Risk Assessment in Clinical Histocompatibility Testing: Challenges, Strategies, and Future Directions
Abstract
116 594
Risk Assessment in Clinical Histocompatibility Testing: Challenges, Strategies, and Future DirectionsAbstract
Though the role of clinical histocompatibility testing is fundamental to successful transplant, systematic risk assessment and mitigation strategies remain underutilised in this domain. This review addresses risk identification, analysis, and control measures across the pre-analytical, analytical, and post-analytical phases of clinical histocompatibility testing, in line with international standards such as ISO 15189:2022. A structured, risk-based quality management system (QMS) is imperative for ensuring accurate [...] 116 594 |
Immunologic Response after COVID-19 Vaccination in Heart Transplant Recipientsby
Abstract
To date, all large-scale randomized controlled trials for COVID-19 vaccines have excluded solid organ transplant recipients; therefore, the effectiveness and safety of COVID-19 vaccines in preventing coronavirus infection using COVID-19 vaccines in patients with heart transplants have not been sufficiently studied. This paper presents the characteristics of humoral and cellular immunity in heart transplant recipients following vaccination against coronavirus infection. The study group consisted of 40 patients who u [...] 268 1422 |
Antibody-Mediated Rejection in Kidney Transplantation: Immunopathogenesis, Innate–Adaptive Crosstalk, and Therapeutic AdvancesAbstract
Antibody-mediated rejection (ABMR) remains a major barrier to long-term graft survival in kidney transplantation. Defined by the presence of donor-specific antibodies (DSAs) and characteristic histological changes, such as C4d deposition in peritubular capillaries, ABMR can present acutely, chronically, or subclinically, often manifesting as graft dysfunction. Recent advances in genomic profiling and diagnostic assays have improved our understanding of its pathophysiology, yet therapeutic strategies remain limited. [...] 648 8211 |
Precision Medicine in Liver and Lung Transplantation: Integrating Immunology, Regenerative Therapies, and Computational AdvancesAbstract
Liver and lung transplantation remain among the most intricate and resource-intensive arenas in modern medicine, challenged by organ scarcity, immunological complexities, and the persistent threat of rejection. According to recent WHO and UNOS reports, approximately 100,000 patients globally await liver transplants annually, with only 30-40% receiving transplants, resulting in waitlist mortality rates of 15-20%. Similarly, lung transplant demand exceeds supply by a factor of 4:1, with 5-year survival rates remainin [...] 492 2821 |
The Essentials of Cell-Mediated Immunity Assays for the Management of CMV Infection after Solid Organ Transplantationby
Abstract
Provided that cell-mediated immunity (CMI) is known to be vital in managing CMV infection post-transplant along with improving methods to predict the development of cytomegalovirus (CMV) following transplant, CMV-specific-cell-mediated immunoassays have been developed, commercially and research based, to be used in conjunction with pre-transplant CMV serological testing and prophylaxis to help tailor an individual care plan post-transplant. In this review, we assess the status of CMV CMI assays, and their potential [...] 348 2442 |
Duration of Hospitalization is Associated with the Gut Microbiome in Patients Undergoing Hematopoietic Stem Cell Transplantation: Early Results from a Randomized Trial of Home Versus Hospital Transplantationby
Abstract
Home-based hematopoietic stem cell transplantation (HCT) is an innovative care model with growing interest, but its impact on the gut microbiome remains unexplored in a randomized setting. We present interim results from the first randomized controlled trials (RCT) evaluating the effect of HCT location—home versus hospital—on gut microbial diversity and antimicrobial resistance (AMR) gene carriage. We hypothesize that patients randomized to undergo home HCT would have higher gut taxonomic diversity and lower AMR ge [...] 986 3458 |
Donor-Derived Cell-Free DNA Assessment in a Predominantly Hispanic/Latino Lung Transplant Population: Single-Center AnalysisAbstract
The demographics of lung transplant (LT) recipients show an evolution towards increased minority racial/ethnic representation, thanks to an increased focus on inclusion in LT access, healthcare and outcomes. Herein we assess potential differences in LT allograft health in a predominantly Hispanic/Latino (HL) vs Non-Latino/White (NLW) cohort during surveillance for acute rejection by analyzing the fraction of donor-derived cell-free DNA (dd-cfDNA%), a plasma biomarker of allograft injury. Of 245 LT recipients, media [...] 407 2443 |
Checkpoint Inhibition Followed by CAR-T Cell Therapy in Refractory PMLBCL: Immunologic Response and Fertility Preservation in a Young Patientby
Abstract
Primary mediastinal large B-cell lymphoma (PMLBCL) is an aggressive B-cell malignancy that may exhibit resistance to standard chemoimmunotherapy. Novel immunotherapeutic strategies, including checkpoint inhibitors and chimeric antigen receptor T-cell (CAR-T) therapy, are being explored in cases that are refractory to treatment. We report the case of a 29-year-old patient with refractory PMLBCL who was treated with pembrolizumab as a bridging therapy followed by axicabtagene ciloleucel (CAR-T) after failing R-CHOP a [...] 451 2724 |
Modern UNOS Data Reveals Septuagenarians Have Inferior Heart Transplant Survivalby
Abstract
While heart transplantation is increasingly performed in the United States for elderly patients, survival outcomes have primarily been analyzed in single-center studies. The few existing long-term studies have indicated no difference in HTx outcomes between patients ≥70 years and 60-69 years age, but these studies only assessed to 5-years post-transplant and included data from the 1980-90s, introducing significant variance due to poorer outcomes in that era. We analyzed the UNOS database from 1987-2020, stratified [...] 518 3263 |
Integrating RNA-Seq Biomarkers and Diagnostic Algorithms to Improve Liver Transplant Outcomes: A Comprehensive Reviewby
Abstract
Graft rejection, early allograft dysfunction (EAD), and poor diagnostic accuracy are some of the challenges that still need to be addressed, even though liver transplantation (LT) has the potential to help patients with end-stage liver disease (ESLD) significantly. Traditional procedures, such as liver biopsies and liver function tests (LFTs), often fail to identify abnormalities early and with accuracy. Genomic RNA sequencing (RNA-Seq) has recently emerged as a powerful approach for identifying molecular markers o [...] 809 6031 |
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