Search Results (570)

Background: The efficacy of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) has been confirmed in numerous controlled studies. However, in clinical practice, pharmacological treatment is heavily dependent upon the parents or guardians of patients. Parental attitudes are shaped not only by medical knowledge but also by parental beliefs about the use of pharmacotherapy and psychoactive substances, including ADHD pharmacotherapy. Parental beliefs about the safety and possible side effects of pharmacotherapy significantly influence their decision to accept or reject pharmacotherapy. This study aimed to explore parental beliefs and attitudes toward ADHD pharmacotherapy and their association with parental treatment acceptance and treatment-related decision-making. Methods: The cross-sectional online survey included 506 parents of children diagnosed with ADHD, recruited through closed social media groups. Parental treatment acceptance and decisions regarding initiation of pharmacotherapy were examined. Results: Parents of children with experience of pharmacotherapy more frequently considered pharmacotherapy safe (83.4% vs. 39.7%, p < 0.001) and expressed readiness to start treatment immediately (73.8% vs. 32.5%, p < 0.001). In this group, 72.6% of parents indicated that the benefits of pharmacotherapy outweigh potential risks. However, concerns about addiction were similar in both groups (49.4% vs. 45.3%, p = 0.400). In a gendered analysis, fathers were more likely than mothers to consider pharmacotherapy unnecessary for treating ADHD (35.3–22.4%; p = 0.002; V = 0.142) or disbelieve in ADHD treatment (25.7–15.1%; p = 0.005; V = 0.132). Furthermore, fathers were more likely than mothers to support limiting the use of pharmacotherapy for treating ADHD to those over 18 (41.3% vs. 26.5%; p < 0.001; V = 0.156), and to report parental opposition (28% vs. 8.1%; p < 0.001; V = 0.264), with a minimal to moderate effect size. Conclusions: Parental treatment acceptance decisions were associated with more favorable parental beliefs, although subjective concerns about addiction remained. Given the study’s cross-sectional and exploratory nature, causal interpretations should be avoided. Parental gender was associated with differences in beliefs and attitudes toward the use of pharmacotherapy for treating children diagnosed with ADHD, especially regarding necessity, consent and age-specificity. In our surveyed sample, fathers tended to be more restrictive or cautious than mothers. The findings also highlight the importance of psychoeducation and partnership-based communication between clinicians and families as key factors that may help support treatment acceptance-related decision-making in ADHD. Full article

The concrete cracking problem can seriously affect the durability and safety of civil structures. Accurately and quickly measuring the width of concrete cracks can help control defect development in a timely manner. Current research mainly relies on pixel detection of two-dimensional images, which lacks real three-dimensional information about crack lesions. Detection results are also obviously affected by various factors, such as shooting distance and posture, resulting in poor accuracy. Therefore, this paper presents an engineering-integrated solution that combines U-Net-based crack segmentation with binocular vision 3D reconstruction. The focus is placed on the practical deployment of the integrated pipeline, the optimization of key parameters under real inspection conditions, and the experimental validation of measurement accuracy on actual concrete cracks. Firstly, the U-Net deep learning algorithm is used to automatically identify and segment the concrete crack region; then, a binocular vision-based 3D reconstruction pipeline is adopted, and a parallax rejection algorithm based on a “double-threshold” decision is proposed to improve the fidelity of crack disparity maps, and the effect of the filter window size on the concrete crack region is analyzed; finally, an intelligent measurement method based on the 3D reconstruction model is proposed, and the measurement results of concrete crack width can be calculated directly from the 3D reconstruction model. The results show that (1) the model can identify the characteristics of the crack, and the detection effect at 4:00 p.m. is the best, because at this time the light is more uniform with less shadow and moderate contrast between the crack and its background; (2) the reconstruction of the 3D point cloud model of the concrete crack with a filtering window of size 9 × 9 is the best; (3) the maximum error between the calculated and measured values of crack width is 0.31mm, the minimum error is 0.07mm, and the average error is 0.15 mm, which indicates that the measurement accuracy reaches the sub-millimetre level and verifies the validity of the proposed method in this paper. Full article

