Transplant immunology最新文献

{"title":"Corrigendum to \"Pre-transplant sensitization and its effect on heart transplant rejection and survival outcomes\"[Transplant Immunology 92 (2025) 102264].","authors":"Kyung-Hwa Shin, Soo Yong Lee, Min Ho Ju, Hyun-Ji Lee","doi":"10.1016/j.trim.2025.102320","DOIUrl":"https://doi.org/10.1016/j.trim.2025.102320","url":null,"abstract":"","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":" ","pages":"102320"},"PeriodicalIF":1.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422878","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}

{"title":"Targeting CD38 to reduce anti-HLA antibody levels: A new and effective option to be integrated into desensitization protocols?","authors":"Viola Chiavetta ,&nbsp;Martina Soldarini ,&nbsp;Anna Maria Cafro ,&nbsp;Paola Bertazzoni ,&nbsp;Giuliana Lando ,&nbsp;Giulia Di Maggio ,&nbsp;Tiziana Sole ,&nbsp;Maria Luisa Pioltelli ,&nbsp;Irene Cuppari ,&nbsp;Alessandro Corso ,&nbsp;Adela Sulejmani ,&nbsp;Roberto Cairoli ,&nbsp;Elisabetta Volpato ,&nbsp;Roberto Crocchiolo","doi":"10.1016/j.trim.2025.102323","DOIUrl":"10.1016/j.trim.2025.102323","url":null,"abstract":"<div><div>Desensitization protocols are employed in patients with antibody-mediated organ rejection or hematopoietic stem cell (HSC) transplant recipients from ´HLA-mismatched´ donors with donor-specific antibodies (DSA). However, these protocols sometimes have limitations in effectively reducing anti-HLA antibody levels and maintaining this reduction over time. As a result, there is an ongoing search for new, effective therapies to implement current protocols, involving anti-CD20, bortezomib, and plasma exchange. This case report explores the impact of daratumumab, a well-known anti-CD38 antibody used in the treatment of multiple myeloma, on a patient enrolled in a prospective observational study MyTH (“(My)eloma (T)herapy vs. Anti-(H)LA antibodies”). The patient has been treated since 2021 and follow-up data are presented here, showing a correlation between the kinetics of daratumumab administration and the MFI levels of an anti-HLA antibody against DR12 (baseline MFI of 3,890). These data support the role of anti-CD38 in reducing anti-HLA antibody synthesis.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102323"},"PeriodicalIF":1.4,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416961","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}

{"title":"Corrigendum to \"Natural killer cell KIR genotype and NKG2C phenotype in correlation to BKV infection following kidney transplantation\" [Transpl Immunol. Dec 2025;93;102303].","authors":"Shubo Tan, Xiaobin Lin, Xueqi Li, Jianhua Long, Yuan Luo, Yao Xiao, Jianjun Li","doi":"10.1016/j.trim.2025.102319","DOIUrl":"10.1016/j.trim.2025.102319","url":null,"abstract":"","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":" ","pages":"102319"},"PeriodicalIF":1.4,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402153","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}

{"title":"Subtype-specific progression of post-transplant lymphoproliferative disease (PTLD) in children: Implications for age-based surveillance and early intervention strategies","authors":"Sujie Wang ,&nbsp;Zhipeng Zong ,&nbsp;Li Li ,&nbsp;Yu Zeng ,&nbsp;Jianchen Fang","doi":"10.1016/j.trim.2025.102321","DOIUrl":"10.1016/j.trim.2025.102321","url":null,"abstract":"<div><div>Post-transplant lymphoproliferative disorder (PTLD) represents a major cause of mortality in pediatric liver transplant recipients. However, data on clinicopathological risk factors across its subtypes remain limited.</div><div>An analysis of 33 pediatric liver transplant recipients revealed significant differences in the time to onset among PTLD subtypes: monomorphic PTLD developed significantly later than non-destructive/polymorphic PTLD, with higher tacrolimus blood concentration at diagnosis in the latter, consistent with the immunosuppressive tapering protocols. Among monomorphic PTLD cases, patients with Burkitt lymphoma (BL-PTLD) had a younger transplant age and higher early tacrolimus blood concentration than those with diffuse large B-cell lymphoma (DLBCL-PTLD), indicating that younger transplant age and more intense immunosuppression may promote Burkitt lymphomagenesis. Notably, among monomorphic PTLD, patients transplanted at &lt;1 year showed a significantly prolonged interval from transplantation to diagnosis than those transplanted at 1–18 years. Universal EBV-encoded RNA (EBER) positivity confirmed Epstein-Barr virus (EBV) as a key pathogenic factor, while the blood EBV DNA load at diagnosis showed no significant differences across subtypes, suggesting it does not influence PTLD subclassification.</div><div>These findings suggest that the time interval from transplantation to PTLD, immunosuppression intensity, and age at liver transplantation play a more determinant role in PTLD subtype progression.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102321"},"PeriodicalIF":1.4,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410074","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}

