Artificial intelligence in transplantation (machine-learning classifiers and transplant oncology).
Abstract PURPOSE OF REVIEW: To highlight recent efforts in the development and implementation of machine learning in transplant oncology - a field that uses liver transplantation for the treatment of hepatobiliary malignancies - and particularly in hepatocellular carcinoma, the most commonly treated diagnosis in transplant oncology. RECENT FINDINGS: The development of machine learning has occurred within three domains related to hepatocellular carcinoma: identification of key clinicopathological variables, genomics, and image processing. SUMMARY: Machine-learning classifiers can be effectively applied fo...
Source: Current Opinion in Organ Transplantation - June 1, 2020 Category: Transplant Surgery Authors: Ivanics T, Patel MS, Erdman L, Sapisochin G Tags: Curr Opin Organ Transplant Source Type: research

Artificial intelligence and organ transplantation: challenges and expectations.
Abstract PURPOSE OF REVIEW: Classifiers based on artificial intelligence have emerged in all areas of medicine. Although very subtle, many decisions in organ transplantation can now be addressed in a more concisely manner with the support of these classifiers. RECENT FINDINGS: Any aspect of organ transplantation (image processing, prediction of results, diagnostic proposals, therapeutic algorithms or precision treatments) consists of a set of input variables and a set of output variables. Artificial intelligence classifiers differ in the way they establish relationships between the input variables, how they s...
Source: Current Opinion in Organ Transplantation - June 1, 2020 Category: Transplant Surgery Authors: Briceno J Tags: Curr Opin Organ Transplant Source Type: research

Infectious complications of vascularized composite allograft transplantation.
Abstract PURPOSE OF REVIEW: Vascularized composite allograft (VCA) transplants constitute multiple tissues transplanted together as one functional unit. These procedures are increasing in frequency and complexity, yet data about graft survival, quality of life, and infection risk remain limited. RECENT FINDINGS: Informative guidance for this patient population is often inferred from the solid organ transplantation literature. Yet, it is important to understand that VCA transplantation additionally carries its own significant and distinctive risk factors for infection. SUMMARY: In this review, we give an ...
Source: Current Opinion in Organ Transplantation - June 1, 2020 Category: Transplant Surgery Authors: Steinbrink JM, Wolfe CR Tags: Curr Opin Organ Transplant Source Type: research

The need for a living donor wellness program.
Abstract PURPOSE OF REVIEW: Living donation has a tremendous impact in bridging the gap between the shortage of organs and the growing list of transplant candidates but remains underutilized as a percentage of total transplants performed. This review focuses on obesity and social determinants of health as potential barriers to the expansion of living kidney donation. RECENT FINDINGS: The growing rate of obesity and associated metabolic syndrome make many potential donors unacceptable as donor candidates because of the future risk for developing chronic health conditions, such as hypertension and diabetes. The...
Source: Current Opinion in Organ Transplantation - June 1, 2020 Category: Transplant Surgery Authors: Kim J, Kim S, Genyk Y, Maw TT Tags: Curr Opin Organ Transplant Source Type: research

Machine-learning algorithms for predicting results in liver transplantation: the problem of donor-recipient matching.
ria R Abstract PURPOSE OF REVIEW: Classifiers based on artificial intelligence can be useful to solve decision problems related to the inclusion or removal of possible liver transplant candidates, and assisting in the heterogeneous field of donor-recipient (D-R) matching. RECENT FINDINGS: Artificial intelligence models can show a great advantage by being able to handle a multitude of variables, be objective and help in cases of similar probabilities. In the field of liver transplantation, the most commonly used classifiers have been artificial neural networks (ANNs) and random forest classifiers. ANNs are exc...
Source: Current Opinion in Organ Transplantation - June 1, 2020 Category: Transplant Surgery Authors: Briceno J, Ayllón MD, Ciria R Tags: Curr Opin Organ Transplant Source Type: research

