BACKGROUND Psychological resilience is an increasingly recognized important protective factor for emotional health after solid organ transplantation; however, its role in the early post-transplant period is insufficiently explored. This study examined the role of psychological resilience in emotional health among kidney and liver transplant recipients, using a cross-sectional indirect-effect model. MATERIAL AND METHODS A cross-sectional, multicenter study was conducted at 4 transplant centers in Poland. Adult kidney and liver transplant recipients were assessed the day before hospital discharge after transplantation (mean hospital stay: 19.62 days). The study included 117 participants (68.4% kidney and 31.6% liver transplant recipients). Perceived social support was assessed with the Multidimensional Scale of Perceived Social Support (MSPSS), psychological resilience with the Psychological Resilience Scale (SPP-25), and overall emotional distress with the Hospital Anxiety and Depression Scale (HADS). Cross-sectional mediation analyses tested an indirect-effect model with MSPSS as the independent variable (X), SPP-25 as the mediator (M), and emotional distress measured by the HADS as the outcome variable (Y). RESULTS Participants reported moderate to high psychological resilience and high perceived social support, particularly from family and significant others, along with low to moderate emotional distress. Mediation analyses showed associations between perceived social support and emotional distress were statistically significant only as indirect effects mediated by psychological resilience. CONCLUSIONS In the early post-transplant period, psychological resilience is statistically associated with emotional health and may serve as an important mediator linking perceived social support to lower levels of emotional distress. These findings are consistent with a theoretical indirect-effect model and underscore the need for longitudinal studies to clarify temporal relationships in psychological adaptation after transplantation.

BACKGROUND Pure laparoscopic donor major hepatectomy (PLDMH) offers important advantages for donors but has largely been restricted to expert surgeons. Evidence on fellowship-trained surgeons (FTSs) performing PLDMH after structured training is limited. This study evaluated donor safety and operative efficiency of FTSs using propensity score matching (PSM) and cumulative sum (CUSUM) analysis. MATERIAL AND METHODS We retrospectively reviewed 517 consecutive PLDMHs from 3 centers, including 1 expert surgeon (n = 462) and 3 FTSs (n = 55). FTSs underwent a structured, phase-task-based training program; 2 received short-term on-site proctorship for initial cases. To reduce baseline differences, we applied 1: 3 propensity score matching (PSM) between FTS and expert cases. Donor and recipient characteristics were balanced. Learning curves were assessed using risk-adjusted CUSUM for major donor complications and residual CUSUM for operative time. RESULTS After PSM, 55 FTS cases were matched to 165 expert cases. Major donor complications were comparable (5.5% vs 4.2%, P=0.714) and no case required conversion to open surgery. Donor operative time was longer in the FTS group (338±102 vs 220±44 minutes, P<0.001). Recipient biliary leakage was more frequent in the FTS group (18.2% vs 8.5%, P=0.046), whereas other outcomes were similar after matching. Risk-adjusted CUSUM demonstrated stabilization of donor safety within 8 to 10 cases per FTS, while operative efficiency stabilized after 6 to 15 cases. CONCLUSIONS FTSs demonstrated acceptable donor safety outcomes under structured training conditions, with operative performance showing a trend toward improvement after approximately 10 to 15 cases.

BACKGROUND Diabetes mellitus (DM) is increasingly prevalent among heart transplant candidates, but its long-term prognostic significance remains undefined. The impact of posttransplant DM (PTDM) and insulin-dependent PTDM on outcomes has not been fully characterized. This study evaluated associations of pretransplant DM, PTDM, and insulin-dependent PTDM with long-term outcomes after heart transplantation. MATERIAL AND METHODS Adult heart transplant recipients in the Scientific Registry of Transplant Recipients between December 2005 and December 2020, with no prior transplant, were included. Recipients were stratified by pretransplant DM status, PTDM development, and insulin dependence among PTDM patients. Overall survival (OS) was assessed using Kaplan-Meier analysis, and independent predictors of mortality and PTDM were evaluated using multivariable Cox and logistic regression. RESULTS A total of 30 430 recipients were analyzed, including 8361 with pretransplant DM. Pretransplant DM was associated with worse 10-year OS and independently predicted mortality (HR=1.39, 95% CI: 1.32-1.46; P<0.001). Recipients with pretransplant DM also had higher rates of acute drug-treated rejection, dialysis requirement, drug-treated infection, and infection- or pulmonary-related death. Among 21 121 recipients without pretransplant DM, 3003 developed PTDM. PTDM was independently associated with worse OS (HR=1.14; 95% CI, 1.06-1.22; P=0.001), acute rejection, and infection. Among patients with PTDM, insulin-dependent PTDM conferred greater mortality risk than non-insulin-dependent PTDM (HR=1.58; 95% CI, 1.38-1.80; P<0.001) and was associated with higher rates of rejection, dialysis, infection, and cardiovascular death. CONCLUSIONS Diabetes across the transplant continuum has distinct prognostic implications after heart transplantation. Pretransplant DM and PTDM are independently associated with worse long-term OS, while insulin-dependent PTDM identifies a particularly high-risk subgroup.

The ethical approval number was incorrectly stated as: "Approval No. KET-/76/UNZ.F1/ETIK/PPM.00.02/2024." It should read: "Approval No. KET-/176/UN2.F1/ETIK/PPM.00.02/2024." Reference: Arnetta Naomi Louise Lalisang, Toar Jean Maurice Lalisang, Yarman Mazni, Ridho Ardhi Syaiful, Lam Sihardo, Vania Myralda Giamour Marbun, Anisa Ayu Maharani, Nathaniel Jason Zacharia, Afid Brilliana Putra, Taufik Agung Wibowo. The Anatomical Landscape of Living Donor Livers: A 101-Case Retrospective Single-Center Study in Indonesia From 2010 to 2025. Ann Transplant. 2026;31:e952031. DOI: 10.12659/AOT.952031.

