【Objective】 Preformed donor-specific anti-HLA antibodies (pDSA) in kidney transplantation (KT) are highly associated with poor graft survival. Conventional immunosuppression induction includes calcineurin inhibitors (CNI), antimetabolites (AM), corticosteroids (CS), and monoclonal antibodies. Additionally, the mTOR inhibitor everolimus (EVR) is expected to provide beneficial effects. We investigated the long-term effects of EVR on KT outcomes in pDSA-positive recipients.

【Materials and Methods】 Forty-two flowcytometry crossmatch-negative, pDSA-positive KT recipients at our hospital from 2005 to 2020 were enrolled. Patients were retrospectively divided into two groups: EVR group (n＝22, 2012-2020) : received EVR in combination with CNI, AM, and CS. MP group (historical control, n＝20, 2008-2012) : received CNI/AM and preoperative/maintenance CS. Both groups received basiliximab and rituximab as induction therapy. Recipients were additionally given plasmapheresis or intravenous immunoglobulin administration before KT. Outcomes analyzed retrospectively included patient survival, graft survival, incidence of antibody-mediated rejection (AMR), and rate of negative conversion of pDSA.

【Results】 Background characteristics were comparable between the groups, except for a significantly shorter follow-up period and a higher median dose of rituximab in the EVR group (9.2 vs. 14.7 years, p＝0.04 and 200 mg vs. 100 mg, p<0.001, respectively). Patient and graft survival at 10 years post-transplant was similar between the two groups. Notably, median time to negative conversion of pDSA tended to be shorter in the EVR group (3.3 years EVR vs. 5.9 MP years, p＝0.08). The higher rituximab dose in the EVR group may have contributed to this outcome. Incidence of AMR was similar in both groups, indicating a possible earlier suppression of pDSA in the EVR group without an increase in the incidence of rejection.

【Conclusion】 Everolimus combined with basiliximab induction tends to promote earlier suppression of pDSA in pDSA-positive kidney transplant recipients.

【Objective】 Living-donor liver transplantation (LDLT) recipients frequently present with preoperative conditions such as malnutrition, edema, muscle atrophy, and hepatic encephalopathy. These factors, combined with a high incidence of postoperative complications, often hinder the recovery of physical endurance. This study aimed to identify perioperative factors associated with exercise tolerance at hospital discharge in LDLT recipients.

【Design】 observational study.

【Methods】 We analyzed adult LDLT cases from January 2021 to December 2023. Patients with severe complications or missing 6MWD data were excluded. Preoperative, intraoperative, and postoperative factors were collected, including demographics, lab values, muscle metrics, and mobility indicators. Exercise tolerance was assessed via 6-minute walk distance (6MWD) before surgery and at discharge. Statistical analysis used univariate and multivariate regression to identify factors associated with discharge 6MWD (significance: p<0.05).

【Result】 Discharge 6MWD was significantly associated with age, sex, BMI, preoperative MELD score, preoperative grip strength, preoperative 6MWD, ICU length of stay, and days to independent walking after surgery (all p<0.05). Multiple regression analysis identified preoperative 6MWD (β＝0.52, p＝.0001) and age (β＝−0.23, p＝.021) as independent predictors of exercise tolerance at discharge (R²＝0.56).

【Conclusion】 Preoperative 6MWD was the strongest predictor of exercise tolerance at hospital discharge. These findings suggest that early rehabilitation interventions before LDLT may play a critical role in enhancing postoperative physical recovery.

【Introduction】 Despite advancements in immunosuppressive therapies, long-term graft loss remains a significant concern following kidney transplantation. Protocol biopsies (PBs) are widely employed in clinically stable recipients to detect subclinical rejection, infections, calcineurin inhibitor (CNI) toxicity, and recurrent glomerulonephritis. However, PBs carry procedural risks, necessitating a careful evaluation of their clinical utility.

