Current Opinion in Organ Transplantation最新文献

Realizing the potential of donation after circulatory death requires understanding and resolving tension between end of life decisions and organ donation decisions.

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-02-19 DOI: 10.1097/MOT.0000000000001211

Brendan Parent, Summer Viscusi

{"title":"Realizing the potential of donation after circulatory death requires understanding and resolving tension between end of life decisions and organ donation decisions.","authors":"Brendan Parent, Summer Viscusi","doi":"10.1097/MOT.0000000000001211","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001211","url":null,"abstract":"Purpose of review: Donation after circulatory death (DCD) is one of the most promising methods for expanding the organ pool for transplantation. Yet realizing the promise of DCD depends on careful coordination of end of life treatment with organ donation authorization, organ preservation, and recovery.Recent findings: As organ procurement organizations (OPO) increase their DCD efforts, challenges regarding timely referral, delays in organ recovery coordination, and the requisite separation of clinical decisions from organ donation decisions are potentially preventing successful organ recovery, and having negative consequences for trust between OPOs, hospital staff, and donor families.Summary: Recent DCD cases should be scientifically studied to understand the variables that lead to successful versus unsuccessful DCD. These variables need to be understood in order to adjust legal, logistical, and ethical approaches to DCD and thus ensure the expansion of the organ pool while preserving trust in organ transplantation.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440153","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

How do we increase deceased donor kidney utilization and reduce discard?

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-02-14 DOI: 10.1097/MOT.0000000000001210

Venkatesh K Ariyamuthu, Abd A Qannus, Bekir Tanriover

{"title":"How do we increase deceased donor kidney utilization and reduce discard?","authors":"Venkatesh K Ariyamuthu, Abd A Qannus, Bekir Tanriover","doi":"10.1097/MOT.0000000000001210","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001210","url":null,"abstract":"Purpose of review: This review aims to address the critical issue of expanding deceased donor kidney pool and reducing the discard rates of viable kidneys in the United States. It highlights advances in organ preservation techniques and explores strategies for expanding the donor pool by leveraging suboptimal and high-risk nonuse kidneys, including those affected by acute kidney injury (AKI), hepatitis C virus (HCV), and hepatitis B virus (HBV).Recent findings: Innovations in organ preservation, including hypothermic and normothermic machine perfusion, have demonstrated efficacy in improving outcomes for marginal and extended-criteria kidneys. The integration of normothermic regional perfusion (NRP) for donation after cardiac death (DCD) donors has enhanced organ utilization and graft viability. Additionally, research confirms that kidneys from AKI and HCV-positive donors, when managed with appropriate protocols, yield comparable long-term outcomes to standard transplants. Emerging data on HBV-positive donor kidneys further underscore their potential to safely expand transplant access with targeted antiviral prophylaxis.Summary: Optimizing deceased donor kidney utilization requires a multi-faceted approach, including advancements in preservation technologies, evidence-based decision-making for high-risk organs, and policy innovations. Leveraging these strategies can help address the growing organ shortage, enhance transplant outcomes, and ensure broader access to life-saving kidney transplants.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406231","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 role of living donor liver transplantation in colorectal cancer liver metastases. 活体肝移植在结直肠癌肝转移中的作用。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-02-01 Epub Date: 2024-11-28 DOI: 10.1097/MOT.0000000000001188

