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American Journal of Transplantation

John R Montgomery, Dana A Telem, Seth A Waits
The obesity epidemic has gripped the transplant community. With nearly 40% of adults in the United States being obese (body mass index ≥30 kg/m2 ) and 20% being morbidly-obese (body mass index ≥35 kg/m2 ), the implications for both donors and recipients of solid organs continue to grow [1]. Nowhere is this more impactful than the candidacy of living kidney donors (LKD). As increasing numbers of obese adults present for LKD consideration and evidence of inferior outcomes among obese LKDs grows, transplant surgeons will become progressively challenged by how to manage these patients in clinic...
January 11, 2019: American Journal of Transplantation
Naim Issa, Lisa E Vaughan, Aleksandar Denic, Walter K Kremers, Harini A Chakkera, Walter Park, Arthur J Matas, Sandra J Taler, Mark D Stegall, Joshua Augustine, Andrew D Rule
It is unclear whether structural findings in the kidneys of living kidney donors predict post-donation kidney function. We studied living kidney donors who had a kidney biopsy during donation. Nephron size was measured by glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area. Age-specific thresholds were defined for low nephron number (calculated from CT and biopsy measures) and nephrosclerosis (global glomerulosclerosis, interstitial fibrosis/tubular atrophy (IF/TA), and arteriosclerosis)...
January 10, 2019: American Journal of Transplantation
Yanping Huang, Anh Dinh, Steven Heron, Allison Gasiewski, Carolina Kneib, Hilary Mehler, Michael T Mignogno, Ryan Morlen, Larissa Slavich, Ethan Kentzel, Edward C Frackelton, Jamie L Duke, Deborah Ferriola, Timothy Mosbruger, Olga A Timofeeva, Steven S Geier, Dimitri Monos
HLA typing in solid organ transplantation (SOT) is necessary for determining HLA matching status between donor-recipient pairs and assessing patients' anti-HLA antibody profiles. Histocompatibility has traditionally been evaluated based on serologically-defined HLA antigens. The evolution of HLA typing and antibody identification technologies, however, has revealed many limitations with using serological equivalents for assessing compatibility in SOT. The significant improvements to HLA typing introduced by next-generation sequencing (NGS) require an assessment of the impact of this technology on SOT...
January 8, 2019: American Journal of Transplantation
Jens Gottlieb, Claus Neurohr, Joachim Müller-Quernheim, Hubert Wirtz, Bjoern Sill, Heinrike Wilkens, Vasiliki Bessa, Christoph Knosalla, Martina Porstner, Carmen Capusan, Martin Strüber
Calcineurin inhibitor (CNI) therapy after lung transplantation increases risk of kidney failure. Early everolimus-based quadruple low CNI immunosuppression may improve renal function without compromising efficacy or safety. A prospective, randomized, open-label, 12-month multicenter trial was conducted at eight German sites. Patients 3-18 months after lung transplantation were randomized (1:1), stratified by baseline estimated glomerular filtration rate (eGFR). In the quadruple low CNI regimen, patients received everolimus (target trough level 3-5 ng/ml) with reduced CNI (tacrolimus 3-5 ng/ml or cyclosporine 25-75 ng/ml) and a cell cycle inhibitor plus prednisone...
January 7, 2019: American Journal of Transplantation
Fawaz Al Ammary, Alvin G Thomas, Allan B Massie, Abimereki D Muzaale, Ashton A Shaffer, Brittany Koons, Mohamud A Qadi, Deidra C Crews, Jacqueline Garonzik-Wang, Hai Fang, Daniel C Brennan, Krista L Lentine, Dorry L Segev, Macey L Henderson
In the United States, kidney donation from international (non-citizen/non-resident) living kidney donors (LKDs) is permitted; however, given heterogeneity of healthcare systems, concerns remain regarding international LKD practice and recipient outcomes. We studied a US cohort of 102,315 LKD transplants from 2000-2016, including 2,088 international LKDs, as reported to the Organ Procurement and Transplantation Network. International LKDs were more tightly clustered among a small number of centers than domestic LKDs (Gini coefficient 0...
