Pub Date : 2025-01-01Epub Date: 2024-11-22DOI: 10.1016/j.trre.2024.100889
Delsante Marco, Gandolfini Ilaria, Palmisano Alessandra, Giuseppe Daniele Benigno, Gentile Micaela, Giovanni Maria Rossi, Fiaccadori Enrico, Maggiore Umberto
The role of the complement system in antibody mediated rejection (AMR) emerged in the last decades, and the demonstration of the presence of complement fragments in renal allograft biopsies is a consolidated diagnostic sign of AMR. However, antibodies against donor antigens may lead to microvascular inflammation and endothelial injury even in the absence of complement activation, and growing evidence suggests that complement-independent mechanisms may be prominent in late (i.e., occurring >6 months after transplantation) vs early AMR. Different donor specific antibodies (DSA) with different biological features and complement activation ability may be involved in late or early AMR. Downregulation of tissue complement inhibitors may happen early after transplantation, partially due to ischemia reperfusion injury, and could facilitate complement activation in early vs late AMR. Clinical and histological features of late AMR and C4d negative AMR seem to converge, and this narrative review analyzes the evidence that supports lower complement activation in late vs early AMR, including differential C4d staining prevalence based on the time after transplantation, differential response to anti-complement therapy and other direct and indirect signs of the complement system activation. The therapeutic approach in early vs late AMR should take into account possible differences in the pathophysiological mechanisms of microvascular inflammation and endothelial injury in early vs late AMR.
补体系统在抗体介导的排斥反应（AMR）中的作用是在过去几十年中出现的，肾移植活检中补体片段的存在是AMR的一个综合诊断标志。然而，即使在没有补体激活的情况下，针对供体抗原的抗体也可能导致微血管炎症和内皮损伤。越来越多的证据表明，在晚期（即移植后 6 个月）与早期 AMR 中，补体无关机制可能更为突出。不同的供体特异性抗体（DSA）具有不同的生物学特征和补体激活能力，可能参与晚期或早期AMR。组织补体抑制剂的下调可能发生在移植后早期，部分原因是缺血再灌注损伤，这可能会促进早期与晚期AMR的补体激活。晚期AMR和C4d阴性AMR的临床和组织学特征似乎趋于一致，本综述分析了支持晚期与早期AMR补体激活程度较低的证据，包括基于移植后时间的不同C4d染色流行率、对抗补体治疗的不同反应以及补体系统激活的其他直接和间接迹象。早期与晚期AMR的治疗方法应考虑到早期与晚期AMR微血管炎症和内皮损伤的病理生理机制可能存在的差异。
{"title":"Early and late antibody mediated rejection: Which game is the complement playing?","authors":"Delsante Marco, Gandolfini Ilaria, Palmisano Alessandra, Giuseppe Daniele Benigno, Gentile Micaela, Giovanni Maria Rossi, Fiaccadori Enrico, Maggiore Umberto","doi":"10.1016/j.trre.2024.100889","DOIUrl":"10.1016/j.trre.2024.100889","url":null,"abstract":"<div><div>The role of the complement system in antibody mediated rejection (AMR) emerged in the last decades, and the demonstration of the presence of complement fragments in renal allograft biopsies is a consolidated diagnostic sign of AMR. However, antibodies against donor antigens may lead to microvascular inflammation and endothelial injury even in the absence of complement activation, and growing evidence suggests that complement-independent mechanisms may be prominent in late (i.e., occurring >6 months after transplantation) vs early AMR. Different donor specific antibodies (DSA) with different biological features and complement activation ability may be involved in late or early AMR. Downregulation of tissue complement inhibitors may happen early after transplantation, partially due to ischemia reperfusion injury, and could facilitate complement activation in early vs late AMR. Clinical and histological features of late AMR and C4d negative AMR seem to converge, and this narrative review analyzes the evidence that supports lower complement activation in late vs early AMR, including differential C4d staining prevalence based on the time after transplantation, differential response to anti-complement therapy and other direct and indirect signs of the complement system activation. The therapeutic approach in early vs late AMR should take into account possible differences in the pathophysiological mechanisms of microvascular inflammation and endothelial injury in early vs late AMR.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100889"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703687","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}
Pub Date : 2025-01-01Epub Date: 2024-11-22DOI: 10.1016/j.trre.2024.100888
Mita M. Shah, Clarkson Crane, Robert W. Steiner
The number of patients waiting for kidney transplants from deceased organ donors continues to increase. In this context, non-transplantation of acceptable kidneys is especially regrettable. Here, we review successful transplantation of deceased donor kidneys with anatomic abnormalities, intrinsic kidney diseases, and other ostensibly problematic conditions. These scenarios will be encountered infrequently and, with limited time to decide, uncertainty often results in organ refusal. In general, anatomic abnormalities can be overcome, kidney diseases remit in recipients, and systemic donor conditions such as poisonings do not affect the recipient. Acknowledging the risk of publication bias and need for more long-term outcome data, familiarity with these “once in a lifetime” deceased donor kidneys potentially avoids unwarranted refusals and provides insights into many disease processes.
