Transplantation Reviews最新文献

Complement in Kidney Transplantation 补体在肾移植中的应用

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-11-26 DOI: 10.1016/j.trre.2024.100897

Pooja Lokkur , Shyam Bihari Bansal

Transplantation is the treatment of choice in most patients with kidney failure. The complement system plays a vital role in transplantation. The complement system forms a major part of innate immunity and acts as a bridge between innate and acquired immunity. Many diseases, particularly concerning the kidneys, result from complement system dysregulation, like atypical hemolytic uremic syndrome (aHUS), C3 glomerulopathy (C3GN), systemic lupus erythematosus (SLE and some other immune complex diseases. The complement system activation is a very important part of post-transplant events like ischemia-reperfusion injury (IRI), delayed graft function (DGF), antibody-mediated rejection (ABMR) and thrombotic microangiopathy (TMA). A better understanding of the complement cascade can help to plan strategies to prevent and manage complement-related problems before and after kidney transplantation. Many newer molecules are either being developed or in the pipeline, which target the complement system at various stages. These novel therapeutics are now considered additional measures to improve graft survival. This review summarises the complement cascade, its role in kidney diseases and kidney transplantation, and possible areas of target and novel therapeutics.

移植是大多数肾衰竭患者的治疗选择。补体系统在移植中起着至关重要的作用。补体系统是先天免疫的重要组成部分，是先天免疫和获得性免疫之间的桥梁。许多疾病，特别是与肾脏有关的疾病，都是由补体系统失调引起的，如非典型溶血性尿毒症综合征（aHUS）、C3肾小球病（C3GN）、系统性红斑狼疮（SLE）和其他一些免疫复合物疾病。补体系统激活是移植后缺血再灌注损伤（IRI）、移植功能延迟（DGF）、抗体介导的排斥反应（ABMR）和血栓性微血管病（TMA）等事件的重要组成部分。更好地了解补体级联可以帮助制定预防和管理肾移植前后补体相关问题的策略。许多新的分子正在开发中或正在研制中，它们针对的是处于不同阶段的补体系统。这些新疗法现在被认为是提高移植物存活率的额外措施。本文综述了补体级联及其在肾脏疾病和肾移植中的作用，以及可能的靶点和新疗法领域。

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引用次数: 0

Complement and T cell activation in transplantation 移植中的补体和T细胞活化

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-11-26 DOI: 10.1016/j.trre.2024.100898

Sara Alibrandi , Angela Clemens , Nicholas Chun

The complement system plays a critical role in modulating adaptive T cell responses. Coordination of the proinflammatory signaling cascade and complement regulators permits efficient T cell priming and survival, while minimizing off-target damage to healthy host cells. In the context of transplantation, anti-donor T cell immunity remains a barrier to long term graft health and complement-targeted therapies have shown the potential to significantly improve patient outcomes. Here we will review our current understanding of complement-mediated T cell function and how these findings may be harnessed in organ transplantation.

补体系统在调节适应性T细胞反应中起关键作用。促炎信号级联和补体调节的协调允许有效的T细胞启动和存活，同时最大限度地减少对健康宿主细胞的脱靶损伤。在移植的背景下，抗供体T细胞免疫仍然是移植物长期健康的障碍，补体靶向治疗已显示出显着改善患者预后的潜力。在这里，我们将回顾我们目前对补体介导的T细胞功能的理解，以及这些发现如何在器官移植中得到利用。

引用次数: 0

Early and late antibody mediated rejection: Which game is the complement playing? 抗体介导的早期和晚期排斥反应：补体在玩什么游戏？

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-11-22 DOI: 10.1016/j.trre.2024.100889

Delsante Marco, Gandolfini Ilaria, Palmisano Alessandra, Giuseppe Daniele Benigno, Gentile Micaela, Giovanni Maria Rossi, Fiaccadori Enrico, Maggiore Umberto

The role of the complement system in antibody mediated rejection (AMR) emerged in the last decades, and the demonstration of the presence of complement fragments in renal allograft biopsies is a consolidated diagnostic sign of AMR. However, antibodies against donor antigens may lead to microvascular inflammation and endothelial injury even in the absence of complement activation, and growing evidence suggests that complement-independent mechanisms may be prominent in late (i.e., occurring >6 months after transplantation) vs early AMR. Different donor specific antibodies (DSA) with different biological features and complement activation ability may be involved in late or early AMR. Downregulation of tissue complement inhibitors may happen early after transplantation, partially due to ischemia reperfusion injury, and could facilitate complement activation in early vs late AMR. Clinical and histological features of late AMR and C4d negative AMR seem to converge, and this narrative review analyzes the evidence that supports lower complement activation in late vs early AMR, including differential C4d staining prevalence based on the time after transplantation, differential response to anti-complement therapy and other direct and indirect signs of the complement system activation. The therapeutic approach in early vs late AMR should take into account possible differences in the pathophysiological mechanisms of microvascular inflammation and endothelial injury in early vs late AMR.

