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Introduction: Living liver donation improves survival of end‐stage liver disease (ESLD) patients. Yet, it continues to represent a small proportion of United States (U.S.) liver transplantation with existing racial disparities. We investigated the interplay of donor–recipient relationship and donor race to understand donor subgroups with no significant increase. Methods: We studied 4407 living liver donors in the U.S. from January 1, 2012, to December 31, 2022 (median age = 36 years, and 59% were biologically related to the recipient). We quantified the change in the number of donors per 3‐year increment using negative binomial regression (incidence rate ratio [IRR]), stratified by donor–recipient relationship and race/ethnicity. Results: Among biologically related donors, the observed annual number of White donors increased from 146 to 253, Hispanic donors from 18 to 53, and Black donors decreased from 11 to 10. Among unrelated donors, White donors increased from 65 to 221, Hispanic donors from 4 to 25, and Black donors from 3 to 11. For the IRR of biologically related donors aged <40 and ≥40 years, White donors increased by 18% and 22%; Hispanic donors increased by 25% and 54%; and Black donors did not change. Likewise, the IRR of unrelated donors aged <40 and ≥40 years, White donors increased by 48% and 55%; Hispanic donors increased by 52% and 65%; and Black donors did not change. Conclusions: While biologically related donors represent the majority of donors, unrelated donors have substantially risen in recent years, primarily driven by White donors. Although the rate of unrelated donations increased among Hispanic donors, the absolute number remains very small (≤25 donors/year). Interventions are needed to increase education among Hispanic and Black communities to grow unrelated living liver donations across race/ethnicity. [ABSTRACT FROM AUTHOR]

Introduction: Medication use in living kidney donor (LKD) candidates may have important implications for evaluation and donation care. We sought to characterize LKD candidate medication use through medication histories conducted at nephrologist evaluation and transplant pharmacist preoperative visits. Methods: This retrospective single‐center cohort study included adult LKD candidates evaluated for donation between October 1, 2019 and October 1, 2021. Scheduled and as‐needed medications for each candidate were abstracted from pre‐donation medication histories collected at the evaluation visit with the nephrologist and the preoperative visit with the transplant pharmacist, if approved for donation. Medication histories from each visit were compared with each other and evaluated by therapeutic class frequency. Results: Among 213 LKD candidates (112 approved for donation and 101 declined for donation), 198 (93.0%) candidates were taking at least one prescription medication, over‐the‐counter agent, or dietary supplement. Antidepressants and antihypertensives were the most common prescription agents used among candidates, with antihypertensives more common among declined donors (20.8% vs. 10.7%, p = 0.042). Nonsteroidal anti‐inflammatory drugs were more commonly identified at the evaluation visit of approved candidates compared to the preoperative visit (29.5% vs. 0.9%, p < 0.001) and dietary supplements were more commonly identified at the preoperative visit compared to the evaluation visit (49.1% vs. 59.8%, p = 0.023). Conclusions: The frequency of nonsteroidal anti‐inflammatory drugs decreased greatly between the evaluation and preoperative visit, likely reflective of discontinuation pre‐donation. Characterizing medication use among candidates evaluated for LKD donation may assist donor programs with developing more targeted patient medication education. Nearly all LKD candidates were taking a medication or dietary supplement pre‐donation. Transplant pharmacists are uniquely positioned to perform medication reconciliations and can also offer guidance to other team providers on best practices for this process. A better understanding of medication patterns in this population may also aid with further developing care guidelines for LKD evaluation and pre‐/postoperative LKD care. [ABSTRACT FROM AUTHOR]

Given the increasing frequency of simultaneous pancreas-kidney transplants performed in recipients with Type II diabetes and CKD, we sought to evaluate possible differences in the rates of allograft rejection, infection, and surgical complications in 298 Type I (T1D) versus 47 Type II (T2D) diabetic recipients of simultaneous pancreas-kidney transplants between 2006-2017. There were no significant differences in patient or graft survival. The risk of biopsy-proven rejection of both grafts was not significantly different between T2D and T1D recipients (HR pancreas = 1.04, p = 0.93; HR kidney = 0.96; p = 0.93). Rejection-free survival in both grafts were also not different between the two diabetes types (p pancreas = 0.57; p kidney = 0.41). T2D had a significantly lower incidence of de novo DSA at 1 year (21% vs. 39%, p = 0.02). There was no difference in T2D vs. T1D recipients regarding readmissions (HR = 0.77, p = 0.25), infections (HR = 0.77, p = 0.18), major surgical complications (HR = 0.89, p = 0.79) and thrombosis (HR = 0.92, p = 0.90). In conclusion, rejection, infections, and surgical complications after simultaneous pancreas-kidney transplant are not statistically significantly different in T2D compared to T1D recipients., Competing Interests: The authors of this manuscript have conflicts of interest to disclose as described by the Transplant International. JO is co-founder of, has equity interest in and serves as Chair of the Scientific Advisory Board of Regenerative Medical Solutions, Inc. He receives clinical trial support from Veloxis Pharmaceuticals, CareDx Transplant Management, Inc., Natera, Inc. and Vertex Pharmaceuticals, Inc. DK reports serving as a scientific advisor for, or member of, eGenesis, and receiving research funding from Medeor Pharma and the National Institutes of Health. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Martinez, Pham, Wang, Stalter, Welch, Leverson, Marka, Al-Qaoud, Mandelbrot, Parajuli, Sollinger, Kaufman, Redfield and Odorico.)