Current Opinion in Organ Transplantation最新文献

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":"","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":"","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

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

Donation after circulatory death; cholangiopathy in the machine age. 循环性死亡后捐赠；机器时代的胆管病。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-21 DOI: 10.1097/MOT.0000000000001222

Ian S Currie, Fiona M Hunt

{"title":"Donation after circulatory death; cholangiopathy in the machine age.","authors":"Ian S Currie, Fiona M Hunt","doi":"10.1097/MOT.0000000000001222","DOIUrl":"10.1097/MOT.0000000000001222","url":null,"abstract":"Purpose of review: Published work evaluating machine perfusion of DCD (donation after circulatory death) liver grafts in situ and ex situ is rapidly evolving, with several landmark studies published in the last 6 months. The central question in DCD liver transplant remains; which strategies most effectively reduce cholangiopathy? This condition, which results in repeated hospital admissions, interventions, re-transplantation and death, is a major deterrent to DCD utilization. This review considers current evidence in the mitigation of transplant cholangiopathy by machine perfusion in DCD liver grafts.Recent findings: Studies which directly address DCD cholangiopathy as a primary outcome are few in number, despite their critical importance. In systematic reviews, Normothermic Regional Perfusion and Hypothermic Machine Perfusion consistently and significantly reduce transplant cholangiopathy rates. By contrast, the efficacy of Normothermic Machine Perfusion performed at donor or recipient centres is less well described and cautious interpretation is required. The most recent development, namely hypothermic followed by normothermic perfusion, has only now appeared in the literature but appears to offer advantages compared to either technology alone.Summary: To reduce DCD cholangiopathy, current data best support the use of donor centre NRP or recipient centre HMP. However, utilization is also improved when warm perfusion is involved.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"337-343"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989684","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

Banff 2022 pancreas pathology update: how to make the right diagnosis and decrease inconclusive pathology results. Banff 2022胰腺病理学更新：如何做出正确的诊断并减少不确定的病理结果。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-21 DOI: 10.1097/MOT.0000000000001231

Cinthia B Drachenberg, Surya V Seshan, John C Papadimitriou

{"title":"Banff 2022 pancreas pathology update: how to make the right diagnosis and decrease inconclusive pathology results.","authors":"Cinthia B Drachenberg, Surya V Seshan, John C Papadimitriou","doi":"10.1097/MOT.0000000000001231","DOIUrl":"10.1097/MOT.0000000000001231","url":null,"abstract":"Purpose of review: The Banff 2022 pancreas transplant pathology update is the most comprehensive to date. It has improved the criteria for T-cell and antibody mediated rejection, recognized other clinicopathological differential diagnoses, and addressed the critically important islet failures. Nevertheless, multidisciplinary discussions during and after the meeting showed a need to enhance the real and perceived value of pancreas transplant biopsies. In particular, the occurrence of clinicopathological discrepancies and/or inconclusive biopsy findings, result in considerable uncertainty in clinical and pathology decision making.Recent findings: The current review expands on the 2022 report by presenting the most common situations leading to an inconclusive diagnosis (Banff \"indeterminate\" category), a major issue of discussion. The entities discussed herein are: nonspecific infiltrates versus active rejection; residual inflammation after treatment of active rejection; ischemic pancreatitis and peripancreatic reactions in the early posttransplant period; biopsy findings associated with exocrine drainage impairment, and other unusual or nonspecific findings. An algorithm for the evaluation of pancreas allograft biopsies is also presented, that should facilitate the interpretation of morphological findings.Summary: Systematic integration of essential clinical information with the pathology findings can improve the diagnostic yield of pancreas allograft biopsies and reduce the cases with and \"indeterminate\" diagnoses.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"258-265"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109947","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

Pancreas rejection: quieting the storm to preserve graft function. 胰腺排斥反应：消弭风暴，保持移植物功能。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-04-23 DOI: 10.1097/MOT.0000000000001223

Christopher J Webb, Robert J Stratta, Sandesh Parajuli

{"title":"Pancreas rejection: quieting the storm to preserve graft function.","authors":"Christopher J Webb, Robert J Stratta, Sandesh Parajuli","doi":"10.1097/MOT.0000000000001223","DOIUrl":"10.1097/MOT.0000000000001223","url":null,"abstract":"Purpose of review: Allograft rejection remains enigmatic and elusive following pancreas transplantation. In the absence of early technical pancreas graft failure, pancreas allograft rejection is the major cause of death-censored pancreas graft loss both short- and long-term. Despite this circumstance, there are variations in the diagnosis and treatment of pancreas rejection. In this article, we summarize recent literature, review common practices, and discuss various management algorithms.Recent findings: Although pancreas allograft biopsy is the gold standard for the diagnosis of rejection, not all transplant centers have the capability to perform pancreas allograft biopsy. Some centers depend on clinical or laboratory parameters exclusively or rely on dysfunction or biopsy of a simultaneous kidney allograft as a marker for pancreas allograft rejection. New biomarkers are evolving to assess the risk for rejection and may help to diagnose early rejection. In the future, the use of machine learning algorithms and artificial intelligence may play a role identifying patients at risk and detecting pancreas rejection without performing a pancreas allograft biopsy.Summary: Despite decades of experience in pancreas transplantation, the diagnosis and management of pancreas rejection remains challenging. Emerging biomarkers and machine learning algorithms are needed to mitigate immunological complications and guide immunosuppression in these patients.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"266-272"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996055","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

Pancreas retransplantation. 胰腺再移植。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-02 DOI: 10.1097/MOT.0000000000001225

Marcelo Perosa, Tiago G Miranda, Fernanda R Danziere

{"title":"Pancreas retransplantation.","authors":"Marcelo Perosa, Tiago G Miranda, Fernanda R Danziere","doi":"10.1097/MOT.0000000000001225","DOIUrl":"10.1097/MOT.0000000000001225","url":null,"abstract":"Purpose of review: Pancreas retransplantation (PRT) remains a topic of debate due to the increased risks involved and advancements in diabetes mellitus management.Recent findings: The majority of PRT are pancreas after kidney (PAK) transplants, typically performed when a primary simultaneous pancreas-kidney (SPK) transplant results in pancreas graft failure while the kidney graft remains functioning. Over the past few decades, the number of PRT procedures has declined, mirroring the decrease in PAK transplant activity. Technical or late immunological loss of the initial pancreas is associated with better PRT outcomes, whereas early immunological failure and sensitization predict poor post-PRT outcome.Summary: Several critical factors must be considered when evaluating PRT, including the cause and timing of primary pancreas graft failure, as well as the recipient's surgical and immunological profile. PRT outcomes should be interpreted with caution, as most primary pancreas transplants (PT) are SPK, whereas the majority of PRT are solitary PT. When comparing only primary solitary PT to PRT, the outcomes are similar, particularly when performed in high-volume centers.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"323-329"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985338","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 : 2025-08-01 Epub Date: 2025-06-11 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":"330-336"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","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