January 7, 2019: American Journal of Transplantation
Roman Reindl-Schwaighofer, Alexander Kainz, Kira Jelencsics, Andreas Heinzel, Gabriela Berlakovich, Ádám Remport, Georg Heinze, Robert Langer, Rainer Oberbauer
Steroid pretreatment of deceased donors reduces inflammation in allografts and is recommended by organ procurement guidelines. The impact on long-term graft outcome, however, remains elusive. In this multicenter randomized controlled trial, 306 deceased donors providing organs for 455 renal transplant recipients were randomized to 1000mg of methylprednisolone or placebo prior to organ procurement (ISRCTN78828338). The incidence of biopsy confirmed rejection (Banff>1) at three months was 23 (10%) in the steroid and 26 (12%) in the placebo group (p=0...
January 7, 2019: American Journal of Transplantation
Christine E Haugen, Mary G Bowring, Courtenay M Holscher, Kyle R Jackson, Jacqueline Garonzik-Wang, Andrew M Cameron, Benjamin Philosophe, Mara McAdams-DeMarco, Dorry L Segev
Livers from older donors (OLD; age≥70) are risky and often declined; however, it is likely that some candidates will benefit from OLDs versus waiting for younger ones. To characterize the survival benefit of accepting OLD grafts, we used 2009-2017 SRTR data to identify 24,431 adult liver transplant (LT) candidates who were offered OLD grafts eventually accepted by someone. Outcomes from the time-of-offer were compared between candidates who accepted an OLD graft and matched controls within MELD±2 who declined the same offer...
January 7, 2019: American Journal of Transplantation
M C Martín-Delgado, F Martínez-Soba, N Masnou, J M Pérez-Villares, T Pont, M J Sánchez-Carretero, J Velasco, B De la Calle, D Escudero, B Estébanez, E Coll, A Pérez-Blanco, M D Perojo, D Uruñuela, B Domínguez-Gil
With the aim of consolidating recommendations about the practice of initiating or continuing Intensive Care measures to facilitate Organ Donation (ICOD), an ad hoc working group was established, comprised of 10 intensivists designated by the Spanish Society of Intensive Care and Coronary Units (SEMICYUC) and the Spanish National Transplant Organization (ONT). Consensus was reached in all recommendations through a deliberative process. After a public consultation, the final recommendations were institutionally adopted by SEMICYUC, ONT and the Transplant Committee of the National Health-Care System...
January 7, 2019: American Journal of Transplantation
Emily R Perito, Mercedes Martinez, Yumirle P Turmelle, Kristen Mason, Katharine M Spain, John C Bucuvalas, Sandy Feng
Although liver biopsy is the gold standard for assessing allograft health, its attendant risk has deterred its use in routine monitoring of stable liver transplant recipients during long-term follow-up. We utilized prospectively collected data on adverse events from two clinical trials of immunosuppression withdrawal to quantify the risk of liver biopsy in pediatric liver transplant recipients. The trials included 451 liver biopsies in 179 children. No biopsies led to bleeding requiring transfusion or intervention, suggesting a clinically significant bleeding risk of <0...
January 7, 2019: American Journal of Transplantation
Shivank Madan, Snehal R Patel, Omar Saeed, Daniel B Sims, Jooyoung Julia Shin, Daniel J Goldstein, Ulrich P Jorde
HIV+ patients are not routinely offered heart transplantation(HT) due to lack of adequate outcomes data. Between January-2004 and March-2017, we identified 41 adult(≥18years) HT recipients with known HIV+ serostatus at the time of transplant in UNOS and evaluated post-HT outcomes. Overall, Kaplan-Meier(KM) estimates of survival at 1 and 5 years were 85.9% and 77.3% respectively with no significant difference in bridge-to-transplant ventricular-assist-device(BTT-VAD,n=22) and no-BTT-VAD(n=19). KM estimates of cardiac allograft vasculopathy(CAV) and malignancy at 5 years were 32% and 19% respectively...
