Rationalizing Incompatible Living Donor Kidney Transplantation for Highly Sensitized Candidates
AbstractPurpose of ReviewBecause highly sensitized kidney transplant candidates must draw from a large donor pool to find a biologically compatible donor, living donor transplantation is uncommon among HLA-sensitized patients in need of kidney transplantations. We review current data on treatment options for highly sensitized kidney transplant candidates and provide recommendations based on the evidence and our clinical experience.Recent FindingsAs kidney paired donation becomes more common in the USA, recent studies have published outcomes from large, multi-center national exchange programs. Recent national studies have a...
Source: Current Transplantation Reports - June 2, 2021 Category: Transplant Surgery Source Type: research
Cell Therapy and Bioengineering in Experimental Liver Regenerative Medicine: In Vivo Injury Models and Grafting Strategies
AbstractPurpose of ReviewTo describe experimental liver injury models used in regenerative medicine, cell therapy strategies to repopulate damaged livers and the efficacy of liver bioengineering.Recent FindingsSeveral animal models have been developed to study different liver conditions. Multiple strategies and modified protocols of cell delivery have been also reported. Furthermore, using bioengineered liver scaffolds has shown promising results that could help in generating a highly functional cell delivery system and/or a whole transplantable liver.SummaryTo optimize the most effective strategies for liver cell therapy,...
Source: Current Transplantation Reports - May 22, 2021 Category: Transplant Surgery Source Type: research
Exercise Interventions for Transplant Recipients
AbstractPurpose of ReviewTo discuss the data which supports post-solid organ transplant (SOT) exercise prescription as well as the potential benefits of incorporating exercise into post-transplant care.Recent FindingsSolid organ transplantation reverses the physiologic derangements which occur in the setting of end-stage liver, lung, kidney, and heart disease. However, many conditions which accompany end-stage organ failure, such as sarcopenia and frailty, or those which are present pre-transplant, such as obesity and the metabolic syndrome (MetS), may improve at variable rates or 16 not at all after SOT. These conditions ...
Source: Current Transplantation Reports - April 10, 2021 Category: Transplant Surgery Source Type: research
Immunosuppression Considerations for Older Kidney Transplant Recipients
AbstractPurpose of ReviewWhile kidney transplantation improves the long-term survival of the majority of patients with end-stage kidney disease (ESKD), age-related immune dysfunction and associated comorbidities make older transplant recipients more susceptible to complications related to immunosuppression. In this review, we discuss appropriate management of immunosuppressive agents in older adults to minimize adverse events, avoid acute rejection, and maximize patient and graft survival.Recent FindingsPhysiological changes associated with senescence can impact drug metabolism and increase the risk of post-transplant infe...
Source: Current Transplantation Reports - April 6, 2021 Category: Transplant Surgery Source Type: research
Lung Transplant from ECMO: Current Results and Predictors of Post-transplant Mortality
We examined data from the last 5 years describing extracorporeal life support (ECLS) as a bridge to lung transplantation. We assessed predictors of survival to transplantation and post-transplant mortality.Recent FindingsThe number of lung transplants performed worldwide is increasing. This is accompanied by an increase in the type of patients being transplanted, including sicker patients with more advanced disease. Consequently, there is an increase in the need for bridging strategies, with varying success. Several predictors of failure have been identified. Major risk factors include retransplantation, other organ dysfun...
Source: Current Transplantation Reports - April 6, 2021 Category: Transplant Surgery Source Type: research
Anticoagulation in Mechanical Circulatory Support
AbstractPurpose of ReviewThe field of mechanical circulatory support is rapidly evolving, and along with it, the management of anticoagulation and hemocompatibility also changes. The purpose of this review is to provide a contemporary approach to the evaluation and management of anticoagulation in mechanical circulatory support device therapies.Recent FindingsImportant recent studies and guidelines have solidified a more uniform approach to anticoagulation in both temporary and durable devices. With advances in technology, it may be possible to reduce the requirements for anticoagulant and antiplatelet therapies.SummaryTho...
Source: Current Transplantation Reports - March 30, 2021 Category: Transplant Surgery Source Type: research
Psychological and Socioeconomic Outcomes Among Directed and Non-directed Living Kidney Donors
AbstractPurpose of ReviewNon-directed living kidney donors (NDDs) are unique from the traditional directed living donors in terms of the circumstances that led NDDs to undergo a donation. The purpose of this study was to synthesize and discuss key similarities, differences, and existing gaps in the literature comparing their kidney donation process experiences and post-donation outcomes among directed and non-directed donors.Recent FindingsA total of eight recent studies were reviewed as part of this study. These studies provided insights into the socioeconomic, physical, and mental health outcomes experienced by NDDs and ...
Source: Current Transplantation Reports - March 30, 2021 Category: Transplant Surgery Source Type: research
Imlifidase as a Potential Treatment for Antibody-Mediated Rejection
AbstractPurpose of ReviewAntibody-mediated rejection (ABMR) is implicated as the leading cause of late kidney allograft failure. Current therapies inadequately control the antibody response and persistent donor-specific antibodies lead to chronic ABMR and allograft failure. Imlifidase is an IgG endopeptidase derived fromStreptococcus pyogenes that cleaves human IgG into F(ab ’)2 and Fc fragments, thereby protecting against complement-dependent cytotoxicity and antibody-dependent cellular cytotoxicity. Favorable outcomes with its use for desensitization in HLA-incompatible kidney transplantation have engendered interest i...
