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American Journal of Transplantation

G Testa, E C Koon, L Johannesson
The uterus is the most recent addition to the list of organs that can be successfully transplanted in humans. This paper analyzes living donor uterus transplantation according to the ethical principle of equipoise. A comparison is made between living donor uterus transplantation and gestational surrogate motherhood. Both are solutions to absolute uterine infertility that allow the transfer of genetic material from intended parents to a child. The analysis concludes that living donor uterus transplantation does not violate the ethical principle of equipoise and should be considered an ethically acceptable solution to absolute uterine infertility...
October 18, 2016: American Journal of Transplantation
Felix Krenzien, Markus Quante, Timm Heinbokel, Midas Seyda, Koichiro Minami, Hirohito Uehara, Hector Rodriguez Cetina Biefer, Jeroen M Schuitenmaker, Steven Gabardi, Katrin Splith, Moritz Schmelzle, Athena K Petrides, Haruhito Azuma, Johann Pratschke, Xian C Li, Abdallah ElKhal, Stefan G Tullius
Immunosuppression in elderly recipients has been underappreciated in clinical trials. Here, we assessed age-specific effects of the calcineurin inhibitor Tacrolimus (TAC) in a murine transplant model and assessed its clinical relevance on human T-cells. Old recipient mice exhibited prolonged skin graft survival when compared to young animals following TAC administration. More importantly, half of the TAC dose was sufficient in old mice to achieve comparable systemic trough levels. TAC administration was able to reduce pro-inflammatory IFN-γ cytokine production and promote IL-10 production in old CD4(+) T-cells...
October 18, 2016: American Journal of Transplantation
Laura A Siminoff, Gerard P Alolod, Maureen Wilson-Genderson, Eva Y N Yuen, Heather M Traino
Available literature points to healthcare providers' discomfort with donation after cardiac death (DCD) and their perception of the public's reluctance toward the procedure. Using a national sample, we report on the communication content of actual DCD and donation after brain death (DBD) approaches by organ procurement organization (OPO) requesters and compare family decision makers' (FDMs') experiences of both modalities. We recruited 1,601 FDMs using a validated protocol; 347 (21.7%) were of potential DCD donors...
October 18, 2016: American Journal of Transplantation
M J Moritz, S Constantinescu, L A Coscia, D Armenti
We, the investigators of the National Transplantation Pregnancy Registry (NTPR), read with concern King and colleagues' Pregnancy Outcomes Related to Mycophenolate Exposure in Female Kidney Transplant Recipients [1], based on a limited subset of our data, which concludes that first trimester exposure to mycophenolate (MPA) may not be associated with increased fetal risks. We disagree with their interpretation of the data and feel strongly that their conclusions convey false information regarding MPA safety during pregnancy...
October 18, 2016: American Journal of Transplantation
Mathijs van de Vrie, Jeroen K Deegens, Michael Eikmans, Johan van der Vlag, Luuk B Hilbrands
Urine represents a non-invasive source in which proteins and nucleic acids can be assessed. Such analytes may function as biomarkers to monitor kidney graft pathology at every desired frequency, thereby providing a time window to prevent graft damage by therapeutic intervention. Recently, several proteins have been measured in urine as markers of graft injury. However, the specificity is limited, and measuring urinary proteins generally lacks the potential to predict early kidney graft damage. Currently, urinary mRNA and microRNA are being investigated to evaluate the prognostic value of changes in gene expression during the initial stages of graft damage...
October 15, 2016: American Journal of Transplantation
Jonathan P Singer, Patricia P Katz, Allison Soong, Pavan Shrestha, Debbie Huang, Jennifer Ho, Malori Mindo, John R Greenland, Steven R Hays, Jeffrey Golden, Jasleen Kukreja, Mary Ellen Kleinhenz, Rupal J Shah, Paul D Blanc
Under the U.S. Lung Allocation Score (LAS) system, older and sicker patients are prioritized for lung transplantation (LT). The impact of these changes on health-related quality of life (HRQL) after transplant has not been determined. In a single-center prospective cohort study, from 2010-2016 we assessed HRQL before and repeatedly after LT for up to 3 years using the SF12-Physical and Mental Health, the respiratory-specific Airway Questionnaire 20-Revised, and the Euroqol 5D/Visual Analog Scale utility measures by multivariate linear mixed models jointly modeled with death...
