Transplantation Reviews最新文献

{"title":"Assessing cumulative exposure to maintenance immunosuppressive drugs: Metrics, outcomes, and implications for transplant patients","authors":"Cavizshajan Skanthan ,&nbsp;Emily Nguyen ,&nbsp;Lakindu Somaweera ,&nbsp;Madhumitha Rabindranath ,&nbsp;Ani Orchanian-Cheff ,&nbsp;Alexandra Viau-Trudel ,&nbsp;Myriam Khalili ,&nbsp;Olusegun Famure ,&nbsp;S. Joseph Kim","doi":"10.1016/j.trre.2025.100914","DOIUrl":"10.1016/j.trre.2025.100914","url":null,"abstract":"<div><div>Immunosuppressive drugs are used in the management of transplant patients to prevent organ rejection. However, immunosuppression can be associated with adverse effects such as infections and cancers. This study aimed to characterize the measures of cumulative immunosuppressive drug exposure (CIDE) used in the literature and their associated outcomes in transplant patients. A literature search was conducted in Ovid MEDLINE, Ovid EMBASE, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews using search terms related to maintenance immunosuppressants and CIDE. Study risk of bias was assessed using the Quality in Prognostic Studies tool. Thirty-one articles were included in this qualitative synthesis. Sixteen articles (52 %) calculated the total dose of immunosuppression over the treatment period, while eight (26 %) used area-under-the-curve of trough level concentrations to quantify CIDE. Five (16 %) articles investigated time-weighted metrics of calcineurin inhibitors and four (13 %) used other metrics that could not be categorized into the previous groups. Most studies investigated CIDE with calcineurin inhibitors and used additive dosing methods. This approach was also popular with corticosteroids and multi-drug exposures. The variety of metrics used in the literature reveals a lack of standardization in the evaluation of CIDE and long-term outcomes. Future studies should validate these metrics for clinical application, especially pertaining to infectious outcomes.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100914"},"PeriodicalIF":3.6,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610460","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":"Transition from preclinical to clinical application of CTLA4-Ig co-stimulation blockage in beta-cell replacement therapy","authors":"Quentin Perrier ,&nbsp;Johan Noble ,&nbsp;Sandrine Lablanche","doi":"10.1016/j.trre.2025.100913","DOIUrl":"10.1016/j.trre.2025.100913","url":null,"abstract":"<div><div>Beta-cell replacement therapies, including islet and pancreas transplantation, offer promising results in term of glycemic control for patients with type 1 diabetes experiencing high glycemic variability and severe hypoglycemia. However, long-term insulin independence remains challenging due to progressive graft function decline. Immunosuppressive regimens, especially calcineurin inhibitors such as tacrolimus, are known to be diabetogenic, contributing to the paradox of impaired beta-cell function in a diabetes treatment setting. Recent studies have focused on CTLA4-Ig (e.g., belatacept) as a potential alternative to calcineurin inhibitors, showing promising results in preclinical and clinical models. This review summarizes key advancements and remaining challenges in CTLA4 applications for beta-cell replacement. First, genetic engineering approaches aiming for CTLA4 expression in islets demonstrated initial success in delaying rejection but remain hindered by immune escape and limited integration efficacy. Coating techniques and exogenous CTLA4-Ig administration offer simpler, albeit transient, immunosuppressive effects, which, combined with encapsulation technologies, can improve graft survival. In non-human primate models, islet transplantation with immunosuppressant regimen using CTLA4-Ig combined with agents such as sirolimus or anti-CD154 has shown extended insulin independence, though full immune tolerance remains elusive. A limited number of human studies using belatacept for beta-cell replacement indicate reduced HbA1c levels and avoidance of severe hypoglycemia, yet consistent absence of rejection remains unachieved. Future research on BCR with CTLA4-Ig should explore graft survival in human islets transplantation and refine immunosuppressive protocols to leverage CTLA4-Ig potential in improving long-term graft function, thus enhancing the sustainability of CTLA4-Ig in clinical beta-cell replacement approach.