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Clinical Transplantation

Hyunwook Kwon, Young Hoon Kim, Ji Yoon Choi, Sung Shin, Joo Hee Jung, Su-Kil Park, Duck Jong Han
The Luminex test can detect low levels of donor-specific antibody (DSA) that cannot be detected by flow-cytometric crossmatching (FCXM) in kidney transplantation (KT). This study evaluated the impact of DSA on clinical outcomes in KT recipients negative on FCXM. Of 575 consecutive patients who underwent living donor KT between January 2013 and July 2016, 494 (85.9%) were DSA-negative and 81 (14.1%) were DSA-positive. Although rates of acute cellular rejection (ACR) at 1 year were similar in the two groups (P = 0...
April 20, 2018: Clinical Transplantation
Richard J Knight, Edward A Graviss, Duc T Nguyen, Samantha A Kuten, Samir J Patel, Lillian Gaber, A Osama Gaber
BACKGROUND: We sought to determine if conversion from tacrolimus/mycophenolate mofetil (TAC-MMF) to tacrolimus/mTOR inhibitor (TAC-mTOR) immunosuppression would reduce the incidences of BK and CMV viremia after kidney/pancreas (KP) transplantation. METHODS: In this single center review, the TAC-mTOR cohort (n=39) was converted at one month post-transplant to an mTOR inhibitor and reduced dose tacrolimus. Outcomes were compared to a cohort of KP recipients (n=40) maintained on TAC-MMF...
April 19, 2018: Clinical Transplantation
Deli Cui, Changjun Tan, Zhong Liu
OBJECTIVE: To investigate the characters and feasibility of continuous-interrupted suture (CIS) method for arterial anastomosis in mouse heart transplantation (MHT). METHODS: A MHT model was adopted. End-to-end anastomosis of donor ascending aorta to recipient abdominal aorta was achieved by CIS or continuous suture (CS) method. In both groups, end-to-end anastomosis of pulmonary vein to inferior vena cava (IVC) was achieved by CS. Technical indexes and histological examination were analyzed between two groups...
April 19, 2018: Clinical Transplantation
Asim Onur, Sami Akbulut, Abuzer Dirican, Burak Isik, Sezai Yilmaz
OBJECTIVE: To determine the relationship between a transplant center's experience and life-threatening or nearly life-threatening complications during living donor hepatectomy (LDH). METHODS: The medical records of 1140 patients who underwent LDH were analyzed. In order to determine the relationship between life-threatening complications and a transplant center's experience, the following comparisons between LDH cases were done: first 100 vs subsequent 100; first 100 vs subsequent 1040; first 200 vs subsequent 940; right hepatectomy vs left hepatectomy, and first 5 years of experience vs subsequent 5 years...
April 17, 2018: Clinical Transplantation
Lauren Z Rynar, Mekhala S Merchant, Daniel F Dilling
BACKGROUND: Suicidality, a term referring to suicidal ideation and/or suicide attempts, has been understudied in lung transplant recipients, despite the well-documented period of high-stress following transplantation. Understanding the full clinical picture of psychiatric morbidity before and after lung transplant is vital to supporting survival. METHODS: Suicidality among lung transplant recipients was examined through case studies of five lung transplant recipients at Loyola University Medical Center in Chicago, IL...
April 17, 2018: Clinical Transplantation
Sanjaya Kumar, Russell G Witt, Stefan G Tullius, Sayeed K Malek
OBJECTIVE: Although there are several variations of laparoscopic living donor nephrectomies, there is no consensus as to the best technique. Our objective was to describe our technique and assess the outcomes of our approach to hand-assisted laparoscopic retroperitoneal donor nephrectomies. METHODS: From July 2001 to October 2015, 507 consecutive hand-assisted laparoscopic retroperitoneal donor nephrectomies were performed. Their clinical information was retrospectively reviewed including warm ischemia time, skin incision to kidney ready time, estimated blood loss, adverse intraoperative events, and postoperative complications...
April 17, 2018: Clinical Transplantation
Evan D Adams, Nicholas J Jackson, Tim Young, Eugene C DePasquale, Leigh C Reardon
BACKGROUND: MELD-XI (Model for End-Stage Liver Disease eXcluding INR) at cardiac transplant has demonstrated prognostic survival utility, but has not been specifically validated in adult congenital heart disease (ACHD) in a registry study. METHODS: Adults undergoing first time orthotopic heart transplant from 2005-2015 in the UNOS (United Network for Organ Sharing) registry were examined in parallel: ACHD (n=543), ischemic dilated cardiomyopathy (IDCM, n=6,954) and valvular heart disease (VHD, n=355)...
