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 - September 1, 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 - September 1, 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 - September 1, 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 - September 1, 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 - September 1, 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 ...
Source: Current Transplantation Reports - September 1, 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 - September 1, 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 ...
Source: Current Transplantation Reports - September 1, 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 - 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 ...
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 ...
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 nu...
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 Netwo...
Source: Current Transplantation Reports - June 1, 2018 Category: Transplant Surgery Source Type: research

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 expec...
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 nu...
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 Netwo...
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 immunosuppressi...
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

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, co...
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, reg...
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...
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