30-Second Takeaway
- De novo malignancy is now a leading late cause of death after solid organ transplant; imaging must be organ- and risk-adapted.
- Quality of pre-dialysis care strongly influences kidney transplant referral and evaluation, concentrating access failures in suboptimal starters.
- Post-transplant hyperphosphataemia and high Ca×P, not hypercalcaemia, independently predict cardiovascular events in kidney recipients.
- Emerging molecular markers—HDAC1, BAL miRNAs, PLAU/Ptgs2—may help personalize immunosuppression and rejection risk management.
- Transplant programs can improve safety and sustainability by rethinking donor evaluation, immunosuppression, and peri-transplant workflows.
Week ending April 18, 2026
Transplant Grand Rounds: Malignancy, Cardiovascular Risk, Immune Monitoring, and Access to Transplant
Imaging Is Central for Surveillance of De Novo Malignancy After Solid Organ Transplant
This review underscores that de novo malignancy is now a leading cause of late morbidity and mortality after solid organ transplantation. It describes how chronic immunosuppression and oncogenic infections drive cancer risk patterns across different allograft types. The article details imaging appearances of major post-transplant cancers and modality selection, including CT, MRI, ultrasound, and PET/CT. It emphasizes integrating noninvasive imaging into surveillance, staging, and response assessment pathways tailored to organ and tumor risk.
Suboptimal Dialysis Starts Markedly Reduce Downstream Kidney Transplant Referral and Evaluation
This cohort of 49,057 incident dialysis patients examined how pre-dialysis care context affects transplant referral and evaluation. Highly, moderately, minimally, and non-optimal starts accounted for 28.8%, 15.5%, 31.0%, and 24.8% of patients, respectively. Compared with highly optimal starts, moderately, minimally, and non-optimal starters were 28%, 31%, and 57% less likely to be referred within 12 months. Non-optimal starters were 37% less likely to begin evaluation after referral, whereas other groups had similar evaluation initiation rates. More than half of adults initiated dialysis in minimal or non-optimal ways, concentrating missed transplant opportunities in these groups.
Neutrophil Proteomics and Low HDAC1 Associate With Tolerance During IS Withdrawal in Pediatric Liver Transplant
This single-center pediatric liver transplant program evaluated baseline neutrophil-associated plasma proteomics as predictors of immunosuppression withdrawal outcomes. In 31 planned withdrawal recipients, LC-MS proteomics identified tolerance-associated proteins enriched in neutrophil degranulation and NET-formation pathways. HDAC1 emerged as a key marker, with significantly lower baseline plasma levels in immune-tolerant versus non-tolerant children. Plasma HDAC1 showed moderate discrimination for tolerance (AUC 0.81), and liver biopsy IHC confirmed lower intrahepatic expression in tolerant recipients. These findings position HDAC1 as a hypothesis-generating biomarker for baseline risk stratification before IS tapering in pediatric liver transplant.
Sustained Hyperphosphataemia Predicts Cardiovascular Events After Kidney Transplant, Unlike Hypercalcaemia
This retrospective cohort of 649 kidney transplant recipients assessed time-weighted calcium, phosphate, and Ca×P versus cardiovascular outcomes. Over a median follow-up of 2943 days, 16.8% experienced major adverse cardiovascular events. Hyperphosphataemia remained independently associated with increased MACE risk and with a composite of MACE and all-cause mortality after eGFR adjustment. Elevated Ca×P similarly predicted higher cardiovascular risk, whereas hypercalcaemia showed no significant association with MACE or mortality. These data support aggressive identification and management of hyperphosphataemia and Ca×P as part of cardiovascular prevention in kidney recipients.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.