The research team, led by Rachel Forbes, Marissa C. Kuo, and Elisa J. Gordon, conducted a prospective, cross-sectional, single-center study using a mixed-methods concurrent triangulation design. They interviewed twenty clinicians and implementation science experts, drawn from the kidney transplant program and Vanderbilt Health’s Center for Clinical Quality and Implementation Research, along with twenty-three patients who had been referred to, waitlisted for, or had received a kidney transplant at the center. Semi-structured interviews were conducted by Microsoft Teams between late February and late April 2024, with clinician interviews averaging fifty-five minutes and patient interviews averaging thirty-three minutes. During the interviews, participants also completed descriptive surveys, allowing the researchers to compare qualitative themes with quantitative ratings and strengthen the validity of their findings.

The analytical backbone of the study was the Consolidated Framework for Implementation Research 2.0, an evidence-based determinant framework comprising thirty-eight constructs across five domains: Innovation Characteristics, Individual Characteristics, Inner Setting, Outer Setting, and Process. In this study, Innovation Characteristics referred to the dashboard itself, Individual Characteristics to the people who would create and use it, Inner Setting to the hospital system, Outer Setting to the surrounding community and state, and Process to the strategies used to deploy it. Transcripts were analyzed using deductive coding guided by the framework, with each transcript independently coded by at least two research team members. Inter-rater reliability was assessed iteratively until the team reached a Cohen’s kappa coefficient above 0.80, and coding discrepancies were resolved through consensus discussions.

The results paint a strikingly optimistic picture. Perceived facilitators included Inner Setting constructs of mission alignment, culture, tension for change, compatibility, and structural characteristics, along with the Individual Characteristics construct of high-level leaders. Participants anticipated that the dashboard would align with the institution’s commitment to patient-centered care, fit naturally into center workflow, and enjoy strong leadership support. One clinician explained that the dashboard highly aligned with the transplant center’s mission of providing lifesaving organs to anyone who could benefit from them, noting that large groups of patient populations lack access to transplant and that the tool would help fix that. Another emphasized that the culture of the transplant center, where people at every level are passionate about helping patients get transplanted, would motivate everyone to step up if findings showed inequities that needed addressing.

Leadership support emerged as a particularly powerful facilitator. Participants anticipated that the transplant center’s and organization’s leadership would provide strong project buy-in because leadership had already demonstrated support for endeavors promoting equitable care. One respondent noted that leadership would have a vested interest in supporting the dashboard for advancing the goal of increasing transplant volumes by identifying and overcoming barriers to transplantation. Respondents recognized the need for sustained and proactive leadership involvement to ensure the dashboard’s effective integration and sustainability within clinical workflows, viewing leadership support not simply as administrative endorsement but as a prerequisite for securing organizational commitment, allocating resources, and sustaining implementation over time.

Perceived barriers, by contrast, were concentrated in the Innovation Characteristics construct of costs and the Inner Setting constructs of access to knowledge and information, information technology infrastructure, and work infrastructure. Financial costs were expected to support information technology development, staff training and time, and interventions arising from dashboard findings. Yet participants generally distinguished between the initial investment required to develop the dashboard and the relatively limited resources anticipated for long-term maintenance. One clinician remarked that while it would cost money, once the original design was established it should become fairly automatic, and that the cost would not be astronomical if the institution valued the project. Another noted that short-term resources would be needed but that long-term requirements would be minimal once the system was in place.

Work infrastructure concerns reflected the realities of a busy academic hospital. Participants worried about how dashboard implementation would add responsibilities to an already overextended workforce, with one noting that people get comfortable with a certain workflow and that adding something else can throw a monkey wrench into how they work. Respondents identified potential challenges of integrating the dashboard into existing workflows, including pre-determining dashboard content, defining data elements and visualization standards, developing mechanisms for maintenance, and determining how findings would be used and disseminated. The potential for variation in dashboard data collection or interpretation was seen as threatening consistency and reliability. Information technology infrastructure was another widely recognized barrier, with respondents emphasizing the importance of securing health IT’s support and identifying team members with expertise in health science informatics to ensure the dashboard could be built within the existing electronic health record.

Beyond barriers and facilitators, the study generated concrete design recommendations. All surveyed clinicians and patients agreed to include six of the eight evaluation phases in the dashboard, including the total number of patients referred for transplantation, the percentage of referred patients who were waitlisted, and the percentages who received a kidney transplant overall, a deceased donor transplant, or a living donor transplant. All clinicians agreed to include eight of the twenty-five social drivers of health listed, with leading variables including patient age, access to healthcare services, and healthcare communications. Patients suggested also tracking pre-referral phases such as the severity of kidney failure, adherence to dialysis, and access to living donors, along with reasons for delays during evaluation and post-transplant outcomes. Notably, clinicians expressed a preference for including more social drivers in the dashboard than patients did, which the researchers attributed to clinicians’ commitment to upholding institutional values of equity, quality improvement, and access to transplant care.

