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Importing pancreata for transplantation: a single-center experience across evolving allocation eras. 输入用于移植的胰腺:在不断发展的分配时代的单中心经验。
Pub Date : 2025-12-18 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1698617
Riccardo Tamburrini, Stacey Hidalgo, Glen Leverson, Dixon B Kaufman, Nikole A Neidlinger, David P Al-Adra, David D Aufhauser, Carrie Thiessen, Didier Mandelbrot, Sandesh Parajuli, Jon S Odorico

Recent changes to allocation systems have increased the geographic distribution of pancreas offers, often originating from outside a transplant center's donor service area or region. The impact of this wider sharing on outcomes remains uncertain. This study analyzed outcomes of primary pancreas transplants (2000-2018) at a large transplant center, stratified retrospectively on the nautical miles distance from the donor hospital. Primary endpoints were death-censored graft survival (DC-GS), patient survival, and graft thrombosis at different time points. No significant differences were found in DC-GS or patient survival for recipients of simultaneous pancreas-kidney (SPK), pancreas after kidney (PAK), or pancreas transplant alone (PTA), regardless of the distance from the donor hospital to the transplant center. Thrombosis rates were comparable across groups. Imported pancreata were from younger donors with lower BMI compared to locally recovered grafts. These findings support the notion that importing pancreata for transplantation is a feasible and safe practice that benefits patients, increases organ utilization, while benefiting transplant center volume data and reducing waiting times for patients. Encouraging wider importation may reduce waiting times and improve access to pancreas transplantation.

最近分配系统的变化增加了胰腺供应的地理分布,通常来自移植中心供体服务区或地区以外。这种更广泛的分享对结果的影响仍不确定。本研究分析了一家大型移植中心的原发性胰腺移植(2000-2018年)的结果,并根据离供体医院的海里距离进行回顾性分层。主要终点是不同时间点的死亡剔除移植存活(DC-GS)、患者存活和移植血栓形成。无论从供体医院到移植中心的距离如何,胰肾联合移植(SPK)、肾后胰移植(PAK)或单独胰移植(PTA)受者的DC-GS或患者生存率均无显著差异。各组间血栓形成率具有可比性。与本地恢复的移植物相比,进口胰腺来自较年轻的供体,BMI较低。这些发现支持这样一种观点,即输入胰腺用于移植是一种可行且安全的做法,有利于患者,增加器官利用率,同时有利于移植中心的容量数据和减少患者的等待时间。鼓励更广泛的进口可以减少等待时间并改善胰腺移植的可及性。
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引用次数: 0
A study on the distribution of BK and JC polyomavirus in discarded donor kidneys. BK和JC多瘤病毒在废弃供肾中的分布研究。
Pub Date : 2025-12-11 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1727407
Wouter T Moest, Aiko P J de Vries, Reshma A Lalai, Hans J Baelde, Jesper Kers, Els Wessels, Jason B Doppenberg, Marten A Engelse, Mariet C W Feltkamp, Joris I Rotmans

Introduction: BK polyomavirus (BKPyV) and JC polyomavirus (JCPyV) are thought to establish persistent, low-grade infections in the kidney. However, their specific intrarenal reservoirs remain unclear. To explore their localization and potential presence prior to transplantation, we analyzed different kidney regions from deceased donors.

Method: Donor kidneys discarded for donation and subsequently designated for research purposes between November 2023 and October 2024 were included. For each kidney, cortex, medulla, pelvis, and ureter were sampled. These samples were analyzed using qPCR for the presence of JCPyV and BKPyV.

Results: In total, 10 kidneys were analyzed with a total 72 samples taken from the cortex: n = 22, medulla: n = 22, renal pelvis: n = 14, and ureter: n = 14. All samples tested negative for BKPyV. JCPyV DNA was detected in 4 out of 10 kidneys. When analyzed by tissue type, positive samples were found in 6/22(27.3%) cortex, 6/22(27.3%) medulla, 4/14(28.6%) renal pelvis, and 4/14(28.6%) ureter samples. The cycle threshold (Ct) values did not show significant differences among the various regions within the kidney. Notably, JCPyV distribution within individual kidneys was markedly heterogeneous, with substantial variation in Ct-values within the same kidney.

