Pub Date : 2026-04-01Epub Date: 2026-01-06DOI: 10.1016/j.trre.2026.101000
Andréa M. Poupard , Georgie Mullin
Primary graft dysfunction (PGD) remains the leading cause of morbidity and mortality following lung transplantation. This narrative review explores current evidence regarding pharmacological strategies for the prevention and management of PGD. A comprehensive literature search identified randomized controlled trials and clinical studies evaluating therapeutic agents targeting ischemia–reperfusion injury and inflammatory pathways. Interventions assessed include inhaled nitric oxide, surfactants, complement inhibitors, platelet-activating factor antagonists, and novel anti-inflammatory agents. Despite promising preclinical data, most trials failed to demonstrate statistically significant improvements in clinical outcomes, primarily due to small sample sizes and methodological heterogeneity. Current PGD management remains supportive and modeled on acute respiratory distress syndrome (ARDS) principles. Future research should focus on multicenter, adequately powered studies testing multimodal strategies combining pharmacologic and procedural interventions. Preventing PGD will be essential to improving early survival and long-term graft function in lung transplant recipients.
{"title":"Therapeutic agents for the prevention of primary graft dysfunction after lung transplantation: A comprehensive narrative review","authors":"Andréa M. Poupard , Georgie Mullin","doi":"10.1016/j.trre.2026.101000","DOIUrl":"10.1016/j.trre.2026.101000","url":null,"abstract":"<div><div>Primary graft dysfunction (PGD) remains the leading cause of morbidity and mortality following lung transplantation. This narrative review explores current evidence regarding pharmacological strategies for the prevention and management of PGD. A comprehensive literature search identified randomized controlled trials and clinical studies evaluating therapeutic agents targeting ischemia–reperfusion injury and inflammatory pathways. Interventions assessed include inhaled nitric oxide, surfactants, complement inhibitors, platelet-activating factor antagonists, and novel anti-inflammatory agents. Despite promising preclinical data, most trials failed to demonstrate statistically significant improvements in clinical outcomes, primarily due to small sample sizes and methodological heterogeneity. Current PGD management remains supportive and modeled on acute respiratory distress syndrome (ARDS) principles. Future research should focus on multicenter, adequately powered studies testing multimodal strategies combining pharmacologic and procedural interventions. Preventing PGD will be essential to improving early survival and long-term graft function in lung transplant recipients.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 2","pages":"Article 101000"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145936897","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}
Pub Date : 2026-04-01Epub Date: 2026-01-24DOI: 10.1016/j.trre.2026.101002
Raul Valério Ponte , Amanda Freitas Pompeu dos Santos , Maria Fernanda Moura de Lima , Priscila Ferreira de Lima Souza , João Bernardo Sancio , Lucas Ernani , Daiki Soma , Werviston De Faria , Thiago Beduschi , Estrella Bianca de Mello
Introduction
Hepatic artery thrombosis (HAT) is a leading cause of graft loss after liver transplantation. While aspirin is used for prophylaxis, its benefit is debated due to potential bleeding risks. We performed a systematic review and meta-analysis to assess the efficacy and safety of aspirin prophylaxis in liver transplant recipients.
Methods
We searched PubMed, Embase, and Cochrane Library for studies comparing aspirin prophylaxis to no aspirin. We computed risk ratios (RR) for binary outcomes, with 95% confidence intervals (CIs), and assessed heterogeneity using I2 statistics.
Results
We included five studies with 4983 patients (2299 on aspirin). Aspirin significantly reduced HAT risk (RR 0.47; 95% CI: 0.24–0.94; p = 0.03) without increasing major bleeding risk (RR 0.81; 95% CI: 0.54–1.22; p = 0.31). Graft survival was higher in the aspirin group at 1 year (RR 1.06; p = 0.003) and 5 years (RR 1.06; p < 0.0001). Aspirin also reduced the incidence of acute cellular rejection at 1 year (RR 0.71; p = 0.03).
Conclusion
Our meta-analysis suggests that aspirin prophylaxis after liver transplantation may reduce the incidence of hepatic artery thrombosis, particularly among high-risk patients, without a significant increase in major bleeding events.
