Managing the Obese Living Kidney Donor
AbstractPurpose of ReviewIn the context of the obesity epidemic, an increasing number of obese individuals present for evaluation as living kidney donor candidates. No standardization exists regarding their selection criteria, evaluation, nephrectomy technique, postdonation follow-up requirements, and predonation weight loss strategies. We review the surgical and long-term medical safety profiles of living kidney donation in obese individuals, address considerations in their evaluation and postdonation follow-up, and explore emerging strategies for predonation weight loss.Recent FindingsMinimally invasive donor nephrectomy...
Source: Current Transplantation Reports - May 2, 2020 Category: Transplant Surgery Source Type: research

Physical Function in Kidney Transplantation: Current Knowledge and Future Directions
AbstractPurpose of ReviewLow physical function (PF) is common among individuals with end-stage kidney disease. In this review, we explore data on the impacts of PF on access to kidney transplantation (KT) and KT outcomes. We also discuss the latest interventions to improve PF in pre- and post-KT settings.Recent FindingsMany US KT programs measure PF or related constructs when assessing KT candidacy. Although carefully selected KT candidates with low PF can benefit from KT with respect to survival and quality of life, low PF decreases the likelihood of being listed for KT and increases the risk of adverse post-KT outcomes. ...
Source: Current Transplantation Reports - May 2, 2020 Category: Transplant Surgery Source Type: research

Cell Replacement Therapy for Insulin-Dependent Diabetes: Maintaining Islet Architecture and Distribution After Graft
AbstractPurpose of ReviewTo survey current practices in clinical islet transplantation to identify the critical factors for designing a successful implant strategy for islets derived from pluripotent stem cells. Of particular importance is the volume of a therapeutic dose and the host sites capable of housing that volume.Recent FindingsA calculated dose of surviving islets required for normoglycemia in patients is large, though less than the number of islets present in a healthy pancreas. Great strides have been made developing methods for delivery of a large dose of islets that maintain cell viability and potency. Althoug...
Source: Current Transplantation Reports - April 30, 2020 Category: Transplant Surgery Source Type: research

Extracellular Vesicles, Apoptotic Bodies and Mitochondria: Stem Cell Bioproducts for Organ Regeneration
AbstractPurpose of ReviewIn the current work, we will present the characterization of the main different stem cell-derived vesicular bio-products with potential application in organ regeneration.Recent FindingsThe therapeutic effects of stem cell therapy in organ repair, specifically those utilizing mesenchymal stromal cells, are largely dependent on the cells ’ release of different bio-products. Among these bio-products, extracellular vesicles (EVs) appear to play a major role due to their ability to carry and deliver bioactive material for modulation of cellular pathways in recipient cells. Concurrently, mitochondr...
Source: Current Transplantation Reports - April 27, 2020 Category: Transplant Surgery Source Type: research

Use of Patient Navigators to Reduce Barriers in Living Donation and Living Donor Transplantation
AbstractPurpose of ReviewThe transplant community is facing an important and growing crisis in healthcare disparities, which limits the access of vulnerable populations to successful transplant and its most ideal form, living donor transplantation [1–6]. The time is now to implement strategies that facilitate access to timely living donor transplant and relieve the pressure on a burdened deceased donor waiting list.Recent FindingsPatient navigation programs have arisen as distinctive model of patient-centered healthcare delivery to overcome existing disparities in access to healthcare. Originally used in oncology [7&...
Source: Current Transplantation Reports - April 4, 2020 Category: Transplant Surgery Source Type: research

Moving the Margins: Updates on the Renaissance in Machine Perfusion for Organ Transplantation
AbstractPurpose of ReviewEscalating end-organ disease coupled with stagnant donor pools has begotten global organ shortages. Ex vivo organ perfusion, used briefly in the early days of clinical transplant and then sidelined for decades by static cold storage, has resurged to address this organ paucity. Given the recent prolific application of machine perfusion as a platform for assessment, preservation, and treatment of marginal grafts, this review summarizes salient results from the past 2 –3 years in kidney, liver, lung, heart, pancreas, vascularized composite allograft, and xenograft transplantation.Recent Fin...
Source: Current Transplantation Reports - March 31, 2020 Category: Transplant Surgery Source Type: research

