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The use of digital health interventions to deliver prehabilitation in solid organ transplant recipients: are we there yet? 利用数字健康干预为实体器官移植受者提供预康复服务:我们做到了吗?
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-10-01 Epub Date: 2024-07-18 DOI: 10.1097/MOT.0000000000001164
Juliet Briggs, Joseph Chilcot, Sharlene A Greenwood

Purpose of review: Prehabilitation, defined as preparing the body physically and psychologically for upcoming surgery is of increasing prominence in presurgical care. The aim of this review is to discuss the evidence base around prehabilitation in solid organ transplantation, the use of digital health as a tool to deliver these interventions, and consider future directions.

Recent findings: Prehabilitation is of increasing interest as an adjunct to pretransplant care for individuals working up for solid organ transplantation. To date, research has shown that prehabilitation is acceptable and feasible; however, the literature base remains small. The majority of research has been delivered using in-person rehabilitation programmes, and the evidence base utilizing digital health as a means to deliver prehabilitation is limited.

Summary: To date, the research evidence base in prehabilitation for solid organ transplantation is limited. Evidence in other surgical populations has demonstrated promising results, particularly in aerobic capacity, physical function and postoperative complications. Further high-quality randomized controlled clinical trials are required to strengthen the evidence base, understand how digital health can be harnessed and utilized to deliver multimodal prehabilitation with an aim to see how this may form part of routine care in the solid organ transplantation pathway.

审查目的:术前康复是指在身体和心理上为即将到来的手术做好准备,在术前护理中的地位日益突出。本综述旨在讨论有关实体器官移植术前康复的证据基础、将数字医疗作为提供这些干预措施的工具的使用情况,并考虑未来的发展方向:康复前护理作为对准备接受实体器官移植的患者进行移植前护理的辅助手段,越来越受到人们的关注。迄今为止,研究表明预康复是可以接受的,也是可行的;但是,文献基础仍然很少。大多数研究都是通过现场康复计划进行的,而利用数字健康作为提供预康复的一种手段的证据基础还很有限。在其他手术人群中的证据显示了良好的效果,尤其是在有氧运动能力、身体功能和术后并发症方面。需要进一步开展高质量的随机对照临床试验,以加强证据基础,了解如何利用数字健康技术提供多模式术前康复,从而了解如何将其作为实体器官移植途径中常规护理的一部分。
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引用次数: 0
Unraveling the spectrum of airway complications following lung transplantation: a comprehensive overview. 解读肺移植术后气道并发症:全面概述。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-10-01 Epub Date: 2024-08-21 DOI: 10.1097/MOT.0000000000001162
Zehra Dhanani, Rachel Criner, Gerard J Criner

Purpose of review: This review delves into the intricate landscape of airway complications post lung transplantation. With the rising prevalence of end-stage lung disease and the increasing number of lung transplantation worldwide, understanding and effectively managing airway complications are crucial. Given the nuanced nature of these complications and the array of treatment options available, this review aims to provide a comprehensive overview of how to identify, classify, mitigate risk factors for, and manage these complications.

Recent findings: Several donor, recipient, and surgical risk factors are associated with the increased risk of airway complications. In managing these complications, bronchoscopic interventions, notably balloon dilation and stenting, are pivotal. Although self-expanding metallic stents offer versatility, silicone stents are preferred in certain scenarios for their durability. Emerging techniques such as biodegradable stents and advancing imaging modalities show promise in mitigating complications and improving outcomes.

Summary: These findings underscore the significance of a multidisciplinary approach and personalized treatment algorithms in managing airway complications post lung transplantation. By elucidating specific indications and complications of treatment modalities, this review serves as a valuable resource for optimally managing airway complications. Ongoing research into novel interventions holds promise for further enhancing outcomes in this challenging clinical setting.

