Search Results (902)

Background: Right ventricular (RV) dysfunction is common in advanced lung disease due to chronic pressure overload and altered pulmonary vascular mechanics. Lung transplantation (LTx) reduces RV afterload, and pulmonary rehabilitation (PR) may further enhance functional recovery. However, the combined effects of LTx and structured PR on RV myocardial deformation—particularly using speckle-tracking echocardiography (STE)—remain insufficiently characterized. Methods: This single-arm pre–post study included 20 bilateral lung transplant recipients who completed an 8-week, twice-weekly supervised outpatient PR program. Echocardiographic evaluation—including 2D measurements, M-mode, tissue Doppler imaging (TDI), and STE-derived strain parameters—was performed immediately post-discharge (baseline) and after PR. RV global longitudinal strain (RVGLS) and RV free-wall longitudinal strain (RVFWS) served as primary functional outcomes. Results: Improvements were observed in RV myocardial deformation after PR. RVGLS improved from a median of 15.52% to 16.64% (p = 0.004), and RVFWS increased from 15.82% to 17.10% (p = 0.001). RV mid-cavity diameter decreased significantly (p = 0.042), reflecting favorably altered RV geometry. Conventional parameters—including TAPSE, S′ velocity, RVEDA, and FAC—showed no statistically significant changes. These findings indicate that STE parameters are more sensitive than traditional indices for detecting early RV remodeling in the post-transplant period. Conclusions: Lung transplantation combined with a structured PR program was associated with early improvements in RV deformation indices measurable by STE, even when traditional echocardiographic indices remained within normal limits. STE may therefore serve as a sensitive tool for monitoring subclinical RV recovery after LTx and for assessing the additive benefits of PR. Full article

The liver is the primary site of synthesis for most coagulation factors and the central organ responsible for maintaining hemostatic equilibrium. In individuals with advanced liver disease, significant disruptions in coagulation homeostasis occur and consequently predispose patients to both thrombotic and bleeding complications. This review summarizes the pathophysiologic basics of liver cirrhosis-associated coagulopathies and discusses the diagnosis and treatment of common procoagulant conditions such as portal vein thrombosis and post-transplant hepatic artery thrombosis. The review also systematically addresses the most common bleeding complications, including spontaneous, portal hypertension-related, and periprocedural bleeding. The proper pre-procedural assessment of the bleeding risk is often required due to the great number of invasive procedures to which these patients are frequently subjected. The viscoelastic testing (thromboelastogram and thromboelastometry) seems to emerge as the most appropriate diagnostic method. Specific treatment recommendations for the correction of coagulation abnormalities and the management of severe thrombocytopenia are hereby presented. Full article

Cutaneous infections caused by dematiaceous fungi are rare in the general population but are increasingly recognized in solid organ transplant recipients as a consequence of prolonged immunosuppression. When Alternaria species are confirmed as the causative agents of a skin infection, the condition is referred to as alternariosis. These infections may clinically resemble bacterial or neoplastic lesions and require accurate diagnosis and individualized therapy. We report one case of cutaneous alternariosis in a kidney transplant recipient receiving tacrolimus-based immunosuppression. The patient was a 47-year-old woman who sustained minor trauma to her knee three months after transplantation. She developed an ulcerated, crusted lesion, which coincided with severe neutropenia. Histology, culture and molecular identification confirmed A. infectoria. Treatment included systemic azole therapy (voriconazole followed by isavuconazole) and surgical excision, resulting in resolution without recurrence. This case highlights the importance of early recognition of alternariosis in transplant recipients. Successful management typically requires combined surgical and systemic antifungal therapy, with careful monitoring of drug interactions and immunosuppressive levels to prevent toxicity or rejection. Full article