Cardiomyopathies in children: classification, diagnosis and treatment.
Abstract PURPOSE OF REVIEW: Cardiomyopathies are rare in the pediatric population, but significantly impact on morbidity and mortality. The present review aims to provide an overview of cardiomyopathies in children and some practical guidelines for their prognostic stratification and management. RECENT FINDINGS: Pediatric cardiomyopathies may present as isolated cardiac muscle disease or in the context of complex clinical syndromes. The etiologic characterization represents an important step in the diagnosis and treatment of cardiomyopathies because of its impact on prognosis and on therapeutic measures. Inde...
Source: Current Opinion in Organ Transplantation - May 8, 2020 Category: Transplant Surgery Authors: De Angelis G, Bobbo M, Paldino A, D'Agata Mottolese B, Altinier A, Dal Ferro M, Merlo M, Sinagra G Tags: Curr Opin Organ Transplant Source Type: research

Cardiac donation after circulatory death.
Abstract PURPOSE OF REVIEW: Increasing number of patients with end-stage heart failure and those with improved survivorship from selective utilization of implantable mechanical circulatory support devices have added further burden and complexity to the transplant waitlist and on the rate-limiting availability of donor hearts from the standard pathway of donation after brain death. Unlike this conventional route, the increasing clinical use of donation after circulatory death (DCD) donor hearts necessitates a closer understanding of the logistics involved in the DCD process as well as of the risks associated with t...
Source: Current Opinion in Organ Transplantation - May 8, 2020 Category: Transplant Surgery Authors: Iyer A, Dhital K Tags: Curr Opin Organ Transplant Source Type: research

The aging transplant population and immunobiology: any therapeutic implication?
Abstract PURPOSE OF REVIEW: The aim of this review is to describe the latest investigations into the immunobiology of aging and the potential impact on outcomes after mechanical circulatory support implantation and heart transplantation. This information is relevant given the growing numbers of older patients with heart failure undergoing evaluation for mechanical circulatory support device (MCSD) or heart transplantation. RECENT FINDINGS: A host of aging-associated aspects of immune dysfunction have been described in the general population including T-cell senescence, exhaustion, and terminal dedifferentiati...
Source: Current Opinion in Organ Transplantation - May 8, 2020 Category: Transplant Surgery Authors: Schaenman J, Goldwater D Tags: Curr Opin Organ Transplant Source Type: research

Update and breakthrough in cardiac xenotransplantation.
Abstract PURPOSE OF REVIEW: Considerable advancements have been made in the field of cardiac xenotransplantation in the recent years, achieving prolonged survival of the life-supporting cardiac xenograft and paving the way toward first clinical implications. RECENT FINDINGS: The combination of genetic modifications and novel immunosuppression with costimulation blockade, as well as supporting therapy with antiinflammatory treatment, growth prevention, and adaptation of the heart procurement system to reduce myocardial ischemia and reperfusion injury improves the overall cardiac xenograft function and overall ...
Source: Current Opinion in Organ Transplantation - May 8, 2020 Category: Transplant Surgery Authors: Brenner P, Mihalj M Tags: Curr Opin Organ Transplant Source Type: research

Organ allocation in the age of the algorithm: avoiding futile transplantation – utility in allocation
Purpose of review This review describes and questions the evolution of allocation systems from local team decisions in the 20th century to patient-oriented allocation using complex algorithm predicting transplant benefit. Recent findings The opening years of the 2000s have seen the implementation of prioritization scores aiming at increasing transparency and reducing waitlist mortality. The 2010s have underlined the necessity of drawing the upper limits of how sick a patient can be while still ensuring acceptable survival. More complex algorithms evaluating transplant benefit have been implemented in allocation system...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: ORGAN ALLOCATION AND PROCUREMENT: Edited by Raymond J. Lynch Source Type: research

Lung transplant programs in developing countries: challenges, solutions, and outcomes
The objective is to summarize the challenges, present solutions, and review outcomes of LT in developing countries. We hope this review will guide healthcare providers in such countries that are contemplating embarking on this journey. Recent findings The key challenges that programs in developing countries encountered included shortage and marginal quality of donated organs, lack of dedicated multi-disciplinary LT team, limited availability of advanced technology and high risk of post-transplant infections. Education and collaboration among government, public, and healthcare sectors was seen as fundamental to building ...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Jasleen Kukreja Source Type: research