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100913"},"PeriodicalIF":3.6,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550224","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":"Effect of everolimus administration on renal function in renal transplant recipients: A systematic review and dose–response meta-analysis","authors":"Takehiro Ohyama ,&nbsp;Shodai Yoshihiro ,&nbsp;Tomoyuki Fujikura ,&nbsp;Takamasa Miyauchi ,&nbsp;Yuki Kataoka","doi":"10.1016/j.trre.2025.100911","DOIUrl":"10.1016/j.trre.2025.100911","url":null,"abstract":"<div><div>Everolimus (EVL) is an effective post-transplant immunosuppressant; however, its optimal trough concentration when switching from calcineurin inhibitors (CNIs) remains unknown. The optimal dosing troughs for CNI-to-EVL switching in kidney transplant recipients were investigated. We searched multiple electronic databases (from inception to March 15, 2024) to identify double-blind or open-label randomized controlled trials evaluating groups (all ages, both sexes) that converted from CNIs to EVL and continued CNI treatment in kidney transplant recipients. Treatment responses, defined as changes in estimated glomerular filtration rate (eGFR), mortality, dropouts for any reason, and adverse events, were the outcomes. We performed a random-effects, one-stage dose–effect meta-analysis with restricted cubic splines. Nine studies were included, comprising 1872 participants. Changes in eGFR increased with increasing trough concentrations; however, the evidence was highly uncertain (95 % effective dose: 4.13 ng/mL, odds ratio [OR]: 1.31, 95 % confidence interval [CI]: 0.10–9.50). Mortality was not estimated owing to the low number of events. The evidence for the relationship between EVL trough levels and treatment discontinuation was also highly uncertain (OR: 1.31, 95 % CI: 0.10–9.39). Adverse events increased with a switch to EVL; however, this evidence was also uncertain (OR: 1.31, 95 % CI: 0.10–9.60). This study could not indicate an appropriate optimal EVL trough concentration owing to the high result uncertainty, and the results do not support the routine switch from CNIs to EVL. Further trials are required to explore the CNI-to-EVL switch timing and the effects of increased EVL dosing to establish a more definitive therapeutic strategy.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100911"},"PeriodicalIF":3.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454604","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":"Diagnosing portal vein stenosis after pediatric liver transplantation: A systematic review","authors":"Bader A. Alfares ,&nbsp;Martijn V. Verhagen ,&nbsp;Rudi A.J.O. Dierckx ,&nbsp;Hubert P. van der Doef ,&nbsp;Robbert J. de Haas ,&nbsp;Reinoud P.H. Bokkers","doi":"10.1016/j.trre.2025.100912","DOIUrl":"10.1016/j.trre.2025.100912","url":null,"abstract":"<div><div>Portal vein stenosis (PVS) is a relatively frequent vascular complication after pediatric liver transplantation (pLT) that may result in portal hypertension. The aim of this study was to provide an overview of various diagnostic methods and imaging criteria used to diagnose PVS and to report their diagnostic accuracy. Until August 2024, PubMed and Embase were searched for English-language manuscripts with &gt;5 patients and radiologic features of PVS. Three investigators screened articles and extracted data. The risk of bias was assessed using QUADAS-2. Twenty studies were identified. Doppler ultrasound (DUS) was the most used imaging method, followed by computed tomography (CT) and digital subtraction angiography (DSA). In studies comparing DUS with other diagnostic modalities, an elevated peak systolic velocity (PSV) and velocity ratio (VR) emerged as reliable indicators of PVS. An anastomotic diameter of &lt;3.5 mm showed the best diagnostic performance, with a sensitivity of 100 % and a specificity of 91.8 %. Although DUS is the preferred initial diagnostic tool due to its non-invasive nature, CT and DSA remain essential in cases where DUS findings are inconclusive or when more detailed vascular assessment is necessary. DSA also allows for simultaneous endovascular treatment, further enhancing its utility. This systematic review emphasizes the need for larger, prospective studies to directly compare the diagnostic performance of these imaging modalities and to establish more consistent and reliable criteria for diagnosing PVS after pLT.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100912"},"PeriodicalIF":3.6,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437656","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 impact of pancreas transplantation on diabetic complications: A systematic review","authors":"Gayathri Giri ,&nbsp;Daniel Doherty ,&nbsp;Shazli Azmi ,&nbsp;Hussein Khambalia ,&nbsp;Giuseppe Giuffrida ,&nbsp;Zia Moinuddin ,&nbsp;David van Dellen","doi":"10.1016/j.trre.2025.100910","DOIUrl":"10.1016/j.trre.2025.100910","url":null,"abstract":"<div><h3>Background</h3><div>Pancreas Transplantation (PT) provides optimal treatment for patients with severe complicated Type 1 Diabetes Mellitus (T1DM). Restoration of beta-cell mass allows return to euglycaemia and insulin independence. We aimed to examine its impact on the secondary complications associated with severe T1DM including diabetic eye disease, neuropathy and cardiovascular disease.