Transplantation最新文献_第6页

The Relative Roles of Inflammation in Kidney Allotransplantation and Xenotransplantation. 炎症在肾异体移植和异体移植中的相对作用。

IF 5 2区医学

Transplantation Pub Date : 2025-09-03 DOI: 10.1097/TP.0000000000005518

Muhammad Furqan Ubaid, Mohamed B Ezzelarab, David K C Cooper

{"title":"The Relative Roles of Inflammation in Kidney Allotransplantation and Xenotransplantation.","authors":"Muhammad Furqan Ubaid, Mohamed B Ezzelarab, David K C Cooper","doi":"10.1097/TP.0000000000005518","DOIUrl":"https://doi.org/10.1097/TP.0000000000005518","url":null,"abstract":"The nature and severity of the inflammatory response influences the outcome of organ allotransplantation and xenotransplantation. In allotransplantation, the source of the allograft, for example, from a living, brain-dead, or circulatory death donor, influences the inflammatory response, as do such factors as the preexisting comorbidities and the length of the period of chronic kidney disease in the recipient and the management he/she has received. There is also inflammation associated with the transplant surgery, for example, as a result of ischemia-reperfusion injury. In xenotransplantation, inflammation associated with donor factors will be reduced and, as the patients will receive a pig graft at a much earlier stage of their chronic organ failure, the contribution of recipient factors should also be reduced. However, there is a well-documented systemic inflammatory response to the presence of a pig xenograft (probably associated with species molecular differences) that plays a role in activating the innate immune response. Indeed, there is a complex interaction between inflammation, coagulation dysfunction, and the innate and adaptive immune responses. Suppression of the inflammatory response, for example, by interleukin-6 receptor blockade, would appear to be beneficial after xenotransplantation. Several biomarkers of inflammation have been identified that may be valuable in assessing the response to therapy.","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970618","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}

引用次数: 0

Tailoring of Immunosuppression With Belatacept in De Novo and Conversion Settings and Risk Mitigation Strategies. 用Belatacept在新生和转化环境中的免疫抑制裁剪和风险缓解策略。

IF 5 2区医学

Transplantation Pub Date : 2025-09-03 DOI: 10.1097/TP.0000000000005506

Richard N Formica, Christian P Larsen, Lionel Rostaing

{"title":"Tailoring of Immunosuppression With Belatacept in De Novo and Conversion Settings and Risk Mitigation Strategies.","authors":"Richard N Formica, Christian P Larsen, Lionel Rostaing","doi":"10.1097/TP.0000000000005506","DOIUrl":"https://doi.org/10.1097/TP.0000000000005506","url":null,"abstract":"Although maintenance immunosuppression with calcineurin inhibitors (CNIs) has greatly reduced rejection rates in renal transplant recipients, long-term use can contribute to eventual nephrotoxicity, potentially leading to allograft injury and loss. Several clinical trials have shown that, compared with CNIs, belatacept-based maintenance immunosuppression can improve renal function, reduce the incidence of de novo donor-specific antibodies, and improve long-term patient/graft survival. However, the US Food and Drug Administration-approved belatacept-based regimen is also associated with higher acute rejection (AR) rates than CNI-based immunosuppression. Recent data from clinical trials and real-world studies suggest that initial posttransplant treatment with CNI-based immunosuppression followed by conversion to a belatacept-based regimen can lower the AR risk while preserving patient and renal health. This review article summarizes the available data pertaining to belatacept treatment protocols, with a focus on conversion to belatacept. Also discussed are studies of protocol modifications intended to further mitigate AR risks and belatacept-related outcomes in special populations, such as patients receiving marginal kidneys and those at risk of new-onset diabetes. Overall, the available data suggest that conversion from CNI- to belatacept-based immunosuppression ≥6 mo posttransplant appears to be effective in lowering the AR risk compared with belatacept use in the de novo setting or conversion <6 mo posttransplant. The addition of an extended transient or low-dose CNI treatment to de novo belatacept or a prolonged CNI taper in the conversion setting may also help lower the AR risk. However, additional studies will be needed to optimize the many variables applicable to belatacept treatment, particularly for different patient subgroups.","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970645","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}

引用次数: 0

First Report of Long-term Outcomes of 700 Pediatric Liver Transplants From India. 印度700例小儿肝移植的长期疗效报告。

IF 5 2区医学

Transplantation Pub Date : 2025-09-03 DOI: 10.1097/TP.0000000000005510

Naresh Shanmugam, Ashwin Rammohan, Jagadeesh Menon, Anu Vasudevan, Ravikumar Thambidurai, Rajesh Rajalingam, Kumar Palaniappan, Gomathy Narasimhan, Akila Rajakumar, Ilankumaran Kaliamoorthy, Mohamed Rela