Background/Objectives: Viral hepatitis remains a significant global cause of chronic liver disease, highlighting the importance of effective vaccination strategies. This review assesses recent evidence on vaccine safety and effectiveness. Methods: A comprehensive search of PubMed, Embase, Web of Science, and Scopus identified English-language studies published from January 2000 to September 2025. Eligible studies evaluated vaccination for hepatitis A, B, C, or E, as well as vaccine responses in individuals with chronic liver disease or HIV infection. Of 5254 records screened, 166 studies met the inclusion criteria. Results: Hepatitis A vaccines demonstrated excellent safety, 95–100% short-term seroprotection, and durable immunity for both inactivated and live-attenuated formulations, with population-level reductions in disease incidence. Hepatitis B vaccines showed consistently strong immunogenicity across age groups, with over 90% seroprotection from recombinant and CpG-adjuvanted formulations. Effective prevention of mother-to-child transmission required maternal antiviral therapy, timely birth-dose vaccination, hepatitis B immunoglobulin (HBIG) administration, and post-vaccination serologic testing. Long-term data demonstrated immune persistence for up to 35 years and significant reductions in liver cancer following neonatal HBV vaccination. Limited studies in hepatitis C populations showed impaired responses, partially improved with higher or booster doses. Hepatitis E vaccines showed excellent safety and over 99% seroconversion. In non-viral liver disease and post-transplant populations, vaccine responses were reduced but remained clinically meaningful, especially with adjuvanted or higher-dose HBV vaccines. Among HIV-infected individuals, HAV vaccination was generally effective, while enhanced HBV regimens markedly improved seroprotection. Conclusions: Hepatitis A, B, and E vaccines are safe, immunogenic, and effective, with neonatal hepatitis B vaccination critical for preventing maternal transmission. No licensed HCV vaccine exists, and therapeutic HCV vaccines show limited efficacy. Optimized and targeted vaccination strategies are needed for individuals with chronic liver disease, HIV infection, HCV infection, transplant recipients, and other immunocompromised populations to maximize public health impact. Full article

Background and Clinical Significance: Kidney transplant recipients have a 2–4-fold higher cancer risk than the general population. The sequential occurrence of multiple myeloma (MM) and native-kidney renal cell carcinoma (RCC) is rare and creates competing priorities between anti-myeloma efficacy and allograft preservation. Case Presentation: A 54-year-old woman with a 2020 living-donor kidney transplant presented in 2024 with bone pain and shoulder swelling. Low-dose whole-body CT showed multiple punched-out osteolytic lesions. Work-up revealed IgG-κ M-protein 38.5 g/L and 25% clonal plasma cells; cytogenetics showed a complex karyotype (R-ISS III). First-line bortezomib/cyclophosphamide/dexamethasone (VCd) was given while maintaining tacrolimus plus low-dose steroid. After four cycles, she achieved very good partial response (M-protein 42.3 to 5.6 g/L) with stable graft function. Follow-up imaging detected a large exophytic mass in the native right kidney; nephrectomy confirmed papillary RCC, type II. Later, the myeloma progressed with epidural extension causing cord compression. Second-line daratumumab/carfilzomib/dexamethasone (DKd) and palliative spine radiotherapy were initiated. The course was complicated by opportunistic infection and pancytopenia, and the patient died in January 2025. Conclusions: Vigilant post-transplant cancer surveillance—including native-kidney RCC—tailored immunosuppression, and multidisciplinary coordination are critical. VCd with tacrolimus may be feasible when graft preservation is prioritized; however, relapsed high-risk MM on DKd carries substantial infectious risk and a guarded prognosis. Full article

Background: Ischemia–reperfusion injury is a major contributor to early graft dysfunction after kidney transplantation and is associated with endothelial damage, reflected by circulating soluble thrombomodulin (sTM). This exploratory study aimed to assess very early graft-level changes in renal vein sTM during reperfusion using a paired-kidney design, in which kidneys from the same donor were preserved using different strategies: static cold storage (SCS) and hypothermic machine perfusion (HMP). Methods: Renal vein blood samples were collected intraoperatively at 1 and 30 min after reperfusion. Plasma sTM concentrations were determined using ELISA. Early graft function was monitored during the first 7 days post-transplantation. Results: Cold ischemia time was longer in the HMP group than in the SCS group (20 ± 8 h vs. 13 ± 6 h, p < 0.05). At 1 min post-reperfusion, sTM levels were comparable between groups. In the HMP group, sTM decreased significantly between 1 and 30 min after reperfusion, whereas no change was observed in the SCS group. Between-group differences at either time point did not reach statistical significance. Early renal function parameters improved in both groups, with no significant inter-group differences. No cases of delayed graft function or graft thrombosis occurred. Conclusions: Kidney preservation strategy may modulate very early graft-level endothelial responses during reperfusion, reflected by renal vein sTM dynamics. Although a limited sample size may have reduced the ability to detect between-group differences, very early renal vein sTM measurements may provide insight into ischemia–reperfusion injury. Clinical relevance requires validation in larger studies. Full article

