Transplant immunology最新文献

{"title":"Myth or reality: Graft versus host disease after autologous hematopoietic cell transplantation, a multicentre experience","authors":"Süreyya Yiğit Kaya ,&nbsp;Leylagül Kaynar ,&nbsp;Yaşa Gül Mutlu ,&nbsp;Mihriban Yıldırım ,&nbsp;İstemi Serin ,&nbsp;Duygu Nurdan Avcı ,&nbsp;Gülşah Akyol ,&nbsp;Osman Şahin ,&nbsp;Senem Maral ,&nbsp;Ömür Gökmen Sevindik","doi":"10.1016/j.trim.2025.102286","DOIUrl":"10.1016/j.trim.2025.102286","url":null,"abstract":"<div><div>Acute graft-versus-host disease (aGvHD) is a rare but clinically significant complication of autologous hematopoietic cell transplantation. The aim of this retrospective multicenter study was to evaluate the clinical features, outcomes and risk factors associated with autologous graft-versus-host disease (auto-GvHD) in 19 patients. The cohort included 12 multiple myeloma and 7 lymphoma patients with a median age of 58 years. All patients developed aGvHD, predominantly involving the gastrointestinal tract, skin or liver, with isolated organ involvement in the majority. Conditioning regimens commonly included melphalan and all patients underwent peripheral blood hematopoietic cell transplantation. First-line treatment with topical corticosteroids and systemic methylprednisolone was effective in most cases, while steroid-resistant GvHD was successfully treated with cyclosporine and ruxolitinib. Lenalidomide maintenance therapy in multiple myeloma patients did not lead to GvHD recurrence. No GvHD-related mortality was observed and complete responses were achieved in all treated cases. These findings underscore the importance of early detection and prompt treatment of auto-GvHD, particularly in high-risk populations and highlight the need for further research to elucidate its pathophysiology and optimise management strategies.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102286"},"PeriodicalIF":1.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001121","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}

{"title":"Case report: Hyperacute rejection of living relative kidney transplantation caused by colony-stimulating factor 2 antibodies","authors":"Qixuan Li ,&nbsp;Zhaoying Pang ,&nbsp;Meng Yang ,&nbsp;Lunli Xiang ,&nbsp;Xulian Hu ,&nbsp;Qin Yang ,&nbsp;Hongwen Zhao ,&nbsp;Jie Li ,&nbsp;Xiaosong Xu","doi":"10.1016/j.trim.2025.102285","DOIUrl":"10.1016/j.trim.2025.102285","url":null,"abstract":"<div><h3>Background</h3><div>Kidney transplantation (KT) stands as a highly effective, life-saving intervention for patients with end-stage renal disease, offering substantial improvements in both quality of life and long-term survival. However, one of the most critical challenges that can arise in this procedure is hyperacute rejection (HR). This severe immune response occurs almost immediately after transplantation and can place the patient at a heightened risk of serious complications and even drastically jeopardizes the survival of the transplanted kidney. This study reports a case of HR mediated by colony-stimulating factor 2 (CSF2) antibodies following living-related KT, elaborates on its clinical features, diagnostic workflow, and therapeutic management, and analyzes the role of CSF2 antibodies in KT-related immunity. The findings aim to provide clinical reference for optimizing HR prevention and management in KT practice.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102285"},"PeriodicalIF":1.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001128","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}

