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American Journal of Transplantation

Richard Kirk, Ann Dipchand
Singh and Gauvreau have applied advanced sophisticated statistical techniques to SRTR data to identify that center mortality at 90 days predicts late center outcomes and replicated a known finding of a "U" shaped survival curve based on center volume. The accompanying editorial by Drs Scheel and Canter mostly focusses on why the curve might be U shaped. However neither the paper or nor the editorial addresses the important fact that it is not survival from a given intervention (in this case transplantation) that is most important to the family and patient but the likelihood of survival and quality of life from the time of diagnosis, or at the very least, listing...
September 19, 2018: American Journal of Transplantation
Peter Dromparis, Nader S Aboelnazar, Siegfried Wagner, Sayed Himmat, Christopher W White, Sanaz Hatami, Jessica G Y Luc, Silas Rotich, Darren H Freed, Jayan Nagendran, Michael Mengel, Benjamin A Adam
Ex vivo lung perfusion (EVLP) shows promise in ameliorating pre-transplant acute lung injury (ALI) and expanding the donor organ pool, but the mechanisms of ex vivo repair remain poorly understood. We aimed to assess the utility of gene expression for characterizing ALI during EVLP. 169 porcine lung samples were collected in vivo (n=25), after 0 (n=11) and 12 (n=11) hours of cold static preservation (CSP), and after 0 (n=57), 6 (n=8) and 12 (n=57) hours of EVLP, utilizing various ventilation and perfusate strategies...
September 19, 2018: American Journal of Transplantation
Kendall R McEachron, Gregory J Beilman, Melena D Bellin
Insulin independence after total pancreatectomy with islet autotransplantation (TPIAT) is limited by a high rate of beta cell apoptosis [1]. The gut-derived hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) have beta cell protective properties, in addition to potentiating insulin secretion [2]. These hormones are degraded by the enzyme dipeptidyl peptidase-4 (DPP-4) in-vivo, and can be increased by inhibition of DPP-4 [3]. This article is protected by copyright. All rights reserved...
September 19, 2018: American Journal of Transplantation
Silke V Niederhaus, Robert J Carrico, Matthew A Prentice, Abigail C Fox, Muhammad A Mujtaba, Ty B Dunn, Oyedolamu K Olaitan, Jonathan S Fisher, Robert J Stratta, Alan C Farney, Jon S Odorico, Jonathan A Fridell
The OPTN Pancreas Transplantation Committee performed a multicenter retrospective study to determine if undetectable serum C-peptide levels correspond to center-reported pancreas graft failures. C-peptide data from 7 participating centers (n=415 graft failures for transplants performed from 2002-2012) were analyzed pre-transplant, at graft failure, and at return to insulin. 149 C-peptide values were submitted at pre-transplant, 94 at return to insulin and 233 at graft failure. There were 77 transplants with 2 available values (at pre- transplant and at graft failure)...
September 19, 2018: American Journal of Transplantation
Andrew Wey, Nicholas Salkowski, Bertram L Kasiske, Melissa Skeans, Cory R Schaffhausen, Sally K Gustafson, Ajay K Israni, Jon J Snyder
The Scientific Registry of Transplant Recipients (SRTR) welcomes comments, suggestions and debate, and we appreciate the letter from Schold et al. SRTR is required to publicly report pretransplant and posttransplant outcomes in a way that patients and families can understand. We embarked on five-tier reporting of posttransplant outcomes in the belief that 1) it is better than the system it replaced, 2) it can likely be improved with better data collection, and 3) it should be accompanied by pretransplant measures of outcomes after listing and clearly inform candidates as to which metrics may be most important to their survival...
September 19, 2018: American Journal of Transplantation
Lara Danziger-Isakov, Deepali Kumar
Vaccination in solid organ transplant (SOT) candidates and recipients decreases infection-related morbidity and mortality. For more than a decade, the American Society of Transplantation Infectious Disease Community of Practice and other local, regional and national organizations have developed and promoted guidelines for vaccination in this population [1]. However, vaccination rates especially in transplant candidates even with targeted interventions have remained suboptimal leaving transplant patients at increased risk for vaccine-preventable illness [2]...
September 19, 2018: American Journal of Transplantation
Clarissa A Cassol, Reut Hod-Dvorai, Charlene Hubbell, Vikram Aggarwal, Shreya Sinha, Teresa Gentile, Robert E Hutchison
Renal allograft dysfunction in the first year post-transplant has many possible causes, commonly including T-cell or antibody-mediated rejection, polyomavirus nephropathy, or recurrence of recipient’s original disease. Rarely, hematological disorders such as post-transplant lymphoproliferative disease, lymphomas or leukemia may cause early allograft dysfunction, in which case they are often donor-derived. Here we report a unique case of renal allograft involvement by donor-derived B-cell acute lymphoblastic leukemia initially diagnosed through an allograft biopsy performed for renal dysfunction...