{"title":"Successful use of deceased donors with medically complex kidneys","authors":"Mita M. Shah, Clarkson Crane, Robert W. Steiner","doi":"10.1016/j.trre.2024.100888","DOIUrl":"10.1016/j.trre.2024.100888","url":null,"abstract":"<div><div>The number of patients waiting for kidney transplants from deceased organ donors continues to increase. In this context, non-transplantation of acceptable kidneys is especially regrettable. Here, we review successful transplantation of deceased donor kidneys with anatomic abnormalities, intrinsic kidney diseases, and other ostensibly problematic conditions. These scenarios will be encountered infrequently and, with limited time to decide, uncertainty often results in organ refusal. In general, anatomic abnormalities can be overcome, kidney diseases remit in recipients, and systemic donor conditions such as poisonings do not affect the recipient. Acknowledging the risk of publication bias and need for more long-term outcome data, familiarity with these “once in a lifetime” deceased donor kidneys potentially avoids unwarranted refusals and provides insights into many disease processes.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100888"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-09-02DOI: 10.1016/j.trre.2024.100880
Gavin G. Calpin , Cian Hehir , Matthew G. Davey , Benjamin M. MacCurtain , Dilly Little , Niall F. Davis
Introduction
The left kidney is preferable in living donor nephrectomy (LDN). We aimed to investigate the safety and efficacy of right versus left LDN in both donor and recipients. A subgroup analysis of outcomes based on operative approach was also performed.
Methods
A systematic review and meta-analysis was performed as per PRISMA guidelines. Outcomes of interest were extracted from included studies and analysed.
Results
There were 31 studies included with 79,912 transplants. Left LDN was performed in 84.1 % of cases and right LDN in 15.9 %. Right LDN was associated with reduced EBL (P = 0.010), intra-operative complications (P = 0.030) and operative time (P = 0.006), but higher rates of conversion to open surgery (1.4 % vs 0.9 %). However, right living donor renal transplantation (LDRT) had higher rates of delayed graft function (5.4 % vs 4.2 %, P < 0.0001) and graft loss (2.6 % vs 1.1 %, P < 0.0001). Graft survival was reduced in right LDRT at 3 years (92.0 % vs 94.2 %, P = 0.001) but comparable to left LDRT at 1- and 5-years. Otherwise, donor and recipient peri-operative outcomes and serum creatinine levels were comparable in both groups. Hand-assisted LDN was associated with shorter warm ischaemia time (P < 0.0001) but longer length of stay (LOS) than laparoscopic LDN and robotic-assisted LDN (P < 0.0001). RA-LDN was associated with less EBL and shorter LOS (both P < 0.0001) while patients who underwent L-LDN had a lower mean serum creatinine (SCr) level on discharge (P < 0.0001).
Conclusion
Right LDRT has higher rates of delayed graft function and graft loss compared to left LDRT. Minimally-invasive surgical approaches potentially offer improved outcomes but further large-scale randomised controlled trials studies are required to confirm this finding.