Background: Despite the lack of formal indication for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium–glucose cotransporter-2 inhibitors (SGLT2i) in post-transplant diabetes mellitus (PTDM), their use in clinical practice is growing. While robust evidence supporting their use in kidney transplant recipients (KTRs) remains limited, PTDM remains a major driver of adverse outcomes, including cardiovascular morbidity, accelerated graft dysfunction, graft loss, and reduced survival. Methods: This retrospective cohort study analyzed adult KTRs with PTDM treated with SGLT2is and/or GLP-1 RAs between 2013 and 2024. Metabolic, kidney, and safety parameters were assessed from baseline to follow-up. Results: After a median treatment duration of 1.8 years, glycated hemoglobin (HbA1c) changed from 7.22% to 7.01% (p = 0.558), whereas fasting plasma glucose increased from 112.62 mg/dL to 125.01 mg/dL (p = 0.03). Body mass index decreased from 27.27 kg/m² to 25.95 kg/m² (p < 0.001). The lipid profile improved, with reductions in total cholesterol (p < 0.01) and low-density lipoprotein cholesterol (LDL-c, p = 0.02). Kidney function remained stable throughout the observation period, and adverse events were infrequent. Conclusions: In KTRs with PTDM, GLP-1 RAs and SGLT2is were associated with significant improvements in weight and lipid metabolism, alongside stable kidney function and a favorable safety profile. These findings support the consideration of these agents in the management of PTDM. Prospective studies are warranted to confirm these results. Full article

Background and Clinical Significance: Histiocytic sarcoma (HS) is a rare and aggressive form of malignant histiocytosis, often associated with poor prognosis. The diagnosis and management of HS are challenging due to the complexity of its pathogenesis, molecular profile, and the unclear cellular origin of histiocytic neoplasms, compounded by the limited literature on treatment strategies. Case Presentation: We report the case of a young patient with HS localized to the lymph nodes, spleen, and liver, who also presented with hemophagocytic lymphohistiocytosis (HLH) documented on bone marrow biopsy. Initial treatment with CHOEP-21 and ICE-21 chemotherapy resulted in only a partial metabolic response, as evidenced by a Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET)/CT scan. Given the aggressive nature of the disease and the presence of HLH, an allogeneic hematopoietic stem cell transplantation (HSCT) from a matched unrelated donor was performed as consolidation therapy, leading to a progressive complete response without significant toxicity. A suspected relapse at 18 months post-transplant was excluded following a mediastinal lymph node biopsy, which revealed a benign intravascular papillary endothelial hyperplasia (IPEH). Over five years post-diagnosis and more than four years after transplantation, the patient remains in complete remission with full functional recovery. Conclusions: This case highlights the diagnostic and molecular challenges of HS and demonstrates the curative potential of early allogeneic HSCT, even when only partial remission is initially achieved. Full article

Transplant patients experience high morbidity and mortality caused by respiratory viral infections (RVIs). In the past decade, numerous methods of prophylaxis and treatment have rapidly developed and continue to expand, with dozens of novel agents in preclinical and clinical trials. This includes recent scientific breakthroughs in virus structure, which have enabled the creation of respiratory syncytial virus (RSV) vaccines. While new vaccines, antivirals, monoclonal antibodies, and non-vaccine agents are becoming more available, their utility and safety in the transplant populations are often uncertain. This review summarizes the current landscape of RVIs in the transplant population, including approaches to pre- and post-exposure prophylaxis and treatment. We discuss the data behind vaccine timing, safety, and efficacy and current pre- and post-transplant recommendations, with a particular focus on influenza, SARS-CoV-2, and RSV. We also examine the potential benefits of antivirals, monoclonal antibodies, and novel agents used as prophylaxis, treatment, or adjuncts. While there remain many knowledge gaps, these new methods and ongoing advancements in RVI treatment and prevention promise to improve transplant patient outcomes. Full article

