<?xml version="1.0" encoding="utf-8"?>
    <rss version="2.0">
      <channel xmlns:content="http://purl.org/rss/1.0/modules/content/">
        <title>Transplant International | New and Recent Articles</title>
        <link>https://www.frontierspartnerships.org/journals/transplant-international</link>
        <description>RSS Feed for Transplant International | New and Recent Articles</description>
        <language>en-us</language>
        <generator>Frontiers Feed Generator,version:1</generator>
        <pubDate>2026-04-20T00:20:27.582+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16100</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16100</link>
        <title><![CDATA[Time as a Therapeutic Ally: The Promise of Long-Term Solid Organ and Tissue Perfusion]]></title>
        <pubdate>2026-04-17T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Florian Huwyler</author><author>Matthias Pfister</author><author>Diwakar Phuyal</author><author>Yomna E. Dean</author><author>Margareta Mittendorfer</author><author>Lars Saemann</author><author>Hannah Rasel</author><author>Simon Stoerzer</author><author>Jonas Binz</author><author>Bahareh Tabatabaei</author><author>Gabor Szabo</author><author>Sandra Lindstedt</author><author>Bahar Bassiri Gharb</author><author>Mark W. Tibbitt</author><author>Pierre-Alain Clavien</author>
        <description><![CDATA[Rapid advances in tissue preservation and the growing adoption of machine perfusion have fundamentally reshaped solid-organ and tissue transplantation in recent years. Multiple short-term perfusion devices have received regulatory approval and are increasingly used in clinical practice to preserve grafts for several hours, improving allograft assessment. The boundaries of dynamic tissue preservation have been pushed even further in research settings, where grafts have been reliably perfused for multiple days. The extended time of long-term machine perfusion opens a new therapeutic window for interventions, allowing for reconditioning and even tissue repair of injured and diseased grafts. The increasing global organ shortage makes these approaches particularly attractive to recover additional allografts for safe transplantation. In this review, we highlight current clinical practice for ex situ perfused allografts, multi-day perfusions in research settings, and potential therapeutic benefits of long-term perfusion with a focus on hearts, livers, lungs and vascularized composite allografts.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15873</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15873</link>
        <title><![CDATA[Totally Video-Assisted Thoracoscopic Surgery for Lung Transplantation: A Case Series]]></title>
        <pubdate>2026-04-17T00:00:00Z</pubdate>
        <category>Letter to the Editor</category>
        <author>Qiang Pu</author><author>Xiaolong Zhang</author><author>Jian Zhou</author><author>Qian Yang</author><author>Xuehua Tu</author><author>Jianrong Hu</author><author>Ningying Ding</author><author>Jiao Chen</author><author>Jun Zeng</author><author>Yuchen Huang</author><author>Jiandong Mei</author><author>Lin Ma</author><author>Chenglin Guo</author><author>Dong Tian</author><author>Lunxu Liu</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16153</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16153</link>
        <title><![CDATA[Exploring Disease-Specific Waitlist Outcomes in Simultaneous Liver-Kidney Transplantation]]></title>
        <pubdate>2026-04-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Rikako Oki</author><author>Luckshi Rajendran</author><author>Dean Yonghoon Kim</author><author>Atsushi Yoshida</author><author>Marwan Abouljoud</author><author>Shunji Nagai</author>
        <description><![CDATA[The current allocation system does not account for liver etiology in simultaneous liver-kidney transplantation (SLKT). This study aims to assess differences in waitlist outcomes among major liver disease groups (alcohol-related liver disease [ALD], metabolic dysfunction-associated steatohepatitis [MASH], hepatitis C virus infection, and biliary diseases) in SLKT using Organ Procurement and Transplantation Network (OPTN) registry. In total, 4,846 adult SLKT candidates listed between January 2018 and March 2024 were enrolled. Patients with MASH had worse waitlist 1-year mortality compared to ALD adjusted for patient characteristics at listing (HR 1.300, 95% CI 1.059–1.597, p = 0.012), whereas the 1-year SLKT probability was comparable. When patients were categorized by MELD score at listing (6–20, 21–29, and ≥30), patients with MASH had significantly higher 1-year waitlist mortality compared to those with ALD in the middle MELD score group (HR 1.365, 95% CI 1.008–1.834, p = 0.044). Prior to the allocation policy change in 2020, patients with MASH experienced higher waitlist mortality compared to ALD, however, this disparity was not observed following the policy change. Waitlist outcomes varied significantly depending on the etiology in SLKT. The revised 2020 allocation policy may be temporally associated with changes in mortality disparities across different liver etiologies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15264</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15264</link>
