Frontiers in transplantation最新文献

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.

[This corrects the article DOI: 10.3389/frtra.2025.1592516.].

Introduction and importance: Liver transplantation (LT) is a life-saving procedure for patients with end-stage liver disease, but post-transplant complications, such as portal vein thrombosis (PVT), can significantly impact patient outcomes. PVT is particularly challenging when it occurs after splenectomy, which is sometimes necessary in LT recipients with persistent hypersplenism or thrombocytopenia. The optimal management of PVT in this context remains unclear, and further clinical insights are needed.

Case presentation: We present a case of a 57-year-old male with a history of chronic hepatitis B-induced liver cirrhosis who underwent LT. Due to persistent hypersplenism and thrombocytopenia, the patient later underwent splenectomy. One month post-splenectomy, the patient developed PVT, which was initially managed with anticoagulation therapy (aspirin and rivaroxaban). Despite treatment, thrombosis progressed, requiring intravenous heparin and urokinase thrombolysis. Serial imaging confirmed thrombus resolution, and the patient was discharged on long-term anticoagulation therapy.

Clinical discussion: PVT following splenectomy in LT patients is a complex and potentially life-threatening condition influenced by altered portal hemodynamics and a hypercoagulable state. The standard treatment involves anticoagulation, but there is no consensus on the optimal regimen in post-transplant patients. This case highlights the potential efficacy of peripheral urokinase infusion as an alternative to interventional thrombolysis, particularly for patients who refuse invasive procedures. Long-term anticoagulation and close monitoring are crucial to prevent recurrence.

Conclusion: This case underscores the importance of early detection, tailored anticoagulation strategies, and a multidisciplinary approach in managing PVT following splenectomy in LT recipients. Peripheral urokinase infusion may serve as a viable treatment option for patients with contraindications or reluctance toward invasive procedures. Further studies are needed to optimize anticoagulation protocols and long-term management strategies in this patient population.

Introduction: Advancements in transplant medicine have increased the incidence of pregnancy among kidney transplant recipients. These pregnancies, however, carry elevated maternal and neonatal risks, warranting comprehensive outcome evaluation.

Materials and methods: To compare key maternal and neonatal outcomes in pregnancies following kidney transplantation with those in healthy pregnancies. A systematic search of MEDLINE, Embase, and PubMed was conducted up until December 2024. Comparative prospective and retrospective observational studies reporting maternal or neonatal outcomes in pregnancies among kidney transplant recipients and healthy controls. Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) was used for quality assessment. Random-effects meta-analyses were conducted to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs) and heterogeneity (I ²). Sensitivity analysis explored the impact of study design and bias.

Results: Eight studies encompassing 893 pregnancies post-kidney transplantation were included. Relative to healthy pregnancies, kidney-transplant recipients showed markedly higher odds of pre-eclampsia (OR: 10.17, 95% CI: 4.25-24.35; I ² = 86%), gestational hypertension (OR: 7.40, 95% CI: 2.20-24.86; I ² = 84%) and preterm birth (OR: 13.65, 95% CI: 4.79-38.92; I ² = 96%). Caesarean delivery (OR: 3.95, 95% CI: 1.67-9.31; I ² = 93%) and fetal mortality (OR: 4.84, 95% CI: 1.33-17.57; I ² = 79%) were also higher, whereas gestational diabetes did not differ (OR: 1.06, 95% CI: 0.67-1.67; I ² = 0%). Sensitivity analyses confirmed the elevated risks of pre-eclampsia and preterm birth, whereas the associations with caesarean section and fetal mortality did not remain statistically significant after adjustment for study quality.

Conclusions: Pregnancies following kidney transplantation are associated with significantly increased maternal and neonatal risks. These findings underscore the need for specialized antenatal care and further large-scale prospective studies to optimize outcomes and inform clinical guidelines.

Graft-vs.-host disease (GVHD) is a rare but potentially fatal complication following solid organ transplantation (SOT), with limited reported cases and high mortality rates after lung transplantation. We present a case of steroid-refractory GVHD (SR-GVHD) following bilateral lung transplantation and review the literature on GVHD in SOT. A patient developed SR-GVHD affecting the skin, gut, liver, and bone marrow following bilateral lung transplantation. Initial treatment with high-dose corticosteroids was ineffective. Subsequent therapy with rabbit anti-thymocyte globulin (rATG) and ruxolitinib led to complete remission over two months. Short tandem repeat (STR) analysis aided in diagnosis and monitoring. This case highlights the importance of early diagnosis and aggressive treatment of GVHD following SOT. We propose a treatment algorithm including rapid escalation to multi-agent immunosuppression for SR-GVHD. Interdisciplinary collaboration between solid organ and stem cell transplant specialists is crucial. Further research is needed to identify optimal strategies for prevention and treatment of GVHD in SOT recipients.

