BACKGROUND Acute-on-chronic liver failure (ACLF) is associated with multiorgan failure and high short-term mortality. Liver transplantation (LT) can be lifesaving, but commonly used pretransplant severity scores were not developed to predict post-transplant mortality. This study compared AARC, CLIF-C ACLF, and MELD-Na for 90-day mortality after LT. MATERIAL AND METHODS This single-center observational cohort study included 78 consecutive patients aged 16 years or older with EASL-CLIF ACLF who underwent LT at the 108 Military Central Hospital between January 2022 and June 2025. All 3 scores were independently recalculated from a common pretransplant assessment. The primary outcome was 90-day all-cause mortality, and the primary score comparison was non-directional. Discrimination was assessed using AUROCs with stratified percentile-bootstrap confidence intervals and paired DeLong comparisons with Holm adjustment. Separate Firth logistic and Cox models evaluated associations per 1-standard-deviation increase. RESULTS HBV-related liver disease accounted for 62.8% of the cohort, and 89.7% underwent living-donor LT. Fourteen patients (17.9%) died within 90 days. CLIF-C ACLF had the highest numerical AUROC (0.755; 95% CI, 0.562-0.917), followed by MELD-Na (0.714; 0.550-0.854) and AARC (0.654; 0.491-0.799); no pairwise difference remained significant after Holm adjustment. A 1-standard-deviation increase in CLIF-C ACLF (11.05 points) and MELD-Na (6.17 points) was associated with higher 90-day mortality, whereas AARC was not. Sensitivity analyses produced similar findings. CONCLUSIONS CLIF-C ACLF showed the strongest numerical prognostic performance, but statistically significant superiority was not established. These scores should complement multidisciplinary transplant assessment.
BACKGROUND Kidney failure and hepatic steatosis (HS) are core elements of cardiovascular-renal-metabolic syndrome. Evidence of HS in kidney transplant (KTx) recipients remains limited. We evaluated the prevalence and determinants of de novo hepatic steatosis (dnHS) after KTx. MATERIAL AND METHODS We retrospectively analyzed adult KTx recipients from a single outpatient center without HS prior to transplantation. Anthropometric data, laboratory results, comorbidities, and medication use were evaluated. HS was diagnosed based on ultrasonography. RESULTS In 127 (53 female) KTx recipients with median age of 56.91 (44.91-64.62) years and median estimated glomerular filtration rate of 39.6 (29.76-48.51) mL/min/1.73 m², 44 patients (30.1%) had dnHS. Patients in the dnHS and nonHS groups were of comparable age, sex, and graft function. Patients in the dnHS group had significantly higher body mass index (BMI) before (25.5±3.29 vs 23.26±3.55 kg/m²; P<0.001) and after KTx (27.86±4.06 vs 24.71±3.69 kg/m²; P<0.001), and dnHS was associated with higher rates of hyperlipidemia (77.3% vs 54.2%; P=0.012), hyperuricemia (52.3% vs 28.9%; P=0.009), and ischemic heart disease (34.1% vs 13.1%, P=0.006). In multivariable logistic regression, higher post-KTx BMI (OR=1.21; 95% CI, 1.08-1.37; P=0.002) and history of ischemic heart disease (OR=3.40; 95% CI, 1.18-9.74; P=0.023) were independently associated with the presence of dnHS. CONCLUSIONS Hepatic steatosis is common among KTx recipients and is strongly associated with metabolic comorbidity, particularly higher BMI and ischemic heart disease.
BACKGROUND Anatomical variations of the hepatic vasculature and bile ducts are critical considerations in living donor liver transplantation (LDLT), yet population-specific data remain limited. This retrospective study aimed to evaluate hepatic artery, portal vein, hepatic vein, and intrahepatic bile duct anatomy in 101 living liver donors at a single center in Indonesia from 2010 to 2025, and to identify donor characteristics associated with these variations. MATERIAL AND METHODS A retrospective review was performed on 101 living liver donors at Cipto Mangunkusumo Hospital, Indonesia (2010-2025). Hepatic artery and portal/hepatic vein anatomy were assessed using computed tomography angiography (CTA), and biliary anatomy using magnetic resonance cholangiopancreatography (MRCP). Variations were classified according to the Michel, Nakamura, and Huang systems. Logistic and multinomial regression analyses evaluated demographic predictors, and linear regression assessed operative time. RESULTS Donors (mean age 31.8±6.2 years; body mass index [BMI] 22.6 kg/m²; 62.5% female) were predominantly Javanese and Sumatran. Canonical anatomy predominated (Michel I 70.8%; Nakamura I 71.9%; Huang A1 59.7%). Sumatran donors demonstrated higher frequencies of hepatic artery and portal vein variants. Increasing age predicted hepatic artery variation (aOR 1.08/year, P=0.046), while BMI influenced portal vein subtypes (P=0.006). No factors affected operative time. CONCLUSIONS Canonical anatomy predominated, with ethnic variations seen in Sumatran donors. Age and BMI predicted vascular variations, while biliary anatomy remained stable. Anatomical variations did not affect operative time, highlighting the importance of preoperative imaging and planning.
