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 ...
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

Ethical Issues in Pediatric VCA
AbstractPurpose of ReviewThere is growing interest in offering vascularized composite allografts (VCAs) to children, particularly upper extremity and face transplants. This review identifies ethical issues that must be addressed as VCA programs consider including more children and adolescents.Recent FindingsThe primary ethical concern in pediatric VCA is that the potential benefits might not justify the risks. Other issues involve eligibility criteria, informed permission and assent, authorizing donations and procuring VCAs, donor and recipient privacy and confidentiality, oversight and evaluation of transplants, and cost-...
Source: Current Transplantation Reports - October 6, 2017 Category: Transplant Surgery Source Type: research

Harnessing Apoptotic Cells for Transplantation Tolerance: Current Status and Future Perspectives
AbstractPurpose of ReviewThe use of donor apoptotic cells is an emerging therapy for inducing transplantation tolerance. In this review, we will discuss current understanding of mechanisms of this approach, as well as crucial aspects necessary for successful translation of this approach to clinical transplantation.Recent FindingsTransplantation tolerance by donor apoptotic cells is mediated by their homeostatic interaction with recipient phagocytes and subsequent expansion of suppressor cell populations as well as inhibition of effector T cells via deletion and anergy. To ensure their tolerogenicity, it is critical to proc...
Source: Current Transplantation Reports - October 6, 2017 Category: Transplant Surgery Source Type: research

Treating the Donor: Strategies to Prolong VCA Preservation
AbstractPurpose of ReviewIn this review, we summarized the latest advances in vascularized composite allografts (VCAs) preservation along with future directions to improve graft viability before transplantation.Recent FindingsAt present, VCAs are preserved using static cold storage methods prior to transplantation. This approach ensures reasonable viability up to 6  h. Beyond this time, ischemia and reperfusion result in substantial graft dysfunction. Ex situ VCA perfusion can potentially improve the graft survival and function and can help spread the procurement to a larger geographic area.SummaryNew strategies to mi...
Source: Current Transplantation Reports - October 4, 2017 Category: Transplant Surgery Source Type: research

Erratum to: Gene Editing, Gene Therapy, and Cell Xenotransplantation: Cell Transplantation Across Species
(Source: Current Transplantation Reports)
Source: Current Transplantation Reports - August 26, 2017 Category: Transplant Surgery Source Type: research

The Approach to Antibodies After Heart Transplantation
AbstractPurpose of ReviewThis review summarizes recent data about antibodies after cardiac transplantation, what testing modalities are available and how frequently to employ them, and when treatment is necessary.Recent FindingsTechnologies available for antibody detection have progressed over the past couple decades. New and preformed antibodies are associated with worse outcomes in transplant recipients.SummaryThe frequency of screening for post-transplant antibodies and for antibody-mediated rejection (AMR) should be based on risk stratification. The presence of antibodies alone post transplant does not constitute a dia...
Source: Current Transplantation Reports - August 11, 2017 Category: Transplant Surgery Source Type: research

Hepatocyte Transplantation: Cell Sheet Technology for Liver Cell Transplantation
AbstractPurpose of ReviewWe will review the recent developments of cell sheet technology as a feasible tissue engineering approach. Specifically, we will focus on the technological advancement for engineering functional liver tissue using cell sheet technology, and the associated therapeutic effect of cell sheets for liver diseases, highlighting hemophilia.Recent FindingsCell-based therapies using hepatocytes have recently been explored as a new therapeutic modality for patients with many forms of liver disease. We have developed a cell sheet technology, which allows cells to be harvested in a monolithic layer format. We h...
Source: Current Transplantation Reports - August 8, 2017 Category: Transplant Surgery Source Type: research

