Outcome of transplantation performed outside the regular working hours: a systematic review and meta-analysis of the literature
Transplant procedures are frequently performed outside the regular working hours (after hours). In general surgery, several studies observed worse outcomes for operations performed after hours. The predetermined hypothesis was that patients undergoing transplantation during after hours might suffer from an excess in post-operative mortality and morbidity when compared to patients undergoing transplantations during the regular working hours. A systematic review of the PubMed database identified 11,993 records, of which eleven cohort studies including a total of 287,741 patients investigated the association between the start...
Source: Transplantation Reviews - May 8, 2018 Category: Transplant Surgery Authors: Jore Hendrikx, Dirk Van Raemdonck, Jacques Pirenne, Steffen Fieuws, Steffen Rex Tags: Review article Source Type: research

The clinical impact of donor-specific antibodies in heart transplantation
Donor-specific antibodies (DSA) are integral to the development of antibody-mediated rejection (AMR). Chronic AMR is associated with high mortality and an increased risk for cardiac allograft vasculopathy (CAV). Anti-donor HLA antibodies are present in 3 –11% of patients at the time of heart transplantation (HTx), with de novo DSA (predominantly anti-HLA class II) developing post-transplant in 10–30% of patients. DSA are associated with lower graft and patient survival after HTx, with one study suggesting a three-fold increase in mortality in pa tients who develop de novo DSA. (Source: Transplantation Reviews)
Source: Transplantation Reviews - May 8, 2018 Category: Transplant Surgery Authors: Markus J. Barten, Uwe Schulz, Andres Beiras-Fernandez, Michael Berchtold-Herz, Udo Boeken, Jens Garbade, Stephan Hirt, Manfred Richter, Arjang Ruhpawar, Tim Sandhaus, Jan Dieter Schmitto, Felix Sch önrath, Rene Schramm, Martin Schweiger, Markus Wilhelm, Tags: Review article Source Type: research

A Review of the Use of Direct Oral Anticoagulant Use in Orthotopic Heart Transplantation Recipients
Over 60 years ago, the vitamin K antagonist (VKA) warfarin was approved and remained the only oral anticoagulation agent until recently [1]. Currently, within North America and Europe there are four DOACs available. Dabigatran, first approved in Europe and Canada in 2008, then in the United States of America in 2010, followed by rivaroxaban, apixaban, and most recently edoxaban. The introduction of direct oral anticoagulants (DOACs) has been a major advancement and these agents are the preferred to VKAs for many indications [2 –5], including stroke prevention in nonvalvular atrial fibrillation (NVAF), acute treatment...
Source: Transplantation Reviews - April 16, 2018 Category: Transplant Surgery Authors: Rosaleen Boswell, Glen J. Pearson Tags: Review article Source Type: research

Challenges of immunosuppressive and antitrypanosomal drug therapy after heart transplantation in patients with chronic Chagas disease: A systematic review of clinical recommendations
Although contraindicated for decades, heart transplantation (HT) has finally become a feasible therapeutic option for the treatment of Chagasic patients with end-stage heart failure. Part of the success in achieving acceptable survival rates after HT is due to the enhancement of the pharmacological management of allograft rejection and reactivation of Trypanosoma cruzi infection. (Source: Transplantation Reviews)
Source: Transplantation Reviews - April 16, 2018 Category: Transplant Surgery Authors: Silas Santana Nogueira, Amanda Aparecida Felizardo, Ivo Santana Caldas, Reggiani Vilela Gon çalves, Rômulo Dias Novaes Tags: Review article Source Type: research

