2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T68e,Heart transplantation (HT) remains the reference therapy for selected eligible patients with advanced heart failure (HF), recent developments in drug and device therapies notwithstanding. The majority of heart transplants are performed in Europe and the USA. However, the rate of heart transplants varies greatly among European countries, ranging from <1 to >10 per million population per annum. Due to donor organ shortage, durable mechanical circulatory support (MCS) became a practical solution for many advanced HF patients, either as a bridge to transplant or as destination therapy. The aim of the present clinical consensus statement of the European Society of Cardiology -Heart Failure Association is to provide a perspective on important issues regarding HT, in particular patient selection, pre-transplant work-up, matching of donor heart and recipient, strategies of bridging patients to transplant with temporary or durable MCS, as well as how to increase the donor organ pool. Furthermore, surgical techniques and complications are discussed, as well as immediate post-transplant, and long-term management including the main aspects of long-term follow up such as rejection surveillance, personalized immunosuppression and managing comorbidities. Cellular and antibody mediated rejection, early cardiac allograft failure, and indications for retransplantation are described. An emphasis is given on the most important post-HT complications, such as cardiac allograft vasculopathy, infections and malignancies. Finally, the need for tailored physical rehabilitation and psychosocial support, and impact of post-transplant status on reproductive health are discussed.31:T6e3,Abstract Heart transplantation (HT) remains the reference therapy for selected eligible patients with advanced heart failure (HF), recent developments in drug and device therapies notwithstanding. The majority of heart transplants are performed in Europe and the USA. However, the rate of heart transplants varies greatly among European countries, ranging from <1 to >10 per million population per annum. Due to donor organ shortage, durable mechanical circulatory support (MCS) became a practical solution for many advanced HF patients, either as a bridge to transplant or as destination therapy. The aim of the present clinical consensus statement of the European Society of Cardiology –Heart Failure Association is to provide a perspective on important issues regarding HT, in particular patient selection, pre-transplant work-up, matching of donor heart and recipient, strategies of bridging patients to transplant with temporary or durable MCS, as well as how to increase the donor organ pool. Furthermore, surgical techniques and complications are discussed, as well as immediate post-transplant, and long-term management including the main aspects of long-term follow up such as rejection surveillance, personalized immunosuppression and managing comorbidities. Cellular and antibody mediated rejection, early cardiac allograft failure, and indications for retransplantation are described. An emphasis is given on the most important post-HT complications, such as cardiac allograft vasculopathy, infections and malignancies. Finally, the need for tailored physical rehabilitation and psychosocial support, and impact of post-transplant status on reproductive health are discussed.32:T706,Cytomegalovirus (CMV) infection remains one of the most prevalent and consequential post solid organ transplant (SOT) infections. Treatment is often challenging, especially when dealing with refractory and resistant CMV infections. We performed a retrospective multicenter cohort study of SOT recipients with clinically significant CMV infection (csCMVi) during 2010-2016. The primary outcome was early refractory CMV infection and secondary outcomes were drug resistance, CMV recurrence, and mortality. Analysis was done with Kaplan-Meier, univariable logistic regression analysis, and multivariable Cox regression. We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti-IL-2 antibody (43.9%). The majority (n = 82; 56.5%) were CMV D+/R- mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+/R- mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48-0.95, p = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01-2.44, p = 0.048). Drug-resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08-3.93, p = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality. Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment.33:Tadf,ABSTRACT Background Cytomegalovirus (CMV) infection remains one of the most prevalent and consequential post solid organ transplant (SOT) infections. Treatment is often challenging, especially when dealing with refractory and resistant CMV infections. Methods We performed a retrospective multicenter cohort study of SOT recipients with clinically significant CMV infection (csCMVi) during 2010–2016. The primary outcome was early refractory CMV infection and secondary outcomes were drug resistance, CMV recurrence, and mortality. Analysis was done with Kaplan‐Meier, univariable logistic regression analysis, and multivariable Cox regression. Results We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti‐IL‐2 antibody (43.9%). The majority ( n = 82; 56.5%) were CMV D+/R‐ mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+/R‐ mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48–0.95, p = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01–2.44, p = 0.048). Drug‐resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08–3.93, p = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality. Conclusion Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Immunosuppression: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Immunosuppression (modality). Clinician-written summaries and actionable practice insights. 