Community-acquired respiratory viruses.
Abstract PURPOSE OF REVIEW: Community-acquired respiratory viruses (CARV) have been historically linked to upper respiratory tract infections; however, new data has emerged in recent years that has provided new insight into their role as causative pathogens for lower respiratory tract infections. We aim to discuss the importance of recognition of viruses both epidemiologically and clinically as causes of lower respiratory tract infection. RECENT FINDINGS: With advances of molecular testing it is now possible to identify viruses from clinical specimens which have many implications that range from therapeutics ...
Source: Current Opinion in Organ Transplantation - June 11, 2019 Category: Transplant Surgery Authors: Dominguez F, Blodget E Tags: Curr Opin Organ Transplant Source Type: research

Innovations in kidney paired donation transplantation.
Abstract PURPOSE OF REVIEW: To analyze the innovations that have increased the reliability, convenience, and outcomes of kidney paired donation (KPD) that has led to thousands of living donor kidney transplants across the United States. RECENT FINDINGS: Over the past 10 years, KPD has grown over 200% on an annual basis. Though concerns had existed over cold ischemia time, research has shown that there is no correlation between travel time of a shipped kidney and the transplant outcome. The voucher program has started to continue to expand how to overcome obstacles to donation by solving the issue of a pair ch...
Source: Current Opinion in Organ Transplantation - June 11, 2019 Category: Transplant Surgery Authors: D'Alessandro T, Veale JL Tags: Curr Opin Organ Transplant Source Type: research

Coccidioidomycosis in solid organ transplant recipients.
Abstract PURPOSE OF REVIEW: The purpose of the review is an update of diagnosis and treatment of coccidioidomycosis infection in solid organ transplant (SOT) patients. Endemic fungal infections continue to be a cause of serious morbidity and mortality in transplant recipients. RECENT FINDINGS: In transplant patients there are recommendations regarding screening in areas that are endemic for coccidioidomycosis. This screening involves serologic testing and chest imaging. In endemic areas pretransplant seropositivity varies from 1.4 to 5.6%. In immunocompromised patients with elevated complement fixation titers...
Source: Current Opinion in Organ Transplantation - June 11, 2019 Category: Transplant Surgery Authors: Nanayakkara DD, Blodget E Tags: Curr Opin Organ Transplant Source Type: research

Carbapenemase-producing organisms in solid organ transplantation.
Abstract PURPOSE OF REVIEW: Carbapenem-resistant enterobacteriaceae (CRE) are a critical healthcare threat. Infections caused by CRE disproportionately affect transplant patients. Retrospective case studies suggest that up to 10% of transplant recipients develop a CRE infection. The current literature is reviewed with a particular focus on transplant-specific implications. RECENT FINDINGS: There are specific risks inherent to transplant recipients that result in an elevated risk for CRE carriage and subsequent infection. Additionally, the manifestations of these infections are dependent on the specific transp...
Source: Current Opinion in Organ Transplantation - June 4, 2019 Category: Transplant Surgery Authors: Wong D, van Duin D Tags: Curr Opin Organ Transplant Source Type: research

Current state of organ transplant tolerance.
Abstract PURPOSE OF REVIEW: Immunological tolerance has long been considered the 'holy grail' of organ transplantation. Although tolerance has been an active area of research for 70 years, its clinical application has only been possible in the last two decades and widespread use remains an, as yet, unattained goal. Recent advances in the understanding of immune regulation have identified many new approaches to tolerance induction and several clinical trials are currently aimed at bringing this treatment to more patients. RECENT FINDINGS: Mixed chimerism remains the most successful approach to tolerance induct...
Source: Current Opinion in Organ Transplantation - June 4, 2019 Category: Transplant Surgery Authors: Rickert CG, Markmann JF Tags: Curr Opin Organ Transplant Source Type: research