BACKGROUND Vascular complications remain a significant concern after kidney transplantation. While external iliac (EI) implantation is standard, common iliac (CI) implantation is occasionally performed in selected cases, particularly in the presence of vascular disease or anatomical constraints. We compared vascular outcomes according to the arterial anastomosis site. MATERIAL AND METHODS We conducted a bicentric retrospective study including kidney transplant recipients between 2015 and 2019. Implantation strategy differed between centers, with a preferential use of CI implantation in one center and EI implantation in the other. Patients underwent arterial anastomosis to the CI (n=157) or EI vessels (n=359). The primary endpoint was vascular complications graded according to the Clavien-Dindo classification. Secondary endpoints included ≥60% vascular stenosis, lymphocele rate, and graft failure at 2 years. RESULTS Baseline characteristics differed between groups, reflecting center-specific practices and case-mix variations. Overall vascular complication rates were similar (22.9% in CI vs 20.1% in EI; P=0.46). However, Clavien-Dindo ≥III complications were more frequent in the CI group (14.6% vs 7.5%; P=0.01). Severe vascular stenosis requiring intervention (Clavien-Dindo III) occurred more often in CI recipients (7.0% vs 0.8%; P<0.01). Lymphocele was also significantly more frequent in the CI group (27.4% vs 9.2%; P<0.01; OR 4.55, 95% CI 2.56-8.09; P<0.001). At 2 years, graft failure rates did not differ significantly (4.1% vs 5.3%; P=0.29). CONCLUSIONS In this bicentric retrospective analysis, CI implantation was associated with a higher rate of severe vascular complications, particularly stenosis, and lymphocele, without a significant impact on graft failure at 2 years. These findings should be interpreted with caution, as they likely reflect, at least in part, differences in patient selection and center-specific surgical practices.
BACKGROUND Liver transplantation in critically ill patients with advanced cirrhosis frequently leads to prolonged ventilation. Percutaneous dilatational tracheostomy is widely used to facilitate weaning, yet the optimal timing after liver transplantation remains uncertain. MATERIAL AND METHODS This retrospective single-center study analyzed 83 of 1352 liver transplant recipients (6.1%) who underwent percutaneous dilatational tracheostomy between December 2010 and June 2024. Patients were retrospectively categorized as early (≤7 days) or late (≥8 days) according to the interval from liver transplantation to tracheostomy. Clinical and laboratory parameters were assessed using group comparisons, multivariable linear regression (with and without log-transformed outcomes), Cox regression, and Kaplan-Meier survival analysis. RESULTS Patients who underwent early percutaneous dilatational tracheostomy had lower platelet counts (57 vs 97×109/L; P=0.047) and higher aspartate aminotransferase (72 vs 46 U/L; P=0.022), alanine aminotransferase (249 vs 67 U/L; P<0.001), and creatinine levels (175 vs 141 μmol/L; P=0.033). Early percutaneous dilatational tracheostomy was independently associated with a shorter intensive care unit stay (ß=-0.651; 95% CI, -1.087 to -0.214; P=0.004; 47.8% reduction) and shorter mechanical ventilation duration (ß=-0.560; 95% CI, -1.027 to -0.093; P=0.020; 42.9% reduction). No significant survival difference was found between early and late percutaneous dilatational tracheostomy (Cox hazard ratio, 0.76; 95% CI, 0.41-1.40; P=0.37). CONCLUSIONS Early percutaneous dilatational tracheostomy was associated with reduced intensive care unit and ventilation times but did not confer a survival benefit. These findings should be interpreted cautiously, given the retrospective single-center design.