综述的目的:这篇综述深入探讨了肺移植术后气道并发症的复杂情况。随着终末期肺病发病率的上升和全球肺移植数量的增加,了解并有效控制气道并发症至关重要。鉴于这些并发症的细微差别和一系列可用的治疗方案,本综述旨在全面概述如何识别、分类、减轻风险因素和管理这些并发症:一些供体、受体和手术风险因素与气道并发症风险的增加有关。在处理这些并发症时,支气管镜介入治疗,特别是球囊扩张和支架植入术至关重要。虽然自膨胀金属支架具有多功能性,但在某些情况下,硅胶支架因其耐用性而成为首选。生物可降解支架和先进的成像模式等新兴技术有望减轻并发症并改善预后。总结:这些研究结果强调了多学科方法和个性化治疗算法在控制肺移植术后气道并发症方面的重要性。本综述阐明了各种治疗方法的具体适应症和并发症,是优化气道并发症管理的宝贵资源。对新型干预措施的持续研究有望进一步提高这一具有挑战性的临床环境的治疗效果。
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引用次数: 0
Progress towards permanent respiratory support. 在实现永久性呼吸支持方面取得进展。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-10-01 Epub Date: 2024-07-10 DOI: 10.1097/MOT.0000000000001163
Suji Shin, Umar Nasim, Hassana O'Connor, Yeahwa Hong

Purpose of review: Although lung transplantation stands as the gold standard curative therapy option for end-stage lung disease, the scarcity of available organs poses a significant challenge in meeting the escalating demand. This review provides an overview of recent advancements in ambulatory respiratory assist systems, selective anticoagulation therapies that target the intrinsic pathway, and innovative surface coatings to enable permanent respiratory support as a viable alternative to lung transplantation.

Recent findings: Several emerging ambulatory respiratory assist systems have shown promise in both preclinical and clinical trials. These systems aim to create more biocompatible, compact, and portable forms of extracorporeal membrane oxygenation that can provide long-term respiratory support. Additionally, innovative selective anticoagulation strategies, currently in various stages of preclinical or clinical development, present a promising alternative to currently utilized nonselective anticoagulants. Moreover, novel surface coatings hold the potential to locally prevent artificial surface-induced thrombosis and minimize bleeding risks.

Summary: This review of recent advancements toward permanent respiratory support summarizes the development of ambulatory respiratory assist systems, selective anticoagulation therapies, and novel surface coatings. The integration of these evolving device technologies with targeted anticoagulation strategies may allow a safe and effective mode of permanent respiratory support for patients with chronic lung disease.

回顾的目的:尽管肺移植是治疗终末期肺病的金标准疗法,但可用器官的稀缺给满足不断增长的需求带来了巨大挑战。本综述概述了非卧床呼吸辅助系统、针对内在通路的选择性抗凝疗法和创新性表面涂层的最新进展,以实现永久性呼吸支持,作为肺移植的可行替代方案:一些新兴的流动呼吸辅助系统已在临床前和临床试验中显示出前景。这些系统旨在创造生物相容性更好、结构更紧凑、更便携的体外膜氧合形式,以提供长期呼吸支持。此外,创新的选择性抗凝策略目前正处于不同的临床前或临床开发阶段,有望替代目前使用的非选择性抗凝剂。此外,新型表面涂层有可能在局部预防人工表面诱发的血栓形成,并将出血风险降至最低。摘要:本文回顾了永久性呼吸支持的最新进展,总结了非卧床呼吸辅助系统、选择性抗凝疗法和新型表面涂层的发展情况。将这些不断发展的设备技术与有针对性的抗凝策略相结合,可为慢性肺病患者提供一种安全有效的永久性呼吸支持模式。
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引用次数: 0
Mechanical circulatory support devices in adults with congenital heart disease. 先天性心脏病成人的机械循环支持装置。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-10-01 Epub Date: 2024-08-05 DOI: 10.1097/MOT.0000000000001165
Deen L Garba, Susan Joseph, Ari Cedars

Purpose of review: Mechanical circulatory support is used frequently as a method of stabilizing patients with end stage heart failure who are unable to safely await allograft availability. While this technology has been fundamentally important in supporting patients with normal cardiac anatomy, it is still used infrequently in adult patients with congenital heart disease and end-stage heart failure. Here, we review the data on mechanical circulatory support technology in this small but growing population of patients with chronic heart disease prone to the development of circulatory failure.

Recent findings: Mechanical circulatory support (MCS) has been increasingly employed in adults with congenital heart disease (ACHD) as a bridge to transplant. The new United Network for Organ Sharing listing system favoring temporary MCS use with a higher listing status offers another tool to stabilize ACHD patients and potentially shorten wait times. Both temporary and Durable MCS could help improve transplant candidacy and posttransplant outcomes in select groups of ACHD patients.