Stem Cell-Derived Insulin-Producing β Cells to Treat Diabetes
AbstractPurpose of ReviewAdvances in human pluripotent stem cell (hPSC) differentiation protocols have enabled cellular replacement therapies to progress to clinical trials. In patients with Type 1 diabetes (T1D), an autoimmune disease eliminates the majority of islet β cells in the pancreas causing insulin deficiency and hyperglycemia.  The only treatment option for patients with T1D is injection of exogenous insulin. Clinical trials of allogeneic islet transplants in immunosuppressed patients have demonstrated that β cell replacement therapies are capable of C-peptide production and glycemic control. Howev...
Source: Current Transplantation Reports - July 31, 2017 Category: Transplant Surgery Source Type: research

Newer Immunosuppression and Strategies on the Horizon in Heart Transplantation
AbstractPurpose of ReviewBalanced immunosuppressive therapy is the key to long-term survival after allograft transplantation. With a worldwide median recipient/graft survival of more than 11  years, heart transplantation is a highly successful treatment for selected patients with end-stage heart failure. However, current immunosuppressive regimens are associated with adverse effects. In the balance between acute rejection, cardiac allograft vasculopathy, infections and an increased ris k of malignancy, there is room for improvement. The aim of this review article is to present an overview of immunosuppressive mechanis...
Source: Current Transplantation Reports - July 29, 2017 Category: Transplant Surgery Source Type: research

Pre-transplant Sensitization for Patient Awaiting Lung Transplant: Are We Concerned?
AbstractPurpose of ReviewThe goal of this paper is to highlight the changes in detection, management, and prognosis of pre-transplant sensitized candidates and recipients.Recent FindingsWith improvements in technology, human leukocyte antigen (HLA) antibody testing has identified a significant proportion of lung transplant candidates with pre-transplant HLA antibody detection. Pre-transplant antibodies are associated with worse early outcomes after lung transplant if not addressed with targeted antibody therapy. There are promising new therapy plans to address pre-transplant HLA antibodies and potentially ameliorate the ea...
Source: Current Transplantation Reports - July 26, 2017 Category: Transplant Surgery Source Type: research

Gene Editing, Gene Therapy, and Cell Xenotransplantation: Cell Transplantation Across Species
AbstractPurpose of ReviewCell xenotransplantation has the potential to provide a safe, ethically acceptable, unlimited source for cell replacement therapies. This review focuses on genetic modification strategies aimed to overcome remaining hurdles standing in the way of clinical porcine islet transplantation and to develop neural cell xenotransplantation.Recent FindingsIn addition to previously described genetic modifications aimed to mitigate hyperacute rejection, instant blood-mediated inflammatory reaction, and cell-mediated rejection, new data showing the possibility of increasing porcine islet insulin secretion by tr...
Source: Current Transplantation Reports - July 21, 2017 Category: Transplant Surgery Source Type: research

Contemporary Issues in Lung Transplant Allocation Practices
AbstractPurpose of ReviewThe purpose of this review is to discuss the current state of donor lung allocation in the United States and future opportunities to increase the efficiency of donor lung allocation.Recent FindingsThe current donor lung allocation system prioritizes clinical acuity by the use of the lung allocation score (LAS) which has reduced waitlist mortality since its implementation in 2005. Access to donor lungs can be further improved through policy changes using broader geographic sharing and developing new technology such as ex vivo lung perfusion to recover marginal donor lungs.SummaryThe number of lung t...
Source: Current Transplantation Reports - July 21, 2017 Category: Transplant Surgery Source Type: research

Extracorporeal Membrane Oxygenation (ECMO) and the Critical Cardiac Patient
ConclusionDue to its versatility and relatively low cost, VA ECMO use is sharply increasing worldwide. It is important to select patients carefully for this mode of therapy as it can keep patients alive even in states of severe neurologic impairment or multiorgan failure. Short courses of ECMO may allow critically ill patients to be salvaged, but ultimately survival depends on resolution of the underlying problem or ability to transition to another more durable mode of cardiac support. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - July 10, 2017 Category: Transplant Surgery Source Type: research

