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

Program interventions to build access to living donor transplantation. 计划干预建立获得活体供体移植的途径。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-03-13 DOI: 10.1097/MOT.0000000000001277

Ingrid Woelfel, Stephanie Yi, Amit K Mathur

{"title":"Program interventions to build access to living donor transplantation.","authors":"Ingrid Woelfel, Stephanie Yi, Amit K Mathur","doi":"10.1097/MOT.0000000000001277","DOIUrl":"10.1097/MOT.0000000000001277","url":null,"abstract":"Purpose of review: Living donor transplantation is the optimal treatment for end-stage renal disease and end-stage liver disease. For the recipient, the benefits of living donation include improved duration of graft survival compared to deceased donation and avoidance of lengthy waiting time and risks of dialysis. For transplant centers, a robust living donor program results in consistent transplant case volumes, daytime cases and a decreased reliance on potentially unfavorable allocation policy changes. Transplant programs require a playbook of actionable initiatives based on consensus best practices and peer-reviewed data to optimize opportunities to increase living donor evaluation and surgery within current legal and policy frameworks.Relevant findings: Strategies to increase center living donor volume include utilization of culturally competent transplant education and outreach, development of living donor champion programs, wider utilization of financial assistance programs available to living donors, increased enrollment in paired donor exchange services and adaptation of modern evidence-based selection and evaluation criteria.Summary: Understanding the current landscape of living donor transplantation and exploring areas of innovation is imperative to a center's ability to continue to serve the full spectrum of patients with end stage organ disease to the best of our collective ability.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"156-161"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456231","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

Genetic testing in living kidney donor candidates. 活体肾供体候选人的基因检测。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-02-25 DOI: 10.1097/MOT.0000000000001276

Yasar Caliskan, Laura Binari, Heidi M Schaefer

{"title":"Genetic testing in living kidney donor candidates.","authors":"Yasar Caliskan, Laura Binari, Heidi M Schaefer","doi":"10.1097/MOT.0000000000001276","DOIUrl":"10.1097/MOT.0000000000001276","url":null,"abstract":"Purpose of review: This review focuses on genetic evaluation in biologically related living kidney donor (LKD) candidates and candidates with suspected inherited disease, highlighting how genetic testing can extend beyond traditional clinical assessment to inform donor selection and counseling.Recent findings: Genetic screening of LKDs can identify monogenic kidney diseases, enable exclusion of at-risk donors and support long-term donor health. Sequential testing that includes genetic confirmation in the intended recipient followed by targeted testing of related donors, has effectively excluded carriers of pathogenic variants while permitting safe donation in noncarriers. Despite these advances, many transplant clinicians have limited experience with test selection, result interpretation, and counseling. In addition, access to renal genetic counselors or clinical geneticists remains constrained.Summary: Genetic testing enables a more personalized and preventive approach to LKD evaluation. Ethical implementation requires genetic counseling, shared decision-making, and longitudinal follow-up. Ongoing research including registry data and long-term donor outcomes is essential to establish best practices for integrating genetic testing into LKD transplantation.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"123-129"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303566","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

Updates in guidelines and policy for selection, care and aftercare of the living kidney donor. 关于活体肾供者的选择、护理和善后护理的指南和政策的更新。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-03-17 DOI: 10.1097/MOT.0000000000001279

Christina Mejia, Beatrice P Concepcion, Krista L Lentine

{"title":"Updates in guidelines and policy for selection, care and aftercare of the living kidney donor.","authors":"Christina Mejia, Beatrice P Concepcion, Krista L Lentine","doi":"10.1097/MOT.0000000000001279","DOIUrl":"10.1097/MOT.0000000000001279","url":null,"abstract":"Purpose of review: Living donor kidney transplantation is a cornerstone of modern transplant systems, offering patients with end-stage kidney disease improved survival, reduced waiting times, and, in many settings, the most effective pathway to transplantation. Despite these benefits, the development and expansion of living donation programs have occurred unevenly across jurisdictions, reflecting variability in donor protections, oversight structures, and long-term monitoring of living donor outcomes.Recent findings: The 2023 Santander Summit convened international stakeholders to establish a global framework for the safe and sustainable expansion of living donation under the principles of sufficiency, transparency, and oversight, emphasizing that living donation should complement deceased donation systems and that expansion must occur within frameworks that support informed decision-making, removal of financial disincentives without introducing incentives, and long-term accountability for living donor well-being. This review examines developments in policy and clinical practice that emerged since the Summit, focusing on evolving approaches to living donor selection and risk assessment, donor care during evaluation and donation, long-term follow-up and registry development, and advances in ethical and regulatory oversight.Summary: This review illustrates how recent evidence and policy initiatives operationalize the Summit's principles and support a transition toward a more transparent, evidence-based, and donor-centered model of care.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"149-155"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472968","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 kidney function in living kidney donor candidates. 活体肾供体候选人肾功能评估。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-03-18 DOI: 10.1097/MOT.0000000000001282

