BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppressio...BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppression remains a concern,as it can adversely affect recipients’quality of life and survival.While the link be-tween immunosuppression and increased cancer risk is well-documented,the specific interactions between graft rejection and post-transplant malignancy(PTM)remain poorly understood.Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.AIM To investigate whether immunosuppression in PTM reduces rejection risk,while immune activation during rejection protects against malignancy.METHODS We analyzed data from the United Network for Organ Sharing’s Organ Procurewith no prior history of malignancy(in donors or recipients).Landmark analyses at 1,2,3,5,10,15,and 20 years post-transplant,Kaplan–Meier analyses,and time-dependent Cox proportional hazards regression models,each incorporating the temporal dimension of outcomes,assessed the association between rejection-induced graft failure(RGF)and PTM.Multivariate models were adjusted for clinical and immunological factors,including immunosuppression regimens.RESULTS The cohort included 579905 recipients(kidney:386878;liver:108390;heart:45046;lung:37643;pancreas:1948)with a mean follow-up of 7.3 years and a median age of 50.6±13.2 years.RGF was associated with a reduction in PTM risk across all time points[hazard ratio(HR)=0.07-0.20,P<0.001],even after excluding mortality cases.Kidney transplant recipients exhibited the most pronounced reduction(HR=0.22,P<0.001).Conversely,among recipients with PTM,RGF risk decreased across all time points up to 15 years after excluding mortality cases(HR=0.49–0.80,P<0.001).This risk reduction was observed in kidney,liver,heart,and lung transplants(HRs=0.90,0.21,0.21,and 0.18,respectively;P<0.001)but not in pancreas transplants.CONCLUSION RGF reduces PTM risk,particularly in kidney transplants,while PTM decreases RGF risk in kidney,liver,heart,and lung transplants.展开更多
Although national transplant organizations share common visions and goals,the creation of a unified global organization remains impractical.Differences in ethnicity,culture,religion,and education shape local practices...Although national transplant organizations share common visions and goals,the creation of a unified global organization remains impractical.Differences in ethnicity,culture,religion,and education shape local practices and infrastructure,making the establishment of a single global entity unfeasible.Even with these social disparities aside,logistical factors such as time and distance between organ procurement and transplantation sites pose significant challenges.While technological advancements have extended organ preservation times,they have yet to support the demands of transcontinental transplantations effectively.This review presents a comparative analysis of the structures,operational frameworks,policies,and legislation governing various transplant organizations around the world.Key differences pertain to the administration of these organizations,trends in organ donation,and organ allocation policies,which reflect the financial,cultural,and religious diversity across different regions.While a global transplant organization may be out of reach,agreeing on best practices for the benefit of patients is essential.展开更多
In China, liver transplantation is an important discipline in the field of organ transplantation. China Liver Transplant Registry (CLTR) is a scientific project that has been set up to advance surgical techniques and ...In China, liver transplantation is an important discipline in the field of organ transplantation. China Liver Transplant Registry (CLTR) is a scientific project that has been set up to advance surgical techniques and procedures and to improve both short-and long-term post-transplant follow-up and outcome of the liver recipients. CLTR also serves as a robust data support platform for the National Liver Transplant Quality Control Center in the quest to upscale its quality control protocols. The mission of CLTR is to register all liver transplantation activities in the mainland of China and to conduct scientific analyses of the collected data. The huge number of compiled cases and the scientific research conducted over the past decade based on this database drastically revolutionized the clinical practice in the country. All CLTR activities and projects will be a guarantee to foster progresses of liver transplantation in China in a more scientific way, to standardize the systematic care in the field of liver transplantation.展开更多
BACKGROUND Solid organ transplantation(SOT)and hematopoietic stem cell transplantation(HSCT)revolutionized the survival and quality of life of patients with malignant diseases,various immunologic,and metabolic disorde...BACKGROUND Solid organ transplantation(SOT)and hematopoietic stem cell transplantation(HSCT)revolutionized the survival and quality of life of patients with malignant diseases,various immunologic,and metabolic disorders or those associated with a significant impairment in a patient's quality of life.AIM To investigate admission causes and treatment outcomes of patients after SOT or HSCT treated in a medical intensive care unit(ICU).METHODS We conducted a single-center,retrospective epidemiological study in the medical ICU at the University Hospital Centre Zagreb,Croatia covering the period from January 1,2018 to December 31,2023.RESULTS The study included 91 patients with either SOT[28 patients(30.8%)]or HSCT[63 patients(69.2%)].The median age was 56(43.2-64.7)years,and 60.4%of the patients were male.Patients with SOT had more comorbidities than patients after HSCT[χ^(2)(5,n=141)=18.513,P<0.001].Sepsis and septic shock were the most frequent reasons for admission,followed by acute respiratory insufficiency in patients following HSCT.Survival rate significantly differed between SOT and HSCT[χ^(2)(1,n=91)=21.767,P<0.001].ICU survival was 57%in the SOT and 12.7%in the HSCT group.The need for mechanical ventilation[χ^(2)(1,n=91)=17.081,P<0.001]and vasopressor therapy[χ^(2)(1,n=91)=36.803,P<0.001]was associated with survival.The necessity for acute renal replacement therapy did not influence patients'survival[χ^(2)(1,n=91)=0.376,P=0.54].In the subgroup of patients with infection,90%had septic shock,and the majority had positive microbiological samples,mostly Gram-negative bacteria.The ICU survival of patients with sepsis/septic shock cumulatively was 15%.The survival of SOT patients with sepsis/shock was 45%.CONCLUSION Patients with SOT or HSCT are frequently admitted to the ICU due to sepsis and septic shock.Despite advancements in critical care,the mortality rate of patients with refractory septic shock and multiorgan failure in this patient population is extremely high.Early recognition and timely ICU admittance might improve the outcome of patients,especially after HSCT.展开更多
