OBJECTIVES:We aimed to review the current evidence on kidney transplant in patients with posterior urethral valves, focusing on transplant-specific lower urinary tract assessment, bladder optimization, graft outcomes, infection burden, and long-term follow-up. MATERIALS AND METHODS:We searched peer-reviewed literature indexed in PubMed and major guideline sources through March 2026, focusing on studies that addressed posterior urethral valves, valve bladder dysfunction, and kidney transplantation. Contemporary cohort studies, critical reviews, pediatric urology and transplant literature, and guideline-based statements were prioritized. In accordance with journal policy, donors considered in the reviewed transplant literature were either deceased donors or living related donors. RESULTS:Available evidence indicated that posterior urethral valves are not a contraindication to kidney transplant when the lower urinary tract is systematically evaluated and optimized. Low-pressure urine storage and reliable bladder emptying are central determinants of graft protection. Vesicoureteral reflux should be actively assessed and, when clinically significant, treated in the context of native kidney function, infection burden, and bladder strategy; in poorly functioning refluxing native kidneys, native nephroureterectomy may be more appropriate than anti-reflux correction. Clean intermittent catheterization, with or without a catheterizable channel, is often graft-protective, whereas augmentation cystoplasty should be reserved for selected hostile bladders refractory to conservative treatment. The timing of reconstruction and native upper-tract surgery should be individualized according to bladder phenotype, residual urine output, donor type, and anticipated wait time. CONCLUSIONS:Kidney transplant in patients with posterior urethral valves can achieve durable allograft function when bladder phenotyping, stepwise optimization, reflux management, infection prevention, donor-specific surgical planning, and lifelong follow-up are integrated into care. Clinically significant vesicoureteral reflux should prompt consideration of anti-reflux surgery or native nephroureterectomy according to kidney function, residual diuresis, and reconstructive timing. A multidisciplinary strategy extending through transition to adult services offers the best opportunity to protect the allograft.
OBJECTIVES:Infections, especially pneumonia, are among the significant causes of morbidity and mortality in transplant recipients. Pneumonia leads to a complex clinical picture, related not only to the infection itself but also to underlying immunosuppression, conco -mitant diseases, and organ dysfunction. Here, we evaluated the effect of the HALP score (ie, hemoglobin, albumin, lymphocyte, and platelet ) on prognosis in patients who developed pneumonia after kidney transplant. MATERIALS AND METHODS:We retrospectively reviewed files of kidney transplant recipients in the chest diseases outpatient clinic of our hospital who were diagnosed with pneumonia on thoracic computed tomography scans between April 2020 and April 2025. We exported data (age, sex, laboratory test results at diagnosis, duration of hospitalization, and mortality rate ) to a database spreadsheet file (Excel ) and compared hemoglobin, albumin, lymphocyte, and platelet scores of patients who died versus survived. We analyzed disease severity by classification according to the Pneumonia Severity Index and CURB -65 (ie, confusion, uremia, respiratory rate, blood pressure, and age ≥65 ) scores. RESULTS:Among 178 included patients (100 female, 78 male ), 148 survived (83.1 % ) and 30 died (16.9 % ). Patients who died had lower hemoglobin, albumin, lymphocyte, and platelet scores than patients who survived. Patients with higher Pneumonia Severity Index scores had significantly lower hemoglobin, albumin, lymphocyte, and platelet scores. CONCLUSIONS:The hemoglobin, albumin, lymphocyte, and platelet score is a biomarker based on easily calculable, low -cost, and accessible parameters and may be a potential tool for evaluation of prognosis in the general patient population. Prospective and multicenter studies with larger sample groups are needed to better evaluate the role of the hemoglobin, albumin, lymphocyte, and platelet score for determination of the prognosis related to infections in kidney transplant recipients.
