Transplantation Reviews最新文献_第3页

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 : 2025-12-01 Epub 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。

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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 : 2025-12-01 Epub 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

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 : 2025-12-01 Epub 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

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 : 2025-12-01 Epub 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

Emerging strategies in the transplantation of HCV-infected pancreases to uninfected recipients: A narrative review 将hcv感染的胰腺移植给未感染的受者的新策略：一篇叙述性综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-01 Epub Date: 2025-07-07 DOI: 10.1016/j.trre.2025.100941

Adam J. Bush , Robyn A.E. Gould , Benjamin C. Storey , Matthew J. Bottomley

The scarcity of suitable candidates for solid organ transplantation (SOT) represents a major barrier to the reduction of waiting lists. The introduction of direct-acting antiviral (DAA) therapeutics eliminates many of the risks associated with the transplantation of Hepatitis C Virus (HCV)-infected donor organs (D+) to uninfected recipients (R-) and may facilitate access to a substantial organ pool, previously considered unacceptably high risk. The extent of clinical investigation into the safety and feasibility of HCV D+/R- SOT varies between allograft types.

Here, we review the current state of pancreatic HCV D+/R-transplant research. Studies are limited to small cohorts who received pancreas allografts from HCV-viraemic donors alongside a regimen of DAA therapy. As of 2025, seven studies investigated a total of 22 patients, using prophylactic or reactive treatment regimens. Outcomes have been positive, with universal viral eradication, favourable allograft function, and minimal HCV-related complications. A favourable adverse event profile is reported, mirroring studies in other transplanted organs.

With the aim to increase clinical use of pancreatic HCV D+/R- SOT, further investigation in the field is necessary to validate these preliminary data. Larger studies are essential to evaluate long-term sequelae and optimise treatment protocols to subsequently establish a standard of care.

缺乏合适的候选人进行实体器官移植（SOT）是减少等待名单的主要障碍。直接作用抗病毒（DAA）疗法的引入消除了与丙型肝炎病毒（HCV）感染的供体器官（D+）移植给未感染的受体（R-）相关的许多风险，并可能促进获得大量器官库，以前被认为是不可接受的高风险。临床研究HCV D+/R- SOT的安全性和可行性的程度因同种异体移植类型而异。在此，我们回顾了目前胰腺HCV D+/ r移植研究的现状。研究仅限于接受hcv病毒供体胰腺同种异体移植和DAA治疗方案的小队列。截至2025年，共有7项研究调查了22名患者，使用预防性或反应性治疗方案。结果是积极的，病毒普遍根除，良好的同种异体移植物功能和最小的hcv相关并发症。报道了有利的不良事件概况，反映了其他移植器官的研究。为了增加胰腺HCV D+/R- SOT的临床应用，有必要在该领域进行进一步的研究来验证这些初步数据。更大规模的研究对于评估长期后遗症和优化治疗方案以随后建立标准护理至关重要。

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引用次数: 0

A systematic review of simulators for kidney transplantation surgical training 肾移植手术训练模拟器系统综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-01 Epub Date: 2025-10-17 DOI: 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.

基于模拟的培训越来越被认为是外科教育的基石，旨在提高技术技能，同时降低患者的风险。然而，在肾移植中，模拟的探索仍然很少，可用模型的有效性和教育价值尚不清楚。材料与方法系统检索PubMed、Embase、Cochrane Library、谷歌Scholar等数据库，检索时间为研究成立至2024年12月31日。纳入了英语和法语报道肾移植模拟器的研究。两位独立审稿人筛选标题、摘要和全文，并通过讨论解决分歧。从研究设计、模拟器特征、验证方法、结果和偏倚等方面提取数据。结果共检索到3343篇文献，其中8篇符合纳入标准。其中3项是机器人辅助移植，5项是开放移植。大多数出版物描述了模拟器的开发或构造，而不是它们的验证。三项研究通过问卷评估参与者满意度，两项研究使用有效的评定量表评估技术性能。然而，其他效度领域——包括内容效度、结构效度、并发效度和预测效度——以及教育影响在任何研究中都没有被正式评估。总体而言，方法学质量较低，样本量小，评价方法异质，没有比较物。结论关于肾移植模拟器的研究文献有限。现有的研究主要集中在描述模型开发，而不是提供可靠的验证或证明教育效益。未来的研究应强调标准化的验证框架和结构化的评估，以确定模拟器在移植训练中的作用。

