Current Opinion in Organ Transplantation最新文献

Use of molecular mismatch to guide induction therapy. 利用分子失配指导诱导治疗。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-10-07 DOI: 10.1097/MOT.0000000000001254

Jenny N Tran, James H Lan

{"title":"Use of molecular mismatch to guide induction therapy.","authors":"Jenny N Tran, James H Lan","doi":"10.1097/MOT.0000000000001254","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001254","url":null,"abstract":"Purpose of review: Current immune risk criteria for selecting induction therapy lack precision. Here, we examined the relationship of human leukocyte antigen (HLA) and molecular matching with outcomes in patients treated with different induction regimens and immunosuppressive minimization protocols to inform their potential utility in guiding therapy.Recent findings: Initial studies evaluating induction therapy suggest the role of HLA matching in immune risk-stratification. However, criteria based on antigen level matching and panel-reactive antibodies are imprecise and risk over-assigning patients to treatment with T-cell-depleting agents. Molecularly defined low-risk patients comprise 19-61% of study cohorts. Across heterogenous induction regimens and immunosuppressive minimization studies, these patients consistently demonstrated low immune event rates, providing the basis for prospective trials to test its utility in guiding the choice of induction regimens.Summary: Granular assessment of immune compatibility using molecular mismatch methods coupled with rapid genotyping technologies may help improve the selection of immunosuppressive regimens but will require prospective confirmation.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Machine perfusion of pediatric and technical variant liver grafts. 儿童和技术异型肝移植的机器灌注。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-10-01 Epub Date: 2025-08-13 DOI: 10.1097/MOT.0000000000001242

Bettina M Buchholz, Uta Herden, Ania C Muntau, Jens G Brockmann

{"title":"Machine perfusion of pediatric and technical variant liver grafts.","authors":"Bettina M Buchholz, Uta Herden, Ania C Muntau, Jens G Brockmann","doi":"10.1097/MOT.0000000000001242","DOIUrl":"10.1097/MOT.0000000000001242","url":null,"abstract":"Purpose of review: Liver transplantation using pediatric and technical variant grafts presents unique challenges due to graft size, vascular anomalies, and ischemia-reperfusion injury. Static cold storage has been the standard preservation method, but machine perfusion is emerging as a superior technique for improving graft function and posttransplant outcomes. This review addresses the role of machine perfusion in preserving pediatric and technical variant grafts with a focus on feasibility and impact on graft viability and early allograft function.Recent findings: Clinical and experimental studies of hypothermic and normothermic machine perfusion were reviewed for pediatric and technical variant grafts. Key parameters, perfusion dynamics, biochemical markers, and outcomes were investigated and suggested that machine perfusion enhances graft quality. In addition, the feasibility and potential of liver splitting during machine perfusion along with technical considerations is being addressed.Summary: Machine perfusion represents a transformative approach for pediatric and technical variant grafts, improving preservation quality and posttransplant outcomes while minimizing adverse events especially primary graft nonfunction. Currently, only normothermic machine perfusion enables viability assessment, offering a potential for expanding the donor pool. Due to the low number of pediatric liver transplantation and utilization of technical variant grafts, multicenter studies are required to define protocols and selection criteria for individual grafts, and establish machine perfusion as a standard practice in pediatric liver transplantation.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"389-397"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epithelial-immune crosstalk in lung transplant ischemia-reperfusion injury. 肺移植缺血再灌注损伤中的上皮免疫串扰。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-10-01 Epub Date: 2025-08-01 DOI: 10.1097/MOT.0000000000001244