Heart transplantation(HTx)is a life-saving procedure for patients with end-stage heart failure and has undergone remarkable advancements since the first succe-ssful transplant in 1967.The introduction of cyclosporine ...Heart transplantation(HTx)is a life-saving procedure for patients with end-stage heart failure and has undergone remarkable advancements since the first succe-ssful transplant in 1967.The introduction of cyclosporine in the 1970s significantly improved patient outcomes,leading to a global increase in transplants,including in India,where the practice has grown despite initial challenges.This review pro-vides an extensive overview of HTx,focusing on current practices,technological advancements,and the ongoing challenges the field faces today.It explores the evolution of surgical techniques,such as minimally invasive and robotic-assisted procedures,and the management of posttransplant rejection through tailored immunosuppressive strategies,including new monoclonal antibodies and perso-nalized therapies.The review also highlights emerging innovations such as mechanical circulatory support devices and xenotransplantation as potential solutions to donor shortages while acknowledging the ethical and logistical challenges these approaches entail.Furthermore,the analysis delves into the implications of using extended-criteria donors and the role of multidisciplinary teams in evaluating absolute and relative contraindications.Despite the progress made,the persistent issues of organ scarcity and ethical concerns underscore the need for ongoing research and innovation to further enhance the efficacy,safety,and accessibility of HTx.展开更多
Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria....Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases pos...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC.The rate of HCC recurrence is generally reported as 8%-20%in the literature.Many predictors of HCC have already been researched,however,to our knowledge there are no published studies on this topic using Australian data.AIM To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.METHODS We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021.Data was collected from various health record databases and included recipient demographics,serum biochemistry,radiology,operation notes,explant histopathology and details of recurrence.Overall survival of HCC patients post-LT,stratified for recurrence,was calculated by Kaplan Meier analysis.Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.RESULTS Between 1/1/2006 and 12/31/2021,119 patients were transplanted with HCC.8.4%of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years.The median time to recurrence was 2.9 years±0.75 years.When comparing baseline characteristics,a greater proportion of subjects with recurrence had common characteristics on explant histopathology,including>3 viable nodules(P=0.001),vascular invasion(P=0.003)and poorly differentiated HCC(P=0.03).Unadjusted survival curves showed lower 1-year,3-year,5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence(90%vs 92%,70%vs 88%,42%vs 80%,14%vs 76%,respectively;log rank P<0.001).CONCLUSION HCC recurrence was low at 8.4%in this contemporary Australian cohort,however it significantly impacted post-LT survival.Further studies are required to confirm predictors of recurrence and improve recipient outcomes.展开更多
With the advances in transplant oncology in recent years, the role of liver transplantation has expanded to make curative treatment a possibility for a wider patient population. We highlight strategies in Hong Kong, C...With the advances in transplant oncology in recent years, the role of liver transplantation has expanded to make curative treatment a possibility for a wider patient population. We highlight strategies in Hong Kong, China that have enabled preoperative prognostication for judicious patient selection, downstaging therapy to definitive treatment, and postoperative therapies that have provided a growing role for liver transplantation in patients with more advanced hepatocellular carcinoma.展开更多
Liver transplantation is hindered by organ shortage. The potential way to relieve this issue is to expand the donor pool via extending the donor criteria and make full use of all available grafts. The concept of “no-...Liver transplantation is hindered by organ shortage. The potential way to relieve this issue is to expand the donor pool via extending the donor criteria and make full use of all available grafts. The concept of “no-donor” liver transplantation allows grafts to be recovered from other liver recipients. This review summarizes the current clinical practice of “no-donor” liver transplantation, focusing on the experiences of Chinese transplant teams. Domino liver transplantation was introduced by Furtado in 1995 and implemented later in 2013 in China, and novel donor indications including some essential-to-treat inherited metabolic liver-based diseases have emerged. The concept of cross-auxiliary domino liver transplantation brings a further expansion of the domino liver graft pool, and the first pair of liver transplantation performed “rigorously without donation” was accomplished in our center in 2018. Our experience with this original transplantation procedure is hereby reviewed. In order to further promote and make successful “no-donor” liver transplantation, close co-operation between researchers, surgeons, physicians, organ procurement organizations, as well as ethical committees is required.展开更多
In China pediatric liver transplantation(PLT)has become a safe and standardized procedure.Innovations and measures to further improve long-term survival and quality of life for children should be the next focus.In par...In China pediatric liver transplantation(PLT)has become a safe and standardized procedure.Innovations and measures to further improve long-term survival and quality of life for children should be the next focus.In particular better strategies related to the surgical treatment of high-risk recipients as well as the long-term follow-up of pediatric liver recipients have to be addressed.A particular attention should be given to children presenting significant co-morbidities and those needing retransplantation.A tight mul-tidisciplinary follow-up system addressing both short-and long-term issues of pediatric liver recipients is still a challenge for the Chinese pediatric transplant community.展开更多
