Frontiers in transplantation最新文献

{"title":"Case Report: Simultaneous pancreas-kidney transplantation in MELAS: first reported case with 5-year follow-up.","authors":"Vera Nilsén, Julia Bojstedt, Johan Nordström","doi":"10.3389/frtra.2026.1737352","DOIUrl":"10.3389/frtra.2026.1737352","url":null,"abstract":"<p><strong>Background: </strong>Mitochondrial encephalomyopathy with lactic acidosis, and stroke-like episodes (MELAS) is a rare mitochondrial DNA disorder that, in severe cases, can result in insulin-dependent diabetes and end-stage renal disease (ESRD). While organ transplantation is a potential treatment, documented cases remain scarce.</p><p><strong>Methods: </strong>A 40-year-old patient with dialysis-dependent ESRD and diabetes secondary to MELAS underwent simultaneous pancreas-kidney transplantation. The perioperative and postoperative periods were uncomplicated with only targeted MELAS-specific adaptations to standard protocols.</p><p><strong>Results: </strong>During the 5-year follow-up, the patient maintained excellent kidney allograft function and sustained insulin independence, with no need for dialysis or exogenous insulin therapy. At 5 years, creatinine was 77 µmol/L with an estimated GFR above 90 mL/min/1.73 m², and glycated hemoglobin was 40 mmol/mol.</p><p><strong>Conclusions: </strong>SPK transplantation may be feasible in carefully selected patients with MELAS, ESRD, and diabetes, providing durable renal and metabolic graft function at 5 years. To our knowledge, this is the first reported SPK case in MELAS, with extended follow-up.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1737352"},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145624","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":"Liver transplant and impact on cerebral autoregulation: a systematic scoping review.","authors":"Tommaso Rochat, Artida Ulaj, Frederic Sangla, Pia De Stefano, Herve Quintard","doi":"10.3389/frtra.2025.1753109","DOIUrl":"10.3389/frtra.2025.1753109","url":null,"abstract":"<p><strong>Background: </strong>Cerebral autoregulation (CA)-the brain's ability to maintain stable cerebral blood flow (CBF) despite changes in mean arterial pressure (MAP)-may be disrupted during orthotopic liver transplantation (OLT) due to profound metabolic, inflammatory, and hemodynamic alterations. Such impairment could increase the risk of cerebral hypoperfusion or hyperemia, yet its perioperative evolution and clinical implications remain unclear. This systematic scoping review aimed to synthesize current evidence on CA monitoring during OLT and to identify methodological gaps and potential clinical applications.</p><p><strong>Methods: </strong>A systematic scoping review was conducted according to Joanna Briggs Institute (JBI) guidelines. Studies including adult patients undergoing OLT with quantitative perioperative CA assessment were identified across PubMed, Embase, Scopus, Web of Science, and Medline.</p><p><strong>Results: </strong>Six studies (<i>n</i> = 99) met inclusion criteria. CA was assessed using diverse methods, including transcranial Doppler (TCD), near-infrared spectroscopy (NIRS), and derived indices such as the pressure reactivity index (PRx), mean flow index (Mx), cerebral oximetry index (COx), static cerebral autoregulation index (SCAI), and transfer function analysis (TFA). Monitoring phases and definitions of impaired CA varied widely. In acute liver failure, CA was commonly impaired pre-transplant and improved postoperatively, whereas findings in chronic liver disease were inconsistent. Only a few studies explored associations with neurological outcomes, yielding inconclusive results.</p><p><strong>Conclusions: </strong>CA appears to be dynamically affected during OLT, particularly in acute liver failure, but evidence remains limited by methodological heterogeneity and small sample sizes. Standardized, prospective studies are needed to clarify the role of CA monitoring and to determine whether individualized blood pressure management could improve neurological outcomes.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1753109"},"PeriodicalIF":0.0,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12862825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115369","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":"Purinergic signaling and cholangiocyte regeneration: a new frontier in ischemic liver injury.","authors":"Chinedu Nwaduru, Onyekachi Emmanuel Anyagwa, Michael Fenlon, Michelle Buff, Motaz Selim, Jean Botha, Zachary Kastenberg, Michael Zimmerman","doi":"10.3389/frtra.2025.1731982","DOIUrl":"10.3389/frtra.2025.1731982","url":null,"abstract":"<p><p>Cholangiocytes-the epithelial cells lining the biliary tree-are especially vulnerable to ischemic injury, particularly in the setting of orthotopic liver transplantation (OLT). This susceptibility stems from their reliance on an arterial