Transplantation Reviews最新文献_第4页

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 : 2025-12-01 Epub 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

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 : 2025-12-01 Epub 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

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 : 2025-12-01 Epub 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

The comparative performance of models predicting patient and graft survival after kidney transplantation: A systematic review 预测肾移植后患者和移植物生存的模型的比较性能：一项系统综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-07-01 Epub Date: 2025-05-02 DOI: 10.1016/j.trre.2025.100934

Joris van de Klundert , Francisco Perez-Galarce , Marcelo Olivares , Liset Pengel , Annelies de Weerd

Background

Cox proportional hazard models have long been the model of choice for survival prediction after kidney transplantation. In recent years, a variety of novel model types have been proposed. We investigate the prediction performance across different model types, including machine learning models and traditional model types.

Methods

A systematic review was conducted following PROBAST and CHARMS, also considering extensions to TRIPOD+AI and PROBAST+AI, for data collection and risk of bias assessment. The review only included publications that reported on prediction performance for models of different types. A comparative analysis tested performance differences between the model types.

Results

The review included 37 publications which presented 134 comparative studies. The designs of many studies left room for improvement and most studies had high risk of bias. The collected data admitted testing of performance differences for 22 pairs of model types, ten of which yielded significant differences. Support Vector Machines and Logistic Regression were never found to outperform other model types. Other comparisons, however, provide inconclusive comparative performance results and none of the model types performed consistently and significantly better than alternatives.

Conclusions

Rigorous review of current evidence and comparative performance evidence finds no significant kidney transplant survival prediction performance differences that Cox Proportional Hazard models are being outperformed. The design of many of the studies implies high risk of bias and more and better designed studies which reutilize best performing models are needed. This enables to resolve model biases, reporting issues, and to increase the power of comparative performance analysis.

cox比例风险模型长期以来一直是肾移植后生存预测的首选模型。近年来，人们提出了各种新颖的模型类型。我们研究了不同模型类型的预测性能，包括机器学习模型和传统模型类型。方法对PROBAST和CHARMS进行系统评价，并考虑扩展到TRIPOD+AI和PROBAST+AI，进行数据收集和偏倚风险评估。该综述只包括了报道不同类型模型预测性能的出版物。比较分析测试了模型类型之间的性能差异。结果纳入文献37篇，比较研究134篇。许多研究的设计仍有改进的余地，大多数研究存在较高的偏倚风险。收集的数据对22对模型类型的性能差异进行了测试，其中10对模型类型产生了显著差异。支持向量机和逻辑回归从未被发现优于其他模型类型。然而，其他比较提供了不确定的比较性能结果，并且没有任何一种模型类型的性能始终优于替代方案。结论：对现有证据和比较性能证据的严格审查发现，Cox比例风险模型在肾移植生存预测性能方面没有显著差异。许多研究的设计意味着高偏倚风险，需要更多和更好的设计研究来重新利用最佳表现的模型。这可以解决模型偏差、报告问题，并增加比较性能分析的能力。

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引用次数: 0

Use of decision algorithms for viscoelastic tests and use of blood products in patients undergoing liver transplantation: A systematic review with meta-analysis 在肝移植患者中使用决策算法进行粘弹性测试和使用血液制品：一项具有荟萃分析的系统综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-07-01 Epub Date: 2025-04-18 DOI: 10.1016/j.trre.2025.100932

Gilvandro Lins de Oliveira Júnior , Viviane Maria Bezerra Cavalcanti Lins , Virgínia Maria Bezerra Cavalcanti , Francisco Tustumi , Cassio Virgílio , Wellington Andraus

Introduction: Viscoelastic tests (VETs), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), provide a global assessment of hemostatic function. The use of a TEG or ROTEM system to guide the administration of blood products has been shown to reduce transfusion requirements in certain types of surgeries, but the decision algorithms for Viscoelastic tests needs to be assessed. This review aimed to assess all published evidence on viscoelastic testing in the context the use of decision algorithms for VETs on liver transplantation. Methods: A systematic review was performed in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Studies assessing VETs for liver transplantation were considered for inclusion, analyzed according to the use or non-use of algorithms for VETs. Results: Out of the 279 studies initially identified, 17 studies were included in this review. Algorithms for VETs reduced red blood cell transfusion (−0.44 (95 % CI -0.62; −0.25; p < 0.01), while there was no significant difference with VETs without algorithms, and the overall measure showed a smaller reduction (−0.33; 95 % CI -0.61 to −0.04; p = 0.02). Conclusion: The results highlight the potential of algorithms for VETs to reduce the use of blood products in liver transplants.

