Kidney Transplantation for HIV-positive Patients
HIV+ patients are at increased risk for end-stage renal disease, but HIV infection was once considered a contraindication to renal transplantation. However, contemporary studies from the United States and Europe have now demonstrated that renal transplantation is a safe and effective treatment for end-stage renal disease in HIV patients, with equivalent patient and allograft survival to those uninfected. Broader experience in transplantation in HIV+ patients has identified unique challenges including high rates of acute rejection, delayed graft function, and significant drug –drug interactions. (Source: Transplantation Reviews)
Source: Transplantation Reviews - October 10, 2016 Category: Transplant Surgery Authors: Deirdre Sawinski Source Type: research
Chronic Allograft Injury: Mechanisms and Potential Treatment Targets
Improving long-term graft survival remains one of the critical challenges facing kidney transplantation since a great portion of kidney grafts are lost by 10years after transplantation. Understanding the causes of chronic allograft injury and providing timely therapeutic interventions are essential for improving these outcomes. In this review, we will discuss the recent data that emerged turning down calcineurin inhibitors as the primary cause of long-term graft injury and highlighting the increased importance of non-compliance, antibody-mediated injury, disease recurrence, and BK nephropathy as culprits. (Source: Transplantation Reviews)
Source: Transplantation Reviews - October 8, 2016 Category: Transplant Surgery Authors: Leonardo V. Riella, Arjang Djamali, Julio Pascual Source Type: research
Immunosuppression for Kidney Transplantation: Where are we now and where are we going?
Advances in immunosuppression have propelled kidney transplantation from a scientific curiosity to the optimal treatment for patients with end stage kidney disease. Declining rates of acute rejection have led to improvements in shorter-term kidney transplant survival, culminating in incrementally better longer-term patient and allograft outcomes. Contextualized around established immune-suppressing drug targets, this review summarizes the history of the clinical science, and highlights the pivotal trials that have led to present-day treatment standards at the level of both individual agents as well as multidrug regimens fo...
Source: Transplantation Reviews - October 8, 2016 Category: Transplant Surgery Authors: Mary Ann Lim, Jatinder Kohli, Roy D Bloom Source Type: research
A critical assessment on kidney allocation systems
The kidney allocation system that took effect on December 4, 2014 represents a significant improvement over the prior approach. It seeks to improve outcomes by longevity matching - pairing kidneys expected to function the longest with recipients expected to live the longest. It addresses the biological barriers faced by highly sensitized patients in an evidence based fashion and it begins to introduce the concept of medical need into kidney allocation by crediting time from the starting dialysis to a patient's waiting time. (Source: Transplantation Reviews)
Source: Transplantation Reviews - October 7, 2016 Category: Transplant Surgery Authors: Richard N. Formica Source Type: research
Acute Antibody-Mediated Rejection in Kidney Transplant Recipients
Antibody-mediated rejection has now been recognized as one of the most important causes of graft loss. Transplantation across HLA barriers and non-adherence can result in acute antibody-mediated rejection, which is associated with particularly worse graft outcomes. New technologies, including genomic studies and assays to detect and define donor-specific antibodies, have provided important insights into the pathophysiology and diagnosis of acute antibody-mediated rejection but have engendered many questions about the clinical application of these tests in the prognosis and prevention of this protean disease process. (Sourc...
Source: Transplantation Reviews - October 7, 2016 Category: Transplant Surgery Authors: Scott Davis, James E. Cooper Source Type: research
Sensitization assessment before kidney transplantation
Kidney transplantation is the treatment of choice for patients with end stage renal disease to optimize survival, freedom from morbidity and quality of life. A fundamental aspect of the pre-transplant assessment is a thorough understanding of their immunological history and prior exposures, so that the immunological risk from a given donor can be estimated, if not quantified, in order to guide interventions to optimize transplant access and success. The methodologies available to complete this assessment have evolved rapidly, with flow cytometric based analyses now standard in many laboratories, availability of comprehensi...