Background: Heart transplantation (HTx) remains the gold-standard therapy for patients with end-stage heart failure. Cardiac rehabilitation (CR) is a multidisciplinary intervention that improves cardiovascular prognosis and quality of life. The aim of this randomized controlled trial was to evaluate the impact of cardiac telerehabilitation on cardiovascular events after HTx. Methods: Forty patients who had undergone HTx were recruited at a single Italian institution and randomly allocated 1:1 to an experimental group (on-site CR followed by 12 weeks of telerehabilitation) or a control group (on-site CR followed by standard homecare and an exercise program). The primary outcome was a 6-month composite of major cardiovascular events, including acute allograft rejection, heart failure hospitalization, coronary allograft vasculopathy, stroke, and all-cause mortality. Secondary outcomes included return to work within 6 months, physical and functional activity levels and treatment adherence. Results: Forty patients were equally allocated to control and experimental groups, with well-balanced baseline demographic, clinical, and functional characteristics. At 6 months, the primary composite endpoint occurred in 35% of patients in both groups, with no significant between-group differences. Return to work was observed in 72.2% of the controls and 64.3% of intervention patients. Physical activity levels were comparable between groups, with most patients classified as sufficiently active. Adherence to the cardiac telerehabilitation program was complete in only 50% of the patients. Conclusions: In this randomized trial on HTx patients, a hybrid telerehabilitation program was as safe as standard care regarding major cardiovascular events at 6 months. The low adherence observed suggests that future digital interventions must focus on enhancing patient engagement. Full article

Automated recognition of celestial bodies from observational imagery is a cornerstone of autonomous space exploration. However, deploying deep learning models in space environments entails rigorous requirements not only for accuracy but also for reliability (calibration) and safety (anomaly rejection). Traditional Convolutional Neural Networks (CNNs) trained on small-scale astronomical datasets often suffer from overfitting and overconfidence on Out-of-Distribution (OOD) artifacts. In this work, we present a robust classification framework based on DINOv2, a Vision Transformer pre-trained via discriminative self-supervised learning. We curate a high-fidelity dataset of seven planetary classes sourced from NASA archives and propose a two-stage domain adaptation strategy to transfer large-scale foundation model features to this fine-grained task. Extensive experiments show that our method reaches 100% Top-1 accuracy on the canonical split, and remains highly stable under split variation, achieving 99.43% ± 0.85% Top-1 accuracy across R = 5 repeated stratified splits. More importantly, we address the critical issue of model trustworthiness. Through post hoc temperature scaling, our model achieves a state-of-the-art Expected Calibration Error (ECE) of 0.08%, representing a 36-fold improvement over ResNet50 (2.90%) and a 4.5-fold improvement over the EfficientNet-B3 baseline (0.36%). Furthermore, by integrating Energy-based OOD detection, the system effectively rejects non-planetary artifacts with an AUROC of 93.7%. Qualitative analysis using Grad-CAM reveals that self-supervised attention mechanisms naturally focus on intrinsic planetary features (e.g., surface textures and rings) while ignoring background noise, confirming the superior robustness of vision foundation models in astronomical vision tasks. Full article

Background/Objectives: Family caregivers play a central role in the provision of long-term home-based care and often provide unpaid support over extended periods. This role is associated with substantial psychological, physical, social, and financial burden. Despite high support needs, access to psychosocial services remains limited for many family caregivers. Against this background, AI-based care companions are discussed as a potential low-threshold supplement to existing support structures. The objective of this study was to explore subjectively perceived family caregiver burden and to examine expectations, acceptance conditions, and concerns regarding a hypothetical AI-based care companion, rather than to evaluate effectiveness. Methods: An exploratory mixed-methods study was conducted using an anonymous online survey. Perceived family caregiver stress was assessed using self-developed, non-validated ordinal items, including a single-item global burden rating and categorical stress domains. The questionnaire combined closed-ended items (Likert-scale and multiple-choice) with one open-ended question to assess perceived stress, experiences with psychosocial support, and attitudes toward a hypothetical AI care companion. Participants were recruited via an online caregiving course platform. Data collection was voluntary and anonymous and took place in Germany between October and November 2025. Quantitative data were analyzed descriptively and exploratorily, and qualitative responses were analyzed using thematic analysis. Results: Fifty-five family caregivers participated in the survey. Overall, perceived family caregiver burden was high, with psychological stress most frequently identified as the dominant stress domain. Difficulties in accessing psychosocial support were reported by 58% of the respondents. Willingness to consider using an AI-based care companion varied by degree of acceptance: 36% reported clear willingness, 31% expressed conditional or tentative willingness, and 33% indicated reluctance or rejection. The most frequently selected expected functions included emotional support, early detection of overload, and caregiving-related information. Data protection, professional reliability, and concerns regarding incorrect advice were identified as the most relevant perceived risks. Conclusions: The findings reflect family caregivers’ perceived burden and anticipated needs, highlighting persistent gaps in psychosocial support. From the perspective of respondents, a hypothetical AI-based care companion could represent a complementary support option if it provides personalized, non-judgmental, and reliable assistance. These results describe perceived potential and acceptance conditions, not verified efficacy. Further research, including prototype development, usability testing, and pilot studies, is required to examine feasibility, ethical implications, and real-world impact. Full article

