Transplantation Reviews最新文献

Optimizing the timing of organ procurement from donors after brainstem death: Impact on outcomes in abdominal organ transplantation – A systematic review 优化脑干死亡后供体器官获取的时机：对腹部器官移植结果的影响——一项系统综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-16 DOI: 10.1016/j.trre.2025.100987

Nikolaos Koliakos , Phong A. Tran , Dimitrios Papakonstantinou , Nikolaos Machairas , Hung N. Dang , Georgios C. Sotiropoulos , Dimitrios Schizas , Valerio Lucidi

Organ transplantation remains the gold-standard treatment for end-stage organ failure, with brain-dead donors being the primary source of transplantable organs. The timing of organ procurement—particularly the interval between brain death declaration and cold perfusion—has emerged as a critical factor influencing graft outcomes. This systematic review synthesizes evidence on the impact of procurement timing on liver, pancreas, and kidney transplantation outcomes. A comprehensive literature search identified six studies (196,389 patients) meeting inclusion criteria. For patients undergoing liver transplantation, longer procurement intervals (median 34.6 vs. 10.5 h) were associated with improved graft survival and reduced acute rejection. In patients undergoing pancreas transplantation, each 10-h delay correlated with a 5.6 % reduction in graft loss and a 6.3 % lower rejection risk. Studies looking into outcomes after kidney transplantation demonstrated that extended intervals (>20 h) reduced delayed graft function (DGF) in younger donors and improved long-term graft survival, without increasing rejection rates. Contrary to traditional beliefs, prolonged procurement intervals did not harm abdominal organ viability and, in some cases, enhanced outcomes, likely due to improved donor stabilization and reduced inflammatory injury. These findings suggest that transplant teams can adopt more flexible procurement timelines while maintaining graft quality. However, study heterogeneity and limited data warrant further research to refine optimal timing strategies. This review supports a paradigm shift toward individualized, organ-specific procurement protocols to maximize transplantation success.

器官移植仍然是治疗终末期器官衰竭的金标准，脑死亡供体是移植器官的主要来源。器官获取的时机，特别是脑死亡宣告和冷灌注之间的时间间隔，已成为影响移植结果的关键因素。本系统综述综合了采购时间对肝脏、胰腺和肾脏移植结果影响的证据。综合文献检索发现6项研究（196389例患者）符合纳入标准。对于接受肝移植的患者，较长的获取间隔（中位数为34.6比10.5小时）与移植物存活率的提高和急性排斥反应的减少相关。在接受胰腺移植的患者中，每延迟10小时，移植物损失减少5.6%，排斥风险降低6.3%。对肾移植后预后的研究表明，延长移植间隔（20小时）可降低年轻供者的延迟移植功能（DGF），提高移植的长期存活率，且不增加排异率。与传统观点相反，延长采收间隔并不会损害腹部器官的活力，在某些情况下，可能是由于供体稳定性的提高和炎症损伤的减少，结果得到了改善。这些发现表明，移植团队可以在保持移植物质量的同时采用更灵活的采购时间表。然而，由于研究的异质性和有限的数据，需要进一步的研究来完善最佳的时间策略。本综述支持向个性化、器官特异性采购方案的范式转变，以最大限度地提高移植成功率。

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引用次数: 0

The role of natural killer cells in the immune response after liver transplantation 自然杀伤细胞在肝移植后免疫应答中的作用。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-15 DOI: 10.1016/j.trre.2025.100986

Zhi-Cheng Gao , Hui Wan , Guan-Yue Shan , Yu-Xin Zhang , Zi-Jun Sun , Yun-Peng Shi , Hai-Jun Li

