Interventions to Preserve Cognitive Functioning among Older Kidney Transplant Recipients
AbstractPurpose of ReviewTo summarize the research on effective interventions for preserving cognitive function and prevent cognitive decline in patients with end-stage kidney disease (ESKD) who are undergoing dialysis and/or kidney transplantation (KT).Recent FindingsAmong ESKD patients undergoing hemodialysis, exercise training has been administered through home-based and intradialytic interventions. Additionally, one pilot study identified intradialytic cognitive training, electronic brain games, as an intervention to preserve cognitive function among patients undergoing hemodialysis. Fewer studies have investigated int...
Source: Current Transplantation Reports - October 21, 2020 Category: Transplant Surgery Source Type: research
Antivirals for COVID-19 in Solid Organ Transplant Recipients
AbstractPurpose of ReviewTo evaluate the critical studies published so far on the most promising antiviral therapies for COVID-19, with particular emphasis on any solid organ transplant –specific information.Recent FindingsAlthough the literature is increasing exponentially, most clinical trials have been preliminary, thus lacking robust evidence to support many of the drugs discussed here. The main exception is remdesivir, for which several trials have been published supporting its use for patients with severe COVID-19. No solid organ transplant –specific data on remdesivir or other antiviral therapies have been publi...
Source: Current Transplantation Reports - October 21, 2020 Category: Transplant Surgery Source Type: research
The New US Heart Allocation Scheme: Impact on Waitlist and Post-Transplant Survival
AbstractPurpose of ReviewIn October 2018, the Organ Procurement and Transplantation Network (OPTN) revised the donor heart allocation system in an attempt to prioritize those patients with highest clinical urgency, reduce waitlist morality, and improve geographic equity in organ allocation. Our goal was to review the changes in the heart allocation policy and its impact on transplant characteristics and outcomes.Recent FindingsAfter the new 2018 donor heart allocation system became effective, there has been a trend toward increased use of temporary mechanical circulatory support. Also, initial reports suggested reduced pos...
Source: Current Transplantation Reports - October 14, 2020 Category: Transplant Surgery Source Type: research
Liver Transplantation for Colorectal Liver Metastasis
AbstractPurpose of ReviewAccumulating evidence suggest that selected patients with nonresectable liver only metastases from colorectal cancer can be offered liver transplantation with acceptable outcome. This review provides an update on the scientific literature.Recent FindingsThe SECA-I study showed an estimated 5-year survival of 60% in a heterogenous patient population and guided the development of the first clinical selection criteria. In the sequel SECA-II trial, an estimated 5-year survival of 83% was obtained. A recent study shows that an Oslo score of 0 –2, a metabolic tumor volume below 70 cm3 on PET-CT or Fon...
Source: Current Transplantation Reports - October 14, 2020 Category: Transplant Surgery Source Type: research
A Multisystemic Approach to Psychosocial Evaluations of Vascularized Composite Allotransplantation Candidates
This report seeks to shed light on multisystem domains of interest in vascularized composite allotransplantation (VCA) to improve patients ’ psychosocial assessment and candidacy, to decrease environmental barriers to transplant success, and to add to the discussion concerning bioethical dilemmas associated to VCA.Recent FindingsPsychosocial assessment tools cover availability, accessibility, and common sense of the treatment at microsystem and individual levels. However, macro-, exo-, and mesosystem risk factors remain unevaluated. Readers are invited to expand and complement the factors described in the review.SummaryP...
Source: Current Transplantation Reports - September 10, 2020 Category: Transplant Surgery Source Type: research
Regulatory T Cells: Promises and Challenges
AbstractPurpose of ReviewSoon after their discovery in 1972, regulatory T cells (Tregs) appeared as nature ’s gift to induce tolerance in auto- and alloimmune settings. We review here the barriers to the use of these bona fide cells and the strategies implanted to overcome them.Recent FindingsTregs are extremely rare and heterogenous, rendering them difficult to isolate and expand in vitro. Furthermore, their adoptive transfer was hurdled by their phenotypic instability and lack of intrinsic survival signals. Most studies in the field have focused on identifying distinctive Tregs markers for their pure isolation. This ha...
Source: Current Transplantation Reports - September 6, 2020 Category: Transplant Surgery Source Type: research
Amplifying the Patient Voice: Key Priorities and Opportunities for Improved Transplant and Living Donor Advocacy and Outcomes During COVID-19 and Beyond
AbstractPurpose of ReviewTo define patient advocacy and engagement for modern transplant and living donation care, particularly in light of the COVID-19 pandemic, describe the patient experience when transplant advocacy and engagement are optimized, and recommend opportunities for advocacy within three key areas: (1) including the patient voice in healthcare decisions and drug development, (2) access to the best evidence-based treatments and informed decision-making, and (3) present and future care innovations and policies.Recent FindingsThere are many avenues for transplant and living donation advocacy and engagement at t...
