30-Second Takeaway
- Robot-assisted living-donor kidney transplantation lowers major perioperative morbidity and reinterventions with comparable early graft outcomes to open surgery.
- Anti-CD38 antibodies show transient reductions in AMR activity but carry regulatory cell and TCMR concerns, warranting cautious, trial-based use.
- mHealth tools improve self-care and reduce rehospitalizations post-transplant without clear mortality or rejection benefit yet.
- Heavy metal exposure is an under-recognized, modifiable contributor to late kidney allograft injury requiring surveillance and mitigation strategies.
- ICP monitoring in acute liver failure is declining without worse outcomes; emphasis is shifting toward ammonia-driven, noninvasive neuroprotection.
Week ending December 20, 2025
Transplant surgery updates: surgical approach, immunomodulation, surveillance, and peri-transplant risk management
Robot-assisted versus open living-donor kidney transplantation: fewer complications, more time
In 733 living-donor kidney transplants across seven European centers, propensity matching yielded 306 robot-assisted and 306 open procedures with similar baselines. RAKT had shorter total vascular anastomosis time but longer overall operative and rewarming times than open transplantation. Early postoperative complications and Clavien-Dindo ≥3 events were significantly lower after RAKT than after open surgery. On multivariable analysis, RAKT independently predicted fewer early complications and fewer reinterventions during follow-up, with comparable survival endpoints.
Anti-CD38 therapy for kidney transplant AMR: promising but transient and complex
This review summarizes anti-CD38 monoclonal antibodies, including daratumumab, felzartamab, and isatuximab, for antibody-mediated rejection in kidney transplantation. These agents target plasma cells and natural killer cells, reducing donor-specific antibodies and microvascular inflammation in early clinical experiences. Benefits appear transient and variable, reflecting heterogeneous B-cell compartments in established alloimmunity. Anti-CD38 drugs also deplete regulatory B and T cells, raising concern for tipping toward T cell–mediated rejection. The authors highlight substantial knowledge gaps and call for mechanistically informed, rigorously controlled trials before routine AMR use.
Automated GMP production of universal CAR Tregs for organ-targeted tolerance
This preclinical study develops an automated, GMP-compatible process to generate universal RevCAR regulatory T cells at clinical scale. Tregs from leukapheresis were enriched, sorted, virally transduced, and expanded using clinical cell-processing platforms. Across five runs, products achieved high purity, central memory–skewed phenotype, and robust RevCAR expression. RevCAR Tregs maintained FOXP3 and Helios stability under inflammatory conditions with minimal pro-inflammatory cytokine production. Using a CEA-targeting module, they showed antigen-specific activation and dose-dependent suppression, supporting future organ-targeted tolerance trials.
References
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Additional Reads
Optional additional studies from this edition.