Transplantation最新文献

{"title":"Does Anybody Really Know What (Warm Ischemia) Time It Is?","authors":"Robert J Stratta, David I Harriman","doi":"10.1097/TP.0000000000005154","DOIUrl":"10.1097/TP.0000000000005154","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e146-e147"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761169","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":"Cutting Down Biliary Complications in Living Donor Hepatectomy: Enter the Robot.","authors":"Nathaly Llore, Jason Hawksworth","doi":"10.1097/TP.0000000000005277","DOIUrl":"10.1097/TP.0000000000005277","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"408"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795226","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":"Where Are All the Clinical Trials for Chronic Rejection?","authors":"Paolo Cravedi, Umberto Maggiore, Paolo Molinari, Josh Levitsky, Emmanuel Zorn","doi":"10.1097/TP.0000000000005081","DOIUrl":"10.1097/TP.0000000000005081","url":null,"abstract":"<p><p>Chronic rejection is arguably the main obstacle to long-term graft survival. Yet, clinical trials focusing on this condition are disappointingly scarce. Significant advances in treating chronic rejection cannot happen if there is no conduit for testing novel therapies. Here, we identified the main hurdles holding back clinical trials for chronic rejection and outlined a series of actions to address these roadblocks. We suggest that a new strategic plan combining expertise in basic and clinical research and leveraging complementary resources be launched to specifically target chronic rejection and achieve long-awaited progress. We only need the will.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"411-417"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923415","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":"Establishing a New Liver Transplant Unit in China-First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, People's Republic of China.","authors":"Jiwei Qin, Xiaodong Yuan, Hao Zheng, Can Qi, Yafei Guo, Zebin Zhu, Wei Wu, Zhijun Xu, Xuefeng Li, Ning Wang, Xiaoqing Chai, Yanhu Xie, Xiaogen Tao, Haihua Liu, Weiyong Liu, Guoyan Liu, Kexue Deng, Yi Li, Xuebing Ji, Changlong Hou, Ziqin Yao, Qiang Huang, Ruipong Song, Shugeng Zhang, Jizhou Wang, Haibo Wang, Lianxin Liu, Björn Nashan","doi":"10.1097/TP.0000000000005219","DOIUrl":"10.1097/TP.0000000000005219","url":null,"abstract":"","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"387-390"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354485","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":"The Microscope and Beyond: Current Trends in the Characterization of Kidney Allograft Rejection From Tissue Samples.","authors":"Bertrand Chauveau, Lionel Couzi, Pierre Merville","doi":"10.1097/TP.0000000000005153","DOIUrl":"10.1097/TP.0000000000005153","url":null,"abstract":"<p><p>The Banff classification is regularly updated to integrate recent advances in the characterization of kidney allograft rejection, gathering novel diagnostic, prognostic, and theragnostic data into a diagnostic and pathogenesis-based framework. Despite ongoing research on noninvasive biomarkers of kidney rejection, the Banff classification remains, to date, biopsy-centered, primarily relying on a semiquantitative histological scoring system that overall lacks reproducibility and granularity. Besides, the ability of histopathological injuries and transcriptomics analyses from bulk tissue to accurately infer the pathogenesis of rejection is questioned. This review discusses findings from past, current, and emerging innovative tools that have the potential to enhance the characterization of allograft rejection from tissue samples. First, the digitalization of pathological workflows and the rise of deep learning should yield more reproducible and quantitative results from routine slides. Additionally, novel histomorphometric features of kidney rejection could be discovered with an overall genuine clinical implementation perspective. Second, multiplex immunohistochemistry enables in-depth in situ phenotyping of cells from formalin-fixed samples, which can decipher the heterogeneity of the immune infiltrate during kidney allograft rejection. Third, transcriptomics from bulk tissue is gradually integrated into the Banff classification, and its specific context of use is currently under extensive consideration. Finally, single-cell transcriptomics and spatial transcriptomics from formalin-fixed and paraffin-embedded samples are emerging techniques capable of producing up to genome-wide data with unprecedented precision levels. Combining all these approaches gives us hope for novel advances that will address the current blind spots of the Banff system.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"440-453"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475769","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":"Kidney Transplant Outcomes in Amyloidosis: US National Database Study.","authors":"Junji Yamauchi, Divya Raghavan, Duha Jweehan, Suayp Oygen, Silviana Marineci, Isaac E Hall, Miklos Z Molnar","doi":"10.1097/TP.0000000000005191","DOIUrl":"10.1097/TP.0000000000005191","url":null,"abstract":"<p><strong>Background: </strong>We aimed to assess contemporary transplant outcomes among kidney recipients with amyloidosis, as the treatment and prognosis of amyloidosis have shown improvement over time.