Transplantation Reviews最新文献_第3页

Disparities while listing for orthotopic heart transplantation: A systematic review and meta-analysis 列出原位心脏移植的差异：一项系统回顾和荟萃分析。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-10-15 DOI: 10.1016/j.trre.2025.100968

Somkiat Phutinart , Akaravit Thamthanaruk , Noppachai Siranart , Watsapon Chuanchai , Walit Sowalertrat , Yanisa Chumpangern , Patavee Pajareya

Background

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.

背景：由于种族、性别、保险、社会经济地位（SES）和获得医疗保健的机会，原位心脏移植（OHT）清单存在差异。本研究旨在探讨这些因素对移植前过程中遇到的不公平现象的影响。方法：检索截至2024年7月的文献，重点关注器官移植结果的差异。主要终点为接受者接受率。次要终点是供体接受、等待名单紧急程度（状态1、1A或1A例外）、等待名单死亡率（在名单上死亡）和等待名单持续时间（从名单到移植的时间）。结果：共纳入40项研究，涉及506,459例OHT患者。教育水平、性别和保险的差异与接受者的接受率无关。然而，黑人患者的受体接受率明显低于白人患者（HR 0.86, 95% CI: 0.84-0.89, I2 = 15.8%）。对于等待名单的紧迫性，黑人患者更有可能被列为状态1 （OR 1.24, 95% CI: 1.11-1.39, I2 = 85.2%）。对于等候名单死亡率，与种族、性别、保险、收入和教育水平没有显著关联，但2018年政策的引入导致等候名单死亡率显著降低（HR 0.61, 95% CI: 0.52-0.72, I2 = 0.0%）。结论：种族仍然是移植机会不公平的主要决定因素。消除种族差异对于实现所有终末期心脏病患者公平获得护理至关重要。

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引用次数: 0

An update on SARS-CoV-2 prevention strategy in solid organ transplant recipients: an expert opinion 实体器官移植受者SARS-CoV-2预防策略的最新进展：专家意见。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-10-02 DOI: 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.

与免疫正常的个体相比，实体器官移植受者（SOTRs）对严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）感染和疫苗接种的免疫反应较弱。尽管抗SARS-CoV-2疫苗可以预防有症状和严重的疾病，但只要SARS-CoV-2继续传播，SOTR人群就仍处于危险之中。为了保护移植患者免受严重COVID-19的侵害，提出了两种主要的预防策略：抗SARS-CoV-2疫苗接种和使用具有对SARS-CoV-2中和活性的单克隆抗体进行暴露前预防（PrEP）。疫苗接种的有效性取决于移植器官的类型和使用的免疫抑制疗法，而PrEP的有效性不取决于这些因素。疫苗接种和预防接种的时机也至关重要。在免疫抑制治疗的最低点进行疫苗接种时，观察到更强的免疫反应。然而，当PrEP与疫苗同时使用时，疫苗接种的效力可能会降低，无论是在抗体产生方面还是在细胞介导的免疫方面。因此，PrEP应在接种疫苗后至少15天进行。除了对最脆弱的移植患者采取各种预防措施外，科学界强烈建议坚持采取保护措施，如戴口罩、保持手部卫生和保持社交距离。这些专家建议为实体器官移植患者预防SARS-CoV-2感染提供了重要指导，适用于日常临床实践。

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引用次数: 0

Harnessing the TNF-TNFR pathway for graft tolerance: Selective immunomodulation in islet transplantation 利用TNF-TNFR通路促进移植物耐受：胰岛移植中的选择性免疫调节

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-09-08 DOI: 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.