{"title":"Clinical characteristics, risk factors, and treatment outcomes of tuberculosis in recipients of solid organ or hematopoietic stem cell transplantation","authors":"Fuyan Shu ,&nbsp;Ping Yuan ,&nbsp;Guohui Zhu ,&nbsp;Jiao Li ,&nbsp;Xiaoqin Xie ,&nbsp;Jian Sheng ,&nbsp;Qiuping Sun ,&nbsp;Mengyao Xiao ,&nbsp;Shenjie Tang ,&nbsp;Ming Yang","doi":"10.1016/j.trim.2025.102322","DOIUrl":"10.1016/j.trim.2025.102322","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) is one of the most severe complications following organ and tissue transplantation. Early detection and prompt initiation of anti-TB therapy are therefore essential to reduce mortality among transplant recipients.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted involving 42 transplant recipients who developed new-onset or recurrent TB following solid organ transplantation (SOT) or hematopoietic stem cell transplantation (HSCT) between January 1, 2017, and February 28, 2025. The objective of this study was to investigate the clinical characteristics and prognosis of TB, as well as risk factors associated with severe TB among SOT and HSCT recipients.</div></div><div><h3>Results</h3><div>Among the 42 transplant recipients included in this study, the median time from SOT or HSCT to the onset of new or recurrent TB was 24 months (interquartile range [IQR]: 0.5–180 months). The median time from the symptom onset to TB diagnosis was 26 days (IQR: 1–180 days). The clinical types of TB comprised secondary pulmonary TB (36 cases, 85.71 %), disseminated TB (14 cases, 33.33 %), hematogenous disseminated pulmonary TB (7 cases, 16.67 %), and extrapulmonary TB (19 cases, 45.24 %). Co-infections were detected in 17 TB patients (40.48 %). Severe TB accounted for 28.58 % of all cases. Hypoproteinemia (OR = 0.532, 95 % CI 0.302–0.937; <em>P</em> = 0.029), co-infections (OR = 44.00, 95 % CI 4.712–410.855; <em>P</em> = 0.001), and early post-transplant onset of TB (OR = 0.963, 95 % CI 0.930–0.988; <em>P</em> = 0.036) were identified as independent risk factors for severe TB. The overall treatment success rate for TB was 57.14 %. The 6-month and 12-month overall survival rates were 85.7 % and 78.6 %, respectively.</div></div><div><h3>Conclusion</h3><div>Our findings indicate that TB may occur at any time following SOT or HSCT, and often affects extrapulmonary sites. Severe TB is relatively common and frequently associated with co-infections, which contribute to increased mortality. Clinically, these results underscore the importance of regular TB screening of transplant recipients.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102322"},"PeriodicalIF":1.4,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416962","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}