        <title><![CDATA[New Antibiotics Against Multidrug-Resistant Gram-Negative Bacteria in Lung Transplantation: Clinical Evidence, Safety, and PK/PD Properties]]></title>
        <pubdate>2026-04-10T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Andrea Lombardi</author><author>Davide Mangioni</author><author>Giulia Viero</author><author>Laura Alagna</author><author>Giulia Renisi</author><author>Paola Saltini</author><author>Alessandra Bandera</author>
        <description><![CDATA[Infections caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) and Pseudomonas aeruginosa are leading causes of morbidity and mortality after lung transplantation (LuTx). We reviewed the pharmacology, clinical evidence, and safety of five agents potentially active against MDR-GNB in LuTx recipients (LUTR): ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam, and cefiderocol. Literature from the last 10 years was reviewed for data on activity spectrum, efficacy in LUTR and adverse events. Ceftolozane/tazobactam and ceftazidime/avibactam were the most studied, providing high cure rates for difficult-to-treat Pseudomonas (DTR-PA) and Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales, respectively. Meropenem/vaborbactam offers reliable coverage of KPC strains, while imipenem/relebactam is an interesting option for imipenem-non-susceptible Pseudomonas spp. Cefiderocol exhibits the broadest in vitro spectrum, including metallo-β-lactamase producers. Across agents, pharmacokinetic variability, augmented renal clearance, and extracorporeal support can compromise target attainment; prolonged or continuous infusion is preferred. Collectively, these antibiotics expand the therapeutic armamentarium against MDR-GNB in LUTR, allowing pathogen-directed, toxicity-sparing regimens. Nonetheless, prospective LuTx-focused studies are needed to optimise their use in such a peculiar setting.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15987</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15987</link>
        <title><![CDATA[Interactions Between Immunosuppressive Regimens and Cytomegalovirus Infection After Solid-Organ Transplantation]]></title>
        <pubdate>2026-04-09T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Lucas Milo Bellier</author><author>Hannah Kaminski</author><author>Pierre Merville</author><author>Lionel Couzi</author>
        <description><![CDATA[Cytomegalovirus (CMV) remains a major infectious complication after solid-organ transplantation, driven by immunosuppressive therapies that alter CMV-specific cell-mediated immunity. Antithymocyte globulin induces profound and prolonged T-cell depletion, transiently impairing CMV-specific cell-mediated immunity and increasing CMV risk in seropositive recipients. Calcineurin inhibitors suppress cytokine production, notably IL-2 and IFN-γ, without significantly impairing cytotoxic function, while mycophenolate mofetil limits lymphocyte proliferation but preserves effector capacity. In contrast, mTOR inhibitors exert dual antiviral and immunomodulatory effects by directly inhibiting CMV replication and enhancing CMV-specific T-cell memory formation. Belatacept, through CD28–CD80/CD86 blockade, may predispose to late, severe, or relapsing CMV disease, particularly in elderly or D+/R− recipients. Corticosteroids broadly inhibit NK cell cytotoxicity and CMV-specific T-cell responses, but clinical data on steroid withdrawal remain inconsistent. Overall, CMV risk is determined less by a single drug than by the cumulative depth of immunosuppression. Integrating immune monitoring tools, such as CMV-specific T-cell assays, could enable tailored immunosuppressive regimens balancing antiviral protection with graft survival.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15340</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15340</link>
        <title><![CDATA[Beyond a Biomarker: Investigations of a Proinflammatory Role for Cell-Free DNA in Liver Transplant Ischemia and Reperfusion]]></title>