The researchers argue that the asymmetry between barriers and facilitators is what makes the dashboard so promising. Perceived barriers were largely modifiable, while perceived facilitators were immutable and integral to the institution’s core values, which would facilitate implementation. The study also identified a reverse causal relationship compared with existing business management literature: rather than the dashboard creating mission alignment, existing institutional values were expected to facilitate dashboard adoption. The team plans to integrate the dashboard into the electronic health record, updated in real time, and to use it during routine quarterly Quality Assurance and Performance Improvement meetings where the full multidisciplinary transplant team will review and monitor results. They emphasize engaging the entire team when discussing dashboard data because it takes a collective effort to address these things, and recommend establishing a safe space for discussion with expectations that not all identified disparities can be acted upon immediately.

The implications extend beyond one transplant center. In 2021, the Organ Procurement and Transplantation Network developed an Equity in Access to Transplant dashboard to assess the impact of social drivers on waitlisting and transplantation, but that dashboard does not assess the impact of social drivers from referral throughout the evaluation process, which the proposed Equity Dashboard aims to do. The Vanderbilt team’s next steps entail building the dashboard and conducting a modified Delphi method including clinicians and patients to refine dashboard variables and integration into existing workflows, with special consideration granted to patient-prioritized variables identified through the present study. The researchers do not anticipate designing the dashboard to be patient-facing, since the transplant center may not be equipped to address upstream, nonmodifiable risk factors contributing to disparities, which could lead patients to misinterpret the data. As a single-center study, the findings may not generalize to other transplant programs, and the researchers acknowledge limitations including low patient participation rates attributed to the opt-in portal recruitment approach and the exclusion of non-English speakers, which may underestimate barriers faced by the very populations the dashboard aims to track. Nevertheless, the convergence between qualitative themes and quantitative survey responses strengthens confidence that the proposed dashboard content reflects stakeholder priorities rather than isolated opinions, and future research will evaluate the dashboard’s implementation on patients’ actual transplant access.

Subject of Research: Barriers and facilitators to implementing an electronic equity dashboard for identifying disparities in kidney transplant access

Article Title: Barriers and facilitators to developing an equity dashboard to identify disparities in kidney transplant access: a mixed methods study

Article References: Forbes, R., Kuo, M. C., Frazee, M. D., Rogers, J. L., Vimalathas, P., Brooks, H. L., & Gordon, E. J. (2026). Barriers and facilitators to developing an equity dashboard to identify disparities in kidney transplant access: a mixed methods study. Frontiers in Transplantation, 5, Article 1906784. https://doi.org/10.3389/frtra.2026.1906784

Image Credits: AI Generated

DOI: 10.3389/frtra.2026.1906784

Keywords: kidney transplant, health equity, equity dashboard, transplant disparities, social drivers of health, implementation science, electronic health record, Consolidated Framework for Implementation Research, mixed methods, transplant evaluation, Quality Assurance and Performance Improvement, patient-centered care

The research, published in Frontiers in Transplantation, used a mixed-methods exploratory sequential design to interview 15 consultant kidney transplant surgeons from seven UK transplant centres about adverse events they had experienced during their careers. Each participant underwent an individual, semi-structured qualitative interview lasting between 22 and 71 minutes, transcribed verbatim and analysed using Braun and Clarke’s reflexive thematic analysis framework. Alongside the interviews, participants completed two validated psychometric instruments: the 44-item Big Five Inventory, measuring the five-factor model of personality across extraversion, agreeableness, conscientiousness, neuroticism and openness, and the Domain-Specific Risk-Taking (DOSPERT) scale, which quantifies attitudes toward risk across ethical, financial, health and safety, social and recreational domains. Integration of the qualitative and quantitative datasets occurred at the analysis stage, allowing the researchers to triangulate how personality traits and lived experience interact in shaping surgeons’ responses to adverse events.

An adverse event was defined as an unintended event occurring during or following transplantation that resulted in patient harm, encompassing both preventable errors made during an operation and known procedural complications. This broad definition was deliberate, allowing the study to capture the full spectrum of harm that transplant surgeons confront. The stakes in transplantation are uniquely high: unlike most surgical fields, the surgeon is responsible for two patients simultaneously, the donor and the recipient, and must balance the imperative not to waste a scarce organ against the risk of implanting one that may fail. Outcomes are closely monitored, and once the operation is performed there is limited opportunity to rectify errors. A surgeon’s influence extends beyond the operating table to organ acceptance decisions, meaning that a shift toward risk aversion after an adverse event could translate into higher rates of organ refusal and fewer transplants performed.