September 17, 2018: American Journal of Transplantation
A A Abbas, J C Young, E L Clarke, J M Diamond, 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
Solid organ transplantation disrupts virus-host relationships, potentially resulting in viral transfer from donor to recipient, reactivation of latent viruses, and new viral infections. Viral transfer, colonization, and reactivation are typically monitored using assays for specific viruses, leaving the behavior of full viral populations (the "virome") understudied. Here we sought to investigate the temporal behavior of viruses from donor lungs and transplant recipients comprehensively. We interrogated the bronchoalveolar lavage (BAL) and blood viromes during the peri-transplant period and 6-16 months post-transplant in 13 donor-recipient pairs using shotgun metagenomic sequencing...
September 11, 2018: American Journal of Transplantation
Jon J Snyder, Nicholas Salkowski, Andrew Wey, Joshua Pyke, Ajay K Israni, Bertram L Kasiske
The Final Rule mandates that organ allocation not be based on the transplant candidate's place of residence or listing, except as required by sound medical judgment and best use of donated organs, to avoid wasting organs and futile transplants, and to promote access and efficiency. Current Organ Procurement and Transplantation Network (OPTN) policies use donation service areas and OPTN regions to distribute and allocate organs for transplant. These policies have recently been called into question as not meeting the requirements of the Final Rule...
September 11, 2018: American Journal of Transplantation
Gopalakrishnan Loganathan, Subhashree Venugopal, Siddharth Narayanan, Benjamin Tweed, Michael Andrew Goedde, Bakeerathan Gunaratnam, William W Tucker, Praneeth Goli, Sriprakash Mokshagundam, Robert C McCarthy, Stuart K Williams, Michael G Hughes, Appakalai N Balamurugan
Human islet isolation from young donor pancreases (YDP) utilizing the current purified standard dose of collagenase-protease enzyme mixtures often results in the release of a high percentage of mantled islets. Mantled islets are those surrounded by exocrine tissue and are difficult to purify by density gradient centrifugation, leading to poor islet recovery. Based on difference in extracellular matrix, and total collagen content between YDP and old donor pancreas (ODP, >35 Y) led us compare results from islet isolation using increased collagenase combination (ICC) or increased protease combination (IPC), to the standard enzyme combination (SEC) in a "trisected" pancreas model to overcome the donor-to-donor variability...
September 11, 2018: American Journal of Transplantation
C Legeai, R M Andrianasolo, O Moranne, R Snanoudj, M Hourmant, M Bauwens, J Soares, C Jacquelinet, C Couchoud, M A Macher
Our objectives were to evaluate kidney transplantation survival benefit in people aged ≥70 on renal replacement therapy (RRT) and identify their risk factors for posttransplant mortality. This study included all patients in the national French REIN registry who started RRT between 2002-2013 at age ≥70. Mortality risk was compared between patients with transplants, on the waiting-list, and on dialysis matched for age, gender, comorbidities and time on dialysis. Of the 41,716 elderly patients starting RRT, 1,219 (2...
September 11, 2018: American Journal of Transplantation
Parmjeet Randhawa, Candice Roufosse
Antibody-mediated rejection (ABMR) in a renal transplant biopsy is most often diagnosed by a combination of microvascular injury (MVI), C4d deposition and presence of circulating DSA. MVI designates the leucocyte margination reaction in glomeruli (glomerulitis, Banff score g) and in peritubular capillaries (peritubular capillaritis, Banff score ptc). MVI (sum of Banff scores g+ptc) is a morphological feature rather than a diagnosis, and is not specific for ABMR. This article is protected by copyright. All rights reserved...
September 11, 2018: American Journal of Transplantation
Ingrid Gan, Jifu Jiang, Dameng Lian, Xuyan Huang, Benjamin Fuhrmann, Winnie Liu, Aaron Haig, Anthony M Jevnikar, Zhu-Xu Zhang
Transplantation is invariably associated with programmed cell death including apoptosis and necrosis, resulting in delayed graft function and organ rejection. We have demonstrated the contribution of necroptosis to mouse microvascular endothelial cells (MVEC) death and transplant rejection. Organ injury results in the opening of mitochondrial permeability transition pore (mPTP) that can trigger apoptotic molecules release that ultimately result in cell death. The effect of mPTP in the necroptotic pathway remains controversial...