Natural killer (NK) cells are crucial components of the innate immune system and are abundantly present in the liver, a unique immune organ frequently subjected to clinical transplantation. NK cells regulate their functional state through a finely tuned balance between activating and inhibitory receptors, allowing them to eliminate target cells independently of major histocompatibility complex class I (MHC-I) restriction. In the context of liver transplantation, NK cells respond dynamically to ischemia-reperfusion injury, donor-recipient immune mismatch and immunosuppressive treatments, thereby influencing graft acceptance, rejection and infection control. Activated NK cells release a broad range of cytokines and chemokines, shaping both innate and adaptive immune responses. This review highlights the multifaceted roles of NK cells in transplant immunity, emphasizes their clinical and translational significance, and summarizes emerging therapeutic strategies that target NK cells. Collectively, it provides insights into NK cell biology and underscores their potential in improving long-term outcomes after liver transplantation.

自然杀伤细胞（NK）是先天免疫系统的重要组成部分，大量存在于肝脏中，肝脏是一个独特的免疫器官，经常受到临床移植的影响。NK细胞通过激活和抑制受体之间的精细平衡来调节其功能状态，使它们能够独立于主要组织相容性复合体I类（MHC-I）的限制来消除靶细胞。在肝移植中，NK细胞对缺血再灌注损伤、供受体免疫错配和免疫抑制治疗有动态反应，从而影响移植物的接受、排斥和感染控制。活化的NK细胞释放广泛的细胞因子和趋化因子，形成先天和适应性免疫反应。这篇综述强调了NK细胞在移植免疫中的多方面作用，强调了它们的临床和翻译意义，并总结了针对NK细胞的新兴治疗策略。总的来说，它提供了NK细胞生物学的见解，并强调了它们在改善肝移植后长期预后方面的潜力。

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引用次数: 0

Global epidemiology and determinants of autoimmune hepatitis recurrence post- liver transplantation: A systematic review and meta-analysis 肝移植后自身免疫性肝炎复发的全球流行病学和决定因素：系统回顾和荟萃分析。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-12 DOI: 10.1016/j.trre.2025.100984

Wellgner Fernandes Oliveira Amador , Isabelle Castro Vitor , Milena Ramos Tomé , Igor Boechat Silveira , Marina de Assis Bezerra Cavalcanti Leite , Pedro Robson Costa Passos , Valbert Oliveira Costa Filho , Mariana Macambira Noronha , Yohanna Idsabella Rossi , Rodrigo Vieira Motta , Guilherme Grossi Lopes Cançado

Autoimmune hepatitis (AIH) recurrence after liver transplantation (LT) compromises graft function and outcomes. Evidence on risk factors is heterogeneous. We assessed recurrence rates and patient-, immunological-, clinical-, and donor-related predictors. A systematic review and meta-analysis of observational studies of LT recipients with AIH was conducted. PubMed, Embase, and CENTRAL were searched. Outcomes were recurrence incidence and associated risk factors. Random-effects models were fitted in R, with pooled proportions, odds ratios (ORs), and mean differences (MDs). Thirty-nine studies (n = 2600) met inclusion criteria. The pooled recurrence proportion was 21 % (95 %CI, 18 to 25 %). Recurrence was more frequent in children than adults (31 % vs 21 %; p-interaction = 0.03). Younger age was associated with recurrence (MD, −6.60 years; 95 %CI, −11.43 to −1.76). Acute rejection (OR, 1.92; 95 %CI, 1.11 to 3.31) and chronic rejection (OR, 2.64; 95 %CI, 0.99 to 6.99) were significant predictors. No significant associations were observed for sex, MELD score, AIH subtype, HLA-DR3/DR4 status, primary calcineurin inhibitor (tacrolimus vs cyclosporine), or donor type. Overall, one in five LT recipients with AIH experience recurrence, with a higher burden in pediatric and younger patients. Younger age and prior acute or chronic rejection confer the greatest risk. Targeted monitoring and tailored immunosuppression may help mitigate recurrence.