Background: Kidney transplantation is the optimal treatment for end-stage renal disease; however, acute rejection remains a major determinant of long-term graft dysfunction and failure. Donor-derived cell-free DNA (dd-cfDNA) has emerged as a minimally invasive biomarker reflecting allograft injury, with growing evidence supporting diagnostic and prognostic utility. Objectives: This structured narrative review aimed to synthesize contemporary evidence (2020–2025) on the diagnostic and prognostic utility of plasma dd-cfDNA and its integration into kidney transplant rejection surveillance. Methods: A narrative literature review was conducted using PubMed to identify studies published or available online ahead of print, between January 2020 and September 2025, evaluating plasma dd-cfDNA in adult kidney transplant recipients. Manual screening of reference lists supplemented the search. Original clinical studies reporting diagnostic or prognostic outcomes were included, and the results were synthesized narratively due to methodological heterogeneity. Results: Across prospective and retrospective cohorts, elevated dd-cfDNA discriminated rejection from non-rejection biopsies, with strongest performance in antibody-mediated and microvascular rejection phenotypes. Longitudinal studies demonstrated that dd-cfDNA elevations often preceded histologically confirmed rejection and predicted adverse graft outcomes, while low levels were associated with immunologic quiescence. Assay variability limited cross-study comparability, whereas integration with donor-specific antibodies, gene expression profiling, or algorithm-based approaches improved diagnostic and prognostic discrimination. Conclusions: Dd-cfDNA is a clinically meaningful biomarker for kidney transplant rejection monitoring, providing diagnostic and prognostic information beyond conventional functional markers. When interpreted longitudinally and in clinical context, dd-cfDNA supports risk stratification and surveillance, with evidence supporting its expanding role in risk-adapted transplant care. Full article

Background: Early excision and autologous split-thickness skin grafting are the cornerstone of surgical management in severe burn injuries. In patients with extremely extensive deep burns, the lack of available donor sites represents a major life-threatening limitation. In the exceptional situation of monozygotic twins, skin isografting offers a unique solution by providing immunologically compatible skin without the risk of rejection. Case report: We report the case of a 33-year-old man who sustained flame burns involving 95% of his total body surface area, resulting in an extremely poor initial prognosis (ABSI 14, UBS 245). After early resuscitation and staged surgical excisions, the absence of sufficient autologous donor sites precluded definitive coverage using conventional techniques. On day 3, the existence of a monozygotic twin brother was identified. HLA genotyping confirmed complete identity, and skin donation was authorized by an independent ethics committee. Methods: Definitive wound coverage was achieved using staged split-thickness skin isografts harvested from the donor twin. Ultra-thin grafts (<0.2 mm) were obtained in three procedures (days 7, 11, and 45), primarily from the scalp, thighs, and back, and applied following sequential excisions. Results: All grafts survived without immunological rejection. Donor-site morbidity was minimal, with rapid healing and only mild residual hypopigmentation. The patient was discharged to rehabilitation on day 145. At 5-year follow-up, wounds were fully healed, functional outcome was satisfactory, and quality of life was good, with return to work and full independence. Conclusions: Skin isografting from a monozygotic twin is a rare but effective salvage strategy for patients with massive deep burns when autologous donor sites are insufficient, provided that ethical, legal, and donor safety considerations are rigorously addressed. Full article

