Transplantation Reviews最新文献_第6页

Characteristics and outcomes of cardiac amyloid disease after heart transplantation: A systematic review and meta-analysis 心脏移植后心脏淀粉样蛋白病的特点和结局：系统回顾和荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-04-01 Epub Date: 2025-01-09 DOI: 10.1016/j.trre.2025.100908

Daler Rahimov , Vivian Z. Yan , Danial Ahmad , Nayeem Nasher , Rob Tatum , Moses Im , Eugene Storozynsky , J. Eduardo Rame , Keshava Rajagopal , John W. Entwistle , Howard T. Massey , Vakhtang Tchantchaleishvili

Purpose

Patients with systemic amyloidosis with cardiac involvement require careful selection for heart transplantation (HTx) due to the associated poor outcomes. Large databases do not provide sufficient granularity to allow for differentiation between its major subtypes [light-chain (AL) and transthyretin (ATTR) amyloidosis]. We sought to pool the existing data on amyloidosis patients undergoing HTx, and perform stratified analysis based on its major subtypes.

Methods

Electronic search identified adult patients with amyloidosis undergoing HTx. Cohort-level data for 340 patients from 19 studies were extracted and analyzed. Patients were categorized based on amyloid subtype into AL and ATTR groups.

Results

AL amyloidosis was diagnosed at an earlier age compared to ATTR [53 (95 % CI 48; 57) years vs. 63 (55; 71) years, p = 0.03], with greater incidence in the Caucasian population [75 % (60; 87) vs. 39 % (21; 59), p ≤0.01]. Females comprised 33 % (25; 41) of the patients with greater preponderance in AL group [41 % (33; 48) vs. 21 % (8; 36), p = 0.02]. AL patients also had higher involvement of ≥two organs [50 % (29; 70) vs. 15 % (3; 32), p = 0.01]. GI involvement [25 % (6; 50) vs. 0 % (0; 8), p = 0.02], and renal involvement [20 % (8; 34) vs. 0 % (0; 2), p < 0.01] were virtually limited to AL, while ATTR patients had more implantable cardioverter defibrillators placed [64 % (34; 90) vs. 15 % (6; 28), p < 0.01] and trended towards greater incidence of neuropathy [24 % (9; 42) vs. 9 % (2; 19), p = 0.07]. The AL group had a significantly higher incidence of recurrent amyloidosis [16 % (7; 27) vs. 0 % (0; 0), p ≤0.01]. Pooled Kaplan-Meier survival analysis showed worse long-term survival in the AL group (p = 0.02).

Conclusion

Patients with AL amyloidosis showed more widespread systemic involvement and worse long-term survival after HTx compared to patients with ATTR amyloidosis. Protocols for mitigating the recurrence of AL amyloidosis are needed to improve survival in this high-risk subtype.

目的：系统性淀粉样变性合并心脏受累的患者由于预后不良，需要谨慎选择心脏移植。大型数据库没有提供足够的粒度来区分其主要亚型[轻链（AL）和转甲状腺素（ATTR）淀粉样变性]。我们试图汇总现有的淀粉样变性患者接受HTx的数据，并根据其主要亚型进行分层分析。方法对成人淀粉样变性行HTx的患者进行电子搜索。从19项研究中提取并分析了340例患者的队列水平数据。根据淀粉样蛋白亚型将患者分为AL组和ATTR组。结果：与ATTR相比，淀粉样变的诊断年龄更早[53](95% CI 48；57岁vs. 63岁(55；71)岁，p = 0.03]，高加索人群发病率更高[75% (60；87) vs. 39% (21；59), p≤0.01]。女性占33% (25；在AL组有较大优势的患者中[41% (33；48) vs. 21% (8；36), p = 0.02]。AL患者也有更高的≥两个器官受累[50% (29；70) vs. 15% (3；32), p = 0.01]。GI受累[25% (6；50) vs. 0% (0；8), p = 0.02]，肾脏受累[20% (8；34) vs. 0% (0；2), p <；[0.01]实际上仅限于AL，而ATTR患者放置了更多的植入式心律转复除颤器[64% (34；90) vs. 15% (6；28), p &；[0.01]并倾向于更高的神经病变发生率[24% (9；42) vs. 9% (2；19), p = 0.07]。AL组复发性淀粉样变性的发生率明显高于对照组[16% (7；27) vs. 0% (0；0), p≤0.01]。Kaplan-Meier生存分析显示，AL组的长期生存率较差（p = 0.02）。结论与ATTR淀粉样变患者相比，AL淀粉样变患者HTx术后表现出更广泛的全身累及和更差的长期生存。需要减轻AL淀粉样变复发的方案来提高这种高风险亚型的生存率。

