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American Journal of Transplantation

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https://www.readbyqxmd.com/read/28544384/esrd-in-living-donors-from-prior-to-1987-obtaining-waitlist-priority
#1
LETTER
R Hays, C Lillesand, D A Mandelbrot
Since 1996, living kidney donors who later developed ESRD have been eligible to receive priority status on the UNOS/OPTN kidney transplant waitlist. In 2015, Potluri et al showed that this system is generally effective: living donors receiving priority points were transplanted faster than controls.(1) Others have noted limited data on living donor ESRD trajectory and treatment access, due to the lack of a system to follow living donor outcomes long-term.(2-3) This article is protected by copyright. All rights reserved...
May 25, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28544101/belatacept-combined-with-transient-calcineurin-inhibitor-therapy-prevents-rejection-and-promotes-improved-long-term-renal-allograft-function
#2
A B Adams, J Goldstein, C Garrett, R Zhang, R E Patzer, K A Newell, N A Turgeon, A S Chami, A Guasch, A D Kirk, S O Pastan, T C Pearson, C P Larsen
Belatacept, a T cell costimulation-blocker demonstrated superior renal function, lower cardiovascular risk, and improved graft/patient survival in renal transplant recipients. Despite the potential benefits, adoption of belatacept has been limited in part due to concerns regarding higher rates and grades of acute rejection in clinical trials. Since July 2011 we have utilized belatacept-based immunosuppression regimens in clinical practice. In this retrospective analysis of 745 patients undergoing renal transplantation at our center, we compared patients treated with belatacept (n=535) to a historical cohort receiving a tacrolimus-based protocol (n=205)...
May 23, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28544604/thymic-peripheral-crosstalk-in-lymphodepletion-therapy
#3
EDITORIAL
M E Snyder, D L Farber
T cell depletion is widely used as induction therapy in solid organ transplants and particularly in kidney transplantation, to reduce the episodes of acute cellular rejection. The resultant reduction in T cell numbers is usually temporary, as T cells are actively replenished due to thymic output and/or lymphopenia-induced proliferation of remaining, depletion-resistant T cells. However, the extent of T cell replenishment and the persistence of lymphopenia varies between individuals, with potential impacts on protective or pathogenic immune responses...
May 22, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28544474/breast-cancer-and-transplantation
#4
Germaine Wong, Eric Au, Sunil V Badve, Wai H Lim
Breast cancer is an important cancer among solid organ transplant recipients. While the incidence of breast cancer in solid organ transplant recipients is comparable to the age matched general population, the outcomes are generally poor. Interventions such as cancer screening which preclude the development of late stage disease through early detection are not well-studied, and clinical practice guidelines for cancer screening rely solely on recommendations from the general population. Among those with a prior breast cancer history, disease recurrence after transplantation is a rare but fearful event...
May 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28544435/solid-renal-masses-in-transplanted-allograft-kidneys-a-closer-look-at-the-epidemiology-and-management
#5
John J Griffith, Katherine A Amin, Nikhil Waingankar, Susan M Lerner, Veronica Delaney, Scott A Ames, Ketan Badani, Michael A Palese, Reza Mehrazin
The objective of this review is to explore the available literature on solid renal masses (SRM) in transplant allograft kidneys to better understand the epidemiology and management of these tumors. A literature review using PubMed was performed according to the PRISMA methodology. Fifty-six relevant studies were identified from 1988-2015. A total of 174 SRMs in 163 patients, were identified with a mean tumor size of 2.75 cm (0.5-9.0cm). Tumor histology was available in 164 (94.3%) tumors: clear cell renal cell carcinoma (RCC) (45...
May 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28544377/brain-dead-donors-with-ornithine-transcarbamylase-deficiency-a-big-learning-opportunity-in-clinical-evaluation
#6
LETTER
F Caballero, J Ris, M Puig, J Leal, S Benito
We have read with interest the report by Ramanathan et al regarding a case of ornithine transcarbamylase (OTC) deficiency unmasked post-liver transplantation (1). This serves as a big learning opportunity in clinical organ donor evaluation. A consequence of this disorder is hyperammonemia. Acute high levels in serum ammonia can cause severe neurological findings such as cerebral edema and brain death (2-4). This article is protected by copyright. All rights reserved.
May 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28520317/a-very-different-paradigm-for-living-kidney-donor-risk
#7
EDITORIAL
R W Steiner
No abstract text is available yet for this article.
May 18, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28520316/the-living-donor-collective-a-scientific-registry-for-living-donors
#8
B L Kasiske, S K Asrani, M A Dew, M L Henderson, C Henrich, A Humar, A K Israni, K L Lentine, A J Matas, K A Newell, D LaPointe Rudow, A B Massie, J J Snyder, S J Taler, J F Trotter, A D Waterman
In the setting of an overall decline in living organ donation and new questions about long-term safety, a better understanding of outcomes after living donation has become imperative. Adequate information on outcomes important to donors may take many years to ascertain and may only be evident by comparing large numbers of donors with suitable controls. Previous studies have been unable to fully answer critical questions, primarily due to lack of appropriate controls, inadequate sample size, and/or follow-up duration too short to allow detection of important risks attributable to donation...
