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        <title>Frontiers in Transplantation | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/transplantation</link>
        <description>RSS Feed for Frontiers in Transplantation | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-05-13T10:44:58.672+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1862909</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1862909</link>
        <title><![CDATA[A tribute to mentor and role model: Dr. Nicholas Lechmere Tilney]]></title>
        <pubdate>2026-05-13T00:00:00Z</pubdate>
        <category>Opinion</category>
        <author>Jerzy W. Kupiec-Weglinski</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1827646</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1827646</link>
        <title><![CDATA[Xenotransplantation: lessons from history, genetic engineering, and early clinical experience—an interview with Dr. David K. C. Cooper]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Perspective</category>
        <author>Reza Abdi</author>
        <description><![CDATA[Xenotransplantation has evolved from speculative experimentation into a scientifically grounded and increasingly applied clinical discipline, propelled by advances in immunology, molecular genetics, and genome engineering. In this interview, Dr. David Cooper, a pioneer in the field, reflects on the historical origins of xenotransplantation and traces key mechanistic breakthroughs, including the identification of carbohydrate xenoantigens, complement incompatibility, and innate immune barriers. Major milestones involving the organ-source pig include the development of αGal-knockout pigs, the expression of human complement-regulatory proteins, and the emergence of highly multi-gene–edited pigs enabled by CRISPR-based technology. Attention is given to kidney-specific challenges, including metabolic and physiologic incompatibilities, coagulation dysregulation, and the continued need for significant immunosuppressive therapy based on blockade of the CD40/CD154 co-stimulation pathway. Differing donor-engineering strategies adopted by various companies, unresolved barriers, such as swine leukocyte antigen (SLA) incompatibility, and lessons from early clinical experience are explored. Together, these insights highlight both the remarkable progress and the substantial challenges that remain before xenotransplantation can become a durable and scalable clinical solution.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1773797</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1773797</link>
        <title><![CDATA[Case Report: Lung transplant recipient with bullous pemphigoid and antibody-mediated rejection: an overlapping immunologic phenomenon?]]></title>
        <pubdate>2026-04-15T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Sandrine Hanna</author><author>Daniel Gutteridge</author><author>Christiane Machado</author><author>Mrunal G. Patel</author><author>David W. Roe</author><author>Nichole A. Smith</author><author>Biplab Saha</author>
        <description><![CDATA[We present what is, to our knowledge, the first reported case of concurrent bullous pemphigoid (BP) and antibody-mediated rejection (AMR) in a lung transplant patient. Similar associations have been described in other solid organ transplant settings, most notably in renal transplantation, where explantation of the allograft has frequently been followed by resolution of the skin disease. These observations suggest a broader potential connection between autoimmune blistering disorders and allograft rejection mechanisms, especially as emerging evidence highlights the role of non–HLA antibodies. A comprehensive review of previously reported cases of BP in solid organ transplant recipients is therefore warranted to place this case in context and to assess its significance within the existing literature.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1811694</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1811694</link>
        <title><![CDATA[Case Report: A rare case of primary graft failure after autologous stem cell transplant for mantle cell lymphoma rescued with darbepoetin, eltrombopag, and cyclosporine]]></title>
        <pubdate>2026-04-15T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Seav Huong Ly</author><author>Jordan Chung Cheng Hwang</author><author>Yeow Kheong Woon</author><author>Chandramouli Nargarajan</author><author>Jeffrey Kim Siang Quek</author><author>Yeh Ching Linn</author><author>Tertius T. Tuy</author>
        <description><![CDATA[We present a case of successful rescue of primary graft failure following autologous hematopoietic stem cell transplantation (autoHSCT) in mantle cell lymphoma using a combination of darbepoetin, eltrombopag, and cyclosporine. Primary graft failure is a rare but serious complication of HSCT that may lead to life-threatening infections, bleeding, and increased overall morbidity and mortality. The underlying mechanisms of graft failure in autoHSCT are not well elucidated, and management options are often limited to autologous stem cell boost or allogeneic stem cell transplantation. Our case highlights the use of a combination of darbepoetin, eltrombopag, and cyclosporine as a potential novel multipronged strategy for rescuing primary graft failure following autoHSCT.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1772174</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1772174</link>
