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American Journal of Transplantation

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https://www.readbyqxmd.com/read/28640949/flawed-assumptions-ethical-problems-with-proposed-presumed-consent-legislation
#1
LETTER
C R Bruce, P Koch
At present, there is a House bill in the Texas Legislature that would shift Texas from an opt-in organ donation model - a model requiring explicit consent for organ donation from the donor or donor's family - to an opt-out, or presumed consent, model. Under this new bill, the state would assume that a person agreed to organ donation unless the donor registered an objection. If passed, this law would be the first-of-its-kind in the United States, and it represents the direct inverse of the nation's current opt-in model as outlined by the Uniform Anatomical Gift Act (although the bill does not violate federal law)...
June 22, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28637095/selective-cd28-blockade-results-in-superior-inhibition-of-donor-specific-t-follicular-helper-cell-and-antibody-responses-relative-to-ctla-4-ig
#2
I R Badell, G M La Muraglia, D Liu, M E Wagener, G Ding, M L Ford
Donor-specific antibodies (DSA) are a barrier to improved long-term outcomes following kidney transplantation. Costimulation blockade with CTLA-4-Ig has shown promise as a potential therapeutic strategy to control DSA. T follicular helper (Tfh) cells, a subset of CD4(+) T cells required for optimum antibody production, are reliant on the CD28 costimulatory pathway. We have previously shown that selective CD28 blockade leads to superior allograft survival through improved control of CD8(+) T cells relative to CTLA-4-Ig, but the impact of CD28-specific blockade on CD4(+) Tfh cells is unknown...
June 21, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28637093/intra-abdominal-cooling-system-limits-ischemia-reperfusion-injury-during-robot-assisted-renal-transplantation
#3
Raphael P H Meier, Vincent Piller, Monika E Hagen, Charles Joliat, Jean-Bernard Buchs, Antonio Nastasi, Raphael Ruttimann, Nicolas C Buchs, Solange Moll, Jean-Paul Vallée, François Lazeyras, Philippe Morel, Leo Bühler
Robot-assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra-abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follow: Robotic renal transplantation with (n=11) and without (n=6) continuous intra-abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n=6). Renal cortex temperature, magnetic resonance imaging and histology were analyzed...
June 21, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28637092/evaluation-of-strategies-for-increasing-transplantation-should-be-based-on-a-current-and-precise-assessment-of-the-state-of-organ-donation
#4
LETTER
K J O'Connor, A K Glazier
In the article "Regional Differences in Communication Process and Outcomes of Requests for Solid Organ Donation", Traino et al claim to "explore regional differences in communication in requests for organ donation." (1) However, old data and incomplete analysis make the conclusions of unclear value to furthering meaningful improvement in the field. This article is protected by copyright. All rights reserved.
June 21, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28637080/the-prognostic-importance-of-bronchoalveolar-lavage-fluid-cxcl9-during-minimal-acute-rejection-on-the-risk-of-chronic-lung-allograft-dysfunction
#5
M Y Shino, S S Weigt, N Li, A Derhovanessian, D M Sayah, R Saggar, Richard H Huynh, A L Gregson, A Ardehali, D J Ross, J P Lynch, R M Elashoff, J A Belperio
The clinical significance and treatment strategies for minimal acute rejection (grade A1), the most common form of acute rejection (AR), remains controversial. In this retrospective single-center cohort study of 441 lung transplant recipients, we formally evaluate the association between minimal AR and chronic lung allograft dysfunction (CLAD) and test a novel hypothesis using BAL CXCL9 concentration during minimal AR as a biomarker of subsequent CLAD development. In univariable and multivariable models adjusted for all histopathologic injury patterns, minimal AR was not associated with CLAD development...
June 21, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28632974/hcv-positive-donor-organs-in-solid-organ-transplantation-mind-the-gap
#6
EDITORIAL
J A Fishman, X Forns
The shortage of organs for transplantation is a major impediment to access to life-saving therapy. The availability of antiviral therapies that control hepatitis B (HBV) and HIV, or cure hepatitis C (HCV), have changed traditional equations in transplantation, allowing infected individuals access to transplantation without unimpeded viral replication during immunosuppression. The availability of these therapies also permits use of organs from donors actively or potentially infected with these viruses. This article is protected by copyright...
June 20, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28621910/allospecific-memory-b-cell-responses-are-dependent-on-autophagy
#7
Miguel Fribourg, Jie Ni, F Nina Papavasiliou, Zhenyu Yue, Peter S Heeger, Jeremy S Leventhal
Long-lived, donor-reactive memory B cells (Bmem) can produce alloantibodies that mediate transplant injury. Autophagy, an intrinsic mechanism of cell organelle/component recycling, is required for Bmem survival in infectious and model antigen systems but whether autophagy impacts alloreactive Bmem is unknown. We studied mice with an inducible yellow fluorescent protein (YFP) reporter expressed under the Activation-Induced Cytidine Deaminase (AID) promoter active in B cells undergoing germinal center reactions...
