Transplantation Reviews最新文献

{"title":"Early surgical complications following kidney transplantation in adults: A systematic review","authors":"Milla Ortved ,&nbsp;Julia Dagnæs-Hansen ,&nbsp;Hein V. Stroomberg ,&nbsp;Malene Rohrsted ,&nbsp;Søren Schwartz Sørensen ,&nbsp;Andreas Røder","doi":"10.1016/j.trre.2025.100963","DOIUrl":"10.1016/j.trre.2025.100963","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify and characterise short-term (&lt;90 days) surgical complications following kidney transplantation and identify risk factors for complications.</div></div><div><h3>Methods</h3><div>This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the protocol registered with PROSPERO (ID CRD42024535328). Studies reporting surgical and postoperative complications within 90 days of surgery were included as well as studies reporting on groups of complications such as urological, vascular or wound related. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS) and number of fulfilled Martin criteria.</div></div><div><h3>Results</h3><div>Of 1654 articles screened, 30 were included. In studies reporting on complications within 30 days of surgery the weighted overall complication rate was 41 % (range 13-70 %), the weighted reoperation rate was 13 % (range 9.8-17 %) and the weighted rate of major complications was 19 % (range 7.6-24 %). In studies reporting on complications within 90 days of surgery the weighted overall complication rate was 36 % (range 12-60 %), the weighted reoperation rate was 17 % (range 5.0-23 %) and the weighted rate of major complications was 24 % (range 19-25 %). Studies were heterogenous and the quality was rated poor to good according to the NOS and fulfilling a median of 7 Martin criteria (range 4-9). Possible risk factors for complications included high BMI, recipient age and sex.</div></div><div><h3>Conclusion</h3><div>Kidney transplantation remains a high-risk surgical procedure. We identified considerable variation in how complications were reported, limiting comparison of outcomes between centres as well as the potential impact of peri-operative interventions to improve surgical outcomes.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100963"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996571","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":"An update on SARS-CoV-2 prevention strategy in solid organ transplant recipients: an expert opinion","authors":"Paolo Antonio Grossi ,&nbsp;Patrizia Burra ,&nbsp;Emanuele Cozzi ,&nbsp;Loreto Gesualdo ,&nbsp;Giuseppe Grandaliano ,&nbsp;Luciano Potena ,&nbsp;Patrizio Vitulo","doi":"10.1016/j.trre.2025.100966","DOIUrl":"10.1016/j.trre.2025.100966","url":null,"abstract":"<div><div>Compared to immunocompetent individuals, solid organ transplant recipients (SOTRs) develop a weaker immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination. Although anti-SARS-CoV-2 vaccines can prevent symptomatic and severe disease, the SOTR population remains at risk as long as SARS-CoV-2 continues to circulate. To protect transplanted patients against severe COVID-19, two primary preventive strategies have been proposed: anti-SARS-CoV-2 vaccination and pre-exposure prophylaxis (PrEP) with monoclonal antibodies that possess neutralizing activity against SARS-CoV-2.</div><div>The effectiveness of vaccination varies depending on the type of organ transplanted and the immunosuppressive therapy used, whereas the effectiveness of PrEP does not depend on these factors. The timing of vaccination and PrEP administration is also crucial. A stronger immune response is observed when vaccination is conducted during the nadir of immunosuppressive therapy. However, when PrEP is administered concomitantly with the vaccine, the efficacy of the vaccination could be reduced, both in terms of antibody production and cell-mediated immunity. Therefore, PrEP should be administered at least 15 days after vaccine administration.</div><div>In addition to the availability of various preventive measures against COVID-19 for the most vulnerable transplant patients, the scientific community strongly recommends adhering to protective measures, such as wearing masks, practicing hand hygiene, and maintaining social distancing. These expert recommendations offer crucial guidance on preventing SARS-CoV-2 infection in solid organ transplant patients and are applicable to everyday clinical practice.