        <title><![CDATA[Building pragmatic transplant immunobiology in Sri Lanka: a concise review with an LMIC lens]]></title>
        <pubdate>2026-04-13T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Anura Priyantha Hewageegana</author>
        <description><![CDATA[Sri Lanka's kidney transplantation programme has matured within a resource-constrained public health system and has achieved short-term outcomes that appear comparable to published ranges from similar middle-income programmes, despite major limitations in real-time transplant immunobiology support. However, increasing recipient sensitisation, prolonged dialysis vintage, and a growing deceased-donor programme demand more reliable immunological risk assessment to improve equity and graft outcomes. This pragmatic narrative review summarises the minimum immunobiology package that can support safer kidney transplantation in low- and middle-income settings, using Sri Lanka as an example. Key concepts are explained in simple operational terms, including sensitisation and antibody screening (PRA, including the Zora assay), single-antigen bead testing and donor-specific antibody interpretation, practical use and limitations of virtual crossmatch when donor HLA data are incomplete, and the continuing role of CDC crossmatch where flow-cytometry crossmatch is unavailable. The review also highlights why unexpected early rejection may still occur even when HLA-based testing appears reassuring, and why over-reliance on any single assay can be misleading. Finally, a staged roadmap is proposed—prioritising feasible upgrades, quality assurance, workforce development, and national coordination—to progressively strengthen transplant immunobiology while preserving affordability, fairness, and sustainability. This is a pragmatic narrative review informed by consensus guidance and key peer-reviewed literature, synthesised to prioritise actionable, scalable immunobiology components for low- and middle-income settings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1779662</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1779662</link>
        <title><![CDATA[Best practices along the kidney transplantation clinical journey]]></title>
        <pubdate>2026-04-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Sara Machado</author><author>Stergios Bobotis</author><author>Alexander Loupy</author><author>Gillian Divard</author><author>Valentin Goutaudier</author><author>Andreas Pascher</author><author>Philipp Houben</author><author>Jacopo Romagnoli</author><author>Filippo Paoletti</author><author>Daniel Casanova</author><author>Sofia Zarraga</author><author>Mehmet Ergisi</author><author>Bryan Ooi</author><author>Zoe-Athena Papalois</author><author>Elias Mossialos</author><author>Vassilios Papalois</author>
        <description><![CDATA[BackgroundKidney transplantation (KTx) practices vary across healthcare systems, yet the operational components of best practice (BP) along the clinical pathway remain incompletely defined. This study aimed to identify key best practice elements across the kidney transplantation journey in four European countries.MethodsA mixed-methods study was conducted across France, Germany, Italy, and Spain. A structured survey (n = 253 respondents, including patients, living donors, nephrologists, transplant surgeons, transplant coordinators, and hospital administrators) assessed clinical practice and patient experience across four domains: CKD management, kidney donation and transplantation, transplant recipient care, and service governance. Semi-structured focus group interviews were performed in each country to contextualise survey findings. Ethics approval was obtained in accordance with national requirements.ResultsKey elements for best practices along the KTx clinical journey were identified: (1) development of protocols to standardise the variable monitoring of CKD, to minimize urban-rural differences in clinical practice due to limited resources and follow-up care; (2) enhanced primary care training and targeted resource allocation to diagnose and monitor early-stage CKD; (3) donor coordination and promotion of living donation, addressing gaps in patient awareness and access to care; (4) development of communication protocols on living donation; (5) implementation of targeted patient and donor educational campaigns on living donation; (6) enhanced post-transplant follow-up care by nephrologists; (7) integration of quality-of-life assessments and psychological donor support post-transplantation; (8) increased availability of transplant coordinators to promote equitable resource allocation and the adoption of innovative practices; (9) streamlined governance structures along clinical journey; and (10) equitable funding models with consistent reimbursement policies across patient groups.ConclusionsThis study provides a cross-national, mixed-methods framework for strengthening equity, coordination, and quality in kidney transplantation. Addressing variability in monitoring pathways, referral structures, patient-centred outcomes, and workforce capacity may enhance implementation of international transplantation guidelines and improve patient and donor outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1758576</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1758576</link>