Update on pediatric lung transplantation: mir-ando into the mechanisms of chronic lung allograft dysfunction in children
Purpose of review Lung transplantation (LTx) is a worthwhile treatment for children with end-stage lung diseases who have no practicable medical or surgical solutions. But the long-term survival remains the lowest in all solid-organ transplant, with a median survival of 5.7 years, limited by the onset of chronic lung allograft dysfunction (CLAD). This reviews a recent publication in pediatric patients that focuses on translational regulation by microRNA. Recent findings The mechanisms that cause transplanted lung allografts have been difficult to identify. This review discusses pertinent findings in the first and larg...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Jasleen Kukreja Source Type: research

Normothermic machine perfusion of donor-lungs ex-vivo: promoting clinical adoption
Purpose of review Lung transplantation offers the only realistic therapeutic option for patients with end-stage lung disease. However, this is impacted by a shortfall in availability of suitable donor-lungs. Normothermic machine perfusion of donor-lungs outside the donor body also known as ex-vivo lung perfusion (EVLP) offers a potential solution through objective assessment, reconditioning and treatment of donor-lungs initially deemed unsuitable for use. This review discusses key advances and challenges in the wider clinical adoption of this technology. Recent findings This review will summarize key research within t...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Jasleen Kukreja Source Type: research

Redefining marginality: donor lung criteria
Purpose of review Despite an increase in lung transplantation globally, the waitlist mortality persists due to organ shortage. In order to keep up with the demand, the marginal lung donor criteria need to be revisited. The goal of this review is to redefine the lung donor criteria based on the most recent data. Recent findings Recent evidence indicates that lungs from donor with traditional extended criteria such as, age more than 55, PaO2/FiO2 threshold of less than 300, ischemia time more than 6 h, positive sputum microbiology, abnormal radiography no longer represent contraindications to lung transplantation by t...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Jasleen Kukreja Source Type: research

An update on frailty in lung transplantation
Purpose of review Frailty is prevalent in lung transplant candidates, and recent studies have demonstrated associations with increased mortality before and after transplantation. This review highlights important findings on the trajectory of frailty throughout the lung transplant process and provides valuable insight into frailty and some of its modifiable elements. Recent findings There have been several frailty indices used in lung transplantation, specifically the Frailty Phenotype, Short Physical Performance Battery (SPPB), and Cumulative Deficits. The two most commonly used measures – Frailty Phenotype and ...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Jasleen Kukreja Source Type: research

Survival in adult lung transplantation: where are we in 2020?
Purpose of review In this article, an overview of the survival after lung transplantation will be given, with a focus on factors affecting outcome and differences in survival determined by underlying disease. Recent findings Lung transplantation is an established treatment modality for patients with various end-stage lung diseases. The most recent International Society for Heart and Lung Transplantation Registry reports a 1 and 5-year survival of 85 and 59%, respectively, for adult lung transplant recipients transplanted since 2010. Over the past decades, significant improvements in patient outcomes have been achieved...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Jasleen Kukreja Source Type: research

Update and breakthrough in cardiac xenotransplantation
Purpose of review Considerable advancements have been made in the field of cardiac xenotransplantation in the recent years, achieving prolonged survival of the life-supporting cardiac xenograft and paving the way toward first clinical implications. Recent findings The combination of genetic modifications and novel immunosuppression with costimulation blockade, as well as supporting therapy with antiinflammatory treatment, growth prevention, and adaptation of the heart procurement system to reduce myocardial ischemia and reperfusion injury improves the overall cardiac xenograft function and overall survival in nonhuman...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Ugolino Livi Source Type: research

The aging transplant population and immunobiology: any therapeutic implication?
Purpose of review The aim of this review is to describe the latest investigations into the immunobiology of aging and the potential impact on outcomes after mechanical circulatory support implantation and heart transplantation. This information is relevant given the growing numbers of older patients with heart failure undergoing evaluation for mechanical circulatory support device (MCSD) or heart transplantation. Recent findings A host of aging-associated aspects of immune dysfunction have been described in the general population including T-cell senescence, exhaustion, and terminal dedifferentiation, as well as impai...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Ugolino Livi Source Type: research

