Transplantation Reviews最新文献

{"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":"2025-04-01","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":"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":"2025-04-01","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":"Ex-situ normothermic machine perfusion prevents ischemic cholangiopathy after liver transplantation: A meta-regression analysis","authors":"Quirino Lai ,&nbsp;Roberta Angelico ,&nbsp;Nicola Guglielmo ,&nbsp;Duilio Pagano ,&nbsp;Paulo N. Martins ,&nbsp;Davide Ghinolfi","doi":"10.1016/j.trre.2025.100915","DOIUrl":"10.1016/j.trre.2025.100915","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Liver transplantation (LT) is the gold standard for end-stage liver disease, but ischemic cholangiopathy (IC) remains a significant complication. Ex-situ normothermic machine perfusion (ESNMP) has emerged as a potential strategy to mitigate ischemic injury. However, the effect of ESNMP on reducing post-LT IC remains controversial. This study aimed to perform an updated meta-analysis to evaluate the impact of ESNMP on IC incidence.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted following PRISMA guidelines. The literature search included studies from 2015 to 2025 comparing LT outcomes using ESNMP vs. static cold storage (SCS). The primary outcome was the incidence of IC. Risk of bias was assessed using the ROBINS-E tool. Statistical analysis, including random-effects meta-analysis, sensitivity analysis, and meta-regression, was performed to evaluate heterogeneity, potential confounders, and the impact of follow-up duration.</div></div><div><h3>Results</h3><div>Seventeen studies, including 76,045 patients (4843 ESNMP; 71,202 SCS), were analyzed. No statistically significant difference in IC incidence was found between ESNMP and SCS (1.3 % vs. 0.6 %; RR = 0.68, 95 %CI = 0.41–1.13; <em>P</em> = 0.14). Sensitivity analysis excluding one outlier study revealed a reduction in IC risk with ESNMP (RR = 0.62, 95 %CI = 0.38–1.01; <em>P</em> = 0.054).</div><div>Two sub-analyses of studies with ≥12 months of follow-up (RR = 0.51, 95 %CI = 0.26–0.99; <em>P</em> = 0.049) and DCDs (RR = 0.33, 95 %CI = 0.16–0.67; <em>P</em> = 0.002) showed risk reduction. The meta-regression revealed that the back-to-base perfusion approach was associated with the occurrence of IC, with an OR of 1.03 (95 %CI = 1.00–1.07, <em>P</em> = 0.035).</div></div><div><h3>Conclusions</h3><div>a correlation between ESNMP use and IC reduced risk appears to exist, especially with longer follow-up periods and DCDs, though more high-quality studies are needed to confirm this finding.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100915"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725882","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":"Survival after heart transplants from circulatory-dead versus brain-dead donors: Meta-analysis of reconstructed time-to-event data","authors":"Mohammed Al-Tawil ,&nbsp;William Wang ,&nbsp;Ashwini Chandiramani ,&nbsp;Feras Zaqout ,&nbsp;Abdel Hannan Diab ,&nbsp;Serge Sicouri ,&nbsp;Basel Ramlawi ,&nbsp;Assad Haneya","doi":"10.1016/j.trre.2025.100917","DOIUrl":"10.1016/j.trre.2025.100917","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplantation (HTx) using donors after circulatory death (DCD) has the potential to significantly boost overall transplant rates. This study aims to reconstruct data from individual studies comparing survival between HTx from DCD recipients and donation after brain (DBD) recipients.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, Scopus, were searched up to August 2024. We included studies that reported a Kaplan-Meier summary of survival comparing DCD and DBD HTx. Digitization of the Kaplan-Meier curves and reconstruction of individual patient data followed by survival analysis that was conducted using R software.</div></div><div><h3>Results</h3><div>Six studies including a total of 3240 patients (2242 DBD and 998 DCD) were included in the final analysis. There was no significant difference in the overall survival rates between DCD and DBD patients (Hazard Ratio (HR): 1.01, 95 % CI [0.81–1.25], <em>P</em> = 0.91). However, the proportional hazard assumption was violated, deeming such results inconclusive. Time-varying flexible parametric model revealed a significantly declining survival in DCD recipients 3 years after surgery. Landmark analyses further suggest this declining trend in the DCD group at the two-year landmark (HR: 1.67, <em>p</em> = 0.021) and the four-year mark (HR: 2.78, <em>p</em> = 0.002). However, data beyond 6 years is limited. Evidence comparing direct procurement and normothermic regional perfusion is scarce, with no significant survival differences observed.</div></div><div><h3>Conclusion</h3><div>This meta-analysis shows that, despite similar early survival outcomes, DCD heart transplants showed a trend towards a lower long-term survival, with the difference becoming evident around three years post-transplantation. These findings highlight the need for enhanced monitoring and optimized post-transplant care in DCD recipients. Further studies with strict and long-term follow-up are warranted to confirm these results.