Clinical transplantation and research最新文献

{"title":"Comparative outcomes of separate versus pantaloon anastomosis in two renal artery living donor kidney transplantation: a retrospective cohort study.","authors":"Asad Bashir, Zia Ul Haq Akram, Nasrum Minallah, Fiaz Ahmad Touqeer, Ali Asad, Mariam Asad, Zaghum Shazad, Muhammad Faheem Aslam, Sehrish Tehreem, Ammar Yousaf","doi":"10.4285/ctr.25.0010","DOIUrl":"https://doi.org/10.4285/ctr.25.0010","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical approach for managing multiple renal arteries in living donor kidney transplantation remains unclear. This study compared outcomes between separate anastomoses (SA) and pantaloon anastomosis (PA).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted from November 2018 to August 2024. In total, 117 patients were included (SA, 67; PA, 50). The primary outcome was arterial complications. Secondary outcomes included renal function, graft and patient survival at 1 year, and intraoperative variables. Statistical analyses utilized the t-test, the Mann-Whitney U-test, and Kaplan-Meier survival curves.</p><p><strong>Results: </strong>The mean warm ischemia time was similar between groups (105.48±35.64 vs. 103.92±33.51 min; P=0.811). Cold ischemia time was also comparable (75.90±14.36 vs. 80.68±17.85 min; P=0.111). However, anastomosis time was significantly longer in the SA group (39.00 [35.00-43.00] min) compared with the PA group (34.00 [28.50-39.50] min; P<0.001). The immediate postoperative creatinine reduction was slightly greater in the SA group (46.83%±20.68% vs. 39.78%±19.04%; P=0.090). Vascular complications requiring re-exploration were infrequent in both groups (1.5% vs. 2.0%). At 1 year posttransplant, creatinine levels were comparable between the SA (1.20 [0.95-1.45] mg/dL) and PA (1.20 [1.05-1.35] mg/dL) groups (P=0.337). Regression analysis confirmed that postoperative creatinine levels were independently associated with SA (P=0.006). Graft survival was similarly high (97% vs. 98%), as was patient survival (100% vs. 96%).</p><p><strong>Conclusions: </strong>Both anastomosis techniques are safe and effective for transplanting kidneys with anatomical anomalies. SA offers surgical efficiency and provides superior early renal recovery.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of probiotic supplementation on kidney transplantation outcomes: a retrospective propensity score matched study.","authors":"Yookyung Jang, Tai Yeon Koo, Young-Eun Choi, Cheol Woong Jung, Young Ju Oh, Heungman Jun, Sewon Oh, Sang-Kyung Jo, Myung-Gyu Kim","doi":"10.4285/ctr.25.0017","DOIUrl":"https://doi.org/10.4285/ctr.25.0017","url":null,"abstract":"<p><strong>Background: </strong>The potential benefits and risks of probiotic use in kidney transplant (KT) recipients remain unclear. This study aimed to evaluate the effects of probiotic supplementation on KT outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was performed using medical records from 354 KT recipients between January 2010 and December 2020. Only patients who received probiotics within the first year following transplantation were included, and transplant outcomes were assessed at 1-3 years after KT.</p><p><strong>Results: </strong>Among the 354 patients, 97 (27%) received probiotics during the study period, and 36 (10%) used them for more than 3 months. Probiotic types included <i>Lactobacillus</i> species (45.4%), <i>Bacillus subtilis</i> (14.4%), and others (40.2%). The average supplementation duration was 104.8 days. No significant differences in estimated glomerular filtration rate at 1 and 3 years posttransplantation were observed between the probiotic and nonprobiotic groups. Cytomegalovirus (CMV) viremia developed in 61 patients, with a significantly higher incidence observed in the probiotic group (25.8% vs. 14.0%). However, there were no significant differences in BK viremia or coronavirus disease 2019 infection rates between groups. During the study period, 116 patients received antibiotics for more than 1 week, and the prevalence of bacterial infections was not significantly different between the two groups. After propensity score matching, probiotic supplementation remained significantly associated only with the development of CMV viremia.