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100966"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260518","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":"Adaptive immune response and evasion strategies of BK virus","authors":"Deema Ibrahim Fallatah ,&nbsp;Steve Christmas ,&nbsp;Abdulkarim Binshaya","doi":"10.1016/j.trre.2025.100959","DOIUrl":"10.1016/j.trre.2025.100959","url":null,"abstract":"<div><div>BKV presents a considerable challenge, particularly in immunocompromised individuals such as kidney transplant recipients. This review explores the adaptive immune responses to BKV, focusing on both humoral and cellular immunity. While BKV-specific antibodies contribute to viral neutralization, their protective role is limited due to viral immune evasion strategies and serotype variations. Cellular immunity, especially BKV-specific T-cell responses, plays a crucial role in con-trolling viral replication and preventing nephropathy. However, BKV employs several immune evasion tactics, including antigenic variation, latency, and modulation of T-cell responses. The absence of standardized serological assays further complicates diagnosis and immune monitoring. Future research should focus on improving diagnostic tools, identifying biomarkers, and developing targeted immunotherapies. Understanding the mechanisms of BKV immune evasion and latency will be essential for improving clinical outcomes in high-risk populations.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100959"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860734","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":"Impact of disease-modifying drugs in patients with transthyretin amyloidosis after liver transplantation: a systematic review","authors":"Christiane Santo,&nbsp;Cristhian Romero,&nbsp;Bruno Vaz Kerges Bueno,&nbsp;Andre Dabarian,&nbsp;Fabio Fernandes","doi":"10.1016/j.trre.2025.100960","DOIUrl":"10.1016/j.trre.2025.100960","url":null,"abstract":"<div><h3>Background</h3><div>Orthotopic liver transplant (OLT) was the first approved treatment for hereditary transthyretin amyloidosis (ATTRv). However, some patients continue to deteriorate due to ongoing wild-type TTR deposition and residual synthesis from extrahepatic sources. In recent years, disease-modifying therapies including TTR stabilizers (e.g., Tafamidis) and gene-silencing agents (e.g., Patisiran) have emerged, but their role in post-OLT patients remains unclear due to their exclusion from most clinical trials.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, Cochrane, and Embase (up to June 2025) using terms related to transthyretin amyloidosis, liver transplantation, and disease-modifying therapies. The objective was to evaluate clinical benefits and safety of these agents in symptomatic ATTRv patients after OLT.</div></div><div><h3>Results</h3><div>Disease-modifying therapies showed potential benefits in post-OLT ATTR patients. A total of 39 patients treated with tafamidis, inotersen, or patisiran were analyzed. Neurological improvements, including autonomic symptoms, NIS score, and quality of life, were based on 3 case reports and 32 patients from observational studies. Cardiovascular results were from 4 case reports, and biomarker findings from 3 case reports.</div></div><div><h3>Conclusions</h3><div>Disease-modifying therapies may offer clinical benefits in post-OLT ATTRv patients. However, robust prospective studies and randomized trials are needed to confirm efficacy and ensure safety in this population.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100960"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903285","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":"Emerging strategies in the transplantation of HCV-infected pancreases to uninfected recipients: A narrative review","authors":"Adam J. Bush ,&nbsp;Robyn A.E. Gould ,&nbsp;Benjamin C. Storey ,&nbsp;Matthew J. Bottomley","doi":"10.1016/j.trre.2025.100941","DOIUrl":"10.1016/j.trre.2025.100941","url":null,"abstract":"<div><div>The scarcity of suitable candidates for solid organ transplantation (SOT) represents a major barrier to the reduction of waiting lists. The introduction of direct-acting antiviral (DAA) therapeutics eliminates many of the risks associated with the transplantation of Hepatitis C Virus (HCV)-infected donor organs (D+) to uninfected recipients (R-) and may facilitate access to a substantial organ pool, previously considered unacceptably high risk. The extent of clinical investigation into the safety and feasibility of HCV D+/R- SOT varies between allograft types.