{"title":"Identification of key predictors of acute GVHD in pediatric acute Leukemia using machine learning methods","authors":"İlknur Buçan Kırkbir ,&nbsp;Hacer Kobya Bulut","doi":"10.1016/j.trim.2025.102318","DOIUrl":"10.1016/j.trim.2025.102318","url":null,"abstract":"<div><h3>Backround</h3><div>Hematopoietic stem cell transplantation (HSCT) is a crucial treatment for leukemia. Allogeneic Hematopoietic cell transplantation (HCT), in which stem cells from a healthy donor are used, carries significant risks, including graft versus host disease (GVHD), a severe complication that leads to high morbidity and mortality. This study aimed to identify significant predictors of acute GVHD (aGVHD) in pediatric patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).</div></div><div><h3>Methods</h3><div>This retrospective study analyzed the predictors of aGVHD in pediatric patients using different machine learning methods: Random Forest (RF), Logistic Regression (LR), and Boruta. The dataset was obtained from the UCI machine learning open-source database, and after balancing the class distribution of the dependent variable aGVHD using the Synthetic Minority Oversampling Technique (SMOTE), a total of 124 pediatric patients, including demographic and clinical variables, were analyzed using the R open-source programming language.</div></div><div><h3>Results</h3><div>Significant differences were observed between the aGVHD and non-aGVHD groups in recipient age (<em>p</em> = 0.002), recipient weight (<em>p</em> = 0.02), donor age (<em>p</em> = 0.01), allele mismatch (<em>p</em> = 0.01), antigen mismatch (<em>p</em> = 0.01), and recipient CMV status (<em>p</em> = 0.04). Feature importance analyses using Random Forest (RF) and Boruta identified recipient age, weight, and donor age as the most influential predictors of aGVHD. Logistic Regression (LR) highlighted recipient Rh-positive status and donor blood group B as additional relevant factors, offering a complementary perspective. These findings may assist in risk assessment and the development of preventive strategies for aGVHD.</div></div><div><h3>Conclusion</h3><div>Machine learning methods effectively identified important predictors of aGVHD, demonstrating their potential to improve post-HCT care and preventive protocols. Our results underscore the complex aGVHD etiology, suggesting the involvement of various factors in its development. Further studies should focus on integrating these findings into the clinical practice to enhance patient outcomes.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102318"},"PeriodicalIF":1.4,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337707","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}

{"title":"Macrophage polarization in organ transplantation rejection and targeted therapeutic strategies","authors":"Changqing Qu ,&nbsp;Yi Chen ,&nbsp;Xiaoyu Xu ,&nbsp;Xianduo Li ,&nbsp;Dongdong Chen ,&nbsp;Wenzhi Du ,&nbsp;Minrui Zhang ,&nbsp;Zhe Yang ,&nbsp;Jianning Wang","doi":"10.1016/j.trim.2025.102316","DOIUrl":"10.1016/j.trim.2025.102316","url":null,"abstract":"<div><div>Organ transplantation improves survival and quality of life in end-stage organ failure, but rejection remains a key barrier to long-term graft success. While current immunosuppression primarily targets adaptive immunity, its limitations and side effects necessitate alternative therapeutic strategies. Macrophages infiltrate grafts extensively, which are involved in antigen presentation function, ischemia-reperfusion injury, and both acute and chronic rejection processes. Notably, their polarization toward an anti-inflammatory phenotype may alleviate rejection and potentially contribute to graft immune tolerance. In this review, we will give an overview on macrophage phenotypes and their functional diversity in allograft rejection. Also, we will discuss emerging strategies to modulate macrophage polarization, including therapies exploiting their dual regulatory capacity, nanoparticle-based targeting systems, gene therapies, and microRNA-mediated regulation. A deeper understanding of macrophage biology in transplantation could enable more sophisticated anti-rejection approaches, whose integration with conventional immunosuppression may ultimately enhance long-term graft outcomes.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102316"},"PeriodicalIF":1.4,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329993","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}

