Transplantation Reviews最新文献_第4页

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 : 2025-07-17 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。

{"title":"Renal resistance during hypothermic machine perfusion: A scoping review of variability and determinants, with a meta-analysis of predictive value for transplant outcomes","authors":"Liliana Fonseca Buitrago , Laurence Verstraeten , Steffen Fieuws , Ina Jochmans","doi":"10.1016/j.trre.2025.100956","DOIUrl":"10.1016/j.trre.2025.100956","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, I<sup>2</sup> = 58 %). While several studies proposed RR-thresholds, none were consistently validated, and heterogeneity in measurement timings and device settings limits comparability.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100956"},"PeriodicalIF":3.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670291","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 : 2025-07-08 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。

{"title":"Graft-versus-host disease after liver transplantation: A global review of pathogenesis, diagnosis, and treatment strategies","authors":"Ayato Obana , Miho Akabane , Khalid Mumtaz , Lauren Von Stein , Johanna Papanikolla , Nicole Gray , Lindsay Sobotka , Sylvester Black","doi":"10.1016/j.trre.2025.100942","DOIUrl":"10.1016/j.trre.2025.100942","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100942"},"PeriodicalIF":3.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654386","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

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 : 2025-07-07 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。

{"title":"Emerging strategies in the transplantation of HCV-infected pancreases to uninfected recipients: A narrative review","authors":"Adam J. Bush , Robyn A.E. Gould , Benjamin C. Storey , Matthew J. Bottomley","doi":"10.1016/j.trre.2025.100941","DOIUrl":"10.1016/j.trre.2025.100941","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 4","pages":"Article 100941"},"PeriodicalIF":3.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587695","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

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。

{"title":"Cognitive impairment assessments in kidney transplantation: A review","authors":"Safaa Azzouz , Laurence Coté , Donald Doell , Alessia N. Paparella , Marcelo Cantarovich , Kathleen Gaudio , Shaifali Sandal","doi":"10.1016/j.trre.2025.100940","DOIUrl":"10.1016/j.trre.2025.100940","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100940"},"PeriodicalIF":3.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563659","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

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 : 2025-06-07 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。

{"title":"Liver transplantation in patients with neurological Wilson disease: What can a five-decade systematic literature review teach us?","authors":"Aurélia Poujois , Rodolphe Sobesky , Nathalie Dorison , Mickael Alexandre Obadia , Dominique Debray","doi":"10.1016/j.trre.2025.100939","DOIUrl":"10.1016/j.trre.2025.100939","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>A systematic PubMed search identified studies on neuroWD and LT published from January 1973 to January 2024.</div></div><div><h3>Results</h3><div>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 % <em>vs.</em> 86.6 %). Sepsis was the primary cause of death in both groups (68.7 % in the Brain group <em>vs.</em> 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. <em>De novo</em> post-LT neurological complications and calcineurin inhibitors-induced neurotoxicity were reported exclusively in the Liver group (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100939"},"PeriodicalIF":3.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271941","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

Exploring the psychological construct of resilience in kidney transplantation: A scoping review 探讨肾移植中恢复力的心理结构：范围综述

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-05-28 DOI: 10.1016/j.trre.2025.100938

Anh Le , Kathleen Gaudio , Alessia N. Paparella , Michael Sullivan , Mara McAdams-DeMarco , Marcelo Cantarovich , Shaifali Sandal

Background

Extensive literature has highlighted the psychological burden experienced by kidney transplant recipients (KTRs) and its association with adverse outcomes. Psychological resilience can serve as a measure of baseline vulnerability, and low resilience is associated with poor mental health. We aimed to synthesize the existing literature that has explored the concept of resilience in kidney transplantation.

Methods

A scoping review was conducted due to the anticipated heterogeneity of the literature. Any empirical study that measured resilience using a validated tool in KTRs was included. Resilience could be a variable, a predictor, or an outcome. All study designs were considered with no time restrictions.

Results

Of the 4525 titles and abstracts screened, 14 were eligible for inclusion. Sample sizes ranged from 10 to 505 KTRs. One study exclusively focused on developing and validating a resilience scale while others used existing tools. Three studies compared resilience between different populations and the results were heterogeneous: similar resilience between KTRs and dialysis/pre-KT patients (n = 2) and another reporting better resilience in KTRs (n = 1). A decline in resilience scores after pediatric-adult transition (n = 1) and 3 months post-transplant (n = 1) was reported. In terms of outcomes, higher resilience was associated with medication adherence (n = 1), lower frailty (n = 2), and lower risk of psychopathology (n = 2). Two of the three included studies reported improvements in resilience scores with an exercise program and a resilience-enhancing program.