Editorial: Circulating antibodies in heart transplantation.
PMID: 31090626 [PubMed - in process] (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Kobashigawa JA Tags: Curr Opin Organ Transplant Source Type: research

Impact of pretransplant antibodies on outcomes after heart transplantation.
Abstract PURPOSE OF REVIEW: Since the discovery of human leukocyte antigen (HLA) in the 1950s, there has been great interest in the role of antibodies in posttransplant rejection. The development of the lymphocyte toxicity test by Terasaki et al. in the 1960s was the first step toward understanding the role of antibodies in posttransplant rejection. RECENT FINDINGS: Subsequently, various organs have been transplanted and improving posttransplant outcomes have become a focus of research. In particular, methods to measure antibodies that affect posttransplant outcomes, including anti-HLA antibodies, and methods...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Nunoda S Tags: Curr Opin Organ Transplant Source Type: research

Crossing low-level donor-specific antibodies in heart transplantation.
Abstract PURPOSE OF REVIEW: Donor-specific antibodies (DSA) detected by solid-phase single-antigen bead (SAB) immunoassays have been associated with antibody-mediated rejection (AMR), cardiac allograft vasculopathy (CAV) and decreased survival after heart transplantation. The clinical relevance of low-level DSA is equivocal. This review examines the techniques used to define low-level DSA, the limitations of these techniques and recent clinical experience crossing low-level DSA. RECENT FINDINGS: Solid-phase multiplex bead immunoassays were introduced to solid-organ transplantation over 15 years ago. These tec...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Olymbios M, Kobashigawa JA Tags: Curr Opin Organ Transplant Source Type: research

Desensitization for sensitized patients awaiting heart transplant.
Abstract PURPOSE OF REVIEW: This review summarizes contemporary desensitization strategies for patients awaiting cardiac transplantation in an era when specific management is still somewhat controversial. RECENT FINDINGS: The number of sensitized patients awaiting heart transplantation is rising. Clinical assessment of antibody levels is mostly focused on human leukocyte antigen (HLA) antibodies. Sensitization to HLA antigens increases the risk of antibody medicated rejection and cardiac allograft vasculopathy after transplant, thus translates to reduced access to compatible donors and increased wait time to ...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Byku M, Chang PP Tags: Curr Opin Organ Transplant Source Type: research

Does the Canadian allocation system for highly sensitized patients work?
Abstract PURPOSE OF REVIEW: The number of sensitized heart transplant candidates is rising. Highly sensitized patients are disadvantaged because they encounter longer waiting times to heart transplant. Strategies to reduce their waiting times include waitlist prioritization and desensitization therapies. The purpose of this review is to describe the listing category for highly sensitized patients in the Canadian allocation system, examine the advantages and limitations of this strategy and provide an approach to the management of the highly sensitized patient awaiting heart transplant. RECENT FINDINGS: Analys...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Aleksova N, Ross HJ Tags: Curr Opin Organ Transplant Source Type: research

The clinical impact of donor-specific antibodies on antibody-mediated rejection and long-term prognosis after heart transplantation.
Abstract PURPOSE OF REVIEW: Outcomes after cardiac transplantation have improved over past decades, but long-term graft survival remains limited in part because of uncertainty regarding clinical implications of donor-specific antibodies (DSAs). The purpose of this review is to consolidate recent advances in knowledge on the topic of DSA and their potential to impact long-term prognosis after heart transplantation. RECENT FINDINGS: The presence of persistent DSA increases the risk of poor outcome after heart transplantation, including development of antibody-mediated rejection (AMR), graft failure, cardiac all...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Su JA, Baxter-Lowe LA, Kantor PF, Szmuszkovicz JR, Menteer J Tags: Curr Opin Organ Transplant Source Type: research