Summary: Durable and temporary MCS have the potential to significantly improve access to transplant and overall transplant outcomes in ACHD patients.

审查目的:机械循环支持是稳定无法安全等待异体移植的终末期心衰患者的常用方法。虽然这项技术在支持心脏解剖正常的患者方面具有根本性的重要意义,但在患有先天性心脏病和终末期心力衰竭的成年患者中仍很少使用。在此,我们回顾了机械循环支持技术在这一人数较少但不断增加的易发生循环衰竭的慢性心脏病患者群体中的应用数据:机械循环支持(MCS)已越来越多地应用于先天性心脏病(ACHD)成人患者,作为通往移植的桥梁。新的器官共享联合网络列名系统倾向于使用临时性机械循环支持,并给予较高的列名地位,这为稳定先天性心脏病患者提供了另一种工具,并有可能缩短等待时间。摘要:持久性和临时性MCS有可能显著改善ACHD患者的移植机会和整体移植效果。
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引用次数: 0
Future directions for xenotransplantation in lungs. 肺部异种移植的未来方向。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-10-01 Epub Date: 2024-07-11 DOI: 10.1097/MOT.0000000000001161
Hidetaka Hara, Hisashi Sahara, Toyofumi Fengshi Chen-Yoshikawa

Purpose of review: Advancements in preclinical xenotransplant studies have opened doors for clinical heart and kidney xenotransplantation. This review assesses recent progress in lung xenotransplantation research and its potential clinical implications.

Recent findings: The efficacy of the humanized von Willebrand factor in reducing platelet sequestration in ex-vivo and in-vivo lung xenotransplant models was showcased. Combining human tissue factor pathway inhibitor and CD47 expression with selectin and integrin inhibition delayed neutrophil and platelet sequestration. Enhanced expression of human complement regulatory proteins and thrombomodulin in genetically engineered pig lungs improved graft survival by reducing platelet activation and modulating coagulation disruptions. Knocking out the CMAH gene decreased antibody-mediated inflammation and coagulation activation, enhancing compatibility for human transplantation. Furthermore, CMAH gene knockout in pigs attenuated sialoadhesin-dependent binding of human erythrocytes to porcine macrophages, mitigating erythrocyte sequestration and anemia. Meanwhile, in-vivo experiments demonstrated extended survival of xenografts for up to 31 days with multiple genetic modifications and comprehensive treatment strategies.

Summary: Experiments have uncovered vital insights for successful xenotransplantation, driving further research into immunosuppressive therapy and genetically modified pigs. This will ultimately pave the way for clinical trials designed to improve outcomes for patients with end-stage lung disease.

综述目的:临床前异种移植研究的进展为临床心脏和肾脏异种移植打开了大门。本综述评估了肺异种移植研究的最新进展及其潜在的临床意义:展示了人源化von Willebrand因子在体内外肺异种移植模型中减少血小板螯合的功效。将人组织因子通路抑制剂和 CD47 表达与选择素和整合素抑制相结合,可延缓中性粒细胞和血小板螯合。在基因工程猪肺中增强人类补体调节蛋白和血栓调节蛋白的表达,通过减少血小板活化和调节凝血紊乱提高移植物存活率。敲除 CMAH 基因可减少抗体介导的炎症和凝血活化,提高人体移植的兼容性。此外,在猪体内敲除 CMAH 基因可减轻人红细胞与猪巨噬细胞的依赖性结合,从而减轻红细胞螯合和贫血。同时,体内实验表明,通过多种基因修饰和综合治疗策略,异种移植物的存活期可延长至 31 天。摘要:实验揭示了成功进行异种移植的重要见解,推动了对免疫抑制疗法和转基因猪的进一步研究。这最终将为旨在改善终末期肺病患者预后的临床试验铺平道路。
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引用次数: 0
The perspective for next-generation lung replacement therapies: functional whole lung generation by blastocyst complementation. 下一代肺替代疗法的前景:通过囊胚补体生成功能性全肺。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-10-01 Epub Date: 2024-07-30 DOI: 10.1097/MOT.0000000000001169
Dai Shimizu, Akihiro Miura, Munemasa Mori

Purpose of review: Blastocyst complementation represents a promising frontier in next-generation lung replacement therapies. This review aims to elucidate the future prospects of lung blastocyst complementation within clinical settings, summarizing the latest studies on generating functional lungs through this technique. It also explores and discusses host animal selection relevant to interspecific chimera formation, a challenge integral to creating functional human lungs via blastocyst complementation.