Recent Progress in T reg Biology and Transplant Therapeutics
AbstractPurpose of ReviewRegulatory T cell (Treg) biology continues to evolve at a rapid pace. The role of Tregs in solid organ transplantation offers a unique window into Treg ontogeny and function as well as limitless possibilities for clinical application. Here we review recent significant discoveries and key translational work.Recent FindingsAdvances in transplantation deepen understanding of Treg differentiation, expansion, transcription, co-stimulation, and signaling. T cell receptor (TCR) sequencing and single-cell analytics allow unprecedented insight into Treg repertoire diversity and phenotypic heterogeneity. Eff...
Source: Current Transplantation Reports - March 27, 2020 Category: Transplant Surgery Source Type: research

Cognitive Function in Liver Transplantation
AbstractPurpose of ReviewLiver transplantation (LT) remains the only way to cure patients with severe liver diseases. Important questions about neurological sequelae and quality of life after LT have emerged. In this review, we discuss the neurocognitive changes associated with LT and we conclude with recommendations in this regard for patients, caregivers, and physicians.Recent FindingsCompared with other solid organ recipients, LT patients tend to have a higher incidence (up to 30%) of neurological complications post-LT. Even in absence of previous episodes of hepatic encephalopathy (HE), some patients display new onset ...
Source: Current Transplantation Reports - March 26, 2020 Category: Transplant Surgery Source Type: research

Changing Landscape of Solid Organ Transplantation for Older Adults: Trends and Post-Transplant Age-Related Outcomes
AbstractPurpose of ReviewThe prevalence of older adults with end organ failure is increasing. This review summarizes recent trends in waitlisting of patients age 65  years and older for solid organ transplantation. Recent data on post-transplantation outcomes in this population are also reviewed.Recent FindingsWaitlisting and transplantation rates in older adults are increasing across all categories of solid organ transplantation. Though survival is worse when compared with that in a younger population, survival remains robust and many patients in this population benefit from transplantation. Compared with younger adu...
Source: Current Transplantation Reports - March 26, 2020 Category: Transplant Surgery Source Type: research

Kidney Regenerative Medicine: Promises and Limitations
AbstractPurpose of ReviewAdvances in renal regenerative medicine are crucial to address the increased rate of kidney disease. Clinicians and researchers are investigating new renal therapeutics aimed at promoting endogenous repair and/or at designing new technologies for organ and tissue regeneration. This review explores the potential promises and limitations of recent renal regenerative medicine approaches.Recent FindingsCurrent research directions include efforts to delay and deter acute and chronic kidney disease progression by exploiting the immune-modulatory and tissue regenerative properties of pharmacology agents, ...
Source: Current Transplantation Reports - March 25, 2020 Category: Transplant Surgery Source Type: research

Platelets: Mechanistic and Diagnostic Significance in Transplantation
AbstractPurpose of ReviewIn addition to their function in coagulation, platelets recently have been recognized as an important component of innate immune responses. This review relates salient immune functions of platelets to transplants.Recent FindingsPlatelets are critical bridges between vascular endothelium and leukocytes. Real-time imaging of platelets has demonstrated that platelets rapidly adhere to vascular endothelium and form a nidus for attachment of neutrophils and then monocytes. However, the majority of platelets subsequently release from endothelium and return to the circulation in an activated state. These ...
Source: Current Transplantation Reports - March 25, 2020 Category: Transplant Surgery Source Type: research