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No sample size, control group, or prospective validation of the proposed serological approach is provided.","practice_takeaway":"For patients with class III/IV LN, consider prioritizing serial anti-dsDNA and C3/C4 complement monitoring over routine protocol biopsies to guide immunosuppression tapering. Reserve repeat biopsy for cases where serological and clinical data are discordant or inconclusive."}},{"doi":"10.1093/europace/euag153","pmid":"42669046","title":"Workup and management of rhythm disorders in myocarditis and inflammatory cardiomyopathy: a clinical consensus statement of the European Heart Rhythm Association and the Heart Failure Association of the ESC, the ESC Working Group on Myocardial & Pericardial Diseases, the European Association of Preventive Cardiology of the ESC, the Heart Rhythm Society, the Asian Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society","journal_title":"Europace","journal_issn":"1099-5129","published_at":"2026-08-28T00:00:00.000Z","url":"https://doi.org/10.1093/europace/euag153","source_score":40,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-31T06:18:42.682Z","updated_at":"2026-08-31T06:18:42.682Z","tags":[{"paper_doi":"10.1093/europace/euag153","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"condition","value":"Atrial Arrhythmia","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"condition","value":"Atrioventricular Conduction Disease","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"condition","value":"Inflammatory Cardiomyopathy","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"condition","value":"Myocarditis","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"condition","value":"Sinus Node Dysfunction","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"condition","value":"Ventricular Arrhythmia","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"modality","value":"Antiarrhythmic Therapy","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"modality","value":"Catheter Ablation","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"modality","value":"Immunosuppression","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"modality","value":"Implantable Cardiac Device","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"study_design","value":"Clinical Consensus Statement","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"warning","value":"Age group tagged as 'adult' based on typical myocarditis/Infl-CMP literature, but the document does not explicitly restrict its scope to adults.","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"warning","value":"No patient-level data or sample size is reported — this is an expert consensus document, not a primary research study; level of evidence is largely opinion- or observational-based.","value_numeric":null},{"paper_doi":"10.1093/europace/euag153","tag_type":"warning","value":"The 'hot-to-cold' phase framework is a conceptual construct introduced by this consensus; its clinical boundaries are not yet validated by prospective trials.","value_numeric":null}],"summaries":{"what_studied":"This multinational clinical consensus statement evaluates the workup and management of rhythm disorders (atrioventricular conduction disease, ventricular arrhythmias, atrial arrhythmias, and sinus node dysfunction) in myocarditis and inflammatory cardiomyopathy (Infl-CMP), using a phase-aware framework (hot, hot-to-cold, and cold phases) integrated with genetic background and disease stage.","key_result":"The statement establishes a structured, phase-stratified framework for arrhythmia management: during active inflammation (hot phase), antiarrhythmic therapy is paired with aetiology-targeted treatment or immunosuppression; in later stages (cold phase), substrate-based strategies — pharmacological therapy, device implantation, or catheter ablation — are prioritized, with particular emphasis on the hot-to-cold transition as a high-risk arrhythmogenic window.","limitations":"Consensus advice is graded as opinion-, observational-, or randomized trial-based, reflecting a limited randomized evidence base in this field; formal recommendations are therefore driven largely by expert consensus and observational data.","practice_takeaway":"Clinicians should recognize myocarditis as an underappreciated cause of serious arrhythmias and use disease phase (hot vs. cold) and genetic background to guide timing of antiarrhythmic therapy, immunosuppression, device implantation, and ablation. The hot-to-cold transition period warrants heightened arrhythmic surveillance and risk stratification before committing to permanent device or ablation strategies."