胰岛移植对于胰岛素依赖型糖尿病或血糖控制不稳定的患者是一种很有希望的治疗方法。然而，它的广泛应用面临两大挑战：供体器官的严重短缺和持续的免疫排斥。最近的研究一致表明，广泛阻断TNFR信号通路不足以控制自身免疫性炎症。相反，选择性地减弱促炎TNFR1途径，同时增强抗炎TNFR2途径可能是一种更有效的策略。这篇综述首次从胰岛移植的角度探讨了选择性TNFR通路靶向促进移植物耐受性的潜力。我们特别强调了调节性B细胞（Bregs）在这一过程中作为关键介质的新兴作用，并提出有针对性地增强其免疫抑制功能-特别是通过TNF-TNFR2信号轴-代表了一种有希望的治疗策略，以促进调节性T细胞（Tregs）的诱导并实现持久的移植耐受。

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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

Transplantation Reviews

Pub Date : 2025-09-06 DOI: 10.1016/j.trre.2025.100964

Ebru Akgün Çıtak, Tuğçe Uçgun, Aylin Günay, Azize Karahan

引用次数: 0

Impact of donor-recipient size mismatch on post-transplant outcomes in kidney transplant recipients: A systematic review 供体-受体大小不匹配对肾移植受者移植后预后的影响：一项系统综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-09-05 DOI: 10.1016/j.trre.2025.100965

Sabaa Asif , Christie Rampersad , Ani Orchanian-Cheff , S. Joseph Kim

Background

Donor-recipient size mismatch builds on the nephron dosing concept, but studies suggest unclear associations with kidney allograft outcomes.

Methods

We systematically searched, critically appraised, and summarized associations between donor-recipient size mismatch and primary outcome of death-censored graft failure, secondary outcomes of kidney function, all-cause graft failure, and mortality. The study protocol was registered a priori on PROSPERO (ID CRD42023455394). We searched MEDLINE, Embase, and Cochrane Databases from 1946 to 2025 for studies evaluating adult kidney transplant recipients. We excluded non-English or unavailable full texts, and studies with donors <16 years old. Risk of bias was assessed using Risk of Bias in Non-randomized Studies – of Exposure tool. Studies were narratively synthesized; marked heterogeneity precluded quantitative meta-analysis.

Results

From 1521 citations, 56 studies were included. Sample sizes ranged from 23 to 238,895 donor-recipient pairs (median 214, IQR [95, 807]), with follow-up from 1 week to >20 years. Studies varied in size mismatch definitions, exposure subgrouping, outcomes, patient populations, and follow-up period. Overall, 32 % demonstrated worse kidney allograft outcomes with unfavorable size mismatch, 9 % showed no association, and 59 % reported mixed findings. All studies had high or very high risk of bias.

Conclusions

Available studies do not provide strong evidence to support or reject the idea of nephron underdosing, however existing reports were generally of poor quality, with high or very high risk of bias. Due to data heterogeneity, quantitative meta-analysis was not performed. Well-designed studies with clear exposure definitions, standardized outcome assessments, appropriate confounder control, adequate follow-up, and robust statistical analyses remain a priority.

供体-受体大小不匹配建立在肾单位剂量概念上，但研究表明与同种异体肾移植结果的关系尚不清楚。方法我们系统地检索、批判性地评估并总结了供体-受体大小不匹配与死亡审查的移植物衰竭的主要结局、肾功能的次要结局、全因移植物衰竭和死亡率之间的关系。该研究方案在PROSPERO （ID CRD42023455394）上先验注册。我们检索了MEDLINE、Embase和Cochrane数据库，检索了1946年至2025年间评估成人肾移植受者的研究。我们排除了非英文或不可用的全文，以及16岁供体的研究。使用非随机研究的偏倚风险-暴露工具评估偏倚风险。研究是以叙述方式综合的；显著的异质性妨碍了定量荟萃分析。结果共收录1521篇文献，56篇文献。样本量为23 ~ 238,895对供体-受体（中位数为214对，IQR[95,807]），随访时间为1周至20年。研究在大小错配定义、暴露亚组、结果、患者群体和随访期等方面有所不同。总的来说，32%的人表现出更差的同种异体肾移植结果，不利的大小不匹配，9%的人没有表现出相关性，59%的人报告了混合结果。所有的研究都有很高或非常高的偏倚风险。现有的研究没有提供强有力的证据来支持或拒绝肾元剂量不足的观点，然而现有的报告通常质量较差，具有高或极高的偏倚风险。由于数据异质性，未进行定量荟萃分析。设计良好的研究、明确的暴露定义、标准化的结果评估、适当的混杂因素控制、充分的随访和可靠的统计分析仍然是一个优先事项。

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引用次数: 0

Early surgical complications following kidney transplantation in adults: A systematic review 成人肾移植术后早期手术并发症：系统回顾

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-09-01 DOI: 10.1016/j.trre.2025.100963

Milla Ortved , Julia Dagnæs-Hansen , Hein V. Stroomberg , Malene Rohrsted , Søren Schwartz Sørensen , Andreas Røder

Objective

To quantify and characterise short-term (<90 days) surgical complications following kidney transplantation and identify risk factors for complications.

