Editorial: The cutting edge of donor-specific antibodies in transplantation.
PMID: 33105197 [PubMed - in process] (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - October 28, 2020 Category: Transplant Surgery Authors: Mandelbrot DA Tags: Curr Opin Organ Transplant Source Type: research

Donor-specific antibodies in liver transplantation: challenges in diagnosis and determining clinical impact.
Abstract PURPOSE OF REVIEW: Our understanding of the clinical impact of donor-specific antibodies in liver transplant recipients has evolved in recent years as outcomes for liver allografts have improved and advances in diagnostic testing have made recognition of antibody mediated rejection in transplant patients more sensitive. RECENT FINDINGS: Two main types of donor-specific antibodies - preformed and de novo - have been reported in the literature to have a negative impact on graft survival, and researchers have been able to further identify subclasses of class II donor-specific antibodies as being the mos...
Source: Current Opinion in Organ Transplantation - October 28, 2020 Category: Transplant Surgery Authors: Kim SC, Foley DP Tags: Curr Opin Organ Transplant Source Type: research

Donor-specific antibodies in lung transplantation.
Abstract PURPOSE OF REVIEW: The development of donor-specific antibodies (DSA) after lung transplantation has been recognized as an important risk factor for poor outcomes over the past 20 years. Recently, this has been a focus of intense research, and the purpose of this review is to summarize our current understanding of humoral responses and important recent findings as well as to identify areas of future research. RECENT FINDINGS: Recent studies have identified donor-derived cell-free DNA (ddcfDNA) as an important biomarker associated with antibody-mediated rejection (AMR). Importantly, ddcfDNA levels are...
Source: Current Opinion in Organ Transplantation - October 28, 2020 Category: Transplant Surgery Authors: Hachem RR Tags: Curr Opin Organ Transplant Source Type: research

Ethical and societal challenges in penis transplantation.
Abstract PURPOSE OF REVIEW: To review the current understanding of the ethical and societal difficulties of penile transplantation. RECENT FINDINGS: Penile transplantation, as with other forms of vascularized composite allotransplantation, has increasing acceptance in society but is still not entirely accepted. Guidelines aiming to help guide future penile transplant programs in an ethical and scientific safe manner were created. Controversies regarding the economic impact, patient safety, and the rights of the patients choosing penile transplant remains. SUMMARY: Penile transplantation has excellent fun...
Source: Current Opinion in Organ Transplantation - October 28, 2020 Category: Transplant Surgery Authors: van der Merwe A, Moosa MR, Barsdorf N Tags: Curr Opin Organ Transplant Source Type: research

The current status and outlook of trachea transplantation.
Abstract PURPOSE OF REVIEW: The trachea is an enigmatic organ due to its complex morphology. Although circumferential tracheal defects are extremely difficult to repair with autologous tissue or with an allotransplant, the trachea has been touted as the first organ that could be regenerated. This review provides a comprehensive evaluation of the published evidence in tracheal tissue replacement surgery. RECENT FINDINGS: In recent years, reports of successful tracheal regeneration have attracted great interest. Despite descriptions of the trachea as a perhaps uniquely regeneratable tissue since 2008, critical ...
Source: Current Opinion in Organ Transplantation - October 28, 2020 Category: Transplant Surgery Authors: Vranckx JJ, Delaere P Tags: Curr Opin Organ Transplant Source Type: research

Limitations and limits and of vascularized composite allotransplantations: can we reach the holy grail?
Abstract PURPOSE OF REVIEW: In recent times, vascularized composite allotransplantation (VCA) have been gaining more attention and applications. Currently, VCA are at the highest level of the reconstruction pyramid, and thus the effects expected after them are intended to outweigh what the 'classical' reconstructive surgery can offer us, including even the most advanced microsurgical techniques. RECENT FINDINGS: Over 40 patients have received a partial or full-face transplant. Others have received penis, uterus, larynx, abdominal wall, and lower extremity transplants. Each type of VCA has its own problems and...
Source: Current Opinion in Organ Transplantation - October 28, 2020 Category: Transplant Surgery Authors: Grajek M, Bula D, Zeman M, Maciejewski A Tags: Curr Opin Organ Transplant Source Type: research