Pancreatic Islet Transplantation Technologies: State of the Art of Micro- and Macro-Encapsulation
AbstractPurpose of ReviewType 1 diabetes (T1D) is an autoimmune disease characterized by the loss of insulin-producing cells in pancreatic islets. Despite islet transplantation is effective for selected T1D patients, its widespread application is limited by islet donor shortage and the need for lifelong immunosuppression. Micro- and macro-encapsulation aimed at enveloping cells in a perm-selective biocompatible membrane can potentially eliminate these limitations. This review summarizes tissue-engineering approaches tested in preclinical models of islet transplantation, highlighting technologies currently in the clinic.Rec...
Source: Current Transplantation Reports - June 2, 2017 Category: Transplant Surgery Source Type: research

Simultaneous Liver-Kidney Transplantation: What are Our Obligations to the Kidney Only Recipient?
AbstractPurpose of ReviewThere has been a recent explosion in the number of simultaneous liver and kidney (SLK) transplants performed. This practice is crowding out the population of ESRD patients waiting for a kidney transplant.Recent FindingsIt has been alleged from retrospective, anecdotal reports, often from voluntary registries, that there is a survival advantage for those with renal dysfunction that receive an SLK compared to Liver Transplant Alone. However, this survival advantage is quite small —about 5% at 1 and 5 years at best. A new algorithm introduced in 2016 by UNOS may make this problem worse by a...
Source: Current Transplantation Reports - May 31, 2017 Category: Transplant Surgery Source Type: research

Concepts of Genomics in Kidney Transplantation
AbstractPurpose of ReviewIdentification of genetic variants to aid in individualized treatment of solid organ allograft recipients would improve graft survival. We will review the current state of knowledge for associations of variants with transplant outcomes.Recent FindingsMany studies have yet to exhibit robust and reproducible results; however, pharmacogenomic studies focusing on cytochrome P450 (CYP) enzymes, transporters, and HLA variants have shown strong associations with outcomes and have relevance towards drugs used in transplant. Genome wide association study data for the immunosuppressant tacrolimus have identi...
Source: Current Transplantation Reports - May 24, 2017 Category: Transplant Surgery Source Type: research

Survival Advantage of Kidney-Pancreas vs. Kidney Alone Transplant in the Modern Era
AbstractPurpose of ReviewThere is a well-defined knowledge of relative benefits of pancreas transplants to patients with respect to specific diabetic complications; however, the degree of survival advantage of a simultaneous pancreas and kidney versus kidney transplant alone in the type I diabetes mellitus patient population remains controversial.Recent FindingsAt the crux of the issue, it remains that there is no randomized, controlled study on this topic. Moreover, the information that does exist is limited by inherent selection biases despite the most robust forms of statistical analysis in order to correct for the know...
Source: Current Transplantation Reports - May 16, 2017 Category: Transplant Surgery Source Type: research

Novel Approaches to Expanding Benefits from Living Kidney Donor Chains
AbstractPurpose of ReviewAlthough allocation strategies such as kidney paired donation (KPD) have helped to enhance transplant opportunities for immunologically incompatible recipient and donor pairs, further expansion and optimization of KPD is possible. This review examines Global Kidney Exchange and Deceased Donors as Chain-Initiating Kidneys, two novel strategies aimed to expand the benefits of KPD.Recent FindingsGlobal Kidney Exchange offers the opportunity to utilize the mechanism of kidney exchange to overcome financial barriers to kidney transplantation, thus increasing the pool of participating pairs, unlocking mo...
Source: Current Transplantation Reports - May 8, 2017 Category: Transplant Surgery Source Type: research

Xenotransplantation: Where Are We with Potential Kidney Recipients? Recent Progress and Potential Future Clinical Trials
AbstractPurposeInterspecies transplantation, xenotransplantation, is becoming a realistic strategy to solve the organ shortage crisis. Here, we focus on seminal publications that have driven research in xenotransplantation, as well as recently published literature and future endeavors.Recent FindingsAdvances in gene editing technology have allowed for the efficient production of multitransgenic porcine donors leading improved xenograft survival in baboons, up to 2  years following heterotopic heart xenotransplantation and from weeks to several months following life-supporting kidney xenotransplanation. As technology e...
Source: Current Transplantation Reports - May 8, 2017 Category: Transplant Surgery Source Type: research

