High-Dimensional Renal Profiling: Towards a Better Understanding of Renal Transplant Immune Suppression
AbstractPurpose of ReviewThe goal of this review is to discuss new approaches to avoid calcineurin inhibitor (CNI)/corticosteroids (CCS) toxicities with a focus on new biologics and new methods to understand transplant rejection at the single-cell level.Recent FindingsRecently developed biologics hold significant promise as the next wave of therapeutics designed to promote CNI/CCS-free long-term allograft acceptance. Indeed, belatacept, soluble CTLA4-Ig, is largely devoid of CNI-like toxicities, although it is accompanied by an increased frequency of acute rejection. Besides belatacept, other biologics hold promise as CNI-...
Source: Current Transplantation Reports - January 14, 2019 Category: Transplant Surgery Source Type: research
Frailty and Outcomes After Liver Transplantation
AbstractPurpose of ReviewFrailty is an emerging concept in liver transplantation. We reviewed the literature for the tests of frailty which have been validated to predict outcomes in patients with cirrhosis evaluated for liver transplantation.Recent FindingsSeveral tools have been developed to further stratify risk of adverse events independent of liver disease severity. These include tests of disability such as activities of daily living and the Karnofsky Performance Score, as well as tests of physical frailty, such as the Liver Frailty Index (handgrip, chair stands, and balance).SummaryIncreasingly, the frailty assessmen...
Source: Current Transplantation Reports - January 14, 2019 Category: Transplant Surgery Source Type: research
Commentary: Peri-Transplant Bariatric Surgery
ConclusionsAlthough bariatric surgery in the transplant population is not yet extensively studied and is mostly reported in small series, it seems a useful approach for the treatment of morbid obesity in these high-risk patients. Comparative data regarding optimal timing and type of bariatric procedure and long-term results are warranted. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - December 13, 2018 Category: Transplant Surgery Source Type: research
Novel Nanoimaging Strategies for Noninvasive Graft Monitoring in Vascularized Composite Allotransplantation
This article focuses on the unmet needs and key challenges in vascularized composite allotransplantation (VCA) and the opportunities for current nanotechnology advances in therapeutics and diagnostics for personalized treatment and optimization of clinical outcomes. The transformative role of nanoimaging as a noninvasive tool in the longitudinal surveillance of acute and chronic rejection after VCA is critically reviewed. Nanoimaging can inform management decisions and guide continuous treatment adjustments over time in patients to improve safety and efficacy in VCA. Nanoimaging signatures can be unbiased and quantitative ...
Source: Current Transplantation Reports - October 27, 2018 Category: Transplant Surgery Source Type: research
Is Lower Extremity Transplantation a Superior Alternative to Prostheses? No —At Least Not Yet
AbstractPurpose of ReviewThis paper reviews previously attempted cases of lower extremity vascularized composite allotransplantation (VCA), critically assesses the challenges associated with this procedure, and highlights alternative approaches to restore function for patients with lower limb loss.Recent FindingsDespite progress in the field of upper extremity transplantation, attempts at lower extremity transplantation have resulted in zero successes. Major hurdles that must be overcome prior to future attempts include, but are not limited to, large motor nerve regeneration and immunosuppression-related complications. For...
Source: Current Transplantation Reports - October 25, 2018 Category: Transplant Surgery Source Type: research
Liver Transplantation for HCC Beyond Milan
AbstractPurpose of the ReviewTo describe how the field of liver transplantation (LT) for hepatocellular carcinoma (HCC) has expanded beyond the Milan criteria.Recent FindingsThe Milan criteria have been the gold standard selection tool for patients with HCC undergoing LT since 1996. However, soon after its creation, the tumor size and number limits imposed by the Milan criteria were expanded upon by new models, such as the University of California-San Francisco criteria and the Metroticket. Still, these models were always limited by radiological inaccuracy in measuring tumor size and number and, more importantly, did not i...
Source: Current Transplantation Reports - October 25, 2018 Category: Transplant Surgery Source Type: research
Utilizing Donors with Hepatitis C Antibody Positivity and Negative Nucleic Acid Testing
AbstractIntroductionThe demand for organs in the USA exceeds supply resulting in high mortality for patients awaiting transplantation. To increase the pool of available organs, the transplant community is investigating the safety and utility of organs previously considered high risk. Guidelines currently advocate for the use of hepatitis C antibody, nucleic acid testing (NAT)-negative organs in hepatitis C –positive recipients. However, data is limited regarding outcomes of using such grafts in hepatitis C–negative recipients.Purpose of ReviewThe purpose of this paper is to review the literature on utilizing hepatitis ...
