The Evolution of the National Liver Review Board
AbstractPurpose of ReviewTo highlight the process of development and summarize the new structure of the National Liver Review Board (NLRB)Recent FindingsThe concept of an NLRB has been considered since the institution of the Model for End-Stage Liver Disease (MELD) score liver allocation system, though barriers included concerns over logistics and loss of local control. Recently, increased volume of exceptions combined with an increased transplant rate for exception versus non-exception patients and growing concern over inequality within the regional system led to a reconsideration of an NLRB. A proposal was recently appro...
Source: Current Transplantation Reports - February 2, 2018 Category: Transplant Surgery Source Type: research
The Psychosocial Impact of Withdrawing from Living Kidney Donation
AbstractPurpose of ReviewWe summarized data on the experience of people who withdraw from living kidney donation for non-medical reasons and suggest transplant centers strategies to enhance support for this population.Recent FindingsReported rates of opting out vary widely, from 0.2 to 22%. Individuals often describe more than one factor that contributed to their decision not to donate. Limited data suggests that most who withdraw from donation do not experience a long-term negative impact on their relationship with their intended recipient. For a minority, however, the decision to opt out may occasionally strain relations...
Source: Current Transplantation Reports - January 30, 2018 Category: Transplant Surgery Source Type: research
Hypothermic Machine Preservation of the Liver: State of the Art
AbstractPurpose of ReviewIn this review, we highlight which livers may benefit from additional treatment before implantation and describe the concept of hypothermic machine liver perfusion. Furthermore, we explain why cold oxygenated perfusion concepts could potentially lead to a breakthrough in this challenging field of transplantation. Accordingly, we summarize recent clinical applications of different hypothermic perfusion approaches.Recent FindingsThe impact of end-ischemic, hypothermic liver perfusion in liver transplantation is currently assessed by two multicenter, randomized controlled trials. Recently, new applica...
Source: Current Transplantation Reports - January 22, 2018 Category: Transplant Surgery Source Type: research
From “Gut Feeling” to Objectivity: Machine Preservation of the Liver as a Tool to Assess Organ Viability
AbstractPurpose of ReviewThe purpose of this review was to summarise how machine perfusion could contribute to viability assessment of donor livers.Recent FindingsIn both hypothermic and normothermic machine perfusion, perfusate transaminase measurement has allowed pretransplant assessment of hepatocellular damage. Hypothermic perfusion permits transplantation of marginal grafts but as yet has not permitted formal viability assessment. Livers undergoing normothermic perfusion have been investigated using parameters similar to those used to evaluate the liver in vivo. Lactate clearance, glucose evolution and pH regulation d...
Source: Current Transplantation Reports - January 20, 2018 Category: Transplant Surgery Source Type: research
Machine Preservation of the Liver: What Is the Future Holding?
AbstractPurpose of ReviewOrgan shortage remains a major problem for liver transplantation resulting in a high mortality on the waiting list. Machine preservation of the liver has been developed as a novel strategy to expand the use of marginal grafts that otherwise would be declined for transplantation and therefore to increase the donor pool. This review will summarize the most relevant publications on machine perfusion in the past 3 years.Recent FindingsIn the last few years, human trials using different perfusion techniques as hypothermic anoxic perfusion, hypothermic oxygenated perfusion, midthermic perfusion, contro...
Source: Current Transplantation Reports - January 19, 2018 Category: Transplant Surgery Source Type: research
The Living Donor Lost Wages Trial: Study Rationale and Protocol
AbstractPurpose of ReviewThis paper describes the background, rationale, and design of an NIH-funded, single-center study to test the impact of offering reimbursement for donor lost wages incurred during the post-nephrectomy recovery period on the live donor kidney transplant (LDKT) rate in newly evaluated kidney transplant candidates, to examine whether offering reimbursement for donor lost wages reduces racial disparity in LDKT rates, and to determine whether higher reimbursement amounts lead to higher LDKT rates.Recent FindingsLDKT is the optimal treatment for renal failure. However, living kidney donation has declined ...
Source: Current Transplantation Reports - January 19, 2018 Category: Transplant Surgery Source Type: research
Simultaneous Liver-Kidney Transplantation: Impact on Liver Transplant Patients and the Kidney Transplant Waiting List
AbstractPurposeThe number of simultaneous liver-kidney transplants (SLKT) performed in the USA has been rising. The Organ Procurement and Transplantation Network implemented a new policy governing SLKT that specifies eligibility criteria for candidates to receive a kidney with a liver, and creates a kidney waitlist “safety net” for liver recipients with persistent renal failure after transplant. This review explores potential impacts for liver patients and the kidney waitlist.Recent FindingsFactors that have contributed to the rise in SLKT including Model for End-stage Liver Disease (MELD)-based allocation, regional sh...