Methods

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the protocol registered with PROSPERO (ID CRD42024535328). Studies reporting surgical and postoperative complications within 90 days of surgery were included as well as studies reporting on groups of complications such as urological, vascular or wound related. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS) and number of fulfilled Martin criteria.

Results

Of 1654 articles screened, 30 were included. In studies reporting on complications within 30 days of surgery the weighted overall complication rate was 41 % (range 13-70 %), the weighted reoperation rate was 13 % (range 9.8-17 %) and the weighted rate of major complications was 19 % (range 7.6-24 %). In studies reporting on complications within 90 days of surgery the weighted overall complication rate was 36 % (range 12-60 %), the weighted reoperation rate was 17 % (range 5.0-23 %) and the weighted rate of major complications was 24 % (range 19-25 %). Studies were heterogenous and the quality was rated poor to good according to the NOS and fulfilling a median of 7 Martin criteria (range 4-9). Possible risk factors for complications included high BMI, recipient age and sex.

Conclusion

Kidney transplantation remains a high-risk surgical procedure. We identified considerable variation in how complications were reported, limiting comparison of outcomes between centres as well as the potential impact of peri-operative interventions to improve surgical outcomes.

目的量化和描述肾移植术后短期（90天）手术并发症，并确定并发症的危险因素。方法本系统评价按照系统评价和荟萃分析指南的首选报告项目和在PROSPERO注册的方案（ID CRD42024535328）进行。报告手术90天内手术和术后并发症的研究，以及报告泌尿、血管或伤口相关并发症的研究。使用纽卡斯尔-渥太华量表（NOS）和满足马丁标准的数量评估证据的质量。结果共筛选1654篇文献，纳入30篇。在报告手术后30天内并发症的研究中，加权总并发症率为41%（范围13- 70%），加权再手术率为13%（范围9.8- 17%），加权主要并发症率为19%（范围7.6- 24%）。在报告手术后90天内并发症的研究中，加权总并发症率为36%（范围12- 60%），加权再手术率为17%（范围5.0- 23%），加权主要并发症率为24%（范围19- 25%）。研究是异质性的，根据NOS和满足7个马丁标准（范围4-9）的中位数，质量被评为差到好。并发症的可能风险因素包括高BMI、受体年龄和性别。结论肾移植仍是一种高危手术。我们发现并发症的报告方式存在很大差异，限制了中心之间结果的比较以及围手术期干预对改善手术结果的潜在影响。

{"title":"Early surgical complications following kidney transplantation in adults: A systematic review","authors":"Milla Ortved , Julia Dagnæs-Hansen , Hein V. Stroomberg , Malene Rohrsted , Søren Schwartz Sørensen , Andreas Røder","doi":"10.1016/j.trre.2025.100963","DOIUrl":"10.1016/j.trre.2025.100963","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify and characterise short-term (<90 days) surgical complications following kidney transplantation and identify risk factors for complications.</div></div><div><h3>Methods</h3><div>This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the protocol registered with PROSPERO (ID CRD42024535328). Studies reporting surgical and postoperative complications within 90 days of surgery were included as well as studies reporting on groups of complications such as urological, vascular or wound related. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS) and number of fulfilled Martin criteria.</div></div><div><h3>Results</h3><div>Of 1654 articles screened, 30 were included. In studies reporting on complications within 30 days of surgery the weighted overall complication rate was 41 % (range 13-70 %), the weighted reoperation rate was 13 % (range 9.8-17 %) and the weighted rate of major complications was 19 % (range 7.6-24 %). In studies reporting on complications within 90 days of surgery the weighted overall complication rate was 36 % (range 12-60 %), the weighted reoperation rate was 17 % (range 5.0-23 %) and the weighted rate of major complications was 24 % (range 19-25 %). Studies were heterogenous and the quality was rated poor to good according to the NOS and fulfilling a median of 7 Martin criteria (range 4-9). Possible risk factors for complications included high BMI, recipient age and sex.</div></div><div><h3>Conclusion</h3><div>Kidney transplantation remains a high-risk surgical procedure. We identified considerable variation in how complications were reported, limiting comparison of outcomes between centres as well as the potential impact of peri-operative interventions to improve surgical outcomes.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100963"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996571","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