Source: Current Transplantation Reports - October 25, 2018 Category: Transplant Surgery Source Type: research
Experimental Models of Penile and Lower Limb Transplantation: Are They Really Translational?
AbstractPurpose of ReviewThe purpose of this review is to evaluate the recent literature about animal models for penile and lower limb transplantation, regarding their relevance to the clinical scenario.Recent FindingsAlthough both penile and lower limb transplantations have been sharing same problems with all other vascularized composite allotransplantations, they have their unique issues that need to be addressed. There is no appropriate animal model to demonstrate functions of both penile and lower limb transplantation.SummaryWe reevaluate and underline the interesting and important findings of the certain animal models...
Source: Current Transplantation Reports - October 12, 2018 Category: Transplant Surgery Source Type: research
Penile Reconstruction Versus Transplantation: Which One Is Ideal?
AbstractPurpose of ReviewReconstruction of composite tissues or organs is challenging, with limited functional and esthetic outcomes. Nearly 100 years passed from the first penile reconstruction is performed; however, the outcomes were far from ideal. With the beginning of the reconstructive transplantation era, new choices became possible.Recent FindingsUntil now, four penis transplantations were performed worldwide, with encouraging short-term results. Although with a short follow-up, these penile transplantations reported success. However, the problems related to systemic lifelong immunosuppression remain as the major...
Source: Current Transplantation Reports - October 11, 2018 Category: Transplant Surgery Source Type: research
The Current State of Pancreas Transplantation in the USA —A Registry Report
AbstractPurposeA successful pancreas transplantation is still the only method to provide long-term insulin independence and provide good metabolic control for patients with type I diabetes. Since the first pancreas transplant in 1966, the patient and graft survival after pancreas transplantation improved significantly. The aim of this report was to study the most recent outcome of pancreas transplants.Recent FindingsBetween 2011 and 2016, 5159 primary deceased donor pancreas transplants in diabetic patients were performed —4342 (84%) SPK, 399 PAK (8%), and 418 (8%) PTA. One-year (3-year) SPK patient survival reached 98% ...
Source: Current Transplantation Reports - October 6, 2018 Category: Transplant Surgery Source Type: research
Ethics and the Future of Vascularized Composite Allotransplantation
AbstractPurpose of ReviewThis paper seeks to identify and examine a number of ethical issues that persist 20 years after the field of vascularized composite allotransplantation was established. Reflection upon these issues will be essential if the field is to fulfill its promise.Recent FindingsA number of scholars, including the authors, have been involved in efforts to identify ethical issues in VCA. Meetings held in the US and in Europe have focused on ethical concerns related to procurement, risk-benefit, consent, and program standards, among others.SummaryImproving the burden and risk vs. benefit ratio, strengthening...
Source: Current Transplantation Reports - October 2, 2018 Category: Transplant Surgery Source Type: research
Type 1 Diabetes Recurrence After Simultaneous Pancreas-Kidney Transplantation
AbstractPurpose of ReviewSimultaneous pancreas-kidney transplantation (SPKT) is an important option for patients with type 1 diabetes (T1D) and end-stage renal disease. While most SPKT recipients experience long-term euglycemia, about 5% return to insulin therapy, 5 –20 years after transplantation due to T1D recurrence (T1DR). Over the last two decades, we have assessed autoimmunity in our patients, evaluating autoantibodies (GAD65, IA2, and ZnT8), autoreactive T cells, and pancreas transplant biopsies.Recent FindingsMost patients demonstrate seroconversion for multiple autoantibodies. Autoreactive memory T cells have b...
Source: Current Transplantation Reports - September 22, 2018 Category: Transplant Surgery Source Type: research
State of the Science in Deceased Organ Donor Management
This article aims to appraise the current literature with a focus on reviewing deceased donor intervention trials.Recent FindingsAggressive critical care management after determination of brain death resulting in meeting of a donor management goal bundle has consistently demonstrated an association with significantly more organs transplanted per donor as well as improved graft outcomes. Although there is a dearth of experience with randomized donor intervention studies, dopamine and targeted mild therapeutic hypothermia have been found to significantly reduce delayed graft function in kidney recipients.SummaryProgress in u...
Source: Current Transplantation Reports - September 19, 2018 Category: Transplant Surgery Source Type: research