The use of organs from hepatitis C virus-viremic donors into uninfected recipients.
Abstract PURPOSE OF REVIEW: There has been an ongoing disparity between the number of organs available for solid organ transplantation (SOT) relative to the need. This has resulted in significant waitlist mortality, may affect transplant outcomes due to transplants being performed on sicker patients and may even increase healthcare costs due to extended hospital stays. Transplanting organs from hepatitis C virus (HCV)-infected donors into uninfected recipients (D+/R-) is now a reality, due to the advent of highly affective direct-acting antivirals (DAAs) which not only have very high efficacy, but also a favorable...
Source: Current Opinion in Organ Transplantation - October 28, 2020 Category: Transplant Surgery Authors: Kahn JA Tags: Curr Opin Organ Transplant Source Type: research

Expedited placement to maximize utilization of marginal organs.
Abstract PURPOSE OF REVIEW: Deceased donation represents the largest supply of organs for transplant in the United States. Organs with suboptimal characteristics related to donor disease or recovery-related issues are increasingly discarded at the time of recovery, prompting late allocation to candidates later in the match sequence. Late allocation contributes to organ injury by prolonging cold ischemia, which may further lead to the risk of organ discard, despite the potential to provide benefit to certain transplant candidates. RECENT FINDINGS: Expedited placement of marginal organs has emerged as a strateg...
Source: Current Opinion in Organ Transplantation - October 28, 2020 Category: Transplant Surgery Authors: Giorgakis E, Mathur AK Tags: Curr Opin Organ Transplant Source Type: research

Expedited placement to maximize utilization of marginal organs
Purpose of review Deceased donation represents the largest supply of organs for transplant in the United States. Organs with suboptimal characteristics related to donor disease or recovery-related issues are increasingly discarded at the time of recovery, prompting late allocation to candidates later in the match sequence. Late allocation contributes to organ injury by prolonging cold ischemia, which may further lead to the risk of organ discard, despite the potential to provide benefit to certain transplant candidates. Recent findings Expedited placement of marginal organs has emerged as a strategy to address the gro...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: RISK OF DISEASE TRANSMISSION IN AN EXPANDED DONOR POPULATION: Edited by Jeffery A. Kahn Source Type: research

Risk of disease transmission in an expanded donor population: the potential of hepatitis B virus donors
Purpose of review Lack of availability of donor organs is a constant challenge that patients and providers face in transplantation. To address this shortage, donors that test positive for hepatitis B, in particular those with resolved infection, have been increasingly utilized in clinical practice. We review here the potential risks for the recipient and the advances in hepatitis B management that have made use of these donors a well tolerated and advisable proposition. Recent findings As routine administration of antiviral prophylaxis in the posttransplant setting among those deemed high risk for transmission, outcom...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: RISK OF DISEASE TRANSMISSION IN AN EXPANDED DONOR POPULATION: Edited by Jeffery A. Kahn Source Type: research

Human immunodeficiency virus from life taking to life giving: expanding the donor pool by using HIV-positive donors
We report the risks and benefits of utilizing HIV-positive organ donors. Recent findings The utilization of HIV-positive organs came with significant concerns including poor organ quality, increased risk of rejection, HIV disease progression, transmission of varying HIV strains and opportunistic infections, virologic failure due to antiretroviral resistance, increased risk for posttransplant malignancy, and recurrent HIV-associated nephropathy. Recently published data have shown, however, that despite the above mentioned risks, patient survival, and graft survival in persons living with HIV (PLWH) who received a kidney ...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: RISK OF DISEASE TRANSMISSION IN AN EXPANDED DONOR POPULATION: Edited by Jeffery A. Kahn Source Type: research

The use of organs from hepatitis C virus-viremic donors into uninfected recipients
Purpose of review There has been an ongoing disparity between the number of organs available for solid organ transplantation (SOT) relative to the need. This has resulted in significant waitlist mortality, may affect transplant outcomes due to transplants being performed on sicker patients and may even increase healthcare costs due to extended hospital stays. Transplanting organs from hepatitis C virus (HCV)-infected donors into uninfected recipients (D+/R−) is now a reality, due to the advent of highly affective direct-acting antivirals (DAAs) which not only have very high efficacy, but also a favorable side effec...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: RISK OF DISEASE TRANSMISSION IN AN EXPANDED DONOR POPULATION: Edited by Jeffery A. Kahn Source Type: research

