Current Opinion in Organ Transplantation最新文献

{"title":"Frailty in kidney transplant candidates: new therapeutic strategies to intervene.","authors":"Danielle L Kirkman","doi":"10.1097/MOT.0000000000001205","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001205","url":null,"abstract":"<p><strong>Purpose of review: </strong>Patients that present with a physical frail phenotype have a higher risk of poor kidney transplant outcomes and are therefore less likely to be wait listed for a transplant. The physical frailty phonotype is more prevalent in older adults >65years with chronic and end stage kidney disease, thus partly contributing to inequitable access to transplant. Frailty can potentially be reversed by prehabilitation.</p><p><strong>Recent findings: </strong>Small studies of prehabilitation in kidney transplant candidates have demonstrated feasibility and safety. These pilot studies have shown efficacy for improving functional surrogates of frailty. Encouraging findings from one small pilot study reported a 50% reduction in postoperative length of hospital stay in patients that participated in prehabilitation. Exercise intervention should be supported with nutrition intervention aimed at increasing energy intake. Lifestyle behavior change coaching and case-by-case clinical psychology support are a key for successful uptake of prehabilitation and sustainable lifestyle change.</p><p><strong>Summary: </strong>There is consensus from the American Society of Transplantation, the European Society of Transplantation, and healthcare providers that prehabilitation is a valuable peri-operative intervention. Robust, multicenter randomized controlled trials will facilitate the establishment of evidence-based guidelines and widespread implementation of prehabilitation into clinical care.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045856","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}

{"title":"The case for value-based care in kidney transplantation: insights into geography, growth, and financial models.","authors":"Amber B Paulus, Dhiren Kumar, Vasco M Pontinha","doi":"10.1097/MOT.0000000000001204","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001204","url":null,"abstract":"<p><strong>Purpose of review: </strong>Kidney transplantation (KT) is the preferred treatment for end-stage renal disease (ESRD), yet systemic challenges, including geographic disparities, impede equitable access. This review evaluates transplant center activity and regional disparities using recent trends and discusses the potential of value-based care (VBC) models like the proposed Increasing Organ Transplant Access (IOTA) model to address these challenges.</p><p><strong>Recent findings: </strong>Analysis of Organ Procurement and Transplantation Network (OPTN) data from 2021 to 2023 identified 185 of 322 transplant centers as potentially eligible for VBC inclusion. High ESRD prevalence states like Texas, California, and New York have the largest number of centers, while states like Wyoming and Vermont lack operational centers, creating access barriers. Growth in KT rates following the 2014 Kidney Allocation System (KAS) reforms has stabilized at 3-5% since 2023. Geographic disparities persist, with regions like the South Atlantic and Pacific showing high transplant activity but unmet demand relative to ESRD prevalence.</p><p><strong>Summary: </strong>The proposed IOTA model could mitigate disparities by incentivizing infrastructure investment and prioritizing equitable access. Tailored VBC strategies are essential to addressing regional needs and improving KT equity and outcomes nationwide.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032476","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}

{"title":"The Early Steps to Transplant Access Registry (E-STAR) dashboard: center-specific reporting on prewaitlisting data to improve access to kidney transplantation.","authors":"Catherine E Kelty, Jade Buford, Mengyu Di, Kelsey M Drewry, Megan Urbanski, Jessica L Harding, Adam S Wilk, Stephen O Pastan, Rachel E Patzer","doi":"10.1097/MOT.0000000000001202","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001202","url":null,"abstract":"<p><strong>Purpose of review: </strong>The 2022 National Academies of Sciences, Engineering, and Medicine report highlighted inequities in access to kidney transplantation and called for a comprehensive dashboard highlighting early transplant steps, yet data on steps such as referral and evaluation start are limited. Addressing this gap is crucial for improving equity in access to transplantation.</p><p><strong>Recent findings: </strong>The Early Steps to Transplant Access Registry (E-STAR) provides a model for how prewaitlisting data can be used to inform quality improvement to drive equity in access to transplantation. E-STAR includes data from 37 transplant centers across 13 states and four regions (Southeast, New York, New England, and the Ohio River Valley), representing ∼217 000 adults with end-stage kidney disease (ESKD) treated in 4365 dialysis facilities, in addition to patients preemptively referred. Similar to the Scientific Registry of Transplant Recipients center-specific reports, the E-STAR dashboard was developed as an interactive website offering center-specific and regional insights into pretransplant access measures within and across centers with the intention to improve access to transplantation. Publicly available de-identified reports illustrate trends in referral, evaluation, and waitlisting by subgroup (e.g., race, sex, age, insurance status), while password-protected features enable transplant centers to benchmark their performance against anonymized peers.</p><p><strong>Summary: </strong>The E-STAR dashboard demonstrates how centralized, standardized data collection can support transplant centers, policymakers, community partners, and regional organizations to identify disparities, drive quality improvement, and develop interventions for the advancement of equity in transplant access. This work may inform future center-specific reports once prewaitlisting data are collected nationally.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032408","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}