{"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":"2025-12-01","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}

引用次数: 0

Graft-versus-host disease after liver transplantation: A global review of pathogenesis, diagnosis, and treatment strategies 肝移植后移植物抗宿主病：发病机制、诊断和治疗策略的全球综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-01 Epub Date: 2025-07-08 DOI: 10.1016/j.trre.2025.100942

Ayato Obana , Miho Akabane , Khalid Mumtaz , Lauren Von Stein , Johanna Papanikolla , Nicole Gray , Lindsay Sobotka , Sylvester Black

Graft-versus-host disease (GVHD) following liver transplantation (LT) (GVHD-LT) is a rare but highly lethal complication, occurring in 0.1–2 % of recipients with mortality rates exceeding 75 %. GVHD-LT develops when donor-derived lymphocytes transferred within the hepatic allograft recognize recipient tissues as foreign and mount an immune attack, primarily targeting the skin, gastrointestinal tract, and bone marrow while characteristically sparing the donor liver graft itself. This comprehensive review synthesizes current knowledge of GVHD-LT pathogenesis, clinical manifestations, diagnostic approaches, and therapeutic strategies based on systematic literature analysis of cases reported from 1988 to 2025. Clinical presentation typically occurs 2–12 weeks post-transplant with the classic triad of fever, maculopapular rash, profuse diarrhea, and progressive pancytopenia. Diagnosis relies on tissue biopsy demonstrating characteristic histopathological changes combined with molecular chimerism analysis confirming donor lymphocyte persistence. Risk factors include recipient age > 50 years, hepatocellular carcinoma as underlying disease, and specific donor-recipient immunologic mismatches. Management remains challenging due to the delicate balance required between intensifying immunosuppression to control donor lymphocyte activity while preventing overwhelming infection. Conventional high-dose corticosteroids yield poor outcomes, with emerging therapies including JAK inhibitors, extracorporeal photopheresis, and targeted cytokine blockade showing promise in steroid-refractory cases. The hyperinflammatory state frequently overlaps with hemophagocytic lymphohistiocytosis, requiring specialized therapeutic approaches. Despite therapeutic advances, prognosis remains poor, with sepsis from opportunistic infections representing the leading cause of death. Future directions emphasize the urgent need for risk stratification models, preventive strategies, and multi-institutional collaborative trials to improve outcomes for this devastating post-transplant complication.

肝移植（LT）后移植物抗宿主病（GVHD-LT）是一种罕见但高度致命的并发症，发生率为0.1% - 2%，死亡率超过75%。当移植到同种异体肝内的供体来源淋巴细胞将受体组织识别为外来组织并发起免疫攻击时，GVHD-LT就会发生，主要针对皮肤、胃肠道和骨髓，同时保留供体肝移植物本身。本综述综合了目前关于GVHD-LT发病机制、临床表现、诊断方法和治疗策略的知识，基于对1988年至2025年报告病例的系统文献分析。临床表现通常发生在移植后2-12周，伴有发热、黄斑丘疹、大量腹泻和进行性全血细胞减少症。诊断依赖于组织活检显示特征性的组织病理学变化，并结合分子嵌合分析证实供体淋巴细胞的持久性。风险因素包括受赠者年龄；50年来，肝细胞癌作为潜在疾病，和特异性供体-受体免疫不匹配。由于加强免疫抑制以控制供体淋巴细胞活性和防止压倒性感染之间需要微妙的平衡，管理仍然具有挑战性。传统的大剂量皮质类固醇治疗效果不佳，包括JAK抑制剂、体外光诱导和靶向细胞因子阻断在内的新兴治疗方法在类固醇难治性病例中显示出希望。高炎症状态经常与噬血细胞性淋巴组织细胞增多症重叠，需要专门的治疗方法。尽管治疗取得了进步，但预后仍然很差，机会性感染引起的败血症是导致死亡的主要原因。未来的方向强调迫切需要风险分层模型、预防策略和多机构合作试验来改善这种破坏性移植后并发症的结果。