Living Donor Pancreas Transplants: Donor Selection and Risk Minimization
In this study, our goal was to analyze nearly 4 decades of experience since the first living donor pancreas transplant in 1979, focusing on what constitutes optimal donor selection and ideal post donation follow-up.When combined with a living donor kidney transplant, a living donor pancreas transplant offers patients with concurrent renal failure and diabetes the option of a single procedure: a living donor simultaneous pancreas-kidney (SPK) transplant. Living donor SPK transplants not only can reduce the waiting time in areas where it is long but also, for highly sensitized patients, can electively identify a donor with a...
Source: Current Transplantation Reports - May 5, 2017 Category: Transplant Surgery Source Type: research

Pharmacologic Complement Inhibition in Clinical Transplantation
AbstractPurpose of ReviewOver the past two decades, significant strides made in our understanding of the etiology of antibody-mediated rejection (AMR) in transplantation have put the complement system in the spotlight. Here, we review recent progress made in the field of pharmacologic complement inhibition in clinical transplantation and aim to understand the impact of this therapeutic approach on outcomes in transplant recipients.Recent FindingsEncouraged by the success of agents targeting the complement cascade in disorders of unrestrained complement activation like paroxysmal nocturnal hemoglobinuria (PNH) and atypical ...
Source: Current Transplantation Reports - April 20, 2017 Category: Transplant Surgery Source Type: research

Opportunities for Therapeutic Intervention During Machine Perfusion
This article reviews the current status of MP with a focus on its role in organ pre-conditioning and therapeutic interventions prior to transplantation.Recent FindingsMP has allowed longer organ preservation compared to conventional static cold storage and allowed the use of organs that might otherwise have been discarded. Moreover, experimental studies have investigated the role of MP in reducing ischemia reperfusion injury of lungs, kidneys, and livers by applying mesenchymal stem cells (MSCs), anti-inflammatory agents, cytotopic anti-coagulants, and defatting cocktails.SummaryMP has opened a new era in the field of orga...
Source: Current Transplantation Reports - April 19, 2017 Category: Transplant Surgery Source Type: research

Biologics in Transplantation (Anti-thymocyte Globulin, Belatacept, Alemtuzumab): How Should We Use Them?
AbstractPurpose of ReviewThe use of immunosuppressive agents for induction and maintenance therapies continues to vary widely among countries and transplant centers. This review will consolidate the published body of evidence addressing the effectiveness and safety of the use of three biological agents: anti-thymocyte globulin, alemtuzumab, and belatacept in adult kidney transplant recipients.Recent FindingsClinical evidence clearly supports the use of Thymoglobulin in high immunological risk patients, while its benefit in low immunological risk patients remains controversial. Alemtuzumab has the advantage of easy administ...
Source: Current Transplantation Reports - April 17, 2017 Category: Transplant Surgery Source Type: research

Nanotechnological Approaches to Immunosuppression and Tolerance Induction
AbstractPurpose of ReviewSeveral pre-clinical studies have engineered nanoparticles for immune regulation and have shown promising results in the fields of autoimmunity and cancer. In solid organ transplantation, the use of nanoparticle-based immune regulation has only just begun to emerge but holds significant promise for the improvement of our current standard of care immunosuppressive regimens. In this review, we will shed light on the current status of nanoparticle-engineered immunotherapeutics and the potential application of these technologies to the field of organ transplantation. Further, we discuss different strat...
Source: Current Transplantation Reports - April 17, 2017 Category: Transplant Surgery Source Type: research