Luckshi Rajendran, Gonzalo Sapisochin, Mark Cattral

{"title":"The role of living donor liver transplantation in colorectal cancer liver metastases.","authors":"Luckshi Rajendran, Gonzalo Sapisochin, Mark Cattral","doi":"10.1097/MOT.0000000000001188","DOIUrl":"10.1097/MOT.0000000000001188","url":null,"abstract":"Purpose of review: Despite technical and therapeutic advances, only 20-40% of patients with colorectal liver metastases (CRLM) have resectable disease. Historically, the remaining patients with unresectable, liver-only CRLM would receive palliative chemotherapy, with a median survival of 8 months.Recent findings: Liver transplantation has emerged as a viable option for selected patients with CRLM. This advancement stems from improved understanding of tumour genomics and biology and better patient selection criteria. The results of recent prospective clinical trials have further ignited enthusiasm for liver transplantation as a viable therapeutic option. Living donor liver transplantation (LDLT) offers several advantages over deceased donor liver transplantation (DDLT) for this disease, including reduced wait-time and optimized timing and coordination of oncologic therapy. On-going LDLT clinical trials have demonstrated favourable outcomes as compared with other liver transplantation indications. However, there is no established consensus or standardization in the implementation of LDLT for CRLM, beyond trials and centre-specific protocols.Summary: LDLT is an excellent therapeutic option in highly selected patients with CRLM. Refining prognostic factors and selection criteria will help to further optimize the utility and broaden the acceptance and implementation of LDLT for patients with CRLM.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"12-20"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738617","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 importance of equity in transplant oncology. 移植肿瘤学中公平的重要性。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-02-01 Epub Date: 2024-10-08 DOI: 10.1097/MOT.0000000000001183

Sudha Kodali, Elizabeth W Brombosz, Maen Abdelrahim, Constance M Mobley

{"title":"The importance of equity in transplant oncology.","authors":"Sudha Kodali, Elizabeth W Brombosz, Maen Abdelrahim, Constance M Mobley","doi":"10.1097/MOT.0000000000001183","DOIUrl":"10.1097/MOT.0000000000001183","url":null,"abstract":"Purpose of review: Transplant oncology encompasses and utilizes liver transplantation (LT) in combination with other aspects of cancer care to offer improved long-term outcomes for patients with liver cancer, but not all patients have equal access and ability to undergo LT. Social determinants of health may negatively impact a patient's ability to receive liver-related oncologic care, including LT. This review highlights recent work exposing gaps in access to LT, including transplant oncology, and interventions to ameliorate these disparities.Recent findings: Members of racial and ethnic minorities and indigenous groups, females, socioeconomically disadvantaged persons, and patients from rural areas are less likely to undergo LT. Recent studies have also described programs that have successfully mitigated some of the barriers in access to transplant oncology that these patients experience, including targeted outreach programs and access to virtual healthcare.Summary: Disparities in access to LT for liver cancer are increasingly well described, but additional research is needed to find effective ways to ameliorate these differences.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"21-29"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459937","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

Ensuring equity in psychosocial risk assessment for solid organ transplantation: a review. 确保实体器官移植心理社会风险评估的公平性：综述。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-02-01 Epub Date: 2024-12-04 DOI: 10.1097/MOT.0000000000001191

Joy E Obayemi, Brian I Shaw, Goni-Katz Greenberg, Jackie Henson, Lisa M McElroy

{"title":"Ensuring equity in psychosocial risk assessment for solid organ transplantation: a review.","authors":"Joy E Obayemi, Brian I Shaw, Goni-Katz Greenberg, Jackie Henson, Lisa M McElroy","doi":"10.1097/MOT.0000000000001191","DOIUrl":"10.1097/MOT.0000000000001191","url":null,"abstract":"Purpose of review: This review summarizes the different instruments for evaluating the psychosocial health of transplant candidates, the evidence demonstrating how these instruments relate to probability of transplant waitlisting and transplant outcomes, and the critical knowledge gaps that exist in the causal pathway between psychosocial health and clinical transplant trajectory.Recent findings: The current literature reveals that psychosocial assessments are a common reason for racial and ethnic minorities to be denied access to the transplant list. Given evidence that a lack of clinician consensus exists regarding the definition of, importance of, and reproducibility of psychosocial support evaluations, this facet of the holistic evaluation process may create a unique challenge for already vulnerable patient populations. Though recent evidence shows that psychosocial evaluation scores predict select transplant outcomes, these findings remain inconsistent.Summary: Multiple instruments for psychosocial transplant evaluation exist, though the utility of these instruments remains uncertain. As equity becomes an increasingly urgent priority for the transplant system, rigorous interrogation of the causal pathway between psychosocial health and transplant longevity is still needed.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"37-45"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767209","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

Language and cultural concordance to promote equity in organ transplantation for Hispanics with limited English proficiency. 语言和文化协调促进英语水平有限的西班牙人器官移植的公平性。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-02-01 Epub Date: 2024-11-29 DOI: 10.1097/MOT.0000000000001189