</div></div><div><h3>Methods</h3><div>A database search using MedLINE to identify publications to April 2023 was conducted. Searches were performed using MeSH terms ‘Pancreas Transplantation’ AND ‘Diabetes Mellitus, Type 1’ ‘Diabetic Retinopathy’ OR ‘Heart Disease’ OR ‘Cardiovascular Diseases’ OR ‘Peripheral Vascular Disease’ OR “Amputation’ OR ‘Neuropathy.”</div></div><div><h3>Results</h3><div>All articles were retrospective with 51.1 % (<em>n</em> = 23) case control studies and 48.9 % (<em>n</em> = 22) cohort studies. 82.2 % (<em>n</em> = 37) examined simultaneous pancreas and kidney (SPK) transplantation and 17.8 % (<em>n</em> = 8) analysed pancreas transplant alone (PTA). Heterogenous outcomes metrics were employed. 15 studies examined diabetic retinopathy (DR) with 53.3 % (<em>n</em> = 8) demonstrated improvements after PT, while the remainder (<em>n</em> = 7) exhibited stabilisation. 16 studies assessed neuropathy and 87.5 % (<em>n</em> = 14) demonstrated beneficial effects of PT on nerve conduction studies, vibration perception threshold or corneal confocal microscopy. There was a positive effect on cardiovascular disease by reduction in the incidence of cardiac events, improvement in metabolic profile and increased left ventricular ejection fraction. 14 studies examined cardiovascular disease (71.4 % (<em>n</em> = 10) improvement; 14.2 % (<em>n</em> = 2) stabilisation; 14.2 % (n = 2) progression).</div></div><div><h3>Conclusion</h3><div>SPK and PTA have beneficial effects in ameliorating or stabilising diabetes complications. Future work should seek to reduce heterogeneity of outcome metrics assessing T1DM complication profile to facilitate robust comparison of beta-cell replacement interventions.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100910"},"PeriodicalIF":3.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049385","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":"Immunology in corneal transplantation—From homeostasis to graft rejection","authors":"Seokjoo Lee,&nbsp;Thomas H. Dohlman,&nbsp;Reza Dana","doi":"10.1016/j.trre.2025.100909","DOIUrl":"10.1016/j.trre.2025.100909","url":null,"abstract":"<div><div>Immunology depends on maintaining a delicate balance within the human body, and disruptions can result in conditions such as autoimmune diseases, immunodeficiencies, and hypersensitivity reactions. This balance is especially crucial in transplantation immunology, where one of the primary challenges is preventing graft rejection. Such rejection can lead to organ failure, increased patient mortality, and higher healthcare costs due to the limited availability of donor tissues relative to patient needs. Xenotransplantation, like using porcine corneas for human transplants, offers a potential solution to the donor tissue shortage but faces substantial immunological rejection issues. To prevent rejection in both allo- and xenotransplantation, a deep understanding of how the body maintains immunological balance is essential, particularly since achieving tolerance to non-self tissues is considered the “holy grail” of the field. The cornea, the most frequently transplanted solid organ, has a high acceptance rate due to its immune-privileged status and serves as an ideal model for studying graft rejection mechanisms that disrupt tolerance. However, multiple immune pathways complicate our understanding of these mechanisms. This review examines the rejection mechanisms in corneal transplantation, identifying key cells involved and potential therapeutic strategies to induce and maintain immunological tolerance in both allo- and xenografts across various transplants.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100909"},"PeriodicalIF":3.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974252","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":"Characteristics and outcomes of cardiac amyloid disease after heart transplantation: A systematic review and meta-analysis","authors":"Daler Rahimov ,&nbsp;Vivian Z. Yan ,&nbsp;Danial Ahmad ,&nbsp;Nayeem Nasher ,&nbsp;Rob Tatum ,&nbsp;Moses Im ,&nbsp;Eugene Storozynsky ,&nbsp;J. Eduardo Rame ,&nbsp;Keshava Rajagopal ,&nbsp;John W. Entwistle ,&nbsp;Howard T. Massey ,&nbsp;Vakhtang Tchantchaleishvili","doi":"10.1016/j.trre.2025.100908","DOIUrl":"10.1016/j.trre.2025.100908","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients with systemic amyloidosis with cardiac involvement require careful selection for heart transplantation (HTx) due to the associated poor outcomes. Large databases do not provide sufficient granularity to allow for differentiation between its major subtypes [light-chain (AL) and transthyretin (ATTR) amyloidosis]. We sought to pool the existing data on amyloidosis patients undergoing HTx, and perform stratified analysis based on its major subtypes.