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引用次数: 0

Effect of everolimus administration on renal function in renal transplant recipients: A systematic review and dose–response meta-analysis 依维莫司给药对肾移植受者肾功能的影响：一项系统评价和剂量反应荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-04-01 Epub Date: 2025-02-17 DOI: 10.1016/j.trre.2025.100911

Takehiro Ohyama , Shodai Yoshihiro , Tomoyuki Fujikura , Takamasa Miyauchi , Yuki Kataoka

Everolimus (EVL) is an effective post-transplant immunosuppressant; however, its optimal trough concentration when switching from calcineurin inhibitors (CNIs) remains unknown. The optimal dosing troughs for CNI-to-EVL switching in kidney transplant recipients were investigated. We searched multiple electronic databases (from inception to March 15, 2024) to identify double-blind or open-label randomized controlled trials evaluating groups (all ages, both sexes) that converted from CNIs to EVL and continued CNI treatment in kidney transplant recipients. Treatment responses, defined as changes in estimated glomerular filtration rate (eGFR), mortality, dropouts for any reason, and adverse events, were the outcomes. We performed a random-effects, one-stage dose–effect meta-analysis with restricted cubic splines. Nine studies were included, comprising 1872 participants. Changes in eGFR increased with increasing trough concentrations; however, the evidence was highly uncertain (95 % effective dose: 4.13 ng/mL, odds ratio [OR]: 1.31, 95 % confidence interval [CI]: 0.10–9.50). Mortality was not estimated owing to the low number of events. The evidence for the relationship between EVL trough levels and treatment discontinuation was also highly uncertain (OR: 1.31, 95 % CI: 0.10–9.39). Adverse events increased with a switch to EVL; however, this evidence was also uncertain (OR: 1.31, 95 % CI: 0.10–9.60). This study could not indicate an appropriate optimal EVL trough concentration owing to the high result uncertainty, and the results do not support the routine switch from CNIs to EVL. Further trials are required to explore the CNI-to-EVL switch timing and the effects of increased EVL dosing to establish a more definitive therapeutic strategy.

依维莫司是一种有效的移植后免疫抑制剂；然而，当从钙调磷酸酶抑制剂（CNIs）切换时，其最佳谷浓度仍然未知。研究了肾移植受者cni - evl转换的最佳给药槽。我们检索了多个电子数据库（从成立到2024年3月15日），以确定双盲或开放标签随机对照试验，评估肾移植受者从CNI转化为EVL并继续CNI治疗的组（所有年龄，两性）。治疗反应，定义为估计肾小球滤过率（eGFR）的变化、死亡率、任何原因的退出和不良事件。我们使用受限三次样条进行了随机效应、一期剂量效应荟萃分析。纳入了9项研究，包括1872名参与者。eGFR的变化随着谷浓度的增加而增加；然而，证据高度不确定（95%有效剂量：4.13 ng/mL，优势比[OR]: 1.31, 95%可信区间[CI]: 0.10-9.50）。由于事件数量少，没有估计死亡率。EVL谷底水平与停药之间关系的证据也高度不确定（OR: 1.31, 95% CI: 0.10-9.39）。不良事件随着EVL的转换而增加；然而，这一证据也不确定（OR: 1.31, 95% CI: 0.10-9.60）。由于结果的高不确定性，本研究不能给出一个合适的最佳EVL谷浓度，并且结果不支持从cni到EVL的常规切换。需要进一步的试验来探索cni到EVL的转换时间和EVL剂量增加的影响，以建立更明确的治疗策略。

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引用次数: 0

Ex-situ normothermic machine perfusion prevents ischemic cholangiopathy after liver transplantation: A meta-regression analysis 离地恒温机灌注预防肝移植后缺血性胆管病：一项荟萃回归分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-04-01 Epub Date: 2025-03-20 DOI: 10.1016/j.trre.2025.100915

Quirino Lai , Roberta Angelico , Nicola Guglielmo , Duilio Pagano , Paulo N. Martins , Davide Ghinolfi

Background & aims

Liver transplantation (LT) is the gold standard for end-stage liver disease, but ischemic cholangiopathy (IC) remains a significant complication. Ex-situ normothermic machine perfusion (ESNMP) has emerged as a potential strategy to mitigate ischemic injury. However, the effect of ESNMP on reducing post-LT IC remains controversial. This study aimed to perform an updated meta-analysis to evaluate the impact of ESNMP on IC incidence.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. The literature search included studies from 2015 to 2025 comparing LT outcomes using ESNMP vs. static cold storage (SCS). The primary outcome was the incidence of IC. Risk of bias was assessed using the ROBINS-E tool. Statistical analysis, including random-effects meta-analysis, sensitivity analysis, and meta-regression, was performed to evaluate heterogeneity, potential confounders, and the impact of follow-up duration.