</div><div>Here, we review the current state of pancreatic HCV D+/R-transplant research. Studies are limited to small cohorts who received pancreas allografts from HCV-viraemic donors alongside a regimen of DAA therapy. As of 2025, seven studies investigated a total of 22 patients, using prophylactic or reactive treatment regimens. Outcomes have been positive, with universal viral eradication, favourable allograft function, and minimal HCV-related complications. A favourable adverse event profile is reported, mirroring studies in other transplanted organs.</div><div>With the aim to increase clinical use of pancreatic HCV D+/R- SOT, further investigation in the field is necessary to validate these preliminary data. Larger studies are essential to evaluate long-term sequelae and optimise treatment protocols to subsequently establish a standard of care.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100941"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587695","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":"A systematic review of simulators for kidney transplantation surgical training","authors":"Jad Kassir ,&nbsp;Kevin Kaulanjan ,&nbsp;Marc Olivier Timsit ,&nbsp;Sarah Drouin ,&nbsp;Thomas Prudhomme ,&nbsp;Romain Boissier ,&nbsp;Lionel Badet ,&nbsp;Xavier Matillon ,&nbsp;Julien Branchereau ,&nbsp;Emilien Seizilles de Mazancourt","doi":"10.1016/j.trre.2025.100967","DOIUrl":"10.1016/j.trre.2025.100967","url":null,"abstract":"<div><h3>Introduction</h3><div>Simulation-based training is increasingly recognized as a cornerstone of surgical education, aiming to improve technical skills while reducing risks for patients. In kidney transplantation, however, simulation remains poorly explored, and the validity and educational value of available models are unclear.</div></div><div><h3>Materials and methods</h3><div>A systematic literature search was performed in PubMed, Embase, Cochrane Library, and Google Scholar from inception until December 31, 2024. Studies in English and French reporting on kidney transplantation simulators were included. Two independent reviewers screened titles, abstracts, and full texts, with disagreements resolved by discussion. Data were extracted on study design, simulator characteristics, validation methods, outcomes, and biases.</div></div><div><h3>Results</h3><div>The search identified 3343 records, of which 8 studies met the inclusion criteria. Three focused on robot-assisted transplantation and five on open transplantation. Most publications described the development or construction of simulators rather than their validation. Three studies evaluated participant satisfaction through questionnaires, and two assessed technical performance using validated rating scales. However, other domains of validity—including content, construct, concurrent, and predictive validity—as well as educational impact were not formally assessed in any study. Overall, the methodological quality was low, with small sample sizes, heterogeneous evaluation methods, and no comparators.</div></div><div><h3>Conclusion</h3><div>The literature on kidney transplantation simulators remains limited. Existing studies focus largely on describing model development rather than providing robust validation or demonstrating educational benefit. Future research should emphasize standardized validation frameworks and structured evaluation to define the role of simulators in transplantation training.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100967"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319586","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":"Graft-versus-host disease after liver transplantation: A global review of pathogenesis, diagnosis, and treatment strategies","authors":"Ayato Obana ,&nbsp;Miho Akabane ,&nbsp;Khalid Mumtaz ,&nbsp;Lauren Von Stein ,&nbsp;Johanna Papanikolla ,&nbsp;Nicole Gray ,&nbsp;Lindsay Sobotka ,&nbsp;Sylvester Black","doi":"10.1016/j.trre.2025.100942","DOIUrl":"10.1016/j.trre.2025.100942","url":null,"abstract":"<div><div>Graft-versus-host disease (GVHD) following liver transplantation (LT) (GVHD-LT) is a rare but highly lethal complication, occurring in 0.1–2 % of recipients with mortality rates exceeding 75 %. GVHD-LT develops when donor-derived lymphocytes transferred within the hepatic allograft recognize recipient tissues as foreign and mount an immune attack, primarily targeting the skin, gastrointestinal tract, and bone marrow