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American Journal of Transplantation

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https://www.readbyqxmd.com/read/28925597/lower-tacrolimus-exposure-and-time-in-therapeutic-range-increase-the-risk-of-de-novo-donor-specific-antibodies-in-the-first-year-of-kidney-transplantation
#1
Scott Davis, Jane Gralla, Patrick Klem, Suhong Tong, Gina Wedermyer, Brian Freed, Alexander Wiseman, James E Cooper
De novo donor-specific antibodies (dnDSA) have been associated with reduced graft survival. Tacrolimus (TAC)-based regimens are the most common immunosuppression used in in clinical practice today, yet an optimal therapeutic dose to prevent dnDSA has not been established. We evaluated mean TAC C0 and TAC time in therapeutic range for the risk of dnDSA in a cohort of 538 patients in the first year of kidney transplant. A mean TAC C0 < 8 ng/ml was associated with dnDSA by 6 months (OR 2.51, 95% CI 1.32-4.79, p=0...
September 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28925596/a-kidney-offer-acceptance-decision-tool-to-inform-the-decision-to-accept-an-offer-or-wait-for-a-better-kidney
#2
Andrew Wey, Nicholas Salkowski, Walter K Kremers, Cory R Schaffhausen, Bertram L Kasiske, Ajay K Israni, Jon J Snyder
We developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and we characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). For accepted offers, Cox proportional hazards models estimated these probabilities using transplanted kidneys. For declined offers, these probabilities were estimated by considering the experience of similar candidates who declined offers and the probability that declining would lead to these outcomes...
September 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28925592/defining-a-microrna-mrna-interaction-map-for-calcineurin-inhibitor-induced-nephrotoxicity
#3
Christopher J Benway, John Iacomini
Calcineurin inhibitors induce nephrotoxicity through poorly understood mechanisms thereby limiting their use in transplantation and other diseases. Here we define a microRNA (miRNA)-messenger RNA (mRNA) interaction map that facilitates exploration into the role of miRNAs in cyclosporine-induced nephrotoxicity (CIN) and the gene pathways they regulate. Using photoactivatable ribonucleoside-enhanced crosslinking and immunoprecipitation (PAR-CLIP), we isolated RNAs associated with Argonaute 2 in the RNA-Induced Silencing Complex (RISC) of cyclosporine A (CsA) treated and control human proximal tubule cells and identified mRNAs undergoing active targeting by miRNAs...
September 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28925583/decreasing-incidence-of-cancer-after-liver-transplantation-a-nordic-population-based-study-over-three-decades
#4
A Nordin, F Åberg, E Pukkala, C R Pedersen, H H Storm, A Rasmussen, W Bennet, M Olausson, H Wilczek, B-G Ericzon, S Tretli, P-D Line, T H Karlsen, K M Boberg, H Isoniemi
Cancer remains one of the most serious long-term complications after liver transplantation (LT). Data for all adult LT patients between 1982 and 2013 was extracted from the Nordic Liver Transplant Registry. Through linkage with respective national cancer-registry data, we calculated standardized incidence ratios (SIRs) based on country, sex, calendar time, and age-specific incidence rates. Altogether 461 cancers were observed in 424 individuals out the 4246 LT patients during a mean 6.6-year follow-up. The overall SIR was 2...
September 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28925582/the-dangers-of-oversimplification-quality-metrics-and-lung-transplantation
#5
EDITORIAL
Victor van Berkel
While many aspects of medical care are learning how to cope with the sudden proliferation of publicly reported quality metrics[1], the transplant community has been interpreting this type of data for over thirty years. Under the National Organ Transplantation Act of 1984, transplant centers are required to report their candidate and recipient information to the Organ Procurement and Transplantation Network (OPTN), and that data is then analyzed by the Scientific Registry of Transplant Recipients (SRTR), with outcomes reported on a twice yearly basis on a public website (www...
