There is a need for a noninvasive, affordable, sensitive, and specific biomarker to diagnose early acute rejection, to negate the need for frequent biopsies. Dd-cfDNA is a powerful adjunct yet there is limited data on the ethnic differences in its values. There is anecdotal evidence that dd-cfDNA values at rejection may be higher in Black as compared to non-Black recipients. This study aims to add to this literature while defining such variability and comparing it to previously validated cutoffs for dd-cfDNA of 0.5% or 1%.

Anxiety symptoms influence health outcomes in pediatric organ transplant recipients. Assessing the quality of anxiety scales is critical to address the psychological challenges these patients face. Variability in how anxiety is conceptualized across scales highlights the need for selecting appropriate instruments.

Lymphocele is a common complication post-kidney transplantation, influenced by various factors including surgical technique, graft vessel count, operator experience, body mass index, ischemia time, and immunotherapy regimens.

Some family members who previously made the decision to donate a family member's organs support the organ procurement organization (OPO) through volunteer work. Volunteers were asked to describe their family's organ donation story to educate the general and medical communities about organ donation. This study explored the transformative learning experienced by volunteers during and following the organ donation consent process and throughout their volunteer work. A narrative inquiry research methodology and transformative learning theoretical framework was used and 6 volunteers were recruited to participate. Two semistructured virtual interviews were conducted. Interviews were transcribed, radically reduced, and subjected to holistic-content and holistic-form narrative analysis. Participants experienced strong emotional responses during and after the loss of their family member, characterized as a period of disorientation, which lasted for an extended period preventing transformative learning. After the OPO contacted participants regarding the opportunity to volunteer, participants experienced a period of self-examination when they reengaged with the topic of organ donation. Critical reflection occurred through the act of storytelling about their family's organ donation story during their volunteer work. Storytelling to the community facilitated making meaning of their loss and transformations. Volunteering for an OPO played an important role by initiating self-examination and critical reflection of their prior assumptions. Through storytelling, participants reflected on their roles and made meaning of their organ donation experiences. The act of inviting donor families to reengage with the topic of organ donation through volunteer work fostered positive permanent meaningful transformations.

: Life expectancy for pediatric liver transplant patients has increased over the past decade. Different stages of the transplant process can impact patients' quality of life (QOL) and create psychological and physical stressors. This study explored whether age at transplant affected adolescents' feelings of anxiety, depression, and QOL. : In this cross-sectional quantitative study, data were collected on 22 adolescent patients aged 13-18 who received a transplant at least 12 months before enrollment. This cohort was divided into 2 groups based on their age at transplant: Group 1 (0-5 years) and Group 2 (6-18 years). To assess transplant-related anxiety, depression, and QOL, participants completed 3 surveys: the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Pediatric Quality of Life Inventory™ Transplant Module (PedsQL TM). : Group 1 experienced less anxiety and fewer problems based on GAD-7 scores but reported stronger feelings of depression based on PHQ-9 scores. Based on the PedsQL TM scale, Group 1 had higher mean scores compared to Group 2 across all components (mean difference range: 7.2- 27.3; Cohen's d range: 0.27 - 1.13). The largest difference between the 2 groups was observed on the PedsQL TM scale's How I Look (Group 1 mean 81.1 vs. Group 2 mean 53.8; Cohen's d: 1.13; P = 0.015), : In this cohort, age at transplant affected adolescents' feelings of anxiety, depression, and QOL. Awareness of these findings can help clinicians screen for and address mental health issues.

Gaps exist in the understanding of the etiology of poor sleep quality after lung transplantation. Research Question: What factors are associated with poor sleep quality in lung transplant recipients?

Patients are at risk of hospital readmission after kidney and liver transplantation due to the complexity of posttransplant care. Currently, clinical practice relies on providers' prediction since there is a lack of specific strategies. However, the accuracy of clinicians' ability to predict readmissions using clinical judgment alone is unknown. What is the accuracy of clinicians' ability to predict readmissions after transplantation using clinical judgment alone? In 2019, clinical providers at a large, urban transplant center were electronically surveyed. Primary surgeons, nephrologists, transplant pharmacists, hepatologists, and nurses were asked, within 24 h of any kidney or liver transplant recipient discharge, to predict whether a patient would be readmitted within 30 days, and the suspected causes of readmission. Prediction accuracy was assessed by sensitivity, specificity, positive and negative predictive value, and F-score. Kappa scores were calculated to assess agreement between transplant surgeons and other providers. Overall,  = 34 unique providers were surveyed about 148 kidney and 63 liver transplant recipients, and 27.0% of kidney recipients and 25.4% of liver recipients were readmitted within 30 days. The positive predictive values were low among clinical providers, ranging from 0.25 to 0.55. Agreements between providers were weak, but higher among kidney transplant providers (range: 0.42-0.44) than for liver transplant providers (range: -0.02-0.26). Clinical judgment alone to predict readmission among transplant recipients may not be sufficient and a combination of clinicians' predictions, multitiered discharge surveillance strategies and data-based predictive models may better identify high-risk patients and guide interventions to reduce readmission.

Eliminating racial inequities in access to kidney transplantation requires multilevel interventions that target both patients and health systems.

The antioxidant effects of vitamins may attenuate the oxidative stress on organs imposed by ischemia-reperfusion injury during the process of organ transplantation from brain-dead donors. Circulating levels of vitamins A, C, and E-α in donors after brain death and their relationships to donor demographics, management, organ utilization, and recipient outcomes are largely unknown.

An inverse relationship has been identified between tacrolimus serum concentrations and donor-derived cell-free DNA (dd-cfDNA) levels after lung transplant, but limited data exists on this relationship in the kidney transplant population. The purpose of this evaluation was to examine the relationship between high tacrolimus variability and elevated dd-cfDNA levels in kidney and simultaneous pancreas-kidney transplant recipients at a single center. Single-center, retrospective, descriptive comparative evaluation of kidney and pancreas-kidney transplant recipients who received longitudinal ddcfDNA surveillance. Intrapatient tacrolimus variability was assessed using the coefficient of variation (%CV) measured between 1 and 12 months posttransplant. Pediatrics, retransplant or multiorgan transplant recipients, and pregnant recipients were excluded. One hundred fifteen recipients with 518 dd-cfDNA levels and 3028 tacrolimus troughs were assessed. Pancreas-kidney recipients had significantly higher median dd-cfDNA (0.29% vs. 0.18%,  = .034) and were excluded from analysis. Ninety-nine kidney transplant recipients were included for analysis. Recipients with tacrolimus %CV ≥30 ( = 66) had significantly higher median dd-cfDNA than %CV <30 (0.22% vs. 0.17%,  = .031). Tacrolimus %CV ≥30 demonstrated higher median peak dd-cfDNA than %CV <30, though this was not statistically significant (0.36% vs. 0.28%,  = .058). These data demonstrated that high intrapatient tacrolimus variability may be associated with elevated dd-cfDNA in the first year after kidney transplant.

The aim of the current study is to understand Americans' attitudes toward deceased organ donation and to assess their level of acceptance on positions toward organ donation. In summer and winter of 2023, 2 national samples completed measures of attitudes toward donation, reported their registration status, rated positions related to donation, and provided demographic information. Data from 2 samples indicated registration estimates between 50% and 57% and a significant proportion of those unregistered reported reluctance to register. The believability of national registry estimates and ratings of acceptability of 9 organ donation positions differed by registration status. Mass media and motor vehicles interventions seeking to increase registration rates should take into consideration individual attitudes and support toward donation may not be as strong as once thought.