        <pubdate>2026-04-08T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Mike Schnepppfister</author><author>Yue Wang</author><author>Chen Zhong</author><author>Tori Huey</author><author>Hesham El-Shewy</author><author>Yichu Kao</author><author>Joseph R. Scalea</author><author>Thomas A. Morinelli</author><author>Yuan Zhai</author><author>Dirk J. van der Windt</author>
        <description><![CDATA[Donor-derived cell-free DNA (dd-cfDNA) is a biomarker for rejection after organ transplantation. We hypothesized that high release of cfDNA immediately after liver transplant also has a biologic role in inflammation in ischemia and reperfusion injury (IRI). To investigate this concept, C57BL/6 mice were subjected to 90 min in situ liver ischemia. After 6 h reperfusion, cfDNA was purified from serum and used to stimulate macrophages in vitro, which resulted in production of high levels of inflammatory cytokines TNFα and IL-6, and chemokine CXCL10. Enzymatic degradation of cfDNA by DNase I inhibited these inflammatory responses (e.g., TNFα: DNase I 48.1 ± 37.4 vs. untreated 1,030 ± 206 pg/mL, p = 0.0001). cfDNA from netosis-deficient PAD4KO mice was found to be equally pro-inflammatory compared to wild type cfDNA (TNFα: PAD4KO 1048 ± 199 vs. wild-type 1,162 ± 150 pg/mL, p = 0.64), indicating its mechanism is not dependent on neutrophils undergoing netosis. Next, a single dose of DNase I was added to the perfusate during rat liver normothermic machine perfusion (NMP) to significantly reduce perfusate cfDNA levels (384 ± 132 to 129 ± 18 ng/mL, p = 0.026). In conclusion, our data suggest that cfDNA can have pro-inflammatory effects during liver IRI beyond being a biomarker. DNase I may be a promising therapeutic intervention during NMP to reduce the graft’s inflammatory propensity prior to implantation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15780</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15780</link>
        <title><![CDATA[Urinary VP1 Flow Cytometry as a Complementary Approach for BK Polyomavirus Monitoring: A Proof-Of-Concept Study]]></title>
        <pubdate>2026-04-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Haris Omic</author><author>David Vecsei</author><author>Michael Eder</author><author>Karim Abd El-Ghany</author><author>Wolfgang Winnicki</author><author>Alice Schmidt</author><author>Sebastian Kapps</author><author>Daniela Gerges</author><author>Robert Strassl</author><author>Ludwig Wagner</author><author>Farsad Eskandary</author>
        <description><![CDATA[Polyomavirus nephropathy (BKPyVAN) is a major cause of allograft dysfunction after kidney transplantation (KTX). While plasma BKPyV-PCR is the diagnostic gold standard, it may not fully reflect tissue injury. We conducted a prospective observational proof-of-concept study in 30 KTX recipients with BKPyV reactivation (November 2022–February 2024); 21 underwent kidney biopsy, 11 were diagnosed with biopsy-proven (BP)-BKPyVAN. Urine samples were analyzed by flow cytometry to quantify the potential of VP1-positive reno-urinary epithelial cells as a novel non-invasive marker of active tubular damage. The control cohort included 21 virology-negative patients. Median urinary VP1-positivity was higher in BP-BKPyVAN (33%, IQR 27–46) vs. non-BKPyVAN patients (5%, IQR 1–13; p < 0.001). The assay achieved an AUC of 0.98 (95% CI 0.93–1.00, p = 0.0003; cut-off: 11.7%; sensitivity = 91%, specificity = 89%) for BP-BKPyVAN. Longitudinally, median VP1-burden declined from 13% (IQR 4–29) at baseline to 0% (IQR 0–0.4). BKPyV-DNAemia declined rapidly, but plateaued at ∼4 × 102–7 × 102 copies/mL, whereas urinary VP1-positive cells became undetectable. Our preliminary results suggest that combining urinary VP1-positivity with plasma BKPyV-PCR may help distinguish BP-BKPyVAN from non-BKPyVAN within a BKPyV-reactivation cohort. Longitudinal VP1 tracking may indicate resolution of viral infection earlier than DNAemia. These findings are hypothesis-generating and require validation in larger independent cohorts.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15517</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15517</link>
        <title><![CDATA[Diagnostic Potential of Urine CXCL10 and Donor-Derived cfDNA in Kidney Transplant Rejection]]></title>
        <pubdate>2026-03-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Daniel Fantus</author><author>Robert Balshaw</author><author>Chee Loong Saw</author><author>Majda Belkaid</author><author>Narin S. Tangprasertchai</author><author>Thierry Viard</author><author>François Gougeon</author><author>Justin Belair</author><author>Claude Daniel</author><author>Caroline Lamarche</author><author>Sílvia Casas</author><author>Heloise Cardinal</author><author>Julie Ho</author>