Current and future regulatory and financial challenges in vascularized composite allotransplantation
Purpose of review To discuss current and future regulatory and financial issues affecting the field of vascularized composite allotransplantation (VCA). Recent findings Vascularized composite allografts are regulated by the US Department of Health and Human Services Organ Procurement and Transplantation Network Final Rule (42 CFR part 121) in the United States and Directive 2010/53/EU of the European Parliament and the Council of 7 July 2010 in the European Union (EU). However, in the United States and most of the EU, VCA is not yet paid for by insurance or third-party payers and many centers depend upon grant funding...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: VASCULARIZED COMPOSITE ALLOTRANSPLANTATION: Edited by Maria Siemionow Source Type: research

Limitations and limits and of vascularized composite allotransplantations: can we reach the holy grail?
Purpose of review In recent times, vascularized composite allotransplantation (VCA) have been gaining more attention and applications. Currently, VCA are at the highest level of the reconstruction pyramid, and thus the effects expected after them are intended to outweigh what the ‘classical’ reconstructive surgery can offer us, including even the most advanced microsurgical techniques. Recent findings Over 40 patients have received a partial or full-face transplant. Others have received penis, uterus, larynx, abdominal wall, and lower extremity transplants. Each type of VCA has its own problems and limitat...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: VASCULARIZED COMPOSITE ALLOTRANSPLANTATION: Edited by Maria Siemionow Source Type: research

The current status and outlook of trachea transplantation
Purpose of review The trachea is an enigmatic organ due to its complex morphology. Although circumferential tracheal defects are extremely difficult to repair with autologous tissue or with an allotransplant, the trachea has been touted as the first organ that could be regenerated. This review provides a comprehensive evaluation of the published evidence in tracheal tissue replacement surgery. Recent findings In recent years, reports of successful tracheal regeneration have attracted great interest. Despite descriptions of the trachea as a perhaps uniquely regeneratable tissue since 2008, critical reporting provided i...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: VASCULARIZED COMPOSITE ALLOTRANSPLANTATION: Edited by Maria Siemionow Source Type: research

Ethical and societal challenges in penis transplantation
Purpose of review To review the current understanding of the ethical and societal difficulties of penile transplantation. Recent findings Penile transplantation, as with other forms of vascularized composite allotransplantation, has increasing acceptance in society but is still not entirely accepted. Guidelines aiming to help guide future penile transplant programs in an ethical and scientific safe manner were created. Controversies regarding the economic impact, patient safety, and the rights of the patients choosing penile transplant remains. Summary Penile transplantation has excellent functional and cosmetic re...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: VASCULARIZED COMPOSITE ALLOTRANSPLANTATION: Edited by Maria Siemionow Source Type: research

Novel approaches in uterus transplantation
Purpose of review Uterus transplantation (UTx) is the first existing infertility treatment for women with no uterus and for women with a present nonfunctional uterus, which is unable to carry a pregnancy. This type of transplantation is a novel addition within the field of vascularized composite allografts and is the first ephemeral kind of transplantation, with the graft intended for only a restricted number of years, until the desired numbers of children have been born and with subsequent graft removal. The proof-of-concept of UTx, as an infertility treatment for women with uterine factor infertility, came with the rep...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: VASCULARIZED COMPOSITE ALLOTRANSPLANTATION: Edited by Maria Siemionow Source Type: research

The current outcomes and future challenges in pediatric vascularized composite allotransplantation
Purpose of review We review the outcomes and future challenges associated with pediatric vascularized composite allotransplantation, including follow-up data from our bilateral pediatric hand–forearm transplantation. Recent findings In 2015, the first heterologous pediatric upper extremity hand–forearm transplant was performed at the Children's Hospital of Philadelphia, and in 2019, the first pediatric neck reconstructive transplantation was performed in Poland. The 5-year follow-up of the pediatric upper extremity recipient demonstrates similar growth rates bilaterally, an increase in bone age parallel to...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: VASCULARIZED COMPOSITE ALLOTRANSPLANTATION: Edited by Maria Siemionow Source Type: research

The past the present and the future of face transplantation
Purpose of review Face transplantation represents vascularized composite allotransplantation (VCA) organ and became one of the most rewarding reconstructive options for severely disfigured patients. This review summarizes the past, current and future challenges of face transplantation, based on our experience and literature reports. Recent findings In 2005, first partial face transplantation was reported by French team. In 2008, we have performed the US first near-total face transplantation. Currently, more than 40 face transplant cases were reported worldwide. Based on the outcomes of our three patients and the liter...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: VASCULARIZED COMPOSITE ALLOTRANSPLANTATION: Edited by Maria Siemionow Source Type: research