        <title><![CDATA[Cell cycle pathway alterations predict outcomes post-liver transplantation for hepatocellular carcinoma]]></title>
        <pubdate>2026-04-10T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ashton A. Connor</author><author>Mahinur Mattohti</author><author>Sudha Kodali</author><author>Maen Abdelrahim</author><author>Ahmed Elaileh</author><author>Samar Semaan</author><author>Youssef Dib</author><author>Khush Patel</author><author>Jason Todd</author><author>Urmi Sengupta</author><author>Constance M. Mobley</author><author>Caroline J. Simon</author><author>Yee Lee Cheah</author><author>Ashish Saharia</author><author>Mary R. Schwartz</author><author>Sadhna Dhingra</author><author>Jessica S. Thomas</author><author>Randall J. Olsen</author><author>Linda W. Moore</author><author>Kirk Heyne</author><author>Xian C. Li</author><author>David W. Victor</author><author>Timothy E. Newhook</author><author>Ahmed O. Kaseb</author><author>Jean-Nicolas Vauthey</author><author>A. Osama Gaber</author><author>R. Mark Ghobrial</author>
        <description><![CDATA[BackgroundHepatocellular carcinoma (HCC) incidence and mortality are rising. Liver transplantation (LT) offers the best outcomes, but current tumor size- and number-based selection criteria restrict access. Molecular profiling may better reflect tumor biology and guide precision-based selection strategies.MethodsThis prospective single-center study included patients with HCC who had undergone LT between 11 November 2016 and 4 April 2023 with sufficient tumor cellularity in explanted livers. Tumor DNA was subjected to targeted sequencing for 38 genes, with the results returned to clinicians. Altered genes were grouped into HCC-relevant signaling pathways. Outcomes included post-LT overall survival (OS), recurrence-free survival (RFS), and recurrence sites. The Cancer Genome Atlas (TCGA) HCC cohort was used for validation.ResultsAmong 1,103 LT recipients, 261 were for HCC and 91 underwent sequencing. Most patients were male (n = 68), white (n = 56), and hepatitis C positive (n = 34). The median tumor size was 3 cm (IQR 1.8–4.5), the number was 1 (IQR 1–3), and the follow-up time was 1,982 days. Of the 36 unique mutations found across 11 genes, six were potentially actionable. Cell cycle pathway alterations (n = 14) were prognostic for worse OS (3-year 90.9% without vs. 62.5% with alterations) and RFS in uni- and multivariable models. Recurrences were more common in the liver and lungs with cell cycle alterations (p < 0.05).ConclusionPost-LT molecular profiling of HCC reveals tumor-specific alterations associated with outcomes, supporting the incorporation of tumor biology into future LT selection criteria.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1750905</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1750905</link>
        <title><![CDATA[Uterus transplantation in the United States: analysis of patients and early postoperative outcomes in the national organ procurement and transplantation network]]></title>
        <pubdate>2026-04-10T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Thomas Schaschinger</author><author>Leonard Knoedler</author><author>Tobias Niederegger</author><author>Gabriel Hundeshagen</author><author>Olivier Mathieu</author><author>Lucile Cabanel</author><author>Michel G. Cazenave</author><author>Samuel Knoedler</author><author>Curtis L. Cetrulo</author><author>Alexandre G. Lellouch</author>
        <description><![CDATA[PurposeUterus Vascularized Composite Allotransplantation (UTx) offers a solution for individuals with uterine factor infertility to enable pregnancy. This exploratory retrospective study evaluates adverse postoperative outcomes in UTx recipients in the U.S. using data from the Organ Procurement and Transplantation Network (OPTN) to identify potential risk factors.MethodsData from the OPTN database were analyzed for 55 patients who underwent UTx in the U.S. Due to missing outcome data, 15 cases were excluded, resulting in a final cohort of 40 patients (73%) eligible for outcome analysis. Variables such as the number of acute rejection (AR) episodes, hospitalizations, and complications were assessed to determine associations with patient related risk factors.ResultsAmong the 40 recipients with a mean age of 31 ± 4.7 years, 24 (60%) received grafts from living donors and 16 (40%) from deceased donors. The 12 AR episodes [median 0.0 (IQR 0.0–0.25)] were significantly associated with increased BMI (p = 0.038). The 20 post-transplant hospitalizations [median 0.0 (IQR: 0.0–1.0)] were less frequent in patients who received grafts from living donors (p = 0.016). 9 patients (23%) experienced at least one postoperative complication, with a trend toward higher incidence in patients with increased BMI (p = 0.066) and significantly higher rates linked to prolonged warm ischemia time (p = 0.031).ConclusionsThis study provides insights into adverse postoperative outcomes in UTx recipients, highlighting the impact of higher BMI, donor status, and warm ischemia time on AR, hospitalizations, and complications.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1731241</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1731241</link>
