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Current opinion: advances in machine perfusion and preservation of vascularized composite allografts - will time still matter?
Curr Opin Organ Transplant. 2023 Oct 13. doi: 10.1097/MOT.0000000000001107. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: A major hurdle hindering more widespread application of reconstructive transplantation is the very limited cold ischemia time (CIT) of vascularized composite allografts (VCAs). In this review, we discuss cutting edge machine perfusion protocols and preservation strategies to overcome this limitation.RECENT FINDINGS: Several preclinical machine perfusion studies have demonstrated the multifactorial utility of this technology to extend preservation windows, assess graft viability prior to transplantati...
Source: Current Opinion in Organ Transplantation - October 12, 2023 Category: Transplant Surgery Authors: Tessa E Muss Amanda H Loftin Byoung Chol Oh Gerald Brandacher Source Type: research

Optimizing the pediatric transplant candidate
Curr Opin Organ Transplant. 2023 Oct 13. doi: 10.1097/MOT.0000000000001115. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: Advances in pediatric transplant parallel those in adult populations; however, there remain critical unique considerations and differences that require specialized knowledge and a specific skill set to optimize care afforded to the pediatric transplant candidate. We introduce general themes regarding optimization of the transplant candidate that are unique to children.RECENT FINDINGS: The pathologies leading to pediatric organ transplant candidacy differ from adults and a precise understanding of the...
Source: Current Opinion in Organ Transplantation - October 12, 2023 Category: Transplant Surgery Authors: James E Squires Vikram K Raghu George V Mazariegos Source Type: research

Defining chronic rejection in vascularized composite allografts - do we have reliable surrogates to look for?
Curr Opin Organ Transplant. 2023 Oct 10. doi: 10.1097/MOT.0000000000001110. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: Chronic rejection (CR) is a major threat in the field of vascularized composite tissue allografts (VCAs) as it causes graft dysfunction and usually graft loss. Unfortunately, knowledge of CR in VCA is incomplete because of the limited number of VCA recipients, the heterogeneous nature of VCAs and the short follow-up.RECENT FINDINGS: The diagnosis of CR in VCA has relied on clinical and pathological findings. Clinical changes include graft fibrosis, dyschromia and ischemic/necrotic ulcerations. Pathol...
Source: Current Opinion in Organ Transplantation - October 9, 2023 Category: Transplant Surgery Authors: Jean Kanitakis Source Type: research

Novel cell-based strategies for immunomodulation in vascularized composite allotransplantation
Curr Opin Organ Transplant. 2023 Oct 7. doi: 10.1097/MOT.0000000000001109. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: Vascularized composite allotransplantation (VCA) has become a clinical reality in the past two decades. However, its routine clinical applications are limited by the risk of acute rejection, and the side effects of the lifelong immunosuppression. Therefore, there is a need for new protocols to induce tolerance and extend VCA survival. Cell- based therapies have emerged as an attractive strategy for tolerance induction in VCA. This manuscript reviews the current strategies and applications of cell-base...
Source: Current Opinion in Organ Transplantation - October 6, 2023 Category: Transplant Surgery Authors: Maria Siemionow Yalcin Kulahci Fatih Zor Source Type: research

Transplant tourism - a missed opportunity
Curr Opin Organ Transplant. 2023 Oct 4. doi: 10.1097/MOT.0000000000001108. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: To explore the resurgence of transplant tourism (TT) despite the recent reiteration of the Declaration of Istanbul (DoI) in 2018. As demand grows exponentially and supply remains static, novel approaches to bridging the gap should be explored.RECENT FINDINGS: TT is estimated to comprise up to 10% of transplants worldwide. Prosecuting patients seeking organs through TT has been unsuccessful. Extra jurisdictional prosecution of brokers, vendors and institutions participating in illicit TT has been diffi...
Source: Current Opinion in Organ Transplantation - October 4, 2023 Category: Transplant Surgery Authors: Hadar Merhav Source Type: research

What is needed to ensure long-term sustainability for the field of vascularized composite allotransplantation?
Curr Opin Organ Transplant. 2023 Sep 29. doi: 10.1097/MOT.0000000000001114. Online ahead of print.ABSTRACTThe field of vascularized composite allotransplantation (VCA) has demonstrated remarkable advances since its inception with some excellent long-term results in a variety of graft types. However, unlike solid organ transplantation, it has yet to become mainstream. We therefore discuss strategies on ensuring long-term sustainability by addressing continued clinical developments of VCA to improve the risk-to-benefit balance, importance of public support, improved policy and financial support, and need for a bridge to the ...
Source: Current Opinion in Organ Transplantation - September 28, 2023 Category: Transplant Surgery Authors: Yoshiko Toyoda L Scott Levin Source Type: research

The history of ethical principles in liver transplant organ allocation in the united states: how historical and proposed allocations system fare in balancing utility vs. urgency and justice vs. pragmatism
Curr Opin Organ Transplant. 2023 Sep 22. doi: 10.1097/MOT.0000000000001103. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: The United States (US) liver transplant community is processing changes to the allocation system and developing a new proposal that will result in even greater change. This review evaluates the ethical implications of these decisions, focusing on two sets of competing ethical principles (Urgency vs. Utility and Justice vs. Pragmatism).RECENT FINDINGS: About four years ago, the Organ Procurement and Transplantation Network (OPTN) implemented the Acuity Circle Model to replace the geographic boundaries...
Source: Current Opinion in Organ Transplantation - September 28, 2023 Category: Transplant Surgery Authors: Aaron Ahearn Source Type: research