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American Journal of Transplantation

Tim Reese, Dimitri A Raptis, Christian E Oberkofler, Olivier de Rougemont, Georg P Györi, Martina Gosteli-Peter, Philipp Dutkowski, Pierre-Alain Clavien, Henrik Petrowsky
Although aorto-hepatic conduits (AHC) provide an effective technique for arterialization in liver transplantation (LT), when the native recipient artery is unusable, various publications report higher occlusion rates and impaired outcome compared to conventional anastomoses. This systematic review and meta-analysis investigates the published evidence of outcome and risk of AHC in LT using bibliographic databases and following the PRISMA guidelines. Primary and secondary outcome were artery occlusion as well as graft and patient survival...
July 11, 2018: American Journal of Transplantation
Itai Gueta, Noa Markovits, Havatzelet Yarden-Bilavsky, Eugenia Raichlin, Dov Freimark, Jacob Lavee, Ronen Loebstein, Yael Peled
Tacrolimus, the major immunosuppressant after heart transplantation therapy is a narrow therapeutic index drug. Hence, achieving stable therapeutic steady state plasma concentrations is essential to ensure efficacy while avoiding toxicity. Whether high variability in steady state concentrations is associated with poor outcomes is unknown. We investigated the association between tacrolimus trough level variability during the first year post-heart transplantation and outcomes during and beyond the first postoperative year...
July 10, 2018: American Journal of Transplantation
P D Uva, J C Papadimitriou, C B Drachenberg, F Toniolo, A Quevedo, A C Dotta, E Chuluyan, D H Casadei
Simultaneous pancreas and kidney transplants offer significant therapeutic advantages but present a diagnostic approach dilemma in the diagnosis of rejection. Since both organs are from the same donor the kidney has been traditionally treated as the "sentinel" organ to biopsy, presumably representing the status of both allografts. Truly concurrent biopsy studies, however are needed to confirm this hypothesis. We examined 101 concurrent biopsies from 70 patients with dysfunction in either or both organs...
July 9, 2018: American Journal of Transplantation
P Bonnafous, J Marlet, C Gaudy-Graffin, A Gautheret-Dejean
David J. Epstein et al. relevantly pointed out the difficulty for recognizing the pathogenic role of HHV-6 reactivation in immunocompromised individuals.1 HHV-6 is a Betaherpesvirus containing two species, HHV-6A and HHV-6B, and exists as two forms, with community strains (seroprevalence over 90%) and inherited chromosomally integrated HHV-6 (iciHHV-6) in around 1% of the population This article is protected by copyright. All rights reserved.
July 9, 2018: American Journal of Transplantation
John J Friedewald, Sunil M Kurian, Raymond L Heilman, Thomas C Whisenant, Emilio D Poggio, Christopher Marsh, Prabhakar Baliga, Jonah Odim, Merideth M Brown, David N Ikle, Brian D Armstrong, Jane I Charette, Susan S Brietigam, Nedjema Sustento-Reodica, Lihui Zhao, Manoj Kandpal, Daniel R Salomon, Michael M Abecassis
Non-invasive biomarkers are needed to monitor stable patients following kidney transplantation (KT), as sub-clinical acute rejection (subAR), currently detectable only with surveillance biopsies can lead to chronic rejection and graft loss. We conducted a multi-center study to develop a blood-based molecular biomarker for subAR using peripheral blood paired with surveillance biopsies and strict clinical phenotyping algorithms for discovery and validation. At a predefined threshold, 72-75% of KT recipients achieved a negative biomarker test correlating with the absence of subAR (NPV: 78-88%), while a positive test was obtained in 25-28% correlating with the presence of subAR (PPV: 47-61%)...
July 9, 2018: American Journal of Transplantation
Amelia G Mociornita, Mitchell B Adamson, Laura C Tumiati, Heather J Ross, Vivek Rao, Diego H Delgado
Human Leukocyte Antigen-G (HLA-G) expression is modulated by immunosuppressant use and is associated with lower incidence of graft rejection and cardiac allograft vasculopathy (CAV). We examined if everolimus induces HLA-G expression and inhibits human coronary artery smooth muscle cell (HCASMC) proliferation, a critical event in CAV. Also, we examined if TNFα-stimulated neutrophil adhesion is inhibited by HLA-G on human coronary artery endothelial cells (HCAECs). HLA-G expression in HCASMCs following everolimus treatment was determined by Western-blot densitometric analysis...
July 9, 2018: American Journal of Transplantation
Hemant Sharma, Ajay Sharma, Raman Dhanda, Sanjay Mehra
We read the article "The influence of socioeconomic deprivation on outcomes in pancreas transplantation in England: Registry data analysis" authored by Asderakis et al from the Cardiff Group by great interest [1]. They have pertinently proved that socioeconomic deprivation is a factor for pancreas graft and patient survival. This article is protected by copyright. All rights reserved.
