current evidence does not demonstrate that ML provides better or more generalizable prediction of DGF or graft survival than conventional regression. The evidence is limited by incomplete reporting, infrequent calibration, high risk of bias, and limited external validation. Future studies should prioritize rigorous design, calibration, independent validation, and complete reporting over increasing model complexity.

Abstract: Background/Objectives: Shared decision making (SDM), which incorporates patients’ values and preferences, may support patient-centered selection of renal replacement therapy, but its association with the clinical characteristics of living-donor kidney transplantation (LDKT) remains unclear. This study aimed to evaluate the association between SDM implementation and the clinical characteristics of LDKT. Methods: A specialized SDM outpatient clinic was established at our institution in 2019. We retrospectively analyzed 65 patients who underwent LDKT at a single center between 2010 and 2025, comparing a pre-SDM group (2010–2018, n = 25) with a post-SDM group (2019–2025, n = 40). Results: Recipient characteristics were similar between groups, whereas donors were older after SDM implementation (62.0 [52.3–68.0] vs. 55.0 [44.5–60.0] years; p = 0.01). ABO-incompatible transplantation (37.5% vs. 4.0%; p = 0.002) and preformed donor-specific antibody-positive transplantation (20.0% vs. 0%; p = 0.02) were more frequent in the post-SDM group. The proportion of preemptive kidney transplantation (PEKT) was similar; however, among PEKT recipients, estimated glomerular filtration rate was higher at initial evaluation and admission, and preoperative dialysis was less frequent in the post-SDM group (20.0% vs. 54.5%; p = 0.049). Conclusions: The introduction of SDM was associated with broader indication of clinically complex LDKT and earlier evaluation among PEKT recipients, supporting a more planned, patient-centered transplantation process.

Abstract: Background: Calcineurin inhibitor (CNI)-based immunosuppression after solid organ transplantation increases the risk of severe COVID-19. Nirmatrelvir/ritonavir, the guideline-preferred oral antiviral in the general population, causes a well-documented, potentially dangerous drug-drug interaction (DDI) with tacrolimus via ritonavir-mediated inhibition of cytochrome P450 3A4 (CYP3A4). Molnupiravir lacks this interaction but remains underused, partly because non-transplant clinicians may not recognize the risk posed by nirmatrelvir/ritonavir or the safety of molnupiravir as an alternative. Methods: We conducted a single-center retrospective analysis evaluating kidney and simultaneous pancreas-kidney (SPK) transplant recipients receiving tacrolimus who completed 61 treatment encounters with molnupiravir (800 mg twice daily for 5 days) for confirmed COVID-19. Tacrolimus trough levels and serum creatinine (SCr) were compared before and after treatment using the Wilcoxon signed-rank test, with Cohen’s d as the effect size estimate. Acute kidney injury (AKI) was classified by KDIGO criteria. Results: Among 52 unique patients, mean tacrolimus trough concentration was unchanged after treatment (pre 5.52 ± 2.26 vs. post 5.47 ± 1.97 ng/mL, mean difference -0.05 ng/mL, 95% CI -0.64 to 0.54; p = 0.941, Cohen’s d = -0.023). Serum creatinine was similarly unchanged (p = 0.706; d = 0.034). Five encounters (8.2%) met KDIGO AKI criteria. None though was attributable to molnupiravir. No adverse effects attributable to molnupiravir were reported, no mortalities, and 1.6% required hospitalization. Conclusions: Molnupiravir showed no evidence of a pharmacokinetic interaction with tacrolimus and no nephrotoxicity in this cohort, supporting its use as the preferred first-line outpatient COVID-19 antiviral for transplant recipients receiving calcineurin inhibitors. Because nirmatrelvir/ritonavir poses a life-threatening interaction risk in this population, primary care providers, emergency physicians, and general nephrologists should default to molnupiravir and consult a transplant pharmacist when uncertain.