Use of Telehealth to Expand Living Kidney Donation and Living Kidney Donor Transplantation
AbstractPurpose of ReviewLiving donor kidney transplantation (LDKT) remains the treatment of choice for suitable candidates with advanced kidney disease. Despite excellent outcomes for living kidney donors, the rate of living kidney donation has remained relatively stable over the past decade despite the growing number of those in need of kidney transplants. Telehealth may represent an opportunity to increase access to evaluation and donation for living donor candidates and improve care and follow-up of living donors. This review discusses current and potential opportunities in the utilization of telehealth throughout the ...
Source: Current Transplantation Reports - March 25, 2020 Category: Transplant Surgery Source Type: research

Overview of the Evolution of the UK Kidney Allocation Schemes
AbstractPurpose of ReviewAllocation of deceased donor kidneys for transplantation has evolved since the first utilitarian approach in 1989. This review looks at how the schemes have evolved over the ensuing three decades.Recent FindingsFour kidney offering schemes have been used in the last 30  years. Successive schemes have evolved from offering only one donor kidney for a nationally prioritised patient to offering both kidneys, from addressing only kidneys from donors after brain death (DBD) to offering kidneys from both DBD and circulatory death donors (DCD) and from prioritising pure ly on the basis of zero class ...
Source: Current Transplantation Reports - March 12, 2020 Category: Transplant Surgery Source Type: research

Allocation and Distribution of 8488 Consecutive Kidneys Obtained in Mexico During a 12  Years Period
We describe allocation and distribution of 8488 kidneys obtained from deceased donors from January 2007 to December 2018. We describe a fragmented health system without universal coverage for organ donation and transplantation, a huge regional variability in organ donation and transplantation activity, a great disparity in access to the waiting list, and a faulty system for organ allocation requiring reform to achieve international standards of transparency and traceability. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - February 17, 2020 Category: Transplant Surgery Source Type: research

Transplantable Liver Organoids, Too Many Cell Types to Choose: a Need for Scientific Self-Organization
AbstractPurpose of ReviewLiver stem cells have been proposed as alternatives or additions for whole liver transplantations to accommodate the donor liver shortage. Various sources of liver stem cells have been described in experimental animal studies. Here we aim to compare the various studies.Recent FindingsIrrespective of the experimental design, the percentage of long-lasting survival and functional recovery of transplanted cells is generally very low. An exception to this are the proliferating hepatocytes transplanted into Fah(-/-) Rag2−/−IL2rg−/− mice; here 4-month post-transplantation around 6...
Source: Current Transplantation Reports - February 15, 2020 Category: Transplant Surgery Source Type: research

Liver Repair and Regeneration in Transplant: State of the Art
AbstractPurpose of ReviewThe liver is known for having the unusual capacity to regenerate itself following injury. Transplantation is necessarily associated with injury, cell death, and regeneration. The regenerative capacity of the liver is vital to the optimal outcomes of patients who undergo transplant.Recent FindingsIn this review, we will investigate the mechanisms, including cells and some of the major molecules and cytokines in this process. These will help to elucidate the importance of these molecules while at the same time demonstrating the complexity of this process. Finally, external factors which affect optima...
Source: Current Transplantation Reports - February 6, 2020 Category: Transplant Surgery Source Type: research

Management of Antimicrobial Agents in Abdominal Organ Transplant Patients in Intensive Care Unit
AbstractPurpose of ReviewEarly diagnosis of infections and immediate initiation of appropriate antimicrobials are crucial in the management of patients before and after organ transplantation. We reviewed the most recent literature and guidelines in this field and organized the current recommendations for healthcare professionals caring for critically ill organ transplant recipients.Recent FindingsThe incidence of multidrug-resistant organisms is increasing. Multidrug-resistant Gram-negative bacteria comprise about 14% of organisms. Vancomycin-resistant enterococci bloodstream infections are also on the rise, as 20.5% of no...
Source: Current Transplantation Reports - January 24, 2020 Category: Transplant Surgery Source Type: research