Background: Sarcopenia and sarcopenic obesity are increasingly recognized in kidney transplant recipients (KTRs), yet their molecular underpinnings remain poorly defined. We sought to synthesize current evidence on biomarker associations with muscle loss and function in the post renal transplant setting. Methods: A comprehensive search of PubMed/MEDLINE and Cochrane databases was conducted according to PRISMA guidelines. Studies evaluating biomarkers related to sarcopenia or sarcopenic obesity in adult and pediatric KTRs were included. Quality assessment was performed with the NHLBI tool. Results: Seven studies were included, encompassing 548 KTRs. Myostatin levels predicted sarcopenia in KTRs (cut-off: 390 pg/mL) and inversely correlated with Metabolic equivalent of Tasks (METs), handgrip strength (HGS), and graft performance. Although adiponectin was negatively correlated with body fat, its high-molecular-weight isoform was linked to lower muscle mass and long-term graft decline. Leptin was associated with sarcopenic obesity and lower estimated Glomerular Filtration Rate (eGFR). Insulin like Growth Factor-1 (IGF-1) independently predicted HGS but not muscle mass. Brain-derived neurotrophic factor (BDNF) levels predicted sarcopenia (cut off: 17.8 ng/mL) and reflected physical activity levels. Visfatin showed no association with sarcopenia but it was positively correlated with eGFR. Lastly, certain polymorphisms of Alpha-actinin-3 (ACTN3) were shown to genetically predispose to post-transplant sarcopenia. Conclusions: These emerging candidate biomarkers provide promising mechanistic insight into post-transplant muscle decline and may ultimately support more personalized risk assessment. Further validation is needed, and functional measures remain the most reliable clinical tools at present. Full article

Background: Haploidentical hematopoietic cell transplantations (haplo-HCTs) with post-transplant cyclophosphamide (PT-Cy) are standard practice, but complications causing morbidity and mortality are not well described. Methods: The aim of this prospective non-interventional multicenter study was to document frequency of potential non-infectious and infection-related complications and main transplant outcomes after the first unmanipulated haplo-HCT with PT-Cy between 2017 and 2019 in 129 adult patients with hematological malignancies. The median follow-up was 37.3 months [95% CI: 34.3–39.7]. Results: The cumulative incidence (CI) of acute graft versus host disease (aGvHD) at day +100 was 22.4% grade II-IV [95% CI: 15.5–30.1] and 8.8% grade III-IV [95% CI: 4.6–14.6], respectively. The cumulative incidence of chronic GvHD (cGvHD) at 24 months was 25.8% [95% CI: 18.5–33.6]; extensive cGvHD was 10.9% [95% CI: 6.3–17.1], respectively. The most frequent non-infectious complications for the whole study population were mucositis—37.5% (n = 48); renal insufficiency—18% (n = 23); and cardiovascular complications—10.9% (n = 14). The following infection-related complications were diagnosed: bacterial in 84 (65.1%), viral in 66 (51.6%), and fungal in 24 (18.6%) recipients. Two-year OS was 58.1% [95% CI: 50.2–67.3]; NRM—27.1% [95% CI: 19.7–35]; PFS—50.4% [95% CI: 42.5–59.8]; and GRFS—38.8% [95% CI: 31.2–48.1]. About 50% of all deaths were directly caused by infection or infection-related conditions. Conclusions: Disease remission status at transplant significantly affected PFS, chronic GvHD, and GRFS. Although clinical applications of haplo-HCT with PTCy are widespread, the study confirms the need to reduce infection-related mortality after this type of GvHD prophylaxis. Full article

The effectiveness of microbial inoculants in agriculture is often limited by their unstable colonization in dynamic soil environments. We investigated the impact of application timing and continuity of a four-member synthetic microbial community (SynCom) on pepper (Capsicum annuum L.) productivity and rhizosphere microbiome dynamics under greenhouse conditions. Four treatments were included: no inoculation (control), single inoculation at the seedling stage (T1; 5 days post-emergence), single inoculation at the potting stage (T2; 14 days post-transplant), and sustained inoculation at both stages (T3). T3 significantly enhanced plant dry weight (113.4%), root activity (267.8%), fruit sugar (43.9%), and yield (29.0%) relative to the control; and profoundly reshaped the rhizosphere microbiome, enriching functional pathways for nutrient cycling (e.g., phosphorus, nitrogen, and potassium metabolism) and phytohormone synthesis (e.g., indoleacetic acid pathway). Co-occurrence network analysis indicated a significant alteration in microbial interaction patterns, revealing a new community architecture with key taxa such as Neocosmospora, Dyella and the Rhizobium group emerging as central hubs in the T3 network. Our findings underscore that application continuity is a critical factor for optimizing bio-inoculant efficacy, providing a strategy to enhance crop productivity through microbiome engineering in sustainable agriculture. Full article

