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Use of cystatin C as a marker for estimated glomerular filtration rate in non-kidney transplant recipients 使用胱抑素C作为估计非肾移植受者肾小球滤过率的标志物
IF 3.6 2区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-01 Epub Date: 2025-11-02 DOI: 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。
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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 Pub Date : 2026-01-01 Epub 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
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 Pub Date : 2026-01-01 Epub 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 Pub Date : 2026-01-01 Epub 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
History and challenges of multi-organ allocation in the United States: A systematic review 美国多器官分配的历史和挑战:系统回顾。
IF 3.6 2区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-01 Epub Date: 2025-12-17 DOI: 10.1016/j.trre.2025.100988
Maggie Cheng , Steven Cao Tri Huynh , Reid Dale , Maria Elizabeth Currie
Current multi-organ candidates are prioritized primarily based on single-organ risk scores. Once the primary organ is allocated, the secondary organ follows to the same recipient, resulting in waitlisted single-organ candidates being skipped in allocation.
Our previous work examined the ethical and statistical alignment of single-organ risk scores. Here, we aim to extend our analysis to multi-organ transplantation policies in the United States, surveying the current state of multi-organ candidate prioritization and the challenges of conducting high-quality research in multi-organ transplantation.
We systematically searched PubMed for published literature on the allocation of all multi-organ pairs involving the liver, kidney, lungs, and heart. After screening based on our inclusion and exclusion criteria, we identified 126 articles to include in this review. These include 31 articles for Heart-Lung, 24 for Heart-Kidney, 52 for Liver-Kidney, and 19 for Liver-Heart transplantation. We did not discuss the remaining organ pairs due to insufficient literature to provide a balanced analysis.
Provider-, center-, and region-dependent variations exist in multi-organ practices due to evolving national guidelines and a lack of standardized institutional protocols for candidate evaluation and listing. The use of single-organ risk scores in multi-organ allocation has not been statistically validated, therefore raising concerns about applicability.
Multi-organ transplant research relies heavily on single-center reports, case studies, and registry-based analyses. The frequent re-use of national registry data limits the novelty and reliability of multi-organ research. We encourage future efforts to consider exploratory, prospective, and perhaps randomized-controlled trials to advance understanding and strengthen the evidence base in multi-organ transplantation.
目前多器官候选手术的优先排序主要基于单器官风险评分。一旦第一器官被分配,第二器官就会跟随同一个接受者,导致等待的单一器官候选人在分配中被跳过。我们之前的工作检查了单器官风险评分的伦理和统计一致性。在这里,我们的目标是将我们的分析扩展到美国的多器官移植政策,调查多器官候选优先级的现状以及在多器官移植中进行高质量研究的挑战。我们系统地检索了PubMed关于包括肝、肾、肺和心脏在内的所有多器官配对分配的已发表文献。根据纳入和排除标准进行筛选后,我们确定了126篇文章纳入本综述。其中心肺移植31篇,心肾移植24篇,肝肾移植52篇,肝心移植19篇。由于文献不足以提供平衡的分析,我们没有讨论其余的器官对。由于不断发展的国家指导方针和缺乏对候选人评估和列出的标准化机构协议,在多机构实践中存在提供者、中心和地区依赖的差异。在多器官分配中使用单器官风险评分尚未得到统计验证,因此引起了对适用性的关注。多器官移植研究在很大程度上依赖于单中心报告、案例研究和基于登记的分析。国家登记数据的频繁重复使用限制了多器官研究的新颖性和可靠性。我们鼓励未来的努力考虑探索性、前瞻性和可能的随机对照试验,以促进对多器官移植的理解和加强证据基础。
