Heart transplantation remains the main treatment for end-stage heart failure. The opioid crisis has increased donor availability, including organs from intoxicated individuals, but the impact on outcomes is uncertain.

Chronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma (HCC). Post-transplant HBV reinfection represents an important post-liver transplantation (LT) complication, which can result in death or graft loss. Hepatitis B immunoglobulin (HBIG) has proven effective in preventing reinfection; however, its high cost and patient inconvenience underscore the need for alternative strategies. In this study, we evaluated the long-term outcomes of HBV-positive LT recipients who received very short-term HBIG immunoprophylaxis combined with life-long antiviral therapy. We conducted a single-center, retrospective cohort study of patients who underwent LT for HBV between 2002 and 2022. Viremic patients received an intraoperative and six consecutive daily doses of HBIG, while non-viremic patients received two doses only post-LT, along with long-term antiviral therapy. The primary outcome was HBV reinfection. Secondary outcomes included death-censored graft survival and overall survival. Seventy-six patients were included. Of these, only three experienced HBV reinfection over the study period. The cumulative incidence of reinfection at 1, 12, 24, and 48 months was observed to be 1.37%, 2.76%, 2.76%, and 2.76%, respectively. The 1-, 3-, and 5-year death-censored graft survival rates were 94%, 94%, and 92%, respectively. The 1-, 3-, and 5-year overall survival rates were 92%, 92%, and 85%, respectively. A very short-term HBIG protocol produced excellent post-transplant outcomes for HBV-positive LT recipients, with very low rates of HBV reinfection and excellent graft and overall survival.

Deceased donor kidney allocation algorithms seek to balance equity, need, and utility within regional healthcare constraints. Although many countries have formal systems, comparative analyses of their structure, context, and evolution remain scarce.

Sarcopenia and frailty are common among kidney transplant candidates and often persist even after transplantation. Exercise therapy initiated during the perioperative period may improve physical function, but its benefits remain underexplored.

The number of living donors in the US has stagnated for over two decades, in part because a substantial number of intended donors are disqualified due to potentially modifiable health conditions like obesity and smoking. Although these conditions can be improved with lifestyle changes, many candidates lack the support to achieve these changes on their own.

There is no consensus on the optimal perioperative management of patients undergoing kidney transplantation, and little is known about variation in clinical practice across the United States (U.S.). We conducted a national survey to describe current perioperative management practices in patients undergoing kidney transplantation in the U.S.

Since FDA approval in 2021, normothermic machine perfusion (NMP) has emerged as a transformative tool to expand transplantation access for patients with end-stage liver disease. This study details the design, implementation, and outcomes of our liver NMP program, highlighting implementation of a stratification algorithm for grafts into low-, medium-, and high-risk categories and evaluation of high-risk grafts from the first 100 cases. A secondary analysis compares NMP outcomes with historical cohorts. The final analysis included 53 grafts from donation after brain death (DBD) and 39 from donation after circulatory death (DCD) donors, excluding eight NMP grafts that were not transplanted. No significant differences were observed in allograft dysfunction, primary non-function, biliary or arterial complications, or patient survival, even among high-risk graft recipients. NMP significantly reduced intraoperative cryoprecipitate (0.41 vs. 1.44 units, p = 0.003) and platelet (0.59 vs. 1.56 units, p = 0.001) use in DCD recipients. While recipients of DBD-NMP grafts experienced longer ICU stays (17.17 vs. 8.96 days, p = 0.03) and higher rates of renal replacement therapy (41.14% vs. 20.75%, p = 0.04) than the historic cohort, inpatient length of stay and long-term dialysis requirements were unaffected. Higherrisk graft use facilitated transplant access for patients with lower MELD scores at our center. These findings highlight NMP's potential to safely expand the donor pool, facilitating transplantation of previously non-utilized livers while maintaining comparable outcomes. The risk stratification developed alongside our program provides a practical algorithm to advance equity in organ allocation through NMP by enabling safe access to high-risk grafts and demonstrates its value in optimizing liver transplantation practices.

Criteria for simultaneous liver kidney transplantation (SLKT) have undergone several iterations. In August 2017, the Organ Procurement Transplantation Network (OPTN) created specific criteria for SLKT allocation and established a "safety net" protocol to allocate kidney allografts for liver transplant recipients with persistent renal dysfunction within the first year after liver transplantation (KALT). Published studies that evaluated patient and kidney allograft survival have applied the "safety net" criteria retrospectively to time periods prior to enactment of the policy. We aimed to assess kidney allograft outcomes in those who underwent KALT compared to those who underwent SLKT during the actual "safety net" era.

