The Author’s Reply: Improving Functional Status Reporting may Save Patient Lives and Reduce Kidney Discard
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Letters to the Editor Source Type: research

Response to Bui et al, “Patient Functional Status at Transplant and Its Impact on Posttransplant Survival of Adult Deceased–donor Kidney Recipients”
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Letters to the Editor Source Type: research

Re: Distinguishing Between Sex and Gender Is Critical for Research in Transplantation
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Letters to the Editor Source Type: research

Distinguishing Between Sex and Gender Is Critical for Research in Transplantation
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Letters to the Editor Source Type: research

A Nationwide Survey of Hepatitis E Virus Infection and Chronic Hepatitis in Heart and Kidney Transplant Recipients in Japan
Conclusions. This is the first nationwide survey of HEV infection in Japanese heart and kidney transplant recipients. The prevalence of anti-HEV IgG and HEV RNA in heart and kidney transplant recipients in Japan was lower than that in European countries. Of note, 42% of viremic transplant patients developed chronic hepatitis. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Comparison of Tacrolimus and Cyclosporine Combined With Methotrexate for Graft Versus Host Disease Prophylaxis After Allogeneic Hematopoietic Cell Transplantation
Background. After patients receive hematopoietic stem cell transplantation (HSCT), both cyclosporine (CsA) and tacrolimus (TAC) in combination with methotrexate (MTX) are recommended as the standard prophylaxis strategy for graft versus host disease (GVHD) by the European Group of Blood and Marrow Transplantation. However, the advantage of TAC combined with MTX lacks conclusive evidence. Methods. We searched online databases for studies comparing CsA + MTX and TAC + MTX in patients who received HSCT. The odds ratio (OR) and 95% confidence interval (CI) were applied to compare the pooled data. Results. We found a si...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Geographic Differences in Population Health and Expected Organ Supply in the Gulf Coast Region of the United States Compared to Non-Gulf States
Conclusions. Although Gulf State DSAs have lower expected donation rates, these differences appear to be driven by the prevalence of health factors negatively associated with donation rate. These data suggest the need to discuss population health characteristics when examining kidney allocation policy, to account for potential lower supply of donors and to further address geographic disparities in access to kidney transplantation. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Amyloidosis Diagnosed in Solid Organ Transplant Recipients
Conclusions. This series is the first description of amyloidosis post solid-organ transplant; 30 cases among 5112 amyloid patients>24 years suggests that amyloidosis may occur post solid-organ transplantation with an overall poor survival. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Letermovir for Difficult to Treat Cytomegalovirus Infection in Lung Transplant Recipients
Conclusions. CMV-infection and -disease were successfully managed with letermovir. Letermovir was well tolerated and effective in treating CMV-infections in lung transplant recipients failing on currently available antiviral agents. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Letermovir as Salvage Therapy for Cytomegalovirus Infection in Transplant Recipients
Background. Letermovir, a new viral terminase complex inhibitor, has been approved for the prevention of cytomegalovirus (CMV) infection in hematopoietic stem cell transplant patients. However, data on the efficacy and safety of letermovir for the treatment of CMV infection in transplant recipients remain scarce. Methods. We performed a single-center retrospective study of stem cell and organ transplant recipients who received letermovir for the treatment of CMV infection from November 2017 to October 2018. Results. Six patients were included, and 5 were evaluable. All received letermovir in the context of a refrac...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Impact of Induction Immunosuppression Strategies in Simultaneous Liver/Kidney Transplantation
Background. There is scant data on the use of induction immunosuppression for simultaneous liver/kidney transplantation (SLKT). Methods. We analyzed the Organ Procurement and Transplant Network registry from 1996 to 2016 to compare outcomes of SLKT, based on induction immunosuppression. Results. Of 5172 patients, 941 (18%) received T-cell depletion induction, 1635 (32%) received interleukin 2 receptor antagonist (IL2-RA), and 2596 (50%) received no induction (NI). At 5 years, patient survivals were 68% in the T-cell group, 74% in the IL2-RA group, and 71% in the NI group (P = 0.0006). Five-year liver and kidney all...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Defining a Willingness-to-transplant Threshold in an Era of Organ Scarcity: Simultaneous Liver–kidney Transplant as a Case Example
Conclusions. We submit that this new framework enables us to distill the question of SLK allocation down to: what is the minimum amount of benefit we require from a deceased donor kidney to allocate it for a particular indication? Addressing the above question will prove helpful to devising a rational system of SLK allocation and is applicable to other transplant settings. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