Conclusion: JCPyV DNA was detected in 40% of kidneys from deceased donors, with comparable detection rates across cortex, medulla, pelvis, and ureter, suggesting no clear tissue preference. However, within individual kidneys, the distribution and Ct-values varied considerably. BKPyV DNA was not detected in any sample. These findings support the hypothesis that JCPyV may be present prior to transplantation and potentially donor-derived. The potential role of JCPyV in kidney transplant recipients and its relationship with BKPyV warrant further investigation.

BK多瘤病毒(BKPyV)和JC多瘤病毒(JCPyV)被认为在肾脏中建立持续的低级别感染。然而,它们具体的肾内宿主尚不清楚。为了探索它们在移植前的定位和潜在存在,我们分析了来自已故供者的不同肾脏区域。方法:纳入2023年11月至2024年10月期间丢弃用于捐赠并随后指定用于研究目的的供体肾脏。对每个肾脏进行皮质、髓质、骨盆和输尿管取样。这些样本采用qPCR检测jjcpyv和BKPyV的存在。结果:共分析了10个肾脏,共从皮质采集了72个样本:n = 22,髓质:n = 22,肾盂:n = 14,输尿管:n = 14。所有样本的BKPyV检测均为阴性。10个肾脏中有4个检测到JCPyV DNA。按组织类型分析,皮层6/22(27.3%)、髓质6/22(27.3%)、肾盂4/14(28.6%)、输尿管4/14(28.6%)呈阳性。周期阈值(Ct)值在肾脏各区域间无显著差异。值得注意的是,JCPyV在单个肾脏内的分布具有明显的异质性,在同一肾脏内的ct值有很大差异。结论:在40%的已故供者肾脏中检测到JCPyV DNA,在皮质、髓质、骨盆和输尿管的检出率相当,表明没有明显的组织偏好。然而,在单个肾脏内,分布和ct值差异很大。未检出BKPyV DNA。这些发现支持了JCPyV可能在移植前存在并可能来自供体的假设。JCPyV在肾移植受者中的潜在作用及其与BKPyV的关系值得进一步研究。
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引用次数: 0
The role of macrophages in the mitigation by decitabine of acute allograft rejection. 巨噬细胞在地西他滨缓解急性同种异体移植排斥反应中的作用。
Pub Date : 2025-12-11 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1723396
William N Daccarett-Bojanini, Manuel Sollmann, Kristine M Yarnoff, Nicola M Heller, Jeffrey M Dodd-O

Introduction: We have recently shown that the DNA hypomethylating agent decitabine (DAC) rescues lung allografts from acute rejection. This involves a mechanism that is dependent on host CD4+ FoxP3+ T cells for maximal benefit. DAC treatment also reduces host T-cell IFN-γ production. We therefore hypothesized that DAC may also reduce host macrophage activation. Our objective was to determine if an effect on macrophages contributes to the beneficial effects of DAC in transplantation.

Methods: In murine orthotopic lung transplant, hosts were treated on post-op day 3-8 with Clodronate (n = 5), DAC (n = 9), or DMSO (n = 11).

Results: Partial macrophage depletion (clodronate) improves allograft gross and histologic integrity. DAC-mediated allograft rescue was associated with reduced host macrophage recruitment into allograft airways, reduced activation of recruited macrophages, and regeneration of donor resident alveolar macrophages.

Discussion: These findings suggest that infiltrating host macrophages promote allograft rejection. They also suggest that donor alveolar health is indicative and/or promoting of allograft tolerance.

我们最近的研究表明,DNA低甲基化剂地西他滨(DAC)可以拯救肺同种异体移植的急性排斥反应。这涉及一种依赖宿主CD4+ FoxP3+ T细胞获得最大益处的机制。DAC处理也减少宿主t细胞IFN-γ的产生。因此,我们假设DAC也可能降低宿主巨噬细胞的活化。我们的目的是确定对巨噬细胞的影响是否有助于DAC在移植中的有益作用。方法:小鼠原位肺移植,术后3 ~ 8天给予氯膦酸钠(n = 5)、DAC (n = 9)、DMSO (n = 11)治疗。结果:部分巨噬细胞去除(氯膦酸钠)改善同种异体移植物的大体和组织学完整性。dac介导的同种异体移植物修复与宿主巨噬细胞向同种异体移植物气道募集减少、募集巨噬细胞活化减少和供体肺泡巨噬细胞再生有关。讨论:这些发现提示浸润的宿主巨噬细胞促进同种异体移植排斥反应。他们还表明,供体肺泡健康是指示和/或促进同种异体移植物耐受的指标。
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引用次数: 0
The role of eplet matching in solid organ transplantation. 胚胎匹配在实体器官移植中的作用。
Pub Date : 2025-12-08 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1710058
Viola A Stögner, Dean M Pucciarelli, Lauren Harkins, Adam Littleton, Richard Formica, Bohdan Pomahac, Siba Haykal