blood supply and limited anaerobic capacity, predisposing them to hypoxia-induced damage. While significant research has focused on hepatocellular ischemia-reperfusion injury (IRI), the specific biology of cholangiocyte injury and regeneration remains underexplored. Recent evidence highlights purinergic signaling as a key regulator<i>y</i> axis in the liver's response to ischemia. Upon hypoxic stress, extracellular ATP is released as a damage-associated molecular pattern (DAMP), activating pro-inflammatory P₂ receptors. Enzymatic degradation of ATP by CD39 and CD73 shifts the signaling balance toward adenosine, a potent anti-inflammatory and cytoprotective molecule acting through P₁ receptors (A₁, A₂A, A₂B, A₃). This review synthesizes emerging data on purinergic signaling in cholangiocyte biology, emphasizing its role in modulating inflammatory injury, cellular crosstalk, and regeneration. We discuss how A₂A and A₂B receptor pathways suppress immune-mediated damage and promote cholangiocyte proliferation, with downstream effects on IL-6 secretion, vascular remodeling, and bile duct survival. As biliary complications remain a major cause of graft dysfunction post-transplant, harnessing purinergic mechanisms may offer a novel therapeutic frontier in improving cholangiocyte resilience and overall transplant outcomes.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1731982"},"PeriodicalIF":0.0,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12852462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146109536","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":"The role of estrogen in cardiac transplantation: mechanistic insights and effects on clinical outcomes.","authors":"Rosalie Wolff von Gudenberg, Constantin Kupsch, Linda Gilles, Yao Xiao, Catalina Ortiz-Koh, Arjang Ruhparwar, Hao Zhou, Stefan G Tullius","doi":"10.3389/frtra.2025.1734545","DOIUrl":"10.3389/frtra.2025.1734545","url":null,"abstract":"<p><p>Sex hormones profoundly shape immune responses and influence outcomes after heart transplantation. Estrogen enhances allosensitization and is associated with a higher incidence of acute rejection in female recipients. Beyond its immunological effects, estrogen also modulates the pharmacokinetics and pharmacodynamics of calcineurin inhibitors-particularly cyclosporine A-thereby influencing immunosuppressive efficacy and early graft performance. Donor-recipient sex mismatch further modulates transplant outcomes. Female-to-male transplants in particular exhibit the poorest short- and long-term survival and show increased rates of primary graft failure and cardiac allograft vasculopathy. Mechanistic and experimental data provide a biological basis for these observations: estrogen protects the myocardium against ischemia-reperfusion injury and preserves vascular integrity through both nuclear estrogen receptors and GPER-mediated signaling. Abrupt withdrawal of this estrogen-mediated protection in male recipients of female donor hearts may therefore increase susceptibility to early graft dysfunction and chronic vasculopathy. Integrating sex and hormonal status into transplant medicine-through hormonal profiling, receptor-specific mechanistic studies, and sex-adapted immunosuppressive strategies-may pave the way toward more individualized and effective therapeutic approaches in heart transplantation.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1734545"},"PeriodicalIF":0.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12827655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047714","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":"Editorial: Bio-engineered organs and grafts for clinical transplantation.","authors":"Siba Haykal","doi":"10.3389/frtra.2025.1763397","DOIUrl":"10.3389/frtra.2025.1763397","url":null,"abstract":"","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1763397"},"PeriodicalIF":0.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12827759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055861","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":"The critical relationship between tacrolimus levels, acute kidney injury, and early chronic lung allograft dysfunction.","authors":"Roman Hauber, Luca Kohlhepp, Ignaz Briegel, Tobias Veit, Jürgen Barton, Bruno Meiser, Christian Schneider, Teresa Kauke, Rudolf Hatz, Dominik J Hoechter, Nikolaus Kneidinger, Jürgen Behr","doi":"10.3389/frtra.2025.1704682","DOIUrl":"10.3389/frtra.2025.1704682","url":null,"abstract":"<p><strong>Background: </strong>Based on clinical observations, we hypothesized that tacrolimus (TAC) exposure and acute kidney injury (AKI) are associated with the development of chronic lung allograft dysfunction (CLAD) after lung transplantation (LTx).