The meaning of donor-specific antibodies after heart transplant.
Abstract PURPOSE OF REVIEW: Antibody-mediated rejection (AMR) is a major contributor of impaired long-term survival after heart transplantation (HTx). The presence of circulating donor-specific antihuman leukocyte antigen (HLA) antibodies (DSAs) is considered as a mandatory criterion for AMR after HTx. DSA are known prognostic biomarkers of outcome, for example, recipients with de-novo DSA have a three-fold increased risk of mortality. RECENT FINDINGS: Although the awareness of the impact and prognosis of DSA on the survival has been increased in the HTx community over the last decade, the management of DSA p...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Barten MJ, Zuckermann A Tags: Curr Opin Organ Transplant Source Type: research

The impact of asymptomatic antibody-mediated rejection on outcome after heart transplantation.
Abstract PURPOSE OF REVIEW: Defining criteria for antibody-mediated rejection (AMR) in heart transplantation were standardized a few years ago, but very little is known about asymptomatic cardiac AMR. We will start the review with a background summarizing the timeline of cardiac AMR. Then we will cover past and current knowledge about asymptomatic cardiac AMR and its impact on outcome after transplantation, with added insight from experience with other solid-organ transplants. RECENT FINDINGS: The incidence of asymptomatic cardiac AMR had likely been under-estimated because biopsy surveillance for it in the a...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Kfoury AG, Miller DV Tags: Curr Opin Organ Transplant Source Type: research

Does the antibody mediated rejection grading scale have prognostic prediction? Yes, but the picture is still blurry.
Abstract PURPOSE OF REVIEW: Antibody-mediated rejection (ABMR) is a condition difficult to diagnose and treat, which may significantly impair the outcome of heart transplant recipients. In clinical practice, diagnosis is based on immunopathology grading of endomyocardial biopsies (EMB). Despite its value, the current diagnostic system has several pitfalls that have been addressed in recent literature. RECENT FINDINGS: Pathology grading of ABMR (pAMR) has a relevant prognostic factor. However, it does not capture several nuances, such as chronic vs. acute ABMR, mixed rejection or microvascular inflammation. Mo...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Potena L, Moriconi V, Sabatino M, Agostini V, Leone O Tags: Curr Opin Organ Transplant Source Type: research

When to intervene for donor-specific antibody after heart transplantation.
Abstract PURPOSE OF REVIEW: Posttransplant donor-specific human leukocyte antigen (HLA) antibodies (DSA) represent a complex area in heart transplantation with nonstandardized practice and paucity of clinical data to guide optimal management. RECENT FINDINGS: De novo DSA after heart transplantation is common and associated with rejection, cardiac allograft vasculopathy, allograft failure, and mortality. Advances in methods for HLA antibody detection have enabled identification of DSA with high precision and sensitivity. The detection of HLA antibodies must, however, be interpreted within appropriate laborator...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Njue F, Chih S Tags: Curr Opin Organ Transplant Source Type: research

Nonhuman leukocyte antigen antibodies that have impact in the heart transplant patient.
Abstract PURPOSE OF REVIEW: Despite human leukocyte antigen (HLA) matching and monitoring for donor-specific HLA antibodies, antibody-mediated rejection and chronic rejection in the form of allograft vasculopathy and chronic graft dysfunction continue to occur. There has been increasing interest in non-HLA antibodies as mediators of these changes. RECENT FINDINGS: In this review, we discuss the recent literature describing the importance of non-HLA antibodies in organ transplantation and summarize the literature evaluating such antibodies in heart transplantation. SUMMARY: Monitoring of non-HLA antibodie...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Reddy YNV, Pereira NL Tags: Curr Opin Organ Transplant Source Type: research

Editorial: Current opinion in organ transplantation: lung transplantation.
PMID: 31090637 [PubMed - in process] (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Glanville AR Tags: Curr Opin Organ Transplant Source Type: research