</p><p><strong>Methods: </strong>Using the US Organ Procurement and Transplantation Network database, we initially evaluated the changes in patient and graft survival among kidney recipients with amyloidosis from 2002 to 2021. We then compared transplant outcomes between recipients with amyloidosis versus those with diabetic and nondiabetic causes of kidney failure, creating 1:4 matches with highly similar characteristics separately for deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) during the last decade (2012-2021).</p><p><strong>Results: </strong>We identified 643 kidney recipients with amyloidosis during 2002-2021. Patient and death-censored graft survival improved over time. In the matching analysis for 207 DDKT and 166 LDKT recipients with amyloidosis during 2012-2021, patient survival was not significantly different between amyloidosis and diabetes groups in both DDKT (log-rank, P  = 0.057) and LDKT ( P  = 0.99). Compared with the nondiabetes group, patient survival in the amyloidosis group was not significantly different for DDKTs ( P  = 0.56) but was significantly lower for LDKTs ( P  = 0.04). Death-censored graft failure risk was not significantly different between amyloidosis and diabetes or nondiabetes groups for both DDKTs ( P  = 0.78 and 0.75) and LDKTs ( P  = 0.40 and 0.24).</p><p><strong>Conclusions: </strong>In this well-matched cohort study, we found no significant differences in patient and graft survival between kidney recipients with amyloidosis and those with diabetes. Similarly, these outcomes were not significantly different between those with amyloidosis versus nondiabetic causes, except for patient survival of LDKT recipients.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"536-548"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081721","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":"Chronic Lung Allograft Dysfunction: Clinical Manifestations and Immunologic Mechanisms.","authors":"Amit I Bery, Natalia Belousova, Ramsey R Hachem, Antoine Roux, Daniel Kreisel","doi":"10.1097/TP.0000000000005162","DOIUrl":"10.1097/TP.0000000000005162","url":null,"abstract":"<p><p>The term \"chronic lung allograft dysfunction\" has emerged to describe the clinical syndrome of progressive, largely irreversible dysfunction of pulmonary allografts. This umbrella term comprises 2 major clinical phenotypes: bronchiolitis obliterans syndrome and restrictive allograft syndrome. Here, we discuss the clinical manifestations, diagnostic challenges, and potential therapeutic avenues to address this major barrier to improved long-term outcomes. In addition, we review the immunologic mechanisms thought to propagate each phenotype of chronic lung allograft dysfunction, discuss the various models used to study this process, describe potential therapeutic targets, and identify key unknowns that must be evaluated by future research strategies.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"454-466"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894411","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":"Preoperative Factors Affecting Graft Survival After ABO-incompatible Adult Liver Transplantation.","authors":"Hyun-Jun Nam, Deok-Gie Kim, Eun-Ki Min, Jae Geun Lee, Dai Hoon Han, Sinyoung Kim, Kyung-A Lee, Gi Hong Choi, Dong Jin Joo, Hyun Ok Kim, Soon Sung Kwon, Myoung Soo Kim","doi":"10.1097/TP.0000000000005231","DOIUrl":"10.1097/TP.0000000000005231","url":null,"abstract":"<p><strong>Background: </strong>Although ABO-incompatible liver transplantation (ABOi LT) has undergone remarkable progress, the prognostic factors are poorly understood. This study aimed to elucidate the preoperative factors affecting graft survival after ABOi LT.</p><p><strong>Methods: </strong>Patients who underwent ABOi LT between January 2012 and December 2020 at a single institution in South Korea were retrospectively reviewed. A total of 146 recipients, including 34 patients with graft loss, were analyzed.</p><p><strong>Results: </strong>In the multivariate Cox proportional hazard model, recipient age (≥55 y; hazard ratio, 2.47; 95% confidence interval, 1.18-5.19; P  = 0.017) and donor ABO type (donor A, hazard ratio, 3.12; 95% confidence interval, 1.33-7.33; P  = 0.009) were significantly associated with an increased risk of graft loss. The most common cause of graft loss was recipient death due to bacterial infection (15/34, 44.1%). Both recipient age and donor ABO type were associated with an increased risk of recipient death due to bacterial infections. The incidence of complications after ABOi LT, including antibody-mediated rejection and diffuse intrahepatic biliary stricture, did not differ according to recipient age or donor ABO type.