{"title":"History and challenges of multi-organ allocation in the United States: A systematic review","authors":"Maggie Cheng ,&nbsp;Steven Cao Tri Huynh ,&nbsp;Reid Dale ,&nbsp;Maria Elizabeth Currie","doi":"10.1016/j.trre.2025.100988","DOIUrl":"10.1016/j.trre.2025.100988","url":null,"abstract":"<div><div>Current multi-organ candidates are prioritized primarily based on single-organ risk scores. Once the primary organ is allocated, the secondary organ follows to the same recipient, resulting in waitlisted single-organ candidates being skipped in allocation.</div><div>Our previous work examined the ethical and statistical alignment of single-organ risk scores. Here, we aim to extend our analysis to multi-organ transplantation policies in the United States, surveying the current state of multi-organ candidate prioritization and the challenges of conducting high-quality research in multi-organ transplantation.</div><div>We systematically searched PubMed for published literature on the allocation of all multi-organ pairs involving the liver, kidney, lungs, and heart. After screening based on our inclusion and exclusion criteria, we identified 126 articles to include in this review. These include 31 articles for Heart-Lung, 24 for Heart-Kidney, 52 for Liver-Kidney, and 19 for Liver-Heart transplantation. We did not discuss the remaining organ pairs due to insufficient literature to provide a balanced analysis.</div><div>Provider-, center-, and region-dependent variations exist in multi-organ practices due to evolving national guidelines and a lack of standardized institutional protocols for candidate evaluation and listing. The use of single-organ risk scores in multi-organ allocation has not been statistically validated, therefore raising concerns about applicability.</div><div>Multi-organ transplant research relies heavily on single-center reports, case studies, and registry-based analyses. The frequent re-use of national registry data limits the novelty and reliability of multi-organ research. We encourage future efforts to consider exploratory, prospective, and perhaps randomized-controlled trials to advance understanding and strengthen the evidence base in multi-organ transplantation.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"40 1","pages":"Article 100988"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Immune cell subsets in young kidney transplant recipients: Mechanistic and clinical perspectives 年轻肾移植受者的免疫细胞亚群:机制和临床观点
IF 3.6 2区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-01 Epub Date: 2025-11-03 DOI: 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.
肾移植为患有终末期肾病的儿童、青少年和年轻人提供了最佳的生存优势,然而这一群体却自相矛盾地经历了最差的长期移植生存。免疫介导的排斥反应是主要原因,但支撑这种年龄相关差异的细胞机制仍未完全确定。本综述综合了适应性和先天区室免疫衰老影响的现有证据,重点关注T细胞、B细胞和自然杀伤(NK)细胞。在年轻的受者中,巨大的naïve T和b细胞池、强大的胸腺输出和有效的生发中心活性赋予了更高的同种免疫反应性,从而增加了急性细胞和抗体介导的排斥反应的风险。相比之下,老年受者表现出免疫衰老的特征,包括CD28表达的丧失,终末分化效应亚群的积累,生发中心反应受损,NK细胞毒性减弱,导致产生新生反应的能力下降,但更容易受到感染。这些免疫轨迹具有直接的临床意义:年轻的受者可能需要强化的、机制靶向的免疫抑制,而年长的受者可能更适合最小化或耐受方案。我们进一步强调了儿科透析人群中过早免疫衰老的新证据,年龄相关的B细胞和NK亚群的贡献,以及免疫表型引导的治疗策略的作用。目前统一的免疫抑制方案不能充分解释发育和年龄相关的免疫异质性。我们主张采用基于年龄和免疫表型的治疗方法,整合纵向免疫分析、生物标志物开发和系统免疫学,以改善风险分层,促进耐受性,并最终延长所有年龄组的同种异体移植物存活时间。
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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 Pub Date : 2026-01-01 Epub 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
Intraoperative unfractionated heparin (UFH) for kidney transplantation: A systematic review and meta-analysis 肾移植术中未分割肝素(UFH):一项系统综述和荟萃分析。
IF 3.6 2区 医学 Q2 IMMUNOLOGY Pub Date : 2026-01-01 Epub Date: 2025-12-19 DOI: 10.1016/j.trre.2025.100985
Animesh Singla , Shirley Cai , Ahmer Hameed , Henry Pleass , Tess Cooper , Melanie Wyld , Angela C. Webster

