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American Journal of Transplantation

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https://www.readbyqxmd.com/read/28742953/invited-response-to-hyperfiltration-after-donation-and-living-kidney-donor-risk
#1
LETTER
R W Steiner
The concerns of Dr. van Londen and colleagues are well founded (1). In the future, obesity and diabetes will occur more often as young adults age and will increase the exponential growth in ESRD rates 20-30 years later. These lifetime outcomes will remain distant and difficult to predict in young candidates. The risks of post-donation hyperfiltration, i.e., an unusually high single nephron glomerular filtration rate (sngfr), have been a concern of transplant centers for decades (2). This article is protected by copyright...
July 25, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28742951/providing-better-access-to-organs-a-comprehensive-overview-of-organ-access-initiatives-from-the-asts-proactor-task-force
#2
M J Hobeika, C M Miller, T L Pruett, K A Gifford, J E Locke, A M Cameron, M J Englesbe, C S Kuhr, J F Magliocca, K R McCune, K L Mekeel, S J Pelletier, A L Singer, D L Segev
The American Society of Transplant Surgeons (ASTS) PROviding better Access To Organs (PROACTOR) Task Force was created to inform ongoing ASTS organ access efforts. Task force members were charged with comprehensively cataloguing current organ access activities and organizing them according to stakeholder type. This White Paper summarizes the task force findings and makes recommendations for future ASTS organ access initiatives. This article is protected by copyright. All rights reserved.
July 25, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28742948/microbial-metabolites-and-graft-versus-host-disease
#3
Mary Riwes, Pavan Reddy
The health of mammals is a reflection of the diversity and composition of the intestinal microbiota. Alterations in the composition and functions of the intestinal microbiota have been implicated in multiple disease processes. The impact of the microbiota in health and disease is in part a function of the nutrient processing and release of metabolites. Recent studies have uncovered a major role for microbial metabolites in the function of the host immune system by which they influence disease processes such as acute graft versus host disease (GVHD), which is the main complication of allogeneic hematopoietic cell transplantation (allo-HCT)...
July 25, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28742945/indication-of-living-donor-liver-transplantation-for-septuagenarians-from-double-equipoise-theory
#4
LETTER
T Ikegami, T Yoshizumi, M Ohira, N Harada, Y Soejima, Y Maehara
We read with great interest the article by Kwon et al from Asan Medical Center (1). The authors presented outcomes of living donor liver transplantation (LDLT) for septuagenarians with a 5-year survival rate of 69.8% and concluded that they should not be excluded from LDLT. On the other hand, at Kyushu University, we have indicated different graft and recipient selection strategies of LDLT for elderly recipients ≥ 65 years with 89.9% for 5-year survival rate (2). We have performed 12 LDLTs for septuagenarian patients (1...
July 25, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28742943/hcv-viremic-donors-with-hepatic-bridging-fibrosis-are-we-ready-to-use-their-livers-in-the-era-of-direct-acting-antivirals
#5
LETTER
S Martini, E David, F Tandoi, D Dell Olio, M Salizzoni, G M Saracco, R Romagnoli
We read with interest the report from the American Society of Transplantation Consensus Conference on the use of hepatitis C (HCV) viremic donors in solid organ transplantation, which took place in Dallas in January 2017 (1). In the interferon-era, liver grafts from HCV-positive donors with no more than periportal fibrosis (F2 Ishak) did not show an outcome disadvantage compared with HCV-negative ones (2,3). In U.S., 16.9% of HCV-positive cirrhotics currently receive an organ from HCV-positive donors, 50% of whom are viremic and expected to transmit the infection (1)...