while characteristically sparing the donor liver graft itself. This comprehensive review synthesizes current knowledge of GVHD-LT pathogenesis, clinical manifestations, diagnostic approaches, and therapeutic strategies based on systematic literature analysis of cases reported from 1988 to 2025. Clinical presentation typically occurs 2–12 weeks post-transplant with the classic triad of fever, maculopapular rash, profuse diarrhea, and progressive pancytopenia. Diagnosis relies on tissue biopsy demonstrating characteristic histopathological changes combined with molecular chimerism analysis confirming donor lymphocyte persistence. Risk factors include recipient age &gt; 50 years, hepatocellular carcinoma as underlying disease, and specific donor-recipient immunologic mismatches. Management remains challenging due to the delicate balance required between intensifying immunosuppression to control donor lymphocyte activity while preventing overwhelming infection. Conventional high-dose corticosteroids yield poor outcomes, with emerging therapies including JAK inhibitors, extracorporeal photopheresis, and targeted cytokine blockade showing promise in steroid-refractory cases. The hyperinflammatory state frequently overlaps with hemophagocytic lymphohistiocytosis, requiring specialized therapeutic approaches. Despite therapeutic advances, prognosis remains poor, with sepsis from opportunistic infections representing the leading cause of death. Future directions emphasize the urgent need for risk stratification models, preventive strategies, and multi-institutional collaborative trials to improve outcomes for this devastating post-transplant complication.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100942"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654386","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":"Renal resistance during hypothermic machine perfusion: A scoping review of variability and determinants, with a meta-analysis of predictive value for transplant outcomes","authors":"Liliana Fonseca Buitrago ,&nbsp;Laurence Verstraeten ,&nbsp;Steffen Fieuws ,&nbsp;Ina Jochmans","doi":"10.1016/j.trre.2025.100956","DOIUrl":"10.1016/j.trre.2025.100956","url":null,"abstract":"<div><h3>Background</h3><div>Renal resistance (RR) measured during hypothermic machine perfusion (HMP) is used to assess donor kidney quality and guide transplantation decisions. However, its clinical reliability and relationship with donor factors remain unclear.</div></div><div><h3>Methods</h3><div>This scoping review and meta-analysis evaluate the variability, determinants, and predictive value of RR during HMP. A systematic search of PubMed, Embase, Web of Science, and Cochrane Library (July 2024) identified 49 primary studies reporting RR in perfused human kidneys. The risk of bias was assessed using the ROBINS-I tool. Meta-analyses for the predictive value of RR were performed when ≥3 studies reported univariable associations for the same time point and outcome.</div></div><div><h3>Results</h3><div>Most studies had moderate to serious risk of bias. RR typically declined rapidly, stabilizing within 5 h (range: 0.30–3.50 to 0.17–1.50 mmHg/mL/min), but patterns varied widely. Determinants included histology, donor characteristics, and perfusion additives, though evidence was inconsistent. A meta-analysis showed terminal RR was significantly associated with delayed graft function (odds ratio 2.49, 95 % CI 1.49–4.18, I² = 58 %). While several studies proposed RR-thresholds, none were consistently validated, and heterogeneity in measurement timings and device settings limits comparability.</div></div><div><h3>Conclusion</h3><div>RR shows potential as a functional assessment parameter during HMP but is influenced by multiple technical and biological factors. Current evidence does not support the use of isolated RR-thresholds for organ acceptance. Standardized HMP protocols, trajectory modeling, and prospective studies are needed to clarify RR's role in clinical decision-making.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100956"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670291","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":"Between uncertainty and hope: A meta-ethnographic synthesis of patients awaiting kidney transplantation","authors":"Ebru Akgün Çıtak,&nbsp;Tuğçe Uçgun,&nbsp;Aylin Günay,&nbsp;Azize Karahan","doi":"10.1016/j.trre.2025.100961","DOIUrl":"10.1016/j.trre.2025.100961","url":null,"abstract":"<div><h3>Objective</h3><div>This study synthesizes qualitative research on the lived experiences of individuals awaiting kidney transplantation, with particular attention to their emotional, psychological, and social journeys during the waiting period.