BACKGROUND Deceased organ donation is the principal source of transplantable organs; however, organ shortages remain a major public health challenge. Healthcare professionals play a pivotal role in shaping societal attitudes toward transplantation. This study aimed to identify sociodemographic, psychological, and attitudinal factors independently associated with lack of willingness to consent to deceased organ donation among nurses and physicians working in dialysis units. MATERIAL AND METHODS A nationwide cross-sectional survey was conducted in Poland between February 2023 and June 2024 among 850 nurses and 243 physicians. Data were collected using paper-based and online questionnaires, incorporating sociodemographic variables, donation-related attitudes, and validated psychometric scales assessing life satisfaction, self-esteem, self-efficacy, and empathy. The primary outcome was lack of willingness to consent to deceased organ donation. Group comparisons were performed using Mann-Whitney U and chi-square tests. Multivariable logistic regression identified independent determinants. RESULTS Overall, 35.2% of participants either declined or did not clearly express willingness to consent to deceased organ donation. Higher levels of personal distress were associated with increased odds of lack of willingness to consent (B = 0.05; OR = 1.05; 95% CI, 1.00-1.10; P = 0.04), whereas higher empathic concern was associated with decreased odds (B = -0.06; OR = 0.94; 95% CI, 0.89-0.98; P = 0.01). Belief in the safety of blood donation was linked to lower odds of lack of willingness to consent (B = -0.28; OR = 0.76; 95% CI, 0.63-0.91; P < 0.001). The strongest association was observed for acceptance of organ donation from a deceased close family member (B = -2.36; OR = 0.09; 95% CI, 0.07-0.13; P < 0.001). Donation-related beliefs demonstrated stronger associations with consent attitudes than sociodemographic characteristics. CONCLUSIONS Unwillingness to consent to deceased organ donation among dialysis staff was associated with empathy dimensions and donation-related beliefs.

BACKGROUND COVID-19 significantly impacted the outcomes of patients, particularly those with comorbidities, including solid organ transplant recipients. The aim of this study was to investigate the incidence and mortality of COVID-19, as well as to identify independent risk factors associated with COVID-19-related death in patients undergoing orthotopic heart transplantation (OHT). MATERIAL AND METHODS The study followed 556 heart transplant recipients at a high-volume transplant center in Poland from March 2020 to March 2024. Patients were classified as infected based on a positive result from reverse transcription-polymerase chain reaction (RT-PCR) tests or SARS-CoV-2 antigen rapid tests performed on nasopharyngeal swab samples. RESULTS In the analyzed cohort, 189 of 556 patients (33.99%; 40 women, 21.16%) were diagnosed with COVID-19 following OHT. In total, 15 patients (7.94%) experienced recurrent SARS-CoV-2 infections, with 1 patient being diagnosed 3 times. A total of 33 patients (5.94%) required hospitalization due to COVID-19. Among the entire study cohort, 75 patients (13.49%) died, with 18 of these deaths (24%) directly attributable to COVID-19. In the multivariable analysis, vaccination against COVID-19 was identified as a protective factor against death due to the virus (OR, 0.22; 95% CI, 0.07-0.68; P=0.009) while increasing age was associated with a higher risk of mortality (OR, 1.08; 95% CI, 1.02-1.14; P=0.008). CONCLUSIONS The lack of COVID-19 vaccination and advanced age significantly influenced the COVID-19-related mortality risk.

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 The University of Wisconsin (UW) solution is the gold standard for kidney preservation. Quercetin (QE), a widely used flavonoid, possesses strong antioxidant, anti-inflammatory, and anti-apoptotic properties. Sucrose (Suc) has shown beneficial effects as a supplement. The aim of this study was to investigate the protective effects of QE and Suc against cold injury in porcine kidneys and to evaluate whether their use improves ischemia-reperfusion (I/R) injury after simple CS. MATERIAL AND METHODS Kidney grafts were procured after 30 min of warm ischemia, followed by preservation under 2 conditions for 22 h: Group 1, preserved with CS/UW solution (n=4), and Group 2, preserved with CS/UW solution containing QE 33.1 μM and Suc 0.1 M (n=6). All grafts were evaluated using an ex vivo isolated kidney reperfusion model with oxygenated, diluted autologous blood at room temperature. RESULTS At the end of reperfusion, creatinine phosphokinase and lactate dehydrogenase levels were significantly lower in Group 2 than in Group 1. We observed more vacuolation in the tubular epithelial cell in Group 1 than in Group 2, and the tubular epithelium showed more irregularity and exfoliation in Group 1 than in Group 2. Additionally, Group 2 had a significantly higher number of anti-ERG-positive endothelial cell nuclei than Group 1 at the end of reperfusion. CONCLUSIONS Our results suggest that the addition of QE and Suc to UW solutions can effectively prevent cold injury in DCD kidneys, with QE exerting this beneficial action, possibly by suppressing oxidative stress, and could potentially enhance kidney transplantation outcomes.

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 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 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 (β=-0.651; 95% CI, -1.087 to -0.214; P=0.004; 47.8% reduction) and shorter mechanical ventilation duration (β=-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 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/m[2]; 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 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 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.