Introduction: Donor-recipient compatibility remains a central determinant of transplant success, yet conventional antigen-level human leukocyte antigen (HLA) matching provides limited resolution for predicting alloimmune risk. Molecular matching at the eplet level, which quantifies structural motifs on HLA molecules recognized by B- and T-cells, has emerged as a promising strategy to refine immunologic risk assessment.

Methods: We conducted a scoping review of 98 studies encompassing 286,101 solid organ transplant (SOT) recipients across kidney, heart, lung, liver, pancreas, and combined grafts. Data on HLA typing approaches, eplet mismatch (epMM) algorithms, thresholds, and associations with clinical outcomes were systematically extracted and synthesized.

Results: The majority of studies were retrospective kidney transplant cohorts, though evidence from heart, lung, and liver transplantation is expanding. Across organs, higher class II epMM burden-particularly at HLA-DQ and HLA-DR-was consistently associated with de novo donor-specific antibodies, antibody mediated rejection, and graft dysfunction. Reported epMM thresholds varied but were most robust for class II loci, while findings for class I loci were less consistent. Observed differences in epMM thresholds and effect sizes reflected both organ-specific immunobiology and methodological heterogeneity, including variation in typing resolution, mismatch algorithms, immunosuppression exposure, and study design.

Conclusion: Eplet matching demonstrates significant potential to improve risk stratification and long-term graft outcomes across SOT. However, clinical translation is limited by inconsistent methods, equity concerns, and the absence of standardized epMM thresholds. Prospective studies, harmonized molecular typing, and integration with allocation frameworks are needed to establish the clinical utility and policy implications of molecular-level HLA matching.

供体-受体相容性仍然是移植成功的核心决定因素,然而传统抗原水平的人类白细胞抗原(HLA)匹配在预测同种免疫风险方面提供了有限的解决方案。在小细胞水平上的分子匹配,量化B细胞和t细胞识别的HLA分子的结构基序,已经成为一种有前途的策略来完善免疫风险评估。方法:我们对98项研究进行了范围综述,包括286101例实体器官移植(SOT)受者,包括肾、心、肺、肝、胰腺和联合移植。系统地提取和合成HLA分型方法、epMM算法、阈值以及与临床结果的关联数据。结果:尽管来自心脏、肺和肝移植的证据正在扩大,但大多数研究是回顾性肾移植队列。在各个器官中,较高的II类epMM负荷-特别是HLA-DQ和hla - dr -始终与新生供体特异性抗体、抗体介导的排斥反应和移植物功能障碍相关。报道的epMM阈值各不相同,但II类基因座的epMM阈值最为稳健,而I类基因座的epMM阈值则不太一致。观察到的epMM阈值和效应大小的差异反映了器官特异性免疫生物学和方法学的异质性,包括分型分辨率、错配算法、免疫抑制暴露和研究设计的差异。结论:Eplet配型具有显著的改善SOT风险分层和长期移植结果的潜力。然而,临床翻译受到方法不一致、公平性问题和缺乏标准化epMM阈值的限制。需要前瞻性研究,统一的分子分型,并整合分配框架,以建立分子水平HLA匹配的临床效用和政策意义。
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引用次数: 0
Comparative evaluation of five tacrolimus assays in transplant recipients: implications for optimizing therapeutic drug monitoring. 移植受者五种他克莫司试验的比较评价:优化治疗药物监测的意义。
Pub Date : 2025-12-01 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1716789
Ivo N SahBandar, Zhen Zhao, Sabrina E Racine-Brzostek, Alex J Rai, Maria Cid, Melissa M Cushing, Neal Lindeman, Thangamani Muthukumar, He S Yang

