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Open AI in Transplantation: A Friend or a Foe? 移植手术中的开放式人工智能:是敌是友?
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2024-11-05 DOI: 10.1097/TP.0000000000005275
Germaine Wong, Jennifer Li
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引用次数: 0
Diagnosing the Recent Decrease in Utilization of Deceased Donor Kidneys.
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2024-08-28 DOI: 10.1097/TP.0000000000005178
Nicholas L Wood, Douglas N VanDerwerken, Allan B Massie, Dorry L Segev, Jon J Snyder, Sommer E Gentry

Background: The number of deceased donor kidney transplants has been increasing and is at a record high, yet nonuse of kidneys recovered for transplantation has risen to 25.8% following circular kidney allocation system based on 250-nautical-mile circles implemented on March 15, 2021 (KAS250).

Methods: Using Scientific Registry of Transplant Recipients data, we studied all deceased donor kidneys recovered for transplant from March 15, 2019, to January 31, 2023. We calculated the association of multiple factors with kidney nonuse, including increasing recovery of kidneys from nonideal donors, delays in offer acceptance observed under KAS250, and impacts of COVID-19.

Results: In the 2 y before KAS250, the nonuse rate was 21.2%. Had this rate continued, 2334 more kidneys would have been transplanted through January 2023. We estimated that about 769 of these nonused kidneys (33%) were associated with offer acceptance delays under KAS250; about 994 of these nonused kidneys (43%) were associated with increased prevalence of nonideal donors: donation after circulatory death donors, older donors, and donors with elevated peak serum creatinine; and about 542 of these nonused kidneys (23%) were associated with an otherwise unexplained gradual upward trend in nonuse of recovered kidneys across the pre-KAS250 and KAS250 eras. The overall impact of COVID-19 on the nonuse rate was not significant.

Conclusions: The rise in kidney nonuse rate was significantly associated with both increased recovery of nonideal donors, and with KAS250 allocation complexity and delays. Increasing recovery of kidneys from nonideal donors benefits patients because recovering more kidneys increases the number of kidneys available for transplant.

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引用次数: 0
Cell-mediated Immunity to Guide Primary Prophylaxis for CMV Infection in Organ Transplant Recipients: A Multicenter Single-arm Prospective Study. 指导器官移植受者 CMV 感染初级预防的细胞介导免疫:一项多中心单臂前瞻性研究。
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2024-08-20 DOI: 10.1097/TP.0000000000005173
Javier T Solera, Victor H Ferreira, Carlos Cervera, Seyed M Hosseini-Moghaddam, John Gill, Sarah Shalhoub, Jeff Zaltzman, Deepali Kumar, Atul Humar

Background: There are few interventional studies using CMV cell-mediated immunity (CMI) to guide antiviral prophylaxis. We assessed the Quantiferon-CMV (QTF-CMV) assay to guide CMV prophylaxis duration in high-risk organ transplant recipients.

Methods: A single-arm, multicenter, prospective interventional study including high-risk kidney, pancreas, liver, and heart transplant recipients who were either donor CMV-seropositive, recipient-seronegative (D + /R - ) or recipient-seropositive with antithymocyte globulin (R + /ATG) induction. CMI testing was performed using the QTF-CMV assay at months 3, 4, 5, and 6 posttransplant. Prophylaxis was discontinued for a positive CMI but continued for a negative result up to a maximum of 6 mo. The primary endpoint was CMV viremia ≥1000 IU/mL up to 1 y posttransplant.

Results: One hundred eight patients were included, comprising kidney (n = 89), kidney-pancreas (n = 7), liver (n = 10), and heart (n = 2) transplants. Eighty-nine patients (82.4%) completed the study protocol (n = 39 D + /R - and n = 50 R + /ATG). In the D + /R - group, only 1 of 39 patients (2.6%) had a positive QTF-CMV result. In the R + /ATG group, 33 of 50 patients (66%) had a positive QTF-CMV result before 6 mo, allowing for early discontinuation of prophylaxis (28 at month 3, 4 at month 4, and 1 at month 5). During the follow-up, CMV viremia ≥1000 IU/mL occurred in only 4 of 33 patients (12.1%) who discontinued prophylaxis early compared with 6 of 17 patients (35.3%) with negative QTF-CMV results and continued prophylaxis (hazard ratio 0.31; 95% confidence interval, 0.09-1.09; P  = 0.07). No R + patient developed CMV disease.

