Clinical Transplantation最新文献

Sarcopenia is a known predictor of morbidity and mortality after liver transplantation (LT); it has been assessed with computed tomography (CT) derived Psoas Area Index (PAI) and mean Hounsfield units (mHU). While literature is abundant regarding the adverse outcomes of liver transplant in sarcopenic patients, a paucity of data exists describing the change in psoas muscle area and density from pre- to post-liver transplant. One hundred and four adult liver transplant recipients had pre- and post-transplant CT scans analyzed with respect to PAI and mHU. Mean PAI pre-transplant was 7.94 and 6.99 cm²/m² post-transplant (12% loss). Mean mHU pre-transplant was 35.47 and 33.00 post-transplant (7% reduction). However, stratified by pre-transplant quartiles, PAI reduction was −15%, −12%, and −6% for the upper, mid-two, and lower quartiles, respectively (p value = 0.0028). The mHU stratification was −15%, −8%, and + 12% for the upper, mid-two, and lower quartiles, respectively (p value = 0.0004). No relationship was noted between PAI and mHU. PAI and mHU decreased following liver transplantation; however, the most pronounced decrease in muscle mass and density was in patients with the highest starting muscle mass and density. However, muscle mass (PAI) and composition (mHU) appear to be affected by multiple factors.

Organ transport remains a critical determinant of transplant success, with delays during transfer prolonging cold ischemia time (CIT) and increasing the risk of delayed graft function or organ discard. Uncrewed aerial vehicles (UAVs) have emerged as a potential means to enhance the speed, predictability, and resilience of transplant logistics. This scoping review synthesized global evidence from 2010 to 2025 across biomedical, engineering, and regulatory domains, mapping research within six key themes: time sensitivity and clinical evidence, integration with preservation and perfusion technologies, technological and infrastructural readiness, regulatory and ethical frameworks, economic and environmental feasibility, and public and professional preparedness. Case studies from North America, Europe, and Asia demonstrate that UAVs can safely deliver donor organs while maintaining temperature and structural stability, with successful clinical transplantation reported. Their current value lies primarily in short-range transfers where direct routing and rapid handover are feasible; however, advances in heavy-lift aircraft, autonomous traffic management, and connected perfusion systems may soon enable longer, more complex missions. Major barriers include restrictions on beyond-visual-line-of-sight (BVLOS) operation, payload and endurance limitations, uncertain liability frameworks, and incomplete hospital-side infrastructure. Future priorities include comparative clinical and economic trials, harmonized international standards, and certified medical air corridors integrated with national allocation systems. With appropriate regulation, interoperability, and clinical validation, drones could become a safe and sustainable extension of existing transplant networks—improving efficiency, equity, and ultimately, patient survival.

Cyclosporine A (CsA) is used as graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT). While polymorphisms in CYP3A4, CYP3A5, and ABCB1 genes influence CsA metabolism, their role in HSCT remains underexplored. We investigated the impact of these polymorphisms on CsA pharmacokinetics, early toxicity, and clinical outcomes in 86 leukemia patients undergoing HSCT (IR.TUMS.HORCSCT.REC.1402.07). CsA levels were monitored via radioimmunoassay, and genotyping for CYP3A4, CYP3A5, and ABCB1 polymorphisms was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Carriers of the rs2740574 (CYP3A4*1B, −392A>G) and the rs776746 (CYP3A5*3, 6986A>G) exhibited significantly higher mean trough concentrations compared to the wild-type genotypes (112.6 ± 52.1 versus 75.6 ± 31.0; p = 0.003, 126.1 ± 55.0 versus 89.5 ± 41.8; p < 0.001, respectively). No significant difference was observed for the rs1045642 variants. Both rs776746 and rs2740574 variants were associated with increased markers of nephrotoxicity and hepatotoxicity within 3 days post-HSCT. None of these polymorphisms showed significant associations with transplant outcomes. In conclusion, patients carrying rs776746 or rs2740574 achieved higher CsA trough levels and may require lower initial dosing. Future research should assess whether genotype-guided CsA dosing improves achieving therapeutic levels and reduces early toxicity or suboptimal immunosuppression post-HSCT.