肝动脉血栓形成（HAT）是肝移植术后移植物丢失的主要原因。虽然阿司匹林用于预防，但由于潜在的出血风险，其益处仍存在争议。我们进行了一项系统回顾和荟萃分析，以评估阿司匹林预防肝移植受者的有效性和安全性。方法检索PubMed、Embase和Cochrane图书馆，比较阿司匹林预防与不服用阿司匹林的研究。我们计算了二元结果的风险比（RR）， 95%置信区间（ci），并使用I2统计量评估异质性。我们纳入了5项研究，共4983例患者（2299例服用阿司匹林）。阿司匹林显著降低HAT风险（RR 0.47; 95% CI: 0.24-0.94; p = 0.03），而不增加大出血风险（RR 0.81; 95% CI: 0.54-1.22; p = 0.31）。阿司匹林组在1年（RR 1.06; p = 0.003）和5年（RR 1.06; p < 0.0001）时移植物存活率更高。阿司匹林也降低了1年后急性细胞排斥反应的发生率（RR 0.71; p = 0.03）。结论：我们的荟萃分析表明，肝移植后阿司匹林预防可以降低肝动脉血栓形成的发生率，特别是在高危患者中，而不会显著增加大出血事件。
{"title":"Use of aspirin for prevention of hepatic artery thrombosis after liver transplantation: A systematic review and meta-analysis","authors":"Raul Valério Ponte , Amanda Freitas Pompeu dos Santos , Maria Fernanda Moura de Lima , Priscila Ferreira de Lima Souza , João Bernardo Sancio , Lucas Ernani , Daiki Soma , Werviston De Faria , Thiago Beduschi , Estrella Bianca de Mello","doi":"10.1016/j.trre.2026.101002","DOIUrl":"10.1016/j.trre.2026.101002","url":null,"abstract":"<div><h3>Introduction</h3><div>Hepatic artery thrombosis (HAT) is a leading cause of graft loss after liver transplantation. While aspirin is used for prophylaxis, its benefit is debated due to potential bleeding risks. We performed a systematic review and meta-analysis to assess the efficacy and safety of aspirin prophylaxis in liver transplant recipients.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Cochrane Library for studies comparing aspirin prophylaxis to no aspirin. We computed risk ratios (RR) for binary outcomes, with 95% confidence intervals (CIs), and assessed heterogeneity using I<sup>2</sup> statistics.</div></div><div><h3>Results</h3><div>We included five studies with 4983 patients (2299 on aspirin). Aspirin significantly reduced HAT risk (RR 0.47; 95% CI: 0.24–0.94; <em>p</em> = 0.03) without increasing major bleeding risk (RR 0.81; 95% CI: 0.54–1.22; <em>p</em> = 0.31). Graft survival was higher in the aspirin group at 1 year (RR 1.06; <em>p</em> = 0.003) and 5 years (RR 1.06; <em>p</em> < 0.0001). Aspirin also reduced the incidence of acute cellular rejection at 1 year (RR 0.71; <em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>Our meta-analysis suggests that aspirin prophylaxis after liver transplantation may reduce the incidence of hepatic artery thrombosis, particularly among high-risk patients, without a significant increase in major bleeding events.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 2","pages":"Article 101002"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090390","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}
Pub Date : 2026-04-01Epub Date: 2025-12-26DOI: 10.1016/j.trre.2025.100989
Hiroshi Kagawa , Nicolas Contreras , Matthew Goodwin , Laura Frye , Sanjeev Raman , Barbara Cahill , Ramsey Hachem , Matthew Morrell , Craig H. Selzman
Even with the advances of perioperative management and surgical techniques, the outcomes of lung transplantation remain inferior to other solid organ transplantations, in part due to the high occurrence of primary graft dysfunction (PGD) which occurs in up to 30–50 % of lung transplant recipients. Ischemia-reperfusion injury (IRI) is one of the main causes of PGD. Neutrophils play an important role in the mechanism of IRI. Recent studies showed that neutrophil extracellular traps (NETs) also play an important role in development of PGD. There are also some studies about the innovative devices which can remove NETs and pathogenic cytokines. In this review, we discuss the effects of a leukocyte-depleting filter, NETs disruption with Deoxyribonuclease, NETs removal with filter (NucleoCapture), cytokine adsorption filter (CytoSorb), and neutrophil elastase inhibitor for the prevention of PGD. All of these techniques have been studied mainly in animal lung transplant models or ex vivo lung perfusion models, and have shown to have a potential to prevent PGD after clinical lung transplantation. However, clinical trials are needed to critically assess these novel therapies.