June 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28621875/retransplantation-after-a-failed-donation-after-circulatory-determination-of-death-liver-transplant-meld-exception-priority-and-second-chances
#8
EDITORIAL
Peter L Abt, David S Goldberg
Increased utilization of higher-risk liver allografts is hampered by concerns about an increased risk of post-transplant graft failure and subsequent death if the patient is not retransplanted. This dilemma faces clinicians considering broader use of livers from donation after circulatory determination of death (DCDD) donors. In the setting of primary non-function or early hepatic artery thrombosis (HAT), there is a mechanism for standardized awarding of Model for End-Stage Liver Disease (MELD) exception points...
June 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28613437/t-cell-subsets-predicting-belatacept-resistant-rejection-finding-the-root-where-the-trouble-starts
#9
EDITORIAL
T Wekerle
The potential of costimulation blockade to revolutionize post-transplant immunosuppression has remained largely unfulfilled to date. Belatacept, the only costimulation blocker approved in organ transplant recipients, has not replaced the 30-plus-year-old CNIs as the mainstay of immunosuppression and is currently used infrequently. Modulating pathogenic immune responses through the interruption of costimulatory signals, which a naïve T cell requires for its full activation, has captivated immunologists since the demonstration that such costimulation blockade leads to antigen-specific immunomodulation (at least in vitro)...
June 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28613436/the-incremental-cost-of-incompatible-living-donor-kidney-transplant-a-national-cohort-analysis
#10
David Axelrod, Krista L Lentine, Mark A Schnitzler, Xun Luo, Huiling Xiao, Babak J Orandi, Allan Massie, Jacqueline Garonzik-Wang, Mark D Stegall, Stanley C Jordan, Jose Oberholzer, Ty B Dunn, Lloyd E Ratner, Sandip Kapur, Ronald P Pelletier, John P Roberts, Marc L Melcher, Pooja Singh, Debra L Sudan, Marc P Posner, Jose M El-Amm, Ron Shapiro, Matthew Cooper, George S Lipkowitz, Michael A Rees, Christopher L Marsh, Bashir R Sankari, David A Gerber, Paul W Nelson, Jason Wellen, Adel Bozorgzadeh, A Osama Gaber, Robert A Montgomery, Dorry L Segev
Incompatible living donor kidney transplant (ILDKT) has been established as an effective option for end stage renal disease (ESRD) patients with willing but HLA incompatible live donors, reducing mortality and improving quality of life. Depending upon antibody titer, ILDKT can require highly resource intensive procedure including intravenous immunoglobulin, plasma exchange and/or cell depleting antibody treatment as well as protocol biopsies and DSA testing. This study sought to compare the cost and Medicare reimbursement, exclusive of organ acquisition payment, for ILDKT recipients (N=926) with varying antibody titers to matched compatible transplants (N=2762) performed between 2002-2011...
June 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28613392/donor-recipient-matching-based-on-predicted-recognizable-hla-epitopes-predicts-the-incidence-of-de-novo-donor-specific-hla-antibodies-following-renal-transplantation
#11
Nils Lachmann, Matthias Niemann, Petra Reinke, Klemens Budde, Danilo Schmidt, Fabian Halleck, Axel Pruß, Constanze Schönemann, Eric Spierings, Oliver Staeck
De novo donor-specific HLA antibodies (dnDSA) are recognized as risk factor for premature allograft failure. Determinants of DSA specificity are generated via the indirect allorecognition pathway. Here, we present supportive data for the relevance of predicted indirectly recognizable HLA epitopes (PIRCHE) to predict dnDSA following kidney transplantation. A total of 2,787 consecutive kidney transplants performed 1995-2015 without preformed DSA have been analyzed. De novo DSA were detected by single antigen bead assay...
June 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28597555/harnessing-scientific-and-technological-advances-to-improve-equity-in-kidney-allocation-policies
#12
Anat R Tambur, Benoit Audry, Corinne Antoine, Caroline Suberbielle, Denis Glotz, Christian Jacquelinet
We reported that current assignment of HLA-DQ is a barrier to organ allocation. Here we simulated the impact of incorporating HLA-DQ antigens and antibodies as A/B and αβ allelic variants, respectively, on calculated PRA and probability of finding potential compatible donors (PCD). A cohort of 1224 donors and 2075 sensitized candidates was analyzed using HLA-DQαβ allelic (study) versus serologic (current practice) nomenclature. A significant (p<10(-4) ) decrease in cPRA was observed with higher impact for male versus female, and first transplant versus retransplant (p<10(-4) ), affecting mostly patients with moderate cPRA (30-80%)...
June 8, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28597548/equitable-access-is-not-a-secondary-goal-of-organ-allocation
#13
LETTER
K Ladin, D Hanto
We appreciate the thoughtful comments expressed by Ms. Glazier.(1) We agree that maintaining local priority for allocation of livers will not address broad health inequalities. In fact, we argue that this is not the purpose of organ allocation. This article is protected by copyright. All rights reserved.
