Clinical Transplantation最新文献

Many patients with heart failure (HF) progress to an advanced stage, characterized by persistent symptoms despite maximal therapy. Heart transplantation (HT) remains the most effective treatment option for improving the survival of patients with advanced HF. This is true even with advancements in medical therapy for HF and the development of mechanical circulatory support systems. Over the past few decades, HT has undergone significant evolution, leading to greatly improved success rates. However, HT recipients face the risk of several potential complications that can negatively impact their outcomes. In this article, we aim to provide a practical framework for clinicians involved in heart transplant medicine. Additionally, we offer an update on a recent and relatively unknown complication of HT: eosinophilic myocarditis (EM).

Chronic graft-versus-host disease (cGVHD) is a complex, immune-mediated, multisystem disease with a high symptom burden. While treatment with systemic corticosteroids is first-line, approximately 70% of patients require additional treatments because of either inadequate efficacy or steroid toxicity, highlighting the need for effective steroid-sparing therapies. Belumosudil, an oral ROCK2 inhibitor, has been studied in trials and real-world cohorts with varying results. We set out to systematically evaluate and meta-analyze the efficacy and safety of belumosudil in cGVHD. We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library databases for relevant studies published up until August 2025. Eligibility criteria were predefined to identify relevant studies assessing belumosudil for cGVHD. Quality assessment of included studies was assessed using the MINORS tool. Meta-analysis was conducted using Comprehensive Meta-Analysis (v.3), adopting an inverse variance random effect model. Systematic literature search yielded inclusion of eleven studies (total participants = 477 patients). At 12 months, the pooled overall response rate (ORR) was 73% (95% CI 64–81) and 58% of patients showed a reduction in corticosteroid use with 95% CI (46%–70%), with improvement in patient-reported quality of life assessed by the Lee Symptom Scale. In a meta-regression analysis, higher baseline cGVHD severity independently predicted corticosteroid tapering success (β = 0.027; OR = 1.03; p = 0.031). Overall survival was 87% (95% CI 82–91) at 12 months and 85% (95% CI 79–90) at 24 months; failure-free survival at 12 months was 65% (95% CI 52–75). Regarding safety of belumosudil, any-grade adverse events occurred in 98% (95% CI 95–99), serious adverse events in 38.9% (95% CI 32.6–45.6); common events were diarrhea 22.1%, headache 22.3%, and fatigue 20.5%. Belumosudil exhibits significant clinical efficacy in cGVHD refractory or dependent on steroids, evidenced by a high objective response rate at 12 months, substantial steroid-sparing benefits, durable survival, and amelioration of disease-associated symptoms.

The gold standard approach to the diagnosis of rejection in kidney transplant recipients currently relies on tissue obtained during biopsies. However, repeat performance of biopsies is cumbersome, and use of dd-cfDNA in conjunction with eGFR may help inform whether ongoing rejection may be persistent after a diagnosis of rejection is made by biopsy and anti-rejection treatment administered. In this single-center prospective study, 52 patients with rejection were followed longitudinally over time with quarterly dd-cfDNA measurements, of whom 78% had repeat biopsies to confirm the presence or absence of persistent rejection. With every 1 percentage point higher baseline (“first”) dd-cfDNA levels drawn at time of enrollment, the odds of persistent rejection were 1.35 (95% CI 1.18-1.55) higher. With every 1 percentage point increase in the slope of dd-cfDNA levels over time, the odds of persistent rejection were 1.62 times higher (95% CI 1.10-2.38). Models including only baseline and the slope of dd-cfDNA provided moderate risk discrimination for rejection (c = 0.73), which improved to c = 0.75 with the addition of eGFR at baseline and change in eGFR over time. Monitoring of dd-cfDNA may offer reasonable discrimination of the likelihood of persistent rejection following anti-rejection therapy. Further validation of these findings is needed.