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

Fc γ Receptors in Solid Organ Transplantation
AbstractIn the current era, one of the major factors limiting graft survival is chronic antibody-mediated rejection (ABMR), whilst patient survival is impacted by the effects of immunosuppression on susceptibility to infection, malignancy and atherosclerosis. IgG antibodies play a role in all of these processes, and many of their cellular effects are mediated by Fc gamma receptors (Fc γRs). These surface receptors are expressed by most immune cells, including B cells, natural killer cells, dendritic cells and macrophages. Genetic variation inFCGR genes is likely to affect susceptibility to ABMR and to modulate the ph...
Source: Current Transplantation Reports - October 3, 2016 Category: Transplant Surgery Source Type: research

Current Perspectives on Cytomegalovirus in Heart Transplantation
AbstractCytomegalovirus (CMV) is the most common infectious agent in heart transplantation. Its peculiar features, including a complex interplay with host ’s immune system and lifelong latency, have been associated with reduced graft survival by the development of manifestations of graft rejection, such as cardiac allograft vasculopathy. Modern antiviral agents have been effective in reducing the clinical impact of acute CMV syndromes, thus question ing the current role of the virus on chronic graft dysfunction. In this setting, prolonged universal antiviral prophylaxis may appear an easy and effective strategy to ab...
Source: Current Transplantation Reports - October 1, 2016 Category: Transplant Surgery Source Type: research

Mechanisms and Strategies for Tolerance in Liver Transplantation
AbstractAlthough there has been improvement in immunosuppressive therapy in preventing acute rejection following liver transplantation, there is less progress in reducing morbidity and mortality related to immunosuppression. In particular, the use of the current maintenance agents is associated with high rates of chronic kidney disease and metabolic and neoplastic complications. The search for improved treatment algorithms includes trial and error dose minimization or even complete withdrawal; most of which have been attempted with variable success rates. These strategies would be potentially more successful if more were k...
Source: Current Transplantation Reports - September 30, 2016 Category: Transplant Surgery Source Type: research

Face Transplantation: Medical Considerations
AbstractFace transplantation has been performed in 37 patients worldwide. To provide excellent outcomes, it is important to understand the medical considerations that are present in every aspect of this procedure. Pre-operative medical considerations are largely related to patient selection, intra-operative considerations are related to anesthesia, and post-operative considerations include complications and treatment of adverse effects of immunosuppression. This paper will discuss each area in more detail. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - September 30, 2016 Category: Transplant Surgery Source Type: research

How Do We Determine Futility for Patients in Need of Liver Transplantation?
AbstractFutility remains poorly defined in healthcare and entails a large portion of healthcare spending. With limited resources, the field of liver transplantation attempts to minimize cases of futility but struggles to balance the difficulty to provide a life-saving procedure to an increasingly sick patient population as seen with rising Model-for-End-Stage-Liver Disease (MELD) scores. This paper aims to explore the historical context of organ allocation, utilize the medical ethical principles for organ allocation, and review the literature on how to improve transplant outcomes and reduce ‘futile’ cases. In a...
Source: Current Transplantation Reports - September 30, 2016 Category: Transplant Surgery Source Type: research

Vascularized Composite Allotransplantation: Medical Complications
The objective of this review is to summarize the collective knowledge regarding the risks and complications in vascularized composite tissue allotransplantation (VCA), focusing on upper extremity and facial transplantation. The field of VCA has entered its second decade with an increasing experience in both the impressive good outcomes, as well as defining challenges, risks, and experienced poor results. The limited and selective publishing of negative outcomes in this relatively new field makes it difficult to conclusively evaluate outcomes of graft and patient survival and morbidities. Therefore, published data, conferen...
Source: Current Transplantation Reports - August 15, 2016 Category: Transplant Surgery Source Type: research

Update on Chronic Lung Allograft Dysfunction
AbstractChronic lung allograft dysfunction (CLAD) encompasses a range of pathologies that cause a transplanted lung to not achieve or maintain normal function. CLAD manifests as airflow restriction and/or obstruction and is predominantly a result of chronic rejection. Three distinct phenotypes of chronic rejection are now recognized: bronchiolitis obliterans, neutrophilic reversible allograft dysfunction, and restrictive allograft syndrome. Recent investigations have revealed that each phenotype has a unique pathology and histopathological findings, suggesting that treatment regimens should be tailored to the underlying et...
Source: Current Transplantation Reports - August 2, 2016 Category: Transplant Surgery Source Type: research

Is It Time to Use De Novo mTOR Inhibitors Posttransplant?
Abstract The use of mTOR inhibitors evokes debate in transplantation. Numerous clinical trials have explored the role of the mTOR inhibitors sirolimus and everolimus in kidney transplantation, but the results have been mixed; they have not shown a clear benefit over the current regimens. However, many of these trials were impacted by the difficulties and uncertainties in managing side effects and the dosing of the mTOR inhibitors. Being aware of the effective treatments available for these side effects, understanding the pathophysiology of the mTOR pathway allows patients to remain on therapy. Successful side effect manag...
Source: Current Transplantation Reports - July 29, 2016 Category: Transplant Surgery Source Type: research