肝移植（LT）后自身免疫性肝炎（AIH）复发损害移植物功能和预后。关于危险因素的证据各不相同。我们评估了复发率和患者、免疫学、临床和供体相关的预测因素。对肝移植患者AIH的观察性研究进行了系统回顾和荟萃分析。检索PubMed， Embase和CENTRAL。结果是复发率和相关危险因素。随机效应模型用R进行拟合，采用合并比例、优势比（ORs）和平均差异（MDs）。39项研究（n = 2600）符合纳入标准。合并复发率为21% （95% CI, 18 ~ 25%）。儿童的复发率高于成人（31% vs 21%； p-相互作用= 0.03）。较年轻的年龄与复发相关（MD, -6.60年；95% CI, -11.43至-1.76）。急性排斥反应（OR, 1.92; 95% CI, 1.11 ~ 3.31）和慢性排斥反应（OR, 2.64; 95% CI, 0.99 ~ 6.99）是显著的预测因子。性别、MELD评分、AIH亚型、HLA-DR3/DR4状态、原发钙调磷酸酶抑制剂（他克莫司vs环孢素）或供体类型均未观察到显著相关性。总体而言，五分之一的AIH肝移植患者经历复发，儿科和年轻患者的负担更高。年龄较小和既往的急性或慢性排斥反应是最大的风险因素。有针对性的监测和量身定制的免疫抑制可能有助于减轻复发。

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引用次数: 0

Research progress on the complement system in ischemia-reperfusion injury of organ transplantation 补体系统在器官移植缺血再灌注损伤中的研究进展。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-11 DOI: 10.1016/j.trre.2025.100981

Cheng Zhang , Kun Dong , Junze Chen , Guanmiao Chen , Chunqiang Dong

Ischemia-reperfusion injury (IRI) critically affects graft survival following organ transplantation, where complement activation mediates the inflammation, endothelial damage, and adaptive immune responses. This review synthesizes the mechanisms through which the classical, lectin, and alternative complement pathways drive organ-specific IRI pathophysiology by generating anaphylatoxins (C3a/C5a) and membrane attack complexes (C5b-9). Specifically, locally synthesized C3 predominates in renal tubular injury, hepatic C3a/C5a paradoxically promote regeneration while exacerbating inflammation, cardiac C4d/C3d deposits correlate with rejection, and lectin pathway activation (notably via mannose-binding lectin, MBL) underlies primary graft dysfunction (PGD) in lung transplantation. Advances in therapeutic research highlight the values of complement inhibitors, including anti-C5 agents (e.g., eculizumab) that mitigate delayed graft function (DGF) in kidney transplantation, C1 esterase inhibitors that attenuate IRI and antibody-mediated rejection (AMR), C5a receptor antagonists (e.g., PMX53) that extend graft survival in preclinical models, and soluble complement receptor 1 (sCR1) that alleviates multi-organ IRI. Future research should focus on optimizing organ-specific targeting strategies, validating the long-term efficacy and safety of these agents via clinical trials, and exploring synergistic immunomodulatory approaches to further improve transplantation outcomes.

缺血再灌注损伤（IRI）严重影响器官移植后移植物的存活，其中补体激活介导炎症、内皮损伤和适应性免疫反应。本文综述了经典、凝集素和替代补体途径通过产生过敏毒素（C3a/C5a）和膜攻击复合物（C5b-9）驱动器官特异性IRI病理生理的机制。具体来说，局部合成的C3在肾小管损伤中占主导地位，肝脏C3a/C5a矛盾地促进再生，同时加剧炎症，心脏C4d/C3d沉积与排斥反应相关，凝集素途径激活（特别是通过甘露糖结合凝集素，MBL）是肺移植中原发性移植物功能障碍（PGD）的基础。治疗研究的进展突出了补体抑制剂的价值，包括抗c5药物（如eculizumab），减轻肾移植中的延迟移植功能（DGF）， C1酯酶抑制剂，减轻IRI和抗体介导的排斥反应（AMR）， C5a受体拮抗剂（如PMX53），延长临床前模型中的移植物存活，可溶性补体受体1 (sCR1)，减轻多器官IRI。未来的研究应侧重于优化器官特异性靶向策略，通过临床试验验证这些药物的长期疗效和安全性，并探索协同免疫调节方法以进一步改善移植结果。