Results

Seventeen studies, including 76,045 patients (4843 ESNMP; 71,202 SCS), were analyzed. No statistically significant difference in IC incidence was found between ESNMP and SCS (1.3 % vs. 0.6 %; RR = 0.68, 95 %CI = 0.41–1.13; P = 0.14). Sensitivity analysis excluding one outlier study revealed a reduction in IC risk with ESNMP (RR = 0.62, 95 %CI = 0.38–1.01; P = 0.054).

Two sub-analyses of studies with ≥12 months of follow-up (RR = 0.51, 95 %CI = 0.26–0.99; P = 0.049) and DCDs (RR = 0.33, 95 %CI = 0.16–0.67; P = 0.002) showed risk reduction. The meta-regression revealed that the back-to-base perfusion approach was associated with the occurrence of IC, with an OR of 1.03 (95 %CI = 1.00–1.07, P = 0.035).

Conclusions

a correlation between ESNMP use and IC reduced risk appears to exist, especially with longer follow-up periods and DCDs, though more high-quality studies are needed to confirm this finding.

背景,银移植（LT）是治疗终末期肝病的金标准，但缺血性胆管病（IC）仍然是一个重要的并发症。体外常温机器灌注（ESNMP）已成为减轻缺血性损伤的潜在策略。然而，ESNMP对降低lt后IC的作用仍存在争议。本研究旨在进行一项更新的荟萃分析，以评估ESNMP对IC发病率的影响。方法按照PRISMA指南进行系统评价和荟萃分析。文献检索包括2015年至2025年的研究，比较了使用ESNMP和静态冷库（SCS）的LT结果。主要终点是IC的发生率。使用ROBINS-E工具评估偏倚风险。统计分析包括随机效应荟萃分析、敏感性分析和荟萃回归，以评估异质性、潜在混杂因素和随访时间的影响。结果17项研究纳入76045例患者(4843例ESNMP；71202个SCS)进行分析。ESNMP和SCS之间IC发生率无统计学差异(1.3% vs 0.6%；Rr = 0.68, 95% ci = 0.41-1.13；p = 0.14)。排除一项异常研究的敏感性分析显示，ESNMP可降低IC风险(RR = 0.62, 95% CI = 0.38-1.01；p = 0.054)。随访≥12个月的两个亚组分析(RR = 0.51, 95% CI = 0.26-0.99；P = 0.049)和论证(RR = 0.33, 95% CI = 0.16 - -0.67;P = 0.002)显示风险降低。meta回归分析显示，颅底灌注与IC的发生相关，OR为1.03 （95% CI = 1.00-1.07, P = 0.035）。结论：ESNMP使用与IC风险降低之间似乎存在相关性，特别是在随访期和dcd较长的情况下，尽管需要更多高质量的研究来证实这一发现。

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引用次数: 0

Survival after heart transplants from circulatory-dead versus brain-dead donors: Meta-analysis of reconstructed time-to-event data 循环死亡与脑死亡供者心脏移植后的生存：重建时间-事件数据的荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-04-01 Epub Date: 2025-03-21 DOI: 10.1016/j.trre.2025.100917

Mohammed Al-Tawil , William Wang , Ashwini Chandiramani , Feras Zaqout , Abdel Hannan Diab , Serge Sicouri , Basel Ramlawi , Assad Haneya

Background

Heart transplantation (HTx) using donors after circulatory death (DCD) has the potential to significantly boost overall transplant rates. This study aims to reconstruct data from individual studies comparing survival between HTx from DCD recipients and donation after brain (DBD) recipients.

Methods

MEDLINE, Embase, Scopus, were searched up to August 2024. We included studies that reported a Kaplan-Meier summary of survival comparing DCD and DBD HTx. Digitization of the Kaplan-Meier curves and reconstruction of individual patient data followed by survival analysis that was conducted using R software.

Results

Six studies including a total of 3240 patients (2242 DBD and 998 DCD) were included in the final analysis. There was no significant difference in the overall survival rates between DCD and DBD patients (Hazard Ratio (HR): 1.01, 95 % CI [0.81–1.25], P = 0.91). However, the proportional hazard assumption was violated, deeming such results inconclusive. Time-varying flexible parametric model revealed a significantly declining survival in DCD recipients 3 years after surgery. Landmark analyses further suggest this declining trend in the DCD group at the two-year landmark (HR: 1.67, p = 0.021) and the four-year mark (HR: 2.78, p = 0.002). However, data beyond 6 years is limited. Evidence comparing direct procurement and normothermic regional perfusion is scarce, with no significant survival differences observed.