Conclusions: QTF-CMV-guided prophylaxis appears useful in R + patients who may benefit from a tailored duration of prophylaxis. This strategy does not appear to be useful in D + /R - patients.

背景:利用CMV细胞介导免疫(CMI)指导抗病毒预防的干预性研究很少。我们评估了Quantiferon-CMV(QTF-CMV)检测方法,以指导高风险器官移植受者的CMV预防持续时间:方法:这是一项单臂、多中心、前瞻性干预研究,研究对象包括高风险肾、胰、肝和心脏移植受者,他们要么是供体 CMV 血清学阳性、受体血清学阴性(D+/R-),要么是受体血清学阳性且有抗胸腺细胞球蛋白(R+/ATG)诱导。移植后第 3、4、5 和 6 个月使用 QTF-CMV 检测法进行 CMI 检测。CMI 阳性则停止预防,阴性则继续预防,最长不超过 6 个月。主要终点是移植后1年内CMV病毒血症≥1000 IU/mL:结果:共纳入了 118 例患者,包括肾移植(89 例)、肾胰移植(7 例)、肝移植(10 例)和心脏移植(2 例)。89名患者(82.4%)完成了研究方案(D+/R-组39人,R+/ATG组50人)。在 D+/R- 组中,39 名患者中只有 1 名(2.6%)的 QTF-CMV 结果呈阳性。在 R+/ATG 组中,50 位患者中有 33 位(66%)在 6 个月前出现 QTF-CMV 阳性结果,因此可以提前停止预防(28 位在第 3 个月,4 位在第 4 个月,1 位在第 5 个月)。在随访期间,33 名早期停止预防治疗的患者中只有 4 人(12.1%)出现 CMV 病毒血症≥1000 IU/mL,而 17 名 QTF-CMV 结果为阴性并继续预防治疗的患者中只有 6 人(35.3%)出现 CMV 病毒血症≥1000 IU/mL(危险比为 0.31;95% 置信区间为 0.09-1.09;P = 0.07)。没有R+患者发展为CMV疾病:结论:QTF-CMV指导下的预防治疗似乎对R+患者有用,他们可能会从定制的预防治疗时间中获益。这一策略似乎对D+/R-患者无用。
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引用次数: 0
Propensity Score-matched Donor and Recipient Outcomes: Robotic Versus Laparoscopic Donor Right Hepatectomy. 倾向得分匹配的供体和受体结果:机器人与腹腔镜供体右肝切除术
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2024-10-23 DOI: 10.1097/TP.0000000000005245
Na Reum Kim, Dai Hoon Han, Dong Jin Joo, Jae Geun Lee, Deok-Gie Kim, Myoung Soo Kim, Jin Sub Choi, Gi Hong Choi

Background: Few studies have examined the long-term outcomes of recipients in minimally invasive donor hepatectomies, particularly comparing robotic and laparoscopic donor procedures. Understanding these outcomes is crucial for optimizing surgical approaches and improving the overall success of living donor liver transplantation. This study aimed to compare the feasibility and safety of robotic donor right hepatectomy (RDRH) and laparoscopic donor right hepatectomy (LDRH) by evaluating total follow-up patient outcomes.

Methods: This retrospective, single-center study included 117 and 118 donors who underwent RDRH and LDRH between March 2016 and June 2023, respectively. After performing 1:1 propensity score matching, 71 donor-recipient pairs were included in each group. Donor and recipient complications were divided into early (within 90 d) and late (after 90 d) biliary and vascular complications.

