世界移植杂志最新文献

Background: Post-transplant tertiary hyperparathyroidism (PT-tHPT) is a well-recognized complication following kidney transplantation, characterized by persistent excessive secretion of parathyroid hormone (PTH) despite improved renal function. It is potentially associated with an increased risk of cardiovascular events, renal osteodystrophy, pathologic fractures, graft loss, and mortality.

Aim: To evaluate the incidence, risk factors, and outcomes of PT-tHPT amongst kidney transplant recipients.

Methods: A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated. Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism. Graft and recipient outcomes were assessed using multivariable Cox regression. A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.

Results: PT-tHPT, defined as elevated PTH (> 65 ng/L) and persistent hypercalcemia (> 2.60 mmol/L), was diagnosed in 14% of recipients. Risk factors for PT-tHPT included older age [odds ratio (OR) = 1.36, P < 0.001], Asian ethnicity (OR = 0.33, P = 0.006), total ischemia time (OR = 1.03, P = 0.048 per hour), pre-transplant serum calcium (OR = 1.38, P < 0.001) per decile increase, pre-transplant PTH level (OR = 1.31, P < 0.001) per decile increase, longer dialysis duration (OR = 1.12, P = 0.002) per year, history of acute rejection (OR = 2.37, P = 0.012), and slope of estimated glomerular filtration rate change (OR = 0.91, P = 0.001). There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT. The three treatment strategies of conservative management, calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.

Conclusion: Pretransplant elevated calcium and PTH levels, older age and dialysis duration are associated with PT-tHPT. While PT-tHPT significantly affects graft and recipient survival, the treatment strategies did not affect survival.

Background: With the increasing use of laparoscopic techniques in living-donor kidney transplantation, limitations in donor vessel length, particularly of the right renal vein, pose significant challenges for vascular anastomosis to the recipient's external iliac vein. These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.

Case summary: To address the issue of short right renal veins, several surgical strategies have been proposed. In this report, we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction. This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.

Conclusion: Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation. It provides additional length and flexibility, easing anastomotic tension and supporting successful transplantation.

Background: Donor-specific antibodies (DSAs) against human leukocyte antigen (HLA)-DQ are increasingly recognized as major contributors to antibody-mediated rejection (AMR) and graft failure in kidney transplantation. However, their clinical impact remains understudied in Morocco.

Aim: To evaluate the presence and implications of anti-HLA-DQ DSAs in Moroccan kidney transplant recipients.

Methods: We retrospectively analyzed the immunological profiles and clinical outcomes of kidney transplant recipients screened for anti-HLA antibodies between 2015 and 2020, who developed anti-HLA-DQ DSAs either before or after transplantation. Anti-HLA antibodies were identified using Luminex^® single antigen bead technology, and clinical follow-up included graft function assessment, biopsy interpretation, and evaluation of immunosuppression.

Results: In the pre-transplant group (n = 6 with confirmed donor typing), patients with low to moderate median fluorescence intensity (MFI) anti-HLA-DQ DSAs (MFI 561-1581) underwent successful transplantation and maintained stable graft function under optimized immunosuppression. In contrast, in the post-transplant group (n = 6 with confirmed donor typing), the emergence of de novo anti-HLA-DQ DSAs was consistently associated with AMR, with MFI values reaching up to 19473, with biopsy-proven AMR in 5 of 6 cases and suspicion of AMR in 1 case. Two representative cases are detailed to illustrate the clinical impact of DQ DSAs: one patient developed high-level anti-DQB1*02 de novo DSA (MFI 12029) with persistent AMR after 5 years, while another developed anti-DQA1*05: 01 de novo DSA after an early AMR episode but maintained stable graft function after 5 years (creatinine 1.48 mg/dL).

Conclusion: Our findings underscore the clinical significance of anti-HLA-DQ DSAs in Moroccan kidney transplant recipients. While preformed DSAs with low immunogenicity may permit successful transplantation, de novo DSAs strongly correlate with AMR. Proactive monitoring, including routine DSA screening and HLA-DQ typing, could improve graft outcomes by enabling early intervention and better donor selection.

Background: Organ transplantation has emerged as a globally prevalent therapeutic modality for end-stage organ failure, yet the post-transplantation trajectory is increasingly complicated by a spectrum of metabolic sequelae, with obesity emerging as a critical clinical challenge.

Aim: To systematically review the multifactorial mechanisms underlying obesity following organ transplantation and to integrate evidence from pharmacological, behavioral, and molecular perspectives, thereby providing a foundation for targeted interventions.

