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American Journal of Transplantation

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https://www.readbyqxmd.com/read/29791069/rethinking-performance-benchmarks-in-kidney-transplantation
#1
EDITORIAL
Kyle H Sheetz, Michael J Englesbe
Transplantation is a highly regulated field. Transplant centers answer to local, regional, and national authorities responsible for ensuring that patients have access to providers who give them the best chance at a good outcome. It is plausible that these efforts have contributed to improvements in kidney transplant outcomes over time. One-year patient and graft survival in the United States (U.S.) both now exceed 93%. Perhaps just as important, outcomes are more consistent. In one recent study, short-term survival rates following deceased donor kidney transplant only differed by 3% between low- and high-performing centers (1)...
May 23, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29791060/implementing-an-innovated-preservation-technology-the-american-society-of-transplant-surgeons-asts-standards-committee-white-paper-on-ex-situ-liver-machine-perfusion
#2
Cristino Quintini, Paulo Martins, Shimul Shah, Mary Killackey, Alan Reed, James Guarrera, David A Axelrod
The pervasive shortage of deceased donor liver allografts contributes to significant waitlist mortality despite efforts to increase organ donation. Ex-vivo liver perfusion appears to enhance preservation of donor organs, extending viability, and, potentially, evaluating function in organs previously considered too high risk for transplant. These devices pose novel challenges for organ allocation, safety, training, and finances. This White Paper describes the American Society of Transplant Surgeons' belief that organ preservation technology is a vital advance, but its use should not change fundamental aspects of organ allocation...
May 23, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29790292/failure-of-voriconazole-therapy-due-to-acquired-azole-resistance-in-aspergillus-fumigatus-in-a-kidney-transplant-recipient-with-chronic-necrotizing-aspergillosis
#3
Benoit Pilmis, Dea Garcia-Hermoso, Alexandre Alanio, Emilie Catherinot, Anne Scemla, Vincent Jullien, Stéphane Bretagne, Olivier Lortholary
Invasive aspergillosis (IA) affects lungs and disseminates mostly in patients with neutropenia and/or receiving immunosuppressive and steroid therapies. Despite progress in diagnosis and therapy of IA, it is still characterized by a high mortality rate. Currently, voriconazole is considered as the standard therapy for invasive aspergillosis. Over the recent years, triazole resistant Aspergillus fumigatus isolates have emerged in the environment due to the use of fungicidal agricultural products with the risk of developing IA related to a resistant isolate...
May 22, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29790290/tacrolimus-prevents-von-willebrand-factor-secretion-by-allostimulated-human-glomerular-endothelium
#4
S Béland, O Désy, R V Ung, P Vallin, E Latulippe, J Riopel, S A De Serres
Little is known about the endothelial injury caused directly by circulating donor-specific antibodies during antibody-mediated rejection. Von Willebrand factor (vWF) is a highly thrombotic glycoprotein stored in Weibel-Palade bodies in endothelial cells. It has been shown that its secretion is triggered by allostimulation. Calcineurin-like phosphatases regulate pathways involved in vWF secretion. Therefore, we hypothesized that tacrolimus would prevent alloantibody-induced glomerular lesions in part via inhibition of vWF secretion from endothelial cells...
May 22, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29790286/vascular-reconstruction-technique-of-a-perforated-portal-vein-during-a-pediatric-total-pancreatectomy-and-islet-autotransplant
#5
Kent J Peterson, Oscar K Serrano, Siobhan Flanagan, Srinath Chinnakotla
Hereditary pancreatitis (HP) is a progressive disease that can manifest in childhood with debilitating, relapsing pain. A total pancreatectomy and islet autotransplant (TPIAT) is a surgical option to relieve chronic pain while preserving the available beta-cell mass. The clinical course of HP is fraught with pancreatitis-related sequelae that can both necessitate and complicate a TPIAT. We describe a child with HP who developed a pancreatic pseudocyst-portal vein (PV) fistula. Active hemorrhage of the perforated PV into the pseudocyst and PV thrombosis complicated the planned TPIAT procedure and, preoperatively, required urgent image-guided stenting...