粘弹性试验（vet），包括血栓弹性成像（TEG）和旋转血栓弹性测量（ROTEM），提供止血功能的全面评估。使用TEG或ROTEM系统来指导血液制品的管理已被证明可以减少某些类型手术的输血需求，但粘弹性试验的决策算法需要评估。本综述旨在评估所有已发表的关于肝移植VETs决策算法中粘弹性测试的证据。方法：在PubMed、EMBASE和Cochrane中央对照试验登记册中进行系统评价。评估肝移植VETs的研究被纳入考虑，并根据VETs算法的使用或不使用进行分析。结果：在最初确定的279项研究中，本综述纳入了17项研究。VETs算法减少红细胞输血(- 0.44 (95% CI -0.62；−0.25;p & lt;0.01)，而未加算法的VETs无显著差异，总体测量显示较小的降低(- 0.33；95% CI -0.61 ~ - 0.04；p = 0.02)。结论：该结果突出了VETs算法在减少肝移植中血液制品使用方面的潜力。

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引用次数: 0

Liver transplantation in patients with neurological Wilson disease: What can a five-decade systematic literature review teach us? 神经性威尔逊病患者的肝移植：50年的系统文献回顾能告诉我们什么？

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-07-01 Epub Date: 2025-06-07 DOI: 10.1016/j.trre.2025.100939

Aurélia Poujois , Rodolphe Sobesky , Nathalie Dorison , Mickael Alexandre Obadia , Dominique Debray

Background

Neurological worsening occurs in up to 20 % of patients with Wilson disease and neurological involvement (neuroWD) despite optimal anti‑copper therapy. This study aimed to analyze the neurological outcomes of patients with neuroWD who underwent liver transplantation (LT) as a rescue therapy for neurological deterioration (Brain group), and to compare them with those who underwent LT for end-stage liver disease (ESLD) (Liver group).

Methods

A systematic PubMed search identified studies on neuroWD and LT published from January 1973 to January 2024.

Results

A total of 368 patients with neuroWD were identified, including 89 and 279 in the Brain and Liver groups, respectively. Post-LT survival rates were similar between groups (82 % vs. 86.6 %). Sepsis was the primary cause of death in both groups (68.7 % in the Brain group vs. 57.1 % in the Liver group). Among survivors beyond 1 year, 86.3 % in the Brain group and 79.7 % in the Liver group showed improvement or complete recovery from neuroWD. De novo post-LT neurological complications and calcineurin inhibitors-induced neurotoxicity were reported exclusively in the Liver group (p < 0.05).

Conclusion

LT is a viable option for neuroWD unresponsive to medical therapy. Delayed introduction or early minimization of calcineurin inhibitors is recommended for ESLD patients to reduce neurotoxicity. Further studies are needed to confirm these observations, as there are currently no evidence-based medicine criteria or standardized inclusion scales for LT in cases of neuro-WD.

背景：尽管采用了最佳的抗铜治疗，但高达20%的Wilson病和神经系统受累（neuroWD）患者仍会出现神经系统恶化。本研究旨在分析接受肝移植（LT）作为神经功能恶化抢救治疗的神经性wd患者（脑组）的神经预后，并将其与终末期肝病（ESLD）接受肝移植（肝组）的患者进行比较。方法系统检索1973年1月至2024年1月发表的神经性wd和LT研究。结果共发现神经性wd患者368例，其中脑组89例，肝组279例。两组间术后生存率相似（82%对86.6%）。败血症是两组患者死亡的主要原因（脑组为68.7%，肝组为57.1%）。在1年以上的幸存者中，脑组86.3%和肝组79.7%的患者表现出神经性wd的改善或完全恢复。肝组仅报道了肝移植后神经系统并发症和钙调磷酸酶抑制剂引起的神经毒性(p <；0.05)。结论对于药物治疗无反应的神经性wd，肝移植是一种可行的治疗方法。延迟引入或早期最小化钙调磷酸酶抑制剂推荐ESLD患者减少神经毒性。需要进一步的研究来证实这些观察结果，因为目前没有基于证据的医学标准或神经型wd中LT的标准化纳入量表。

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引用次数: 0

Cognitive impairment assessments in kidney transplantation: A review 肾移植患者认知障碍评估综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-07-01 DOI: 10.1016/j.trre.2025.100940

Safaa Azzouz , Laurence Coté , Donald Doell , Alessia N. Paparella , Marcelo Cantarovich , Kathleen Gaudio , Shaifali Sandal

Mild cognitive impairment (CI) is not an absolute contraindication for kidney transplantation (KT). However, clinical assessment has not been standardized, and several practice challenges remain. We synthesized existing evidence on the effect of CI on adult kidney transplant recipients (KTRs) and KT candidates. Of the 1333 titles and abstracts screened, seven studies were eligible; all were observational. Our synthesis included 1035 KTRs and 4659 patients being evaluated for KT. Studies that used the Montreal Cognitive Assessment (38–55 %) reported a higher CI prevalence than those that used the Modified Mini-Mental State Exam (6–10 %). CI decreased the chances of KT waitlisting, however, the association with KT, graft loss and death varied by the cohort characteristics and tests used. The implications of our synthesis are limited by selection bias due to the exclusionary criterion, variability in tests and thresholds used. This may have misclassified participants with normal cognition as having CI and included those with dementia. Overall, additional evidence is needed to standardize the cognitive assessment of KTRs and candidates and inform clinical practice. A comprehensive assessment of cognition and function is indicated for the accurate diagnosis of CI, to determine CI severity, and to assess transplant candidacy.

