Nephrology Dialysis Transplantation最新文献

{"title":"Real-time monitoring of postfilter calcium in regional citrate anticoagulation for continuous renal replacement therapy.","authors":"Zhang Qi, Zhang Beiyi, Yue Zengqi, Sun Chen, Yu Jin, Ding Feng","doi":"10.1093/ndt/gfaf006","DOIUrl":"10.1093/ndt/gfaf006","url":null,"abstract":"","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1055-1058"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acquired and genetic determinants of disease phenotype and therapeutic strategies in C3 glomerulopathy and immunoglobulin-associated MPGN.","authors":"Marie-Sophie Meuleman, Julia Roquigny, Romain Brousse, Carine El Sissy, Guillaume Durieux, Moglie Le Quintrec, Jean-Paul Duong Van Huyen, Véronique Frémeaux-Bacchi, Sophie Chauvet","doi":"10.1093/ndt/gfae245","DOIUrl":"10.1093/ndt/gfae245","url":null,"abstract":"<p><p>C3 glomerulopathy (C3G), a prototype of complement-mediated disease, is characterized by significant heterogeneity, in terms of not only clinical, histological and biological presentation but also prognosis, and response to existing therapies. Recent advancements in understanding the factors responsible for alternative pathway dysregulation in the disease have highlighted its even more complex nature. Here, we propose a reexamination of the diversity of C3G presentations in light of the drivers of complement activation. Autoantibodies targeting complement proteins, genetic abnormalities in complement genes and monoclonal immunoglobulins are now well-known to drive disease occurrence. This review discusses how these drivers contribute to the heterogeneity in disease phenotype and outcomes, providing insights into tailored diagnostic and therapeutic approaches. In recent years, a broad spectrum of complement inhibitory therapies has emerged, soon to be available in clinical practice. The recognition of specific clinical, biological and histological patterns associated with different forms of C3G is crucial for personalized management, particularly treatment strategies.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"842-851"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stenosis of the glomerulotubular neck in progressive chronic kidney disease.","authors":"Eric P Cohen, Aleksandar Denic, Fnu Aperna, Aidan F Mullan, Laura Barisoni, Vidit Sharma, Ian W Gibson, Andrew D Rule","doi":"10.1093/ndt/gfae234","DOIUrl":"10.1093/ndt/gfae234","url":null,"abstract":"<p><strong>Background: </strong>Morphology and morphometric evaluation of lesions beyond conventional parameters can inform the pathophysiology of chronic kidney disease (CKD). We sought to determine whether the occurrence of glomerulotubular neck stenoses associates with progressive CKD.</p><p><strong>Methods: </strong>We evaluated the normal parenchyma from radical nephrectomies removed for tumor between 2000 and 2021 and analyzed cortex for stenoses of the glomerulotubular neck. Stenosis of the glomerulotubular neck is defined a focal narrowing for which the draining tubule has a greater diameter than at the neck. Progressive CKD was defined as dialysis, kidney transplantation, sustained estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m2 or sustained 40% decline from the post-nephrectomy eGFR. Each case of progressive CKD was age- and sex-matched to two controls without progressive CKD. Logistic regression models assessed the risk of progressive CKD with stenotic necks adjusting for other histological features, kidney function and CKD risk factors.</p><p><strong>Results: </strong>There were 65 cases with a mean of 255 glomeruli and 130 controls with a mean of 329 glomeruli. Among both cases and controls, 5% of glomeruli showed visible glomerulotubular necks. The proportion of necks that were stenotic was higher in cases than controls (35% vs 11%, P < .0001). Stenotic necks associated with progressive CKD independent of other histologic and clinical characteristics.</p><p><strong>Conclusion: </strong>Glomerulotubular neck stenosis is associated with development of progressive CKD.