Introduction

Balancing bleeding risk with graft thrombosis is a challenge in transplantation surgery. This systematic review assessed the efficacy and safety of intraoperative administration of intravenous (IV) unfractionated heparin (UFH) bolus during adult kidney transplantation.

Methodology

We searched MEDLINE, Embase, and CENTRAL (from inception to May 2025) for comparative studies of any design recruiting adults undergoing living or deceased donor kidney transplantation (PROSPERO CRD42023391473), that examined intraoperative IV UFH as a perioperative intervention. Study quality was assessed using the Newcastle Ottawa Scale. Outcomes: Graft thrombosis (including subgroup analysis of arterial thromboses), bleeding complications, delayed graft function, and transplant nephrectomy. Relative and absolute effects were synthesised using a random-effects model as risk ratio (RR) with 95 % confidence intervals (CI). Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Results

Three retrospective cohort studies (1989 participants) met inclusion criteria. Study quality was rated as ‘fair’ in two studies and ‘good’ in one study. There was no difference for graft thrombosis with intraoperative IV UFH (3 studies, 1989 participants, RR 1.02, 95 % CI 0.49–2.12, I2 = 0 %, very low certainty evidence). Sub-group analysis also did not identify any difference for arterial thrombosis risk. Nearly all graft thromboses (17/23) resulted in transplant nephrectomy. IV UFH did not increase bleeding complications (3 studies, 1989 participants, RR 1.29, 95 % CI 0.78–2.13, I2 68 %, very low certainty evidence). There was no difference in delayed graft function (2 studies, 461 participants, RR = 0.95, 95 % CI 0.57 to 1.58, I2 = 40 %, very low certainty evidence).

Conclusion

Despite its common use in clinical practice, evidence supporting intraoperative IV UFH during kidney transplant surgery is sparce and of very low certainty. Current evidence does not demonstrate a reduction in graft thrombosis or delayed graft function demonstrated with intraoperative IV UFH, nor a clear increase in bleeding complications. High-quality prospective studies are needed to clarify the net clinical benefit of intraoperative UFH in kidney transplant surgery.
在移植手术中平衡出血风险和移植物血栓形成是一个挑战。本系统综述评估了成人肾移植术中静脉注射未分割肝素(UFH)丸的有效性和安全性。方法:我们检索MEDLINE, Embase和CENTRAL(从成立到2025年5月),以比较任何设计招募接受活体或已故供体肾移植的成人(PROSPERO CRD42023391473)的研究,这些研究检查术中IV UFH作为围手术期干预。研究质量采用纽卡斯尔渥太华量表进行评估。结果:移植物血栓形成(包括动脉血栓亚组分析),出血并发症,移植物功能延迟,移植肾切除术。相对效应和绝对效应采用随机效应模型作为风险比(RR),置信区间为95%。证据的确定性采用GRADE(建议评估、发展和评价分级)方法进行评估。结果:三个回顾性队列研究(1989名参与者)符合纳入标准。研究质量在两项研究中被评为“一般”,在一项研究中被评为“良好”。术中静脉注射UFH在移植物血栓形成方面没有差异(3项研究,1989名参与者,RR 1.02, 95% CI 0.49-2.12, I2 = 0%,非常低确定性证据)。亚组分析也没有发现动脉血栓形成风险的任何差异。几乎所有的移植物血栓形成(17/23)导致移植肾切除术。IV UFH不增加出血并发症(3项研究,1989名受试者,RR 1.29, 95% CI 0.78-2.13, I2 68%,极低确定性证据)。延迟移植物功能没有差异(2项研究,461名参与者,RR = 0.95, 95% CI 0.57至1.58,I2 = 40%,非常低确定性证据)。结论:尽管在临床实践中普遍使用,但支持肾移植手术术中静脉注射UFH的证据很少,而且确定性很低。目前的证据并没有表明术中静脉UFH能减少移植物血栓形成或延迟移植物功能,也没有明显增加出血并发症。需要高质量的前瞻性研究来阐明术中UFH在肾移植手术中的净临床效益。
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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 Pub Date : 2026-01-01 Epub 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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引用次数: 0
Corrigendum to ‘Between uncertainty and hope: A meta-ethnographic synthesis of patients awaiting kidney transplantation’ [Transplantation Reviews volume 39/4 (2025)100961] “在不确定性和希望之间:等待肾移植患者的元人种学综合”的勘误表[移植评论卷39/4(2025)100961]。
IF 3.6 2区 医学 Q2 IMMUNOLOGY Pub Date : 2025-12-01 Epub Date: 2025-09-06 DOI: 10.1016/j.trre.2025.100964
Ebru Akgün Çıtak, Tuğçe Uçgun, Aylin Günay, Azize Karahan
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引用次数: 0
期刊
Transplantation Reviews
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