Stress is well known to affect the immune system. However, in patients suffering from end-stage renal disease (ESRD) who underwent a kidney transplant (KT), the problem of stress appears to still be underestimated. The review aims to discuss the influence of chronic stress on the immune function and the relationship between chronic stress and the fate of a transplanted kidney. Therefore, we analyzed the relevant literature, searching for articles linking chronic stress to kidney transplant. Although the biology of stress is well documented in the literature, its impact on the fate of transplanted kidneys remains poorly understood. We have found only a limited number of studies examining the role of stress in patients after kidney transplantation, especially regarding graft function. However, a few studies have shown that psychological and behavioral interventions appear to reduce perceived stress and improve quality of life among KT patients. Here, we present the Integrated Stress–Immune–Transplant Kidney Model that highlights how stress-related neuroendocrine signals converge with immune and vascular processes to shape chronic immune activation and, ultimately, graft outcomes. It also incorporates behavioral and psychological responses as downstream modulators of the same pathway, rather than parallel or unrelated factors. Addressing this problem in transplant rejection requires an integrative biopsychosocial approach that combines psychological assessment, biological monitoring, and supportive interventions as part of routine post-transplant care. Full article

Background/Objectives: Myeloid sarcoma (MS) is a rare extramedullary manifestation of myeloid blasts, with limited systematic data, particularly regarding molecular (NGS) concordance between MS tissue and bone marrow. We hypothesized that clonal heterogeneity may exist between these sites due to their distinct biological environments. Methods: We conducted a systematic review and meta-analysis of 85 studies encompassing 7241 MS patients, to evaluate clinical characteristics, mutational profiles, treatment patterns, and outcomes. Mutational concordance or discordance between MS and bone marrow was assessed in a subset of 112 patients. Results: Male predominance (59%) and skin/soft tissue localization (31%) were most common. NPM1 (25%) and FLT3 (20%) were the most frequently reported mutations. Among 112 patients with paired sequencing, 56% showed discordance in mutational profiles. NPM1 was significantly enriched in MS sites compared to bone marrow (35% vs. 21%, p = 0.02) and was associated with skin involvement. Discordance was more frequent in isolated and secondary MS. Venetoclax with hypomethylating agents achieved a 44% response rate, mainly in secondary MS. Post-transplant isolated extramedullary relapse occurred in 46% of relapsed patients and was linked to high rates of graft-versus-host disease. The pooled median overall survival was 12.8 months. Conclusions: MS demonstrates significant molecular heterogeneity. Routine site-specific NGS profiling may guide targeted therapy in this rare disease. Full article

Background: Liver transplantation (LT) continues to evolve with techniques aimed at minimizing perioperative complications associated with caval and portal vein clamping. Caval-sparing approaches, such as the piggyback technique, preserve hemodynamic stability; however, portal clamping remains necessary and may trigger postreperfusion syndrome, endotoxemia, and hepatic microcirculatory disturbances. Temporary portocaval shunts (PCSs) have been developed to maintain portal flow during LT, mitigating these adverse effects and allowing for hemodynamic stability and a reduced intraoperative bleeding. Portocaval Shunts: Various PCS techniques—including end-to-side, right-branch, portosaphenous, mesenterico-saphenous, iliac-venous conduit interposition, portoumbilical, and Rex-saphenous shunts—allow an individualized approach based on patient anatomy and surgical complexity. Review of Evidence: Available evidence demonstrates that PCS improves intraoperative hemodynamic stability, reduces blood transfusion requirements, and preserves renal function, particularly in patients with high portal flow or severe portal hypertension. PCS may also shorten warm ischemia time, facilitate hepatectomy, and enhance outcomes in extended criteria donor grafts or marginal organs. Meta-analyses and randomized studies support its role in reducing intraoperative blood loss, improving early graft function, and accelerating postoperative recovery. However, the effect of PCS on long-term survival and major postoperative morbidity remains variable, likely due to heterogeneity in patient populations, donor types, and perioperative management. Conclusions: Overall, PCS represents a safe and feasible adjunct in LT, offering significant hemodynamic and technical advantages. Its use should be individualized based on patient risk factors, intraoperative hemodynamics, and anticipated intraoperative challenges. PCS provides a practical strategy to preserve portal flow, minimizing intraoperative complications and facilitating the hepatectomy. However, the decision to create a PCS during LT still depends on the surgeon’s preference. Postoperative outcomes and impact on long-term survival require further investigation. Full article