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

Critical care aspects of the patient awaiting liver transplantation. 等待肝移植病人的重症监护方面。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-09-09 DOI: 10.1097/MOT.0000000000001311

Myura Nagendran, Emma Grimes, Georg Auzinger

{"title":"Critical care aspects of the patient awaiting liver transplantation.","authors":"Myura Nagendran, Emma Grimes, Georg Auzinger","doi":"10.1097/MOT.0000000000001311","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001311","url":null,"abstract":"Purpose of review: The indications for liver transplantation have continued to evolve and now extend beyond elective transplantation for decompensated cirrhosis and emergency liver transplantation for acute liver failure (ALF), to patients who present with acute-on-chronic liver failure (ACLF), including those with severe alcoholic hepatitis. This review focuses on the pretransplant critical care aspects of ALF patients and on recent developments, as the ACLF syndrome was defined and early transplantation for alcohol-related hepatitis has entered practice in some countries.Recent findings: ACLF severity, graded by the number of failing organs, predicts both waiting list and posttransplant mortality. The UK has introduced a national prioritization tier for selected critically ill patients with ACLF. High-volume plasma exchange improves transplant-free survival in ALF, with ongoing trials in ACLF. Artificial liver support and G-CSF have not shown survival benefit in randomized trials. Continuous renal replacement therapy lowers ammonia and is associated with reduced mortality in ALF. Early transplantation for steroid-nonresponsive severe alcohol-related hepatitis produces survival comparable to standard transplantation and is now delivered through structured programmes in some countries.Summary: Pretransplant critical care focuses on extrahepatic organ support and maintaining transplant candidacy. Prognostic scores identify risk but do not by themselves determine futility, which is dynamic and selection-dependent.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911154","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

Precision monitoring of kidney transplant health via cell-free DNA and RNA. 通过无细胞DNA和RNA精确监测肾移植健康。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-08-25 DOI: 10.1097/MOT.0000000000001309

Maya S Schlesinger, Darshana M Dadhania, John R Lee, Iwijn De Vlaminck

{"title":"Precision monitoring of kidney transplant health via cell-free DNA and RNA.","authors":"Maya S Schlesinger, Darshana M Dadhania, John R Lee, Iwijn De Vlaminck","doi":"10.1097/MOT.0000000000001309","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001309","url":null,"abstract":"Purpose of review: Cell-free nucleic acids (cfNAs) in plasma and urine have emerged as noninvasive biomarkers for monitoring kidney transplant health. This review summarizes recent advances in the development of cell-free DNA (cfDNA) and cell-free RNA (cfRNA) assays for immune and infection-related complications, and discusses their potential to enable precision monitoring of allograft health.Recent findings: Large prospective multicenter studies have established donor-derived cfDNA as a robust biomarker of acute allograft rejection, with increasing evidence supporting the use of cfDNA for surveillance, prognostication, and integration with complementary molecular and clinical biomarkers. Metagenomic cfDNA assays enable broad detection of bacterial, viral, and fungal pathogens. More recently, cfRNA profiling has emerged as a complementary approach that captures tissue-type and cell-type-specific transcriptional activity, providing molecular insight into immune activation, tissue injury, and disease mechanisms. Urine cfRNA is particularly promising because of its enriched representation of kidney-derived transcripts.Summary: Cell-free nucleic acid assays are reshaping the management of kidney transplant recipients by enabling noninvasive assessment of rejection, infection, and allograft injury. Continued advances in sequencing technologies, computational methods, and multimodal biomarker integration are expected to accelerate their clinical adoption and improve precision care for transplant recipients.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812330","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

Intestinal transplantation for tumors. 肠移植治疗肿瘤。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-08-01 Epub Date: 2026-06-18 DOI: 10.1097/MOT.0000000000001298

Cal S Matsumoto, Sukanya Subramanian

{"title":"Intestinal transplantation for tumors.","authors":"Cal S Matsumoto, Sukanya Subramanian","doi":"10.1097/MOT.0000000000001298","DOIUrl":"10.1097/MOT.0000000000001298","url":null,"abstract":"Purpose of review: Transplantation of the intestine is a vital component in the treatment of many intrabdominal tumors. This is a comprehensive review of current practice and outcome of intestinal transplantation for tumors.Recent findings: Most commonly described for the intrabdominal desmoid tumor, excellent survival outcomes can be attained, particularly for the more aggressive desmoid tumors associated with familial adenomatous polyposis syndrome and early referral is critical in order to avoid diffuse tumor spread which would necessitate a more complex multivisceral transplant. Currently, consensus within the intestinal transplant community lists invasive intrabdominal desmoid tumor as a primary indication for intestinal transplantation. Rare tumors such as metastatic neuroendocrine tumors confined to the abdomen, and pseudomyxoma peritonei have been associated with acceptable survival and recurrence outcomes with intestinal transplantation in carefully selected patients who would otherwise have a dismal prognosis. In addition, intestinal transplantation is an option for patients with a history of abdominal malignancy who have been rendered with intestinal failure due to surgical complications from resection of a primary tumor.Summary: Intestinal transplantation is a therapeutic option with excellent results in selected patients with intrabdominal desmoid tumors, neuroendocrine tumors and pseudomyxoma peritonei. Careful patient selection, technical expertise, and posttransplant oncologic surveillance is critical for successful long-term outcomes.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"189-194"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293559","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