Donor-specific antibodies in lung transplantation
Purpose of review The development of donor-specific antibodies (DSA) after lung transplantation has been recognized as an important risk factor for poor outcomes over the past 20 years. Recently, this has been a focus of intense research, and the purpose of this review is to summarize our current understanding of humoral responses and important recent findings as well as to identify areas of future research. Recent findings Recent studies have identified donor-derived cell-free DNA (ddcfDNA) as an important biomarker associated with antibody-mediated rejection (AMR). Importantly, ddcfDNA levels are noted to be elevate...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: DSA IN ORGAN TRANSPLANTATION: CONUNDRUMS AND SOLUTIONS: Edited by Didier A. Mandelbrot Source Type: research

Donor-specific antibodies in heart transplantation: can we afford the price or is it too steep to pay?
Purpose of review One-third of patients awaiting heart transplant are sensitized and 25–35% of heart allograft recipients develop de novo DSAs. Solid phase assays for DSA measurement have facilitated wider use of antibody monitoring and as such, our experience with DSAs is continuously evolving. Recent findings DSAs continue to exhibit poor correlation with biopsy-proven rejection. Novel molecular technologies, such as cell-free DNA and the molecular microscope (MMDx, which detects rejection-associated intragraft mRNA transcripts), are emerging as more sensitive methods to capture subclinical graft injury. High-...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: DSA IN ORGAN TRANSPLANTATION: CONUNDRUMS AND SOLUTIONS: Edited by Didier A. Mandelbrot Source Type: research

Donor-specific antibodies in liver transplantation: challenges in diagnosis and determining clinical impact
Purpose of review Our understanding of the clinical impact of donor-specific antibodies in liver transplant recipients has evolved in recent years as outcomes for liver allografts have improved and advances in diagnostic testing have made recognition of antibody mediated rejection in transplant patients more sensitive. Recent findings Two main types of donor-specific antibodies – preformed and de novo – have been reported in the literature to have a negative impact on graft survival, and researchers have been able to further identify subclasses of class II donor-specific antibodies as being the most clinic...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: DSA IN ORGAN TRANSPLANTATION: CONUNDRUMS AND SOLUTIONS: Edited by Didier A. Mandelbrot Source Type: research

Donor-specific antibodies in kidney transplantation: the University of Wisconsin experience
This article provides a summary of the clinical research relating to donor-specific antibodies (DSA) and ABMR in kidney transplant recipients at the University of Wisconsin-Madison Transplant Center. Recent findings Over 40% of the kidney transplant candidates on the UNOS waitlist are sensitized, and both preformed and de novo DSA are associated with increased risk of rejection and graft loss. We have developed graded induction-desensitization treatment and monitoring protocols based on the degree of immunologic risk. We have also implemented standard treatment and surveillance strategies for patients with ABMR. Additio...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: DSA IN ORGAN TRANSPLANTATION: CONUNDRUMS AND SOLUTIONS: Edited by Didier A. Mandelbrot Source Type: research

The role of non-HLA antibodies in solid organ transplantation: a complex deliberation
Purpose of review There is tremendous interest in understanding when, if, and how non-HLA antibodies contribute to allograft injury. Numerous non-HLA target antigens have been identified and sensitization to these targets have been associated with delayed allograft function, rejection, and allograft failure. This review focuses on the clinical utility of HLA antibody testing, highlighting the strengths and limitations of current clinical studies, and the need for defining characteristics to inform non-HLA antibody pathogenicity. Recent findings Clinical studies continue to show associations between non-HLA antibodies ...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: DSA IN ORGAN TRANSPLANTATION: CONUNDRUMS AND SOLUTIONS: Edited by Didier A. Mandelbrot Source Type: research