}},{"doi":"10.1001/jamaneurol.2026.2778","pmid":"42606839","title":"Anti-CD320 Autoantibodies and Central Nervous System Vitamin B\n ₁₂\n Deficiency in Idiopathic Myelopathy","journal_title":"JAMA Neurology","journal_issn":"2168-6149","published_at":"2026-08-17T00:00:00.000Z","url":"https://doi.org/10.1001/jamaneurol.2026.2778","source_score":51,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-21T06:28:04.975Z","updated_at":"2026-08-21T06:28:04.975Z","tags":[{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"category","value":"Clinical Neurology","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"condition","value":"Idiopathic Myelopathy","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"condition","value":"Vitamin B12 Deficiency","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"generic","value":"cyanocobalamin","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"generic","value":"methylcobalamin","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"modality","value":"Immunosuppression","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"modality","value":"Vitamin Supplementation","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"sample_size","value":"n=148","value_numeric":148},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"study_design","value":"Retrospective Case-Control Study","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"warning","value":"Anti-CD320 autoantibodies were also detected at lower rates in known autoimmune myelitis (NMOSD, MOGAD), suggesting the antibody is not entirely specific to idiopathic cases; clinical context is essential.","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"warning","value":"Serum B12 was normal or elevated in several positive cases, underscoring that standard serum B12 testing alone cannot exclude this diagnosis.","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"warning","value":"The study is retrospective and multi-center; cohort selection criteria and assay methods may introduce ascertainment bias.","value_numeric":null},{"paper_doi":"10.1001/jamaneurol.2026.2778","tag_type":"warning","value":"The treatment cohort is very small (n=5), so the 4/5 improvement rate should be interpreted cautiously—formal efficacy data are lacking.","value_numeric":null}],"summaries":{"what_studied":"This retrospective case-control study (May 2014–October 2025, 4 tertiary care centers) used proteome-wide phage display and targeted immunoassays to identify anti-CD320 autoantibodies in 148 patients with idiopathic myelopathy (IM), comparing clinical, radiographic, and CSF metabolic features against other neurological disease (OND, n=32) and known autoimmune myelitis (n=30) controls.","key_result":"Anti-CD320 antibodies (targeting the transcobalamin receptor for CNS vitamin B12 uptake) were found in 56% (18/32) of the discovery cohort and confirmed in two independent cohorts (45%, 41/91; 48%, 12/25). Positive cases had lower CSF bioactive B12 (mean 15.1 vs 22.9 pmol/L; P=.03), more subacute onset (56% vs 7%; P=.008), normal CSF profiles (83% vs 50%; P=.04), and dorsolateral MRI cord changes (61% vs 7%; P=.003). Of 5 treated with B12 supplementation ± immunosuppression, 4 improved.","limitations":"- Retrospective design with small treatment group (n=5) limits conclusions about therapeutic efficacy.\n- Serum B12 levels were unavailable in validation cohorts, though all met IM inclusion criteria.\n- Long-term outcomes and optimal treatment protocol (B12 alone vs. combined immunosuppression) remain undefined.","practice_takeaway":"In patients with unexplained myelopathy, consider screening for anti-CD320 antibodies followed by CSF holotranscobalamin measurement to identify autoimmune CNS vitamin B12 deficiency—even when serum B12 is normal or elevated. Early vitamin B12 supplementation, with or without immunosuppression, may lead to clinical improvement."}},{"doi":"10.1093/ndt/gfag183","pmid":"42578942","title":"Management of Recurrent C3 Glomerulopathy After Kidney Transplantation","journal_title":"Nephrology Dialysis Transplantation","journal_issn":"0931-0509","published_at":"2026-08-11T00:00:00.000Z","url":"https://doi.org/10.1093/ndt/gfag183","source_score":15,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-19T06:28:54.578Z","updated_at":"2026-08-19T06:28:54.578Z","tags":[{"paper_doi":"10.1093/ndt/gfag183","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"condition","value":"C3 Glomerulopathy","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"condition","value":"Kidney Transplant Recurrence","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"modality","value":"Complement Inhibitor","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"modality","value":"Immunosuppression","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"warning","value":"No sample size applies — this is a narrative review with no primary data or patient cohort.