Over the past six decades,liver transplantation(LT)has evolved from an experimental procedure into a standardized and life-saving intervention,reshaping the landscape of organ transplantation.Driven by pioneering brea...Over the past six decades,liver transplantation(LT)has evolved from an experimental procedure into a standardized and life-saving intervention,reshaping the landscape of organ transplantation.Driven by pioneering breakthroughs,technological advancements,and a deepened understanding of immunology,LT has seen remarkable progress.Some of the most notable breakthroughs in the field include advances in immunosuppression,a revised model for end-stage liver disease,and artificial intelligence(AI)-integrated imaging modalities serving diagnostic and therapeutic roles in LT,paired with ever-evolving technological advances.Additionally,the refinement of transplantation procedures,resulting in the introduction of alternative transplantation methods,such as living donor LT,split LT,and the use of marginal grafts,has addressed the challenge of organ shortage.Moreover,precision medicine,guiding personalized immunosuppressive strategies,has significantly improved patient and graft survival rates while addressing emergent issues,such as short-term complications and early allograft dysfunction,leading to a more refined strategy and enhanced postoperative recovery.Looking ahead,ongoing research explores regenerative medicine,diagnostic tools,and AI to optimize organ allocation and posttransplantation car.In summary,the past six decades have marked a transformative journey in LT with a commitment to advancing science,medicine,and patient-centered care,offering hope and extending life to individuals worldwide.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)pneumonia with severe septic shock and acute respiratory distress syndrome(ARDS)are critical illnesses for patients following transplant.Intravenous immunoglobulin(IVIG)pla...BACKGROUND Coronavirus disease 2019(COVID-19)pneumonia with severe septic shock and acute respiratory distress syndrome(ARDS)are critical illnesses for patients following transplant.Intravenous immunoglobulin(IVIG)plays a role in both immune support and inflammation control,especially in immunocompromised patients.This case report describes the first successful experience using IVIG and pulse steroids to manage this critical condition following lung transplantation.CASE SUMMARY A 65-year-old male patient reported a history of chronic obstructive pulmonary disease and poor lung function and received bilateral sequential lung transplantations.Postoperatively,he developed COVID-19 pneumonia,severe septic shock,and ARDS.He recovered from this critical condition after empirical antibiotics administration and veno-venous extracorporeal membrane oxygenation,in addition to IVIG and pulse steroids.CONCLUSION IVIG is a valuable adjunct in managing severe sepsis in lung transplant recipients after COVID-19 infection.We aim,for the first time,to report the success of such a management approach for COVID-19 ARDS and sepsis in the post-lung transplant setting.With further investigations,this is a starting point for wider analysis of such an approach in this setting and consequently helps guide clinical practice for such a challenging patient population moving forward.展开更多
BACKGROUND Since being declared as a pandemic on March 11,2020,coronavirus disease 2019(COVID-19)has profoundly influenced heart and lung transplant programs,impacting donor availability,patient management,and healthc...BACKGROUND Since being declared as a pandemic on March 11,2020,coronavirus disease 2019(COVID-19)has profoundly influenced heart and lung transplant programs,impacting donor availability,patient management,and healthcare resources.This study offers a citation-based review of the research output on this subject,seeking to understand how the transplant community has responded to these challenges.Through a review of literature from the beginning of the pandemic to early 2023,we evaluate the shifts in academic emphasis and the emerging trends in heart and lung transplantation during the COVID-19 period.AIM To assess the impact of COVID-19 on heart and lung transplantation research,highlighting key themes,contri-butions,and trends in the literature during the pandemic.METHODS We conducted an extensive search of the Web of Science database on February 9,2023.We employed the terms"transplant"and"transplantation",as well as organ-specific terms like"heart","cardiac",and"lung",combined with COVID-19-related terms such as"COVID-19","coronavirus",and"SARS-CoV-2".The search encompassed public-ations from March 11,2020 to February 9,2023.Data on authors,journals,countries,institutions,and publication types(articles,reviews,conference papers,letters,notes,editorials,brief surveys,book chapters,and errata)were analyzed.The data was visualized and processed with VOSviewer 1.6.18 and Excel.RESULTS We included 847 research items.There were 392 articles(46.3%)and 88 reviews(10.3%).The studies included were referenced 7757 times,with an average of 9.17 citations per article.The majority of the publications(n=317)were conducted by institutes from the United States with highest citations(n=4948)on this subject,followed by Germany,Italy,and France.The majority of papers(n=101)were published in the Journal of Heart and Lung Transplantation.CONCLUSION To the fullest extent of our knowledge,this is the first bibliometric study of COVID-19's impact on heart and lung transplantation to offer a visual analysis of the literature in order to predict future frontiers and provide an over-view of current research hotspots.展开更多
BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,...BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,as it would elucidate the compre-hensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.AIM To compare the levels of burden,stress and depression among family caregivers of cirrhotic and liver transplant patients.METHODS This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital.Instruments included identification cards,interview scripts,the caregiver burden scale Inventory,Lipp’s Stress Symptom Inventory,and the Beck Depression Inventory-Second Edition.Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability.Factor scores were compared with the Mann-Whitney U test,with effect size as the rank-biserial correlation coefficient(r).Statistical analysis was performed with R software(P<0.05).RESULTS Seventy-seven CP caregivers and 65 LT recipient caregivers were included.Most were female(CP:85.7%vs LT:84.6%)and the patients’spouses(76.6%vs 63.1%).The median age and caregiving duration were 55.4(23.3-76.3)vs 54.6(25.7-82.1)and 3.9(1-20)vs 8(1.5-24)years,respectively(P=0.001).LT caregivers were less likely to be at risk of overload(21.5%vs 49.4%),to be under stress(33.8%vs 36.4%)and to show symptoms of depression(15.4%vs 35.1%).Compared with LT caregivers,CP caregivers had greater median factor scores for burden(general tension,P=0.012;isolation,P=0.014;disappointment,P=0.004),depression(P=0.008),and stress(P=0.047),with small to moderate effect sizes.The disappointment(r=0.240)and depression(r=0.225)dimensions had the largest effect sizes.CONCLUSION Family caregivers of LT recipients are less likely to exhibit symptoms of burden,stress,and depression,suggesting that the benefits of LT extend to the patients’family members.展开更多
