Transplantation Reviews最新文献

{"title":"Technical challenges in LDLT – Overcoming small for size syndrome and venous outflow reconstruction","authors":"Paola A. Vargas ,&nbsp;Narmina Khanmammadova ,&nbsp;Deniz Balci ,&nbsp;Nicolas Goldaracena","doi":"10.1016/j.trre.2023.100750","DOIUrl":"10.1016/j.trre.2023.100750","url":null,"abstract":"<div><p><span><span><span>Living Donor Liver Transplantation (LDLT) emerged as an alternative </span>treatment option for patients with end-stage liver disease waiting for an organ from a deceased donor. In addition to allowing for a faster access to transplantation, LDLT provides improved recipient outcomes when compared to deceased donor LT. However, it represents a more complex and demanding procedure for the </span>transplant surgeon<span>. In addition to a comprehensive preoperative donor assessment and stringent technical considerations during the donor hepatectomy<span> to ensure upmost donor safety, the recipient procedure also comes with intrinsic challenges during LDLT. A proper approach during both procedures will result in favorable donor and recipient's outcomes. Hence, it is critical for the transplant surgeon to know how to overcome such technical challenges and avoid deleterious complications. One of the most feared complications following LDLT is small-for-size syndrome (SFSS). Although, surgical advances and deeper understanding of the pathophysiology behind SFSS has allowed for a safer implementation of LDLT, there is currently no consensus on the best strategy to prevent or manage this complication. Therefore, we aim to review current practices in technically challenging situations during LDLT, with a particular focus on management of small grafts and </span></span></span>venous outflow reconstructions, as they possess one of the biggest technical challenges faced during LDLT.</p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"37 1","pages":"Article 100750"},"PeriodicalIF":4.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9330023","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":"Use of sodium-glucose co-transporter 2 inhibitors in solid organ transplant recipients with pre-existing type 2 or post-transplantation diabetes mellitus: A systematic review","authors":"Yolanda Lin ,&nbsp;Merisa Mok ,&nbsp;Jennifer Harrison ,&nbsp;Marisa Battistella ,&nbsp;Ashley Farrell ,&nbsp;Marianna Leung ,&nbsp;Catherine Cheung","doi":"10.1016/j.trre.2022.100729","DOIUrl":"10.1016/j.trre.2022.100729","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors have demonstrated kidney, cardiovascular and mortality benefits in the general population; however, the evidence is limited in solid organ transplant recipients. The aim of this systematic review was to evaluate the current efficacy and safety data of SGLT2 inhibitors in adult kidney, heart, lung, and liver transplant recipients with pre-existing type 2 or post-transplantation diabetes mellitus.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;p&gt;&lt;span&gt;We searched MEDLINE, MEDLINE Epub, CENTRAL, CDSR, EMBASE, CINAHL, and sources of unpublished literature. All primary interventional and observational studies on SGLT2 inhibitors in transplant recipients were included. Clinical outcomes included mortality, cardiovascular and kidney events, and adverse events such as graft rejection. Surrogate markers including &lt;/span&gt;hemoglobin A1c&lt;span&gt; (HbA1c) and weight reduction were also evaluated.&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;&lt;span&gt;Of the 17 studies that were included in this systematic review, there were 15 studies on kidney transplant recipients (&lt;/span&gt;&lt;em&gt;n&lt;/em&gt;&lt;span&gt; = 2417 patients) and two studies on heart transplant recipients (&lt;/span&gt;&lt;em&gt;n&lt;/em&gt;&lt;span&gt; = 122 patients). There was only one randomized controlled trial&lt;span&gt;&lt;span&gt;&lt;span&gt; which evaluated 49 kidney transplant patients over 24 weeks. Overall, studies were heterogeneous in study design, sample size, duration of diabetes, time to SGLT2 inhibitor initiation post-transplantation (ranging from 0.88 to 11 years post kidney transplant; five to 5.7 years post heart transplant) and follow-up (ranging from 0.4 to 5.25 years in kidney transplant patients; 0.75 to one year in heart transplant patients). Only one retrospective study evaluated mortality as a part of a composite outcome in kidney transplant patients; however, study limitations restrict generalizability of results. Overall, studies could not confirm clinical cardiovascular and kidney benefits in the transplant population. Findings suggested that SGLT2 inhibitors may improve glycemic control; however, they are associated with urinary tract infection. &lt;/span&gt;Diabetic ketoacidosis and &lt;/span&gt;acute kidney injury&lt;span&gt;&lt;span&gt; also occurred in these studies, with precipitating factors such as infection and &lt;/span&gt;acute heart failure exacerbation.