Conclusions

Our review highlights that resilience is an underused and poorly explored construct in KTRs. We recommend explorative and interventional work as resilience is measurable and modifiable.

背景大量文献强调了肾移植受者所经历的心理负担及其与不良后果的关系。心理弹性可以作为基准脆弱性的衡量标准，而低弹性与心理健康状况不佳有关。我们的目的是综合现有的探讨肾移植中恢复力概念的文献。方法考虑到文献的异质性，进行范围综述。在ktr中使用经过验证的工具测量弹性的任何实证研究都包括在内。弹性可以是一个变量，一个预测因子，或者一个结果。所有的研究设计都没有时间限制。结果在筛选的4525篇标题和摘要中，有14篇符合纳入标准。样本量从10到505 ktr不等。一项研究专注于开发和验证弹性量表，而其他研究则使用现有工具。三项研究比较了不同人群之间的恢复能力，结果是异质的：ktr患者和透析/预kt患者之间的恢复能力相似（n = 2），另一项研究报告ktr患者的恢复能力更好（n = 1）。据报道，在儿科-成人过渡（n = 1）和移植后3个月（n = 1）后恢复力评分下降。在结果方面，较高的恢复力与药物依从性（n = 1），较低的虚弱（n = 2）和较低的精神病理风险（n = 2）相关。三项纳入的研究中有两项报告了锻炼计划和增强恢复力计划对恢复力得分的改善。结论我们的综述强调，在KTRs中，弹性是一个未被充分利用和探索的概念。我们建议探索性和干预性工作，因为弹性是可测量和可修改的。

{"title":"Exploring the psychological construct of resilience in kidney transplantation: A scoping review","authors":"Anh Le , Kathleen Gaudio , Alessia N. Paparella , Michael Sullivan , Mara McAdams-DeMarco , Marcelo Cantarovich , Shaifali Sandal","doi":"10.1016/j.trre.2025.100938","DOIUrl":"10.1016/j.trre.2025.100938","url":null,"abstract":"<div><h3>Background</h3><div>Extensive literature has highlighted the psychological burden experienced by kidney transplant recipients (KTRs) and its association with adverse outcomes. Psychological resilience can serve as a measure of baseline vulnerability, and low resilience is associated with poor mental health. We aimed to synthesize the existing literature that has explored the concept of resilience in kidney transplantation.</div></div><div><h3>Methods</h3><div>A scoping review was conducted due to the anticipated heterogeneity of the literature. Any empirical study that measured resilience using a validated tool in KTRs was included. Resilience could be a variable, a predictor, or an outcome. All study designs were considered with no time restrictions.</div></div><div><h3>Results</h3><div>Of the 4525 titles and abstracts screened, 14 were eligible for inclusion. Sample sizes ranged from 10 to 505 KTRs. One study exclusively focused on developing and validating a resilience scale while others used existing tools. Three studies compared resilience between different populations and the results were heterogeneous: similar resilience between KTRs and dialysis/pre-KT patients (<em>n</em> = 2) and another reporting better resilience in KTRs (<em>n</em> = 1). A decline in resilience scores after pediatric-adult transition (n = 1) and 3 months post-transplant (n = 1) was reported. In terms of outcomes, higher resilience was associated with medication adherence (n = 1), lower frailty (n = 2), and lower risk of psychopathology (n = 2). Two of the three included studies reported improvements in resilience scores with an exercise program and a resilience-enhancing program.</div></div><div><h3>Conclusions</h3><div>Our review highlights that resilience is an underused and poorly explored construct in KTRs. We recommend explorative and interventional work as resilience is measurable and modifiable.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100938"},"PeriodicalIF":3.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189954","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

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 : 2025-05-21 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。

{"title":"Management of multidrug-resistant gram-negative bacilli infections in adult solid organ transplant recipients: GESITRA-IC/SEIMC, CIBERINFEC, and SET recommendations update.","authors":"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","doi":"10.1016/j.trre.2025.100937","DOIUrl":"10.1016/j.trre.2025.100937","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100937"},"PeriodicalIF":3.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124257","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

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 : 2025-05-18 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

The experiences of clinical staff approaching families for organ donation consent: A systematic review and thematic synthesis of qualitative studies 临床工作人员接触器官捐赠同意家属的经验：定性研究的系统回顾和专题综合

