Transplantation Reviews最新文献_第2页

Cognitive impairment assessments in kidney transplantation: A review 肾移植患者认知障碍评估综述

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-07-01 DOI: 10.1016/j.trre.2025.100940

Safaa Azzouz , Laurence Coté , Donald Doell , Alessia N. Paparella , Marcelo Cantarovich , Kathleen Gaudio , Shaifali Sandal

{"title":"Cognitive impairment assessments in kidney transplantation: A review","authors":"Safaa Azzouz , Laurence Coté , Donald Doell , Alessia N. Paparella , Marcelo Cantarovich , Kathleen Gaudio , Shaifali Sandal","doi":"10.1016/j.trre.2025.100940","DOIUrl":"10.1016/j.trre.2025.100940","url":null,"abstract":"<div><div>Mild cognitive impairment (CI) is not an absolute contraindication for kidney transplantation (KT). However, clinical assessment has not been standardized, and several practice challenges remain. We synthesized existing evidence on the effect of CI on adult kidney transplant recipients (KTRs) and KT candidates. Of the 1333 titles and abstracts screened, seven studies were eligible; all were observational. Our synthesis included 1035 KTRs and 4659 patients being evaluated for KT. Studies that used the Montreal Cognitive Assessment (38–55 %) reported a higher CI prevalence than those that used the Modified Mini-Mental State Exam (6–10 %). CI decreased the chances of KT waitlisting, however, the association with KT, graft loss and death varied by the cohort characteristics and tests used. The implications of our synthesis are limited by selection bias due to the exclusionary criterion, variability in tests and thresholds used. This may have misclassified participants with normal cognition as having CI and included those with dementia. Overall, additional evidence is needed to standardize the cognitive assessment of KTRs and candidates and inform clinical practice. A comprehensive assessment of cognition and function is indicated for the accurate diagnosis of CI, to determine CI severity, and to assess transplant candidacy.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100940"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563659","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

Liver transplantation in patients with neurological Wilson disease: What can a five-decade systematic literature review teach us? 神经性威尔逊病患者的肝移植：50年的系统文献回顾能告诉我们什么？

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-06-07 DOI: 10.1016/j.trre.2025.100939

Aurélia Poujois , Rodolphe Sobesky , Nathalie Dorison , Mickael Alexandre Obadia , Dominique Debray

{"title":"Liver transplantation in patients with neurological Wilson disease: What can a five-decade systematic literature review teach us?","authors":"Aurélia Poujois , Rodolphe Sobesky , Nathalie Dorison , Mickael Alexandre Obadia , Dominique Debray","doi":"10.1016/j.trre.2025.100939","DOIUrl":"10.1016/j.trre.2025.100939","url":null,"abstract":"<div><h3>Background</h3><div>Neurological worsening occurs in up to 20 % of patients with Wilson disease and neurological involvement (neuroWD) despite optimal anti‑copper therapy. This study aimed to analyze the neurological outcomes of patients with neuroWD who underwent liver transplantation (LT) as a rescue therapy for neurological deterioration (Brain group), and to compare them with those who underwent LT for end-stage liver disease (ESLD) (Liver group).</div></div><div><h3>Methods</h3><div>A systematic PubMed search identified studies on neuroWD and LT published from January 1973 to January 2024.</div></div><div><h3>Results</h3><div>A total of 368 patients with neuroWD were identified, including 89 and 279 in the Brain and Liver groups, respectively. Post-LT survival rates were similar between groups (82 % <em>vs.</em> 86.6 %). Sepsis was the primary cause of death in both groups (68.7 % in the Brain group <em>vs.</em> 57.1 % in the Liver group). Among survivors beyond 1 year, 86.3 % in the Brain group and 79.7 % in the Liver group showed improvement or complete recovery from neuroWD. <em>De novo</em> post-LT neurological complications and calcineurin inhibitors-induced neurotoxicity were reported exclusively in the Liver group (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>LT is a viable option for neuroWD unresponsive to medical therapy. Delayed introduction or early minimization of calcineurin inhibitors is recommended for ESLD patients to reduce neurotoxicity. Further studies are needed to confirm these observations, as there are currently no evidence-based medicine criteria or standardized inclusion scales for LT in cases of neuro-WD.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100939"},"PeriodicalIF":3.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271941","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