Heart Retransplantation: Candidacy, Outcomes, and Management
AbstractPurpose of ReviewTo describe the incidence and epidemiology of heart retransplantation in adults and children and to review the risk factors associated with adverse outcome following retransplantation to help guide recipient selection.Recent FindingsHeart retransplantation is associated with inferior short-term and long-term survival when compared with primary heart transplantation and its use remains controversial although less so in the pediatric heart transplant population.SummaryIn the most recent era of heart transplantation, patients retransplanted for CAV, greater than 1 year from their primary transplant, a...
Source: Current Transplantation Reports - December 17, 2019 Category: Transplant Surgery Source Type: research

Management of Renal Failure in the Liver Transplant Patient
AbstractPurpose of ReviewTo examine several current issues in the management of patients undergoing orthotopic liver transplantation (OLT) with significant renal injury.Recent FindingsReview of the recent literature suggests that the actual cause of acute kidney injury (AKI) in cirrhotic patients undergoing OLT may significantly influence outcomes. Strategies such a simultaneous liver-kidney transplant (SLK) and intraoperative renal replacement therapy have been employed to achieve comparable results to either single organ transplant or those without pre-OLT AKI.SummaryWith the dramatic rise in acuity at the time of transp...
Source: Current Transplantation Reports - December 4, 2019 Category: Transplant Surgery Source Type: research

Machine Perfusion of Lungs
AbstractPurpose of ReviewThe purpose of this review is to summarize the fundamentals, rationale, research topics, and clinical outcomes of ex vivo lung perfusion.Recent FindingsSince the first clinical case in 2000, the usefulness of ex vivo lung perfusion to increase the donor lung pool has been supported by much evidence. The main role of ex vivo lung perfusion is to evaluate, preserve, and treat lungs that otherwise might not be useable for transplantation. Many studies have been conducted to evaluate the optimal perfusate, flow, method of evaluation, markers of lung performance, and possible treatment strategies. Moreo...
Source: Current Transplantation Reports - November 30, 2019 Category: Transplant Surgery Source Type: research

The Use of Gene Expression Profiling in Lung Transplantation
AbstractPurpose of ReviewGene expression profiling is increasingly being used to better elucidate the physiology that occurs after lung transplantation. Through better understanding of the mechanisms of rejection, researchers demonstrate potential targets for future therapeutics as well as less invasive means of detecting rejection. We reviewed recently published literature that focused on the use of gene expression in lung transplant recipients in order to determine if there were trends in the genetic pathways involved in rejection.Recent FindingsIn our review, we found significant roles for both the innate and adaptive i...
Source: Current Transplantation Reports - November 22, 2019 Category: Transplant Surgery Source Type: research

Allocation and Reporting of Deceased Donor Kidney Transplantation in Canada
AbstractPurpose of ReviewThe review provides an overview of deceased donor kidney allocation in Canada.Recent FindingsOrgan donation and transplant services are organized provincially in Canada. In the absence of a national system, provincial organ allocation policies aspire to balance considerations of utility and justice consistent with national best practice recommendations established in inter-provincial initiatives. As deceased donor kidneys are not routinely shared between regions, variations in provincial allocation policy are justifiable based on regional differences in donor supply and waiting times.SummaryThe lac...
Source: Current Transplantation Reports - November 20, 2019 Category: Transplant Surgery Source Type: research

Composite Vascularized Allograft Machine Preservation: State of the Art
AbstractPurpose of ReviewIn this review, we aim to introduce the concept of machine perfusion of vascularized composite allografts (VCAs). We briefly discuss the basic elements of the circuit design, role of the temperature during the perfusion, types of perfusate, and future trends in this field.Recent FindingsSeveral large animal models have demonstrated the efficacy of machine perfusion over static cold storage. While the maximum allowable ischemia time in VCA is 4 –6 h with cold storage method, promising results have been achieved in extended preservation times up to 24 h in machine perfusion technique....
Source: Current Transplantation Reports - November 19, 2019 Category: Transplant Surgery Source Type: research