BACKGROUND Tacrolimus(TAC)is metabolized primarily by the CYP3A-encoded enzyme family(CYP3A4,CYP3A5,and CYP3A7).Individuals expressing the CYP3A51 allele are considered fast metabolizers and generally require higher T...BACKGROUND Tacrolimus(TAC)is metabolized primarily by the CYP3A-encoded enzyme family(CYP3A4,CYP3A5,and CYP3A7).Individuals expressing the CYP3A51 allele are considered fast metabolizers and generally require higher TAC doses to reach therapeutic levels.AIM To evaluate the predictive value of the TAC concentration-to-dose(C0/D)ratio for identifying CYP3A5 poly-morphisms in renal transplant recipients.METHODS Eighty-six de novo kidney transplant recipients with TAC-based immunosuppression from the Department of Nephrology and Dialysis at Military Hospital 103(Hanoi,Vietnam)were included in this retrospective study.Blood samples were collected within the first week post-transplantation to monitor TAC levels and to perform genotyping for CYP3A5 genetic polymorphisms.RESULTS The CYP3A53/3 genotype was identified in 37 patients(43%),CYP3A51/3 in 40 patients(46.5%),and CYP3A51/1 in 9 patients(10.5%).Patients carrying the CYP3A51/3 or CYP3A51/1 genotype,classified as fast metabolizers(CYP3A5 expressers),had significantly lower TAC C0 concentrations and C0/D ratios compared to slow meta-bolizers(CYP3A53/3 genotype)at multiple time points during follow-up(all P<0.001).Notably,the TAC C0/D ratio obtained on day 1(0.91)was shown to predict CYP3A5 polymorphism with a sensitivity of 84.6%and a specificity of 84.6%.CONCLUSION This study demonstrates that the TAC C0/D ratio provides a reliable predictive value for CYP3A5 polymorphisms,which can be used to individualize TAC dosing in renal transplant recipients in Vietnam and other low-income countries.展开更多
BACKGROUND Urinary tract infections(UTIs)in kidney transplant patients are a challenge.AIM To evaluate epidemiology,clinical status,therapeutic management,and clinical outcome of kidney transplant patients in a univer...BACKGROUND Urinary tract infections(UTIs)in kidney transplant patients are a challenge.AIM To evaluate epidemiology,clinical status,therapeutic management,and clinical outcome of kidney transplant patients in a university hospital for UTI.METHODS We conducted a retrospective observational study,enrolling all kidney transplant patients hospitalized for UTI,with the objective to evaluate the epidemiology,clinical status,therapeutic management,and clinical outcome of kidney transplant patients.RESULTS From our real-life experience,infection with multidrug-resistant germs was confirmed as a risk factor for the severe evolution of the infection.At the same time,the re-evaluation of immunosuppressive therapy could be an important therapeutic strategy in the course of infection.CONCLUSION Prompt initiation of empiric antibiotic therapy upon initiation of microbiological investigations may reduce the risk of severe infection progression.展开更多
Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significa...Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.展开更多
To the Editor:Graft-versus-host disease(GVHD)is a rare but fatal complication after solid organ transplantation(SOT),with an incidence of 0.2–2.0%.Recent retrospective studies have shown a mortality rate of approxima...To the Editor:Graft-versus-host disease(GVHD)is a rare but fatal complication after solid organ transplantation(SOT),with an incidence of 0.2–2.0%.Recent retrospective studies have shown a mortality rate of approximately 85–98%among patients with SOT-GVHD.[1]Various drugs and methods have been shown to improve or alleviate clinical symptoms,but no effective treatments for GVHD currently exist.Recent clinical experience with SOTGVHD treatment is mixed and limited,including systemic or partial corticosteroid support,the use of Janus kinase(JAK)inhibitors,allogeneic hematopoietic cell transplantation(alloHCT),and donor-targeted serotherapy.Since the number of lymphocytes transplanted with the organ may be a risk factor for GVHD,reducing the number of donor lymphocytes seems beneficial.Intensity-modulated radiation therapy(IMRT)is a type of radiotherapy that uses optimized,non-uniform radiation beam intensities on the patient.[2]Local allograft irradiation has also been used to treat severe resistant rejection after liver transplantation(LT)in previous studies.[3]Based on this,we hypothesized that whole-liver IMRT at a low dosage could be used as a rescue therapy to control acute GVHD after LT by reducing the number of donor-derived immune cells.展开更多
To the Editor:To reduce the risk of acute rejection(AR)after renal transplantation,immunosuppressive induction therapy has been commonly used in the perioperative period.At present,rabbit anti-thymocyte globulin(rATG)...To the Editor:To reduce the risk of acute rejection(AR)after renal transplantation,immunosuppressive induction therapy has been commonly used in the perioperative period.At present,rabbit anti-thymocyte globulin(rATG)and basiliximab are the two main induction agents used for kidney transplantation.In adult kidney transplantation,the incidence of AR with rATG induction is generally lower than that with basiliximab.[1]Children have different immune systems than adults do.In pediatric kidney transplantation,which induction therapy is more effective in preventing early AR is an important clinical question worth answering.Because there are few reports in this field and differences in the immune systems of children at different ages,we have now conducted a total and age-stratified analysis of Chinese multicenter cohort data to compare the AR rates and other outcomes between rATG and basiliximab induction therapy groups in pediatric deceased-donor kidney transplantation.展开更多
The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future car...The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)diseases.Chronic kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the endothelium.ED is also associated with a decline in estimated glomerular filtration rate.After kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV health.However,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft survival.ED in kidney transplant recipients is an underrecognized and poorly studied entity.CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts.ED contributes to the pathogenesis of many of the CV diseases.Various biomarkers and vasoreactivity tests are available to study endothelial functions.With an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.展开更多