Background/Objectives: Chronic lung allograft dysfunction (CLAD) remains the leading cause of late graft failure after lung transplantation (LuTX). De novo donor-specific anti-HLA antibodies (dnDSA), especially HLA-DQ, have been implicated; we assessed associations between dnDSA (class and specificity) and CLAD after LuTX. Methods: We retrospectively analyzed all LuTX recipients transplanted from 2005–2018 at a single center (n = 585). dnDSA were measured by Luminex single-antigen bead assays (MFI > 1000) at 1, 3, 6, and 12 months and at least annually thereafter. CLAD was defined by ISHLT criteria; time-to-event comparisons used log-rank testing. Results: dnDSA developed in 151/585 recipients (25.8%), predominantly class II (129/585; 22.1%); class I dnDSA occurred in 52/585 (8.9%). CLAD occurred more frequently in dnDSA-positive than dnDSA-negative recipients (64/151; 42.4% vs. 109/434; 25.1%; p < 0.0001). Rejection-attributed death was higher in dnDSA-positive recipients (19/151; 11.3% vs. 25/434; 5.3%; p = 0.01). Both class I and class II dnDSA were associated with higher CLAD rates (log-rank p < 0.001 each). Locus-specific analyses identified HLA-DQ dnDSA as strongly associated with CLAD (p < 0.0001); DQ7 was the most frequent specificity (n = 44) and showed the strongest association (p < 0.0001). Conclusions: dnDSA after LuTX were associated with increased CLAD incidence and rejection-attributed mortality, with a prominent association for HLA-DQ—particularly DQ7. Full article

Background/Objectives: The scientific community is still divided between supporters of the implantation theory and researchers who advocate the theory of coelomic metaplasia/embryonic cell remnants to explain the initiation of endometriosis. A frequently cited argument in favor of the coelomic metaplasia/embryonic cell remnants theory is the occurrence of endometriosis in the Mayer-Rokitansky-Kuster-Hauser syndrome, since retrograde menstruation is not possible without endometrium. However, nearly all women with uterovaginal agenesis have uterine remnants that harbour islets of endometrium. Methods: To verify the validity of the coelomic metaplasia/embryonic cell rests theory, we analysed all reports of endometriosis in patients with Mayer-Rokitansky-Kuster-Hauser syndrome without endometrium, published between 1980 and 2025. Three criteria had to be met in order to clearly demonstrate the absence of endometrium and the presence of endometriosis: (i) preoperative imaging, (ii) surgical visualization, and (iii) histological examination. Results: None of the nine reports fully met all three criteria, and the presence of endometrium could never be ruled out. In addition, we used ten characteristics to assess the ‘goodness’ of a theory: testability, logical coherence, conceptual clarity and comprehensibility, external consistency, empirical validity, predictive power, parsimony, broad applicability, practical utility, and heuristic value. Conclusions: Overall, the implantation theory appears to fully satisfy all criteria to explain the onset of endometriosis in Mayer-Rokitansky-Kuster-Hauser syndrome. In contrast, the coelomic metaplasia/embryonic cell rests theory satisfies eight criteria only partly and does not satisfy two of them. Therefore, the null hypothesis that endometriosis can be present in the absence of endometrium in patients with utero-vaginal agenesis can be reasonably rejected. Full article

Background/Objectives: To evaluate the outcome of developing BKPyV-DNAemia and presumptive BKPyV-nephropathy (BKPyV-DNAemia ≥ 10⁴ copies/mL for more than 2 weeks) within the first 2 years post-transplant in a Belgian population of renal transplanted children. Methods: All children transplanted between 1 January 2010 and 31 December 2022 at Queen Fabiola Children’s University Hospital, Brussels (HUDERF) and at University Hospitals Leuven (UHL) were included in this retrospective study and 86 were followed for at least 2 years post-transplantation. Results: Within the first 2 years, 11/86 (13%) patients developed BKPyV-DNAemia ≥ 10⁴ copies/mL (82% within the first 6 months). Among the 11 patients, 7 underwent a biopsy, of whom 4 were confirmed to have biopsy-proven BKPyV-nephropathy. Of those 11 patients, 4 (36%) developed an acute cellular rejection following immunosuppression reduction. The median eGFR at 2 years post-transplantation was 69 mL/min/1.73 m² (IQR: 59–79) in the seven patients with presumptive BKPyV-nephropathy and 40 mL/min/1.73 m² (IQR: 39–41) in the four with biopsy-proven BKPyV-nephropathy. At last follow-up visit, the median eGFR was 65 mL/min/1.73 m² (IQR: 59–71) in the children with presumptive BKPyV-nephropathy, and 28 mL/min/1.73 m² (IQR: 20–34) in the patients with biopsy-proven BKPyV-nephropathy. No risk factors for developing BKPyV-DNAemia were identified. Conclusions: Our study confirms that while BKPyV-DNAemia monitoring is essential in pediatric kidney transplant recipients, decisions based solely on viral load risk overtreatment and immunological complications. A personalized approach integrating viral, clinical, and immunological markers is urgently needed to balance infection control with graft preservation. Full article