Miriam Vélez-Bermúdez, Larissa Myaskovsky

{"title":"Language and cultural concordance to promote equity in organ transplantation for Hispanics with limited English proficiency.","authors":"Miriam Vélez-Bermúdez, Larissa Myaskovsky","doi":"10.1097/MOT.0000000000001189","DOIUrl":"10.1097/MOT.0000000000001189","url":null,"abstract":"Purpose of review: Hispanics with limited English proficiency (LEP) face unique challenges in accessing organ transplantation due to limited culturally concordant care and linguistically appropriate resources, leading to disparities in healthcare delivery and transplantation outcomes. This review examines how language barriers affect access to kidney and liver transplant, and highlights the importance of institutional support for quality interpretation services in promoting healthcare equity in transplantation.Recent findings: Hispanics experience greater disease burden, but are less likely to receive a transplant compared to non-Hispanic Whites. LEP is a significant barrier to transplantation. Culturally and linguistically concordant interventions, such as the \"Hispanic Kidney Transplant Program,\" have demonstrated success in improving transplant-related outcomes among Hispanics. However, limited resources affect widespread implementation, and the broad lack of interpretation services in healthcare settings delay timely care in transplantation.Summary: Despite some progress demonstrated by culturally and linguistically concordant clinical intervention trials, disparities in transplantation for Hispanics with LEP remain. Enhancing the availability of interpretation services, recruiting and hiring bilingual healthcare professionals, and training healthcare staff to effectively engage with language and interpretation resources are critical to improving health equity. Efforts must prioritize language access and cultural concordance to address the unique challenges faced by Hispanics with LEP.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"52-59"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750182","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

Molecular matching tools for allocation and immunosuppression optimization. Ready for primetime? 用于分配和免疫抑制优化的分子匹配工具。准备好迎接黄金时段了吗？

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-02-01 Epub Date: 2024-11-12 DOI: 10.1097/MOT.0000000000001185

Matthias Niemann, Benedict M Matern

{"title":"Molecular matching tools for allocation and immunosuppression optimization. Ready for primetime?","authors":"Matthias Niemann, Benedict M Matern","doi":"10.1097/MOT.0000000000001185","DOIUrl":"10.1097/MOT.0000000000001185","url":null,"abstract":"Purpose of review: Molecular matching continues to be an important topic in organ transplantation. Over the years, several studies - larger and smaller - supported correlations of molecular incompatibility loads and clinical outcomes. However, their practical utility for clinical decision making remains controversial and there is no consensus on the context in which they should be used.Recent findings: The recent literature on molecular matching can be divided into four main areas of research: several groups present improvements of the algorithmic pipelines (1), increasing the robustness of previous findings. Further clinical evidence is reported (2) in various cohorts and other organ transplant domains, such as liver and lung transplantation. Consideration is given to the application of molecular matching in the allocation of deceased organs (3), suggesting options to improve allocation equity and utility. Furthermore, evidence is provided for personalized immunosuppression based on immunological risk (4), including infection and post graft failure management.Summary: There is ample evidence that current molecular matching algorithms add value to immunologic risk stratification for organ transplant recipients. First studies on how to translate these insights into patient management with respect to organ allocation and personalized medicine are underway and require further support.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":"30 1","pages":"30-36"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11676598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876666","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

Giving a voice to patient and caregiver perspectives on equity in transplantation. 从患者和护理人员的角度阐述移植中的公平问题。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-02-01 Epub Date: 2024-11-27 DOI: 10.1097/MOT.0000000000001190

Rhiannon D Reed, Jayme E Locke

{"title":"Giving a voice to patient and caregiver perspectives on equity in transplantation.","authors":"Rhiannon D Reed, Jayme E Locke","doi":"10.1097/MOT.0000000000001190","DOIUrl":"10.1097/MOT.0000000000001190","url":null,"abstract":"Purpose of review: While prior reviews have assessed barriers to transplantation experienced by patients and their families, they have not summarized how these stakeholders feel about whether and how those barriers impact equity in transplantation. We seek to comprehensively present the literature of patients and family perspectives on disparities in transplant access and potential solutions.Recent findings: Some patients and their families report experiences of discrimination, while others from traditionally marginalized groups feel the system is equitable and do not perceive any different treatment as a result of their race/ethnicity, sex, age, religion, or geography. This summary suggests that not all of the disparities observed in transplant access are attributable to systemic or unconscious bias and may be partially alleviated through enhanced education and communication.Summary: Lack of understanding and transparency lead to mistrust of organ transplantation, further exacerbating existing disparities. Patient and family engagement is paramount for ensuring the trust of the public who are the source of organs and those who directly benefit from this field. Partnerships between patient advocacy groups, professional societies, and policymakers have the potential to increase transparency while ensuring that the patient voice is represented in any system-level change and assessment.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"46-51"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738614","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