补体系统在抗体介导的排斥反应（AMR）中的作用是在过去几十年中出现的，肾移植活检中补体片段的存在是AMR的一个综合诊断标志。然而，即使在没有补体激活的情况下，针对供体抗原的抗体也可能导致微血管炎症和内皮损伤。越来越多的证据表明，在晚期（即移植后 6 个月）与早期 AMR 中，补体无关机制可能更为突出。不同的供体特异性抗体（DSA）具有不同的生物学特征和补体激活能力，可能参与晚期或早期AMR。组织补体抑制剂的下调可能发生在移植后早期，部分原因是缺血再灌注损伤，这可能会促进早期与晚期AMR的补体激活。晚期AMR和C4d阴性AMR的临床和组织学特征似乎趋于一致，本综述分析了支持晚期与早期AMR补体激活程度较低的证据，包括基于移植后时间的不同C4d染色流行率、对抗补体治疗的不同反应以及补体系统激活的其他直接和间接迹象。早期与晚期AMR的治疗方法应考虑到早期与晚期AMR微血管炎症和内皮损伤的病理生理机制可能存在的差异。

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引用次数: 0

Successful use of deceased donors with medically complex kidneys 成功利用已故捐献者的医学复杂肾脏

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-11-22 DOI: 10.1016/j.trre.2024.100888

Mita M. Shah, Clarkson Crane, Robert W. Steiner

The number of patients waiting for kidney transplants from deceased organ donors continues to increase. In this context, non-transplantation of acceptable kidneys is especially regrettable. Here, we review successful transplantation of deceased donor kidneys with anatomic abnormalities, intrinsic kidney diseases, and other ostensibly problematic conditions. These scenarios will be encountered infrequently and, with limited time to decide, uncertainty often results in organ refusal. In general, anatomic abnormalities can be overcome, kidney diseases remit in recipients, and systemic donor conditions such as poisonings do not affect the recipient. Acknowledging the risk of publication bias and need for more long-term outcome data, familiarity with these “once in a lifetime” deceased donor kidneys potentially avoids unwarranted refusals and provides insights into many disease processes.

等待已故器官捐献者肾脏移植的患者人数不断增加。在这种情况下，无法移植可接受的肾脏尤其令人遗憾。在此，我们回顾了解剖异常、内在肾脏疾病和其他表面上有问题的已故捐献者肾脏的成功移植案例。这些情况并不常见，而且由于决定的时间有限，不确定性往往会导致器官被拒绝。一般来说，解剖异常是可以克服的，肾脏疾病在受者身上也会缓解，而中毒等全身性供体疾病也不会对受者造成影响。虽然存在发表偏差的风险，而且需要更多的长期结果数据，但熟悉这些 "一生只有一次 "的已故捐献者肾脏有可能避免不必要的拒绝，并提供对许多疾病过程的见解。

引用次数: 0

Heart transplantation in adults with congenital heart diseases: A comprehensive meta-analysis on waiting times, operative, and survival outcomes 成人先天性心脏病患者的心脏移植手术：关于等待时间、手术和存活结果的综合荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-11-22 DOI: 10.1016/j.trre.2024.100886

Abdulaziz Abdulelah Banaja , Nicolae Cristian Bulescu , Caroline Martin-Bonnet , Marc Lilot , Roland Henaine