Introduction to pediatric solid organ transplantation - not just little adults! 介绍小儿实体器官移植-不只是小孩子！

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-08-01 Epub Date: 2026-07-01 DOI: 10.1097/MOT.0000000000001291

Vikas R Dharnidharka

引用次数: 0

Is the Banff Human Organ Transplant panel ready for prime time? 班夫人体器官移植小组准备好黄金时段了吗？

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-08-01 Epub Date: 2026-06-10 DOI: 10.1097/MOT.0000000000001297

Agni Papamanoli, Marian C Clahsen-van Groningen, Ivy A Rosales

{"title":"Is the Banff Human Organ Transplant panel ready for prime time?","authors":"Agni Papamanoli, Marian C Clahsen-van Groningen, Ivy A Rosales","doi":"10.1097/MOT.0000000000001297","DOIUrl":"10.1097/MOT.0000000000001297","url":null,"abstract":"Purpose of review: The Banff Human Organ Transplant (B-HOT) panel was developed to enable standardized targeted transcriptomic assessment of formalin-fixed paraffin-embedded (FFPE) transplant biopsies across centers and organs. As literature has now moved beyond proof-of-principle studies, it is time to examine whether B-HOT is ready for routine clinical use and in what context.Recent findings: The literature is dominated by retrospective studies using archival FFPE kidney transplant biopsies. Data support use of B-HOT for diagnostic refinement of antibody-mediated (AMR) rejection, especially in biopsies with incomplete, borderline, or threshold-limited phenotypes. Studies also suggest value for prognostic enrichment and clarification of diagnostically challenging Banff phenotypes. Cross-organ applications in heart and uterus transplantation, as well as exploratory mechanistic studies in placenta-associated rejection biology, and xenotransplantation, support the panel's translatability. Emerging implementation-oriented studies include sparse classifiers, multiclass models, and automated reporting frameworks.Summary: The strongest readiness evidence is for adjunctive use in kidney rejection classification, particularly AMR and threshold-limited or incomplete phenotypes. However, broader routine implementation remains limited by challenges related to threshold harmonization, cross-platform standardization, and per-biopsy heterogeneity. Prospective clinical utility studies are needed to determine whether B-HOT-guided management improves treatment decisions and graft outcomes.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"212-218"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216789","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

Pediatric lung transplantation in 2026: recent changes and current challenges. 2026年的儿童肺移植：近期变化和当前挑战。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-08-01 Epub Date: 2026-05-08 DOI: 10.1097/MOT.0000000000001290

Saba Sheikh, Christian Benden, Gary A Visner

{"title":"Pediatric lung transplantation in 2026: recent changes and current challenges.","authors":"Saba Sheikh, Christian Benden, Gary A Visner","doi":"10.1097/MOT.0000000000001290","DOIUrl":"10.1097/MOT.0000000000001290","url":null,"abstract":"Purpose of review: Lung transplantation has evolved as an accepted therapy in carefully selected children with end-stage lung disease, offering prolonged survival and improved health-related quality of life (HRQoL). Pediatric lung transplantation is complex and multilayered and differs from adult transplant. Specific aspects of pediatric lung transplantation will be reviewed, updates on recent developments in the field will be shared, and current challenges will be discussed.Recent findings: The underlying diagnoses leading to lung transplantation vary considerably by age group and have shifted in the last decade. With children requiring special consideration due to their size and immune status, early referral, careful patient selection, and appropriate timing of listing are crucial. Surgical techniques, donor organ utilization, bridging sick patients to transplant and management of posttransplant complications are continually evolving to improve long term survival.Summary: Despite its challenges, lung transplant in pediatrics is successful and can improve HRQoL. Developments and further research in expanding the donor pool, peri-transplant management and prevention and treatment of infectious complications and transplant rejection are needed.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"221-226"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834844","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

Evaluation of older living donors and outcomes. 老年活体供体的评估及其结果。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-08-01 Epub Date: 2026-05-14 DOI: 10.1097/MOT.0000000000001292