Measuring human leukocyte antigen alloantibodies: beyond a binary decision
Purpose of review Accurate measurement of human leukocyte antigen antibodies is critical for making clinical decisions treating patients awaiting transplantation or monitoring them post transplantation. Single antigen bead assay results are given as Mean Fluorescence Intensity, falling short of providing the required quantitative measure. Recent findings Titration studies were shown to circumvent the limitation of target-saturation that affect interpretation of single antigen bead assays especially in highly sensitized patients with strong antibodies. In fact, titration information can serve to measure efficacy of ant...
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: DSA IN ORGAN TRANSPLANTATION: CONUNDRUMS AND SOLUTIONS: Edited by Didier A. Mandelbrot Source Type: research

Editorial: The cutting edge of donor-specific antibodies in transplantation
No abstract available (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: DSA IN ORGAN TRANSPLANTATION: CONUNDRUMS AND SOLUTIONS: Edited by Didier A. Mandelbrot Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - October 27, 2020 Category: Surgery Tags: EDITORIAL INTRODUCTIONS Source Type: research

Limitations and limits and of vascularized composite allotransplantations: can we reach the holy grail?
Abstract PURPOSE OF REVIEW: In recent times, vascularized composite allotransplantation (VCA) have been gaining more attention and applications. Currently, VCA are at the highest level of the reconstruction pyramid, and thus the effects expected after them are intended to outweigh what the 'classical' reconstructive surgery can offer us, including even the most advanced microsurgical techniques. RECENT FINDINGS: Over 40 patients have received a partial or full-face transplant. Others have received penis, uterus, larynx, abdominal wall, and lower extremity transplants. Each type of VCA has its own problems and...
Source: Current Opinion in Organ Transplantation - October 21, 2020 Category: Transplant Surgery Authors: Grajek M, Bula D, Zeman M, Maciejewski A Tags: Curr Opin Organ Transplant Source Type: research

The cutting edge of donor-specific antibodies in transplantation.
PMID: 33105163 [PubMed - as supplied by publisher] (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - October 21, 2020 Category: Transplant Surgery Authors: Mandelbrot DA Tags: Curr Opin Organ Transplant Source Type: research

Measuring human leukocyte antigen alloantibodies: beyond a binary decision.
Abstract PURPOSE OF REVIEW: Accurate measurement of human leukocyte antigen antibodies is critical for making clinical decisions treating patients awaiting transplantation or monitoring them post transplantation. Single antigen bead assay results are given as Mean Fluorescence Intensity, falling short of providing the required quantitative measure. RECENT FINDINGS: Titration studies were shown to circumvent the limitation of target-saturation that affect interpretation of single antigen bead assays especially in highly sensitized patients with strong antibodies. In fact, titration information can serve to mea...
Source: Current Opinion in Organ Transplantation - October 13, 2020 Category: Transplant Surgery Authors: Maguire CH, Schinstock CA, Tambur AR Tags: Curr Opin Organ Transplant Source Type: research

Human immunodeficiency virus from life taking to life giving: expanding the donor pool by using HIV-positive donors.
We report the risks and benefits of utilizing HIV-positive organ donors. RECENT FINDINGS: The utilization of HIV-positive organs came with significant concerns including poor organ quality, increased risk of rejection, HIV disease progression, transmission of varying HIV strains and opportunistic infections, virologic failure due to antiretroviral resistance, increased risk for posttransplant malignancy, and recurrent HIV-associated nephropathy. Recently published data have shown, however, that despite the above mentioned risks, patient survival, and graft survival in persons living with HIV (PLWH) who received a kidn...
Source: Current Opinion in Organ Transplantation - October 13, 2020 Category: Transplant Surgery Authors: Mehta S, Locke JE Tags: Curr Opin Organ Transplant Source Type: research

Current and future regulatory and financial challenges in vascularized composite allotransplantation.
Abstract PURPOSE OF REVIEW: To discuss current and future regulatory and financial issues affecting the field of vascularized composite allotransplantation (VCA). RECENT FINDINGS: Vascularized composite allografts are regulated by the US Department of Health and Human Services Organ Procurement and Transplantation Network Final Rule (42 CFR part 121) in the United States and Directive 2010/53/EU of the European Parliament and the Council of 7 July 2010 in the European Union (EU). However, in the United States and most of the EU, VCA is not yet paid for by insurance or third-party payers and many centers depen...
Source: Current Opinion in Organ Transplantation - October 13, 2020 Category: Transplant Surgery Authors: Cooney CM, Brandacher G Tags: Curr Opin Organ Transplant Source Type: research