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"917-928"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obinutuzumab versus rituximab for the treatment of refractory primary membranous nephropathy.","authors":"Mingyue Xu, Yifeng Wang, Meihe Wu, Ruiying Chen, Wenqian Zhao, Mingxin Li, Chuan-Ming Hao, Qionghong Xie","doi":"10.1093/ndt/gfae230","DOIUrl":"10.1093/ndt/gfae230","url":null,"abstract":"<p><strong>Background: </strong>Rituximab has been shown effective in patients with primary membranous nephropathy refractory to glucocorticoids plus cyclophosphamide (GC + CTX) or calcineurin inhibitors (CNIs), but the response rates remain limited. Compared with rituximab, obinutuzumab is a humanized anti-CD20 monoclonal antibody with greater B-cell depletion capacity. This study was performed to investigate the effectiveness of obinutuzumab compared with rituximab in treating patients with refractory primary membranous nephropathy.</p><p><strong>Methods: </strong>A retrospective study was conducted at Huashan Hospital, Fudan University between 1 January 2015 and 31 July 2024, and included adult patients with primary membranous nephropathy who met the following criteria: (i) resistance to GC + CTX and/or CNI regimens, (ii) dependence on CNIs or (iii) relapse within 1 year after CTX discontinuation. The patients subsequently received either obinutuzumab or rituximab. The primary endpoint was treatment response, which was defined as overall remission of nephrotic syndrome with no need for rescue therapy after obinutuzumab versus rituximab treatment. The secondary measures included immunological remission and safety profiles.</p><p><strong>Results: </strong>Among the 51 participants, 20 received obinutuzumab and 31 received rituximab. The response rate was significantly greater in patients receiving obinutuzumab than in those receiving rituximab (90.0% vs 38.7%, P < .001) during a follow-up period of 24 [interquartile range (IQR) 10-34] months. Cox proportional hazards survival regression analysis also revealed the superior effectiveness of obinutuzumab (P < .001). Immunological remission rates were higher in patients receiving obinutuzumab at both 3 months (75.0% vs 20.0%, P < .001) and 6 months (87.5% vs 21.4%, P < .001). The safety profiles of the two treatments were comparable. Among the 19 non-responders treated with rituximab, 10 subsequently received obinutuzumab, and 8 achieved remission during a follow-up period of 20.0 (IQR 18.5-22.3) months.</p><p><strong>Conclusion: </strong>This retrospective study suggests that obinutuzumab is an effective treatment option for patients with primary membranous nephropathy refractory to GC + CTX, CNI and rituximab regimens.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"978-986"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery from rituximab-associated persistent hypogammaglobulinaemia in children with nephrotic syndrome.","authors":"Daishi Hirano, Takuya Fujimaru, Mayumi Sako, Seiji Tanaka, Aya Inaba, Toru Uchimura, Koichi Kamei, Takuo Kubota, Toshiyuki Ohta, Takayuki Okamoto, Hiroshi Tanaka, Riku Hamada, Shuichi Ito","doi":"10.1093/ndt/gfae228","DOIUrl":"10.1093/ndt/gfae228","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on the long-term outcomes and risk factors for non-recovery after development of rituximab (RTX)-associated persistent hypogammaglobulinaemia among children with idiopathic nephrotic syndrome (NS).</p><p><strong>Methods: </strong>A nationwide Japanese survey was conducted to determine the prognosis of patients with childhood-onset idiopathic NS who developed persistent hypogammaglobulinaemia after RTX administration. Specifically, predictors of IgG level recovery and risk factors for serious infection were examined.</p><p><strong>Results: </strong>The cohort comprised 118 patients (66.1% boys; median age at initial RTX administration, 7.5 years). Among the 121 patients diagnosed with persistent hypogammaglobulinaemia, only 31 (26.3%) recovered within a median observation period of 2.8 years; approximately 70% of patients continued to exhibit persistent hypogammaglobulinaemia. Among the patients who recovered from hypogammaglobulinaemia, the median time to recovery was 14.1 months. Patients with a history of steroid-resistant NS were less likely to recover from persistent hypogammaglobulinaemia (hazard ratio 0.28; 95% confidence interval 0.09-0.87). In addition, of the 118 eligible patients, 18 (15.3%) developed serious infections requiring hospitalization, and the main risk factor for infection during hypogammaglobulinaemia was agranulocytosis (a well-known adverse effect of RTX in children).