The Role of Desensitization in Kidney Paired Donation
AbstractPurpose of ReviewKidney paired donation (KPD), desensitization, and prioritization in the deceased donor kidney allocation system (KAS) are current options to facilitate kidney transplant in difficult-to-match, highly sensitized patients. KPD participation has increased while new desensitization tools are developed. We review these trends and discuss the combined role of desensitization and KPD.Recent FindingsAccording to the National Kidney Registry (NKR), KPD utilizing desensitization decreased while the number of highly sensitized KPD transplants and deceased donor transplants increased over the past decade. Thi...
Source: Current Transplantation Reports - November 14, 2019 Category: Transplant Surgery Source Type: research

Where Have All the Pancreas Transplants Gone and What Needs to Change?
AbstractPurpose of ReviewTo shed light on the multiple factors impacting a decline in pancreas transplant volume and to present strategies that individual transplant centers can implement to increase their volumes.Recent FindingsOverall, pancreas transplant volume is declining in the USA and in several other countries of the world. The reasons are multifactorial, but an important driving factor is the delayed progression to end-stage renal disease in patients with type 1 diabetes due to better diabetes care. Another factor contributing to the lack of expansion of the pancreas transplant field is an under appreciation by th...
Source: Current Transplantation Reports - November 14, 2019 Category: Transplant Surgery Source Type: research

Artificial Lungs: Current Status and Future Directions
AbstractPurpose of ReviewAlthough lung transplantation can be used to treat lung failure, limited donor organ availability creates a pressing need for improved artificial lung technology. This review discusses recent developments and future research pathways for respiratory assist devices and regenerative therapies intended to treat advanced lung disease.Recent FindingsHollow fiber membrane gas exchangers can be used to bridge lung failure patients to transplantation. Engineering improvements to such devices are on the verge of enabling longer term wearable systems that simplify and improve support. Progress with microchan...
Source: Current Transplantation Reports - November 11, 2019 Category: Transplant Surgery Source Type: research

The Importance of Non-HLA Antibodies After Heart Transplant
AbstractPurpose of ReviewAntibodies to human leukocyte antigens (HLA) are associated with adverse patient and allograft outcomes after heart transplantation. Non-HLA antibodies have increasingly been recognized as important mediators of rejection, cardiac allograft vasculopathy (CAV), and allograft injury. In particular, these antibodies have been implicated in a subset of heart transplant recipients who have clinical and/or pathologic evidence of antibody-mediated rejection in the absence of detectable antibodies against HLA.Recent FindingsNon-HLA antigens have been identified to have important roles in both the innate an...
Source: Current Transplantation Reports - November 10, 2019 Category: Transplant Surgery Source Type: research

Cardiac Evaluation in Liver Transplantation
AbstractPurpose of ReviewWith more than 14,000 patients awaiting liver transplantation in the USA and a mortality rate of 20 –25% on the wait list, a diligent pre-operative evaluation is crucial to ensure optimal risk assessment. Cardiac disease remains the leading cause of early mortality after liver transplantation. In this review, we discuss common cardiac comorbidities, frequently used testing modalities, and update d literature on cardiac evaluation in liver transplant candidates.Recent FindingsOptimal cardiac evaluation, especially in the asymptomatic patient, remains controversial as shown by conflicting resul...
Source: Current Transplantation Reports - November 8, 2019 Category: Transplant Surgery Source Type: research

Belatacept and CD28 Costimulation Blockade: Preventing and Reducing Alloantibodies over the Long Term
AbstractPurpose of ReviewHighlight developments in T and B cell biology that are helping elucidate the mechanisms underlying CD28 pathway blockade-mediated inhibition of alloantibodies in transplantation, and discuss recent clinical observations on the impact of belatacept on de novo and established HLA antibodies.Recent FindingsThe identification of T follicular helper cells as the CD4+ T cell subset required for optimal humoral immunity, along with newly identified roles for CD28 and the B7 molecules on B cell lineage cells, has begun to pave the way for improved understanding and discovery of the mechanisms of CD28 cost...
Source: Current Transplantation Reports - November 2, 2019 Category: Transplant Surgery Source Type: research

