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...
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 rela...
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-specif...
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 possib...
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 n...
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 ...
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 all...
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 t...
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 su...
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...
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 antibod...
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, the...
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 th...
Source: Clinical Transplants - May 20, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