Methods: We conducted a systematic search in PubMed and Web of Science for literature published from 2020 to 15 July 2025. The search strategy incorporated terms including "obesity", "overweight" and "post organ transplantation". Only randomized controlled trials, meta-analyses, and systematic reviews were included. Non-empirical publications and irrelevant studies were excluded. Data extraction and quality assessment were performed by two independent reviewers, with disagreements resolved by a third researcher.

Results: A total of 1457 articles were initially identified, of which 146 met the inclusion criteria. These studies encompassed liver, kidney, heart, and lung transplant recipients. Key findings indicate that immunosuppressive drugs-especially corticosteroids and calcineurin inhibitors-promote hyperphagia, insulin resistance, and dyslipidemia. Post-transplant sedentary behavior and hypercaloric diets further contribute to positive energy balance. At the molecular level, immunosuppressants disrupt adipokine signaling (e.g., leptin and adiponectin), induce inflammatory and oxidative stress responses, and activate adipogenic pathways leading to lipid accumulation.

Conclusion: Post-transplant obesity arises from a complex interplay of pharmacological, behavioral, and molecular factors. A multidisciplinary approach-incorporating pharmacological modification, nutritional management, physical activity, and molecular-targeted therapies-is essential to mitigate obesity and improve transplant outcomes. Further large-scale and mechanistic studies are warranted to establish evidence-based preventive and treatment strategies.

Background: Living donor kidney transplantation is the optimal method of long-term renal replacement therapy. Minimally invasive donor nephrectomy techniques, such as robot-assisted (RALDN) and hand-assisted (HALDN) laparoscopic procedures, are well-established in high-income countries and are being increasingly adopted worldwide. Nevertheless, no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.

Aim: To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.

Methods: A case-control matching analysis was performed based on the following parameters: Sex, age, body mass index, procedure laterality, number of renal arteries, and previous abdominal surgeries. Key surgical outcomes, including primary warm ischemia time, operative duration, and post-operative recovery, were evaluated.

Results: In this cohort of 140 living donors (70 RALDN vs 70 HALDN), donor and recipient outcomes were equivalent across key metrics: Pain scores, overall complication rates, readmissions, reoperations, and creatinine levels at 30 days and 1 year. Recipient long-term renal function did not differ between groups. Operative time for RALDN decreased significantly over the study period, indicating progressive improvement along the learning curve. Although RALDN was associated with a modestly longer mean warm ischaemia time (3.53 minutes vs 2.76 minutes, P < 0.001) and extended hospital stay (4.21 days vs 3.17 days, P < 0.001), these did not translate into any disadvantage in clinical outcomes.

Conclusion: In this first United Kingdom comparative cohort, RALDN demonstrated excellent safety and efficacy, even in the early phase of our programme, matching the outcomes of the well-established, gold-standard HALDN approach. Moreover, the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.

With advances in solid organ transplantation, the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failure. Kidney allograft dysfunction is well known to be associated with increased adverse outcomes post solitary kidney transplant however, outcomes for patients and the kidney allograft are somewhat understudied in the setting of kidney transplantation when combined with other solid organ transplantation such as in a simultaneous liver-kidney transplant. We will provide an overview of the current literature available on kidney allograft clinical outcome measures in combined solid organ transplant recipients such as delayed kidney allograft function, kidney allograft rejection, kidney allograft and patient survival metrics and how they compare to patients with kidney transplants alone. Worse kidney allograft survival outcomes were noted in most combined other organ with kidney transplantation (liver-kidney, heart-kidney, and lung-kidney) due to comorbidities attributed to non-renal organ dysfunction whereas improved kidney allograft survival outcomes were noted for pancreas-kidney transplantation.

Liver transplantation (LT) remains the optimal life-saving intervention for patients with end-stage liver disease. Despite the recent advances in LT several barriers, including organ allocation, donor-recipient matching, and patient education, persist. With the growing progress of artificial intelligence, particularly large language models (LLMs) like ChatGPT, new applications have emerged in the field of LT. Current studies demonstrating usage of ChatGPT in LT include various areas of application, from clinical settings to research and education. ChatGPT usage can benefit both healthcare professionals, by decreasing the time spent on non-clinical work, but also LT recipients by providing accurate information. Future potential applications include the expanding usage of ChatGPT and other LLMs in the field of LT pathology and radiology as well as the automated creation of discharge summaries or other related paperwork. Additionally, the next models of ChatGPT might have the potential to provide more accurate patient education material with increased readability. Although ChatGPT usage presents promising applications, there are certain ethical and practical limitations. Key concerns include patient data privacy, information accuracy, misinformation possibility and lack of legal framework. Healthcare providers and policymakers should collaborate for the establishment of a controlled framework for the safe use of ChatGPT. The aim of this minireview is to summarize current literature on ChatGPT in LT, highlighting both opportunities and limitations, while also providing future possible applications.