Conclusion

This meta-analysis shows that, despite similar early survival outcomes, DCD heart transplants showed a trend towards a lower long-term survival, with the difference becoming evident around three years post-transplantation. These findings highlight the need for enhanced monitoring and optimized post-transplant care in DCD recipients. Further studies with strict and long-term follow-up are warranted to confirm these results.

背景：循环死亡（DCD）后使用供体进行心脏移植（HTx）有可能显著提高总体移植率。本研究旨在重建比较DCD受者HTx和脑后捐赠（DBD）受者HTx存活率的个体研究数据。方法检索至2024年8月的medline、Embase、Scopus数据库。我们纳入了报告了比较DCD和DBD HTx的Kaplan-Meier生存总结的研究。Kaplan-Meier曲线的数字化和个体患者数据的重建，随后使用R软件进行生存分析。结果6项研究共纳入3240例患者，其中DBD 2242例，DCD 998例。DCD和DBD患者的总生存率差异无统计学意义（危险比（HR）： 1.01, 95% CI [0.81-1.25], P = 0.91）。然而，违反了比例风险假设，认为这些结果不具有决定性。时变柔性参数模型显示DCD患者术后3年生存率显著下降。里程碑分析进一步表明，DCD组在两年里程碑（HR: 1.67, p = 0.021）和四年标记（HR: 2.78, p = 0.002）时呈下降趋势。然而，6年以上的数据有限。比较直接获取和常温区域灌注的证据很少，没有观察到明显的生存差异。本荟萃分析显示，尽管早期生存结果相似，但DCD心脏移植的长期生存趋势较低，在移植后3年左右差异变得明显。这些发现强调了加强监测和优化DCD受者移植后护理的必要性。需要进一步的研究和严格的长期随访来证实这些结果。

{"title":"Survival after heart transplants from circulatory-dead versus brain-dead donors: Meta-analysis of reconstructed time-to-event data","authors":"Mohammed Al-Tawil , William Wang , Ashwini Chandiramani , Feras Zaqout , Abdel Hannan Diab , Serge Sicouri , Basel Ramlawi , Assad Haneya","doi":"10.1016/j.trre.2025.100917","DOIUrl":"10.1016/j.trre.2025.100917","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplantation (HTx) using donors after circulatory death (DCD) has the potential to significantly boost overall transplant rates. This study aims to reconstruct data from individual studies comparing survival between HTx from DCD recipients and donation after brain (DBD) recipients.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, Scopus, were searched up to August 2024. We included studies that reported a Kaplan-Meier summary of survival comparing DCD and DBD HTx. Digitization of the Kaplan-Meier curves and reconstruction of individual patient data followed by survival analysis that was conducted using R software.</div></div><div><h3>Results</h3><div>Six studies including a total of 3240 patients (2242 DBD and 998 DCD) were included in the final analysis. There was no significant difference in the overall survival rates between DCD and DBD patients (Hazard Ratio (HR): 1.01, 95 % CI [0.81–1.25], <em>P</em> = 0.91). However, the proportional hazard assumption was violated, deeming such results inconclusive. Time-varying flexible parametric model revealed a significantly declining survival in DCD recipients 3 years after surgery. Landmark analyses further suggest this declining trend in the DCD group at the two-year landmark (HR: 1.67, <em>p</em> = 0.021) and the four-year mark (HR: 2.78, <em>p</em> = 0.002). However, data beyond 6 years is limited. Evidence comparing direct procurement and normothermic regional perfusion is scarce, with no significant survival differences observed.</div></div><div><h3>Conclusion</h3><div>This meta-analysis shows that, despite similar early survival outcomes, DCD heart transplants showed a trend towards a lower long-term survival, with the difference becoming evident around three years post-transplantation. These findings highlight the need for enhanced monitoring and optimized post-transplant care in DCD recipients. Further studies with strict and long-term follow-up are warranted to confirm these results.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 2","pages":"Article 100917"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680503","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

Donor–derived cell–free dna as a diagnostic biomarker for acute rejection in heart transplantation: A systematic review and meta–analysis 供体来源的无细胞dna作为心脏移植急性排斥反应的诊断生物标志物：系统回顾和荟萃分析

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-04-01 Epub Date: 2025-03-20 DOI: 10.1016/j.trre.2025.100916

Shujun Liu, Lixing Wang, Shan Liu, Yinlong Zhao

Background

Endomyocardial biopsy is widely acknowledged as the gold standard for detecting rejection following heart transplantation. However, the operation itself carries a risk of myocardial tissue damage and associated complications during and after surgery. Given the limitations of existing diagnostic approaches, non-invasive biomarkers are crucial.

Objective

This study assessed the diagnostic utility of donor-derived cell-free DNA (dd-cfDNA) in detecting AR in heart transplant recipients.