{"title":"Targeting leukocytes, neutrophil extracellular traps and cytokines: A conceptual review to prevent primary graft dysfunction after lung transplantation","authors":"Hiroshi Kagawa , Nicolas Contreras , Matthew Goodwin , Laura Frye , Sanjeev Raman , Barbara Cahill , Ramsey Hachem , Matthew Morrell , Craig H. Selzman","doi":"10.1016/j.trre.2025.100989","DOIUrl":"10.1016/j.trre.2025.100989","url":null,"abstract":"<div><div>Even with the advances of perioperative management and surgical techniques, the outcomes of lung transplantation remain inferior to other solid organ transplantations, in part due to the high occurrence of primary graft dysfunction (PGD) which occurs in up to 30–50 % of lung transplant recipients. Ischemia-reperfusion injury (IRI) is one of the main causes of PGD. Neutrophils play an important role in the mechanism of IRI. Recent studies showed that neutrophil extracellular traps (NETs) also play an important role in development of PGD. There are also some studies about the innovative devices which can remove NETs and pathogenic cytokines. In this review, we discuss the effects of a leukocyte-depleting filter, NETs disruption with Deoxyribonuclease, NETs removal with filter (NucleoCapture), cytokine adsorption filter (CytoSorb), and neutrophil elastase inhibitor for the prevention of PGD. All of these techniques have been studied mainly in animal lung transplant models or ex vivo lung perfusion models, and have shown to have a potential to prevent PGD after clinical lung transplantation. However, clinical trials are needed to critically assess these novel therapies.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 2","pages":"Article 100989"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852385","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}
Pub Date : 2026-04-01Epub Date: 2026-01-02DOI: 10.1016/j.trre.2025.100990
Keshvi Chauhan , Neetika Garg , Matthew R. Wolff , Didier A. Mandelbrot , Ravi Dhingra
Most studies concluding that living kidney donation does not increase cardiovascular risk have been conducted in low-risk cohorts. As transplant programs increasingly encounter medically complex donors, careful consideration of long-term cardiovascular risks is essential. There is significant variation among institutions in the practices regarding the selection of living donors. This comprehensive review examines the existing evidence on post-donation cardiovascular outcomes, and prevalent risk factors in the donor candidate population including older age, hypertension, prediabetes, diabetes, obesity, dyslipidemias and metabolic syndrome. The use of atherosclerotic cardiovascular risk calculators for coronary artery disease screening and medical optimization is discussed. Data on outcomes with commonly encountered electrocardiographic and echocardiographic abnormalities identified on screening tests in the donor population are essentially non-existent. To address this gap, we review the literature on their prevalence, natural history and outcomes in the general population. Extrapolating from these data, we make recommendations on risk stratification, decision-making regarding donor selection and follow up. Uncertainties in the context of living kidney donation are highlighted. This review underscores the importance of informed consent, and the need for ongoing research regarding long-term cardiovascular effects of kidney donation in higher-risk individuals.
