Current Transplantation Reports最新文献

Purpose of review: This review examines the expanding role of non-human leukocyte antigen (non-HLA) genetic factors in kidney transplantation, with a particular focus on their implications for living donor evaluation and outcomes. It emphasizes the potential of genetic testing to improve risk stratification beyond conventional HLA matching, especially for donor candidates with a family history of hereditary kidney disease.

Recent findings: Non-HLA genetic mismatches, including single nucleotide variants affecting minor histocompatibility antigens, can drive alloimmune responses, leading to graft rejection and failure even in HLA-matched transplants. The presence of non-HLA antibodies further contributes to adverse immunological outcomes. Genetic testing in related living donors can uncover monogenic kidney diseases, enabling early identification of at-risk individuals and enhancing donor safety. While polygenic risk scores and gene panels show promise in predicting complications and guiding post-transplant care, most genome-wide association studies have focused on recipients. There remains a significant gap in understanding how donor-specific genetic factors influence post-donation kidney function and long-term health outcomes.

Summary: The integration of non-HLA genetic testing into living donor evaluation supports a precision medicine approach to kidney transplantation, offering improved risk assessment and donor-recipient matching. As the field advances, longitudinal studies and robust data collection, particularly around donor genetics, are essential to optimize transplant outcomes, inform clinical decision-making, and uphold ethical standards in donor care.

Purpose of review: Cellular therapies have shown great promise in enhancing immune tolerance and managing opportunistic infections in transplant recipients. This review explores the latest advancements in regulatory T cell (Treg) and virus-specific T cell (VST) therapies in solid organ transplantation.

Recent findings: Treg-based therapies, including polyclonal Tregs, donor antigen-reactive Tregs (darTregs), and chimeric antigen receptor Tregs (CAR-Tregs) are being studied to minimize conventional, systemic immunosuppression while preventing graft rejection. Clinical trials demonstrated the safety and feasibility of ex vivo-expanded Tregs in kidney and liver transplantation, supporting reduced rejection rates and lower infection risks. The clinical applicability of CAR-T cell therapies extends to autoimmune diseases. Additionally, VSTs targeting BK virus, cytomegalovirus, Epstein-Barr virus, and adenovirus offer a novel approach for refractory viral infections in transplant recipients. Advances in third-party, "off-the-shelf" and multi-VSTs allow faster availability and standardized, scalable manufacturing compared to conventional VSTs.

Summary: By reducing dependence on conventional immunosuppression, cellular therapies provide a promising approach in transplantation. To establish their role in clinical transplantation, further research is needed to optimize dosing and manufacture, improve antigen specificity, and address long-term safety concerns.

Purpose of review: Living donor nephrectomy is a cornerstone of kidney transplantation. Minimally invasive approaches offer reduced morbidity and faster recovery over open techniques. The purpose of this review is to elucidate recent advances and best practices in minimally invasive living donor nephrectomy procedures.

Recent findings: Although robotic living donor nephrectomies have longer operative and warm ischemia times compared to the open and laparoscopic techniques, early and late graft function including graft survival are comparable in the open, robotic and laparoscopic groups. Enhanced recovery after surgery (ERAS) protocols are increasingly being used to improve perioperative outcomes.

Summary: This review focuses on the innovation of minimally invasive approaches to living donor nephrectomy over time and highlights the best practices during donor selection and the choice of surgical technique.

Purpose of review: Currently, there are number of initiatives underway across the world to remove barriers and increase education about living donation and living donor transplantation, including among professionals. Widespread use of the internet and social media (SoMe) started a new era of online information sharing. Extensive studies have highlighted the significant role of visual abstracts (VAs) and infographics in disseminating medical information including related to donation and transplantation. SoMe can foster networking and collaboration between transplant professionals across the globe.

Recent findings: The American Society of Transplantation Living Donor Community of Practice (LDCOP) Multimedia Workgroup (MMWG) was established to support the LDCOP's professional education mission by providing audiovisual support for various initiatives using visual abstracts, infographics, and professional community engagement. The MMWG employs rigorous multi-layered vetting by professionals with academic expertise to ensure the reliability and accuracy of the content, pioneering a model for creating visual educational content, collaborative learning and skill-building across experience levels.