April 16, 2018: Clinical Transplantation
Cybele Lara R Abad, Raymund R Razonable
BACKGROUND: Mycobacterium tuberculosis (TB) is a common pathogen worldwide, and it may cause significant infection after solid organ transplantation (SOT). We reviewed all reported TB cases to provide an update on its epidemiology, clinical presentation, management and outcome after SOT. METHODS: MEDLINE, EMBASE, and OVID were reviewed from January 1, 1998 to Dec 31, 2016 using key words tuberculosis and solid organ transplant or transplantation. RESULTS: There were 187 publications reporting 2082 cases of TB among kidney (n=1719), liver (n=253), heart (n=77), lung (n=25), and kidney-pancreas (n=8) recipients...
April 15, 2018: Clinical Transplantation
David D Aufhauser, Allison W Peng, Douglas R Murken, Seth J Concors, Peter L Abt, Deirdre Sawinski, Roy D Bloom, Peter P Reese, Matthew H Levine
INTRODUCTION: The new Kidney Allocation System (KAS) prioritizes patients based on date of dialysis initiation or wait-listing, whichever is earlier. We hypothesized that this change would increase transplant rates for patients with prolonged pre-transplant dialysis times (DT) and aimed to assess the impact of prolonged DT on post-transplant outcomes. METHODS: We used United Network for Organ Sharing registry data to assess outcomes for patients added to the renal transplant waitlist from Jan 1 1998 - Dec 31 2010 and patients transplanted from Jan 1 1998 - Dec 3 2012...
April 15, 2018: Clinical Transplantation
Sarah Jane Commander, Brian Shaw, Laura Washburn, Dor Yoeli, Abbas Rana, John A Goss
The Milan Criteria (MC) have historically determined eligibility for transplantation for hepatocellular carcinoma (HCC). The United Network for Organ Sharing (UNOS) Region 4 expanded the criteria for transplantation in HCC to include a single tumor ≤6 cm or up to 3 tumors with the largest diameter ≤5 cm and total additive diameter ≤9 cm (R4C). The aim of this study is to report the 10-year outcomes of this expanded criteria compared to MC. Transplants performed for HCC in Region 4 between October 2007 and December 2016 were reviewed using the UNOS database...
April 10, 2018: Clinical Transplantation
Marc-Antoine Allard, Carlos Castro-Benitez, Katsunori Imai, Jasmijn Selten, Alexandre Lopez, Mylène Sebagh, Antoinette Lemoine, Antonio Sa Cunha, Daniel Cherqui, Denis Castaing, Eric Vibert, René Adam
BACKGROUND: Many factors may compromise the functional recovery of a harvested potential liver for engraftment. Normothermic Machine Perfusion (NMP) can revive hepatic metabolism ex-vivo enabling subsequent transplantation. In this study, we evaluated the recovery of 11 discarded livers' function utilizing NMP. MATERIALS AND METHODS: Eleven consecutive discarded livers underwent NMP for 6 hours. Liver function recovery was defined by lactate levels of ≤ 3 mmol/l and continuous bile production...
April 10, 2018: Clinical Transplantation
Miho Horie, Pascal Salazar, Tomohito Saito, Matthew Binnie, Kristy Brock, Kazuhiro Yasufuku, Sassan Azad, Shaf Keshavjee, Tereza Martinu, Narinder Paul
Chronic lung allograft dysfunction (CLAD) is a major cause of mortality in lung transplant recipients. CLAD can be sub-divided into at least 2 subtypes with distinct mortality risk characteristics: restrictive allograft syndrome (RAS), which demonstrates increased overall computed tomography (CT) lung density in contrast with bronchiolitis obliterans syndrome (BOS), which demonstrates reduced overall CT lung density. This study aimed to evaluate a reader-independent quantitative density metric (QDM) derived from CT histograms to associate with CLAD survival...
April 10, 2018: Clinical Transplantation
Amanda Pinter Carvalheiro da Silva Boteon, Yuri Longatto Boteon, Eduardo F Vinuela, Carlos Derosas, Hynek Mergental, John R Isaac, Paolo Muiesan, Homoyoon Mehzard, Yuk Ting Ma, Tahir Shah, Darius F Mirza, M Thamara P R Perera
BACKGROUND: Loco-regional complications of transarterial chemoembolization (TACE) may adversely affect technical aspects of the liver transplantation (LT). This study reviewed the impact of those complications on postoperative outcomes encompassing implications on graft selection. METHODS: A retrospective, propensity score matching (1:1) analysis accounting for donor and recipient confounders was performed on a dataset of patients undergoing LT for hepatocellular carcinoma...