Results: In the matched cohort, major complication rates of donors were similar in both groups. Bile duct (BD) variation was not significantly different; however, the rates of multiple BD openings (26.8% versus 54.9%; P  =   0.001) and major biliary complications in recipients were higher in the LDRH group (22.5% versus 42.3%; P  =   0.012). The cumulative biliary complication rate was significantly higher in the LDRH group. Early biliary complications were not significantly different; however, the rate of late biliary complications was higher in the LDRH group (11.3% versus 23.9%; P  =   0.047).

Conclusions: RDRH demonstrated comparable postoperative complications to LDRH in donors but showed fewer recipient biliary complications. This could be attributed to the precision of robotic dissection and BD division, resulting in fewer multiple BD openings.

背景:很少有研究对微创供体肝切除术中受体的长期疗效进行研究,尤其是对机器人和腹腔镜供体手术进行比较。了解这些结果对于优化手术方法和提高活体肝移植的整体成功率至关重要。本研究旨在通过评估患者的总随访结果,比较机器人供体右肝切除术(RDRH)和腹腔镜供体右肝切除术(LDRH)的可行性和安全性:这项回顾性单中心研究纳入了2016年3月至2023年6月期间分别接受RDRH和LDRH手术的117名和118名供体。在进行1:1倾向评分匹配后,每组包括71对供体-受体。供体和受体并发症分为早期(90天内)和晚期(90天后)胆道和血管并发症:结果:在配对队列中,两组供体的主要并发症发生率相似。胆管(BD)变异无显著差异;然而,LDRH 组受者胆管多处开口率(26.8% 对 54.9%;P = 0.001)和主要胆道并发症发生率更高(22.5% 对 42.3%;P = 0.012)。LDRH 组的累积胆道并发症发生率明显更高。早期胆道并发症无明显差异;但LDRH组的晚期胆道并发症发生率更高(11.3%对23.9%;P = 0.047):结论:RDRH与LDRH的供体术后并发症相似,但受体胆道并发症较少。结论:RDRH对供体的术后并发症与LDRH相当,但受体胆道并发症较少,这可能归因于机器人解剖和BD分割的精确性,从而减少了多个BD开口。
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引用次数: 0
Does Anybody Really Know What (Warm Ischemia) Time It Is? 有人真正知道现在是什么(暖缺血)时间吗?
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2024-07-25 DOI: 10.1097/TP.0000000000005154
Robert J Stratta, David I Harriman
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引用次数: 0
Cutting Down Biliary Complications in Living Donor Hepatectomy: Enter the Robot. 减少活体供体肝切除术中的胆道并发症:使用机器人。
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2024-12-09 DOI: 10.1097/TP.0000000000005277
Nathaly Llore, Jason Hawksworth
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引用次数: 0
Where Are All the Clinical Trials for Chronic Rejection? 慢性排斥反应的临床试验在哪里?
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2025-01-03 DOI: 10.1097/TP.0000000000005081
Paolo Cravedi, Umberto Maggiore, Paolo Molinari, Josh Levitsky, Emmanuel Zorn

Chronic rejection is arguably the main obstacle to long-term graft survival. Yet, clinical trials focusing on this condition are disappointingly scarce. Significant advances in treating chronic rejection cannot happen if there is no conduit for testing novel therapies. Here, we identified the main hurdles holding back clinical trials for chronic rejection and outlined a series of actions to address these roadblocks. We suggest that a new strategic plan combining expertise in basic and clinical research and leveraging complementary resources be launched to specifically target chronic rejection and achieve long-awaited progress. We only need the will.