January 7, 2019: American Journal of Transplantation
Jay A Fishman
Tuberculosis remains a major infectious challenge worldwide notably in immunocompromised hosts. Guidelines for management exist. In areas with low TB endemicity, the prevalence among transplant recipients is 0.5-6.4% rising to 15.2% in highly endemic areas. Factors affecting tuberculosis incidence after transplantation include T-cell depleting therapies, treatment of graft rejection, renal insufficiency, chronic liver disease, diabetes mellitus, hepatitis C virus infection, or increased recipient age. This article is protected by copyright...
January 6, 2019: American Journal of Transplantation
Jacobo López-Abente, Esther Bernaldo-de-Quirós, Manuela Camino, Nuria Gil, Esther Panadero, Minia Campos-Domínguez, Elena Seoane-Reula, Juan M Gil-Jaurena, Marjorie Pion, Rafael Correa-Rocha
Atopic dermatitis (AD) has a high incidence in heart-transplant children, and the reason why there is more AD after transplantation is still unknown. We conducted a cross-sectional study comparing 11 AD and 11 non-AD age-matched heart-transplant children, to assess which immune alterations are related with AD in these patients. AD patients had been transplanted at a younger age compared to non-AD, indicating that age at transplant may be determinant in the onset of AD. The earlier thymectomy in AD heart-transplant children favoured the presence of more differentiated phenotypes in the T-cell compartment...
January 4, 2019: American Journal of Transplantation
Kevin Lam, Eric A Coomes, Mélissa Nantel-Battista, Jessica Kitchen, An-Wen Chan
Guidelines recommend annual dermatology screening after solid organ transplantation to facilitate early detection of keratinocyte carcinoma (non-melanoma skin cancer), the most common post-transplant malignancy. There are limited data on adherence levels and barriers to screening. We conducted a cross-sectional survey of 477 physicians and nurses providing post-transplant care in Canada. The questionnaire asked about skin cancer screening and education practices, including the perceived importance and barriers...
January 2, 2019: American Journal of Transplantation
Jeffrey Campsen, Tyler Call, Chelsea McCarty Allen, Angela P Presson, Eryberto Martinez, George Rofaiel, Robin D Kim
Opioid exposure is a concern after live donation for kidney transplant. We theorized that an Enhanced Recovery After Surgery pathway (ERAS) using pregabalin pre-operation to desensitize nerves followed by the NSAID, ketorolac, during and after surgery can control pain thus requiring less perioperative narcotic need. The aim of this study was to determine if the use of a non-opioid analgesics ERAS protocol for donor nephrectomies could decrease the use of narcotics without an increase in complications compared to standard of care (SOC)...
December 27, 2018: American Journal of Transplantation
Ana Isabel Sánchez-Fructuoso, Isabel Pérez-Flores, Francisco Del Río, Jesús Blázquez, Natividad Calvo, Maria Ángeles Moreno de la Higuera, Angel Gómez, Santiago Alonso-Lera, Ana Soria, Manuel González, Ervigio Corral, Alonso Mateos, Jesús Moreno-Sierra, Cristina Fernández Pérez
Despite good long term outcomes of kidney transplants from controlled donation after circulatory death (DCD) donors, there are few uncontrolled DCD (uDCD) programs. This longitudinal study compares outcomes for all uDCD (N=774) and all donation after brain death (DBD) (N=613) kidney transplants performed from 1996 to 2015 at our center. DBD transplants were divided into those from standard-criteria (SCD) (N=366) and expanded-criteria (N=247) brain dead donors (ECD). One-, five- and ten year graft survival rates were: 91...
December 27, 2018: American Journal of Transplantation
Brittany A Shelton, Gideon Berdahl, Deirdre Sawinski, Benjamin P Linas, Peter P Reese, Margaux N Mustian, Rhiannon D Reed, Paul A MacLennan, Jayme E Locke
End-stage renal disease (ESRD) patients co-infected with HCV and HIV have access to effective treatment options for HCV infection. However, they also have access to HCV-infected kidneys, which historically afford shorter times to transplantation. Given high waitlist mortality and rapid progression of liver fibrosis among co-infected kidney-only transplant candidates identifying the optimal treatment strategy is paramount. Two strategies, treatment pre- and post-transplant, were compared using Monte Carlo microsimulation of 1,000,000 candidates...