BACKGROUND Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following pediatric liver transplantation. Reduction of immunosuppression is a cornerstone of PTLD management; however, the feasibility and safety of complete immunosuppression withdrawal (ISW) in this setting remain unclear. MATERIAL AND METHODS We retrospectively reviewed 6 pediatric liver transplant recipients diagnosed with PTLD who subsequently underwent complete ISW at our center between 2013 and 2019. Demographic characteristics, clinical features, pathological classification, treatments, and follow-up outcomes were analyzed. RESULTS The cohort included 6 children (4 females and 2 males) who underwent liver transplantation at a median age of 8 months. PTLD subtypes included infectious mononucleosis-type (n=3), polymorphic PTLD (n=1), Burkitt lymphoma (n=1), and classical Hodgkin lymphoma-like PTLD (n=1). All patients achieved complete remission following multimodal therapy. The median interval from transplantation to initiation of ISW was 35 months. During a median follow-up of 52 months after ISW, 4 patients maintained stable graft function without biopsy-proven rejection, whereas 2 developed rejection-related complications, both of which resolved after restart of low-dose immunosuppressive therapy. No graft loss or PTLD recurrence occurred. CONCLUSIONS In carefully selected pediatric liver transplant recipients with PTLD, supervised ISW may be achieved without irreversible graft injury. However, a substantial risk of rejection remains, highlighting the importance of close clinical and histological monitoring.
BACKGROUND Solid organ transplant recipients carry an elevated risk of de novo malignancies under chronic immunosuppression, including aggressive squamous cell carcinoma (SCC) of the oral cavity and oropharynx. Practical, evidence-based guidance for maxillofacial management in this population remains limited. CASE REPORT Case 1 involved a 44-year-old man who developed T1N0 SCC of the lateral tongue 23 months after orthotopic liver transplantation for alcoholic cirrhosis. He was treated with partial glossectomy and selective neck dissection, followed by re-excision for a positive deep margin; he remains disease-free at 2 years, with mild residual tongue hypomobility. Case 2 involved a 59-year-old man who developed T2N1M0 SCC of the tongue 8 months after kidney transplantation. He underwent extended hemiglossectomy with neck dissection, anterolateral thigh free flap reconstruction, and adjuvant chemoradiotherapy; suspected locoregional recurrence required limited resection, and he remains disease-free at 5 years. Case 3 involved a 62-year-old woman who developed T1N0M0 SCC of the floor of the mouth 12 years after liver transplantation. She was treated via local excision followed by block neck dissection without adjuvant therapy and remains disease-free at 1 year, with preserved function. CONCLUSIONS Oral SCC in transplant recipients can arise early or late after transplantation and requires meticulous surgical clearance, judicious use of adjuvant therapy, and vigilant surveillance. Close multidisciplinary coordination with transplant teams to optimize and, when feasible, de-escalate immunosuppression is essential, along with routine oral cancer screening and risk factor modification. Larger multicenter studies are needed to refine screening intervals and peri-oncologic immunosuppressive strategies.
BACKGROUND Primary nonfunction (PNF) is a severe complication following liver transplantation (LT), yet precise molecular biomarkers for early identification of patients at risk remain lacking, which can delay timely therapeutic intervention. MATERIAL AND METHODS Liver biopsies were collected from patients and classified into 4 groups: control, optimal graft (OG), early allograft dysfunction (EAD), and PNF. Samples were obtained at 3 time points: T0 (pre-cold perfusion), T1 (pre-reperfusion), and T2 (post-reperfusion). Isobaric tags for relative and absolute quantitation (iTRAQ) and multiple reaction monitoring (MRM) were used for proteomic analysis and biomarker verification. RESULTS Baseline characteristics of the patients showed no significant differences between groups. A total of 6505 proteins were identified in human liver samples. There were 160 differentially expressed proteins (67 upregulated and 93 downregulated) found in the PNF group compared to the control, while 54 and 36 proteins were identified in the EAD and OG groups, respectively. Ten proteins were selected for MRM verification, confirming the significant upregulation of VWF and downregulation of PRDX1, HGD, THIO, 6PGD, and HPPD, consistent with the iTRAQ results. CONCLUSIONS PRDX1, HGD, THIO, 6PGD, HPPD, and VWF were identified as candidate proteins associated with PNF and ischemia-reperfusion injury (IRI) after LT. These findings are hypothesis-generating and require validation in larger, independent cohorts to determine their potential clinical value.