Recent findings: Various gene mutations have been utilized to create vacant lung niches, enhancing the efficacy of donor cell contribution to the complemented lungs in rodent models. By controlling the lineage to induce gene mutations, chimerism in both the lung epithelium and mesenchyme has been improved. Interspecific blastocyst complementation underscores the complexity of developmental programs across species, with several genes identified that enhance chimera formation between humans and other mammals.

Summary: While functional lungs have been generated via intraspecies blastocyst complementation, the generation of functional interspecific lungs remains unrealized. Addressing the challenges of controlling the host lung niche and selecting host animals relevant to interspecific barriers between donor human and host cells is critical to enabling the generation of functional humanized or entire human lungs in large animals.

综述目的:囊胚补体是下一代肺替代疗法中前景广阔的前沿领域。本综述旨在阐明肺囊胚补体在临床环境中的未来前景,总结通过该技术生成功能性肺的最新研究。它还探讨和讨论了与种间嵌合体形成相关的宿主动物选择,这是通过囊胚补体产生功能性人肺时不可或缺的一项挑战:最近的研究结果:利用各种基因突变来创建空置的肺龛,从而提高供体细胞对啮齿动物模型互补肺的贡献效率。通过控制细胞系诱导基因突变,肺上皮细胞和间质细胞的嵌合能力都得到了提高。种间囊胚互补凸显了物种间发育程序的复杂性,已发现多个基因可增强人类与其他哺乳动物之间嵌合体的形成。摘要:虽然功能性肺已通过种内囊胚互补产生,但功能性种间肺的产生仍未实现。解决控制宿主肺生态位和选择与供体人类和宿主细胞间种间障碍相关的宿主动物的难题,对于在大型动物中生成功能性人化肺或整个人类肺至关重要。
{"title":"The perspective for next-generation lung replacement therapies: functional whole lung generation by blastocyst complementation.","authors":"Dai Shimizu, Akihiro Miura, Munemasa Mori","doi":"10.1097/MOT.0000000000001169","DOIUrl":"10.1097/MOT.0000000000001169","url":null,"abstract":"<p><strong>Purpose of review: </strong>Blastocyst complementation represents a promising frontier in next-generation lung replacement therapies. This review aims to elucidate the future prospects of lung blastocyst complementation within clinical settings, summarizing the latest studies on generating functional lungs through this technique. It also explores and discusses host animal selection relevant to interspecific chimera formation, a challenge integral to creating functional human lungs via blastocyst complementation.</p><p><strong>Recent findings: </strong>Various gene mutations have been utilized to create vacant lung niches, enhancing the efficacy of donor cell contribution to the complemented lungs in rodent models. By controlling the lineage to induce gene mutations, chimerism in both the lung epithelium and mesenchyme has been improved. Interspecific blastocyst complementation underscores the complexity of developmental programs across species, with several genes identified that enhance chimera formation between humans and other mammals.</p><p><strong>Summary: </strong>While functional lungs have been generated via intraspecies blastocyst complementation, the generation of functional interspecific lungs remains unrealized. Addressing the challenges of controlling the host lung niche and selecting host animals relevant to interspecific barriers between donor human and host cells is critical to enabling the generation of functional humanized or entire human lungs in large animals.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Integrating risks and benefits: pretransplant assessment and patient selection for heart transplantation in adult congenital heart disease. 整合风险与收益:成人先天性心脏病患者心脏移植前评估与患者选择。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1097/MOT.0000000000001170
Matthew J Lewis, Kelly H Schlendorf, Leigh C Reardon

Purpose of review: The number of adult congenital heart disease (ACHD) patients presenting for consideration of heart transplantation continues to grow. Comprehensive pretransplant assessment and thoughtful patient selection are of critical importance to mitigate perioperative and posttransplant morbidity and mortality in this population.