{"title":"The cardiovascular evaluation of candidates for living kidney donation","authors":"Keshvi Chauhan , Neetika Garg , Matthew R. Wolff , Didier A. Mandelbrot , Ravi Dhingra","doi":"10.1016/j.trre.2025.100990","DOIUrl":"10.1016/j.trre.2025.100990","url":null,"abstract":"<div><div>Most studies concluding that living kidney donation does not increase cardiovascular risk have been conducted in low-risk cohorts. As transplant programs increasingly encounter medically complex donors, careful consideration of long-term cardiovascular risks is essential. There is significant variation among institutions in the practices regarding the selection of living donors. This comprehensive review examines the existing evidence on post-donation cardiovascular outcomes, and prevalent risk factors in the donor candidate population including older age, hypertension, prediabetes, diabetes, obesity, dyslipidemias and metabolic syndrome. The use of atherosclerotic cardiovascular risk calculators for coronary artery disease screening and medical optimization is discussed. Data on outcomes with commonly encountered electrocardiographic and echocardiographic abnormalities identified on screening tests in the donor population are essentially non-existent. To address this gap, we review the literature on their prevalence, natural history and outcomes in the general population. Extrapolating from these data, we make recommendations on risk stratification, decision-making regarding donor selection and follow up. Uncertainties in the context of living kidney donation are highlighted. This review underscores the importance of informed consent, and the need for ongoing research regarding long-term cardiovascular effects of kidney donation in higher-risk individuals.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 2","pages":"Article 100990"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145936907","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}
Pub Date : 2026-04-01Epub Date: 2026-01-20DOI: 10.1016/j.trre.2026.101001
Paula Etayo-Urtasun , Mikel L. Sáez de Asteasu , Mikel Izquierdo
Background
Lifelong immunosuppression is the standard care after solid organ transplantation; however, it is associated with a wide range of adverse effects. Emerging evidence indicates that structured exercise may help reduce these complications. Therefore, this review aimed to assess the effects of exercise interventions on the side effects of immunosuppressive treatment.
Methods
A systematic search was conducted in PubMed, Web of Science, and Scopus following the PRISMA 2020 guidelines (PROSPERO CRD420251078616). Randomised controlled trials (RCTs) examining post-transplant exercise interventions were included. Two reviewers independently screened studies published since 2000 using the PICOS framework and assessed their quality with the PEDro scale. Pooled analyses employed random effects models.
Results
Twenty-five RCTs involving 560 participants were included. Exercise significantly increased peak oxygen uptake (VO2peak; standardised mean difference [SMD] = 0.749, 95% confidence interval [CI]: 0.225 to 1.274, p = 0.010) and decreased body fat percentage (SMD = −0.509, 95% CI: −0.899 to −0.118, p = 0.022). No significant effects were observed on blood pressure, muscle strength, or metabolism. Evidence on bone health and immunomodulatory efficacy remains limited.
Conclusion
Exercise may partially mitigate adverse effects of immunosuppressants by improving cardiorespiratory fitness and body composition. However, gaps still exist regarding its impact on metabolic, skeletal, and immunological effects.
背景：终身免疫抑制是实体器官移植后的标准治疗；然而，它与广泛的不良反应有关。新出现的证据表明，有组织的锻炼可能有助于减少这些并发症。因此，本综述旨在评估运动干预对免疫抑制治疗副作用的影响。方法：按照PRISMA 2020指南（PROSPERO CRD420251078616）在PubMed、Web of Science和Scopus中进行系统检索。纳入了检查移植后运动干预的随机对照试验（RCTs）。两位审稿人使用PICOS框架独立筛选了自2000年以来发表的研究，并用PEDro量表评估了它们的质量。合并分析采用随机效应模型。结果：纳入25项随机对照试验，涉及560名受试者。运动显著增加峰值摄氧量（vo2峰值；标准化平均差[SMD] = 0.749, 95%可信区间[CI]: 0.225 ~ 1.274, p = 0.010），降低体脂率（SMD = -0.509, 95% CI: -0.899 ~ -0.118, p = 0.022）。没有观察到对血压、肌肉力量或新陈代谢的显著影响。关于骨骼健康和免疫调节功效的证据仍然有限。结论：运动可以通过改善心肺健康和身体成分来部分减轻免疫抑制剂的不良影响。然而，关于其对代谢、骨骼和免疫作用的影响，仍然存在空白。
{"title":"Effects of exercise on the efficacy and adverse effects of immunosuppressants: a systematic review and meta-analysis","authors":"Paula Etayo-Urtasun , Mikel L. Sáez de Asteasu , Mikel Izquierdo","doi":"10.1016/j.trre.2026.101001","DOIUrl":"10.1016/j.trre.2026.101001","url":null,"abstract":"<div><h3>Background</h3><div>Lifelong immunosuppression is the standard care after solid organ transplantation; however, it is associated with a wide range of adverse effects. Emerging evidence indicates that structured exercise may help reduce these complications. Therefore, this review aimed to assess the effects of exercise interventions on the side effects of immunosuppressive treatment.