{"title":"Efficacy and safety of everolimus with reduced tacrolimus versus standard tacrolimus in liver transplant recipients: A systematic review and meta-analysis of randomized controlled trials","authors":"Akash Kumar ,&nbsp;Mateen Ahmad ,&nbsp;Amna Hussain ,&nbsp;Khadija Mohib ,&nbsp;Muhammad Asjad Saleem ,&nbsp;Muhammad Saad ,&nbsp;Muhammad Ansab ,&nbsp;Ram ,&nbsp;Pinkey Kumari ,&nbsp;Nisha Kumari","doi":"10.1016/j.trim.2025.102317","DOIUrl":"10.1016/j.trim.2025.102317","url":null,"abstract":"<div><h3>Background</h3><div>Liver transplantation (LT) requires immunosuppression to prevent rejection while minimizing adverse effects. Tacrolimus (TAC) is standard but linked to nephrotoxicity and leukopenia. Everolimus (EVR) with reduced-dose TAC (rTAC) offers a potential alternative, potentially improving safety while preserving efficacy.</div></div><div><h3>Objectives</h3><div>To compare everolimus with reduced-dose tacrolimus (EVR + rTAC) versus standard tacrolimus (sTAC) in liver transplant recipients, assessing composite efficacy as the primary outcome, with graft loss, peripheral edema, mortality and evaluating safety via incidence of adverse events.</div></div><div><h3>Methods</h3><div>PubMed, Cochrane Library, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> were systematically searched from inception until 1st March 2025. Randomized controlled trials (RCTs) comparing everolimus with reduced-dose tacrolimus (EVR + rTAC) versus standard tacrolimus (TAC) in liver transplant (LT) recipients were included. A random-effects model was used for meta-analysis to calculate pooled risk ratios with 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>A total of seven studies encompassing 1853 liver transplant recipients (EVR + rTAC: 1167; sTAC: 1174) were included. EVR + rTAC significantly reduced the risk of treated biopsy-proven acute rejection (tBPAR) compared to sTAC (RR: 0.67; 95 % CI: 0.47–0.94; <em>p</em> = 0.02; I² = 1 %). Renal function, assessed by estimated glomerular filtration rate (eGFR), was significantly better in the EVR + rTAC group (MD: 8.41; 95 % CI: 2.37–14.44; <em>p</em> = 0.006; I² = 86 %). Additionally, EVR + rTAC was associated with a significantly higher risk of peripheral edema (RR: 1.56; 95 % CI: 1.25–1.95; <em>p</em> &lt; 0.0001; I² = 0 %) and leukopenia (RR: 2.87; 95 % CI: 1.99–4.13; <em>p</em> &lt; 0.00001; I² = 0 %).</div><div>No significant differences were observed between the EVR + rTAC and sTAC groups regarding the composite efficacy outcome (RR: 0.79; 95 % CI: 0.62–1.00; <em>p</em> = 0.05; I² = 0 %), graft loss (RR: 1.25; 95 % CI: 0.73–2.14; <em>p</em> = 0.41; I² = 0 %), mortality (RR: 1.30; 95 % CI: 0.87–1.96; <em>p</em> = 0.20; I² = 0 %), or the incidence of serious adverse events (RR: 1.03; 95 % CI: 0.94–1.12; <em>p</em> = 0.52; I² = 79 %). Furthermore, no significant differences were noted regarding diarrhea, abdominal pain, headache, or hypertension.</div></div><div><h3>Conclusion</h3><div>Everolimus with reduced-dose tacrolimus (EVR + rTAC) showed comparable efficacy to standard tacrolimus, with no significant differences in graft loss or mortality. It significantly reduced the risk of acute rejection and improved renal function (higher eGFR) but increased the risk of leukopenia and peripheral edema. Further studies are needed to optimize this renal-sparing regimen.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102317"},"PeriodicalIF":1.4,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329972","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}

