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

Recipient risk factors impacting outcomes after pancreas transplantation: strategies for optimization. 影响胰腺移植结果的受体危险因素：优化策略。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-06-05 DOI: 10.1097/MOT.0000000000001233

Emma Folch-Puy, Ramón Rull, Joana Ferrer-Fàbrega

{"title":"Recipient risk factors impacting outcomes after pancreas transplantation: strategies for optimization.","authors":"Emma Folch-Puy, Ramón Rull, Joana Ferrer-Fàbrega","doi":"10.1097/MOT.0000000000001233","DOIUrl":"10.1097/MOT.0000000000001233","url":null,"abstract":"Purpose of review: Numerous donor risk factors have been identified as contributing to poor outcomes and posttransplant complications following pancreas transplantation; however, recipient risk factors have received less attention and study. A thorough evaluation of recipient factors, that is, careful patient selection and/or prehabilitation, is essential for improving patient and graft survival rates. This review synthesizes recent studies on recipient-related risk factors and explores potential strategies to optimize transplant outcomes.Recent findings: Traditional recipient risk factors include advanced age, cardiovascular disease, and peripheral vascular disease. Recipient risk factors can be categorized as either preoperative or immediate postoperative. Emerging studies have investigated additional preoperative recipient risk factors in pancreas transplantation, such as socioeconomic factors including education level and insurance status, frailty, donor-recipient sex mismatch, donor-recipient size mismatch, obesity, hypoalbuminemia, and donor-specific antibody (DSA). Immediate postoperative risk factors that have been newly examined include hospital stays, kidney delayed graft function (DGF), weight gain, orthostatic hypotension, de-novo DSA (dnDSA), and posttransplant diabetes mellitus (PTDM).A recently published Pancreas Transplantation Outcome Predictions (PTOP) tool incorporating both donor and recipient characteristics may offer a holistic model and provide longer-term outcome predictions, but remains to be validated. Still, the field would benefit from a universally standardized and consistently implemented tool for guiding patient selection and testing prehabilitation strategies.Summary: This article provides a comprehensive, up-to-date analysis of recently studied recipient-related risk factors and a novel tool for risk assessment.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"289-303"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224649","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 donors in pancreas transplantation: challenges and opportunities. 儿童胰腺移植供体：挑战与机遇。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-06-20 DOI: 10.1097/MOT.0000000000001232

Riccardo Tamburrini, Jon S Odorico

{"title":"Pediatric donors in pancreas transplantation: challenges and opportunities.","authors":"Riccardo Tamburrini, Jon S Odorico","doi":"10.1097/MOT.0000000000001232","DOIUrl":"10.1097/MOT.0000000000001232","url":null,"abstract":"Purpose of review: The purpose of this review is to provide a comprehensive analysis of the current literature on pediatric donors for pancreas transplantation, with a focus on donor selection, clinical outcomes and surgical approaches. This review aims to highlight the feasibility and challenges of utilizing pediatric donors, assess the impact of donor and recipient selection criteria on outcomes, and explore innovations in surgical techniques.Recent findings: Numerous retrospective studies show that pediatric donors yield outcomes comparable to those from adult donors. Despite challenges posed by small caliber vessels and donor-recipient size mismatches, favorable long-term outcomes, including high rates of insulin independence and stable graft function have been reported, even in cases where initial concerns about low islet mass existed. Complications such as thrombosis, pancreatitis, and ischemia-reperfusion injury remain risks, but improved anticoagulation protocols and perioperative management have significantly mitigated them. Surgical innovations, such as en-bloc transplantation with kidneys and refined vascular anastomosis techniques may minimize thrombotic and graft loss complications.Summary: Pediatric donors are a viable option for pancreas transplantation, with outcomes matching those from adult donors, when properly selected and managed. Advances in surgical techniques and perioperative care have improved utilization and success rates.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"304-314"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332623","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

Normothermic regional perfusion and liver transplant: expanding the donation after circulatory death donor pool. 常温区域灌注与肝移植：扩大循环死亡后供体池。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-14 DOI: 10.1097/MOT.0000000000001230

Christopher C Stahl, David D Aufhauser

{"title":"Normothermic regional perfusion and liver transplant: expanding the donation after circulatory death donor pool.","authors":"Christopher C Stahl, David D Aufhauser","doi":"10.1097/MOT.0000000000001230","DOIUrl":"10.1097/MOT.0000000000001230","url":null,"abstract":"Purpose of review: Normothermic regional perfusion (NRP) is a novel technique developed to improve organ utilization and recipient outcomes following donation after circulatory death (DCD). NRP has revolutionized DCD liver transplant by extending donor criteria and reducing the incidence of ischemic cholangiopathy (IC) and other complications in recipients. However, there is significant geographic and center-specific variation in NRP use and practices. This review collates practices from pioneering NRP centers across the globe regarding donor selection criteria, NRP techniques, organ viability monitoring, and other key areas to help guide the continued growth of NRP liver transplantation.Recent findings: DCD livers recovered using NRP have consistently demonstrated excellent outcomes, with IC and patient and graft survival rates approaching those seen with grafts from donation after brain death donors. Recently, transplant centers have been working to increase the DCD donor pool by relaxing limits on donor quality, reconsidering organ viability markers, and combining NRP with ex situ machine perfusion technologies.Summary: NRP is a powerful organ recovery technology transforming the practice of DCD liver transplantation. Current evidence suggests that organ utilization could be further expanded using NRP recovery, with excellent clinical outcomes reported by centers using less stringent donor and organ viability criteria.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"225-235"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982792","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

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

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

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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237112/pdf/","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

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

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