Antibody-medicated rejection after heart transplantation: diagnosis and clinical implications
Purpose of review The present article will review the diagnosis of antibody-mediated rejection in heart transplant recipients and further explore the clinical implications. Recent findings Improved diagnostic techniques have led to increased recognition of antibody-mediated rejection and better understanding of the long-term consequences in heart transplant recipients. Endomyocardial biopsy remains the gold standard for the diagnosis of antibody-medicated ejection; however, several advances in molecular testing have emerged, including the use of gene expression profiling, messenger RNA, and microRNA. Routine surveilla...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Ugolino Livi Source Type: research

Cardiac donation after circulatory death
Purpose of review Increasing number of patients with end-stage heart failure and those with improved survivorship from selective utilization of implantable mechanical circulatory support devices have added further burden and complexity to the transplant waitlist and on the rate-limiting availability of donor hearts from the standard pathway of donation after brain death. Unlike this conventional route, the increasing clinical use of donation after circulatory death (DCD) donor hearts necessitates a closer understanding of the logistics involved in the DCD process as well as of the risks associated with the unique pathoph...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Ugolino Livi Source Type: research

Current status of normothermic ex-vivo perfusion of cardiac allografts
Purpose of review Ex-vivo perfusion has emerged in recent years as an alternative to cold static preservation of organs harvested for transplant. Normothermic ex-vivo perfusion, the subject of this review, maintains the donor heart in a near physiologic state, and allows the transplant team to monitor and control perfusion to the organ prior to implantation. A growing body of evidence has established the safety and viability of this technique, which may improve on current standards of donor management. Recent findings Following initial single-arm studies over a decade ago, ex-vivo perfusion has been studied in a prosp...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Ugolino Livi Source Type: research

Current status of pediatric mechanical circulatory support
Purpose of review The field of pediatric mechanical circulatory support has experienced exponential evolution in recent decades. With favorable complication profiles, implantable continuous-flow ventricular assist devices (VADs) have become a standard option in children, as has been seen in the adult counterpart. Nevertheless, there still exists room for further advances, not just for survival, but throughout the whole trajectory of treatment courses. With reviewing the current state of pediatric VAD support, including existing challenges, we aim to highlight the targets clinicians should focus on for further improvement...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Ugolino Livi Source Type: research

Cardiomyopathies in children: classification, diagnosis and treatment
Purpose of review Cardiomyopathies are rare in the pediatric population, but significantly impact on morbidity and mortality. The present review aims to provide an overview of cardiomyopathies in children and some practical guidelines for their prognostic stratification and management. Recent findings Pediatric cardiomyopathies may present as isolated cardiac muscle disease or in the context of complex clinical syndromes. The etiologic characterization represents an important step in the diagnosis and treatment of cardiomyopathies because of its impact on prognosis and on therapeutic measures. Indeed, replacement ther...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Ugolino Livi Source Type: research

Heart transplantation in cardiac storage diseases: data on Fabry disease and cardiac amyloidosis
Purpose of review To deeply investigate one type of intracellular cardiac storage disease, the Fabry disease and one example of extracellular cardiac storage disease, the cardiac amyloidosis, with the aim to collect data about cardiac treatment at the end-stage level and the feasibility of heart transplantation (HTx) in this setting of patients. Recent findings Some registry describes that Fabry disease and cardiac amyloidosis showed similar characteristics as hypertrophic cardiomyopathies; thus, their correct diagnosis is often missing or time consuming. A multiorgan approach is mandatory to recognize the main system...
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Ugolino Livi Source Type: research

Editorial: Heart transplantation
No abstract available (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: HEART TRANSPLANTATION: Edited by Ugolino Livi Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - May 6, 2020 Category: Surgery Tags: EDITORIAL INTRODUCTIONS Source Type: research

Cardiomyopathies in children: classification, diagnosis and treatment.
Abstract PURPOSE OF REVIEW: Cardiomyopathies are rare in the pediatric population, but significantly impact on morbidity and mortality. The present review aims to provide an overview of cardiomyopathies in children and some practical guidelines for their prognostic stratification and management. RECENT FINDINGS: Pediatric cardiomyopathies may present as isolated cardiac muscle disease or in the context of complex clinical syndromes. The etiologic characterization represents an important step in the diagnosis and treatment of cardiomyopathies because of its impact on prognosis and on therapeutic measures. Inde...
Source: Current Opinion in Organ Transplantation - May 4, 2020 Category: Transplant Surgery Authors: De Angelis G, Bobbo M, Paldino A, D'Agata Mottolese B, Altinier A, Dal Ferro M, Merlo M, Sinagra G Tags: Curr Opin Organ Transplant Source Type: research

