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 16, 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 65% repopulation ...
Source: Current Transplantation Reports - February 14, 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 5, 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 23, 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 16, 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 3, 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 29, 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 21, 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 19, 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.SummaryCurre...
Source: Current Transplantation Reports - November 18, 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 13, 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 13, 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 10, 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 9, 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 results i...
Source: Current Transplantation Reports - November 7, 2019 Category: Transplant Surgery Source Type: research