Annika Schmidt, Daniel R Calabrese

{"title":"Epithelial-immune crosstalk in lung transplant ischemia-reperfusion injury.","authors":"Annika Schmidt, Daniel R Calabrese","doi":"10.1097/MOT.0000000000001244","DOIUrl":"10.1097/MOT.0000000000001244","url":null,"abstract":"Purpose of review: This review examines the epithelial-immune crosstalk in lung transplant ischemia-reperfusion injury (IRI). IRI is the mechanism underpinning primary graft dysfunction (PGD), a clinical syndrome that occurs in nearly one-third of lung transplant recipients associated with increased mortality.Recent findings: The epithelium is constituted by a diverse array of cells with complex contributions to allograft airway homeostasis. IRI disrupts this balance leading epithelial barrier compromise. However, emerging evidence suggests that epithelial cells are central to the propagation of this initial injury. Epithelial stress responses, including glycocalyx shedding and mitochondrial dysfunction, trigger innate immune activation through the release of DAMPs and stress ligands. Resident macrophages, neutrophils, and NK cells interface directly with epithelial-derived signals to drive inflammation and propagate tissue injury. Additionally, adaptive immune cells, particularly cytotoxic and senescent T cells and B cells, contribute to early and late allograft injury. Novel therapeutic strategies aim to preserve epithelial integrity and modulate immune activation.Summary: Understanding epithelial-immune crosstalk reveals new avenues for mitigating PGD by targeting epithelial pathways and innate immune effector cells. These insights can inform future therapies to improve lung transplant outcomes and mitigate additional allograft injuries.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"356-364"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Airway epithelial cell chimerism and chronic lung allograft dysfunction associated with ischemia-reperfusion-injury in lung transplantation. 肺移植缺血-再灌注损伤相关的气道上皮细胞嵌合和慢性肺同种异体移植物功能障碍。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-10-01 Epub Date: 2025-07-07 DOI: 10.1097/MOT.0000000000001238

Yasufumi Goda, Nirmal S Sharma, Andrew S Potter, Don Hayes

{"title":"Airway epithelial cell chimerism and chronic lung allograft dysfunction associated with ischemia-reperfusion-injury in lung transplantation.","authors":"Yasufumi Goda, Nirmal S Sharma, Andrew S Potter, Don Hayes","doi":"10.1097/MOT.0000000000001238","DOIUrl":"10.1097/MOT.0000000000001238","url":null,"abstract":"Purpose of review: The ischemia-reperfusion injury (IRI) of the bronchial epithelium after lung transplant (LTx) leads to tissue-specific stem cells (TSC) activation, promoting their migration and facilitation of airway remodeling characterized by a chimeric mixture of donor-derived and recipient-derived epithelial cells. This process results in airway epithelial cell chimerism, which we will discuss in this review as having a role in the pathogenesis of chronic lung allograft dysfunction (CLAD) in LTx recipients (LTRs).Recent findings: In LTx, IRI of the airway epithelium can be significant, contributing to cell death and inflammatory processes. TSCs have been implicated in the pathogenesis of CLAD. In cystic fibrosis LTRs where we can differentiate epithelial cells by cystic fibrosis transmembrane conductance regulator (CFTR) function, integration of recipient-derived cells expressing dysfunctional CFTR protein were discovered even years after the LTx, and this chimerism impacted CFTR function. Recent findings also highlight similarities between pulmonary chronic graft-versus-host disease and CLAD. Animal studies have demonstrated that donor-derived epithelial cells can successfully engraft and aid tissue repair.Summary: Airway epithelial cell chimerism occurs in LTRs because of the normal human bronchial epithelial repairing mechanisms by TSCs that result from the IRI after surgical implantation of donor lungs. Enhancing donor-derived TSCs may offer a promising therapeutic strategy to promote epithelial repair and reduce the risk of CLAD following LTx.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"365-371"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ethical considerations in access to heart transplant for adults with congenital heart disease. 成人先天性心脏病患者获得心脏移植的伦理考虑。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-10-01 Epub Date: 2025-07-11 DOI: 10.1097/MOT.0000000000001239