OBJECTIVES:Erectile dysfunction is highly prevalent in men with end -stage renal disease and substantially impairs quality of life. Although kidney transplant can mitigate systemic complications, its effect on erectile dysfunction varies. Here, we evaluated 1 -year changes in erectile function following living donor kidney transplant in Azerbaijani men and identified clinical predictors of postoperative improvement. MATERIALS AND METHODS:This retrospective observational study included 121 male patients undergoing living donor kidney transplant between 2017 and 2024. Erectile function was evaluated with the 5 -item International Index of Erectile Function preoperatively and at 6 and 12 months postoperatively. We used multivariate linear regression to identify independent predictors of improvement. RESULTS:All patients (mean age: 35.9 ± 11.7 y ) had erectile dysfunction at baseline, predominantly mild -to -moderate (42.1 % ) or moderate (28.9 %). Mean 5-item International Index of Erectile Function scores increased significantly from 11.0 ± 3.8 at baseline to 12.2 ± 4.1 at 6 months and to 14.0 ± 4.8 at 12 months (both P < .001 ). At 1 year, 97.5 % of patients demonstrated improvement in score, with a mean increase of 3.0 ± 1.6 points. Univariate analysis linked older age, smoking, regular sexual partnerships, and mild baseline erectile dysfunction with greater increase in score. However, multivariate analysis established the baseline score as the sole independent predictor of 1 -year erectile function improvement (P < .001 ). CONCLUSIONS:Living donor kidney transplant was associated with significant and progressive improvement in erectile function over 1 year in men with end -stage renal disease. Baseline erectile function was the key determinant of recovery, underscoring the importance of early evaluation and management.
OBJECTIVES:Donor pathways (donation after neurological death, ie, brain death; and donation after circulatory death ) are influenced, within each country, by several factors such as social trends and disease prevalence, which profoundly affect the mechanism and age of deaths in a population. An informed perspective on this process requires a rigorous analysis of donor efficiency (number of organs retrieved and transplanted, utilization rate, and organs per donor ) and procurement policies. MATERIALS AND METHODS:We assessed the procurement activity regarding deceased donors in the Tuscany region from the period 2022 -2025. We focused on trends in donation after brain death and donation after circulatory death (both controlled and uncontrolled donation after circulatory death ), and on deceased donor pathway efficiency as assessed by utilization rate and organs per donor. RESULTS:In the Tuscany region, 1517 donors were assessed from the period 2022-2025. Most were donations after brain death (1260 /1517, 83 % ), and the remaining 257 (17 % ) were donations after circulatory death (162 uncontrolled, 63 %; and 95 controlled, 37 % ). The number of uncontrolled donations after circulatory death remained stable, whereas the number of controlled donations after circulatory death showed progressive growth. Utilization rate remained stable in donations after brain death and controlled donations after circulatory death, whereas the rate progressively increased in uncontrolled donations after circulatory death (from 56 % in 2022, to 73 % in 2025 ). During the study period, 1367 transplants were performed, and donations after brain death were the main source for transplants. CONCLUSIONS:Among 1517 deceased donors, the high performance of the donation after brain death pathway, particularly regarding transplant volume and transplant type, underscores the critical need for the systematic identification and optimal management of all potential donations after brain death within the territory.
Distinguishing BK virus nephropathy from T -cell -mediated rejection remains a clinicopathological challenge in kidney transplants, because the 2 entities may share overlapping histological features while requiring opposite therapeutic approaches. We report a kidney transplant recipient with biopsy -proven BK virus nephropathy who later underwent repeat biopsy showing low -level BK virus nephropathy with borderline T -cell -mediated rejection. Despite histological concern for rejection, the broader clinical picture did not support clinically significant T -cell -mediated rejection; specifically, serum creatinine remained stable, BK viral load showed marked improvement, donor -specific antibodies were negative, and there were no vascular or microvascular features of active rejection. A peripheral blood next-generation RNA sequencing gene expression profile yielded a low -risk acute rejection score of 6. Antirejection therapy was deferred, immunosuppression was not escalated, and the patient remained clinically stable. This case highlights the potential adjunctive role of peripheral blood RNA profiling for resolution of histologically ambiguous cases of BK virus nephropathy and borderline T -cell-mediated rejection.
