Orthotopic Heart and Combined Heart Liver Transplantation: the Ultimate Treatment Option for Failing Fontan Physiology
AbstractPurpose of the ReviewThis is a comprehensive update on failing Fontan physiology and the role of heart and combined heart and liver transplantation in the current era.Recent FindingsSingle ventricle physiology encompasses a series of rare congenital cardiac abnormalities that are characterized by absence of or hypoplasia of one ventricle. This effectively results in a single ventricular pumping chamber. These abnormalities are rarely compatible with long-term survival if left without surgical palliation in the first few years of life. Surgical treatment of single ventricle physiology has evolved over the past 60 ...
Source: Current Transplantation Reports - February 4, 2021 Category: Transplant Surgery Source Type: research
New Breakthroughs for Liver Transplantation of Cholangiocarcinoma
AbstractPurposeLiver transplantation (LT) has gained ground as a treatment for cholangiocarcinoma. LT has achieved an established role as curative treatment for unresectable hilar cholangiocarcinoma (hCCA), and there are emerging data supporting its use in select patients with intrahepatic cholangiocarcinoma (iCCA). This review explores the current frontiers and future directions of LT for CCA.Recent FindingsResults of retrospective studies support randomized trials of LT for resectable hCCA. Select patients with iCCA who have small tumors or favorable disease biology, as demonstrated by response to neoadjuvant therapy, ha...
Source: Current Transplantation Reports - February 2, 2021 Category: Transplant Surgery Source Type: research
Neuro-Ophthalmologic Hurdles in Whole-Eye Transplantation
AbstractPurpose of ReviewAnatomical and functional successes have extended into the field of vascularized composite allotransplantation. However, the goal of whole-eye transplantation continues as an unfinished effort, primarily because of difficulties accomplishing optic nerve repair and regeneration. This review provides a summary of neuro-ophthalmological findings regarding eye donors and recipients, based on ocular function in donors and neurophysiological events known to occur in blind people.Recent FindingsExperimental advances regarding regeneration of the optic nerve in lower mammals have demonstrated anatomical su...
Source: Current Transplantation Reports - January 24, 2021 Category: Transplant Surgery Source Type: research
Tolerance Protocols in Large Animal VCA Models —Comprehensive Review
This article reviews the current state of large animal tolerance protocols published for VCA.Recent FindingsThe most successful tolerance protocols thus far include the use of hematopoietic stem cell transplant with non-myeloablative preconditioning and establishment of donor cell chimerism. In addition to this strategy, several groups have examined the inclusion of mesenchymal and adipose-derived stem cells to address the complications related to the use of hematopoietic stem cell transplant (such as graft versus host disease).SummaryThese large animal models are critical to development of a viable pre-clinical model for ...
Source: Current Transplantation Reports - December 4, 2020 Category: Transplant Surgery Source Type: research
Liver Transplantation for Neuroendocrine Metastases
AbstractPurpose of ReviewNeuroendocrine tumor (NET) metastasis localized to the liver is an accepted indication for liver transplantation as such tumors have a low biological aggressiveness in terms of malignancy and are slow growing.Recent FindingsMoreover, the long-term results are comparable with and in some cases even better than those of transplantations performed for primary liver cancer. However, compared with nonmalignant conditions, neuroendocrine liver metastasis (NELM) may result in an inferior outcome of transplantation. In the face of the scarcity of donated organs and recent improved results of non-surgical t...
Source: Current Transplantation Reports - November 22, 2020 Category: Transplant Surgery Source Type: research
Nonalcoholic Fatty Liver Disease in the Post Liver Transplant Patient
AbstractPurpose of ReviewNonalcoholic fatty liver disease (NAFLD) may occur as a de novo or recurrent disease among recipients of liver transplant (LT). We seek to review the currently available information on the diagnosis, implications, and management of NAFLD in the post LT population with a focus on the practical medical management of this disease.Recent FindingsRecent studies emphasize that NAFLD is the hepatic manifestation of the metabolic syndrome, mediated largely by insulin resistance, with liver recipient factors being the primary determinants of the development of graft steatosis. Post-transplant nonalcoholic s...
Source: Current Transplantation Reports - November 17, 2020 Category: Transplant Surgery Source Type: research
Skin Immunology and Rejection in VCA and Organ Transplantation
AbstractPurpose of ReviewSkin provides a window into the health of an individual. Using transplanted skin as a monitor can provide a powerful tool for surveillance of rejection in a transplant. The purpose of this review is to provide relevant background to the role of skin in vascularized transplantation medicine.Recent FindingsDiscrete populations of T memory cells provide distributed immune protection in skin, and cycle between skin, lymph nodes, and blood. Skin-resident TREG cells proliferate in response to inflammation and contribute to long-term VCA survival in small animal models. Early clinical studies show sentine...
Source: Current Transplantation Reports - November 11, 2020 Category: Transplant Surgery Source Type: research
Advancements in Robotic Living Donor Hepatectomy, Review of Literature and Single-Center Experience
AbstractPurpose of ReviewTo highlight the use of robotic surgical system in live liver donor hepatectomy.Recent FindingOur early experience with 175 robotic donor hepatectomies showed that the procedure is safe, feasible, and reproducible in the hands of an experienced surgeon.SummaryThe robotic surgical system has added more benefits to the minimal invasive surgery rather than laparoscopy; it offers better visualization, better ergonomics, better range of movements, and reduced physiological tremors. Moreover, the amplified 3D view with steady instrumental movements ensured meticulous tissue handling; this encouraged many...