The rising prevalence of congenital heart disease (CHD) among adults has led to increased heart transplantation (HT) procedures in this population. However, CHD patients face significant challenges including longer waiting times, higher early mortality rates, and increased risks of complications such as renal dysfunction. This systematic review and meta-analysis examined 50 studies to assess waiting times, postoperative outcomes, and survival rates in CHD patients undergoing HT compared to non-CHD patients. Results revealed that CHD patients experience longer HT waiting times (mean difference [MD]: 53.86 days, 95 % CI: [22.00, 85.72], P = 0.0009) and increased ischemic times (MD: 20.01 min, 95 % CI: [10.51, 29.51], P < 0.0001), which may increase waitlist and early postoperative mortality. Regarding complications, renal dysfunction is more prevalent in CHD patients than in non-CHD patients (RR: 2.05, 95 % CI: [1.61, 2.61], P < 0.00001). Despite these challenges, long-term survival rates for CHD patients are comparable to those of non-CHD recipients, with significant improvements noted in recent allocation systems. Our findings emphasize the need for ongoing refinements in HT allocation systems to improve outcomes for CHD patients, particularly in reducing waiting times and managing post-transplant complications.

先天性心脏病（CHD）在成年人中的发病率不断上升，导致这一人群中的心脏移植手术（HT）数量增加。然而，先天性心脏病患者面临着巨大的挑战，包括等待时间更长、早期死亡率更高以及肾功能障碍等并发症的风险增加。这篇系统性综述和荟萃分析报告对 50 项研究进行了考察，以评估与非心脏病患者相比，接受心脏移植手术的心脏病患者的等待时间、术后效果和存活率。结果显示，心脏病患者的 HT 等待时间更长（平均差 [MD]：53.86 天，95 % CI：[22.00, 85.72]，P = 0.0009），缺血时间更长（MD：20.01 分钟，95 % CI：[10.51, 29.51]，P < 0.0001），这可能会增加等待时间和术后早期死亡率。在并发症方面，冠心病患者的肾功能障碍比非冠心病患者更常见（RR：2.05，95 % CI：[1.61, 2.61]，P < 0.00001）。尽管存在这些挑战，但冠心病患者的长期生存率与非冠心病患者相当，最近的分配制度也有了显著改善。我们的研究结果表明，有必要不断完善高温热疗分配系统，以改善心脏病患者的治疗效果，尤其是在缩短等待时间和控制移植后并发症方面。

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引用次数: 0

Targeting complement in kidney transplantation: Therapeutic approaches based on preclinical and experimental evidence 靶向补体在肾移植中的应用：基于临床前和实验证据的治疗方法

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-11-22 DOI: 10.1016/j.trre.2024.100887

Daigo Nakazawa

The complement system is implicated in various facets of kidney transplantation, including ischemia-reperfusion injury (IRI), delayed graft function, allograft rejection, and chronic allograft injury. IRI, prevalent in cadaveric renal transplantation, leads to acute tubular necrosis and engages innate immunity, including neutrophils and the complement system, fostering a cycle of inflammation and necrosis. Experimental and preclinical evidence suggest that targeting the complement system could offer therapeutic benefits in IRI during kidney transplantation. This article explores potential therapeutic approaches targeting complement pathways in kidney transplantation, drawing from experimental and preclinical research findings.

补体系统涉及肾移植的各个方面，包括缺血再灌注损伤（IRI）、移植物功能延迟、同种异体移植物排斥反应和慢性同种异体移植物损伤。IRI在尸体肾移植中普遍存在，导致急性肾小管坏死，并涉及先天免疫，包括中性粒细胞和补体系统，促进炎症和坏死的循环。实验和临床前证据表明，靶向补体系统可以为肾移植期间IRI提供治疗益处。本文从实验和临床前研究结果出发，探讨了针对补体通路在肾移植中的潜在治疗方法。

引用次数: 0

Complement and complement regulatory protein in allogeneic and xenogeneic kidney transplantation 同种异体肾移植中的补体和补体调节蛋白

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-11-07 DOI: 10.1016/j.trre.2024.100885

Yoichi Kakuta , Shuji Miyagawa , Soichi Matsumura , Yoko Higa-Maegawa , Shota Fukae , Ryo Tanaka , Shigeaki Nakazawa , Kazuaki Yamanaka , Takuji Kawamura , Shunsuke Saito , Shigeru Miyagawa , Norio Nonomura

Kidney transplantation is the most optimal treatment for patients with end-stage renal disease, offering significant improvements in patient outcomes over dialysis. However, the potential for immune rejection, where the recipient's immune system attacks the transplanted kidney, can compromise transplant success. The complement system, a key component of the immune response, plays a crucial role in both acute and chronic rejection, including T-cell- and antibody-mediated rejection. Understanding and controlling the complement system is essential for managing rejection and enhancing graft survival and overall success of kidney transplantation. In allogeneic transplantation, complement activation through various pathways contributes to graft damage and failure. Recent advancements in genetic engineering enable the development of transgenic pigs expressing human complement regulatory proteins, which display potential for reducing rejection in xenotransplantation. Despite these advances, the complex mechanisms of complement activation and regulation are not fully understood, necessitating further research. This review examines the role of the complement system in kidney transplantation, explores the latest developments in complement regulatory strategies, and discusses potential therapeutic approaches to improve transplant outcomes.

