Evolution of Clinical Care in COVID-Infected Solid Organ Transplant Recipients
AbstractPurpose of ReviewIn this review, we aim to summarize the evolution of care for the solid organ transplant recipient (SOTR) with COVID-19 disease, based on the current published guidelines and our center ’s experience.Recent FindingsOral antiviral medications and monoclonal antibodies are now used with the goal to prevent severe disease. Immunomodulating drugs in addition to antivirals have been used in the treatment of severe COVID-19.SummaryWith the ongoing pandemic and unique challenges posed by the SOTR, understanding the risk and advancing management and treatment of COVID-19 infections are imperative to the ...
Source: Current Transplantation Reports - May 31, 2022 Category: Transplant Surgery Source Type: research
Understanding Structural Racism as a Barrier to Living Donor Kidney Transplantation and Transplant Care
AbstractRecent FindingsBlack and Hispanic patients carry higher burden of kidney disease, yet have lower access to LDKT. Until recently, these differences were thought to be due to medical co-morbidities and variation in transplant center practices. However, recent studies have shown that systemic and structural inequities related to race may be one of the major drivers.Purpose of ReviewIn this paper, we examine the definition of race and systemic racism, then describe patient-, transplant center –, and society-level barriers to LDKT. We identify how social determinants, cultural biases and mistrust in medical system, in...
Source: Current Transplantation Reports - May 28, 2022 Category: Transplant Surgery Source Type: research
Correction to: Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation
(Source: Current Transplantation Reports)
Source: Current Transplantation Reports - May 27, 2022 Category: Transplant Surgery Source Type: research
Past and Present Policy Efforts in Achieving Racial Equity in Kidney Transplantation
AbstractPurpose of ReviewInequities in transplant access for underrepresented minorities and people of low socioeconomic status persist. The central principle to organ allocation, the “Final Rule” is grounded on “equitable allocation of cadaveric organs,” regardless of background, including race/ethnicity, gender, and socioeconomic status, and there have been ongoing previous and current efforts in achieving the goal of equity in access to transplantation.Recent FindingsSome of these disparities are caused by impeded access to the transplant waiting list (i.e., lack of referral to transplantation, socioeconomic con...
Source: Current Transplantation Reports - May 24, 2022 Category: Transplant Surgery Source Type: research
Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation
This article reviews controversial questions within the field of lung transplantation, with a focus on data generated within the last 3 years. We aim to summarize differing opinions on a selection of topics, including bridge-to-transplantation, intraoperative machine circulatory support, bronchial anastomosis, size mismatch, delayed chest closure, and ex vivo lung perfusion.Recent FindingsWith the growing rate of lung transplantations worldwide and increasing numbers of patients placed on waiting lists, the importance of determining best practices has only increased in recent years. Factors which promote successful outcome...
Source: Current Transplantation Reports - May 16, 2022 Category: Transplant Surgery Source Type: research
Fungal Infections in Lung Transplantation
AbstractPurpose of ReviewWe aim to understand the most common fungal infections associated with the post-lung transplant period, how to diagnose, treat, and prevent them based on the current guidelines published and our center ’s experience.Recent FindingsDifferent fungi inhabit specific locations. Diagnosis of invasive fungal infections (IFIs) depends on symptoms, radiologic changes, and a positive microbiological or pathology data. There are several molecular tests that have been used for diagnosis. Exposure to fungal prophylaxis can predispose lung transplant recipients to these emerging molds. Understanding and manag...
Source: Current Transplantation Reports - May 9, 2022 Category: Transplant Surgery Source Type: research
COVID-19 Vaccine Efficacy and Immunogenicity in End-Stage Renal Disease Patients and Kidney Transplant Recipients
AbstractPurpose of ReviewTo summarize the current literature with respect to COVID-19 vaccine efficacy patients with end-stage renal disease on dialysis and kidney transplant recipients.Recent FindingsImmunosuppressed patients are at greater risk of morbidity and mortality from COVID-19 infection. Patients with ESRD and KTR are immunosuppressed and mount a weaker antibody response to COVID-19 mRNA vaccination, and factors including immunosuppressant medications have been implicated for this weakened response. Third and fourth doses of vaccine doses have been shown to increase seropositivity and antibody production in kidne...
Source: Current Transplantation Reports - April 29, 2022 Category: Transplant Surgery Source Type: research
The Intersection of Aging and Lung Transplantation: its Impact on Transplant Evaluation, Outcomes, and Clinical Care
AbstractPurposeOlder adults (age ≥ 65 years) are the fastest growing age group undergoing lung transplantation. Further, international consensus document for the selection of lung transplant candidates no longer suggest a fixed upper age limit. Although carefully selected older adults can derive great benefit, understanding which older adults will do well after transplant with improved survival and health-related qualiy of life is key to informed decision-making. Herein, we review the epidemiology of aging in lung transplantation and its impact on outcomes, highlight selected physiological measures that may be info...