        <description><![CDATA[Data suggests donor-derived cell-free DNA (dd-cfDNA) and urine CXCL10 outperform serum creatinine as a biomarker of antibody-mediated rejection (AMR) and T cell-mediated rejection (TCMR). We hypothesized that combining these biomarkers would improve the overall detection of rejection. We performed a retrospective two-center, case-controlled study of 103 adult renal transplant recipients who had for-cause or surveillance biopsies with corresponding urine and plasma samples. Rejection was classified by Banff 2022 criteria. While log10%dd-cfDNA correlated more strongly than log10CXCL10 with glomerulitis (r = 0.55, p < 0.001 vs. r = 0.25, p = 0.01) and peritubular capillaritis (r = 0.47, p < 0.001 vs. r = 0.23, p = 0.02), log10CXCL10 was a better correlate of tubulitis (r = 0.28, p = 0.004 vs. r = 0.054, p = 0.59). Both dd-cfDNA > 0.5% (OR 21.9, 95% CI 3.74–180, p < 0.001) and de novo DSA (OR 10.4, 95% CI 1.16–157, p = 0.037) were independently associated with AMR vs. no rejection (NR), while log10 serum creatinine and log10CXCL10 were not (p > 0.05). While dd-cfDNA >0.5% (OR 5.37, 95% CI 1.04–31.5, p = 0.047) was independently associated with Banff ≥1A TCMR vs. NR, log10CXCL10 was a significant predictor of TCMR in a model without %dd-cfDNA (OR 3.12, 95% CI 1.09–10.4, p = 0.043). Biomarker-guided screening strategies based on dd-cfDNA and urine chemokines such as CXCL10 for AMR (microvascular injury) and TCMR (tubulitis) warrant further study.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16563</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16563</link>
        <title><![CDATA[Correction: Achievements, Challenges and Promises of Minimally Invasive Liver Transplantation]]></title>
        <pubdate>2026-03-25T00:00:00Z</pubdate>
        <category>Correction</category>
        <author>Transplant International Production Office </author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15547</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15547</link>
        <title><![CDATA[Evaluation of the Prevalence of Occult Fibrin in Donor Organs, Its Origins, and Consequences: Insights From the COPE Studies]]></title>
        <pubdate>2026-03-25T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Christopher J. E. Watson</author><author>Ina Jochmans</author><author>Stephen Macdonald</author><author>Danielle White</author><author>Christopher Bridgeman</author><author>Andrew J. Butler</author><author>Rohit Gaurav</author><author>Lisa Swift</author><author>Anna L. Paterson</author><author>Letizia Lo Faro</author><author>Maria E. Kaisar</author><author>David Nasralla</author><author>Peri Husen</author><author>Sarah Cross</author><author>Peter J. Friend</author><author>Rutger J. Ploeg</author><author>Vasilis Kosmoliaptsis</author>
        <description><![CDATA[Microthrombi are often observed in the glomerular tufts of peri-transplant renal biopsies, and occult fibrin has been described in livers undergoing normothermic perfusion, with its presence associated with cholangiopathy and poorer transplant survival. To further examine the phenomenon, we measured D-dimers in the perfusates of kidneys and livers that were part of organ perfusion studies conducted by the Consortium for Organ Preservation in Europe. Both kidneys and livers were found to contain variable amounts of D-dimers. The need for dialysis in kidneys donated after circulatory death (DCD) was associated with higher levels of D-dimers in the hypothermic kidney perfusate. Higher amounts of D-dimers in the liver perfusate were associated with poorer liver transplant survival. There was no significant difference in D-dimer release from livers and kidneys between donors who died from head trauma, stroke, or hypoxia. Organs from donors who died by euthanasia had significantly fewer D-dimers. This study shows that occult fibrin is common in both livers and kidneys from deceased donors and has adverse consequences. The different D-dimer loads by donor cause of death suggest a donor origin for at least some of the occult fibrin.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16528</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16528</link>
        <title><![CDATA[Oncology and Solid Organ Transplantation: New Biological and Clinical Insights]]></title>
        <pubdate>2026-03-24T00:00:00Z</pubdate>
        <category>Special Issue Editorial</category>
        <author>Gianluigi Zaza</author><author>Annemarie Weissenbacher</author><author>Alessandro Vitale</author><author>Lorna Marson</author><author>Pål-Dag Line</author><author>David Cucchiari</author><author>Andreas Kronbichler</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.14640</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.14640</link>