Exploring the psychological construct of resilience in kidney transplantation: A scoping review 探讨肾移植中恢复力的心理结构：范围综述

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-05-28 DOI: 10.1016/j.trre.2025.100938

Anh Le , Kathleen Gaudio , Alessia N. Paparella , Michael Sullivan , Mara McAdams-DeMarco , Marcelo Cantarovich , Shaifali Sandal

{"title":"Exploring the psychological construct of resilience in kidney transplantation: A scoping review","authors":"Anh Le , Kathleen Gaudio , Alessia N. Paparella , Michael Sullivan , Mara McAdams-DeMarco , Marcelo Cantarovich , Shaifali Sandal","doi":"10.1016/j.trre.2025.100938","DOIUrl":"10.1016/j.trre.2025.100938","url":null,"abstract":"<div><h3>Background</h3><div>Extensive literature has highlighted the psychological burden experienced by kidney transplant recipients (KTRs) and its association with adverse outcomes. Psychological resilience can serve as a measure of baseline vulnerability, and low resilience is associated with poor mental health. We aimed to synthesize the existing literature that has explored the concept of resilience in kidney transplantation.</div></div><div><h3>Methods</h3><div>A scoping review was conducted due to the anticipated heterogeneity of the literature. Any empirical study that measured resilience using a validated tool in KTRs was included. Resilience could be a variable, a predictor, or an outcome. All study designs were considered with no time restrictions.</div></div><div><h3>Results</h3><div>Of the 4525 titles and abstracts screened, 14 were eligible for inclusion. Sample sizes ranged from 10 to 505 KTRs. One study exclusively focused on developing and validating a resilience scale while others used existing tools. Three studies compared resilience between different populations and the results were heterogeneous: similar resilience between KTRs and dialysis/pre-KT patients (<em>n</em> = 2) and another reporting better resilience in KTRs (<em>n</em> = 1). A decline in resilience scores after pediatric-adult transition (n = 1) and 3 months post-transplant (n = 1) was reported. In terms of outcomes, higher resilience was associated with medication adherence (n = 1), lower frailty (n = 2), and lower risk of psychopathology (n = 2). Two of the three included studies reported improvements in resilience scores with an exercise program and a resilience-enhancing program.</div></div><div><h3>Conclusions</h3><div>Our review highlights that resilience is an underused and poorly explored construct in KTRs. We recommend explorative and interventional work as resilience is measurable and modifiable.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100938"},"PeriodicalIF":3.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189954","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

Management of multidrug-resistant gram-negative bacilli infections in adult solid organ transplant recipients: GESITRA-IC/SEIMC, CIBERINFEC, and SET recommendations update. 成人实体器官移植受者多重耐药革兰氏阴性杆菌感染的管理：GESITRA-IC/SEIMC， CIBERINFEC和SET建议更新

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-05-21 DOI: 10.1016/j.trre.2025.100937

Isabel Rodríguez-Goncer , Elisa Ruiz-Arabi , Sabina Herrera , Nuria Sabé , Ibai Los-Arcos , José Tiago Silva , Elena Pérez-Nadales , Isabel Machuca , Rocío Álvarez , Maricela Valerio , Juan José Castón , Victoria Aguilera , Marta Bodro , Ángela Cano , Rafael Cantón , Purificación Carmona , Jordi Carratalà , Elisa Cordero , Josep María Cruzado , María Carmen Fariñas , José María Aguado