A Review of the Use of Direct Oral Anticoagulant Use in Orthotopic Heart Transplantation Recipients
Over 60 years ago, the vitamin K antagonist (VKA) warfarin was approved and remained the only oral anticoagulation agent until recently [1]. Currently, within North America and Europe there are four DOACs available. Dabigatran, first approved in Europe and Canada in 2008, then in the United States of America in 2010, followed by rivaroxaban, apixaban, and most recently edoxaban. The introduction of direct oral anticoagulants (DOACs) has been a major advancement and these agents are the preferred to VKAs for many indications [2 –5], including stroke prevention in nonvalvular atrial fibrillation (NVAF), acute treatment...
Source: Transplantation Reviews - April 16, 2018 Category: Transplant Surgery Authors: Rosaleen Boswell, Glen J. Pearson Tags: Review article Source Type: research

Challenges of immunosuppressive and antitrypanosomal drug therapy after heart transplantation in patients with chronic Chagas disease: A systematic review of clinical recommendations
Although contraindicated for decades, heart transplantation (HT) has finally become a feasible therapeutic option for the treatment of Chagasic patients with end-stage heart failure. Part of the success in achieving acceptable survival rates after HT is due to the enhancement of the pharmacological management of allograft rejection and reactivation of Trypanosoma cruzi infection. (Source: Transplantation Reviews)
Source: Transplantation Reviews - April 16, 2018 Category: Transplant Surgery Authors: Silas Santana Nogueira, Amanda Aparecida Felizardo, Ivo Santana Caldas, Reggiani Vilela Gon çalves, Rômulo Dias Novaes Tags: Review article Source Type: research

Identifying risk profiles in liver transplant candidates and implications for induction immunosuppression
Changes in recipient and donor characteristics are redefining the role of induction in liver transplant recipients. Older recipients are more common, with greater concomitant comorbidity. Moderate or severe renal dysfunction is now estimated to affect 40% of liver transplant recipients. Donors are also becoming older, and other factors such as more frequent non-alcoholic fatty liver disease (NAFLD) compromise the quality of some grafts. Rejection rates are now relatively low (~10%) but some patients have a markedly increased risk such as younger recipients and those undergoing re-transplantation. (Source: Transplantation Reviews)
Source: Transplantation Reviews - April 13, 2018 Category: Transplant Surgery Authors: Umberto Cillo, Wolf O. Bechstein, Gabriela Berlakovich, Philipp Dutkowski, Frank Lehner, Silvio Nadalin, Faouzi Saliba, Hans J. Schlitt, Johann Pratschke Tags: Review article Source Type: research

Ex situ liver perfusion: Organ preservation into the future
In recent years, remarkable progress has occurred in the development of technologies to support ex situ liver perfusion. Building upon extensive preclinical studies in large animal models, pilot and randomized clinical trials have been initiated, and preliminary outcomes suggest more optimal protection of both standard and extended criteria liver grafts. There currently exists an incredible opportunity and need to further refine this technology, determine appropriate viability measures to predict usable liver grafts, and to explore potent protective additive strategies to further optimize the quality of extended criteria o...
Source: Transplantation Reviews - April 4, 2018 Category: Transplant Surgery Authors: Mariusz Bral, Boris Gala-Lopez, David L. Bigam, Darren H. Freed, A.M. James Shapiro Tags: Review article Source Type: research

Ex Situ Liver Perfusion: Organ Preservation Into the Future
In recent years, remarkable progress has occurred in the development of technologies to support ex situ liver perfusion. Building upon extensive preclinical studies in large animal models, pilot and randomized clinical trials have been initiated, and preliminary outcomes suggest more optimal protection of both standard and extended criteria liver grafts. There currently exists an incredible opportunity and need to further refine this technology, determine appropriate viability measures to predict usable liver grafts, and to explore potent protective additive strategies to further optimize the quality of extended criteria o...
Source: Transplantation Reviews - April 4, 2018 Category: Transplant Surgery Authors: Mariusz Bral, Boris Gala-Lopez, David L. Bigam, Darren H. Freed, A.M. James Shapiro Tags: Review article Source Type: research