{"title":"Enhancement of allograft acceptance by combined dexmedetomidine and rapamycin","authors":"Chen-Fang Lee ,&nbsp;Chih-Hsien Cheng ,&nbsp;Hui-Hsin Chuang ,&nbsp;Hao-Chien Hung ,&nbsp;Wei-Chen Lee ,&nbsp;Hsiang-Sheng Wang","doi":"10.1016/j.trim.2025.102313","DOIUrl":"10.1016/j.trim.2025.102313","url":null,"abstract":"<div><h3>Background</h3><div>Dexmedetomidine, an α2-adrenoceptor agonist, is known for its sedative effects and unique pharmacological mechanism. Research increasingly emphasizes its potential to modulate immune responses. Further investigation is needed to fully understand how dexmedetomidine influences T cell differentiation and its potential synergy with tolerance-promoting agents. This study aims to explore a new approach to enhance allograft acceptance by combining dexmedetomidine with the mTOR inhibitor rapamycin.</div></div><div><h3>Methods</h3><div>The effects of both drugs on T cell proliferation, regulatory T cell preservation, and allograft survival were examined through both in vitro and in vivo animal experiments, including a fully MHC-mismatched mouse skin transplantation model. The study also evaluated the effect of combined drugs on immune memory via retransplantation surgery.</div></div><div><h3>Results</h3><div>Our data demonstrate that combining dexmedetomidine with rapamycin effectively inhibits T cell proliferation. This combination also increases the frequency of regulatory T cells, thereby preserving immune regulation. Furthermore, dual therapy significantly extends the median survival time (MST) of the skin compared to dexmedetomidine, or rapamycin alone or no treatment (20 vs. 12 days, <em>p</em> &lt; 0.001; 20 vs. 16 days, <em>p</em> &lt; 0.05; 20 vs. 7 days, <em>p</em> &lt; 0.0001). Similarly, mice treated with the combination therapy have notably prolonged MST of the second allogenic graft, compared to no treatment (11 days versus 7.5 days, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Our findings highlight the potential of combining dexmedetomidine with mTOR inhibitors to enhance graft acceptance and reduce memory responses.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102313"},"PeriodicalIF":1.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309318","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}

{"title":"Hemophagocytic Lymphohistiocytosis with onset of mental and behavioral disorders following allogeneic hematopoietic stem cell transplantation: A case report","authors":"Heng Liu,&nbsp;Yaozhu Pan,&nbsp;Wu Tao,&nbsp;Dongfeng Mao,&nbsp;Hongjuan Tian,&nbsp;Feng Xue,&nbsp;Miao He","doi":"10.1016/j.trim.2025.102314","DOIUrl":"10.1016/j.trim.2025.102314","url":null,"abstract":"<div><div>Hemophagocytic lymphohistiocytosis (HLH) is a rare but highly fatal complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT), with central nervous system involvement (CNS-HLH) being exceptionally uncommon in adults and posing significant diagnostic challenges. This report details a 24-year-old male with acute myeloid leukemia (AML-M5) who developed CNS-HLH on +50 day after haploidentical allo-HSCT. The patient achieved complete donor chimerism post-transplant with no active infections but subsequently presented with acute neuropsychiatric symptoms, including short-term memory impairment, hypersomnia, reduced verbal output, and psychomotor retardation, rapidly progressing to coma. Laboratory findings revealed pancytopenia, hyperferritinemia (4301 μg/L), hypertriglyceridemia, and elevated CD8⁺ T lymphocytes (58 %). Cerebrospinal fluid analysis showed increased pressure (220 mmH₂O) and markedly elevated protein (1350.3 mg/L), while cranial MRI demonstrated bilateral hippocampal and amygdaloid hyperintensities. Bone marrow examination confirmed hemophagocytosis, fulfilling the HLH-2004 criteria and modified post-HSCT HLH diagnostic criteria for secondary HLH. Despite aggressive interventions—high-dose methylprednisolone, intravenous immunoglobulin, plasma exchange, and ruxolitinib combined with intrathecal therapy—the patient remained comatose and succumbed to multi-organ failure. This case underscores the unique clinical trajectory of post-HSCT CNS-HLH, where neuropsychiatric manifestations precede classical hematologic abnormalities and conventional immunosuppressive therapies exhibit limited efficacy. The findings emphasize the imperative for heightened clinical suspicion of HLH in transplant recipients with unexplained neurological deterioration accompanied by progressive cytopenias and biomarker derangements. Furthermore, this report highlights the urgent need for optimized early diagnostic strategies and targeted therapeutic approaches for CNS-HLH. The case provides critical insights into the clinical management and mechanistic understanding of post-transplant HLH.</div></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"93 ","pages":"Article 102314"},"PeriodicalIF":1.4,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303680","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}