• Issue

    American Journal of Transplantation: Volume 22, Issue 12

    2713-3190
    December 2022

COVER IMAGE

Free Access

American Journal of Transplantation: Volume 22, Number 12, December 2022

  • First Published: 02 December 2022

On the cover: This final issue of 2022 centers on cellular therapeutics in transplantation. Hirai and colleagues (page 3061) engineer a strategy to neutralize the negative impact of calcineurin inhibitors on regulatory T cell (Treg) number and function. In a mouse model, administration of mutant IL-2 after transfer of Tregs bearing a mutant IL-2 receptor selectively stimulated transduced Tregs and resulted in heart allograft tolerance. Arcolino et al. (page 2791) exploited their ability to isolate, from the urine of preterm neonates, a population of kidney stem/progenitor cells. Delivery to adult human kidneys during normothermic perfusion induced de novo expression of a developmental transcription factor and upregulation of regeneration markers in proximal tubular cells. And finally, Luijmes et al. (page 2723) succinctly review the panoply of stem cell-based therapies to regenerate suboptimal organs during ex vivo perfusion. Covering hearts, lungs, livers, and kidneys, they delineate the cell products tested, their route of administration, mechanisms of action, and accrued record of safety and efficacy.

THE AJT REPORT

Free Access

AJT Digest for Patients: Their Own Window into Key Research

  • Pages: 2713-2714
  • First Published: 02 December 2022

In this month's installment of “The AJT Report,” we announce the launch of The AJT Digest for Patients, our new source of research information curated and designed specifically for transplant recipients. We also report on positive news concerning the use of living unrelated donor kidneys for pediatric kidney transplants.

LITERATURE WATCH

Free Access

RASA2 a new gatekeeper for TCR signaling

  • Page: 2715
  • First Published: 02 December 2022

RASA2 is a new checkpoint inhibitor suppressing T cell activation and promoting T cell exhaustion.

EDITORIALS

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Pure laparoscopic or robotic liver transplantation: Feel the movement?

  • Pages: 2717-2718
  • First Published: 29 August 2022

This editorial examines minimally invasive liver transplantation and discusses its future. See Dokmak et al (page 3069).

Free Access

Humans versus machines: Who learns faster? Editorial regarding: “Machine learning-supported interpretation of kidney graft elementary lesions in combination with clinical data”

  • Pages: 2719-2720
  • First Published: 25 October 2022

The study by Labriffe et al (page 2821) offers an innovative approach, supported by artificial intelligence, to integrate histological and clinical information.

Free Access

Tracheal replacement: A never–ending search

  • Pages: 2721-2722
  • First Published: 20 August 2022

Successful application of cryopreserved aortic homografts for long segment tracheal replacement is a significant contribution to the field. See Martinod et al (page 2961).

MINIREVIEW

Open Access

The current status of stem cell-based therapies during ex vivo graft perfusion: An integrated review of four organs

  • Pages: 2723-2739
  • First Published: 27 July 2022

This mini-review of pre-clinical studies describes the current landscape of stem-cell based therapies administered during ex vivo organ perfusion and urges the initiation of clinical trials.

COMPREHENSIVE REVIEWS

Open Access

Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021

  • Pages: 2759-2780
  • First Published: 13 September 2022

This comprehensive overview of organ donation after medical assistance in dying and its attendant issues reports an increasing frequency of this practice internationally.

PERSONAL VIEWPOINTS

Open Access

The 21st Century Cures Act and psychosocial electronic documentation in solid organ transplantation: Potential harms and practical strategies

  • Pages: 2781-2785
  • First Published: 16 July 2022
The 21st Century Cures Act and psychosocial electronic documentation in solid organ transplantation: Potential harms and practical strategies

The authors delineate the implications of the 21st Century Cures Act for psychosocial electronic health information in solid organ transplantation and provide practical documentation strategies relevant to all clinicians.

Open Access

Emerging technologies and ethics—exogenic chimeric humanized organs

  • Pages: 2786-2790
  • First Published: 02 September 2022

This Personal Viewpoint outlines the scientific and ethical issues associated with the engineering of human-animal chimeras to generate life-saving organs for transplantation.