肾移植是治疗终末期肾病患者的最佳方法，与透析相比，它能显著改善患者的预后。然而，潜在的免疫排斥反应（即受者的免疫系统攻击移植的肾脏）会影响移植的成功率。补体系统是免疫反应的关键组成部分，在急性和慢性排斥反应（包括 T 细胞和抗体介导的排斥反应）中发挥着至关重要的作用。了解和控制补体系统对于控制排斥反应、提高移植物存活率和肾移植的整体成功率至关重要。在异体移植中，补体通过各种途径激活会导致移植物损伤和失败。基因工程的最新进展使表达人类补体调节蛋白的转基因猪得以开发，这显示了在异种移植中减少排斥反应的潜力。尽管取得了这些进展，但人们对补体激活和调节的复杂机制还不完全了解，因此有必要开展进一步的研究。这篇综述探讨了补体系统在肾移植中的作用，探索了补体调节策略的最新进展，并讨论了改善移植结果的潜在治疗方法。

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引用次数: 0

Frailty serves as an adverse predictor for mortality in liver transplant candidates: A systematic review and meta-analysis 虚弱是肝移植候选者死亡率的不利预测因素：系统回顾和荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-10-09 DOI: 10.1016/j.trre.2024.100884

Fei Zhang , Ying Yan , Baifeng Li , Chunlin Ge

Background

Physical frailty increases susceptibility to stressors and has been associated with increased mortality among liver transplant candidates. However, evidence about this population's frailty prevalence and mortality is inconsistent and needs to be clarified. This study aimed to quantitatively synthesize the prevalence of frailty and the role of frailty on mortality in liver transplant candidates.

Methods

All eligible studies published in Embase, PubMed, Scopus, and Web of Science from inception until March 5, 2024, were included. The pooled prevalence and hazard ratio (HR) corresponding to 95 % confidence intervals (CI) in mortality estimates were conducted. The random-effects model was used for the calculations.

Results

A total of 17 studies containing 4509 patients with liver transplant waitlist candidates were included. The prevalence of frailty in liver transplant waitlist candidates was 32 % (95 % CI = 25–38; p < 0.01). In this population, frailty was associated with an increased hazard ratio for mortality (8 studies) (HR = 2.49; 95 % CI = 1.77–3.51; p < 0.01). Furthermore, subgroup analysis showed that frailty was associated with a higher mortality in the USA (HR = 4.03; 95 % CI = 1.77–3.51; p < 0.01) compared with the non-USA area (HR = 2.03; 95 % CI = 1.51–2.72; p < 0.01).

Conclusion

Our results suggest that frailty is prevalent in patients awaiting liver transplants, which strongly predicts waitlist mortality among this population. These findings highlight the importance of frailty in the decision of transplantation and in designing studies that consider frailty. Reducing the severity or impact of frailty on this population may improve prognosis.

背景身体虚弱会增加对压力的易感性，并与肝移植候选者死亡率的增加有关。然而，有关该人群体弱患病率和死亡率的证据并不一致，需要加以澄清。本研究旨在定量综合肝移植候选者的虚弱患病率以及虚弱对死亡率的影响。方法纳入从开始到2024年3月5日在Embase、PubMed、Scopus和Web of Science上发表的所有符合条件的研究。对死亡率的估计值进行了汇总，得出了与95%置信区间（CI）相对应的患病率和危险比（HR）。结果共纳入 17 项研究，包含 4509 名肝移植候选患者。肝移植候选者中体弱的发生率为 32% (95 % CI = 25-38; p < 0.01)。在这一人群中，虚弱与死亡率危险比增加有关（8 项研究）（HR = 2.49; 95 % CI = 1.77-3.51; p <0.01）。此外，亚组分析表明，与非美国地区（HR = 2.03; 95 % CI = 1.51-2.72; p <0.01）相比，美国地区的虚弱与较高的死亡率相关（HR = 4.03; 95 % CI = 1.77-3.51; p <0.01）。这些发现凸显了体弱在决定移植和设计考虑体弱的研究中的重要性。减轻虚弱的严重程度或对这一人群的影响可能会改善预后。