</p><p><strong>Methods: </strong>Of 827 lung transplant recipients treated between 2000 and 2018, 509 with complete data sets from the University Hospital of Munich (LMU) were included in this study. In the context of a 10% reduction in FEV₁ (CLAD10), tacrolimus and renal function were examined descriptively, inferentially, and through confounder analysis with regard to the occurrence of CLAD10.</p><p><strong>Results: </strong>Of 509 LTx patients, 67 (13%) died within the first 2 years after LTx. Among these 67 patients, 38 (57%) developed CLAD10 within 2 years of LTx. In these patients, we observed a temporal pattern characterized by a peak in TAC levels, followed by AKI, and subsequently subtherapeutic TAC concentrations, which occurred a few weeks before the onset of CLAD10. The confounder analysis demonstrated a significant influence of renal failure and tacrolimus fluctuations on the hazards ratio for developing CLAD10.</p><p><strong>Conclusion: </strong>Our data suggest that a transient decline in TAC serum concentrations, often caused by a TAC-induced AKI, may trigger the onset of CLAD10 and subsequently elevate the risk of premature death.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1704682"},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032664","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":"2024 transplant AI symposium: key AI models shaping the future of transplant care.","authors":"Annabel Koivu, Ghazal Azarfar, Saba Maleki, Aman Sidhu, Mamatha Bhat","doi":"10.3389/frtra.2025.1723799","DOIUrl":"10.3389/frtra.2025.1723799","url":null,"abstract":"<p><p>Experts in transplantation medicine and AI innovation came together to showcase advancements in AI applications with the potential to improve transplant outcomes. Ethical deployment, consolidation of multimodal data and supporting clinical decision making were among the themes addressed. Experts presented foundational models such as MedSAM for universal medical image segmentation, scPGT for single-cell genomics and Clinical Camel for clinical decision support, each demonstrating high capability and adaptability across transplant specialities. Experts highlighted future directions, considerations, and challenges for integrating these tools into clinical practice in an ethical and safe manner. We will summarize these themes as discussed at the Ajmera Transplant Centre's second annual Transplant AI Symposium.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1723799"},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12812975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014026","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":"Immunosuppressive and antiinfectious regimens in vascular composite allograft recipients-a systematic review.","authors":"Leonard Knoedler, Tobias Niederegger, Thomas Schaschinger, Gabriel Hundeshagen, Javier Gonzalez, Samuel A Knoedler, Martin Kauke-Navarro, Jasper Iske, Curtis L Cetrulo, Maxime Jeljeli, Elena Hofmann, Max Heiland, Steffen Koerdt, Alexandre G Lellouch","doi":"10.3389/frtra.2025.1714886","DOIUrl":"10.3389/frtra.2025.1714886","url":null,"abstract":"<p><strong>Introduction: </strong>Vascularized composite allotransplantation (VCA) has achieved significant clinical success, but lifelong immunosuppression remains essential to prevent rejection. Despite potent regimens, including tacrolimus, mycophenolate mofetil, and steroids, rejection episodes frequently occur within the first postoperative year. The side effects of immunosuppressive drugs must be carefully balanced against the risks of insufficient therapy. This review specifically aims to evaluate current immunosuppressive regimens and infection prophylaxis in VCA to identify evidence based approaches that attempt to mitigate rejection, prevent infections, and improve long-term graft survival.</p><p><strong>Methods: </strong>A systematic review was conducted across PubMed/MEDLINE, EMBASE, and Web of Science databases, adhering to PRISMA 2020 guidelines. Inclusion criteria focused on studies reporting immunosuppressive regimens, dosages, and infection prophylaxis in VCA surgery. Non-VCA, animal, feasibility studies, and non-English publications were excluded.</p><p><strong>Results: </strong>Of 1,150 screened articles, 42 met inclusion criteria. Upper extremity and facial VCAs represented 50% and 29% of cases, respectively, with traumatic amputation as the primary indication (37%). Antithymocyte globulin was the most common induction drug, while tacrolimus, mycophenolate mofetil, and steroids were predominant for maintenance therapy in 33% and 11% of cases, respectively. Infection prophylaxis was used in 31% of cases. Drug dosages varied widely, and no standardized immunosuppressive protocols were identified.</p><p><strong>Conclusion: </strong>Current immunosuppressive strategies in VCA lack standardization, leading to variability in outcomes and increased risks. Infection prophylaxis remains underutilized despite recipient vulnerability. There is a critical need for standardized and tailored guidelines to optimize immunosuppressive therapy and infection control, ensuring graft survival and improved patient outcomes.