{"title":"Right and left living donor nephrectomy and operative approach: A systematic review and meta-analysis of donor and recipient outcomes","authors":"Gavin G. Calpin , Cian Hehir , Matthew G. Davey , Benjamin M. MacCurtain , Dilly Little , Niall F. Davis","doi":"10.1016/j.trre.2024.100880","DOIUrl":"10.1016/j.trre.2024.100880","url":null,"abstract":"<div><h3>Introduction</h3><div>The left kidney is preferable in living donor nephrectomy (LDN). We aimed to investigate the safety and efficacy of right versus left LDN in both donor and recipients. A subgroup analysis of outcomes based on operative approach was also performed.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was performed as per PRISMA guidelines. Outcomes of interest were extracted from included studies and analysed.</div></div><div><h3>Results</h3><div>There were 31 studies included with 79,912 transplants. Left LDN was performed in 84.1 % of cases and right LDN in 15.9 %. Right LDN was associated with reduced EBL (<em>P</em> = 0.010), intra-operative complications (<em>P</em> = 0.030) and operative time (<em>P</em> = 0.006), but higher rates of conversion to open surgery (1.4 % vs 0.9 %). However, right living donor renal transplantation (LDRT) had higher rates of delayed graft function (5.4 % vs 4.2 %, <em>P</em> < 0.0001) and graft loss (2.6 % vs 1.1 %, <em>P</em> < 0.0001). Graft survival was reduced in right LDRT at 3 years (92.0 % vs 94.2 %, <em>P</em> = 0.001) but comparable to left LDRT at 1- and 5-years. Otherwise, donor and recipient peri-operative outcomes and serum creatinine levels were comparable in both groups. Hand-assisted LDN was associated with shorter warm ischaemia time (<em>P</em> < 0.0001) but longer length of stay (LOS) than laparoscopic LDN and robotic-assisted LDN (<em>P</em> < 0.0001). RA-LDN was associated with less EBL and shorter LOS (both <em>P</em> < 0.0001) while patients who underwent L-LDN had a lower mean serum creatinine (SCr) level on discharge (<em>P</em> < 0.0001).</div></div><div><h3>Conclusion</h3><div>Right LDRT has higher rates of delayed graft function and graft loss compared to left LDRT. Minimally-invasive surgical approaches potentially offer improved outcomes but further large-scale randomised controlled trials studies are required to confirm this finding.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100880"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-11-26DOI: 10.1016/j.trre.2024.100898
Sara Alibrandi , Angela Clemens , Nicholas Chun
The complement system plays a critical role in modulating adaptive T cell responses. Coordination of the proinflammatory signaling cascade and complement regulators permits efficient T cell priming and survival, while minimizing off-target damage to healthy host cells. In the context of transplantation, anti-donor T cell immunity remains a barrier to long term graft health and complement-targeted therapies have shown the potential to significantly improve patient outcomes. Here we will review our current understanding of complement-mediated T cell function and how these findings may be harnessed in organ transplantation.
{"title":"Complement and T cell activation in transplantation","authors":"Sara Alibrandi , Angela Clemens , Nicholas Chun","doi":"10.1016/j.trre.2024.100898","DOIUrl":"10.1016/j.trre.2024.100898","url":null,"abstract":"<div><div>The complement system plays a critical role in modulating adaptive T cell responses. Coordination of the proinflammatory signaling cascade and complement regulators permits efficient T cell priming and survival, while minimizing off-target damage to healthy host cells. In the context of transplantation, anti-donor T cell immunity remains a barrier to long term graft health and complement-targeted therapies have shown the potential to significantly improve patient outcomes. Here we will review our current understanding of complement-mediated T cell function and how these findings may be harnessed in organ transplantation.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100898"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748169","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}
Pub Date : 2025-01-01Epub Date: 2024-11-22DOI: 10.1016/j.trre.2024.100887
Daigo Nakazawa
The complement system is implicated in various facets of kidney transplantation, including ischemia-reperfusion injury (IRI), delayed graft function, allograft rejection, and chronic allograft injury. IRI, prevalent in cadaveric renal transplantation, leads to acute tubular necrosis and engages innate immunity, including neutrophils and the complement system, fostering a cycle of inflammation and necrosis. Experimental and preclinical evidence suggest that targeting the complement system could offer therapeutic benefits in IRI during kidney transplantation. This article explores potential therapeutic approaches targeting complement pathways in kidney transplantation, drawing from experimental and preclinical research findings.
