Italian register of therapeutic apheresis: 30 years of activity.

Preeclampsia is a significant cause of maternal and fetal morbidity and mortality worldwide. Characterized by the onset of hypertension and end organ dysfunction after 20weeks of gestation, preeclampsia poses complex challenges, particularly in solid organ transplant (SOT) recipients who often have multiple comorbidities. Calcineurin inhibitors (CNIs) are the cornerstone of contemporary immunosuppression, but they are also associated with endothelial and vascular dysfunction - most commonly hypertension and nephrotoxicity - which may overlap with pathways implicated in the development of preeclampsia. This review synthesises clinical and mechanistic evidence relevant to CNI exposure and preeclampsia in SOTs. We also examine pregnancy related pharmacokinetic changes that lower measured whole blood tacrolimus concentrations and outline why reliance on trough targets alone can be misleading. Building on this evidence, we discuss a practical approach to tacrolimus dosing and monitoring during gestation, and highlight the need for accelerated development and validation of unbound tacrolimus measurement for routine clinical use in this population.

Published data describing epidemiological trends of abdominal injury on a national level are scarce. This study aims to analyse trends in demographics, severity, population-adjusted incidences, and short-term outcomes of abdominal trauma based on national trauma register data. Observational, complete national cohort study of all consecutive traumatic incidents resulting in abdominal injuries reported to the National Trauma Register (NTR) of Norway between 2015 and 2023. The NTR has demonstrated an overall coverage rate of 92.2% of trauma patients, with excellent data accuracy. Standardised incidence rates were estimated using the direct method with standard populations. Temporal trends were evaluated in regression models. Abdominal injuries occurred in 9.0% (7086/78,416) of all registered traumatic incidents. Children represented 18.1% (n = 1275) of the patients, and 14.8% (n = 1047) were elderly. The median age was 35 years (interquartile range, IQR: 19-55) and increased by 0.4 years annually (95% confidence interval, CI: 0.0-0.8). Men accounted for 69.5% (n = 4926) and 30.5% (n = 2160) were female. Blunt injury type dominated with 85.3% (n = 6044). Traffic-related accidents were the most common mechanism (48.0%, n = 3401), followed by falls (26.9%, n = 1903). The median Injury Severity Score (ISS) was 10 (IQR 2-18), and 36.3% (n = 2567) displayed ISS>15 indicating severe injury. Polytrauma occurred in 20.6% (n = 1457) of trauma cases suffering abdominal injury. Age- and sex-adjusted incidence of all abdominal injuries was 14.9/100,000/year (95% CI: 14.5-15.3). The annual increase was 0.43 per 100,000 person-years (95% CI: 0.14-0.71) among children and 0.68 per 100,000 person-years (95% CI: 0.39-0.97) for elderly patients. The subgroup of solid organ injuries showed an adjusted incidence of 7.2/100,000/year (95% CI: 7.0-7.5), and hollow viscus injuries of 1.2/100,000/year (95% CI: 1.1-1.3). Overall 30-day mortality was 3.4% (n = 240), with no statistically significant change during the study period. Trauma patients presenting with abdominal injury are getting older. One third sustained severe injuries and one in five patients suffered polytraumatic injuries. The incidence of abdominal trauma increased over the last decade, predominantly amongst elderly patients and children. The mortality was low, and stable over time. None.

En bloc resection with IVC reconstruction is often required for retroperitoneal and solid organ tumors involving the IVC. Techniques include direct repair, patch angioplasty, and interposition grafting. We conducted a retrospective review of all patients who underwent IVC reconstruction between January 2013 and June 2023 at a single tertiary center. Outcomes included reconstruction type, long-term patency, and survival. Eighty patients (mean age 59 ± 15.9 years; 63.8% men) underwent IVC reconstruction: direct repair (38.8%), patch angioplasty (48.8%), and interposition graft (12.4%). Renal cell carcinoma (56.3%) and retroperitoneal sarcomas were the most common tumor types. Most tumors were high grade (53.8%), with IVC involvement most frequently at the perirenal level (63.8%). Antithrombotic regimens at discharge included aspirin (47.5%) and systemic anticoagulation (50%). Complete or severe thrombosis occurred in 12.5% of patients, largely due to local recurrence (50%) or early technical issues (40%). Kaplan-Meier estimated primary patency at 1, 2, and 3 years was 97.6%, 94.4%, and 87.7%, respectively. Thirty-day survival was 96.3%, with 1-, 2-, and 3-year survival rates of 86.5%, 76.8%, and 76.8%, respectively. IVC reconstruction during oncologic resection is safe and durable, with high mid-term patency and survival when performed at high-volume centers. Thrombosis is uncommon and often attributable to tumor recurrence or technical factors.

