Transplant Surgery

Living donor liver transplantation supports renal recovery in MELD ≥35 recipients on RRT

This propensity score-matched study compared 326 LDLT and 386 DDLT recipients with MELD ≥35, including a subgroup on preoperative RRT. LDLT was associated with significantly lower in-hospital mortality, despite longer operative times and similar overall complication rates. Among patients on preoperative RRT, LDLT yielded higher renal recovery and improved long-term graft survival versus DDLT. LDLT was not an independent predictor of overall survival; age >65 years, retransplantation, and vasopressor use drove mortality risk. The data support LDLT as a viable option in carefully selected high-MELD, RRT-dependent candidates when aiming to maximize renal recovery. 1

Organ-specific effects of originator and generic immunosuppressants on rejection and survival

This SRTR analysis linked acute rejection with reduced survival across liver, kidney, heart, lung, pancreas, intestine, heart–lung, and pancreas–kidney transplants. Immunosuppressants showed organ-specific patterns for rejection and survival, challenging one-size-fits-all drug selection. In liver transplantation, generic tacrolimus increased acute rejection risk, while azathioprine reduced rejection incidence. In kidney transplantation, tacrolimus increased rejection risk, whereas cyclosporine was associated with lower rejection risk. Mycophenolate mofetil increased mortality risk in several organ types but decreased death risk in pancreas transplant recipients. Originator and generic cyclosporine had divergent effects in heart transplantation, with originator improving survival and generic linked to worse outcomes and more rejection. 2

Prophylactic ureteral stents increase UTIs without reducing major ureteral complications

This NSQIP Transplant analysis included 3407 kidney recipients, 75.6% of whom received prophylactic ureteral stents. Major ureteral complication rates were similar with and without stents, around 2.5%, with no reduction in leaks or stenosis. Stent placement independently doubled UTI risk, with higher UTI rates persisting after propensity score matching. Patients selected for stenting had higher BMI, more smoking, and longer warm ischemia times, but adjustment did not reveal ureteral benefit. These findings support selective rather than routine stenting to lower UTI burden without increasing ureteral complications. 3

Multicellular drivers and potential targets in renal allograft interstitial fibrosis

This review focuses on renal interstitial fibrosis as the central lesion in chronic allograft dysfunction after kidney transplantation. It describes how immune cells, tubular epithelium, and stromal populations form a self-reinforcing profibrotic network in the graft. Both immune and non-immune mechanisms orchestrate progressive matrix deposition and irreversible architectural remodeling. The authors highlight regulatory nodes and profibrotic signaling pathways as candidate targets for precision antifibrotic interventions. Current clinical therapies remain limited, underscoring the need to translate these mechanistic insights into graft-preserving strategies. 4