【Design and Methods】 This retrospective study analyzed 96 PBs from 32 kidney transplant recipients at a single center between January 2019 and February 2024. PBs were performed at 6 months, 1 year, and 2 years post-transplant in clinically stable patients. Episode biopsies were excluded. Histopathological findings and subsequent clinical interventions were assessed. Outcomes were compared between pre-transplant donor-specific antibody (DSA)-positive (n＝5) and DSA-negative (n＝27) patients.

【Results】 Histopathological abnormalities were identified in 36.5% of PBs, including 4.2% with rejection (2 chronic active antibody-mediated rejection and 2 chronic active T-cell-mediated rejection), all occurring in the DSA-positive group (p<0.01). CNI toxicity was observed in 21.9% of biopsies, with no significant difference by DSA status. Clinical interventions were initiated in 16.7% of cases, most commonly at 6 months (31.2%), and declined significantly by 2 years (0%; p<0.01). No rejections or interventions were noted in DSA-negative patients at 2 years.

【Conclusion】 PBs are valuable for identifying subclinical rejection, particularly in DSA-positive recipients. However, their utility in DSA-negative patients diminishes over time. Risk-stratified PB strategies, especially based on DSA status, may enhance clinical decision-making while minimizing unnecessary procedural risk.

【Objective and Design】 To prevent antibody-mediated rejection (ABMR) and adequately suppress the immune response following transplantation, desensitization is performed in donor-specific antibody (DSA) or anti-human leukocyte antigen antibody positive kidney transplant recipients. However, no standard desensitization method has been established. Therefore, we conducted an open-label, non-randomized, multicenter Phase III study to evaluate the efficacy of rituximab and tacrolimus in a desensitization protocol.

【Methods】 Living donor kidney transplant recipients aged 16 to 74 years who were positive for complement-dependent cytotoxicity cross-match (CDCXM), flow cytometric cross-match (FCXM), or DSA were eligible for the study. Patients received pre-transplant desensitization with rituximab, tacrolimus, mycophenolate mofetil, glucocorticoid, and plasma exchange (optional). The primary endpoint was graft survival rate at 24 weeks post-transplant, estimated using Bayesian analysis.

【Results】 Of the original 25 patients, 24 received rituximab. Baseline histocompatibility testing showed no patients to be T-CDCXM-positive. Twenty-two patients underwent kidney transplantation (91.7%, 95% confidence interval: 73.0; 99.0%). Patient and graft survival rates at 48 weeks were both 100%. ABMR developed in four patients (18.2%). In Bayesian analysis, the mode for graft survival rate at 24 weeks post-transplant was 90.8% (95% credible interval: 81.3; 95.6%), and the posterior probability below the threshold 74.9% was 0.1%. There were no serious adverse events related to desensitization that led to discontinuation of the study.

【Conclusion】 The study demonstrated that CDCXM, FCXM, and DSA-positive patients can safely undergo kidney transplantation following desensitization including rituximab and tacrolimus, and that such desensitization is effective and well tolerated for up to 48 weeks post-transplant.

【Objective】 The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to provide a standardized, objective, and evidence-based psychosocial evaluation of the main pretransplant psychosocial risk factors that may influence transplant outcomes. Because established assessment procedures or standardized tools designed to perform pre-solid organ transplant psychosocial evaluation are currently unavailable in Japan, the present study aimed to develop and preliminarily validate the Japanese version of the SIPAT.

【Design】 retrospective study.

【Methods】 First, the Japanese version of the SIPAT was developed using standard forward-back-translation procedures. Then, the Japanese versions of the SIPAT and the Japanese version of Psychosocial Assessment of Candidates for Transplant were retrospectively and blindly applied to 107 transplant cases by 4 independent raters.

【Results】 The interrater reliability of the scores obtained with the Japanese version of the SIPAT was excellent (Pearson’s correlation coefficient＝0.86). The concurrent validity of the SIPAT to the Psychosocial Assessment of Candidates for Transplant for each examiner was substantial (Spearman’s rank correlation coefficient ＝ 20.66).

【Conclusion】 These findings suggest that the Japanese version of the SIPAT is a promising and reliable instrument. Further research is required to test the predictive validity of the Japanese version of the SIPAT.