Update and breakthrough in cardiac xenotransplantation.
Abstract PURPOSE OF REVIEW: Considerable advancements have been made in the field of cardiac xenotransplantation in the recent years, achieving prolonged survival of the life-supporting cardiac xenograft and paving the way toward first clinical implications. RECENT FINDINGS: The combination of genetic modifications and novel immunosuppression with costimulation blockade, as well as supporting therapy with antiinflammatory treatment, growth prevention, and adaptation of the heart procurement system to reduce myocardial ischemia and reperfusion injury improves the overall cardiac xenograft function and overall ...
Source: Current Opinion in Organ Transplantation - May 4, 2020 Category: Transplant Surgery Authors: Brenner P, Mihalj M Tags: Curr Opin Organ Transplant Source Type: research

The aging transplant population and immunobiology: any therapeutic implication?
Abstract PURPOSE OF REVIEW: The aim of this review is to describe the latest investigations into the immunobiology of aging and the potential impact on outcomes after mechanical circulatory support implantation and heart transplantation. This information is relevant given the growing numbers of older patients with heart failure undergoing evaluation for mechanical circulatory support device (MCSD) or heart transplantation. RECENT FINDINGS: A host of aging-associated aspects of immune dysfunction have been described in the general population including T-cell senescence, exhaustion, and terminal dedifferentiati...
Source: Current Opinion in Organ Transplantation - May 4, 2020 Category: Transplant Surgery Authors: Schaenman J, Goldwater D Tags: Curr Opin Organ Transplant Source Type: research

Cardiac donation after circulatory death.
Abstract PURPOSE OF REVIEW: Increasing number of patients with end-stage heart failure and those with improved survivorship from selective utilization of implantable mechanical circulatory support devices have added further burden and complexity to the transplant waitlist and on the rate-limiting availability of donor hearts from the standard pathway of donation after brain death. Unlike this conventional route, the increasing clinical use of donation after circulatory death (DCD) donor hearts necessitates a closer understanding of the logistics involved in the DCD process as well as of the risks associated with t...
Source: Current Opinion in Organ Transplantation - May 4, 2020 Category: Transplant Surgery Authors: Iyer A, Dhital K Tags: Curr Opin Organ Transplant Source Type: research

Survival in adult lung transplantation: where are we in 2020?
Abstract PURPOSE OF REVIEW: In this article, an overview of the survival after lung transplantation will be given, with a focus on factors affecting outcome and differences in survival determined by underlying disease. RECENT FINDINGS: Lung transplantation is an established treatment modality for patients with various end-stage lung diseases. The most recent International Society for Heart and Lung Transplantation Registry reports a 1 and 5-year survival of 85 and 59%, respectively, for adult lung transplant recipients transplanted since 2010. Over the past decades, significant improvements in patient outcome...
Source: Current Opinion in Organ Transplantation - April 22, 2020 Category: Transplant Surgery Authors: Bos S, Vos R, Van Raemdonck DE, Verleden GM Tags: Curr Opin Organ Transplant Source Type: research

Lung transplant programs in developing countries: challenges, solutions, and outcomes.
The objective is to summarize the challenges, present solutions, and review outcomes of LT in developing countries. We hope this review will guide healthcare providers in such countries that are contemplating embarking on this journey. RECENT FINDINGS: The key challenges that programs in developing countries encountered included shortage and marginal quality of donated organs, lack of dedicated multi-disciplinary LT team, limited availability of advanced technology and high risk of post-transplant infections. Education and collaboration among government, public, and healthcare sectors was seen as fundamental to buildi...
Source: Current Opinion in Organ Transplantation - April 22, 2020 Category: Transplant Surgery Authors: Nguyen AT, Brzezinski M, Chen J, Nguyen NV, Dinh LV, Kukreja J Tags: Curr Opin Organ Transplant Source Type: research

