Recent Trends in Kidney Transplant in the United States.
Authors: Sampaio M, Shekhtman G, Ahearn P, Huang E, Bunnapradist S Abstract The number of new wait list registrants has increased in the last decade but not to the same magnitude as the increase in the number of end stage renal disease patients in the United States. The number of wait list patients has increased at a much higher pace due to the lack of kidney supply. The overall number of kidney transplants only increased slightly. Paired exchange kidney transplant is a viable source of increasing the availability of kidney transplant and also offers access to transplant to patients with immunologic barriers to the...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

MELD Exceptions for Hepatocellular Carcinoma: Regional Variations in the Impact of the Share 35 Liver Allocation Policy.
This report emphasizes the geographic inequities and regional variations in transplant practices, with a focus on liver transplant candidates with hepatocellular carcinoma exceptions, and highlights the need for strategies to promote equitable organ distribution across geographical regions and patient conditions. PMID: 28514564 [PubMed] (Source: Clinical Transplants)
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

An Update on Cardiac Transplantation in the United States Based on an Analysis of the UNOS Registry.
Authors: Khatiwala JR, Everly MJ Abstract Cardiac transplantation remains a viable option for those with end-stage heart disease. In the last few years, the number of heart transplants has begun to increase slightly. Over the last 27 years, the major reasons for cardiac transplant remain coronary artery disease and dilated cardiomyopathy. Currently, heart transplants have an average lifespan of 10.5 years. The main United Network for Organ Sharing characteristics correlating with poor allograft survival include repeat transplantation, ischemic time, post-transplant dialysis, and age at the time of transplant. Data ...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Long-Term Pancreas Allograft Survival in Simultaneous Pancreas-Kidney Transplantation by Era.
Authors: Waki K, Hayashi A, Yamaguchi S, Nangaku M, Ohe K, Kadowaki T, Kokudo N Abstract Data collected by the United Network for Organ Sharing from all approved United States transplant programs were analyzed; the data included 20,290 adult diabetic patients who received primary pancreas transplants between October 1987 and December 2014. Simultaneous pancreas-kidney (SPK) transplantation has become the major therapeutic option for diabetes patients. The number of SPKs per year has not increased since 1999; it leveled off or decreased slightly each year. Recipients in the most recent period, 2010-2014, were more l...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Impact of Diabetes Mellitus on Survival Outcome of Lung Transplant Recipients: An Analysis of OPTN/UNOS Data.
CONCLUSIONS: Diabetes was associated with mortality in lung transplant recipients overall and in lung recipients without cystic fibrosis. However, there was no association between diabetes and mortality in lung recipients with cystic fibrosis. PMID: 28514567 [PubMed] (Source: Clinical Transplants)
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

The 25th Anniversary of the National Transplantation Pregnancy Registry.
Authors: Coscia LA, Constantinescu S, Armenti DP, Moritz MJ Abstract The National Transplantation Pregnancy Registry (NTPR) is a unique resource for comprehensive information about parenthood after transplantation. To date, 1461 female solid organ transplant recipients with 2609 pregnancies and 879 male recipients who fathered 1358 pregnancies have participated in the NTPR. Over the first 25 years of the NTPR, pregnancy after transplantation has progressed from a situation where termination was once advised, to a topic of pre-transplant counselling with likelihood for success if established criteria are met. Pregna...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Hepatitis C and Human Immunodeficiency Virus Kidney Transplantation: The Mount Sinai Experience.
Authors: Nair V, Khaim R, El-Salem F, Kent R, Lerner S, Berger A, Miko L, Rollins B, Ebcioglu Z, Delaney V, Sehgal V, Menon M, Ames S, Benvenisty A, Wadhera V, Arvelakas A, Schiano T, Rana M, Huprikar S, Florman S, Shapiro R Abstract Mount Sinai Hospital in New York has a long history in the field of organ transplantation. The first kidney transplant at Mount Sinai was performed in 1967 by the late Dr. Lewis Burrows and the first laparoscopic donor nephrectomy in New York was performed at Mount Sinai in 1996. Over 3000 kidney transplantations have been performed at Mount Sinai. In the early 1990s, the first hepatit...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Liver Transplant at the University of Pennsylvania 2015.
CONCLUSION: Our program activity data mirrors trends that are seen in many of the established busy liver transplant centers in the United States. There is greater recognition that liver transplantation can be offered to a larger number of candidates who are diagnosed with progressive liver failure of primary cancer in the setting of liver cirrhosis, and there is an increase in donor organs from either extended criteria cadaveric donors or living donors. Despite more complex candidate populations and increased utilization of extended criteria donors, Penn's outcomes continue to be excellent. We postulate that the future dep...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