</p><p><strong>Conclusions: </strong>A significant portion of patients with RTX-associated persistent hypogammaglobulinaemia did not exhibit recovery even after 1 year. Moreover, the data indicate that patients with a history of steroid-resistant NS have a significantly lower probability of recovering from this condition. Agranulocytosis under hypogammaglobulinaemia was significantly associated with an elevated risk of serious infections.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"967-977"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of perinatal exposition to xenobiotics with kidney volume at birth.","authors":"Katy Valeria De Santiago-Rodríguez, Alejandro Aarón Peregrina-Lucano, Fernando Jaramillo-Arriaga, Emmanuel Oziel Helguera-Gomez, Daniel Ibarra-Orenday, Salomón Israel González-Domínguez, Elizabeth Ramirez Sandoval, Emmanuel Salomon Macias Duron, Eduardo Alfredo Enriquez Muñoz, Juan Fernando Hernandez Rocha, Julio Cesar Rangel Talamantes, Tayde Selene Martinez Medina, Octavio Daniel Reyes Gonzalez, Myriam Del Carmen Corrales-Aguirre, María Del Rosario Sánchez-Ortiz, Omar Oswaldo Camarillo-Contreras, Alfredo Chew-Wong, Carmen Lucrecia Ramos-Medellín, Leslie Paola Zuñiga-Macias, Oscar Abraham Flores Amaro, Laura Yamamoto Flores, Alma Lilian Guerrero Barrera, Francisco Javier Avelar-González, José Manuel Arreola-Guerra","doi":"10.1093/ndt/gfae238","DOIUrl":"10.1093/ndt/gfae238","url":null,"abstract":"<p><strong>Background: </strong>The state of Aguascalientes has the highest prevalence of kidney failure in young adults globally. A low nephron endowment has been suggested as a possible aetiology. This study aims to evaluate the association between exposure to xenobiotics and low kidney volume (KV) at birth.</p><p><strong>Methods: </strong>This is a cross-sectional, observational, descriptive study of at-term pregnant women with no comorbidities. We collected the mother's urine (MU) and amniotic fluid (AF) and the neonate's urine (NU). Metals and non-metals were measured with inductively coupled plasma mass spectrometry, pesticides with high-performance liquid chromatography and fluoride with ion-selective potentiometry. The total KV adjusted by body surface area (TKVBS) was calculated based on the kidney ultrasound.</p><p><strong>Results: </strong>Between March 2022 and July 2023, we included 299 women with an average age of 24.2 years [standard deviation (SD) 5.1]. A total of 54.2% of neonates were male with an average weight of 3266 g (SD 399). Factors associated with TKVBS ≤5th percentile were female sex, weight gain during pregnancy, glomerular filtration rate, methomyl concentration in AF {odds ratio [OR] 7.41 [95% confidence interval (CI) 2.31-23.8], P = .001}, 2,4-dichlorophenoxyacetic (2,4-D) >10 ng/ml in AF [OR 4.99 (95% CI 1.58-15.7), P = .002], MU [OR 6.1 (95% CI 1.9-19.7), P = 0.002] and NU [OR 5.1 (95% CI 1.10-26.2), P = .023] and fluoride in MU [OR 5.1 (95% CI 1.10-23.5), P = .010] and AF [OR 6.76 (95% CI 1.28-35.7), P = .024]. In all matrices (MU, AF and NU), exposure to pesticides was also significantly associated with greater concentrations of electrolytes (sodium, potassium, calcium, phosphate and magnesium) and trace elements (zinc and iron).</p><p><strong>Conclusions: </strong>In neonates born to at-term women with no comorbidities, the presence of pesticides and fluoride was associated with low KV. The significant loss of electrolytes and trace elements associated with pesticides suggests proximal tubulopathy.