The thematic analysis identified four main themes with nine subthemes. The first and most visceral theme was that adverse events have a profound psychological impact. Every surgeon described an immediate emotional response, sharing in the trauma of the patient with feelings of sadness, anxiety, guilt and frustration. One participant described being “devastated, devastated, obviously, really upset,” while another recounted mentally replaying the entire operation on the drive home, unable to stop. The long-term emotional response proved more varied: some surgeons continued to feel the same intensity of distress years later, while others reported a more subdued reflection over time. In both cases, the emotional burden faded from daily consciousness but remained accessible, resurfacing when the surgeon encountered the same patient’s name or faced a similar clinical scenario. One surgeon reflected, “You don’t forget about it. And it carries with you. And you still think about it. And every time you see their name, you shudder.”

The second theme centred on how the surgical environment shapes the response to an adverse event. Participants consistently emphasised that a cohesive, supportive unit was foundational in navigating the aftermath. Informal peer support, colleagues offering perspective and reassurance, was regarded as the most effective coping mechanism, often described as an inherent part of team culture rather than a formal service. This relational support was preferred over accessing structured support services, which surgeons said they would not routinely rely upon. Conversely, a fragmented team dynamic was found to add to the burden. The study also revealed a darker side of the surgical environment: scrutiny following an adverse event evoked doubt in surgical capabilities, with some surgeons admitting that their decision-making became governed by concern over peer perceptions rather than clinical reasoning. One participant noted that at times they had considered changing their mind not because they felt the decision was wrong, but because of “the perception of your peers in a heavily scrutinised environment.” Pressure from external bodies reviewing departmental metrics compounded this anxiety, with one surgeon describing fear that statistics would be processed “without knowing the context” in a way deleterious to the department.

Yet scrutiny was not uniformly destructive. A positive aspect emerged within the morbidity and mortality (M&M) meeting process, where surgeons found value in thorough, non-personalised review of errors. Participants distinguished this constructive accountability from perceived colleague scrutiny, which they described as harmful and associated with self-doubt. A well-conducted M&M process allowed surgeons to learn from mistakes and take responsibility in a manner that, as one put it, “you can’t be personal about.” This distinction reinforces the importance of psychological safety, an environment where staff are comfortable admitting mistakes and learning from them, which is shaped by continuous interpersonal interactions among co-workers and ultimately benefits patient outcomes.

The third theme concerned changes in practice following an adverse event. Surgeons commonly expressed a desire to improve, driven by surgical pride and a sense of responsibility to every patient who comes to harm. Some sought out colleagues to observe alternative techniques, such as reviewing how peers perform arterial anastomoses after their own approach failed. Critically, participants reported that changes to practice should be based on decision-making processes rather than outcomes alone, warning against overcorrecting based on isolated incidents while remaining alert to patterns suggesting systemic issues. Some surgeons reported formalising their consent process and risk explanation when counselling future patients. Perhaps most significantly, the study documented shifts in risk attitude: many surgeons described a natural, often temporary, move toward conservatism in the immediate aftermath of an adverse event, followed by a recalibration of risk appetite based on surgical confidence and patient need. One surgeon observed that a disastrous first case could have a massive impact on the rest of a career, making a surgeon “much more conservative and much less willing to accept risk.” Others noted that the easiest path is risk aversion, which they considered “very bad medicine because patients are not getting the treatment that they deserve.”

The fourth theme explored the influence of personality on responses to adverse events. Participants consistently believed there to be a link between personality and how they processed these events. The Big Five Inventory findings provided descriptive context: mean neuroticism scores were higher among surgeons reporting greater long-term emotional impact (3.28) than among those reporting lesser impact (2.08), though the researchers caution that given the limited sample size this comparison is descriptive rather than associative. DOSPERT scores were comparable across all domains. Two subthemes emerged as protective mechanisms. The first was “robustness,” the ability to draw a line after an adverse event, temporarily pausing one’s own emotional response to continue clinical tasks and process the trauma later. Participants described compartmentalising emotions, with one stating, “Frankly, your emotions, in my opinion, are in that situation, secondary. You just got to put them away somewhere, compartmentalise them.” The second was “purpose”: surgeons described a period of introspection that reinforced the fundamental values of their career, a duty to patients, to shoulder responsibility, and to perform to the standards their training has allowed. One participant asked whether their core purpose was to massage departmental figures or to act in the patient’s best interests, concluding that declining to implant a kidney would have served statistics rather than the individual.

