{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:47:26Z","timestamp":1790934446834,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute cellular rejection (ACR) after heart transplantation remains incompletely explained despite standardized immunosuppression. Environmental exposures may contribute to residual immune activation; however, prior studies have focused primarily on air pollution rather than residential land-use composition. Objectives: To determine whether buffer-specific residential environmental composition is associated with rejection risk and whether these associations are scale-dependent and domain-specific. Methods: In this retrospective single-center cohort study, 30 heart transplant recipients contributed 267 biopsy-linked observations. Residential land-use composition was quantified within 300 m, 500 m, 700 m, and 1000 m buffers and aggregated into five domains: trees, other green surroundings, roads, water, and industrial land. Associations with ACR were evaluated using clustered logistic regression models adjusted for time since transplantation. Results: The strongest and only statistically robust associations after FDR correction were observed within the 300 m buffer. Tree-dominant (OR 1.42, 95% CI 1.22\u20131.65, q = 0.010) and industrial land exposure (OR 1.50, 95% CI 1.28\u20131.76, q = 0.010) were independently associated with increased odds of ACR. At 500 m, the association with trees persisted nominally (OR 1.39, 95% CI 1.03\u20131.88, p = 0.034), but did not remain significant after FDR correction, whereas water exposure showed a non-significant trend (OR 1.28, p = 0.057), which did not reach statistical significance. No associations were observed beyond 700 m across all models. Conclusions: Residential environmental composition may be associated with acute cellular rejection after heart transplantation in a scale-dependent manner, with signals confined to the immediate residential environment. Tree-dominant exposure within 300 m showed an association in clustered models; however, this finding was attenuated in mixed-effects sensitivity analyses. These results should be considered exploratory and hypothesis-generating study.<\/jats:p>","DOI":"10.3390\/jcm15093272","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:40:12Z","timestamp":1777981212000},"page":"3272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Residential Environmental Composition and Risk of Acute Cellular Rejection After Heart Transplantation: A Multi-Scale Buffer Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8080-2764","authenticated-orcid":false,"given":"Tomasz","family":"Urbanowicz","sequence":"first","affiliation":[{"name":"Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-107 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2689-1182","authenticated-orcid":false,"given":"Krzysztof","family":"Skotak","sequence":"additional","affiliation":[{"name":"Institute of Environmental Protection\u2014National Research Institute, 02-170 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Konecka-Mr\u00f3wka","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Silesian Centre for Heart Disease, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"Skowronek","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Silesian Centre for Heart Disease, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7329-6269","authenticated-orcid":false,"given":"Jakub","family":"Bratkowski","sequence":"additional","affiliation":[{"name":"Institute of Environmental Protection\u2014National Research Institute, 02-170 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerzy","family":"No\u017cy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Silesian Centre for Heart Disease, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3858-5809","authenticated-orcid":false,"given":"Julia","family":"Gierszewska","sequence":"additional","affiliation":[{"name":"Student Research Group, Medical Faculty, Poznan University of Medical Sciences, 61-107 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8016-3226","authenticated-orcid":false,"given":"Jaros\u0142aw","family":"Bartkowski","sequence":"additional","affiliation":[{"name":"Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-107 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Wachowiak-Baszy\u0144ska","sequence":"additional","affiliation":[{"name":"Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-107 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Przyby\u0142owski","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Silesian Centre for Heart Disease, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2442-4644","authenticated-orcid":false,"given":"Marek","family":"Jemielity","sequence":"additional","affiliation":[{"name":"Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-107 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.healun.2022.10.015","article-title":"The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipi-ents","volume":"42","author":"Velleca","year":"2023","journal-title":"J. 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