ISMETT: An International Collaboration on Organ Transplantation.
Authors: Vizzini GB, Gruttadauria S, Spada M, Bertani A, Bertani T, Casu A, Raffa G, Sciacca S, Di Gesaro G, Pilato M, De Monte L, Vitulo P, Luca A, Arcadipane A, Gridelli B Abstract The Institute of the Mediterranean for Transplantation and High Specialty Therapies (ISMETT) is a multi-organ transplant and high specialty center located in Palermo, Italy and managed by the University of Pittsburgh Medical Center. Clinical transplant activity started in 1999 and, herein, we illustrate the outcomes achieved over the past 15 years. In total, ISMETT has performed 997 liver transplants (83.9% adults, 16.1% pediatrics) wi...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Liver Transplantation in Groningen, The Netherlands: A Single Center Status Report.
Authors: de Vries Y, de Jong IEM, Berendsen TA, Lisman T, Verkade HJ, Scheenstra R, Reyntjens KMEM, de Boer MT, Blokzijl J, Peeters PMG, van den Berg AP, Porte RJ Abstract The liver transplantation program of the University Medical Center Groningen in the Netherlands was started in 1979, making it one of the first programs worldwide. During the past 36 years, a total of 1478 liver transplantations have been performed, 459 of which were in children. One of the first patients transplanted in 1979 is still alive and is one of the longest surviving patients after liver transplantation worldwide. During the last decade,...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Pancreas Transplant at the University of Maryland.
Authors: Yi SY, Shaw K, Costa N, Leeser DB Abstract The characteristic of our diabetic population has been ever changing. No longer are our Type 1 diabetics young and thin; they too suffer from the obesity epidemic and now present later with the complications of diabetes (renal dysfunction, hypoglycemic unawareness, vision loss, neuropathy, etc.). Even with all of our medical and technological advances to combat diabetes, there are many who are not very well controlled. We evaluated the pancreas transplant recipients in the last three years at the University of Maryland to study the outcomes of these older and high...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

A Single Center 11 Year Experience with 202 Pancreas Transplants in the New Millennium: Evolving Trends.
CONCLUSIONS: Excellent 5-year outcomes following PTx can be achieved as>86% of patients are alive,>87% of surviving patients are dialysis-free, 80% of surviving patients remain insulin-free, and 88% of surviving patients have detectable C-peptide levels. PMID: 28514574 [PubMed] (Source: Clinical Transplants)
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Alloantibodies in Organ Transplant: A Review of Data Published in 2015.
Authors: Maehara C, Everly MJ Abstract In recent years, there have been multiple studies published on longitudinal and retrospective analysis of anti-human leukocyte antigen (anti-HLA) antibodies. The focus of these reports was to determine specific characteristics of the impact of donor specific anti-HLA antibodies (DSA) in organ transplantation. There has been a growing concern about DSA in a multitude of organ transplants. Research efforts are attempting to gain a better understanding of DSA and possible treatment implications for patients with DSA. In 2015, many studies confirm and expand upon both the understa...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Advances in Transplantation: Editorial.
Authors: Morris RE PMID: 28514576 [PubMed] (Source: Clinical Transplants)
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