ORIGINAL ARTICLES

Basic Science

Open Access

De novo SIX2 activation in human kidneys treated with neonatal kidney stem/progenitor cells

  • Pages: 2791-2803
  • First Published: 01 August 2022
De novo SIX2 activation in human kidneys treated with neonatal kidney stem/progenitor cells

In human discarded kidneys, administration of neonatal kidney stem/progenitor cells during normothermic machine perfusion exerts immunomodulatory effects and induces de novo expression of a developmental transcription factor and markers of regeneration in proximal tubular cells.

Free Access

Humanized anti-IL-26 monoclonal antibody as a novel targeted therapy for chronic graft-versus-host disease

  • Pages: 2804-2820
  • First Published: 23 August 2022

In an allogeneic graft-versus host disease (GVHD) mouse model, IL-26 markedly increases neutrophil levels and augments T helper 17 responses while in a xenogeneic model, humanized neutralizing anti-IL-26 monoclonal antibody impedes the development of chronic GVHD with preservation of graft-versus-leukemia effect.

Clinical Science

Free Access

Machine learning-supported interpretation of kidney graft elementary lesions in combination with clinical data

  • Pages: 2821-2833
  • First Published: 05 September 2022
Machine learning-supported interpretation of kidney graft elementary lesions in combination with clinical data

Machine learning algorithms were trained and validated for the automated interpretation of both Banff scores and clinical data and suggest differential weights for elementary lesions, depending upon the diagnosis. Mengel comment page 2719.

Free Access

Maximizing the use of potential donors through increased rates of family approach for authorization

  • Pages: 2834-2841
  • First Published: 05 September 2022

Analysis of donor referrals reveals substantial variation among organ procurement organizations in rates of approach, authorization, and organ recovery and suggests that high authorization rates may result from selective approach practices while high donation rates may result from aggressively approaching families for authorization.

Free Access

Influence of organ quality on the observed association between deceased donor kidney procurement biopsy findings and graft survival

  • Pages: 2842-2854
  • First Published: 10 August 2022

This retrospective analysis of U.S. registry data demonstrates that deceased donor kidney procurement biopsy findings are associated with post-transplant outcomes in a subset of kidneys that are likely to be both biopsied and transplanted.

Free Access

The new French kidney allocation system for donations after brain death: Rationale, implementation, and evaluation

  • Pages: 2855-2868
  • First Published: 24 August 2022

This study of the French Kidney Allocation Scheme strongly advocates for allocation areas of sufficient size, combined with multiplicative interactions among allocation criteria, to optimally balance competing considerations.

Open Access

Scandiatransplant acceptable mismatch program—10 years with an effective strategy for transplanting highly sensitized patients

  • Pages: 2869-2879
  • First Published: 28 August 2022

The acceptable mismatch program administered by Scandiatransplant, the Nordic organ allocation organization, achieves 10-year graft survival for highly sensitized patients that is comparable to non-sensitized patients.

Open Access

Criteria for prediabetes and posttransplant diabetes mellitus after kidney transplantation: A 2-year diagnostic accuracy study of participants from a randomized controlled trial

  • Pages: 2880-2891
  • First Published: 01 September 2022

Analyses of data from kidney transplant recipients who participated in a randomized controlled trial show that the oral glucose tolerance test is indispensable to diagnose diabetes and pre-diabetes because concordance between hemoglobin A1c and fasting plasma glucose tests is poor.

Free Access

Delirium, changes in cognitive function, and risk of diagnosed dementia after kidney transplantation

  • Pages: 2892-2902
  • First Published: 18 August 2022

Post-kidney transplant delirium, a preventable surgical complication, is associated with improved executive function in the first two years but worse executive function thereafter, as well as a seven-fold greater risk of diagnosed dementia.

Open Access

Comparative outcomes for over 100 deceased donor kidney transplants from SARS-CoV-2 positive donors: A single-center experience

  • Pages: 2903-2911
  • First Published: 29 September 2022

A single center retrospective study comparing kidney transplant outcomes from SARS-CoV-2 positive versus negative donors finds no differences in rates of post-transplant COVID diagnoses, metrics of allograft function, and graft or patient survival.