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引用次数: 0

The expanding frontier: Global use of DCD livers from donors over 60 years 不断扩大的前沿：全球使用60岁以上捐赠者的DCD肝脏。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-07 DOI: 10.1016/j.trre.2025.100983

Emmanouil Giorgakis , Paulo N. Martins , Amelia J. Hessheimer , Davide Ghinolfi , Dimitrios Moris , Anastasios Giannou , Esteban Calderon , Amit Mathur , Nigel Heaton , Andrea Schlegel

Liver transplant (LT) waitlists keep growing globally. Simultaneously, donation after circulatory death (DCD) LT has evolved from a marginal to a mainstream practice, now representing a vital strategy to expand the donor pool. Historically, livers from older DCD donors (≥60 years) were regarded as high risk due to concerns about post-transplant cholangiopathy, primary non-function, and poorer long-term survival. These risks led many centers to exclude grafts from older DCD donors. Nonetheless, the adoption of dynamic preservation technologies, including in situ normothermic regional perfusion, ex situ normothermic machine perfusion, and ex situ hypothermic oxygenated perfusion modalities, has fundamentally altered this risk-benefit calculus. Contemporary data from national and multicenter registries demonstrate that older DCD grafts can reach patient and graft survival rates comparable to those of younger DCD and donation after brain death livers when dynamically recovered and/or preserved. The United Kingdom and Spain have led this growth, routinely transplanting donors in their 60s and 70s. Italy has pushed boundaries further with the successful use of nonagenarian donors under sequential perfusion protocols. The United States, historically hesitant with older DCDs, has rapidly adopted them since 2020, driven by the approval of machine perfusion and changes in organ allocation. These worldwide trends underscore a fundamental shift: advanced age alone is no longer a definitive barrier to DCD LT when combined with advanced preservation, graft assessment, and careful recipient selection.

肝移植（LT）等待名单在全球范围内不断增长。与此同时，循环死亡后捐赠已从边缘做法演变为主流做法，现在是扩大供体库的一项重要战略。从历史上看，年龄较大的DCD供者（≥60岁）的肝脏被认为是高风险的，因为担心移植后胆管病变、原发性无功能和较差的长期生存。这些风险导致许多中心排除老年DCD供者的移植。然而，动态保存技术的采用，包括原位恒温区域灌注、非原位恒温机器灌注和非原位低温氧灌注模式，从根本上改变了这种风险-收益计算。来自国家和多中心登记的最新数据表明，在动态恢复和/或保存后，老年DCD移植物的患者和移植物存活率可以达到与年轻DCD和脑死亡后捐赠的患者和移植物存活率相当。英国和西班牙引领了这一增长趋势，它们通常会在六七十岁时移植捐赠者。意大利进一步突破了界限，成功地使用了顺序灌注方案下的90多岁捐赠者。美国历来对老式dcd犹豫不决，自2020年以来，在机器灌注批准和器官分配变化的推动下，美国迅速采用了dcd。这些世界范围的趋势强调了根本性的转变：当结合先进的保存、移植物评估和仔细的受体选择时，高龄不再是DCD LT的决定性障碍。

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引用次数: 0

The impact of immunosuppression withdrawal strategies on sensitization and safety outcomes after kidney transplant failure: A systematic review with meta-analysis 免疫抑制停药策略对肾移植失败后致敏性和安全性结果的影响：一项系统综述和荟萃分析。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-04 DOI: 10.1016/j.trre.2025.100982

Pedro Fragoso , Andreia Borges , Francisco Caramelo , Helena Oliveira Sá , Arnaldo Figueiredo , Rui Alves , Rita Leal

Background

Kidney transplant recipients with graft failure face reduced access to retransplantation due to sensitization. Evidence-based guidance on optimal immunosuppression (IS) management after graft loss is limited. This systematic review with meta-analysis assessed the impact of rapid versus prolonged IS withdrawal on sensitization and safety outcomes.