        <title><![CDATA[Evaluating the impact of neighborhood socioenvironmental burden on patient characteristics and survival in liver transplant recipients]]></title>
        <pubdate>2026-04-09T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Samar Semaan</author><author>Ashton A. Connor</author><author>Sudha Kodali</author><author>Anil K. Vadathya</author><author>Ahmed Elaileh</author><author>Youssef Dib</author><author>Khush Patel</author><author>Jason Todd</author><author>Jennifer Cullen</author><author>Caroline J. Simon</author><author>Yee Lee Cheah</author><author>Constance M. Mobley</author><author>Ashish Saharia</author><author>Tamneet Basra</author><author>David W. Victor</author><author>Linda W. Moore</author><author>A. Osama Gaber</author><author>R. Mark Ghobrial</author>
        <description><![CDATA[BackgroundThe Environmental Justice Index (EJI) measures neighborhood level environmental, social, and health disparities. The Social-Environmental Ranking (SER) components of the EJI is used when linking to health outcomes. Higher SER scores (≥0.75) indicate greater environmental injustice and potential health inequities. This study assesses whether EJI's through SER can inform the care of liver transplantation (LT) patients in Houston, Texas.MethodsThis single-center, retrospective analysis was conducted on LT recipients between January 2008 and December 2024. Patient addresses were linked to census tract-level EJI data and stratified at a 0.75 score threshold. Propensity score matching (PSM) was performed. Overall survival (OS) was assessed pre and post matching.ResultsA total of 2,030 LT recipients were stratified by SER score (<0.75 vs. ≥0.75). Pre-matching, high SER patients were more often female (44.4% vs. 38.9%, p = 0.02), non-Hispanic Black (14.9% vs. 6.7%) or Hispanic (36.2% vs. 16.1%, p < 0.001), had public insurance (44.0% vs. 33.8%, p < 0.001), were unemployed at transplant (27.4% vs. 31.9%, p = 0.046), and had lower education levels (p < 0.001). They also had higher BMI (28.90 vs. 28.05, p = 0.024), longer waitlist times (103 vs. 71 days, p = 0.036), more diabetes (35.4% vs. 28.4%, p = 0.002), CMV positivity (79.3% vs. 71.0%, p < 0.001), and multi-organ transplants (18.6% vs. 14.4%, p = 0.015). Pre-LT, more were hospitalized on the floor (21.8% vs. 14.0%) and fewer in ICU (40.3% vs. 44.4%, p < 0.001). PSM yielded 619 matched pairs with covariate balance (SMD < 0.1). OS and graft survival did not differ by SER strata before or after matching (p > 0.05).ConclusionThese findings suggest that EJI is associated with pre-transplant variables and may help identify patients in need of social supports. However, individual patient factors seem to determine post-LT survival.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1788046</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1788046</link>
        <title><![CDATA[Exploratory biomarkers for acute rejection in vascularized composite allotransplantation]]></title>
        <pubdate>2026-04-01T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Dominika Pullmann</author><author>William J. Rifkin</author><author>Haruyuki Hirayama</author><author>Bruce E. Gelb</author><author>Ata S. Moshiri</author><author>Massimo Mangiola</author><author>Eduardo D. Rodriguez</author><author>Catherine P. Lu</author><author>Piul S. Rabbani</author>
        <description><![CDATA[Vascularized composite allotransplantation (VCA) involves immunologically heterogeneous tissues with a high incidence of acute rejection. Reliable and timely detection of rejection onset remains a major unmet challenge in VCA management. This longitudinal exploratory case study assessed blood- and tissue-derived biomarkers for acute rejection monitoring in a full-face and bilateral hand transplant recipient over 4.6 years. Of these biomarkers, donor-derived cell-free DNA (dd-cfDNA) and short tandem repeats (STR) showed trends toward elevated recipient levels during acute rejection, though differences were not statistically significant. CD8+ T-cell percentages increased before acute rejection onset, highlighting a temporal association. Anti-angiotensin II type 1 receptor antibody (AT1R-Ab) levels did not differ significantly between acute rejection and non-rejection episodes, possibly due to prophylactic immune cell depletion. While dd-cfDNA and STR levels correlate with rejection episodes and reflect key graft cellular events, CD8+ T-cell dynamics demonstrated the strongest temporal association with rejection episodes in this patient, though no biomarker showed statistically significant differences. These exploratory findings support the need for further longitudinal, multi-patient studies to validate emerging biomarkers and refine rejection monitoring strategies in VCA.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1783796</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1783796</link>
        <title><![CDATA[Challenges and perspectives in xenoliver research: lessons from decedent and primate models]]></title>
        <pubdate>2026-03-13T00:00:00Z</pubdate>
        <category>Mini Review</category>
        <author>Zoe Hahn</author><author>Kasra Shirini</author><author>Joseph M. Ladowski</author><author>Raphael P.H. Meier</author>