A 3-month, Multicenter, Randomized, Open-label Study to Evaluate the Impact on Wound Healing of the Early (vs Delayed) Introduction of Everolimus in De Novo Kidney Transplant Recipients, With a Follow-up Evaluation at 12 Months After Transplant (NEVERWOUND Study)
Conclusions. The early introduction of EVR after KT did not increase the risk of WHC, showing good efficacy and safety profile. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Physical Impairment and Access to Kidney Transplantation
Background. The short physical performance battery (SPPB) test is an objective measurement of lower extremity function (walk speed, balance, chair stands). SPPB impairment is associated with longer length of stay and increased mortality in kidney transplant (KT) recipients. Furthermore, the SPPB test may represent an objective quantification of the “foot of the bed test” utilized by clinicians; therefore, impairment may translate with decreased access to KT. Methods. We studied 3255 participants (2009–2018) at 2 KT centers. SPPB impairment was defined as a score of ≤10. We estimated time to listin...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Executive Functioning in Pediatric Solid Organ Transplant Recipients: A Meta-analytic Review
Conclusions. Pediatric solid organ transplant recipients demonstrate worse overall EF skills and deficits in working memory, processing speed, attentional control, and metacognitive skills. Many children who have undergone solid organ transplantation will require additional support in medical and academic settings because of deficits in various EF domains. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Perceptions and Practices Regarding Frailty in Kidney Transplantation: Results of a National Survey
Conclusions. Among US KT programs, frailty is recognized as a clinically relevant construct and is commonly measured at evaluation. However, there is considerable heterogeneity in the tools used to measure frailty. Efforts to identify optimal measurement of frailty using either an existing or a novel tool and subsequent standardization of its measurement and application across KT programs should be considered. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Organ Procurement Organization Run Department of Motor Vehicle Registration and Drivers Licensing Offices Leads to Increased Organ Donor First Person Authorization Registrations
Background. More people who have personally consented to organ donation via first person authorization (FPA) registration before death become organ donors than those not personally consenting. The majority of registrations occur at state-specific department of motor vehicle (DMV) and licensing offices, where people register their vehicles and obtain driver's licenses. Methods. One organ procurement organization (OPO) ran 3 DMV offices and implemented an intervention: a donor-centric approach, including employee education, office decoration with donation materials, and customer experience improvements. Data about regis...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Education Strategies in Dialysis Centers Associated With Increased Transplant Wait-listing Rates
Conclusions. Educators should prioritize transplant education strategies shown to be associated with increasing wait-listing rates. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Development and Preliminary Evaluation of IRD-1-2-3: An Animated Video to Inform Transplant Candidates About Increased Risk Donor Kidneys
Background. Current educational interventions about increased risk donors (IRDs) are less effective in improving knowledge among African American (AA) kidney transplant candidates compared to other races. We aimed to develop an IRD educational animated video culturally responsive to AAs and conduct feasibility testing. Methods. Between May 1, 2018, and June 25, 2018, we iteratively refined a culturally targeted video for AAs with input from multiple stakeholders. We then conducted a one group pre-post study between June 28, 2018, and October 29, 2018, with 40 kidney transplant candidates to assess the feasibility and ...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Incidence, Predictors, and Impact on Survival of Long-term Cardiovascular Events After Liver Transplantation
Conclusions: Age, male gender, cardiovascular disease before LT, and cyclosporine A were associated with the risk of long-term CVE. The impact of serum creatinine was restricted to patients with pre-LT cardiovascular disease. In these patients, preservation of kidney function early after LT may lessen the incidence of CVE, which are an independent predictor of post-LT death. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—Liver Source Type: research

Safe Use of Right Lobe Live Donor Livers With up to 20% Macrovesicular Steatosis Without Compromising Donor Safety and Recipient Outcome
Background. The principle in right lobe living donor liver transplantation is to use “near-perfect” grafts to maximize recipient benefit with minimal donor risk. Whether and what degree of graft macrovesicular steatosis is safe for both recipient and donor is debatable. Methods. We compared donor and recipient outcomes in 623 primary right lobe living donor liver transplantations, using grafts with (Group A; 10%–20% steatosis, n = 92) and without (Group B; 3b), hospital stay were similar in both groups. Recipients in both groups had similar age, model for end-stage liver disease score. Right lobe gra...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—Liver Source Type: research

New Evidence Supporting Increased Use of Split Liver Transplantation
Background. Young children and small-statured candidates are dying on liver candidate waitlists. The Organ Procurement and Transplantation Network and United Network for Organ Sharing have proposed a split liver (SL) variance encouraging transplant programs to split more livers to aid these smaller statured candidates. Methods. We evaluated the US experience of splitting donor livers during 2002–2016. The results of our analysis provide new evidence to support this variance. Results. During 2002–2016, SL grafts from 935 donors were transplanted into 1870 recipients. Controlling for recipient factors and...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—Liver Source Type: research

