Transplant Surgery

High intrapatient variability in immunosuppressant troughs associates with rejection and graft loss

Meta-analysis of 41 renal transplant studies found high intrapatient variability (IPV) linked to more acute rejection and worse allograft survival. Patients with low IPV had 44% lower risk of acute rejection versus high-IPV patients (RR = 0.56). High IPV was associated with increased graft loss (HR = 2.42, 95% CI 1.70–3.46). Authors conclude IPV is a potentially modifiable risk factor warranting routine monitoring in renal transplant care. 1

Donor wage reimbursement (up to $3,000) did not increase living-donor kidney transplants at 1 year

Randomized trial compared maximum reimbursements of $1500 or $3000 versus matched historical controls for patients undergoing transplant evaluation. At one year, access to any reimbursement was not associated with higher LDKT (aOR 0.85; 95% CI 0.39–1.85; P = 0.68). Reimbursement level ($1500 vs $3000) did not change donor evaluation initiation or LDKT rates. Exploratory longer follow-up suggested possible benefit, but primary one-year results do not support wage reimbursement alone as an effective short-term expansion strategy. 2

Three pretransplant phenogroups predict divergent five-year mortality after heart transplant

Latent class analysis of 3,683 adult first heart transplant recipients identified three recipient phenogroups with distinct risks. Five-year mortality was 24.0%, 28.5%, and 33.0% across groups, with higher HRs in phenogroups 2 and 3 versus group 1. Causes of death differed by group: graft failure predominated in group 1, infection in groups 2 and 3. Phenotype classification showed high internal stability but only modest discrimination (optimism-adjusted C = 0.55), suggesting usefulness for tailoring surveillance rather than definitive prognostication. 3