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100917"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680503","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":"Donor–derived cell–free dna as a diagnostic biomarker for acute rejection in heart transplantation: A systematic review and meta–analysis","authors":"Shujun Liu,&nbsp;Lixing Wang,&nbsp;Shan Liu,&nbsp;Yinlong Zhao","doi":"10.1016/j.trre.2025.100916","DOIUrl":"10.1016/j.trre.2025.100916","url":null,"abstract":"<div><h3>Background</h3><div>Endomyocardial biopsy is widely acknowledged as the gold standard for detecting rejection following heart transplantation. However, the operation itself carries a risk of myocardial tissue damage and associated complications during and after surgery. Given the limitations of existing diagnostic approaches, non-invasive biomarkers are crucial.</div></div><div><h3>Objective</h3><div>This study assessed the diagnostic utility of donor-derived cell-free DNA (dd-cfDNA) in detecting AR in heart transplant recipients.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from inception to August 1, 2024, to identify studies evaluating the diagnostic performance of dd-cfDNA for AR in heart transplant recipients. Retrieved studies were screened using EndNote X9. Meta-analysis was performed using Meta-Disc software version 1.4 and STATA/SE 14.0.</div></div><div><h3>Results</h3><div>Ten studies were included in the meta-analysis. The pooled sensitivity, specificity, and area under the receiver operating characteristic curve with 95 % confidence intervals (CIs) were 65 % (95 % CI, 61–68 %), 79 % (95 % CI, 78–80 %), and 0.83, respectively.</div></div><div><h3>Conclusions</h3><div>This meta-analysis indicates that plasma dd-cfDNA may serve as a promising non-invasive biomarker for the diagnosis of acute rejection in heart transplant recipients. However, further research is warranted to investigate factors influencing diagnostic performance and optimize clinical utility.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100916"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680588","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 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":"2025-04-01","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":"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":"Complement and complement regulatory protein in allogeneic and xenogeneic kidney transplantation","authors":"Yoichi Kakuta ,&nbsp;Shuji Miyagawa ,&nbsp;Soichi Matsumura ,&nbsp;Yoko Higa-Maegawa ,&nbsp;Shota Fukae ,&nbsp;Ryo Tanaka ,&nbsp;Shigeaki Nakazawa ,&nbsp;Kazuaki Yamanaka ,&nbsp;Takuji Kawamura ,&nbsp;Shunsuke Saito ,&nbsp;Shigeru Miyagawa ,&nbsp;Norio Nonomura","doi":"10.1016/j.trre.2024.100885","DOIUrl":"10.1016/j.trre.2024.100885","url":null,"abstract":"<div><div>Kidney transplantation is the most optimal treatment for patients with end-stage renal disease, offering significant improvements in patient outcomes over dialysis. However, the potential for immune rejection, where the recipient's immune system attacks the transplanted kidney, can compromise transplant success. The complement system, a key component of the immune response, plays a crucial role in both acute and chronic rejection, including T-cell- and antibody-mediated rejection. Understanding and controlling the complement system is essential for managing rejection and enhancing graft survival and overall success of kidney transplantation. In allogeneic transplantation, complement activation through various pathways contributes to graft damage and failure. Recent advancements in genetic engineering enable the development of transgenic pigs expressing human complement regulatory proteins, which display potential for reducing rejection in xenotransplantation. Despite these advances, the complex mechanisms of complement activation and regulation are not fully understood, necessitating further research. This review examines the role of the complement system in kidney transplantation, explores the latest developments in complement regulatory strategies, and discusses potential therapeutic approaches to improve transplant outcomes.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100885"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635659","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":"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":"Complement in Kidney Transplantation","authors":"Pooja Lokkur ,&nbsp;Shyam Bihari Bansal","doi":"10.1016/j.trre.2024.100897","DOIUrl":"10.1016/j.trre.2024.100897","url":null,"abstract":"<div><div>Transplantation is the treatment of choice in most patients with kidney failure. The complement system plays a vital role in transplantation. The complement system forms a major part of innate immunity and acts as a bridge between innate and acquired immunity. Many diseases, particularly concerning the kidneys, result from complement system dysregulation, like atypical hemolytic uremic syndrome (aHUS), C3 glomerulopathy (C3GN), systemic lupus erythematosus (SLE and some other immune complex diseases. The complement system activation is a very important part of post-transplant events like ischemia-reperfusion injury (IRI), delayed graft function (DGF), antibody-mediated rejection (ABMR) and thrombotic microangiopathy (TMA). A better understanding of the complement cascade can help to plan strategies to prevent and manage complement-related problems before and after kidney transplantation. Many newer molecules are either being developed or in the pipeline, which target the complement system at various stages. These novel therapeutics are now considered additional measures to improve graft survival. This review summarises the complement cascade, its role in kidney diseases and kidney transplantation, and possible areas of target and novel therapeutics.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100897"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748171","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}