Tacrolimus is a widely used immunosuppressive therapy in transplant recipients, but its narrow therapeutic index necessitates accurate monitoring. Tacrolimus levels can be quantified using immunoassays (IAs) and liquid chromatography-tandem mass spectrometry (LC-MS/MS), however, differences between these methods may influence clinical decision-making. In this study, we compared two IAs, i.e., chemiluminescent (CMIA) and electrochemiluminescent (ECLIA), with three LC-MS/MS assays in 181 clinical specimens. When compared with the overall mean concentration, all five assays showed strong correlations, though with variability across methods: three LC-MS/MS assays demonstrated correlation coefficients of 0.9927, 0.9612, and 0.9920, while two immunoassays yielded coefficients of 0.9938 and 0.9857. Deming regression analysis revealed slopes of 0.96, 0.94, and 0.93 for the three LC-MS/MS, while the immunoassays showed higher slopes of 1.032 (ECLIA) and 1.21 (CMIA). Bland-Altman analysis indicated systematic underestimation by the LC-MS/MS methods (-7.5%, -18.7%, and -8%) and overestimation by the immunoassays (ECLIA +9.7%, CMIA +18.4%), relative to the overall mean. The two immunoassays showed only moderate agreement with each other (slope = 0.85, intercept = 0.49), and even the LC-MS/MS assays were not fully concordant. Among 47 patients within 3 months post-transplantation and 134 patients beyond 3 months, clinically relevant discrepancies (≥2 ng/ml) between LC-MS/MS and immunoassay results were observed in 13 patients (28%) and 49 patients (37%), respectively. These findings underscore the substantial impact of assay-dependent variability on tacrolimus monitoring and emphasize the need for standardized laboratory practices as well as assay-specific therapeutic ranges to prevent underexposure with rejection or overexposure with toxicity.

他克莫司是一种广泛应用于移植受者的免疫抑制药物,但其狭窄的治疗指数需要精确的监测。他克莫司的水平可以通过免疫分析法(IAs)和液相色谱-串联质谱法(LC-MS/MS)进行定量,然而,这些方法之间的差异可能会影响临床决策。在本研究中,我们比较了化学发光(CMIA)和电化学发光(ECLIA)两种IAs与三种LC-MS/MS方法在181例临床标本中的应用。与总体平均浓度相比,所有五种检测方法都显示出很强的相关性,尽管不同方法之间存在差异:三种LC-MS/MS检测方法的相关系数为0.9927、0.9612和0.9920,而两种免疫检测方法的相关系数为0.9938和0.9857。Deming回归分析显示,3种LC-MS/MS的斜率分别为0.96、0.94和0.93,而免疫分析法的斜率分别为1.032 (ECLIA)和1.21 (CMIA)。Bland-Altman分析显示LC-MS/MS方法系统性低估(-7.5%,-18.7%和-8%),免疫测定法高估(ECLIA +9.7%, CMIA +18.4%),相对于总体平均值。两种免疫测定结果仅显示中等程度的一致性(斜率= 0.85,截距= 0.49),甚至LC-MS/MS测定结果也不完全一致。在移植后3个月内的47例患者和3个月以上的134例患者中,LC-MS/MS与免疫测定结果分别有13例(28%)和49例(37%)存在临床相关差异(≥2 ng/ml)。这些发现强调了检测依赖性变异性对他克莫司监测的重大影响,并强调了标准化实验室实践以及检测特异性治疗范围的必要性,以防止暴露不足引起排斥或暴露过度引起毒性。
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引用次数: 0
Thomas E. Starzl, M.D., Ph.D-the Sui Generis Medical Pioneer and Mentor. Thomas E. Starzl,医学博士,医学博士,杰出的医学先驱和导师。
Pub Date : 2025-11-26 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1688201
John J Fung, Merit Remzi

As the "Father of Modern Transplantation", Dr. Starzl pioneered every aspect of organ transplantation: immunosuppression, organ procurement and preservation, tissue matching, surgical transplant technology, and the operational management of the transplant team. His work paved the way for heart, lung, pancreas, intestinal, liver, and kidney transplantation and opened doors to understanding immune regulation of a number of acquired and inherited disorders. Dr. Starzl's contributions to the scientific literature, in a span of 60 years, are nothing short of remarkable-2,872 publications placing him at the top of scientific citations according to the Institute of Scientific Information. Dr. Starzl was a man of unique vision, enthusiasm, and persistence; many of his ideas were considered revolutionary and radical-stimulating opposition and criticism. He called upon an inner strength, likely entrenched from his small-town upbringing, to persist in spite of adversity and promote social and medical acceptance of transplantation. Through his tireless efforts he educated scientists, other professionals, and the public. He was involved in all of the controversies of organ donation, from the use of non-heart beating donors, to living donors, to brain dead donor and to xenotransplantation (animal-to-human transplantation).