Free Access

Awarding additional MELD points to the shortest waitlist candidates improves sex disparity in access to liver transplant in the United States

  • Pages: 2912-2920
  • First Published: 24 July 2022

Liver Simulated Allocation Modeling shows that awarding additional MELD points to the shortest in stature liver transplant candidates improves sex-based disparities in waitlist outcomes.

Free Access

Assessment of donor quality and risk of graft failure after liver transplantation: The ID2EAL score

  • Pages: 2921-2930
  • First Published: 02 September 2022

The ID2EAL score, a novel and objective score comprised of donor type, cause of death, insulin-dependent diabetes, serum creatinine, age, weight and height outperforms the Donor Risk Index in predicting one-year graft failure, especially in the current era.

Open Access

UNOS policy change benefits high-priority patients without harming those at low priority

  • Pages: 2931-2941
  • First Published: 17 August 2022

The updated heart allocation policy is associated with improved waitlist outcomes in high-acuity patients, no significant difference in waitlist outcomes for low-acuity patients, and no change in one-year post-transplant survival.

Free Access

Characteristics and outcomes of heart transplant recipients with a pretransplant history of malignancy

  • Pages: 2942-2950
  • First Published: 01 September 2022

Heart transplant recipients with pre-transplant malignancy, compared to those without, show significantly higher incidence of post-transplant malignancies but comparable overall survival and long-term outcome.

Free Access

Long-term follow-up of acute and chronic rejection in heart transplant recipients from hepatitis C viremic (NAT+) donors

  • Pages: 2951-2960
  • First Published: 02 September 2022

A prospective study comparing patients who received heart transplants from hepatitis C viremic and non-viremic donors finds no differences in acute or chronic rejection, graft dysfunction or mortality.

Free Access

Expected effect of the lung Composite Allocation Score system on US lung transplantation

  • Pages: 2971-2980
  • First Published: 23 July 2022

Simulations of continuous distribution scenarios show that adoption of a framework that equally weighs waitlist and posttransplant survival and minimally weighs placement efficiency decreases waitlist deaths and maximizes posttransplant survival.

Free Access

Place-based heterogeneity in lung transplant recipient outcomes

  • Pages: 2981-2989
  • First Published: 12 August 2022
Place-based heterogeneity in lung transplant recipient outcomes

Place, defined as a social or environmental area with meaning to a patient, is associated with lung transplant outcomes, indicating that clinical or transplant center factors alone fail to fully explain outcomes.

Free Access

Antiviral toxicities in pediatric solid organ transplant recipients

  • Pages: 3012-3020
  • First Published: 16 August 2022

Among pediatric solid organ transplant recipients, prophylactic use of valganciclovir is associated with neutropenia and kidney injury in the first year after transplant.

Free Access

Epidemiology of surgical site infections after solid organ transplants in the period 2015–2019: A single-center retrospective cohort study

  • Pages: 3021-3030
  • First Published: 02 September 2022

A single-center epidemiologic study shows that surgical site infections continue to adult solid organ transplants and are associated with increased transplant hospitalization, length of stay, graft failure, and mortality.

Open Access

Epidemiology and outcomes of bone and joint infections in solid organ transplant recipients

  • Pages: 3031-3046
  • First Published: 29 August 2022

In solid organ transplant recipients, bone and joint infections, rare complications with subtle clinical presentation, high morbidity and frequent relapse, require special attention from treating physicians.

Free Access

Pediatric solid organ transplant recipients demonstrate robust cell-mediated and humoral responses to three doses of mRNA SARS-CoV-2 vaccine

  • Pages: 3047-3052
  • First Published: 09 September 2022

SARS-CoV-2-specific interferon-gamma response and antibody testing demonstrate that pediatric solid-organ transplant recipients develop cell-mediated and humoral responses to three doses of BNT162b2 mRNA vaccine.

Free Access

Short- and long-term complications after living donor ileal resection

  • Pages: 3053-3060
  • First Published: 06 September 2022

Living-donor ileal resection for intestinal transplantation is associated with minimal morbidity and no mortality.