Behavioral and mental health challenges are important to understand in order to ensure that patients receive the anticipated benefits from organ transplantation. The present review centers on what we believe are the most important (and best researched) actionable challenges that may inform the care of transplant recipients - adherence to medical recommendations, transitions of care, and posttraumatic stress following transplantation. Recent research has moved from identifying (and quantifying) the problem and is now trying to investigate how to best recognize - and address - behavioral and mental health challenges in this population. While much remains unknown, it is increasingly becoming clear that early recognition is best done by increasing awareness amongst transplant team members, and objective surveillance methods. Subjective patient and parent reports should be considered if other methods are not available. It is becoming increasingly clear that psychosocial interventions are feasible and potentially effective. Transplant programs should try to be aware of such interventions, implement them when feasible, and create referral pathways that can be used when needed.

Impact of immunosuppressive therapy on non-melanoma skin cancer after solid organ transplantation: A critical systematic review.

Passenger lymphocyte syndrome after solid organ transplantation: Laboratory perspective.

Regulatory T cells (Tregs) represent a critical subset of T lymphocytes essential for maintaining immune homeostasis. Through diverse molecular mechanisms, Tregs exert potent immunosuppressive effects that preserve self-tolerance and mitigate aberrant immune activation. Dysregulation in Treg frequency or function is closely associated with the development of various immune-mediated disorders. This has prompted extensive preclinical investigations and clinical trials evaluating the therapeutic potential of Tregs in conditions such as graft-versus-host disease, solid organ transplantation, and autoimmune diseases, which have yielded promising outcomes. This review provides a comprehensive overview of current preclinical and clinical applications of Treg-based therapies, including adoptive Treg transfer, low-dose IL-2, and CAR-Treg therapy, and discusses their effectiveness in modulating immune responses across diverse pathological contexts.

Effect of comprehensive geriatric assessment and supportive care on quality of life in older patients with cancer receiving curative treatment: The GOSPEL randomised controlled trial.

The long-term outcome of lung transplantation remains inferior to that of other solid organ transplants, primarily due to rejection/infection. This pilot study investigates longitudinal changes in the bronchoalveolar lavage (BAL) leukocyte transcriptomes and phenotypes, and their impact on clinical outcomes. BAL samples were collected at baseline and 1-12 mo posttransplantation. Leukocyte phenotypes, activation status, and biomarkers were characterized alongside their gene expression profiles. We identified distinct BAL leukocyte transcriptional signatures associated with allograft rejection across 2 independent cohorts. Alveolar macrophages (AMs) predominated after transplantation, whereas granulocytes increased during the first year. This was associated with decreased expression of CD163, an anti-inflammatory marker, and increased expression of proinflammatory markers CD80 and CD86 on AMs. In a patient subgroup, a unique foamy macrophage (FM) subset with distinct cytology, featuring cytoplasmic lipid-laden vacuoles, was identified and confirmed in lung biopsies. FMs were accompanied by a unique non-FM (no-FM) population and were associated with elevated BAL levels of interleukin (IL)-8, IL-1β, and IL-10 and more frequent hospital readmissions. BAL transcriptomic analysis for patients carrying both FMs and no-FMs showed upregulation of genes linked to lipid metabolism, leukocyte chemotaxis, and inflammatory response pathways. We identified a rejection gene signature and proinflammatory shift in BAL leukocyte phenotypes after lung transplantation. The presence of FMs/no-FMs was associated with proinflammatory changes and worse clinical outcomes as per our data analysis, unadjusted for confounders due to relatively limited sample size. These findings could facilitate further investigations into early detection of lung allograft rejection and help focus on AM-targeted interventions.

