Stem Cells to Modulate IR: a Regenerative Medicine-Based Approach to Organ Preservation
AbstractPurpose of ReviewSolid organ transplantation is limited by lack of suitable donor organs. Older and comorbid organs are frequently discarded on the basis that they will not withstand the overall process —principally the degree of ischemia reperfusion injury associated with preservation and transplantation. Interventions to prevent injury and promote regeneration are badly needed. Recent stem cells of multiple types including mesenchymal stem cells (MSCs) and adipose-derived regenerative cells (AD RCs) have been demonstrated to protect against tissue injury in multiple models relevant to transplantation.Recent...
Source: Current Transplantation Reports - June 4, 2019 Category: Transplant Surgery Source Type: research

Overcoming Disparities in Living Donor Kidney Transplantation in the USA: the Promise of Academic and Community Stakeholder Partnerships
This article provides a systematic review of existing academic-community partnerships designed to address disparities in LDKT for adult populations in the USA. Few academic-community partnerships exist that were designed to specifically address LDKT disparities. Among the 7 existing partnerships identified within this review, the majority were developed as part of grant-funded interventions targeting healthcare access, health education, and health attitudes and behaviors as barriers to LDKT.SummaryFuture work is needed to identify practical methods for expanding LDKT partnerships among health equity researchers, healthcare...
Source: Current Transplantation Reports - May 23, 2019 Category: Transplant Surgery Source Type: research

mTOR Inhibitor in Combination with Cyclosporine as Primary Maintenance Immunosuppression in Combined Kidney/Pancreas Transplant Recipients
We report our experience employing a steroid-free, mammalian target of rapamycin (mTOR) inhibitor –based immunosuppression regimen in pancreas transplantation and review literature germane to the use of this regimen.Recent FindingsIn our experience, using mTOR inhibitor –based, steroid-free immunosuppression with low-dose cyclosporine and anti-thymocyte globulin (ATG) induction in 309 combined kidney/pancreas transplants resulted in one-year patient survival and death censored graft survivals of 95.8%, 93.5% (pancreas), and 96.1% (kidney). The biopsy-proven acute rejection incidence was 15.2% at 1 year. De...
Source: Current Transplantation Reports - May 21, 2019 Category: Transplant Surgery Source Type: research

Correction to: Implications of Frailty for Peritransplant Outcomes in Kidney Transplant Recipient
The original version of this article did not include the authors ’ National Institutes of Health grant in the Funding and Acknowledgements. The following should appear in the Funding and Conflict of Interest sections of the paper. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - May 16, 2019 Category: Transplant Surgery Source Type: research

Outcomes of Interest to Living Kidney Donors
We describe living kidney donor priorities and perspectives on outcomes and discuss implications for including their priorities in research, practice, and policy.Recent FindingsThe outcomes important to donors, from their perspective, include kidney function, time to recovery (defined as time taken to return to usual activities and physical and psychological functioning), surgical complications, impact on the family, quality of the donor-recipient relationship, life satisfaction, lifestyle restrictions, kidney failure, mortality, and pain or discomfort. In comparison, frequently reported outcomes in trials and observationa...
Source: Current Transplantation Reports - May 14, 2019 Category: Transplant Surgery Source Type: research

Living Kidney Donation in Individuals with Hepatitis C and HIV Infection: Rationale and Emerging Evidence
AbstractPurpose of ReviewHIV-infected (HIV+) and hepatitis C virus-infected (HCV+) individuals with end-stage renal disease (ESRD) have decreased access to kidney transplantation. With new opportunities provided by the HIV Organ Policy Equity (HOPE) Act and direct-acting antivirals (DAAs) for HCV, we explore the potential risks and benefits of living-donor kidney transplantation from HIV+ or HCV+ donors from the perspective of both donor health and recipient outcomes.Recent FindingsThe HOPE Act permits organ donation from both deceased and living HIV+ persons to HIV+ recipients; however, there is only a clinical experience...
Source: Current Transplantation Reports - April 30, 2019 Category: Transplant Surgery Source Type: research