An update on frailty in lung transplantation.
Abstract PURPOSE OF REVIEW: Frailty is prevalent in lung transplant candidates, and recent studies have demonstrated associations with increased mortality before and after transplantation. This review highlights important findings on the trajectory of frailty throughout the lung transplant process and provides valuable insight into frailty and some of its modifiable elements. RECENT FINDINGS: There have been several frailty indices used in lung transplantation, specifically the Frailty Phenotype, Short Physical Performance Battery (SPPB), and Cumulative Deficits. The two most commonly used measures - Frailty ...
Source: Current Opinion in Organ Transplantation - April 22, 2020 Category: Transplant Surgery Authors: Varughese R, Rozenberg D, Singer LG Tags: Curr Opin Organ Transplant Source Type: research

Heart transplantation in cardiac storage diseases: data on Fabry disease and cardiac amyloidosis.
Abstract PURPOSE OF REVIEW: To deeply investigate one type of intracellular cardiac storage disease, the Fabry disease and one example of extracellular cardiac storage disease, the cardiac amyloidosis, with the aim to collect data about cardiac treatment at the end-stage level and the feasibility of heart transplantation (HTx) in this setting of patients. RECENT FINDINGS: Some registry describes that Fabry disease and cardiac amyloidosis showed similar characteristics as hypertrophic cardiomyopathies; thus, their correct diagnosis is often missing or time consuming. A multiorgan approach is mandatory to recog...
Source: Current Opinion in Organ Transplantation - April 16, 2020 Category: Transplant Surgery Authors: Di Nora C, Livi U Tags: Curr Opin Organ Transplant Source Type: research

Heart transplantation.
PMID: 32304421 [PubMed - as supplied by publisher] (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - April 16, 2020 Category: Transplant Surgery Authors: Livi U Tags: Curr Opin Organ Transplant Source Type: research

Current status of normothermic ex-vivo perfusion of cardiac allografts.
Abstract PURPOSE OF REVIEW: Ex-vivo perfusion has emerged in recent years as an alternative to cold static preservation of organs harvested for transplant. Normothermic ex-vivo perfusion, the subject of this review, maintains the donor heart in a near physiologic state, and allows the transplant team to monitor and control perfusion to the organ prior to implantation. A growing body of evidence has established the safety and viability of this technique, which may improve on current standards of donor management. RECENT FINDINGS: Following initial single-arm studies over a decade ago, ex-vivo perfusion has bee...
Source: Current Opinion in Organ Transplantation - April 16, 2020 Category: Transplant Surgery Authors: Ragalie WS, Ardehali A Tags: Curr Opin Organ Transplant Source Type: research

Current status of pediatric mechanical circulatory support.
Abstract PURPOSE OF REVIEW: The field of pediatric mechanical circulatory support has experienced exponential evolution in recent decades. With favorable complication profiles, implantable continuous-flow ventricular assist devices (VADs) have become a standard option in children, as has been seen in the adult counterpart. Nevertheless, there still exists room for further advances, not just for survival, but throughout the whole trajectory of treatment courses. With reviewing the current state of pediatric VAD support, including existing challenges, we aim to highlight the targets clinicians should focus on for fu...
Source: Current Opinion in Organ Transplantation - April 16, 2020 Category: Transplant Surgery Authors: Spigel ZA, Cho J, Adachi I Tags: Curr Opin Organ Transplant Source Type: research

Update on pediatric lung transplantation: mir-ando into the mechanisms of chronic lung allograft dysfunction in children.
Abstract PURPOSE OF REVIEW: Lung transplantation (LTx) is a worthwhile treatment for children with end-stage lung diseases who have no practicable medical or surgical solutions. But the long-term survival remains the lowest in all solid-organ transplant, with a median survival of 5.7 years, limited by the onset of chronic lung allograft dysfunction (CLAD). This reviews a recent publication in pediatric patients that focuses on translational regulation by microRNA. RECENT FINDINGS: The mechanisms that cause transplanted lung allografts have been difficult to identify. This review discusses pertinent findings i...
Source: Current Opinion in Organ Transplantation - April 16, 2020 Category: Transplant Surgery Authors: Conrad C Tags: Curr Opin Organ Transplant Source Type: research