Methods

Cohort studies comparing IS withdrawal strategies after graft failure were systematically reviewed. Outcomes included HLA sensitization, graft nephrectomy, hospitalization, and mortality. Searches were conducted in Medline, Embase, and the Cochrane Library. Pooled odds ratios (ORs) and weighted mean differences (WMD) were calculated using a random-effects model.

Results

Thirteen studies comprising 1531 patients were included. Prolonging immunosuppression (>3 months of at least two immunosuppressants) was associated with significantly lower odds of graft exclusion (OR 0.41; 95 % CI 0.27–0.64), and a trend toward reduced donor-specific antibody formation and cPRA stabilization, although not statistically significant. Sensitivity analysis confirmed an association between early IS withdrawal and higher cPRA at follow-up (WMD +0.30, 0.01–0.59). The IS withdrawal strategy did not impact hospitalization, mortality, or retransplantation.

Conclusion

Prolonging IS after kidney graft failure reduces nephrectomy risk and favours a decrease in HLA sensitization, without added morbidity and mortality. Further prospective studies are warranted to provide stronger evidence-based data.

背景：肾移植失败的受者由于致敏性降低了再移植的机会。基于证据的移植物丢失后最佳免疫抑制（IS）管理指导是有限的。本系统综述和荟萃分析评估了快速和长期停药对致敏性和安全性结果的影响。方法：系统回顾比较移植失败后IS退出策略的队列研究。结果包括HLA致敏、移植肾切除术、住院和死亡率。在Medline、Embase和Cochrane图书馆进行了检索。采用随机效应模型计算合并优势比（ORs）和加权平均差（WMD）。结果：纳入13项研究，1531例患者。延长免疫抑制（至少使用两种免疫抑制剂3个月）与移植物排斥几率显著降低相关（OR 0.41; 95% CI 0.27-0.64），并有减少供体特异性抗体形成和cPRA稳定的趋势，尽管没有统计学意义。敏感性分析证实早期IS戒断与随访时较高的cPRA之间存在关联（WMD +0.30, 0.01-0.59）。IS退出策略不影响住院、死亡率或再移植。结论：肾移植失败后延长IS可降低肾切除术风险，有利于降低HLA敏化，未增加发病率和死亡率。进一步的前瞻性研究有必要提供更有力的循证数据。

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引用次数: 0

Inflammation in deceased kidney donors in the pre-organ retrieval period and the association with transplant outcomes: A systematic review 器官移植前死亡肾脏供者的炎症及其与移植结果的关系：一项系统综述。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-03 DOI: 10.1016/j.trre.2025.100980

Annie Mae Goncalves Bullock , Ascanio Tridente , Nina C. Dempsey

Systemic hyper-inflammation is an established cause of organ dysfunction, evidenced by the multi-organ failure observed in sepsis. Similarly, the process of death invokes a complex set of events leading to profound hyper-inflammation. It is reasonable to infer that in deceased organ donors, death-induced hyperinflammation could have significant consequences for organs being offered for transplant. This systematic review aimed to; 1) clarify what is currently known about the sources of inflammation following death, and 2) systematically review the current body of evidence reporting levels of inflammation in deceased donors and living donors and linking donor inflammation with kidney transplant outcome. The systematic review was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 8. We searched the Medline, Web of Science, Scopus and CINHAL databases from January 2000 to March 2023 for articles relating donor inflammation with kidney transplant outcomes. The National Institute of Health ‘Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies’ was used to assess validity of studies. Twenty-one studies were analysed, collectively totalling 3397 donors and 4596 recipients. A high degree of heterogeneity in inflammatory markers and transplant outcomes studied existed between studies, yet collective evidence showed higher inflammation, complement activation, and tissue injury in deceased donors compared with living donors, and strongly suggested associations with poorer short- and long-term transplant outcomes.