        <description><![CDATA[Liver xenotransplantation is a potential strategy to address the shortage of donor livers, either as a temporary bridge to allotransplantation, bridge to native liver recovery, or destination therapy. Advances in genetic engineering and immunosuppression have enabled liver xenografts to evade hyperacute rejection, yet durable graft survival remains elusive. Profound thrombocytopenia, consumptive coagulopathy, and xenotransplantation-associated thrombotic microangiopathy limit long-term graft survival. Evidence from nonhuman primates, decedents, and recent clinical models suggests that hematologic and physiologic species incompatibilities (in addition to classical immune-mediated rejection) constitute additional barriers to successful liver xenotransplantation. These problems are driven by species-specific platelet–endothelial interactions, dysregulated coagulation factor synthesis, and platelet sequestration within the xenograft. This review synthesizes lessons from decedent and primate xenoliver models, highlighting progress in this area to date, barriers to prolonged survival after liver xenotransplant, and directions for further research.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1686667</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1686667</link>
        <title><![CDATA[Case Series: Endoscopic ultrasound-directed transgastric ERCP in liver transplant recipients with Roux-en-Y gastric bypass]]></title>
        <pubdate>2026-03-12T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Peyton Crest</author><author>Julius S. Navarro</author><author>Fawzy Barry</author><author>Chloe Sasakado</author><author>John P. Roberts</author>
        <description><![CDATA[IntroductionAmong liver transplant recipients, Roux-en-Y gastric bypass (RYGB) may lead to postoperative malnutrition and nutrient deficiencies. Procedures such as the endoscopic ultrasound-directed transgastric ERCP (EDGE) can result in advantageous weight gain for liver transplant recipients with prior RYGB who do not respond to enteral or parenteral nutritional interventions.MethodsWe present three patients who underwent EDGE for post-transplant malnutrition and weight loss.ResultsEDGE resulted in weight gain across all patients. Liver transplant recipients with a history of RYGB may be at significant nutritional risk following transplant due to fat malabsorption, underestimation of resting energy expenditure, and appetite suppression mediated by neurohormonal signals.ConclusionWhen traditional nutritional interventions are unsuccessful, the EDGE procedure may be an effective alternative to promote post-transplant weight gain in this unique population.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1701648</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1701648</link>
        <title><![CDATA[Variability in clinical triggers for organ donation referrals]]></title>
        <pubdate>2026-03-09T00:00:00Z</pubdate>
        <category>Policy and Practice Reviews</category>
        <author>Kylie Casey</author><author>Elizabeth Thomas</author>
        <description><![CDATA[In organ transplantation, regulatory efforts have mainly targeted Organ Procurement Organizations (OPOs) and transplant centers, while donor hospitals—crucial to the donation process—have remained under-examined. As the first point of contact for potential donors, these hospitals lack standardized criteria for when and how to refer patients to OPOs, creating variability that can delay referral and reduce organ availability. This viewpoint focuses on clinical triggers: the physiological criteria that prompt hospitals to notify OPOs of potential donors. While CMS requires donor hospitals to maintain written agreements with their designated OPOs and to inform the OPO of deaths and “imminent deaths,” there is no national standard defining which bedside clinical criteria should prompt timely notifications; most hospitals defer to their local OPO for guidance. We analyzed clinical triggers from 55 of 56 U.S. OPOs and found marked inconsistency. Glasgow Coma Scale thresholds were used by 69.1%, and brainstem reflexes by 54.6%, with wide variation in both. Fewer than half addressed family discussions, and notification windows ranged from immediate to 240 min. These discrepancies reflect a critical bottleneck in the donor identification process. Standardizing clinical triggers and instituting a referral-based performance metric framework may improve metrics, thereby enhancing early donor identification, reducing missed referral opportunities, enhancing organ recovery, and reducing waitlist mortality. As scrutiny of OPOs and transplant centers increases, improving donor hospital practices is essential to optimizing the transplant system.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1760147</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1760147</link>
        <title><![CDATA[Systematic review of emerging technologies in vascularized composite allotransplantation]]></title>
        <pubdate>2026-03-09T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Anjali Chakradhar</author><author>Melody Yu</author><author>Simon G. Talbot</author>