June 8, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28556487/response-to-prophylactic-ureteric-stents-in-renal-transplant-recipients-a-multicentre-randomised-controlled-trial-of-early-versus-late-removal
#14
LETTER
J A Richards, K Jones, Z Moinuddin, G J Pettigrew
This study was powered on "stent complications", rather than major ureteric complications (MUC). On an intention to treat basis there was no significant benefit from early stent removal (p = 0.055), but when looking overall at patients with early stent removal (irrespective of intention to treat), they did demonstrate a decrease in "stent complications" (predominantly reduced urinary tract infections (UTIs) 7.6% versus 24.6%). Despite being underpowered to look at MUC, there was a significant increase in overall urological complications with early stent removal...
May 29, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28556451/skin-cancers-in-organ-transplant-recipients
#15
Amit Mittal, Oscar R Colegio
Long-term utilization of immunosuppression in organ transplant recipients (OTRs) leads to decreased immune-mediated tumor surveillance and development of malignant tumors. A delicate balance needs to be maintained in the intensity of immunosuppression to keep the risk of malignancy low without jeopardizing life-saving graft function. OTRs are prone to developing skin cancers which exhibit unique epidemiologic, pathophysiologic and prognostic characteristics. In this review, we discuss the most commonly reported skin cancers in OTRs: squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Kaposi's sarcoma, Merkel cell carcinoma and malignant melanoma (MM)...
May 29, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28556433/it-is-bad-policy-and-contrary-to-federal-law-to-prioritize-local-allocation-of-livers-to-address-geographically-based-social-inequities
#16
LETTER
Alexandra K Glazier
In the article "Geographic Disparities in Liver Availability: Accidents of geography or consequences of poor social policy" Ladin et al argue that those who live in underserved areas, with high rates of preventable deaths from gunshot wounds, motor vehicle accidents and reduced medical services, may have a "special claim" to local organs in order to adjust for the geographically based "poor social policies" that contribute to low access to healthcare (1). This article is protected by copyright. All rights reserved...
May 29, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28556422/the-american-society-of-transplantation-consensus-conference-on-the-use-of-hepatitis-c-viremic-donors-in-solid-organ-transplantation
#17
J Levitsky, R N Formica, R D Bloom, M Charlton, M Curry, J Friedewald, J Friedman, D Goldberg, S Hall, M Ison, T Kaiser, D Klassen, G Klintmalm, J Kobashigawa, A Liapakis, K O'Conner, P Reese, K Shelat, D Stewart, N Terrault, N Theodoropoulos, J Trotter, E Verna, M Volk
The availability of direct acting antiviral agents for the treatment of hepatitis C virus (HCV) has resulted in a profound shift in the approach to the management of this infection. These changes have impacted the practice of solid organ transplantation by altering the framework by which patients with end stage organ disease are managed and receive organ transplants. The high level of safety and efficacy of these medications in patients with chronic HCV infection provide the opportunity to explore their use in the setting of transplanting organs from HCV viremic patients into HCV non-viremic recipients...
May 29, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28556380/waitlist-outcomes-for-patients-relisted-following-failed-donation-after-cardiac-death-liver-transplant-implications-for-awarding-meld-exception-scores
#18
Kristopher P Croome, David D Lee, Justin H Nguyen, Andrew P Keaveny, C Burcin Taner
Understanding of outcomes for patients re-listed for ischemic cholangiopathy (IC) following a donation after cardiac death (DCD) liver transplant (LT) will help standardization of MELD exception scheme for re-transplantation. Early relisting (E-RL) for DCD graft failure due to PNF or HAT was defined as re-listing ≤ 14 days after DCD-LT, late relisting (L-RL) due to biliary complications was defined as re-listing 14 days- 3 years after DCD-LT. Of 3908 DCD-LT performed nationally between 2002-2016, 540 (13...
May 29, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28556608/impact-of-a-national-controlled-donation-after-circulatory-death-dcd-programme-on-organ-donation-in-the-uk-a-10-year-study
#19
Russell Hodgson, Alastair L Young, Magdy A Attia, J Peter A Lodge
Organ transplantation is the most successful treatment for some forms of organ failure yet a lack of organs means many die on the waiting list. In the UK, the Organ Donation Taskforce was set up to identify barriers to organ donation and in 2008 released its first report (ODTR). This study assesses the success since the ODTR and examines the impact of the UK's controlled Donation after Circulatory Death (DCD) programme and the controversies surrounding it. There were 12864 intended Donation after Brain Death (DBD) or DCD donors from April 2004 to March 2014...
May 28, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28556588/effects-of-dna-methylation-on-progression-to-interstitial-fibrosis-and-tubular-atrophy-in-renal-allograft-biopsies-a-multi-omics-approach
#20
Sai Vineela Bontha, Daniel G Maluf, Kellie J Archer, Catherine I Dumur, Mikhail Dozmorov, Anne King, Enver Akalin, Thomas F Mueller, Lorenzo Gallon, Valeria R Mas
Progressive fibrosis of the interstitium is the dominant final pathway in renal destruction in native and transplanted kidneys. Over time, the continuum of molecular events following immunological and non-immunological insults lead to interstitial fibrosis and tubular atrophy (IFTA) and culminate in kidney failure. We hypothesize that these insults trigger changes in DNA methylation (DNAm) patterns which in turn could exacerbate injury and slow down the regeneration processes, leading to fibrosis development and graft dysfunction...
May 28, 2017: American Journal of Transplantation
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