The researchers also identified external factors that modulated the emotional response, including the severity of the adverse event, whether it involved an overtly technical error, the surgeon’s seniority at the time, and the reaction of the patient’s family. More severe events and technical errors were associated with greater and more lasting emotional impact, possibly because surgeons view complications as an inevitability of surgery while errors feel like personal failures. Seniority cut both ways: reduced clinical experience was perceived to increase vulnerability in surgical confidence, yet being among the most experienced surgeons in a department carried its own burden, with an expectation of emotional resilience and a perceived lack of peer reassurance. Antagonistic responses from patients’ families amplified the emotional toll, forcing surgeons to confront hostility while still processing the event itself.

The findings map closely onto the “Second Victim Syndrome” framework, a term coined by Albert Wu in 2000 to describe the harm clinicians incur from adverse events, encompassing guilt, fear, anger and concerns about professional reputation and confidence. The study’s authors situate their results within the Bowlby and Parkes model of grief, attributing interview responses across its four stages and supporting the concept that all surgeons experience an acute reaction while longer-term emotional impact varies. Notably, a recent systematic review co-authored by members of this study team found that over half of surgeons experience anxiety, guilt and sleep disturbance following an adverse event. What makes the transplant context distinct is that the psychological consequences may ripple outward: risk aversion following an adverse event could reduce organ acceptance rates, meaning the second victim phenomenon in transplantation carries implications not just for surgeon wellbeing but for patients on dialysis who may never receive the transplant they need. The researchers argue that avoiding surgery because of personal risk perception may be as paternalistic as proceeding based solely on belief in its benefit.

Perhaps the most striking finding is what surgeons did not rely upon: formal support services. Existing literature has highlighted the limited effectiveness of single-session psychological debriefing following traumatic events, and aspects of surgical culture, the expectation that surgeons should cope alone, act as barriers to engagement with structured support. Instead, the most effective mechanism came from collegial relationships within a cohesive team. The authors point to evidence supporting Schwartz rounds, which improve team cohesion, support staff wellbeing and encourage compassionate reflection, as potentially beneficial in the complex, multidisciplinary transplant setting. They also highlight emerging resilience-focused interventions, such as Enhanced Stress Resilience Training, which showed improvements in burnout, stress and mindfulness among surgical trainees who fully engaged with a five-week course. Whether such training could benefit transplant surgeons warrants further investigation. The study acknowledges its limitations, including its modest sample size concentrated across two centres, the interviews being conducted by a medical student introducing a potential power dynamic, and quantitative data serving only descriptive rather than inferential purposes. Nevertheless, the findings open a conversation long overdue in transplant surgery, suggesting that strengthening collegial support within units, and re-evaluating formal support systems that remain underused, could protect both the surgeons who perform these operations and the patients whose lives depend on their willingness to take calculated risks.

Subject of Research: Psychological and professional impact of perioperative adverse events on kidney transplant surgeons

Article Title: The impact of perioperative adverse events on kidney transplant surgeons: a mixed-methods study

Article References: Laverty, D., Stevenson, K., Jones, C., Bisset, C., Moug, S., & Aitken, E. (2026). The impact of perioperative adverse events on kidney transplant surgeons: a mixed-methods study. Frontiers in Transplantation, 5, Article 1959604. https://doi.org/10.3389/frtra.2026.1959604

Image Credits: AI Generated

DOI: 10.3389/frtra.2026.1959604

Keywords: kidney transplant, adverse events, second victim syndrome, surgeon wellbeing, surgical psychology, risk aversion, organ acceptance, Big Five Inventory, DOSPERT, thematic analysis, peer support, transplant surgery

The research team, led by Hadi Hosseini, associate professor of informatics and intelligent systems and associate professor of economics at Penn State, set out to map where the moral judgments of leading AI chatbots align with human values and where they diverge. Rather than building a new ethical framework from scratch, the researchers took advantage of an unusual resource: existing datasets from published academic studies in which hundreds of real participants, with no specified medical training, had already faced the kidney allocation dilemma and recorded their choices. That gave the team a human baseline against which the judgments of several AI chatbots could be measured, using the very same scenarios that human participants had encountered in the earlier studies.

