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
Behind the Curtain — the Do’s and Do Not’s of the OPTN and the Final Rule
AbstractPurpose of ReviewAs the transplant community begins to implement and assess the impact of new allocation policies, it is imperative that we understand the journey to where we are now and where we hope to be in the future. Looking at 1-year survival as the only metric for success or program review is an inadequate way to assess whether or not the donor and recipient families are being served in the best way possible. Interaction with governing bodies in the context of policy making is complex. Consensus is even harder to achieve. A discussion of how we best go about maintaining self-governance while moving forward w...
Source: Current Transplantation Reports - January 27, 2022 Category: Transplant Surgery Source Type: research
SARS-CoV-2 Vaccines: Safety and Immunogenicity in Solid Organ Transplant Recipients and Strategies for Improving Vaccine Responses
AbstractPurpose of ReviewWhile solid organ transplant (SOT) recipients are at the highest risk for severe complications and increased mortality from COVID19 disease, their vaccination against SARS-CoV-2 remains challenging due to fear of immune-mediated adverse events and suboptimal immune response. Our current review is aimed to summarize current knowledge about the safety and efficacy of SARS-CoV-2 vaccines, describe factors that are correlated with immune response, and discuss strategies to improve vaccine immunogenicity in SOT recipients.Recent FindingsSARS-CoV-2 vaccines are safe in SOT recipients and not related to r...
Source: Current Transplantation Reports - January 22, 2022 Category: Transplant Surgery Source Type: research
Heart Transplant Donor Selection: Recent Insights
AbstractPurpose of ReviewThere are several aspects of donor selection for heart transplantation that are particularly challenging. Information about the donor is often limited and relayed through a review of selected chart snippets and tests. The donor heart must work immediately unlike kidney transplantation where delayed function is common and not life-threatening. This review focuses on recent findings in the literature which are distilled for the transplant clinician to be eminently practical to advise teams as they consider which donor factors are important in individual situations.Recent FindingsLeft ventricular dysf...
Source: Current Transplantation Reports - January 19, 2022 Category: Transplant Surgery Source Type: research
COVID-19 and Solid Organ Transplantation: Role of Anti-SARS-CoV-2 Monoclonal Antibodies
AbstractPurpose of ReviewSolid organ transplant recipients (SOTRs) are ideal candidates for early treatment or prevention of coronavirus disease 2019 (COVID-19) using anti-SARS-CoV-2 monoclonal antibodies because of multiple underlying medical conditions, chronic immune-suppression, sub-optimal immunogenic response to vaccination, and evolving epidemiological risks. In this article, we review pertinent challenges regarding the management of COVID-19 in SOTRs, describe the role of active and passive immunity in the treatment and prevention of COVID-19, and review real-world data regarding the use of anti-SARS-CoV-2 monoclon...
Source: Current Transplantation Reports - January 15, 2022 Category: Transplant Surgery Source Type: research
Heart Transplant in Older Adults
AbstractPurpose of ReviewOlder adults with end-stage heart failure may be candidates for heart transplantation (HT) and changing guidelines and institutional policies have increased the availability of HT for septuagenarians. This review explores historical, pre-HT evaluation, and post-HT outcomes for older adult HT recipients.Recent FindingsRates of HT in older adults have increased in the past decade and more than 800 septuagenarians have undergone HT. Older adult HT recipients have similar survival, rehospitalization, and graft failure rates when compared to younger patients despite additional comorbidities and higher r...
Source: Current Transplantation Reports - January 13, 2022 Category: Transplant Surgery Source Type: research
Moving Toward Continuous Organ Distribution
AbstractPurpose of ReviewThe Organ Procurement and Transplantation Network has chosen continuous distribution as its preferred framework for the next evolution of organ allocation policies. This review explains the approach, contrasting it with the current policy structure. It also provides an update on the continuous distribution of lungs proposal and shares ideas about how continuous distribution might improve kidney, liver, and heart allocation.Recent FindingsContinuous distribution replaces an ordered list of discrete “classifications,” or groups of patients, with a composite score that simultaneously accounts for ...