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1007-1019"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inherited kidney disease and CAKUT are common causes of kidney failure requiring kidney replacement therapy: an ERA Registry study.","authors":"Alberto Ortiz, Anneke Kramer, Gema Ariceta, Olga L Rodríguez Arévalo, Ann C Gjerstad, Carmen Santiuste, Sara Trujillo-Alemán, Pietro Manuel Ferraro, Shona Methven, Rafael Santamaría, Radomir Naumovic, Halima Resic, Kristine Hommel, Mårten Segelmark, Patrice M Ambühl, Søren S Sorensen, Cyrielle Parmentier, Enrico Vidal, Sevcan A Bakkaloglu, Lucy Plumb, Runolfur Palsson, Julia Kerschbaum, Marc A G J Ten Dam, Vianda S Stel, Kitty J Jager, Roser Torra","doi":"10.1093/ndt/gfae240","DOIUrl":"10.1093/ndt/gfae240","url":null,"abstract":"<p><strong>Background: </strong>Inherited kidney diseases (IKDs) and congenital anomalies of the kidney and urinary tract (CAKUT) are causes of kidney failure requiring kidney replacement therapy (KRT) that major renal registries usually amalgamate into the primary renal disease(PRD) category 'miscellaneous' or in the glomerulonephritis or pyelonephritis categories. This makes IKDs invisible (except for polycystic kidney disease) and may negatively influence the use of genetic testing, which may identify a cause for IKDs and some CAKUT.</p><p><strong>Methods: </strong>We re-examined the aetiology of KRT by composing a separate IKD and CAKUT PRD group using data from the European Renal Association (ERA) Registry.</p><p><strong>Results: </strong>In 2019, IKD-CAKUT was the fourth most common cause of kidney failure among incident KRT patients, accounting for 8.9% of cases [IKD 7.4% (including 5.0% autosomal dominant polycystic kidney disease), CAKUT 1.5%], behind diabetes (23.0%), hypertension (14.4%) and glomerulonephritis (10.6%). IKD-CAKUT was the most common cause of kidney failure among patients <20 years of age (41.0% of cases), but their incidence rate was highest among those ages 45-74 years (22.5 per million age-related population). Among prevalent KRT patients, IKD-CAKUT (18.5%) and glomerulonephritis (18.7%) were the two most common causes of kidney failure overall, while IKD-CAKUT was the most common cause in women (21.6%) and in patients <45 years of age (29.1%).</p><p><strong>Conclusion: </strong>IKD and CAKUT are common causes of kidney failure among KRT patients. Distinct categorization of IKD and CAKUT better characterizes the epidemiology of the causes of chronic kidney disease (CKD) and highlights the importance of genetic testing in the diagnostic workup of CKD.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1020-1031"},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Kidney Injury in Very Old Patients - Incidence, Severity, Risk Factors and Short-Term Outcomes.","authors":"Stefan Herget-Rosenthal, Kolja Stille, Klaus Albrecht, Hajo Findeisen, Martin Scharpenberg, Andreas Kribben","doi":"10.1093/ndt/gfaf074","DOIUrl":"https://doi.org/10.1093/ndt/gfaf074","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Although old age is a risk factor for acute kidney injury (AKI), data on AKI in individuals ≥80 years is limited. We aimed to provide data on AKI incidence, severity, and outcomes, to identify risk factors of AKI and 30-day mortality in those ≥80 years.</p><p><strong>Methods: </strong>Cohort study of 2132 patients admitted to hospital. AKI was defined and classified by extended KDIGO criteria to detect community-acquired AKI, frailty as a clinical frailty score ≥5. Primary endpoints were AKI and its stages, secondary endpoints 30-day mortality and major adverse kidney events (MAKE30), a composite of mortality, new renal replacement therapy, or serum creatinine values ≥200% of baseline, all at 30 days.</p><p><strong>Results: </strong>Median age was 86 years. AKI was frequent (35.3%) and predominately community-acquired (80.2%). The incidence rate of AKI rose with increasing age, reaching the maximum in patients 95 years old. 48.9% of AKI patients developed stage 1, while 27.0% and 24.1% reached stages 2 and 3, respectively. Frailty was identified as an independent AKI risk factor (adjusted odds ratio (aOR) 2.42 (95% confidence intervals (CI) 1.93-3.03). 30-day mortality rate was significantly higher in AKI compared to non-AKI patients (25.4 vs. 7.6%), 44.4% of AKI patients developed MAKE30. Among others, AKI and frailty were risk factors for 30-day mortality (aOR 3.02 (95% CI 2.25-4.07) and 1.53 (95% CI 1.16-2.02)), with frailty exceeding AKI in patients ≥90 years.