The experimental design was deliberately simple and revealing. Two hypothetical patients were described side by side, each characterized by attributes such as age, the number of dependents they supported, their health status and their drinking habits. Both patients needed the same kidney, and only one organ was available. The chatbots were then asked to decide who should receive it. As Hosseini explained, the comparisons were run in several different ways: sometimes a single trait was isolated at a time to see how the models valued it on its own; sometimes several traits were mixed together to observe how the AI weighed competing factors against one another; and sometimes a flip-a-coin option was added, giving the model a way to express indecision — a key feature of human moral judgment that the researchers wanted to test explicitly.

Two findings stood out. The first concerns how AI models weigh the attributes of the patients. Human participants, the earlier studies showed, tend to balance multiple considerations simultaneously, accepting that a patient’s age might matter in one direction while their health status matters in another, and that dependents and lifestyle factors complicate the picture further. The AI chatbots did something quite different. They tended to fixate on a single factor — drinking habits was one example cited by the researchers — and let that one attribute dominate the decision, rather than integrating the full set of considerations the way people do. In effect, the models oversimplified decisions that humans experience as irreducibly complex, collapsing a many-dimensional moral trade-off into a one-dimensional judgment.

The second finding may be even more consequential. When humans confront a dilemma with no clearly correct answer, they frequently express indecision. Hosseini suggests this may be because people are reluctant to accept full agency over a decision that determines who lives and who dies — declining to choose is, in a sense, a refusal to own the outcome. The AI models almost never behaved this way. Even when the researchers directly offered the option to flip a coin, the chatbots overwhelmingly committed to a confident, deterministic answer instead. Where humans recognize ambiguity, the models projected certainty that the underlying problem simply does not support. That gap, the researchers argue, is meaningful precisely because real moral dilemmas — in medicine, in law, in the allocation of any scarce resource — often lack a single correct answer, and an advisor that cannot represent that uncertainty misrepresents the nature of the problem itself.

The stakes of this mismatch are not hypothetical. Hosseini is blunt about what is at risk: moral decisions in settings like organ allocation directly determine who lives and who dies, so getting AI’s role in them right is not optional. At the same time, he is careful to note that the study is not an argument for handing such decisions to machines. The researchers do not intend to encourage the use of AI as a substitute for professional judgment in medical decision-making or other high-stakes contexts. The point, rather, is that individuals, organizations and firms are already relying on AI to make decisions or to receive recommendations, and that reliance makes it essential to understand how these systems actually behave when the questions turn moral. A chatbot consulted informally by a clinician, a policymaker or a member of the public does not announce that its moral calculus differs from human consensus; it simply delivers an answer with confidence.

That confidence problem connects to a broader theme in the study of large language models. These systems are trained to produce fluent, decisive outputs, and their interface design rewards a single authoritative response over an expression of doubt. The Penn State findings suggest that this design tendency carries over into moral reasoning, where decisiveness is not always a virtue. Human moral judgment, by contrast, is built to tolerate ambiguity: people weigh competing values, acknowledge trade-offs, and sometimes refuse to choose at all. When an AI model collapses that process into a confident pick, it does not merely differ in its conclusion — it differs in its understanding of what kind of question is being asked. A dilemma is being treated as a calculation, and the calculation hides the dilemma.

The divergence in attribute weighting raises its own set of concerns. If a model fixates on drinking habits when allocating a kidney, it effectively imposes a moral hierarchy that human participants in the underlying studies did not adopt, penalizing one attribute out of proportion to how people balance it against dependents, age or health status. Because the researchers used the same scenarios given to humans in earlier academic work, the mismatch cannot be attributed to different framings or different questions; the models and the people were answering the same prompts. The divergence lies in the models themselves — in how they encode, prioritize and combine the moral information presented to them. That is exactly the kind of misalignment that matters for decision support, because a recommendation that silently overweights one factor can steer a human decision-maker without that person ever realizing the machine’s priorities differ from their own.

John Dickerson, chief executive officer at Mozilla.ai, who collaborated on the work, framed the problem in terms of how societies handle scarcity. When something scarce is allocated — a kidney, a job, access to some other resource — there is not always a single objectively correct answer, he observed. Humans recognize that ambiguity and codify it through open debate into the allocative process. AI models often do not. The observation points to a structural difference between human institutions and machine outputs: the legitimacy of a contested allocation decision often comes not from the answer itself but from the process of deliberation that produced it, a process in which disagreement, hesitation and debate are features rather than bugs. A model that outputs a single confident verdict bypasses that process entirely, offering the appearance of objectivity where only contested judgment exists.

