Transplantation最新文献

{"title":"Long-term Metabolic Outcomes Post-Simultaneous Pancreas-Kidney Transplantation in Recipients With Type 1 Diabetes.","authors":"Harsham Choksi, Henry Pleass, Paul Robertson, Eric Au, Natasha Rogers","doi":"10.1097/TP.0000000000005334","DOIUrl":"10.1097/TP.0000000000005334","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous pancreas-kidney (SPK) transplantation is an effective treatment option for type 1 diabetes mellitus and concurrent end-stage kidney disease. However, the diabetogenic effects of immunosuppression can counteract the beneficial effects of sustained normoglycemia. Long-term metabolic trends that reflect cardiovascular risk are reported poorly in the literature.</p><p><strong>Methods: </strong>A total of 500 patients with type 1 diabetes mellitus receiving SPK transplants at a single center with at least 2-y follow-up were evaluated retrospectively. Metabolic parameters and allograft function were followed longitudinally, including patient and allograft survival, body mass index (BMI), lipid profile, quantitative insulin sensitivity check index, estimated glomerular filtration rate, and urinary albumin-creatinine ratio up to 10 y posttransplant.</p><p><strong>Results: </strong>Patient survival at 1, 5, and 10 y was 97%, 92%, and 87%, and overall death-censored graft survival was 87%, 84%, and 80%, respectively. Survival remained unchanged when stratified by BMI. Compared with pretransplant measurements, BMI significantly increased at 1, 3, and 5 y posttransplant. Total cholesterol, triglycerides, and low-density lipoprotein cholesterol decreased at 10 y posttransplant, with significantly increased high-density lipoprotein cholesterol at 5 y posttransplant. Insulin sensitivity improved significantly at 10 y posttransplant but did not normalize. Urinary albumin-creatinine ratio decreased by 3 y posttransplant but increased significantly between 3 and 10 y posttransplant, although the estimated glomerular filtration rate was unchanged during this time.</p><p><strong>Conclusions: </strong>SPK transplantation is associated with excellent patient and graft survival. Significant long-term weight gain occurs despite improving lipid profiles and insulin sensitivity posttransplant. These data potentially reflect an overall cardiovascular burden that should be addressed in this population.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1222-1229"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024816","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":"Machine Learning Algorithms in Controlled Donation After Circulatory Death Under Normothermic Regional Perfusion: A Graft Survival Prediction Model.","authors":"Rafael Calleja, Marcos Rivera, David Guijo-Rubio, Amelia J Hessheimer, Gloria de la Rosa, Mikel Gastaca, Alejandra Otero, Pablo Ramírez, Andrea Boscà-Robledo, Julio Santoyo, Luis Miguel Marín Gómez, Jesús Villar Del Moral, Yiliam Fundora, Laura Lladó, Carmelo Loinaz, Manuel C Jiménez-Garrido, Gonzalo Rodríguez-Laíz, José Á López-Baena, Ramón Charco, Evaristo Varo, Fernando Rotellar, Ayaya Alonso, Juan C Rodríguez-Sanjuan, Gerardo Blanco, Javier Nuño, David Pacheco, Elisabeth Coll, Beatriz Domínguez-Gil, Constantino Fondevila, María Dolores Ayllón, Manuel Durán, Ruben Ciria, Pedro A Gutiérrez, Antonio Gómez-Orellana, César Hervás-Martínez, Javier Briceño","doi":"10.1097/TP.0000000000005312","DOIUrl":"10.1097/TP.0000000000005312","url":null,"abstract":"<p><strong>Background: </strong>Several scores have been developed to stratify the risk of graft loss in controlled donation after circulatory death (cDCD). However, their performance is unsatisfactory in the Spanish population, where most cDCD livers are recovered using normothermic regional perfusion (NRP). Consequently, we explored the role of different machine learning-based classifiers as predictive models for graft survival. A risk stratification score integrated with the model of end-stage liver disease score in a donor-recipient (D-R) matching system was developed.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study used 539 D-R pairs of cDCD livers recovered with NRP, including 20 donor, recipient, and NRP variables. The following machine learning-based classifiers were evaluated: logistic regression, ridge classifier, support vector classifier, multilayer perceptron, and random forest. The endpoints were the 3- and 12-mo graft survival rates. A 3- and 12-mo risk score was developed using the best model obtained.</p><p><strong>Results: </strong>Logistic regression yielded the best performance at 3 mo (area under the receiver operating characteristic curve = 0.82) and 12 mo (area under the receiver operating characteristic curve = 0.83). A D-R matching system was proposed on the basis of the current model of end-stage liver disease score and cDCD-NRP risk score.</p><p><strong>Conclusions: </strong>The satisfactory performance of the proposed score within the study population suggests a significant potential to support liver allocation in cDCD-NRP grafts. External validation is challenging, but this methodology may be explored in other regions.