Abstract: Donor-derived cell-free DNA (dd-cfDNA) is an emerging non-invasive biomarker of kidney allograft injury. Elevated dd-cfDNA has been associated with acute rejection, particularly antibody-mediated rejection; however, dd-cfDNA reflects graft-derived tissue injury rather than a specific alloimmune mechanism. Its interpretation may therefore be challenging in conditions characterized by endothelial and microvascular injury, such as atypical hemolytic uremic syndrome (aHUS). This retrospective observational study included 14 kidney transplant recipients who underwent their first kidney transplantation at Wroclaw Medical University between April and December 2022. Twelve non-aHUS recipients with stable renal function and two recipients with aHUS were assessed. Plasma samples were collected at four early post-transplant time points: day 7 (D7), day 14 (D14), month 1 (M1), and month 2 (M2). dd-cfDNA was measured using next-generation sequencing with the AlloSeq cfDNA assay. Donor-specific anti-HLA antibodies (DSA) were assessed using single-antigen bead testing. In non-aHUS recipients, median %dd-cfDNA declined from 0.72% [0.28%, 2.33%] at D7 to 0.12% [0.05%, 0.34%] by M1. In contrast, recipients with aHUS demonstrated persistently elevated dd-cfDNA values fluctuating around 1% [0.88%, 1.14%] during the first month of follow-up. No DSA were detected in any patient during the observation period. No apparent correlation was observed between %dd-cfDNA and serum creatinine in this small cohort. In this preliminary observational study, kidney transplant recipients with aHUS showed persistently elevated early post-transplant dd-cfDNA despite the absence of detectable DSA, absence of clinically documented rejection, and preserved graft function during follow-up. These findings suggest that universal dd-cfDNA thresholds may require cautious interpretation in aHUS. Larger biopsy-anchored studies integrating complement and endothelial injury markers are needed to clarify whether dd-cfDNA elevation in aHUS reflects alloimmune injury, complement-mediated microvascular injury, or overlapping mechanisms.

Abstract: Background/Objectives: Cardiac troponin I (cTnI) has shown inconsistent diagnostic performance for acute cellular rejection (ACR) after heart transplantation. We evaluated whether time-normalized cTnI kinetics provide incremental diagnostic value beyond the concurrent concentration for detecting ACR grade ≥2R. Methods: This retrospective single-center study included 1237 biopsy episodes from 139 heart transplant recipients after exclusion of ambiguous measurements and episodes without a preceding confirmed cTnI value. Two generalized linear mixed-effects logistic regression models with patient-specific random intercepts were compared. M1 included concurrent log₂-transformed cTnI, whereas M2 additionally included the time-normalized change in log₂-transformed cTnI per 7 days. Discrimination was assessed using leave-one-patient-out cross-validation; 95% confidence intervals were obtained from 2000 patient-level cluster bootstrap resamples. Results: In the overall cohort, M1 showed modest discrimination (AUC 0.641, 95% CI 0.592–0.689), whereas M2 provided no improvement (AUC 0.635, 95% CI 0.584–0.685; ΔAUC −0.007, 95% CI −0.021 to 0.007). Within 90 days after transplantation, neither model was informative (M1 AUC 0.503; M2 AUC 0.494). Beyond 90 days, M1 showed moderate discrimination (AUC 0.758, 95% CI 0.664–0.838), but M2 again provided no improvement (AUC 0.746, 95% CI 0.654–0.828; ΔAUC −0.012, 95% CI −0.037 to 0.008). Conclusions: Concurrent cTnI showed no discrimination within 90 days and moderate discrimination thereafter in exploratory stratified analyses. The kinetic term provided no incremental value. cTnI cannot replace endomyocardial biopsy but may warrant further evaluation as an adjunctive late-period marker.

