Should We Revisit HLA Matching to Improve Long-Term Graft Outcomes?
We present here an overview of the needs and requirements for human leukocyte antigen (HLA) matching, explain and explore the potential benefits of epitope matching, and discuss the benefits of allele-level high-resolution matching at all HLA loci, i.e. HLA-A, -B, -DR, -DQ and -DP, for donor selection needs during renal transplantation.Recent FindingsDonor recipient HLA matching has a substantial impact on organ transplantation by prolonging graft survival, minimizing rejection episodes, preventing sensitization, providing a better chance for retransplantation and reducing the percentage of deaths due to graft dysfunction....
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research
Pediatric Training and Experience Requirements —Development of UNOS Bylaws
AbstractPurpose of ReviewWe review the background and process of policy development, which led to the development of the UNOS Pediatric Training and Experience Bylaws.Recent FindingsPre- and posttransplant outcomes mirror findings observed in the management of a variety of pediatric surgical diseases ranging from acute appendicitis to complex congenital heart disease. Specifically, patients treated at higher volume and typically pediatric focused institutions exhibit improved outcomes in terms of diagnosis, waitlist survival, and postoperative morbidity and mortality.SummaryPediatric transplantation is a defined subspecial...
Source: Current Transplantation Reports - August 25, 2018 Category: Transplant Surgery Source Type: research
Perioperative Assessment and Intraoperative Core Concepts in the Complex Kidney Patient
AbstractPurposeLife span and sense of well-being continue to improve post-transplantation in patients with end-stage kidney disease, despite referral of an older and more medically complex population for transplantation. In this issue of the journal, we review existing evidence about risk assessment in kidney transplant candidates from the perspective of the anesthesiologist. The authors explore cardiovascular assessment and risk in the context of intraoperative events that can influence short- and long-term outcomes.Recent FindingsThe number of patients referred for kidney transplantation continues to increase and has far...
Source: Current Transplantation Reports - August 4, 2018 Category: Transplant Surgery Source Type: research
Current Hematological Concepts and Viscoelastic-Based Transfusion Practices During Liver Transplantation
ConclusionWhile we were successful in formulating a dosing regimen based on available literature and our own institutional practices for treating deficiencies of clotting factors and fibrinogen, more research is needed to arrive at a dosing regimen for platelets based on functional deficiency. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - August 3, 2018 Category: Transplant Surgery Source Type: research
Approaches for Effective Clinical Application of Stem Cell Transplantation
AbstractPurpose of ReviewThis review highlights problems related to translation of advanced therapy medicinal products (ATMPs) from bench to bedsite. Regenerative medicine within the current regulatory frame reveals common hitches in the course of development, translation, and clinical application. This paper suggests outlining a path from the few examples of successfully approved vs unsuccessful advanced therapies.Recent FindingsIn the multitude of ongoing studies, few of them achieved positive results with a final treatment available to patients; this result was possible due to multidisciplinary teams working together fr...
Source: Current Transplantation Reports - August 2, 2018 Category: Transplant Surgery Source Type: research
Impact of Allograft Steatosis on Cardiovascular Outcomes
AbstractPurpose of ReviewCardiovascular events are among the most consequential long-term outcomes in liver transplant recipients. While underlying non-alcoholic fatty liver disease has been independently associated with unfavorable cardiovascular outcomes and increased mortality, it is unclear yet if the same holds true for allograft steatosis. We here review the available data on cardiovascular outcomes after liver transplant with specific focus on allograft steatosis.Recent FindingsTwo subtypes of hepatic allograft steatosis exist, recurrent and de novo, and both are common. Although the current data suggest an associat...
Source: Current Transplantation Reports - July 31, 2018 Category: Transplant Surgery Source Type: research
Biopsy-Negative Rejection: a Rare but Difficult Issue in Heart Transplantation
AbstractPurpose of ReviewBiopsy-negative rejection is a condition defined by a cardiac dysfunction with a left ventricular ejection fraction (LVEF) ≤ 45% with normal histology and with the absence of other causes of cardiac allograft damage. The purpose of this review is to determine the incidence of biopsy-negative rejection, the therapeutics, and the outcome in the light of new techniques of evaluation or detection of acute rejection in h eart-transplanted patients. Although rare, many physicians have once experienced this difficult situation. Even though it is considered the gold standard for the diagnosis of reject...