{"title":"Targeting complement in kidney transplantation: Therapeutic approaches based on preclinical and experimental evidence","authors":"Daigo Nakazawa","doi":"10.1016/j.trre.2024.100887","DOIUrl":"10.1016/j.trre.2024.100887","url":null,"abstract":"<div><div>The complement system is implicated in various facets of kidney transplantation, including ischemia-reperfusion injury (IRI), delayed graft function, allograft rejection, and chronic allograft injury. IRI, prevalent in cadaveric renal transplantation, leads to acute tubular necrosis and engages innate immunity, including neutrophils and the complement system, fostering a cycle of inflammation and necrosis. Experimental and preclinical evidence suggest that targeting the complement system could offer therapeutic benefits in IRI during kidney transplantation. This article explores potential therapeutic approaches targeting complement pathways in kidney transplantation, drawing from experimental and preclinical research findings.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100887"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748170","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}
Pub Date : 2025-01-01Epub Date: 2024-11-22DOI: 10.1016/j.trre.2024.100886
Abdulaziz Abdulelah Banaja , Nicolae Cristian Bulescu , Caroline Martin-Bonnet , Marc Lilot , Roland Henaine
The rising prevalence of congenital heart disease (CHD) among adults has led to increased heart transplantation (HT) procedures in this population. However, CHD patients face significant challenges including longer waiting times, higher early mortality rates, and increased risks of complications such as renal dysfunction. This systematic review and meta-analysis examined 50 studies to assess waiting times, postoperative outcomes, and survival rates in CHD patients undergoing HT compared to non-CHD patients. Results revealed that CHD patients experience longer HT waiting times (mean difference [MD]: 53.86 days, 95 % CI: [22.00, 85.72], P = 0.0009) and increased ischemic times (MD: 20.01 min, 95 % CI: [10.51, 29.51], P < 0.0001), which may increase waitlist and early postoperative mortality. Regarding complications, renal dysfunction is more prevalent in CHD patients than in non-CHD patients (RR: 2.05, 95 % CI: [1.61, 2.61], P < 0.00001). Despite these challenges, long-term survival rates for CHD patients are comparable to those of non-CHD recipients, with significant improvements noted in recent allocation systems. Our findings emphasize the need for ongoing refinements in HT allocation systems to improve outcomes for CHD patients, particularly in reducing waiting times and managing post-transplant complications.
{"title":"Heart transplantation in adults with congenital heart diseases: A comprehensive meta-analysis on waiting times, operative, and survival outcomes","authors":"Abdulaziz Abdulelah Banaja , Nicolae Cristian Bulescu , Caroline Martin-Bonnet , Marc Lilot , Roland Henaine","doi":"10.1016/j.trre.2024.100886","DOIUrl":"10.1016/j.trre.2024.100886","url":null,"abstract":"<div><div>The rising prevalence of congenital heart disease (CHD) among adults has led to increased heart transplantation (HT) procedures in this population. However, CHD patients face significant challenges including longer waiting times, higher early mortality rates, and increased risks of complications such as renal dysfunction. This systematic review and meta-analysis examined 50 studies to assess waiting times, postoperative outcomes, and survival rates in CHD patients undergoing HT compared to non-CHD patients. Results revealed that CHD patients experience longer HT waiting times (mean difference [MD]: 53.86 days, 95 % CI: [22.00, 85.72], <em>P</em> = 0.0009) and increased ischemic times (MD: 20.01 min, 95 % CI: [10.51, 29.51], <em>P</em> < 0.0001), which may increase waitlist and early postoperative mortality. Regarding complications, renal dysfunction is more prevalent in CHD patients than in non-CHD patients (RR: 2.05, 95 % CI: [1.61, 2.61], <em>P</em> < 0.00001). Despite these challenges, long-term survival rates for CHD patients are comparable to those of non-CHD recipients, with significant improvements noted in recent allocation systems. Our findings emphasize the need for ongoing refinements in HT allocation systems to improve outcomes for CHD patients, particularly in reducing waiting times and managing post-transplant complications.</div></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"39 1","pages":"Article 100886"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-21DOI: 10.1016/j.trre.2024.100873
Silvia Corcione , Tommaso Lupia , Davide Vita , Francesca Sidoti , Elisa Zanotto , Paolo Solidoro , Luigi Biancone , Cristina Costa , Roberto Balagna , Francesco Giuseppe De Rosa