BACKGROUND Pure laparoscopic donor hepatectomy (PLDH) is increasingly adopted in living donor liver transplantation (LDLT) to enhance donor recovery. However, evidence on long-term health-related quality of life (HRQoL) following PLDRH is scarce, particularly in low-volume centers. This study aimed to compare perioperative outcomes and longitudinal HRQoL between PLDH and conventional open donor hepatectomy (CODH) in a single low-volume LDLT center. MATERIAL AND METHODS A retrospective cohort study was conducted between March 2010 and July 2023, including 50 living liver donors who underwent donor hepatectomy (27 CODH; 23 PLDH). Donor demographics, operative details, complications, and liver function test results were retrieved from the institutional database. HRQoL was assessed using the 36-Item Short Form Health Survey (SF-36) at 1, 3, 6, and 12 months postoperatively, prospectively administered during follow-up visits and retrospectively reviewed. Statistical analyses included the t test, Fisher exact test, Mann-Whitney U test, and repeated-measures ANOVA. RESULTS Baseline characteristics were similar between groups except for higher education levels among PLDH donors (P<0.001). PLDH group showed a trend toward shorter hospital stay (6.83 vs 8.44 days; P=0.055). Postoperative complications and liver function test results were similar. PLDH donors reported significantly higher HRQoL scores in physical function, role physical, general health, and social function domains (P<0.05), with favorable trends in other domains. CONCLUSIONS In this low-volume LDLT center, PLDH demonstrated perioperative safety comparable to CODH, while achieving superior recovery in multiple HRQoL domains and reduced transfusion requirements. These findings support PLDH as the preferred donor approach when expertise is available.
BACKGROUND We developed and validated a questionnaire assessing intensive care unit (ICU) nurses' knowledge, attitude, and practice (KAP) regarding early mobilization of patients who are critically ill following liver transplantation. MATERIAL AND METHODS Using KAP theory, an initial questionnaire was formed via a literature review, Delphi expert consultation, and pre-survey. In January 2024, ICU nurses from 7 Chinese tertiary hospitals conducting liver transplants were surveyed, yielding 334 valid responses. RESULTS The Early Activity Assessment Tools for ICU Nurses after Liver Transplantation Based on the Theory of Knowledge, Attitude, and Practice contains 3 dimensions and 40 entries, including 17 entries in the knowledge dimension, 10 entries in the attitude dimension, and 13 entries in the practice dimension. The content validity index (CVI) of the questionnaire was 0.937, and the CVI of each entry ranged from 0.800 to 1.000. The exploratory factor analysis extracted 3 male factors, accounting for a cumulative variance contribution of 86.852%. The Cronbach's alpha coefficient of the questionnaire was 0.976, the folded half reliability was 0.772, and the retest reliability was 0.784. CONCLUSIONS The reliability of the Early Activity Assessment Tools for ICU Nurses after Liver Transplantation Based on the Theory of Knowledge, Attitude, and Practice is good, and the tool can support the preliminary verification of the knowledge, attitude, and practice level of ICU nurses on early activities of patients who are critically ill following liver transplantation.
BACKGROUND Kidney transplantation (KT) is frequently associated with substantial postoperative pain, while opioid use in these patients increases the risk of adverse outcomes. Peripheral nerve blocks (PNBs) have been proposed as opioid-sparing strategies; however, evidence in kidney transplant recipients remains inconsistent, likely due to heterogeneity in block techniques, variability in perioperative analgesic regimens, and differences in study design and methodological rigor. This systematic review and meta-analysis aimed to evaluate the impact of PNBs on postoperative analgesia in kidney transplant recipients. MATERIAL AND METHODS A systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science was conducted through April 2025 following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting 24-h postoperative opioid consumption in adult kidney transplant recipients were included. The primary outcome was cumulative opioid use within 24 hours after surgery, expressed as intravenous morphine or fentanyl. RESULTS Twelve studies met the inclusion criteria, of which 10 contributed to the quantitative synthesis. Pooled analysis showed that PNBs significantly reduced 24-h morphine consumption compared with control analgesia (pooled mean difference=-16.20 mg of intravenous morphine equivalents, 95% confidence interval -24.66 to -7.74; P=0.0002). Heterogeneity was high (I²=99%), but no study reported higher opioid use or increased adverse events in the PNB groups. CONCLUSIONS PNBs appear to be an effective opioid-sparing adjunct for postoperative analgesia in kidney transplant recipients. However, the available evidence remains limited, and further well-designed comparative trials are needed to define their role within multimodal analgesic strategies in this population.