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e362-e370"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955720","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":"Deceased Organ Donation and Transplantation in the United Arab Emirates: A View 7 y After Implementation.","authors":"Maria Paula Gómez, Ali Abdulkareem Al-Obaidli","doi":"10.1097/TP.0000000000005358","DOIUrl":"10.1097/TP.0000000000005358","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1055-1058"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568395","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":"The Aberrantly Expressed Nuclear Factor (Erythroid-derived 2)-Like 2 Participates in aGVHD by Modulating the Activation and Differentiation of CD4 + T Lymphocytes.","authors":"Xu Chen, Yue Zhang, Yan Chen, Wei Qin, Tingting Cheng, Shiyu Wang, Yajing Xu","doi":"10.1097/TP.0000000000005289","DOIUrl":"10.1097/TP.0000000000005289","url":null,"abstract":"<p><strong>Background: </strong>Current investigation indicates that nuclear factor (erythroid-derived 2)-like 2 (NRF2) possesses both proinflammatory and anti-inflammatory capabilities in T cells, yet its exact function in acute graft-versus-host disease (aGVHD) CD4 + T cells remains unexplored.</p><p><strong>Methods: </strong>This study aims to determine NRF2 levels within CD4 + T cells of patients with or without aGVHD and analyze the correlation between T-cell receptor activation and NRF2 expression. RNA sequencing was used to detect changes in the expression profile of CD4 + T cells after overexpression of NRF2, and functional enrichment analysis was performed on the sequencing results. Finally, after treating aGVHD CD4 + T cells with NRF2 inhibitor, the expression of related pathway molecules was detected.</p><p><strong>Results: </strong>Our findings demonstrated a significant upregulation of NRF2 expression in CD4 + T cells from patients in the aGVHD group compared with patients in the non-aGVHD group, and its expression level is correlated with the severity of aGVHD. Additionally, T-cell receptor activation in CD4 + T cells elevates NRF2 expression. Postactivation of NRF2-inhibited CD4 + T cells, the expression levels of T-cell activation markers were notably lower than those in non-NRF2-inhibited CD4 + T cells. Sequencing analysis identified 904 genes that changed after NRF2 overexpression. These genes were categorized into 288 gene subsets, encompassing pathways such as T-cell receptor signaling transduction, Janus kinase 1/signal transducer and activator of transcription 1 (JAK1-STAT1) signaling, T helper cell 17 (Th17) cell differentiation, etc. Ultimately, treating CD4 + T cells of aGVHD patients with an NRF2 inhibitor led to a significant downregulation of JAK1-STAT1 signaling and Th17 cells.</p><p><strong>Conclusions: </strong>Elevated NRF2 expression in CD4 + T cells of patients with aGVHD initiates and exacerbates aGVHD by potentiating T-cell activation, amplifying JAK1/STAT1 signaling, and instigating Th17/regulatory T-cell ratio imbalance.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1152-1165"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366084","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":"Human Papillomavirus Infection and Cytological Atypia in Female Allogeneic Hematopoietic Stem Cell Transplantation Recipients.","authors":"Adela Saco, Sara Carbonell, Natalia Rakislova, Isabel Matas, Silvia Alòs, Sandra Hoya, María Suárez-Lledó, Katarzyna Darecka, Lia Sisuashvili, Lorena Marimon, Naiara Vega, Roser Esteve, Carmen Martínez, Cristina Martí, Ariel Glickman, Olga Balagué, Aureli Torne, Jaume Ordi, Marta Del Pino","doi":"10.1097/TP.0000000000005323","DOIUrl":"10.1097/TP.0000000000005323","url":null,"abstract":"<p><strong>Background: </strong>Female recipients of allogeneic hematopoietic stem cell transplantation are at high risk of developing human papillomavirus (HPV)-associated lesions and (pre)cancer. We describe the results of a cervical cancer screening program in these women.</p><p><strong>Methods: </strong>From 2010 to 2022, 70 female recipients of allogeneic hematopoietic stem cell transplantation in our institution entered a standardized protocol of gynecological evaluation. HPV testing, Papanicolaou smear, and thorough gynecological examinations were conducted in all the women.</p><p><strong>Results: </strong>The cumulative prevalence of HPV infection was 21.4% (15/70). Ten of 70 women (14.3%) had a positive HPV test result in the first gynecological evaluation and 5 additional women (7.1%) became positive during follow-up. Thirteen women (18.5%) presented cytohistological lesions (3 high-grade lesions and 10 low-grade lesions). Twenty-nine women (41.4%) showed HPV-negative reactive atypical abnormalities related to the conditioning treatment, which closely mimicked HPV-associated lesions, which spontaneously disappeared during follow-up.</p><p><strong>Conclusions: </strong>Gynecological evaluation should be maintained over time, as a significant proportion of these women may become HPV positive during follow-up. Reactive benign, atypical changes related to the treatment, which closely mimic HPV-associated lesions, are a frequent finding in these women. HPV testing is a key tool for the evaluation of these patients, as it allows for identifying women at risk and excluding cytological mimickers.