Transplantation最新文献

Background: HLA-DQ mismatches between donor and recipient confer the highest risk for generation of donor-specific antibodies leading to poor allograft survival. Therefore, understanding hierarchical immunogenicity of HLA-DQ mismatches is needed to guide risk stratification.

Methods: Adsorption/elution experiments were optimized using homozygous cell lines as targets. Serum samples from transplant recipients studied herein were limited to those obtained at first documentation of de novo HLA-DQ donor-specific antibodies.

Results: The use of different HLA-DQ targets in optimized adsorption/elution experiments allowed for separation of sera exhibiting polyclonal antibody reactivity into individual antibodies recognizing epitopes with monospecificity. Our heterogeneous cohort demonstrated only a small repertoire of amino acids, or regions of interest, associated with the initial HLA-DQ humoral response. Most of the mismatches listed in the HLA Eplet Registry did not participate in these first-tier responses. Adsorption/elution studies were instrumental in documenting epitope spreading in patients with broadening of HLA-DQ antibody repertoire, highlighting the occurence of a first-tier response before triggering additional immune responses. Finally, first-tier regions of interest correlate with first-field (low-resolution) HLA typing, namely conventional serologic HLA-DQ antigen families, enriched with DQα chains specificity.

Conclusions: These findings clearly demonstrate that some "molecular mismatches" are more immunogenic than others. They further support our previous observations documenting increased risk of HLA-DQα*05 heterodimer mismatches and provide a tool to continue interrogating differential immunogenicity. Finally, we provide guidance to identify high- and low-risk HLA-DQ mismatches. Taken together, our study supports a different conceptual and experimental framework to study HLA-DQ immunogenicity, and an immunological rationale to guide risk stratification.

Worldwide, the number of patients receiving solid organ transplantation each year is increasing. In recent years, there has been growing recognition of the need to understand how these additional life years are experienced and valued by recipients. Patient-reported outcomes (PROs)-such as symptoms, functioning, and health-related quality of life-provide direct insight into health from the patient's perspective and are increasingly acknowledged as key outcomes in both research and clinical care. Different patient-reported outcome measures (PROMs) have been developed in the field of transplantation. However, their current use in both clinical care and research in solid organ transplant recipients remains inconsistent and limited. This narrative review summarizes the current state of PRO and PROM use in solid organ transplantation across different organs and settings, highlights recent initiatives and ongoing implementation efforts, and outlines challenges in PROM selection, application and interpretation. Although the field of kidney transplantation is currently leading in the development and implementation of PROM initiatives, comparable efforts in liver, lung, and heart transplantation remain limited, resulting in slow and heterogeneous progress across organ domains. To support broader adoption, we propose a stepwise roadmap for PROM implementation in transplantation. A more systematic and thoughtful integration of PROs and PROMs holds potential to improve shared decision-making, generate evidence that aligns more closely with the priorities of transplant recipients, and ultimately support more meaningful clinical decisions and improved outcomes for transplant recipients.

Background: Although solid organ transplant prolongs survival in end-stage disease, recipients face high symptom burden and complex decisions at multiple junctures. Palliative care (PC) may address these needs, but referrals in transplant programs are infrequent, often reactive, and the benefits remain unclear.

Methods: We retrospectively studied 12 676 heart, liver, lung, and kidney transplants across 3 Mayo Clinic sites (2018-2024). PC encounters were classified as pretransplant (≤1 y before admission), peritransplant (during hospitalization), or posttransplant (≤1 y after discharge).

Results: Only 8.3% engaged PC, with patterns varying by organ and timing. Heart programs demonstrated the highest overall engagement, primarily pre- and peritransplant, whereas lung and kidney referrals occurred more often after discharge. Earlier timing coincided with longer survival, whereas peri- and posttransplant encounters occurred closer to death. In heart transplantation, pre- and peritransplant PC were observed in recipients with lower procedural volume and fewer short-term readmissions. Liver and lung cohorts displayed variable patterns. Kidney referrals occurred infrequently and were concentrated among recipients with higher morbidity. Timing of inpatient consultation showed a strong positive correlation with hospital length of stay, and pretransplant PC coincided with higher rates of goals-of-care discussions and fewer hospital interventions. Adapting screening criteria to focus on high-risk recipients, PC was associated with fewer short-term readmissions for heart and lung recipients.

Conclusions: PC among solid organ transplant was infrequent and varied. Referral timing often aligned with patient morbidity and mortality. Structured, prospective validation of screening methods may identify patients most likely to benefit from palliative involvement.

Backgrounds: Primary effusion lymphoma (PEL) is a rare, highly aggressive malignancy that severely affects patient survival. This study aims to help scholars build a comprehensive framework to identify current challenges, opportunities, and development trends.

Methods: A total of 2544 relevant articles were retrieved from the Web of Science, PubMed, and Scopus databases, encompassing the primary research findings and methodologies in this field. The analysis results indicate that while the number of studies has shown growth in certain years, there remains a challenge of concentrated research themes and a lack of clinical application.

Results: The findings revealed that while the United States dominates PEL research, countries in Asia, particularly China and Japan, are also experiencing growth in this domain. Further keyword co-occurrence analysis indicates that current research hotspots in PEL primarily focus on viral mechanisms, immune evasion, and treatment methods. However, clinical treatment-related keywords such as "chemotherapy agents" and "immunotherapy" appear infrequently in the literature, suggesting a significant disconnect between basic research and clinical application.

Conclusion: The study reveals the current situation and trend of the growing PEL research around the world. The findings of this study not only illuminate current trends in PEL research but also emphasize the necessity of continued scholarly inquiry to address the multifaceted challenges faced by patients and healthcare providers alike.

Rationale: Krabbe disease is a rare autosomal recessive genetic disorder for which no specific cure is currently available. In clinical practice, management primarily relies on supportive and symptomatic therapies aimed at alleviating patient suffering. Although the disease remains incurable, the intensity of medical interventions has decreased over time, highlighting the need for innovative and integrated therapeutic approaches. This case study presents a patient who received a combination of Western medicine and traditional Chinese medicine, resulting in a significant reduction in clinical symptoms.

Patient concerns: The patient primarily presents with unsteady gait, bilateral lower extremity weakness, and nocturnal muscle tremors in both lower limbs. Electromyography examination revealed functional impairment of the deep sensory pathways in both lower extremities. Additionally, the mutation sites identified in this patient are c.1901T>C and c.98T>G; notably, the mutation site c.98T>G has not been previously reported. The therapeutic efficacy of Western medicine for this condition appears to be unsatisfactory.

Diagnoses: This patient was diagnosed with Krabbe disease.

Interventions: On January 17, 2025, the patient decided to incorporate traditional Chinese medicine into the treatment regimen for concurrent therapy.

Outcomes: During the concurrent treatment with integrated traditional Chinese and Western medicine, the patient exhibited remission of clinical symptoms and a corresponding improvement in quality of life.

Lessons: The integrated treatment of traditional Chinese and Western medicine offers new therapeutic options for the management of Krabbe disease.