Cryptosporidium infection, usually self-limited in immunocompetent individuals, can lead to severe complications in immunosuppressed patients, such as solid organ transplant recipients. Biliary tract infection is a rare but potentially devastating complication, with limited therapeutic options. We report the case of a woman who developed fatal liver failure secondary to Cryptosporidium-induced cholangiopathy fifteen years after liver transplantation. The patient, maintained on triple immunosuppression, initially presented with diarrhea and acute renal failure. PCR on stool identified Cryptosporidium spp., and immunosuppression minimization combined with specific therapies were initiated with temporary improvement. Despite sequential antiparasitic therapies, recurrent diarrhea and progressive liver enzyme elevation ensued. Serial liver biopsies revealed portal and lobular inflammation with granulomas and biliary injury, evolving toward hepatic failure and fibrosis. Profound and persistent lymphopenia was observed throughout the course. This case underscores the underestimated risk of Cryptosporidium infection in liver transplant recipients and its potential to cause irreversible biliary damage and liver failure. Early recognition, and prompt targeted therapy are crucial to improve the outcomes in this life-threatening complication.

Passenger Lymphocyte Syndrome Following Minor ABO-incompatible Liver Transplantation: A Case Report.

Cytokine Release Syndrome and Cardiogenic Shock Following Anti-Thymocyte Globulin Induction in a Kidney Transplant Recipient: A Case Report.

Intraoperative Iliac Artery Dissection and Postoperative Cerebral Infarction in a Kidney Transplant Recipient With an RNF213 p.R4810K Variant: A Case Report.

Torque teno virus (TTV) viral loads may reflect patients' net state of immunosuppression and identify patients at risk of infections and rejection early after solid organ transplantation. However, its role in long-term kidney recipients (KTRs) is less clear. This single-centre prospective cohort study evaluated the association between TTV viral load at recruitment and severe infections requiring hospitalisation within 12 months as the primary outcome in kidney recipients > 1-year post-transplant and on stable immunosuppression for > 3 months. Participants were followed up for 12 months, until change of immunosuppression, graft loss, or death. Pre-specified, exploratory secondary outcomes, including opportunistic infections, malignancy, composite outcomes were also analysed. Median time after transplant amongst the 171 included participants was 10.3 years (interquartile range (IQR) 4.9-16.0). Thirty-one developed severe infections 105 days (IQR 65-204) after baseline TTV measurement. Higher baseline log10-transformed TTV viral load (logTTV) was associated with severe infections within 12 months (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.01-1.86, p = 0.045) with a modest area under receiver operating characteristics curve of 0.60 (95% CI 0.50-0.71). Compared to logTTV < 4.6 copies/mL, logTTV > 6.6 copies/mL (hazard ratio (HR) 3.45, 95% CI 1.10-10.9, p = 0.04) was associated with time to hospitalisations for infections but not logTTV 4.6-6.6 copies/mL (HR 2.30, 95% CI 0.97-5.47, p = 0.06). The ORs for the association between logTTV and malignancy, opportunistic infection and biopsy-proven rejection were 1.86 (95% CI 1.09-3.16), 1.21 (95% CI 0.69-2.13) and 1.09 (95% CI 0.70-1.69) respectively. Elevated TTV viral loads were associated with severe infections amongst our cohort of long-term KTRs and may be a useful biomarker in this population.