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Review: Management of patients with kidney allograft failure
Late allograft loss in kidney transplant recipients remains a common problem and is associated with high mortality and morbidity. The management of patients with a failed kidney allograft includes a few major dilemmas: when to start dialysis, what is the optimal management regarding immunosuppression, and should an allograft nephrectomy be performed. In suitable candidates for a repeated transplantation there are additional matters to take in consideration. In this review we will discuss these dilemmas by providing an overview of current evidence and gaps in our knowledge. (Source: Transplantation Reviews)
Source: Transplantation Reviews - March 29, 2018 Category: Transplant Surgery Authors: Kim L.W. Bunthof, Marc Hazzan, Luuk B. Hilbrands Tags: Review article Source Type: research

Preserving and perfusing the allograft pancreas: Past, present, and future
The concept of organ preservation by perfusion dates back to the mid-19th century. Innovations since then have included temperature regulation, perfusion fluid composition and various pumping systems. Advances made in liver, heart and kidney machine preservation are now contributing to increased graft utilisation, assessment of graft viability and potentially improved graft survival. Pancreas transplantation has not benefitted to the same extent from the application of perfusion technology, although the need is just as great. (Source: Transplantation Reviews)
Source: Transplantation Reviews - March 6, 2018 Category: Transplant Surgery Authors: Shamik Dholakia, Elisabeth Royston, Edward J. Sharples, Visesh Sankaran, Rutger J. Ploeg, Peter J. Friend Tags: Review article Source Type: research

Preserving and Perfusing the Allograft Pancreas: Past, Present, and Future
The concept of organ preservation by perfusion dates back to the mid-19th century. Innovations since then have included temperature regulation, perfusion fluid composition and various pumping systems. Advances made in liver, heart and kidney machine preservation are now contributing to increased graft utilisation, assessment of graft viability and potentially improved graft survival. Pancreas transplantation has not benefitted to the same extent from the application of perfusion technology, although the need is just as great. (Source: Transplantation Reviews)
Source: Transplantation Reviews - March 6, 2018 Category: Transplant Surgery Authors: Shamik Dholakia, Elisabeth Royston, Edward J. Sharples, Visesh Sankaran, Rutger J. Ploeg, Peter J. Friend Tags: Review article Source Type: research

Innate networking: Thrombotic microangiopathy, the activation of coagulation and complement in the sensitized kidney transplant recipient
Thrombotic microangiopathy (TMA) is a histological feature of antibody-mediated rejection and has the potential to cause problematic graft dysfunction, particularly for highly sensitized cross-match positive kidney transplant recipients. Prompt recognition of pertinent histopathological and systemic features of TMA in kidney transplantation is necessary. Underlying mechanisms of this process involve the activation of both complement and coagulation systems as a response to HLA antibody. As serine proteases, coagulation and complement cascades exhibit similar characteristics with respect to homeostatic function. (Source: Tr...
Source: Transplantation Reviews - February 10, 2018 Category: Transplant Surgery Authors: Miriam Manook, Jean Kwun, Steven Sacks, Anthony Dorling, Nizam Mamode, Stuart Knechtle Tags: Review article Source Type: research

Renal scintigraphy for post-transplant monitoring after kidney transplantation
Clinicians use several diagnostic modalities to recognize post-transplant complications, such as acute tubular necrosis, acute rejection, urologic and vascular complications. Currently, there is no consensus about the best procedural approach to evaluate post-transplant renal dysfunction. Renal needle-biopsy is often required, however, this is invasive and may lead to sample errors and complications, and most clinicians prefer using one of the noninvasive diagnostic modalities. (Source: Transplantation Reviews)
Source: Transplantation Reviews - December 28, 2017 Category: Transplant Surgery Authors: S. Benjamens, S.P. Berger, A.W.J.M. Glaudemans, J.S.F. Sanders, R.A. Pol, R.H.J.A. Slart Source Type: research