Methods

A systematic literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from inception to August 1, 2024, to identify studies evaluating the diagnostic performance of dd-cfDNA for AR in heart transplant recipients. Retrieved studies were screened using EndNote X9. Meta-analysis was performed using Meta-Disc software version 1.4 and STATA/SE 14.0.

Results

Ten studies were included in the meta-analysis. The pooled sensitivity, specificity, and area under the receiver operating characteristic curve with 95 % confidence intervals (CIs) were 65 % (95 % CI, 61–68 %), 79 % (95 % CI, 78–80 %), and 0.83, respectively.

Conclusions

This meta-analysis indicates that plasma dd-cfDNA may serve as a promising non-invasive biomarker for the diagnosis of acute rejection in heart transplant recipients. However, further research is warranted to investigate factors influencing diagnostic performance and optimize clinical utility.

背景：心肌内膜活检被广泛认为是检测心脏移植后排斥反应的金标准。然而，手术本身存在心肌组织损伤的风险以及手术期间和手术后的相关并发症。鉴于现有诊断方法的局限性，非侵入性生物标志物至关重要。目的评价供体来源无细胞DNA （dd-cfDNA）检测心脏移植受者AR的诊断价值。方法系统检索PubMed、Embase、Cochrane Library和Web of Science自成立以来至2024年8月1日的文献，以确定评估dd-cfDNA对心脏移植受者AR诊断性能的研究。使用EndNote X9对检索到的研究进行筛选。采用Meta-Disc软件1.4版和STATA/SE 14.0进行meta分析。结果10项研究被纳入meta分析。在95%置信区间（CI）下，患者工作特征曲线下的总灵敏度、特异度和面积分别为65% （95% CI, 61 ~ 68%）、79% （95% CI, 78 ~ 80%）和0.83。结论：血浆dd-cfDNA可作为诊断心脏移植受者急性排斥反应的无创生物标志物。然而，需要进一步研究影响诊断性能的因素并优化临床应用。

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引用次数: 0

The impact of pancreas transplantation on diabetic complications: A systematic review 胰腺移植对糖尿病并发症的影响：系统综述。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-04-01 Epub Date: 2025-01-22 DOI: 10.1016/j.trre.2025.100910

Gayathri Giri , Daniel Doherty , Shazli Azmi , Hussein Khambalia , Giuseppe Giuffrida , Zia Moinuddin , David van Dellen

Background

Pancreas Transplantation (PT) provides optimal treatment for patients with severe complicated Type 1 Diabetes Mellitus (T1DM). Restoration of beta-cell mass allows return to euglycaemia and insulin independence. We aimed to examine its impact on the secondary complications associated with severe T1DM including diabetic eye disease, neuropathy and cardiovascular disease.

Methods

A database search using MedLINE to identify publications to April 2023 was conducted. Searches were performed using MeSH terms ‘Pancreas Transplantation’ AND ‘Diabetes Mellitus, Type 1’ ‘Diabetic Retinopathy’ OR ‘Heart Disease’ OR ‘Cardiovascular Diseases’ OR ‘Peripheral Vascular Disease’ OR “Amputation’ OR ‘Neuropathy.”

Results

All articles were retrospective with 51.1 % (n = 23) case control studies and 48.9 % (n = 22) cohort studies. 82.2 % (n = 37) examined simultaneous pancreas and kidney (SPK) transplantation and 17.8 % (n = 8) analysed pancreas transplant alone (PTA). Heterogenous outcomes metrics were employed. 15 studies examined diabetic retinopathy (DR) with 53.3 % (n = 8) demonstrated improvements after PT, while the remainder (n = 7) exhibited stabilisation. 16 studies assessed neuropathy and 87.5 % (n = 14) demonstrated beneficial effects of PT on nerve conduction studies, vibration perception threshold or corneal confocal microscopy. There was a positive effect on cardiovascular disease by reduction in the incidence of cardiac events, improvement in metabolic profile and increased left ventricular ejection fraction. 14 studies examined cardiovascular disease (71.4 % (n = 10) improvement; 14.2 % (n = 2) stabilisation; 14.2 % (n = 2) progression).

Conclusion

SPK and PTA have beneficial effects in ameliorating or stabilising diabetes complications. Future work should seek to reduce heterogeneity of outcome metrics assessing T1DM complication profile to facilitate robust comparison of beta-cell replacement interventions.

