Adela Dina Mattiazzi

A 4-month course of rifampin is one of the recommended first-line regimens for latent tuberculosis infection (LTBI). However, data on its use among kidney transplant candidates (KTC) remain limited. We conducted a retrospective study of all KTC treated with either 4-month rifampin or 9-month isoniazid (INH) for LTBI at a transplant infectious disease clinic in Miami from January 1, 2021 to December 31, 2024. We assessed rates of treatment completion, adverse reactions leading to discontinuation of therapy, and transaminase elevation (> 2 times the upper limit of normal). The potential impact of rifampin on blood pressure (BP) in patients on antihypertensive drugs (AHD) known to interact with rifampin was also evaluated. A total of 66 patients were analyzed (49 [74%] in the INH group and 17 [26%] in the rifampin group). There was a trend towards higher treatment completion in the rifampin group compared to the INH group (16 [94%] vs. 34 [69%], p = 0.05). There was no difference in adverse reactions leading to treatment discontinuation. Transaminase elevations were not observed in the rifampin group, whereas they occurred in 3 (6%) of the INH group. Three patients experienced an increase in BP while receiving rifampin, leading to treatment discontinuation in one case. A 4-month rifampin course is an excellent option for LTBI among KTC due to its high completion rate and favorable liver safety profile; however, close monitoring for AHD interactions is essential.

The American Society for Apheresis (ASFA) Attending Physician Subcommittee of the Physicians' Committee performed an annual review of articles published in 2024 related to apheresis medicine. The 10 seminal apheresis articles selected by the subcommittee members are summarized in this review. PubMed was used to identify manuscripts published in 2024 in four areas of interest: donor apheresis, therapeutic apheresis, apheresis education, and apheresis for cellular therapy. Only full length, peer-reviewed manuscripts in English with data from human subjects were included. Case reports, review articles, and meta-analyses were excluded. Articles were considered seminal if they met at least one of the following previously established criteria: novel finding(s), practice-altering outcomes, international in scope, randomized-controlled trial, relevant to current clinical practice, and/or provide evidence for category III or IV indications based on the ASFA 9th special issue of the Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach.

Robotic-assisted living donor nephrectomy (RALDN) has been shown to be a safe and feasible option, offering enhanced visualization and improved surgical dexterity, allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants, even in cases of grafts with anatomical variants. We report our recent experience in using RALDN for open kidney transplantation (OKT). Between August 2021 and July 2025, 122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute. Clinical outcomes, during the first 12 months post-transplant, including the incidence of delayed graft function (DGF), surgical complications, estimated glomerular filtration rate (eGFR), and graft loss, were evaluated. Sixteen pediatric and 106 adult recipients were included. The median recipient and donor ages were 42.2 yr and 39.5 yr, respectively. Male recipients comprised 63.1% (77/122); female donors comprised 56.6% (69/122). Among the donors, no conversion to open surgery was needed, and no post-operative complications attributed to the RALDN procedure were observed. Thirty-one kidney grafts required back-table reconstruction. The median cold and warm ischemia times were 55.5 min and 27.0 min, respectively. One case (0.8%) of DGF was observed. One recipient (0.8%) developed a post-operative vascular complication; five (4.1%) developed a urologic complication. The median eGFRs at 1 mo, 3 mo, 6 mo, and 12 mo post-transplant were 71.9, 77.1, 75.1, and 72.1 mL/min/1.73m2, respectively. No cases of graft failure during the first 12 months post-transplant were observed, and one patient died with a functioning graft. RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients. This minimally invasive approach should be offered as a safe alternative to living donor patients.

Purpose: To identify factors associated with hemorrhagic adverse events requiring secondary intervention after ultrasound (US)-guided or computed tomography (CT)-guided transplant kidney biopsy. Materials and Methods: A retrospective analysis of 1,017 patients who underwent transplant kidney biopsy between January 2019 and August 2023 was conducted. Data collected included patient demographics, age of kidney transplant at biopsy, number of cores sampled, serum creatinine levels, medication use, and hemorrhagic adverse events (AEs). AEs were graded using the Society of Interventional Radiology (SIR) classification system. Outcomes were analyzed on the basis of graft age at the time of biopsy. Results: Among 1,017 biopsies, 34 hemorrhagic AEs were recorded. Severe hemorrhagic AEs, defined as those requiring secondary intervention, occurred in 1% (10 of 1,017) of cases, with a significantly higher incidence in the <90-day graft group than in the >90-day graft group (1.57% [8 of 509] vs 0.39% [2 of 508], P = .04). Mild hemorrhagic AEs, managed conservatively, were observed in 2.4% (24 of 1,017) of cases, with no significant difference between the <90-day group (1.77% [9 of 509]) and the >90-day group (2.95% [15 of 508], P = .24). No graft failures were reported during the study period. The median time from biopsy to surgical evacuation for severe AEs was 3.5 hours (interquartile range, 2.8-5.1 hours). Conclusions: Biopsies performed within 90 days after transplantation were associated with a significantly increased risk of severe hemorrhagic AEs requiring secondary intervention. These findings underscore the need for careful risk stratification and precautionary measures when performing transplant kidney biopsies in early grafts.