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;While SGLT2 inhibitors are promising agents with expanding indications in the non-transplant population, these agents may not be suitable for all solid organ transplant recipients, and close monitoring (e.g. for urinary tract infections) and patient education (e.g. sick day management) are essential if these agents are initiated. Evidence is based on short-term findings and suggests an association with hemoglobin A1c reduction and increased adverse events. Further long-term randomized controlled trials are needed to evaluate the effect of SGLT2 inhibitors on clinically important ou","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"37 1","pages":"Article 100729"},"PeriodicalIF":4.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9335321","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":"Alloimmune risk assessment for antibody-mediated rejection in kidney transplantation: A practical proposal","authors":"Laura Llinàs-Mallol ,&nbsp;Dàlia Raïch-Regué ,&nbsp;Julio Pascual ,&nbsp;Marta Crespo","doi":"10.1016/j.trre.2022.100745","DOIUrl":"10.1016/j.trre.2022.100745","url":null,"abstract":"<div><p><span>Kidney transplantation<span> is the treatment of choice for patients with end-stage renal disease. Although an improvement in </span></span>graft survival<span><span><span> has been observed in the last decades with the use of different immunosuppressive drugs, this is still limited in time with antibody-mediated rejection being a main cause of graft-loss. Immune monitoring and risk assessment of antibody-mediated rejection before and after kidney transplantation with useful biomarkers is key to tailoring treatments to achieve the best outcomes. Here, we provide a review of the rationale and several accessible tools for immune monitoring, from the most classic to the modern ones. Finally, we end up discussing a practical proposal for alloimmune risk assessment in kidney transplantation, including </span>histocompatibility </span>leukocyte antigen<span> (HLA) and non-HLA antibodies, HLA molecular mismatch analysis and characterization of peripheral blood immune cells.</span></span></p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"37 1","pages":"Article 100745"},"PeriodicalIF":4.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9335975","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":"Cannabinoids and solid organ transplantation: Psychiatric perspectives and recommendations","authors":"Gerald Scott Winder ,&nbsp;Sarah R. Andrews ,&nbsp;Arpita Goswami Banerjee ,&nbsp;Filza Hussain ,&nbsp;Ana Ivkovic ,&nbsp;Kristin Kuntz ,&nbsp;Lesley Omary ,&nbsp;Akhil Shenoy ,&nbsp;Thida Thant ,&nbsp;Amy VandenBerg ,&nbsp;Paula Zimbrean","doi":"10.1016/j.trre.2022.100715","DOIUrl":"10.1016/j.trre.2022.100715","url":null,"abstract":"<div><p><span>Cannabinoid<span> use in patients seeking </span></span>solid organ transplantation<span> (SOT) is an important and unsettled matter which all transplantation clinicians regularly encounter. It is also a multifaceted, interprofessional issue, difficult for any specialty alone to adequately address in a research article or during clinical care. Such uncertainty lends itself to bias for or against cannabinoid use accompanied by inconsistent policies and procedures. Scientific literature in SOT regarding cannabinoids often narrowly examines the issue and exists mostly in liver and kidney transplantation<span>. Published recommendations from professional societies are mosaics of vagueness and specificity mirroring the ongoing dilemma. The cannabinoid information SOT clinicians need for clinical care may require data and perspectives from diverse medical literature which are rarely synthesized. SOT teams may not be adequately staffed or trained to address various neuropsychiatric cannabinoid effects and risks in patients. In this article, authors from US transplantation centers conduct a systematized review of the few existing studies regarding clinician perceptions, use rates, and clinical impact of cannabinoid use in SOT patients; collate representative professional society guidance on the topic; draw from diverse medical literature bases to detail facets of cannabinoid use in psychiatry and addiction pertinent to all transplantation clinicians; provide basic clinical and policy recommendations; and indicate areas of future study.