Renal Scintigraphy for Post-Transplant Monitoring after Kidney Transplantation
Clinicians use several diagnostic modalities to recognize post-transplant complications, such as acute tubular necrosis, acute rejection, urologic and vascular complications. Currently, there is no consensus about the best procedural approach to evaluate post-transplant renal dysfunction. Renal needle-biopsy is often required, however, this is invasive and may lead to sample errors and complications, and most clinicians prefer using one of the noninvasive diagnostic modalities. (Source: Transplantation Reviews)
Source: Transplantation Reviews - December 28, 2017 Category: Transplant Surgery Authors: S. Benjamens, S.P. Berger, A.W.J.M. Glaudemans, J.S.F. Sanders, R.A. Pol, R.H.J.A. Slart Tags: Review article Source Type: research

Circulating and urinary microRNAs as possible biomarkers in kidney transplantation
The invasive needle biopsy is currently the only established technique to distinguish between different types of kidney allograft damage and there is an urgent need for the development of reliable non-invasive methods for the timely recognition of upcoming rejection episodes. microRNAs (miRNAs) belong to a class of small non-coding RNAs that modulate physiological and pathological processes by regulating gene expression via post-transcriptional inhibition of target messenger RNAs (mRNAs). Recently, miRNAs were detected in remarkably stable forms in human body fluids and found to be involved in pathological processes that o...
Source: Transplantation Reviews - December 19, 2017 Category: Transplant Surgery Authors: No émi Janszky, Caner Süsal Source Type: research

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Clinical impact of culture-positive preservation fluid on solid organ transplantation: A systematic review and meta-analysis
Contamination of the preservation fluid (PF) used for donated organs is a potential source of post-transplant infection. However, the information on this issue is scarce. We therefore conducted a systematic review and meta-analysis to assess the incidence of culture-positive PF and its impact on solid organ transplant (SOT) recipients. Seventeen studies were identified and included. The overall incidence of culture-positive PF was 37% (95% CI: 27% to 49%), and the incidence of PF-related infections among SOT recipients with PF cultures that grew pathogenic microorganisms was 10% (95% CI: 7% to 15%). (Source: Transplantation Reviews)
Source: Transplantation Reviews - December 5, 2017 Category: Transplant Surgery Authors: Isabel Oriol, N. Sab é, C. Tebé, M. Veroux, I.F.S.F. Boin, J. Carratalà Source Type: research

Clinical Impact of Culture-positive Preservation Fluid on Solid Organ Transplantation: A Systematic Review and Meta-analysis
Contamination of the preservation fluid (PF) used for donated organs is a potential source of post-transplant infection. However, the information on this issue is scarce. We therefore conducted a systematic review and meta-analysis to assess the incidence of culture-positive PF and its impact on solid organ transplant (SOT) recipients. Seventeen studies were identified and included. The overall incidence of culture-positive PF was 37% (95% CI: 27% to 49%), and the incidence of PF-related infections among SOT recipients with PF cultures that grew pathogenic microorganisms was 10% (95% CI: 7% to 15%). (Source: Transplantation Reviews)
Source: Transplantation Reviews - December 5, 2017 Category: Transplant Surgery Authors: Isabel Oriol, N. Sab é, C. Tebé, M. Veroux, I.F.S.F. Boin, J. Carratalà Tags: Review article Source Type: research

The evidence and rationale for the perioperative use of loop diuretics during kidney transplantation: A comprehensive review
Loop diuretics (LD) attenuate ischemic injury in nephrons. They are thought to decrease delayed graft function (DGF) during kidney transplantation (KT). This review aimed to summarize the current evidence for the perioperative use of LD during KT. (Source: Transplantation Reviews)
Source: Transplantation Reviews - November 23, 2017 Category: Transplant Surgery Authors: Shaifali Sandal, Pannya Bansal, Marcelo Cantarovich Source Type: research