Background/Objectives: Refractory macular holes (MHs) that persist after conventional internal limiting membrane (ILM) peeling pose a significant surgical challenge. In this study, we analyzed the anatomical and functional outcomes of epiretinal human amniotic membrane (hAM) transplantation in patients with MHs. Methods: This retrospective study included 10 eyes of 10 patients with refractory MHs. All patients underwent 25-gauge pars plana vitrectomy, epiretinal cryopreserved hAM transplantation, and C3F8 gas tamponade. The large hAM graft was placed over the macula with the stromal side facing the retina. Preoperative and postoperative best-corrected visual acuity (BCVA), optical coherence tomography (OCT) findings, and MH dimensions were recorded. Results: The mean follow-up period was 7 months (range: 3–14 months). The mean preoperative minimum linear diameter and base diameter of the MHs were 715 ± 212 μm and 1114 ± 258 μm, respectively. Anatomical closure was achieved in all patients (100%). Postoperative OCT revealed rearrangement of the inner and other retinal layers in 7 out of 10 patients (70%), with partial restoration of the outer retinal layers. The mean logMAR BCVA improved significantly from 1.60 ± 0.37 preoperatively to 1.00 ± 0.45 postoperatively (p < 0.001). No graft dislocation, rejection, or other significant complications were observed. Conclusions: Our preliminary results suggest that epiretinal human amniotic membrane transplantation is a feasible and promising surgical technique for achieving anatomical closure and functional improvement in refractory macular holes in which conventional ILM peeling has failed. Full article

Background/objectives: Kidney transplant recipients require lifelong immunosuppression and monitoring to prevent rejection, infection, and graft dysfunction. Current surveillance relies on tacrolimus therapeutic drug monitoring and, when needed, invasive biopsies. Dried blood spot (DBS) sampling provides a minimally invasive, patient-friendly option for remote follow-up. This study aims to develop and evaluate a DBS-based method for CXCL-10 quantification that, in combination with tacrolimus exposure monitoring, could help identify kidney recipients at risk of rejection and cytomegalovirus (CMV) infection and guide immunosuppression adjustment. Methods: The study included 81 selected kidney recipients for CXCL-10-DBS analysis by ELISA (12 T-cell mediated rejection; 10 antibody-mediated rejection; 6 CMV infection and 53 clinical event-free) and 10 healthy volunteers. A Tacrolimus-DBS LC-MS/MS method was developed and validated, and it was compared with the reference method on venous whole blood (WB) LC-MS/MS in a validation cohort (n = 160) and a clinical cohort (n = 36) using linear regression, Passing–Bablok and Bland–Altman analyses. Results: CXCL-10-DBS concentrations were significantly higher in rejectors (p < 0.001), with intermediate increases in CMV infection in comparison with event-free patients and healthy volunteers. ROC analysis demonstrated excellent diagnostic accuracy for rejection (AUC: 0.952; cutoff: 216.2 pg/mL; sensitivity: 100%; specificity: 79%; PPV: 88%; NPV: 100%). In contrast, tacrolimus trough concentrations did not differ significantly among the three clinical groups but showed strong correlation and agreement between DBS and venous WB with no systematic or proportional bias. Conclusions: This pilot study demonstrates the feasibility and diagnostic potential of DBS-based CXCL-10 measurement in adult kidney recipients. Integration of DBS-tacrolimus monitoring supports a minimally invasive pharmacokinetic–pharmacodynamic approach for personalized immunosuppression management. Full article