September 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28898574/integrating-kidney-transplantation-into-value-based-care-for-people-with-renal-failure
#6
Benjamin E Hippen, Franklin W Maddux
Healthcare reimbursement is increasingly tied to value instead of volume, with special attention paid to resource-intensive populations such as patients with renal disease. To this end, Medicare has sponsored pilot projects to encourage providers to develop care coordination and population health management strategies to provide quality care while reducing resource utilization. In this Personal Viewpoint essay, we argue in favor of expanding one such pilot project-the Comprehensive ESRD Care (CEC) initiative-to include patients with advanced chronic kidney disease and kidney transplant recipients...
September 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28898563/direct-acting-antiviral-agents-based-regimen-for-hcv-recurrence-after-combined-liver-kidney-transplantation-results-from-the-anrs-co23-cupilt-study
#7
Sébastien Dharancy, Audrey Coilly, Claire Fougerou-Leurent, Christophe Duvoux, Nassim Kamar, Vincent Leroy, Albert Tran, Pauline Houssel-Debry, Valérie Canva, Christophe Moreno, Filoména Conti, Jérome Dumortier, Vincent Di Martino, Sylvie Radenne, Victor De Ledinghen, Louis D'Alteroche, Christine Silvain, Camille Besch, Philippe Perré, Danielle Botta-Fridlund, Claire Francoz, François Habersetzer, Hélène Montialoux, Armand Abergel, Maryline Debette-Gratien, Alexandra Rohel, Emilie Rossignol, Didier Samuel, Jean-Charles Duclos-Vallée, Georges-Philippe Pageaux
HCV infection is associated with reduced patient survival following combined liver-kidney transplantation (LKT). The aim of this study was to assess the efficacy and safety of second generation direct active antiviral (DAAs) in this difficult-to-treat population. The ANRS CO23 CUPILT study is a prospective cohort including transplant recipients with recurrent HCV treated with DAAs. The present work focused on recipients with recurrent HCV following LKT. The study population included 23 patients. All patients received at least one NS5B inhibitor (Sofosbuvir) in their antiviral regimen an average of 90 months after LKT...
September 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28898546/taking-the-challenge-a-protocolized-approach-to-optimize-pneumocystis-pneumonia-prophylaxis-in-renal-transplant-recipients
#8
K F Urbancic, F Ierino, E Phillips, P F Mount, A Mahony, J A Trubiano
While trimethoprim-sulfamethoxazole is considered first-line therapy for Pneumocystis pneumonia prevention in renal transplant recipients, reported adverse drug reactions may limit use and increase reliance on costly and less effective alternatives, often aerosolized pentamidine. We report our experience implementing a protocolized approach to trimethoprim-sulfamethoxazole adverse drug reaction assessment and rechallenge to optimize prophylaxis in this patient cohort. We retrospectively reviewed 119 patients receiving Pneumocystis pneumonia prophylaxis prior to and after protocol implementation...
September 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28898542/maximizing-donor-allocation-a-review-of-unos-region-9-donor-heart-turn-downs
#9
Donna Mancini, Daniel Goldstein, Samantha Taylor, Leway Chen, Alan Gass, Samantha DeLair, Sean Pinney
This study was performed to determine if organ selection practices for heart utilization by Region 9 transplant programs were optimal, and to identify opportunities to increase local organ recovery. A retrospective review of de-identified region-wide donor data 1/1/10-12/31/13 was performed. Over the study period 537 heart donors were identified, of which 321 (60%) were transplanted. 216 consented hearts were not used; 190 of these were not recovered, and 26 were recovered but not transplanted. 245/321 (76%) hearts were transplanted at one of 5 regional programs, 15 (5%) were transplanted out of region as primary offers, and 61 (19%) were turned down in region and exported...