</span></span></p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"36 4","pages":"Article 100715"},"PeriodicalIF":4.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40518752","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 art of interprofessional psychosocial communication: Optimizing patient interfaces with psychiatric specialists in liver transplantation","authors":"Gerald Scott Winder ,&nbsp;Erin G. Clifton ,&nbsp;Ponni Perumalswami ,&nbsp;Jessica L. Mellinger","doi":"10.1016/j.trre.2022.100728","DOIUrl":"10.1016/j.trre.2022.100728","url":null,"abstract":"<div><p><span><span>Psychiatric and substance use disorders (SUD) commonly cause and contribute to advanced liver diseases and psychosocial phenomena remain some of the most challenging matters that liver transplantation (LT) teams encounter. Patients are often most focused on biomedical aspects of their </span>treatment and LT course rather than subtler </span>psychosocial factors which must be addressed alongside medical and surgical problems. This means that patients may not accept teams' recommendations for psychiatric and SUD treatment despite their primary role in treating liver disease and promoting successful LT. Alcohol-related liver disease is the archetype of these challenges. A crucial, actionable, and rarely discussed factor in creating a therapeutic interface between liver patients and psychiatric and SUD specialists is medical and surgical clinicians' interprofessional psychosocial communication (IPC; i.e., a clinician's personal ability to communicate effectively with patients about psychiatric and substance-related matters). In this article, we describe three crucial IPC timepoints during a typical ALD transplantation timeline, briefly review and synthesize diverse literature and perspectives into an overview of potential IPC pitfalls, propose practical IPC strategies for institutions and clinicians, and indicate future areas of study.</p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"36 4","pages":"Article 100728"},"PeriodicalIF":4.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40445795","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":"Inducible Co-Stimulator (ICOS) in transplantation: A review","authors":"Russell Hodgson ,&nbsp;Dale Christiansen ,&nbsp;Francesco Ierino ,&nbsp;Mauro Sandrin","doi":"10.1016/j.trre.2022.100713","DOIUrl":"10.1016/j.trre.2022.100713","url":null,"abstract":"<div><p><span>Prevention of T cell<span><span> activation is one of the goals of successful organ and tissue transplantation. Blockade of T cell co-stimulation, particularly of the CD28:B7 interaction, has been shown to prolong </span>graft survival. Inducible Co-Stimulator (ICOS) is the third member of the B7 family and here we review the literature on ICOS, its receptor (B7RP-1), and blockade of this pathway in transplant models. ICOS:B7RP-1 are a single receptor:ligand pair with a loss of function of either being implicated in some autoimmune diseases. ICOS has multiple functions, related to its constitutive expression on B cells and activated T cells. In </span></span><em>in vitro</em><span> transplant models, ICOS:B7RP-1 blockade has produced mixed results as to its ability to modulate lymphocyte proliferation. Several </span><em>in vivo</em><span><span> transplant models demonstrate varying degrees of success in prolonging graft survival. Timing and dose of treatment appear important, and combination with other </span>immunosuppressive treatments may also be of benefit. As ICOS has multiple functions, it may be that the observed variable results are due to inadvertent inactivation of graft protective functions. If these barriers can be overcome, ICOS:B7RP-1 blockade could provide an important target for future immunosuppression regimens.</span></p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"36 4","pages":"Article 100713"},"PeriodicalIF":4.