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引用次数: 0

Renal resistance during hypothermic machine perfusion: A scoping review of variability and determinants, with a meta-analysis of predictive value for transplant outcomes 低温机器灌注期间的肾抵抗：变异性和决定因素的范围审查，移植结果预测价值的荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-12-01 Epub Date: 2025-07-17 DOI: 10.1016/j.trre.2025.100956

Liliana Fonseca Buitrago , Laurence Verstraeten , Steffen Fieuws , Ina Jochmans

Background

Renal resistance (RR) measured during hypothermic machine perfusion (HMP) is used to assess donor kidney quality and guide transplantation decisions. However, its clinical reliability and relationship with donor factors remain unclear.

Methods

This scoping review and meta-analysis evaluate the variability, determinants, and predictive value of RR during HMP. A systematic search of PubMed, Embase, Web of Science, and Cochrane Library (July 2024) identified 49 primary studies reporting RR in perfused human kidneys. The risk of bias was assessed using the ROBINS-I tool. Meta-analyses for the predictive value of RR were performed when ≥3 studies reported univariable associations for the same time point and outcome.

Results

Most studies had moderate to serious risk of bias. RR typically declined rapidly, stabilizing within 5 h (range: 0.30–3.50 to 0.17–1.50 mmHg/mL/min), but patterns varied widely. Determinants included histology, donor characteristics, and perfusion additives, though evidence was inconsistent. A meta-analysis showed terminal RR was significantly associated with delayed graft function (odds ratio 2.49, 95 % CI 1.49–4.18, I² = 58 %). While several studies proposed RR-thresholds, none were consistently validated, and heterogeneity in measurement timings and device settings limits comparability.

Conclusion

RR shows potential as a functional assessment parameter during HMP but is influenced by multiple technical and biological factors. Current evidence does not support the use of isolated RR-thresholds for organ acceptance. Standardized HMP protocols, trajectory modeling, and prospective studies are needed to clarify RR's role in clinical decision-making.

背景：在低温机器灌注（HMP）期间测量肾阻力（RR）用于评估供体肾脏质量并指导移植决策。然而，其临床可靠性和与供体因素的关系尚不清楚。方法本综述和荟萃分析评估了HMP期间RR的变异性、决定因素和预测价值。对PubMed、Embase、Web of Science和Cochrane Library（2024年7月）的系统检索确定了49项报告灌注肾RR的主要研究。使用ROBINS-I工具评估偏倚风险。当≥3项研究报告同一时间点和结果的单变量关联时，对RR的预测值进行荟萃分析。结果大多数研究存在中度至重度偏倚风险。RR通常迅速下降，在5小时内稳定（范围：0.30-3.50至0.17-1.50 mmHg/mL/min），但模式差异很大。决定因素包括组织学、供体特征和灌注添加剂，尽管证据不一致。一项荟萃分析显示，终末RR与移植延迟功能显著相关（优势比2.49,95% CI 1.49-4.18, I2 = 58%）。虽然有几项研究提出了rr阈值，但没有一项得到一致的验证，而且测量时间和设备设置的异质性限制了可比性。结论rr有作为HMP功能评价参数的潜力，但受多种技术和生物学因素的影响。目前的证据不支持使用孤立的rr阈值进行器官接受。需要标准化的HMP方案、轨迹建模和前瞻性研究来阐明RR在临床决策中的作用。

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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 : 2025-12-01 Epub 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

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 : 2025-12-01 Epub 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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