</p><p><strong>Conclusions: </strong>These findings suggest that recipient age and donor ABO type should be considered when preparing for ABOi LT. Careful monitoring and care after transplantation are required for recipients with preoperative risk factors.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"e157-e165"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508773","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":"Kidney Transplantation in Patients With aHUS: A Comparison of Eculizumab Prophylaxis Versus Rescue Therapy.","authors":"Caroline Duineveld, Emily K Glover, Romy N Bouwmeester, Nicole C A J van de Kar, David Kavanagh, Jack F M Wetzels, Neil S Sheerin","doi":"10.1097/TP.0000000000005135","DOIUrl":"10.1097/TP.0000000000005135","url":null,"abstract":"<p><strong>Background: </strong>Guidelines advise eculizumab prophylaxis for most kidney transplant recipients with atypical hemolytic uremic syndrome (aHUS). However, recurrence rates may be overestimated, and starting eculizumab at relapse (\"rescue therapy\") may prevent graft loss. Randomized controlled trials have not compared the efficacy, safety, and costs of different treatment strategies. We performed a comparative study, including a previously described Dutch cohort treated with rescue therapy and a UK cohort using eculizumab prophylaxis.</p><p><strong>Methods: </strong>In the Netherlands, we selected all adult patients with aHUS who received a kidney transplant between 2010 and 2021 in the Radboud University Medical Center (n = 30) and enriched this cohort with 8 patients who received rescue therapy in other centers. The UK cohort included all adult patients with aHUS at moderate or high risk of recurrence, transplanted between 2013 and 2017 with prophylactic eculizumab.</p><p><strong>Results: </strong>We included 38 Dutch patients and 35 UK patients. Characteristics were comparable, although the UK cohort included more patients with a complement factor H SCR20 mutation or hybrid gene (31% versus 5%; P < 0.01), and more Dutch patients received living donor kidneys (66% versus 20%; P < 0.001). Follow-up was comparable (the Dutch patients 70.8 mo, range, 10-134; UK patients 55.4 mo, range, 2-95). Eighteen (47%) Dutch patients received rescue therapy. Death-censored graft survival was not significantly different (the Dutch patients 1 y, 3 y, and 6 y: 97.4%, 91.2%, and 87.1%, respectively; UK patients 1 y, 3 y, and 6 y: 97.1%, 88.2%, and 65.6%, respectively, log-rank P = 0.189).</p><p><strong>Conclusions: </strong>In a population characterized by low prevalence of \"very high risk\" genes, who were predominantly transplanted using an endothelial protective regime, death-censored graft survival with eculizumab rescue therapy was not inferior to prophylaxis.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"511-518"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761181","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":"Impact of Donor Warm Ischemia Time on Graft Survival for Donation After Circulatory Death Kidney Transplantation.","authors":"Ritah R Chumdermpadetsuk, Donna Marie L Alvino, Sumedh Kaul, Aaron Fleishman, Devin E Eckhoff, Martha Pavlakis, David D Lee","doi":"10.1097/TP.0000000000005155","DOIUrl":"10.1097/TP.0000000000005155","url":null,"abstract":"<p><strong>Background: </strong>The utilization of kidneys donated after circulatory death (DCD) is an important strategy to address the ongoing shortage of organs suitable for transplantation in the United States. However, the nonuse rate of DCD kidneys remains high compared with kidneys donated after brain death (DBD) because of concerns regarding the injury incurred during donor warm ischemia time (DWIT). Therefore, we investigated the impact of DWIT on the risk of death-censored graft failure after DCD kidney transplantation (KT).</p><p><strong>Methods: </strong>Retrospective analysis was conducted on DCD KTs using the Standard Transplant Analysis and Research data set. The association of DWIT with death-censored graft failure was evaluated using multivariable Cox proportional hazard regression, with reference to DCD KTs with Kidney Donor Risk Index (KDRI) of ≤0.78 and the median DWIT of 26 min.</p><p><strong>Results: </strong>A total of 28 032 DCD kidney-alone transplants between January 2010 and December 2021 were studied. When stratified by KDRI, increasing DWIT was associated with a clinically significant increased risk for death-censored graft failure only in the subset of kidneys with KDRI >1.14 but not in those with KDRI >0.78-≤0.94 and >0.94-≤1.14, compared with the reference group.</p><p><strong>Conclusions: </strong>We suggest that clinicians should not decline kidneys on the basis of DWIT in favor of potential offers of DBD or other DCD kidneys with shorter DWIT, provided that their KDRI scores are within an acceptable limit. Our study highlights opportunities for more efficient usage of DCD kidneys and improving the shortage of transplantable organs.</p>","PeriodicalId":23316,"journal":{"name":"Transplantation","volume":" ","pages":"504-510"},"PeriodicalIF":5.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761173","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}