        <title><![CDATA[Risk Assessment of Delayed Graft Function in Pediatric Kidney Transplantation – a CERTAIN Research Network Analysis]]></title>
        <pubdate>2026-03-19T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Christian Patry</author><author>Miriam Boßung</author><author>Manuel Feißt</author><author>Kai Krupka</author><author>Britta Höcker</author><author>Lars Pape</author><author>Nele Kanzelmeyer</author><author>Lutz T. Weber</author><author>Jun Oh</author><author>Atif Awan</author><author>Thomas Simon</author><author>Licia Peruzzi</author><author>Ali Duzova</author><author>Jon Jin Kim</author><author>Mohan Shenoy</author><author>Claus Peter Schmitt</author><author>Alexander Fichtner</author><author>Burkhard Tönshoff</author>
        <description><![CDATA[Delayed graft function (DGF) in pediatric kidney transplantation is a serious complication with negative impact on graft survival. Currently, there are no reliable methods available to assess the risk of DGF in children. We performed a retrospective analysis of data from the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) registry to develop a DGF risk assessment model for pediatric kidney transplantation, based on parameters available within the first 24 h post-transplant. The model was developed by forward selection and logistic regression. This study included n = 694 patients. The overall rate of DGF was 8.5%. The following key parameters were selected for the DGF risk assessment model: (i) occurrence of post-transplant surgical complications, (ii) immediate graft urine production, (iii) rate of change in recipient’s serum creatinine, (iv) initial calcineurin inhibitor therapy. The significance of these parameters was confirmed by calculating adjusted odds ratios. In the training cohort and the internal validation cohort the ROC-AUCs were 0.9043 and 0.878. This multivariable model based on early post-transplant parameters can predict the occurrence of DGF in pediatric kidney transplant recipients with high accuracy and may facilitate future interventional trials of targeted pharmacological strategies against ischemia-reperfusion injury in this population.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16061</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16061</link>
        <title><![CDATA[Discovery of Donor-Derived Exosomal DNA as an Exploratory Biomarker of Kidney Graft Rejection: A Cross-Sectional Study]]></title>
        <pubdate>2026-03-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Elena Cuadrado-Payán</author><author>María José Ramírez-Bajo</author><author>Elisenda Banón-Maneus</author><author>Jordi Rovira</author><author>Natalia Hierro</author><author>Daniel Serrano-Jorcano</author><author>María Argudo</author><author>Enrique Montagud-Marrahi</author><author>Diana Rodríguez-Espinosa</author><author>Carolt Arana</author><author>Alicia Molina-Andújar</author><author>Angela González-Rojas</author><author>Nuria Esforzado</author><author>Vicens Torregrosa</author><author>Pedro Ventura-Aguiar</author><author>José Jesús Broseta</author><author>Eva González-Roca</author><author>Eduard Palou</author><author>Fritz Diekmann</author><author>David Cucchiari</author><author>Ignacio Revuelta</author>
        <description><![CDATA[Circulating donor DNA has emerged as a valuable tool for clinical decision-making in kidney transplantation. While most studies focus on cell-free DNA, the role of donor DNA associated with extracellular vesicles (EVs) remains unexplored. To address this, we analyzed donor-derived exosomal DNA (dd-exoDNA) in 100 kidney transplant recipients (KTR) undergoing surveillance or indicated biopsies. Serum exosomes were isolated using precipitation-based technology, and dd-exoDNA was analyzed via digital PCR targeting donor/recipient HLA-DRB1 mismatches. Dd-exoDNA levels were higher in rejection versus non-rejection (2.66 [0.56–7.10] ×10−3 vs. 0.69 [0.28–1.71] ×10−3, p = 0.004) and were associated with Banff score items: glomerulitis ≥1 (p = 0.037), peritubular capillaritis ≥1 (p = 0.040), and tubulitis ≥2 (p = 0.043). In multivariate analysis, dd-exoDNA remained independently associated with rejection, although with wide confidence intervals (OR [95%CI] 3.68 [1.32–10.26], P = 0.013). Exploratory threshold analyses suggested moderate discriminative performance. These findings indicate that donor DNA associated with circulating EVs may offer complementary information to existing biomarkers, warranting validation in external cohorts and comparison with established assays.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15952</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15952</link>