July 25, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28742936/benefits-and-limitations-of-belatacept-in-4-hand-transplanted-patients
#6
J Grahammer, A Weissenbacher, B G Zelger, B Zelger, C Boesmueller, M Ninkovic, A Mühlbacher, I Peschel, G Brandacher, D Öfner, S Schneeberger
Belatacept (CTLA4Ig) is an emerging treatment in kidney transplantation. Lack of nephrotoxicity and possibly an inhibitory effect on the development of donor specific antibodies (DSA) make it an interesting agent in hand transplantation. In order to reduce CNI immunosuppression and preserve kidney function, we have added belatacept to the therapeutic regimen of 4 hand transplanted patients at month 4, at 6, 9, and 13 years after hand/forearm transplantation. Patients received 5mg/kg belatacept every 2 weeks, the dosing interval was extended to 4 weeks after 5 applications...
July 25, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28730633/pd-1-expression-on-cd8-t-cells-regulates-their-differentiation-within-lung-allografts-and-is-critical-for-tolerance-induction
#7
T Takahashi, H M Hsiao, S Tanaka, W Li, R Higashikubo, D Scozzi, A Bharat, J H Ritter, A S Krupnick, A E Gelman, D Kreisel
Immunological requirements for rejection and tolerance induction differ between various organs. While memory CD8(+) T cells are considered a barrier to immunosuppression-mediated acceptance of most tissues and organs, tolerance induction after lung transplantation is critically dependent on central memory CD8(+) T lymphocytes. Here we demonstrate that costimulation blockade-mediated tolerance after lung transplantation is dependent on PD-1 expression on CD8(+) T cells. In the absence of PD-1 expression, CD8(+) T cells form prolonged interactions with graft-infiltrating CD11c(+) cells, their differentiation is skewed towards an effector memory phenotype and grafts are rejected acutely...
July 20, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28727250/lack-of-adjustment-for-confounding-could-lead-to-misleading-conclusions
#8
EDITORIAL
S Christakoudi, M P Hernandez-Fuentes
In a recent issue Asare et al. (1) assess the utility of a previously identified signature of tolerance, based on the expression of two B-cell receptor genes (IGKV1D-13 and IGKV4-1). The authors set to determine the prevalence of "tolerance" predictions in treated stable kidney transplant recipients (KTRs) and "tolerance" frequency in patients with different immunosuppressant (IS) regimens. They illustrate (Figure 6), very successfully, that changes in the signature are compatible with known alterations of the B-cell compartment elicited by IS drugs...
July 20, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28726327/changing-metrics-of-organ-procurement-organization-performance-in-order-to-increase-organ-donation-rates-in-the-united-states
#9
D Goldberg, M J Kallan, L Fu, M Ciccarone, J Ramirez, P Rosenberg, J Arnold, G Segal, K P Moritsugu, H Nathan, R Hasz, P L Abt
The shortage of deceased-donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009-2012 and State Inpatient Databases (SIDs) from 2008-2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi-organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation...
July 20, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28722285/innate-allorecognition-by-monocytic-cells-and-its-role-in-graft-rejection
#10
Fadi G Lakkis, Xian C Li
Innate recognition of microbial products and danger molecules by monocytes and macrophages has been well established; this is mediated primarily by pattern recognition receptors and is central to activation of innate and adaptive immune cells required for productive immunity. Whether monocytes and macrophages are equipped with an allorecognition system that allows them to directly respond to allogeneic grafts is a topic of much debate. Recent studies provide compelling evidence that these cells are capable of recognizing allogeneic entities and mediate graft rejection via direct cytotoxicity and priming of alloreactive T cells...
July 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28719147/human-immunology-studies-using-organ-donors-impact-of-clinical-variations-on-immune-parameters-in-tissues-and-circulation
#11
D J Carpenter, T Granot, N Matsuoka, T Senda, B V Kumar, J J C Thome, C L Gordon, M Miron, J Weiner, T Connors, H Lerner, A Friedman, T Kato, A D Griesemer, D L Farber
Organ donors are sources of physiologically healthy organs and tissues for life-saving transplantation, and have been recently used for human immunology studies which are typically confined to the sampling of peripheral blood. Donors comprise a diverse population with different causes of death and clinical outcomes during hospitalization, and the effects of such variations on immune parameters in blood and tissues are not known. We present here coordinate analyses of innate and adaptive immune components in blood, lymphoid (bone marrow, spleen, lymph nodes), and mucosal (lungs, intestines) sites from a population of brain-dead organ donors (3-months-93-years; n=291) across eight clinical parameters...