作为“现代移植之父”,Starzl博士开创了器官移植的各个方面:免疫抑制、器官获取和保存、组织匹配、外科移植技术、移植团队的操作管理。他的工作为心脏、肺、胰腺、肠道、肝脏和肾脏移植铺平了道路,并为理解许多获得性和遗传性疾病的免疫调节打开了大门。在60年的时间里,斯塔兹博士对科学文献的贡献堪称卓越——根据美国科学信息研究所(Institute of scientific Information)的数据,他发表了2872篇论文,在被引用的科学文献中名列前茅。斯塔兹博士是一个有着独特眼光、热情和毅力的人;他的许多想法被认为是革命性的和激进的,激起了反对和批评。他呼吁内心的力量,这可能是他从小在小镇长大,尽管逆境,坚持不懈,促进社会和医学对移植的接受。通过他孜孜不倦的努力,他教育了科学家、其他专业人士和公众。他参与了所有关于器官捐赠的争议,从使用无心脏跳动的捐赠者,到活体捐赠者,到脑死亡捐赠者和异种移植(动物到人类的移植)。
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引用次数: 0
Glycocalyx kinetics and injury during liver procurement and transplantation as predictors of early graft dysfunction. 肝获取和移植过程中糖萼动力学和损伤作为早期移植物功能障碍的预测因子。
Pub Date : 2025-11-25 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1662187
Nassiba Beghdadi, Alexis Texier, Marc Antoine Allard, Mylene Sebagh, Nour Bousaleh, Haitham Triki, Daniel Pietrasz, Nicolas Cabrit, Nicolas Golse, René Adam, Cyrille Feray, Peter J Lenting, Stéphanie Roullet, Daniel Azoulay

Introduction: Ischemia-reperfusion injury causes endothelial damage, partly through degradation of the glycocalyx. This study aimed to evaluate glycocalyx degradation from graft procurement to reperfusion and assess its potential as a biomarker of early graft function (early allograft dysfunction, EAD).

Methods: This single-center observational prospective study was conducted at Paul Brousse Hospital from April 2022 to April 2023. All primary liver transplantation (LT) recipients were included. Glycocalyx degradation was assessed at procurement, at the end of cold ischemia, and during LT in liver graft caval effluent and correlated with liver histological injury. The primary endpoint was EAD, defined as a Model for Early Allograft Function score ≥9. We quantified glycocalyx components [Syndecan-1 (Synd-1), heparan sulfate, angiopoietin-1, and angiopoietin-2], inflammation (TNF-alpha), and cell death markers.

Results: Thirty-one patients were included; 12 (39%) developed EAD. Synd-1 plasma levels at procurement (donor Synd-1 level = d-Synd-1) were significantly higher in patients with EAD [12,173 pg/mL (10,538-17,570) vs. 6,282 pg/mL (4,604-10,002), p = 0.004]. A plasma d-Synd-1 cutoff of 9,419.7 pg/mL predicted EAD [AUC = 0.81, 95% confidence interval (95% CI) (0.65-0.97); sensitivity 83%; specificity 74%, positive predictive value = 67%, negative predictive value = 88%, p < 0.05]. d-Synd-1 ≥9,419.7 pg/mL was associated with severe post-LT complications (p = 0.007).

Conclusions: d-Synd-1 levels in graft effluent during procurement may serve as a predictor of early allograft dysfunction. Strategies aimed at protecting the endothelial during procurement could improve graft outcomes.