慢性排斥反应是移植物长期存活的主要障碍。然而,令人失望的是,针对这种情况的临床试验很少。如果没有测试新疗法的渠道,治疗慢性排斥反应的重大进展就不可能发生。在这里,我们确定了阻碍慢性排斥临床试验的主要障碍,并概述了一系列解决这些障碍的措施。我们建议制定一项新的战略计划,结合基础和临床研究的专业知识,并利用互补资源,专门针对慢性排斥反应,实现期待已久的进展。我们只需要意志。
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引用次数: 0
Establishing a New Liver Transplant Unit in China-First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, People's Republic of China. 在中国建立新的肝移植病房--中国科学技术大学第一附属医院,安徽合肥。
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2024-09-30 DOI: 10.1097/TP.0000000000005219
Jiwei Qin, Xiaodong Yuan, Hao Zheng, Can Qi, Yafei Guo, Zebin Zhu, Wei Wu, Zhijun Xu, Xuefeng Li, Ning Wang, Xiaoqing Chai, Yanhu Xie, Xiaogen Tao, Haihua Liu, Weiyong Liu, Guoyan Liu, Kexue Deng, Yi Li, Xuebing Ji, Changlong Hou, Ziqin Yao, Qiang Huang, Ruipong Song, Shugeng Zhang, Jizhou Wang, Haibo Wang, Lianxin Liu, Björn Nashan
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引用次数: 0
The Microscope and Beyond: Current Trends in the Characterization of Kidney Allograft Rejection From Tissue Samples. 显微镜及其他:从组织样本鉴定肾脏移植排斥反应的当前趋势》。
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2024-08-06 DOI: 10.1097/TP.0000000000005153
Bertrand Chauveau, Lionel Couzi, Pierre Merville

The Banff classification is regularly updated to integrate recent advances in the characterization of kidney allograft rejection, gathering novel diagnostic, prognostic, and theragnostic data into a diagnostic and pathogenesis-based framework. Despite ongoing research on noninvasive biomarkers of kidney rejection, the Banff classification remains, to date, biopsy-centered, primarily relying on a semiquantitative histological scoring system that overall lacks reproducibility and granularity. Besides, the ability of histopathological injuries and transcriptomics analyses from bulk tissue to accurately infer the pathogenesis of rejection is questioned. This review discusses findings from past, current, and emerging innovative tools that have the potential to enhance the characterization of allograft rejection from tissue samples. First, the digitalization of pathological workflows and the rise of deep learning should yield more reproducible and quantitative results from routine slides. Additionally, novel histomorphometric features of kidney rejection could be discovered with an overall genuine clinical implementation perspective. Second, multiplex immunohistochemistry enables in-depth in situ phenotyping of cells from formalin-fixed samples, which can decipher the heterogeneity of the immune infiltrate during kidney allograft rejection. Third, transcriptomics from bulk tissue is gradually integrated into the Banff classification, and its specific context of use is currently under extensive consideration. Finally, single-cell transcriptomics and spatial transcriptomics from formalin-fixed and paraffin-embedded samples are emerging techniques capable of producing up to genome-wide data with unprecedented precision levels. Combining all these approaches gives us hope for novel advances that will address the current blind spots of the Banff system.

班夫分类法定期更新,以整合肾脏异体移植排斥反应特征描述方面的最新进展,将新的诊断、预后和治疗数据收集到一个基于诊断和发病机制的框架中。尽管对肾脏排斥反应的非侵入性生物标志物的研究仍在进行,但班夫分类至今仍以活检为中心,主要依赖于半定量的组织学评分系统,该系统总体上缺乏可重复性和精细度。此外,组织病理学损伤和大块组织转录组学分析能否准确推断排斥反应的发病机制也受到质疑。本综述将讨论过去、现在和新兴的创新工具的研究结果,这些工具有可能提高从组织样本鉴定异体移植排斥反应的能力。首先,病理工作流程的数字化和深度学习的兴起应能从常规切片中获得更多可重复的定量结果。此外,还可以从整体真正的临床实施角度发现肾脏排斥反应的新组织形态特征。其次,多重免疫组化技术可以对福尔马林固定样本中的细胞进行深入的原位表型分析,从而解读肾脏异体移植排斥反应过程中免疫浸润的异质性。第三,来自大块组织的转录组学正在逐步纳入班夫分类法,其具体使用环境目前正在广泛考虑之中。最后,来自福尔马林固定和石蜡包埋样本的单细胞转录组学和空间转录组学是新兴技术,能够以前所未有的精度水平产生全基因组数据。综合所有这些方法,我们有望取得新的进展,解决班夫系统目前存在的盲点。
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引用次数: 0
Kidney Transplant Outcomes in Amyloidosis: US National Database Study. 淀粉样变性的肾移植结果:美国国家数据库研究。
IF 5.3 2区 医学 Q1 IMMUNOLOGY Pub Date : 2025-03-01 Epub Date: 2024-08-28 DOI: 10.1097/TP.0000000000005191
Junji Yamauchi, Divya Raghavan, Duha Jweehan, Suayp Oygen, Silviana Marineci, Isaac E Hall, Miklos Z Molnar