May 22, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29790274/polymer-scafffolds-for-pancreatic-islet-transplantion-progress-and-challenges
#6
Alexandra M Smink, Bart J de Haan, Jonathan R T Lakey, Paul de Vos
Pancreatic-islet transplantation is a safe and non-invasive therapy for Type 1 diabetes. However, the currently applied site for transplantation, i.e. the liver, is not the most optimal site for islet survival. Since the human body has shortcomings in providing an optimal site, artificial transplantation sites have been proposed. Such an artificial site could consist of a polymeric scaffold that mimics the pancreatic microenvironment and supports islet function. Recently, remarkable progress has been made in the technology of engineering scaffolds...
May 22, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29786954/urinary-metabolites-predict-prolonged-duration-of-delayed-graft-function-in-dcd-kidney-transplant-recipients
#7
S Kostidis, J R Bank, D Soonawala, E Nevedomskaya, C van Kooten, O A Mayboroda, J W de Fijter
Extending kidney donor criteria, including donation after circulatory death (DCD), has resulted in increased rates of delayed graft function (DGF) and primary nonfunction. Here, we used Nuclear Magnetic Resonance (NMR) spectroscopy to analyze the urinary metabolome of DCD transplant recipients at multiple time points (days 10, 42, 180 and 360 after transplantation). The aim was to identify markers that predict prolonged duration of functional DGF (fDGF). Forty-seven metabolites were quantified and their levels were evaluated in relation to fDGF...
May 22, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29767478/the-effect-of-share-35-on-biliary-complications-an-interrupted-time-series-analysis
#8
J N Fleming, D J Taber, D Axelrod, K D Chavin
The purpose of the Share 35 allocation policy was to improve liver transplant waitlist mortality, targeting high MELD waitlisted patients. However, policy changes may also have unintended consequences that must be balanced with the primary desired outcome. We performed an interrupted time series assessing the impact of Share 35 on biliary complications in a select national liver transplant population using the Vizient CDB/RM™ database. Liver transplants that occurred between October 2012 and September 2015 were included...
May 16, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29767455/ureterocalicostomy-with-lower-pole-nephrectomy-in-a-renal-transplant-a-case-report
#9
Rafael Haddad Astolfi, Guilherme Alonso Daud Patavino, Claudia Felipe Rosso, Helio Tedesco Silva Junior, Jose Osmar Medina Pestana, Alex Elton Meller, Wilson Aguiar
As the number of kidney transplants continues to rise, so does the number and complexities of surgical-related complications, which may be associated with increased morbidity and potentially graft loss. Ureteral stenosis, the most prevalent urological complication, may require diverse techniques for surgical correction depending on several recipient and graft abnormalities. Here we report the surgical and clinical outcomes of a 62-year-old man with a postransplant pyeloureterostomy stricture successfully treated with ureterocalycostomy after a lower pole nephrectomy...
May 16, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29767445/comparison-of-de-novo-igm-and-igg-anti-hla-dsa-between-belatacept-and-calcineurin-treated-patients-an-analysis-of-the-benefit-and-benefit-ext-trial-cohorts
#10
Matthew J Everly, Mustimbo Roberts, Robert Townsend, Robert A Bray, Howard M Gebel
Preventing conversion of donor-specific anti-HLA antibodies (DSA) from an IgM-to-IgG could a way to prevent chronic rejection. We evaluated whether belatacept-treated patients [belatacept less-intensive (LI) more-intensive (MI) regimens] have a lower rate of conversion than cyclosporine A (CsA) treated patients. We included 330 HLA mismatched patients from two phase-3 trials with either (a) complete donor/recipient HLA-A,-B,-DR, and -DQ loci typing or (b) incomplete HLA typing with IgG DSA detected pre- or post-transplant...