Source: Current Transplantation Reports - November 7, 2020 Category: Transplant Surgery Source Type: research
Abdominal Wall Transplantation: Indications and Outcomes
This article aims to review published outcomes associated with full-thickness vascularized abdominal wall transplantation, with particular emphasis on advances in the field in the last 3 years.Recent FindingsForty-six full-thickness vascularized abdominal wall transplants have been performed in 44 patients worldwide. Approximately 35% of abdominal wall transplant recipients will experience at least one episode of acute rejection in the first year after transplant, compared with rejection rates of 87.8% and 72.7% for hand and face transplant respectively. Recent evidence suggests that combining a skin containing abdominal...
Source: Current Transplantation Reports - November 7, 2020 Category: Transplant Surgery Source Type: research
General Approach to the Clinical Care of Solid Organ Transplant Recipients with COVID-19 Infection
AbstractPurpose of ReviewInsufficient knowledge about COVID-19 and the potential risks of COVID-19 are limiting organ transplantation in wait-listed candidates and deferring essential health care in solid organ transplant recipients. In this review, we expand the understanding and present an overview of the optimized management of COVID-19 in solid organ transplant recipients.Recent FindingsTransplant recipients are at an increased risk of severe COVID-19. The unique characteristics of transplant recipients can make it more difficult to identify COVID-19. Based on the COVID-19 data to date and our experience, we present te...
Source: Current Transplantation Reports - October 29, 2020 Category: Transplant Surgery Source Type: research
Role of Whole Organ Pancreas Transplantation in the Day of Bioartificial and Artificial Pancreas
AbstractPurposeWhile exogenous insulin administration remains the cornerstone of management for type I diabetes mellitus (T1DM), patients now have a variety of options that include whole organ pancreas transplant, islet cell transplant, extracorporeal mechanical (bihormonal artificial pancreas), and implanted bioartificial (encapsulated islet) delivery systems. The purpose of this review is to compare these options and consider future developments.Recent ResultsUse of whole organ pancreas transplant has declined in the USA over the past several years. Pancreas transplant offers the most durable form of beta cell replacemen...
Source: Current Transplantation Reports - October 27, 2020 Category: Transplant Surgery Source Type: research
Pediatric Upper Extremity Vascularized Composite Allotransplantation —Progress and Future
This article summarizes the worldwide experience with transplantation of vascularized composite upper extremities in children and discusses the unique considerations facing potential pediatric VCA recipients.Recent FindingsThree children have successfully received composite upper or lower extremity transplants, of which two involved isografts and one involved allografts. Numerous research and clinical advances relevant to VCA have been made, including patient screening, perioperative rehabilitation, allograft preservation and transportation, enhancement of nerve regeneration, understanding of cortical plasticity, and immun...
Source: Current Transplantation Reports - October 27, 2020 Category: Transplant Surgery Source Type: research
Diagnostic Testing of COVID-19 in Solid Organ Transplantation: Current Clinical Application and Future Strategies
AbstractPurpose of ReviewWhile a great deal of literature has been published recently on the viral kinetics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and diagnostic testing performance for coronavirus disease 2019 (COVID-19) in the general population, a relative paucity of information has come to light regarding implications of COVID-19 diagnostics for solid organ transplantation. This review examines the current state of knowledge regarding the two principal diagnostic testing strategies for SARS-CoV-2 infection, polymerase chain reaction (PCR) –based testing and serology, and discusses C...
Source: Current Transplantation Reports - October 25, 2020 Category: Transplant Surgery Source Type: research
Pancreas vs. Islet Transplantation: the False Dilemma
AbstractPurpose of ReviewPancreas and islet cell transplantation are the only treatment modalities that can restore euglycemia and allow freedom from hypoglycemic events. Transplantation for diabetes has decreased in the USA over the last 6 years due to several factors. Reasons for this and possible future paths will be explored.Recent FindingsClinical application of islet transplantation is mostly limited by regulatory hurdles in the USA. The limitations of pancreas transplantation are multifactorial and more nuanced. Both types of transplants are limited by the number of suitable organ donors; however, pancreas and isl...
Source: Current Transplantation Reports - October 23, 2020 Category: Transplant Surgery Source Type: research
Immunomodulatory Therapies for COVID-19 in Solid Organ Transplant Recipients
AbstractPurpose of ReviewSevere coronavirus disease 2019 (COVID-19) is characterized by the development of a deleterious hyperinflammatory response, in which the pleiotropic cytokine interleukin (IL)-6 plays a pivotal role. The administration of immunomodulatory therapies has been proposed to revert the tissue damage induced by COVID-19-related cytokine release syndrome (CRS). The present review summarizes the biological rationale and available clinical experience with this therapeutic strategy in the specific scenario solid organ transplantation (SOT).Recent FindingsA number of case reports, case series, and non-controlle...
Source: Current Transplantation Reports - October 23, 2020 Category: Transplant Surgery Source Type: research