Background: We aimed to assess contemporary transplant outcomes among kidney recipients with amyloidosis, as the treatment and prognosis of amyloidosis have shown improvement over time.

Methods: Using the US Organ Procurement and Transplantation Network database, we initially evaluated the changes in patient and graft survival among kidney recipients with amyloidosis from 2002 to 2021. We then compared transplant outcomes between recipients with amyloidosis versus those with diabetic and nondiabetic causes of kidney failure, creating 1:4 matches with highly similar characteristics separately for deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) during the last decade (2012-2021).

Results: We identified 643 kidney recipients with amyloidosis during 2002-2021. Patient and death-censored graft survival improved over time. In the matching analysis for 207 DDKT and 166 LDKT recipients with amyloidosis during 2012-2021, patient survival was not significantly different between amyloidosis and diabetes groups in both DDKT (log-rank, P  = 0.057) and LDKT ( P  = 0.99). Compared with the nondiabetes group, patient survival in the amyloidosis group was not significantly different for DDKTs ( P  = 0.56) but was significantly lower for LDKTs ( P  = 0.04). Death-censored graft failure risk was not significantly different between amyloidosis and diabetes or nondiabetes groups for both DDKTs ( P  = 0.78 and 0.75) and LDKTs ( P  = 0.40 and 0.24).

Conclusions: In this well-matched cohort study, we found no significant differences in patient and graft survival between kidney recipients with amyloidosis and those with diabetes. Similarly, these outcomes were not significantly different between those with amyloidosis versus nondiabetic causes, except for patient survival of LDKT recipients.

背景:随着时间的推移,淀粉样变性的治疗和预后都有所改善,因此我们旨在评估患有淀粉样变性的肾脏受者的移植结果:随着时间的推移,淀粉样变性的治疗和预后都有所改善,因此我们旨在评估患有淀粉样变性的肾脏受者的移植结果:利用美国器官获取和移植网络数据库,我们初步评估了 2002 年至 2021 年期间淀粉样变性肾脏受者中患者和移植物存活率的变化。然后,我们比较了淀粉样变性受者与糖尿病和非糖尿病肾衰竭受者的移植结果,在过去十年(2012-2021 年)中,分别为死亡供体肾移植(DDKT)和活体供体肾移植(LDKT)创建了特征高度相似的 1:4 匹配者:结果:我们发现2002-2021年间有643名肾脏受者患有淀粉样变性。随着时间的推移,患者和死亡校正后的移植物存活率有所提高。在对2012-2021年期间207例DDKT和166例LDKT淀粉样变性受者的配对分析中,DDKT(对数秩,P = 0.057)和LDKT(P = 0.99)淀粉样变性组和糖尿病组的患者存活率无显著差异。与非糖尿病组相比,淀粉样变性组患者的 DDKT 存活率无显著差异(P = 0.56),但 LDKT 存活率显著较低(P = 0.04)。对于DDKTs(P = 0.78和0.75)和LDKTs(P = 0.40和0.24),淀粉样变性组与糖尿病组或非糖尿病组的死亡剪除移植物失败风险无明显差异:在这项匹配良好的队列研究中,我们发现淀粉样变性肾脏受者和糖尿病肾脏受者的患者和移植物存活率没有显著差异。同样,除了LDKT受者的患者存活率外,淀粉样变性与非糖尿病患者的这些结果也没有明显差异。
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引用次数: 0
期刊
Transplantation
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