{"title":"Management of multidrug-resistant gram-negative bacilli infections in adult solid organ transplant recipients: GESITRA-IC/SEIMC, CIBERINFEC, and SET recommendations update.","authors":"Isabel Rodríguez-Goncer , Elisa Ruiz-Arabi , Sabina Herrera , Nuria Sabé , Ibai Los-Arcos , José Tiago Silva , Elena Pérez-Nadales , Isabel Machuca , Rocío Álvarez , Maricela Valerio , Juan José Castón , Victoria Aguilera , Marta Bodro , Ángela Cano , Rafael Cantón , Purificación Carmona , Jordi Carratalà , Elisa Cordero , Josep María Cruzado , María Carmen Fariñas , José María Aguado","doi":"10.1016/j.trre.2025.100937","DOIUrl":"10.1016/j.trre.2025.100937","url":null,"abstract":"<div><div>Multidrug-resistant (MDR) Gram-negative bacilli (GNB) infections in solid organ transplant (SOT) recipients continue to pose a significant threat despite advances in diagnostics and treatments. The last international consensus guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the management of MDR GNB in adult solid organ transplant (SOT) recipients were published in 2018, underscoring the need for an update to incorporate recent advances, particularly the availability of new drugs that may improve the current standard of care. A working group consisting of members from the Study Group of Infection in Transplantation and Immunocompromised Hosts (GESITRA-IC) of SEIMC, the Center for Biomedical Research Network in Infectious Diseases (CIBERINFEC) and the Spanish Society of Transplantation (SET) developed consensus-based recommendations for managing MDR GNB infections during the transplant procedure. Recommendations were categorized based on evidence quality and strength, utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The final recommendations were endorsed through a consensus meeting and approved by the expert panel.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100937"},"PeriodicalIF":3.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124257","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

Cardiac allograft vasculopathy and the endothelial glycocalyx: a missing link? 异体心脏移植血管病变与内皮糖萼：缺失的一环？

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-05-18 DOI: 10.1016/j.trre.2025.100936

Mitchell J. Wagner , Michael Khoury , Jennifer Conway , Darren H. Freed

引用次数: 0

The experiences of clinical staff approaching families for organ donation consent: A systematic review and thematic synthesis of qualitative studies 临床工作人员接触器官捐赠同意家属的经验：定性研究的系统回顾和专题综合

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-05-05 DOI: 10.1016/j.trre.2025.100935

L.H.M. Pengel , V. Mazarello-Paes , D. Paredes-Zapata , G.C. Oniscu , C. Gouveia Gaglianone , L. Zhu , Y. Wang , N. Dhanda , J. Tocher , L. Aviles

{"title":"The experiences of clinical staff approaching families for organ donation consent: A systematic review and thematic synthesis of qualitative studies","authors":"L.H.M. Pengel , V. Mazarello-Paes , D. Paredes-Zapata , G.C. Oniscu , C. Gouveia Gaglianone , L. Zhu , Y. Wang , N. Dhanda , J. Tocher , L. Aviles","doi":"10.1016/j.trre.2025.100935","DOIUrl":"10.1016/j.trre.2025.100935","url":null,"abstract":"<div><div>Healthcare professionals (HCPs) play an essential role in organ donation (OD) particularly when approaching families to discuss consent to OD. We synthesized the evidence on experiences of HCPs when approaching potential organ donor families. Fourteen electronic databases were searched to identify studies describing HCP experiences or associations between HCP experiences and consent rates. Methodological quality was assessed by independent reviewers using the Mixed Methods Appraisal Tool. Qualitative data were analysed using thematic synthesis, while quantitative data were summarized by narrative review. Ninety-two studies were included. HCP experiences were conceptualised as a paradox due to the challenges to negotiate the boundaries between life and death. Organisational and personal aspects broadly shape the experiences of professionals. Studies suggest that staff experiences can be improved by training and education, however, quantitative studies did not show a strong association between OD training and improved consent rates. The complexities of the family approach were evident in the variety of interactions between HCPs and the donor family, which may explain why there is no uniform approach across settings and countries. The review highlights the challenges faced by professionals when negotiating policy and practice and informs recommendations to support staff involved in the OD process worldwide.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100935"},"PeriodicalIF":3.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937927","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

The comparative performance of models predicting patient and graft survival after kidney transplantation: A systematic review 预测肾移植后患者和移植物生存的模型的比较性能：一项系统综述

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-05-02 DOI: 10.1016/j.trre.2025.100934

Joris van de Klundert , Francisco Perez-Galarce , Marcelo Olivares , Liset Pengel , Annelies de Weerd