OBJECTIVES:Normothermic machine perfusion in liver transplants has emerged as a technique to preserve donor allografts, potentially improving graft quality and increasing organ availability. However, a need exists to evaluate long -term recipient and graft survival using normothermic machine perfusion. We evaluated graft survival and outcomes after liver transplant using normothermic machine perfusion. MATERIALS AND METHODS:From the United Network for Organ Sharing database, we identified adult recipients ( ≥18 years old ) of liver transplants that occurred between January 1, 2016, and December 31, 2024. The primary outcome was graft loss (retransplant or recipient death ). We used Cox regression to identify graft loss predictors in the normothermic machine perfusion group versus static cold storage. RESULTS:Among 67 447 transplants, 4385 transplant (6.5 % )utilized normothermic machine perfusion. The normothermic machine perfusion donors were older, had higher body mass index (measured as kilograms body mass per meter squared ), had diabetes more commonly, and were more often donors after circulatory death. After multivariable adjustment, normothermic machine perfusion showed graft survival rates comparable with static cold storage (hazard ratio, 1.019; 95 % CI, 0.989 -1.051; P = .218 ). Subgroup analysis showed that donor body mass index, donor diabetes, donor hepatitis C infection, and donation after circulatory death predicted graft loss in static cold storage recipients but not normothermic machine perfusion recipients, suggesting that normothermic machine perfusion may mitigate high =risk donor characteristics. CONCLUSIONS:Despite higher =risk donor profiles, normothermic machine perfusion liver transplants achieved graft survival rates comparable with static cold storage liver transplants. Normothermic machine perfusion may safely expand the donor pool by enabling use of marginal allografts. Prospective studies with longer follow =up are needed to optimize normothermic machine perfusion.
OBJECTIVES:The introduction of direct -acting antivirals has transformed kidney transplantation with hepatitis C virus -positive donors from a high -risk practice to a safe strategy for expanding the donor pool. This study aimed to highlight global research trends, collaborations, and shifts in hepatitis C virus -positive donor kidney transplant before and after the direct -acting antiviral era. MATERIALS AND METHODS:We conducted a thorough search of the Web of Science database, focusing on research output with relevant key words related to the hepatitis C virus and kidney transplant, resulting in 414 pertinent research items. We analyzed these items using bibliometric parameters. RESULTS:Over the past 2 decades, notable shifts have occurred in the research trajectory, with a peak in publications observed in 2018 and 2019 following the introduction of direct -acting antivirals, followed by a decline in subsequent years. The United States generated the highest research output, followed by France and Spain. The journals Transplantation and American Journal of Transplantation dominated in terms of citations. The University of Toulouse, the University of Pennsylvania, and the University of Miami were the leading institutional contributors. CONCLUSIONS:The introduction of direct -acting anti -virals coincided with a rapid rise in research activity and global collaboration, reflecting the transition of hepatitis C virus -positive donor kidney transplant from a high -risk practice to routine clinical adoption.
OBJECTIVES:Pregnancy after transplant still confers increased risks of various complications. This study analyzed obstetrical and perinatal outcomes of posttransplant pregnancy in kidney and liver transplant recipients. MATERIALS AND METHODS:We included kidney and liver transplant recipients with posttransplant pregnancy who were followed in our institution from 2011 to 2025. Patients were monitored simultaneously in the transplant outpatient clinic and obstetrics and gynecology clinics. We retrospectively analyzed the obstetrical complications, perinatal outcomes, and the effect of pregnancy on allograft function. RESULTS:We analyzed 18 kidney and 13 liver transplant recipients with posttransplant pregnancy. Mean mater-nal age of kidney transplant recipients was 31.1 years at the birth of the child. In the kidney transplant group, 7 patients (35 % ) delivered live birth at term, 7 patients (35 % ) experienced pregnancy complications of ges-tational hypertension or preeclampsia, and 1 patient experienced graft rejection during the postpartum period. In the liver transplant group, 8 patients (61.5 % ) delivered live birth at term. One patient had intrahepatic cholestasis of pregnancy, 1 patient had preterm premature rupture of membranes, 1 patient had preeclampsia, and 1 patient had gestational diabetes. There were no graft rejections in the liver transplant group. Mean maternal age and rate of nulliparity were higher in the kidney transplant versus the liver transplant group (P = . ⁰³² and P = . ⁰¹³, respectively ). No significant differences were shown for gestational age at delivery, preterm birth rate, birth weights of the newborns, and rates of neonatal intensive care unit hospitalizations. CONCLUSIONS:Pregnancy after solid -organ transplant is associated with potential risks for the mother, newborn, and the allograft. We observed higher rates of adverse obstetrical outcomes in the kidney transplant group versus the liver transplant group. We believe that a multidisciplinary approach during the antenatal and postpartum periods is essential to improve outcomes and minimize complications.