全身过度炎症是器官功能障碍的一个确定的原因，在败血症中观察到的多器官衰竭证明了这一点。同样，死亡的过程会引发一系列复杂的事件，导致严重的高度炎症。我们有理由推断，在已故的器官供者中，死亡引起的过度炎症可能对供移植的器官产生重大影响。本系统综述旨在；1)澄清目前已知的死亡后炎症的来源，2)系统地回顾目前报告死亡供体和活体供体炎症水平的证据，并将供体炎症与肾移植结果联系起来。系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行8。从2000年1月到2023年3月，我们检索了Medline、Web of Science、Scopus和CINHAL数据库，查找供体炎症与肾移植结果相关的文章。使用美国国立卫生研究院的“观察性队列和横断面研究质量评估工具”来评估研究的有效性。分析了21项研究，总共有3397名捐赠者和4596名接受者。研究之间存在炎症标志物和移植结果的高度异质性，但集体证据表明，与活体供体相比，死亡供体的炎症、补体激活和组织损伤更高，并强烈提示与较差的短期和长期移植结果相关。

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引用次数: 0

Cryptococcosis in kidney transplant recipients: Pathogenesis, clinical challenges, and evolving therapeutic strategies 肾移植受者的隐球菌病：发病机制、临床挑战和不断发展的治疗策略。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-11-29 DOI: 10.1016/j.trre.2025.100979

Yalong Zhang , Rui Yan , Hao Wang , Kangyu Wang , Jiangwei Man , Li Yang

With the widespread use of immunosuppressants and improved post-transplant survival, cryptococcosis has become a consequential opportunistic infection in kidney transplant recipients. This review synthesizes recent advances in epidemiology, pathogenesis, clinical presentation, diagnostics, treatment, and prognosis. Kidney transplant–associated cryptococcosis often presents insidiously, is prone to central nervous system involvement, and carries substantial risks of mortality and allograft loss. The adoption of rapid cryptococcal antigen lateral flow assays, broader access to liposomal amphotericin B, and individualized adjustments of immunosuppression have improved outcomes; however, challenges persist, including relapse, drug toxicities, and immune reconstitution inflammatory syndrome. We summarize current evidence and outline priorities for research and clinical practice, aiming to support timely diagnosis and optimized, phase-based antifungal strategies in this high-risk population.

随着免疫抑制剂的广泛使用和移植后生存率的提高，隐球菌病已成为肾移植受者的一种重要的机会性感染。本文综述了近年来在流行病学、发病机制、临床表现、诊断、治疗和预后方面的最新进展。肾移植相关隐球菌病通常表现不明显，容易累及中枢神经系统，并有很大的死亡率和移植物丧失的风险。采用快速隐球菌抗原侧流检测、广泛使用两性霉素B脂质体和个体化免疫抑制调整改善了结果；然而，挑战依然存在，包括复发、药物毒性和免疫重建炎症综合征。我们总结了目前的证据，并概述了研究和临床实践的重点，旨在支持这一高危人群的及时诊断和优化的、基于阶段的抗真菌策略。

引用次数: 0

A systematic review of frailty changes following solid organ transplantation: Is it all about the frailty tool? 对实体器官移植后衰弱变化的系统回顾：是否都与衰弱工具有关？

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-11-10 DOI: 10.1016/j.trre.2025.100969

Kaixin Li , Trent Payne , Ross Francis , Ruth E. Hubbard , Emily H. Gordon

Introduction

Frailty is increasingly recognized among patients with advanced organ disease (AOD). Solid organ transplantation (SOT) improves survival rates of patients with AOD and also impacts frailty status. However, there is considerable heterogeneity in frailty changes post-SOT reported in the literature. This study aims to determine whether the type of frailty tool contributes to heterogeneity in frailty outcomes after transplantation.