{"title":"Lung transplantation in patients with diabetes: A systematic review","authors":"Fatemeh Moosaie ,&nbsp;Shiva Abedinzadeh ,&nbsp;Sepide Javankiani ,&nbsp;Fatemeh Asli ,&nbsp;Prajjwol Luitel ,&nbsp;Seyede Marzie Fatemi Abhari","doi":"10.1016/j.trim.2025.102279","DOIUrl":"10.1016/j.trim.2025.102279","url":null,"abstract":"<div><h3>Background and aim</h3><div>Lung transplantation (LTx) is increasingly performed worldwide, yet post-transplant survival remains lower than for other solid organs. Diabetes mellitus (DM) is common among LTx recipients and impacts outcomes. This systematic review evaluates the effects of DM on LTx outcomes and the influence of diabetes onset timing on survival.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in December 2024 across PubMed, Scopus, and Web of Science to identify original studies or case series involving patients with pre-transplant DM undergoing or waitlisted for LTx. The quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS).</div></div><div><h3>Results</h3><div>Eighty-four studies published between 1992 and 2024 were included, with sample sizes ranging from 10 to over 4 million patients and follow-up from 1 to 25 years. Diabetes was present in 8–56 % of lung transplant recipients. Patients with diabetes, including pre-existing diabetes, cystic fibrosis-related diabetes (CFRD), and new-onset diabetes after transplantation (NODAT), showed higher risks of infections, acute kidney injury, thromboembolic events, chronic lung allograft dysfunction, and cardiovascular complications. Diabetes was consistently associated with increased short- and long-term mortality, prolonged mechanical ventilation, and greater hospitalization rates.</div></div><div><h3>Conclusion</h3><div>Diabetes—whether present before or developing after lung transplantation—is a significant predictor of adverse clinical outcomes and mortality. These findings underscore the need for careful perioperative glycemic management, tailored immunosuppression, and vigilant monitoring to reduce complications. Further standardized, prospective research is essential to guide optimal diabetes management and improve survival in lung transplant recipients.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102279"},"PeriodicalIF":1.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001147","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}

{"title":"Exploration of causal relationship between transplant rejection and immune cells: A two-sample Mendelian randomization study","authors":"Fei Xue ,&nbsp;Xuanpeng Wu ,&nbsp;Ming Ni ,&nbsp;Tao Jiang ,&nbsp;Hao Wang ,&nbsp;Yunfeng Ma ,&nbsp;Qifei Wu","doi":"10.1016/j.trim.2025.102278","DOIUrl":"10.1016/j.trim.2025.102278","url":null,"abstract":"<div><div>Post-transplant rejection is a serious problem for patients undergoing organ transplantation. It is currently believed that immune-related factors are the main causes of transplant rejection, but the roles of many immune cell phenotypes are still unclear.</div><div>We utilized Mendelian randomization analysis to explore the association between 731 immune cell and the risk of transplant rejection.</div><div>We systematically analyzed 731 immune cell phenotypes (including absolute counts, surface markers, and functional states) from peripheral blood of 3657 European individuals. Genetic instruments were selected at a genome-wide significance threshold (<em>p</em> &lt; 1 × 10⁻⁵) to assess bidirectional causal relationships with transplant rejection events from FinnGen biobank (<em>n</em> = 16,380,395 SNPs). Forward MR analysis identified 33 immune phenotypes significantly associated with rejection risk: 19 protective (odds ratio [OR] &lt; 1, <em>p</em> &lt; 0.05) predominantly in B cell subsets, and 14 risk-enhancing phenotypes (OR &gt; 1). Reverse MR revealed that rejection events causally altered 34 immune phenotypes, upregulated 18 effector phenotypes and downregulated 16 regulatory phenotypes. Sensitivity analyses confirmed robustness against pleiotropy (MR-Egger intercept <em>p</em> &gt; 0.05, MR-PRESSO global test <em>p</em> &gt; 0.01 and heterogeneity test p &gt; 0.05). These findings highlight the dynamic interplay between B cell plasticity and Treg depletion in transplant outcomes, suggesting novel therapeutic targets for rejection prevention.</div><div>Our research confirms the close relationship between transplant rejection and immune cells, especially that certain B cell subsets are causally linked to a lower risk of transplant rejection, providing new targets and insights for future clinical treatments.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102278"},"PeriodicalIF":1.4,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904580","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}