{"title":"Frailty serves as an adverse predictor for mortality in liver transplant candidates: A systematic review and meta-analysis","authors":"Fei Zhang , Ying Yan , Baifeng Li , Chunlin Ge","doi":"10.1016/j.trre.2024.100884","DOIUrl":"10.1016/j.trre.2024.100884","url":null,"abstract":"<div><h3>Background</h3><div>Physical frailty increases susceptibility to stressors and has been associated with increased mortality among liver transplant candidates. However, evidence about this population's frailty prevalence and mortality is inconsistent and needs to be clarified. This study aimed to quantitatively synthesize the prevalence of frailty and the role of frailty on mortality in liver transplant candidates.</div></div><div><h3>Methods</h3><div>All eligible studies published in Embase, PubMed, Scopus, and Web of Science from inception until March 5, 2024, were included. The pooled prevalence and hazard ratio (HR) corresponding to 95 % confidence intervals (CI) in mortality estimates were conducted. The random-effects model was used for the calculations.</div></div><div><h3>Results</h3><div>A total of 17 studies containing 4509 patients with liver transplant waitlist candidates were included. The prevalence of frailty in liver transplant waitlist candidates was 32 % (95 % CI = 25–38; <em>p</em> < 0.01). In this population, frailty was associated with an increased hazard ratio for mortality (8 studies) (HR = 2.49; 95 % CI = 1.77–3.51; <em>p</em> < 0.01). Furthermore, subgroup analysis showed that frailty was associated with a higher mortality in the USA (HR = 4.03; 95 % CI = 1.77–3.51; <em>p</em> < 0.01) compared with the non-USA area (HR = 2.03; 95 % CI = 1.51–2.72; <em>p</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>Our results suggest that frailty is prevalent in patients awaiting liver transplants, which strongly predicts waitlist mortality among this population. These findings highlight the importance of frailty in the decision of transplantation and in designing studies that consider frailty. Reducing the severity or impact of frailty on this population may improve prognosis.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"38 4","pages":"Article 100884"},"PeriodicalIF":3.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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

Outcomes of kidney replacement therapies after kidney transplant failure: A systematic review and meta-analysis 肾移植失败后肾脏替代疗法的结果：系统回顾和荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-10-02 DOI: 10.1016/j.trre.2024.100883

Xingge Sun , Stephen O'Neill , Helen Noble , Jia Zeng , Sarah Chanakarn Tuan , Clare McKeaveney

Background

Following kidney transplant failure, patients generally have three kidney replacement therapy (KRT) options: peritoneal dialysis (PD), haemodialysis (HD), or pre-emptive kidney re-transplantation. This review aims to explore KRT options after kidney transplant failure and compare clinical outcomes.

Method

This review included studies from five databases: Medline, PubMed, Embase, Cochrane, and CINAHL. The study protocol was registered at PROSPERO [CRD42024514346]. Causes of kidney transplant failure were explored. Survival and re-transplantation rates among three groups after kidney transplant failure were compared: patients starting PD (TX-PD group), patients starting HD (TX-HD group), and patients re-transplanted without bridging dialysis (TX-TX group). Causes of death were also explored. The quality of the included studies was assessed using the CASP checklist and the meta-analysis was assessed using the GRADE approach.

Results

Of 6405 articles, eight articles were included in the systematic review. Chronic damage was identified as the primary cause of kidney transplant failure. The TX-TX group had a lower mortality rate than the TX-HD group and TX-PD group, though this difference was only statistically significant in comparison to the TX-HD group (OR: 2.57; 95 % CI:1.58, 4.17; I² = 79 %; P = 0.0001). Additionally, the TX-PD group had a significantly lower mortality rate (OR: 0.83; 95 % CI:0.76, 0.90; I² = 88 %; P < 0.0001) and higher re-transplantation rate (OR: 1.56; 95 % CI:1.41, 1.73; I² = 0 %; P < 0.00001) compared to the TX-HD group. Cardiovascular disease, infection, and cancer were the leading causes of death.

Conclusion

The TX-TX group had better survival than the TX-HD group. Survival and re-transplantation rates were higher in the TX-PD group than the TX-HD group. However, age and comorbidities may impact survival and re-transplantation rates between the TX-PD and TX-HD groups, which should be explored further.