{"title":"Xenotransplantation: future frontiers and challenges.","authors":"Ian S Jaffe, Imad Aljabban, Jeffrey M Stern","doi":"10.1097/MOT.0000000000001203","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001203","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recent advancements in genetic engineering have propelled the field of xenotransplantation from preclinical models to early compassionate use cases. As first-in-human clinical trials (FIHCTs) approach, we examine recent developments, ethical and regulatory challenges, immunological considerations, and the clinical infrastructure necessary for successful xenotransplantation trials.</p><p><strong>Recent findings: </strong>Expanded access transplants of pig hearts, kidneys, and livers have identified key challenges. Heart xenotransplants revealed risks of antibody-mediated rejection and zoonotic infections, while kidney xenotransplants suggest that patient selection, rather than immune rejection, may have caused failures. While there has been a report of auxiliary liver transplantation conducted abroad, profound thrombocytopenia poses an obstacle. As FIHCTs draw near, critical clinical challenges include determining the optimal donor genetic constructs and immunosuppressive regimens. Enrollment criteria and patient selection pose additional complexity, alongside ethical concerns such as lifelong zoonosis monitoring. Only a limited number of centers have the expertise needed to conduct these complex trials.</p><p><strong>Summary: </strong>Xenotransplantation holds great promise as a solution to organ shortages, but success in FIHCTs will require careful design, multidisciplinary collaboration, and strong infrastructure. Addressing immunologic, ethical, and patient selection challenges will be critical. With proper preparation, xenotransplantation could transform organ transplantation.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032410","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}

{"title":"Equity and the operational considerations of the kidney transplant allocation system.","authors":"Sumit Mohan, Miko Yu, S Ali Husain","doi":"10.1097/MOT.0000000000001201","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001201","url":null,"abstract":"<p><strong>Purpose of review: </strong>Demonstrate the impact of allocation system design on access to the waitlist and transplantation for patients with end-stage kidney disease (ESKD).</p><p><strong>Recent findings: </strong>Minoritized groups are more likely to be declined from transplant listing owing to psychosocial criteria. Lack of consistent definitions, screening tools with differential subgroup validity, and insufficient evidence-base contribute to concerns about reliance on psychosocial factors in transplant listing decisions.</p><p><strong>Summary: </strong>Although kidney transplantation is the preferred treatment choice, a shrinking proportion of prevalent patients are waitlisted for this option in the United States, even among our youngest ESKD patients. Recent HRSA proposals to expand data collection to encompass the prewaitlisting process suggest a timely need to capture additional data on transplant referrals to improve access to transplantation. In 2021, KAS250 was implemented in response to concerns of geographic inequities in transplant rates. However, updates to this system have also resulted in a dramatic rise in organ offers, the number of offers needed to successfully place an organ and lowered utilization rates. Since KAS250, the use of alternative pathways to improve organ utilization rates, such as out-of-sequence placements has increased dramatically across the organ quality spectrum and risk exacerbating disparities in access to transplant. Additionally, the current absence of meaningful oversight risks undermining the perception of the transplant system as an objective process.</p><p><strong>Summary: </strong>There is a need for a more robust evaluation of recent iterative changes in waitlist and organ allocation practices to ensure equity in access for our most vulnerable patients.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930753","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}

{"title":"Utility and bias in psychosocial evaluations for transplant listing.","authors":"Keren Ladin","doi":"10.1097/MOT.0000000000001198","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001198","url":null,"abstract":"<p><strong>Purpose of review: </strong>Disparities in access to transplantation are persistent and pervasive among minoritized populations, and remain incompletely explained by socioeconomic status, insurance, geography, or medical factors. Although much attention has been paid to factors contributing to disparities in organ allocation, fewer studies have focused on barriers to the transplant waitlist. Given increasing calls for equity in organ transplantation, we examine the role of nonmedical factors used in transplant listing decisions, including psychosocial factors like social support, motivation, and knowledge in improving utility in transplant listing decisions, as well as their potential for reinforcing bias.</p><p><strong>Recent findings: </strong>Minoritized groups are more likely to be declined from transplant listing owing to psychosocial criteria. Lack of consistent definitions, screening tools with differential subgroup validity, and insufficient evidence-base contribute to concerns about reliance on psychosocial factors in transplant listing decisions.</p><p><strong>Summary: </strong>Improving consistency and evidence-based approaches in patient evaluation and listing decisions will require greater efforts to identify which psychosocial risk factors are predictive of posttransplant outcomes. Social needs screening presents a strengths-based framework for incorporating psychosocial factors in transplant listing decisions.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930779","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}