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"warning","value":"Published August 11, 2026 — proximal complement inhibitor evidence cited may reflect very recent or unpublished trial data not yet independently verified.","value_numeric":null},{"paper_doi":"10.1093/ndt/gfag183","tag_type":"warning","value":"Study design labeled as 'Narrative Review'; the abstract notes this reflects a transplant-centered clinical perspective, which may introduce viewpoint bias.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates the management of recurrent C3 glomerulopathy (C3G) after kidney transplantation, covering transplant candidacy, pre-transplant evaluation, post-transplant monitoring, and therapeutic decision-making including the role of complement inhibitors.","key_result":"C3G frequently recurs early post-transplant, often subclinically; no validated biomarkers reliably predict recurrence, preventive strategies remain unproven, and the emerging role of proximal complement inhibitors is discussed but not yet established by trial data.","limitations":"- Review reflects a single transplant-centered clinical perspective, not a systematic review or meta-analysis.\n- No validated predictive biomarkers exist, limiting evidence-based pre-transplant risk stratification.\n- Therapeutic goals and interpretation of treatment response for subclinical histologic recurrence remain undefined.","practice_takeaway":"Adopt a surveillance-driven approach with protocol biopsies post-transplant for early detection of subclinical C3G recurrence rather than prophylactic intervention. Conventional immunosuppression has limited efficacy; proximal complement inhibitors are emerging but lack validated trial evidence to guide routine use."}},{"doi":"10.1016/j.fertnstert.2026.06.032","pmid":"42401395","title":"Confronting complexities of uterus transplantation: Balancing Innovation, Risk and Access","journal_title":"Fertility and Sterility","journal_issn":"0015-0282","published_at":"2026-07-04T00:00:00.000Z","url":"https://doi.org/10.1016/j.fertnstert.2026.06.032","source_score":3,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-13T17:42:34.604Z","updated_at":"2026-07-13T17:42:34.604Z","tags":[{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"condition","value":"Absolute Uterine Factor Infertility","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"condition","value":"Infertility","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"modality","value":"Immunosuppression","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"modality","value":"Organ Transplantation","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"study_design","value":"Narrative Review / Expert Opinion","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"warning","value":"No primary data or quantitative outcomes (e.g., specific graft failure rates or sample sizes) are reported in the abstract; all numerical claims in summaries reflect the paper's qualitative characterizations only.","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"warning","value":"Study design classification as 'Narrative Review / Expert Opinion' is inferred from the abstract's description as a 'Views and Reviews article' drawing on multidisciplinary expert perspectives — no formal methodology is described.","value_numeric":null},{"paper_doi":"10.1016/j.fertnstert.2026.06.032","tag_type":"warning","value":"The paper was published July 4, 2026 with a DOI suggesting a 2026 journal issue; the field is rapidly evolving and some clinical guidance may already be superseded.","value_numeric":null}],"summaries":{"what_studied":"This Views and Reviews article examines the key complexities and challenges of uterus transplantation (UTx) as a treatment for absolute uterine factor infertility, covering donor selection, recipient risks, immunosuppression, pregnancy outcomes, ethical considerations, and access disparities compared with gestational surrogacy.","key_result":"The multidisciplinary expert panel concludes that UTx is an effective and ethically acceptable infertility treatment, while highlighting persistent challenges: high historical graft failure rates, immunosuppression risks, pregnancy complications, geographic and socioeconomic access gaps, and unresolved ethical tensions around acceptable risk in a non-life-saving procedure.","limitations":"This is a narrative review and expert opinion piece, not a systematic review or original trial — no new primary data or quantitative outcomes are reported. Conclusions rest on accumulated clinical experience and registry data rather than controlled evidence.","practice_takeaway":"Clinicians considering UTx referrals should counsel patients on the procedure's significant complexity, financial barriers, and risk profile relative to gestational surrogacy. 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CNV was present in 46.6% of eyes at diagnosis; 20 more eyes developed CNV during follow-up (0.06/eye-year). Immunosuppression was associated with reduced odds of active CNV (OR 0.50; 95% CI 0.27–0.93). All 10 eyes with vision worse than 20/40 had CNV; 8 recovered to better than 20/40 after anti-VEGF therapy.","limitations":"Small sample (n=52) from a single tertiary centre, which may introduce referral bias and limit generalisability. Retrospective design limits causal inference, especially for immunosuppression effects. Only 4 unilateral patients received immunosuppression, making that subgroup analysis underpowered.","practice_takeaway":"Monitor PIC patients closely for fellow-eye involvement, especially within the first 5 years. 