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e371-e378"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024813","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":"Progress Update on the Transplant Surgery Training Pipeline in the United States.","authors":"Alan Zambeli-Ljepović, Catherine E Kling, Leigh Anne Dageforde, Kristina Lemon, R Cutler Quillin, Alexander R Cortez","doi":"10.1097/TP.0000000000005389","DOIUrl":"10.1097/TP.0000000000005389","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1059-1061"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701629","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":"The Challenge of Minding the Glomerular Filtration Rate Gap Between Pancreas Transplant Alone and Simultaneous Pancreas-Kidney Transplantation: Stuck in the Middle.","authors":"Sandesh Parajuli, Didier Mandelbrot, Robert J Stratta, Raja Kandaswamy, Ronald F Parsons, Neeraj Singh, Angelika Gruessner, Dixon B Kaufman, Jon Odorico","doi":"10.1097/TP.0000000000005390","DOIUrl":"10.1097/TP.0000000000005390","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1062-1065"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701635","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":"Standardizing Care and Management of Cytomegalovirus Infections in Solid Organ Transplant Recipients: Highlights From the Fourth Consensus Guidelines.","authors":"Germaine Wong, Jennifer Li","doi":"10.1097/TP.0000000000005380","DOIUrl":"10.1097/TP.0000000000005380","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1111-1112"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812600","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":"Should We Transplant Candidates With a Positive SARS-CoV-2 RT-PCR Test?","authors":"Ilies Benotmane, Nathan Kasriel, Christophe Masset, Baptiste Michard, Paolo Malvezzi, Baptiste Giguet, Claire Tinel, Filomena Conti, Florent Von Tokarski, José Ursic-Bedoya, Marie Matignon, Adrien Flahault, Inna Mohamadou, Fanny Lebossé, Nassim Kamar, Mehdi Maanaoui, Ilias Kounis, Coralie Poulain, Marie-Noëlle Hilleret, Dany Anglicheau, Florence Lacaille, Nicolas Bouvier, Léonard Golbin, Agnès Duveau, Sophie Caillard, Lionel Couzi, Hannah Kaminski, Jérôme Dumortier","doi":"10.1097/TP.0000000000005333","DOIUrl":"10.1097/TP.0000000000005333","url":null,"abstract":"<p><strong>Background: </strong>It remains unclear whether physicians should accept transplantation offers for candidates with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test due to the potential risk of severe infection after initiating immunosuppressive therapy.</p><p><strong>Methods: </strong>A multicenter observational study was conducted in 19 French solid organ transplantation units. Patients on the waiting list for liver or kidney transplants who had a positive SARS-CoV-2 reverse transcription polymerase chain reaction nasopharyngeal swab at the time of transplantation were recorded.</p><p><strong>Results: </strong>Sixty-five patients were included. The recipients were predominantly men (n = 40; 62%) with a mean age of 55.4 y (SD = 16.5). On the day of transplantation, 2 patients exhibited symptoms compatible with COVID-19. The majority of patients (n = 55; 85%) underwent thoracic imaging, with only 3 patients showing imaging results compatible with COVID-19. Ten patients (28%) had a cycle threshold value <30. Anti-SARS-CoV-2 spike protein serology within 3 mo before transplantation was available for 36 patients; only 2 patients were seronegative. Due to COVID-19, physicians adapted the immunosuppressive therapy for 16 patients (25%). Specific antiviral therapy was used for 15 patients (23%), primarily remdesivir (n = 12). Overall, the majority of patients did not receive any adjustment of immunosuppressive therapy or antiviral treatment (n = 36; 55%). The outcomes were generally favorable even for patients with the lowest cycle threshold values, indicating a high viral load. Four patients died during follow-up, although none of these deaths were attributable to COVID-19.</p><p><strong>Conclusions: </strong>Transplantation appears to be safe for patients who are asymptomatic or have mild symptoms, reassuring thoracic imaging, and a history of anti-SARS-CoV-2 infection and/or immunization.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1257-1260"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068208","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":"Understanding Liver Transplantation Outcomes Through the Lens of Its Tissue-resident Immunobiome.","authors":"Amy C Prosser, Paul Klenerman, Michaela Lucas","doi":"10.1097/TP.0000000000005303","DOIUrl":"10.1097/TP.0000000000005303","url":null,"abstract":"<p><p>Tissue-resident lymphocytes (TRLs) provide a front-line immunological defense mechanism uniquely placed to detect perturbations in tissue homeostasis. The heterogeneous TRL population spans the innate to adaptive immune continuum, with roles during normal physiology in homeostatic maintenance, tissue repair, pathogen detection, and rapid mounting of immune responses. TRLs are especially enriched in the liver, with every TRL subset represented, including liver-resident natural killer cells; tissue-resident memory B cells; conventional tissue-resident memory CD8, CD4, and regulatory T cells; and unconventional gamma-delta, natural killer, and mucosal-associated invariant T cells. The importance of donor- and recipient-derived TRLs after transplantation is becoming increasingly recognized, although it has not been examined in detail after liver transplantation. This review summarizes the evidence for the roles of TRLs in liver transplant immunology, focusing on their features, functions, and potential for their harnessing to improve transplant outcomes.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e349-e361"},"PeriodicalIF":5.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955724","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}