Pub 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":"2025-11-29","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 : 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":"2025-11-10","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}
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。
{"title":"Late-onset pneumocystis pneumonia after kidney transplantation: A systematic review and meta-analysis of prevalence, risk factors, and outcomes","authors":"Sirihatai Konwai , Chanyanuch Rakpithayanon , Thunyatorn Wuttiputhanun , Asada Leelahavanichkul , Natavudh Townamchai , Jakapat Vanichanan , Kamonwan Jutivorakool , Yingyos Avihingsanon , Kearkiat Praditpornsilpa , Suwasin Udomkarnjananun","doi":"10.1016/j.trre.2025.100972","DOIUrl":"10.1016/j.trre.2025.100972","url":null,"abstract":"<div><h3>Background</h3><div>Late-onset <em>Pneumocystis jirovecii</em> pneumonia (PCP) is increasingly recognized in kidney transplant recipients (KTRs) despite widespread prophylaxis. However, its prevalence and risk factors remain unclear.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 1","pages":"Article 100972"},"PeriodicalIF":3.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491378","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 : 2025-11-03DOI: 10.1016/j.trre.2025.100971
Michael Corr , Nawal Khan , Dessi Malinova , Alexander P. Maxwell , Gareth J. McKay , Matthew D. Griffin
Kidney transplantation provides the best survival advantage for children, adolescents, and young adults with end-stage kidney disease, yet this group paradoxically experiences the poorest long-term graft survival. Immune-mediated rejection is the predominant cause, but the cellular mechanisms that underpin this age-related disparity remain incompletely defined. This review synthesises current evidence on the impact of immune ageing across adaptive and innate compartments, focusing on T cells, B cells, and natural killer (NK) cells. In younger recipients, a large naïve T- and B-cell pool, robust thymic output, and efficient germinal centre activity confer heightened alloimmune reactivity, driving increased risk of acute cellular and antibody-mediated rejection. In contrast, older recipients exhibit features of immunosenescence, including loss of CD28 expression, accumulation of terminally differentiated effector subsets, impaired germinal centre responses, and attenuated NK cytotoxicity, resulting in diminished capacity to mount de novo responses but greater vulnerability to infection. These immune trajectories have direct clinical implications: younger recipients may require intensified, mechanism-targeted immunosuppression, whereas older recipients may be more amenable to minimisation or tolerance protocols. We further highlight emerging evidence for premature immunosenescence in paediatric dialysis populations, the contribution of age-associated B cells and NK subsets, and the role of immunophenotype-guided therapeutic strategies. Current uniform immunosuppression protocols inadequately account for developmental and age-related immune heterogeneity. We argue for an age- and immune phenotype–informed approach to therapy, integrating longitudinal immune profiling, biomarker development, and systems immunology to improve risk stratification, promote tolerance, and ultimately extend allograft survival across all age groups.
{"title":"Immune cell subsets in young kidney transplant recipients: Mechanistic and clinical perspectives","authors":"Michael Corr , Nawal Khan , Dessi Malinova , Alexander P. Maxwell , Gareth J. McKay , Matthew D. Griffin","doi":"10.1016/j.trre.2025.100971","DOIUrl":"10.1016/j.trre.2025.100971","url":null,"abstract":"<div><div>Kidney transplantation provides the best survival advantage for children, adolescents, and young adults with end-stage kidney disease, yet this group paradoxically experiences the poorest long-term graft survival. Immune-mediated rejection is the predominant cause, but the cellular mechanisms that underpin this age-related disparity remain incompletely defined. This review synthesises current evidence on the impact of immune ageing across adaptive and innate compartments, focusing on T cells, B cells, and natural killer (NK) cells. In younger recipients, a large naïve T- and B-cell pool, robust thymic output, and efficient germinal centre activity confer heightened alloimmune reactivity, driving increased risk of acute cellular and antibody-mediated rejection. In contrast, older recipients exhibit features of immunosenescence, including loss of CD28 expression, accumulation of terminally differentiated effector subsets, impaired germinal centre responses, and attenuated NK cytotoxicity, resulting in diminished capacity to mount de novo responses but greater vulnerability to infection. These immune trajectories have direct clinical implications: younger recipients may require intensified, mechanism-targeted immunosuppression, whereas older recipients may be more amenable to minimisation or tolerance protocols. We further highlight emerging evidence for premature immunosenescence in paediatric dialysis populations, the contribution of age-associated B cells and NK subsets, and the role of immunophenotype-guided therapeutic strategies. Current uniform immunosuppression protocols inadequately account for developmental and age-related immune heterogeneity. We argue for an age- and immune phenotype–informed approach to therapy, integrating longitudinal immune profiling, biomarker development, and systems immunology to improve risk stratification, promote tolerance, and ultimately extend allograft survival across all age groups.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 1","pages":"Article 100971"},"PeriodicalIF":3.6,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145442533","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 : 2025-11-02DOI: 10.1016/j.trre.2025.100970
Kristen D. Belfield , Krysta Walter , Jennifer E. Marvin , Ryan W. Bonner , Rebecca B. Carlson , Kristen R. Szempruch
Introduction
Current methods of estimating glomerular filtration rate (eGFR) are commonly based on serum creatinine (SCr); however, cystatin C (CysC)-based methods have recently become more available with increased uptake of CysC testing. Currently, there is a gap in literature reviewing the use of CysC in non-kidney transplant recipients. The aim of this literature review is to evaluate the use of CysC in the assessment of GFR in non-kidney transplant recipients.