Source: Current Transplantation Reports - March 24, 2021 Category: Transplant Surgery Source Type: research
Delirium Among Adults Undergoing Solid Organ Transplantation
AbstractPurpose of ReviewTo summarize the research on postoperative delirium among patients undergoing solid organ transplantation in efforts to improve recognition, evaluation, and management, as well as highlight areas for future research.Recent FindingsDelirium is a common complication in patients with organ failure before and after undergoing solid organ transplant (range: 4.7 –47%). However, it is frequently unrecognized and underdiagnosed—even among those closely monitored after major surgery—given that its manifestation is often variable and inconsistent. Delirium has multifactorial etiologies comprising of a ...
Source: Current Transplantation Reports - March 23, 2021 Category: Transplant Surgery Source Type: research
Cardiac Regeneration: the Heart of the Issue
AbstractPurpose of ReviewThe regenerative capacity of the heart is insufficient to compensate for the pathological loss of cardiomyocytes during a large injury, such as a myocardial infarction. Therapeutic options for patients after cardiac infarction are limited: treatment with drugs that only treat the symptoms or extraordinary measures, such as heart transplantation. Cell therapies offer a promising strategy for cardiac regeneration. In this brief review, the major issues in these areas are discussed, and possible directions for future research are indicated.Recent FindingsCardiac regeneration can be obtained by at leas...
Source: Current Transplantation Reports - March 23, 2021 Category: Transplant Surgery Source Type: research
Bioengineered Islet Cell Transplantation
AbstractPurpose of Reviewβ cell replacement via whole pancreas or islet transplantation has greatly evolved for the cure of type 1 diabetes. Both these strategies are however still affected by several limitations. Pancreas bioengineering holds the potential to overcome these hurdles aiming to repair and regenerate β cell compartment. In this review, we detail the state-of-the-art and recent progress in the bioengineering field applied to diabetes research.Recent FindingsThe primary target of pancreatic bioengineering is to manufacture a construct supporting insulin activity in vivo. Scaffold-base technique, 3D bioprintin...
Source: Current Transplantation Reports - March 13, 2021 Category: Transplant Surgery Source Type: research
Immune Responses to SARS-CoV-2 in Solid Organ Transplant Recipients
AbstractPurpose of ReviewCoronavirus disease 2019 (COVID-19) is caused by a complex interplay between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dynamics and host immune responses. Hosts with altered immunity, including solid organ transplant recipients, may be at increased risk of complications and death due to COVID-19. A synthesis of the available data on immune responses to SARS-CoV-2 infection is needed to inform therapeutic and preventative strategies in this special population.Recent FindingsFew studies have directly compared immune responses to SARS-CoV-2 between transplant recipients and the gene...
Source: Current Transplantation Reports - March 4, 2021 Category: Transplant Surgery Source Type: research
Engineering Vascularized Composite Tissues by Perfusion Decellularization/Recellularization: Review
AbstractPurpose of ReviewIn the field of tissue engineering, the “perfusion decellularization and recellularization” emerged over the last decade. This technique is generating a complex and perfusable acellular scaffolds (e.g., solid organ) from discarded living tissue. The present work aims to describe all studies in which this technique was applied to compl ex composite tissues, or one of their elementary tissues.Recent FindingsA total of 25 experimental publications were found between 2009 and 2020. Studies interested skin/adipose, muscle and nerve flaps for elementary tissues, and larynx, ears, face, upper limbs, u...
Source: Current Transplantation Reports - March 3, 2021 Category: Transplant Surgery Source Type: research
A Comprehensive Review of Infections in Older Kidney Transplant Recipients
AbstractPurpose of ReviewWhile a great deal of literature has been published in recent years on infections in kidney transplant (KT) recipients, there is a relative paucity of literature on infections and their impact on the graft and overall health of older KT recipients. We reviewed the most recent literature and guidelines in the field of kidney transplantation and summarized the current recommendations for physicians caring for older KT recipients at risk for infections.Recent FindingsOlder KT recipients are at an increased risk of infections during the first year post-KT resulting in readmission or other poor outcomes...
Source: Current Transplantation Reports - February 22, 2021 Category: Transplant Surgery Source Type: research
Strategies to Improve Liver Allocation, Distribution, and Utilization in a Broader Sharing Climate
AbstractPurpose of the ReviewIn an attempt to eliminate geographic disparities in median MELD at transplant, the allocation of deceased donor liver allografts has transitioned to the use of acuity-based circles. This has provided new obstacles for both organ procurement organizations and transplant centers to accommodate the implications of a broader sharing climate.Recent FindingsWith changes to allocation, OPOs and transplant centers have experienced new challenges in donor organ evaluation and logistics. However, these changes present an opportunity to refocus on the deceased liver donation process. Opportunities exist ...
Source: Current Transplantation Reports - February 10, 2021 Category: Transplant Surgery Source Type: research