背景：胰腺移植（胰腺移植）是严重合并1型糖尿病（T1DM）患者的最佳治疗方法。β细胞群的恢复使血糖和胰岛素的独立性得以恢复。我们的目的是研究其对严重T1DM相关的继发性并发症的影响，包括糖尿病性眼病、神经病变和心血管疾病。方法：使用MedLINE数据库检索截至2023年4月的出版物。使用MeSH术语“胰腺移植”、“糖尿病1型”、“糖尿病视网膜病变”、“心脏病”、“心血管疾病”、“周围血管疾病”、“截肢”或“神经病变”进行搜索。结果：所有文章均为回顾性研究，其中51.1% （n = 23）为病例对照研究，48.9% （n = 22）为队列研究。82.2% （n = 37）接受胰肾联合移植（SPK）， 17.8% （n = 8）接受单独胰肾移植（PTA）。采用异质性结局指标。15项研究检查了糖尿病视网膜病变（DR）， 53.3% （n = 8）在PT后表现出改善，而其余（n = 7）表现出稳定。16项研究评估了神经病变，87.5% （n = 14）的研究表明PT对神经传导研究、振动感知阈值或角膜共聚焦显微镜有有益作用。通过降低心脏事件的发生率、改善代谢谱和增加左心室射血分数，对心血管疾病有积极影响。14项研究检查了心血管疾病（71.4% (n = 10)）的改善；稳定度14.2% (n = 2)；14.2% （n = 2）进展)。结论：SPK和PTA在改善或稳定糖尿病并发症方面有良好的作用。未来的工作应寻求减少评估T1DM并发症的结果指标的异质性，以促进β细胞替代干预措施的有力比较。

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引用次数: 0

Non-adherence to immunosuppressive medications in kidney transplant recipients- a systematic scoping review 肾移植受者免疫抑制药物不依从性-系统范围综述。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-01-01 Epub Date: 2024-12-03 DOI: 10.1016/j.trre.2024.100900

Michael Corr , Andrew Walker , Alexander P. Maxwell , Gareth J. McKay

Background

Rejection and graft failure remain common in kidney transplant recipients. Non-adherence to immunosuppressive medications is considered a major contributary factor to reduced long-term graft survival, particularly in younger people. Improvements in clinical practice based on adherence studies has been minimal.

Methods

Joanna Briggs' Institute Methodology was used. MedlineALL, Embase, Web of Science Core Collection and Scopus databases were searched from January 2000 through to December 2023. Abstract and full text reviews were undertaken independently by two reviewers. Data was collated using a pre-designed extraction tool.

Results

359 articles met the inclusion criteria. Non-adherence was commonly defined using self-reported questionnaires or pharmacy re-fill rates. Prevalence of non-adherence varied widely. There was little correlation between method of measurement and reported rates of non-adherence. Despite younger age being identified as a risk factor for non-adherence, pooled reported prevalence did not differ significantly in studies reporting prevalence in children, adolescents, or young adults vs. older adults (36.0 % vs. 34.0 %). Interventional studies to detect or improve adherence are highly heterogenous, often report small effects and are limited by the lack of gold-standard methods to measure adherence.

Discussion

This scoping review outlines the complexities of non-adherence to immunosuppressive medications among kidney transplant recipients, highlighting significant variability in adherence definitions, measurements, and intervention efficacy. Reported non-adherence rates vary widely (2–89 %), underscoring the need for standardisation of the definition of non-adherence in research. Findings suggest that non-adherence to immunosuppressive medication is driven by a mix of demographic, psychosocial, and transplant-specific factors. Future research should prioritise standardised definitions of adherence, validated tools to measure adherence, and focus on clinically significant outcomes in non-adherent populations to develop meaningful, impactful interventions for long-term patient benefit.

背景：排斥反应和移植物衰竭在肾移植受者中仍然很常见。不坚持使用免疫抑制药物被认为是导致移植物长期存活率降低的主要因素，尤其是在年轻人中。基于依从性研究的临床实践的改进一直很小。方法：采用Joanna Briggs研究所的方法。检索了2000年1月至2023年12月期间的MedlineALL、Embase、Web of Science Core Collection和Scopus数据库。摘要和全文评审由两位审稿人独立进行。使用预先设计的提取工具对数据进行整理。结果：359篇文章符合纳入标准。非依从性通常通过自我报告的问卷或药房重新填充率来定义。不依从的发生率差别很大。测量方法与报告的不依从率之间几乎没有相关性。尽管较年轻的年龄被确定为不依从性的危险因素，但在报告儿童、青少年或年轻人与老年人患病率的研究中，汇总报告的患病率没有显着差异（36.0%对34.0%）。检测或改善依从性的介入研究是高度异质性的，通常报告的效果很小，并且由于缺乏衡量依从性的金标准方法而受到限制。讨论：本综述概述了肾移植受者免疫抑制药物不依从性的复杂性，强调了依从性定义、测量和干预效果的显著差异。报告的不依从率差异很大（2- 89%），强调了研究中不依从定义标准化的必要性。研究结果表明，不坚持使用免疫抑制药物是由人口统计学、社会心理和移植特异性因素共同驱动的。未来的研究应优先考虑依从性的标准化定义，有效的工具来衡量依从性，并将重点放在非依从性人群的临床显著结果上，以开发有意义的、有效的干预措施，以获得长期患者利益。