{"title":"First Report of Long-term Outcomes of 700 Pediatric Liver Transplants From India.","authors":"Naresh Shanmugam, Ashwin Rammohan, Jagadeesh Menon, Anu Vasudevan, Ravikumar Thambidurai, Rajesh Rajalingam, Kumar Palaniappan, Gomathy Narasimhan, Akila Rajakumar, Ilankumaran Kaliamoorthy, Mohamed Rela","doi":"10.1097/TP.0000000000005510","DOIUrl":"10.1097/TP.0000000000005510","url":null,"abstract":"Background: Acceptance of pediatric liver transplantation (PLT) in this part of the world has been slow because of a number of considerations, including those of cost, infections, and the nonavailability of expertise. Despite several obstacles, PLT has seen impressive growth in the recent years. Against a backdrop of this changing landscape of PLT in India, we present our experience of performing 700 PLT over a period of 13 y.Methods: All 700 children (<18 y old) who underwent PLT from January 2011 to February 2024 were included in the study. Children were grouped in to group 1 (<5 kg), group 2 (5-10 kg) and group 3 (>10 kg) and survival analysis was performed. The outcomes of PLT performed over the first 7 y were compared with those of the next 6 y, with the aim to present any learning curve/teething troubles that could have presented while setting up the unit.Results: The overall 90-d, 1-, 5-, and 10-y survivals were 94.2%, 90.4%, 86%, and 85.4%, respectively. The median (interquartile range) follow-up of the entire cohort was 65 mo (16-96 mo). There was no statistically significant difference in survival between the 3 weight-based groups or between the 2 eras.Conclusions: We present the first report of long-term survival of the largest series of PLT from an emerging nation. Remarkably, with increasing numbers of liver transplantation being performed in the region over the past decade, the focus of care has now shifted from achieving early survival after liver transplantation to long-term follow-up.","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970637","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}

引用次数: 0

Global Observatory on Donation and Transplantation on Gender Disparity in Organ Transplantation in India From 2019 to 2023. 2019年至2023年印度器官移植性别差异全球捐赠与移植观察站

IF 5 2区医学

Transplantation Pub Date : 2025-09-01 Epub Date: 2025-06-24 DOI: 10.1097/TP.0000000000005455

Vivek Kute, Anil Kumar, Beatriz Domínguez-Gil, Khushboo Saxena, Mar Carmona Sanz, Vasanthi Ramesh, Manish R Balwani, Arpita Ray Chaudhury

引用次数: 0

The Survival Benefit of Accepting an Older Donor Lung Transplant Compared With Waiting for a Younger Donor Offer. 与等待年轻供体相比，接受老年供体肺移植的生存益处。

IF 5 2区医学

Transplantation Pub Date : 2025-09-01 Epub Date: 2025-04-21 DOI: 10.1097/TP.0000000000005417

Laura B Zeiser, Jessica M Ruck, Dorry L Segev, Luis F Angel, Darren E Stewart, Allan B Massie

{"title":"The Survival Benefit of Accepting an Older Donor Lung Transplant Compared With Waiting for a Younger Donor Offer.","authors":"Laura B Zeiser, Jessica M Ruck, Dorry L Segev, Luis F Angel, Darren E Stewart, Allan B Massie","doi":"10.1097/TP.0000000000005417","DOIUrl":"10.1097/TP.0000000000005417","url":null,"abstract":"Background: Donor pool expansion is critical as lung candidates suffer high mortality, yet older donor lungs remain underutilized. We evaluated whether accepting an older donor (defined 4 ways: donor age 30-39, 40-49, 50-59, or 60-69 y) lung transplant was associated with a survival benefit over waiting for a younger donor offer.Methods: Adult candidates who received a lung offer were identified using Scientific Registry of Transplant Recipients data, 2015-2022. Offers were categorized by donor age and candidate lung allocation score (LAS; <40, 40-55, >55). Postoffer mortality was compared between candidates for whom the offer was accepted (\"acceptors\") versus declined (\"decliners\") within each age-LAS category using weighted Cox regression.Results: A total of 21 426 candidates received an offer from a donor age ≥30 y; 11 679 accepted. For LAS >55 candidates, a survival benefit was observed for acceptors of donors ages 30-39 y (weighted hazard ratio [wHR] of mortality: 0.45 0.52 0.59 ), 40-49 y (wHR: 0.61 0.70 0.79 ), and 50-59 y (wHR: 0.67 0.77 0.88 ); P < 0.001. For candidates with LAS 40-55, results suggest a survival benefit of accepting lung offers from donors age 30-39 y (wHR: 0.77 0.87 0.99 ) and 40-49 y (wHR: 0.76 0.87 0.99 ); P = 0.03. However, for candidates with LAS <40, a survival benefit was not observed for accepting any older donor transplant, with possible harm in accepting an age 50+ donor offer.Conclusions: Compared with declining and waiting for a younger donor offer, accepting an older donor lung transplant was associated with a survival advantage in candidates with high LAS in the precontinuous distribution era. Decision makers should consider these findings while recognizing potential changes in waiting time dynamics in the current era.","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1551-1559"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035877","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}

