Current Opinion in Organ Transplantation最新文献_第3页

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

Artificial intelligence-enhanced interpretation of kidney transplant biopsy: focus on rejection. 人工智能增强的肾移植活检解释：关注排斥反应。

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.0000000000001213

Alton B Farris, Jeroen van der Laak, Dominique van Midden

{"title":"Artificial intelligence-enhanced interpretation of kidney transplant biopsy: focus on rejection.","authors":"Alton B Farris, Jeroen van der Laak, Dominique van Midden","doi":"10.1097/MOT.0000000000001213","DOIUrl":"10.1097/MOT.0000000000001213","url":null,"abstract":"Purpose of review: The objective of this review is to provide an update on the application of artificial intelligence (AI) for the histological interpretation of kidney transplant biopsies.Recent findings: AI, particularly convolutional neural networks (CNNs), has demonstrated great potential in accurately identifying kidney structures, detecting abnormalities, and diagnosing rejection with improved objectivity and reproducibility. Key advancements include the segmentation of kidney compartments for accurate assessment and the detection of inflammatory cells to aid in rejection classification. Development of decision support tools like the Banff Automation System and iBox for predicting long-term allograft failure have also been made possible through AI techniques. Challenges in AI implementation include the need for rigorous evaluation and validation studies, computational resource requirements and energy consumption concerns, and regulatory hurdles. Data protection regulations and Food and Drug Administration (FDA) approval represent such entry barriers. Future directions involve the integration of AI of histopathology with other modalities, such as clinical laboratory and molecular data. Development of more efficient CNN architectures could be possible through the exploration of self-supervised and graph neural network approaches.Summary: The field is progressing towards an automated Banff Classification system, with potential for significant improvements in diagnostic processes and patient care.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"201-207"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763291","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

Polygenic risk scores in kidney transplantation. 肾移植的多基因风险评分。

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.0000000000001212

Kira Jelencsics, Rainer Oberbauer

{"title":"Polygenic risk scores in kidney transplantation.","authors":"Kira Jelencsics, Rainer Oberbauer","doi":"10.1097/MOT.0000000000001212","DOIUrl":"10.1097/MOT.0000000000001212","url":null,"abstract":"Purpose of review: Estimation of genetic risk is crucial for understanding heritable diseases but also transplant outcomes. Polygenic risk scores (PRSs) are constructed from genome-wide association studies (GWAS) summing an individual's risk alleles weighted by their effect size. Introducing PRSs into transplant medicine may improve predictions of outcomes such as rejection, graft loss or death. This review of recent publications highlights the additional variability in outcomes explained by PRSs beyond established clinical models.Recent findings: Four studies on PRSs in transplantation have examined outcomes such as acute rejection, changes in posttransplant estimated glomerular filtration rate (eGFR) and posttransplant diabetes mellitus (PTDM) and explored the role of donor polygenic burden for cerebrovascular traits. PRSs have been showing utility in predicting PTDM [adjusted odds ratio (OR):1.48 (95% confidence interval (CI): 1.06, 2.08]. A PRS based on a non-HLA alloimmunity GWAS explained additional variability for acute rejection [adjusted hazard ratio (HR): 1.54, 95% CI: 1.07, 2.22]. Donor PRSs for hypertension and cerebrovascular traits correlated with lower recipient eGFR (HR: 1.44, 95% CI: 1.07, 1.93). Genetic variation was also linked to long-term kidney function, though clinical variables explained a greater proportion of the variability (0.3% vs. 32%).Summary: Currently, PRSs modestly enhance outcome prediction in transplantation when added to clinical models. With a more biologically based selection of variants, PRSs may gain greater value in transplant risk assessment.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"208-214"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763297","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

Hispanic survival paradox: a systematic review of short-term hospital readmissions among Hispanic kidney transplant recipients in the United States. 西班牙裔生存悖论：美国西班牙裔肾移植受者短期再入院的系统回顾。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-04-01 Epub Date: 2025-01-10 DOI: 10.1097/MOT.0000000000001199

Grecia B Vargas Meléndez, Andrew D Jopson, Flor Alvarado, Darrell J Gaskin, Tanjala S Purnell