Given our desire to reduce kidney transplant waiting times by utilizing more difficult-to-place ("higher-risk") DD kidneys, we wanted to better understand post-transplant renal function among 1119 adult DD recipients consecutively transplanted during 2016-2019. Stepwise linear regression of eGFR (CKD-EPI formula) at 3-, 6-, and 12-months post-transplant (considered as biomarkers for longer-term outcomes), respectively, was performed to determine the significant multivariable baseline predictors, using a type I error ≤ 0.01 to avoid spurious/weak associations. Three unfavorable characteristics were selected as highly significant in all three models: Older DonorAge (yr) (p < 0.000001), Longer StaticColdStorage Time (hr) (p < 0.000001), and Higher RecipientBMI (p ≤ 0.00003). Other significantly unfavorable characteristics included: Shorter DonorHeight (cm) (p ≤ 0.00001), Higher Natural Logarithm {Initial DonorCreatinine} (p ≤ 0.001), Longer MachinePerfusion Time (p ≤ 0.003), Greater DR Mismatches (p = 0.01), DonorHypertension (p ≤ 0.004), Recipient HIV+ (p ≤ 0.006), DCD Kidney (p = 0.002), Cerebrovascular DonorDeath (p = 0.01), and DonorDiabetes (p = 0.01). Variables not selected into any model included DonorAKI Stage (p ≥ 0.24), Any DonorAKI (p ≥ 0.04), and five KDRI components: two DonorAge splines at 18 years (p ≥ 0.52) and 50 years (p ≥ 0.28), BlackDonor (p ≥ 0.08), DonorHCV+ (p ≥ 0.06), and DonorWeight spline at 80 kg (p ≥ 0.03), indicating that DonorAKI and the weaker KDRI components have little, if any, prognostic impact on renal function during the first 12 months post-transplant. Additionally, biochemical determinations with skewed distributions such as DonorCreatinine are more accurately represented by natural logarithmic transformed values. In conclusion, one practical takeaway is that donor AKI may be ignored when evaluating DD risk.

In Solid Organ Transplant (SOT) recipients, due to immunosuppression, the immunogenicity after COVID-19 vaccination is suboptimal and its durability is unknown. We conducted a post-hoc analysis of a patient-blinded, single center, randomized controlled trial comparing BNT162b2 vs JNJ-78436735 as the third dose after two doses of BNT162b2 in adult SOT recipients with active graft to compare long-term immunogenicity. Forty-one recipients were analyzed. Median IgG levels against SARS-CoV-2 at 6 months were 53,747 (range 949 - 657,558) and 7,632 (range 642 - 672,000) AU/ml for BNT162b2 vs JNJ-78436735, respectively (p=0.017). The median geometric mean fold increase ratio at 6 months was 37.2 (0.12-618.5) and 4.30 (0.1-204.2) for BNT162b2 vs JNJ-78436735, respectively (p<0.05). After two doses of BNT162b2, homologous approach with BNT162b2 achieved a superior immunogenicity compared to heterologous approach with JNJ-78436735. In this post hoc analysis, we report durability of specific IgG between two vaccine strategies and found no statistically significant difference between two groups. (Clinical Trial Registry: NCT05047640).

ABSTRACT In this first annual review article, the American Society for Apheresis (ASFA) Attending Physician Subcommittee (APSc) of the Physicians' Committee (PC) curated key apheresis literature in 2023 and presented their choices for the 10 most seminal apheresis articles. PubMed and OVID search engines were used to identify manuscripts from four topic areas: donor apheresis, therapeutic apheresis, education, and cellular therapy. To further identify seminal criteria, they had to present at least one of the following: novel findings, practice‐altering outcomes, international scope, randomized controlled trial, relevant to current clinical practice, and/or provide evidence for category III or IV indications based on the ASFA ninth special issue of the Guidelines on the Use of Therapeutic Apheresis in Clinical Practice‐Evidence‐Based Approach. Inclusion criteria included: full‐length, peer‐reviewed, English language, and human subjects. Case reports, review articles, and meta‐analyses were excluded.