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No N is reported.","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag051","tag_type":"warning","value":"The paper was published May 5, 2026 and today is May 11, 2026 — this is a very recent document; clinical uptake and external validation are pending.","value_numeric":null}],"summaries":{"what_studied":"This clinical consensus statement from the ESC Heart Failure Association covers the full spectrum of heart transplantation (HT) management — including patient selection, pre-transplant workup, donor-recipient matching, bridging strategies with mechanical circulatory support (MCS), surgical techniques, immunosuppression, rejection surveillance, and long-term complications such as cardiac allograft vasculopathy, infections, and malignancies.","key_result":"HT remains the gold-standard therapy for eligible advanced heart failure patients; however, European transplant rates vary widely, from <1 to >10 per million population per year, with donor organ shortage driving increased use of durable MCS as bridge-to-transplant or destination therapy.","limitations":"As a consensus statement rather than a systematic review or RCT, recommendations reflect expert opinion and may not be graded by formal evidence levels. Variability in practice across European countries may limit uniform applicability.","practice_takeaway":"Clinicians managing advanced heart failure should use this consensus to guide patient selection, optimize pre-transplant bridging with MCS, and personalize post-transplant immunosuppression and comorbidity management. Attention to cardiac allograft vasculopathy, infection risk, malignancy surveillance, and psychosocial support are essential components of long-term post-HT care."}},{"doi":"10.1111/ctr.70552","pmid":"42053990","title":"Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and Clinical Outcomes","journal_title":"Clinical Transplantation","journal_issn":"0902-0063","published_at":"2026-04-29T00:00:00.000Z","url":"https://doi.org/10.1111/ctr.70552","source_score":18,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-03","doi":"10.1111/ctr.70552","days":"14","issn":"0902-0063","rank":"8","field":"Clinical Medicine","score":"18","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1111/ctr.70552","title":"Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and Clinical Outcomes.","journal":"Clinical transplantation","methods":"","results":"We included 145 SOT recipients with csCMVi, majority were liver transplant (49%). Most common induction was an anti-IL-2 antibody (43.9%). The majority (n = 82; 56.5%) were CMV D+/R- mismatch and presented asymptomatic infection (50.3%). After the initial 3 weeks of antiviral therapy, 13 (8.9%) patients had probable refractory csCMVi; most of them (10 [76.9%]) were CMV D+/R- mismatch. Longer time after transplant had lower risk (OR 0.68; CI 0.48-0.95, p = 0.029) while lower absolute lymphocyte count (ALC) had a higher risk of early refractory csCMVi (OR 1.54; CI 1.01-2.44, p = 0.048). Drug-resistant csCMVi occurred in 7 patients (4.8%); a high initial CMV DNA level was associated with resistant csCMVi (OR 2.00; CI 1.08-3.93, p = 0.031). 25 patients (17.2%) experienced recurrent csCMVi within 6 months. 30 patients (20.7%) died; refractory, resistant or recurrent CMV infections were not associated with mortality.","abstract":"$32","keywords":["CMV D+/R‐ mismatch","CMV viral load","Cytomegalovirus (CMV)","antiviral resistance","lymphopenia","post transplant infection","refractory CMV infection","solid organ transplantation (SOT)"],"pubmed_id":"42053990","conclusions":"Refractory csCMVi is associated with a low ALC and an earlier onset after transplant. Resistant csCMVi is associated with high initial CMV DNA levels. Recurrence of csCMVi is common and potentially associated with low ALC at the end of antiviral treatment.","publication_date":"2026-04-29T00:00:00"},"crossref":{"DOI":"10.1111/ctr.70552","URL":"https://doi.org/10.1111/ctr.70552","ISSN":["0902-0063","1399-0012"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/ctr.70552","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ctr.70552","content-type":"application/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/ctr.70552","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":"5","score":1,"title":["Refractory, Resistant and Recurrent Cytomegalovirus Infections in Solid Organ Transplant Recipients: Risk Factors and Clinical 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A.","family":"Yetmar","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases, and Occupational Medicine Mayo Clinic Rochester Minnesota USA"},{"name":"Department of Infectious Disease Cleveland Clinic Foundation Cleveland Ohio USA"}]},{"given":"Raymund R.","family":"Razonable","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases, and Occupational Medicine Mayo Clinic Rochester Minnesota 