Ex Vivo Lung Perfusion
This article will review the rationale for EVLP and the different EVLP methods including the Toronto EVLP method, describe technical details of EVLP, report on the clinical results of EVLP, and describe the use of EVLP as a platform to deliver different therapies.Recent FindingsEVLP has been demonstrated to be a safe method of assessing high-risk donor lungs. The long-term survival and graft function of patients that received high-risk donor lungs assessed and treated with EVLP have been shown to be comparable to those receiving conventional donor lungs. Preclinical studies demonstrate that EVLP can serve as a platform for...
Source: Current Transplantation Reports - April 12, 2017 Category: Transplant Surgery Source Type: research

Intraoperative Management of the Kidney Transplant Recipient
AbstractPurpose of ReviewThe purpose of this study was to review current literature on the intraoperative management of the kidney transplant recipient in terms of preoperative evaluation, anesthetic agents of choice, monitoring needs, intraoperative fluid and hemodynamic management, and perioperative pain control options.Recent FindingsMore recent literature regarding intraoperative kidney management suggests less aggressive volume loading with a balanced crystalloid solution, particularly in regard to albumin and blood products, with increased consideration for multimodal therapies for nausea and pain control.SummaryPeri...
Source: Current Transplantation Reports - April 11, 2017 Category: Transplant Surgery Source Type: research

Acute and Chronic Micro- and Macrovascular Lesions in Pancreas Transplants: Implications for the Diagnosis of T Cell-Mediated and Antibody-Mediated Allograft Rejection
AbstractPurpose of ReviewT cell-mediated and antibody-mediated rejections are recognized as the main rejection pathways in pancreas transplantation. In comparison to other organs, rejection-related vascular lesions have not been described systematically yet.Recent FindingsTissue involvement in acute and chronic T cell-mediated and antibody-mediated rejections are very distinctive with respect to the epithelial components and the microvasculature, but have overlapping features regarding larger arterial branches. More specifically, the microvasculature (predominantly represented by the interacinar capillaries) which is targe...
Source: Current Transplantation Reports - April 10, 2017 Category: Transplant Surgery Source Type: research

Decision Aids to Increase Living Donor Kidney Transplantation
AbstractPurpose of ReviewFor the more than 636,000 adults with end-stage renal disease (ESRD) in the USA, kidney transplantation is the preferred treatment compared to dialysis. Living donor kidney transplantation (LDKT) comprised 31% of kidney transplantations in 2015, an 8% decrease since 2004. We aimed to summarize the current literature on decision aids that could be used to improve LDKT rates.Recent FindingsDecision aids are evidence-based tools designed to help patients and their families make difficult treatment decisions. LDKT decision aids can help ESRD patients, patients ’ family and friends, and healthcare...
Source: Current Transplantation Reports - February 9, 2017 Category: Transplant Surgery Source Type: research

Measuring Transplant Center Performance: the Goals Are Not Controversial but the Methods and Consequences Can Be
AbstractPurpose of ReviewRisks of regulatory scrutiny has generated widespread concern about increasingly risk averse transplant center behaviors regarding both donor and candidate acceptance patterns. To address potential unintended consequences threatening access to care, we discuss recent changes in regulatory metrics and potential improvements in quality oversight of transplant centers.Recent FindingsDespite many recent changes to 1-year patient and graft survival regulatory criteria, the capacity to accurately identify true underperforming centers and avoiding false positive flagging remains an area of great concern. ...
Source: Current Transplantation Reports - February 8, 2017 Category: Transplant Surgery Source Type: research

Practical Approaches to Mitigating Economic Barriers to Living Kidney Donation for Patients and Programs
AbstractPurposeLive donor kidney transplantation has superior outcomes to deceased donor transplantation; however, the number of living kidney donors continues to decrease in the USA. This is in part attributed to economic barriers.Recent FindingsThe significant economic barriers that exist include out-of-pocket expenses, loss or increased costs of insurability, and potential loss of employment. This paper describes the economic barriers to living kidney donation and national, local, and private sector initiatives needed to alleviate these barriers.SummaryOngoing attention to economic barriers is needed including improveme...
Source: Current Transplantation Reports - January 30, 2017 Category: Transplant Surgery Source Type: research