缺血再灌注损伤引起内皮损伤,部分原因是糖萼降解。本研究旨在评估从移植物获取到再灌注的糖萼降解,并评估其作为早期移植物功能(早期同种异体移植物功能障碍,EAD)的生物标志物的潜力。方法:这项单中心观察性前瞻性研究于2022年4月至2023年4月在Paul Brousse医院进行。所有原发性肝移植(LT)受者均包括在内。肝移植腔静脉流出液在获取时、冷缺血结束时和肝移植期间评估糖萼降解,并与肝组织损伤相关。主要终点是EAD,定义为早期同种异体移植功能评分≥9的模型。我们量化了糖杯成分[Syndecan-1 (Synd-1),硫酸肝素,血管生成素-1和血管生成素-2],炎症(tnf - α)和细胞死亡标志物。结果:纳入31例患者;12例(39%)发生EAD。在EAD患者中,采购时Synd-1血浆水平(供体Synd-1水平= d-Synd-1)显著升高[12,173 pg/mL (10,538-17,570) vs. 6,282 pg/mL (4,604-10,002), p = 0.004]。血浆d-Synd-1截止值为9419.7 pg/mL预测EAD [AUC = 0.81, 95%可信区间(95% CI) (0.65-0.97);灵敏度83%;特异性74%,阳性预测值= 67%,阴性预测值= 88%,p = 0.007)。结论:移植物获取过程中流出物中的d-Synd-1水平可作为早期同种异体移植物功能障碍的预测指标。在移植过程中保护内皮细胞的策略可以改善移植结果。
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引用次数: 0
Impact of different blood group incompatibilities in kidney transplantation: a 15-year outcomes analysis from a large kidney transplant center. 不同血型不相容对肾移植的影响:来自大型肾移植中心的15年结果分析。
Pub Date : 2025-11-18 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1690999
Dalia A Obeid, Dieter C Broering, Khalid A AlMeshari, Yaser Z Shah, Hassan A Aleid, Hadeel M AlManea, Amira M AlAbassi, Nour AlMozain, Kris Marquez, Eman A Alsaadi, Tariq Z Ali

Background: While ABO-incompatible kidney transplantation (ABOiKT) has demonstrated favorable short-term outcomes, data on its long-term effects remain limited. This study evaluated the short- and long-term clinical outcomes of ABOiKT across various ABO-incompatible donor-recipient combinations.

Methods: We included patients who underwent ABOiKT at our institution in 2007-2024. The outcomes assessed included 15-year data on graft, patient survival, and early AMR rates.

Results: Of 239 ABOiKT cases, AMR occurred in 9.2% and was linked to longer hospitalization and higher graft failure. AMR was most frequent in B-O (20.3%) and A1-O (13.3%) transplants but no cases of AMR were observed in the recipients of kidneys from A2 donors. B to O mismatch significantly increased the risk of AMR-related graft loss. Patient survival was 99.1% at 1 year and 86.2% at 15 years and Graft survival was 92.7% and 87.5% respectively.

Conclusions: Our study showed favorable outcomes of ABOiKT across different mismatch types. As the largest ABOiKT study in the Middle East with extended follow-up, our study provides important regional insights and contribute significantly to the global understanding of ABOiKT outcomes.

背景:虽然abo血型不相容肾移植(ABOiKT)已显示出良好的短期结果,但其长期效果的数据仍然有限。本研究评估了ABOiKT在各种abo血型不相容的供体-受体组合中的短期和长期临床结果。方法:我们纳入了2007-2024年在我院接受ABOiKT的患者。评估的结果包括15年的移植物数据、患者生存率和早期AMR率。结果:239例ABOiKT病例中,AMR发生率为9.2%,与住院时间更长和移植物衰竭发生率更高有关。AMR在B-O(20.3%)和A1-O(13.3%)移植中最为常见,但在A2供者肾脏受体中未观察到AMR病例。B - O配错显著增加了amr相关移植物损失的风险。患者1年生存率为99.1%,15年生存率为86.2%,移植物生存率分别为92.7%和87.5%。结论:我们的研究显示ABOiKT在不同的错配类型中效果良好。作为中东地区规模最大的ABOiKT研究,我们的研究提供了重要的区域见解,并对ABOiKT结果的全球理解做出了重大贡献。
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引用次数: 0
Graft dysfunction is associated with late CMV infection after kidney transplantation. 移植物功能障碍与肾移植后晚期巨细胞病毒感染有关。
Pub Date : 2025-11-14 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1647725
Angela Zeng, Katherine Barraclough, Michael Lian, Rosemary Masterson, Peter Hughes, Kevin V Chow

Background: Cytomegalovirus (CMV) causes significant morbidity and mortality following kidney transplantation. Late CMV infection (≥2 years post-transplant) is uncommon, and its risk factors and outcomes may differ from earlier infection.