September 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28898528/post-transplant-oxygen-inhalation-improves-the-outcome-of-subcutaneous-islet-transplantation-a-promising-clinical-alternative-to-the-conventional-intrahepatic-site
#10
H Komatsu, J Rawson, A Barriga, N Gonzalez, D Mendez, J Li, K Omori, F Kandeel, Y Mullen
Subcutaneous tissue is a promising site for islet transplantation, due to its large area and accessibility, which allows minimally invasive procedures for transplantation, graft monitoring, and removal of malignancies as needed. However, relative to the conventional intrahepatic transplantation site, the subcutaneous site requires a large number of islets to achieve engraftment success and diabetes reversal, due to hypoxia and low vascularity. We report that the efficiency of subcutaneous islet transplantation in a Lewis rat model is significantly improved by treating recipients with inhaled 50% oxygen, in conjunction with prevascularization of the graft bed by agarose-bFGF...
September 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28898527/voriconazole-and-squamous-cell-carcinoma-after-lung-transplantation-a-multicenter-study
#11
B Hamandi, C Fegbeutel, F P Silveira, E A Verschuuren, M Younus, J Mo, J Yan, P Ussetti, P V Chin-Hong, A Solé, C L Holmes-Liew, E M Billaud, P A Grossi, O Manuel, D J Levine, R G Barbers, D Hadjiliadis, J Aram, L G Singer, S Husain
This study evaluated the independent contribution of voriconazole to the development of squamous cell carcinoma (SCC) in lung transplant recipients, by attempting to account for important confounding factors, particularly immunosuppression. This international, multicenter, retrospective, cohort study included adult patients who underwent lung transplant during 2005-2008. Cox regression analysis was used to assess the effects of voriconazole and other azoles, analyzed as time-dependent variables, on the risk of developing biopsy-confirmed SCC...
September 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28891206/a-helpful-approach-to-organ-donation-from-end-of-life-care-to-effective-organ-transplantation
#12
LETTER
F Caballero, M Puig, J Leal, O Trejo, I Díaz, S Herrera, M Turbau, J Ris, S Benito
We read with interest the report by Witjes et al regarding the influence of end-of-life care on organ donor potential (1). The report promotes innovation in management of potential organ donors outside the ICU, particularly in patients admitted to the emergency department (ED) with acute devastating brain injury (DBI) and imminent brain death. This article is protected by copyright. All rights reserved.
September 11, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28891156/overcoming-pre-existing-alloantibody-in-renal-transplantation-improving-outcomes-while-reducing-need-and-cost
#13
EDITORIAL
A Bentall, Solomon Shlomo J Cohney
In this week's journal, Axelrod and colleagues examine costs incurred by various US centers undertaking Incompatible Live-Donor Kidney Transplantation (ILDKT) - living donor renal transplantation in the presence of preformed antibody (ies) directed against donor HLA (DSAb) [1]. As expected, cost increased as the immunological barrier intensified (as defined by solid phase and cell based assays). While certain aspects of cost recovery are specific to US health care, effectively managing humoral allo-immunity is important to all transplant clinicians, with little progress despite nearly 2 decades of ILDKT [2, 3]...
September 11, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28891113/the-impact-of-repeated-mismatches-in-kidney-transplantations-performed-after-non-renal-solid-organ-transplantation
#14
J M Côté, X Zhang, M Dahhou, R Sapir-Picchadze, B Foster, H Cardinal
The aim of this study was to determine whether kidney transplantations performed after previous non-renal solid organ transplants are associated with worse graft survival when there are repeated HLA mismatches (RMM) with the previous donor(s). We performed a retrospective cohort study using data from the Scientific Registry of Transplant Recipients. Our cohort comprised 6, 624 kidney transplantations performed between January 1(st) 1990 and January 1(st) , 2015. All patients had previously received one or more non-renal solid organ transplants...
September 11, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28889654/patient-reported-health-outcomes-in-long-term-lung-transplant-survivors-a-prospective-cohort-study
#15
A Shahabeddin Parizi, P F M Krabbe, E A M Verschuuren, R A S Hoek, J M Kwakkel-van Erp, M E Erasmus, W van der Bij, K M Vermeulen
During the last 3 decades lung transplantation (LTx) has become a proven modality to increase both survival and health-related quality of life (HRQoL) in patients with various end-stage lung diseases. Most previous studies have reported improved HRQoL shortly after LTx. With regard to long-term effects on HRQoL, however, the evidence is less solid. This prospective cohort study was started with 828 patients who were on the waiting list for LTx. Then, in a longitudinal follow-up, 370 post-LTx patients were evaluated annually for up to 15 years...