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, Web of Science, and Scopus following the PRISMA 2020 guidelines (PROSPERO CRD420251078616). Randomised controlled trials (RCTs) examining post-transplant exercise interventions were included. Two reviewers independently screened studies published since 2000 using the PICOS framework and assessed their quality with the PEDro scale. Pooled analyses employed random effects models.</div></div><div><h3>Results</h3><div>Twenty-five RCTs involving 560 participants were included. Exercise significantly increased peak oxygen uptake (VO<sub>2</sub>peak; standardised mean difference [SMD] = 0.749, 95% confidence interval [CI]: 0.225 to 1.274, <em>p</em> = 0.010) and decreased body fat percentage (SMD = −0.509, 95% CI: −0.899 to −0.118, <em>p</em> = 0.022). No significant effects were observed on blood pressure, muscle strength, or metabolism. Evidence on bone health and immunomodulatory efficacy remains limited.</div></div><div><h3>Conclusion</h3><div>Exercise may partially mitigate adverse effects of immunosuppressants by improving cardiorespiratory fitness and body composition. However, gaps still exist regarding its impact on metabolic, skeletal, and immunological effects.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 2","pages":"Article 101001"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047749","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}
Pub Date : 2026-01-01Epub Date: 2025-12-03DOI: 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。
{"title":"Inflammation in deceased kidney donors in the pre-organ retrieval period and the association with transplant outcomes: A systematic review","authors":"Annie Mae Goncalves Bullock , Ascanio Tridente , Nina C. Dempsey","doi":"10.1016/j.trre.2025.100980","DOIUrl":"10.1016/j.trre.2025.100980","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 1","pages":"Article 100980"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727891","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}
Pub Date : 2026-01-01Epub Date: 2025-11-29DOI: 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.
{"title":"Cryptococcosis in kidney transplant recipients: Pathogenesis, clinical challenges, and evolving therapeutic strategies","authors":"Yalong Zhang , Rui Yan , Hao Wang , Kangyu Wang , Jiangwei Man , Li Yang","doi":"10.1016/j.trre.2025.100979","DOIUrl":"10.1016/j.trre.2025.100979","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 1","pages":"Article 100979"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663228","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}
Pub Date : 2026-01-01Epub Date: 2025-12-16DOI: 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.
{"title":"Optimizing the timing of organ procurement from donors after brainstem death: Impact on outcomes in abdominal organ transplantation – A systematic review","authors":"Nikolaos Koliakos , Phong A. Tran , Dimitrios Papakonstantinou , Nikolaos Machairas , Hung N. Dang , Georgios C. Sotiropoulos , Dimitrios Schizas , Valerio Lucidi","doi":"10.1016/j.trre.2025.100987","DOIUrl":"10.1016/j.trre.2025.100987","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 1","pages":"Article 100987"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789599","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}
Pub Date : 2026-01-01Epub Date: 2025-12-07DOI: 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.
{"title":"The expanding frontier: Global use of DCD livers from donors over 60 years","authors":"Emmanouil Giorgakis , Paulo N. Martins , Amelia J. Hessheimer , Davide Ghinolfi , Dimitrios Moris , Anastasios Giannou , Esteban Calderon , Amit Mathur , Nigel Heaton , Andrea Schlegel","doi":"10.1016/j.trre.2025.100983","DOIUrl":"10.1016/j.trre.2025.100983","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 1","pages":"Article 100983"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717218","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}
Pub Date : 2026-01-01Epub Date: 2025-11-10DOI: 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.
{"title":"A systematic review of frailty changes following solid organ transplantation: Is it all about the frailty tool?","authors":"Kaixin Li , Trent Payne , Ross Francis , Ruth E. Hubbard , Emily H. Gordon","doi":"10.1016/j.trre.2025.100969","DOIUrl":"10.1016/j.trre.2025.100969","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Forteen studies (<em>n</em> = 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; I<sup>2</sup> = 0 %). In contrast, studies using deficit accumulation tools showed inconsistent results with high heterogeneity (MD: −0.19; 95 % CI: −1.18 to 0.79; I<sup>2</sup> = 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 1","pages":"Article 100969"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544847","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}
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