        <description><![CDATA[Vascularized composite allotransplantation (VCA) enables functional reconstruction for patients with extensive tissue defects, but has obstacles such as immune rejection, lifelong immunosuppression, and systems-level barriers that limit widespread adoption. VCA has rapidly evolved through novel surgical, immunologic, and bioengineering technologies. This systematic review synthesizes the current landscape of emerging VCA technologies, identifies literature gaps, and emphasizes opportunities for future research. We conducted a systematic literature review of PubMed and Embase with supplemental manual reference review. English-language experimental studies reporting novel VCA technologies and innovations published after 2004 were included. Case reports, reviews, studies without technological innovation, and non-English publications were excluded. Seventy-two studies fit the inclusion criteria. Novel immunomodulation strategies including belatacept, phototherapy, siRNA therapeutics, and tolerance induction via regulatory T-cells show potential to reduce systemic immunosuppression, while mesenchymal stem cell approaches may increase graft tolerance. On another front, advanced surgical techniques with real-time monitoring and nerve regeneration protocols are looking to promote functional recovery. Digital innovations like 3D modeling and virtual surgical planning allow for patient-specific preoperative planning and intra-operative assistance. In parallel, machine perfusion and cryopreservation extend tolerable ischemia times and may also enable early rejection detection. Similarly, biomarkers and imaging provide early and noninvasive rejection prediction. On a bigger scale, patient selection incorporating evidence-backed psychosocial factors and communication training work to address systems-level barriers to expand access. Ongoing research to translate these innovations into clinical practice will be important in realizing the potential of VCA.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1723729</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1723729</link>
        <title><![CDATA[Liver transplantation in patients with history of extra-hepatic malignancies]]></title>
        <pubdate>2026-03-05T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jerry Xiao</author><author>Ashton A. Connor</author><author>Ahmed Elaileh</author><author>Khush Patel</author><author>Samar Semaan</author><author>Youssef Dib</author><author>Jason Todd</author><author>Linda W. Moore</author><author>Sudha Kodali</author><author>David W. Victor III</author><author>Maen Abdelrahim</author><author>Anaum Maqsood</author><author>Caroline J. Simon</author><author>Yee Lee Cheah</author><author>Constance M. Mobley</author><author>Ashish Saharia</author><author>A. Osama Gaber</author><author>R. Mark Ghobrial</author><author>Kirk Heyne</author>
        <description><![CDATA[IntroductionIncreasing use of solid organ transplantation [SOT] has coincided with increasing cancer survivorship. Consensus statements exist for SOT in patients with pre-transplant malignancy [PTM]. Yet, most outcomes have been reported in heart and kidney transplant. This paper addresses the shortage of information on liver transplant [LT] in patients with PTM.MethodsA retrospective case-control study was conducted of patients who underwent LT between 1/1/2008–5/31/2024 at an American transplant center. Patients were stratified according to history of extrahepatic PTM, time from PTM to LT, and post-LT PTM recurrence. Primary outcomes were overall survival [OS] and time to recurrence.Results1,876 patients underwent LT. 143(7.62%) had an extrahepatic PTM pre-LT. PTM patients were older and had lower MELD at LT. There was no significant difference in post-LT survival (p = 0.293) between patients who did and did not have PTM. Of 121 patients with known time from PTM to LT, 19(15.7%) had an interval less than 2 years. When stratifying by 2-year interval from PTM to LT, there was no difference in survival (p = 0.34). Post-LT, 20 patients (14.0%) had recurrence of their PTM. The average time to recurrence was 595.5 days. When treated as a time-dependent co-variate, recurrence was a strong predictor of worse post-LT survival (HR 10.9, 95% CI 4.32–27.7, p < 0.001).ConclusionIn our experience, a history of pre-LT PTM, including with an interval to LT of less than 2 years, was not associated with worse post-LT survival. Recurrence of PTM did portend worse prognosis.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1737467</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1737467</link>
        <title><![CDATA[Double whammy: increased severe primary graft dysfunction after prolonged warm ischemia and inadequate oxygen delivery during heart transplant]]></title>
        <pubdate>2026-02-24T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chen Chia Wang</author><author>Awab Ahmad</author><author>Mark Petrovic</author><author>Walter Navid</author><author>Christian Eidson</author><author>John Trahanas</author><author>Aaron M. Williams</author><author>Swaroop Bommareddi</author><author>Duc Q. Nguyen</author><author>Tarek Absi</author><author>Eric Quintana</author><author>Stephen DeVries</author><author>Joey A. Lepore</author><author>Matt Warhoover</author><author>Aniket S. Rali</author><author>Kelly H. Schlendorf</author><author>Matthew Bacchetta</author><author>Ashish S. Shah</author><author>Brian Lima</author>