Source: Transplantation Reviews - October 7, 2016 Category: Transplant Surgery Authors: Ben C Reynolds, Kathryn Tinckam Tags: Invited review article: transplantation reviews Source Type: research
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Source: Transplantation Reviews - September 16, 2016 Category: Transplant Surgery Source Type: research
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Source: Transplantation Reviews - September 16, 2016 Category: Transplant Surgery Source Type: research
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Source: Transplantation Reviews - September 16, 2016 Category: Transplant Surgery Source Type: research
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Source: Transplantation Reviews - September 16, 2016 Category: Transplant Surgery Source Type: research
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Source: Transplantation Reviews - September 16, 2016 Category: Transplant Surgery Source Type: research
Liver transplantation in transthyretin amyloidosis: characteristics and management related to kidney disease
Orthotopic liver transplantation (LT) was implemented as the inaugural disease-modifying therapy for hereditary transthyretin (ATTR) amyloidosis, a systemic amyloidosis mainly affecting the peripheral nervous system and heart. The first approach to pharmacologic therapy was focused on the stabilization of the TTR tetramer; following that new advent LT was assumed as the second step of treatment, for those patients whose neuropathy becomes worse after a course of pharmacologic therapy.The renal disease has been ignored in hereditary ATTR amyloidosis. (Source: Transplantation Reviews)
Source: Transplantation Reviews - September 13, 2016 Category: Transplant Surgery Authors: Ana Rocha, Lu ísa Lobato Source Type: research
Drug –drug interactions between immunosuppressants and antidiabetic drugs in the treatment of post-transplant diabetes mellitus
Post-transplant diabetes mellitus is a frequent complication of solid organ transplantation that generally requires treatment with lifestyle interventions and antidiabetic medication. A number of demonstrated and potential pharmacokinetic drug –drug interactions (DDIs) exist between commonly used immunosuppressants and antidiabetic drugs, which are comprehensively summarized in this review. Cyclosporine (CsA) itself inhibits the cytochrome P450 (CYP) 3A4 enzyme and a variety of drug transporters. (Source: Transplantation Reviews)
Source: Transplantation Reviews - September 13, 2016 Category: Transplant Surgery Authors: Thomas Vanhove, Quinten Remijsen, Dirk Kuypers, Pieter Gillard Source Type: research
Hematopoietic Stem Cells and Solid Organ Transplantation
Solid organ transplantation provides life saving therapy for patients with end stage organ disease. In order that the transplanted organ survive, the recipient must take a lifelong cocktail of immunosuppressive medications that increase the risk for infections, malignancies and drug toxicities. Data from many animal studies have shown that recipients can be made tolerant of their transplanted organ by infusing stem cells, particularly hematopoietic stem cells, prior to the transplant. The animal data have been translated into humans and now several clinical trials have demonstrated that infusion of hematopoietic stem cells...
Source: Transplantation Reviews - August 2, 2016 Category: Transplant Surgery Authors: Reza Elahimehr, Andrew T. Scheinok, Dianne B. McKay Source Type: research
From chronic kidney disease to kidney transplantation: the impact of obesity and its treatment modalities
Obesity is associated with worse short-term outcomes after kidney transplantation but the effect on long-term outcomes is unknown. Although some studies have reported worse outcomes for obese recipients when compared to recipients with a BMI in the normal range, obese recipients who receive a transplant have better outcomes than those who remain wait-listed. Whether transplant candidates should be advised to lose weight before or after transplant has been debated and this is mainly due to the gap in the literature linking pre-transplant weight loss with better outcomes post-transplantation. (Source: Transplantation Reviews)
Source: Transplantation Reviews - July 28, 2016 Category: Transplant Surgery Authors: Brian Camilleri, Julie M. Bridson, Ajay Sharma, Ahmed Halawa Source Type: research