A Review of the Management of Pregnancy After Cardiac Transplantation.
Authors: Tran DD, Kobashigawa J Abstract Success and advances in the management of all aspects of heart disease and heart transplantation have allowed for normalcy in life, including the question as to the possibility of pregnancy in transplantation. With the growing young adult population undergoing heart transplant, pregnancy and transplantation have become an issue of importance. Despite the fact that nearly 50 years have passed since the first heart transplant, there remains to be little evidence in regard to management of pregnant heart transplant recipients. Thus, this review will address issues related to pr...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Strategies to Improve Novel Drug Development in Kidney Transplantation Through the Clinical Trials Process.
Authors: Jordan SC, Choi J, Vo A Abstract Kidney transplantation has emerged as the preferred treatment for end-stage renal disease. Despite excellent short-term outcomes with standard T-cell centric immunosuppression, long-term outcomes have not improved. Indeed, approximately 5,000 renal allografts fail in the United States each year. Until recently, the focus on causes for late graft failures was on calcineurin inhibitor toxicity and the effects of primary co-morbid conditions (i.e., diabetes and hypertension) or recurrent glomerular diseases. However, several recent studies have identified donor-specific antibo...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Should We Be Performing More Pancreas Transplants?
Authors: Bonner KP, Kudva YC, Stegall MD, Dean PG Abstract Pancreas transplantation can provide insulin independence, improved survival, and improved quality of life for patients with diabetes mellitus. However, there has been a steady decline in the number of pancreas transplants (either alone or with a kidney) performed in the United States over the past decade. This decline has occurred despite a steady increase in the number of diabetic patients with end stage renal disease on the kidney transplant alone waiting list. This paper will review the current status of pancreas transplantation, suggest possible explan...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Advancing Liver Transplantation.
Authors: Jadlowiec CC, Taner T Abstract Donor organ scarcity remains a major limitation in liver transplantation and accounts for a great proportion of wait list mortality. As a result, over the past decade, significant efforts have been made to increase the existing donor pool. These efforts have, in part, resulted in greater use of liver allografts following donation after cardiac death (DCD) along with suboptimal (so-called marginal) and extended criteria donors. Improved understanding of the pathophysiology underlying the inferior outcomes of the liver allografts procured after circulatory arrest has not only r...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Advancing Histocompatibility Testing for Solid Organ Transplantation - What is Needed? A Personal Opinion.
Authors: Cusick MF, Tambur AR Abstract The field of histocompatibility testing has seen significant changes and advancements in the past quarter of a century. The introduction of polymerase chain reaction amplification into routine human leukocyte antigen (HLA) typing has informed us on the magnitude of polymorphism among HLA alleles. Solid phase testing for antibodies has provided unparalleled insight into antibody specificity and the role of antibody mediated rejection in transplant outcomes. Herein, we provide a brief overview of advancements in the field that are currently in progress. We also provide our own p...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

There is a Road, No Simple Highway: Envisioning a Path to Better Long-Term Organ Transplant Survival.
Authors: Everly MJ Abstract The current half-life of a transplanted organ has not improved in a very long time. Historical reports on the causes of allograft failure have pointed to a plethora of contributing issues. However, in recent years, alloantibody-mediated injury has emerged as the major cause of allograft loss. As such, one road to advance transplant is to address this problem. There is a hope that new treatments can minimize the impact of alloantibody-mediated injury just as T-cell directed therapies developed over the last few decades have minimized the impact of T-cell mediated rejection on allograft su...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Modernization of Chronic Allograft Injury Research: Better Biomarkers, Better Studies, Better Outcomes.
Authors: Seifert ME, Mannon RB Abstract Despite dramatic improvements in acute rejection rates and short-term allograft survival, long-term allograft survival remains unchanged in the modern era, largely due to chronic allograft injury, a progressive disease that is common across all solid organ transplantation but has no proven treatment. Studies of novel diagnostic and therapeutic strategies for chronic allograft injury have been relatively sparse, in part due to the time and expense required to conduct traditional long-term clinical studies of a variably progressive disease. In this article, we review the pathop...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Kidney Transplant Survival: Transforming Early Post-Transplant Opportunities to Long-Term Success.
Authors: Mehta R, Cherukuri A, Sood P, Puttarajappa C, Hoffman W, Wu C, Shah N, Hariharan S Abstract Substantial strides have been made in improving the short-term success after kidney transplantation. Although there has been some progress, there has not been a robust improvement with respect to long-term outcomes. However, there remain many potentially modifiable transplant-specific risks to long-term patient and graft survival. In this chapter, we detail the current state of five important short-term transplant-specific clinical events. The early post-transplant events that negatively impact long-term survival di...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Advancing Lung Transplantation.
Authors: Hachem RR Abstract Lung transplantation rapidly evolved from an experimental to a conventional therapy for patients with end-stage lung disease. In recent years, approximately 4,000 lung transplants are performed annually worldwide. A shortage of suitable donor organs remains the main obstacle to increasing transplant volume. In addition, long-term outcomes remain disappointing, and the median survival after transplantation is approximately 6 years. Chronic rejection has clearly emerged as the leading obstacle to better outcomes beyond the first year after transplantation. This generally follows a progress...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