Ethical Implications in Donor and Recipient Utilization for Liver Transplant
AbstractPurpose of ReviewThe inception of liver transplantation although controversial continues to save daily lives of patients in need. Its successful practice is owed to the various medical advancements to cross the complex immunological and surgical barriers. Herein, we discuss the several ethical dilemmas in organ donation and transplantation with application of ethical principles and reflections from the literatureRecent FindingsThere are several ethical and moral complexities when evaluating living donors and matching deceased donor livers to recipients. The lack of “one size fits all” turns these comple...
Source: Current Transplantation Reports - November 1, 2019 Category: Transplant Surgery Source Type: research

Biosynthetic Tubules: Multiscale Approaches to Kidney Engineering
AbstractPurpose of ReviewThere are over 700,000 cases of end-stage renal disease in the USA, resulting in more deaths per year than prostate or breast cancer. Many researchers have proposed the generation of in vitro kidney models or implantable therapeutic replacements using biomedical engineering strategies. Because the functional unit of the kidney —the nephron—is based on tubule structures, the formation of biosynthetic tubules is at the foundation of creating models or devices to recapitulate the kidney.Recent FindingsRecent approaches to engineering kidney tubules involve both bioengineering (perfusable m...
Source: Current Transplantation Reports - August 3, 2019 Category: Transplant Surgery Source Type: research

Liver Machine Preservation: State of the Art
AbstractPurpose of ReviewMachine perfusion (MP) is an expanding area of interest in experimental and clinical liver transplantation (LT). Varied technologies and procedures have been reported, and operational standards have yet to be established. We carried out a systematic literature review on use of machine perfusion (MP) in adult liver transplantation (LT) focusing on patients ’ characteristics, post-transplant complications, and outcome. The goal of this review was to analyze all clinical studies on MP. We seek to report how many clinical studies on MP existed in literature, what was the MP setting, and results.R...
Source: Current Transplantation Reports - July 30, 2019 Category: Transplant Surgery Source Type: research

Kidney Machine Preservation: State of the Art
AbstractPurpose of the ReviewMachine perfusion has become an important asset in solid organ transplantation to improve the constant organ shortage. This review summarizes advances in machine perfusion of kidney grafts over the last 3 years.Recent FindingsBecause of the severe organ shortage, more and more marginal grafts are being accepted for transplantation. In an attempt to decrease preservation injury and better assess grafts before transplantation, research studies have focused their attention on ex vivo machine perfusion. Hypothermic machine perfusion has been used in a clinical setting for years and has proven to be...
Source: Current Transplantation Reports - July 13, 2019 Category: Transplant Surgery Source Type: research

Machine Perfusion of Donor Heart: State of the Art
AbstractPurpose of ReviewThe purpose of this manuscript is to briefly review the past, present, and potential future of machine perfusion (MP) of the donor heart and to highlight its potentials to improve heart transplantation rates and outcomes.Recent FindingsDuring the last few decades, the interests in MP has been raised. Experimental studies in animal and human models, together with clinical trials have provided robust evidence that MP may be considered as a better organ preservation method compared to conventional cold storage, as it avoids cold ischemia and maintains aerobic metabolism requirements of the donor heart...
Source: Current Transplantation Reports - July 11, 2019 Category: Transplant Surgery Source Type: research

Kidney Allocation System for Transplantation in Brazil
AbstractPurpose of ReviewWorldwide allocation systems are subjected to regulatory and ethical unique themes prevailing under the local socioeconomic and health care system. We sought to describe kidney allocation system, local transplant regulatory environment, and some general information concerning reimbursement in Brazil.Recent FindingsUnder a universal health care program, the national transplant system coordinates national transplant activity. Organ procurement occurs through a combination of organ procurement organizations and hospital commissions. Donation after circulatory death is still prohibited. Allocation syst...
Source: Current Transplantation Reports - July 4, 2019 Category: Transplant Surgery Source Type: research

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