OBJECTIVES:Gene expression profiling is an emerging noninvasive method for rejection surveillance in heart transplants. Tricuspid regurgitation prevalence increases over time after heart transplant, and many prior studies have implicated invasive endomyocardial biopsy. The relationship between the use of gene expression profiling (AlloMap molecular expression test; CareDx ) versus endomyocardial biopsy with regard to prevalence of tricuspid damage has never been studied. MATERIALS AND METHODS:Among 158 heart transplant patients with history of gene expression profiling and mean follow -up duration of 10.3 years that we reviewed, 114 patients were included in this study. Patients were divided into 4 groups based on mean endomyocardial biopsy and mean gene expression profiling sampling times. Tricuspid regurgitation grade change was compared between the group with less gene expression profiling and more endomyocardial biopsy versus the group with more gene expression profiling and less endomyocardial biopsy. RESULTS:Results from this single -center study showed that no statistically significant difference in tricuspid regurgitation for cardiac transplant patients who were monitored for rejection by endomyocardial biopsy versus gene expression profiling. CONCLUSIONS:Preference of gene expression profiling instead of endomyocardial biopsy for rejection surveillance does not have a significant effect on tricuspid valve regurgitation.
OBJECTIVES:Spousal living donor kidney transplant is commonly performed; however, the optimal induction immunosuppression strategy in recipients with low immunological risk remains unclear. We compared the early clinical and immunological outcomes of low -dose rabbit anti -thymocyte globulin and basiliximab in low -risk spousal kidney transplant recipients. MATERIALS AND METHODS:We retrospectively analyzed 43 recipients with low immunological risk who underwent spousal living donor kidney transplant and received induction therapy with either rabbit anti -thymocyte globulin (n = 20 ) or basiliximab (n = 23 ). Low immunological risk was defined as first -time transplant with negative panel reactive antibody and negative complement -dependent cytotoxicity crossmatch. Primary endpoints were early graft function, as assessed by serum creatinine trends, and biopsy -proven acute rejection within the first 2 postoperative months. Secondary endpoints included perioperative lymphocyte dynamics and documented infections, including cytomegalovirus and urinary tract infections. RESULTS:Peripheral blood lymphocyte counts were significantly lower in the group treated with rabbit anti -thymocyte globulin on postoperative day 1 and day 7 versus the basiliximab -treated group (P < .001 ). In contrast, no significant differences were observed between groups in early graft function trajectories (P = .71 ) or the incidence of biopsy-proven acute rejection (rabbit anti -thymocyte globulin, 3 of 20; vs basiliximab, 2 of 23; P > .05 ). All documented urinary tract infections (n =3 ) and the single cytomegalovirus infection occurred in the group treated with rabbit anti -thymocyte globulin; however, these differences were not statistically significant (P > .05 ). CONCLUSIONS:In spousal kidney transplant recipients with low immunological risk, low -dose rabbit anti -thymocyte globulin (4.5 mg /kg ) and basiliximab provide comparable early graft function and similar protection against acute rejection. Although rabbit anti -thymocyte globulin induces more pronounced lymphocyte depletion, this observation does not translate into superior early clinical outcomes in this patient population.