Lung donation after circulatory death.
Abstract PURPOSE OF REVIEW: The current review presents a concise update on published literature on donation after circulatory death (DCD) and lung transplantation (LTx). Worldwide an increasing need for lungs is evident, however the utilization rate of DCD lung donors is still considerably low. In this summary article, we reviewed both the experimental background and international clinical experience. RECENT FINDINGS: Our analysis confirmed satisfactory results for LTx from DCD donors, which equals the results from donation after brain death. Although most studies reported on short-term results, some confirm...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Ceulemans LJ, Inci I, Van Raemdonck D Tags: Curr Opin Organ Transplant Source Type: research

Ex-vivo lung perfusion and ventilation: where to from here?
Abstract PURPOSE OF REVIEW: Within the last decade, ex-vivo lung perfusion (EVLP) has become a widespread technology used for organ assessment and reconditioning within clinical transplantation. This review aims to offer insights toward future applications and developments in regards to its utility. RECENT FINDINGS: The intervention of EVLP is a well-tolerated method to effectively allow for extended preservation periods. The thoughtful usage of EVLP can therefore be used to optimize operating room logistics and progress lung transplantation toward becoming a more elective procedure. EVLP has also demonstrate...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Ali A, Cypel M Tags: Curr Opin Organ Transplant Source Type: research

The lung microbiome and transplantation.
Abstract PURPOSE OF REVIEW: Lung transplantation survival is still limited compared with other solid organ transplant modalities, due to a range of factors that are continuing to be elucidated. However, new research is emerging which indicates that the microbiome of the lungs, and of other organs, may have important implications for immune response and mediating transplant outcomes. Pathogenic bacterial and viral species are known to have deleterious effects on the allograft, but taking a more global view, and considering the overall composition of the community of microbial species may undercover a greater unders...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Mitchell AB Tags: Curr Opin Organ Transplant Source Type: research

Community-acquired respiratory viruses.
Abstract PURPOSE OF REVIEW: Incidence of community-acquired respiratory viruses (CARVs) after lung transplantation (LTx) is 10-68 cases per 100 patient-years. Infected patients may develop graft failure and there seems to be an association between CARV infection and development of chronic lung allograft dysfunction (CLAD). This review summarizes the impact of CARV infection after LTx and potential treatment strategies. RECENT FINDINGS: Detection rate of CARV depends on diagnostic methods. CARV infections after LTx are reported more frequently probably attributed to improved diagnostic methods, especially nucl...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Gottlieb J Tags: Curr Opin Organ Transplant Source Type: research

Chronic lung allograft dysfunction: light at the end of the tunnel?
Abstract PURPOSE OF REVIEW: Chronic lung allograft dysfunction (CLAD) has been recently introduced as an umbrella-term encompassing all forms of chronic pulmonary function decline posttransplant with bronchiolitis obliterans syndrome and restrictive allograft syndrome as the most important subtypes. Differential diagnosis and management, however, remains complicated. RECENT FINDINGS: Herein, we provide an overview of the different diagnostic criteria (pulmonary function, body plethysmography and radiology) used to differentiate bronchiolitis obliterans syndrome and restrictive allograft syndrome, their advant...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Verleden SE, Vos R, Verleden GM Tags: Curr Opin Organ Transplant Source Type: research

Pediatric lung transplantation: supply and demand.
Abstract PURPOSE OF REVIEW: Lung transplantation has become an accepted therapy in infants, children, and adolescents suffering from end-stage lung diseases, an impaired quality of life and reduced life expectancy. The aim of this review is to highlight specific aspects of pediatric lung transplantation and to give an update on recent findings. RECENT FINDINGS: Currently, over 100 lung transplant procedures are performed in children annually worldwide. Long-term success is limited by availability of donor organs and waitlist mortality pretransplant, and an increased infection risk because of immunosuppression...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Benoit TM, Benden C Tags: Curr Opin Organ Transplant Source Type: research

Editorial: Ethical considerations in expanding the organ supply.
PMID: 31090644 [PubMed - in process] (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Axelrod DA Tags: Curr Opin Organ Transplant Source Type: research