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1714886"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12756177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902139","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":"Importing pancreata for transplantation: a single-center experience across evolving allocation eras.","authors":"Riccardo Tamburrini, Stacey Hidalgo, Glen Leverson, Dixon B Kaufman, Nikole A Neidlinger, David P Al-Adra, David D Aufhauser, Carrie Thiessen, Didier Mandelbrot, Sandesh Parajuli, Jon S Odorico","doi":"10.3389/frtra.2025.1698617","DOIUrl":"10.3389/frtra.2025.1698617","url":null,"abstract":"<p><p>Recent changes to allocation systems have increased the geographic distribution of pancreas offers, often originating from outside a transplant center's donor service area or region. The impact of this wider sharing on outcomes remains uncertain. This study analyzed outcomes of primary pancreas transplants (2000-2018) at a large transplant center, stratified retrospectively on the nautical miles distance from the donor hospital. Primary endpoints were death-censored graft survival (DC-GS), patient survival, and graft thrombosis at different time points. No significant differences were found in DC-GS or patient survival for recipients of simultaneous pancreas-kidney (SPK), pancreas after kidney (PAK), or pancreas transplant alone (PTA), regardless of the distance from the donor hospital to the transplant center. Thrombosis rates were comparable across groups. Imported pancreata were from younger donors with lower BMI compared to locally recovered grafts. These findings support the notion that importing pancreata for transplantation is a feasible and safe practice that benefits patients, increases organ utilization, while benefiting transplant center volume data and reducing waiting times for patients. Encouraging wider importation may reduce waiting times and improve access to pancreas transplantation.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1698617"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12756387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902178","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":"A study on the distribution of BK and JC polyomavirus in discarded donor kidneys.","authors":"Wouter T Moest, Aiko P J de Vries, Reshma A Lalai, Hans J Baelde, Jesper Kers, Els Wessels, Jason B Doppenberg, Marten A Engelse, Mariet C W Feltkamp, Joris I Rotmans","doi":"10.3389/frtra.2025.1727407","DOIUrl":"10.3389/frtra.2025.1727407","url":null,"abstract":"<p><strong>Introduction: </strong>BK polyomavirus (BKPyV) and JC polyomavirus (JCPyV) are thought to establish persistent, low-grade infections in the kidney. However, their specific intrarenal reservoirs remain unclear. To explore their localization and potential presence prior to transplantation, we analyzed different kidney regions from deceased donors.</p><p><strong>Method: </strong>Donor kidneys discarded for donation and subsequently designated for research purposes between November 2023 and October 2024 were included. For each kidney, cortex, medulla, pelvis, and ureter were sampled. These samples were analyzed using qPCR for the presence of JCPyV and BKPyV.</p><p><strong>Results: </strong>In total, 10 kidneys were analyzed with a total 72 samples taken from the cortex: <i>n</i> = 22, medulla: <i>n</i> = 22, renal pelvis: <i>n</i> = 14, and ureter: <i>n</i> = 14. All samples tested negative for BKPyV. JCPyV DNA was detected in 4 out of 10 kidneys. When analyzed by tissue type, positive samples were found in 6/22(27.3%) cortex, 6/22(27.3%) medulla, 4/14(28.6%) renal pelvis, and 4/14(28.6%) ureter samples. The cycle threshold (Ct) values did not show significant differences among the various regions within the kidney. Notably, JCPyV distribution within individual kidneys was markedly heterogeneous, with substantial variation in Ct-values within the same kidney.</p><p><strong>Conclusion: </strong>JCPyV DNA was detected in 40% of kidneys from deceased donors, with comparable detection rates across cortex, medulla, pelvis, and ureter, suggesting no clear tissue preference. However, within individual kidneys, the distribution and Ct-values varied considerably. BKPyV DNA was not detected in any sample. These findings support the hypothesis that JCPyV may be present prior to transplantation and potentially donor-derived. The potential role of JCPyV in kidney transplant recipients and its relationship with BKPyV warrant further investigation.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1727407"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12738908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852178","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}