Does Delayed Graft Function Still Herald a Poorer Outcome in Kidney Transplantation?
Abstract Delayed graft function (DGF), or post-operative acute kidney injury leading to the need for dialysis within the first week after kidney transplantation, most commonly occurs in the setting of donor kidney recovery and the ischemia–reperfusion injury associated with the transplantation process. Despite advances in immunosuppressive regimens and medical management of kidney transplant recipients, the short- and long-term sequelae of DGF continue to be important determinants of kidney allograft prognosis. In this review, we will highlight the following areas as it relates to DGF: definition, pathophysi...
Source: Current Transplantation Reports - June 28, 2016 Category: Transplant Surgery Source Type: research

Potential of Tolerogenic Dendritic Cells in Transplantation
Abstract Dendritic cells (DC) are the most important subset of antigen presenting cells (APC) that are able to polarize the immune response to pro-inflammatory or anti-inflammatory response. This duality places DC in the axis between tolerance and immunogenicity. The regulation of polarization is the key point in autoimmune diseases and organ transplantation. In order to manipulate this duality, DC have been generated ex vivo with a tolerogenic or immunogenic profile since several years. During the last decade, cell therapy using tolerogenic DC (TolDC) has been shown to be safe and effective both in autoimmune dis...
Source: Current Transplantation Reports - June 15, 2016 Category: Transplant Surgery Source Type: research

Autologous Cells for Kidney Bioengineering
Abstract Worldwide, increasing numbers of patients are developing end-stage renal disease, and at present, the only treatment options are dialysis or kidney transplantation. Dialysis is associated with increased morbidity and mortality, poor life quality and high economic costs. Transplantation is by far the better option, but there are insufficient numbers of donor kidneys available. Therefore, there is an urgent need to explore alternative approaches. In this review, we discuss how this problem could potentially be addressed by using autologous cells and appropriate scaffolds to develop ‘bioengineered&rsqu...
Source: Current Transplantation Reports - June 9, 2016 Category: Transplant Surgery Source Type: research

Lung Transplant Rejection and Surveillance in 2016: Newer Options
Abstract Lung allograft rejection is a major risk factor for the development of chronic lung allograft dysfunction. It is a significant cause of morbidity and mortality, and limits survival post lung transplantation, which is lower than any other solid organ transplant. The invasive nature of current methods of diagnosis which consists of histological diagnosis via transbronchial biopsy and the lack of sensitivity of clinical surveillance warrants the search for novel less invasive and more accurate methods of diagnosis. This review aims to highlight recent changes to current methods of surveillance and diagnosis ...
Source: Current Transplantation Reports - June 7, 2016 Category: Transplant Surgery Source Type: research

Cardiac Allograft Vasculopathy: What We Know in 2016
Abstract Cardiac allograft vasculopathy (CAV) is an immune and nonimmune-mediated process in which heart transplantation patients develop neointimal proliferative hyperplasia of the coronary arteries, typically starting distally and resulting in diffuse luminal narrowing. Risk factors include traditional coronary risk factors often resulting from side effects of immunosuppressive drugs, infection by cytomegalovirus and rejection, particularly antibody-mediated. Despite the advent of effective immunosuppression, CAV remains the primary cause of long-term mortality for heart transplant recipients. Patients undergo r...
Source: Current Transplantation Reports - June 4, 2016 Category: Transplant Surgery Source Type: research

Early Results Using Donation After Circulatory Death (DCD) Donor Hearts
Abstract Donation after circulatory death (DCD) has contributed significantly to kidney, lung and liver transplant activities over the last decade. With an ever increasing demand for cardiac transplantation and worsening shortages of donor hearts, there has been growing interests in transplanting hearts from DCD donors. This was initially made possible by co-locating the donor and recipient to ensure the shortest possible ischaemic time for the DCD heart. More recently, reconditioning and distant procurement of arrested DCD hearts has been achieved by using machine perfusion. Early outcomes have been very encourag...
Source: Current Transplantation Reports - June 2, 2016 Category: Transplant Surgery Source Type: research

The “Unusual Suspects” in Allograft Rejection: Will T Regulatory Cell Therapy Arrest Them?
Abstract Several trials with adoptively transferred T regulatory cells (TRegs) have shown to be safe and—in some instances—to be effective in patients with hematological malignancies after allogeneic hematopoietic stem cell transplantation (to prevent graft-versus-host disease), with type 1 diabetes (to preserve residual beta cell function), and with refractory Crohn’s disease (to control the disease). In solid organ transplantation, TReg-cell therapy trials with TReg-supportive immunosuppression are currently being undertaken to control the well-documented T effector cells responsible for allogr...
Source: Current Transplantation Reports - June 2, 2016 Category: Transplant Surgery Source Type: research

Islet Cell Transplantion: Update on Current Clinical Trials
Abstract In the last 15 years, clinical islet transplantation has made the leap from experimental procedure to standard of care for a highly selective group of patients. Due to a risk/benefit calculation involving the required systemic immunosuppression, the procedure is only considered in patients with type 1 diabetes, complicated by severe hypoglycemia or end stage renal disease. In this review, we summarize current outcomes of the procedure and take a look at ongoing and future improvements and refinements of beta cell therapy. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - May 17, 2016 Category: Transplant Surgery Source Type: research

Impact of Pancreas Transplant on Diabetic Complications: Retinoparhy, Gastroparesis and Automatic Dysregulation
Conclusion Proof of the beneficial effects on diabetic complications requires detailed long-term follow-up to clarify and validate many of the small studies performed with regard to the various comorbidities associated with diabetes. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - April 12, 2016 Category: Transplant Surgery Source Type: research