October 15, 2016: American Journal of Transplantation
I Lobb, J Jiang, D Lian, W Liu, A Haig, M N Saha, R Torregrossa, M E Wood, M Whiteman, A Sener
Ischemia-reperfusion injury (IRI) is unavoidably caused by loss and subsequent restoration of blood flow during organ procurement and prolonged IRI results in increased rates of delayed graft function and early graft loss. The endogenously produced gasotransmitter, hydrogen sulfide (H2 S), is a novel molecule that mitigates hypoxic tissue injury. The current study investigates the protective mitochondrial effects of H2 S during in vivo cold storage and subsequent renal transplantation (RTx) and in vitro cold hypoxic renal injury...
October 15, 2016: American Journal of Transplantation
Emily A Blumberg, Jay A Fishman
In 1952, Dick et al published a series of studies of a new virus isolated from sentinel rhesus macaque monkeys in the Zika Forest near Entebbe, Uganda (1). The first human isolation of Zika virus (ZIKV) occurred 2 years later in Nigeria. Cases of human infection were uncommonly identified until a major outbreak in Yap Island, Micronesia in 2007. This article is protected by copyright. All rights reserved.
October 15, 2016: American Journal of Transplantation
A Sharif, T Trey, A Schwarz, M Fiatarone Singh, J Lavee
No abstract text is available yet for this article.
October 13, 2016: American Journal of Transplantation
E Yu, H Ueta, H Kimura, Y Kitazawa, Y Sawanobori, K Matsuno
Graft-versus-host disease (GvHD) following liver transplantation (LT) is a rare but serious complication, with no presently available animal model and no preventive measure. To develop a rat LT-GvHD model, we preconditioned hosts with sublethal irradiation plus reduction of NK cells with anti-CD8α mAb treatment, which invariably resulted in acute LT-GvHD. Compared to those in the peripheral counterpart, graft CD4(+) CD25(-) passenger T cells showed lower alloreactivities in mixed leukocyte culture. Immunohistology revealed that donor CD4(+) T cells migrated and formed clusters with host dendritic cells in secondary lymphoid organs, with early expansion and subsequent accumulation in target organs...
October 12, 2016: American Journal of Transplantation
A A Abbas, J M Diamond, C Chehoud, B Chang, J J Kotzin, J C Young, I Imai, A R Haas, E Cantu, D J Lederer, K Meyer, R K Milewski, K M Olthoff, A Shaked, J D Christie, F D Bushman, R G Collman
Primary graft dysfunction (PGD) is a principal cause of early morbidity and mortality after lung transplantation, but its pathogenic mechanisms are not fully clarified. Thus far, studies using standard clinical assays have not linked microbial factors to PGD. We previously used comprehensive metagenomic methods to characterize viruses in lung allografts >1 month post-transplant and found that levels of Anellovirus, mainly Torque teno viruses (TTV), were significantly higher than in non-transplant healthy controls...
October 12, 2016: American Journal of Transplantation
T Bittermann, A Shaked, D S Goldberg
Outcomes of retransplantation after initial living donor liver transplantation (LDLT) are poorly understood. The aim of this study is to better understand the indications, timing, and outcomes of retransplantation after initial LDLT when compared to after initial deceased donor transplantation (DDLT). From 2002 to 2013, 209 retransplant recipients after initial LDLT and 2893 after initial DDLT were identified in Organ Procurement and Transplantation Network/United Network for Organ Sharing. Multivariable logistic models evaluated the association between initial transplant type and 1-year mortality...
October 6, 2016: American Journal of Transplantation
N A Zwang, A Shetty, N Sustento-Reodica, E J Gordon, J Leventhal, L Gallon, J J Friedewald
Homozygosity for apolipoprotein-L1 (APOL1) risk variants has emerged as an important predictor of renal disease in individuals of African descent over the past several years. Additionally, these risk variants may be important predictors of renal allograft failure when present in a living or deceased donor. Currently, there is no universal recommendation for screening of potential donors. We present a case of end-stage renal disease with focal segmental glomerulosclerosis in a living donor 7 years following donor nephrectomy...
October 6, 2016: American Journal of Transplantation
R Roat, M M Hossain, J Christopherson, C Free, S Jain, C Guay, R Regazzi, Z Guo
Currently there is no effective approach for monitoring early β cell loss during islet graft rejection following human islet transplantation (HIT). Due to ethical and technical constraints, it is difficult to directly study biomarkers of islet destruction in humans. Here, we established a humanized mouse model with induced human β cell death using adoptive lymphocyte transfer (ALT). Human islet grafts of ALT-treated mice had peri-graft lymphocyte infiltration, fewer insulin(+) β cells, and increased β cell apoptosis...