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-05-05 DOI: 10.1016/j.trre.2025.100935

L.H.M. Pengel , V. Mazarello-Paes , D. Paredes-Zapata , G.C. Oniscu , C. Gouveia Gaglianone , L. Zhu , Y. Wang , N. Dhanda , J. Tocher , L. Aviles

Healthcare professionals (HCPs) play an essential role in organ donation (OD) particularly when approaching families to discuss consent to OD. We synthesized the evidence on experiences of HCPs when approaching potential organ donor families. Fourteen electronic databases were searched to identify studies describing HCP experiences or associations between HCP experiences and consent rates. Methodological quality was assessed by independent reviewers using the Mixed Methods Appraisal Tool. Qualitative data were analysed using thematic synthesis, while quantitative data were summarized by narrative review. Ninety-two studies were included. HCP experiences were conceptualised as a paradox due to the challenges to negotiate the boundaries between life and death. Organisational and personal aspects broadly shape the experiences of professionals. Studies suggest that staff experiences can be improved by training and education, however, quantitative studies did not show a strong association between OD training and improved consent rates. The complexities of the family approach were evident in the variety of interactions between HCPs and the donor family, which may explain why there is no uniform approach across settings and countries. The review highlights the challenges faced by professionals when negotiating policy and practice and informs recommendations to support staff involved in the OD process worldwide.

医疗保健专业人员（HCPs）在器官捐赠（OD）中发挥着至关重要的作用，特别是在接近家属讨论同意OD时。我们综合了HCPs接触潜在器官供体家庭时的经验。检索了14个电子数据库，以确定描述HCP经历或HCP经历与同意率之间关系的研究。方法学质量由独立评审员使用混合方法评估工具进行评估。定性数据采用专题综合法分析，定量数据采用叙述性综述法总结。纳入92项研究。HCP的体验被概念化为一种悖论，因为它挑战了生死之间的界限。组织和个人方面广泛地塑造了专业人士的经历。研究表明，培训和教育可以改善工作人员的经验，但是，数量研究并没有显示OD培训与提高同意率之间的密切联系。家庭方法的复杂性在卫生保健提供者与供体家庭之间的各种相互作用中显而易见，这可能解释了为什么在不同的环境和国家没有统一的方法。该审查强调了专业人员在谈判政策和实践时面临的挑战，并提供了建议，以支持世界各地参与OD流程的工作人员。

{"title":"The experiences of clinical staff approaching families for organ donation consent: A systematic review and thematic synthesis of qualitative studies","authors":"L.H.M. Pengel , V. Mazarello-Paes , D. Paredes-Zapata , G.C. Oniscu , C. Gouveia Gaglianone , L. Zhu , Y. Wang , N. Dhanda , J. Tocher , L. Aviles","doi":"10.1016/j.trre.2025.100935","DOIUrl":"10.1016/j.trre.2025.100935","url":null,"abstract":"<div><div>Healthcare professionals (HCPs) play an essential role in organ donation (OD) particularly when approaching families to discuss consent to OD. We synthesized the evidence on experiences of HCPs when approaching potential organ donor families. Fourteen electronic databases were searched to identify studies describing HCP experiences or associations between HCP experiences and consent rates. Methodological quality was assessed by independent reviewers using the Mixed Methods Appraisal Tool. Qualitative data were analysed using thematic synthesis, while quantitative data were summarized by narrative review. Ninety-two studies were included. HCP experiences were conceptualised as a paradox due to the challenges to negotiate the boundaries between life and death. Organisational and personal aspects broadly shape the experiences of professionals. Studies suggest that staff experiences can be improved by training and education, however, quantitative studies did not show a strong association between OD training and improved consent rates. The complexities of the family approach were evident in the variety of interactions between HCPs and the donor family, which may explain why there is no uniform approach across settings and countries. The review highlights the challenges faced by professionals when negotiating policy and practice and informs recommendations to support staff involved in the OD process worldwide.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100935"},"PeriodicalIF":3.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937927","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

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 : 2025-05-02 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。

{"title":"The comparative performance of models predicting patient and graft survival after kidney transplantation: A systematic review","authors":"Joris van de Klundert , Francisco Perez-Galarce , Marcelo Olivares , Liset Pengel , Annelies de Weerd","doi":"10.1016/j.trre.2025.100934","DOIUrl":"10.1016/j.trre.2025.100934","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 3","pages":"Article 100934"},"PeriodicalIF":3.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143913062","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