Recent findings: There is increasing evidence that patient outcomes after the onset of heart failure in the ACHD population are poor while overall transplant outcomes for ACHD patients have improved over time. Delineation of factors associated with better versus worse posttransplant outcomes is an area of ongoing research. Several studies have found that delayed patient referral, anatomic complexity and the presence of noncardiac organ dysfunction may increase peri-transplant and posttransplant risk.

Summary: Pretransplant assessment and patient selection in ACHD patients should focus on mitigating perioperative and early posttransplant risk. Anatomic complexity, noncardiac organ dysfunction, and referral timing after the onset of heart failure can contribute to poor posttransplant outcomes and should inform patient selection.

审查目的:考虑进行心脏移植的成人先天性心脏病(ACHD)患者人数持续增长。全面的移植前评估和深思熟虑的患者选择对于降低这一人群的围手术期和移植后发病率及死亡率至关重要:越来越多的证据表明,ACHD 患者在心力衰竭发生后的预后较差,而随着时间的推移,ACHD 患者的总体移植预后有所改善。目前正在研究与移植后预后好坏相关的因素。一些研究发现,患者转诊延迟、解剖结构复杂以及存在非心脏器官功能障碍可能会增加移植围手术期和移植后的风险。摘要:ACHD 患者的移植前评估和患者选择应侧重于降低围手术期和早期移植后的风险。解剖复杂性、非心脏器官功能障碍和心力衰竭发生后的转诊时机可能会导致移植后不良预后,因此在选择患者时应加以考虑。
{"title":"Integrating risks and benefits: pretransplant assessment and patient selection for heart transplantation in adult congenital heart disease.","authors":"Matthew J Lewis, Kelly H Schlendorf, Leigh C Reardon","doi":"10.1097/MOT.0000000000001170","DOIUrl":"10.1097/MOT.0000000000001170","url":null,"abstract":"<p><strong>Purpose of review: </strong>The number of adult congenital heart disease (ACHD) patients presenting for consideration of heart transplantation continues to grow. Comprehensive pretransplant assessment and thoughtful patient selection are of critical importance to mitigate perioperative and posttransplant morbidity and mortality in this population.</p><p><strong>Recent findings: </strong>There is increasing evidence that patient outcomes after the onset of heart failure in the ACHD population are poor while overall transplant outcomes for ACHD patients have improved over time. Delineation of factors associated with better versus worse posttransplant outcomes is an area of ongoing research. Several studies have found that delayed patient referral, anatomic complexity and the presence of noncardiac organ dysfunction may increase peri-transplant and posttransplant risk.</p><p><strong>Summary: </strong>Pretransplant assessment and patient selection in ACHD patients should focus on mitigating perioperative and early posttransplant risk. Anatomic complexity, noncardiac organ dysfunction, and referral timing after the onset of heart failure can contribute to poor posttransplant outcomes and should inform patient selection.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ethical issues in organ procurement: donation after normothermic regional perfusion in liver transplantation. 器官获取中的伦理问题:肝脏移植中常温区域灌注后的捐赠。
IF 2.2 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-09-20 DOI: 10.1097/mot.0000000000001174
Brian M Nguyen
PURPOSE OF REVIEWWith ongoing organ shortages, new perfusion technologies are being embraced to help fill the unmet requirement. Improvement in utilization of donation after cardiac death (DCD) donors has the potential to greatly expand the pool of usable liver allografts. Normothermic regional perfusion (NRP) has been shown to increase usage of DCD donors and improve recipient outcomes. Yet, there remains heterogeneity in its usage worldwide.RECENT FINDINGSResults from the first US multicenter study show improved biliary outcomes with NRP, consistent with prior data from Europe. Internationally, there are wide variations in DCD and NRP usage, highlighting the opportunities for improvement and increased utilization. The ethics of this technique continue to be considered.SUMMARYNRP is a sound technique that can improve utilization for DCD donors, thereby increasing organ supply. Its usage is increasing worldwide. New data continue to show the benefit of this procurement strategy. NRP agrees with the principles of ethics.
综述目的随着器官短缺问题的持续存在,新的灌注技术正在被广泛应用,以帮助满足未得到满足的需求。提高心脏死亡后捐献(DCD)供体的利用率有可能大大增加可用肝脏同种异体移植的数量。常温区域灌注(NRP)已被证明能提高心脏死亡后捐献者的利用率并改善受者的预后。美国第一项多中心研究结果显示,NRP可改善胆道预后,这与欧洲之前的数据一致。在全球范围内,DCD 和 NRP 的使用情况差异很大,这凸显了改进和提高使用率的机会。总结NRP是一项完善的技术,可以提高DCD捐献者的利用率,从而增加器官供应。其使用率在全球范围内不断增加。新的数据不断显示出这种获取策略的益处。NRP 符合伦理原则。
{"title":"Ethical issues in organ procurement: donation after normothermic regional perfusion in liver transplantation.","authors":"Brian M Nguyen","doi":"10.1097/mot.0000000000001174","DOIUrl":"https://doi.org/10.1097/mot.0000000000001174","url":null,"abstract":"PURPOSE OF REVIEWWith ongoing organ shortages, new perfusion technologies are being embraced to help fill the unmet requirement. Improvement in utilization of donation after cardiac death (DCD) donors has the potential to greatly expand the pool of usable liver allografts. Normothermic regional perfusion (NRP) has been shown to increase usage of DCD donors and improve recipient outcomes. Yet, there remains heterogeneity in its usage worldwide.RECENT FINDINGSResults from the first US multicenter study show improved biliary outcomes with NRP, consistent with prior data from Europe. Internationally, there are wide variations in DCD and NRP usage, highlighting the opportunities for improvement and increased utilization. The ethics of this technique continue to be considered.SUMMARYNRP is a sound technique that can improve utilization for DCD donors, thereby increasing organ supply. Its usage is increasing worldwide. New data continue to show the benefit of this procurement strategy. NRP agrees with the principles of ethics.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Physical exercise, the immune system and infection risk: implications for prehabilitation and rehabilitation for solid organ transplantation candidates and recipients. 体育锻炼、免疫系统和感染风险:对实体器官移植候选者和接受者的预康复和康复的影响。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2024-06-07 DOI: 10.1097/MOT.0000000000001156
Nicolette C Bishop

