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 1, 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 complexities i...
Source: Current Transplantation Reports - October 31, 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 microflui...
Source: Current Transplantation Reports - August 2, 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.Recen...
Source: Current Transplantation Reports - July 29, 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 12, 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 10, 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 3, 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 Fin...
Source: Current Transplantation Reports - June 3, 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 22, 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 novo donor-...
Source: Current Transplantation Reports - May 20, 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 15, 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 13, 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 29, 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 asso...
Source: Current Transplantation Reports - April 26, 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 pursue st...
Source: Current Transplantation Reports - April 26, 2019 Category: Transplant Surgery Source Type: research