Abstract: Background: Subnormothermic oxygenated machine perfusion has been shown to improve kidney preservation in the preclinical setting. However, whether oxygenated perfusion without an oxygen carrier provides superior protection over standard hypothermic machine perfusion at 4 °C in human kidneys has not been established. Methods: In this study, we assessed whether oxygenated University of Wisconsin (UW) solution perfusion at 22 °C provides improved protection compared with conventional hypothermic machine perfusion (HMP) at 4 °C using a paired human kidney model. Five pairs of discarded human kidneys were recruited for the study. For each donor pair, one kidney was randomized to 12 h oxygenated UW perfusion at 22 °C and the contralateral kidney was perfused at 4 °C with a clinically relevant kidney perfusion pump. After preservation, both kidneys were reperfused with whole blood at 37 °C for 4 h. Hemodynamic and functional parameters were assessed during preservation and reperfusion, including vascular resistance, renal blood flow, creatinine clearance, blood urea nitrogen, electrolyte levels, tissue oxygenation, and urine output. Histological injury was evaluated and a panel of kidney injury biomarkers were also measured. Results: Vascular resistance during the preservation period was significantly lower in the kidneys preserved at 22 °C compared to the HMP group, indicating improved flow dynamics. However, the improved vascular resistance observed during 22 °C preservation did not translate into superior post-reperfusion kidney function or tissue protection compared with 4 °C HMP. Renal blood flow, creatinine clearance, tissue oxygenation, cytochrome c release and malondialdehyde (MDA) levels were comparable between groups, while kidneys preserved at 22 °C had significantly higher acute tubular necrosis scores, higher blood urea nitrogen (BUN) levels, increased calbindin, glutathione S-transferase A1, monocyte chemoattractant protein-1 levels, and lower epidermal growth factor levels. Conclusion: These data demonstrate that oxygenated UW perfusion at 22 °C fails to provide superior protection to conventional HMP at 4 °C in discarded human kidneys transplantation model.

Abstract: Background/Objectives: Early allograft dysfunction (EAD) is a common complication after liver transplantation and is associated with inferior graft survival While normothermic machine perfusion (NMP) has reduced EAD incidence, prediction of early graft performance prior to implantation remains elusive. We aimed to correlate peri-transplant energetic and metabolic profile of liver grafts with post-transplant outcome in a cohort that included grafts preserved with NMP. Methods: Sequential biopsies were taken from 20 transplanted livers (10 immediate graft function [IGF] and 10 EAD), preserved by either static cold storage or NMP. Samples were collected immediately prior to implantation and 30 minutes after hepatic arterial reperfusion. Untargeted liquid chromatography-mass spectrometry was performed, and energy charge was calculated as (ATP + ½ ADP)/(ATP + ADP + AMP). Univariate and receiver operating characteristic analysis identified metabolites correlated with EAD and assessed predictive accuracy. Results: Hepatic concentrations of adenine nucleotides and calculated energy charge did not differ between outcome groups either before implantation or after reperfusion. In contrast, trans-urocanate was significantly enriched in IGF livers across both time points, and additional histidine catabolism pathway metabolites were preferentially increased in IGF grafts. Trans-urocanate demonstrated discriminatory performance for EAD with 80% sensitivity and 80% specificity, confirmed as the single strongest predictive feature among >1,600 detected metabolites. Conclusions: These data identify histidine catabolism as a novel metabolic pathway associated with early graft function and a potential indicator of allograft resilience to ischemia-reperfusion injury. Integration of histidine-pathway metabolites into perfusion-era viability assessment may serve as a discriminative biomarker of EAD and support future metabolite-guided graft optimization strategies.

Abstract: Accurate donor-recipient allograft size matching remains a critical determinant of outcomes in lung transplantation, yet current approaches rely predominantly on predicted total lung capacity (pTLC) and height-based metrics derived from population-based equations. These simplified surrogates fail to capture individual anatomical variability, disease-specific alterations in thoracic geometry, and the spatial relationship between donor lungs and recipient chest cavities. In this review, we examine the limitations of conventional size matching and synthesize emerging evidence supporting imaging-based approaches, including computed tomography (CT) volumetry, radiomics, and machine learning. CT-derived volumetric analysis enables individualized anatomical assessment and has been associated with clinically relevant prediction of primary graft dysfunction and mortality. Advanced computational methods may further support extraction of imaging-derived features and integration with clinical data, although these approaches remain investigational. Collectively, these developments signal a paradigm shift from crude population-based metrics toward imaging-driven and computational approaches in the modern era. With rigorous validation and careful clinical integration, imaging-based approaches may complement conventional size metrics and support more individualized donor-recipient assessment.