轻度认知障碍（CI）不是肾移植（KT）的绝对禁忌症。然而，临床评估尚未标准化，一些实践挑战仍然存在。我们综合了CI对成人肾移植受者（KTRs）和KT候选人影响的现有证据。在筛选的1333篇标题和摘要中，有7篇研究符合条件；所有研究都是观察性的。我们的合成包括1035例ktr和4659例正在评估KT的患者。使用蒙特利尔认知评估（38 - 55%）的研究报告CI患病率高于使用改良迷你精神状态测试（6 - 10%）的研究。CI降低了KT等待登记的机会，然而，与KT、移植物损失和死亡的关联因队列特征和使用的测试而异。由于排除标准、试验的可变性和使用的阈值，我们的综合影响受到选择偏倚的限制。这可能将认知正常的参与者错误地归类为CI，并将痴呆症患者包括在内。总的来说，需要更多的证据来规范ktr和候选人的认知评估，并为临床实践提供信息。全面的认知和功能评估是准确诊断CI，确定CI严重程度和评估移植候选性的指标。

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引用次数: 0

Management of multidrug-resistant gram-negative bacilli infections in adult solid organ transplant recipients: GESITRA-IC/SEIMC, CIBERINFEC, and SET recommendations update. 成人实体器官移植受者多重耐药革兰氏阴性杆菌感染的管理：GESITRA-IC/SEIMC， CIBERINFEC和SET建议更新

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-07-01 Epub Date: 2025-05-21 DOI: 10.1016/j.trre.2025.100937

Isabel Rodríguez-Goncer , Elisa Ruiz-Arabi , Sabina Herrera , Nuria Sabé , Ibai Los-Arcos , José Tiago Silva , Elena Pérez-Nadales , Isabel Machuca , Rocío Álvarez , Maricela Valerio , Juan José Castón , Victoria Aguilera , Marta Bodro , Ángela Cano , Rafael Cantón , Purificación Carmona , Jordi Carratalà , Elisa Cordero , Josep María Cruzado , María Carmen Fariñas , José María Aguado

Multidrug-resistant (MDR) Gram-negative bacilli (GNB) infections in solid organ transplant (SOT) recipients continue to pose a significant threat despite advances in diagnostics and treatments. The last international consensus guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the management of MDR GNB in adult solid organ transplant (SOT) recipients were published in 2018, underscoring the need for an update to incorporate recent advances, particularly the availability of new drugs that may improve the current standard of care. A working group consisting of members from the Study Group of Infection in Transplantation and Immunocompromised Hosts (GESITRA-IC) of SEIMC, the Center for Biomedical Research Network in Infectious Diseases (CIBERINFEC) and the Spanish Society of Transplantation (SET) developed consensus-based recommendations for managing MDR GNB infections during the transplant procedure. Recommendations were categorized based on evidence quality and strength, utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The final recommendations were endorsed through a consensus meeting and approved by the expert panel.

尽管在诊断和治疗方面取得了进展，但实体器官移植（SOT）受者中耐多药（MDR）革兰氏阴性杆菌（GNB）感染仍然构成重大威胁。西班牙传染病和临床微生物学会（SEIMC）关于成人实体器官移植（SOT）受者MDR GNB管理的最新国际共识指南于2018年发布，强调需要更新以纳入最新进展，特别是可能改善当前护理标准的新药的可用性。由SEIMC移植感染和免疫功能低下宿主研究组（GESITRA-IC）、传染病生物医学研究网络中心（CIBERINFEC）和西班牙移植学会（SET）成员组成的工作组就移植过程中MDR GNB感染的管理提出了基于共识的建议。根据证据质量和强度对建议进行分类，利用建议评估、发展和评估分级（GRADE）系统。最后的建议经协商一致会议通过，并经专家小组批准。

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引用次数: 0

Effect of donor body weight on en bloc pediatric kidney transplantation in adults: A systematic review and meta-analysis 供体体重对成人整体儿童肾移植的影响：系统回顾和荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-07-01 Epub Date: 2025-03-28 DOI: 10.1016/j.trre.2025.100918

Haichen Yan , Yitian Fang , Jacqueline van de Wetering , Hendrikus J.A.N. Kimenai , Ron W.F. de Bruin , Robert C. Minnee

Background

The shortage of donor grafts for kidney transplantation remains a critical challenge. En bloc kidney transplantation (EBKT) using small deceased pediatric donors has the potential to expand the donor pool. This review aimed to investigate the outcomes of pediatric-donor EBKT in adults compared with standard single kidney transplantation (SKT).