Summary: In this perspective review, we summarize the history of a professional society multimedia work group and our experience building a multimedia approach to living donation education for transplant professionals.

Purpose of review: Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease causing amyloidosis (AA type) which may result in development of end-stage kidney disease (ESKD). Colchicine is the initial treatment option for patients FMF/amyloidosis both before and after KT. Although, kidney transplantation (KT) can be offered to patients with ESKD due to FMF/amyloidosis, FMF attacks did not resolve in some of kidney transplant recipients (KTRs) and de-novo development of amyloidosis after KT may be observed despite colchicine treatment. For these patients, other treatment options are warranted including anti-interleukin-1 agents such as anakinra and canakinumab. The purpose of the review is to summarize the use of anti-interleukin-1 agents in KTRs with FMF and amyloidosis.

Recent findings: Recent studies showed that these agents are effective in KTRs in terminating FMF attacks and decreasing inflammatory parameters. Furthermore, no significant interaction with immunosuppressive drugs were recorded and side effects were few. However, there are various knowledge gaps.

Purpose of the review: Despite recent advancements in technology for the treatment of type 1 diabetes (T1D), exogenous insulin delivery through automated devices remains the gold standard for treatment. This review will explore progress made in pancreatic islet bioengineering within the field of beta-cell replacement for T1D treatment.

Recent findings: First, we will focus on the use of decellularized extracellular matrices (dECM) as a platform for pancreatic organoid development. These matrices preserve microarchitecture and essential biochemical signals for cell differentiation, offering a promising alternative to synthetic matrices. Second, advancements in 3D bioprinting for creating complex organ structures like pancreatic islets will be discussed. This technology allows for increased precision and customization of cellular models, crucial for replicating native pancreatic islet functionality. Finally, this review will explore the use of stem cell-derived organoids to generate insulin-producing islet-like cells. While these organoids face challenges such as functional immaturity and poor vascularization, they represent a significant advancement for disease modeling, drug screening, and autologous islet transplantation.

Summary: These innovative approaches promise to revolutionize T1D treatment by overcoming the limitations of traditional therapies based on human pancreatic islets.

Purpose of review: To provide a comprehensive update on the evaluation of kidney transplant recipients with complement-mediated kidney diseases and their living donor (LD) candidates.

Recent findings: Atypical hemolytic syndrome (aHUS) and C3 glomerulopathy (C3G) are rare complement-mediated diseases characterized by excessive activation of the alternative complement pathway. The evaluation of living kidney donor candidates for complement-mediated kidney diseases is evolving in response to emerging evidence and advancements in risk assessment tools. Criteria once considered contraindications to living donation are now part of standard practice, while novel genetic markers and risk factors are being identified. For complement-mediated kidney diseases, genetic testing is particularly relevant as it can identify variants that influence disease recurrence risk and donor suitability. Despite these advances, data to guide the evaluation of LD candidates for aHUS and C3G are still very limited. The application and interpretation of novel genetic testing technologies remain in the early stages, and standardized guidance is lacking. In this review, we summarize the approach to LD kidney transplantation for complement-mediated kidney diseases, addressing utility of genetic testing, risks, and ongoing challenges for recipients and LDs.

Summary: The present review highlights the importance and complexity of kidney transplantation from an LD for patients with complement-related kidney disorders and motivates further research to determine the optimal risk-assessment for LD candidates to recipients with aHUS and C3G.

Purpose of review: This paper summarizes predictive models developed to determine transplant eligibility over the past 5 years, focusing on application of novel data sources and methodologic approaches.

Recent findings: The contemporary body of research employing predictive models to inform transplant eligibility mainly relies on pre- or post-transplant patient survival. No studies have sought to assimilate all features collected during the transplant evaluation process to produce a composite prediction of post-transplant success or failure.

Summary: Predictive modeling is a commonly used statistical technique that uses available data on a subset of a target population to estimate the current health state or the probability of developing a future health outcome among individuals in the target population. Modern analytic techniques allow for transformation of vast amounts of data into actionable information but require curated organized well-defined data to deploy. That data is currently lacking for patients referred for transplant.