Transplant tolerance: a new role for IL-34
Immune-suppressive cell populations, including Tregs and suppressor monocytes, have been implicated in long-term survival of allografts in both human transplant recipients and animal models. The factors that drive differentiation and function of these cell populations are not completely understood. In this issue, Bézie and colleagues identify IL-34 as an important mediator of allograft tolerance in a rat model of heart transplantation. Their data support a model in which IL-34 production by Tregs promotes a population of suppressive macrophages that in turn promote Treg differentiation. The results of this study support further exploration of the immunosuppressive properties of IL-34.
The foundation of successful strategy in thoracic transplantation is to overcome multiple barriers to donor and recipient compatibility. Once blood group barriers are surmounted, anatomic considerations become a principal guiding consideration. The available allograft may not be of similar size as the recipient's diseased organ (Figure 1). An undersized allograft is associated with an increased risk of primary graft dysfunction (PGD) in both heart1 and lung transplantation,2 making assessment of donor-recipient size match a fundamental issue.
In the current issue of the Journal, dual imaging vasodilator stress echocardiography (SE) with combined assessment of regional wall motion abnormalities and coronary flow velocity reserve shows excellent feasibility and negative predictive value for excluding significant cardiac allograft vasculopathy (CAV) in patients evaluated after heart transplantation (HT) . These results add further evidence to previous similar experiences showing that SE can offer several opportunities in HT setting for acute and chronic rejection surveillance and heart recruitment from marginal donors.
Cardiac allograft vasculopathy (CAV) is a major complication limiting long-term survival after heart transplantation (HTx). However, long-term outcome data of HTx recipients with detailed information on angiographic severity are scarce.
This thirty-sixth adult lung and heart –lung transplant report summarizes data from 69,200 adult lung and 4,128 adult heart-lung transplants performed through June 30, 2018 and reported to the International Thoracic Organ Transplant Registry. With each year's report, we now provide more detailed analyses on a particular focus theme imp ortant to patient outcomes. Since 2013, these have been donor and recipient age; retransplantation; early graft failure; indication for transplant; allograft ischemic time; and multiorgan transplantation.
CONCLUSIONS: GP after SOT is associated with a high risk of PTLD, allograft loss and poor survival. The combination of SPE, SIFE, SFLC and UIFE is optimal for GP detection. These methods aid in identifying patients who are at risk for PTLD or allograft damage and should be included in regular post-Tx follow-up. PMID: 31398462 [PubMed - as supplied by publisher]
The deleterious effects of cigarette smoking (CS) have been well documented. Active cigarette use is a relative contraindication for heart transplantation (HT) with a recommendation that candidates be abstinent for at least 6 months prior to HT. Animal studies have shown that a history of CS is associated with increased risk of allograft rejection. Our study examines the association of CS history and HT outcomes.
Hypertension (HTN) is common after orthotopic heart transplant (OHT) and is associated with cardiac allograft vasculopathy (CAV), which is strongly related to mortality. Few data are available regarding whether anti-HTN medications in OHT patients who develop HTN will reduce mortality or incidence of CAV. Our goal was to determine if specific anti-HTN medications were associated with a reduction in CAV or were associated with survival.
Cardiac allograft vasculopathy (CAV) is a main cause of graft failure beyond the first year post heart transplantation (HTx). Post-HTx restrictive physiology, which is characterized by increased right sided cardiopulmonary pressures (CPP), particularly right atrial pressure (RAP) and pulmonary wedge pressure (PCWP) makes up part of the CAV classification criteria. Cardiovascular magnetic resonance (CMR) allows for the assessment of changes in myocardial tissue structure and function.
Due to donor organ shortage, the number of patients listed for transplant greatly exceeds the supply of available heart allografts Recent approval of direct-acting antiviral (DAA) agents for HCV provides an opportunity to expand the donor pool through the use of organs from HCV NAT+ donors and offering highly-effective anti-HCV therapy to organ recipients who develop HCV infection
Coronary allograft vasculopathy (CAV) is implicated in a large subset of orthotopic heart transplant recipients with primary graft failure. Until recently, pharmacologic therapy for CAV prevention has been based around HMG-CoA reductase inhibitors. Given their drug-drug interactions with immunosuppressive therapy, often leading to elevations in creatine kinase and intolerable myalgias, tolerance to therapy has been poor. Although proprotein convertase subtilisin-kexin type 9 inhibitors have been shown to be a viable alternative in patients refractory to traditional lipid lowering therapy, these medications have not been st...