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40536690","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":"Immune checkpoint inhibitor therapy for malignant tumors in liver transplantation recipients: A systematic review of the literature","authors":"Pinzhe Zhang ,&nbsp;Guanghao Zhu ,&nbsp;Leping Li ,&nbsp;Guanzhi Lai ,&nbsp;Zekang Wang ,&nbsp;Chengjun Sun ,&nbsp;Wuzheng Xia ,&nbsp;Linwei Wu","doi":"10.1016/j.trre.2022.100712","DOIUrl":"10.1016/j.trre.2022.100712","url":null,"abstract":"<div><h3>Background</h3><p>Treatment for de novo or recurrent tumors of liver transplantation (LT) recipients is challenging and immune checkpoint inhibitor (ICI) is recently well developed and could be a potentially effective option for this population. There remains limited evidence on the safety and efficacy of ICI therapy in LT recipients.</p></div><div><h3>Methods</h3><p>A systematic literature search was conducted on PubMed database through April 1, 2022, to identify publications reporting ICI treatment for malignant tumors in LT recipients. We summarized the allograft rejection, mortality, and tumor response of ICI treatment.</p></div><div><h3>Results</h3><p>24 articles with 41 LT recipients were identified. The age of LT recipients ranged from 14 to 78, 76.2% were male, 56.1% had recurrent HCC, and 87.8% received anti-PD-1 therapy. Allograft rejection occurred in 31.7% of patients, death was reported in 46.3% and 6 cases died secondary to allograft rejection. Progressive disease rate of this population was 48.8% and 10 patients responded to immunotherapy. Half of recipients with positive PD-L1 staining (4/8) experienced allograft rejection.</p></div><div><h3>Conclusions</h3><p>ICI therapy has potential therapeutic value on malignant tumors for LT recipients, accompanied by a high rate of allograft rejection and mortality. PD-L1 expression, type of ICI, and immunosuppression agent should be taken into consideration before initiation of immunotherapy. Further studies are needed to optimize this anticancer treatment approach in these patients.</p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"36 4","pages":"Article 100712"},"PeriodicalIF":4.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955470X22000350/pdfft?md5=240bc429ebf59c15743b674c0b4ad581&pid=1-s2.0-S0955470X22000350-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40532607","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":"Therapeutic efficacy of extracellular vesicles to suppress allograft rejection in preclinical kidney transplantation models: A systematic review and meta-analysis","authors":"Yitian. Fang ,&nbsp;Sarah Bouari ,&nbsp;Martin J. Hoogduijn ,&nbsp;Jan N.M. Ijzermans ,&nbsp;Ron W.F. de Bruin ,&nbsp;Robert C. Minnee","doi":"10.1016/j.trre.2022.100714","DOIUrl":"10.1016/j.trre.2022.100714","url":null,"abstract":"<div><h3>Background</h3><p>Kidney transplantation is the optimal treatment of end-stage renal disease. Extracellular vesicles (EVs) have tremendous therapeutic potential, but their role in modulating immune responses in kidney transplantation remains unclear.</p></div><div><h3>Methods</h3><p>We performed a systematic review and meta-analysis to investigate the therapeutic efficacy of EVs in preclinical kidney transplant models. Outcomes for meta-analysis were graft survival and renal function. Subgroup analysis was conducted between immune cell derived EVs (immune cell-EVs) and mesenchymal stromal cell derived EVs (MSC-EVs).</p></div><div><h3>Results</h3><p>Seven studies published from 2013 to 2021 were included. The overall effects showed that EVs had a positive role in prolonging allograft survival (standardized mean difference (SMD) = 2.00; 95% confidence interval (CI), 0.79 to 3.21; <em>P</em> &lt; 0.01; I² = 94%), reducing serum creatinine (SCr) (SMD = -2.19; 95%CI, −3.35 to −1.04; P &lt; 0.01; I² = 93%) and blood urea nitrogen (BUN) concentrations (SMD = -1.69; 95%CI, −2.98 to −0.40; <em>P</em> = 0.01; I² = 94%). Subgroup analyses indicated that only immune cell-EVs significantly prolonged graft survival and improve renal function but not MSC-EVs.</p></div><div><h3>Conclusions</h3><p>EVs are promising candidates to suppress allograft rejection and improve kidney transplant outcome. Immune cell-EVs showed their superiority over MSC-EVs in prolonging graft survival and improving renal function. For interpretation of the outcomes, additional studies are needed to validate these findings.</p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"36 4","pages":"Article 100714"},"PeriodicalIF":4.