Hosseini argues that closing this gap requires continued research and governance involving policymakers, regulators and other stakeholders. Asking whether AI can make moral decisions, and whether its judgments are aligned with human values, he notes, are more than philosophical musings — they sit at the core of today’s AI discourse, and the ethical stakes of AI’s role in life-altering decisions demand deep reflection. The study, published in the proceedings of the FAccT 2026 conference held in June, was partially funded by the U.S. National Science Foundation under grant numbers 2144413 and 2107173. Two students from Penn State’s College of Information Sciences and Technology contributed to the work: Samarth Khanna, a doctoral student in informatics, and Leona Pierce, a fourth-year undergraduate and Schreyer Scholar triple majoring in data sciences, mathematics and statistics. As AI systems move deeper into domains where every recommendation touches a human life, the study’s message is hard to ignore: before trusting a machine’s moral answer, it matters enormously whether that machine weighs the world the way we do — and whether it knows, as we do, when there is no right answer at all.

Subject of Research: Alignment of large language model moral judgment with human values in kidney allocation decisions

Article Title: Who gets the kidney? AI chatbots do not make the same moral choices humans do

Article References: Who gets the kidney? AI chatbots do not make the same moral choices humans do. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: artificial intelligence, large language models, AI alignment, medical ethics, organ allocation, kidney transplant, moral decision-making, FAccT 2026, decision support, human-AI values, indecision, resource scarcity

The research team, led by Wenjing Wang and colleagues, searched PubMed, Scopus, and Web of Science for studies published since 2014, applying the rigorous standards of the PRISMA reporting framework and registering the protocol prospectively with PROSPERO under registration number CRD42025648170. Their aim was deceptively simple but methodologically demanding: to estimate pooled incidence and prevalence of urinary tract infections across different healthcare settings, and then to dissect those estimates by geography, infection setting, and host risk profile. The final dataset included 969,476 participants, a scale that lends considerable statistical weight to the pooled estimates.

The headline finding concerns the stark divide between hospital-acquired and community-acquired infections. Hospital-acquired urinary tract infections, abbreviated HAUTIs in the study, showed a pooled incidence proportion of 0.17, with a 95 percent confidence interval of 0.13 to 0.22, and a pooled prevalence of 0.21, with a confidence interval of 0.16 to 0.25. By comparison, community-acquired urinary tract infections showed a pooled incidence of just 0.08, with a confidence interval of 0.06 to 0.10. In practical terms, roughly one in five hospitalised patients in the included studies had or acquired a urinary tract infection, a figure that underscores how the hospital environment itself, with its invasive devices, immunocompromised patients, and dense microbial ecology, amplifies infection risk.

Within the hospital setting, the single most dangerous factor identified was the urinary catheter. Catheter-associated urinary tract infections emerged as a particularly high-risk category, which is consistent with the well-understood biology of these devices. An indwelling catheter provides bacteria with a direct conduit into the bladder, bypassing the natural flushing action of urination and forming a biofilm on its surface that shields microbes from both immune defences and antibiotics. The meta-analysis confirms that this device-related pathway remains a dominant driver of nosocomial urinary infection, and that catheter stewardship, meaning the avoidance, early removal, and meticulous management of urinary catheters, must sit at the centre of any prevention strategy.

Geography mattered as much as setting. The burden of hospital-acquired urinary tract infections was highest in Asia, Africa, and South America, a pattern that likely reflects a combination of factors including differences in healthcare infrastructure, catheterisation practices, antibiotic access, and surveillance capacity across regions. The authors argue that this regional variation exposes a central weakness in current infection control thinking: a uniform, one-size-fits-all prevention approach cannot adequately serve settings whose baseline risks, resources, and microbial ecologies differ so dramatically. Tailored protocols calibrated to local epidemiology, they suggest, are the realistic path forward.

On the microbiological front, the analysis confirmed what clinical microbiologists have long observed: gram-negative bacteria, and particularly Escherichia coli, dominate the etiology of urinary tract infections. Escherichia coli’s specialised adaptations for the urinary tract, including adhesive pili that bind to bladder epithelial cells and an ability to persist intracellularly, make it an exceptionally effective uropathogen. The predominance of gram-negative organisms carries practical consequences, because rising antimicrobial resistance in this bacterial group, particularly extended-spectrum beta-lactamase production, increasingly constrains empiric treatment choices in many regions.

Beyond setting and geography, the study systematically catalogued host-level risk factors, identifying gender, age, comorbidities, and prior disease history as consistent predictors of infection. Some of the most striking quantitative results came from specific vulnerable populations. Among kidney transplant recipients, those who experienced delayed graft function, a complication in which the transplanted kidney does not immediately work properly, faced a risk ratio of 1.63 for urinary tract infection, with a confidence interval of 1.19 to 2.22. This makes biological sense: impaired graft function alters urinary flow and immune regulation, and transplant patients are simultaneously subjected to immunosuppressive drugs that blunt their defences against bacterial invasion.