文摘BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppression remains a concern,as it can adversely affect recipients’quality of life and survival.While the link be-tween immunosuppression and increased cancer risk is well-documented,the specific interactions between graft rejection and post-transplant malignancy(PTM)remain poorly understood.Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.AIM To investigate whether immunosuppression in PTM reduces rejection risk,while immune activation during rejection protects against malignancy.METHODS We analyzed data from the United Network for Organ Sharing’s Organ Procurewith no prior history of malignancy(in donors or recipients).Landmark analyses at 1,2,3,5,10,15,and 20 years post-transplant,Kaplan–Meier analyses,and time-dependent Cox proportional hazards regression models,each incorporating the temporal dimension of outcomes,assessed the association between rejection-induced graft failure(RGF)and PTM.Multivariate models were adjusted for clinical and immunological factors,including immunosuppression regimens.RESULTS The cohort included 579905 recipients(kidney:386878;liver:108390;heart:45046;lung:37643;pancreas:1948)with a mean follow-up of 7.3 years and a median age of 50.6±13.2 years.RGF was associated with a reduction in PTM risk across all time points[hazard ratio(HR)=0.07-0.20,P<0.001],even after excluding mortality cases.Kidney transplant recipients exhibited the most pronounced reduction(HR=0.22,P<0.001).Conversely,among recipients with PTM,RGF risk decreased across all time points up to 15 years after excluding mortality cases(HR=0.49–0.80,P<0.001).This risk reduction was observed in kidney,liver,heart,and lung transplants(HRs=0.90,0.21,0.21,and 0.18,respectively;P<0.001)but not in pancreas transplants.CONCLUSION RGF reduces PTM risk,particularly in kidney transplants,while PTM decreases RGF risk in kidney,liver,heart,and lung transplants.
文摘Although national transplant organizations share common visions and goals,the creation of a unified global organization remains impractical.Differences in ethnicity,culture,religion,and education shape local practices and infrastructure,making the establishment of a single global entity unfeasible.Even with these social disparities aside,logistical factors such as time and distance between organ procurement and transplantation sites pose significant challenges.While technological advancements have extended organ preservation times,they have yet to support the demands of transcontinental transplantations effectively.This review presents a comparative analysis of the structures,operational frameworks,policies,and legislation governing various transplant organizations around the world.Key differences pertain to the administration of these organizations,trends in organ donation,and organ allocation policies,which reflect the financial,cultural,and religious diversity across different regions.While a global transplant organization may be out of reach,agreeing on best practices for the benefit of patients is essential.
基金supported by grants from the National Natural Science Foundation of China (82470690 and 92159202)the Major Research Plan of Key Research and Development Project of Zhejiang Province (2024C03149 and 2023C03046)。
文摘In China, liver transplantation is an important discipline in the field of organ transplantation. China Liver Transplant Registry (CLTR) is a scientific project that has been set up to advance surgical techniques and procedures and to improve both short-and long-term post-transplant follow-up and outcome of the liver recipients. CLTR also serves as a robust data support platform for the National Liver Transplant Quality Control Center in the quest to upscale its quality control protocols. The mission of CLTR is to register all liver transplantation activities in the mainland of China and to conduct scientific analyses of the collected data. The huge number of compiled cases and the scientific research conducted over the past decade based on this database drastically revolutionized the clinical practice in the country. All CLTR activities and projects will be a guarantee to foster progresses of liver transplantation in China in a more scientific way, to standardize the systematic care in the field of liver transplantation.
文摘BACKGROUND Solid organ transplantation(SOT)and hematopoietic stem cell transplantation(HSCT)revolutionized the survival and quality of life of patients with malignant diseases,various immunologic,and metabolic disorders or those associated with a significant impairment in a patient's quality of life.AIM To investigate admission causes and treatment outcomes of patients after SOT or HSCT treated in a medical intensive care unit(ICU).METHODS We conducted a single-center,retrospective epidemiological study in the medical ICU at the University Hospital Centre Zagreb,Croatia covering the period from January 1,2018 to December 31,2023.RESULTS The study included 91 patients with either SOT[28 patients(30.8%)]or HSCT[63 patients(69.2%)].The median age was 56(43.2-64.7)years,and 60.4%of the patients were male.Patients with SOT had more comorbidities than patients after HSCT[χ^(2)(5,n=141)=18.513,P<0.001].Sepsis and septic shock were the most frequent reasons for admission,followed by acute respiratory insufficiency in patients following HSCT.Survival rate significantly differed between SOT and HSCT[χ^(2)(1,n=91)=21.767,P<0.001].ICU survival was 57%in the SOT and 12.7%in the HSCT group.The need for mechanical ventilation[χ^(2)(1,n=91)=17.081,P<0.001]and vasopressor therapy[χ^(2)(1,n=91)=36.803,P<0.001]was associated with survival.The necessity for acute renal replacement therapy did not influence patients'survival[χ^(2)(1,n=91)=0.376,P=0.54].In the subgroup of patients with infection,90%had septic shock,and the majority had positive microbiological samples,mostly Gram-negative bacteria.The ICU survival of patients with sepsis/septic shock cumulatively was 15%.The survival of SOT patients with sepsis/shock was 45%.CONCLUSION Patients with SOT or HSCT are frequently admitted to the ICU due to sepsis and septic shock.Despite advancements in critical care,the mortality rate of patients with refractory septic shock and multiorgan failure in this patient population is extremely high.Early recognition and timely ICU admittance might improve the outcome of patients,especially after HSCT.