July 18, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28719135/multiple-breath-washout-in-paediatric-patients-after-lung-transplantation
#12
Sylvia Nyilas, Julia Carlens, Timothy Price, Florian Singer, Carsten Müller, Gesine Hansen, Gregor Warnecke, Philipp Latzin, Nicolaus Schwerk
Forced expiratory volume in 1 second (FEV1 ) from spirometry, is the most commonly used parameter to detect early allograft dysfunction after lung transplantation (LTx). There are concerns regarding its sensitivity. Nitrogen-multiple breath washout (N2 -MBW) is sensitive at detecting early global (lung clearance index; LCI), and acinar (Sacin ) airway inhomogeneity. We investigated whether N2 -MBW indices indicate small airways pathology after LTx in children with stable spirometry. Thirty-seven children without BOS on median 1...
July 18, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28719059/pancreatic-allograft-thrombosis-suggestion-for-a-ct-grading-system-and-management-algorithm
#13
Abdul Hakeem, John Chen, Satheesh Iype, Menna Clatworthy, Christopher Watson, Edmund M Godfrey, Sara Upponi, Kourosh Saeb-Parsy
Pancreatic allograft thrombosis (PAT) remains the leading cause of non-immunological graft failure. Herein we propose a new CT grading system of PAT to identify risk factors for allograft loss and outline a management algorithm by retrospective review of consecutive pancreatic transplants between 2009-2014. Triple-phase CT scans were graded independently by two radiologists as; Grade 0 - no thrombosis, Grade 1 - peripheral thrombosis, Grade 2 - intermediate non-occlusive thrombosis and Grade 3 - central occlusive thrombosis...
July 18, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28719024/the-immunoproteasome-an-old-player-with-a-novel-and-emerging-role-in-alloimmunity
#14
S K Eskandari, M A J Seelen, G Lin, J R Azzi
Modern treatment strategies for the maintenance of allograft acceptance frequently target ubiquitously-expressed pathways, leading to significant side-effects and poor long-term allograft outcomes. Constitutive proteasome inhibitors, which have recently been introduced for the treatment of antibody-mediated rejection, target the ubiquitously-expressed proteasome. To limit off-target effects and serious mechanism-based toxicity, however, these inhibitors are administered intermittently and suboptimally. Immunoproteasomes, which are an inducible subset of proteasomes enriched in immune cells, replace constitutive proteasomes after cell exposure to proinflammatory cytokines such as interferon-γ...
July 18, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28710900/pre-kidney-transplant-lower-extremity-impairment-and-post-transplant-mortality
#15
Anthony J Nastasi, Mara A McAdams-DeMarco, Jennifer Schrack, Hao Ying, Israel Olorundare, Fatima Warsame, Alexandra Mountford, Christine E Haugen, Marlís González Fernández, Silas P Norman, Dorry L Segev
Prediction models for post-kidney transplant (KT) mortality have had limited success (C-statistics≤0.70). Adding objective measures of potentially modifiable factors may improve prediction and, consequently, KT survival through intervention. The short physical performance battery (SPPB) is an easily administered objective test of lower extremity function consisting of three parts (balance, walking speed, chair stands), each with scores of 0-4, for a composite score of 0-12, with higher scores indicating better function...