Assessing the outcome of organ allocation: choosing metrics.
Abstract PURPOSE OF REVIEW: Organ allocation is a highly complex process with significant impact on outcomes of donor organs and end-stage organ disease patients. Policies governing allocation must incorporate numerous factors to meet stated objective. There have been significant alterations and ongoing discussion about changes in allocation policy for all solid organs in the United States. As with any policy change, rigorous evaluation of the impact of changes is important. RECENT FINDINGS: This manuscript discusses metrics to consider to evaluate the impact of organ allocation policy that may be monitored o...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Schold JD Tags: Curr Opin Organ Transplant Source Type: research

Geographic inequity in transplant access.
Abstract PURPOSE OF REVIEW: Scarcity is a defining feature of the modern transplant landscape, and in light of chronic shortages in donor organs, there is cause for concern about geographic inequities in patients' access to lifesaving resources. Recent policy changes designed to ameliorate unequal donor supply and demand have brought new interest to measuring and addressing disparities at all stages of transplant care. The purpose of this review is to describe an overview of recent literature on geographic inequities in transplant access, focusing on kidney, liver, and lung transplantation and the impact of policy...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Lynch RJ, Patzer RE Tags: Curr Opin Organ Transplant Source Type: research

Current practices in deceased organ donor management.
Abstract PURPOSE OF REVIEW: Optimizing the management of deceased organ donors focuses on providing critical care that prevents, mitigates, or repairs the pathophysiologic sequelae of brain death. This review discusses protocol-based care; approaches to monitoring, resuscitation, hormone replacement therapy, and respiratory management; and the potential of various additional donor therapies. RECENT FINDINGS: Protocol-based critical care after the determination of brain death has the potential to substantially increase the quantity and improve the quality of organs available for transplantation. Close hemodyna...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Patel MS, Abt PL Tags: Curr Opin Organ Transplant Source Type: research

Balancing the risk and rewards of utilizing organs from hepatitis C viremic donors.
Abstract PURPOSE OF REVIEW: Owing to long waitlist times and high waitlist morbidity and mortality, strategies to increase utilization of hepatitis C viremic-deceased donor organs are under investigation in kidney, liver, heart, and lung transplantation. RECENT FINDINGS: Direct-acting antiviral medications for hepatitis C virus infection have high cure rates and are well tolerated. Small, single-center trials in kidney and heart transplant recipients have demonstrated that with early posttransplant direct-acting antiviral therapy, 100% of uninfected recipients of hepatitis C viremic organs have been cured of ...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Sise ME, Strohbehn IA, Bethea E, Gustafson JL, Chung RT Tags: Curr Opin Organ Transplant Source Type: research

Uncontrolled donation after circulatory death: ethics of implementation.
This article addresses the ethical concerns that arise in the implementation of uDCD. RECENT FINDINGS: The first ethical concern is that associated with the determination of an irreversible cardiac arrest. Professionals must strictly adhere to local protocols and international standards on advanced cardiopulmonary resuscitation, independent of their participation in an uDCD program. Cardiac compression and mechanical ventilation are extended beyond futility during the transportation of potential uDCD donors to the hospital with the sole purpose of preserving organs. Importantly, potential donors remain monitored while...
Source: Current Opinion in Organ Transplantation - May 17, 2019 Category: Transplant Surgery Authors: Molina M, Domínguez-Gil B, Pérez-Villares JM, Andrés A Tags: Curr Opin Organ Transplant Source Type: research

Uncontrolled donation after circulatory death: ethics of implementation
This article addresses the ethical concerns that arise in the implementation of uDCD. Recent findings The first ethical concern is that associated with the determination of an irreversible cardiac arrest. Professionals must strictly adhere to local protocols and international standards on advanced cardiopulmonary resuscitation, independent of their participation in an uDCD program. Cardiac compression and mechanical ventilation are extended beyond futility during the transportation of potential uDCD donors to the hospital with the sole purpose of preserving organs. Importantly, potential donors remain monitored while be...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: ETHICAL CONSIDERATIONS OF ALLOCATION: Edited by David A. Axelrod Source Type: research