May 16, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29766641/tailoring-the-homing-capacity-of-human-tregs-for-directed-migration-to-sites-of-th1-inflammation-or-intestinal-regions
#11
Romy E Hoeppli, Katherine N MacDonald, Pascal Leclair, Vivian C W Fung, Majid Mojibian, Jana Gillies, Seyed M R Rahavi, Andrew I M Campbell, Sanjiv K Gandhi, Anne M Pesenacker, Gregor Reid, Chinten J Lim, Megan K Levings
Cell-based therapy with CD4+ FOXP3+ Regulatory T cells (Tregs) is a promising strategy to limit organ rejection and graft-versus-host disease. Ongoing clinical applications have yet to consider how human Tregs could be modified to direct their migration to specific inflammation sites and/or tissues for more targeted immunosuppression. We show here that stable, homing-receptor-tailored human Tregs can be generated from thymic Tregs isolated from pediatric thymus or adult blood. To direct migration to Th1-inflammatory sites, addition of IFN-γ and IL-12 during Treg expansion produced suppressive, epigenetically-stable CXCR3+ TBET+ FOXP3+ Th1-Tregs...
May 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29766640/subclinical-inflammation-phenotypes-and-long-term-outcomes-after-pediatric-kidney-transplantation
#12
Michael E Seifert, Megan V Yanik, Daniel I Feig, Vera Hauptfeld-Dolejsek, Elizabeth C Mroczek-Musulman, David R Kelly, Frida Rosenblum, Roslyn B Mannon
The implementation of surveillance biopsies in pediatric kidney transplantation remains controversial. Surveillance biopsies detect subclinical injury prior to clinical dysfunction, which could allow for early interventions that prolong allograft survival. We conducted a single-center retrospective cohort study of 120 consecutive pediatric kidney recipients, of whom 103 had surveillance biopsies ≤ 6 months post-transplant. We tested the hypothesis that subclinical inflammation (borderline or T cell-mediated rejection without clinical dysfunction) is associated with a 5-year composite endpoint of acute rejection and allograft failure...
May 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29762908/the-era-of-warm-organ-transplantation-is-coming
#13
LETTER
Zhiyong Guo, Uu En Fung, Yunhua Tang, Qiang Zhao, Zhiheng Zhang, Zebin Zhu, Shanzhou Huang, Linhe Wang, Yixi Zhang, Jie Yang, Weiqiang Ju, Dongping Wang, Lu Yang, Maogen Chen, Linwei Wu, Yi Ma, Anbin Hu, Guodong Chen, Xiaopeng Yuan, Changjie Cai, Xiaofeng Zhu, Changxi Wang, Xian C Li, Jiefu Huang, Xiaoshun He
We would like to thank Otto van Leeuwen and colleagues for their interests in our paper titled "The First Case of Ischemia-Free Organ Transplantation (IFOT) in Human: A Proof of Concept"[1,2]. We appreciate that their team considers our innovation of IFOT "a milestone in the history of organ transplantation". All conventional transplant procedures require cessation of blood supply to the donor organs, a period in which the organs become cold and hypoxic. This article is protected by copyright...
May 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29762906/response-to-it-is-time-to-revise-the-kidney-allocation-system-to-restore-the-pediatric-advantage
#14
LETTER
Brittany A Shelton, Jayme E Locke
We thank Dr. Gallo and colleagues for their support of our recent work examining the deceased donor kidney transplant rate pre- and post-implementation of the current kidney allocation system (KAS). The authors draw upon their work to highlight that pediatric recipients also experience higher rates of delayed graft function post-KAS. This article is protected by copyright. All rights reserved.
May 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29758130/pediatric-heart-transplantation-at-adult-specialty-centers-in-the-us-a-multicenter-registry-analysis
#15
Son Q Duong, Johnathan G Yabes, Jeffery J Teuteberg, Diana A Shellmer, Brian Feingold
Recent OPTN bylaw revisions mandate US transplant programs have an "approved pediatric component" in order to perform heart transplantation (HT) in patients <18 years old. The impact of this change on adolescents, a group known to be at high-risk for graft loss and nonadherence, is unknown. We studied all US pediatric (age <18 years) HT from 2000-2015 to compare graft survival between centers organized primarily for adult versus pediatric care. Centers were designated as pediatric- or adult-specialty care according to the ratio of pediatric:adult HT performed and minimum age of HT (pediatric-specialty defined as ratio>0...