BKV Viremia and Development of De Novo DSA in Renal Transplant Recipients.
Authors: Sawinski D, Trofe-Clark J Abstract BK virus (BKV) viremia is a common complication of kidney transplantation. In 2008, we enacted a screening protocol to detect BKV infection at our institution. The cumulative incidence of BKV viremia at our center is 24%, with most cases being detected in the first year post-transplant. We have previously identified the development of de novo donor specific antibody as a consequence of BKV infection treated with immunosuppression reduction; in this report, we confirm our prior findings and extend them to include an association of both Class I and Class II antibodies with ...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

BK Virus After Kidney Transplantation: A Review of Screening and Treatment Strategies and a Summary of the Massachusetts General Hospital Experience.
Authors: Safa K, Heher E, Gilligan H, Williams W, Tolkoff-Rubin N, Wojciechowski D Abstract BK virus (BKV) is a common infection encountered after kidney transplantation. BKV is associated with a spectrum of manifestations, starting with sub-clinical viruria, followed by viremia and BKV-associated nephropathy. Standard of care includes routine post-transplant screening for BK viruria and/or viremia. Both the Kidney Disease Improving Global Outcomes and the American Society of Transplantation Infectious Diseases Community of Practice have published screening recommendations. Although they vary slightly, they both hi...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Immunologic and Infectious Complications in Highly Sensitized Patients Post-Kidney Transplantation.
Authors: Kahwaji J, Choi J, Vo A, Jordan SC Abstract Desensitization therapies evolved more than a decade ago to deal with the growing numbers of highly human leukocyte antigen sensitized patients who have an immunologic barrier to successful transplantation. Two protocols have evolved and have been adopted for primary desensitization. These include high dose intravenous immune globulin (IVIG), plasma exchange + low doses IVIG +/- rituximab. These protocols have been very successful and have extended and improved the lives of numerous sensitized patients who would otherwise languish on dialysis. Despite these succe...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Complications in Transplantation: Medication Nonadherence.
Authors: Kaiser TE, Alloway RR Abstract Following solid organ transplant, complex, lifelong medication regimens are required to prevent allograft rejection. Estimates of medication nonadherence in transplant recipients vary and may be as high as 70%. Poor medication adherence post transplant has been recognized as a contributing factor to reduced outcomes, including rejection, graft loss, and survival. Despite the numerous identified approaches for adherence assessment, there remains no gold standard. Ongoing efforts to identify optimal immunosuppressant adherence monitoring and measuring tools in an attempt to ide...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