文摘Heart transplantation(HTx)is a life-saving procedure for patients with end-stage heart failure and has undergone remarkable advancements since the first succe-ssful transplant in 1967.The introduction of cyclosporine in the 1970s significantly improved patient outcomes,leading to a global increase in transplants,including in India,where the practice has grown despite initial challenges.This review pro-vides an extensive overview of HTx,focusing on current practices,technological advancements,and the ongoing challenges the field faces today.It explores the evolution of surgical techniques,such as minimally invasive and robotic-assisted procedures,and the management of posttransplant rejection through tailored immunosuppressive strategies,including new monoclonal antibodies and perso-nalized therapies.The review also highlights emerging innovations such as mechanical circulatory support devices and xenotransplantation as potential solutions to donor shortages while acknowledging the ethical and logistical challenges these approaches entail.Furthermore,the analysis delves into the implications of using extended-criteria donors and the role of multidisciplinary teams in evaluating absolute and relative contraindications.Despite the progress made,the persistent issues of organ scarcity and ethical concerns underscore the need for ongoing research and innovation to further enhance the efficacy,safety,and accessibility of HTx.
文摘Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC.The rate of HCC recurrence is generally reported as 8%-20%in the literature.Many predictors of HCC have already been researched,however,to our knowledge there are no published studies on this topic using Australian data.AIM To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.METHODS We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021.Data was collected from various health record databases and included recipient demographics,serum biochemistry,radiology,operation notes,explant histopathology and details of recurrence.Overall survival of HCC patients post-LT,stratified for recurrence,was calculated by Kaplan Meier analysis.Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.RESULTS Between 1/1/2006 and 12/31/2021,119 patients were transplanted with HCC.8.4%of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years.The median time to recurrence was 2.9 years±0.75 years.When comparing baseline characteristics,a greater proportion of subjects with recurrence had common characteristics on explant histopathology,including>3 viable nodules(P=0.001),vascular invasion(P=0.003)and poorly differentiated HCC(P=0.03).Unadjusted survival curves showed lower 1-year,3-year,5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence(90%vs 92%,70%vs 88%,42%vs 80%,14%vs 76%,respectively;log rank P<0.001).CONCLUSION HCC recurrence was low at 8.4%in this contemporary Australian cohort,however it significantly impacted post-LT survival.Further studies are required to confirm predictors of recurrence and improve recipient outcomes.
文摘With the advances in transplant oncology in recent years, the role of liver transplantation has expanded to make curative treatment a possibility for a wider patient population. We highlight strategies in Hong Kong, China that have enabled preoperative prognostication for judicious patient selection, downstaging therapy to definitive treatment, and postoperative therapies that have provided a growing role for liver transplantation in patients with more advanced hepatocellular carcinoma.
基金supported by grants from Capital’s Funds for Health Improvement and Research (2024–1–2022)Beijing Nat-ural Science Foundation (7244318)。
文摘Liver transplantation is hindered by organ shortage. The potential way to relieve this issue is to expand the donor pool via extending the donor criteria and make full use of all available grafts. The concept of “no-donor” liver transplantation allows grafts to be recovered from other liver recipients. This review summarizes the current clinical practice of “no-donor” liver transplantation, focusing on the experiences of Chinese transplant teams. Domino liver transplantation was introduced by Furtado in 1995 and implemented later in 2013 in China, and novel donor indications including some essential-to-treat inherited metabolic liver-based diseases have emerged. The concept of cross-auxiliary domino liver transplantation brings a further expansion of the domino liver graft pool, and the first pair of liver transplantation performed “rigorously without donation” was accomplished in our center in 2018. Our experience with this original transplantation procedure is hereby reviewed. In order to further promote and make successful “no-donor” liver transplantation, close co-operation between researchers, surgeons, physicians, organ procurement organizations, as well as ethical committees is required.
文摘In China pediatric liver transplantation(PLT)has become a safe and standardized procedure.Innovations and measures to further improve long-term survival and quality of life for children should be the next focus.In particular better strategies related to the surgical treatment of high-risk recipients as well as the long-term follow-up of pediatric liver recipients have to be addressed.A particular attention should be given to children presenting significant co-morbidities and those needing retransplantation.A tight mul-tidisciplinary follow-up system addressing both short-and long-term issues of pediatric liver recipients is still a challenge for the Chinese pediatric transplant community.