OBJECTIVES:To our knowledge, a systematic review that has comprehensively evaluated the prevalence and clinical impact of multidrug -resistant bacteria in adult liver transplant recipients is not available. This review assessed the prevalence and clinical impact of multidrug -resistant bacteria among liver transplant recipients. MATERIALS AND METHODS:In accordance with PRISMA guidelines, we searched Web of Science, PubMed, and Google Scholar through August 2025. The study protocol was registered in PROSPERO (CRD420251181202 ). We included cohort and case -control studies that reported on adult first liver transplant recipients harboring and not harboring multidrug -resistant bacteria. Two reviewers assessed eligibility and conducted a risk of bias evaluation using the Newcastle -Ottawa Scale. We synthesized data using the web -based Review Manager for a meta -analysis, with a random -effects model to compute the pooled odds ratio and 95 % CI. Statistical heterogeneity was determined using the I2 statistic. RESULTS:In the 13 included studies (12 cohort studies, 1 case -control study ), multidrug -resistant bacteria were identified in 507 of 28 599 liver transplant recipients. Multidrug -resistant bacteria colonization significantly increased posttransplant infection (odds ratio 5.98; 95 % CI, 2.24 -15.94 ), and their presence significantly increased mortality (odds ratio 5.32; 95 % CI, 2.36 -11.97 ). Subgroup analyses suggested a regional variation in mortality risk with a higher association in China and Japan (odds ratio, 22.26; 95 % CI, 6.83 -72.6 ). Exposure to these bacteria was also associated with prolonged hospital and intensive care unit stay and showed a borderline association with acute kidney injury but not with graft rejection. CONCLUSIONS:Colonization with multidrug -resistant bacteria is associated with increased infection, and both colonization and infection raise the risk of mortality. Despite the variations across studies in geography, follow -up duration, and screening methods, actions to prevent colonization in transplant candidates are warranted.
Therapy-related acute myeloid leukemia often exhibits adverse biologic features and treatment resistance. Allogeneic hematopoietic stem cell transplant as consolidation in remission status after initial therapy offers the greatest possibility of long-term disease control. For patients without options of human leukocyte antigen-matched family donor or unrelated human leukocyte antigen-matched donor or killer immunoglobulin-like receptor-favorable haploidentical donor, an alternative strategy using vaccine hematopoietic stem cell transplant such as complementary haplo-cord hematopoietic stem cell transplant could have good graft-versus-leukemia effect and enable long-term remission. Here, we reported a successful case of more than 3 years of leukemia-free survival in a patient with therapy-related acute myeloid leukemia who underwent haplo-cord hematopoietic stem cell transplant with vaccine effect.
OBJECTIVES:Early prediction of graft rejection is critical for ensuring long-term graft survival and improving patient prognosis following heart transplant. Here, we investigated the association between interleukin 40, a proinflammatory cytokine, and key components of the innate (neutrophils) and adaptive (lymphocytes) immune systems. Furthermore, we evaluated the predictive value of the change in lymphocyte-to-neutrophil ratio for acute and chronic rejection and overall survival after heart transplant. MATERIALS AND METHODS:In this 2-center study, peripheral blood lymphocyte and neutrophil counts were monitored in 121 heart transplant recipients at multiple time points: pretransplant, early postoperatively, and 1, 3, 6, 9, 12, 18, and 24 months posttransplant. Change in the lymphocyte-to-neutrophil ratio was calculated for each patient. Serum interleukin 40 levels were measured in patients with and without a confirmed diagnosis of rejection. We included a control group of 28 healthy volunteers. We performed statistical analyses to determine the relationship between change in lymphocyte-to-neutrophil ratio and acute rejection, chronic rejection, and patient survival. RESULTS:Interleukin 40 levels and neutrophil percentages were significantly higher in the rejection group compared with the nonrejection and healthy control groups (P < .001). Conversely, lymphocyte percentage was significantly lower in the rejection group. Lymphocyte-to-neutrophil ratio was significantly different among study groups (P < .001). A negative correlation was identified between interleukin 40 levels and both lymphocyte percentage and lymphocyte-to-neutrophil ratio. Change in lymphocyte-to-neutrophil ratio demonstrated significant discriminatory power in predicting acute rejection (area under the curve = 0.631; P = .040), with lower rates of acute rejection observed in patients with a change in lymphocyte-to-neutrophil ratio of -≤0.412. Correlation coefficients among hematological indices were robust and consistent with clinical findings. CONCLUSIONS:The significant correlation shown between interleukin 40 levels and lymphocyte-to-neutrophil ratio and rejection episodes in heart transplant recipients represents promising noninvasive biomarkers for predicting posttransplant rejection.