December 27, 2018: American Journal of Transplantation
Christopher J E Watson, Fiona Hunt, Simon Messer, Ian Currie, Stephen Large, Andrew Sutherland, Keziah Crick, Stephen J Wigmore, Corrina Fear, Sorina Cornateanu, Lucy V Randle, John D Terrace, Sara Upponi, Rhiannon Taylor, Elisa Allen, Andrew J Butler, Gabriel C Oniscu
Livers from controlled donation after circulatory death (DCD) donors suffer a higher incidence of non-function, poor function, and ischemic cholangiopathy. In situ normothermic regional perfusion (NRP) restores a blood supply to the abdominal organs after death using an extracorporeal circulation for a limited period before organ recovery. We undertook a retrospective analysis to evaluate whether NRP was associated with improved outcomes of livers from DCD donors. NRP was performed on 70 DCD donors from which 43 livers were transplanted...
December 27, 2018: American Journal of Transplantation
Thibaud Garcin, Anne-Sophie Gauthier, Emmanuel Crouzet, Zhiguo He, Pascal Herbepin, Chantal Perrache, Sophie Acquart, Fabrice Cognasse, Fabien Forest, Gilles Thuret, Philippe Gain
Optimal ex vivo corneal storage in eye banks is crucial to increase both the number of corneas suitable for graft and their intrinsic quality, mainly the number of viable endothelial cells, which dictates graft survival in recipients. With both passive storage methods used worldwide (short-term cold storage in the USA, long-term organ culture in Europe), significant endothelial cell loss is inevitable. Here we show that, with an active storage machine, also called a bioreactor, which restores two fundamental physiological parameters, intraocular pressure and medium renewal, endothelial cells survival is improved by 23% compared with organ culture after 4 weeks' storage...
December 27, 2018: American Journal of Transplantation
Yvonne de Vries, Alix P M Matton, Maarten W N Nijsten, Maureen J M Werner, Aad P van den Berg, Marieke T de Boer, Carlijn I Buis, Masato Fujiyoshi, Ruben H J de Kleine, Otto B van Leeuwen, Peter Meyer, Marius C van den Heuvel, Vincent E de Meijer, Robert J Porte
Ex situ dual hypothermic oxygenated machine perfusion (DHOPE) and normothermic machine perfusion (NMP) of donor livers may have a complementary effect when applied sequentially. While DHOPE resuscitates the mitochondria and increases hepatic ATP content, NMP enables hepatobiliary viability assessment prior to transplantation. In contrast to DHOPE, NMP requires a perfusion solution with an oxygen carrier, for which red blood cells (RBC) have been used in most series. RBC, however, have limitations and cannot be used cold...
December 26, 2018: American Journal of Transplantation
M Faraci, A Bertaina, A Dalissier, M Ifversen, A Schulz, A Gennery, B Burkhardt, I Badell Serra, C Diaz-de-Heredia, E Lanino, A C Lankester, B Gruhn, S Matthes-Martin, J S Kühl, S Varotto, C Paillard, A Guilmatre, A Sastre, M Abecasis, B Garwer, P Sedlacek, J J Boelens, Eric Beohou, P Bader
We report data obtained from a retrospective multicenter pediatric survey on behalf of the European Society for Blood and Marrow Transplantation (EBMT). Information on Solid Organ Transplantation (SOT) performed in pediatric recipients of either autologous or allogeneic hematopoietic stem cell transplantation (HSCT) between 1984 and 2016 were collected in 20 pediatric EBMT Centers (25.6%). Overall, we evaluated data on 44 SOTs following HSCT including 20 liver (LTx), 12 lung (LuTx), 6 heart (HTx), and 6 kidney (KTx) transplantations...
December 26, 2018: American Journal of Transplantation
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