        <title><![CDATA[Kidney Transplantation in Western Balkans: A Regional Blueprint for Access, Capacity, and Equity]]></title>
        <pubdate>2026-03-13T00:00:00Z</pubdate>
        <category>Position Paper</category>
        <author>Elvana Rista</author><author>Goce Spasovski</author><author>Damir Rebic</author><author>Mirjana Lausevic</author><author>Danilo Radunovic</author><author>Vjollca Godanci</author><author>Ariana Strakosha</author><author>Alma Idrizi</author><author>Kristi Saliaj</author><author>Emin Baris Akin</author><author>Jelena Stojanovic</author><author>Fernanda Ortiz</author><author>Carmen Lefaucheur</author><author>Luciano Potena</author><author>Efstratios Chatzixiros</author><author>Jamil Azzi</author><author>Devi Mey</author>
        <description><![CDATA[There is no medical field where the impact of medical evolution is more palpable than in kidney transplantation. The pioneers of this procedure, 70 years ago, laid out the foundation for organ transplantation in general and kidney transplantation in particular. Despite the incredible advancements that have been made since, huge differences exist worldwide in terms of access, equity and quality of care. Nowhere are these disparities more prominent than in developing countries with limited resources, underfunded healthcare systems and transplantation infrastructures, particularly the Western Balkans. This position paper delineates the biggest barriers hindering the development of kidney transplantation in the Western Balkans, put forth and agreed upon by a group of regional experts on the field, based on the Modified Delphi Method. Limitations in training, infrastructure, restrictive and outdated legislative practices, lack of a centralized coordination network and fragmented regional collaboration, emerged as the principal challenges. Endorsed by European Society for Organ Transplantation (ESOT), this paper outlines a pragmatic and practical framework to overcome these obstacles, towards building robust and sustainable transplantation programs that ensure high-quality and equitable access to kidney transplantation, for all patients in this region.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15929</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15929</link>
        <title><![CDATA[Longitudinal Monitoring of Donor-Derived Cell-Free DNA Supports Risk Stratification in Kidney Transplant Recipients With Allograft Dysfunction]]></title>
        <pubdate>2026-03-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Iris Schröter</author><author>Lisa Loi</author><author>Marvin Reineke</author><author>Markus Rudek</author><author>Christian Nusshag</author><author>Florian Kälble</author><author>Claudius Speer</author><author>Martin Zeier</author><author>Thuong Hien Tran</author><author>Christian Morath</author><author>Louise Benning</author>
        <description><![CDATA[The prognostic value of donor-derived cell-free DNA (dd-cfDNA) for long-term kidney allograft outcomes after indication biopsy remains incompletely defined. In this prospective single-center cohort, 106 kidney transplant recipients with 108 indication biopsies were assessed for dd-cfDNA at biopsy and at 7, 30, and 90 days thereafter. dd-cfDNA was analyzed as a continuous, threshold-based, and longitudinal time-dependent variable. Clinical endpoints included ≥30% eGFR decline within 2 years, indication for re-biopsy, and graft failure. Persistent elevation of dd-cfDNA (≥0.5% at 90 days) occurred in 7.4% of patients, with 50% requiring re-biopsy and 37.5% developing graft failure. A single measurement ≥1.0% significantly predicted ≥30% eGFR decline (HR 2.28; 95% CI 1.03–5.05), whereas levels ≥0.5% were less discriminative. In multivariable time-dependent Cox models adjusted for age, sex, time from transplantation to biopsy, baseline eGFR, baseline proteinuria, and Banff domain scores, longitudinal dd-cfDNA remained independently associated with ≥30% eGFR decline (HR 1.68; 95% CI 1.12–2.51), re-biopsy (HR 1.88; 95% CI 1.38–2.55), and graft failure (HR 3.42; 95% CI 2.00–5.86). In conclusion, dd-cfDNA levels, particularly when assessed longitudinally, are associated with adverse allograft outcomes after indication biopsy and may provide relevant prognostic information beyond a single measurement.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16092</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.16092</link>
        <title><![CDATA[Sexual Dimorphism in Renal Progenitors: Do Immunosuppressants Erase the Female Advantage?]]></title>
        <pubdate>2026-03-10T00:00:00Z</pubdate>
        <category>Letter to the Editor</category>