Abstract: Background: Psychosocial assessment is a critical component of transplant candidate evaluation, yet its clinical utility is often limited by the descriptive nature of existing tools such as the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Translating multidimensional assessment data into actionable clinical insights remains a challenge in routine practice. Methods: We developed a clinical decision support application that integrates SIPAT item-level data with probabilistic risk estimation, visualization, and cohort-referenced interpretation. The application was based on a retrospective dataset of 496 lung transplant candidates evaluated at a single tertiary transplant center. Random forest–based models were used to transform SIPAT item-level data into probabilistic risk representations to estimate domain-specific risks, including depression, anxiety, nicotine-related risk, alcohol-related risk, illicit drug use, social support deficits, and non-adherence. Risk estimates were expressed as calibrated probabilities and categorized into clinically interpretable levels. Additional components included domain-level burden scoring and unsupervised clustering of multidomain risk profiles. Results: Estimated risks were predominantly low across the cohort, with high-risk subgroups identified for depression (6.5%), anxiety (2.2%), nicotine-related risk (11.3%), alcohol-related risk (4.4%), illicit drug use (2.2%), social support deficits (8.1%), and non-adherence (1.4%). Clustering analysis revealed three distinct profiles: a low-risk majority group, a subgroup characterized by elevated nicotine-related risk, and a small high-burden group with substantially elevated psychological distress, reduced social support, and increased non-adherence risk. Risk estimates showed strong and domain-consistent correlations with SIPAT scores (Spearman rho up to 0.80, p < 0.001). Feature importance analyses confirmed that risk estimation was primarily driven by clinically relevant SIPAT items. The application generated structured outputs integrating risk estimates, visualization, and intervention prioritization. Conclusions: The proposed application translates SIPAT-based psychosocial assessment into structured, multidomain risk profiles that enhance clinical interpretability and support targeted psychosocial prehabilitation. This approach provides a practical framework for translating psychosocial assessment into individualized intervention planning in lung transplant settings.

Abstract: Background: Psychosocial assessment is central to lung transplant evaluation. Structured tools such as the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) can be used either to support exclusionary decisions or to guide psychosocial prehabilitation by identifying modifiable targets for intervention. We examined how SIPAT functions in a program that explicitly prioritizes remediation of modifiable psychosocial risks. Methods: We conducted a retrospective observational cohort study of consecutive adult lung transplant candidates evaluated at a single center in Poland between December 2021 and November 2025. Psychosocial risk was assessed using SIPAT (locally translated), including total and domain scores, candidate categories, and binary indicators of clinically relevant alcohol, illicit substance and nicotine related risk. The primary endpoint was a pragmatic program outcome, defined as ever being listed (including transplanted) versus not listed. Analyses focused on describing psychosocial risk profiles and their relationship to the program pathway rather than on building a predictive model of listing decisions. Results: In 491 candidates (mean age 57.2 years; 40.5% women), psychosocial burden was generally low (mean total SIPAT 12.4, SD 6.8) and most patients were rated as excellent or good candidates. SIPAT total, domain scores and candidate categories were not meaningfully associated with ever being listed. Nicotine related risk was more frequent among listed candidates, consistent with a clinical strategy in which smoking histories in predominantly COPD and emphysema patients trigger intensive cessation support rather than automatic exclusion. Cluster analyses identified a smaller high-risk subgroup, and ROC analyses showed modest discrimination for alcohol and nicotine related risk, supporting SIPAT as a structured needs assessment. Conclusions: In this prehabilitation oriented program, SIPAT did not operate as a binary gatekeeping instrument for listing. Instead, it primarily served to identify modifiable psychosocial targets that trigger tailored support. These findings support using SIPAT as a structured roadmap for psychosocial prehabilitation rather than a stand-alone exclusion tool.