Source: Current Transplantation Reports - July 16, 2018 Category: Transplant Surgery Source Type: research
Immunosuppression for Lung Transplantation: Current and Future
AbstractPurpose of the ReviewThe number of lung transplantations performed worldwide continues to increase. There is a growing need in these patients for more effective immunosuppressive medications with less toxicity.Recent FindingsThis review article summarizes the recent studies and developments in lung transplant immunosuppression. Novel immunosuppressive medications and strategies used in other solid organ transplantations are being trialed in lung transplantation. This includes the use of co-stimulation blockers like belatacept and mTOR inhibitors like everolimus. Calcineurin-sparing regimens have been described in a...
Source: Current Transplantation Reports - July 13, 2018 Category: Transplant Surgery Source Type: research
Should We Revisit HLA Matching to Improve Long-Term Graft Outcomes?
We present here an overview of the needs and requirements for human leukocyte antigen (HLA) matching, explain and explore the potential benefits of epitope matching, and discuss the benefits of allele-level high-resolution matching at all HLA loci, i.e. HLA-A, -B, -DR, -DQ and -DP, for donor selection needs during renal transplantation.Recent FindingsDonor recipient HLA matching has a substantial impact on organ transplantation by prolonging graft survival, minimizing rejection episodes, preventing sensitization, providing a better chance for retransplantation and reducing the percentage of deaths due to graft dysfunction....
Source: Current Transplantation Reports - July 13, 2018 Category: Transplant Surgery Source Type: research
Review of Major Drug-Drug Interactions in Thoracic Transplantation
AbstractPurpose of ReviewThe first human lung transplant surgery in the world was done in 1963, followed by the first heart transplant in 1967, making this year its 50th anniversary. Since then, there has been great advancement in immunotherapy, with the adoption of calcineurin inhibitors (CNI), mycophenolate mofetil, and proliferation signal inhibitors (PSI). However, while these medications are crucial to maintenance of allograft function and prevention of allograft rejection, they have many toxicities and side effects, which make therapeutic dose monitoring and recognition of drug-drug interactions of critical importanc...
Source: Current Transplantation Reports - July 10, 2018 Category: Transplant Surgery Source Type: research
Transplantation for the Very Sick Patient —Donor and Recipient Factors
AbstractPurpose of ReviewPatients with end-stage chronic liver disease (CLD) frequently deteriorate with development of a ‘frail’ state and progress to development of extra-hepatic organ failures. Making the clinical judgement when a patient is ‘too sick’ to proceed with liver transplantation is challenging; we summarise recent studies that may inform decision-making.Recent FindingsReports quantify the impact of both recipient and donor factors related to early post-transplant survival, with consistent adverse association of advanced donor and recipient age, under-nutrition, sarcopenia and impaired functional statu...
Source: Current Transplantation Reports - July 9, 2018 Category: Transplant Surgery Source Type: research
DCD Liver Transplant: a Meta-review of the Evidence and Current Optimization Strategies
AbstractPurposeIn the current era of liver transplantation (LT), there is a large discrepancy between waiting list demand and organ donor availability. Increased utilization of donation after circulatory death (DCD) donors continues to expand the donor pool and improve access; however, concerns regarding recipient outcomes have limited wider adoption of these donor livers. This review will describe the current evidence regarding recipient outcomes and strategies that may help to optimize them.Recent FindingsHistorical outcomes of DCD LT are somewhat inferior to the DBD LT, yet new emerging evidence suggests that this outco...
Source: Current Transplantation Reports - June 1, 2018 Category: Transplant Surgery Source Type: research
Are We Ready for a Human Head Transplant? The Obstacles That Must Be Overcome
AbstractPurpose of ReviewSaving an individual ’s life by replacing his/her terminally diseased body with a healthy donor body would be an extraordinary scientific achievement. However, body-to-head transplantation (BHT) is neither a conventional proposal nor necessarily a logical “next step” in transplantation medicine. This review highli ghts the major hurdles standing in the way of performing human BHT.Recent FindingsRecent human BHT publicity was initiated by Sergio Canavero ’s TED talk “Head Transplantation: The Future Is Now” (At:https://www.youtube.com/watch?v=_EHCHv5u3O4) and a number of public interview...
Source: Current Transplantation Reports - June 1, 2018 Category: Transplant Surgery Source Type: research
Liver Transplantation for Hepatoma: Raising the Bar
AbstractPurpose of ReviewEver since the birth of liver transplantation, cancer has played a major role in the advances to the field. With improved outcomes came increasing demands on a limited organ supply and the need for policy development to guide organ allocation. This is an attempt to summarize important milestones in the practice and policy developments over the past 50 years with a nod to our collective ability to continue to improve the field of transplantation, care of liver cancer, and value of that gift of life—the donor liver.Recent FindingsThe most recent Organ Procurement and Transplantation Network (OPTN...
Source: Current Transplantation Reports - June 1, 2018 Category: Transplant Surgery Source Type: research