Role of immunotherapy in managing cancers prior to liver transplantation. 免疫治疗在肝移植前癌症治疗中的作用。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-02-01 Epub Date: 2024-12-02 DOI: 10.1097/MOT.0000000000001187

Philip Bredin, Zita Galvin, Grainne M O'Kane

{"title":"Role of immunotherapy in managing cancers prior to liver transplantation.","authors":"Philip Bredin, Zita Galvin, Grainne M O'Kane","doi":"10.1097/MOT.0000000000001187","DOIUrl":"10.1097/MOT.0000000000001187","url":null,"abstract":"Purpose of review: Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape in advanced hepatocellular carcinoma and increasingly are being evaluated in earlier stage disease. Herein we explore the role of ICIs pre-liver transplant for liver cancers.Recent findings: Given the high response rates with combination approaches including locoregional treatments, more patients with liver confined disease, without vascular invasion, who have received ICIs are now being rendered eligible for potential liver transplant. This opportunity to expand the population who may benefit from liver transplant has also come with challenges recognizing the global shortage of organs. Post-liver transplant immunosuppression potentially competes with the immune-stimulating effects of ICIs and graft rejection has been a concern. ICIs may provide an opportunity to maintain patients on the waiting list but an understanding of who is likely to benefit is needed, to circumvent possible toxicities. In addition, ICIs are now considered standard of care, in combination with chemotherapy, for advanced cholangiocarcinoma, where the role of liver transplant is evolving.Summary: As the eligibility criteria globally for liver transplant in the setting of malignancy continues to expand, the integration of ICIs becomes increasingly important.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"3-11"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767213","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

Costimulation blockade: the next generation.

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-01-31 DOI: 10.1097/MOT.0000000000001206

Idris Yakubu, Irfan Moinuddin, Andrew Brown, Sara Sterling, Pawan Sinhmar, Dhiren Kumar

{"title":"Costimulation blockade: the next generation.","authors":"Idris Yakubu, Irfan Moinuddin, Andrew Brown, Sara Sterling, Pawan Sinhmar, Dhiren Kumar","doi":"10.1097/MOT.0000000000001206","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001206","url":null,"abstract":"Purpose of the review: Calcineurin inhibitors (CNIs) are central to immunosuppression in kidney transplantation (KT), improving short-term outcomes but falling short in enhancing long-term outcomes due to cardiovascular, metabolic, and renal complications. Belatacept, an FDA-approved costimulation blocker, offers a less toxic alternative to CNIs but is limited by its intravenous administration and reduced efficacy in high-immunological-risk patients.Recent findings: Emerging therapies target more specific pathways to improve efficacy and accessibility. Abatacept, a first-generation cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) immunoglobulin, has shown favorable outcomes in small studies. VEL-101 and Lulizumab selectively block CD28 while preserving CTLA-4 signaling, showing promise in early trials. In the CD40/CD40L pathway, results have been mixed. Iscalimab (CD40 antibody) was inferior to tacrolimus in Phase 2 trials, and Bleselumab (CD40 antibody) showed variable rejection rates despite being noninferior to tacrolimus. CD40L-targeting agents such as TNX-1500, Tegoprubart, and Dazodalibep have demonstrated promising efficacy and safety in rejection prophylaxis.Summary: The focus in transplantation is shifting toward safer, long-term therapies with greater accessibility. Investigational agents with subcutaneous delivery methods could overcome logistical challenges, improve adherence, and redefine posttransplant care. These advancements in costimulation blockade may enhance long-term graft survival and transform the management of KT recipients.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064153","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