Redefining marginality: donor lung criteria.
Abstract PURPOSE OF REVIEW: Despite an increase in lung transplantation globally, the waitlist mortality persists due to organ shortage. In order to keep up with the demand, the marginal lung donor criteria need to be revisited. The goal of this review is to redefine the lung donor criteria based on the most recent data. RECENT FINDINGS: Recent evidence indicates that lungs from donor with traditional extended criteria such as, age more than 55, PaO2/FiO2 threshold of less than 300, ischemia time more than 6 h, positive sputum microbiology, abnormal radiography no longer represent contraindications to lung ...
Source: Current Opinion in Organ Transplantation - April 16, 2020 Category: Transplant Surgery Authors: Kukreja J, Chen J, Brzezinski M Tags: Curr Opin Organ Transplant Source Type: research

Normothermic machine perfusion of donor-lungs ex-vivo: promoting clinical adoption.
Abstract PURPOSE OF REVIEW: Lung transplantation offers the only realistic therapeutic option for patients with end-stage lung disease. However, this is impacted by a shortfall in availability of suitable donor-lungs. Normothermic machine perfusion of donor-lungs outside the donor body also known as ex-vivo lung perfusion (EVLP) offers a potential solution through objective assessment, reconditioning and treatment of donor-lungs initially deemed unsuitable for use. This review discusses key advances and challenges in the wider clinical adoption of this technology. RECENT FINDINGS: This review will summarize k...
Source: Current Opinion in Organ Transplantation - April 16, 2020 Category: Transplant Surgery Authors: Gilmour J, Griffiths C, Pither T, Scott WE, Fisher AJ Tags: Curr Opin Organ Transplant Source Type: research

Organ allocation in the age of the algorithm: avoiding futile transplantation - utility in allocation.
Abstract PURPOSE OF THE REVIEW: This review describes and questions the evolution of allocation systems from local team decisions in the 20th century to patient-oriented allocation using complex algorithm predicting transplant benefit. RECENT FINDINGS: The opening years of the 2000s have seen the implementation of prioritization scores aiming at increasing transparency and reducing waitlist mortality. The 2010s have underlined the necessity of drawing the upper limits of how sick a patient can be while still ensuring acceptable survival. More complex algorithms evaluating transplant benefit have been implemen...
Source: Current Opinion in Organ Transplantation - April 16, 2020 Category: Transplant Surgery Authors: Faitot F, Michard B, Artzner T Tags: Curr Opin Organ Transplant Source Type: research

Antibody-medicated rejection after heart transplantation: diagnosis and clinical implications.
Abstract PURPOSE OF REVIEW: The present article will review the diagnosis of antibody-mediated rejection in heart transplant recipients and further explore the clinical implications. RECENT FINDINGS: Improved diagnostic techniques have led to increased recognition of antibody-mediated rejection and better understanding of the long-term consequences in heart transplant recipients. Endomyocardial biopsy remains the gold standard for the diagnosis of antibody-medicated ejection; however, several advances in molecular testing have emerged, including the use of gene expression profiling, messenger RNA, and microRN...
Source: Current Opinion in Organ Transplantation - April 16, 2020 Category: Transplant Surgery Authors: Nguyen VP, Kobashigawa JA Tags: Curr Opin Organ Transplant Source Type: research

Current status of pediatric intestinal transplantation in the United States
Purpose of review The present review aims to describe in detail the characteristics, outcomes, and recent trends in the field of pediatric intestinal transplantation in the United States. It will examine the route cause and future implications of these developments. The review will draw from recent publications in the field, the Intestinal Transplant Registry, and contemporary data from large U.S. single centers. Recent findings More than 1500 pediatric intestinal transplants have been performed in the United States since 1985, however, over the past decade there have been fewer than 50 transplants/year nationwide. ...
Source: Current Opinion in Organ Transplantation - March 9, 2020 Category: Surgery Tags: SMALL BOWEL TRANSPLANTATION: Edited by Cal S. Matsumoto Source Type: research

Adult intestinal transplantation in the United States
Purpose of review There has been a striking decline in the annual volumes of adult intestinal transplants performed in the United States from a peak in 2008, reaching its lowest volume in 2019. The current review examines the pattern and potential reasons for the decline. Recent findings We observe that while improvements in intestinal rehabilitation may be contributing to some of the decline, movements of key personnel and the paucity of experts in a rarefied field may also be contributing to declining volumes. Summary We suggest that the decline in volumes of adult intestinal transplants are likely to be multifac...
Source: Current Opinion in Organ Transplantation - March 9, 2020 Category: Surgery Tags: SMALL BOWEL TRANSPLANTATION: Edited by Cal S. Matsumoto Source Type: research

