Expanding the Utilization of Kidneys from Donors with Acute Kidney Injury
AbstractPurpose of ReviewOur aim is to review the experience with transplanting kidneys from decreased donors with acute kidney injury (AKI).Recent FindingsThe discard rate is higher for kidneys from AKI donors. Studies have uniformly shown that the risk of delayed graft function (DGF) is higher. However, the majority of studies have shown that other outcomes including short and long graft survival, eGFR, and risk of rejection are not inferior with transplanting AKI donor kidneys. To select AKI donor kidneys, we depend on preimplantation biopsy to exclude AKI kidneys with> 10% cortical necrosis or more than mild chro...
Source: Current Transplantation Reports - July 2, 2020 Category: Transplant Surgery Source Type: research
Cognitive Function in Kidney Transplantation
We describe the potential role of pre-transplant cognition, immunosuppression, and peri-transplant factors in post-transplant cognitive impairment.Recent FindingsA majority of patients with kidney transplant have cognitive impairment. Cognitive impairment affects both pre-transplant evaluation and post-transplant outcomes. Failure to identify patients with cognitive impairment can withhold appropriate care and timely intervention.SummaryCognitive impairment is common in kidney transplant and affects outcomes. Studies addressing modifiable risk factors and possible interventions to slow cognitive decline in patients with ki...
Source: Current Transplantation Reports - June 30, 2020 Category: Transplant Surgery Source Type: research
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 1, 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 1, 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 29, 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, mitochondria t...
Source: Current Transplantation Reports - April 26, 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 [7–9]...
Source: Current Transplantation Reports - April 3, 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 FindingsCli...
Source: Current Transplantation Reports - March 30, 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 26, 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 25, 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 adults,...
Source: Current Transplantation Reports - March 25, 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 24, 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 24, 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 24, 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 2 an...
Source: Current Transplantation Reports - March 11, 2020 Category: Transplant Surgery Source Type: research