Source: Current Transplantation Reports - August 31, 2020 Category: Transplant Surgery Source Type: research
Military VCA in the World
AbstractPurpose of ReviewThe world ’s first hand transplant was performed for a serviceman in 1964, following a blast injury. Despite a need for such effective reconstruction of military wounds, only eight further transplants have been performed for injured soldiers. This review analysed the specific factors that have informed the use of vascularized composite allotransplantation (VCA) in military patients.Recent FindingsNine servicemembers have received reconstructive transplants worldwide. Seven have received upper limb transplants, one a partial face transplant and one a penile transplant. These have been in Ecuador, ...
Source: Current Transplantation Reports - August 29, 2020 Category: Transplant Surgery Source Type: research
Utility of Liver Transplantation Within the Bounds of Non-futility
AbstractPurpose of ReviewTo evaluate the measures of utility of liver transplant within the bounds of non-futility for controversial and high-risk scenarios associated with greatest transplant benefit and also possibilities of high futility.Recent FindingsLiver organ allocation policies are routinely adjusted to be in line with the Final Rule, maximizing transplant opportunities and minimizing futile transplants. Transplanting patients with high survival benefit is the construct of the liver allocation models with “sickest first” approach, but such policies have unintended consequences of futile transplants which raise...
Source: Current Transplantation Reports - August 9, 2020 Category: Transplant Surgery Source Type: research
Challenges, Innovations, and Next Steps in Achieving Financial Neutrality for Living Donors
AbstractPurpose of ReviewRecent national attention on living kidney donation brings renewed focus on policy related to alleviating financial burdens for donors, reducing out-of-pocket expenses incurred in the donation process, and optimizing follow-up care. This review examines the Advancing American Kidney Health Executive Order and its potential to improve financial neutrality for living organ donors.Recent FindingsAvailable research, including single and multi-center studies, demonstrate that living donors face financial burdens in the donation process, which may be decreased by covering lost wages and expenses related ...
Source: Current Transplantation Reports - July 30, 2020 Category: Transplant Surgery Source Type: research
Subclinical Rejection: a Universally Held Concept?
AbstractPurpose of ReviewThe goal of this paper is to evaluate the published literature to assess the evidence for a pathogenic role for subclinical inflammation in the renal allograft.Recent FindingsIt has become apparent from a growing body of evidence that most of the inflammation observed in renal allografts is alloimmune in nature, and ultimately pathogenic, even if it is below the classic Banff threshold for rejection.SummaryThere are recent data to indicate the subclinical inflammation that is usually detectable only by protocol biopsies is a risk factor for subsequent clinical T cell –mediated rejection, the deve...
Source: Current Transplantation Reports - July 24, 2020 Category: Transplant Surgery Source Type: research
The Changing Landscapes in DCD Liver Transplantation
AbstractPurpose of ReviewThe transplant community continues to look for ways to help address the discordance between donor liver graft availability and patients on the liver transplant waiting list. Donation after circulatory death (DCD) donor livers represents one potential means to help address this discordance. The present review describes the changing landscape of DCD liver transplantation (LT).Recent FindingsThe number of DCD LTs performed annually within the USA has continued to grow on an annual basis. Importantly, national data has demonstrated that outcomes with DCD LT have been improving. This improvement has bee...
Source: Current Transplantation Reports - July 12, 2020 Category: Transplant Surgery Source Type: research
The Current State of Minimally Invasive Living Donor Hepatectomy
AbstractPurpose of ReviewTo evaluate the current state of minimally-invasive living donor hepatectomy by briefly summarizing its history, examining up-to-date technical considerations, reviewing important recently published reports, and discussing the path forward to continued progress.Recent FindingsThe last several years have seen a surge in reports of purely laparoscopic major donor hepatectomy. These accounts span several continents and include updates from centers with significant experience. Other studies come as case reports or small case series from centers just developing their minimally invasive expertise. There ...
Source: Current Transplantation Reports - July 11, 2020 Category: Transplant Surgery Source Type: research
The Emerging Need for Combined Heart and Liver Transplantation in Congenital Heart Disease
AbstractPurpose of ReviewPatients with congenital heart disease (CHD) are living longer due to advances in cardiovascular medicine. We sought to review the physiology and evaluation of these CHD patients who demonstrate the emerging need for combined heart and liver transplantation.Recent FindingsThe principal population affected by failing cardiohepatic physiology are those with single-ventricle physiology palliated to Fontan. Patients are evaluated by a multidisciplinary team including transplant cardiology and hepatology to determine the degree of liver damage and necessity of combined heart and liver transplantation. W...
Source: Current Transplantation Reports - July 7, 2020 Category: Transplant Surgery Source Type: research
CAR-Tregs as a Strategy for Inducing Graft Tolerance
AbstractPurpose of ReviewThe adoptive transfer of alloantigen-specific regulatory T cells (Tregs) following organ transplantation is an emerging treatment paradigm that may induce tolerance and reduce the risk for graft rejection. In particular, redirecting Treg specificity via expression of synthetic chimeric antigen receptors (CARs) has demonstrated therapeutic promise in several preclinical studies. In this review, we highlight recent progress and remaining barriers to the clinical translation of CAR-Treg therapies.Recent FindingsCAR Tregs targeting human leukocyte antigen (HLA)-A2 showed antigen-specific in vitro activ...
Source: Current Transplantation Reports - July 3, 2020 Category: Transplant Surgery Source Type: research