Methods

We searched PubMed, Embase, MEDLINE, Scopus, and Web of Science up to 1 August 2025 for studies assessing frailty before and after SOT in adults. Frailty tools were classified as phenotypic or deficit accumulation tools. Meta-analyses were conducted on baseline prevalence and changes in prevalence, with subgroup analyses by tool type and organ type. Narrative synthesis described changes in frailty scores, state transitions, and domain-specific outcomes across early, intermediate, and late post-transplant stages.

Results

Forteen studies (n = 3443) were included. Overall, phenotypic tools consistently captured reductions in frailty prevalence during the intermediate stage (6–12 months) post-transplant (mean difference, MD: −0.09; 95 % CI: −0.12 to −0.07; I² = 0 %). In contrast, studies using deficit accumulation tools showed inconsistent results with high heterogeneity (MD: −0.19; 95 % CI: −1.18 to 0.79; I² = 96.9 %). The organ-specific subgroup analysis revealed substantial heterogeneity within organ groups. Improvements in frailty scores and transitions to non-frail states were more frequently observed with the phenotypic tools with physical domains such as grip strength and activity improvement, while some deficit accumulation tools demonstrated deterioration.

Conclusions

Phenotypic frailty tools consistently detect improvements during intermediate post-SOT recovery, while deficit accumulation tools yield variable findings, highlighting the importance of appropriate frailty tool choice.

在晚期器官疾病（AOD）患者中越来越多地认识到虚弱。实体器官移植（SOT）提高了AOD患者的生存率，也影响了虚弱状态。然而，文献中报道的sot后的虚弱变化存在相当大的异质性。本研究旨在确定衰弱工具的类型是否会导致移植后衰弱结果的异质性。方法：我们检索了PubMed、Embase、MEDLINE、Scopus和Web of Science，检索了截至2025年8月1日评估成人SOT前后衰弱的研究。脆弱性工具分为表型工具和缺陷积累工具。对基线患病率和患病率变化进行了荟萃分析，并按工具类型和器官类型进行了亚组分析。叙述性综合描述了移植后早期、中期和晚期虚弱评分、状态转换和特定领域结果的变化。结果：纳入14项研究（n = 3443）。总体而言，表型工具一致捕获移植后中期（6-12个月）虚弱患病率的减少（平均差异，MD: -0.09; 95% CI: -0.12至-0.07;I2 = 0%）。相比之下，使用赤字积累工具的研究结果不一致，异质性高（MD: -0.19; 95% CI: -1.18至0.79;I2 = 96.9%）。器官特异性亚组分析揭示了器官组内的实质性异质性。虚弱评分的改善和向非虚弱状态的转变更常被观察到，表型工具具有物理领域，如握力和活动的改善，而一些缺陷积累工具则表现出恶化。结论：表型脆弱性工具一致地检测到sot后中期恢复的改善，而缺陷积累工具产生不同的结果，强调了适当的脆弱性工具选择的重要性。

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引用次数: 0

Late-onset pneumocystis pneumonia after kidney transplantation: A systematic review and meta-analysis of prevalence, risk factors, and outcomes 肾移植后迟发性肺囊虫肺炎：患病率、危险因素和结局的系统回顾和荟萃分析。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-11-07 DOI: 10.1016/j.trre.2025.100972

Sirihatai Konwai , Chanyanuch Rakpithayanon , Thunyatorn Wuttiputhanun , Asada Leelahavanichkul , Natavudh Townamchai , Jakapat Vanichanan , Kamonwan Jutivorakool , Yingyos Avihingsanon , Kearkiat Praditpornsilpa , Suwasin Udomkarnjananun

Background

Late-onset Pneumocystis jirovecii pneumonia (PCP) is increasingly recognized in kidney transplant recipients (KTRs) despite widespread prophylaxis. However, its prevalence and risk factors remain unclear.