        <author>Zeynep Ural</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15844</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15844</link>
        <title><![CDATA[Impact of Vascular Anastomosis Time on Kidney Transplant Outcomes – A Systematic Review]]></title>
        <pubdate>2026-03-09T00:00:00Z</pubdate>
        <category>Systematic Review and Meta-Analysis</category>
        <author>Khaled Sayah</author><author>Henry Burt</author><author>Yizi Zheng</author><author>Taina Lee</author><author>Lawrence Yuen</author><author>Christopher Nahm</author><author>Jinna Yao</author><author>Wai Lim</author><author>Germaine Wong</author><author>Leonard Lee</author><author>Ahmer Hameed</author><author>Henry Pleass</author>
        <description><![CDATA[Anastomotic time (AT), also termed second warm ischaemic time (SWIT), is a potentially important intraoperative factor in kidney transplantation, yet its impact on outcomes has not been systematically synthesised. We conducted a systematic review to examine the association between AT and delayed graft function (DGF), graft survival, and patient survival. Cochrane, Embase, and Medline were searched to 21 July 2025. Nine retrospective cohort studies comprising 155,523 transplants were included. Across all donor types, longer AT was consistently associated with higher rates of DGF within individual studies. Several studies also reported poorer 1- and 5-year graft survival with prolonged AT, while findings for patient survival were equivocal. However, substantial heterogeneity across studies, including donor type, AT definitions, outcome reporting, and incomplete adjustment for key confounders, precluded formal meta-analysis. None of the included studies consistently adjusted for major determinants of graft outcomes. These findings suggest a potential link between prolonged AT and adverse graft outcomes, but high-quality prospective studies with standardised reporting and confounder adjustment are required before AT can be considered an independent determinant of transplant outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier PROSPERO CRD42024549222.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15423</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15423</link>
        <title><![CDATA[Novel Allocation Strategies Can Boost Kidney Exchange Programs: A Monte Carlo Simulation]]></title>
        <pubdate>2026-03-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mattheüs F. Klaassen</author><author>Marry de Klerk</author><author>Marije C. Baas</author><author>Hanneke Bouwsma</author><author>Laura B. Bungener</author><author>Maarten H. L. Christiaans</author><author>Twan Dollevoet</author><author>Kristiaan Glorie</author><author>Sebastiaan Heidt</author><author>Aline C. Hemke</author><author>Margriet F. C. de Jong</author><author>Judith A. Kal-van Gestel</author><author>Marcia M. L. Kho</author><author>Jeroen D. Langereis</author><author>Karlijn A. M. I. van der Pant</author><author>Claudia M. Ranzijn</author><author>Dave L. Roelen</author><author>Eric Spierings</author><author>Christina E. M. Voorter</author><author>Jacqueline van de Wetering</author><author>Arjan D. van Zuilen</author><author>Joke I. Roodnat</author><author>Annelies E. de Weerd</author>
        <description><![CDATA[Kidney exchange programs (KEPs) enhance access to living donor kidney transplantation. Nonetheless, transplant rates in KEP remain low for highly immunized and blood type O patients. In the Netherlands, a novel allocation algorithm is being implemented, allowing ABO-incompatible matching for long waiting patients, next to prioritization and ‘low-level’ HLA-incompatible matching for selected highly immunized patients. We simulated this novel algorithm along with additional scenarios, by using a retrospective, 6-year cohort of Dutch KEP. For each scenario, 30 simulations were repeated with Monte Carlo technique. The novel algorithm increased median KEP transplant rate for incompatible pairs (53% versus 44%, p < 0.001) and for difficult-to-match subgroups. HLA-incompatible matching increased transplant rate for selected highly immunized patients significantly, while participation with multiple donors per recipient did not. In additional simulations, including all non-KEP unspecified donors (n = 150) for local KEP participation increased transplant rate for incompatible pairs up to 64% (p < 0.001). Simulating additional KEP participation by compatible pairs (n = 149), on the condition a KEP match should have fewer HLA mismatches, resulted in 58% being matched in KEP. In conclusion, differential matching algorithms can boost KEP transplant rates, allowing incompatible matching for difficult-to-match subgroups, facilitating participation of unspecified donors, and optimizing the HLA matching of compatible pairs.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15502</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15502</link>