Methods
Electronic databases Embase, PubMed, Cumulative Index for Nursing and Allied Health Literature, ClinicalTrials.gov, and EU Clinical Trials Register were searched.
Results
Of the 487 unique citations, 11 were included (eight liver, two lung, and one heart transplant). Five liver transplant studies found a better prognostic parameter or correlation to measured GFR with CysC based equations, and two liver and two lung transplant studies found the combined Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFRSCr-CysC equation demonstrated higher correlation, accuracy, or performance than with either SCr or CysC-based equations.
Conclusion
The inclusion of CysC-based eGFR measurements, in particular the 2012 and 2021 CKD-EPI eGFRSCr-CysC equation, for GFR assessment overall correlated with the control assessments more than its comparators in non-kidney transplant recipients while maintaining accuracy.
目前估计肾小球滤过率（eGFR）的方法通常基于血清肌酐（SCr）；然而，基于胱抑素C （CysC）的方法最近随着CysC检测的增加而变得更加可行。目前，关于CysC在非肾移植受者中的应用的文献综述存在空白。本文献综述的目的是评估CysC在评估非肾移植受者GFR中的应用。方法检索Embase、PubMed、Nursing and Allied Health Literature Cumulative Index、ClinicalTrials.gov和EU ClinicalTrials Register等电子数据库。结果487例文献引用中，有11例文献被引用（8例肝移植，2例肺移植，1例心脏移植）。五项肝移植研究发现基于CysC的方程与测量的GFR有更好的预后参数或相关性，两项肝和两项肺移植研究发现慢性肾脏疾病流行病学合作（CKD-EPI）联合egfrcr -CysC方程比基于SCr或CysC的方程具有更高的相关性、准确性或性能。结论纳入基于cysc的eGFR测量，特别是2012年和2021年CKD-EPI egfrcr - cysc方程，用于GFR评估总体上与非肾移植受者对照评估的相关性大于其比较物，同时保持准确性。
{"title":"Use of cystatin C as a marker for estimated glomerular filtration rate in non-kidney transplant recipients","authors":"Kristen D. Belfield , Krysta Walter , Jennifer E. Marvin , Ryan W. Bonner , Rebecca B. Carlson , Kristen R. Szempruch","doi":"10.1016/j.trre.2025.100970","DOIUrl":"10.1016/j.trre.2025.100970","url":null,"abstract":"<div><h3>Introduction</h3><div>Current methods of estimating glomerular filtration rate (eGFR) are commonly based on serum creatinine (SCr); however, cystatin C (CysC)-based methods have recently become more available with increased uptake of CysC testing. Currently, there is a gap in literature reviewing the use of CysC in non-kidney transplant recipients. The aim of this literature review is to evaluate the use of CysC in the assessment of GFR in non-kidney transplant recipients.</div></div><div><h3>Methods</h3><div>Electronic databases Embase, PubMed, Cumulative Index for Nursing and Allied Health Literature, <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, and EU Clinical Trials Register were searched.</div></div><div><h3>Results</h3><div>Of the 487 unique citations, 11 were included (eight liver, two lung, and one heart transplant). Five liver transplant studies found a better prognostic parameter or correlation to measured GFR with CysC based equations, and two liver and two lung transplant studies found the combined Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR<sub>SCr-CysC</sub> equation demonstrated higher correlation, accuracy, or performance than with either SCr or CysC-based equations.</div></div><div><h3>Conclusion</h3><div>The inclusion of CysC-based eGFR measurements, in particular the 2012 and 2021 CKD-EPI eGFR<sub>SCr-CysC</sub> equation, for GFR assessment overall correlated with the control assessments more than its comparators in non-kidney transplant recipients while maintaining accuracy.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 1","pages":"Article 100970"},"PeriodicalIF":3.6,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520974","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 : 2025-10-17DOI: 10.1016/j.trre.2025.100967
Jad Kassir , Kevin Kaulanjan , Marc Olivier Timsit , Sarah Drouin , Thomas Prudhomme , Romain Boissier , Lionel Badet , Xavier Matillon , Julien Branchereau , Emilien Seizilles de Mazancourt
Introduction
Simulation-based training is increasingly recognized as a cornerstone of surgical education, aiming to improve technical skills while reducing risks for patients. In kidney transplantation, however, simulation remains poorly explored, and the validity and educational value of available models are unclear.
