Current Opinion in Organ Transplantation最新文献_第2页

Transplant oncology: an emerging field in cancer care. 移植肿瘤学：癌症治疗的新兴领域。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-04-09 DOI: 10.1097/MOT.0000000000001221

Mackenzie C Morris, Steven C Kim

{"title":"Transplant oncology: an emerging field in cancer care.","authors":"Mackenzie C Morris, Steven C Kim","doi":"10.1097/MOT.0000000000001221","DOIUrl":"10.1097/MOT.0000000000001221","url":null,"abstract":"Purpose of review: Primary and secondary liver cancers are frequently unresectable at the time of diagnosis. Historically, these patients were treated with palliative therapy and no hope for curative resection. While liver transplant has been the standard of care for unresectable hepatocellular carcinoma (HCC), its indications have expanded to other oncologic indications based on promising data from select centers. This review focuses on the utilization of liver transplant for HCC, cholangiocarcinoma, and colorectal liver metastasis.Recent findings: In the realm of HCC, immunotherapy is an emerging treatment that has the potential for use in the advanced and neoadjuvant setting. It can benefit patients by downstaging them to resectable or transplantable disease burden. Regarding cholangiocarcinoma, better molecular profiling and targeted therapies have benefited patients, and ongoing studies in the United States and internationally will help further delineate the patients with cholangiocarcinoma who benefit from transplantation. Finally, there is emerging evidence that liver transplant for colorectal liver metastases can be safe and effective. While there is promising data showing survival benefit of liver transplantation (LT) for CRLM, standardized guidelines and recommendations in coordination with multidisciplinary oncology teams will be essential for establishing best practices.Summary: Similar to the evolution of LT becoming the standard of care for well selected patients with HCC, the evolution of the role for LT for other hepatobiliary malignancies is quickly progressing as centers in Europe, Asia, and North America gain experience and develop protocols for selected patients with favorable tumor biology. Optimal oncology treatment requires multidisciplinary tumor board and case-by-case approaches which are essential for providing these patients with the best chance at optimal survival.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"251-257"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810685","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

Expanding pediatric liver transplants: the role of split grafts, allocation policies, and machine perfusion. 扩大儿童肝移植：分裂移植的作用，分配政策和机器灌注。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-04-02 DOI: 10.1097/MOT.0000000000001220

Christine S Hwang, Amal A Aqul, Yong Kyong Kwon

{"title":"Expanding pediatric liver transplants: the role of split grafts, allocation policies, and machine perfusion.","authors":"Christine S Hwang, Amal A Aqul, Yong Kyong Kwon","doi":"10.1097/MOT.0000000000001220","DOIUrl":"10.1097/MOT.0000000000001220","url":null,"abstract":"Purpose of review: Pediatric liver transplant waitlist mortality remains disproportionately high, particularly among infants under one year old. Despite the success of split liver transplantation (SLT) in improving pediatric access to transplants, its utilization remains limited. This review examines barriers to SLT adoption, explores the impact of pediatric-focused allocation policies, and evaluates the potential of machine perfusion technology in expanding the pediatric donor pool.Recent findings: Studies have demonstrated that SLT outcomes are comparable to whole graft transplants when performed at experienced centers. However, logistical challenges, technical expertise, and policy limitations hinder its widespread adoption. Countries with pediatric-prioritized allocation and mandatory SLT policies, such as Italy and the United Kingdom, have significantly reduced pediatric waitlist mortality. Additionally, machine perfusion technology has emerged as a promising solution, allowing for ex vivo graft splitting and reducing ischemic injury, which may enhance graft utilization.Summary: A multifaceted approach is necessary to improve pediatric liver transplant outcomes, including stronger pediatric-first allocation policies, SLT training expansion, and integration of machine perfusion technologies. Implementing these strategies in the United States could significantly reduce pediatric waitlist mortality without negatively impacting adult transplant candidates.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"236-241"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771791","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

Liver transplantation for hepatocellular carcinoma following immunotherapy. 肝细胞癌免疫治疗后的肝移植。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-05 DOI: 10.1097/MOT.0000000000001228

