世界移植杂志最新文献

Antibody-mediated rejection (AMR) represents a major challenge in kidney transplantation, significantly contributing to tissue injury and graft failure. AMR is primarily driven by donor-specific alloantibodies (DSAs), which recognize and bind to specific target antigens present within the transplanted kidney tissue. Upon binding, these DSAs commonly initiate activation of the complement system within the graft. The activation of the complement cascade sets off a powerful inflammatory response characterized by the recruitment and activation of immune cells, endothelial damage, and subsequent tissue injury. This inflammation underlies many clinical and histological manifestations of AMR, making complement activation a critical player in the disease process. Advancements in our understanding of how complement pathways contribute to kidney graft injury have opened new avenues for therapeutic intervention. Recent research has facilitated the development and application of novel therapies specifically designed to inhibit complement activation. Such targeted complement-inhibitory strategies have shown promise in improving graft outcomes by inhibiting complement-mediated damage and extending graft survival. This review comprehensively discusses the critical role of complement activation in inducing kidney graft injury with a focus on its role in AMR. By elucidating the detailed mechanisms and contributions of complement pathways, the review seeks to enhance the understanding necessary for developing targeted therapeutic interventions to prevent or treat AMR effectively.

Colorectal cancer (CRC) is the third most common cancer globally, with 20%-25% of patients diagnosed at stage IV, significantly affecting overall survival (OS). Only 14% of stage IV patients survive for 5 years with palliative chemotherapy. However, the role of liver transplantation (LT) in the management of CRC liver metastasis (CRCLM) is an evolving area of interest. Recent advancements in oncologic outcomes and clinical understanding have prompted the re-evaluation of LT as a viable treatment option for CRCLM. A promising result from some prospective pilot studies reported a 5-year OS rate of 60% after LT for patients with CRCLM. Key factors influencing eligibility include tumor biology, absence of extrahepatic disease, and the patient's performance status. By synthesizing the latest research findings, we aim to provide a comprehensive overview that summarizes the most relevant data related to the clinical outcomes of patients who underwent LT for CRCLM. We aim to provide a comprehensive overview by synthesizing the latest research findings. This review discusses the inclusion criteria and eligibility for LT in CRCLM, which are of great importance to patient outcomes.

Background: Malabsorptive bariatric surgery, including Roux-en-Y gastric bypass and duodenal switch, are known to be more metabolically effective than restrictive surgery. However, the permanent alteration of gastrointestinal anatomy from these operations has been shown to alter the kinetics of drug absorption and may make subsequent surgeries more technically challenging.

Aim: To evaluate perioperative liver transplant outcomes and rates of acute cellular rejection in recipients with prior malabsorptive bariatric surgery.

Methods: Patients who underwent liver transplantation at a single institution between 2005-2024 with a history of malabsorptive bariatric surgery were identified. Matched controls were selected based on age, sex, listing model for end-stage liver disease (MELD), and primary liver diagnosis.

Results: A total of 12 liver transplant patients with prior malabsorptive surgery and 25 controls were included. The mean age in the malabsorptive group was 50.5 years at the time of transplant and 92% were female. The mean MELD at the time of transplant was 27.6 and mean body mass index was 28. There were no significant differences in length of stay, post operative complications, or 1 year survival between the controls and malabsorptive patients. However, the malabsorptive group was significantly more likely to experience biopsy-proven and clinically treated acute cellular rejection than the controls (24% vs 66.7%, P = 0.012), more frequent rejection episodes (0.28 ± 0.53 vs 1.0 ± 0.91, P = 0.006), and earlier time to first rejection episode (P = 0.002).

Conclusion: Previous malabsorptive bariatric surgery in liver transplant recipients did not increase the risk of perioperative complications or mortality but significantly increased the rate and frequency of acute cellular rejection.

Background: The utilization of hearts from older donors has increased, particularly for older recipients. However, the impact of older donor hearts on recipients of different ages is less known.