To address the challenges of ambient light interference and slow overload recovery in transimpedance amplifiers (TIAs) for automotive Light Detection and Ranging (LiDAR) systems, this paper proposes a high-performance TIA with integrated ambient light cancellation and fast recovery capabilities. The core design includes an adaptive ambient light cancellation (ALC) loop that eliminates background currents up to 3 mA without relying on AC coupling capacitors, achieving a low-frequency cutoff frequency of 321 kHz to ensure the signal-to-noise ratio (SNR) of weak target signals. A multi-stage clamping and current transfer mechanism is employed to realize rapid overload recovery: under 100 mA heavy overload conditions, the recovery time is controlled around 8.7 ns, and the pulse broadening is limited to 2.7 ns, avoiding measurement blind zones. Implemented in a 0.18-μm SiGe BiCMOS process, the proposed TIA occupies a compact area of 0.15 mm², with a transimpedance gain of 80 dBΩ (10 kΩ) and a −3 dB bandwidth of 421 MHz. The input-referred noise current spectral density is 4.7 $\mathrm{pA}/\sqrt{\mathrm{Hz}}$, and the integrated equivalent input noise current from 1 Hz to 250 MHz is 73.6 nA_rms. Operating over a temperature range of −40 ℃ to 125 ℃, the TIA meets the rigorous requirements of automotive-grade applications. Performance comparisons with commercial products and state-of-the-art designs demonstrate its competitive ambient light rejection and fast recovery capabilities, validating its potential for use in direct time-of-flight (dToF) LiDAR systems for autonomous driving. Full article

Background: Patients after heart transplantation (HTX) require lifelong immunosuppressive therapy to prevent graft rejection, thereby increasing susceptibility to infections. C-reactive protein (CRP) is a recognized biochemical marker of system-wide inflammation and generally rises with increasing infection severity. As the prognostic relevance of elevated CRP (≥20 mg/L) prior to HTX has been unclear, we analyzed its effects on post-transplant outcomes. Methods: We performed a retrospective, observational, single-center study including 418 patients who received HTX at Heidelberg Heart Center between the years 2000 and 2019. HTX recipients were grouped according to pre-transplant CRP (<20 or ≥20 mg/L). We analyzed donor and recipient characteristics, post-transplant pharmacotherapy, and post-transplant mortality including causes of death. Results: Pre-transplant CRP was ≥20 mg/L in 102 of 418 HTX recipients (24.4%). These patients had a significantly higher 30-day (11.8% versus 5.1%, p = 0.019), 1-year (39.2% versus 17.4%, p < 0.001), 2-year (42.2% versus 23.1%, p < 0.001), and 5-year post-transplant mortality (47.1% versus 30.4%, p = 0.002). Infection/sepsis was more frequently the cause of death within five years after HTX among patients with a pre-transplant CRP ≥ 20 mg/L (28.4% vs. 15.8%, p = 0.005), particularly pulmonary infections (19.6% vs. 9.5%, p = 0.006). Multivariate Cox regression showed pre-transplant CRP ≥ 20 mg/L as an independent predictor of 5-year post-transplant mortality (HR: 1.630, 95% CI: 1.144–2.323, p = 0.007). Conclusions: Pre-transplant CRP ≥ 20 mg/L identifies HTX candidates at increased risk of infection-related mortality after HTX, particularly pulmonary infections. Intensified pre-transplant evaluation for occult infection and close post-transplant infectious surveillance is advisable. Full article

Background: Obesity is increasingly prevalent among kidney transplant candidates; however, its impact on graft outcomes in Asian populations is not well characterized. We evaluated the association between preoperative obesity and living-donor kidney transplantation outcomes in Japan. Methods: We analyzed 623 living-donor kidney transplants performed from 1998 to 2021 at six centers in northern Japan. Recipients were categorized by body mass index (BMI) at transplant, and multivariable Cox regression was employed for assessing graft outcomes. Results: Obesity (BMI, ≥30 kg/m²; n = 27 [4.3%]) was the strongest graft failure predictor (hazard ratio, 4.62) compared with normal-weight recipients. Moreover, overweight status (BMI, 25–29.9 kg/m²), acute rejection, and older donor age were independent risk factors. Despite similar rejection rates across the BMI groups, recipients with obesity exhibited persistently impaired kidney function from 1-week posttransplant to the 5-year follow-up. Patient survival was comparable across BMI groups; however, underweight status (BMI < 18.5 kg/m²) was associated with higher mortality. Conclusions: Preoperative obesity and overweight status were significant risk factors for graft failure in Japanese living-donor kidney transplant recipients. Meanwhile, the mortality rate was significantly higher in the patients with underweight status at transplant. Pre-transplant weight optimization and shared decision-making with candidates warrant consideration. Full article