Abstract: Kidney transplantation for patients affected by end stage renal failure is considered the best therapeutic option, but this possibility is limited by deceased donor shortage. Living donor kidney transplantation (LDKD) is a valuable option, frequently limited by immunological incompatibility between donor and recipient. This review will consider the to date possibility of performing living donor kidney donation in the case of AB0 blood group incompatibility and the progresses that have been made in this field. Kidney paired donation is one possibility. Such technique offers the best possibility if the number of pairs available is wide. This is possible by performing national and also international registries. The technique more diffuse is the desensitization of the recipients. Desensitization may be obtained by several ways that are extensively treated in this review. In the recent period some published studies document the possibility to enzymatically convert A or B group from the cells of the donor to 0 group. This possibility is only on the beginning, but may represent the future eventually associated to a mild desensitization.

Abstract: Background: Transparent and complete reporting of clinical trial information across registries and peer-reviewed publications is essential for reliable interpretation of clinical evidence. Previous studies have demonstrated discrepancies between trial registries and journal publications, but data specifically focusing on transfusion medicine trials remain limited. Objectives: To assess reporting completeness and consistency for key WHO Trial Registration Data Set (WHO TRDS) items and safety outcomes across the trial life cycle in transfusion medicine-related clinical trials. Methods: We conducted an observational study of clinical trials in transfusion medicine with available results registered in ClinicalTrials.gov between January 2011 and May 2019. Reporting of WHO TRDS items was evaluated at three predefined time points: initial registry entry, final registry update, and corresponding peer-reviewed journal publication. Changes and missing items were systematically assessed, and adverse event and mortality reporting were compared between registry records and journal publications. Results: A total of 67 eligible clinical trials were identified, of which 45 had corresponding peer-reviewed journal publications. At initial registration, several TRDS items were frequently missing, particularly timeline and outcome-related fields. Completeness improved substantially in the final registry updates but was not consistently maintained in journal publications, where incomplete or discordant reporting was common for enrolment and completion dates, eligibility criteria, and outcome definitions. Differences between final registry records and publications were observed in the majority of trials. Safety reporting also differed between sources: serious adverse events were reported at similar overall frequencies, but were more detailed in registry entries, whereas deaths were more frequently reported in publications and explicit reporting of zero adverse events was more common in the registry. Conclusions: Clinical trials in transfusion medicine show inconsistencies between registry records and corresponding journal publications across key methodological and safety reporting domains. These differences may limit transparency, reproducibility, and the reliability of evidence synthesis. Closer alignment between trial registries and scientific publications is needed to strengthen the trustworthiness of clinical information in transfusion medicine.

Abstract: Background: Lung transplantation (LTx) remains the final therapeutic option for patients with end-stage and irreversible respiratory failure. The most common complication after LTx is chronic lung allograft dysfunction (CLAD), which affects long-term outcomes. However, CLAD may be partially reversible, especially after early detection of the cause. For this reason, systematic monitoring of transplanted lung function, including spirom-etry values, is so important. In these cases, the usage of modern technologies and tele-medicine can be extremely useful and allow for early response to possible decreases of spirometry values. Objective: The aim of our study is to evaluate the feasibility and clinical usefulness of spirometry telemonitoring in lung transplant patients. Methods: This retrospective study compared lung transplant recipients, where the first group of patients was subjected to spirometry telemonitoring (N=21), the second group was monitored with standard home spirometry (N=23), and the control group underwent routine follow-ups only in the transplant center (N=32). Results: The mean number of emergency visits was found to be lower in the telemoni-toring vs routine care group (1.24 vs 2.34, P=.05). Additionally, the mean duration of all visits was higher in the routine care group (10.0 days) in comparison to the telemonitoring group (5.8 days, P< .001) and to the standard home spirometry group (8.7 days, P=0.03). Conclusions: Spirometry telemonitoring using digital devices is not only feasible in lung transplant recipients, but it may provide substantial clinical benefits in this group of patients. It makes it possible to react faster in the event of abnormalities, which results in a reduction in the number of emergency visits and their duration.