Emerging Ethical Challenges in Living Kidney Donation
AbstractPurpose of ReviewLiving-donor kidney transplantation (LDKT) offers the best medical outcomes in terms of graft and patient survival for end-stage renal disease (ESRD) patients. LDKT involves a medically and psychologically suitable individual willingly agreeing to donate a kidney to a loved one or stranger. It is a unique situation in which a healthy person consents to having a medical procedure for another person ’s benefit. LDKT raises numerous ethical issues, particularly with respect to voluntary consent, risks and benefits, and vulnerability.Recent FindingsIn recent years, the discovery of APOL1, a gene ...
Source: Current Transplantation Reports - April 27, 2019 Category: Transplant Surgery Source Type: research

Billing for Living Kidney Donor Care: Balancing Cost Recovery, Regulatory Compliance, and Minimized Donor Burden
AbstractPurpose of ReviewTo provide standardized guidance for transplant programs to maximize financial reimbursement related to living donor care and to minimize financial consequences of evaluation, surgical, and follow-up care to living donor candidates and donors.Recent FindingsIn 2014, the American Society for Transplantation (AST) Live Donor Community of Practice (LDCOP) “Consensus Conference on Best Practices in Live Kidney Donation” identified inconsistencies in billing practices as a barrier to living donor financial neutrality and issued a strong recommendation that the transplant community actively p...
Source: Current Transplantation Reports - April 27, 2019 Category: Transplant Surgery Source Type: research

Mesenchymal Stem Cells to Treat Digestive System Disorders: Progress Made and Future Directions
AbstractPurpose of ReviewThe purpose of this review is to summarize the results from clinical trials that evoked promise and discouragement for the use of mesenchymal stem cells (MSCs) to treat digestive system disorders.Recent FindingsAdult MSCs are defined as a non-homogeneous population of pluripotent progenitor cells, which can be isolated and expanded in vitro from different tissues. The differentiation capacity of MSC along mesenchymal lineages and their immunomodulatory properties have been considered a new therapeutic approach for intestinal disorders. A dysregulated immune response is the cause and sustainment of ...
Source: Current Transplantation Reports - April 24, 2019 Category: Transplant Surgery Source Type: research

Liver Bioengineering: Promise, Pitfalls, and Hurdles to Overcome
AbstractPurpose of ReviewIn this review, we discuss the recent advancements in liver bioengineering and cell therapy and future advancements to improve the field towards clinical applications.Recent Findings3D printing, hydrogel-based tissue fabrication, and the use of native decellularized liver extracellular matrix as a scaffold are used to develop whole or partial liver substitutes. The current focus is on developing a functional liver graft through achieving a non-leaky endothelium and a fully constructed bile duct. Use of cell therapy as a treatment is less invasive and less costly compared to transplantation, however...
Source: Current Transplantation Reports - March 25, 2019 Category: Transplant Surgery Source Type: research

Evasion of Pre-Existing Immunity to Cas9: a Prerequisite for Successful Genome Editing In Vivo?
AbstractPurpose of ReviewCRISPR-Cas9-mediated genome editing holds promise for the future correction of congenital defects in vivo, providing potentially curative interventions for numerous intractable diseases. Nevertheless, the bacterial origin of the Cas9 endonuclease raises the spectre of pre-existing immunity that threatens to undermine the success of this powerful technology, necessitating a careful assessment of the potential risks involved.Recent FindingsGiven that genome editing commonly exploits the specificity of Cas9 endonucleases from species of bacteria that are a common cause of infection in humans, the rece...
Source: Current Transplantation Reports - March 19, 2019 Category: Transplant Surgery Source Type: research

Cell Therapy: Past, Present, and Future
AbstractPurpose of ReviewCellular therapy started in the early twentieth century with the development of blood transfusion and later bone marrow transplantation. This review describes the historical origins and major milestones in the field of cellular therapy. We discuss ethical concerns associated with certain cell sources and how they influenced therapy strategies. A focus of this article is on the use of stem cells to understand regenerative repair after kidney injury. In addition, we give an overview over past and current kidney-related cellular therapy trials.Recent FindingsThe number of kidney-related cellular thera...
Source: Current Transplantation Reports - March 18, 2019 Category: Transplant Surgery Source Type: research