Sandiya Bindroo, Ben Biesterveld, Mona D Doshi

{"title":"Evaluation of older living donors and outcomes.","authors":"Sandiya Bindroo, Ben Biesterveld, Mona D Doshi","doi":"10.1097/MOT.0000000000001292","DOIUrl":"10.1097/MOT.0000000000001292","url":null,"abstract":"Purpose of review: The widening gap between the demand for and supply of kidneys for transplantation has intensified the need to expand the living donor pool. At the same time, a growing proportion of individuals aged 65 years and older are being waitlisted for kidney transplantation. Living donor kidney transplantation remains the optimal therapy for end-stage kidney disease, and older living donor candidates represent a promising but underutilized resource. Although older donors typically present with greater medical complexity, their lifetime risk of developing end-stage kidney disease is comparatively low, allowing for more flexible acceptance criteria than those applied to younger donors. Despite a ninefold increase in the number of older living kidney donors over recent decades, they still comprise only 6-7% of all living donor transplants.Recent findings: Recent evidence suggests that older donors experience adequate compensatory renal function after nephrectomy, and transplant recipients of kidneys from older donors achieve favorable outcomes. These findings highlight the potential to safely expand the donor pool by more effectively incorporating older adults.Summary: In this review, we summarize age-related macro- and microscopic renal physiological changes relevant to donor evaluation. We then examine the literature on post-donation renal functional adaptation, cardiovascular risk, and all-cause mortality among older donors. Additionally, we compare age-specific glomerular filtration rate (GFR) thresholds used internationally to guide donor selection. Finally, we discuss future directions, including refining donor risk prediction models, standardizing age-adapted GFR criteria, and integrating biological rather than chronological markers of aging to better identify suitable older donor candidates.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"227-233"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927461","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

Current state of medical rehabilitation for adult short bowel syndrome patients with intestinal failure. 成人短肠综合征伴肠衰竭患者的医学康复现状

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-08-01 Epub Date: 2026-06-15 DOI: 10.1097/MOT.0000000000001296

Palle Bekker Jeppesen

{"title":"Current state of medical rehabilitation for adult short bowel syndrome patients with intestinal failure.","authors":"Palle Bekker Jeppesen","doi":"10.1097/MOT.0000000000001296","DOIUrl":"10.1097/MOT.0000000000001296","url":null,"abstract":"Purpose of review: Short bowel syndrome intestinal failure (SBS-IF) occupies a unique position at the interface between chronic organ failure management and intestinal transplantation (iTx). Historically, patients with SBF-IF progressed inevitably toward lifelong home parenteral support (HPS) dependence and, in a small and highly selected subset with impending HPS failure, ultimately to iTx. Recent advances in pro-adaptive pharmacological strategies, focusing on glucagon-like peptide (GLP)-2 and GLP-1-based approaches as adjuncts to conventional antimotility and antisecretory therapies, are reviewed, with implications for decision-making across the SBS-IF disease trajectory presented.Recent findings: SBS-IF is now recognized as a dynamic and modifiable form of organ failure. Targeted pro-adaptive interventions reduce HPS dependence and improve patient-centered outcomes. Conventional antimotility and antisecretory therapies remain foundational, whereas GLP-2 analogues are the first pathophysiology-targeted, pro-adaptive therapies in SBS-IF, while GLP-1 receptor agonists have emerged as promising adjuncts in selected patients, particularly those with high-output phenotypes.Summary: Multidisciplinary intestinal failure rehabilitation and gut-directed pharmacotherapy have altered the natural history of SBS-IF. Medical rehabilitation has shifted iTx from a default end-stage therapy to a targeted rescue option reserved for irreversible HPS failure, to be considered after optimized rehabilitation but before the transplant window is lost.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"195-202"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257648","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

Utility and Cost-effectiveness of Surveillance Biopsies. 监测活检的效用和成本效益。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-08-01 Epub Date: 2026-06-08 DOI: 10.1097/MOT.0000000000001295

Deeptanshu Jain, Parmjeet S Randhawa, Chethan M Puttarajappa

{"title":"Utility and Cost-effectiveness of Surveillance Biopsies.","authors":"Deeptanshu Jain, Parmjeet S Randhawa, Chethan M Puttarajappa","doi":"10.1097/MOT.0000000000001295","DOIUrl":"10.1097/MOT.0000000000001295","url":null,"abstract":"Purpose of review: The role of surveillance (protocol) biopsies in kidney transplantation remains controversial. Historically used to detect subclinical rejection before functional decline occurs, their utility must now be reassessed in the context of modern immunosuppression, evolving donor and recipient profiles, expanding therapies for recurrent kidney disease, and the emergence of noninvasive biomarkers. This review examines the effectiveness and cost-effectiveness of surveillance biopsies and proposes a pragmatic framework for their clinical use.Recent findings: The prevalence of subclinical rejection has declined substantially in the modern immunosuppression era, particularly among recipients without donor-specific antibodies. Most lesions detected on surveillance biopsies now represent borderline or mild T-cell-mediated rejection or mild microvascular inflammation and the benefit of treating these findings remains uncertain. At the same time, surveillance biopsies continue to provide important diagnostic information, including early evidence of chronic injury, donor-derived disease, and recurrent primary kidney diseases. Decision-analytic models indicate that the cost-effectiveness of screening strategies depends heavily on recipient age, immunologic risk, and the likelihood that detected pathology will meaningfully alter management. Emerging non-invasive biomarkers offer promising adjuncts, but they cannot fully replace histological evaluation.Summary: Routine surveillance biopsies for all kidney transplant recipients are unlikely to represent the most efficient monitoring strategy. A risk-stratified approach integrating immunologic risk, clinical context, dynamic changes in immunosuppression, and selective use of biomarkers may optimize detection of clinically meaningful injury while minimizing unnecessary procedures and healthcare costs.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"203-211"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197687","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 introduction. 编辑介绍。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-08-01 Epub Date: 2026-07-01 DOI: 10.1097/MOT.0000000000001293

引用次数: 0