The current outcomes and future challenges in pediatric vascularized composite allotransplantation.
Abstract PURPOSE OF REVIEW: We review the outcomes and future challenges associated with pediatric vascularized composite allotransplantation, including follow-up data from our bilateral pediatric hand-forearm transplantation. RECENT FINDINGS: In 2015, the first heterologous pediatric upper extremity hand-forearm transplant was performed at the Children's Hospital of Philadelphia, and in 2019, the first pediatric neck reconstructive transplantation was performed in Poland. The 5-year follow-up of the pediatric upper extremity recipient demonstrates similar growth rates bilaterally, an increase in bone age par...
Source: Current Opinion in Organ Transplantation - October 9, 2020 Category: Transplant Surgery Authors: Azoury SC, Lin I, Amaral S, Chang B, Levin LS Tags: Curr Opin Organ Transplant Source Type: research

The role of non-HLA antibodies in solid organ transplantation: a complex deliberation.
Abstract PURPOSE OF REVIEW: There is tremendous interest in understanding when, if, and how non-HLA antibodies contribute to allograft injury. Numerous non-HLA target antigens have been identified and sensitization to these targets have been associated with delayed allograft function, rejection, and allograft failure. This review focuses on the clinical utility of HLA antibody testing, highlighting the strengths and limitations of current clinical studies, and the need for defining characteristics to inform non-HLA antibody pathogenicity. RECENT FINDINGS: Clinical studies continue to show associations between...
Source: Current Opinion in Organ Transplantation - October 9, 2020 Category: Transplant Surgery Authors: Jackson AM, Wiebe C, Hickey MJ Tags: Curr Opin Organ Transplant Source Type: research

The past the present and the future of face transplantation.
Abstract PURPOSE OF REVIEW: Face transplantation represents vascularized composite allotransplantation (VCA) organ and became one of the most rewarding reconstructive options for severely disfigured patients. This review summarizes the past, current and future challenges of face transplantation, based on our experience and literature reports. RECENT FINDINGS: In 2005, first partial face transplantation was reported by French team. In 2008, we have performed the US first near-total face transplantation. Currently, more than 40 face transplant cases were reported worldwide. Based on the outcomes of our three pa...
Source: Current Opinion in Organ Transplantation - October 9, 2020 Category: Transplant Surgery Authors: Siemionow M Tags: Curr Opin Organ Transplant Source Type: research

Donor-specific antibodies in heart transplantation: can we afford the price or is it too steep to pay?
Abstract PURPOSE OF REVIEW: One-third of patients awaiting heart transplant are sensitized and 25-35% of heart allograft recipients develop de novo DSAs. Solid phase assays for DSA measurement have facilitated wider use of antibody monitoring and as such, our experience with DSAs is continuously evolving. RECENT FINDINGS: DSAs continue to exhibit poor correlation with biopsy-proven rejection. Novel molecular technologies, such as cell-free DNA and the molecular microscope (MMDx, which detects rejection-associated intragraft mRNA transcripts), are emerging as more sensitive methods to capture subclinical graft...
Source: Current Opinion in Organ Transplantation - October 9, 2020 Category: Transplant Surgery Authors: Nikolova AP, Kobashigawa JA Tags: Curr Opin Organ Transplant Source Type: research

Novel approaches in uterus transplantation.
m-Kähler P Abstract PURPOSE OF REVIEW: Uterus transplantation (UTx) is the first existing infertility treatment for women with no uterus and for women with a present nonfunctional uterus, which is unable to carry a pregnancy. This type of transplantation is a novel addition within the field of vascularized composite allografts and is the first ephemeral kind of transplantation, with the graft intended for only a restricted number of years, until the desired numbers of children have been born and with subsequent graft removal. The proof-of-concept of UTx, as an infertility treatment for women with uterine fact...
Source: Current Opinion in Organ Transplantation - October 9, 2020 Category: Transplant Surgery Authors: Brännström M, Kvarnström N, Dahm-Kähler P Tags: Curr Opin Organ Transplant Source Type: research

