{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T04:33:11Z","timestamp":1770438791610,"version":"3.49.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n Total particulate matter with a diameter of 2.5 \u00b5m or less (PM\n 2.5<\/jats:sub>\n ) has been found to be associated with adverse posttransplant outcomes among kidney transplant (KT) recipients. However, PM\n 2.5<\/jats:sub>\n is a complex mixture of multiple constituents, all of which have different toxicity profiles, so it is not clear which constituents are most associated with adverse outcomes among KT recipients.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To investigate the associations between PM\n 2.5<\/jats:sub>\n constituents and post-KT outcomes among KT recipients.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study was conducted among patients who received a KT between January 2000 and December 2016 and lived in the contiguous United States. Follow-up continued through December 2021, and data were analyzed from August 2023 to May 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n \n Fifteen PM\n 2.5<\/jats:sub>\n constituents (including elemental carbon, ammonium, nitrate, organic carbon [OC], sulfate [SO\n 4<\/jats:sub>\n 2-<\/jats:sup>\n ], bromine, calcium, copper, iron, potassium, nickel [Ni], lead [Pb], silicon, vanadium, and zinc) at the zip code of residence prior to KT, estimated from ensembled machine learning models.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Adverse post-KT outcomes included acute rejection, delayed graft function (DGF), death-censored graft failure (DCGF), and mortality. The association of PM\n 2.5<\/jats:sub>\n constituents and the outcome were evaluated with weighted quantile sum regressions.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In total, 192\u202f587 KT recipients were included in the analysis (mean [SD] age at transplant, 51.56 [13.47] years; 75\u202f021 [39.0%] female; 51\u202f455 [26.7%] Black, 28\u202f586 [14.8%] Hispanic, and 97\u202f927 [50.8%] White). Each decile increase in the PM\n 2.5<\/jats:sub>\n constituent mixture was associated with a 6.8% (95% CI, 5.8%-7.8%) and 3.6% (95% CI, 2.1%-5.1%) increase in the odds of DGF and acute rejection, respectively. OC and Ni contributed the largest weights to the observed association between PM\n 2.5<\/jats:sub>\n mixture and DGF (OC: relative importance, 35.6%; Ni: relative importance, 34.4%), while Pb had the largest impact on acute rejection (relative importance, 75.0%). Each decile increase in PM\n 2.5<\/jats:sub>\n constituent mixture was associated with a 4.7% (95% CI, 3.3%-6.3%) and 3.9% (95% CI, 2.5%-5.2%) increase in the hazard of DCGF and all-cause mortality, respectively. The constituent that contributed the largest weight to the observed association between PM\n 2.5<\/jats:sub>\n mixture and long-term post-KT outcomes was SO\n 4<\/jats:sub>\n 2-<\/jats:sup>\n (relative importance, 51.3%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n In this cohort study, PM\n 2.5<\/jats:sub>\n constituents were associated with an increased risk of adverse posttransplant outcomes among KT recipients. Of the PM\n 2.5<\/jats:sub>\n constituents included in this study, SO\n 4<\/jats:sub>\n 2-<\/jats:sup>\n contributed most to long-term outcomes, while Pb, OC, and Ni were more associated with short-term outcomes.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.27142","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T15:31:05Z","timestamp":1755185465000},"page":"e2527142","source":"Crossref","is-referenced-by-count":0,"title":["Particulate Constituents and Posttransplant Outcomes Among Kidney Transplant Recipients"],"prefix":"10.1001","volume":"8","author":[{"given":"Yijing","family":"Feng","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Harvard T.H. 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