A Look into a New Approach to Transplant Program Evaluation —the COIIN Project
AbstractPurpose of ReviewCurrent kidney transplant program performance assessment metrics are reviewed, including their use by regulatory entities, and a new approach to program assessment, the Collaborative Innovation and Improvement Network (COIIN), is described.Recent FindingsCurrent kidney transplant program performance assessment is based on 1-year patient and graft survival data. Program specific reports used by the OPTN, CMS, and third-party payers have resulted in risk-averse clinical decision making by transplant programs limiting the transplantation of less than ideal kidneys and access to transplantation for inc...
Source: Current Transplantation Reports - January 26, 2017 Category: Transplant Surgery Source Type: research

Strategies for Assessing GFR and Albuminuria in the Living Kidney Donor Evaluation
We describe strategies for clinical decision-making in assessment of GFR and albuminuria in the evaluation of living kidney donor candidates. Our premise is that all measurements will contain error; no single test result should lead to a decision to accept or decline a donor candidate.SummaryA structured approach to use of information from multiple sources (e.g., estimated and measured GFR, estimated and measured albuminuria) aids in test interpretation and can lead to increased accuracy of testing and efficiency of evaluation strategies. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - January 24, 2017 Category: Transplant Surgery Source Type: research

Promise of Normothermia
AbstractPurpose of this ReviewNormothermic ex vivo machine perfusion (NMP) is a novel preservation modality that has been investigated as a tool to preserve and protect organs from extended criteria donors (ECDs). This review summarizes the latest clinical and experimental progress in this field and tries to answer questions such as what are the future implications of NMP, what are its therapeutic potentials, and what are the limitations associated with this technology?Recent FindingsNew emerging data from clinical trials with NMP devices have demonstrated the safety and feasibility of this technology as well as its abilit...
Source: Current Transplantation Reports - January 23, 2017 Category: Transplant Surgery Source Type: research

Culturally Competent Strategies for Increasing Knowledge of Live Kidney Donation in the Hispanic Community
AbstractPurpose of ReviewDespite a greater prevalence of end-stage renal disease than in non-Hispanic whites, Hispanics/Latinos receive disproportionately fewer kidney transplants, particularly living donor kidney transplants. Because a lack of knowledge and cultural beliefs contribute to Hispanics ’ low living donation rates, it is critical to understand how culturally competent interventions may increase knowledge of living kidney donation and live donor transplantation in the Hispanic population.Recent FindingsOnly three interventions have been culturally targeted to Hispanic persons, including a mass media campai...
Source: Current Transplantation Reports - January 20, 2017 Category: Transplant Surgery Source Type: research

Key Ethical Considerations in the Study and Clinical Translation of Uterine Transplantation
AbstractUterine factor infertility (UFI) is a condition that affects approximately 1.5 million women around the world. Advances in reproductive science have made it possible that uterine transplantation may be the first true treatment for women with UFI. While uterine transplantation is still in the experimental stages, the first successful live births from women who received a uterine transplant mark the real potential of this procedure. Although uterine transplant may offer an important new step for the management of women with UFI, it also poses important ethical questions that must be thoroughly considered and addresse...
Source: Current Transplantation Reports - November 5, 2016 Category: Transplant Surgery Source Type: research

Machine Perfusion for the Assessment and Resuscitation of Marginal Donors in Liver Transplantation
AbstractA limited supply of donor livers has led many centers to use marginal liver allografts for transplantation with increasing frequency. These allografts are at increased risk for both primary non-function, early allograft dysfunction, and other recipient complications following transplantation. Machine perfusion preservation is an emerging technology that limits the ischemia-reperfusion injury sustained during allograft preservation and may lead to improved outcomes following liver transplantation. While several clinical series has shown a benefit of machine perfusion in both standard and extended criteria donors, no...
Source: Current Transplantation Reports - October 29, 2016 Category: Transplant Surgery Source Type: research