</div></div><div><h3>Methods</h3><div>Electronic search identified adult patients with amyloidosis undergoing HTx. Cohort-level data for 340 patients from 19 studies were extracted and analyzed. Patients were categorized based on amyloid subtype into AL and ATTR groups.</div></div><div><h3>Results</h3><div>AL amyloidosis was diagnosed at an earlier age compared to ATTR [53 (95 % CI 48; 57) years vs. 63 (55; 71) years, <em>p</em> = 0.03], with greater incidence in the Caucasian population [75 % (60; 87) vs. 39 % (21; 59), <em>p</em> ≤0.01]. Females comprised 33 % (25; 41) of the patients with greater preponderance in AL group [41 % (33; 48) vs. 21 % (8; 36), <em>p</em> = 0.02]. AL patients also had higher involvement of ≥two organs [50 % (29; 70) vs. 15 % (3; 32), <em>p</em> = 0.01]. GI involvement [25 % (6; 50) vs. 0 % (0; 8), <em>p</em> = 0.02], and renal involvement [20 % (8; 34) vs. 0 % (0; 2), <em>p</em> &lt; 0.01] were virtually limited to AL, while ATTR patients had more implantable cardioverter defibrillators placed [64 % (34; 90) vs. 15 % (6; 28), p &lt; 0.01] and trended towards greater incidence of neuropathy [24 % (9; 42) vs. 9 % (2; 19), <em>p</em> = 0.07]. The AL group had a significantly higher incidence of recurrent amyloidosis [16 % (7; 27) vs. 0 % (0; 0), <em>p</em> ≤0.01]. Pooled Kaplan-Meier survival analysis showed worse long-term survival in the AL group (<em>p</em> = 0.02).</div></div><div><h3>Conclusion</h3><div>Patients with AL amyloidosis showed more widespread systemic involvement and worse long-term survival after HTx compared to patients with ATTR amyloidosis. Protocols for mitigating the recurrence of AL amyloidosis are needed to improve survival in this high-risk subtype.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100908"},"PeriodicalIF":3.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143145438","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":"Safety and efficacy of direct oral anticoagulants in kidney transplant recipients: A systematic review and meta-analysis","authors":"Maria Meritxell Roca Mora ,&nbsp;Andre Milani Reis ,&nbsp;Filipe Piazzi Tavares ,&nbsp;Lídia Santos Oliveira ,&nbsp;Amanda Godoi ,&nbsp;Patricia Viana ,&nbsp;Juliano Riella","doi":"10.1016/j.trre.2024.100899","DOIUrl":"10.1016/j.trre.2024.100899","url":null,"abstract":"<div><h3>Introduction</h3><div>Direct-acting oral anticoagulants (DOACs) have recently shown potential efficacy for many conditions without the need for regular monitoring. However, their use in kidney transplant recipients (KTRs) is controversial, with no clear consensus on how they compare to vitamin K antagonists (VKAs), which have traditionally been used as preferred anticoagulation therapy in these patients.</div></div><div><h3>Methods</h3><div>PubMed, Cochrane Central, and Embase databases were systematically searched up to December 2023 for studies comparing DOACs versus VKAs in KTRs. The main outcomes of interest included venous thromboembolism (VTE), major bleeding, graft failure, mortality, and changes in estimated glomerular filtration rate (eGFR). Statistical analyses were performed using RStudio 4.1.2 software. PROSPERO ID: CRD42024498423.</div></div><div><h3>Results</h3><div>Five studies with a total of 959 participants were included. Of these, 433 (45.15 %) participants were treated with DOACs. The mean age of participants was 60.05 years, and 65.9 % were male. The use of DOACs in KTRs was associated with a significant reduction in major bleeding (RR 0.56; 95 % CI 0.35 to 0.90; <em>p</em> = 0.02; I² = 0 %) and mortality (RR 0.49; 95 % CI 0.33 to 0.74; <em>p</em> = 0.0006; I² = 0 %). No significant differences were found between groups in VTE (RR 0.82; 95 % CI 0.47 to 1.43; <em>p</em> = 0.48; I² = 12 %), graft failure (RR 0.43; 95 % CI 0.14 to 1.27; <em>p</em> = 0.13; I² = 52 %), and eGFR (MD 3.72 mL/Kg/1.73 m2; 95 % CI -1.58 to 9.03; <em>p</em> = 0.17; I² = 0 %). Evidence quality for some outcomes remains low to moderate, limiting the confidence in these conclusions.</div></div><div><h3>Conclusion</h3><div>Our meta-analysis suggests that DOACs represent an effective anticoagulation strategy in KTR, with a significant reduction in major bleeding and mortality relative to VKA.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100899"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857408","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":"Non-adherence to immunosuppressive medications in kidney transplant recipients- a systematic scoping review","authors":"Michael Corr ,&nbsp;Andrew Walker ,&nbsp;Alexander P. Maxwell ,&nbsp;Gareth J. McKay","doi":"10.1016/j.trre.2024.100900","DOIUrl":"10.1016/j.trre.2024.100900","url":null,"abstract":"<div><h3>Background</h3><div>Rejection and graft failure remain common in kidney transplant recipients. Non-adherence to immunosuppressive medications is considered a major contributary factor to reduced long-term graft survival, particularly in younger people. Improvements in clinical practice based on adherence studies has been minimal.