Pregnant women formed another clearly delineated high-risk group. The analysis found that lower educational attainment among pregnant women was associated with an elevated risk of urinary tract infection, with a pooled effect estimate of 0.40 and a confidence interval of 0.16 to 0.63. Pregnancy itself predisposes to urinary infection through hormonal relaxation of the ureters and mechanical compression of the urinary tract by the growing uterus, which slows urine flow and allows bacteria more time to establish themselves. Untreated infections in pregnancy can escalate to pyelonephritis and are associated with adverse outcomes for both mother and fetus, which is why identifying modifiable social determinants of risk, such as access to health education, carries real public health value.

The study also highlighted the elderly and people with diabetes as key vulnerable groups. Diabetes impairs immune function and, when poorly controlled, glycosuria creates a nutrient-rich environment in the urine that favours bacterial growth. Ageing, meanwhile, brings anatomical and physiological changes, incomplete bladder emptying, and higher rates of catheterisation and institutional care, all of which compound infection risk. By quantifying these risks within a single analytical framework, the review provides clinicians and policymakers with a stratified map of exactly where preventive effort should be concentrated, rather than spreading resources thinly across the entire patient population.

The broader significance of this work lies in its framing. Rather than treating urinary tract infections as a single homogeneous disease, the authors demonstrate that the burden is sharply stratified by where a patient is treated and who the patient is. That insight supports the development of risk-stratified infection control protocols: aggressive catheter reduction programmes and surveillance in hospitals, targeted screening and education for pregnant women, heightened vigilance in transplant units, and tailored prevention for diabetic and elderly patients. As antimicrobial resistance narrows the treatment options available for gram-negative uropathogens, preventing infections in the first place becomes not merely a convenience but a necessity. This meta-analysis, synthesising evidence from nearly a million people across continents and care settings, offers the clearest evidence yet of where that prevention effort must be aimed.

Subject of Research: Global epidemiology and risk-stratified burden of urinary tract infections across healthcare settings and high-risk populations

Article Title: Risk-stratified epidemiology and global burden of urinary tract infections across healthcare and high-risk populations: a systematic review and meta-analysis

Article References: Wang, W., Huo, N., Ma, H., Li, X., & Wang, Y. (2026). Risk-stratified epidemiology and global burden of urinary tract infections across healthcare and high-risk populations: a systematic review and meta-analysis. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14395-z

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14395-z

Keywords: urinary tract infection, hospital-acquired infection, catheter-associated UTI, meta-analysis, Escherichia coli, kidney transplant, pregnancy, diabetes, infection control, antimicrobial resistance, global health burden, risk factors

The new research, conducted at Rabin Medical Center, the largest solid organ transplant center in Israel, and published in Archives of Osteoporosis, followed 39 adults who received teriparatide, a recombinant analogue of human parathyroid hormone, after kidney, lung, or liver transplantation. The investigators report that patients treated with the drug for a median of more than 22 months gained significant bone mineral density at the lumbar spine, femoral neck, and total hip, while clinicians observed acceptable metabolic safety and no episodes of graft rejection during therapy. The findings offer some of the most detailed evidence to date on anabolic osteoporosis treatment in a population that has long been underrepresented in bone research.

The scale of the skeletal problem after transplantation is difficult to overstate. In this cohort, 90 percent of patients had already suffered at least one fragility fracture before starting teriparatide, and 79 percent had multiple broken bones. The immune-suppressing glucocorticoids that nearly all transplant recipients take, at an average dose of around 7 milligrams of prednisone-equivalent per day in this study, directly impair the bone-forming cells called osteoblasts while accelerating bone resorption. Combined with pre-existing organ dysfunction, vitamin D deficiency, and the metabolic upheaval of end-stage organ disease, the result is a skeleton under relentless attack in patients who often cannot tolerate standard therapies.

Teriparatide works differently from the antiresorptive drugs, such as bisphosphonates, that are usually the first line of defense against post-transplant bone loss. Rather than slowing bone breakdown, it stimulates new bone formation by mimicking intermittent pulses of parathyroid hormone, a signal that activates osteoblasts when delivered in daily injections. This anabolic mechanism has made it a first-line option for severe glucocorticoid-induced osteoporosis in the general population. But transplant medicine has harbored a persistent worry: laboratory and clinical studies have suggested that bones in chronic kidney disease and after transplantation may become resistant to parathyroid hormone signaling, a condition linked to adynamic bone disease in which the cellular machinery for building bone falls silent. Skeptics questioned whether an anabolic drug could overcome that resistance.