文摘Over the past six decades,liver transplantation(LT)has evolved from an experimental procedure into a standardized and life-saving intervention,reshaping the landscape of organ transplantation.Driven by pioneering breakthroughs,technological advancements,and a deepened understanding of immunology,LT has seen remarkable progress.Some of the most notable breakthroughs in the field include advances in immunosuppression,a revised model for end-stage liver disease,and artificial intelligence(AI)-integrated imaging modalities serving diagnostic and therapeutic roles in LT,paired with ever-evolving technological advances.Additionally,the refinement of transplantation procedures,resulting in the introduction of alternative transplantation methods,such as living donor LT,split LT,and the use of marginal grafts,has addressed the challenge of organ shortage.Moreover,precision medicine,guiding personalized immunosuppressive strategies,has significantly improved patient and graft survival rates while addressing emergent issues,such as short-term complications and early allograft dysfunction,leading to a more refined strategy and enhanced postoperative recovery.Looking ahead,ongoing research explores regenerative medicine,diagnostic tools,and AI to optimize organ allocation and posttransplantation car.In summary,the past six decades have marked a transformative journey in LT with a commitment to advancing science,medicine,and patient-centered care,offering hope and extending life to individuals worldwide.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)pneumonia with severe septic shock and acute respiratory distress syndrome(ARDS)are critical illnesses for patients following transplant.Intravenous immunoglobulin(IVIG)plays a role in both immune support and inflammation control,especially in immunocompromised patients.This case report describes the first successful experience using IVIG and pulse steroids to manage this critical condition following lung transplantation.CASE SUMMARY A 65-year-old male patient reported a history of chronic obstructive pulmonary disease and poor lung function and received bilateral sequential lung transplantations.Postoperatively,he developed COVID-19 pneumonia,severe septic shock,and ARDS.He recovered from this critical condition after empirical antibiotics administration and veno-venous extracorporeal membrane oxygenation,in addition to IVIG and pulse steroids.CONCLUSION IVIG is a valuable adjunct in managing severe sepsis in lung transplant recipients after COVID-19 infection.We aim,for the first time,to report the success of such a management approach for COVID-19 ARDS and sepsis in the post-lung transplant setting.With further investigations,this is a starting point for wider analysis of such an approach in this setting and consequently helps guide clinical practice for such a challenging patient population moving forward.
文摘BACKGROUND Since being declared as a pandemic on March 11,2020,coronavirus disease 2019(COVID-19)has profoundly influenced heart and lung transplant programs,impacting donor availability,patient management,and healthcare resources.This study offers a citation-based review of the research output on this subject,seeking to understand how the transplant community has responded to these challenges.Through a review of literature from the beginning of the pandemic to early 2023,we evaluate the shifts in academic emphasis and the emerging trends in heart and lung transplantation during the COVID-19 period.AIM To assess the impact of COVID-19 on heart and lung transplantation research,highlighting key themes,contri-butions,and trends in the literature during the pandemic.METHODS We conducted an extensive search of the Web of Science database on February 9,2023.We employed the terms"transplant"and"transplantation",as well as organ-specific terms like"heart","cardiac",and"lung",combined with COVID-19-related terms such as"COVID-19","coronavirus",and"SARS-CoV-2".The search encompassed public-ations from March 11,2020 to February 9,2023.Data on authors,journals,countries,institutions,and publication types(articles,reviews,conference papers,letters,notes,editorials,brief surveys,book chapters,and errata)were analyzed.The data was visualized and processed with VOSviewer 1.6.18 and Excel.RESULTS We included 847 research items.There were 392 articles(46.3%)and 88 reviews(10.3%).The studies included were referenced 7757 times,with an average of 9.17 citations per article.The majority of the publications(n=317)were conducted by institutes from the United States with highest citations(n=4948)on this subject,followed by Germany,Italy,and France.The majority of papers(n=101)were published in the Journal of Heart and Lung Transplantation.CONCLUSION To the fullest extent of our knowledge,this is the first bibliometric study of COVID-19's impact on heart and lung transplantation to offer a visual analysis of the literature in order to predict future frontiers and provide an over-view of current research hotspots.
文摘BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,as it would elucidate the compre-hensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.AIM To compare the levels of burden,stress and depression among family caregivers of cirrhotic and liver transplant patients.METHODS This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital.Instruments included identification cards,interview scripts,the caregiver burden scale Inventory,Lipp’s Stress Symptom Inventory,and the Beck Depression Inventory-Second Edition.Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability.Factor scores were compared with the Mann-Whitney U test,with effect size as the rank-biserial correlation coefficient(r).Statistical analysis was performed with R software(P<0.05).RESULTS Seventy-seven CP caregivers and 65 LT recipient caregivers were included.Most were female(CP:85.7%vs LT:84.6%)and the patients’spouses(76.6%vs 63.1%).The median age and caregiving duration were 55.4(23.3-76.3)vs 54.6(25.7-82.1)and 3.9(1-20)vs 8(1.5-24)years,respectively(P=0.001).LT caregivers were less likely to be at risk of overload(21.5%vs 49.4%),to be under stress(33.8%vs 36.4%)and to show symptoms of depression(15.4%vs 35.1%).Compared with LT caregivers,CP caregivers had greater median factor scores for burden(general tension,P=0.012;isolation,P=0.014;disappointment,P=0.004),depression(P=0.008),and stress(P=0.047),with small to moderate effect sizes.The disappointment(r=0.240)and depression(r=0.225)dimensions had the largest effect sizes.CONCLUSION Family caregivers of LT recipients are less likely to exhibit symptoms of burden,stress,and depression,suggesting that the benefits of LT extend to the patients’family members.