{"title":"Hispanic survival paradox: a systematic review of short-term hospital readmissions among Hispanic kidney transplant recipients in the United States.","authors":"Grecia B Vargas Meléndez, Andrew D Jopson, Flor Alvarado, Darrell J Gaskin, Tanjala S Purnell","doi":"10.1097/MOT.0000000000001199","DOIUrl":"10.1097/MOT.0000000000001199","url":null,"abstract":"Purpose of review: The epidemiologic phenomenon known as the \"Hispanic paradox\" postulates that Hispanic/Latino Americans generally tend to live longer than other racial/ethnic communities, despite facing many socioeconomic disadvantages and other healthcare barriers. Whether this phenomenon is relevant among kidney transplantation (KT) recipients remains unclear. To investigate the possibility of a Hispanic mortality advantage, we conducted a systematic review of the published literature comparing short-term KT outcomes (first 12-months) for US Hispanic versus non-Hispanic White KT recipients.Recent findings: This systematic review summarizes recent findings from sixteen observational retrospective cohort studies that met our study criteria. Study sample sizes ranged from 42 to 244 037 total KT recipients and examined data between 2005 and 2022. Compared to their Non-Hispanic comparator, the Hispanic sub-samples were more likely to be younger, spend more time on dialysis, and less likely to receive preemptive transplant or living donation. Hispanic KT recipients experienced similar or more favorable outcomes in eleven studies (ten studies examining patient and graft survival, one study examining readmissions), but only three studies with statistical significance.Summary: As the US Hispanic and Latino population continues to grow into the diverse American melting pot, this review highlights the need for better approaches to studying racial and ethnic variables within kidney transplantation.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"120-129"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946117","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 case for value-based care in kidney transplantation: insights into geography, growth, and financial models. 基于价值的肾移植护理案例：对地理、增长和金融模型的见解。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-04-01 Epub Date: 2025-01-24 DOI: 10.1097/MOT.0000000000001204

Amber B Paulus, Dhiren Kumar, Vasco M Pontinha

{"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":"10.1097/MOT.0000000000001204","url":null,"abstract":"Purpose of review: 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.Recent findings: 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.Summary: 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.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"87-95"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","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}

引用次数: 0

Optimizing kidney allocation: challenges and solutions. 优化肾脏分配：挑战与解决方案。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-04-01 Epub Date: 2024-12-27 DOI: 10.1097/MOT.0000000000001195

Darren E Stewart, Loren Gragert, Michal A Mankowski

{"title":"Optimizing kidney allocation: challenges and solutions.","authors":"Darren E Stewart, Loren Gragert, Michal A Mankowski","doi":"10.1097/MOT.0000000000001195","DOIUrl":"10.1097/MOT.0000000000001195","url":null,"abstract":"Purpose of review: With the kidney nonuse rate approaching 30%, one-fifth of kidneys placed out of sequence, and unsatisfactory long-term recipient outcomes, U.S. kidney allocation is at a crossroads. This review highlights recent studies and efforts geared toward improving the system.Recent findings: The Organ Procurement & Transplantation Network's kidney transplantation committee is tasked with migrating kidney allocation policy, currently based on 250 nautical mile circles, to a fully continuous, points-based system. Challenges in designing a system assured to improve, not worsen, placement efficiency have hampered progress. OPO and transplant center practice patterns have adapted to a rapidly changing donation landscape. Advances in transplant immunology, particularly involving molecular HLA typing methods, are opening doors for more precise donor-recipient matching that appear to hold promise for improved long-term outcomes.Summary: The largely one-size-fits-all kidney allocation system is in desperate need of an overhaul. The continuous distribution paradigm is flexible enough to accommodate bold, new ideas for addressing major pain points in an equitable way. The OPTN should use policy variances to conduct time-limited, controlled experiments with various continuous distribution policies and build upon what works. Advances in transplant immunology, such as eplet matching, should increasingly be incorporated into kidney offer decision-making and, eventually, the allocation algorithm.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":"30 2","pages":"61-73"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556205","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

Global perspectives on transplant disparities. 移植差异的全球视角。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-04-01 Epub Date: 2024-12-26 DOI: 10.1097/MOT.0000000000001200

Deena Brosi, Marina Wainstein, Lilia Cervantes, Jesse D Schold

{"title":"Global perspectives on transplant disparities.","authors":"Deena Brosi, Marina Wainstein, Lilia Cervantes, Jesse D Schold","doi":"10.1097/MOT.0000000000001200","DOIUrl":"10.1097/MOT.0000000000001200","url":null,"abstract":"Purpose of review: 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.Recent findings: 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.Summary: 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.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"107-113"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","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}

引用次数: 0