Gender Disparities in Patients With Alcoholic Liver Disease Evaluated for Liver Transplantation
Background. The morbidity and mortality from alcohol-related liver disease (ALD) is increasing in the United States. However, little is known about gender differences in evaluation and listing for liver transplantation (LT) in patients with ALD. Methods. This is a retrospective review of adult patients with ALD evaluated for LT at a single transplant center from January 1, 2010, to March 1, 2017. Univariate, multivariate, and time-series analyses were performed. Results. Among the 949 patients with ALD evaluated, mean age was 53 years, 84% were Caucasian, and 33% were women. The median model for end-stage liver dis...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—Liver Source Type: research

Living Donor Liver Transplant for Alcoholic Liver Disease: Data from the Adult-to-adult Living Donor Liver Transplantation Study
Conclusions. LDLT for ALD results in excellent 1-, 5-, and 10-year graft and patient survival. Patients with ALD and impaired renal function have a higher risk of graft loss and death. These findings support the notion that early LDLT for patients with ALD may help optimize outcomes. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—Liver Source Type: research

Do Social Determinants Define “Too Sick” to Transplant in Patients With End-stage Liver Disease?
Background. Delisting for being “too sick” to be transplanted is subjective. Previous work has demonstrated that the mortality of patients delisted for “too sick” is unexpectedly low. Transplant centers use their best clinical judgment for determining “too sick,” but it is unclear how social determinants influence decisions to delist for “too sick.” We hypothesized that social determinants and Donor Service Area (DSA) characteristics may be associated with determination of “too sick” to transplant. Methods. Data were obtained from the Scientific Registry of T...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Clinical Science—Liver Source Type: research

Impact of CMV Reactivation, Treatment Approaches, and Immune Reconstitution in a Nonmyeloablative Tolerance Induction Protocol in Cynomolgus Macaques
Conclusions. We developed an assay to monitor CMV in Cynomolgus macaques. CMV reactivation occurred in 100% of seropositive animals in this model. Rapamycin delayed CMV reactivation and ganciclovir treatment was effective at high doses. As in humans, CD8+ T cells proliferated during CMV viremia. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Basic Science—General Source Type: research

Noninvasive Fluorine-19 Magnetic Resonance Relaxometry Measurement of the Partial Pressure of Oxygen in Acellular Perfluorochemical-loaded Alginate Microcapsules Implanted in the Peritoneal Cavity of Nonhuman Primates
Conclusions. The peritoneal pO2 of normal NHPs is relatively low and we predict would decrease further when encapsulated islets are transplanted intraperitoneally. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Original Basic Science—General Source Type: research

The Challenges With the Cardiac Evaluation of Liver and Kidney Transplant Candidates
Cardiovascular events are among the leading cause of mortality in kidney and liver transplant recipients. Thus, screening for cardiovascular disease and risk stratification for cardiovascular events constitute an important part of the pretransplant evaluation. In this review, we first summarize current guidelines in the cardiac risk assessment of kidney and liver transplant candidates. We then elaborate on the limitations of these guidelines, summarize the current knowledge gaps, and narrow down a spectrum of 6 themes that serve as challenges to research and practice development. This spectrum pertains to understanding the...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Reviews Source Type: research

A Comprehensive Review of Outcome Predictors in Low MELD Patients
This article reviews the literature of risk prediction in patients with cirrhosis, identifies which patients may benefit from earlier interventions, such as transplantation, and proposes directions for future research. (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Reviews Source Type: research

The Causes of Kidney Allograft Failure: More Than Alloimmunity. A Viewpoint Article
Kidney allograft failure is a serious condition, as it implies the need for reinitiation of dialysis with associated morbidity and mortality, reduced quality of life, and higher economic cost. Despite improvements in short-term survival of kidney allografts, this progress was not matched in long-term graft survival. In this viewpoint article, we summarize the available literature on the causes of kidney allograft failure, both early and late, both nonimmune and alloimmune, to gain better insight into the causes of graft failure. Such insight is necessary to better target therapies or take preventative measures that improve...
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Reviews Source Type: research

A Fine Balance: Using Letermovir for Salvage Antiviral Treatment While Preserving Efficacy
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Commentaries Source Type: research

Cytomegalovirus: The “Troll of Transplantation” Is Now the “Troll of Tolerance”
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Commentaries Source Type: research

Strategies to Improve the Oxygen Supply to Microencapsulated Islets
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Commentaries Source Type: research

Living Donor Liver Transplant in Alcohol-related Liver Disease: An Option Whose Time Has Come
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Commentaries Source Type: research