Aim: To determine the impact of older donor hearts on post-transplant outcomes across different recipient age groups.

Methods: The Organ Procurement and Transplant Network database was queried from 2006 to March 2024. Four groups were created stratifying by donor age (> 55 years) and recipient age (> 60 years). Kaplan-Meier curves and Cox regression models were used.

Results: One thousand fifty out of 39868 transplants (2.6%) were performed utilizing hearts from older donors. The rate of older donor hearts in younger recipients was only 1.8%, while the older donor hearts were used 4.0% in older recipients (P < 0.001). Old donor/old recipient and young donor/old recipient combinations were associated with post-transplant mortality [hazard ratio (HR): 1.64 (95%CI: 1.42-1.90) and 1.42 (95%CI: 1.34-1.51)], while old donor/young recipient was not. Within each recipient age group, the older recipient groups showed greater differences in 1- and 5-year survival probabilities (80.4% and 67.4% with old donors, 89.2% and 76.8% with young donors) than younger recipient groups (90.3% and 77.5% with old donors, 92.2% and 80.3% with young donors).

Conclusion: This study demonstrates the higher utilization of older donor hearts (aged more than 55) in older recipients. Paradoxically, the combination of older donor hearts with older recipients is associated with a higher risk of mortality. However, these organs remain valuable options across all recipient age groups in current context of organ shortage.

Background: Pediatric liver transplantation (LT) is the definitive treatment for end-stage liver disease and acute liver failure in children. However, graft size mismatch poses significant challenges, particularly in infants weighing less than 10 kg. Large-for-size grafts can lead to severe complications, including vascular thrombosis and impaired graft perfusion. Surgical innovations, such as hyper-reduced left lateral segment (HRLLS) grafts and monosegmental grafts (MSG), offer viable solutions by tailoring graft size without compromising vascular or biliary integrity.

Aim: To analyze the techniques and outcomes of HRLLS and MSG grafts in pediatric liver trabsplantation.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar, including studies up to February 2025. Eligible studies included case-control, observational, and randomized controlled trials reporting clinical outcomes of HRLLS, MSG, or reduced left lateral segment grafts (RLLS) in pediatric LT. The Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment. Meta-analysis was performed using MetaXL software to pool survival outcomes and assess complication profiles.

Results: Eighteen studies involving various graft reduction techniques were included. Both HRLLS and MSG demonstrated comparable one-year survival rates exceeding 80%, with some studies reporting rates above 95%. Complications such as hepatic artery thrombosis, portal vein thrombosis, and sepsis were slightly more frequent in HRLLS/RLLS recipients but remained within acceptable limits. Meta-analysis revealed no significant differences in survivability between graft types.

Conclusion: HRLLS and MSG techniques enable successful liver transplantation in small pediatric recipients, achieving long-term outcomes comparable to standard approaches. These graft modification strategies expand donor pool utilization and optimize patient survival while mitigating large-for-size complications.

This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation (ECMO) management. The study by Zhang et al indicates that direct advanced heart failure and transplant involvement improves survival in ECMO patients, especially those on veno-arterial ECMO. However, the optimal approach varies due to multiple factors. This article discusses the clinical implications, research design limitations, and future directions to enhance ECMO care.

Antibody-mediated rejection (ABMR) and recurrent primary renal disease (PRD) represent major causes of kidney transplant (KT) loss. The standard of care for desensitization, ABMR, and relapsing autoimmune glomerulopathies or nephrotic syndrome includes apheresis for antibody removal and polyclonal immunoglobulin for antibody blockage. Although frequently used to achieve B-cell depletion, the administration of the type 1 anti-CD20 monoclonal antibodies (mAb) rituximab (RTX) or ofatumumab (OFA) has failed to demonstrate a significant survival benefit. Obinutuzumab (OBI) is a humanized glycoengineered type 2 anti-CD20 mAb. Compared to RTX or OFA, OBI-induced B-cell depletion is not related to complement-dependent cytotoxicity, mostly operating through antibody-dependent cell-mediated cytotoxicity, antibody-dependent phagocytosis, and direct cell death. These characteristics could play a pivotal role in the development of new anti-rejection strategies, enabling the simultaneous administration of complement inhibitors and B-cell-depleting agents. OBI has also demonstrated more powerful peripheral and central B-cell depletion capacities than RTX, with enhanced effects on memory B cells and plasmablasts. In patients with autoimmune glomerulopathies or multidrug-dependent nephrotic syndrome, OBI has shown encouraging results, representing a potential evolution of the treatment of post-transplant relapsing PRD. The present review summarizes the current knowledge on OBI use in KT setting.