OBJECTIVES:Regulation of immune responses in renal transplant recipients is complex, and the CTLA -4 gene plays a crucial role in maintaining immune tolerance. Methylation of CpG regions in the CTLA -4 promoter may affect its expression, potentially influencing transplant outcomes. This pilot study investigated the relationship between CTLA -4 promoter methylation and gene expression in CD8 + T cells of renal transplant recipients. MATERIALS AND METHODS:We analyzed the CTLA -4 promoter methylation profile in CD8 + T cells from 29 renal transplant recipients using bisulfite sequencing. The methylation status of specific CpG regions was correlated with CTLA -4 expression levels to assess any potential influence of methylation on gene regulation. RESULTS:Two patients with hemi -methylated CpG regions in the CTLA -4 promoter showed an increase in CTLA -4 expression. However, no overall correlation between methylation levels and gene expression was observed across the patient cohort. CONCLUSIONS:The findings suggested that immune responses and treatment outcomes may differ considerably between individuals. In addition, other epigenetic mechanisms may play a role in modulating CTLA -4 expression. These results highlight the complexity of immune regulation in renal transplant recipients and the need for further investigation into the epigenetic factors influencing transplant outcomes.
OBJECTIVES:We evaluated outcomes of liver transplant from donors after cardiac death versus transplants from donors after brain death, assessing trends over time. MATERIALS AND METHODS:Using the Scientific Registry of Transplant Recipients, we retrospectively analyzed liver transplants in the United States from January 2000 through May 2023. We categorized patients by donor type and transplant period. RESULTS:After inclusion and exclusion criteria were considered, 99 014 patients were evaluated (32 498 patients in the 2000 -2010 group and 66 516 patients in the 2011 -2023 group ). From the first to the second time period, liver transplants from donors after cardiac death increased from 4 -% to 8.5 -%. For both time periods, liver transplant recipients from donors after cardiac death had lower Model for End-Stage Liver Disease scores than recipients from donors after brain death (18.61 ± 8.39 vs 20.32 ± 8.91 in 2000-2010 {P < .001 } and 17.31 ± 7.24 vs 22.49 ± 10.45 in 2011-2023 {P < .001 } ). Compared with transplants with donors after cardiac death, transplants with donors after brain death had higher 5 -year graft survival (72.36 % vs 68.56 % in 2000-2010 {P < .001 }; 80.22 % vs 78.06 % in 2011 -2023 {P = .021 } ) and patient survival rates (72.09 % vs 68.56 % in 2000 -2010 {P < .001 }; 79.65 % vs 77.32 % in 2011 -2023 {P = .016 } ). Of note, the survival difference decreased in the second time period. Regarding graft failure, more transplant recipients from donors after cardiac death (vs donors after brain death ) had biliary tract complications (9.7 % vs 4.9 %; P < .001 ). CONCLUSIONS:Outcomes of liver transplants from donations after cardiac death have significantly improved, potentially partly as a result of allocation of donation after cardiac death livers to patients with lower Model for End -Stage Liver Disease scores in recent years.
OBJECTIVES:In renal transplant recipients, infections can have atypical outcomes due to immunosuppression therapy, and delayed diagnosis causes high mortality. We developed an infection risk score in renal transplant recipients to rapidly predict infection risk in emergency departments. MATERIALS AND METHODS:Of 870 renal transplant recipients admitted to the emergency department, we included 608 patients and 262 control cases. Hospital record system data for renal transplant recipients were retrospectively investigated for the period January 2021 through December 2025. Laboratory and vital signs of patients suspected of infection were compared versus asymptomatic control cases admitted for routine check -ups. All of our patients metethical standards and were selected as related donors and recipients. RESULTS:Demographic characteristics and findings of 608 patients and 262 control cases were compared, and no significant difference was found between the 2 groups in terms of comorbidities (P > .05 ). The most frequent presenting symptom was diarrhea (20.1 % ); the least frequent symptom was sore throat (6.6 % ). Leukocytes, neutrophils, neutrophil -lymphocyte ratio, plasma -lymphocyte ratio, C -reactive protein, and sodium and potassium levels, as well as vital signs including fever, pulse, blood pressure, and peripheral oxygen saturation, were associated with infection. This novel infection risk score comprised 6 parameters, including C-reactive protein, neutrophil -lymphocyte ratio, sodium, fever, pulse, and systolic blood pressure, predicted infections with 89.1 % (area under the curve ) accuracy. Sensitivity, specificity, positive predictive value, and negative predictive value of the score were 0.734, 0.905, 0.947, and 0.594, respectively. CONCLUSIONS:The novel infection risk score developed in our study predicts infections in renal transplant recipients with high accuracy using only routine biochemical and vital parameters. This practical, rapid, and reliable system can contribute to early diagnosis processes in emergency departments. Future external validation through multicenter studies is needed to support its integration into clinical guidelines.