Balancing the risk and rewards of utilizing organs from hepatitis C viremic donors
Purpose of review Owing to long waitlist times and high waitlist morbidity and mortality, strategies to increase utilization of hepatitis C viremic-deceased donor organs are under investigation in kidney, liver, heart, and lung transplantation. Recent findings Direct-acting antiviral medications for hepatitis C virus infection have high cure rates and are well tolerated. Small, single-center trials in kidney and heart transplant recipients have demonstrated that with early posttransplant direct-acting antiviral therapy, 100% of uninfected recipients of hepatitis C viremic organs have been cured of infection after tran...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: ETHICAL CONSIDERATIONS OF ALLOCATION: Edited by David A. Axelrod Source Type: research

Current practices in deceased organ donor management
Purpose of review Optimizing the management of deceased organ donors focuses on providing critical care that prevents, mitigates, or repairs the pathophysiologic sequelae of brain death. This review discusses protocol-based care; approaches to monitoring, resuscitation, hormone replacement therapy, and respiratory management; and the potential of various additional donor therapies. Recent findings Protocol-based critical care after the determination of brain death has the potential to substantially increase the quantity and improve the quality of organs available for transplantation. Close hemodynamic monitoring with ...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: ETHICAL CONSIDERATIONS OF ALLOCATION: Edited by David A. Axelrod Source Type: research

Geographic inequity in transplant access
Purpose of review Scarcity is a defining feature of the modern transplant landscape, and in light of chronic shortages in donor organs, there is cause for concern about geographic inequities in patients’ access to lifesaving resources. Recent policy changes designed to ameliorate unequal donor supply and demand have brought new interest to measuring and addressing disparities at all stages of transplant care. The purpose of this review is to describe an overview of recent literature on geographic inequities in transplant access, focusing on kidney, liver, and lung transplantation and the impact of policy changes on...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: ETHICAL CONSIDERATIONS OF ALLOCATION: Edited by David A. Axelrod Source Type: research

Assessing the outcome of organ allocation: choosing metrics
Purpose of review Organ allocation is a highly complex process with significant impact on outcomes of donor organs and end-stage organ disease patients. Policies governing allocation must incorporate numerous factors to meet stated objective. There have been significant alterations and ongoing discussion about changes in allocation policy for all solid organs in the United States. As with any policy change, rigorous evaluation of the impact of changes is important. Recent findings This manuscript discusses metrics to consider to evaluate the impact of organ allocation policy that may be monitored on an ongoing basis i...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: ETHICAL CONSIDERATIONS OF ALLOCATION: Edited by David A. Axelrod Source Type: research

Editorial: Ethical considerations in expanding the organ supply
No abstract available (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: ETHICAL CONSIDERATIONS OF ALLOCATION: Edited by David A. Axelrod Source Type: research

Pediatric lung transplantation: supply and demand
Purpose of review Lung transplantation has become an accepted therapy in infants, children, and adolescents suffering from end-stage lung diseases, an impaired quality of life and reduced life expectancy. The aim of this review is to highlight specific aspects of pediatric lung transplantation and to give an update on recent findings. Recent findings Currently, over 100 lung transplant procedures are performed in children annually worldwide. Long-term success is limited by availability of donor organs and waitlist mortality pretransplant, and an increased infection risk because of immunosuppression, and most important...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Allan R. Glanville Source Type: research

Chronic lung allograft dysfunction: light at the end of the tunnel?
Purpose of review Chronic lung allograft dysfunction (CLAD) has been recently introduced as an umbrella-term encompassing all forms of chronic pulmonary function decline posttransplant with bronchiolitis obliterans syndrome and restrictive allograft syndrome as the most important subtypes. Differential diagnosis and management, however, remains complicated. Recent findings Herein, we provide an overview of the different diagnostic criteria (pulmonary function, body plethysmography and radiology) used to differentiate bronchiolitis obliterans syndrome and restrictive allograft syndrome, their advantages and disadvantag...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Allan R. Glanville Source Type: research

