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Jon Scott Odorico

Specialty Chief Editor

University of Wisconsin-Madison

Cell and Stem Cell Transplantation
Reviewer
Not reviewing

Recently published in their journal

Original Research

Comparative long-term outcomes of kidney transplantation from donors with isolated microscopic hematuria and thin basement membrane disease versus donors with isolated microscopic hematuria and normal histology: the largest cohort analysis to date

Yaser Shah, Dieter Broering, Dalia Obeid, Hassan Aleid, Ahmed Nazmi, Hani Alahdal, Kris Ann Hervera Marquez, Turki AlHussain, Tariq Ali

Thin basement membrane disease (TBMD) represents a frequent etiology of isolated microscopic hematuria (IMH) and is often identified during the evaluation of living kidney donor candidates. Although typically regarded as a benign condition, its genotypic overlap with Alport spectrum disorders has raised concerns regarding potential post-transplant implications. This study aimed to compare long-term graft and recipient outcomes following kidney transplantation from donors with biopsy-confirmed TBMD versus donors exhibiting IMH with normal histopathological findings. A retrospective cohort analysis was conducted including 93 living donor–recipient pairs: 39 donors (41.9%) with TBMD and 54 donors (58.1%) with normal biopsy results despite IMH. Donor and recipient demographic, clinical, and immunologic parameters were examined. Primary outcomes encompassed renal function, persistence of hematuria, proteinuria, arterial blood pressure, biopsy-proven rejection episodes, and both patient and graft survival. Follow-up duration extended up to 9 years (median 3 years). Baseline demographic and clinical characteristics were comparable between the two groups. At 12 months post-transplant, mean serum creatinine levels did not differ significantly between recipients of TBMD donor kidneys and those of normal biopsy donors (95 µmol/L vs. 88.5 µmol/L; p = 0.579). Renal function and graft survival remained stable over the follow-up period. The incidences of delayed graft function and biopsy-confirmed acute rejection were low and similar between groups. Persistent microscopic hematuria was observed in 87.2% of recipients from TBMD donors and 73.1% of those from normal biopsy donors; however, none developed albuminuria. One-year graft survival was excellent and sustained at the latest follow-up (97.4% vs. 98.1%). Kidney allografts from donors with TBMD demonstrate long-term graft function and survival outcomes equivalent to those from donors with IMH and normal histology, supporting the overall safety of the allograft after kidney transplantation from TBMD donors. Although persistent microscopic hematuria was common, it did not adversely affect graft outcomes. Further large-scale, prospective, and genetically stratified studies including both recipients and donors are warranted to confirm long-term allograft safety and to refine donor selection criteria.

Perspective

Advancing cardiac xenotransplantation: overcoming challenges and ethical considerations for clinical integration

Ahmed A. Abdelrehim, Daniel J. Hurst, W. Hampton Gray, Robert Sorabella, Luz A. Padilla

Advanced heart failure affects over 6 million adults in the United States alone. Orthotopic heart transplantation remains the definitive treatment, with over 90% one-year survival and meaningful gains in functional status and quality of life. The therapy is, however, constrained by an intractable supply problem. For decades, xenotransplantation (XTx), the transplantation of organs across species, has been proposed as a means of closing this gap, though for most of that time it remained a theoretical aspiration. With the discovery of CRISPR-Cas9 gene editing, improved immunosuppressive strategies, and refined preclinical models, the field has accelerated at an unprecedented pace. Multi-gene-edited porcine donors have survived for more than 200 days in orthotopic non-human primate models, and two compassionate-use pig-to-human cardiac transplants at the University of Maryland (2022 and 2023) demonstrated some feasibility for clinical cardiac XTx for the first time. In May 2026, the FDA granted clearance under an investigational new drug application to allow the EXPRESS study, the first prospective clinical trial of a gene-edited porcine heart, to proceed. In this perspective, we discuss the ethical, regulatory, and equity considerations that remain as decisive barriers to clinical integration and may shape how this therapy is introduced along the remaining immunologic and virologic challenges. We outline what we regard as the near-term priorities: defining the antibody targets that drive xenograft rejection, standardizing virologic surveillance, candidate selection and outcome benchmarking, and building access patterns with embedded distributive justice from the outset of its implementation.