September 10, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28889651/living-donor-liver-transplantation-for-biliary-atresia-an-analysis-of-2-085-cases-in-the-registry-of-the-japanese-liver-transplantation-society
#16
Mureo Kasahara, Koji Umeshita, Seisuke Sakamoto, Akinari Fukuda, Hiroyuki Furukawa, Shotaro Sakisaka, Eiji Kobayashi, Eiji Tanaka, Yukihiro Inomata, Seiji Kawasaki, Mitsuo Shimada, Norihiro Kokudo, Hiroto Egawa, Hideki Ohdan, Shinji Uemoto
Biliary atresia (BA) is the most common indication for liver transplantation (LT) in pediatric population. This study analyzed the comprehensive factors that might influence the outcomes of patients with BA who undergo living donor LT by evaluating the largest cohort with the longest follow-up in the world. Between November 1989 and December 2015, 2,085 BA patients underwent LDLT in Japan. There were 763 male and 1,322 female recipients with a mean age of 5.9 years and body weight of 18.6 kg. The 1-, 5-, 10-, 15-and 20-year graft survival rates for the BA patients undergoing LDLT were 90...
September 10, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28889600/normothermic-ex-vivo-kidney-perfusion-for-graft-quality-assessment-prior-to-transplantation
#17
J Moritz Kaths, Mátyás Hamar, Juan Echeverri, Ivan Linares, Peter Urbanellis, Jun Yu Cen, Sujani Ganesh, Luke S Dingwell, Paul Yip, Rohan John, Darius Bagli, Istvan Mucsi, Anand Ghanekar, David Grant, Lisa A Robinson, Markus Selzner
Normothermic ex vivo kidney perfusion (NEVKP) represents a novel approach for graft preservation and functional improvement in kidney transplantation. We investigated whether NEVKP also allows graft quality assessment prior to transplantation. Kidneys from 30kg pigs were recovered in a model of heart-beating donation (HBD) (group A), following 30min of warm ischemia (WI) (group B), or 60min WI (group C) (n=5/group). Following 8hrs of NEVKP, contralateral kidneys were resected, grafts autotransplanted, and pigs followed for 3 days...
September 10, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28887863/fate-of-transplanted-lungs-is-controlled-by-immune-cells-encounter-within-pulmonary-allografts
#18
EDITORIAL
Nicolas Degauque
Lung transplantation represents a highly successful therapy for patients with end-stage lung diseases. Nevertheless, compared with other types of solid-organ transplants, the survival rate of lung transplantation is one of the lowest: 50% of patients will lose their graft 5 years after transplantation. A technically challenging mouse model of orthotopic lung transplant has been helpful in unveiling the singularity of the immune response during the course of a lung transplant(1) . This article is protected by copyright...
September 9, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28887858/liver-transplantation-equity-supply-demand-and-access
#19
EDITORIAL
David Axelrod, Heidi Yeh
Despite advances in treatment for end stage liver disease (ESLD), death from cirrhosis and chronic liver disease remains a major source of morbidity and mortality, particularly in younger patients. The National Center for Health Statistics estimates that the years of life lost prior to age 75 due to ESLD has increased from 164.1 per 100,000 in 2000 to 190.3 in 2015, exceeding life years lost from cerebrovascular disease (161.0), colorectal cancer (123.3), and HIV (50.4).(1) Liver transplantation is the sole treatment for patients with decompensated liver failure, with exceptional success among patients who make it through transplant...
September 9, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28862804/people-should-not-be-banned-from-transplantation-only-because-of-their-country-of-origin
#20
LETTER
Alvin E Roth, Kimberly D Krawiec, Siegfredo Paloyo, Obi Ekwenna, Christopher L Marsh, Alexandra J Wenig, Ty B Dunn, Michael A Rees
No abstract text is available yet for this article.
September 1, 2017: American Journal of Transplantation
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