<div><p>The treatment of refractory CMV is often associated with high toxicity. Maribavir (MBV) is a novel oral antiviral, known for its favourable safety profile in fragile patients. We describe a case of CMV disease with end organ damage following kidney transplantation at high risk, for recipient-donor serological mismatch. A 54-year-old female with history of obesity, hypertension, and chronic kidney disease, on prednisone and tacrolimus after kidney transplantation in November 2022, soon after developed primary CMV infection, treated with Valganciclovir and CMV Ig. In January 2023 the patient presented with fever and dyspnea. Pulmonary miliary opacities and right-upper lobe consolidation were found at CT-scan along with CMV-DNA positivity on BAL and serum. Lung biopsy confirmed CMV infection. Antiviral was switched to Ganciclovir. Despite initial benefit, fever and respiratory failure happened 8 days later, leading to intubation at day 15. Due to slow decrease serum CMV-DNA and detection of UL97 mutation, conferring resistance to valganciclovir and ganciclovir, the patient was started on foscarnet and letermovir. She was extubated after a gradual respiratory improvement and discharged from ICU to rehabilitation department with HFNC; reduction in serum CMV-DNA, but persistently elevated CMV-DNA on BAL were documented. At week 8, MBV was started and letermovir continued, for a 8 weeks course, without notable adverse effects. Respiratory function improved but soon after septic shock occurred. A bone marrow biopsy resulted in lymphoma, without indications for treatment: the patient developed coma and died 6 months after admission. MBV has recently been approved in Europe for treatment of R/R CMV in HSCT and SOT recipients. MBV showed superior rates of viraemia clearance after 8 weeks compared to SOC, demonstrating also a favourable safety profile with fewer patients discontinuing treatment and being affected by nephrotoxicity and neutropenia. Its main side effects are taste impairment, gastro-intestinal symptoms and asthenia. Based on actual promising perspectives regarding antiviral stewardship, more data are required to corroborate benefit of MBV in terms of toxicity and impact on mortality in highly fragile populations as SOT recipients.</p><p>MBV received approval for the treatment of refractory or resistant CMV infections to other antiviral agents. Nevertheless, real-life data on efficacy and safety of MBV are still lacking.</p><p>We conducted a narrative review of the current literature on MBV as treatment for CMV infection in kidney transplant recipients to understand clinical characteristics, safety and outcomes of MBV in this population. A search was run on the main scientific databases. 194 papers were identified, of which 188 were excluded by title and abstract evaluation. Subsequently, 6 papers were included. We performed descriptive statistics on the entire study population. The studies included in our analysis showed a higher preva
{"title":"Maribavir treatment for resistant cytomegalovirus disseminated disease in kidney transplant recipients: A case-based scoping review of real life data in literature","authors":"Silvia Corcione , Tommaso Lupia , Davide Vita , Francesca Sidoti , Elisa Zanotto , Paolo Solidoro , Luigi Biancone , Cristina Costa , Roberto Balagna , Francesco Giuseppe De Rosa","doi":"10.1016/j.trre.2024.100873","DOIUrl":"10.1016/j.trre.2024.100873","url":null,"abstract":"<div><p>The treatment of refractory CMV is often associated with high toxicity. Maribavir (MBV) is a novel oral antiviral, known for its favourable safety profile in fragile patients. We describe a case of CMV disease with end organ damage following kidney transplantation at high risk, for recipient-donor serological mismatch. A 54-year-old female with history of obesity, hypertension, and chronic kidney disease, on prednisone and tacrolimus after kidney transplantation in November 2022, soon after developed primary CMV infection, treated with Valganciclovir and CMV Ig. In January 2023 the patient presented with fever and dyspnea. Pulmonary miliary opacities and right-upper lobe consolidation were found at CT-scan along with CMV-DNA positivity on BAL and serum. Lung biopsy confirmed CMV infection. Antiviral was switched to Ganciclovir. Despite initial benefit, fever and respiratory failure happened 8 days later, leading to intubation at day 15. Due to slow decrease serum CMV-DNA and detection of UL97 mutation, conferring resistance to valganciclovir and ganciclovir, the patient was started on foscarnet and letermovir. She was extubated after a gradual respiratory improvement and discharged from ICU to rehabilitation department with HFNC; reduction in serum CMV-DNA, but persistently elevated CMV-DNA on BAL were documented. At week 8, MBV was started and letermovir continued, for a 8 weeks course, without notable adverse effects. Respiratory