30-Second Takeaway
- Nebulized liposomal amphotericin B lowers mold infection rates in lung recipients but residual, high-mortality breakthroughs cluster in structurally abnormal grafts.
- Banff Chronicity Index, more than Activity Index, tracks long-term graft function after pediatric kidney rejection.
- Renal transplantation shifts stone composition toward carbonate apatite and mixed stones, supporting transplant-specific nephrolithiasis protocols.
- Ferroptosis modulation via the STARD10–YBX1–ACSL1 axis may protect steatotic liver grafts from ischemia–reperfusion injury.
- Kidney transplant oncology care hinges on coordinated immunosuppression adjustment, tailored screening, and modern systemic therapies.
Week ending April 11, 2026
Transplant Grand Rounds: Infection, Malignancy, Injury, and Risk Stratification Across Solid Organ Programs
Long-term nebulized liposomal amphotericin B in lung transplantation: low breakthrough rate but high mortality when infection occurs
In this 10-year single-center cohort, 802 lung transplant recipients received lifelong nebulized liposomal amphotericin B prophylaxis. Breakthrough mold infection occurred in 8.7% within the first post-transplant year and 11.7% over a median 2.56-year follow-up. Bronchial stenosis, bronchial stent placement, and single-lung transplantation independently increased breakthrough mold infection risk. Nebulized prophylaxis was highly tolerable, with adverse-event-related discontinuation in only 2.2% of recipients. Both mold colonization and breakthrough infection markedly increased mortality risk, with adjusted hazard ratios above 5 and 14, respectively.
Banff Activity and Chronicity Indices refine rejection prognostication in pediatric kidney transplantation
Among 535 pediatric kidney transplant recipients, 18.3% experienced at least one acute rejection episode. Independent predictors of rejection included HLA-DR mismatch, prior transplantation, preformed donor-specific antibodies, and age 9–15 years. Higher Banff Activity Index correlated with worse eGFR at rejection diagnosis but lost prognostic value during longer follow-up. A Chronicity Index ≥4 predicted substantially lower eGFR three years after rejection compared with CI <4. High CI at first biopsy was associated with donation after circulatory death and late biopsies three or more years post-transplant.
Kaposi sarcoma in solid organ transplantation: multimodal management centered on HHV-8 and immunosuppression control
This review summarizes Kaposi sarcoma epidemiology, pathogenesis, and management in solid organ transplant recipients. Incidence varies with HHV-8 prevalence, immunosuppression intensity, and donor–recipient serostatus combinations. Post-transplant Kaposi sarcoma often involves viscera and lymph nodes without skin lesions, complicating timely diagnosis. The therapeutic cornerstone is immunosuppression reduction and conversion to mTOR inhibitors when feasible. Visceral or advanced disease usually requires systemic chemotherapy, commonly with liposomal doxorubicin.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.