</p><p><strong>Conclusions: </strong>This study identified a significant association between probiotic use and the occurrence of CMV viremia in KT recipients. To better define the safety and efficacy of probiotics in immunocompromised patients, large-scale prospective studies are necessary to establish comprehensive evidence.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibromuscular dysplasia and living kidney donors: a narrative review.","authors":"Yassin Rekhif","doi":"10.4285/ctr.25.0003","DOIUrl":"https://doi.org/10.4285/ctr.25.0003","url":null,"abstract":"<p><p>To address the shortage of grafts, renal transplant teams actively utilize all available donation options, including those that challenge the conventional criteria for living donors. However, this approach may involve situations requiring careful assessment of specific risks-particularly those that could jeopardize donor safety, expose the recipient or graft to vascular complications associated with certain arterial reconstructions, or threaten graft function in the recipient. Kidney donation in the context of fibromuscular dysplasia represents one such scenario, as this condition encompasses all three of these risks. Transplant centers that do not automatically exclude such donations recommend a selective approach, with decisions to accept these kidneys made on a case-by-case basis through evaluation by multidisciplinary teams comprising nephrologists, angiologists, and transplant surgeons. This narrative review aims to provide an update on (1) the identification and assessment of this arterial lesion during predonation evaluation, (2) the acceptability criteria for kidneys affected by fibromuscular dysplasia, (3) the safety and long-term outcomes for donors following nephrectomy, and (4) technical considerations for transplanting these grafts and their outcomes in recipients.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases.","authors":"Nalini Kanta Ghosh, Kausar Makki, Yogesh Yadav, Tathagata Karan, Piyush Srivastava, Anil Agarwal, Vivek Vij","doi":"10.4285/ctr.24.0061","DOIUrl":"10.4285/ctr.24.0061","url":null,"abstract":"<p><p>ABO-incompatible (ABOi) living donor liver transplantation (LDLT) carries a substantial risk of antibody-mediated rejection (AMR) in both the short and long term. However, when no ABO-compatible donor is available, ABOi LDLT can be a viable option for patients with liver failure requiring emergency transplantation. To prevent AMR, various strategies have been implemented. However, typically, a pretransplant preparation period of at least 2 to 3 weeks is required to reduce the CD19+ or CD20+ cell count and antibody levels to an acceptable threshold (1:64). In emergency ABOi cases, due to time constraints, the desensitization protocol must be modified in accordance with the patient's needs. We present a series of three cases involving emergency ABOi LDLT: one of primary graft nonfunction and two of acute-on-chronic liver failure. The goal was to achieve both short- and long-term rejection-free outcomes. Each case required different protocols based on the patient's antibody titer, clinical condition, and intraoperative findings, and postoperative immunosuppression regimens were also individualized according to each patient's clinical condition. This case series demonstrates the safety and feasibility of emergency ABOi LDLT with modifications to the desensitization protocol. However, further research into emergency ABOi transplantation is necessary to establish recommendations for managing such patients.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"161-168"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the utility of near-infrared spectroscopy in liver transplantation: insights and challenges.","authors":"Ravshan Ibadov, Konstantin Semash, Mirshavkat Akbarov, Timur Dzhanbekov, Oybek Omonov, Azimjon Usmonov, Sardor Ibragimov","doi":"10.4285/ctr.24.0067","DOIUrl":"10.4285/ctr.24.0067","url":null,"abstract":"<p><p>Maintaining adequate tissue perfusion and oxygen delivery to the transplanted liver is critical for positive patient outcomes. Near-infrared spectroscopy (NIRS) has emerged as a promising tool for evaluating graft function in liver transplantation, particularly in assessing tissue perfusion. This review consolidates current knowledge regarding the application of NIRS in liver transplantation, highlighting its potential for noninvasive, continuous monitoring of liver perfusion and early detection of hemodynamic disturbances. Initial studies demonstrate the sensitivity of NIRS in evaluating liver oxygenation, with significant correlations observed between NIRS readings and biochemical markers of liver function. However, the effectiveness of NIRS can be influenced by factors such as subcutaneous fat thickness and patient positioning. Recent advancements also suggest that NIRS may assist in predicting graft fibrosis and other longterm complications. More extensive studies are required to establish standardized protocols and validate the clinical utility of NIRS in liver transplantation.