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955470X22000374/pdfft?md5=4e12dd4eebd178393ab27d7aa5fa9d38&pid=1-s2.0-S0955470X22000374-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40518753","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":"Costs related to obtaining organs for transplantation: A systematic review","authors":"Aline Moraes da Silva ,&nbsp;Marcos Antonio Ferreira Júnior ,&nbsp;Andréia Insabralde de Queiroz Cardoso ,&nbsp;Maria Lucia Ivo ,&nbsp;Jéssica Prince Fontes Almeida ,&nbsp;Rayane Dayara Souza Melo","doi":"10.1016/j.trre.2022.100724","DOIUrl":"10.1016/j.trre.2022.100724","url":null,"abstract":"<div><h3>Introduction</h3><p>The number of transplants in the world is growing, although there is a demand that exceeds supply. It is worth mentioning that the costs for obtaining organs are considered high. However, few studies have been developed on analyzing the costs of obtaining organs and tissues for transplants in order to support the decision-making of managers and health professionals.</p></div><div><h3>Objective</h3><p>To summarize the studies related to the cost of obtaining organs for transplants from a deceased donor.</p></div><div><h3>Method</h3><p>A systematic literature review<span> was conducted in the following databases: PubMed, Cochrane Library CINAHAL, Virtual Health Library (BVS), SCOPUS, Web of Science and EMBASE, using the following descriptors: Costs and cost analysis; Donor Selection; Tissue and Organ Procurement; Tissue and Organ Harvesting; and Tissue Donors, in studies published until April 2021. The risk of bias assessment was performed using the Joanna Briggs Institute's Checklist for Economic Assessments. It was not possible to perform a meta-analysis due to the heterogeneity of the studies.</span></p></div><div><h3>Results</h3><p>A total of 1731 studies were identified, of which 11 were analyzed. The cost of kidneys in US dollars (USD) ranged between USD $1672 and USD $25,058. Obtaining a liver ranged from USD $586 to USD $44,478. Heart procurement ranged from USD $633 to USD $24,264. The combined heart-lung transplant ranged from USD $860 to USD $23,203. Obtaining the pancreas ranged from USD $413 to USD $29,708.</p></div><div><h3>Conclusions</h3><p>Cost of obtaining organs for transplants from a deceased donor is substantial and varies widely across different studies. The overall cost of failures to obtain organs is currently unknown. Understanding organ procurement expenses can help clarify areas in which organ and tissue procurement can improve in cost and efficiency.</p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"36 4","pages":"Article 100724"},"PeriodicalIF":4.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40660443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic kidney disease after lung transplantation in a changing era","authors":"Heleen Grootjans ,&nbsp;Erik A.M. Verschuuren ,&nbsp;Johanna P. van Gemert ,&nbsp;Huib A.M. Kerstjens ,&nbsp;Stephan J.L. Bakker ,&nbsp;Stefan P. Berger ,&nbsp;C. Tji Gan","doi":"10.1016/j.trre.2022.100727","DOIUrl":"10.1016/j.trre.2022.100727","url":null,"abstract":"<div><p>Lung transplant (LTx) physicians are responsible for highly complex post-LTx care, including monitoring of kidney function and responding to kidney function loss. Better survival of the LTx population and changing patient characteristics, including older age and increased comorbidity, result in growing numbers of LTx patients with chronic kidney disease (CKD). CKD after LTx is correlated with worse survival, decreased quality of life and high costs. Challenges lie in different aspects of post-LTx renal care. First, serum creatinine form the basis for estimating renal function, under the assumption that patients have stable muscle mass. Low or changes in muscle mass is frequent in the LTx population and may lead to misclassification of CKD. Second, standardizing post-LTx monitoring of kidney function and renal care might contribute to slow down CKD progression. Third, new treatment options for CKD risk factors, such as diabetes mellitus, proteinuria and heart failure, have entered clinical practice. These new treatments have not been studied in LTx yet but are of interest for future use. In this review we will address the difficult aspects of post-LTx renal care and evaluate new and promising future approaches to slow down CKD progression.</p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"36 4","pages":"Article 100727"},"PeriodicalIF":4.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0955470X22000507/pdfft?md5=5fadfdc41923d638479448b6e6496ec1&pid=1-s2.0-S0955470X22000507-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33479572","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}