        <description><![CDATA[ObjectiveThis exploratory study examined the relationship between oxygen delivery index (DO2i) during DCD heart transplant (HT), warm ischemic time, and posttransplant outcomes.MethodsAll DCD HT between 10/2021 and 12/2024 using normothermic regional perfusion (NRP) at our institution were included. Multiorgan transplants and congenital heart disease patients were excluded. Critical areas—sum of magnitude and duration of DO2i under specific thresholds—were calculated for thresholds 300, 280, and 260 mL/min/m2. Receiver operating characteristics (ROC) analysis dichotomized the critical area into high area (low DO2i) and low area (high DO2i) groups. Patients were then stratified into 4 groups based on high/low functional warm ischemic time (FWIT), and high/low DO2i. Outcomes were compared across groups.ResultsThe critical area under 260 mL/min/m2 was the best predictor of severe primary graft dysfunction (PGD). 102 patients met inclusion criteria, and were stratified into four groups based on FWIT above/below 23 min and critical area below/above 1,424 mL/m2 (identified by ROC analysis). 39 (38.2%) patients had low FWIT/ high DO2i, 18 (17.6%) had low FWIT/ low DO2i, 24 (23.5%) had high FWIT/high DO2i, and 21 (20.6%) had high FWIT/low DO2i. Rates of severe PGD were greater in the high FWIT/low DO2i group compared to the low FWIT/high DO2i group (23.8% vs. 0%, p = 0.004). Rates of 30-day mortality were higher in the high FWIT/low DO2i group compared to the low FWIT/high DO2i group (14.3% vs. 0%, p = 0.039).ConclusionsHigher oxygen delivery during HT was associated with improved short-term outcomes, and may counteract the myocardial damage from warm ischemia during DCD.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1739776</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1739776</link>
        <title><![CDATA[Standardized evaluation protocols for deceased and living liver donors: a practical framework for emerging liver transplant programs]]></title>
        <pubdate>2026-02-20T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Pablo Coste Murillo</author><author>Rodrigo Álvarez Buitrago</author><author>Vanessa López Jara</author><author>María Fernanda Lynch-Mejía</author><author>Francisco Vargas Navarro</author><author>Wagner Ramírez Quesada</author><author>Christie Perelló</author><author>José Luis Calleja</author>
        <description><![CDATA[BackgroundLiver transplantation (LT) remains the definitive therapy for end-stage liver disease. However, significant variability in infrastructure, policy, and clinical practice continues to influence the implementation of deceased donor (DDLT) and living donor liver transplantation (LDLT) worldwide, particularly across emerging and expanding programs.MethodsThis narrative review synthesizes contemporary guidelines, expert consensus documents, and high-impact clinical studies on donor evaluation. It presents a standardized and pragmatic framework for both DDLT and LDLT, integrating medical, radiologic, ethical, and psychosocial domains. Protocols are designed to be evidence-based, reproducible, and aligned with international standards.Key content and findingsIn DDLT, optimal donor management, accurate neurological determination of death, and comprehensive infectious disease screening are essential for graft viability. In LDLT, meticulous psychosocial and anatomical assessments remain critical to donor safety. Advances such as machine perfusion, desensitization protocols, and expanded donor criteria have improved outcomes and broadened transplant opportunities. The proposed framework consolidates global best practices to support program consistency and quality assurance.ConclusionsThis review provides a comprehensive and practical approach to donor evaluation in LT, promoting harmonization of practices across diverse healthcare systems. Its adoption may enhance donor safety, optimize graft utilization, and support the sustainable growth of both DDLT and LDLT programs worldwide.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1740314</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1740314</link>
        <title><![CDATA[Mechanisms inducing differentiation of adult islet progenitor-like cells into functional islet-like organoids]]></title>
        <pubdate>2026-02-20T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Carly M. Darden</author><author>Jayachandra Kuncha</author><author>Jeffrey T. Kirkland</author><author>Jordan Mattke</author><author>Srividya Vasu</author><author>Prathab Balaji Saravanan</author><author>Bashoo Naziruddin</author><author>Michael C. Lawrence</author>
        <description><![CDATA[IntroductionAdult pancreatic tissue contains cell populations with latent regenerative potential, but the processes governing their expansion and differentiation into endocrine lineages remain unclear.MethodsAdult human pancreatic cells obtained from donor tissue were isolated and expanded and analyzed for lineage potential using single-cell RNA sequencing, flow cytometry, and functional assays. A CD9+ PROCR+ RGS16+ subpopulation, termed islet progenitor-like cells (IPCs), was evaluated for proliferative capacity and differentiation potential.ResultsIPCs exhibited robust proliferative capacity and, upon differentiation, formed insulin- and glucagon-secreting organoids. Treatment of IPCs with the small molecule ISX9 induced expression of key transcription factors RFX6 and NEUROD1 through calcium-dependent chromatin remodeling mediated by NFAT recruitment of p300 and displacement of histone deacetylases (HDAC1-3). Pharmacologic inhibition of HDACs further enhanced IPC maturation and glucose-stimulated insulin secretion.DiscussionThese findings define the molecular and epigenetic mechanisms driving the expansion and differentiation of adult IPCs into functional islet-like organoids, providing a foundation for future regenerative approaches using adult pancreatic tissue as a renewable source for endocrine cell replacement.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1703048</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1703048</link>