May 18, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28510355/the-national-landscape-of-living-kidney-donor-follow-up-in-the-united-states
#9
Macey L Henderson, Alvin G Thomas, Ashton Shaffer, Allan B Massie, Xun Luo, Courtenay M Holscher, Tanjala S Purnell, Krista Lentine, Dorry L Segev
In 2013, OPTN/UNOS mandated that transplant centers collect data on living kidney donors (LKDs) at 6-months, 1-year, and 2-years post-donation, with policy-defined thresholds for the proportion of complete living donor follow-up (LDF) data submitted in a timely manner (60 days before or after the expected visit date). While mandated, it was unclear how centers across the country would perform in meeting thresholds, given potential donor and center-level challenges of LDF. To better understand the impact of this policy, we studied SRTR data for 31,615 LKDs between 1/2010-6/2015, comparing proportions of complete and timely LDF form submissions pre- and post-policy implementation...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28510349/potential-disadvantages-of-over-centralization-of-organ-recovery-centres-response-to-marsolais-et-al
#10
LETTER
Matthew J Weiss, Andrew Healey, Sonny Dhanani, Jean-François Lizé
As physicians involved in the Canadian organ donation system, we read with interest the report by Marsolais et al (1). While the team at Hôpital Sacre-Coeur de Montréal deserves to be congratulated for their excellence in the organ donation, the described model has potential disadvantages, and we believe its advantages have been overstated. Marsolais et al. chose people transplanted per million (tpm) as their primary outcome, which is less frequently reported than donors per million. We disagree that tpm is the correct statistic, and we also disagree with how it was calculated...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28510341/living-donor-liver-transplantation-for-patients-older-than-age-70-years-a-single-center-experience
#11
J H Kwon, Y I Yoon, G W Song, K H Kim, D B Moon, D H Jung, G C Park, E Y Tak, V A Kirchner, S G Lee
Over the past two decades, the age of liver transplantation (LT) recipients has been increasing. We reviewed our experience with LT for patients aged 70 years or older (range: 70-78) and investigated the feasibility of performing LT, especially living donor LT (LDLT), for older patients. We retrospectively reviewed the medical records of 25 patients (15 LDLT recipients, 10 DDLT recipients), aged 70 years or older who underwent LT from January 2000 to April 2016. Their perioperative morbidity rate was 28.0% and the in-hospital mortality rate was 16...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28510335/proteoforms-in-peripheral-blood-mononuclear-cells-as-novel-rejection-biomarkers-in-liver-transplant-recipients
#12
T K Toby, M Abecassis, K Kim, P M Thomas, R T Fellers, R D LeDuc, N L Kelleher, J Demetris, J Levitsky
Biomarker profiles of acute rejection in liver transplant recipients could enhance the diagnosis and management of recipients. Our aim was to identify diagnostic proteoform signatures of acute rejection in circulating immune cells, using an emergent "top down" proteomics methodology. We prepared differentially processed and cryopreserved cell lysates from 26 non-viral liver transplant recipients by molecular weight-based fractionation and analyzed them by mass spectrometry of whole proteins in three steps: 1) Nanocapillary liquid chromatography coupled with high-resolution tandem mass spectrometry; 2) database searching to identify and characterize intact proteoforms; 3) data processing through a hierarchical linear model matching the study design to quantify proteoform fold changes in patients with rejection vs...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28510318/report-from-the-american-society-of-transplantation-conference-on-donor-heart-selection-in-adult-cardiac-transplantation-in-the-u-s
#13
J Kobashigawa, K Khush, M Colvin, M Acker, A Van Bakel, H Eisen, Y Naka, J Patel, D A Baran, T Daun, M Luu, M Olymbios, J Rogers, V Jeevanandam, F Esmailian, F D Pagani, B Lima, J Stehlik
Cardiac transplantation remains the only definitive treatment for end-stage heart failure. Transplantation rates are limited by a shortage of donor hearts. This shortage is magnified because many hearts are discarded due to strict selection criteria and concern for regulatory reprimand for less than optimal post-transplant outcomes. There is no standardized approach to donor selection despite proposals to liberalize acceptance criteria. A donor heart selection conference was organized to facilitate discussion, and generate ideas for future research...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28510315/bk-virus-nephropathy-revisited
#14
EDITORIAL
Michael Mengel
More than 20 years after its first description and increased morbidity under powerful immunosuppression, the understanding of the pathogenesis of BK polyomavirus induced allograft nephropathy (BKVN) has changed clinical practice in renal transplantation. Screening programs were introduced at most transplant centers causing the prevalence of BKVN to decrease. However, BK viremia is still found in 10-30% of renal allograft recipients with 1-10% developing BKVN. This article is protected by copyright. All rights reserved...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28510280/modelling-the-iatrogenic-pancreatic-cancer-risk-after-islet-autotransplantation-in-mouse