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"89-96"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living donor liver transplantation for autoimmune hepatitis in identical monozygotic twins: a case report.","authors":"Kulbhushan Haldeniya, Kausar Makki, Yogesh Yadav, Tathagata Karan, Nalini Kanta Ghosh, Piyush Srivastava, Anil Agarwal, Vivek Vij","doi":"10.4285/ctr.25.0008","DOIUrl":"10.4285/ctr.25.0008","url":null,"abstract":"<p><p>Liver transplantation (LT) is an effective treatment for end-stage liver diseases, including autoimmune hepatitis. Advances in immunosuppressive therapy have improved patient and graft survival; however, these treatments can cause serious side effects such as cardiovascular and metabolic complications. Some recipients achieve immunotolerance after LT, enabling them to safely reduce or even discontinue immunosuppression. In transplantation between identical twins, perfect human leukocyte antigen matching eliminates the need for immunosuppressive medications, thereby reducing long-term morbidity. We present a case of living donor LT between identical twins in which both the donor and recipient have remained healthy for over 2 years without the need for immunosuppression.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"174-178"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on predictors of moderate, severe, and critical COVID-19 infection in a largely vaccinated kidney transplant recipient cohort during the Omicron era.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.4285/ctr.25.0012","DOIUrl":"10.4285/ctr.25.0012","url":null,"abstract":"","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"179-180"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the correlation between six scoring systems for assessing the severity of end-stage liver disease and intraoperative blood loss during liver transplantation: a retrospective study.","authors":"Amer Majeed, Noon E Abdelgadir, Momina Amer, Muhammad Shabbir, Mohammed Ibrahim, Mohamad S Nagy, Bilal Tufail, Luluah Altukhaifi, Areej A G AlFattani","doi":"10.4285/ctr.24.0063","DOIUrl":"10.4285/ctr.24.0063","url":null,"abstract":"<p><strong>Background: </strong>Patients with end-stage liver disease (ESLD) are particularly susceptible to intraoperative hemorrhage during liver transplantation (LT), a risk partly attributable to coagulopathy. Various scoring systems are used to assess ESLD severity and predict waitlist mortality for LT. However, the potential association between ESLD severity and intraoperative blood loss remains underexplored. Therefore, we investigated the relationship between six widely utilized ESLD scoring systems and intraoperative blood loss during LT.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of all adult patients who underwent LT at a single center between 2011 and 2021.</p><p><strong>Results: </strong>A total of 719 adult patients were included, with a male-to-female ratio of 2:1. The mean age was 53.9 years (standard deviation [SD], 13.5 years), and the average body mass index was 26.9 kg/m² (SD, 5.5 kg/m²). The mean estimated blood loss volume (eBLV) was 3,292 mL (SD, 4,232 mL), leading to a cumulative transfusion volume (TxV) of 2,695 mL (SD, 3,288 mL), which included both homologous and cell-salvaged blood. On average, 6.49 units of homologous packed red blood cells were transfused. All six ESLD scoring systems and their constituent parameters exhibited weak positive correlations with both eBLV and TxV; notably, Model for End-Stage Liver Disease-Sodium (MELD-Na) showed the strongest correlation (R=0.265, P<0.001), while UKELD (UK MELD) showed the weakest (R=0.088, P=0.018).</p><p><strong>Conclusions: </strong>Although statistically significant, the predictive power of ESLD scoring systems for blood loss during LT was generally weak. This finding suggests the need for further research to develop a scoring system specifically tailored for this purpose.