Hyperlipidemia and Allograft Rejection
AbstractPurpose of ReviewAdvances in the development of immunosuppressive drug regimens have led to impressive survival rates in the year following organ transplantation. However, rates of long-term graft dysfunction remain undesirably high. Recently, it has been shown that co-morbidities in the patient population may affect graft survival. In mouse models, hyperlipidemia, a co-morbidity present in the majority of cardiac transplant patients, can significantly alter T cell responses to cardiac and skin allografts and accelerate graft rejection. Here, we review recent advances in our understanding of how alterations in lipi...
Source: Current Transplantation Reports - February 26, 2019 Category: Transplant Surgery Source Type: research

Should Hepatitis C Donors Be Used in Na ïve Urgent Status Patients on the Heart Transplant Waitlist?
AbstractPurpose of ReviewThe aim of this commentary is to review contemporary data on the use of hearts from hepatitis C positive donors.Recent FindingsThere continues to be a critical shortage of suitable heart donors available for patients with advanced heart failure requiring transplantation. Historically, donors with chronic hepatitis C virus were not utilized for heart transplantation due to concern about poor post-transplant outcomes. This was due, in part, to concerns about successfully treating chronic hepatitis C after transmitting the infection from donor to recipient. The availability of direct-acting anti-viral...
Source: Current Transplantation Reports - February 12, 2019 Category: Transplant Surgery Source Type: research

Frailty and Long-Term Post-Kidney Transplant Outcomes
AbstractPurpose of ReviewTo highlight recent research about frailty and its role as a predictor of adverse, long-term post-kidney transplant (KT) outcomes.Recent FindingsFrailty is easily measured using the physical frailty phenotype (PFP) developed by gerontologist Dr. Linda Fried and colleagues. In recent studies,>  50% of KT recipients were frail (20%) or intermediately frail (32%) at KT admission. Frail recipients were at 1.3-times higher risk of immunosuppression intolerance and 2.2-times higher risk of mortality, even after accounting for recipient, donor, and transplant factors; these findings were cons is...
Source: Current Transplantation Reports - February 9, 2019 Category: Transplant Surgery Source Type: research

The Evolving Role of Neutrophils in Liver Transplant Ischemia-Reperfusion Injury
AbstractPurpose of ReviewHepatic ischemia-reperfusion injury (IRI), an inevitable event during liver transplantation, represents a major risk factor for the primary graft dysfunction as well as the development of acute and chronic rejection. Neutrophils, along macrophages, are pivotal in the innate immune-driven liver IRI, whereas the effective neutrophil-targeting therapies remain to be established. In this review, we summarize progress in our appreciation of the neutrophil biology and discuss neutrophil-based therapeutic perspectives.Recent FindingsNew technological advances enable to accurately track neutrophil movement...
Source: Current Transplantation Reports - January 29, 2019 Category: Transplant Surgery Source Type: research

A Contraindication for Transplantation? Consequences of Frailty on Immunity and Immunosuppression
AbstractPurpose of ReviewFrailty has gained clinical relevance. While the condition may negatively impact outcomes, organ transplantation may also improve frailty. Notably, available assessment tools are broad and have not allowed for a detailed analysis or prognosis.Recent FindingsFrailty has been linked to adverse surgical outcomes while imparting on immune competency. Immunosuppressive treatment may therefore require modifications in frail patients, and effects on drug metabolism may need consideration. Moreover, cognitive impairment may impact compliance. Here, we provide a comprehensive update on clinical features, di...
Source: Current Transplantation Reports - January 28, 2019 Category: Transplant Surgery Source Type: research

Implications of Frailty for Peritransplant Outcomes in Kidney Transplant Recipients
AbstractPurpose of ReviewResearch over the past few decades points to the importance of frailty, or the lack of physiologic reserve, in the natural history of chronic diseases and in modifying the impact of potential interventions. End-stage kidney disease (ESKD) and the intervention of kidney transplantation are no exception. We review the recent epidemiologic and cohort-based evidence on the association between frailty and kidney transplant outcomes and provide a framework of questions with which to approach future research endeavors and clinical practice.Recent FindingsFrailty in kidney transplant candidates can be meas...
Source: Current Transplantation Reports - January 26, 2019 Category: Transplant Surgery Source Type: research