Impact of disease-modifying drugs in patients with transthyretin amyloidosis after liver transplantation: a systematic review 改善疾病药物对肝移植后转甲状腺蛋白淀粉样变患者的影响：系统综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-08-22 DOI: 10.1016/j.trre.2025.100960

Christiane Santo, Cristhian Romero, Bruno Vaz Kerges Bueno, Andre Dabarian, Fabio Fernandes

Background

Orthotopic liver transplant (OLT) was the first approved treatment for hereditary transthyretin amyloidosis (ATTRv). However, some patients continue to deteriorate due to ongoing wild-type TTR deposition and residual synthesis from extrahepatic sources. In recent years, disease-modifying therapies including TTR stabilizers (e.g., Tafamidis) and gene-silencing agents (e.g., Patisiran) have emerged, but their role in post-OLT patients remains unclear due to their exclusion from most clinical trials.

Methods

A systematic search was conducted in PubMed, Cochrane, and Embase (up to June 2025) using terms related to transthyretin amyloidosis, liver transplantation, and disease-modifying therapies. The objective was to evaluate clinical benefits and safety of these agents in symptomatic ATTRv patients after OLT.

Results

Disease-modifying therapies showed potential benefits in post-OLT ATTR patients. A total of 39 patients treated with tafamidis, inotersen, or patisiran were analyzed. Neurological improvements, including autonomic symptoms, NIS score, and quality of life, were based on 3 case reports and 32 patients from observational studies. Cardiovascular results were from 4 case reports, and biomarker findings from 3 case reports.

Conclusions

Disease-modifying therapies may offer clinical benefits in post-OLT ATTRv patients. However, robust prospective studies and randomized trials are needed to confirm efficacy and ensure safety in this population.

背景：原位肝移植（OLT）是首个被批准治疗遗传性甲状腺转蛋白淀粉样变性（ATTRv）的方法。然而，由于持续的野生型TTR沉积和肝外来源的残留合成，一些患者继续恶化。近年来，包括TTR稳定剂（如Tafamidis）和基因沉默剂（如Patisiran）在内的疾病改善疗法已经出现，但由于它们被排除在大多数临床试验之外，它们在olt后患者中的作用尚不清楚。方法系统检索PubMed、Cochrane和Embase（截至2025年6月），检索与转甲状腺蛋白淀粉样变性、肝移植和疾病改善疗法相关的术语。目的是评估这些药物在OLT后有症状的ATTRv患者中的临床益处和安全性。结果疾病修饰疗法在olt后ATTR患者中显示出潜在的益处。总共分析了39例接受他法米底斯、intertersen或patisiran治疗的患者。神经系统的改善，包括自主神经症状、NIS评分和生活质量，是基于观察性研究的3例病例报告和32例患者。心血管结果来自4例报告，生物标志物结果来自3例报告。结论疾病改良治疗可为olt后ATTRv患者提供临床益处。然而，需要强有力的前瞻性研究和随机试验来确认其在该人群中的有效性和安全性。

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引用次数: 0

Between uncertainty and hope: A meta-ethnographic synthesis of patients awaiting kidney transplantation 在不确定性和希望之间：等待肾移植患者的元人种学综合

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-08-21 DOI: 10.1016/j.trre.2025.100961

Ebru Akgün Çıtak, Tuğçe Uçgun, Aylin Günay, Azize Karahan

Objective

This study synthesizes qualitative research on the lived experiences of individuals awaiting kidney transplantation, with particular attention to their emotional, psychological, and social journeys during the waiting period.