Treatment of Rejection in Vascularized Composite Allotransplantation
AbstractVascularized composite allotransplantation (VCA) has become an important modality to restore disfigured parts of the body that cannot be restored with conventional reconstructive techniques. Reported short- and long-term functional and esthetic outcomes have been excellent. However, acute rejection remains the most common complication associated with VCA. In addition, recent reports have linked the loss of some allografts to chronic rejections potentially fueled by insufficiently treated acute rejections. Here, we highlight recent diagnostic and therapeutic strategies for the prevention and treatment of acute and c...
Source: Current Transplantation Reports - October 29, 2016 Category: Transplant Surgery Source Type: research

Current Perspectives on Lung Allocation Schemes in the USA and Europe
AbstractOver the past three decades, lung transplantation has evolved as a recognized treatment for patients with advanced lung disease. However, lung transplantation has remained limited by the shortage of acceptable donor lung organs. Previously, allocation of donor lungs in the USA was based primarily upon a recipient ’s wait list time. However, in 2005, under the mandate of the US Department of Health and Human Services, the lung allocation system was changed in order to incorporate medical urgency and to ensure equitable and efficient allocation for all transplant candidates. Clinical criteria that predicted wai...
Source: Current Transplantation Reports - October 29, 2016 Category: Transplant Surgery Source Type: research

Adoptive Cell Therapy with Tregs to Improve Transplant Outcomes: the Promise and the Stumbling Blocks
AbstractThe contribution of regulatory T cells (Treg) to the induction and maintenance of tolerance is well-recognized in rodents and may contribute to long-term human organ allograft survival. The therapeutic efficacy of adoptively transferred Treg in promoting tolerance to organ allografts is well-recognized in mouse models. Early phase 1/2 clinical studies of Treg therapy have been conducted in patients with type-1 (autoimmune) diabetes and refractory Crohn ’s disease and for inhibition of graft-versus-host disease following bone marrow transplantation with proven safety. The feasibility of adoptive Treg therapy i...
Source: Current Transplantation Reports - October 25, 2016 Category: Transplant Surgery Source Type: research

Macrophages as Effectors of Acute and Chronic Allograft Injury
AbstractOrgan transplants give a second chance of life to patients with end-stage organ failure. However, the immunological barriers prove to be very challenging to overcome and graft rejection remains a major hurdle to long-term transplant survival. For decades, adaptive immunity has been the focus of studies, primarily based on the belief that T cells are necessary and sufficient for rejection. With better-developed immunosuppressive drugs and protocols that effectively control adaptive cells, innate immune cells have emerged as key effector cells in triggering graft injury and have therefore attracted much recent attent...
Source: Current Transplantation Reports - October 25, 2016 Category: Transplant Surgery Source Type: research

Detecting Cardiac Allograft Rejection in the Era of Personalized Medicine: a Review of Current Genomic Surveillance Techniques
AbstractApproximately 25  % of patients will experience an episode of treated cellular rejection in the first year post-transplant. Endomyocardial biopsy has long been considered the gold standard for detecting rejection, despite its invasive nature and limitations in sampling, timing, and interpretation. Numerous prior st udies of imaging techniques and biomarkers have failed to provide a reliable non-invasive alternative to biopsy, until the introduction of gene-expression profiling. Gene-expression profiling has been shown to be non-inferior to endomyocardial biopsy in low-risk populations and has now entered routi...
Source: Current Transplantation Reports - October 22, 2016 Category: Transplant Surgery Source Type: research

Uterus Transplantation: Medical Considerations
AbstractBackgroundUterine transplantation is a novel treatment for uterine factor infertility (UFI), a condition which affects women who have an absent or nonfunctioning uterus and cannot carry their own biological children. Traditionally, surrogacy and adoption have been the only options for women with UFI. With recent successful living donor transplants in a clinical trial from Sweden, there is new hope for women with UFI to be able to experience pregnancy.Donor SelectionCurrent medical considerations in uterine transplantation include living versus deceased donor protocols and the relevant issues pertaining to this choi...
Source: Current Transplantation Reports - October 22, 2016 Category: Transplant Surgery Source Type: research