Background.Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits, but there are little data in solid organ transplant populations. We aimed to assess the effect of GLP-1 RA or SGLT2i on the incidence of post-transplant major adverse cardiovascular events (MACE), graft failure, renal outcomes, and mortality in liver or simultaneous liver-kidney transplant populations.Methods.A retrospective chart review of adults with diabetes mellitus and either solitary liver or simultaneous liver-kidney transplantation from January 2012 to March 2022 was completed. The multivariate Cox regression and Fine and Gray competing risk regression analyses were used.Results.Among 457 patients, 33 received a GLP-1 RA or SGLT2i. The GLP-1 RA/SGLT2i group had a lower incidence of graft failure (P = 0.038), new-onset end-stage renal disease requiring dialysis (P = 0.012), and new-onset post–liver transplant MACE at 5 y (adjusted subdistribution hazard ratio, 0.24; P = 0.049; 95% confidence interval, 0.059-0.99).Conclusions.After propensity score matching, the incidence of 5-y post–liver transplant MACE-free survival was significantly higher, and mortality was significantly lower in the GLP-1 RA/SGLT2i group. The use of a GLP-1 RA/SGLT2i post–liver transplant was associated with a lower incidence of new-onset MACE, graft failure, and new-onset end-stage renal disease requiring dialysis. There was an improvement in survival after propensity score matching.

Update on the management of leptomeningeal disease in solid organ malignancy: Systemic, intrathecal and novel therapies.

Background.Norovirus infection causes significant morbidity in solid organ transplant (SOT) recipients, yet few treatments are available, and evidence for efficacy is sparse. In this scoping review, we identify and evaluate potential interventions for managing norovirus infections in SOT recipients.Methods.We searched electronic databases from inception to July 6, 2025. Eligible studies were analyzed for participants’ characteristics, intervention types, and reported outcomes.Results.After screening 245 abstracts, 58 studies were included (1 randomized controlled trial, 27 cohort studies, 5 case series and 25 case reports), mainly from the United States. Transplant types included kidney (n = 36), liver (n = 12), cardiac (n = 12), pulmonary (n = 7), pancreas (n = 6), small bowel (n = 7), and multiorgan (n = 13) transplants. The most frequently reported primary outcome was resolution of gastrointestinal (GI) symptoms. Interventions were diverse: immunosuppression modification (n = 14), nitazoxanide (n = 6), IVIG (n = 3), oral immunoglobulin (n = 10), combination of these (n = 19), fecal transplant (n = 2), supportive management (n = 4), and others not classified (n = 5). Limited quality evidence for the resolution of gastrointestinal symptoms was reported for immunosuppression modification (n = 7/14), nitazoxanide (n = 4/6), IVIG (n = 2/3), oral immunoglobulin alone (n = 10/10), fecal transplant (n = 2/2), supportive treatment (n = 4/4), and a combination of treatments (n = 10/19). A lack of clinical improvement was described in 13 of 58 studies.Conclusions.A wide range of interventions has been used to manage norovirus infections in SOT recipients; however, the evidence is limited to observational studies, and the findings are uncertain. High-quality randomized controlled trials are needed to establish treatment efficacy and safety.

The Organ Utilisation Group was established to address barriers in solid organ transplantation and improve patient outcomes across the United Kingdom. The group produced a series of recommendations in February 2023. To address these recommendations, the Department of Health and Social Care formed the Implementation Steering Group for Organ Utilisation (ISOU). A dedicated Histocompatibility and Immunogenetics (H&I) sub-group was formed with a remit to provide recommendations for HLA compatibility assessments and new technologies that could improve patient outcomes, within a 5 to 10 year time frame. The ISOU H&I sub-group made five key recommendations, grouped under three themes: (1) implementation and digital capture of high-resolution HLA typing data for organ donor and recipients; (2) utilising high-resolution HLA typing data to improve donor/recipient compatibility assessment and patient outcomes and (3) use of other technologies/innovations to improve patient outcomes. This article discusses the recommendations with an emphasis on advanced technologies and methodologies such as high-resolution HLA typing, molecular matching, non-HLA antigen systems, donor-derived cell-free DNA (dd-cfDNA) and artificial intelligence (AI). Implementation of these recommendations aims to enhance organ matching, reduce immunological risk and improve equity and long-term outcomes for transplant recipients and position UK transplantation services at the forefront of innovation and patient-centred care.

Not available.