Pawan Sinhmar, Nivedita Satishchandra Girimaji, Dhiren Kumar

{"title":"Evaluation of kidney function in living kidney donor candidates.","authors":"Pawan Sinhmar, Nivedita Satishchandra Girimaji, Dhiren Kumar","doi":"10.1097/MOT.0000000000001282","DOIUrl":"10.1097/MOT.0000000000001282","url":null,"abstract":"Purpose of review: Living kidney donation remains the most effective and cost-efficient therapy for end-stage kidney disease (ESKD), yet the donor population is aging and pre-donation glomerular filtration rate (GFR) thresholds are increasingly encountered in the intermediate range (60-89 ml/min/1.73 m 2 ). Concurrently, evolving evidence has refined our understanding of long-term donor risk and the accuracy of GFR measurement. This review summarizes contemporary approaches to kidney function assessment in living donor candidates.Recent findings: Recent studies reaffirm a graded association between lower pre-donation GFR and long-term ESKD risk, while emphasizing that absolute risk remains low in carefully selected donors. Advances in plasma clearance methodologies (e.g., Iohexol) have improved the feasibility of measured GFR. Adoption of the 2021 chronic kidney disease epidemiology collaboration (CKD-EPI) race-free equation has enhanced equity in transplantation without major loss of accuracy. Emerging data also support combined creatinine-cystatin C equations and individualized end-stage renal disease (ESRD) risk projection models for donor counseling.Summary: Accurate kidney function assessment in donor candidates requires integration of race-free eGFR equations, confirmatory measured GFR when indicated, age-calibrated interpretation, and individualized risk prediction. Contemporary literature supports a structured, risk-based framework that prioritizes donor safety while preserving access to living donation.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"111-116"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479899","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

Disparities in access to living donor kidney transplantation. 获得活体肾移植的差异。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-03-20 DOI: 10.1097/MOT.0000000000001283

Ben E Biesterveld, Sandiya Bindroo, Mona Doshi

{"title":"Disparities in access to living donor kidney transplantation.","authors":"Ben E Biesterveld, Sandiya Bindroo, Mona Doshi","doi":"10.1097/MOT.0000000000001283","DOIUrl":"10.1097/MOT.0000000000001283","url":null,"abstract":"Purpose of review: Living donor kidney transplantation (LDKT) provides superior outcomes compared to deceased donor kidney transplantation (DDKT), yet significant disparities persist in access and utilization across demographic groups in the United States. This review synthesizes current evidence on racial, socioeconomic, and geographic barriers affecting LDKT access.Recent findings: Racial disparities remain substantial; white patients are most likely to receive LDKT, while black and Hispanic populations face lower referral, evaluation, and donation rates. Socioeconomic status further compounds disparities, with higher income and privately insured candidates enjoying greater LDKT access. Financial burdens for donors, including lost wages and donation expenses, are insufficiently offset by policies to date. Geographic variation in LDKT mirrors differences in access to transplant centers, with disadvantaged neighborhoods and low-volume centers contributing to reduced LDKT rates. Center-level practices, state policies, and distance to care all play critical roles.Summary: As disparities in LDKT persist or worsen, achieving equity requires coordinated intervention across patient, provider, institutional, and policy levels, centered on dismantling structural barriers and meeting the goals established by national transplant initiatives. Addressing these factors is essential for ensuring just and equitable access to LDKT for all patients.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"143-148"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497666","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

Etiology and management of cholangitis in pediatric liver transplant recipients: a systematic review. 小儿肝移植受者胆管炎的病因和治疗：一项系统综述。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-04-14 DOI: 10.1097/MOT.0000000000001285

Alizée Hof, Robin Rey, Nathalie Rock, Arnaud G L'Huillier

{"title":"Etiology and management of cholangitis in pediatric liver transplant recipients: a systematic review.","authors":"Alizée Hof, Robin Rey, Nathalie Rock, Arnaud G L'Huillier","doi":"10.1097/MOT.0000000000001285","DOIUrl":"10.1097/MOT.0000000000001285","url":null,"abstract":"Purpose of review: Children undergoing liver transplantation are highly vulnerable to infections. Cholangitis is a potential post-transplant complication requiring broad-spectrum anti-infective therapy, raising concerns about antimicrobial resistance in this immunosuppressed population. We conducted a systematic review to evaluate antimicrobial management of post-transplant cholangitis in pediatric patients.Recent findings: Nine heterogeneous studies were included. Definitions of cholangitis varied widely, combining clinical, laboratory, imaging, and microbiological criteria, highlighting the need for standardization. Gram-negative bacteria predominated, particularly Klebsiella spp., Pseudomonas aeruginosa , and Escherichia coli . Prophylaxis commonly relied on broad-spectrum antibiotics, and initial treatment was empirical in all studies, with occasional adjustment based on microbiological results. First-line therapies included piperacillin-tazobactam and third-generation cephalosporins. Second-line regimens involved agents from various antibiotic classes, including glycopeptides, lipopeptides, aminoglycosides, and fluoroquinolones, as well as antifungals. Meropenem was used as either first-line or second-line therapy.Summary: Improved characterization and standardized reporting of pathogens and treatments are needed to guide targeted antimicrobial strategies and limit multidrug-resistant organisms. More detailed and harmonized data reporting is essential to optimize management of post-transplant cholangitis in children.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"172-181"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632857","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