Purpose of review: Solid organ transplantation recipients have an increased risk of infection, exacerbated by immunosuppressant medications that need to finely balance suppression of the immune system to prevent allograft rejection while avoiding over-suppression leading to infections and malignancy. Exercise modulates immune functions, with moderate-intensity activities particularly associated with enhanced antiviral immunity and reduced infection incidence. However, investigations of the effects of exercise and physical activity on immune function and infection risk posttransplantation are scarce. This review highlights areas where the relationship between exercise, immune function and infection risk has greatest potential for benefit for solid organ transplantation and therefore greatest need for investigation.

Recent findings: Moderate and higher intensity exercise do not appear to cause adverse immunological effects in kidney transplantation recipients, although evidence from other organ transplantation is lacking. Evidence from healthy younger and older adults suggests that regular exercise can reduce risk of respiratory infections and latent herpesvirus reactivation and improves antibody responses to vaccination, which is of great importance for organ transplantation recipients.

Summary: There is a strong need for research to investigate the role of exercise on immune function and infection risk in solid organ transplantation to improve both allograft survival and long-term health of the recipient.

审查目的:实体器官移植受者感染的风险增加,而免疫抑制剂药物需要在抑制免疫系统以防止异体移植排斥反应之间取得微妙的平衡,同时避免过度抑制导致感染和恶性肿瘤,这加剧了感染的风险。运动可调节免疫功能,中等强度的运动尤其与增强抗病毒免疫力和降低感染发病率有关。然而,有关运动和体力活动对移植后免疫功能和感染风险影响的研究还很少。本综述强调了运动、免疫功能和感染风险之间的关系对实体器官移植的最大潜在益处,因此也是最需要调查的领域:中等强度和较高强度的运动似乎不会对肾移植受者的免疫系统造成不良影响,但缺乏其他器官移植的证据。来自健康的年轻人和老年人的证据表明,经常锻炼可以降低呼吸道感染和潜伏疱疹病毒再激活的风险,并提高疫苗接种的抗体反应,这对器官移植受者非常重要。小结:亟需研究锻炼对实体器官移植中免疫功能和感染风险的作用,以提高异体移植物的存活率和受者的长期健康。
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引用次数: 0
Better liver transplant outcomes by donor interventions? 通过捐献者干预改善肝移植效果?
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2024-05-24 DOI: 10.1097/MOT.0000000000001153
Amelia J Hessheimer, Eva Flores, Jordi Vengohechea, Constantino Fondevila

