Transplant Surgery

Time-horizon choice substantially alters dynamic survival prediction performance in kidney transplant

Heterogeneous definitions of the prediction horizon markedly affected discrimination and calibration across 171 dynamic-prediction studies. In 2,523 kidney recipients, a 5-year sliding horizon showed modestly improved discrimination with early landmarks and reasonable calibration. An 11-year final horizon produced high discrimination at early landmarks but shifted from underestimation to overestimation over time. Recommendation: report whether horizons are sliding or final because prognostic performance depends on that choice. 1

Target-trial emulation: bilateral lung transplant improves survival for COPD but not IPF

Among 3,274 dually listed adults, BLT versus SLT yielded higher five-year survival for COPD (61% vs 52%; HR 0.67, CI 0.50–0.88). For IPF, five-year survival was similar between BLT and SLT (59% vs 56%; HR 1.04, CI 0.85–1.26). Age modified COPD benefit: outcomes were comparable for patients ≥70 years (HR 0.75, credible interval 0.38–1.37). Apply findings to dually listed, first-time transplant candidates when balancing organ allocation and recipient age. 2

Locus-specific HLA signals for graft survival in deceased-donor liver transplants — hypothesis-generating

In 610 first deceased-donor liver transplants, HLA-C mismatching associated with worse graft survival on KM analysis (p=0.02) in a small subgroup (n=38). HLA-DRB1 mismatching paradoxically linked to improved graft survival (aHR 0.34, 95% CI 0.14–0.87), but matched cases were few (n=9). No associations were found at other HLA loci, and hepatic artery thrombosis independently worsened graft survival (aHR 3.42). Interpretation: results are hypothesis-generating only given small subgroup sizes and imprecise estimates. 3