OBJECTIVES:Absolute uterine factor infertility is a condition characterized by the absence of a functional uterus, resulting in the inability to achieve or maintain pregnancy. Uterus transplantation has emerged as an experimental therapeutic option aimed at restoring reproductive capacity in women with absolute uterine factor infertility. Here, we reviewed the current clinical experience with uterus transplantation, focusing on surgical approaches, donor sources, reproductive outcomes, and ethical considerations. MATERIALS AND METHODS:We conducted a narrative review of the literature using the PubMed, Scopus, and Google Scholar databases. We screened publications from 2000 through 2025 using the keywords "uterus transplantation," "absolute uterine factor infertility," and "MRKH syndrome." We included 42 relevant publications that described clinical outcomes, surgical techniques, and ethical aspects of uterus transplantation. We focused on reports of successful pregnancies and births following uterus transplantation. RESULTS:Uterus transplantation has progressed from experimental animal models to clinical application. To date, more than 90 transplants have been performed worldwide, resulting in over 50 live births. The procedure involves complex microsurgical vascular anastomoses and requires long-term immunosuppression until childbirth. All pregnancies are achieved through in vitro fertilization with cryopreserved embryos. Both living and deceased donors have been successfully used, each associated with specific ethical and surgical considerations. CONCLUSIONS:Uterus transplantation represents a promising experimental therapy for women with absolute uterine factor infertility. Although encouraging reproductive outcomes have been reported, the procedure remains technically demanding and associated with substantial ethical, surgical, and immunological challenges. Further multicenter studies and long-term follow-up are required to establish standardized protocols and evaluate long-term maternal and neonatal outcomes.
OBJECTIVES:Historical registry analyses have reported inferior outcomes and higher early technical failure rates following pancreas-only retransplant after simultaneous pancreas-kidney transplantation, contributing to cautious utilization. Implementation of standardized pancreas graft failure definitions permits contemporary national reassessment of these outcomes. MATERIALS AND METHODS:National registry data were extracted to evaluate 7966 adult recipients undergoing primary simultaneous pancreas-kidney transplantation (n = 7895) or pancreas-only retransplant with preserved kidney allograft function (n = 71) between February 2018 and December 2024. Multivariable regression and Cox proportional hazards models assessed pancreas graft failure and mortality. RESULTS:Among 7966 adult simultaneous pancreas-kidney transplant recipients (7895 primary; 71 pancreas-only retransplant) from 2018 through 2024, retransplant recipients were older (71.8% vs 54.8% aged 40-59 years; P = .007), more frequently White (70.4% vs 46.9%; P = .003), had longer waiting times (627.9 vs 321.5 days; P < .001), longer pancreas preservation time (12.6 vs 10.4 hours; P < .001), and were more often transplanted at high-volume centers (69.0% vs 47.9% at centers with >100 simultaneous pancreas-kidney transplants; P < .001). Retransplant was not independently associated with pancreas graft failure or mortality at 1 year or 3 years. In Cox models, retransplant was not associated with pancreas graft failure (hazard ratio 0.84; P = .683) or mortality (hazard ratio 1.19; P = .544). Increasing recipient age and national sharing independently predicted mortality. CONCLUSIONS:In the contemporary era of standardized pancreas graft failure reporting, pancreas retransplant with preserved kidney function achieves graft and patient survival comparable to primary simultaneous pancreas-kidney transplant nationally. Although retransplant recipients represent a small and highly selected cohort, these population-level data reinforce selective retransplant consideration at experienced centers following pancreas allograft failure.