Ryan D Byrne, David W Bearl

{"title":"Ethical considerations in access to heart transplant for adults with congenital heart disease.","authors":"Ryan D Byrne, David W Bearl","doi":"10.1097/MOT.0000000000001239","DOIUrl":"10.1097/MOT.0000000000001239","url":null,"abstract":"Purpose of review: Heart failure is a final common pathway for many patients with adult congenital heart disease (ACHD). As such, ACHD heart transplantation is increasingly being considered and performed. Ethical considerations exist at each step in the transplantation process.Recent findings: ACHD patients face many challenges to successful heart transplantation. A dearth of ACHD cardiologists and many barriers to transplant consideration highlight inequities related to recognition of end-stage disease and timely referral for advanced therapies. Certain vulnerable ACHD sub-groups may more easily elude heart transplant consideration emphasizing injustices for patients such as those transitioning from pediatric to adult care, patients that are under- or uninsured, and those with chronic disabilities. Increased short-term transplant morbidity and mortality requires ACHD cardiologists and heart transplant teams to balance aspects of both beneficence and nonmaleficence when considering who, when, and where to transplant these complex patients.Summary: Given the rising incidence of ACHD transplantation, centers around the globe are tasked with how to best manage this patient cohort through successful heart transplantation. This review highlights multiple ethical issues in an effort to identify opportunities to provide more accessible, equitable, and standardized advanced cardiac therapies to this unique patient population.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"351-355"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Forging a path toward kidney transplant equity through multilevel interventions. 通过多层次干预为肾脏移植公平开辟道路。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-10-01 Epub Date: 2025-08-11 DOI: 10.1097/MOT.0000000000001243

Dinushika Mohottige, Clarissa J Diamantidis, Tanjala S Purnell, Regina M Longley, L Ebony Boulware

{"title":"Forging a path toward kidney transplant equity through multilevel interventions.","authors":"Dinushika Mohottige, Clarissa J Diamantidis, Tanjala S Purnell, Regina M Longley, L Ebony Boulware","doi":"10.1097/MOT.0000000000001243","DOIUrl":"10.1097/MOT.0000000000001243","url":null,"abstract":"Purpose of review: Persistent disparities in access to kidney transplantation, particularly living donor transplant and preemptive transplant, have gained increasing national attention including efforts to describe their multifactorial root causes. Multilevel structural impediments occurring at the recipient, donor, clinician, and health system level contribute to these disparities. This review overviews these key barriers, as well as recent successful interventions designed to address longstanding disparities.Recent findings: Several systems-level interventions including the Systems Intervention to Achieve Early and Equitable Transplants (STEPS) study (NCT05014256) may offer effective solutions to address critical roadblocks that lead to living donor kidney transplantation (LDKT) disparities by leveraging health system capabilities, coupled with individually-tailored support. Novel approaches leveraging community-based organizations, tele-health programs that overcome physical and transport related barriers, transplant navigators, and other individuals trained to meet patients' specific needs as they navigate complex transplant journeys, also offer promise. In addition, programs that fast-track complex evaluation requirements through tailored coordination offer promise to reduce racial and ethnic disparities in transplant receipt.Summary: The success and sustainability of future interventions designed to eliminate longstanding transplant disparities will require concerted investments in multilevel interventions and access-enhancing policies that address the cascade of barriers impacting patients, donors, clinicians, and health systems.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"379-388"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Heart transplantation in congenital heart disease: long-term outcomes and complications. 先天性心脏病的心脏移植：长期结果和并发症

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-10-01 Epub Date: 2025-07-15 DOI: 10.1097/MOT.0000000000001240

Maan Jokhadar

引用次数: 0

Mesenchymal stem cell therapy against ischemia-reperfusion injury in lung transplantation. 间充质干细胞治疗肺移植缺血再灌注损伤。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-10-01 Epub Date: 2025-08-11 DOI: 10.1097/MOT.0000000000001249