Purpose of review: Donor risk factors and events surrounding donation impact the quantity and quality of grafts generated to meet liver transplant waitlist demands. Donor interventions represent an opportunity to mitigate injury and risk factors within donors themselves. The purpose of this review is to describe issues to address among donation after brain death, donation after circulatory determination of death, and living donors directly, for the sake of optimizing relevant outcomes among donors and recipients.

Recent findings: Studies on donor management practices and high-level evidence supporting specific interventions are scarce. Nonetheless, for donation after brain death (DBD), critical care principles are employed to correct cardiocirculatory compromise, impaired tissue oxygenation and perfusion, and neurohormonal deficits. As well, certain treatments as well as marginally prolonging duration of brain death among otherwise stable donors may help improve posttransplant outcomes. In donation after circulatory determination of death (DCD), interventions are performed to limit warm ischemia and reverse its adverse effects. Finally, dietary and exercise programs have improved donation outcomes for both standard as well as overweight living donor (LD) candidates, while minimally invasive surgical techniques may offer improved outcomes among LD themselves.

Summary: Donor interventions represent means to improve liver transplant yield and outcomes of liver donors and grafts.

审查目的:捐献者的风险因素和与捐献有关的事件会影响为满足肝移植等待者需求而产生的移植物的数量和质量。捐献者干预是减轻捐献者自身损伤和风险因素的机会。本综述旨在描述脑死亡后捐献、循环系统确定死亡后捐献以及直接活体捐献者之间需要解决的问题,以优化捐献者和受者的相关结果:有关捐献者管理实践的研究和支持具体干预措施的高级证据很少。然而,对于脑死亡(DBD)后的捐献,重症监护原则被用来纠正心循环系统受损、组织氧合和灌注受损以及神经元缺陷。此外,对病情稳定的捐献者进行某些治疗并稍微延长脑死亡持续时间,可能有助于改善移植后的预后。在循环系统确定死亡(DCD)后的捐献中,要进行干预以限制温缺血并扭转其不良影响。最后,饮食和运动计划改善了标准和超重活体供体(LD)候选者的捐献结果,而微创手术技术可能会改善LD本身的结果。
{"title":"Better liver transplant outcomes by donor interventions?","authors":"Amelia J Hessheimer, Eva Flores, Jordi Vengohechea, Constantino Fondevila","doi":"10.1097/MOT.0000000000001153","DOIUrl":"10.1097/MOT.0000000000001153","url":null,"abstract":"<p><strong>Purpose of review: </strong>Donor risk factors and events surrounding donation impact the quantity and quality of grafts generated to meet liver transplant waitlist demands. Donor interventions represent an opportunity to mitigate injury and risk factors within donors themselves. The purpose of this review is to describe issues to address among donation after brain death, donation after circulatory determination of death, and living donors directly, for the sake of optimizing relevant outcomes among donors and recipients.</p><p><strong>Recent findings: </strong>Studies on donor management practices and high-level evidence supporting specific interventions are scarce. Nonetheless, for donation after brain death (DBD), critical care principles are employed to correct cardiocirculatory compromise, impaired tissue oxygenation and perfusion, and neurohormonal deficits. As well, certain treatments as well as marginally prolonging duration of brain death among otherwise stable donors may help improve posttransplant outcomes. In donation after circulatory determination of death (DCD), interventions are performed to limit warm ischemia and reverse its adverse effects. Finally, dietary and exercise programs have improved donation outcomes for both standard as well as overweight living donor (LD) candidates, while minimally invasive surgical techniques may offer improved outcomes among LD themselves.</p><p><strong>Summary: </strong>Donor interventions represent means to improve liver transplant yield and outcomes of liver donors and grafts.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Current Opinion in Organ Transplantation
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