Current Opinion in Organ Transplantation最新文献

Pediatric donors in pancreas transplantation: challenges and opportunities. 儿童胰腺移植供体：挑战与机遇。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-23 DOI: 10.1097/MOT.0000000000001232

Riccardo Tamburrini, Jon S Odorico

{"title":"Pediatric donors in pancreas transplantation: challenges and opportunities.","authors":"Riccardo Tamburrini, Jon S Odorico","doi":"10.1097/MOT.0000000000001232","DOIUrl":"10.1097/MOT.0000000000001232","url":null,"abstract":"Purpose of the review: The purpose of this review is to provide a comprehensive analysis of the current literature on pediatric donors for pancreas transplantation, with a focus on donor selection, clinical outcomes and surgical approaches. This review aims to highlight the feasibility and challenges of utilizing pediatric donors, assess the impact of donor and recipient selection criteria on outcomes, and explore innovations in surgical techniques.Recent findings: Numerous retrospective studies show that pediatric donors yield outcomes comparable to those from adult donors. Despite challenges posed by small caliber vessels and donor-recipient size mismatches, favorable long-term outcomes, including high rates of insulin independence and stable graft function have been reported, even in cases where initial concerns about low islet mass existed. Complications such as thrombosis, pancreatitis, and ischemia-reperfusion injury remain risks, but improved anticoagulation protocols and perioperative management have significantly mitigated them. Surgical innovations, such as en-bloc transplantation with kidneys and refined vascular anastomosis techniques may minimize thrombotic and graft loss complications.Summary: Pediatric donors are a viable option for pancreas transplantation, with outcomes matching those from adult donors, when properly selected and managed. Advances in surgical techniques and perioperative care have improved utilization and success rates.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332623","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

Novel techniques of pancreas and islet preservation. 胰腺和胰岛保存新技术。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-12 DOI: 10.1097/MOT.0000000000001234

Abraham J Matar, Joseph S Rao, Raja Kandaswamy

{"title":"Novel techniques of pancreas and islet preservation.","authors":"Abraham J Matar, Joseph S Rao, Raja Kandaswamy","doi":"10.1097/MOT.0000000000001234","DOIUrl":"10.1097/MOT.0000000000001234","url":null,"abstract":"Purpose of review: In recent years, rates of pancreas transplantation have remained stagnant in part due to increasingly stringent donor criteria. Compared to other abdominal organs, the use of extended criteria grafts in pancreas transplantation, including donation after cardiac death (DCD) donors, remains limited. The purpose of this review is to highlight recent work in the field of pancreas and islet preservation.Recent findings: Emerging preclinical and clinical data support the use of machine perfusion, both normothermic and hypothermic, as a mechanism by which to assess graft viability in an ex-situ circulation system prior to transplantation. Similarly, as normothermic regional perfusion (NRP) gains popularity, it will have significant implications on the potential organ pool for pancreas transplantation. Finally, recent advancements in cryoprotective agent composition as well as cooling and rewarming technologies have great potential to facilitate subzero preservation of pancreata and islets for long-term storage.Summary: Broad scaling of newer preservation techniques for pancreas and islet transplantation will require overcoming challenges, including optimizing protocols, ensuring cost-effectiveness, and translation of experimental techniques to the clinical setting. Nevertheless, these strategies for pancreas procurement and preservation may facilitate increased use of marginal grafts and increase the donor pool.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224648","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

Recipient risk factors impacting outcomes after pancreas transplantation: strategies for optimization. 影响胰腺移植结果的受体危险因素：优化策略。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-06 DOI: 10.1097/MOT.0000000000001233

Emma Folch-Puy, Ramón Rull, Joana Ferrer-Fàbrega

{"title":"Recipient risk factors impacting outcomes after pancreas transplantation: strategies for optimization.","authors":"Emma Folch-Puy, Ramón Rull, Joana Ferrer-Fàbrega","doi":"10.1097/MOT.0000000000001233","DOIUrl":"10.1097/MOT.0000000000001233","url":null,"abstract":"Purpose of review: Numerous donor risk factors have been identified as contributing to poor outcomes and posttransplant complications following pancreas transplantation; however, recipient risk factors have received less attention and study. A thorough evaluation of recipient factors, that is, careful patient selection and/or prehabilitation, is essential for improving patient and graft survival rates. This review synthesizes recent studies on recipient-related risk factors and explores potential strategies to optimize transplant outcomes.Recent findings: Traditional recipient risk factors include advanced age, cardiovascular disease, and peripheral vascular disease. Recipient risk factors can be categorized as either preoperative or immediate postoperative. Emerging studies have investigated additional preoperative recipient risk factors in pancreas transplantation, such as socioeconomic factors including education level and insurance status, frailty, donor-recipient sex mismatch, donor-recipient size mismatch, obesity, hypoalbuminemia, and donor-specific antibody (DSA). Immediate postoperative risk factors that have been newly examined include hospital stays, kidney delayed graft function (DGF), weight gain, orthostatic hypotension, de-novo DSA (dnDSA), and posttransplant diabetes mellitus (PTDM).A recently published Pancreas Transplantation Outcome Predictions (PTOP) tool incorporating both donor and recipient characteristics may offer a holistic model and provide longer-term outcome predictions, but remains to be validated. Still, the field would benefit from a universally standardized and consistently implemented tool for guiding patient selection and testing prehabilitation strategies.Summary: This article provides a comprehensive, up-to-date analysis of recently studied recipient-related risk factors and a novel tool for risk assessment.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224649","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

Editorial introductions. 编辑介绍。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-01 Epub Date: 2025-04-30 DOI: 10.1097/MOT.0000000000001216