Is It Time to Make Renal Transplantation Referral Mandatory?
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: Commentaries Source Type: research

Robert A Montgomery, MD, DPhil Pioneering Surgeon and Transplant Recipient, NYU Langone Transplant Institute, NYU Langone Health, New York, NY
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: In View: People in Transplantation Source Type: research

An Unexpected Partnership: MHC Class II Molecules as Ligands for NK Cells
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: In View: Game Changer Source Type: research

Research Highlights
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: In View: Research Highlights Source Type: research

Heart Transplantation in a Distant Island Population: Accessibility and Outcomes in Patients From the Canary Islands Transplanted in Madrid
No abstract available (Source: Transplantation)
Source: Transplantation - February 1, 2020 Category: Transplant Surgery Tags: In View: Around the World Source Type: research

Graft Portal Vein Thrombosis Before Liver Transplant
No abstract available (Source: Transplantation)
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Letters Source Type: research

Sequential Deceased Donor Intestine Transplantation Followed by Living Donor Liver Transplantation, Also Known as Hybrid Intestine-liver Transplantation
No abstract available (Source: Transplantation)
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Letters Source Type: research

The Authors’ Reply to Letter to the Editor, Re: Biliary Bicarbonate, pH, and Glucose Are Suitable Biomarkers of Biliary Viability During Ex Situ Normothermic Machine Perfusion of Human Donor Livers
No abstract available (Source: Transplantation)
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Letters Source Type: research

The Authors' Reply: Biliary Bicarbonate, pH, and Glucose Are Suitable Biomarkers of Biliary Viability During Ex Situ Normothermic Machine Perfusion of Human Donor Livers
No abstract available (Source: Transplantation)
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Letters Source Type: research

PCSK9 Inhibitor Use in Heart Transplant Recipients: A Case Series and Review of the Literature
No abstract available (Source: Transplantation)
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Letters Source Type: research

Diabetogenic Effects of Immunosuppression: An Integrative Analysis
Conclusions. We discovered that the significantly dysregulated genes in the context of immunosuppression are implicated in insulin signaling and insulin secretion, as a manifestation of pancreatic β-cell function. In vitro validation confirmed key diabetes-related genes in the context of immunosuppression. Further analysis and in vitro validation revealed that metformin optimally reverts diabetogenic genes dysregulated in the context of immunosuppression. The optimal therapeutic management of posttransplant diabetes mellitus needs to be further investigated, taking into account the mechanistic impact of immunosuppre...
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Comparing Pretransplant and Posttransplant Outcomes When Choosing a Transplant Center: Focus Groups and a Randomized Survey
Conclusions. The presentation of public reports influenced decision-making behavior. The combination of qualitative and quantitative research helped to guide and enhance understanding of the impacts of proposed changes in reported metrics. (Source: Transplantation)
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Clostridium difficile: A Frequent Infection in Children After Intestinal Transplantation
Conclusions. CDI is more prevalent in children after ITx compared with other organ Tx; it is most often symptomatic but mildly or moderately severe. Standard antibiotics efficiently control the symptoms. Induction of rejection is a rare event. (Source: Transplantation)
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Heterogeneity of Human Pancreatic Islet Isolation Around Europe: Results of a Survey Study
Conclusions. The result highlighted the presence of a heterogeneity in the islet cell product process and product release criteria. (Source: Transplantation)
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Delayed Bleeding of the Transplant Duodenum After Simultaneous Kidney-pancreas Transplantation: Case Series
Conclusions. Bleeding of the transplanted donor duodenum can present as a late complication, several years after SPK transplantation. The development of enlarged, congestive submucosal veins could play a role in these late bleedings, and antiplatelet therapy could be a precipitating factor. Further research is necessary to investigate the pathophysiology, the prevalence, optimal treatment, and the consequent influence on mortality, morbidity, and graft loss after SPK transplantation. (Source: Transplantation)
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research

Assessing the Limits in Kidney Transplantation: Use of Extremely Elderly Donors and Outcomes in Elderly Recipients
Background. Patient survival with end-stage renal disease is longer after kidney transplantation (KT) compared with those remaining on dialysis. Nevertheless, this remains uncertain when receiving a kidney from a donor ≥80 years old. Methods. In a longitudinal mortality study in the Catalan Renal Registry including 2585 patients ≥60 years old on dialysis and placed on the KT waiting list, 1084 received a first KT from a deceased donor aged 60 to 79 years and 128 from a deceased donor ≥80 years. We calculated adjusted risk of graft loss by means of competing-risks regression, considering patient death with fun...
Source: Transplantation - December 28, 2019 Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research