Source: Current Transplantation Reports - April 21, 2022 Category: Transplant Surgery Source Type: research
Psychosocial Evaluation for Lung Transplantation: an Empirically Informed Update
AbstractPurpose of ReviewThis review summarizes the pre-surgical psychosocial evaluation for lung transplant (LT), positioned within an evidence-based practice framework and a biopsychosocial model of phenotypes of risk and resilience. We incorporate updated research pertinent to LT published since the landmark 2018 multi-society consensus document on psychosocial evaluations for cardiothoracic transplant.Recent FindingsThe conceptualization and recommendations generated from the psychosocial pre-LT evaluation should be based on current evidence and may be enhanced by incorporating biopsychosocial phenotypes of risk and re...
Source: Current Transplantation Reports - March 18, 2022 Category: Transplant Surgery Source Type: research
Current Bioethical Issues in Geriatric Organ Transplantation
AbstractPurpose of ReviewThere have been many recent developments in geriatric organ transplantation. This review covers the current ethical issues concerning geriatric organ allocation, donation of organs to older recipients, and donation of organs from older donors.Recent FindingsThe population is rapidly aging, yet there is a lack of consensus for the best model for organ allocation in older adults. Young-to-old living donation is complicated by family dynamics. Frailty and cognitive impairment are commonly used to determine which adults gain access to transplantation, but many older recipients still feel overwhelmed an...
Source: Current Transplantation Reports - March 17, 2022 Category: Transplant Surgery Source Type: research
Evaluation of Genetic Kidney Diseases in Living Donor Kidney Transplantation: Towards Precision Genomic Medicine in Donor Risk Assessment
AbstractPurpose of ReviewTo provide a comprehensive update on the role of genetic testing for the evaluation of kidney transplant recipient and living donor candidates.Recent FindingsThe evaluation of candidates for living donor transplantation and their potential donors occurs within an ever-changing landscape impacted by new evidence and risk assessment techniques. Criteria that were once considered contraindications to living kidney donation are now viewed as standard of care, while new tools identify novel risk markers that were unrecognized in past decades. Recent work suggests that nearly 10% of a cohort of patients ...
Source: Current Transplantation Reports - March 16, 2022 Category: Transplant Surgery Source Type: research
Solid Organ Transplantation in SARS-CoV-2 Recovered Transplant Candidates: a Comprehensive Review of Recent Literature
AbstractPurpose of ReviewAs the coronavirus disease 2019 (COVID-19) pandemic continues to surge, determining the safety and timing of proceeding with solid organ transplantation (SOT) in transplant candidates who have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and who are otherwise transplant eligible is an important concern. We reviewed the current status of protocols and the outcomes of SOT in SARS-CoV-2 recovered patients.Recent FindingsWe identified 44 published reports up through 7 September 2021, comprising 183 SOT [kidney = 115; lung = 27; liver = 36; heart =...
Source: Current Transplantation Reports - March 9, 2022 Category: Transplant Surgery Source Type: research
Pancreas Transplant for Combined Pancreatic Endocrine and Exocrine Insufficiency
AbstractPurpose of ReviewTo highlight the role of pancreas transplantation in pancreatogenic diabetes and to familiarize the reader with disease processes that can result in both problematic diabetes and exocrine insufficiency that even when maximally medically managed, can adversely impact quality of life and increase the risk of morbidity and mortality.Recent FindingsSuccessful simultaneous lung/liver/pancreas transplant and the first sequential simultaneous kidney pancreas transplant after lung transplant for cystic fibrosis have recently been reported, spurring renewed interest for the application of pancreas transplan...
Source: Current Transplantation Reports - March 6, 2022 Category: Transplant Surgery Source Type: research
Removal of DSA from KP/Pancreas Allocation
AbstractPurpose of ReviewThis review describes the Organ Procurement and Transplantation Network (OPTN) recently implemented policy to remove donation service area (DSA) and region from combined kidney and pancreas (KP) and pancreas (PA) allocation. It also highlights the OPTN 6-month post-implementation monitoring report data analysis findings and discusses the next steps in terms of continuous distribution.Recent FindingsPost-implementation data demonstrates an increase in transplantation rates and volumes for KP and PA post-policy implementation. Distance from donor hospital to transplant center increased for KP but dec...
Source: Current Transplantation Reports - February 7, 2022 Category: Transplant Surgery Source Type: research
Multi-Organ Allocation: Medical and Ethical Considerations
AbstractPurpose of ReviewSince the creation of the Organ Procurement and Transplantation Network (OPTN), the allocation of deceased donated organs for transplantation has been guided by the principles of equity, fairness, and utility. Each individual organ has a well-designed policy which generates a list of eligible potential recipients, with a clearly defined prioritization based on their points. While this system works for single organ transplants, there is an increasing incidence of situations where more than one organ is requested for the recipient.Recent FindingsThese multi-organ transplants (MOTs) are being performe...
Source: Current Transplantation Reports - January 27, 2022 Category: Transplant Surgery Source Type: research