Source: Current Transplantation Reports - November 22, 2021 Category: Transplant Surgery Source Type: research
Science Over Stigma: Lessons and Future Direction of HIV-to-HIV Transplantation
AbstractPurpose of ReviewThe HIV Organ Policy Equity (HOPE) Act permits transplantation from donors-with-HIV to recipients-with-HIV (HIV D + /R +). We assess HOPE implementation, summarizing progress and challenges at clinical, legislative, and community levels.Recent FindingsAs of July 2021, there have been 300 kidney and 87 liver transplants within HOPE research studies in the USA. Early HIV D + /R + kidney transplant outcomes show excellent patient survival (100%) and graft survival (92%). The number of HOPE donors continues to grow annually but remains lower than projections. State-level policy restrict...
Source: Current Transplantation Reports - November 18, 2021 Category: Transplant Surgery Source Type: research
Telehealth Use by Living Kidney Donor Transplant Programs During the COVID-19 Pandemic and Beyond: a Practical Approach
AbstractPurpose of ReviewCOVID-19 pandemic led to a decline in living kidney donor evaluations and transplants. This was due to concerns for donor and recipient safety, restrictions on elective cases, and diversion of staff and resources in centers with a higher incidence of COVID-19 infections. Telehealth was explored as a strategy to continue living donor evaluations during the pandemic, but faced barriers including restrictive physician licensing, reduced reimbursement, lack of infrastructure, prohibitive local policies, limited exam, and personal biases. This review highlights these barriers and potential solutions.Rec...
Source: Current Transplantation Reports - November 17, 2021 Category: Transplant Surgery Source Type: research
Reducing Kidney Discard With Artificial Intelligence Decision Support: the Need for a Transdisciplinary Systems Approach
AbstractPurpose of ReviewA transdisciplinary systems approach to the design of an artificial intelligence (AI) decision support system can more effectively address the limitations of AI systems. By incorporating stakeholder input early in the process, the final product is more likely to improve decision-making and effectively reduce kidney discard.Recent FindingsKidney discard is a complex problem that will require increased coordination between transplant stakeholders. An AI decision support system has significant potential, but there are challenges associated with overfitting, poor explainability, and inadequate trust. A...
Source: Current Transplantation Reports - November 15, 2021 Category: Transplant Surgery Source Type: research
Hepatitis C Positive Organ Donation in Heart Transplantation
AbstractPurpose of ReviewTo summarize outcomes to date, as well as important considerations and unanswered questions related to the use of hepatitis C virus (HCV) positive donors for heart transplantation.Recent FindingsOutcomes from single-center studies and registry data to date suggest that among patients who develop donor-transmitted HCV after heart transplantation, direct-acting antiviral therapies (DAAT) are effective and well-tolerated, and that short-term survival is similar to that of patients transplanted with HCV − donors.SummaryIn an era marked by increasing numbers of HCV positive deceased donors and a ...
Source: Current Transplantation Reports - November 10, 2021 Category: Transplant Surgery Source Type: research
Donor-Derived Cell-Free DNA for Acute Rejection Monitoring in Heart and Lung Transplantation
AbstractPurpose of ReviewAcute allograft rejection is a common cause of morbidity and mortality in heart and lung transplantation. Unfortunately, the current monitoring gold standard —biopsy plus histopathology—has several limitations. Plasma donor-derived cell-free DNA (dd-cfDNA) has emerged as a potentially valuable biomarker for rejection that addresses some of the limitations of biopsy. This review covers the current state of the evidence and future directions for the us e of dd-cfDNA in the monitoring of acute rejection.Recent FindingsThe results of several observational cohort studies demonstrate that levels of d...
Source: Current Transplantation Reports - November 5, 2021 Category: Transplant Surgery Source Type: research