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"124-130"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiogram pattern of recurrent urinary tract infections in kidney transplant patients: a single-center cohort study.","authors":"Hossein Bahari, Ali Tajik, Armin Doostparast, Reza Nejad Shahrokh Abadi, Saeed Javanshir, Mohsen Aliakbarian, Rozita Khodashahi","doi":"10.4285/ctr.24.0070","DOIUrl":"10.4285/ctr.24.0070","url":null,"abstract":"<p><strong>Background: </strong>Recurrent urinary tract infections (UTIs) are a common complication among renal transplant recipients and can significantly affect patient outcomes. This study investigates the antibiogram patterns of uropathogens in this population to improve treatment strategies.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 58 renal transplant recipients diagnosed with recurrent UTIs. Pathogen types and antibiotic sensitivity profiles were documented using VITEK2 (bioMérieux). Inclusion criteria required that patients had undergone renal transplantation within the previous 5 years, experienced at least one confirmed UTI episode, and had complete antibiogram profiles. Only bacterial infections confirmed by both positive cultures and symptoms were included; cases with negative cultures or asymptomatic bacteriuria were excluded.</p><p><strong>Results: </strong><i>Escherichia coli</i> was the predominant pathogen (58%), followed by <i>Klebsiella</i> spp. (16%) and <i>Klebsiella pneumoniae</i> (10%). Notably, high resistance rates were observed against commonly used antibiotics; for example, <i>E. coli</i> exhibited 100% resistance to ampicillin and cefazolin. Statistical analysis revealed significant differences in resistance patterns among the various microorganisms, highlighting the prevalence of multidrug-resistant strains.</p><p><strong>Conclusions: </strong>The findings highlight the urgent need for continuous monitoring of antibiogram patterns and the development of disease-specific antibiograms tailored to renal transplant recipients to optimize treatment strategies and improve patient outcomes. The high prevalence of antibiotic resistance indicates that empirical antibiotic guidelines must be revised to ensure effective management of UTIs in this vulnerable population.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"116-123"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status of xenotransplantation from an immunobiological standpoint.","authors":"Jaecheon Ko, Geon Lee, Hyun Woo Kim, Minji Kang, Hyun Je Kim, Chung-Gyu Park","doi":"10.4285/ctr.24.0065","DOIUrl":"10.4285/ctr.24.0065","url":null,"abstract":"<p><p>Xenotransplantation, which involves the transplantation of organs, tissues, or cells from animals into humans, is emerging as a promising solution to mitigate the global shortage of human donor organs. Nonetheless, its clinical application is constrained by significant immunological and physiological barriers-most notably, the rapid rejection of xenografts by both the innate and adaptive immune systems. This review discusses critical immunological challenges such as natural antibodies, complement activation, coagulation dysregulation, and cellular immune responses mediated by T cells, macrophages, and natural killer cells. Advances in genetic engineering-such as the development of multi-knockout pigs that lack major xenoantigens and the transgenic expression of human regulatory proteins-have considerably prolonged xenograft survival in preclinical models. Moreover, approaches such as mixed hematopoietic chimerism, thymic transplantation, cell-based therapies, and synthetic particle-based delivery hold promise for inducing immune tolerance. Innovations in pharmacological immunosuppression and bioengineering, including islet encapsulation and thrombo-regulatory modifications, further enhance graft viability. While recent breakthroughs, including pig-to-human transplants, demonstrate considerable clinical potential, challenges remain in achieving long-term graft survival. This review summarizes current progress in xenotransplantation research and outlines future directions to overcome cross-species immune barriers, bringing the field closer to widespread clinical application.</p>","PeriodicalId":519901,"journal":{"name":"Clinical transplantation and research","volume":" ","pages":"97-115"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}