Materials and methods
A systematic literature search was performed in PubMed, Embase, Cochrane Library, and Google Scholar from inception until December 31, 2024. Studies in English and French reporting on kidney transplantation simulators were included. Two independent reviewers screened titles, abstracts, and full texts, with disagreements resolved by discussion. Data were extracted on study design, simulator characteristics, validation methods, outcomes, and biases.
Results
The search identified 3343 records, of which 8 studies met the inclusion criteria. Three focused on robot-assisted transplantation and five on open transplantation. Most publications described the development or construction of simulators rather than their validation. Three studies evaluated participant satisfaction through questionnaires, and two assessed technical performance using validated rating scales. However, other domains of validity—including content, construct, concurrent, and predictive validity—as well as educational impact were not formally assessed in any study. Overall, the methodological quality was low, with small sample sizes, heterogeneous evaluation methods, and no comparators.
Conclusion
The literature on kidney transplantation simulators remains limited. Existing studies focus largely on describing model development rather than providing robust validation or demonstrating educational benefit. Future research should emphasize standardized validation frameworks and structured evaluation to define the role of simulators in transplantation training.
{"title":"A systematic review of simulators for kidney transplantation surgical training","authors":"Jad Kassir , Kevin Kaulanjan , Marc Olivier Timsit , Sarah Drouin , Thomas Prudhomme , Romain Boissier , Lionel Badet , Xavier Matillon , Julien Branchereau , Emilien Seizilles de Mazancourt","doi":"10.1016/j.trre.2025.100967","DOIUrl":"10.1016/j.trre.2025.100967","url":null,"abstract":"<div><h3>Introduction</h3><div>Simulation-based training is increasingly recognized as a cornerstone of surgical education, aiming to improve technical skills while reducing risks for patients. In kidney transplantation, however, simulation remains poorly explored, and the validity and educational value of available models are unclear.</div></div><div><h3>Materials and methods</h3><div>A systematic literature search was performed in PubMed, Embase, Cochrane Library, and Google Scholar from inception until December 31, 2024. Studies in English and French reporting on kidney transplantation simulators were included. Two independent reviewers screened titles, abstracts, and full texts, with disagreements resolved by discussion. Data were extracted on study design, simulator characteristics, validation methods, outcomes, and biases.</div></div><div><h3>Results</h3><div>The search identified 3343 records, of which 8 studies met the inclusion criteria. Three focused on robot-assisted transplantation and five on open transplantation. Most publications described the development or construction of simulators rather than their validation. Three studies evaluated participant satisfaction through questionnaires, and two assessed technical performance using validated rating scales. However, other domains of validity—including content, construct, concurrent, and predictive validity—as well as educational impact were not formally assessed in any study. Overall, the methodological quality was low, with small sample sizes, heterogeneous evaluation methods, and no comparators.</div></div><div><h3>Conclusion</h3><div>The literature on kidney transplantation simulators remains limited. Existing studies focus largely on describing model development rather than providing robust validation or demonstrating educational benefit. Future research should emphasize standardized validation frameworks and structured evaluation to define the role of simulators in transplantation training.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100967"},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319586","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}
Disparities in orthotopic heart transplant (OHT) listing exist due to race, gender, insurance access, socioeconomic status (SES) and access to healthcare. This study aims to investigate the impact of these factors on the inequities encountered within the pre-transplantation process.
Methods
Literature search was conducted up to July 2024, focusing on disparities in organ transplant outcomes. The primary endpoint was the recipient acceptance rate. Secondary endpoints were donor acceptance, waitlist urgency (status 1, 1A, or 1A exception), waitlist mortality (death while on the list), and waitlist duration (time from listing to transplantation).