Introduction: This report describes the novel perioperative application of VV-ECMO combined with CRRT in a high-risk liver transplant recipient with irreversible hypoxemia and multi-organ dysfunction, expanding therapeutic options for traditionally contraindicated patients.

Case presentation: A 27-year-old male with acute-on-chronic liver failure (chronic hepatitis B + alcoholic liver disease), hepatic encephalopathy, severe pulmonary infection, and coagulopathy developed life-threatening hypoxemia (PaO₂ 60 mmHg on FiO₂ 100%) during transplantation.

Interventions: Emergency intraoperative VV-ECMO and postoperative CRRT were initiated.

Outcomes: ECMO was withdrawn on postoperative day 4, the ventilator on day 11, and the patient was discharged on day 61. Follow-up showed normal liver function.

Conclusion: Combined VV-ECMO/CRRT provides synergistic cardiopulmonary-renal support for high-risk liver transplants, creating a critical window for graft recovery. Multidisciplinary coordination is essential for success.

Cardiovascular disease continues to be the number one cause of morbidity and mortality across the world. Coronary artery bypass graft (CABG) procedures are the most commonly performed major surgery in the U.S. Grafts are difficult to source as patients do not have many sites from which to harvest donor tissues as autografts. Plastic grafts have issues of infection and are only used as a last resort. Tissue engineered vascular grafts have potential to solve the need for all-natural vascular grafts in the clinic. In this study, we evaluate the feasibility of a completely biological engineered vascular graft for implantation in a large animal model of a rabbit. An all-biological tissue engineered graft was grown in our laboratory, composed of a tunica adventitia derived from human dermal fibroblasts and a tunica media made from human aortic smooth muscle cells. The all-biological engineered graft exhibited the "look and feel" of a natural vessel. The engineered graft was implanted into the abdominal aorta of a New Zealand rabbit. The graft easily anastomosed to the native abdominal aorta and showed no leakages. Once reperfused, the graft was able to withstand blood flow briefly, prior to exhibiting dissection between the media and adventitia. Color doppler ultrasound showed flow through the abdominal aorta, however, not through the graft region due to the dissected layers creating a blockage. These results support a shift from the traditional paradigm of designing vascular grafts to mimic the multi-layered native structure. The two-layer engineered graft tested here exhibited dissection between the layers, a phenomenon that has yet to be reported in the field to our knowledge. Based on these findings, we recommend a single layer engineered graft to best prevent dissection.

Background: Donation after circulatory death (DCD) may be complicated by incidental findings, including tumor lesions that require urgent diagnosis. Here, we describe the case of a DCD donor with a large adnexal mass. Abdominal normothermic regional perfusion (A-NRP) enabled the safe resection of the mass, real-time pathological analysis, and subsequent kidney transplantation.

Case summary: A 60-year-old woman suffered a hypoxic cardiac arrest and subsequently remained in a deep coma with poor neurological prognostic indicators. In accordance with her presumed wishes, life support was withdrawn, and a controlled DCD procedure with A-NRP was initiated. Imaging revealed a 27-cm adnexal mass. Laboratory markers showed elevated cancer antigen 125 (CA 125) but low cancer antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA), and cytology was negative. Bilateral oophorectomy was performed under A-NRP, and the frozen section excluded malignancy, with final pathology confirming an ovarian thecoma. Both kidneys were procured; only the left kidney was transplanted successfully. The recipient experienced immediate diuresis and regained stable renal function at 1 month.

Discussion: This case illustrates how A-NRP provides oxygenated perfusion while allowing time for surgical excision and a pathological diagnosis of incidental tumors. It prevented unnecessary donor exclusion and enabled transplantation.

Conclusion: In selected DCD donors with incidental lesions, A-NRP can safely bridge the diagnostic process, preserve organ viability, and expand the donor pool.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is effective for rapid weight loss in kidney transplant (KT) candidates. This study aims to evaluate satisfaction or regret with the decision to undergo LSG in preparation for KT and the long-term durability of this approach to weight loss.

Methods: From 2012 to 2019, all patients who underwent LSG prior to waitlisting for KT were included. The Decision Regret Scale (DRS) was assessed regarding the decision to undergo LSG before KT. The long-term weight evolution was also collected.

Findings: Forty-six subjects completed the DRS survey at a median follow-up of 8 years post-LSG: 67% reported absolutely no regret, 22% mild regret, and 11% moderate to strong regret. Successful surgical weight loss was achieved in 36 patients and was significantly associated with lower levels of regret (p = 0.005). Body mass index reductions after LSG were highly significant compared to baseline values at all time points over 10 years (p = 0.0001) and remained significantly lower for up to 7 years post-KT. Thirty-two patients received KT, yet this had no significant association with decision regret.

Conclusion: Laparoscopic sleeve gastrectomy as a pre-transplantation weight loss strategy is associated with very low levels of regret, regardless of the KT status. LSG has demonstrated long-term, durable weight loss.