A detailed analysis of the current status of intestinal transplantation in Latin America
Purpose of review Latin America and the Caribbean represent a vast territory, with very different economic and healthcare realities, which result in significant disparities in the management of intestinal failure patients throughout the region. Since 1968, multiple attempts have been done to accomplish a successful intestinal transplant; but it was not until 2004, with the establishment of multidisciplinary programs, that large series with long-term results could be obtained. Currently, three countries (Colombia, Argentina, and Brazil) in the region are actively performing these procedures. Recent findings A total num...
Source: Current Opinion in Organ Transplantation - March 9, 2020 Category: Surgery Tags: SMALL BOWEL TRANSPLANTATION: Edited by Cal S. Matsumoto Source Type: research

Current status of pediatric intestinal transplant in Europe
Purpose of review This review features articles published during 2018 and 2019 regarding pediatric visceral transplantation in Europe. In this biannual review, the authors identify and summarize key articles pertinent to clinical and research areas. Recent findings There is a trend to a lower use of intestinal transplantation in pediatric population in Europe. Most articles were focused in long-term follow-up. The burden of the disease 10 years after intestinal transplantation is still significant, including the need of several medications, readmissions, and the need of specific follow-up, mostly because of psychiatri...
Source: Current Opinion in Organ Transplantation - March 9, 2020 Category: Surgery Tags: SMALL BOWEL TRANSPLANTATION: Edited by Cal S. Matsumoto Source Type: research

Current state of adult intestinal transplantation in Europe
Purpose of review In Europe, adult intestinal transplantation (ITx) has continuously evolved since the first successful case in 1989. However, despite several recent innovations, no significant improvement in survival has been seen since 2005, illustrating the unique difficulty of transplanting the intestine. In this review, a subanalysis of adult ITx in Europe is discussed and recent publications on adult ITx in Europe are presented. Recent findings Increased medical and surgical arsenal in the treatment of intestinal failure reduce the need for ITx. At the same time, new indications (diffuse ischemia) have emerged. ...
Source: Current Opinion in Organ Transplantation - March 9, 2020 Category: Surgery Tags: SMALL BOWEL TRANSPLANTATION: Edited by Cal S. Matsumoto Source Type: research

A detailed analysis of the current status of intestinal transplantation in the middle east
Purpose of review Intestinal transplantations are among the most complex transplantations, which are performed in few centers in the world. When patients develop intestinal failure, different treatment modalities including parenteral nutrition, autologous gastrointestinal tract reconstructive surgery, and intestinal transplantations are considered. The Middle East is a region where reports on intestinal failures and intestinal transplantations are mainly lacking. In the present review, we highlighted the status of intestinal transplantations in the Middle East and focused on existing reports from this region. Recent fin...
Source: Current Opinion in Organ Transplantation - March 9, 2020 Category: Surgery Tags: SMALL BOWEL TRANSPLANTATION: Edited by Cal S. Matsumoto Source Type: research

Current status of intestinal transplantation in East Asia
Purpose of review Intestinal transplantation (ITx) activity remains low in East Asia. We conducted a multinational, retrospective study on patients who underwent ITx in Korea, Taiwan, and Japan, to provide an overview and to foresee future developments and collaborations in this region. Recent findings Total 71 ITx were performed in 67 patients. Living donor ITx was most commonly conducted in Japan (n = 13). Despite the low caseload, all three countries demonstrated acceptable patient survival rates of approximately 70% at 5 years. Over 70% of recipients with a functioning graft were free from total parenteral nutriti...
Source: Current Opinion in Organ Transplantation - March 9, 2020 Category: Surgery Tags: SMALL BOWEL TRANSPLANTATION: Edited by Cal S. Matsumoto Source Type: research

Editorial: The current status of intestinal transplantation around the world
No abstract available (Source: Current Opinion in Organ Transplantation)
Source: Current Opinion in Organ Transplantation - March 9, 2020 Category: Surgery Tags: SMALL BOWEL TRANSPLANTATION: Edited by Cal S. Matsumoto Source Type: research