April 10, 2018: Clinical Transplantation
Guillaume Coutance, Lucas Van Aelst, Guillaume Hékimian, Charles Vidal, Philippe Rouvier, Samir Saheb, Chantal Gautreau, Pascal Leprince, Shaida Varnous
BACKGROUND: Data are scarce on the prognosis of heart allograft antibody-mediated rejection (AMR) with cardiogenic shock (CS). METHODS: We performed a retrospective, single center, observational study. We included patients with biopsy proven AMR and CS. We aimed to analyze the characteristics, treatment and prognosis of patients treated for CS due to AMR. Patients alive after AMR were followed to analyze recurrences of AMR, graft function and cardiac allograft vasculopathy (CAV)...
April 7, 2018: Clinical Transplantation
William M Whited, Mickey S Ising, Jaimin R Trivedi, Matthew P Fox, Victor van Berkel
INTRODUCTION: The number of increasing deaths due to the opioid epidemic have led to a potential greater supply of organ donors. There is hesitancy to use drug intoxicated donors, and we evaluated their impact on post-transplant survival. BACKGROUND: Patients >18 years of age undergoing lung transplantation and donors from whom at least one organ was donated between January 2005 and December 2014 were selected from the United Network of Organ Sharing database...
April 6, 2018: Clinical Transplantation
Erin M Lowery, Meagan Yong, Arala Cohen, Cara Joyce, Elizabeth J Kovacs
Little is known about the alcohol habits of people with advanced lung disease. Following lung transplantation patients are asked to abstain from or minimize alcohol use. The aim of this investigation is to assess alcohol use in a cohort of patients with advanced lung disease undergoing evaluation for lung transplant. This is a prospective observational investigation comparing patient self-report of alcohol use with their responses on the Alcohol Use Disorder and Identification Test, and alcohol biomarkers collected at the time of transplant...
April 5, 2018: Clinical Transplantation
Shahnawaz M Amdani, Wei Du, Sanjeev Aggarwal
Active donor infection at time of organ procurement poses a potential infection risk and may increase post-transplant morbidity and mortality in recipients. Our hypothesis was that pediatric heart transplant recipients from blood culture positive donors (BCPD) would have increased morbidity and mortality compared to non-blood culture positive donors (NBCPD). A retrospective analyses of pediatric heart transplant recipients using the Organ Procurement and Transplant Network (OPTN) between 1987 and 2015 were conducted...
April 1, 2018: Clinical Transplantation
Hilary Miller-Handley, Grant Paulsen, David Hooper, Michael Lake, Danielle Lazear, Lara Danziger-Isakov
Since hepatitis B virus (HBV) vaccine implementation, HBV infection has significantly decreased. However, adult renal transplant recipients show a higher rate of seroreversion compared to the general population leading to HBV infection risk. Data are limited in pediatric renal transplant recipients. Retrospective data were collected to determine the seroprotection and durability of HBV vaccination in pediatric renal transplant patients from 2004-2014. One hundred subjects were categorized based on pre- and post-transplant hepatitis B surface antibody (HBsAb)...
March 30, 2018: Clinical Transplantation
J R Harris, J J Teuteberg, M A Shullo
Cardiac allograft vasculopathy is a major risk factor influencing graft loss and patient survival following orthotopic heart transplant. Allograft vasculopathy is a multifactorial process which includes both immunologic and non-immunologic mechanisms. Given the non-immunological risk factors for vasculopathy, particularly hyperlipidemia, it is intuitive that reducing a patient's LDL would help attenuate the disease process. Multiple studies have shown benefits with the use of statin therapy. However, current heart transplant guidelines do not give a specific recommendation as to what LDL goal should be achieved in this patient population...
March 30, 2018: Clinical Transplantation
Sanjaya K Satapathy, Kanak Das, Mehmet Kocak, Ryan A Helmick, James D Eason, Satheesh Nair, Jason M Vanatta
BACKGROUND: Sorafenib has shown survival benefits in patients with advanced HCC; however limited data is available on its role in OLT recipients with advanced HCC in the explant. AIM: Evaluate the role of preemptive sorafenib therapy on HCC recurrence and survival after OLT with advanced HCC on explant pathology. METHODS: We retrospectively reviewed the outcome after OLT of all HCC recipients with advanced HCC in the explant pathology from 04/2006 to 12/2012 based on preemptive treatment with sorafenib...
March 26, 2018: Clinical Transplantation
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