引用次数: 0

Chronic Graft-versus-host Disease, Part 2: Clinical Success and Roadmap to the Future. 慢性移植物抗宿主病，第2部分：临床成功和未来路线图。

IF 5 2区医学

Transplantation Pub Date : 2025-09-01 Epub Date: 2025-02-07 DOI: 10.1097/TP.0000000000005345

Najla El Jurdi, Bruce R Blazar, Steven Z Pavletic

{"title":"Chronic Graft-versus-host Disease, Part 2: Clinical Success and Roadmap to the Future.","authors":"Najla El Jurdi, Bruce R Blazar, Steven Z Pavletic","doi":"10.1097/TP.0000000000005345","DOIUrl":"10.1097/TP.0000000000005345","url":null,"abstract":"Chronic graft-versus-host disease (cGVHD) is an immune-mediated, heterogeneous, multiorgan complication affecting allogeneic hematopoietic cell transplantation recipients, leading to increased morbidity, mortality, and decline in health-related quality-of-life. Advances in understanding the complex disease pathophysiology, and collaborative efforts lead by the National Institutes of Health to standardize criteria for clinical trials, led to bench-to-bedside efforts resulting in the development of 4 US Food and Drug Administration-approved agents for the treatment steroids-refractory cGVHD since 2017. Despite the remarkable advances in the field of hematopoietic cell transplantation in prevention of cGVHD, and more treatment options, the outcome of patients with moderate-severe cGVHD remains suboptimal. Essential to successful cGVHD management is to recognize the disease at early stages before the onset of irreversible damage, allowing for personalized multidisciplinary specialized interventions that include pharmacologic therapies and additional supportive care measures. The aim of this review is to summarize key areas of active clinical research and new developments in cGVHD therapeutic approaches, with focus on (1) preemptive therapy, (2) upfront therapy beyond corticosteroids, (3) treatment refractory cGVHD novel agents, role of combination therapies, and organ-specific approaches, and (4) challenges, gaps, and future directions.","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e446-e454"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366080","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}

引用次数: 0

Frans Claas (1951-2025): A Visionary in Transplantation Immunology. 弗兰斯·克拉斯（1951-2025）：移植免疫学的远见者。

IF 5 2区医学

Transplantation Pub Date : 2025-09-01 Epub Date: 2025-06-09 DOI: 10.1097/TP.0000000000005429

Carla C Baan

引用次数: 0

Donor-derived Cell-free DNA as a Noninvasive Biomarker of Kidney Allograft Rejection in Pediatric Kidney Transplantation. 供体来源的无细胞DNA作为儿童肾移植排斥反应的无创生物标志物。

IF 5 2区医学

Transplantation Pub Date : 2025-09-01 Epub Date: 2025-04-09 DOI: 10.1097/TP.0000000000005403

Julien Hogan, Roshan George, Carissa Hayes, Olivier Aubert, Véronique Baudouin, Elodie Cheyssac, Charlotte Duneton, Chris Fan, Margret Kamel, Marion Rabant, Hong Yin, Alexandre Loupy, Rouba Garro