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virologic/resistance-proven refractory disease, introducing potential misclassification.","value_numeric":null},{"paper_doi":"10.1111/ctr.70552","tag_type":"warning","value":"Very small subgroup for drug-resistant CMV (n=7) — odds ratio estimates for resistance should be interpreted with caution.","value_numeric":null}],"summaries":{"what_studied":"This retrospective multicenter cohort study evaluated risk factors and clinical outcomes of refractory, resistant, and recurrent clinically significant CMV infection (csCMVi) in 145 solid organ transplant (SOT) recipients with csCMVi between 2010–2016.","key_result":"8.9% (n=13) developed probable refractory csCMVi — linked to lower absolute lymphocyte count (ALC; OR 1.54) and earlier post-transplant onset (OR 0.68); 4.8% (n=7) had drug-resistant csCMVi — linked to high initial CMV DNA (OR 2.00); 17.2% (n=25) had recurrence within 6 months; 20.7% (n=30) died, but refractory/resistant/recurrent CMV was not independently associated with mortality.","limitations":"- Retrospective design limits causal inference and may introduce selection and documentation bias.\n- Small sample size (n=145), especially for resistant CMV (n=7), limits statistical power.\n- Study period (2010–2016) predates newer antivirals (e.g., letermovir, maribavir), reducing contemporary applicability.","practice_takeaway":"Monitor ALC closely in SOT recipients with CMV infection — low ALC raises risk of both refractory and recurrent disease. A high initial CMV DNA load should prompt heightened vigilance for antiviral resistance."}},{"doi":"10.1016/j.cardfail.2025.07.016","pmid":"40889573","title":"Evolving Paradigms and Future Frontiers in Heart Transplantation in the Modern Era: a State-of-Art Focus Review","journal_title":"Journal of Cardiac Failure","journal_issn":"1071-9164","published_at":"2025-08-30T00:00:00.000Z","url":"https://doi.org/10.1016/j.cardfail.2025.07.016","source_score":19,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-12T13:26:22.227Z","updated_at":"2026-08-12T13:26:22.227Z","tags":[{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"condition","value":"Cardiac Allograft Vasculopathy","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"condition","value":"Heart Failure","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"condition","value":"Hepatitis C Virus Infection","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"modality","value":"Ex Situ Organ Perfusion","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"modality","value":"Heart Transplantation","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"modality","value":"Immunosuppression","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"modality","value":"Left Ventricular Assist Device","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"modality","value":"Xenotransplantation","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"warning","value":"No patient-level data or quantitative outcomes are reported; this is a narrative review and level of evidence is correspondingly low.","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"warning","value":"The paper was published 2025-08-30 but today's date is 2026-08-12, so some referenced 'emerging' advances may now have further updated evidence available.","value_numeric":null},{"paper_doi":"10.1016/j.cardfail.2025.07.016","tag_type":"warning","value":"Xenotransplantation discussion is based on early scientific findings and may not reflect current clinical practice as of the paper's publication.","value_numeric":null}],"summaries":{"what_studied":"This state-of-the-art review covers six major evolving domains in heart transplantation: organ preservation (ex situ/normothermic perfusion), heart transplant vs. durable LVAD decision-making, donor pool expansion (DCD and HCV-positive donors), precision immunosuppression with novel biomarkers, long-term post-transplant complications (cardiac allograft vasculopathy, malignancy, renal dysfunction), and xenotransplantation.","key_result":"No primary quantitative outcome is reported; the review synthesizes current evidence and emerging trends across the heart transplantation continuum, highlighting DCD and HCV-positive donor use and xenotransplantation as paradigm-shifting advances in organ availability.","limitations":"As a narrative review, it does not perform systematic search or meta-analysis, limiting the ability to quantify effect sizes or grade evidence across topics. Xenotransplantation findings cited are from early-phase science and may not yet be clinically generalizable.","practice_takeaway":"Clinicians should consider DCD and HCV-positive donor hearts as viable options to expand the donor pool, and integrate noninvasive biomarker surveillance for earlier rejection detection. Individualized net survival benefit analysis should guide the choice between heart transplant and durable LVAD."}}],"initialOffset":9,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Immunosuppression"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Immunosuppression"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Immunosuppression"}}}]]

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