Metrics of Aging in Transplantation
AbstractPurpose of ReviewTo describe potential metrics of aging beyond chronological age and their associations with outcomes after solid organ transplantation.Recent FindingsInvestigation in this field has focused primarily on two areas: biomarkers related to replicative cell senescence and frailty and constructs related to frailty (e.g., sarcopenia, physical performance). Indicators of replicative senescence and frailty are more prevalent among transplant candidates than in the general elderly population, and both have been shown in recent studies to be associated with adverse outcomes following transplantation.SummaryDe...
Source: Current Transplantation Reports - January 25, 2019 Category: Transplant Surgery Source Type: research

Measuring Alloreactive B Cell Responses in Transplant Recipients
AbstractPurpose of ReviewDespite advanced immunosuppression, donor-specific antibodies (DSA) remain the leading cause of acute and chronic transplant tissue injury. Comprehensive evaluation of anti-donor humoral immune responses is critical for successful prevention, diagnosis, and treatment of antibody-mediated rejection. This review summarizes the evolution of techniques used for this purpose in experimental and clinical transplantation.Recent FindingsFor decades, measuring DSA serum levels was the only way to assess recipient humoral immunity. Recently, the interest shifted from quantifying circulating DSA to the analys...
Source: Current Transplantation Reports - January 24, 2019 Category: Transplant Surgery Source Type: research

Sarcopenia in Liver Transplantation
AbstractPurpose of ReviewSarcopenia is highly prevalent in end-stage liver disease (ESLD) patients and has been linked to poor outcomes on the wait list and post-transplantation. This current perspectives article reviews the ongoing challenges to define sarcopenia in ESLD patients, describes associations of sarcopenia with wait list and post-transplantation outcomes, and provides summarized data on efforts to prevent and treat sarcopenia through novel interventions.Recent FindingsSupervised exercise programs improve muscle strength, but muscle mass outcomes are limited by short study follow-up times. Branched-chain amino a...
Source: Current Transplantation Reports - January 21, 2019 Category: Transplant Surgery Source Type: research

The Role of Secretory Leukocyte Proteinase Inhibitor During Transplantation
AbstractPurpose of ReviewOld and new players of the innate immune response have been studied in the context of transplantation. Nonetheless, little interest has been focused toward the immune regulatory feedback in transplantation. Here, we revised the role of secretory leukocyte proteinase inhibitor (SLPI), which limits the activity of serine proteases, in solid organ transplantation.Recent FindingsIschemia-reperfusion injury increases SLPI gene expression. Furthermore, post-transplant acute kidney injury increases the expression of SLPI transcript and protein. Several studies have shown that SLPI exerts direct, indirect,...
Source: Current Transplantation Reports - January 16, 2019 Category: Transplant Surgery Source Type: research

Role of Complement Activation in Allograft Inflammation
AbstractPurpose of ReviewNovel paradigms have broadened our understanding of mechanisms through which complement mediates allograft inflammation/injury. Herein, we review advances in the field and highlight therapeutic implications.Recent FindingsPre-clinical and translational human trials have elucidated complement-dependent mechanisms of post-transplant ischemia-reperfusion (I/R) injury. Immune cell-derived, and intracellular, complement activation is newly linked to proinflammatory T cell immunity relevant to allograft rejection. Complement-induced immune regulation, including C5a ligation of C5a receptor 2 on T cells, ...
Source: Current Transplantation Reports - January 15, 2019 Category: Transplant Surgery Source Type: research

High-Dimensional Renal Profiling: Towards a Better Understanding of Renal Transplant Immune Suppression
AbstractPurpose of ReviewThe goal of this review is to discuss new approaches to avoid calcineurin inhibitor (CNI)/corticosteroids (CCS) toxicities with a focus on new biologics and new methods to understand transplant rejection at the single-cell level.Recent FindingsRecently developed biologics hold significant promise as the next wave of therapeutics designed to promote CNI/CCS-free long-term allograft acceptance. Indeed, belatacept, soluble CTLA4-Ig, is largely devoid of CNI-like toxicities, although it is accompanied by an increased frequency of acute rejection. Besides belatacept, other biologics hold promise as CNI-...
Source: Current Transplantation Reports - January 14, 2019 Category: Transplant Surgery Source Type: research