July 9, 2018: American Journal of Transplantation
Cyril Garrouste, Julien Baudenon, Philippe Gatault, Bruno Pereira, Isabelle Etienne, Antoine Thierry, Nora Szlavik, Julien Aniort, Marion Rabant, Céline Lambert, Johnny Sayegh, Julie Oniszczuk, Dany Anglicheau, Anne Elisabeth Heng
The diagnosis of disseminated intravascular coagulation (DIC) is often considered to be a contraindication to organ donation. The aim of this study was to evaluate the impact of DIC+ donors on kidney recipient (KR) evolution. We identified 169 KRs with DIC+ brain-dead donors between 01/1996 and 12/2012 in 6 French transplant centers. Individuals were matched using propensity scores to 338 recipients with DIC- donors according to donor age and sex, whether expanded criteria for the donor existed, graft year, and transplantation center...
July 7, 2018: American Journal of Transplantation
David F Pinelli, Andrea A Zachary, John J Friedewald, David W Gjertson, Michelle D Evans, Erik N Chatroop, Mary S Leffell, Ashley A Vo, Stanley C Jordan, Robert A Montgomery, Anat R Tambur
Currently, the ability to predict or monitor efficacy of HLA antibody removal therapies is deficient. We previously reported that titration studies are a consistent and accurate means of assessing antibody strength. To test whether titration studies can also predict which patients are better candidates for desensitization, we studied 38 patients from 3 centers (29 receiving plasmapheresis/low-dose IVIg; 9 patients receiving high-dose IVIg). For patients undergoing plasmapheresis/low-dose IVIg, antibody titer reduction correlated with number of treatment cycles for both Class I and II antibodies, but only up to approximately 4 cycles...
July 7, 2018: American Journal of Transplantation
Imeshi Wijetunga, Clare Ecuyer, Sonsoles Martinez-Lopez, Muhammad Jameel, Richard J Baker, Matthew Wellberry-Smith, Chirag Patel, Michael Weston, Niaz Ahmad
Kidney transplants from young paediatric donors are uncommonly performed in the UK. Published literature of kidney transplant from donors under 5kg in weight is sparse. We present our initial experience of en bloc kidney transplantation (EKT) from donors under 20kg in weight including neonatal donors. All recipients undergoing EKT from donors under 20kg at our centre from January 2005 to October 2016 were included. Donor and recipient details were recorded from a prospective database. Electronic patient records were examined for follow-up data...
July 7, 2018: American Journal of Transplantation
Philip G Thomas
In the article " MELD as a metric for survival benefit of liver transplantation. AJT 2018;18:1231-1237", the authors have put forth a vast amount of statistical evidence to support their hypothesis that with higher MELD scores, the calculated survival benefit of liver transplant is increased. The sickest patients, who have the shortest expected life span on the waiting list, have always been considered highest priority for liver transplant(2) . Despite higher post operative mortality than patients coming from home in a more stable condition, immediate survival benefit has justified this policy...
July 7, 2018: American Journal of Transplantation
G J Webb, J Hodson, A Chauhan, J O'Grady, J M Neuberger, G M Hirschfield, J W Ferguson
In the United States, distance from liver transplant center correlate with worsened outcomes; the effects of geography elsewhere are unassessed. We performed a national registry analysis of United Kingdom listings for liver transplantation (1995-2014) and assessed whether the travel time to transplant center correlates with outcome. 11,188 listings were assessed (8,490 transplanted), with a median travel time to center of 60mins(36-86). Of the national population, 3.38×107 (55.1%) reside ≥60mins from a center, and 7...
July 7, 2018: American Journal of Transplantation
Dhiren Kumar, Idris Yakubu, Richard H Cooke, Philip F Halloran, Gaurav Gupta
There is scant literature on the use of belatacept for maintenance immunosuppression in patients with non-kidney solid organ transplants. We report the case of a 61-year-old female with transthyretin amyloidosis, chronic kidney disease stage 3B and amyloid polyneuropathy with chronic hypotension, who initially underwent a simultaneous heart-liver transplant (SHLT). Her post-transplant course was complicated by hypotension requiring prolonged vasopressors and then chronic use of midodrine. Her renal function deteriorated and she became hemodialysis dependent...
July 7, 2018: American Journal of Transplantation
Nicole D Ferrante, David S Goldberg
A controversial issue in the transplant community is whether or not to provide deceased donor liver.transplantation (DDLT) to non-citizen/non-residents (NCNRs) who travel for liver transplantation (LT). The expectation is that transplantation of NCNRs will not compromise access for US citizens/residents.(USCRs), and that NCNRs would have similar post-LT follow-up. This has never been formally.assessed. UNOS data from 2/27/02-12/31/16 were used to identify NCNRs and compare to USCRs, excluding Status 1 adults...