基金Supported by the Vietnam National Foundation for Science and Technology Development,No.NAFOSTED 04/2020/TN.
文摘BACKGROUND Tacrolimus(TAC)is metabolized primarily by the CYP3A-encoded enzyme family(CYP3A4,CYP3A5,and CYP3A7).Individuals expressing the CYP3A51 allele are considered fast metabolizers and generally require higher TAC doses to reach therapeutic levels.AIM To evaluate the predictive value of the TAC concentration-to-dose(C0/D)ratio for identifying CYP3A5 poly-morphisms in renal transplant recipients.METHODS Eighty-six de novo kidney transplant recipients with TAC-based immunosuppression from the Department of Nephrology and Dialysis at Military Hospital 103(Hanoi,Vietnam)were included in this retrospective study.Blood samples were collected within the first week post-transplantation to monitor TAC levels and to perform genotyping for CYP3A5 genetic polymorphisms.RESULTS The CYP3A53/3 genotype was identified in 37 patients(43%),CYP3A51/3 in 40 patients(46.5%),and CYP3A51/1 in 9 patients(10.5%).Patients carrying the CYP3A51/3 or CYP3A51/1 genotype,classified as fast metabolizers(CYP3A5 expressers),had significantly lower TAC C0 concentrations and C0/D ratios compared to slow meta-bolizers(CYP3A53/3 genotype)at multiple time points during follow-up(all P<0.001).Notably,the TAC C0/D ratio obtained on day 1(0.91)was shown to predict CYP3A5 polymorphism with a sensitivity of 84.6%and a specificity of 84.6%.CONCLUSION This study demonstrates that the TAC C0/D ratio provides a reliable predictive value for CYP3A5 polymorphisms,which can be used to individualize TAC dosing in renal transplant recipients in Vietnam and other low-income countries.
文摘BACKGROUND Urinary tract infections(UTIs)in kidney transplant patients are a challenge.AIM To evaluate epidemiology,clinical status,therapeutic management,and clinical outcome of kidney transplant patients in a university hospital for UTI.METHODS We conducted a retrospective observational study,enrolling all kidney transplant patients hospitalized for UTI,with the objective to evaluate the epidemiology,clinical status,therapeutic management,and clinical outcome of kidney transplant patients.RESULTS From our real-life experience,infection with multidrug-resistant germs was confirmed as a risk factor for the severe evolution of the infection.At the same time,the re-evaluation of immunosuppressive therapy could be an important therapeutic strategy in the course of infection.CONCLUSION Prompt initiation of empiric antibiotic therapy upon initiation of microbiological investigations may reduce the risk of severe infection progression.
基金supported by grants from the National Natural Science Foundation of China (82150 0 04)the National Municipal Key Clinical Specialtythe Clinical Research Project for Major Diseases in Municipal Hospitals (SHDC2020CR1022B)。
文摘Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.
基金supported by a grant from the Key Research and Development Plan of Hubei Province(No.2022BCA015).
文摘To the Editor:Graft-versus-host disease(GVHD)is a rare but fatal complication after solid organ transplantation(SOT),with an incidence of 0.2–2.0%.Recent retrospective studies have shown a mortality rate of approximately 85–98%among patients with SOT-GVHD.[1]Various drugs and methods have been shown to improve or alleviate clinical symptoms,but no effective treatments for GVHD currently exist.Recent clinical experience with SOTGVHD treatment is mixed and limited,including systemic or partial corticosteroid support,the use of Janus kinase(JAK)inhibitors,allogeneic hematopoietic cell transplantation(alloHCT),and donor-targeted serotherapy.Since the number of lymphocytes transplanted with the organ may be a risk factor for GVHD,reducing the number of donor lymphocytes seems beneficial.Intensity-modulated radiation therapy(IMRT)is a type of radiotherapy that uses optimized,non-uniform radiation beam intensities on the patient.[2]Local allograft irradiation has also been used to treat severe resistant rejection after liver transplantation(LT)in previous studies.[3]Based on this,we hypothesized that whole-liver IMRT at a low dosage could be used as a rescue therapy to control acute GVHD after LT by reducing the number of donor-derived immune cells.
基金supported by the Clinical Research Flagship Project of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology(No.2019CR108).
文摘To the Editor:To reduce the risk of acute rejection(AR)after renal transplantation,immunosuppressive induction therapy has been commonly used in the perioperative period.At present,rabbit anti-thymocyte globulin(rATG)and basiliximab are the two main induction agents used for kidney transplantation.In adult kidney transplantation,the incidence of AR with rATG induction is generally lower than that with basiliximab.[1]Children have different immune systems than adults do.In pediatric kidney transplantation,which induction therapy is more effective in preventing early AR is an important clinical question worth answering.Because there are few reports in this field and differences in the immune systems of children at different ages,we have now conducted a total and age-stratified analysis of Chinese multicenter cohort data to compare the AR rates and other outcomes between rATG and basiliximab induction therapy groups in pediatric deceased-donor kidney transplantation.
文摘The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)diseases.Chronic kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the endothelium.ED is also associated with a decline in estimated glomerular filtration rate.After kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV health.However,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft survival.ED in kidney transplant recipients is an underrecognized and poorly studied entity.CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts.ED contributes to the pathogenesis of many of the CV diseases.Various biomarkers and vasoreactivity tests are available to study endothelial functions.With an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.