Pediatric heart transplantation. 儿童心脏移植。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-04-04 DOI: 10.1097/MOT.0000000000001289

Jonathan N Johnson, Steven J Kindel, Rebecca K Ameduri

{"title":"Pediatric heart transplantation.","authors":"Jonathan N Johnson, Steven J Kindel, Rebecca K Ameduri","doi":"10.1097/MOT.0000000000001289","DOIUrl":"10.1097/MOT.0000000000001289","url":null,"abstract":"Purpose of review: To summarize important papers published in the pediatric heart transplantation in the last year.Recent findings: While advances have been made for pediatric patients who need heart transplantation, considerable challenges remain. Donor availability remains a key challenge, and work to both increase the number of donors and the quality of donor organs is ongoing. The field of pediatric heart transplantation benefits from registries such as the Pediatric Heart Transplant Society (PHTS) and learning networks such as the Advanced Cardiac Therapies Improving Outcomes Network (ACTION), allowing for multisite collaboration to optimize survival both before and after transplant, and to share learning about complex cases. Psychosocial evaluations of potential recipients and families can be challenging, and a consensus framework is now available for these evaluations, to provide appropriate oversight and management of a scarce resource. Looking ahead, heart transplant specialists are anticipating advances in xenotransplantation, which has the potential to revolutionize current standards of care.Summary: Donor availability and organ scarcity are the dominant challenges we face, with many recent impactful papers addressing this issue either directly or indirectly. It will be critical to maintain the forward progress made in addressing these challenges, while readying the field for big changes to come.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"167-171"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615895","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

Updates in pediatric kidney transplantation. 儿童肾移植的最新进展。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-03-20 DOI: 10.1097/MOT.0000000000001281

Rachel M Engen

引用次数: 0

Kidney-paired donation: benefits and challenges. 配对肾捐赠：益处与挑战。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-04-04 DOI: 10.1097/MOT.0000000000001286

Darshana M Dadhania, Dinesh Kannabhiran, David Serur

{"title":"Kidney-paired donation: benefits and challenges.","authors":"Darshana M Dadhania, Dinesh Kannabhiran, David Serur","doi":"10.1097/MOT.0000000000001286","DOIUrl":"10.1097/MOT.0000000000001286","url":null,"abstract":"Purpose of review: Living-donor kidney transplantation offers the highest survival benefit for patients with kidney failure, yet access remains limited by immunologic, biologic, geographic and logistical barriers. This review summarized recent developments in kidney-paired donation (KPD), highlights current challenges and outlines future directions to optimize program performance and equity.Recent findings: KPD has expanded rapidly in the Unites States and globally, with multicenter national and transnational programs demonstrating excellent allograft and patient outcomes. Increasing the use of altruistic donors, advanced donation models and molecular HLA-matching algorithms have improved match rates and compatibility. Despite these advances, significant challenges persist, including overrepresentation of blood group O and highly sensitized candidates, uneven program participation, financial and logistical barriers, and the need for robust ethical frameworks.Summary: Creating a national KPD program that is accessible to all transplant programs and incorporates compatible recipient-donor pairs would significantly improve the opportunities for living-donor kidney transplantation.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"135-142"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615774","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

Innovations in living kidney donor surgery. 活体肾移植手术的创新。

IF 2.5 4区医学

Current Opinion in Organ Transplantation Pub Date : 2026-06-01 Epub Date: 2026-03-13 DOI: 10.1097/MOT.0000000000001278

Sharon R Weeks, Jacqueline Garonzik-Wang

{"title":"Innovations in living kidney donor surgery.","authors":"Sharon R Weeks, Jacqueline Garonzik-Wang","doi":"10.1097/MOT.0000000000001278","DOIUrl":"10.1097/MOT.0000000000001278","url":null,"abstract":"Purpose of review: Living donor kidney transplantation is an important avenue to address persistent shortage of deceased donor organs. Although transplantation offers superior survival and quality-of-life outcomes compared to dialysis, living donation rates have declined from their mid-2000s peak despite ongoing demand.Recent findings: Innovations in surgical techniques, expanded living donor acceptance criteria, and growth of paired kidney donation programs represent opportunities to improve and expand living donor kidney transplantation. The transition from open donor nephrectomy to minimally invasive laparoscopic approaches significantly reduced perioperative morbidity, postoperative pain, and recovery time. Robotic-assisted techniques offer enhanced visualization and ergonomics, with comparable clinical outcomes to conventional laparoscopy, though cost and resource constraints remain barriers to widespread adoption. Concurrently, transplant centers have broadened donor eligibility to include older individuals, donors with obesity, controlled hypertension, and more complex renal anatomy. Paired kidney donation has enabled incompatible donor-recipient pairs to undergo transplantation through multicenter exchanges and chain-based mechanisms. Despite logistical and resource challenges limiting universal participation, these programs now account for a growing proportion of living donor transplants.Summary: Continued innovation in surgical practice, donor selection, and exchange networks is essential to expand living kidney transplantation and mitigate organ shortage.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"130-134"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456228","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