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引用次数: 0

Complement and complement regulatory protein in allogeneic and xenogeneic kidney transplantation 同种异体肾移植中的补体和补体调节蛋白

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-01-01 Epub Date: 2024-11-07 DOI: 10.1016/j.trre.2024.100885

Yoichi Kakuta , Shuji Miyagawa , Soichi Matsumura , Yoko Higa-Maegawa , Shota Fukae , Ryo Tanaka , Shigeaki Nakazawa , Kazuaki Yamanaka , Takuji Kawamura , Shunsuke Saito , Shigeru Miyagawa , Norio Nonomura

Kidney transplantation is the most optimal treatment for patients with end-stage renal disease, offering significant improvements in patient outcomes over dialysis. However, the potential for immune rejection, where the recipient's immune system attacks the transplanted kidney, can compromise transplant success. The complement system, a key component of the immune response, plays a crucial role in both acute and chronic rejection, including T-cell- and antibody-mediated rejection. Understanding and controlling the complement system is essential for managing rejection and enhancing graft survival and overall success of kidney transplantation. In allogeneic transplantation, complement activation through various pathways contributes to graft damage and failure. Recent advancements in genetic engineering enable the development of transgenic pigs expressing human complement regulatory proteins, which display potential for reducing rejection in xenotransplantation. Despite these advances, the complex mechanisms of complement activation and regulation are not fully understood, necessitating further research. This review examines the role of the complement system in kidney transplantation, explores the latest developments in complement regulatory strategies, and discusses potential therapeutic approaches to improve transplant outcomes.

肾移植是治疗终末期肾病患者的最佳方法，与透析相比，它能显著改善患者的预后。然而，潜在的免疫排斥反应（即受者的免疫系统攻击移植的肾脏）会影响移植的成功率。补体系统是免疫反应的关键组成部分，在急性和慢性排斥反应（包括 T 细胞和抗体介导的排斥反应）中发挥着至关重要的作用。了解和控制补体系统对于控制排斥反应、提高移植物存活率和肾移植的整体成功率至关重要。在异体移植中，补体通过各种途径激活会导致移植物损伤和失败。基因工程的最新进展使表达人类补体调节蛋白的转基因猪得以开发，这显示了在异种移植中减少排斥反应的潜力。尽管取得了这些进展，但人们对补体激活和调节的复杂机制还不完全了解，因此有必要开展进一步的研究。这篇综述探讨了补体系统在肾移植中的作用，探索了补体调节策略的最新进展，并讨论了改善移植结果的潜在治疗方法。

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引用次数: 0

Safety and efficacy of direct oral anticoagulants in kidney transplant recipients: A systematic review and meta-analysis 肾移植受者直接口服抗凝剂的安全性和有效性：一项系统回顾和荟萃分析。

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-01-01 Epub Date: 2024-12-04 DOI: 10.1016/j.trre.2024.100899

Maria Meritxell Roca Mora , Andre Milani Reis , Filipe Piazzi Tavares , Lídia Santos Oliveira , Amanda Godoi , Patricia Viana , Juliano Riella

Introduction

Direct-acting oral anticoagulants (DOACs) have recently shown potential efficacy for many conditions without the need for regular monitoring. However, their use in kidney transplant recipients (KTRs) is controversial, with no clear consensus on how they compare to vitamin K antagonists (VKAs), which have traditionally been used as preferred anticoagulation therapy in these patients.

Methods

PubMed, Cochrane Central, and Embase databases were systematically searched up to December 2023 for studies comparing DOACs versus VKAs in KTRs. The main outcomes of interest included venous thromboembolism (VTE), major bleeding, graft failure, mortality, and changes in estimated glomerular filtration rate (eGFR). Statistical analyses were performed using RStudio 4.1.2 software. PROSPERO ID: CRD42024498423.

Results

Five studies with a total of 959 participants were included. Of these, 433 (45.15 %) participants were treated with DOACs. The mean age of participants was 60.05 years, and 65.9 % were male. The use of DOACs in KTRs was associated with a significant reduction in major bleeding (RR 0.56; 95 % CI 0.35 to 0.90; p = 0.02; I² = 0 %) and mortality (RR 0.49; 95 % CI 0.33 to 0.74; p = 0.0006; I² = 0 %). No significant differences were found between groups in VTE (RR 0.82; 95 % CI 0.47 to 1.43; p = 0.48; I² = 12 %), graft failure (RR 0.43; 95 % CI 0.14 to 1.27; p = 0.13; I² = 52 %), and eGFR (MD 3.72 mL/Kg/1.73 m2; 95 % CI -1.58 to 9.03; p = 0.17; I² = 0 %). Evidence quality for some outcomes remains low to moderate, limiting the confidence in these conclusions.