{"title":"Impacts of donor-specific anti-HLA antibodies on post-transplant clinical outcomes in hematopoietic stem cell transplantation: A systematic review and meta-analysis","authors":"Muchen Liu ,&nbsp;Zhongyu Kang ,&nbsp;Huan Zhang","doi":"10.1016/j.trim.2025.102275","DOIUrl":"10.1016/j.trim.2025.102275","url":null,"abstract":"<div><h3>Background</h3><div>Donor-specific antibodies (DSAs) are a major risk factor for adverse clinical outcomes in hematopoietic stem cell transplantation (HSCT). However, their clinical relevance remains controversial and unclear. This meta-analysis evaluated the impact of DSAs in HSCT.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis compared outcomes between patients positive and negative for DSAs. Databases including PubMed, Embase, and Cochrane Library were searched for English-language studies published up to January 2025. Studies assessing DSAs and outcomes, including overall survival (OS), graft failure, poor graft function (PGF), poor engraftment rates, and graft-versus-host disease (GVHD). Pooled odds ratios and confidence intervals were calculated using fixed- or random-effects models.</div></div><div><h3>Results</h3><div>Thirty-two studies with 5555 patients with HSCT (557 DSA-positive, 4998 DSA-negative) were included. DSA positivity was considerably associated with increased risk of PGF, graft failure, and overall mortality. Additionally, patients with DSA-positive had lower OS. However, no notable associations were found with GVHD, neutrophil or platelet engraftment, relapse, or infections such as cytomegalovirus or Epstein-Barr virus. Study heterogeneity was moderate to high for several outcomes, necessitating the use of random-effects models.</div></div><div><h3>Conclusion</h3><div>DSAs are linked to poorer HSCT outcomes, particularly graft failure and reduced overall survival. Routine DSA screening and targeted interventions may improve outcomes.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102275"},"PeriodicalIF":1.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812453","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}

{"title":"Research progress and current status of gene-edited-pig to non-human primate kidney xenotransplantation drug application","authors":"Shujun Yang ,&nbsp;Hao Wei ,&nbsp;Haihong Yang ,&nbsp;Xilong Lin ,&nbsp;Panfeng Shang ,&nbsp;Shengkun Sun","doi":"10.1016/j.trim.2025.102276","DOIUrl":"10.1016/j.trim.2025.102276","url":null,"abstract":"<div><div>Kidney transplantation is the only effective treatment for patients with end-stage renal disease (ESRD). With the application of gene-editing technology and modern immunosuppressants, kidney transplants from pigs with up to 12 edited genes have shown significant survival in non-human primates (NHP) and have been transplanted in handful of patients. Our review describes the most current progress in gene-edited pigs used for kidney xenotransplantation (KXTx) to NHP. Furthermore, this review reports about drug treatment options such as immune induction, immune maintenance, anti-inflammatory therapy, and anticoagulant therapy aiming to provide in prospects of KXTx. We stress the following highlights: 1) The application of induction and maintenance therapies with gene edited pigs for NHP KXTx; 2) The application of CD40-CD154 co-stimulatory pathway blockers as essential in immune maintenance medication; 3) The role of cytokines in monitoring of anti-inflammatory treatment’ and 4) The salvage administration measures during suspected rejection reactions can to some extent prolong the functional survival of the recipient kidney.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102276"},"PeriodicalIF":1.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812454","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}