C1q Assay Results in Complement-Dependent Cytotoxicity Crossmatch Negative Renal Transplant Candidates with Donor-Specific Antibodies: High Specificity But Low Sensitivity When Predicting Flow Crossmatch.
Authors: Arreola-Guerra JM, Morales-Buenrostro LE, Castelán N, de Santiago A, Arvizu A, Gonzalez-Tableros N, López M, Vilatobá M, Granados J, Alberú J Abstract In complement dependent cytotoxicity crossmatch negative renal transplant candidates with human leukocyte antigen donor-specific antibodies (DSA), both the presence of DSA C1q+ and the dominant DSA fluorescence were significantly associated with a positive flow cytometry crossmatch (FXM+). The C1q+ assay was highly specific, but had low sensitivity when predicting FXM+, so the clinical significance of a FXM+ in the absence of DSA ...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Risk Stratification of Human Leukocyte Antigen Class II Donor Specific Antibody Positive Patients by Immunoglobulin G Subclasses.
CONCLUSION: Patients with IgG3 subclass HLA DSA showed lower graft survival. Post-transplant monitoring for IgG subclasses rather than total IgG monitoring may identify patients at risk for graft failure. PMID: 28514591 [PubMed] (Source: Clinical Transplants)
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Annual review of transplant: kidney transplant 2012.
Authors: Dunn TB, Matas AJ Abstract This chapter highlights contributions to the body of knowledge in kidney transplant for 2012. Specifically, we focus on new developments in alloantibody and chronic allograft injury research. Also, we discuss new immunosuppressant agent trial results. One important new immunosuppressant we cover is belatacept, the first new FDA approved immunosuppressant in many years. Finally, we discuss some key peripheral studies that made 2012 an exciting year in kidney transplant research. PMID: 23721019 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Liver transplantation for hepatocellular carcinoma: past, present, and future.
Authors: Asham EH, Boktour M, Ghobrial RM Abstract Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death globally. HCC is an aggressive disease with high fatality as reflected by the close numbers of annual deaths per year from HCC and annual incidence worldwide. In the United States, HCC incidence has increased substantially during the past two decades and is projected to continue to rise. Surgical resection remains the best treatment option for anatomically resectable tumors in patients with well-preserved liver function. For patients who are not resection candidates, liver transplant...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Updates in lung transplantation.
Authors: Zamora MR Abstract The past two years have seen major advances in the lung transplant (LTX) field. In 2010, for the first time, over 3500 lungs were reported to the International Society for Heart and Lung Transplantation Registry. Widening application of extracorporeal life support as a bridge to transplant, or as intra- or postoperative support, has allowed transplantation of critically ill candidates with end-stage pulmonary parenchymal or vascular disease. Ex-vivo lung perfusion expanded the donor pool, allowing transplant teams time to evaluate non-ideal lungs or those from donation after cardiac deat...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Clinical islet transplantation: recent advances in the field.
Authors: Danobeitia JS, Fernandez LA Abstract Islet transplantation has emerged as a novel and promising surgical strategy for the treatment of type 1 diabetes mellitus. Almost a decade after the introduction of steroid-free immunosuppression, we have observed steady improvement in the success rate of islet transplantation for the treatment of patients with hypoglycemic unawareness and glycemic lability. However, cell-based therapies face several barriers for widespread success. These barriers include: limited donor pool, innate immune driven inflammation after infusion, acute and chronic immune rejection, and a la...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Cell-free DNA as a measure of transplant injury.
Authors: Sigdel TK, Sarwal MM Abstract Organ transplantation is the treatment of choice for patients with end-stage organ failure. The donor organ in the recipient body experiences several immune and non-immune related insults. Improved immunosuppressive drugs and surgical techniques and procedures have helped in the short-term outcome in terms of graft survival. However, in the absence of effective and specific methods of monitoring the transplanted organ, the long-term outcome is still far from satisfactory. Currently available methods are far from optimal as they are either not specific or are invasive. This rea...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

