Purpose Bayesian-based precision dosing software (BPDS) has been utilized for therapeutic drug monitoring. However, BPDS for tacrolimus (TAC) is not routinely utilized in clinical settings. The objective of this study was to evaluate the predictive performance of BPDS for TAC in early post-kidney transplant recipients (KTR). Methods A single-center, retrospective cohort study was performed among KTR between 01/2018 - 12/2019 with TAC dosing and trough concentrations (C0) during the index hospitalization. The predictive performance of two models were evaluated within the BPDS. Predictive performance was determined by assessing both bias (calculated as the mean difference between observed and predicted TAC C0 and mean absolute prediction error (MAPE)) and precision (measured as the standard deviation (SD) of the difference). Results A total of 111 patients with 344 TAC C0 were included. MAPE improved for both models as additional C0 were included. Bias for both models using mean difference however was variable (-2.59 to 0.95 ng/mL) and both models showed low precision in terms of SD (3.78 to 5.53 ng/mL). Conclusion In this cohort of early post-KTR, BPDS predictive performance was inconsistent, with variable bias and low precision across both models despite improvement in MAPE with additional C0 data. Factors such as slow graft function and high initial C0 appear to affect the model. These findings highlight the need for model refinement and prospective validation before BPDS can be routinely applied to guide TAC dosing in early post-transplant.
Donor derived Ig A nephropathy is generally considered to follow a transient benign course. We report a case of donor derived IgA nephropathy causing severe and persistent nephrotic syndrome after kidney transplantation.
Post-transplant lymphoproliferative disorder (PTLD) is a heterogeneous spectrum of lymphoproliferative disorders that can develop in the setting of immunosuppression following transplant. In this report, we highlight the first presentation of recurrent EBV-negative monomorphic PTLD in sequential liver allografts.
Lung transplantation remains a critical therapeutic option for patients with end-stage pulmonary diseases, yet postoperative management continues to face significant challenges including immune rejection, infections, and graft dysfunction. Traditional immunosuppressive regimens, while effective, are often associated with adverse effects and complications, prompting the search for adjunctive therapies with improved safety profiles. In recent years, natural compounds have gained increasing attention due to their multi-target regulatory properties and relatively low toxicity, positioning them as promising candidates for post-lung transplantation adjuvant treatment. This review comprehensively summarizes the latest research progress on the application of natural compounds in modulating immune responses, reducing inflammation, and preventing fibrosis after lung transplantation. We explore the underlying molecular mechanisms through which these compounds exert their effects, such as modulation of immune cell activity, cytokine regulation, and inhibition of fibrotic pathways. Additionally, the review discusses the current challenges and future clinical prospects of integrating natural compounds into comprehensive post-transplant care, highlighting their potential to enhance graft survival and patient outcomes. By providing an updated and critical overview, this article aims to offer new insights and strategic directions for improving postoperative management in lung transplant recipients through the use of natural bioactive agents.
Introduction Kidney transplantation is the gold standard treatment for end-stage kidney failure, and most organs are derived from brain-dead (BD) organ donors. BD triggers a cascade of physiological disturbances that may compromise renal function and frequently results in diabetes insipidus (DI). This condition is associated with negative transplant outcomes, such as impaired graft survival and acute rejection. Methods We conducted a single-center retrospective cohort study (2018–2023) involving 1015 BD organ donors. Kidney function was assessed by measuring serum urea and creatinine levels. Serum sodium levels, DI treatment, and reasons for kidney discard were also analyzed. These parameters were evaluated at two critical time points: upon initial hospital admission for the primary neurological injury and before organ retrieval (pre-retrieval). Results In our cohort, most kidneys were transplanted (74.3%), while 25.7% were discarded. Organ donors showed a significant worsening of laboratory markers of kidney function between admission and pre-retrieval, with a mean paired increase in urea of 39.96 mg/dL (95% CI: 38.14–41.78; p < 0.001) and creatinine of 1.11 mg/dL (95% CI: 0.97–1.25; p < 0.001). Hypernatremia also worsened, with a mean increase in serum sodium of 11.4 mEq/L (95% CI: 10.6–12.2; p < 0.001). Moreover, significantly lower pre-retrieval serum sodium levels were observed in donors who received treatment for DI compared to those who did not (p < 0.001). Discarded kidneys were more frequently associated with morphological abnormalities, followed by infection and hepatitis C. Conclusion In a 6-year single-center cohort of BD donors, pre-retrieval laboratory markers of kidney function and serum sodium levels were worse than at admission; DI correction was associated with lower pre-retrieval sodium. These findings support rigorous donor-management protocols, but causal effects cannot be inferred from this retrospective analysis.
