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 attem...
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 C1q+ remains to...
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 t...
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 car...
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,...
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....
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 i...
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, eme...
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...
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 ...
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 cl...
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 Lumine...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