Background: An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients (KTRs). Despite cardiac clearance, potential KTRs still have structural and functional abnormalities. Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pre-transplant risk stratification and improving post-transplant outcomes.

Aim: To determine the prevalence of left ventricular hypertrophy (LVH), left ventricular systolic dysfunction (LVSD), diastolic dysfunction (DD), pulmonary hypertension (PH), and their predictors, and to assess their impact on graft function in pre-transplant candidates.

Methods: The study included all successful transplant candidates older than 14 who had a baseline echocardiogram. Binary logistic regression models were constructed to identify factors associated with LVH, LVSD, DD, and PH.

Results: Out of 259 patients, LVH was present in 64% (166), 12% (31) had LVSD, 27.5% (71) had DD, and 66 (25.5%) had PH. Independent predictors of LVH included male gender [odds ratio (OR): 2.51; 95%CI: 1.17-5.41 P = 0.02], PH (OR = 2.07; 95%CI: 1.11-3.86; P = 0.02), DD (OR: 2.47; 95%CI: 1.29-4.73; P = 0.006), and dyslipidemia (OR = 1.94; 95%CI: 1.07-3.53; P = 0.03). Predictors for LVSD included patients with DD (OR = 3.3, 95% CI: 1.41-7.81; P = 0.006) and a family history of coronary artery disease (OR = 4.50, 95%CI: 1.33-15.20; P = 0.015). Peritoneal dialysis was an independent predictor for DD (OR = 10.03; 95%CI: 1.71-58.94, P = 0.011). The presence of LVH (OR = 3.32, 95%CI: 1.05-10.55, P = 0.04) and mild to moderate or moderate to severe mitral regurgitation (OR = 4.63, 95%CI: 1.45-14.78, P = 0.01) were significant factors associated with PH. These abnormalities had no significant impact on estimated glomerular filtration at discharge, 6 months, 1 year, or 2 years post-transplant.

Conclusion: Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance, although they don't affect future graft function. Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre- and post-transplant to achieve better outcomes.

Background: Complement-mediated thrombotic microangiopathy (TMA) is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway, often linked to genetic abnormalities in complement factor H (CFH), complement factor I, or complement factor H-related (CFHR) proteins. Both renal transplantation and pregnancy are independent triggers for recurrence. This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition, emphasizing individualized risk stratification, close surveillance, and multidisciplinary management for favourable maternal and graft outcomes.

Case summary: A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA-homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication-was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother. Post-transplant immunosuppression included tacrolimus, mycophenolate mofetil, and prednisolone, later modified to azathioprine during pregnancy planning. One-year post-transplant, she conceived spontaneously. Pregnancy was complicated by transient gestational hypertension, controlled with nifedipine, labetalol, and amlodipine. Proteinuria remained < 150 mg/day; white blood cell counts 5.8-7.2 × 10⁹/L without cytopenia. Serum creatinine ranged 0.9-1.1 mg/dL, and tacrolimus trough levels 5-7 ng/mL. At 36 weeks, she delivered a healthy 3 kg infant by elective caesarean section. Postpartum follow-up at three months confirmed stable maternal and graft function.

Conclusion: High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.

Diabetes is a widespread disease affecting millions of people, making it one of the leading causes of death in the world. It is a leading cause of cardiovascular disease and end-stage renal disease. Despite advancements in treatment, including insulin therapy and glucose monitoring devices, diabetes continues to significantly impact quality of life and current modalities do not reverse the end-organ damage associated with its progression. While traditionally indicated for type 1 diabetes, recent clinical practice refinements have made pancreas transplants available to select type 2 diabetics meeting specific criteria. These transplants are usually a part of a simultaneous kidney-pancreas transplant. However, although less frequently performed, transplants of pancreas alone or pancreas after kidney transplant are still available. For selected diabetic patients, pancreas transplants offer significant survival benefits and the improvement of cardiovascular and metabolic complications; however, they are not without risks. Complications such as bleeding, vascular thrombosis, infection, organ leak, and rejection are possible. Another challenge to pancreas transplantation is the decreasing number of procedures being performed due to decline in the volume of available high-quality allografts and resource constraints of transplant centers. Advancements in monitoring and treatment of diabetes are contributing to the decline in pancreas transplants nowadays.