Frailty and Outcomes After Liver Transplantation
AbstractPurpose of ReviewFrailty is an emerging concept in liver transplantation. We reviewed the literature for the tests of frailty which have been validated to predict outcomes in patients with cirrhosis evaluated for liver transplantation.Recent FindingsSeveral tools have been developed to further stratify risk of adverse events independent of liver disease severity. These include tests of disability such as activities of daily living and the Karnofsky Performance Score, as well as tests of physical frailty, such as the Liver Frailty Index (handgrip, chair stands, and balance).SummaryIncreasingly, the frailty assessmen...
Source: Current Transplantation Reports - January 14, 2019 Category: Transplant Surgery Source Type: research

Commentary: Peri-Transplant Bariatric Surgery
ConclusionsAlthough bariatric surgery in the transplant population is not yet extensively studied and is mostly reported in small series, it seems a useful approach for the treatment of morbid obesity in these high-risk patients. Comparative data regarding optimal timing and type of bariatric procedure and long-term results are warranted. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - December 13, 2018 Category: Transplant Surgery Source Type: research

Novel Nanoimaging Strategies for Noninvasive Graft Monitoring in Vascularized Composite Allotransplantation
This article focuses on the unmet needs and key challenges in vascularized composite allotransplantation (VCA) and the opportunities for current nanotechnology advances in therapeutics and diagnostics for personalized treatment and optimization of clinical outcomes. The transformative role of nanoimaging as a noninvasive tool in the longitudinal surveillance of acute and chronic rejection after VCA is critically reviewed. Nanoimaging can inform management decisions and guide continuous treatment adjustments over time in patients to improve safety and efficacy in VCA. Nanoimaging signatures can be unbiased and quantitative ...
Source: Current Transplantation Reports - October 27, 2018 Category: Transplant Surgery Source Type: research

Is Lower Extremity Transplantation a Superior Alternative to Prostheses? No —At Least Not Yet
AbstractPurpose of ReviewThis paper reviews previously attempted cases of lower extremity vascularized composite allotransplantation (VCA), critically assesses the challenges associated with this procedure, and highlights alternative approaches to restore function for patients with lower limb loss.Recent FindingsDespite progress in the field of upper extremity transplantation, attempts at lower extremity transplantation have resulted in zero successes. Major hurdles that must be overcome prior to future attempts include, but are not limited to, large motor nerve regeneration and immunosuppression-related complications. For...
Source: Current Transplantation Reports - October 25, 2018 Category: Transplant Surgery Source Type: research

Liver Transplantation for HCC Beyond Milan
AbstractPurpose of the ReviewTo describe how the field of liver transplantation (LT) for hepatocellular carcinoma (HCC) has expanded beyond the Milan criteria.Recent FindingsThe Milan criteria have been the gold standard selection tool for patients with HCC undergoing LT since 1996. However, soon after its creation, the tumor size and number limits imposed by the Milan criteria were expanded upon by new models, such as the University of California-San Francisco criteria and the Metroticket. Still, these models were always limited by radiological inaccuracy in measuring tumor size and number and, more importantly, did not i...
Source: Current Transplantation Reports - October 25, 2018 Category: Transplant Surgery Source Type: research

Utilizing Donors with Hepatitis C Antibody Positivity and Negative Nucleic Acid Testing
AbstractIntroductionThe demand for organs in the USA exceeds supply resulting in high mortality for patients awaiting transplantation. To increase the pool of available organs, the transplant community is investigating the safety and utility of organs previously considered high risk. Guidelines currently advocate for the use of hepatitis C antibody, nucleic acid testing (NAT)-negative organs in hepatitis C –positive recipients. However, data is limited regarding outcomes of using such grafts in hepatitis C–negative recipients.Purpose of ReviewThe purpose of this paper is to review the literature on utilizing he...
Source: Current Transplantation Reports - October 25, 2018 Category: Transplant Surgery Source Type: research

Experimental Models of Penile and Lower Limb Transplantation: Are They Really Translational?
AbstractPurpose of ReviewThe purpose of this review is to evaluate the recent literature about animal models for penile and lower limb transplantation, regarding their relevance to the clinical scenario.Recent FindingsAlthough both penile and lower limb transplantations have been sharing same problems with all other vascularized composite allotransplantations, they have their unique issues that need to be addressed. There is no appropriate animal model to demonstrate functions of both penile and lower limb transplantation.SummaryWe reevaluate and underline the interesting and important findings of the certain animal models...
Source: Current Transplantation Reports - October 12, 2018 Category: Transplant Surgery Source Type: research