Methods

A meta-ethnographic approach was employed, guided by Noblit and Hare's seven-phase framework. Systematic searches were conducted across six databases—PubMed (MEDLINE), Scopus, Web of Science, ScienceDirect, Wiley, and Ovid—resulting in 5452 records. After applying predefined eligibility criteria, eight qualitative studies published between 2015 and 2025 were included. First-order constructs (participants' accounts) and second-order constructs (researchers' interpretations) were integrated to generate third-order interpretive themes.

Results

Six overarching themes were identified: (1) navigating uncertainty, (2) sustaining hope and anticipation, (3) psychological strain and emotional weight, (4) readiness and coping resources, (5) support systems and communication, and (6) identity transformation and personal growth. These themes emphasize the complexity of the experience of waiting for a transplant, which is characterized by temporal ambiguity, emotional vulnerability, and existential reflection. Support from peers and healthcare professionals, as well as adaptive coping strategies, played a pivotal role in fostering psychological resilience.

Conclusion

Waiting for a kidney transplant profoundly reshapes patients' perceptions of self, time, and well-being. Insights from this synthesis can guide the design of targeted psychosocial interventions and patient-centered support programs. These findings hold relevance for nurses, transplant coordinators, and mental health practitioners involved in caring for this population.

目的本研究综合了对等待肾移植个体生活经历的定性研究，特别关注他们在等待期间的情感、心理和社会旅程。方法采用元民族志方法，以Noblit和Hare的七阶段框架为指导。在pubmed （MEDLINE）、Scopus、Web of Science、ScienceDirect、Wiley和ovid等6个数据库中进行了系统搜索，共获得5452条记录。在应用预定义的资格标准后，纳入了2015年至2025年间发表的8项定性研究。一阶构念（参与者的描述）和二阶构念（研究者的解释）被整合成三阶解释性主题。结果确定了6个主要主题：(1)应对不确定性，(2)维持希望和期待，(3)心理压力和情绪负担，(4)准备和应对资源，(5)支持系统和沟通，(6)身份转换和个人成长。这些主题强调了等待移植经历的复杂性，其特点是时间的模糊性、情感的脆弱性和存在性的反思。来自同伴和保健专业人员的支持，以及适应性应对策略，在培养心理弹性方面发挥了关键作用。结论等待肾移植深刻地重塑了患者对自我、时间和幸福的看法。这种综合的见解可以指导有针对性的社会心理干预和以患者为中心的支持计划的设计。这些发现对护士、移植协调员和参与照顾这一人群的心理健康从业人员具有相关性。

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引用次数: 0

Adaptive immune response and evasion strategies of BK virus BK病毒的适应性免疫反应及逃避策略

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-08-14 DOI: 10.1016/j.trre.2025.100959

Deema Ibrahim Fallatah , Steve Christmas , Abdulkarim Binshaya

BKV presents a considerable challenge, particularly in immunocompromised individuals such as kidney transplant recipients. This review explores the adaptive immune responses to BKV, focusing on both humoral and cellular immunity. While BKV-specific antibodies contribute to viral neutralization, their protective role is limited due to viral immune evasion strategies and serotype variations. Cellular immunity, especially BKV-specific T-cell responses, plays a crucial role in con-trolling viral replication and preventing nephropathy. However, BKV employs several immune evasion tactics, including antigenic variation, latency, and modulation of T-cell responses. The absence of standardized serological assays further complicates diagnosis and immune monitoring. Future research should focus on improving diagnostic tools, identifying biomarkers, and developing targeted immunotherapies. Understanding the mechanisms of BKV immune evasion and latency will be essential for improving clinical outcomes in high-risk populations.