Methods

Relevant databases, including Ovid, Web of Knowledge, Google Scholar, Wiley, and Embase, were searched for eligible studies. Demographic data and transplant outcomes were extracted from the included studies. The primary outcome was graft survival. A random-effects model was used for the meta-analysis.

Results

Thirteen studies were included. The median 1-year graft survival rates were 83.8 % and 89.2 % for EBKT and SKT, respectively (risk ratio [RR], 0.97; 95 % confidence interval [CI], 0.93–1.01). The median 5-year graft survival rates were 78.7 % and 72.7 % for EBKT and SKT, respectively (RR, 1.05; 95 % CI, 0.93–1.19). For donors with a body weight > 10 kg (EBKT >10 kg) and ≤ 10 kg (EBKT ≤10 kg), the median 1-year graft survival rates were 100.0 % and 90.0 %, respectively (RR, 1.08; 95 % CI, 1.05–1.12). Vascular complications were identified as the primary cause of graft loss.

Conclusions

Pediatric-donor EBKT in adults is a safe approach with excellent long-term functional outcomes comparable to those of SKT. EBKT represents an effective option to further utilizing pediatric donor kidneys. Outcomes of EBKT vary based on donor body weight. EBKT ≤10 kg was associated with higher short-term graft failure rates despite long-term performance being comparable to EBKT >10 kg.

肾移植供体的短缺仍然是一个严峻的挑战。整体肾移植（EBKT）使用小的死亡儿童供体有可能扩大供体池。本综述旨在研究成人儿童供体EBKT与标准单肾移植（SKT）的比较结果。方法检索Ovid、Web of Knowledge、谷歌Scholar、Wiley、Embase等相关数据库，检索符合条件的研究。从纳入的研究中提取人口统计数据和移植结果。主要结局是移植物存活。meta分析采用随机效应模型。结果共纳入13项研究。EBKT和SKT的1年移植存活率中位数分别为83.8%和89.2%(风险比[RR]， 0.97；95%可信区间[CI]， 0.93-1.01)。EBKT和SKT的中位5年移植存活率分别为78.7%和72.7% (RR, 1.05；95% ci, 0.93-1.19)。对于体重>；10 kg （EBKT >10 kg）和≤10 kg (EBKT≤10 kg)，移植骨1年中位存活率分别为100.0%和90.0% (RR, 1.08；95% ci, 1.05-1.12)。血管并发症被认为是移植物丢失的主要原因。结论成人儿童供体EBKT是一种安全的方法，与SKT相比具有良好的长期功能预后。EBKT是进一步利用儿童供肾的有效选择。EBKT的结果因供体体重而异。EBKT≤10 kg的患者短期移植物失败率较高，尽管长期表现与EBKT≤10 kg的患者相当。

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引用次数: 0

Cardiac allograft vasculopathy and the endothelial glycocalyx: a missing link? 异体心脏移植血管病变与内皮糖萼：缺失的一环？

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-07-01 Epub Date: 2025-05-18 DOI: 10.1016/j.trre.2025.100936

Mitchell J. Wagner , Michael Khoury , Jennifer Conway , Darren H. Freed

Cardiac allograft vasculopathy (CAV) is a significant contributor to graft loss following heart transplantation, with a linear cumulative incidence over time. Both immune and non-immune risk factors are associated with the development of CAV, however, a cohesive mechanistic link between them is yet to be established. Immune and non-immune risk factors may be linked to CAV via disturbance of the endothelial glycocalyx (EGX), a protective vascular structure whose functions appear to be impaired in the context of CAV progression. In this review, we present this hypothesis, summarizing the evidence and implications for EGX loss during CAV. We synthesize a novel model that places EGX disturbance at the center of CAV pathogenesis. As a currently incurable disease, we highlight that this new model may unlock new approaches to prevention and therapy and requires further research.

同种异体心脏移植物血管病变（CAV）是心脏移植后移植物损失的一个重要因素，随着时间的推移，其发病率呈线性累积。免疫和非免疫危险因素都与CAV的发生有关，然而，它们之间的内在机制联系尚未建立。免疫和非免疫危险因素可能通过内皮糖萼（EGX）的紊乱与CAV有关，EGX是一种保护性血管结构，其功能在CAV进展中似乎受损。在这篇综述中，我们提出了这一假设，总结了CAV期间EGX丢失的证据和意义。我们合成了一个新的模型，将EGX干扰置于CAV发病机制的中心。作为一种目前无法治愈的疾病，我们强调这种新的模型可能会开启新的预防和治疗方法，需要进一步的研究。

引用次数: 0