Results
A total of 40 studies involving 506,459 patients at listing for OHT were included. Disparities in education level, gender, and insurance were not associated with recipient acceptance rate. However, black patients have a significantly lower recipient acceptance rate compared to the white patients (HR 0.86, 95 % CI: 0.84–0.89, I2 = 15.8 %). For waitlist urgency, black patients were more likely to be listed for status 1 (OR 1.24, 95 % CI: 1.11–1.39, I2 = 85.2 %). For waitlist mortality, there was no significant association with race, gender, insurance, income and education level, but the introduction of the 2018 policy led to a significantly lower waitlist mortality (HR 0.61, 95 % CI: 0.52–0.72, I2 = 0.0 %).
Conclusion
Race remains a primary determinant of inequity in transplant access. Addressing racial disparity is crucial for achieving equitable access to care for all patients with end-stage heart disease.
{"title":"Disparities while listing for orthotopic heart transplantation: A systematic review and meta-analysis","authors":"Somkiat Phutinart , Akaravit Thamthanaruk , Noppachai Siranart , Watsapon Chuanchai , Walit Sowalertrat , Yanisa Chumpangern , Patavee Pajareya","doi":"10.1016/j.trre.2025.100968","DOIUrl":"10.1016/j.trre.2025.100968","url":null,"abstract":"<div><h3>Background</h3><div>Disparities in orthotopic heart transplant (OHT) listing exist due to race, gender, insurance access, socioeconomic status (SES) and access to healthcare. This study aims to investigate the impact of these factors on the inequities encountered within the pre-transplantation process.</div></div><div><h3>Methods</h3><div>Literature search was conducted up to July 2024, focusing on disparities in organ transplant outcomes. The primary endpoint was the recipient acceptance rate. Secondary endpoints were donor acceptance, waitlist urgency (status 1, 1A, or 1A exception), waitlist mortality (death while on the list), and waitlist duration (time from listing to transplantation).</div></div><div><h3>Results</h3><div>A total of 40 studies involving 506,459 patients at listing for OHT were included. Disparities in education level, gender, and insurance were not associated with recipient acceptance rate. However, black patients have a significantly lower recipient acceptance rate compared to the white patients (HR 0.86, 95 % CI: 0.84–0.89, I<sup>2</sup> = 15.8 %). For waitlist urgency, black patients were more likely to be listed for status 1 (OR 1.24, 95 % CI: 1.11–1.39, I<sup>2</sup> = 85.2 %). For waitlist mortality, there was no significant association with race, gender, insurance, income and education level, but the introduction of the 2018 policy led to a significantly lower waitlist mortality (HR 0.61, 95 % CI: 0.52–0.72, I<sup>2</sup> = 0.0 %).</div></div><div><h3>Conclusion</h3><div>Race remains a primary determinant of inequity in transplant access. Addressing racial disparity is crucial for achieving equitable access to care for all patients with end-stage heart disease.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100968"},"PeriodicalIF":3.6,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319061","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 : 2025-10-02DOI: 10.1016/j.trre.2025.100966
Paolo Antonio Grossi , Patrizia Burra , Emanuele Cozzi , Loreto Gesualdo , Giuseppe Grandaliano , Luciano Potena , Patrizio Vitulo
Compared to immunocompetent individuals, solid organ transplant recipients (SOTRs) develop a weaker immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination. Although anti-SARS-CoV-2 vaccines can prevent symptomatic and severe disease, the SOTR population remains at risk as long as SARS-CoV-2 continues to circulate. To protect transplanted patients against severe COVID-19, two primary preventive strategies have been proposed: anti-SARS-CoV-2 vaccination and pre-exposure prophylaxis (PrEP) with monoclonal antibodies that possess neutralizing activity against SARS-CoV-2.
The effectiveness of vaccination varies depending on the type of organ transplanted and the immunosuppressive therapy used, whereas the effectiveness of PrEP does not depend on these factors. The timing of vaccination and PrEP administration is also crucial. A stronger immune response is observed when vaccination is conducted during the nadir of immunosuppressive therapy. However, when PrEP is administered concomitantly with the vaccine, the efficacy of the vaccination could be reduced, both in terms of antibody production and cell-mediated immunity. Therefore, PrEP should be administered at least 15 days after vaccine administration.
In addition to the availability of various preventive measures against COVID-19 for the most vulnerable transplant patients, the scientific community strongly recommends adhering to protective measures, such as wearing masks, practicing hand hygiene, and maintaining social distancing. These expert recommendations offer crucial guidance on preventing SARS-CoV-2 infection in solid organ transplant patients and are applicable to everyday clinical practice.