Immunosuppressive Properties of Mesenchymal Stem Cells
AbstractThe properties of mesenchymal stem cells (MSCs) have become better known over the past decade and show potentially attractive new capabilities in solid-organ transplantation. After systemic administration, MSCs migrate to the damaged tissues, engraft, and then display potent anti-inflammatory and immunomodulatory properties through cell-to-cell interactions and secretion of soluble factors. They are weakly immunogenic and influence the differentiation and function of both innate and adaptive immune cells, thus promoting a tolerogenic response. Moreover, the results of the preclinical studies and the initial clinica...
Source: Current Transplantation Reports - October 19, 2016 Category: Transplant Surgery Source Type: research

Mixed Chimerism-Based Regimens in VCA
AbstractAmputations and devastating injuries throughout the body can now be reconstructed by transplanting vascularized composite allografts (VCAs) of the extremities, face, penis, scalp, skull, abdominal wall, and even the uterus. While functional and quality of life outcomes have been highly promising, the requirement for, and complications from long-term immunosuppression have predictably been reported in VCA recipients as with solid organ transplantation. Immunologic tolerance represents an alternative strategy to prevent rejection of VCAs without the need for immunosuppression. Clinically, long-term tolerance of allog...
Source: Current Transplantation Reports - October 12, 2016 Category: Transplant Surgery Source Type: research

Notch Signaling and Immune Regulation in Alloimmunity
AbstractNotch signaling plays a pivotal role in the differentiation and fate determination of T cells, B cells, dendritic cells (DCs), and innate lymphoid cells (ILCs). Recent gene-targeting and antibody approaches advanced our knowledge of the importance of Notch signaling in fine-tuning the peripheral immune response. Here, we review current knowledge of the Notch pathway, focusing on solid organ transplant and graft-versus-host disease preclinical models, and discuss the potential of targeting Notch to suppress the immune response and improve transplant outcomes. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - October 10, 2016 Category: Transplant Surgery Source Type: research

What Is Direct Allorecognition?
AbstractDirect allorecognition is the process by which donor-derived major histocompatibility complex (MHC)-peptide complexes, typically presented by donor-derived ‘passenger’ dendritic cells, are recognised directly by recipient T cells. In this review, we discuss the two principle theories which have been proposed to explain why individuals possess a high-precursor frequency of T cells with direct allospecificity and how self-restricted T cells recognise allogeneic MHC-peptide complexes. These theories, both of which are supported by functional and structural data, suggest that T cells recognising allogeneic ...
Source: Current Transplantation Reports - October 7, 2016 Category: Transplant Surgery Source Type: research

Liver-allocation policies for patients affected by HCC in Europe
AbstractThe main goal of organ-allocation systems is to guarantee equal access to the limited resource of liver grafts for every patient on the waiting list, striking a balance between the ethical principles of equity, utility, benefit, need, and fairness. The European healthcare scenario is very complex, as it is essentially decentralized, and each nation —and region inside the nation—operates with a significant degree of autonomy. Furthermore, the epidemiology of liver diseases and hepatocarcinoma (HCC) differs between European countries and clearly affects indications and priorities. The aims of this review ...
Source: Current Transplantation Reports - October 7, 2016 Category: Transplant Surgery Source Type: research

Advances in How We Prioritize Liver Allocation for Hepatocellular Carcinoma in the USA
AbstractTreatment options for hepatocellular carcinoma (HCC) have changed significantly, beginning in 1994 with the establishment of successful long-term outcomes for HCC patients within Milan criteria who went on to receive liver transplantation (LT). Improved outcomes for patients with HCC undergoing LT led to challenges in determining the optimal liver allocation policy, which could provide relatively equal access for patients with and without HCC in the face of a long-standing critical shortage of available donor organs. United Network for Organ Sharing/Organ Procurement Transplantation Network (UNOS/OPTN) policy chang...
Source: Current Transplantation Reports - October 6, 2016 Category: Transplant Surgery Source Type: research