Methods

We systematically searched electronic databases for studies published up to May 1, 2025, that reported prevalence or risk factors of late-onset PCP. Pooled prevalence, weighted mean differences (WMDs), and pooled odds ratios (ORs) were synthesized using a random-effects model.

Results

Of 1448 studies screened, 24 met inclusion criteria, comprising 57,662 KTRs, of whom 556 developed late-onset PCP. The pooled prevalence was 1.28 % (95 %CI 0.90–1.65). Lymphocyte counts were significantly lower in the infection group (WMD –408.34 cells/μL; 95 %CI –706.03 to −110.66). Risk was significantly increased with ABO-incompatible transplantation (OR 4.12; 95 %CI 1.04–16.30), rituximab induction (OR 4.77; 95 %CI, 1.50–15.21), corticosteroid (OR 2.56; 95 %CI 1.00–6.52) or mammalian target of rapamycin inhibitor (mTORi) maintenance (OR 2.37; 95 %CI 1.27–4.42), CMV infection (OR 5.21; 95 %CI 2.45–11.10), and rejection episodes (OR 2.93; 95 %CI 1.72–4.99), particularly when treated with plasma exchange, intravenous methylprednisolone, or rituximab. In contrast, cotrimoxazole prophylaxis reduced risk (OR 0.06; 95 %CI 0.01–0.60). Late-onset PCP was associated with graft loss (OR 6.11; 95 %CI 2.98–12.55) and mortality (OR 10.48; 95 %CI 1.92–57.16).

Conclusions

Although uncommon, late-onset PCP in KTRs is strongly linked with ABO-incompatible transplantation, lack of cotrimoxazole prophylaxis, lymphopenia, CMV infection, corticosteroid and mTORi, and rejection. KTRs with these high-risk features, including those receiving mTORi and corticosteroid maintenance, should be considered for prolonged or life-long PCP prophylaxis.

背景：迟发性肺囊虫肺炎（PCP）越来越多地在肾移植受者（KTRs）中得到认可，尽管广泛的预防。然而，其流行程度和危险因素仍不清楚。方法：我们系统地检索了电子数据库中截至2025年5月1日发表的关于迟发性PCP患病率或危险因素的研究。合并患病率、加权平均差异（wmd）和合并优势比（ORs）采用随机效应模型进行综合。结果：在筛选的1448项研究中，24项符合纳入标准，包括57,662例ktr，其中556例发展为晚发性PCP。合并患病率为1.28% （95% CI 0.90-1.65）。感染组淋巴细胞计数明显降低（WMD为-408.34 cells/μL； 95% CI为-706.03 ~ -110.66）。abo血型不相容移植（OR 4.12; 95% CI 1.04-16.30）、利妥昔单抗诱导（OR 4.77; 95% CI 1.50-15.21）、皮质类固醇（OR 2.56; 95% CI 1.00-6.52）或哺乳动物雷帕霉素靶抑制剂（mTORi）维持（OR 2.37; 95% CI 1.27-4.42）、巨细胞病毒感染（OR 5.21; 95% CI 2.45-11.10）和排斥事件（OR 2.93; 95% CI 1.72-4.99），尤其是当接受血浆交换、静脉注射甲基泼尼松龙或利妥昔单抗治疗时，风险显著增加。相反，复方新诺明预防可降低风险（OR 0.06; 95% CI 0.01-0.60）。晚发性PCP与移植物丢失（OR 6.11; 95% CI 2.98-12.55）和死亡率（OR 10.48; 95% CI 1.92-57.16）相关。结论：虽然不常见，但KTRs的晚发性PCP与abo血型不相容移植、缺乏复方新诺明预防、淋巴细胞减少、巨细胞病毒感染、皮质类固醇和mTORi以及排斥反应密切相关。具有这些高风险特征的ktr患者，包括那些接受mTORi和皮质类固醇维持治疗的患者，应考虑长期或终身预防PCP。

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