BRIEF COMMUNICATIONS

Free Access

IL-2 receptor engineering enhances regulatory T cell function suppressed by calcineurin inhibitor

  • Pages: 3061-3068
  • First Published: 28 August 2022
IL-2 receptor engineering enhances regulatory T cell function suppressed by calcineurin inhibitor

Novel cytokine receptor engineering technology overcomes the inhibition of IL-2 signaling in regulatory T cells by calcineurin inhibitors.

Free Access

Laparoscopic-assisted liver transplantation: A realistic perspective

  • Pages: 3069-3077
  • First Published: 15 June 2022

A series of successful laparoscopically assisted liver transplantation for unresectable neuroendocrine metastases evidences feasibility and safety of this surgical approach in highly selected patients. Kyun Hong comment page 2717.

Free Access

Clonal hematopoiesis confers an increased mortality risk in orthotopic heart transplant recipients

  • Pages: 3078-3086
  • First Published: 16 August 2022
Clonal hematopoiesis confers an increased mortality risk in orthotopic heart transplant recipients

Examining specific gene mutations in hematopoietic stem cells, we have demonstrated that clonal hematopoiesis is a novel non-invasive test that can risk stratify adverse outcomes such as mortality and cardiac allograft vasculopathy in heart transplant recipients.

Free Access

Deceased donor kidneys are discarded at higher rates when labeled as high kidney donor profile index

  • Pages: 3087-3092
  • First Published: 11 September 2022

Deceased donor kidneys with the same kidney donor risk index are more frequently discarded when labelled as high kidney donor profile index.

Open Access

ABO-adjusted calculated panel reactive antibody (cPRA): A unified metric for immunologic compatibility in kidney transplantation

  • Pages: 3093-3100
  • First Published: 17 August 2022

A metric for both HLA and ABO immune sensitization can be applied in organ allocation systems to address disparities in transplant access among candidates in different ABO blood groups.

Free Access

A multi-institutional study of renal outcomes and renal-related pregnancy outcomes in uterus transplant recipients

  • Pages: 3101-3110
  • First Published: 13 July 2022

In an international cohort of uterus transplant recipients, alterations in renal function occur early after transplant and frequently persist through pregnancy into the early postpartum period.

Free Access

Donor-derived acute myeloid leukemia in solid organ transplantation

  • Pages: 3111-3119
  • First Published: 18 August 2022

In-depth genomic analysis of acute myeloid leukemia transmission following solid organ transplantation reveals distinct clonal evolution provides a molecular explanation for tumor escape.

Free Access

Cerebral cortical activity after withdrawal of life-sustaining measures in critically ill patients

  • Pages: 3120-3129
  • First Published: 13 July 2022

This prospective observational cohort study estimated the temporal relationship between cessation of brain cortical electrical activity and circulatory arrest after withdrawal of life sustaining measures in critically ill adults.

Free Access

Tixagevimab/cilgavimab pre-exposure prophylaxis is associated with lower breakthrough infection risk in vaccinated solid organ transplant recipients during the omicron wave

  • Pages: 3130-3136
  • First Published: 21 June 2022

A retrospective matched cohort study shows that tixagevimab-cilgavimab pre-exposure prophylaxis in vaccinated solid organ transplant recipients is associated with a lower risk of breakthrough SARS-CoV-2 infection during the Omicron wave.

Free Access

mTOR inhibitors, mycophenolates, and other immunosuppression regimens on antibody response to SARS-CoV-2 mRNA vaccines in solid organ transplant recipients

  • Pages: 3137-3142
  • First Published: 23 July 2022

Examination of the association of mammalian target of rapamycin inhibitors, mycophenolic acid, and other immunosuppressive agents with responses to SARS-CoV-2 mRNA vaccines shows that mycophenolic acid avoidance is independently associated with improved vaccine response.

CASE REPORTS

Free Access

First report of auxiliary liver transplantation for severe cholangiopathy after SARS-CoV-2 respiratory infection

  • Pages: 3143-3145
  • First Published: 05 August 2022

Auxillary right lobe living donor liver transplantation is a treatment option for severe cholangiopathy after COVID-19 infection.

LETTERS TO THE EDITOR