Methods: We conducted a single-centre retrospective study of kidney transplant recipients between 2009 and 2019. Patients were grouped by CMV status: no infection, early infection (<2 years post-transplant), and late infection (≥2 years post-transplant). Clinical characteristics and outcomes were compared.

Results: Donor-positive/recipient-negative (D+/R-) serostatus was observed in 105/710 (14.8%) patients without CMV, 28/42 (66.7%) with early CMV, and 2/28 (7.1%) with late CMV (p < 0.001). Prior rejection occurred in 5.9%, 16.7%, and 10.7% respectively (p = 0.017). Median serum creatinine was 113.0, 127.5, and 219.5 µmol/L respectively (p < 0.001). CMV serostatus was significantly associated with early infection (p < 0.001), while only serum creatinine was associated with late infection (p = 0.003). Trends were seen toward better one-year patient survival (97.6% vs. 85.7%, p = 0.051) and graft survival (88.1% vs. 71.4%, p = 0.073) after early vs. late infection.

Conclusions: Risk factors for CMV infection differ by timing post-transplant. Renal dysfunction may be a key predictor of late infection. identifying at-risk patients may support targeted surveillance and improve long-term outcomes.

背景:巨细胞病毒(CMV)在肾移植术后引起显著的发病率和死亡率。晚期巨细胞病毒感染(移植后≥2年)并不常见,其危险因素和结果可能与早期感染不同。方法:我们对2009年至2019年的肾移植受者进行了单中心回顾性研究。患者按CMV状态分组:无感染、早期感染(结果:105/710例(14.8%)无CMV, 28/42例(66.7%)有早期CMV, 2/28例(7.1%)有晚期CMV (p p = 0.017)。血清肌酐中位数分别为113.0、127.5和219.5µmol/L (p < 0.05)。早期感染和晚期感染后患者的1年生存率(97.6% vs. 85.7%, p = 0.051)和移植物生存率(88.1% vs. 71.4%, p = 0.073)均有提高的趋势。结论:移植后不同时间CMV感染的危险因素不同。肾功能不全可能是晚期感染的关键预测因素。识别高危患者可以支持有针对性的监测和改善长期预后。
{"title":"Graft dysfunction is associated with late CMV infection after kidney transplantation.","authors":"Angela Zeng, Katherine Barraclough, Michael Lian, Rosemary Masterson, Peter Hughes, Kevin V Chow","doi":"10.3389/frtra.2025.1647725","DOIUrl":"10.3389/frtra.2025.1647725","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) causes significant morbidity and mortality following kidney transplantation. Late CMV infection (≥2 years post-transplant) is uncommon, and its risk factors and outcomes may differ from earlier infection.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective study of kidney transplant recipients between 2009 and 2019. Patients were grouped by CMV status: no infection, early infection (<2 years post-transplant), and late infection (≥2 years post-transplant). Clinical characteristics and outcomes were compared.</p><p><strong>Results: </strong>Donor-positive/recipient-negative (D+/R-) serostatus was observed in 105/710 (14.8%) patients without CMV, 28/42 (66.7%) with early CMV, and 2/28 (7.1%) with late CMV (<i>p</i> < 0.001). Prior rejection occurred in 5.9%, 16.7%, and 10.7% respectively (<i>p</i> = 0.017). Median serum creatinine was 113.0, 127.5, and 219.5 µmol/L respectively (<i>p</i> < 0.001). CMV serostatus was significantly associated with early infection (<i>p</i> < 0.001), while only serum creatinine was associated with late infection (<i>p</i> = 0.003). Trends were seen toward better one-year patient survival (97.6% vs. 85.7%, <i>p</i> = 0.051) and graft survival (88.1% vs. 71.4%, <i>p</i> = 0.073) after early vs. late infection.</p><p><strong>Conclusions: </strong>Risk factors for CMV infection differ by timing post-transplant. Renal dysfunction may be a key predictor of late infection. identifying at-risk patients may support targeted surveillance and improve long-term outcomes.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1647725"},"PeriodicalIF":0.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12660292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Elective semaglutide prescription enabled waitlisting and transplantation of otherwise ineligible obese renal transplant candidates. 选择性的西马鲁肽处方使不符合条件的肥胖肾移植候选人能够等待和移植。
Pub Date : 2025-10-29 eCollection Date: 2025-01-01 DOI: 10.3389/frtra.2025.1623096
Emilie Navaux, Caroline La, Sylvain Dufour, Vincent Huberty, Youssef Mourabit, Thomas Caes, Nikolaos Koliakos, Dimitri Mikhalski, Alain Le Moine, Concetta Catalano