</div></div><div><h3>Methods</h3><div>Joanna Briggs' Institute Methodology was used. MedlineALL, Embase, Web of Science Core Collection and Scopus databases were searched from January 2000 through to December 2023. Abstract and full text reviews were undertaken independently by two reviewers. Data was collated using a pre-designed extraction tool.</div></div><div><h3>Results</h3><div>359 articles met the inclusion criteria. Non-adherence was commonly defined using self-reported questionnaires or pharmacy re-fill rates. Prevalence of non-adherence varied widely. There was little correlation between method of measurement and reported rates of non-adherence. Despite younger age being identified as a risk factor for non-adherence, pooled reported prevalence did not differ significantly in studies reporting prevalence in children, adolescents, or young adults vs. older adults (36.0 % vs. 34.0 %). Interventional studies to detect or improve adherence are highly heterogenous, often report small effects and are limited by the lack of gold-standard methods to measure adherence.</div></div><div><h3>Discussion</h3><div>This scoping review outlines the complexities of non-adherence to immunosuppressive medications among kidney transplant recipients, highlighting significant variability in adherence definitions, measurements, and intervention efficacy. Reported non-adherence rates vary widely (2–89 %), underscoring the need for standardisation of the definition of non-adherence in research. Findings suggest that non-adherence to immunosuppressive medication is driven by a mix of demographic, psychosocial, and transplant-specific factors. Future research should prioritise standardised definitions of adherence, validated tools to measure adherence, and focus on clinically significant outcomes in non-adherent populations to develop meaningful, impactful interventions for long-term patient benefit.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100900"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789667","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":"Right and left living donor nephrectomy and operative approach: A systematic review and meta-analysis of donor and recipient outcomes","authors":"Gavin G. Calpin ,&nbsp;Cian Hehir ,&nbsp;Matthew G. Davey ,&nbsp;Benjamin M. MacCurtain ,&nbsp;Dilly Little ,&nbsp;Niall F. Davis","doi":"10.1016/j.trre.2024.100880","DOIUrl":"10.1016/j.trre.2024.100880","url":null,"abstract":"<div><h3>Introduction</h3><div>The left kidney is preferable in living donor nephrectomy (LDN). We aimed to investigate the safety and efficacy of right versus left LDN in both donor and recipients. A subgroup analysis of outcomes based on operative approach was also performed.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was performed as per PRISMA guidelines. Outcomes of interest were extracted from included studies and analysed.</div></div><div><h3>Results</h3><div>There were 31 studies included with 79,912 transplants. Left LDN was performed in 84.1 % of cases and right LDN in 15.9 %. Right LDN was associated with reduced EBL (<em>P</em> = 0.010), intra-operative complications (<em>P</em> = 0.030) and operative time (<em>P</em> = 0.006), but higher rates of conversion to open surgery (1.4 % vs 0.9 %). However, right living donor renal transplantation (LDRT) had higher rates of delayed graft function (5.4 % vs 4.2 %, <em>P</em> &lt; 0.0001) and graft loss (2.6 % vs 1.1 %, <em>P</em> &lt; 0.0001). Graft survival was reduced in right LDRT at 3 years (92.0 % vs 94.2 %, <em>P</em> = 0.001) but comparable to left LDRT at 1- and 5-years. Otherwise, donor and recipient peri-operative outcomes and serum creatinine levels were comparable in both groups. Hand-assisted LDN was associated with shorter warm ischaemia time (<em>P</em> &lt; 0.0001) but longer length of stay (LOS) than laparoscopic LDN and robotic-assisted LDN (<em>P</em> &lt; 0.0001). RA-LDN was associated with less EBL and shorter LOS (both <em>P</em> &lt; 0.0001) while patients who underwent L-LDN had a lower mean serum creatinine (SCr) level on discharge (<em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>Right LDRT has higher rates of delayed graft function and graft loss compared to left LDRT. Minimally-invasive surgical approaches potentially offer improved outcomes but further large-scale randomised controlled trials studies are required to confirm this finding.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100880"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147282","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}