2012 annual literature review of donor-specific HLA antibodies after organ transplantation.
Authors: Kaneku H Abstract From the articles reviewed in the present chapter, we observed: 1. The frequency of de novo donor-specific human leukocyte antigen (HLA) antibodies (DSA) detection in different organs is very similar: ranging between 15% and 23% in kidney, 23% in pancreas, and 18% in intestinal transplant patients. Apparently, all organs can elicit humoral responses after transplantation at comparable rates. 2. Although rates of de novo DSA formation after kidney transplantation are very similar across different centers--between 15% and 23%--, the mean time to the first detection of de novo DSA is markedl...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Immunosuppression regimens to address alloantibodies in transplant recipients.
Authors: Everly MJ Abstract The purpose of immunosuppression in patients receiving a solid organ transplant is to prevent both acute and chronic rejection, while avoiding the complications of immunodeficiency such as infections and malignancy. Over the last 50 years, immunosuppressive agents have been developed and put into clinical practice to achieve this purpose. The majority of immunosuppressive agents developed during this time have focused on suppressing the T cells. T cell centric immunosuppressive development was a result of the early belief that the T cell caused an allograft to fail. However, emerging evi...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Understanding and addressing the humoral immune response in transplant recipients.
Authors: Everly MJ PMID: 23721026 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Changes in IgG subclasses of donor specific anti-HLA antibodies following bortezomib-based therapy for antibody mediated rejection.
Authors: Kannabhiran D, Everly MJ, Walker-McDermott JK, Tiongko S, Friedlander R, Putheti P, Sharma V, Dadhania D Abstract The predominant anti-HLA IgG subclass during antibody mediated rejection episodes is IgG1. Class I DSA IgG subclasses respond to single cycle of bortezomib-based therapy more frequently as compared to Class II DSA IgG subclasses. High titer Class II DSA IgG subclasses are less likely to respond to single cycle bortezomib-based therapy. Future studies are needed to determine if the response to bortezomib-based therapy is dependent on the type of DSA and/or the strength of the DSA at the time of ...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Pre-transplant presence of antibodies to MICA and HLA class I or II are associated with an earlier onset of bronchiolitis obliterans syndrome in lung transplant recipients.
Authors: Lyu DM, Grazia TJ, Benson AB, Cagle LR, Freed BM, Zamora MR Abstract Previous reports using cell-based methods (CDC-AHG) suggest that the presence of pre-transplant HLA Class I and II antibodies are associated with worse survival following lung transplantation. Similarly, antibodies to major histocompatibility complex Class I chain-related gene A (MICA) have been associated with increased graft failure following kidney transplantation. Using highly sensitive solid phase assays, we sought to determine whether the pre-transplant presence of antibodies to MICA or HLA Class I or II predicted short or long-term...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Incidences of preformed and de novo donor-specific HLA antibodies and their clinicohistological correlates in the early course of kidney transplantation.
Authors: Huang Y, Ramon D, Luan FL, Sung R, Samaniego M Abstract Our center started routine monitoring of preformed and de novo human leukocyte antigen donor-specific antibodies (DSA) in September 2010 using single antigen beads on the Luminex platform. Recipients with preformed DSA or other high immunological risk factors had serial DSA monitoring at 3, 6, and 12-months posttransplant, and low-risk recipients were screened only at 12-months. Surveillance biopsies were performed at 3, 6, and 12-months post-transplant for all recipients. In addition, for-cause biopsies and DSA testing were performed when clinically ...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Flashback to 2002: a retesting and reanalysis suggests an important role of DSA.
Authors: Reyes N Abstract In 2002, Lee et al. published the first paper describing the effect of HLA antibodies on graft failure in kidney transplant patients, yet remained skeptical as to why some patient grafts were surviving years longer than others while testing positive for HLA antibodies. Through a retesting and reanalysis of these patient samples, we confirm the effect that HLA antibodies had on graft failure. Furthermore, our data suggests an explanation for the discrepancy in patient graft survival lasting significant periods of time with HLA antibodies. Through use of updated technology by Luminex testing...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Immune responses to self-antigens (autoimmunity) in allograft rejection.
Authors: Ramachandran S, Subramanian V, Mohanakumar T Abstract Many lung, heart, and kidney transplant recipients with clinically as well as pathologically diagnosed chronic rejection don't have detectable antibodies directed to the mismatched donor HLA in their sera. This has led to the hypothesis that antibody responses to other tissue-restricted antigens may contribute to the development of chronic rejection. Development of immune responses to self-antigens has been described following all solid organ transplantations. Studies have further presented evidence for a significant cross talk between the alloimmune an...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Understanding trends and predictors of outcome in elderly renal transplant recipients: an analysis of the UNOS registry.