BACKGROUND Cardiac dysfunction after brain death limits donor heart utilization. We sought to define the incidence and time course of brain death (BD)-induced left ventricular (LV) dysfunction and its association with NLRP3-related inflammatory signaling in a murine model. Upstream regulators of NLRP3 signaling, including P2X7 and PPAR-γ, were also evaluated. MATERIAL AND METHODS Thirty C57BL/6 mice were studied. In phase I, mice were randomized to control (n=8) and BD (n=10) groups. Echocardiography was performed at baseline, and serially for 3 hours. Hemodynamic data were compared. In phase II, mice were randomized to control (n=6) and BD (n=6) groups. Similar measurements were obtained at baseline and periodically for 60 minutes (T60). Mice were killed, and LV tissue samples collected for biochemical analyses. RESULTS In phase I, all BD animals developed significantly depressed LVEF by T60, with no deaths. Six animals in each group survived to T120, and 4 animals to T180. In phase II, all animals survived to T60. Mean LVEF, fractional shortening, and stroke volume were significantly reduced in the BD group. BD group demonstrated significantly greater expression of NLRP3, IL-1ß, TNF-alpha, and IL-6 in LV tissue. P2X7 expression did not differ between groups, while PPAR-γ expression showed a trend toward increase in BD animals. CONCLUSIONS The incidence of depressed LV function was 100% at T60, with no attrition. BD-induced LV dysfunction was associated with increased expression of NLRP3 and pro-inflammatory cytokines in LV tissue, suggesting involvement of NLRP3-related inflammatory signaling. Targeting this pathway may represent a potential strategy to preserve myocardial function following brain death.
BACKGROUND Early bacterial infections are a common and clinically significant complication after living donor liver transplantation. However, clinically usable tools for early individualized risk stratification remain limited in routine clinical practice. MATERIAL AND METHODS This single-center retrospective cohort study included 205 adult patients who underwent LDLT between October 1, 2017, and October 31, 2025. All patients had complete 30-day follow-up for outcome ascertainment. Early bacterial infection was defined as a microbiologically confirmed infection occurring within 30 days after transplantation. Univariable and multivariable logistic regression analyses were performed to identify independent predictors. Model performance was evaluated using receiver operating characteristic (ROC) analysis, bootstrap-based calibration, and decision curve analysis. Static and web-based dynamic nomograms were constructed based on the final model. RESULTS Early bacterial infections occurred in 45 patients (21.9%). Higher pre-transplant MELD score, post-transplant blood transfusion, bile leakage, and longer intensive care unit (ICU) stay were independently associated with infection risk. The dynamic risk stratification tool demonstrated good discrimination (AUC=0.792, 95% CI 0.716-0.867), good calibration on internal bootstrap validation (MAE and MSE), and favorable net clinical benefit on decision curve analysis. The web-based dynamic nomogram enabled real-time individualized risk estimation using routinely available clinical variables. CONCLUSIONS We developed and internally validated a dynamic risk stratification tool for early bacterial infections after LDLT, implemented as static and web-based dynamic nomograms. The tool reflects evolving postoperative risk rather than prediction at a fixed time point, with good apparent performance. However, its true performance and generalizability remain uncertain, and external validation is required before clinical application.
BACKGROUND In regions with limited deceased-donor liver transplantation, living-donor liver transplantation is often the only viable option. Altruistic (unrelated, nondirected) living-donor liver donation offers a novel strategy to expand the donor pool, particularly for patients lacking suitable related donors. MATERIAL AND METHODS This retrospective study analyzed all altruistic liver donors and their recipients at King Fahad Specialist Hospital-Dammam between April 2018 and December 2024. Donors underwent medical, psychosocial, and ethical evaluations, with final approval by an independent multidisciplinary committee. Data on donor demographics, hospital stay, complications, and graft type were reviewed. RESULTS Thirty-two altruistic donors (mean age 34.6 years; 68.8% male) successfully donated left lateral liver grafts. Allocation prioritized pediatric and high-urgency recipients. The average donor hospital stay was 4 days. No major complications (Clavien-Dindo grade ≥III) occurred; 81.2% had no complications, and 18.8% had minor (grade I-II) issues. All donors were alive and well at follow-up. CONCLUSIONS Altruistic liver donation is a safe, ethical, and effective strategy to address organ shortages for liver transplantation. With strong oversight and donor screening, this model enables life-saving transplants in vulnerable populations and represents a replicable innovation in transplant care.