Conclusion

Our meta-analysis suggests that DOACs represent an effective anticoagulation strategy in KTR, with a significant reduction in major bleeding and mortality relative to VKA.

直接作用口服抗凝剂（DOACs）最近显示出对许多疾病的潜在疗效，而无需定期监测。然而，它们在肾移植受者（KTRs）中的使用是有争议的，关于它们与维生素K拮抗剂（VKAs）的比较没有明确的共识，维生素K拮抗剂传统上被用作这些患者首选的抗凝治疗。方法：系统检索PubMed、Cochrane Central和Embase数据库，检索截至2023年12月比较ktr患者doac与vka的研究。研究的主要结果包括静脉血栓栓塞（VTE）、大出血、移植物失败、死亡率和肾小球滤过率（eGFR）的变化。采用RStudio 4.1.2软件进行统计分析。普洛斯彼罗id: CRD42024498423。结果：纳入5项研究，共959名受试者。其中，433名（45.15%）参与者接受了DOACs治疗。参与者的平均年龄为60.05岁，65.9%为男性。在KTRs中使用DOACs与大出血的显著减少相关(RR 0.56；95% CI 0.35 ~ 0.90；p = 0.02；I2 = 0%)和死亡率(RR 0.49；95% CI 0.33 ~ 0.74；p = 0.0006；i2 = 0%)。两组间VTE无显著差异(RR 0.82；95% CI 0.47 ~ 1.43；p = 0.48；I2 = 12%)，移植物衰竭(RR 0.43；95% CI 0.14 ~ 1.27；p = 0.13；I2 = 52%), eGFR (MD 3.72 mL/Kg/1.73 m2；95% CI -1.58 - 9.03；p = 0.17；i2 = 0%)。一些结果的证据质量仍然低到中等，限制了这些结论的可信度。结论：我们的荟萃分析表明，与VKA相比，DOACs在KTR中是一种有效的抗凝策略，可显著降低大出血和死亡率。

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引用次数: 0

Complement in Kidney Transplantation 补体在肾移植中的应用

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews

Pub Date : 2025-01-01 Epub Date: 2024-11-26 DOI: 10.1016/j.trre.2024.100897

Pooja Lokkur , Shyam Bihari Bansal

Transplantation is the treatment of choice in most patients with kidney failure. The complement system plays a vital role in transplantation. The complement system forms a major part of innate immunity and acts as a bridge between innate and acquired immunity. Many diseases, particularly concerning the kidneys, result from complement system dysregulation, like atypical hemolytic uremic syndrome (aHUS), C3 glomerulopathy (C3GN), systemic lupus erythematosus (SLE and some other immune complex diseases. The complement system activation is a very important part of post-transplant events like ischemia-reperfusion injury (IRI), delayed graft function (DGF), antibody-mediated rejection (ABMR) and thrombotic microangiopathy (TMA). A better understanding of the complement cascade can help to plan strategies to prevent and manage complement-related problems before and after kidney transplantation. Many newer molecules are either being developed or in the pipeline, which target the complement system at various stages. These novel therapeutics are now considered additional measures to improve graft survival. This review summarises the complement cascade, its role in kidney diseases and kidney transplantation, and possible areas of target and novel therapeutics.

移植是大多数肾衰竭患者的治疗选择。补体系统在移植中起着至关重要的作用。补体系统是先天免疫的重要组成部分，是先天免疫和获得性免疫之间的桥梁。许多疾病，特别是与肾脏有关的疾病，都是由补体系统失调引起的，如非典型溶血性尿毒症综合征（aHUS）、C3肾小球病（C3GN）、系统性红斑狼疮（SLE）和其他一些免疫复合物疾病。补体系统激活是移植后缺血再灌注损伤（IRI）、移植功能延迟（DGF）、抗体介导的排斥反应（ABMR）和血栓性微血管病（TMA）等事件的重要组成部分。更好地了解补体级联可以帮助制定预防和管理肾移植前后补体相关问题的策略。许多新的分子正在开发中或正在研制中，它们针对的是处于不同阶段的补体系统。这些新疗法现在被认为是提高移植物存活率的额外措施。本文综述了补体级联及其在肾脏疾病和肾移植中的作用，以及可能的靶点和新疗法领域。

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引用次数: 0