</p><p><strong>Conclusions: </strong>AKI occurs frequently, increases with age, is severe and predominately community-acquired in individuals ≥80 years admitted to hospital. Frailty is a risk factor for AKI besides established factors. Very old patients with AKI more frequently died or developed a high rate of the composite endpoint MAKE30. AKI and frailty are risk factors for 30-day mortality. The effect of frailty on mortality exceeded that of AKI in nonagenarians.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Involvement in ANCA-associated Vasculitis.","authors":"Ahmad Sarmad, Zohreh Gholizadeh Ghozloujeh, Paul E Hanna, Andreas Kronbichler, Duvuru Geetha, Giv Heidari-Bateni, Roy Mathew, Muhammad Ahmad, Afnan Mohammed, Samrah Siddiqui, Amir Abdipour, Sayna Norouzi","doi":"10.1093/ndt/gfaf070","DOIUrl":"https://doi.org/10.1093/ndt/gfaf070","url":null,"abstract":"<p><p>Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic necrotizing vasculitis with significant cardiovascular involvement, primarily manifesting in granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis. AAV patients face a 65% higher cardiovascular event risk, with common manifestations such as myocardial infarction, stroke, and myocarditis, and less frequently, aortitis. Pathophysiology includes endothelial dysfunction, vascular inflammation, and direct inflammatory infiltration of cardiac tissue, exacerbated by traditional risk factors such as hypertension, dyslipidemia and non-traditional factors like immunosuppressive therapies. Management emphasizes cardiovascular risk reduction through traditional methods alongside cautious use of glucocorticoids and immunosuppressants to control disease activity and minimize cardiovascular impact. Despite therapeutic advancements, long-term cardiovascular morbidity and mortality risks persist, underscoring the need for enhanced predictive tools and individualized therapeutic strategies. We aim to review current literature on the incidence, clinical manifestations, and outcomes of cardiovascular involvement in AAV, with a focus on pathophysiology, risk factors, predictive models, and strategies for prevention and management.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genome-wide donor recipient non-HLA mismatch and graft loss.","authors":"Josef Pickl, Andreas Heinzel, Stephen Shoebridge, Alexander Kainz, Rainer Oberbauer","doi":"10.1093/ndt/gfaf073","DOIUrl":"https://doi.org/10.1093/ndt/gfaf073","url":null,"abstract":"<p><p>HLA-matching between donor (D) and recipient (R) is routinely performed in kidney allocation to optimize allograft survival but explains only a moderate variability of these outcomes. Recent findings suggest that donor to recipient mismatches outside the HLA region contributes to alloimmunity and graft loss but the extent varies in different publications. We therefore conducted a systematic review of publications on this subject using a broad search string in our literature review in accordance with current guidelines for systematic reviews. The effect sizes were analyzed by a meta-analysis. 1890 Publications from 2019-2025 within three different repositories (465 Medline; 1408 Embase; 17 Central) were systematically screened using the PICOTS system, which resulted in 12 eligible papers that met the inclusion criteria. Cohort studies that investigated the association of D-R non-HLA SNP-mismatch and graft rejection/loss in renal transplant patients were included. We found that overall SNP mismatch between D-R pairs outside the HLA region was independently numerically associated with rejection HR 1.26 (95% CI 0.97-1.65) and graft loss HR 1.35 (95% CI 0.86-2.12). Furthermore, loss of function mutation of the gene LIMS1 in the recipient who received a transplant organ with at least one functioning copy (collision genotype) was numerically associated with rejection HR 1.23 (95% CI 0.68-2.23) and graft loss HR 1.43 (95% CI 0.61-3.36). The exact quantification of the effect size of these mismatches varied by publication and needs further investigation. Based on these data, the strength of immunosuppression may be guided by the load of D-R mismatches in the future.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}