Solid organ transplantation is a life-saving procedure, yet its long-term success is limited by rejection and other pathological processes. Traditional histopathology and bulk molecular analysis lack the necessary spatial resolution to resolve the complex cellular interactions within the allograft microenvironment. The emergence of spatial-omics technologies offers new capabilities for molecular analysis within intact tissue architecture. This review provides an overview of major spatial transcriptomic and proteomic platforms, including sequencing-based technologies, imaging-based technologies, and high-plex protein imaging technologies. We synthesize and provide mechanistic insights into the key findings from the application of these tools in kidney, lung, liver, and heart transplantation. Key applications discussed include as follows: resolving the heterogeneity of rejection (T-cell mediated and antibody-mediated rejection (ABMR)), elucidating the driving mechanisms of chronic allograft dysfunction and ischemia-reperfusion injury (IRI), and delineating the immune microenvironments associated with operational tolerance (OT) and tertiary lymphoid structures (TLS). We further explore how these technologies are beginning to refine our understanding of transplant pathology from a diffuse inflammatory process to the identification of specific pathogenic microenvironments. Finally, we discuss the challenges and prospects of translating these powerful research tools toward the long-term goal of precision immunosuppression, for instance, through the potential future development of digital biopsies to help guide individualized therapies.

Most studies on socioeconomic factors in liver transplantation (LT) rely on national databases without considering regional characteristics. This study uniquely investigated how educational attainment, income, and insurance status simultaneously impact early readmission and graft survival among LT recipients at a single center in Ohio, accounting for county-level characteristics.

Adherence to immunosuppressive therapy is crucial for successful outcomes in solid organ transplantation. Tacrolimus intra-patient variability (%CV) is a validated marker of adherence and has been associated with graft outcomes. Health literacy (HL), a modifiable factor, may influence this variability, but its role remains unexplored.

Normothermic regional perfusion (NRP) is rapidly gaining adoption for donation after cardiac death (DCD) organ recovery in the United States. However, little is known about trends in NRP procured grafts for simultaneous pancreas-kidney transplantation (SPK).

Frail kidney transplant (KT) candidates, characterized by low physical activity/function, have decreased chances of listing and increased risk of waitlist mortality. Impairments in these physical domains contribute to perceived physical burden and may exacerbate one another. Further, understanding the association of each domain individually with adverse outcomes may improve pre-KT risk stratification.

Heparin induced thrombocytopenia (HIT) is often suspected among lung transplant recipients (LTRs) due to a high prevalence of thrombocytopenia and frequent heparin use. This study explores the utility of the 4Ts score in stratifying HIT risk among adult LTRs.

Despite the efforts by the Organ Procurement and Transplantation Network (OPTN) to improve utilization of organs from very small pediatric donors, en bloc kidney grafts are still disproportionately discarded. Although associated with increased technical complications, en bloc kidney transplants achieve excellent graft function and longevity. We present our single-center experience with en bloc kidney transplants in adult recipients and compare outcomes between donation after cardio-circulatory death (DCD) and brain death/death by neurologic criteria (BD/DNC) organs.

The role of failure to rescue (FTR) in solid organ transplantation (SOT) is less clear. This scoping review aimed to evaluate the incidence, complications, and risk factors for FTR in SOT.

Following pediatric liver transplantation (pLT), the significance and management of donor-specific antibodies (DSA) against human leukocyte antigen (HLA) remain undefined. The aim of this single-center study was to investigate the occurrence of DSA, their clinical impact on predictors for and protectors against DSA.

Older patients who are evaluated for kidney transplantation (KT) experience an earlier onset of cognitive impairment due to dialysis, comorbidities, and inactivity. Ambient fine particulate matter (PM) is a modifiable risk factor for dementia among community-dwelling older adults. Inflammatory responses and oxidative stress caused by inactivity in older patients evaluated for KT may heighten vulnerability to PM. Thus, the impact of PM on dementia may be more severe in this population.

Normothermic machine perfusion (NMP) is an alternative to static cold storage (SCS) for liver graft preservation, potentially reducing ischemia-reperfusion injury and improving organ utilization.

Extracorporeal cardiopulmonary resuscitation (ECPR) is a potentially life-saving intervention in refractory out-of-hospital cardiac arrest (OHCA). ECPR enables, in most of the treated cases, ICU admission to patients who otherwise would have died at the emergency department (ED). Still, many of them die, frequently after withdrawal of life-sustaining therapies due to irreversible critical conditions and related complications. The additional time provided by ECPR, however, might allow for the assessment of organ donor suitability. The aim of this study was to evaluate the impact of ECPR on the number of potential organ donors after refractory OHCA.

Despite substantial advances in surgical technique and immunosuppressive therapy, kidney transplantation continues to face limitations in long-term graft and patient survival. Increasingly, attention is shifting toward the exposome, the comprehensive profile of environmental, social, and biological exposures accumulated across the lifespan, as a critical yet under-investigated determinant of transplant outcomes. Evidence from diverse domains, including air pollution, heavy metal burden, dietary composition, infections, microbiome dynamics, psychosocial context, and digital health engagement, suggests that these factors exert profound effects on immune regulation, metabolic health, and graft integrity. By applying innovative approaches such as exposome-wide association studies, high-resolution biomonitoring, and multi-omics integration, researchers can begin to unravel complex exposure-disease relationships and identify previously unrecognized modifiable risks. Positioning the exposome within the kidney transplantation paradigm offers a pathway toward precision environmental medicine, enabling refined risk stratification, novel preventive strategies, and ultimately improved durability of both graft function and patient survival. However, exposome influences are highly individualized and interact in complex, non-additive ways; current evidence remains largely associative and hypothesis-generating rather than causal.