背景肾移植失败后，患者通常有三种肾脏替代疗法（KRT）选择：腹膜透析（PD）、血液透析（HD）或肾脏再移植术。本综述旨在探讨肾移植失败后的 KRT 选择，并比较临床结果：本综述纳入了五个数据库中的研究：Medline、PubMed、Embase、Cochrane 和 CINAHL。研究方案已在 PROSPERO [CRD42024514346] 注册。探讨了肾移植失败的原因。比较了肾移植失败后三组患者的存活率和再移植率：开始 PD 的患者（TX-PD 组）、开始 HD 的患者（TX-HD 组）和无桥接透析的再移植患者（TX-TX 组）。研究还探讨了死亡原因。采用 CASP 检查表评估了纳入研究的质量，并采用 GRADE 方法评估了荟萃分析。慢性损伤被认为是肾移植失败的主要原因。TX-TX组的死亡率低于TX-HD组和TX-PD组，但这一差异仅在与TX-HD组比较时才具有统计学意义（OR：2.57；95 % CI：1.58，4.17；I2 = 79 %；P = 0.0001）。此外，与 TX-HD 组相比，TX-PD 组的死亡率明显较低（OR：0.83；95 % CI：0.76，0.90；I2 = 88 %；P = 0.0001），再移植率较高（OR：1.56；95 % CI：1.41，1.73；I2 = 0 %；P = 0.00001）。心血管疾病、感染和癌症是死亡的主要原因。TX-PD组的存活率和再移植率均高于TX-HD组。然而，年龄和合并症可能会影响TX-PD组和TX-HD组之间的存活率和再移植率，这一点有待进一步探讨。

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引用次数: 0

Cutaneous squamous cell carcinoma in solid organ transplant recipients: Current therapeutic and screening strategies 实体器官移植受者的皮肤鳞状细胞癌：当前的治疗和筛查策略。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2024-09-25 DOI: 10.1016/j.trre.2024.100882

Ann-Kristin Struckmeier , Martin Gosau , Ralf Smeets

Solid organ transplant recipients (SOTRs) are particularly prone to developing malignancies, often manifesting multiple tumors and tumors with a heightened susceptibility to metastasis, resulting in much lower survival rates when compared to the general population. Among these, cutaneous squamous cell carcinoma (CSCC) respresent a major challenge in terms of morbidity and mortality following organ transplantation. The management of post-transplant CSCC requires expertise from various disciplines, including dermatology, maxillofacial surgery, transplant medicine, radiation oncology, and medical oncology. Furthermore, the unique behaviors and prevalence of tumors in SOTRs necessitate tailored pathways for screening and treatment, distinct from those designed for immunocompetent patients. Despite the proven efficacy of immune checkpoint inhibitors (ICIs) in several cancers, SOTRs have often been systematically excluded from clinical trials due to concerns about potential allograft rejection and loss. Consequently, most data on the safety and efficacy of ICIs in SOTRs are derived from case series and reports. Given the significant risks involved, alternative therapeutic options should be thoroughly discussed with patients before considering ICI therapy. This literature review aims to provide an overview of CSCC in SOTRs, with a specific emphasis on therapeutic and screening strategies, particularly highlighting immunotherapy.

实体器官移植受者（SOTRs）特别容易罹患恶性肿瘤，通常表现为多种肿瘤和易转移的肿瘤，导致生存率远低于普通人群。其中，皮肤鳞状细胞癌（CSCC）是器官移植后发病率和死亡率方面的一大挑战。移植后 CSCC 的治疗需要皮肤科、颌面外科、移植内科、放射肿瘤科和肿瘤内科等多个学科的专业知识。此外，SOTRs 中肿瘤的独特行为和发病率使得筛查和治疗的路径必须有别于为免疫功能正常患者设计的路径。尽管免疫检查点抑制剂（ICIs）在多种癌症中的疗效已得到证实，但由于担心潜在的异体移植排斥反应和损失，SOTR 往往被系统性地排除在临床试验之外。因此，有关 ICIs 在 SOTR 中安全性和有效性的大多数数据都来自病例系列和报告。考虑到所涉及的重大风险，在考虑使用 ICI 治疗之前，应与患者充分讨论其他治疗方案。这篇文献综述旨在概述SOTRs中的CSCC，特别强调了治疗和筛查策略，尤其突出了免疫疗法。

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引用次数: 0