Transplant Surgery

Active HBV donor kidneys show low transmission risk but antivirals appear crucial

This meta-analysis included 20 cohorts totaling 600 HBsAg-negative kidney recipients from donors with active HBV. Overall HBV transmission was 4.0% (95% CI 1.8–8.3%), mostly transient, low-level viremia rather than overt hepatitis. Transmission reached 16.0% when all donors were NAT positive and fell to 0.8–1.4% in living or anti-HBs–positive recipients. Three HBV-related deaths occurred, all in patients not receiving post-transplant antiviral prophylaxis. The authors suggest kidneys from active-HBV donors can be used with risk stratification, prophylaxis, consent, and close virologic monitoring. 1

Sustained pig-to-human kidney xenotransplant sets new survival benchmark and drives trials

This review describes a landmark pig-to-human kidney xenotransplant that outlived all prior clinical attempts. During functional graft periods, the patient achieved near-normal creatinine clearance, improved energy, and markedly reduced dialysis requirements. The case demonstrates that a pig kidney can provide meaningful renal function despite continued background dialysis. On this basis, the FDA has authorized multicenter clinical trials enrolling over 30 xenotransplant candidates. The article positions kidney xenotransplantation as a realistic strategy to address organ shortages pending rigorous safety and efficacy data. 2

CYP3A5*6 loss-of-function alleles reduce tacrolimus exposure more than *3

This cohort study analyzed 4,293 dose-normalized tacrolimus AUC0–24 measurements from 1,461 adult kidney recipients in 67 countries. CYP3A56 carriers had 17% lower dose-normalized AUC0–24 and 20% lower troughs than CYP3A53 carriers after adjustment. Genotypes containing *6 showed markedly reduced exposure versus *3/*3, especially *1/*6 (−39%) and *3/*6 (−18%). African country of birth was independently associated with 23% higher AUC0–24, indicating ancestry and genotype exert distinct influences. These data support genotype-guided tacrolimus dosing that distinguishes *6 from *3, particularly in patients of African ancestry. 3

Pediatric liver transplant access remained stable after acuity-circle allocation

Using SRTR data, this analysis compared pediatric liver transplant access before and after acuity-circle allocation implementation. Transplantation rates appeared higher post-policy, but after competing-risk adjustment the increase was attenuated and not statistically significant. Waitlist mortality was unchanged, while the prevalent pediatric waitlist shrank from 396 in 2017 to 225 in 2023. Deceased donor liver transplantation from pediatric donors and access to living donor liver transplantation both increased in the later era. Findings suggest modest changes likely reflect shifts in patient and donor pools more than the allocation policy itself. 4