September 11, 2018: American Journal of Transplantation
Joseph R Scalea, Stephen Restaino, Matthew Scassero, Stephen T Bartlett, Norman Wereley
Technical, immunologic, and patient care advancements have improved transplant outcomes, but geography and organ transportation remain impediments to access to transplantation. Organs are moved using a complex network of couriers, commercial aircraft, and transplant personnel. Reliance on commercial aircraft schedules and couriers add cold ischemia time (CIT) and may prohibit transplantation altogether.1 Private charters can be used, however this comes at great expense. This article is protected by copyright...
September 11, 2018: American Journal of Transplantation
Ana Ivkovic, Sarah Wakeman
Opioid use disorder (OUD) is an increasing public health problem. Transplant centers worldwide are being confronted with increasing numbers of patients with opioid use disorder and end stage organ disease. Opioid agonist therapy (OAT; i.e. methadone, buprenorphine, and buprenorphine/naloxone) is a scientifically proven, effective, physician-prescribed treatment for OUD. Although data in transplant populations remains limited, studies suggest that OAT does not appear to negatively affect graft or patient survival...
September 7, 2018: American Journal of Transplantation
Jonathan A Fridell, Silke Niederhaus, Michael Curry, Read Urban, Abigail Fox, Jon Odorico
Patient Survival following Pancreas After Kidney transplantation (PAK) has been reported to be inferior to patient survival following Simultaneous Pancreas and Kidney transplantation (SPK). This analysis examines national data to further explore allograft (kidney and pancreas) and patient survival after PAK. Kaplan-Meier and Cox proportional Hazard models were used to analyze OPTN data from 1995-2010. The analysis compared PAK and SPK candidates and recipients. Kaplan-Meier analysis demonstrated that PAK following either a living or deceased donor kidney transplant is associated with increased kidney graft survival compared to Type 1 diabetic recipients who only received a kidney...
September 6, 2018: American Journal of Transplantation
Florian Lemaitre, Camille Tron, Caroline Jezequel, Marie-Clémence Verdier, Michel Rayar
We read with great interest the article of Gueta and colleagues and we wanted to congratulate the authors for this first observation of intra-patient variability (IPV) impact on clinical outcomes in heart transplant (HTx) recipients (1). Indeed, in their retrospective study conducted in 72 HTx patients, the authors found that the coefficient of variation (CV) of tacrolimus (TAC) whole-blood trough concentrations measured between 3 and 12 months is associated with worst mid- to long-term (total rejection score after the first year post-transplantation that is the sum of all biopsies grades divided by the number of biopsies; 0...
September 6, 2018: American Journal of Transplantation
Peter V Chin-Hong
Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide, and the cause of anogenital warts. More than 80% of sexually active adults are infected at some point. Although most acquired HPV infection is transient because of a successful CD4+ T cell-dominated Th1 response, in some individuals HPV can persist, become latent and cause disease. One important at-risk population is immunosuppressed patients. HIV-infected and transplant recipients have a disproportionate burden of anogenital warts for two reasons...
September 6, 2018: American Journal of Transplantation
Tao Liao, Yannan Zhang, Jie Ren, Haofeng Zheng, Hongjun Zhang, Xiujie Li, Xiaonan Liu, Tinghui Yin, Qiquan Sun
Antibody-mediated rejection (AMR) has emerged as a major cause of renal allograft dysfunction. C4d, a specific marker for AMR diagnosis, was strongly recommended for routine surveillance; however, currently, C4d detection is dependent upon tissue biopsy, which is invasive and only provides local semi-quantitative data. Targeted ultrasound imaging has been extensively used for noninvasive and real-time molecular detection with advantages of high specificity and sensitivity. In this study, we designed C4d-targeted microbubbles using a streptavidin-biotin conjugated method and detected C4d deposition in vivo in a rat model of AMR by enhanced ultrasound imaging...
September 1, 2018: American Journal of Transplantation
Kadiyala V Ravindra, Scott Sanoff, Deepak Vikraman, Ahmad Zaaroura, Aditya Nanavati, Debra Sudan, William Irish
Delayed graft function (DGF) is a risk factor for acute rejection (AR) in renal transplant recipients and KDIGO guidelines suggest use of lymphocyte depletion induction when DGF is anticipated. We analyzed the UNOS/OPTN database to assess the impact of induction immunosuppression on the risk of AR in deceased kidney recipients based on pre-transplant risk of DGF using a validated model. Subjects were categorized into 4-groups based upon the induction immunosuppression: 1. Rabbit anti-thymocyte globulin (rATG), 2...
September 1, 2018: American Journal of Transplantation
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