This report aims to give an actual overview of outcomes in deceased donor transplantation of advanced age recipients, by comparing graft and patient survival of transplants recorded in the United Network for Organ Sharing registry from 2000 to 2012, between three age groups: 70-84, 50-69, and 35-49 years of age. Subsequently, risk factors for graft failure and death were analyzed for elderly (70-84 years) recipients and their mortality compared to young (35-49 years) recipients. Elderly recipients showed higher death-censored graft survival and lower patient survival (log-rank p
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Donor risk factors in orthotopic liver transplant: analysis of the OPTN/UNOS registry.
This study of the United Network for Organ Sharing registry data analyzed reputed donor factors using the post-MELD data and evaluated them further in HCV positive and HCV negative recipients with hepatic cirrhosis to develop a modified DRI (mDRI). We found that HCV negative cirrhotic recipients have generally higher tolerance against inferior qualities of donors than HCV positive cirrhotic patients. In addition, the results revealed the post-MELD prognostic factors that should be considered in the donor procurement processes. The group of "all recipients" and the subset of HCV positive cirrhotic recipients showe...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Causes of graft failure in simultaneous pancreas-kidney transplantation by various time periods.
Authors: Wakil K, Sugawara Y, Kokudo N, Kadowaki T Abstract Data collected by the United Network for Organ Sharing from all approved United States transplant programs was analyzed. The data included 26,572 adult diabetic patients who received a primary pancreas transplant between January 1987 and December 2012. Simultaneous pancreas-kidney (SPK) transplantation was the major therapeutic option for diabetes patients. SPK had better graft survival than pancreas transplant alone (PTA) or pancreas-after-kidney (PAK) or pancreas-with-kidney (from a living donor, PWK). The 5-year pancreas graft survival rates for SPK, PW...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Heart transplantation in an aging society: an analysis of 25 years of the OPTN/UNOS registry.
Authors: Hörmann M, Everly MJ Abstract The annual number of adult heart transplantations in the United States is still low due to a lack of donor organs. Median long-term survival has been improved by about 1.7 years over the last 12 years. The aging of society is reflected in the United Network for Organ Sharing data, with more patients older than 70 years old receiving cardiac transplantation. The rate of acute rejection is higher in the group of younger patients, whereas older patients suffer from renal failure. They die more often from infection and malignancies, most likely due to immunosuppression. In th...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Kidney failure requiring kidney transplantation after pancreas transplant alone.
In conclusion, KF/KT after PTA was not uncommon (9.7% at 5 years), and prospective PTA recipients should be aware of the risks of kidney failure after transplantation. PMID: 25095491 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Report from the Japan Registry of Pancreas Transplantation (2000-2012): outcomes of pancreas transplantation from marginal donors.
Authors: Ito T, Gotoh M Abstract One hundred forty-eight pancreas transplants [119 simultaneous pancreas and kidney transplantations (SPK), 20 pancreas after kidney transplantations, 9 pancreas transplants alone] from deceased donors were performed in Japan during the period from 2000 to 2012. According to Kapur's criteria, 108 out of 148 (73.0%) cases involved marginal donors. Of importance, when total cold ischemic time was more than 12 hours, early pancreas graft loss (first 3 months posttransplantation) significantly increased. Other donor-related risk factors such as donor age, obesity, cause of death, and mar...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

2013 annual literature review of donor-specific HLA antibodies after organ transplantation.
Authors: Kaneku H Abstract 1. There is still a need to better differentiate clinically relevant from irrelevant DSA in all organs. Modified bead assay testing for different immunoglobulin (Ig) G characteristics (Clq-fixing DSA, C4d-fixing DSA, IgG subclasses, or IgM) often improve the predictive value for rejection and failure compared to standard IgG DSA. A new approach looking for intragraft DSA instead of serum DSA represents a very interesting attempt. The relevance of DSA may not solely be determined by antibody characteristics, but may be in the capacity of an antibody to bind specific antigens on the allogra...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research

Progress and outcomes of the first high-volume pediatric liver transplantation program in Saudi Arabia.
Authors: Fayyad A, Shagrani M, AlGoufi T, ElSheikh Y, Murray J, Elgohary A, AlSebayel M, Burdelski M, Broering DC Abstract In 2010, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, established a dedicated Organ Transplant Center to overcome the inadequacy in transplantation care in the region. Due to the high need for solid organ transplantation in children, this center focused on pediatric transplantation. Between 2011 and 2013, a total of 112 pediatric liver transplantations have been performed in our center, mostly from living donors (n=103, 92%). Eight percent of transplants were perfo...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research