        <title><![CDATA[Effect of Normothermic Machine Perfusion on Glycocalyx Shedding During Liver Transplantation – A Prospective Pilot Study]]></title>
        <pubdate>2026-03-02T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Simon Mathis</author><author>Gabriel Putzer</author><author>Lukas Gasteiger</author><author>Nikolai Staier</author><author>Lisa Schlosser</author><author>Pia Tscholl</author><author>Robert Breitkopf</author><author>Benno Cardini</author><author>Alexander Kofler</author><author>Rupert Oberhuber</author><author>Thomas Resch</author><author>Stefan Schneeberger</author><author>Judith Martini</author>
        <description><![CDATA[Ischemia–reperfusion injury (IRI) plays a pivotal role in liver transplantation by inducing oxidative stress and inflammation, thereby contributing to impaired graft function and postoperative complications. A key element of IRI is degradation of the endothelial glycocalyx, resulting in microcirculatory dysfunction. This study investigated the impact of normothermic machine perfusion (NMP) on glycocalyx integrity and its association with early postoperative outcomes. Thirty grafts undergoing NMP prior to transplantation were analyzed. Syndecan-1 and heparan sulfate were quantified in perfusate and recipient serum. Donor-related factors influencing glycocalyx injury during NMP were assessed, and correlations with outcomes established. Syndecan-1 levels increased during NMP and remained significantly elevated in grafts from circulatory-death (DCD) donors compared with brain-death (DBD) donors. Receiver operating characteristics revealed predictive potential for early allograft dysfunction (EAD) with a syndecan-1 cut-off of 4,796.13 ng/mL after 6 h of NMP. In contrast, heparan sulfate concentrations showed no relevant changes. Postoperatively, syndecan-1 levels in recipient serum were elevated immediately after transplantation but declined over subsequent days, while heparan sulfate remained stable. These findings indicate that glycocalyx injury develops during NMP, particularly in DCD livers, with elevated syndecan-1 reflecting endothelial vulnerability and a potentially modifiable aspect of graft physiology relevant to future protective strategies.Clinical Trial Registrationwww.Clinicaltrials.gov, identifier NCT: 04764266.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15718</guid>
        <link>https://www.frontierspartnerships.org/articles/10.3389/ti.2026.15718</link>
        <title><![CDATA[CNI Trough Variability Does Not Reliably Reflect Medication Adherence: Insights From a 3-Year Follow-Up Study]]></title>
        <pubdate>2026-03-02T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Claire Villeneuve</author><author>Jean-phillipe Rerolle</author><author>Lionel Couzi</author><author>Pierre-Francois Westeel</author><author>Isabelle Etienne</author><author>Laure Esposito</author><author>Nassim Kamar</author><author>Mathias Büchler</author><author>Antoine Thierry</author><author>Pierre Marquet</author><author>Caroline Monchaud</author>
        <description><![CDATA[Calcineurin inhibitor (CNI) trough concentrations and their variability are frequently used as adherence proxies, despite limited validation. We evaluated the association between self-reported adherence and CNI exposure during the first year after kidney transplantation. We included 619 patients from two prospective French cohorts (14,829 C0 values). Adherence was assessed using the MMAS-4 questionnaire. CNI exposure was evaluated via C0 levels, intra-patient variability (IPV; CV threshold = 30%), and underexposure rates. Cross-sectional and longitudinal analyses were performed. No significant differences in C0, IPV, or underexposure were observed between adherent and non-adherent patients, regardless of the CNI used or analytical approach. In longitudinal analysis, IPV was similar (31.3% [25.5–38.2] vs. 31.6% [23.6–38.9], p = 0.68), as was the proportion of patients with high IPV (55.5% vs. 51.5%, p = 0.5). At 3 years, high IPV was not significantly associated with rejection (HR 1.02 [0.67–1.55], p = 0.93). Self-reported adherence was not associated with CNI C0 levels, IPV, or underexposure. CNI C0 variability alone cannot reliably detect non-adherence and should not be interpreted as a standalone adherence marker. Multimodal strategies combining pharmacokinetics with validated self-report tools are needed to evaluate adherence.]]></description>
      </item>
      </channel>
    </rss>