The evidence and rationale for the perioperative use of loop diuretics during kidney transplantation: a comprehensive review
Loop diuretics (LD) attenuate ischemic injury in nephrons. They are thought to decrease delayed graft function (DGF) during kidney transplantation (KT). This review aimed to summarize the current evidence for the perioperative use of LD during KT. (Source: Transplantation Reviews)
Source: Transplantation Reviews - November 23, 2017 Category: Transplant Surgery Authors: Shaifali Sandal, Pannya Bansal, Marcelo Cantarovich Tags: Review article Source Type: research

Is carotid revascularization worthwhile in patients waiting for kidney transplantation?
Renal failure and haemodialysis are associated with an increased risk of cardiovascular disease. Patients undergoing renal transplantation undergo rigorous pre-operative vascular assessment, including optimisation of risk factors for stroke. The indication for carotid intervention and the threshold for carotid endarterectomy in asymptomatic patients with incidental carotid disease has not been clarified in the context chronic kidney disease (CKD). This review aims to analyse outcomes following carotid endarterectomy in patients with CKD, in order to ascertain whether general guidelines for carotid artery revascularisation ...
Source: Transplantation Reviews - November 15, 2017 Category: Transplant Surgery Authors: Peter Balaz, Petrut Gogalniceanu, Chris Callaghan Source Type: research

Cancer Evaluation in the Assessment of Solid Organ Transplant Candidates: A Systematic Review of Clinical Practice Guidelines
Active malignancies are a contraindication to transplantation, as immunosuppression can lead to worse cancer outcomes; therefore, ensuring transplant candidates are free of malignancy before transplantation is essential. This systematic review assesses the availability, quality, and consistency of recommended cancer evaluation prior to transplantation in Clinical Practice Guidelines (CPGs) for the selection of solid organ transplant candidates. (Source: Transplantation Reviews)
Source: Transplantation Reviews - November 7, 2017 Category: Transplant Surgery Authors: Sergio A. Acuna, Winnie Lam, Corinne Daly, S. Joseph Kim, Nancy N. Baxter Tags: Review article Source Type: research

De Novo Thrombotic Microangiopathy after Kidney Transplantation
Thrombotic microangiopathy (TMA) is a serious complication of transplantation that adversely affects kidney transplant recipient and allograft survival. Post-transplant TMA is usually classified into two categories: 1) recurrent TMA and 2) de novo TMA. Atypical hemolytic uremic syndrome (aHUS) resulting from dysregulation and over-activation of the alternate complement pathway is a rare disease but the most common diagnosis associated with recurrence in the allografts. De novo TMA, on the other hand, represents an overwhelming majority of the cases of post-transplant TMA and is a substantially more heterogeneous entity tha...
Source: Transplantation Reviews - November 4, 2017 Category: Transplant Surgery Authors: Neetika Garg, Helmut G. Rennke, Martha Pavlakis, Kambiz Zandi-Nejad Tags: Review article Source Type: research

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Primary care interventions to encourage organ donation registration: a systematic review
Previous research has proposed that primary care interventions to increase organ donation rates can help address the discrepancy between organ donation rates and the number of patients awaiting transplant. However, no systematic review has been conducted to examine interventions in this setting. (Source: Transplantation Reviews)
Source: Transplantation Reviews - September 2, 2017 Category: Transplant Surgery Authors: Catrin Pedder Jones, Chris Papadopoulos, Gurch Randhawa Tags: Review article Source Type: research

The Epigenetic Promise to Improve Prognosis of Heart Failure and Heart Transplantation
Heart transplantation (HT) remains the gold standard treatment for end-stage heart failure (HF) ensuring the highest long-term survival; however, due to the shortage of organ donors, the left ventricular assist device (LVAD) provides a backup strategy for patients as bridge to transplantation or when clinical contraindications are present [1,2]. HF represents the end-stage of several cardiac pathological conditions including atherosclerosis, coronary heart disease (CHD) and dilated, hypertrophic and restrictive cardiomyopathies [3-5]. (Source: Transplantation Reviews)
Source: Transplantation Reviews - August 15, 2017 Category: Transplant Surgery Authors: Chiara Sabia, Antonietta Picascia, Vincenzo Grimaldi, Cristiano Amarelli, Ciro Maiello, Claudio Napoli Tags: Review article Source Type: research