May 14, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29758129/twenty-four-hour-normothermic-perfusion-of-discarded-human-kidneys-with-urine-recirculation
#16
Annemarie Weissenbacher, Letizia Lo Faro, Olga Boubriak, Maria F Soares, Ian S Roberts, James P Hunter, Daniel Voyce, Nikolay Mikov, Andrew Cook, Rutger J Ploeg, Constantin C Coussios, Peter J Friend
Transportable normothermic kidney perfusion for 24 hours or longer could enable viability assessment of marginal grafts, increased organ utilization and improved transplantation logistics. Eleven clinically-declined kidneys were perfused normothermically, six from donors after brain stem death (DBD, median cold ischemia time 33±36.9 hours) and five from donors after circulatory death (DCD, 36.2±38.3 hours): n=3 kidneys were perfused using Ringer's lactate to replace excreted urine volume, and n=8 using urine recirculation to maintain perfusate volume without fluid replenishment...
May 14, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29758123/clinical-outcomes-of-hepatitis-c-treatment-before-and-after-kidney-transplantation-and-its-impact-on-time-to-transplant-a-multi-center-study
#17
David M Chascsa, Omar Y Mousa, Surakit Pungpapong, Nan Zhang, Amy Chervenak, Sreecharita Nidamanuri, Eduardo Rodriguez, Diana Franco, Kristen Ryland, Andrew P Keaveny, Janna L Huskey, Maxwell Smith, Kunam S Reddy, C Burcin Taner, Hugo E Vargas, Bashar A Aqel
Waitlist time for kidney transplantation is long but may be shortened with the utilization of hepatitis C positive allografts. We retrospectively reviewed the course of 36 hepatitis C positive patients awaiting kidney transplantation at two large centers within the same health system, with near-identical care delivery models with the exception of timing of hepatitis C treatment, to determine the impact of timing of hepatitis C treatment on access to transplant, waitlist time and treatment efficacy and tolerability...
May 14, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29745051/innovation-in-organ-transplantation-a-meeting-report
#18
Jay A Fishman, Melissa Greenwald
This workshop targeted opportunities to stimulate transformative innovation in organ transplantation. Participants reached consensus regarding the following: 1) Mechanisms are needed to improve the coordination of policy and oversight activities, given overlapping responsibilities for transplantation and clinical investigation among federal agencies. Innovative clinical trials span traditional administrative boundaries and include stakeholders with diverse interests. Participants identified the need for a governmental inter-agency working group to coordinate nation-wide transplant-related activities...
May 9, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29745028/intellectual-and-academic-outcomes-after-pediatric-liver-transplantation-relationship-with-transplant-related-factors
#19
Soheil Afshar, Melanie Porter, Belinda Barton, Michael Stormon
As survival rates for pediatric liver transplantation continue to increase, research attention is turning towards long-term functional consequences, with particular interest in whether medical and transplant-related factors are implicated in neurocognitive outcomes. The relative importance of different factors is unclear, due to a lack of methodological uniformity, inclusion of differing primary diagnoses, variable transplant policies, and organ availability in different jurisdictions. This cross-sectional, single-site study sought to address various methodological limitations in the literature and the paucity of studies conducted outside of North America and Western Europe by examining the intellectual and academic outcomes of Australian pediatric liver transplant recipients (N = 40)...
May 9, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29745020/post-transplant-muscle-mass-measured-by-urinary-creatinine-excretion-rate-predicts-long-term-outcomes-after-liver-transplantation
#20
Suzanne P Stam, Maryse Cj Osté, Michele F Eisenga, Hans Blokzijl, Aad P van den Berg, Stephan Jl Bakker, Vincent E de Meijer
Long-term survival in orthotopic liver transplant (OLT) recipients remains impaired due to many contributing factors, among which a low pre-transplant muscle mass (or sarcopenia). However, influence of post-transplant muscle mass on survival is currently unknown. We hypothesized that post-transplant urinary creatinine excretion rate (CER), an established non-invasive marker of total body muscle mass, is associated with long-term survival after OLT. In a single-center cohort study of 382 adult OLT recipients, mean±standard deviation CER at 1 year post-transplantation was 13...
May 9, 2018: American Journal of Transplantation
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