Liver transplantation is a vital intervention for patients with end-stage liver disease; however, the Arab world faces significant barriers that hinder access to this life-saving procedure in terms of both practice and research. This narrative review explores the multifaceted challenges, including financial constraints, limited healthcare infrastructure, cultural factors, and the prevalence of infectious diseases. In the Arab countries, both culture and religion were found to play major roles in the acceptability of liver transplantation. High rates of misconceptions and financial strain on patients and healthcare systems necessitate more transplantation programs and improved financial coverage and insurance policies. Enhancing healthcare facilities and improving access to innovative technologies through research is essential for optimizing transplantation outcomes, considering that common diseases in the region decrease the donor pool and increase complication risks. Public health initiatives to prevent and control prevalent liver diseases, particularly hepatitis, and to manage infection risk are also critical. Stricter regulations should be enforced in less developed countries in the region along with early screening practices to address inherited blood disorders and infectious diseases. Additionally, targeted research on liver diseases specific to the Arab context is crucial, along with fostering dialogue about cultural, religious, economic, and health-related factors affecting donor and recipient eligibility. By tackling these complex barriers through targeted comprehensive strategies, the Arab world can advance to a more equitable and effective liver transplantation system, ultimately improving patient outcomes and quality of life.

Background: Chylous ascites (CA), which is characterized by lymphatic leakage into the peritoneal cavity, is a rare but significant complication of liver transplantation. Although dietary and pharmacological strategies have shown effectiveness in managing CA, standardized treatment protocols have yet to be established.

Aim: To evaluate the comparative effectiveness of low-fat diet (LFD) enriched with medium-chain triglycerides (MCTs) vs octreotide therapy in managing post-liver transplantation CA.

Methods: A comprehensive literature review was conducted to analyze the outcomes of dietary interventions and octreotide therapy. The key parameters examined included resolution rates, treatment duration, and recurrence.

Results: A comprehensive literature search yielded 13 studies that met the inclusion criteria, comprising 4 retrospective cohort studies and 8 case studies. The incidence of CA following liver transplantation ranges from 0.6% to 4.7%. The onset varied, with a median time to diagnosis of 10 days after transplantation. A LFD with MCT supplementation was used as the first-line therapy in 83.3% of the studies, with resolution rates ranging from 62.5% to 100%. Octreotide therapy was utilized in 66.7% of the studies, primarily as a second-line therapy, with resolution rates of 83.3% to 100%. Combination therapy showed a significantly higher resolution rate than did dietary management alone (97.8% vs 78.9%, P = 0.02). The time to resolution was significantly shorter with octreotide-containing regimens than with dietary management alone (median, 7 days vs 14 days; P = 0.03).

Conclusion: A stepwise approach to CA management is recommended, initiating dietary interventions and escalating to octreotide when necessary. Further research through well-designed randomized controlled trials is essential to establish standardized treatment protocols for optimizing patient outcomes.

Kidney transplant is the treatment of choice for patients with end-stage kidney disease. Meticulous anaesthetic management is the cornerstone of good postoperative patient and graft outcomes. Over the decades, the perioperative strategies for preoperative optimization, fluid management, immunosuppression, haemodynamic monitoring, and pain management keep changing with the inclusion of newer studies. The aim of this review is to update anaesthesia colleagues for recent advancements in perioperative care of patients undergoing kidney transplantation.