July 7, 2018: American Journal of Transplantation
Edward Y Zavala
In their recent letter to the editor, Pilch, et al. present the viewpoint that it is time for board certification for transplant pharmacists in order to standardize the field. As the field of transplantation evolved, the development of the multidisciplinary team that manages the longitudinal care of the transplant patient became a central feature. The OPTN/UNOS membership by-laws require specific non-physician members of the multidisciplinary team to include clinical transplant coordinator, mental health and social support, financial coordinator and clinical transplant pharmacist...
July 6, 2018: American Journal of Transplantation
Johannes Wedel, Sarah Bruneau, Kaifeng Liu, Sek Won Kong, Peter T Sage, David M Sabatini, Mathieu Laplante, David M Briscoe
DEPTOR is an evolutionarily conserved cell-intrinsic binding partner of mTOR that functions as a negative regulator of signaling responses. In this study, we show that DEPTOR is expressed within CD4+ T cells, and we observed that its relative level of expression modulates differentiation as well as glucose utilization within CD4+ T effectors in vitro. Using knockin mice, we also find that induced expression of DEPTOR within CD4+ T regulatory cells stabilizes Foxp3 expression, shifts metabolism towards oxidative phosphorylation and increases survival and suppressive function...
July 3, 2018: American Journal of Transplantation
Christian Manzardo, Maria C Londoño, Lluis Castells, Milagros Testillano, José Luis Montero, Judit Peñafiel, Marta Subirana, Ana Moreno, Victoria Aguilera, María Luisa González-Diéguez, Jorge Calvo-Pulido, Xavier Xiol, Magdalena Salcedo, Valentin Cuervas-Mons, José Manuel Sousa, Francisco Suarez, Trinidad Serrano, Jose Ignacio Herrero, Miguel Jiménez, José R Fernandez, Carlos Giménez, Santos Del Campo, Juan I Esteban-Mur, Gonzalo Crespo, Asunción Moreno, Gloria de la Rosa, Antoni Rimola, Jose M Miro
Direct-acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection. However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV-coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV-coinfected LT patients who received DAAs therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV-monoinfected LT recipients who received similar treatment...
July 2, 2018: American Journal of Transplantation
Katrin Kienzl-Wagner, Alejandra Rosales, Stefan Scheidl, Thomas Giner, Claudia Bösmüller, Michael Rudnicki, Rupert Oberhuber, Christian Margreiter, Afschin Soleiman, Dietmar Öfner, Stefan Schneeberger, Siegfried Waldegger
Primary focal segmental glomerulosclerosis (FSGS) recurs in up to 55% after kidney transplantation. Here, we report the successful management of recurrent FSGS. A 5-year old boy with primary FSGS received a deceased donor renal transplant. Immediate and fulminant recurrence of FSGS caused anuric graft failure resistant to plasmapheresis and rituximab. After exclusion of structural or immunological damage to the kidney by repeated biopsies, the allograft was retrieved from the first recipient on day 27 and transplanted into a 52-year old second recipient suffering from vascular nephropathy...
July 1, 2018: American Journal of Transplantation
Fatima Warsame, Christine E Haugen, Hao Ying, Jacqueline M Garonzik-Wang, Niraj M Desai, Rasheeda K Hall, Rekha Kambhampati, Deidra C Crews, Tanjala S Purnell, Dorry L Segev, Mara A McAdams-DeMarco
More than one third of U.S. adults have limited health literacy putting them at risk of adverse clinical outcomes. We evaluated the prevalence of limited health literacy among 1,578 adult kidney transplant (KT) candidates (5/2014-11/2017) and examined its association with listing for transplantation and waitlist mortality in this pilot study. Limited health literacy was assessed at KT evaluation using a standard cutoff score≤5 on the Brief Health Literacy Screen (scores range from 0-12, lower scores indicate worse health literacy)...
July 1, 2018: American Journal of Transplantation
Robert Steiner
A recent analysis of the UNOS registry in AJT by Wainright et al. identified predonation eGFR* as a risk factor for postdonation ESRD (1). Two other recent studies also seem to confirm GFR-related risks by observing that ESRD was 8-11 times more common after donation when compared to two-kidney controls (2,3). In these studies, ESRD rates may have been increased in donors by familial diseases or increased in controls by less thorough vetting. But more fundamentally, ESRD may have occurred more often in donors because nephrectomy lowered eGFR, permitting more new onset kidney diseases to reach ESRD vs...
July 1, 2018: American Journal of Transplantation
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