The new data argue that, in many patients, it can. Among the subset of participants with paired bone density scans taken at the start and end of therapy, lumbar spine bone mineral density rose by an average of 11 percent, femoral neck density by 8 percent, and total hip density by 11 percent, gains that the authors note are comparable to responses reported in non-transplant populations and exceed what antiresorptive drugs typically achieve in transplant recipients. Statistically, the increases reached significance at all three skeletal sites. Treatment was started a median of 36 months after transplantation, once graft function and immunosuppressive regimens had often stabilized, and continued for a median of 22.3 months, a longer exposure than in most previous reports.

Fracture outcomes, though limited by small numbers, added a reassuring note. Six patients broke bones after starting teriparatide, but only two of those fractures occurred while the drug was actively being taken; the other four happened months to years after treatment had stopped. Given that nearly every participant entered the study with an already shattered fracture history, the apparent stabilization of fracture incidence during therapy is clinically meaningful, even though the retrospective design and small sample size prevented the study from formally demonstrating fracture reduction.

Safety, particularly for the transplanted organ itself, was a central question. Kidney function, measured by estimated glomerular filtration rate, declined modestly during the first six months of therapy, from an average of 73 to 64 milliliters per minute per 1.73 square meters, and then stabilized through the remainder of treatment and follow-up. Crucially, a contemporaneous matched group of transplant recipients who never took teriparatide showed a broadly similar decline over the same period, suggesting the change reflected the natural course of post-transplant kidney function rather than a drug effect. No patient progressed to end-stage kidney disease or required dialysis, and metabolic complications were rare: a single case of hypercalcemia, which resolved when the drug was stopped, and no cases of significant hypercalciuria despite most patients taking calcium and vitamin D supplements.

The study’s authors are careful to frame these results within the limits of a single-center, retrospective design. Patients were not randomly assigned; teriparatide was reserved for those with the most severe disease, often after failure of or intolerance to bisphosphonates, a selection reinforced by national reimbursement criteria in Israel. The matched control group was used only to contextualize kidney function trends, not to compare treatment effects, and causality cannot be inferred. Yet the very severity of the treated cohort strengthens the clinical signal: these were patients whose skeletons had already failed, and they still built substantial new bone. Only one randomized trial has previously tested teriparatide after transplantation, a short six-month study in kidney recipients begun during the intense immunosuppression of early recovery, which found no density gains but did prevent bone loss compared with placebo.

By including lung and liver recipients alongside kidney patients, the new study extends the evidence base to populations for which no dedicated osteoporosis treatment guidelines exist, in contrast to the organ-specific guidelines published for heart, kidney, and liver transplant care. The results align with recent observational work showing that teriparatide outperformed alendronate in renal transplant recipients and produced meaningful density gains in patients with low bone turnover, and they add histological and clinical weight to case reports of improved bone formation in heart transplant patients. Taken together, the picture emerging is that skeletal resistance to parathyroid hormone after transplantation, while a real phenomenon, is not an insurmountable barrier when therapy is timed after graft stabilization and sustained for nearly two years.

For clinicians, the message is one of selective optimism rather than blanket prescription. Teriparatide is expensive, requires daily injections, and carries a limited treatment duration, so it is unlikely to become a universal post-transplant remedy. But for the growing population of transplant survivors with severe osteoporosis, prior fractures, and few remaining options, the study suggests a viable path: an anabolic window that can rebuild what immunosuppression has torn down, administered with routine monitoring of calcium and kidney function. The authors call for prospective trials to define the optimal timing, duration, and sequencing of anabolic therapy after transplantation, questions that will only grow more urgent as transplant medicine continues to extend survival and shifts its focus toward the long-term quality of the lives it saves.

Subject of Research: Teriparatide treatment of severe osteoporosis in solid organ transplant recipients

Article Title: Teriparatide treatment of osteoporosis in solid organ transplant recipients—a single-center experience

Article References: Diker Cohen, T., Shraga-Slutzky, I., Kaminer, K., Gorshtein, A., Dotan, I., & Tsvetov, G. (2026). Teriparatide treatment of osteoporosis in solid organ transplant recipients—a single-center experience. Archives of Osteoporosis, 21(1), Article 136. https://doi.org/10.1007/s11657-026-01751-4

Image Credits: AI Generated

DOI: 10.1007/s11657-026-01751-4

Keywords: teriparatide, osteoporosis, solid organ transplantation, bone mineral density, fragility fractures, glucocorticoid-induced osteoporosis, anabolic therapy, kidney transplant, lung transplant, liver transplant, kidney function, transplant immunosuppression