Community-acquired respiratory viruses
Purpose of review Incidence of community-acquired respiratory viruses (CARVs) after lung transplantation (LTx) is 10–68 cases per 100 patient-years. Infected patients may develop graft failure and there seems to be an association between CARV infection and development of chronic lung allograft dysfunction (CLAD). This review summarizes the impact of CARV infection after LTx and potential treatment strategies. Recent findings Detection rate of CARV depends on diagnostic methods. CARV infections after LTx are reported more frequently probably attributed to improved diagnostic methods, especially nucleic acid testi...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Allan R. Glanville Source Type: research

The lung microbiome and transplantation
Purpose of review Lung transplantation survival is still limited compared with other solid organ transplant modalities, due to a range of factors that are continuing to be elucidated. However, new research is emerging which indicates that the microbiome of the lungs, and of other organs, may have important implications for immune response and mediating transplant outcomes. Pathogenic bacterial and viral species are known to have deleterious effects on the allograft, but taking a more global view, and considering the overall composition of the community of microbial species may undercover a greater understanding of the co...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Allan R. Glanville Source Type: research

Ex-vivo lung perfusion and ventilation: where to from here?
Purpose of review Within the last decade, ex-vivo lung perfusion (EVLP) has become a widespread technology used for organ assessment and reconditioning within clinical transplantation. This review aims to offer insights toward future applications and developments in regards to its utility. Recent findings The intervention of EVLP is a well-tolerated method to effectively allow for extended preservation periods. The thoughtful usage of EVLP can therefore be used to optimize operating room logistics and progress lung transplantation toward becoming a more elective procedure. EVLP has also demonstrated itself as an excel...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Allan R. Glanville Source Type: research

Lung donation after circulatory death
Purpose of review The current review presents a concise update on published literature on donation after circulatory death (DCD) and lung transplantation (LTx). Worldwide an increasing need for lungs is evident, however the utilization rate of DCD lung donors is still considerably low. In this summary article, we reviewed both the experimental background and international clinical experience. Recent findings Our analysis confirmed satisfactory results for LTx from DCD donors, which equals the results from donation after brain death. Although most studies reported on short-term results, some confirmed these results on ...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Allan R. Glanville Source Type: research

Editorial: Current opinion in organ transplantation: lung transplantation
No abstract available (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Allan R. Glanville Source Type: research

Nonhuman leukocyte antigen antibodies that have impact in the heart transplant patient
Purpose of review Despite human leukocyte antigen (HLA) matching and monitoring for donor-specific HLA antibodies, antibody-mediated rejection and chronic rejection in the form of allograft vasculopathy and chronic graft dysfunction continue to occur. There has been increasing interest in non-HLA antibodies as mediators of these changes. Recent findings In this review, we discuss the recent literature describing the importance of non-HLA antibodies in organ transplantation and summarize the literature evaluating such antibodies in heart transplantation. Summary Monitoring of non-HLA antibodies requires additional m...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Jon A. Kobashigawa Source Type: research

When to intervene for donor-specific antibody after heart transplantation
Purpose of review Posttransplant donor-specific human leukocyte antigen (HLA) antibodies (DSA) represent a complex area in heart transplantation with nonstandardized practice and paucity of clinical data to guide optimal management. Recent findings De novo DSA after heart transplantation is common and associated with rejection, cardiac allograft vasculopathy, allograft failure, and mortality. Advances in methods for HLA antibody detection have enabled identification of DSA with high precision and sensitivity. The detection of HLA antibodies must, however, be interpreted within appropriate laboratory and clinical conte...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Jon A. Kobashigawa Source Type: research