Although transplantation remains the treatment of choice for end-stage renal disease, patients suffering from severe obesity are too often unlisted for this reason. Pre-transplant bariatric surgery is not free of risk and the use of 'Glucagon Like Peptide-1'analogues in these patients is limited. Our study aims to determine whether semaglutide administration enabled waitlisting and transplantation of otherwise ineligible obese renal transplant candidates. Between 01/01/2021 and 10/30/2023, patients rejected from renal transplantation because of obesity received pre-transplant subcutaneous semaglutide up to 1 mg/week. Of the 23 patients included, initial mean body weight, BMI and waist circumference were 102.9 Kg, 35.6 and 119.5 cm respectively. After a median of 12.2 months on semaglutide, these parameters decreased by 11.4 Kg (p ≤ 0.001), 3.9 points (p ≤ 0.001) and 9.6 cm (p ≤ 0.001) respectively. 56.5% of patients initially rejected for transplantation were listed within a median of 5.4 months, and 61.5% of them were transplanted. No major side effects were reported. In summary semaglutide administration enabled waitlisting and transplantation of otherwise ineligible obese renal transplant candidates. This treatment should be an integral part of the pre-transplant management of obesity.

尽管移植仍然是治疗终末期肾脏疾病的首选,但严重肥胖的患者往往因此而未被列入名单。移植前减肥手术并非没有风险,在这些患者中使用胰高血糖素样肽-1类似物是有限的。我们的研究目的是确定西马鲁肽是否能使不符合条件的肥胖肾移植候选人排队和移植。在2021年1月1日至2023年10月30日期间,因肥胖而拒绝肾移植的患者在移植前接受了高达1mg /周的皮下semaglutide。23例患者的初始平均体重为102.9 Kg, BMI为35.6,腰围为119.5 cm。中位服用西马鲁肽12.2个月后,这些参数分别下降了11.4 Kg (p≤0.001)、3.9点(p≤0.001)和9.6 cm (p≤0.001)。56.5%最初拒绝移植的患者中位时间为5.4个月,61.5%的患者接受了移植。没有重大副作用的报道。综上所述,西马鲁肽的使用使不符合条件的肥胖肾移植候选人能够等待和移植。这种治疗应该是肥胖移植前管理的一个组成部分。
{"title":"Elective semaglutide prescription enabled waitlisting and transplantation of otherwise ineligible obese renal transplant candidates.","authors":"Emilie Navaux, Caroline La, Sylvain Dufour, Vincent Huberty, Youssef Mourabit, Thomas Caes, Nikolaos Koliakos, Dimitri Mikhalski, Alain Le Moine, Concetta Catalano","doi":"10.3389/frtra.2025.1623096","DOIUrl":"10.3389/frtra.2025.1623096","url":null,"abstract":"<p><p>Although transplantation remains the treatment of choice for end-stage renal disease, patients suffering from severe obesity are too often unlisted for this reason. Pre-transplant bariatric surgery is not free of risk and the use of 'Glucagon Like Peptide-1'analogues in these patients is limited. Our study aims to determine whether semaglutide administration enabled waitlisting and transplantation of otherwise ineligible obese renal transplant candidates. Between 01/01/2021 and 10/30/2023, patients rejected from renal transplantation because of obesity received pre-transplant subcutaneous semaglutide up to 1 mg/week. Of the 23 patients included, initial mean body weight, BMI and waist circumference were 102.9 Kg, 35.6 and 119.5 cm respectively. After a median of 12.2 months on semaglutide, these parameters decreased by 11.4 Kg (<i>p</i> ≤ 0.001), 3.9 points (<i>p</i> ≤ 0.001) and 9.6 cm (<i>p</i> ≤ 0.001) respectively. 56.5% of patients initially rejected for transplantation were listed within a median of 5.4 months, and 61.5% of them were transplanted. No major side effects were reported. In summary semaglutide administration enabled waitlisting and transplantation of otherwise ineligible obese renal transplant candidates. This treatment should be an integral part of the pre-transplant management of obesity.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"4 ","pages":"1623096"},"PeriodicalIF":0.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12606581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Frontiers in transplantation
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