        <title><![CDATA[Microbiota management: a perspective for kidney transplant patients]]></title>
        <pubdate>2026-02-19T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Cláudia Silva Souza</author><author>Niels Olsen Saraiva Camara</author><author>Thaís Alves-Silva</author>
        <description><![CDATA[Chronic kidney disease (CKD) is recognized as one of the most significant public health issues globally, with approximately 40% of patients progressing to end-stage kidney disease (ESKD). Transplantation remains the most indicated option for many patients with ESKD; however, these individuals frequently experience hospital readmissions and face a heightened risk of developing other complications. Although short-term allograft survival, typically around one year, tends to be satisfactory, long-term graft survival is often compromised due to acute and chronic rejection, which can be mediated by antibodies or other recipient-related factors. Recent studies and review articles have emphasized the relationship between intestinal dysbiosis and chronic renal failure, as well as the poor outcomes associated with kidney transplantation. The CKD itself, as well as the immunosuppressive medications used by organ transplant recipients, can lead to intestinal dysbiosis, which in turn increases the production of uremic toxins that can harm even the transplanted kidney. Clinical studies have demonstrated that the combination of prebiotics, probiotics, and synbiotics—supplements that aid in the establishment of intestinal microbiota—can effectively help control the production of nitrogenous substances, reduce renal inflammation, and alleviate gastrointestinal symptoms in patients with CKD. Experimental models have shown that short-chain fatty acids derived from gut fermentation of dietary fiber, such as butyrate and acetate, could improve renal function and reduce renal inflammation, allowing better acceptance of kidney allograft, partly by inducing T regulatory cells. Despite the growing evidence supporting the positive effects of maintaining a balanced microbiota, there is still a lack of comprehensive reviews in this field. Additionally, recent findings suggest that the type of fiber consumed may influence intestinal health and even increase susceptibility to colorectal cancer, depending on the fiber type. Therefore, we aim to explore how substances derived from gut fermentation of dietary fiber, in addition to probiotics, prebiotics, and synbiotics, contribute to allograft tolerance, with a particular focus on their potential application in establishing renal function in allograft recipients.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/frtra.2026.1745991</guid>
        <link>https://www.frontiersin.org/articles/10.3389/frtra.2026.1745991</link>
        <title><![CDATA[100 most-cited publications in vascularized composite allotransplantation]]></title>
        <pubdate>2026-02-18T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Pharel Njessi</author><author>Carter J. Boyd</author><author>Palmina Petruzzo</author><author>Olivier Camuzard</author><author>Antoine Sicard</author><author>Rami Kantar</author><author>Eduardo D. Rodriguez</author><author>Elise Lupon</author>
        <description><![CDATA[BackgroundCitation analysis is a useful bibliometric tool to identify impactful publications and trace the evolution of a specialty or a technique. In the past three decades, the research on vascularized composite allotransplantation (VCA) has grown exponentially but very few studies have examined the most influential papers in this field.MethodsThe Web of Science Core Collection database was searched for articles published from inception to August 4th, 2025. Titles, full authors' names, years of publication, source journals, regions of origin, and numbers of citations were recorded. VCA anatomical location, main topics, and citation density were determined. Articles were ranked based on number of citations and citation density; they were then categorized based on methodology, study design, and main topic.ResultsThe 100 most-cited articles on VCA were published between 1996 and 2018 with the number of citations per article ranging from 61 to 604 citations. There were 53 non-clinical studies, the most prevalent topics were outcomes and rehabilitation (n = 48 articles) and immunology (n = 37). Of the 75 studies evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence, most (n = 51) were classified as level 4.DiscussionThis list of the top 100 most-cited articles highlights seminal and influential papers in VCA. It also demonstrates the relative novelty of this field with ongoing efforts in immunological research to allow its further expansion. The present study provides an understanding of VCA evolution while directing future clinical and preclinical studies.]]></description>
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