{"title":"Using machine learning to examine pre-transplant factors influencing De novo HLA-specific antibody development post-kidney transplant","authors":"George E. Nita ,&nbsp;Alex Rothwell ,&nbsp;Matthew Howse ,&nbsp;Dan Ridgway ,&nbsp;Abdul Hammad ,&nbsp;Sanjay Mehra ,&nbsp;Andrew R. Jones ,&nbsp;Petra Goldsmith","doi":"10.1016/j.trim.2025.102269","DOIUrl":"10.1016/j.trim.2025.102269","url":null,"abstract":"<div><h3>Introduction</h3><div>The development of <em>de novo</em> donor-specific antibodies (DSAs) against HLA is associated with premature graft failure in kidney transplantation. However, reported rates and contributing factors vary widely. We aimed to identify pre-transplant factors influencing <em>de novo</em> HLA-specific antibody development using machine learning (ML).</div></div><div><h3>Methods</h3><div>Data from 460 kidney transplant recipients at a single centre (2009–2014) was analysed. Pre-transplant clinical and immunological variables were collected, and post-transplant sera were screened for HLA antibodies. Positive samples underwent Single Antigen Bead (SAB) testing. ML models (CART, RF, XGBoost, CatBoost) were trained on a set of pre-transplant data to predict <em>dn</em>DSA formation, with and without SMOTE oversampling. Model performance was evaluated using F1 scores, and feature importance was assessed using SHAP.</div></div><div><h3>Results</h3><div>In the full cohort, 115 patients (25 %) developed <em>dn</em>HLA-specific antibodies, including 36 (31 %) with <em>dn</em>DSAs. XGBoost achieved the best performance (F1 0.54–0.59 without SMOTE; 0.72–0.79 with SMOTE). Univariate analysis identified significant predictors: pre-transplant HLA-specific antibodies (<em>p</em> &lt; 0.001), prior transplantation (p &lt; 0.001), cold ischaemia time (CIT) (<em>p</em> = 0.02), female gender (<em>p</em> = 0.01), younger age (<em>p</em> = 0.03), HLA mismatch (p = 0.01), aminoacid mismatch (p = 0.01), and depleting induction (p = 0.01). SHAP plots confirmed the importance of pre-existing antibodies and re-transplantation. Extremes of CIT and age ≥ 65 was associated were associated with reduced predicted risk. Model performance in the unsensitised subgroup was limited (F1 &lt; 0.2).</div></div><div><h3>Conclusion</h3><div>ML models can be used to identify pre-transplant risk factors for <em>de novo</em> HLA-specific antibody development. Monitoring and risk-stratification based on these factors may inform immunological strategies and recipient selection to improve long-term allograft outcomes.</div></div><div><h3>Translational statement</h3><div>This study identified pre-transplant risk factors for the development of <em>de novo</em> DSA in kidney transplantation. Monitoring and risk-stratifying patients based on these factors may help guide preventive immunological strategies and recipient selection to improve long-term allograft outcomes.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102269"},"PeriodicalIF":1.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804933","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}

{"title":"The KIR/HLA class I co-expression and transplantation outcomes after HSCT/BMT from HLA-matched sibling donors","authors":"Joanna Dębska-Zielkowska ,&nbsp;Bartosz Słomiński ,&nbsp;Hanna Zielińska ,&nbsp;Anna Dukat-Mazurek ,&nbsp;Grażyna Moszkowska ,&nbsp;Maria Bieniaszewska ,&nbsp;Jan Maciej Zaucha ,&nbsp;Piotr Trzonkowski ,&nbsp;Maciej Zieliński","doi":"10.1016/j.trim.2025.102274","DOIUrl":"10.1016/j.trim.2025.102274","url":null,"abstract":"<div><h3>Background</h3><div>Natural killer (NK) cells express killer immunoglobulin-like receptors (KIRs), which regulate their functions. Self-human leukocyte antigens (HLA) class I molecules act as inhibitory molecules for KIRs, blocking the killing activity of NK cells. Since normal NK activity may affect the outcomes of hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT) from their HLA-matched sibling donors, we investigated the interaction between KIRs and class I HLA presented on NK cells. Complications such as graft-versus-host disease (GvHD) or transplant rejection may result because of deficient expression of class I HLA ligand inhibitors in the transplant recipient.</div></div><div><h3>Methods</h3><div>We examined the effect of missing KIR ligands (MSL) and KIR haplotypes on GvHD development, relapses, death, infections, and cell recovery in HSCT patients. Our group included 59 patients [<em>n</em> = 24 with acute myeloid leukemia (AML), <em>n</em> = 12 with chronic myeloid leukemia (CML), n = 12 with myelodysplastic syndrome (MDS), and <em>n</em> = 11 with acute lymphoblastic leukemia (ALL)], who received HSCT/BMT from their sibling donors.</div></div><div><h3>Results</h3><div>Our results showed that haplotype AA was more common than Bx in donors for patients with MDS and was associated with a higher incidence of chronic (c) GvHD (<em>p</em> = 0.003). In this group, we also observed a statistically significant relationship between the AA donor haplotype and absolute neutrophil count reconstruction of 0.5 G/l (0.5 × 10⁹ cells/L) under 28 days (<em>p</em> = 0.03). Our results also showed an excellent correlation between KIR MSL values and cGvHD in AML patients (<em>r</em> = 0.9932).</div></div><div><h3>Conclusion</h3><div>Our results indicate that KIR/HLA class I analysis at the stage of selection of a related donor could have an impact on the results of hematological transplantation and possibly reduce complications.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102274"},"PeriodicalIF":1.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795634","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}

