Is the Updated Kidney Allocation System Working?
AbstractPurpose of ReviewIn December 2014, the current kidney allocation system (KAS) was implemented after over 10 years of development by the OPTN Kidney Committee. The Kidney Committee noted several limitations with the prior kidney allocation schema and sought to improve many of these limitations. This review will discuss those goals and the available results at a 2-year review.Recent FindingsTwo-year results of the new kidney allocation system: This system increased the allocation of allografts with longer expected function as estimated by the Kidney Donor Profile Index (KDPI) to those patients with longer expected ...
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 - April 23, 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 - April 19, 2018 Category: Transplant Surgery Source Type: research
Posttransplant Medical Adherence: What Have We Learned and Can We Do Better?
AbstractPurpose of reviewNon-adherence to the medical regimen after kidney transplantation can contribute to poor clinical outcomes, and strategies to maximize adherence are sought by care providers and patients alike. We assessed recent evidence on prevalence, risk factors, and clinical outcomes associated with non-adherence to the medical regimen after kidney transplantation. We summarized recent clinical trials testing interventions to improve adherence and generated recommendations for future research and clinical practice.Recent findingsA large evidence base documents rates of non-adherence to each of the multiple com...
Source: Current Transplantation Reports - April 17, 2018 Category: Transplant Surgery Source Type: research
Simultaneous Liver-Kidney Transplantation: Policy Update and the Challenges Ahead
AbstractPurpose of the ReviewInstitution of a Simultaneous Liver Kidney (SLK) policy by the OPTN in 2016 represented the culmination of more than a decade of consensus conferences, public comments, and inter-society cooperation. The debates produced a multi-tiered proposal that established medical eligibility criteria for kidney allocation, a requirement for the regional sharing of a kidney to a MELD 35 medical eligible candidate and creation of a safety net for patients receiving a liver-alone transplant with subsequent kidney failure within the first post transplant year.Recent InterventionsThe stratifications and altera...
Source: Current Transplantation Reports - April 10, 2018 Category: Transplant Surgery Source Type: research
The New Direct Antiviral Agents and Hepatitis C in Thoracic Transplantation: Impact on Donors and Recipients
AbstractPurpose of ReviewThe landscape of abdominal organ transplantation has been altered by the emergence of curative direct-acting antiviral agents for hepatitis C. Expansion of the thoracic donor pool to include the hearts and the lungs from hepatitis C-positive donors holds promise to increase available donor organs.Recent FindingsCase reports have documented separate lung and heart transplant patients who acquired, and then were cured of, donor-derived hepatitis C using these newer, more effective therapies. Single sites and national consortia are underway to help make this approach part of the standard-of-care. Pang...
Source: Current Transplantation Reports - April 10, 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 - March 29, 2018 Category: Transplant Surgery Source Type: research
Pediatric Vascular Composite Allograft Transplantation: Medical Considerations
This report summarizes recent medical findings in the case of an allogenic bilateral hand-forearm allotransplantation in a previously immunocompromised child and discusses the implications for expanding vascular composite allotransplantation to non-immunocompromised pediatric candidates.Recent FindingsA pediatric recipient of bilateral hand-forearm allotransplantation now over 2 years post-transplant has shown functional recovery that surpassed pre-transplant function, with evidence of somatosensory cortical reorganization. However, the child who was previously immunocompromised has required augmented immunosuppression a...
Source: Current Transplantation Reports - March 20, 2018 Category: Transplant Surgery Source Type: research
Pushing the Limits: Machine Preservation of the Liver as a Tool to Recondition High-Risk Grafts
AbstractPurpose of the ReviewMachine perfusion (MP) is a novel technology recently introduced in liver transplantation, redefining the current practice of organ preservation and pushing the limits of high-risk liver utilisation. This review highlights the key benefits of machine perfusion over conventional static cold storage (SCS), demonstrated in human liver research and clinical transplants.Recent FindingsThe first clinical trials have demonstrated both safety and feasibility of MP. The most recent transplant series and result from a randomised trial suggest the technology is superior to SCS. The key benefits include ex...
Source: Current Transplantation Reports - March 20, 2018 Category: Transplant Surgery Source Type: research
Correction to: Hypothermic Machine Preservation of the Liver: State of the Art
AbstractThe article Hypothermic Machine Preservation of the Liver: State of the Art, written by Andrea Schlegel, Xavier Muller, and Philipp Dutkowski, was originally published electronically on the publisher ’s internet portal (currently SpringerLink) on January 22, 2018, without open access. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - March 3, 2018 Category: Transplant Surgery Source Type: research
Normothermic Machine Preservation of the Liver: State of the Art
AbstractPurpose of ReviewThis review aims to introduce the concept of normothermic machine perfusion (NMP) and its role in liver transplantation. By discussing results from recent clinical studies and highlighting the potential opportunities provided by this technology, we aim to provide a greater insight into NMP and the role it can play to enhance liver transplantation.Recent FindingsNMP has recently been shown to be both safe and feasible in liver transplantation and has also demonstrated its superiority to traditional cold storage in terms of early biochemical liver function. Through the ability to perform a viability ...
Source: Current Transplantation Reports - February 27, 2018 Category: Transplant Surgery Source Type: research
Roadblocks in the Path of iPSC to the Clinic
AbstractPurpose of ReviewThe goal of this paper is to highlight the major challenges in the translation of human pluripotent stem cells into a clinical setting.Recent FindingsInnate features from human induced pluripotent stem cells (hiPSCs) positioned these patient-specific cells as an unprecedented cell source for regenerative medicine applications. Immunogenicity of differentiated iPSCs requires more research towards the definition of common criteria for the evaluation of innate and host immune responses as well as in the generation of standardized protocols for iPSC generation and differentiation. The coming years will...
Source: Current Transplantation Reports - February 8, 2018 Category: Transplant Surgery Source Type: research
Optimizing Efficiency in the Evaluation of Living Donor Candidates: Best Practices and Implications
AbstractPurpose of ReviewAn inefficient living donor candidate evaluation process can be a barrier to timely living donor transplantation and optimal donor satisfaction. In this review, we examine the inefficiencies of the living kidney donor evaluation and make recommendations to optimize this process.Recent FindingsThere is increasing awareness that the living donor evaluation process is inefficient, but little research has been done to date. The time to complete the evaluation can be several or even many months. Avoidable delays can lead to dialysis initiation for pre-emptive transplant candidates, lengthen dialysis tim...
Source: Current Transplantation Reports - February 7, 2018 Category: Transplant Surgery Source Type: research
Strategies for Increasing Knowledge, Communication, and Access to Living Donor Transplantation: an Evidence Review to Inform Patient Education
AbstractPurpose of ReviewInadequate knowledge of the benefits, risks, and opportunities for living donation is an important, potentially modifiable barrier to living donor transplantation. We assessed the current state of the evidence regarding strategies to increase knowledge, communication, and access to living donor transplantation, as reported in peer-reviewed medical literature.Recent FindingsNineteen studies were reviewed, categorized as programs evaluated in randomized controlled trials (8 studies) and programs supported by observational (non-randomized) studies (11 studies). Content extraction demonstrated that com...
Source: Current Transplantation Reports - February 5, 2018 Category: Transplant Surgery Source Type: research