July 15, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28710896/renal-allograft-histology-at-10-years-after-transplantation-in-the-tacrolimus-era-evidence-of-pervasive-chronic-injury
#16
Mark D Stegall, Lynn D Cornell, Walter D Park, Byron H Smith, Fernando G Cosio
Improving long-term renal allograft survival remains an important unmet need. To assess the extent of histologic injury at 10 years after transplantation in functioning grafts, we studied 575 consecutive adult solitary renal transplants performed between 2002 and 2005-77% from living donors and 92% maintained on tacrolimus-based immunosuppression. Ten-year graft survival was 59% and death-censored graft survival was 74%. Surveillance allograft biopsies were assessed at implantation, 5 years and 10 years from 145 patients that reached 10 years...
July 15, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28710889/minimization-of-ischemic-cholangiopathy-in-donation-after-cardiac-death-liver-transplantation-is-it-thrombolytic-therapy-or-warm-ischemic-time-stringency-and-donor-bile-duct-flush
#17
LETTER
Emmanouil Giorgakis, Shirin Elizabeth Khorsandi, Wayel Jassem, Nigel Heaton
Donation after cardiac death (DCD) liver transplantation (LT) is the fastest expanding donor pool. Despite the promise, initial DCD experience showed discouraging outcomes(1) . Cumulative experience from aggressive LT centers re-ignited the interest in DCD LT(2) , culminating in outstanding outcomes, comparable to that of donation after brain death (DBD)(3) . This article is protected by copyright. All rights reserved.
July 15, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28707821/splenic-vein-thrombosis-following-pancreas-transplantation-identification-of-factors-that-support-conservative-management
#18
Jack W Harbell, Tara Morgan, Vickie A Feldstein, Garrett R Roll, Andrew Posselt, Sang-Mo Kang, Sandy Feng, Ryutaro Hirose, Chris E Freise, Peter Stock
Prophylaxis for graft portal/splenic venous thrombosis following pancreas transplant varies between institutions. Similarly, treatment of venous thrombosis ranges from early re-exploration to conservative management with anticoagulation. We wished to determine the prevalence of graft splenic vein (SV) thrombosis, as well as the clinical significance of non-occlusive thrombus observed on routine imaging. Records of 112 pancreas transplant recipients over a five-year period at a single center were reviewed. Venous thrombosis was defined as absence of flow or presence of thrombus identified in any part of the graft SV on ultrasound...
July 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28707779/belatacept-rescue-therapy-in-kidney-transplant-recipients-with-vascular-lesions-a-case-control-study
#19
D Bertrand, L Cheddani, I Etienne, A François, M Hanoy, C Laurent, L Lebourg, F Le Roy, L Lelandais, M C Loron, M Godin, D Guerrot
Immunosuppression in kidney transplant recipients with decreased graft function and severe histological vascular changes can be particularly challenging. Belatacept could be a valuable option, as a rescue therapy in this context. We report a retrospective case control study comparing a CNI to belatacept switch in 17 patients with vascular damage and low eGFR to a control group of 18 matched patients with CNI continuation. Belatacept switch was performed on average 51.5 months after kidney transplantation (6...
July 14, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28696079/impact-of-protease-inhibitor-based-anti-retroviral-therapy-on-outcomes-for-hiv-kidney-transplant-recipients
#20
Deirdre Sawinski, Brittany A Shelton, Shikha Mehta, Rhiannon D Reed, Paul A MacLennan, Sally Gustafson, Dorry L Segev, Jayme E Locke
Excellent outcomes have been demonstrated among select HIV-positive kidney transplant (KT) recipients with well-controlled infection, but to date no national study has explored outcomes among HIV+ KT recipients by antiretroviral therapy (ART) regimen. IMS pharmacy fills (1/1/01 - 10/1/12) were linked with SRTR data. 332 recipients with pre- and post-transplant fills were characterized by ART at time of transplant as protease inhibitor (PI) or non-PI based ART (88 PI vs. 244 non-PI). Cox proportional hazards models were adjusted for recipient and donor characteristics...
July 11, 2017: American Journal of Transplantation
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