{"title":"Donor-derived Cell-free DNA as a Noninvasive Biomarker of Kidney Allograft Rejection in Pediatric Kidney Transplantation.","authors":"Julien Hogan, Roshan George, Carissa Hayes, Olivier Aubert, Véronique Baudouin, Elodie Cheyssac, Charlotte Duneton, Chris Fan, Margret Kamel, Marion Rabant, Hong Yin, Alexandre Loupy, Rouba Garro","doi":"10.1097/TP.0000000000005403","DOIUrl":"10.1097/TP.0000000000005403","url":null,"abstract":"Background: Allograft biopsy remains the gold standard to diagnose rejection. New noninvasive biomarkers are needed to avoid unnecessary biopsies and to diagnose early rejection. We studied the performance of donor derived cell-free DNA (dd-cfDNA) to detect rejection in an unselected cohort of pediatric kidney transplant recipients (pKTRs) and determined whether dd-cfDNA could improve standard-of-care monitoring and detection of kidney allograft rejection in children.Methods: We included 196 pKTRs, who underwent 367 biopsies with concomitant dd-cfDNA assessment. We assessed the association of dd-cfDNA with histological lesions and with rejection using a Cox regression model and compared the discrimination of 3 models: standard of care, dd-cfDNA alone, and combined.Results: We found a significant increase in dd-cfDNA levels with higher degree of inflammation on the biopsies. dd-cfDNA was strongly and independently associated with the presence of allograft rejection (odds ratio 1.89, 95% confidence interval [CI], 1.40-2.60). dd-cfDNA alone had a fair discrimination of 0.76 (95% CI, 0.69-0.81) to detect rejection and its addition to standard of care resulted in a significant increase in discrimination from 0.80 (95% CI, 0.71-0.85) to 0.84 (95% CI, 0.79-0.90), P = 0.01.Conclusions: dd-cfDNA combined with standard of care improves the prediction of rejection in pKTRs. Further specific studies are needed to better define how to use this promising biomarker in various contexts of use in children.","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1520-1525"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812596","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}

引用次数: 0

Patient Selection for Xenotransplant Human Clinical Trials: A Data-driven Approach. 异种移植人体临床试验的患者选择：数据驱动的方法。

IF 5 2区医学

Transplantation Pub Date : 2025-09-01 Epub Date: 2025-04-01 DOI: 10.1097/TP.0000000000005384

Baris Ata, Robert A Montgomery, Yucel Naz Ozyoruk, Brendan Parent, Jesse D Schold

引用次数: 0

Acute Response of Hepatocyte MRP2 Internalization as an Indicator of Ischemia-reperfusion Injury in Liver Transplantation. 肝移植中肝细胞MRP2内化的急性反应作为缺血再灌注损伤的指标。

IF 5 2区医学

Transplantation Pub Date : 2025-09-01 Epub Date: 2025-05-05 DOI: 10.1097/TP.0000000000005418

Christopher Monti, Seung-Keun Hong, Alice Lee, Johnny C Hong, Calvin M Eriksen, Amit Joshi, Ranjan K Dash, Said H Audi, Whayoung Lee, Suresh N Kumar, Joohyun Kim

{"title":"Acute Response of Hepatocyte MRP2 Internalization as an Indicator of Ischemia-reperfusion Injury in Liver Transplantation.","authors":"Christopher Monti, Seung-Keun Hong, Alice Lee, Johnny C Hong, Calvin M Eriksen, Amit Joshi, Ranjan K Dash, Said H Audi, Whayoung Lee, Suresh N Kumar, Joohyun Kim","doi":"10.1097/TP.0000000000005418","DOIUrl":"10.1097/TP.0000000000005418","url":null,"abstract":"Background: The introduction of normothermic machine perfusion (NMP) offers new opportunities to evaluate liver graft viability before liver transplantation (LT). Under ischemic stress, multidrug resistance-associated protein 2 (MRP2) translocates from the hepatocyte membrane to the cytoplasm, resulting in loss of function.Methods: We measured the cytoplasmic proportion of MRP2 (MRP2 internalization index, MII) by immunofluorescence colocalization analysis using CD13 as a canalicular membrane marker.Results: The data showed that MII significantly correlated with ischemia time in both in situ ischemia-reperfusion injury and NMP rat models (R 2 = 0.331, P < 0.0001; R 2 = 0.632, P < 0.0001, respectively). Perfusate levels of liver injury markers at the end of NMP showed a significant positive correlation with MII for aspartate aminotransferase (R² = 0.444, P = 0.0013) and arginase 1 (R² = 0.637, P < 0.0001). Conversely, bile production exhibited a significant inverse correlation with MII (R² = 0.618, P < 0.0001). The maximum transport rate of MRP2 ( Vmax,MRP2 ), derived from kinetic modeling of sodium fluorescein biliary excretion, showed a significant inverse correlation with ischemia time (R 2 = 0.326, P = 0.0086) and MII (R 2 = 0.554, P = 0.0002). In human LT, MII values from donor liver biopsies preLT correlated significantly with peak postLT serum aminotransferase levels (R 2 = 0.398, P = 0.0007).Conclusions: MRP2 is a putative biomarker for the assessment of hepatic ischemia-reperfusion injury. The biliary excretion kinetics of sodium fluorescein reflects MRP2-mediated transport activity, providing a novel diagnostic method for predicting liver graft viability after LT.","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"1495-1505"},"PeriodicalIF":5.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053285","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}

引用次数: 0