Rebecca Marino, Ahmed Talaat Hassan, Alexander Fagenson, Parissa Tabrizian

{"title":"Liver transplantation for hepatocellular carcinoma following immunotherapy.","authors":"Rebecca Marino, Ahmed Talaat Hassan, Alexander Fagenson, Parissa Tabrizian","doi":"10.1097/MOT.0000000000001228","DOIUrl":"10.1097/MOT.0000000000001228","url":null,"abstract":"Purpose of review: To explore the emerging use of immune checkpoint inhibitors (ICIs) in hepatocellular carcinoma (HCC) patients eligible for liver transplantation (LT), particularly as bridging and downstaging therapies. This review also addresses the clinical challenges of integrating ICIs into transplant protocols, including graft rejection, immune-related toxicities, and gaps in evidence.Recent findings: ICIs have shown potential as bridging and downstaging therapies before LT, with multicentric studies reporting 75.6% successful downstaging, 85% 3-year post-LT survival, and 7.2% rejection-related mortality. A washout interval >94 days and older age have been identified as protective factors against allograft rejection. Combining locoregional therapies with ICIs has proven effective in the EMERALD-1 and LEAP-012 trials, which demonstrated improved progression-free survival (15.0 and 14.6 months, respectively) with ICI-TACE combinations. Similarly, the STAR-FIT phase II trial, combining TACE, SBRT, and avelumab, showed a 42% complete response rate and 12% conversion to curative therapy. Toxicity and rejection risk remain major challenges.Summary: ICIs represent a promising tool for expanding transplant eligibility in HCC, but their integration into LT pathways remains complex. Safety concerns, particularly regarding timing and immune modulation, require careful evaluation. Prospective studies and biomarker development are needed to guide clinical decision-making. Novel therapies such as CAR-T cells may offer more targeted approaches in the future.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"242-250"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957293","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

Obesity management before and after pancreas transplantation. 胰腺移植前后的肥胖管理。

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.0000000000001226

Ali B Abbasi, Andrew Posselt, Babak J Orandi, Jon S Odorico, Peter G Stock

{"title":"Obesity management before and after pancreas transplantation.","authors":"Ali B Abbasi, Andrew Posselt, Babak J Orandi, Jon S Odorico, Peter G Stock","doi":"10.1097/MOT.0000000000001226","DOIUrl":"10.1097/MOT.0000000000001226","url":null,"abstract":"Purpose of review: We provide a review on the incidence, consequences, and management of obesity in patients before and after pancreas transplant.Recent findings: Obesity is common in patients with both type 1 and type 2 diabetes. Obesity at the time of pancreas transplant is associated with worse graft and patient survival, while weight gain after transplant is associated with insulin resistance and posttransplant diabetes. Currently, lifestyle interventions are the backbone of obesity management and can improve insulin sensitivity, but result in only modest weight loss. Metabolic and bariatric surgery (MBS) offers the potential for substantial and durable weight loss. Laparoscopic sleeve gastrectomy is the procedure of choice and can be performed safely both before and after pancreas transplant. Antiobesity medications (AOMs) may also be effective, but concerns remain regarding determine the safety and efficacy when used in pancreas transplant recipients. More evidence is needed to guide the use of AOMs and MBS in pancreas transplant recipients.Summary: Lifestyle interventions, MBS, and AOMs each have a role in managing obesity after pancreas transplantation. In light of limited evidence and unique challenges in pancreas transplant patients, obesity management in pancreas transplant patients requires an individualized approach that leverages multidisciplinary expertise.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"315-322"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980854","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

A new era in liver transplantation: expanding indications and donor supply. 肝移植的新时代：扩大适应证和供体供应。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-07-03 DOI: 10.1097/MOT.0000000000001227

David D Aufhauser

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 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-07-16 DOI: 10.1097/MOT.0000000000001240

Maan Jokhadar

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 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-07-08 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":"https://doi.org/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":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-08","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

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