Does the antibody mediated rejection grading scale have prognostic prediction? Yes, but the picture is still blurry
Purpose of review Antibody-mediated rejection (ABMR) is a condition difficult to diagnose and treat, which may significantly impair the outcome of heart transplant recipients. In clinical practice, diagnosis is based on immunopathology grading of endomyocardial biopsies (EMB). Despite its value, the current diagnostic system has several pitfalls that have been addressed in recent literature. Recent findings Pathology grading of ABMR (pAMR) has a relevant prognostic factor. However, it does not capture several nuances, such as chronic vs. acute ABMR, mixed rejection or microvascular inflammation. Molecular biology-base...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Jon A. Kobashigawa Source Type: research

The impact of asymptomatic antibody-mediated rejection on outcome after heart transplantation
Purpose of review Defining criteria for antibody-mediated rejection (AMR) in heart transplantation were standardized a few years ago, but very little is known about asymptomatic cardiac AMR. We will start the review with a background summarizing the timeline of cardiac AMR. Then we will cover past and current knowledge about asymptomatic cardiac AMR and its impact on outcome after transplantation, with added insight from experience with other solid-organ transplants. Recent findings The incidence of asymptomatic cardiac AMR had likely been under-estimated because biopsy surveillance for it in the absence of clinical m...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Jon A. Kobashigawa Source Type: research

The meaning of donor-specific antibodies after heart transplant
Purpose of review Antibody-mediated rejection (AMR) is a major contributor of impaired long-term survival after heart transplantation (HTx). The presence of circulating donor-specific antihuman leukocyte antigen (HLA) antibodies (DSAs) is considered as a mandatory criterion for AMR after HTx. DSA are known prognostic biomarkers of outcome, for example, recipients with de-novo DSA have a three-fold increased risk of mortality. Recent findings Although the awareness of the impact and prognosis of DSA on the survival has been increased in the HTx community over the last decade, the management of DSA pre and posttransplan...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Jon A. Kobashigawa Source Type: research

The clinical impact of donor-specific antibodies on antibody-mediated rejection and long-term prognosis after heart transplantation
Purpose of review Outcomes after cardiac transplantation have improved over past decades, but long-term graft survival remains limited in part because of uncertainty regarding clinical implications of donor-specific antibodies (DSAs). The purpose of this review is to consolidate recent advances in knowledge on the topic of DSA and their potential to impact long-term prognosis after heart transplantation. Recent findings The presence of persistent DSA increases the risk of poor outcome after heart transplantation, including development of antibody-mediated rejection (AMR), graft failure, cardiac allograft vasculopathy,...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Jon A. Kobashigawa Source Type: research

Does the Canadian allocation system for highly sensitized patients work?
Purpose of review The number of sensitized heart transplant candidates is rising. Highly sensitized patients are disadvantaged because they encounter longer waiting times to heart transplant. Strategies to reduce their waiting times include waitlist prioritization and desensitization therapies. The purpose of this review is to describe the listing category for highly sensitized patients in the Canadian allocation system, examine the advantages and limitations of this strategy and provide an approach to the management of the highly sensitized patient awaiting heart transplant. Recent findings Analysis of data from the ...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Jon A. Kobashigawa Source Type: research

Desensitization for sensitized patients awaiting heart transplant
Purpose of review This review summarizes contemporary desensitization strategies for patients awaiting cardiac transplantation in an era when specific management is still somewhat controversial. Recent findings The number of sensitized patients awaiting heart transplantation is rising. Clinical assessment of antibody levels is mostly focused on human leukocyte antigen (HLA) antibodies. Sensitization to HLA antigens increases the risk of antibody medicated rejection and cardiac allograft vasculopathy after transplant, thus translates to reduced access to compatible donors and increased wait time to transplant. Desensit...
Source: Current Opinion in Organ Transplantation - May 16, 2019 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Jon A. Kobashigawa Source Type: research