{"title":"Regulatory B cells: Synergistic cellular mechanisms and therapeutic potential for alleviating transplant rejection","authors":"Shaochen Yu ,&nbsp;Mengjie Zhang ,&nbsp;Ziyue Dou ,&nbsp;Jian Lu","doi":"10.1016/j.trim.2025.102277","DOIUrl":"10.1016/j.trim.2025.102277","url":null,"abstract":"<div><div>Posttransplantation rejection remains a critical challenge in organ transplantation. While immunosuppressants improve graft survival, their long-term side effects compromise patient quality of life, necessitating novel, side effect-free strategies to reduce the incidence of rejection. Regulatory B cells (Bregs), an immunomodulatory B lymphocyte subset within the immune microenvironment, have the potential to mitigate transplant rejection. However, Bregs alone are insufficient to control rejection, and their suppressive effects are notably limited in the absence of immunosuppression, highlighting their dependence on synergistic interactions with other regulatory mechanisms. This review summarizes the diverse phenotypes of Bregs and elucidates their immunomodulatory mechanisms, with a focus on cellular interactions (e.g., with Tregs, macrophages, dendritic cells, and NK cells) and cytokine secretion (e.g., IL-10, TGF-β, and IL-35). We critically evaluate animal and clinical trial data concerning the role of Bregs in transplantation, discussing their potential as therapeutic targets and the current limitations and future directions for harnessing Bregs to alleviate transplant rejection.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102277"},"PeriodicalIF":1.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780156","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}

{"title":"Risk factors for acute rejection in pediatric kidney transplantation","authors":"Roman Gorchs ,&nbsp;Matt Stout ,&nbsp;Brooke Cohen ,&nbsp;Jaden Ju ,&nbsp;Eileen Brewer ,&nbsp;Nhu Thao Nguyen Galván ,&nbsp;Abbas Rana","doi":"10.1016/j.trim.2025.102273","DOIUrl":"10.1016/j.trim.2025.102273","url":null,"abstract":"<div><h3>Background</h3><div>Acute rejection in pediatric kidney transplant patients can increase posttransplant costs and lead to limited survival of the graft. Identifying key risk factors for acute rejection in pediatric kidney recipients may allow for physicians to better tailor immunosuppressant regimens and decrease the occurrence of acute rejection.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed using kidney transplantation data provided by the United Network for Organ Sharing (UNOS) for patients younger than 18 years old who received their first kidney transplant between January 2005 and December 2022. The resulting study population consisted of 10,126 patients over the 18-year span. Risk factors for acute rejection in the first year post-transplant were identified using a multivariate analysis.</div></div><div><h3>Results</h3><div>Several variables were found to be statistically significant risk factors for acute rejection, including donor age ≤ 10 (Odds Ratio 1.44), Obese BMI (BMI-for-age z-score &gt; 2.0), (Odds Ratio 1.22), a 6 Human Leukocyte Antigen (HLA) mismatch (Odds Ratio 1.22) and recipient age between 15 and 18 (Odds Ratio 1.21). Multiple factors were found to be protective, including male sex (Odds Ratio 0.85) and recipient age between 5 and 10 (Odds Ratio 0.79).</div></div><div><h3>Conclusions</h3><div>The results indicate several significant risk factors such as the recipient age, Body Mass Index, sex and the number of HLA mismatches between the donor and the recipient. Physicians should consider these factors when personalizing immunosuppressive regimens for pediatric kidney transplant patients.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"92 ","pages":"Article 102273"},"PeriodicalIF":1.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761451","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}