function improved but soon after septic shock occurred. A bone marrow biopsy resulted in lymphoma, without indications for treatment: the patient developed coma and died 6 months after admission. MBV has recently been approved in Europe for treatment of R/R CMV in HSCT and SOT recipients. MBV showed superior rates of viraemia clearance after 8 weeks compared to SOC, demonstrating also a favourable safety profile with fewer patients discontinuing treatment and being affected by nephrotoxicity and neutropenia. Its main side effects are taste impairment, gastro-intestinal symptoms and asthenia. Based on actual promising perspectives regarding antiviral stewardship, more data are required to corroborate benefit of MBV in terms of toxicity and impact on mortality in highly fragile populations as SOT recipients.</p><p>MBV received approval for the treatment of refractory or resistant CMV infections to other antiviral agents. Nevertheless, real-life data on efficacy and safety of MBV are still lacking.</p><p>We conducted a narrative review of the current literature on MBV as treatment for CMV infection in kidney transplant recipients to understand clinical characteristics, safety and outcomes of MBV in this population. A search was run on the main scientific databases. 194 papers were identified, of which 188 were excluded by title and abstract evaluation. Subsequently, 6 papers were included. We performed descriptive statistics on the entire study population. The studies included in our analysis showed a higher preva","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"38 4","pages":"Article 100873"},"PeriodicalIF":3.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040452","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}
Despite the clinical relevance of graft pancreatitis (GP) after pancreas transplantation (PT), a universally accepted definition is lacking. Aim of this scoping review was to provide a systematic overview of GP definitions reported in the literature. MEDLINE, Web of Science and Embase were searched for relevant articles. Prospective/retrospective studies reporting a GP definition were included. The included series (n = 20) used four main criteria (clinical, biochemical, radiological and pathological) to define GP. Overall, 9 studies defined GP using a single criterion (n = 8 biochemical, n = 1 pathological), 7 series using two criteria (n = 3 clinical + biochemical, n = 3 biochemical + radiological, n = 1 clinical + radiological), 3 series using three criteria (n = 3 clinical + biochemical + radiological), and 1 series using four criteria. Overall, 20 definitions of GP were found. GP rate was reported by 19 series and ranged between 0% and 87%. This scoping review confirms that a universally accepted definition of GP is absent, and there is no consensus on the criteria on which it should be grounded. Future research should focus on developing a validated definition of GP.
尽管胰腺移植（PT）后的移植物胰腺炎（GP）与临床息息相关，但却缺乏一个普遍接受的定义。本综述旨在对文献中报道的 GP 定义进行系统性概述。检索了 MEDLINE、Web of Science 和 Embase 中的相关文章。纳入了报告 GP 定义的前瞻性/回顾性研究。纳入的系列研究（n = 20）采用了四种主要标准（临床、生化、放射和病理）来定义 GP。总体而言，9 项研究使用单一标准（n = 8 项生化标准，n = 1 项病理标准）定义 GP，7 项系列研究使用两项标准（n = 3 项临床标准 + 生化标准，n = 3 项生化标准 + 放射标准，n = 1 项临床标准 + 放射标准），3 项系列研究使用三项标准（n = 3 项临床标准 + 生化标准 + 放射标准），1 项系列研究使用四项标准。总体而言，共发现了 20 种 GP 定义。19个系列报告了GP率，介于0%和87%之间。此次范围界定审查证实，目前还没有一个普遍接受的 GP 定义，对于 GP 定义所应依据的标准也没有达成共识。未来的研究应侧重于制定 GP 的有效定义。
{"title":"Exploring definitions of graft pancreatitis following pancreas transplantation: A scoping review","authors":"Stefano Partelli , Valentina Andreasi , Valentina Tomajer , Domenico Tamburrino , Rossana Caldara , Paolo Rigotti , Davide Catarinella , Lorenzo Piemonti , Massimo Falconi","doi":"10.1016/j.trre.2024.100861","DOIUrl":"https://doi.org/10.1016/j.trre.2024.100861","url":null,"abstract":"<div><p>Despite the clinical relevance of graft pancreatitis (GP) after pancreas transplantation (PT), a universally accepted definition is lacking. Aim of this scoping review was to provide a systematic overview of GP definitions reported in the literature. MEDLINE, Web of Science and Embase were searched for relevant articles. Prospective/retrospective studies reporting a GP definition were included. The included series (<em>n</em> = 20) used four main criteria (clinical, biochemical, radiological and pathological) to define GP. Overall, 9 studies defined GP using a single criterion (<em>n</em> = 8 biochemical, <em>n</em> = 1 pathological), 7 series using two criteria (<em>n</em> = 3 clinical + biochemical, <em>n</em> = 3 biochemical + radiological, <em>n</em> = 1 clinical + radiological), 3 series using three criteria (<em>n</em> = 3 clinical + biochemical + radiological), and 1 series using four criteria. Overall, 20 definitions of GP were found. GP rate was reported by 19 series and ranged between 0% and 87%. This scoping review confirms that a universally accepted definition of GP is absent, and there is no consensus on the criteria on which it should be grounded. Future research should focus on developing a validated definition of GP.</p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"38 4","pages":"Article 100861"},"PeriodicalIF":4.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141308585","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}