Source: Current Transplantation Reports - January 19, 2018 Category: Transplant Surgery Source Type: research
Social Media in the Identification of Living Kidney Donors: Platforms, Tools, and Strategies
This article describes the state of contemporary evidence regarding use of social media tools and interventions to increase access to living donor transplantation, as reported in peer-reviewed medical literature, as well as programs that have not yet been formally evaluated.SummaryAs social media platforms continue to grow and expand, a commitment to understanding and facilitating the use of social media by the transplant community may support patients who are interested in using social media as a tool to find a living kidney donor. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - January 18, 2018 Category: Transplant Surgery Source Type: research
Correction to: Pharmacologic Complement Inhibition in Clinical Transplantation
AbstractThe article Pharmacologic Complement Inhibition in Clinical Transplantation, written by Vasishta S. Tatapudi and Robert A. Montgomery, was originally published Online First without open access. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - November 25, 2017 Category: Transplant Surgery Source Type: research
Commercialization Considerations for Cell-Based Therapies: What We Have Learned So Far
AbstractPurpose of ReviewDespite an increasing list of clinically impactful products in cancer, wound care, and graft versus host disease, cellular therapeutics have yet to be fully embraced by large pharma and biotech. While there have been several high-profile investments in the past 5 years, the list of clinically and commercially successful products is still a short one. Here, we highlight some of the critical considerations to increase the likelihood of commercial success.Recent FindingsThe field of Regenerative Medicine is poised to introduce several products that could have profound clinical impact. The recent acq...
Source: Current Transplantation Reports - November 11, 2017 Category: Transplant Surgery Source Type: research
Combining Adoptive Treg Transfer with Bone Marrow Transplantation for Transplantation Tolerance
AbstractPurpose of ReviewThe mixed chimerism approach is an exceptionally potent strategy for the induction of donor-specific tolerance in organ transplantation and so far the only one that was demonstrated to work in the clinical setting. Regulatory T cells (Tregs) have been shown to improve chimerism induction in experimental animal models. This review summarizes the development of innovative BMT protocols using therapeutic Treg transfer for tolerance induction.Recent FindingsTreg cell therapy promotes BM engraftment in reduced conditioning protocols in both, mice and non-human primates. In mice, transfer of polyclonal r...
Source: Current Transplantation Reports - November 4, 2017 Category: Transplant Surgery Source Type: research
Donation, Not Disease! A Multiple-Hit Hypothesis on Development of Post-Donation Kidney Disease
AbstractPurpose of ReviewThe risks following living kidney donation has been the subject of rigorous investigation in the past several decades. How to utilize the burgeoning new knowledge base to better the risk assessment, education, and health maintenance of donors is unclear. We review the physiologic and epidemiologic evidences on the post-donation state and submit a multiple-hit hypothesis to reconcile the finite elevation in risk of kidney disease after donation with the benign course of most kidney donors.Recent FindingsThe risk of end-stage kidney disease is higher in kidney donors compared to similarly healthy non...
Source: Current Transplantation Reports - November 4, 2017 Category: Transplant Surgery Source Type: research
Report (2017) of the International Registry on Hand and Composite Tissue Allotransplantation (IRHCTT)
AbstractPurpose of ReviewAnalysis of all upper extremity (UET) and face allotransplantations (FT) reported to the International Registry on Hand and Composite Tissue Transplantation (IRHCTT) by May 2017.Recent FindingsThe IRHCTT includes 66 cases of UET (18 unilateral and 38 bilateral) and 30 of FT. Acute and chronic rejections were reported in the presence of immunosuppression. Complications similar to those reported in solid organ transplantation occurred. UET patient survival was 96.7% at 1, 5, and 10 years after transplantation; graft survival was 90.4% at 1 year and 86.6% at 5 and 10 years. FT patient survival was...
Source: Current Transplantation Reports - October 16, 2017 Category: Transplant Surgery Source Type: research
Clinical Hepatocyte Transplantation: What Is Next?
AbstractPurpose of ReviewSignificant recent scientific developments have occurred in the field of liver repopulation and regeneration. While techniques to facilitate liver repopulation with donor hepatocytes and different cell sources have been studied extensively in the laboratory, in recent years, clinical hepatocyte transplantation (HT) and liver repopulation trials have demonstrated new disease indications and also immunological challenges that will require the incorporation of a fresh look and new experimental approaches.Recent FindingsGrowth advantage and regenerative stimulus are necessary to allow donor hepatocytes...
Source: Current Transplantation Reports - October 14, 2017 Category: Transplant Surgery Source Type: research
Fifty Shades of Transplantation Tolerance: Beyond a Binary Tolerant/Non-Tolerant Paradigm
AbstractPurpose of ReviewIt has long been considered that tolerance in a transplant recipient is a binary all-or-none state: either the graft is accepted without immunosuppression identifying the recipient as tolerant, or the recipient rejects the graft and is not tolerant. This tolerance paradigm, however, does not accurately reflect data emerging from animal models and patients and requires revision.Recent FindingsIt is becoming appreciated that there may be different gradations in the quality of transplantation tolerance based on underlying cellular mechanisms of immunological tolerance, and that individuals may enhance...
Source: Current Transplantation Reports - October 6, 2017 Category: Transplant Surgery Source Type: research