{"title":"Psychosocial information sharing to improve equity in kidney transplant evaluation.","authors":"Adam S Wilk, Anne M Huml, Megan Urbanski, Dorothy Muench, Kristen M Fischer","doi":"10.1097/MOT.0000000000001197","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001197","url":null,"abstract":"<p><strong>Purpose of review: </strong>Increasing transplant access overall and particularly among historically underserved and marginalized patient groups is a shared goal nationwide. Patient challenges with psychosocial factors, such as social support and health literacy, are recognized as among the top reasons patients may not be referred, evaluated, or waitlisted, key steps along the pathway to transplantation. Yet referring providers' (e.g., dialysis clinics') and transplant centers' processes for measuring, communicating about, and addressing patients' psychosocial challenges are inconsistent, can emphasize measures more relevant to dialysis care than transplant care, and are highly susceptible to implicit bias.</p><p><strong>Recent findings: </strong>In this article, we illuminate the opportunity to standardize the patient psychosocial information that dialysis clinics and other nephrology care providers share with the transplant center when referring a patient for transplant evaluation. We highlight potential benefits and trade-offs to this approach and describe how regional coalitions comprising patients, caregivers, and community members can support developing and implementing a standardized template for this purpose, as well as the objectives that the coalition's efforts should pursue to this end.</p><p><strong>Summary: </strong>Standardized templates for psychosocial information sharing at referral represent a key opportunity to improve quality, efficiency, and equity in pretransplant care as well as transplant access outcomes broadly.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913915","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}

{"title":"Global perspectives on transplant disparities.","authors":"Deena Brosi, Marina Wainstein, Lilia Cervantes, Jesse D Schold","doi":"10.1097/MOT.0000000000001200","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001200","url":null,"abstract":"<p><strong>Purpose of review: </strong>Our goal was to review and summarize the current state of global disease burden from organ failure and the efforts to improve outcomes with organ transplantation. We also reviewed intra- and inter-country disparities in organ failure and organ transplantation along with potential mechanisms to improve access to organ transplantation globally.</p><p><strong>Recent findings: </strong>Many disparities and inequities observed globally can be characterized by the country's income category. Low- and lower-middle income countries (LLMICs) have higher rates of communicable disease-attributed organ failure, while upper-income countries (UICs) have high overall prevalence due to global growth in noncommunicable etiologies of organ failure. Many downstream disparities in access to organ transplantation and outcomes are associated with country income designation. Improvements in data collection and surveillance of populations with organ failure and organ transplantation are urgently needed.</p><p><strong>Summary: </strong>Improving outcomes for patients with end-organ disease globally will require countries to improve organ transplantation access and care. For LLMICs, collaboration with international transplant systems and engagement with neighboring countries may establish important foundations for organ transplant systems. For UICs, increasing organ donor availability through technological advances and increasing public engagement will help meet the growing needs for organ transplantation as an important treatment modality.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913911","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}

{"title":"Role of continuous renal replacement therapy in management of the preliver transplant patient.","authors":"Priya Yenebere, Chandrashekhar A Kubal, Muhammad Yahya Jan","doi":"10.1097/MOT.0000000000001194","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001194","url":null,"abstract":"<p><strong>Purpose of review: </strong>Highlight the importance of acute kidney injury (AKI) among liver transplant candidates, its importance of survival and the vital role of continuous renal replacement therapy (CRRT) as a supportive therapy.</p><p><strong>Recent findings: </strong>Kidney dysfunction is common in the preliver transplant patient. Early recognition, broad diagnostic work up, and therapeutic interventions are vital in minimizing morbidity and mortality in this critically ill group of patients. Liver dysfunction can impact kidney function in multiple ways, leading to worsening of clinical illness. High mortality and poor prognosis in those with AKI without CRRT and Liver Transplant are highlighted.</p><p><strong>Summary: </strong>Etiology of AKI may not be as important as is the potential for liver transplant (LT) listing in offering CRRT. Non eligibility for a LT does not by default imply non eligibility for CRRT. Multidisciplinary approach should be adopted among those with a need for CRRT in the setting of end-stage liver disease. Goals of care conversations are key, in evaluating the role of CRRT in this group of individuals as they have a very high risk of mortality.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812662","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}

{"title":"Ethical considerations in lung re-transplantation.","authors":"Lynette A Lester, Valerie P Huang, Sean C Wightman, Graeme M Rosenberg","doi":"10.1097/MOT.0000000000001171","DOIUrl":"10.1097/MOT.0000000000001171","url":null,"abstract":"<p><strong>Purpose of review: </strong>Patients undergoing re-transplantation constitute a growing proportion of annual lung transplants. It is necessary to consider ethical considerations of re-transplantation in parallel with clinical progress.</p><p><strong>Recent findings: </strong>Most clinical data demonstrate patients undergoing re-transplantation have worse survival outcomes; however, there is limited discussion of the ethical principles surrounding re-transplantation. Ethical guidance in re-transplantation trails clinical advancement.</p><p><strong>Summary: </strong>The four-box model offers a valuable framework for assessing the ethical considerations in re-transplantation. This includes an analysis of medical indications, patient preferences, quality-of-life and contextual factors to support the ethical use of scarce donor lungs.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"388-393"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901209","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}