BKV提出了相当大的挑战，特别是在免疫功能低下的个体，如肾移植受体中。本文综述了对BKV的适应性免疫反应，重点是体液免疫和细胞免疫。虽然bkv特异性抗体有助于病毒中和，但由于病毒免疫逃避策略和血清型变异，其保护作用有限。细胞免疫，特别是bkv特异性t细胞反应，在控制病毒复制和预防肾病中起着至关重要的作用。然而，BKV采用几种免疫逃避策略，包括抗原变异、潜伏期和t细胞反应调节。标准化血清学检测的缺乏进一步复杂化了诊断和免疫监测。未来的研究应侧重于改进诊断工具、识别生物标志物和开发靶向免疫疗法。了解BKV免疫逃避和潜伏期的机制对于改善高危人群的临床结果至关重要。

引用次数: 0

The impact of standard- versus reduced-dose tacrolimus exposure on clinical outcomes in adult kidney transplant recipients: A systematic review and meta-analysis 标准剂量与减少剂量他克莫司暴露对成人肾移植受者临床结果的影响：系统回顾和荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-07-31 DOI: 10.1016/j.trre.2025.100958

Suwasin Udomkarnjananun , Mohamed Soliman , Sangil Min , Ha Phan Hai An , Chih-Yuan Lee , Yongji Lu , Teun van Gelder

Concerns around calcineurin inhibitor–induced nephrotoxicity after kidney transplantation have led to dose-reduction practices. However, “reduced dose” remains poorly defined, and evidence comparing outcomes for standard- versus reduced-dose tacrolimus trough concentration (C₀) above 5 ng/mL is limited. We searched multiple electronic databases (Jan 1, 2000-June 30, 2024) for randomized controlled or observational studies that reported clinical outcomes (acute rejection, nephrotoxicity, graft survival, patient survival, and estimated glomerular filtration rate) directly against tacrolimus C₀ as an independent clinical variable in adult kidney transplant recipients who received tacrolimus. Ten publications were included. No eligible study of tacrolimus with mammalian target of rapamycin inhibitors was identified, so results focused on patients treated with tacrolimus plus mycophenolic acid. Four randomized controlled trials with similar immunosuppression regimens were included in the meta-analysis to compare the impact of standard- versus reduced-dose tacrolimus exposure (per study definition) on C₀ and clinical outcomes. Standard-dose tacrolimus exposure was associated with significantly lower acute rejection rates versus reduced-dose exposure (odds ratio, 0.4 [95 % confidence interval: 0.17, 0.95]; P = 0.037). There were no significant differences between groups in graft loss or patient survival. An overlap in drug concentrations between standard- and reduced-dose tacrolimus C₀ suggests that reduced-dose tacrolimus regimens can often result in an exposure that falls within the standard range (i.e., 5–10 ng/mL). Clinicians should consider the precise tacrolimus dose ranges reported in publications and optimize tacrolimus concentration levels for individual patients, potentially contradicting some recommendations for calcineurin inhibitor minimization.

对肾移植后钙调磷酸酶抑制剂引起的肾毒性的担忧导致了剂量减少的做法。然而，“减少剂量”的定义仍然不明确，比较标准剂量与减少剂量他克莫司谷浓度（C0）高于5 ng/mL的结果的证据有限。我们检索了多个电子数据库（2000年1月1日至2024年6月30日），以获取随机对照或观察性研究，这些研究报告了他克莫司C0作为成人肾移植受者接受他克莫司的独立临床变量的临床结果（急性排斥反应、肾毒性、移植物存活率、患者存活率和估计肾小球滤过率）。其中包括10份出版物。没有合适的研究确定他克莫司与哺乳动物雷帕霉素抑制剂靶点，所以结果集中在他克莫司加霉酚酸治疗的患者。荟萃分析包括四项具有相似免疫抑制方案的随机对照试验，以比较标准剂量与减少剂量他克莫司暴露（每个研究定义）对C0和临床结果的影响。标准剂量他克莫司暴露与低剂量暴露相比，急性排斥反应发生率显著降低（优势比为0.4[95%可信区间：0.17,0.95];P = 0.037）。两组间移植物丢失和患者存活率无显著差异。标准剂量和减剂量他克莫司C0之间药物浓度的重叠表明，减剂量他克莫司方案通常可导致暴露在标准范围内（即5-10纳克/毫升）。临床医生应该考虑出版物中报道的精确的他克莫司剂量范围，并为个体患者优化他克莫司浓度水平，这可能与一些钙调磷酸酶抑制剂最小化的建议相矛盾。

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引用次数: 0