{"title":"An update on SARS-CoV-2 prevention strategy in solid organ transplant recipients: an expert opinion","authors":"Paolo Antonio Grossi , Patrizia Burra , Emanuele Cozzi , Loreto Gesualdo , Giuseppe Grandaliano , Luciano Potena , Patrizio Vitulo","doi":"10.1016/j.trre.2025.100966","DOIUrl":"10.1016/j.trre.2025.100966","url":null,"abstract":"<div><div>Compared to immunocompetent individuals, solid organ transplant recipients (SOTRs) develop a weaker immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination. Although anti-SARS-CoV-2 vaccines can prevent symptomatic and severe disease, the SOTR population remains at risk as long as SARS-CoV-2 continues to circulate. To protect transplanted patients against severe COVID-19, two primary preventive strategies have been proposed: anti-SARS-CoV-2 vaccination and pre-exposure prophylaxis (PrEP) with monoclonal antibodies that possess neutralizing activity against SARS-CoV-2.</div><div>The effectiveness of vaccination varies depending on the type of organ transplanted and the immunosuppressive therapy used, whereas the effectiveness of PrEP does not depend on these factors. The timing of vaccination and PrEP administration is also crucial. A stronger immune response is observed when vaccination is conducted during the nadir of immunosuppressive therapy. However, when PrEP is administered concomitantly with the vaccine, the efficacy of the vaccination could be reduced, both in terms of antibody production and cell-mediated immunity. Therefore, PrEP should be administered at least 15 days after vaccine administration.</div><div>In addition to the availability of various preventive measures against COVID-19 for the most vulnerable transplant patients, the scientific community strongly recommends adhering to protective measures, such as wearing masks, practicing hand hygiene, and maintaining social distancing. These expert recommendations offer crucial guidance on preventing SARS-CoV-2 infection in solid organ transplant patients and are applicable to everyday clinical practice.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100966"},"PeriodicalIF":3.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260518","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 : 2025-09-08DOI: 10.1016/j.trre.2025.100962
Qibin Wu , Yinglin Yuan , Hongji Yang , Qiang Fu
Islet transplantation represents a promising treatment for patients with insulin-dependent diabetes or unstable glycemic control. However, its widespread application faces two major challenges: a severe shortage of donor organs and persistent immune rejection. Recent studies consistently indicate that broad blockade of the TNFR signaling pathway is insufficient for controlling autoimmune inflammation. Instead, selectively attenuating the pro-inflammatory TNFR1 pathway while enhancing the anti-inflammatory TNFR2 pathway may offer a more effective strategy. This review is the first to explore, from an islet transplantation perspective, the potential of selective TNFR pathway targeting to promote graft tolerance. We specifically highlight the emerging role of regulatory B cells (Bregs) as key mediators in this process, and propose that targeted enhancement of their immunosuppressive function—particularly through the TNF-TNFR2 signaling axis—represents a promising therapeutic strategy to promote the induction of regulatory T cells (Tregs) and achieve durable transplant tolerance.
{"title":"Harnessing the TNF-TNFR pathway for graft tolerance: Selective immunomodulation in islet transplantation","authors":"Qibin Wu , Yinglin Yuan , Hongji Yang , Qiang Fu","doi":"10.1016/j.trre.2025.100962","DOIUrl":"10.1016/j.trre.2025.100962","url":null,"abstract":"<div><div>Islet transplantation represents a promising treatment for patients with insulin-dependent diabetes or unstable glycemic control. However, its widespread application faces two major challenges: a severe shortage of donor organs and persistent immune rejection. Recent studies consistently indicate that broad blockade of the TNFR signaling pathway is insufficient for controlling autoimmune inflammation. Instead, selectively attenuating the pro-inflammatory TNFR1 pathway while enhancing the anti-inflammatory TNFR2 pathway may offer a more effective strategy. This review is the first to explore, from an islet transplantation perspective, the potential of selective TNFR pathway targeting to promote graft tolerance. We specifically highlight the emerging role of regulatory B cells (Bregs) as key mediators in this process, and propose that targeted enhancement of their immunosuppressive function—particularly through the TNF-TNFR2 signaling axis—represents a promising therapeutic strategy to promote the induction of regulatory T cells (Tregs) and achieve durable transplant tolerance.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100962"},"PeriodicalIF":3.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060255","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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