{"title":"The comparative performance of models predicting patient and graft survival after kidney transplantation: A systematic review","authors":"Joris van de Klundert , Francisco Perez-Galarce , Marcelo Olivares , Liset Pengel , Annelies de Weerd","doi":"10.1016/j.trre.2025.100934","DOIUrl":"10.1016/j.trre.2025.100934","url":null,"abstract":"<div><h3>Background</h3><div>Cox proportional hazard models have long been the model of choice for survival prediction after kidney transplantation. In recent years, a variety of novel model types have been proposed. We investigate the prediction performance across different model types, including machine learning models and traditional model types.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following PROBAST and CHARMS, also considering extensions to TRIPOD+AI and PROBAST+AI, for data collection and risk of bias assessment. The review only included publications that reported on prediction performance for models of different types. A comparative analysis tested performance differences between the model types.</div></div><div><h3>Results</h3><div>The review included 37 publications which presented 134 comparative studies. The designs of many studies left room for improvement and most studies had high risk of bias. The collected data admitted testing of performance differences for 22 pairs of model types, ten of which yielded significant differences. Support Vector Machines and Logistic Regression were never found to outperform other model types. Other comparisons, however, provide inconclusive comparative performance results and none of the model types performed consistently and significantly better than alternatives.</div></div><div><h3>Conclusions</h3><div>Rigorous review of current evidence and comparative performance evidence finds no significant kidney transplant survival prediction performance differences that Cox Proportional Hazard models are being outperformed. The design of many of the studies implies high risk of bias and more and better designed studies which reutilize best performing models are needed. This enables to resolve model biases, reporting issues, and to increase the power of comparative performance analysis.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100934"},"PeriodicalIF":3.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913062","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

Outcomes of urgent lung transplantation in critically ill patients versus standard lung transplantation: A systematic review and meta-analysis 危重患者紧急肺移植与标准肺移植的结果：系统回顾和荟萃分析

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-04-23 DOI: 10.1016/j.trre.2025.100933

Xiaohan Jin , Haoji Yan , Zengwei Yu , Jier Ma , Xiangyun Zheng , Weiyang Chen , Yaling Liu , Jiaze Li , Qiang Pu , Dong Tian

{"title":"Outcomes of urgent lung transplantation in critically ill patients versus standard lung transplantation: A systematic review and meta-analysis","authors":"Xiaohan Jin , Haoji Yan , Zengwei Yu , Jier Ma , Xiangyun Zheng , Weiyang Chen , Yaling Liu , Jiaze Li , Qiang Pu , Dong Tian","doi":"10.1016/j.trre.2025.100933","DOIUrl":"10.1016/j.trre.2025.100933","url":null,"abstract":"<div><h3>Background</h3><div>Whether survival differs between urgent lung transplantation (ULTx) and standard lung transplantation (LTx) remains unclear. This systematic review and meta-analysis aimed to evaluate survival and other post-transplant outcomes between ULTx and standard LTx.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Cochrane Library were searched up to July 31, 2024 for relevant studies. A meta-analysis of baseline characteristics and postoperative outcomes was then performed, with subgroup analyses by study designs and indications. Overall survival (OS) was set as the primary outcome in this study. Risk ratio (RR), mean differences (MD) with 95 % confidence interval (CI) were assessed using fixed-effects or random-effects models.</div></div><div><h3>Results</h3><div>Nine studies with 934 ULTx and 2980 standard LTx patients were included. ULTx group exhibited lower donor PaO<sub>2</sub>/FiO<sub>2</sub> (<em>P</em> = 0.03) and higher pre-operative life support use (<em>P</em> < 0.001) than standard LTx group. No statistical difference in waiting list mortality was found between groups (28.4 % vs. 12.6 %; <em>P</em> = 0.54). ULTx was associated with significantly lower 1-year, 3-year, and 5-year OS than standard LTx (70.2 % vs. 80.0 %, 57.7 % vs. 66.7 %, 46.5 % vs. 56.2 %; all <em>P</em> < 0.001). At each time point, about 10 % OS rate differences were found consistently. In most subgroups, ULTx was associated with worse outcomes, but no difference in OS was observed in cystic fibrosis (CF) patients.</div></div><div><h3>Conclusions</h3><div>ULTx reduces waiting list mortality in critical patients, but is associated with worse OS than standard LTx. ULTx may limit short-term survival rather than long-term survival compared with standard LTx.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100933"},"PeriodicalIF":3.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873710","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