</div></div><div><h3>Methods</h3><div>A meta-ethnographic approach was employed, guided by Noblit and Hare's seven-phase framework. Systematic searches were conducted across six databases—PubMed (MEDLINE), Scopus, Web of Science, ScienceDirect, Wiley, and Ovid—resulting in 5452 records. After applying predefined eligibility criteria, eight qualitative studies published between 2015 and 2025 were included. First-order constructs (participants' accounts) and second-order constructs (researchers' interpretations) were integrated to generate third-order interpretive themes.</div></div><div><h3>Results</h3><div>Six overarching themes were identified: (1) navigating uncertainty, (2) sustaining hope and anticipation, (3) psychological strain and emotional weight, (4) readiness and coping resources, (5) support systems and communication, and (6) identity transformation and personal growth. These themes emphasize the complexity of the experience of waiting for a transplant, which is characterized by temporal ambiguity, emotional vulnerability, and existential reflection. Support from peers and healthcare professionals, as well as adaptive coping strategies, played a pivotal role in fostering psychological resilience.</div></div><div><h3>Conclusion</h3><div>Waiting for a kidney transplant profoundly reshapes patients' perceptions of self, time, and well-being. Insights from this synthesis can guide the design of targeted psychosocial interventions and patient-centered support programs. These findings hold relevance for nurses, transplant coordinators, and mental health practitioners involved in caring for this population.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100961"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of standard- versus reduced-dose tacrolimus exposure on clinical outcomes in adult kidney transplant recipients: A systematic review and meta-analysis","authors":"Suwasin Udomkarnjananun ,&nbsp;Mohamed Soliman ,&nbsp;Sangil Min ,&nbsp;Ha Phan Hai An ,&nbsp;Chih-Yuan Lee ,&nbsp;Yongji Lu ,&nbsp;Teun van Gelder","doi":"10.1016/j.trre.2025.100958","DOIUrl":"10.1016/j.trre.2025.100958","url":null,"abstract":"<div><div>Concerns around calcineurin inhibitor–induced nephrotoxicity after kidney transplantation have led to dose-reduction practices. However, “reduced dose” remains poorly defined, and evidence comparing outcomes for standard- versus reduced-dose tacrolimus trough concentration (C₀) above 5 ng/mL is limited. We searched multiple electronic databases (Jan 1, 2000-June 30, 2024) for randomized controlled or observational studies that reported clinical outcomes (acute rejection, nephrotoxicity, graft survival, patient survival, and estimated glomerular filtration rate) directly against tacrolimus C₀ as an independent clinical variable in adult kidney transplant recipients who received tacrolimus. Ten publications were included. No eligible study of tacrolimus with mammalian target of rapamycin inhibitors was identified, so results focused on patients treated with tacrolimus plus mycophenolic acid. Four randomized controlled trials with similar immunosuppression regimens were included in the meta-analysis to compare the impact of standard- versus reduced-dose tacrolimus exposure (per study definition) on C₀ and clinical outcomes. Standard-dose tacrolimus exposure was associated with significantly lower acute rejection rates versus reduced-dose exposure (odds ratio, 0.4 [95 % confidence interval: 0.17, 0.95]; <em>P</em> = 0.037). There were no significant differences between groups in graft loss or patient survival. An overlap in drug concentrations between standard- and reduced-dose tacrolimus C₀ suggests that reduced-dose tacrolimus regimens can often result in an exposure that falls within the standard range (i.e., 5–10 ng/mL). Clinicians should consider the precise tacrolimus dose ranges reported in publications and optimize tacrolimus concentration levels for individual patients, potentially contradicting some recommendations for calcineurin inhibitor minimization.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100958"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863468","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}