Penile Reconstruction Versus Transplantation: Which One Is Ideal?
AbstractPurpose of ReviewReconstruction of composite tissues or organs is challenging, with limited functional and esthetic outcomes. Nearly 100  years passed from the first penile reconstruction is performed; however, the outcomes were far from ideal. With the beginning of the reconstructive transplantation era, new choices became possible.Recent FindingsUntil now, four penis transplantations were performed worldwide, with encouraging short-term results. Although with a short follow-up, these penile transplantations reported success. However, the problems related to systemic lifelong immunosuppression remain as the m...
Source: Current Transplantation Reports - October 11, 2018 Category: Transplant Surgery Source Type: research

The Current State of Pancreas Transplantation in the USA —A Registry Report
AbstractPurposeA successful pancreas transplantation is still the only method to provide long-term insulin independence and provide good metabolic control for patients with type I diabetes. Since the first pancreas transplant in 1966, the patient and graft survival after pancreas transplantation improved significantly. The aim of this report was to study the most recent outcome of pancreas transplants.Recent FindingsBetween 2011 and 2016, 5159 primary deceased donor pancreas transplants in diabetic patients were performed —4342 (84%) SPK, 399 PAK (8%), and 418 (8%) PTA. One-year (3-year) SPK patient survival reached ...
Source: Current Transplantation Reports - October 6, 2018 Category: Transplant Surgery Source Type: research

Ethics and the Future of Vascularized Composite Allotransplantation
AbstractPurpose of ReviewThis paper seeks to identify and examine a number of ethical issues that persist 20  years after the field of vascularized composite allotransplantation was established. Reflection upon these issues will be essential if the field is to fulfill its promise.Recent FindingsA number of scholars, including the authors, have been involved in efforts to identify ethical issues in VCA. Meetings held in the US and in Europe have focused on ethical concerns related to procurement, risk-benefit, consent, and program standards, among others.SummaryImproving the burden and risk vs. benefit ratio, strengthe...
Source: Current Transplantation Reports - October 2, 2018 Category: Transplant Surgery Source Type: research

Type 1 Diabetes Recurrence After Simultaneous Pancreas-Kidney Transplantation
AbstractPurpose of ReviewSimultaneous pancreas-kidney transplantation (SPKT) is an important option for patients with type 1 diabetes (T1D) and end-stage renal disease. While most SPKT recipients experience long-term euglycemia, about 5% return to insulin therapy, 5 –20 years after transplantation due to T1D recurrence (T1DR). Over the last two decades, we have assessed autoimmunity in our patients, evaluating autoantibodies (GAD65, IA2, and ZnT8), autoreactive T cells, and pancreas transplant biopsies.Recent FindingsMost patients demonstrate seroconversion for multiple autoantibodies. Autoreactive memory T cell...
Source: Current Transplantation Reports - September 22, 2018 Category: Transplant Surgery Source Type: research

State of the Science in Deceased Organ Donor Management
This article aims to appraise the current literature with a focus on reviewing deceased donor intervention trials.Recent FindingsAggressive critical care management after determination of brain death resulting in meeting of a donor management goal bundle has consistently demonstrated an association with significantly more organs transplanted per donor as well as improved graft outcomes. Although there is a dearth of experience with randomized donor intervention studies, dopamine and targeted mild therapeutic hypothermia have been found to significantly reduce delayed graft function in kidney recipients.SummaryProgress in u...
Source: Current Transplantation Reports - September 19, 2018 Category: Transplant Surgery Source Type: research

Perioperative Management of Patients with Hepatopulmonary Syndrome
AbstractPurpose of ReviewHepatopulmonary syndrome (HPS) is a syndrome of hypoxemia in patients with advanced liver disease, which results in significant mortality in the absence of liver transplantation. Management of HPS is complex both prior to and following liver transplantation as illustrated by a case presentation. This review considers the pathophysiology, diagnosis, assessment of severity, and treatment of HPS with a particular emphasis on perioperative management.Recent FindingsScreening for HPS should be performed in all liver transplant candidates with room air saturation less than 97%. Diagnosis of HPS has been ...
Source: Current Transplantation Reports - September 17, 2018 Category: Transplant Surgery Source Type: research