BACKGROUND Pancreas transplantation is the best causal treatment for type I diabetes. The triglyceride-glucose (TyG) index is a validated marker of the long-term risk of cardiovascular episodes. The purpose of this study is to evaluate the potential reduction in cardiovascular risk, using the TyG index as a surrogate marker, in patients undergoing pancreas transplantation. MATERIAL AND METHODS The analysis was conducted on data obtained from 86 patients undergoing pancreas transplantation at the Department of General and Transplantation Surgery, Medical University of Warsaw. Serum triglyceride and glucose levels were recorded at the stage of qualification for transplantation and at 1, 3, 6, and 12 months after transplantation. The repeated measures ANOVA model was applied to the group of patients with complete data (n=14), showing a statistically significant effect of time. The difference between values before and after 12 months was statistically significant. RESULTS The mixed model confirmed the significant effect of time on the TyG index value. The mean TyG index value decreased significantly 1 month after transplantation and remained stable. Trend analysis was performed for the TyG index values at 3 time points: before transplant, early follow-up, and late follow-up. The mean TyG index decreased significantly as early as 1 to 3 months. CONCLUSIONS In this cohort of pancreas transplant recipients, transplantation was strongly associated with a reduction in the TyG index, suggesting a lower long-term risk of cardiovascular events.
BACKGROUND We investigated the association of single antiplatelet (AP) therapy with reduction of cardiovascular disease (CVD) events in kidney transplantation recipients (KTRs). MATERIAL AND METHODS This retrospective single-center study included KTRs from our institution between 2015 and 2024. Patients receiving anticoagulation or dual AP therapy were excluded. Patients were divided into those receiving AP therapy after kidney transplantation (AP group) and those not receiving such therapy (NoAP group). A separate analysis was performed for patients without known CVD. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events (MACE). Major bleeding events were also recorded. Kaplan-Meier survival curves and Cox proportional hazards models were constructed. RESULTS Overall, 518 KTRs met the study criteria (175 AP, 343 NoAP). The AP group was significantly older and had higher prevalences of diabetes and coronary artery disease. Over a median follow-up of 52.5 months (interquartile range: 33.1-71.1), 41 (24%) patients in the AP group and 76 (22%) patients in the NoAP group experienced the composite study outcome. After adjustment for confounders, AP therapy was independently associated with a lower risk of the outcome (hazard ratio 0.67, 95% confidence interval 0.45-0.99, P=0.046). AP therapy was not associated with major bleeding events. No significant association between AP therapy and outcomes was observed among patients without known CVD. CONCLUSIONS AP therapy after kidney transplantation was associated with lower risk of the composite outcome (MACE and all-cause mortality) in the overall cohort. No significant association was observed among patients without known CVD.
BACKGROUND Cardiovascular disease remains the leading cause of morbidity and mortality in kidney transplant (KT) recipients. Stress echocardiography (STE) is frequently used in pretransplant risk stratification, but its prognostic value in predicting posttransplant outcomes is uncertain. This retrospective study from a single center aimed to evaluate pretransplant STE findings in 354 KT recipients and their association with posttransplant major adverse cardiovascular events (MACE). MATERIAL AND METHODS We included KT recipients from our Midwest academic institution between January 2015 and January 2024 who underwent pretransplant STE. STEs were classified as positive (ischemic EKG changes or new wall motion abnormalities) or negative. MACE was defined as cardiovascular death, acute coronary syndrome, heart failure hospitalization, fatal arrhythmia, or stroke. Kaplan-Meier survival curves and Cox regression models were constructed to assess the associations between STE parameters and outcomes. RESULTS Among 354 KT recipients, 58 (16.3%) had a positive STE. Over a mean follow-up of 54±19 months, 67 patients (18.9%) experienced MACE. In unadjusted analyses, age, diabetes, and coronary artery disease were associated with higher MACE risk; however, positive STE was not significantly associated with outcomes. In multivariable models, abnormal STE remained unassociated with MACE or the composite outcome. Kaplan-Meier survival analysis confirmed no difference in MACE-free survival between groups. CONCLUSIONS In this contemporary single-center cohort of KT recipients, abnormal pretransplant STE was not independently associated with posttransplant cardiovascular events. These findings suggest the need to re-evaluate the role of traditional stress testing targeted toward detecting myocardial ischemia in pre-KT evaluation.