#15
E Dugnani, V Pasquale, D Liberati, A Citro, E Cantarelli, S Pellegrini, P Marra, T Canu, G Balzano, M Scavini, A Esposito, C Doglioni, L Piemonti
Iatrogenic pancreatic cancer metastasis after islet infusion is a potential risk of islet autotransplantation performed after pancreatectomy. To model this risk islets and/or pancreatic exocrine clusters obtained from a genetically engineered mouse model for pancreatic ductal adenocarcinoma (the LSL-Kras(G12D/+) ;LSL-Trp53(R172H/+) ;Pdx-1-Cre, termed KPC mouse) were transplanted via the portal vein in syngeneic wild type (WT) severely diabetic recipients in the following treatment groups: group A (n=11) received KPC exocrine clusters in volume equal to 250 equivalent islets (IEQs); group B (n=12) received 250 WT IEQs mixed with KPC exocrine clusters (1:1 volume ratio); group C (n=5) received 250 KPC IEQs and group D (n=7) received 250 wild type IEQs...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28508535/costimulation-blockade-america-first-canada-second-what-about-norway
#16
LETTER
Karsten Midtvedt, Hallvard Holdaas, Stein Bergan, Anders Åsberg
We read with interest the letter by Gill et al "commenting on costimulation blockade in large markets only» (1). They pinpoint the fact that the United States for long times have been the testing ground for development and commercialization of new therapeutics. This is a problem for therapeutics with small target patient populations such as immunosuppressant drugs. The authors anticipate that this will be a bigger issue in the future arguing that establishing a market foothold for new transplant therapeutics in the U...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28508451/the-impact-of-left-ventricular-diastolic-dysfunction-on-lung-transplant-outcome-in-patients-with-pulmonary-arterial-hypertension
#17
Avital Avriel, Anat Hershko Klement, Sindhu R Johnson, Marc de Perrot, John Granton
Diastolic dysfunction may influence perioperative outcome, early graft function and long-term survival. We compared the outcomes of DLTx for PAH patients with pre-operative LV diastolic dysfunction to those without diastolic dysfunction. Of 116 consecutive patients with PAH (who underwent transplantation between January 1995 and December 2013), 44 met our inclusion and exclusion criteria. Fourteen patients (31.8%) with diastolic dysfunction pre-LTx had a higher BMI [29 (IQR 21.5-32.6) vs. 22.4 (IRQ 19.9-25...
May 16, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28502128/belatacept-resistant-rejection-is-associated-with-cd28-memory-cd8-t-cells
#18
D V Mathews, W C Wakwe, S C Kim, M C Lowe, C Breeden, M E Roberts, A B Farris, E A Strobert, J B Jenkins, C P Larsen, M L Ford, R Townsend, A B Adams
Recently newer therapies have been designed to more specifically target rejection in an effort to improve efficacy and limit unwanted toxicity. Belatacept, a CD28-CD80/86 specific reagent is associated with superior patient survival and graft function than traditional therapy but its adoption as a mainstay immunosuppressive therapy has been tempered by increased rejection rates. It is essential that the underlying mechanisms associated with this rejection be elucidated before belatacept is more widely employed...
May 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28502091/increased-pre-transplant-frequency-of-cd28-cd4-tem-predicts-belatacept-resistant-rejection-in-human-renal-transplant-recipients
#19
Miriam Cortes-Cerisuelo, Sonia J Laurie, David V Mathews, Pamela D Winterberg, Christian P Larsen, Andrew B Adams, Mandy L Ford
While most human T cells express the CD28 costimulatory molecule constitutively, it is well-known that age, inflammation, and viral infection can drive the generation of CD28(null) T cells. In vitro studies have demonstrated that CD28(null) cell effector function is not impacted by the presence of the CD28 costimulation blocker belatacept. As such, a prevailing hypothesis suggests that CD28(null) cells may precipitate costimulation blockade-resistant rejection. However, CD28(+) cells possess more proliferative and multi-functional capacity, factors that may increase their ability to successfully mediate rejection...
May 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28500691/an-interventional-study-using-cell-mediated-immunity-to-personalize-therapy-for-cytomegalovirus-infection-after-transplantation
#20
Deepali Kumar, Muhtashim Mian, Lianne Singer, Atul Humar
Cell mediated immune responses predict clinical CMV events but have not been adopted into routine practice due to lack of interventional studies. Our objective was to demonstrate the safety and feasibility of early discontinuation of antivirals based on the real-time measurement of CMV-specific CMI in patients with CMV viremia. Transplant patients were enrolled at the onset of CMV viremia requiring antiviral therapy. CD8 T-cell responses were determined using the Quantiferon-CMV assay, and results were used to guide subsequent management...
May 13, 2017: American Journal of Transplantation
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