October 3, 2016: American Journal of Transplantation
Jesse D Schold, Michael P Phelan, Laura D Buccini
There is substantial evidence across different healthcare contexts that social determinants of health are strongly associated with morbidity and mortality in the US. These factors, including socioeconomic status, behavior and environmental risks, education, social support, healthy food and access to healthcare also vary widely by region and individual communities. One of the implications of heterogeneity in these risks is the potential impact on measured quality of healthcare providers. In particular, there is concern that providers treating disproportionally vulnerable communities may be disadvantaged by lack of risk adjustment for these factors that affect health but not indicators of quality of care...
October 3, 2016: American Journal of Transplantation
Nicoline Valentina Krogstrup, Mihai Oltean, Gertrude J Nieuwenhuijs-Moeke, Frank J M F Dor, Ulla Møldrup, Søren Palmelund Krag, Bo Martin Bibby, Henrik Birn, Bente Jespersen
Delayed graft function is a frequent complication following deceased donor renal transplantation, and is closely related to ischaemia-reperfusion injury. Experimental and clinical studies have shown protection by remote ischaemic conditioning (RIC). We hypothesised that recipient RIC before kidney graft reperfusion reduces the time to graft recovery. This multicentre, blinded, randomised, controlled clinical trial included 225 adult recipients of renal transplants from deceased donors at four transplantation centres in Denmark, Sweden and the Netherlands...
October 3, 2016: American Journal of Transplantation
T L Pruett, A Vathsala, T Berney, J Lerut, J S Odorico, M Johnson, H Egawa, F Gonzalez-Martinez, M Haberal, N L Ascher, A K Chandraker
No abstract text is available yet for this article.
October 3, 2016: American Journal of Transplantation
M Y Shino, S S Weigt, N Li, A Derhovanessian, D M Sayah, R H Huynh, R Saggar, A L Gregson, A Ardehali, D J Ross, J P Lynch, R M Elashoff, J A Belperio
The impact of allograft injury time-of-onset on the risk of chronic lung allograft dysfunction (CLAD) remains unknown. We hypothesized that episodes of late-onset (≥6 months) allograft injury would produce an augmented CXCR3/ligand immune response, leading to increased CLAD. In a retrospective single-center study, 1894 transbronchial biopsies from 441 lung transplant recipients were reviewed for the presence of acute rejection (AR), lymphocytic bronchiolitis (LB), diffuse alveolar damage (DAD) and organizing pneumonia (OP)...
September 27, 2016: American Journal of Transplantation
Andrea Schlegel, Michael Linecker, Philipp Kron, Georg Györi, Michelle L De Oliveira, Beat Müllhaupt, Pierre-Alain Clavien, Philipp Dutkowski
Allocation of liver grafts triggers emotional debates, as those patients, not receiving an organ, are prone to death. We analyzed a high MELD cohort (lab MELD≥30, n=100, median lab MELD of 35 (IQR: 31-37) of liver transplant recipients at our center over the last ten years, and compared results with a low MELD group, matched by propensity scoring for donor age, recipient age and cold ischemia. Endpoints of our study were cumulative post-transplant morbidity, cost, and survival. Six different prediction models, including D-MELD, Delta MELD, DRI, SOFT, BAR, and UCLA-FRS, were applied in both cohorts to identify risk for poor outcome and high cost...
September 27, 2016: American Journal of Transplantation
Mohammad Alrawashdeh, Rachelle Zomak, Mary Amanda Dew, Susan Sereika, Mi-Kyung Song, Joseph Pilewski, Annette DeVito Dabbs
Hospital readmission after lung transplantation negatively impacts quality of life and resource utilization. A secondary analysis of data collected prospectively was conducted to identify the pattern (incidence, count, cumulative duration), reasons and predictors of readmission for 201 lung transplant recipients (LTR) assessed at 2, 6, and 12 months post-discharge. The majority of LTRs (83.6%) were readmitted, and 64.2% had multiple readmissions. The median cumulative readmission duration was 19 days. The main reasons for readmission were: other than infection or rejection (55...
September 27, 2016: American Journal of Transplantation
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