Use of decision algorithms for viscoelastic tests and use of blood products in patients undergoing liver transplantation: A systematic review with meta-analysis 在肝移植患者中使用决策算法进行粘弹性测试和使用血液制品：一项具有荟萃分析的系统综述

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-04-18 DOI: 10.1016/j.trre.2025.100932

Gilvandro Lins de Oliveira Júnior , Viviane Maria Bezerra Cavalcanti Lins , Virgínia Maria Bezerra Cavalcanti , Francisco Tustumi , Cassio Virgílio , Wellington Andraus

{"title":"Use of decision algorithms for viscoelastic tests and use of blood products in patients undergoing liver transplantation: A systematic review with meta-analysis","authors":"Gilvandro Lins de Oliveira Júnior , Viviane Maria Bezerra Cavalcanti Lins , Virgínia Maria Bezerra Cavalcanti , Francisco Tustumi , Cassio Virgílio , Wellington Andraus","doi":"10.1016/j.trre.2025.100932","DOIUrl":"10.1016/j.trre.2025.100932","url":null,"abstract":"<div><div>Introduction: Viscoelastic tests (VETs), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), provide a global assessment of hemostatic function. The use of a TEG or ROTEM system to guide the administration of blood products has been shown to reduce transfusion requirements in certain types of surgeries, but the decision algorithms for Viscoelastic tests needs to be assessed. This review aimed to assess all published evidence on viscoelastic testing in the context the use of decision algorithms for VETs on liver transplantation. Methods: A systematic review was performed in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Studies assessing VETs for liver transplantation were considered for inclusion, analyzed according to the use or non-use of algorithms for VETs. Results: Out of the 279 studies initially identified, 17 studies were included in this review. Algorithms for VETs reduced red blood cell transfusion (−0.44 (95 % CI -0.62; −0.25; <em>p</em> < 0.01), while there was no significant difference with VETs without algorithms, and the overall measure showed a smaller reduction (−0.33; 95 % CI -0.61 to −0.04; <em>p</em> = 0.02). Conclusion: The results highlight the potential of algorithms for VETs to reduce the use of blood products in liver transplants.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100932"},"PeriodicalIF":3.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873748","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

Mechanism and regulation of the complement activity in kidney xenotransplantation 异种肾移植补体活性的机制及调控

IF 3.6 2区医学

Transplantation Reviews Pub Date : 2025-04-13 DOI: 10.1016/j.trre.2025.100931

Takayuki Hirose , Kiyohiko Hotta , Ryo Otsuka , Ken-Ichiro Seino

{"title":"Mechanism and regulation of the complement activity in kidney xenotransplantation","authors":"Takayuki Hirose , Kiyohiko Hotta , Ryo Otsuka , Ken-Ichiro Seino","doi":"10.1016/j.trre.2025.100931","DOIUrl":"10.1016/j.trre.2025.100931","url":null,"abstract":"<div><div>Xenotransplantation is emerging as one of several potential solutions for addressing organ donor shortages, with significant progress bringing it closer to clinical application. However, challenges remain, particularly concerning complement system dysregulation caused by species differences, as well as xenoantigens and coagulopathy. Complement regulatory proteins expressed on endothelial cells of donor xenografts are less compatible with complement components in recipients. These difficulties contribute to hyperacute rejection, characterized by antibody-mediated complement activation that destroys the graft within 24 h. Moreover, because molecules are incompatible across different species, ischemia-reperfusion injury or infection can easily elicit complement activity via all three pathways, resulting in xenograft loss via complement-mediated vascular injury. Complement activity also stimulate innate and adaptive immune cells. To address this issue, genetic modifications in donor pigs and the development of novel medicines have been tested in preclinical models with promising results. Pigs modified to express human complement-regulating molecules such as CD46, CD55, and CD59 have shown longer kidney xenograft survivals over years in preclinical models with nonhuman primates, paving the way for clinical trials. Anti-complement component agents such as C1 esterase and C5 inhibitors have also been shown to increase xenograft survivals. This review examines the role of the complement system in kidney xenotransplantation, emphasizing new research and clinical trial advancements.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100931"},"PeriodicalIF":3.6,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829632","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