Infectious Complications in Pancreas Transplantation
AbstractPurpose of ReviewIn addition to the infectious risk associated with all solid organ transplants, pancreas transplantation poses some unique risks associated with surgical technique and host risk factors. This review highlights several key areas of infectious diseases that physicians must consider in patients undergoing pancreas transplantation.Recent FindingsSurgical site infections are common after pancreas transplantation, and empiric antimicrobials, including antifungal coverage, are often needed to reduce the risk of these infections. Cytomegalovirus and Epstein-Barr virus (EBV) infections require close monitor...
Source: Current Transplantation Reports - September 13, 2018 Category: Transplant Surgery Source Type: research

Total Artificial Heart Technology: Where Are We Now?
AbstractPurpose of ReviewThe intended goal of this paper is to review current indications, available devices, and future directions of total artificial heart therapies. Throughout the paper, we sought to help clinicians identify appropriate patients who might be considered for total artificial heart therapy, highlighting the most current data regarding outcomes and adverse events.Recent FindingsThe INTERMACS report on the total artificial heart has recently been published in theJournal of Heart and Lung Transplantation and represents the largest study to date on available TAH therapies. Notable findings include better outc...
Source: Current Transplantation Reports - September 4, 2018 Category: Transplant Surgery Source Type: research

Review of Major Drug-Drug Interactions in Thoracic Transplantation
AbstractPurpose of ReviewThe first human lung transplant surgery in the world was done in 1963, followed by the first heart transplant in 1967, making this year its 50th anniversary. Since then, there has been great advancement in immunotherapy, with the adoption of calcineurin inhibitors (CNI), mycophenolate mofetil, and proliferation signal inhibitors (PSI). However, while these medications are crucial to maintenance of allograft function and prevention of allograft rejection, they have many toxicities and side effects, which make therapeutic dose monitoring and recognition of drug-drug interactions of critical importanc...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research

Perioperative Assessment and Intraoperative Core Concepts in the Complex Kidney Patient
AbstractPurposeLife span and sense of well-being continue to improve post-transplantation in patients with end-stage kidney disease, despite referral of an older and more medically complex population for transplantation. In this issue of the journal, we review existing evidence about risk assessment in kidney transplant candidates from the perspective of the anesthesiologist. The authors explore cardiovascular assessment and risk in the context of intraoperative events that can influence short- and long-term outcomes.Recent FindingsThe number of patients referred for kidney transplantation continues to increase and has far...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research

Immunosuppression for Lung Transplantation: Current and Future
AbstractPurpose of the ReviewThe number of lung transplantations performed worldwide continues to increase. There is a growing need in these patients for more effective immunosuppressive medications with less toxicity.Recent FindingsThis review article summarizes the recent studies and developments in lung transplant immunosuppression. Novel immunosuppressive medications and strategies used in other solid organ transplantations are being trialed in lung transplantation. This includes the use of co-stimulation blockers like belatacept and mTOR inhibitors like everolimus. Calcineurin-sparing regimens have been described in a...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research

Current Hematological Concepts and Viscoelastic-Based Transfusion Practices During Liver Transplantation
ConclusionWhile we were successful in formulating a dosing regimen based on available literature and our own institutional practices for treating deficiencies of clotting factors and fibrinogen, more research is needed to arrive at a dosing regimen for platelets based on functional deficiency. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research

Impact of Allograft Steatosis on Cardiovascular Outcomes
AbstractPurpose of ReviewCardiovascular events are among the most consequential long-term outcomes in liver transplant recipients. While underlying non-alcoholic fatty liver disease has been independently associated with unfavorable cardiovascular outcomes and increased mortality, it is unclear yet if the same holds true for allograft steatosis. We here review the available data on cardiovascular outcomes after liver transplant with specific focus on allograft steatosis.Recent FindingsTwo subtypes of hepatic allograft steatosis exist, recurrent and de novo, and both are common. Although the current data suggest an associat...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research