引用次数: 0

Realizing the potential of donation after circulatory death requires understanding and resolving tension between end of life decisions and organ donation decisions. 实现循环性死亡后器官捐赠的潜力需要理解和解决生命结束决定和器官捐赠决定之间的紧张关系。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-01 Epub Date: 2025-02-18 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":"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":"186-192"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","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? 我们如何提高已故供者肾脏的利用率并减少丢弃？

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-01 Epub Date: 2025-02-13 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":"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":"215-221"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","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

Urinary biomarkers of kidney transplant rejection. 肾移植排斥反应的尿液生物标志物。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-01 Epub Date: 2025-04-02 DOI: 10.1097/MOT.0000000000001217

Tamara Merhej, Rania El Fekih, Jamil R Azzi

{"title":"Urinary biomarkers of kidney transplant rejection.","authors":"Tamara Merhej, Rania El Fekih, Jamil R Azzi","doi":"10.1097/MOT.0000000000001217","DOIUrl":"10.1097/MOT.0000000000001217","url":null,"abstract":"Purpose of review: Despite the introduction of many new immunosuppressive medications, allograft rejection remains a significant complication in transplantation. The use of \"liquid biopsy\" to evaluate allograft function and detect early rejection has recently become a prominent focus of investigation as it holds promise in providing noninvasive and immediate insights into the cellular and molecular makeup of the graft.Recent findings: In recent years, the introduction of molecular medicine along with the use of new technologies, including high-throughput techniques, has not only accelerated biomarker discovery but has also contributed to improving our understanding of the mechanisms underlying immune rejection. Genomics, transcriptomics, and metabolomics approaches, along with the increasing use of machine learning techniques, have paved the way for the discovery and development of novel biomarkers.Summary: Each year, there are hundreds of new biomarker discoveries in the publications. However, only a small fraction can be practically used as clinical tests or surrogate endpoints, receive FDA approval, and reach clinical application. Well designed and reproducible discovery and validation studies are rare and crucial. A contributing factor could be poor study design or quality of biospecimen repositories. In this review, we discuss urinary biomarkers of kidney allograft rejection that have shown promising findings but have yet to be successfully transitioned from bench to bedside.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"195-200"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771794","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 liver allocation landscape: MELD 3.0 and continuous distribution. 肝脏分配格局：MELD 3.0，连续分布。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-01 Epub Date: 2025-04-02 DOI: 10.1097/MOT.0000000000001215

Yeshika Sharma, Connor Fischbach, Sumeet K Asrani

{"title":"The liver allocation landscape: MELD 3.0 and continuous distribution.","authors":"Yeshika Sharma, Connor Fischbach, Sumeet K Asrani","doi":"10.1097/MOT.0000000000001215","DOIUrl":"10.1097/MOT.0000000000001215","url":null,"abstract":"Purpose of review: This review highlights recent advancements in liver organ allocation, specifically the transition to MELD 3.0 and the potential introduction of continuous distribution. These developments are timely, as they address the increasing need for a more efficient, equitable, and personalized system for prioritizing liver transplant candidates.Recent findings: The review covers two key innovations: MELD 3.0: A refined version of the original MELD score, designed to improve the prioritization process by incorporating additional factors that offer a more accurate and urgent measure of transplant need. This approach aims to better assess the severity of liver disease and the need for transplantation. Continuous distribution: A dynamic approach that shifts away from the static allocation model. It integrates multiple donor and recipient variables - such as geographic location, organ quality, and recipient condition - into a continuous, flexible allocation process. This framework seeks to make more nuanced decisions based on a broader set of factors that reflect transplant suitability.Summary: These innovations aim to enhance fairness and patient outcomes by refining candidate prioritization and reducing disparities in access to transplants. However, implementing these systems presents challenges, such as technical complexities and regional differences in access. Ongoing evaluation is necessary to ensure their effectiveness and equitable implementation across diverse patient populations.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"171-178"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771792","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

Recipient prioritization and graft choice in liver transplantation for colorectal liver metastasis. 肝移植治疗结直肠肝转移的受体优先和移植物选择。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-01 Epub Date: 2025-04-01 DOI: 10.1097/MOT.0000000000001214

Matthew M Byrne, Yuki Bekki, Mariana Chávez-Villa, Roberto Hernandez-Alejandro

{"title":"Recipient prioritization and graft choice in liver transplantation for colorectal liver metastasis.","authors":"Matthew M Byrne, Yuki Bekki, Mariana Chávez-Villa, Roberto Hernandez-Alejandro","doi":"10.1097/MOT.0000000000001214","DOIUrl":"10.1097/MOT.0000000000001214","url":null,"abstract":"Purpose of review: Liver transplantation for metastatic colorectal cancer has been shown to be efficacious in the well selected patient. In the United States, there remains controversy on the appropriate selection criteria and optimal graft type to be utilized in these patients. Our group advocates for strict recipient selection and early access to quality grafts for these recipients.Recent findings: In the past two years, there has been an explosion of centers reporting outcomes after liver transplantation for colorectal liver metastases. In North America, the publications have focused on single center experiences. The group in Oslo has reported their long-term outcomes of all transplanted patients. The TransMet randomized controlled trial has demonstrated efficacy of liver transplantation with chemotherapy over chemotherapy alone.Summary: Liver transplantation for metastatic colorectal cancer is an efficacious procedure for the well selected patient. Regardless of graft type, potential liver transplant recipients with liver limited unresectable colorectal liver metastases should be evaluated with a strict criterion to determine eligibility. Once eligible, patients should receive early access to high quality grafts.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"179-185"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763300","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

Emerging biomarkers of rejection. 新兴的排斥生物标志物。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-06-01 Epub Date: 2025-04-30 DOI: 10.1097/MOT.0000000000001219

Lorenzo Gallon, Elisa Gessaroli

引用次数: 0