Donor-specific antibodies in kidney transplantation: the University of Wisconsin experience.
This article provides a summary of the clinical research relating to donor-specific antibodies (DSA) and ABMR in kidney transplant recipients at the University of Wisconsin-Madison Transplant Center. RECENT FINDINGS: Over 40% of the kidney transplant candidates on the UNOS waitlist are sensitized, and both preformed and de novo DSA are associated with increased risk of rejection and graft loss. We have developed graded induction-desensitization treatment and monitoring protocols based on the degree of immunologic risk. We have also implemented standard treatment and surveillance strategies for patients with ABMR. Addi...
Source: Current Opinion in Organ Transplantation - October 9, 2020 Category: Transplant Surgery Authors: Garg N, Parajuli S, Mandelbrot DA, Djamali A Tags: Curr Opin Organ Transplant Source Type: research

Risk of disease transmission in an expanded donor population: the potential of hepatitis B virus donors.
Abstract PURPOSE OF REVIEW: Lack of availability of donor organs is a constant challenge that patients and providers face in transplantation. To address this shortage, donors that test positive for hepatitis B, in particular those with resolved infection, have been increasingly utilized in clinical practice. We review here the potential risks for the recipient and the advances in hepatitis B management that have made use of these donors a well tolerated and advisable proposition. RECENT FINDINGS: As routine administration of antiviral prophylaxis in the posttransplant setting among those deemed high risk for ...
Source: Current Opinion in Organ Transplantation - October 6, 2020 Category: Transplant Surgery Authors: Zhou K, Zhou S Tags: Curr Opin Organ Transplant Source Type: research

Ethical decision-making in simultaneous heart–liver transplantation
Purpose of review Simultaneous heart–liver (SHL) transplants are only a small proportion of overall heart and liver transplantation, they have been increasing in frequency and thus challenge the equitable allocation of organs. Recent findings The incidence of SHL transplants is reviewed along with the outcomes of SHL transplants and their impact on the waitlist, particularly in the context of solitary heart and liver transplantation. The ethical implications, most importantly the principles of utility and equity, of SHL transplant are addressed. In the context of utility, the distinction of a transplant being li...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: COMBINED HEART AND LIVER TRANSPLANTATION: Edited by Juliet Emamaullee and Eugene DePasquale Source Type: research

Immune benefit of combined heart and liver transplantation
Purpose of review Understanding the mechanisms involved in immune protection provided by a hepatic allograft is imperative as further therapies for highly sensitized patients could be developed and thus expanding the donor pool and improving outcomes. Recent findings The clinical data from immune protection comes mainly from combined liver and kidney transplants with excellent results in overall survival and also that of the allograft. This phenomenon has also been observed in dual liver transplants with heart, lung, skin and intestines, albeit with less data. In heart transplant recipients, the liver allograft has pr...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: COMBINED HEART AND LIVER TRANSPLANTATION: Edited by Juliet Emamaullee and Eugene DePasquale Source Type: research

The emerging psychosocial profile of the adult congenital heart disease patient
Purpose of review With advances in the diagnosis and treatment of congenital heart disease (CHD), over 90% of infants born with CHD now reach adulthood. Patients with CHD require lifelong care and are at an increased risk of psychological distress, neurocognitive deficits, social challenges, and a lower quality of life (QOL). There exists limited research on how to best to support the long-term mental healthcare needs of this unique cohort. There remains limited data on directed mental health interventions and their long-term results in adults with CHD (ACHD). Recent findings Recent findings indicate high incidences o...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: COMBINED HEART AND LIVER TRANSPLANTATION: Edited by Juliet Emamaullee and Eugene DePasquale Source Type: research

Anesthetic considerations for combined heart--liver transplantation in patients with Fontan-associated liver disease
Purpose of review The success of the Fontan procedure has led to increased survival of patients born with certain congenital heart disease to the point that new sequlae, as a result of Fontan circulation, are being discovered. Included among these is Fontan-associated liver disease (FALD). The purpose of this review is to present available literature on the perioperative management of the combined heart--liver transplantation (CHLT) in patients with FALD. Recent findings The perioperative management of a combined heart-liver transplant in a patient with Fontan circulation is complex. The patient is at risk for hemodyn...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: COMBINED HEART AND LIVER TRANSPLANTATION: Edited by Juliet Emamaullee and Eugene DePasquale Source Type: research