Defining the Phenotype of Antibody-Mediated Rejection in Kidney Transplantation: Advances in Diagnosis of Antibody Injury
The diagnostic criteria for antibody-mediated rejection (ABMR) are constantly evolving in light of the evidence. Inclusion of C4d-negative ABMR has been one of the major advances in the Banff Classification in recent years. Currently Banff 2015 classification requires evidence of donor specific antibodies (DSA), interaction between DSA and the endothelium, and acute tissue injury (in the form of microvasculature injury (MVI); acute thrombotic microangiopathy; or acute tubular injury in the absence of other apparent cause). (Source: Transplantation Reviews)
Source: Transplantation Reviews - August 14, 2017 Category: Transplant Surgery Authors: Neetika Garg, Milagros D. Samaniego, Dana Clark, Arjang Djamali Tags: Review article Source Type: research

Osteoporosis following heart transplantation and immunosuppressive therapy
Heart transplantation (HT) remains the ultimate final therapy for patients with end-stage heart failure, who despite optimal medical and surgical treatments exhibit severe symptoms. To prevent rejection of the transplanted organ, HT patients require life-long immunosuppressive therapy. The goal of the immunosuppression is to minimise the risk of immune-mediated graft rejection, while avoiding clinical side-effects. Current immunosuppressive agents have yielded good survival outcome, however, complications of the immunosuppressive therapy, such as impaired bone strength and increased fracture risk, are common among HT patie...
Source: Transplantation Reviews - August 12, 2017 Category: Transplant Surgery Authors: Eveline L öfdahl, Göran Rådegran Tags: Review article Source Type: research

Cancer Recurrence after Solid Organ Transplantation: A Systematic Review and Meta-analysis
Solid organ transplant recipients (SOTR) with a pre-transplant malignancy (PTM) have been thought to be at high risk of cancer recurrence. However, recent population-based studies report cancer recurrence rates in SOTR similar to those of non-transplant patients. (Source: Transplantation Reviews)
Source: Transplantation Reviews - August 9, 2017 Category: Transplant Surgery Authors: Sergio A. Acuna, Johnny W. Huang, Fahima Dossa, Prakesh S. Shah, S. Joseph Kim, Nancy N. Baxter Tags: Review article Source Type: research

Significance of Steatosis in Pancreatic Transplantation
The on-going success of whole organ pancreatic transplantation is dependent on overcoming the imbalance between demand and supply of optimal organs as well as tackling the vast comorbidity associated with the procedure. Pancreas steatosis is a common contributing factor to the problem and with obesity pandemics affecting the global population; the size and type of organs received from donors will only make steatosis more of an issue.The aim of this review is to highlight what is known about steatosis in the context of pancreas transplantation identifying potential methods to help its evaluation. (Source: Transplantation Reviews)
Source: Transplantation Reviews - August 9, 2017 Category: Transplant Surgery Authors: S. Dholakia, E.J. Sharples, R.J. Ploeg, P.J. Friend Tags: Review article Source Type: research

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations
Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate ´s phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to ...
Source: Transplantation Reviews - July 26, 2017 Category: Transplant Surgery Authors: J.M. Aguado, J.T. Silva, M. Fern ández-Ruiz, E. Cordero, J. Fortún, C. Gudiol, L. Martínez-Martínez, E. Vidal, L. Almenar, B. Almirante, R. Cantón, J. Carratalá, J.J. Caston, E. Cercenado, C. Cervera, J.M. Cisneros, M.G. Crespo-Leiro, V. Cuervas-Mon Tags: Review article Source Type: research

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