Ichiro Sakanoue, Daisuke Nakajima

{"title":"Mesenchymal stem cell therapy against ischemia-reperfusion injury in lung transplantation.","authors":"Ichiro Sakanoue, Daisuke Nakajima","doi":"10.1097/MOT.0000000000001249","DOIUrl":"10.1097/MOT.0000000000001249","url":null,"abstract":"Purpose of review: Ischemia-reperfusion injury (IRI) remains a major challenge in lung transplantation, contributing to early graft dysfunction and negatively affecting long-term outcomes. This review highlights recent advances in the use of mesenchymal stem cells (MSCs) and their extracellular vesicles (EVs) as emerging therapeutic approaches to reduce IRI and improve graft viability.Recent findings: MSCs exert beneficial effects through paracrine mechanisms, including the release of EVs that carry bioactive molecules such as microRNAs, cytokines, and growth factors. These vesicles play a critical role in modulating the immune response, reducing inflammation, and promoting tissue repair. In preclinical models, MSCs and EVs have been shown to limit neutrophilic infiltration, downregulate pro-inflammatory mediators, and enhance alveolar fluid clearance. Furthermore, the use of ex vivo lung perfusion (EVLP) has emerged as a promising platform for the controlled administration of MSCs and EVs, allowing for targeted intervention prior to implantation.Summary: Accumulating preclinical data support the potential of MSC- and EV-based therapies to mitigate IRI and improve graft function. Clinical translation will depend on refining delivery strategies, determining optimal dosing, and ensuring reproducibility - particularly when integrated with EVLP protocols.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"372-378"},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Review: outcomes of transplant candidates with psychotic disorders. 回顾：有精神障碍的移植候选人的结局。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-09-25 DOI: 10.1097/MOT.0000000000001251

Kathy L Coffman

{"title":"Review: outcomes of transplant candidates with psychotic disorders.","authors":"Kathy L Coffman","doi":"10.1097/MOT.0000000000001251","DOIUrl":"10.1097/MOT.0000000000001251","url":null,"abstract":"Purpose of review: Transplantation in candidates with psychotic disorders has been a controversial topic for over 40 years. Reviewing the outcomes of these candidates may inform decisions going forward, though it is unclear whether outcomes with kidney recipients is generalizable to other organs, which are life-sparing not mainly life-enhancing.Recent findings: Outcomes in recipients with psychotic disorders after kidney transplants were described in three studies. Outcomes with heart, lung, pancreas, and small bowel or multivisceral transplants is sparse to nonexistent. There were 26 cases and 8 case series published, mostly highly selected patients, with small sample size, and the majority had less than 3-year follow-up. Guidelines were proposed for this population based on a survey of 12 centers.Summary: More systematic study is needed on the risks and barriers to transplantation in these candidates. More data is needed regarding outcomes in those recipients with life-sparing transplants for whom there is not a rescue plan in case the graft is lost. Candidates should be evaluated on an individual basis based on known risk factors in accordance with the ethical principles of beneficence, justice, and utility in the face of scarce resources.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The ethics of buy-in before transplantation. 移植前买进的伦理问题。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-07 DOI: 10.1097/MOT.0000000000001241

Erin Yu, Baddr A Shakhsheer, Sean C Wightman

{"title":"The ethics of buy-in before transplantation.","authors":"Erin Yu, Baddr A Shakhsheer, Sean C Wightman","doi":"10.1097/MOT.0000000000001241","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001241","url":null,"abstract":"Purpose of review: This paper explores the ethical complexities of surgical buy-in within the context of organ transplantation. Surgical buy-in refers to an implicit agreement in which transplant recipients consent not only to the surgery itself, but also to the necessary postoperative care in the context of scarce donor organs. Ethical tensions arise when patients choose to deviate from suggested care pathways after receiving organ transplantation, challenging the balance between respecting individual autonomy and ensuring just stewardship of finite donor organs.Recent findings: Recent literature highlights the experience of transplant teams when patients withdraw from posttransplant care, a phenomenon termed \"cashing out.\" Approximately 60% of surgeons performing high-risk surgeries expect postoperative compliance as a precondition to surgery. In transplant settings, this expectation is intensified by the communal impact of organ allocation, raising justice-based concerns when organ recipients withdraw from postoperative protocols.Summary: This review proposes a modified informed consent process that explicitly delineates a recipient's ethical commitment when receiving an organ transplant. Improving transparency and aligning expectations with patients can help transplant teams better navigate the ethical tension between respecting patient autonomy and responsibly stewarding scarce public resources.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0