Considerations and experience driving expansion of combined heart–liver transplantation
Purpose of review Heart transplantation concomitant with a liver transplant may be warranted when end-stage heart failure results in irreversible liver failure. Previously reported outcomes have been excellent yet the specific immunoprotective role of the liver allograft is not known. We review the current literature about the immunologic benefit for combined heart and liver transplantation (CHLT). Recent findings The total number of combined heart and liver transplants continues to increase and accounts for approximately 25 cases per year. Familial amyloid polyneuropathy with cardiac cirrhosis is the most common indi...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: COMBINED HEART AND LIVER TRANSPLANTATION: Edited by Juliet Emamaullee and Eugene DePasquale Source Type: research

Research priorities in Fontan-associated liver disease
Purpose of review Fontan-associated liver disease (FALD) is an emerging condition in patients who have undergone surgical correction of univentricular congenital heart disease. There is little known about the epidemiology of FALD, including risk factors for end-organ failure or hepatocellular carcinoma nor a consensus on surveillance guidelines. Furthermore, there is a need to understand the role of heart versus combined heart–liver transplantation in this population. Research is limited by systemic barriers hindering the ability to track longitudinal FALD outcomes. Recent findings Nearly all patients post-Fonta...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: COMBINED HEART AND LIVER TRANSPLANTATION: Edited by Juliet Emamaullee and Eugene DePasquale Source Type: research

Ethical considerations in xenotransplantation: a review
Purpose of review The purpose of this review is to present and analyse recent literature on the patterns, trends, and developments of ethical considerations concerning xenotransplantation by appraising normative aspects within a coherent framework. Recent findings Developments within xenotransplantation may soon allow for pig-to-human xenotransplantation to take place. Ethical analysis of xenotransplantation commonly follows an anthropocentric cost–benefit analysis, which may imprecisely measure costs. Xenotransplantation should not merely be approached from an anthropocentric perspective. Rather, the potential ...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: XENOTRANSPLANTATION: Edited by Parsia A. Vagefi Source Type: research

The role of machine perfusion in liver xenotransplantation
Purpose of review To review the role of machine perfusion in advancing the study and clinical application of liver xenotransplantation to liver transplantation. Recent findings Recent multicenter trial has shown the benefits of normothermic machine perfusion (NMP) in the assessment and selection of suitable allografts for liver transplantation, especially marginal liver allografts. Advances in ex-vivo therapeutic intervention with proof-of-concept studies demonstrating successful ex-vivo genetic modification of donor allografts and blockade of gene expression with siRNA. Summary Xenotransplantation and NMP are two ...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: XENOTRANSPLANTATION: Edited by Parsia A. Vagefi Source Type: research

Skin xenotransplantation: technological advances and future directions
Purpose of review To summarize the evolution of skin xenotransplantation and contextualize technological advances and the status of clinically applicable large animal research as well as prospects for translation of this work as a viable future treatment option. Recent findings Porcine xenografts at the start of the millennium were merely biologic dressings subject to rapid rejection. Since then, numerous important advances in swine to nonhuman primate models have yielded xenotransplant products at the point of clinical translation. Critical genetic modifications in swine from a designated pathogen-free donor herd hav...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: XENOTRANSPLANTATION: Edited by Parsia A. Vagefi Source Type: research

Progress towards xenogenic tolerance
Purpose of review To describe the most recent progress towards tolerance in xenotransplantation. Recent findings Mixed chimerism and thymic transplantation have been used to promote tolerance in xenotransplantation models. Intra-bone bone marrow transplantation is a recent advance for mixed chimerism, which promotes longer lasting chimerism and early graft function of subsequent organ transplantation. The hybrid thymus, an advancement to the vascularized thymokidney and vascularized thymic lobe, is being developed to allow for both donor and recipient T-cell selection in the chimeric thymus, encouraging tolerance to s...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: XENOTRANSPLANTATION: Edited by Parsia A. Vagefi Source Type: research

Current status of porcine islet xenotransplantation
Purpose of review Human islet transplantation has proven to be a highly effective treatment for patients with labile type 1 diabetes mellitus, which can free patients from daily glucose monitoring and insulin injections. However, the shortage of islet donors limits its’ broad application. Porcine islet xenotransplantation presents a solution to the donor shortage and recent advances in genetic modification and immunosuppressive regimens provide renewed enthusiasm for the potential of this treatment. Recent findings Advances in genetic editing technology are leading to multigene modified porcine islet donors with...
Source: Current Opinion in Organ Transplantation - September 10, 2020 Category: Surgery Tags: XENOTRANSPLANTATION: Edited by Parsia A. Vagefi Source Type: research