Pub Date : 2024-12-01Epub Date: 2024-08-08DOI: 10.1016/j.trre.2024.100876
Baris Afsar, Rengin Elsurer Afsar, Yasar Caliskan, Krista L. Lentine
Although kidney transplantation (KT) is the best treatment option for end-stage kidney disease, long-term complications such as chronic kidney allograft dysfunction and cardiovascular disorders are observed. To decrease these complications, preventive measures must be applied in kidney transplant recipients (KTRs). One of these common measures is the increase of water/fluid intake although this is not evidence-based practice. Indeed, surprisingly very limited studies evaluated the impact of increased water/fluid intake on graft function, with small number of KTRs and short term follow-up. We suggest that the water/fluid intake should be personalized based on baseline graft function, time onset after KT (which water homeostasis changes), presence of hyponatremia and hypervolemia, concomitant medications, and patient willingness. Methods for estimating water/fluid intake (direct measurement, 24-h urine volume measurement, urine osmolarity) has both advantages and drawbacks and the best method has not been identified. Increase of water/fluid intake in specific conditions (in hot, and humid weather, before exercise, during Ramadan fasting) or in distinct KTRs (KTRs with de novo nephrolithiasis, frequent urinary tract infections) is not tested. Furthermore, the relationship between water/fluid intake and major cardiovascular adverse events are not known. There is no doubt that minimum amount of water/fluid intake is necessary for graft function (the amount is not known) but there is no evidence for a particular target level of water/fluid intake. In the current review, we summarize the studies assessing fluid/water intake in KTR, explained the pathophysiologic basis of water disorders in early period of KT and late after KT, elucidate conflicts and unknown issues of water intake in KTRs and suggest future research needs.
{"title":"Water/fluid intake in Kıdney transplant recipients: An underrated topic","authors":"Baris Afsar, Rengin Elsurer Afsar, Yasar Caliskan, Krista L. Lentine","doi":"10.1016/j.trre.2024.100876","DOIUrl":"10.1016/j.trre.2024.100876","url":null,"abstract":"<div><p>Although kidney transplantation (KT) is the best treatment option for end-stage kidney disease, long-term complications such as chronic kidney allograft dysfunction and cardiovascular disorders are observed. To decrease these complications, preventive measures must be applied in kidney transplant recipients (KTRs). One of these common measures is the increase of water/fluid intake although this is not evidence-based practice. Indeed, surprisingly very limited studies evaluated the impact of increased water/fluid intake on graft function, with small number of KTRs and short term follow-up. We suggest that the water/fluid intake should be personalized based on baseline graft function, time onset after KT (which water homeostasis changes), presence of hyponatremia and hypervolemia, concomitant medications, and patient willingness. Methods for estimating water/fluid intake (direct measurement, 24-h urine volume measurement, urine osmolarity) has both advantages and drawbacks and the best method has not been identified. Increase of water/fluid intake in specific conditions (in hot, and humid weather, before exercise, during Ramadan fasting) or in distinct KTRs (KTRs with de novo nephrolithiasis, frequent urinary tract infections) is not tested. Furthermore, the relationship between water/fluid intake and major cardiovascular adverse events are not known. There is no doubt that minimum amount of water/fluid intake is necessary for graft function (the amount is not known) but there is no evidence for a particular target level of water/fluid intake. In the current review, we summarize the studies assessing fluid/water intake in KTR, explained the pathophysiologic basis of water disorders in early period of KT and late after KT, elucidate conflicts and unknown issues of water intake in KTRs and suggest future research needs.</p></div>","PeriodicalId":48973,"journal":{"name":"Transplantation Reviews","volume":"38 4","pages":"Article 100876"},"PeriodicalIF":3.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011599","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}
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