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Qiuheng Zhang, Michelle Hickey, Diana Drogalis-Kim, Ying Zheng, David Gjertson, Martin Cadeiras, Tam Khuu, Arnold S Baas, Eugene C Depasquale, Nancy J Halnon, Gregory Perens, Juan Alejos, Daniel Cruz, Nsair Ali, Richard Shemin, Murray Kwon, Michael C Fishbein, Abbas Ardehali, Mario Deng, Elaine F Reed
BACKGROUND: Donor specific HLA antibodies (DSA) are associated with increased rates of rejection and of graft failure in cardiac transplantation. The goal of this study was to determine the association of preformed and posttransplant development of newly detected DSA (ndDSA) with antibody mediated rejection (AMR) and characterize the clinical relevance of complement activating DSA in heart allograft recipients. METHODS: The study included 128 adult and 48 pediatric heart transplant patients transplanted between 2010 to 2013...
June 18, 2018: Transplantation
Ahmer M Hameed, Jinna Yao, Richard D M Allen, Wayne J Hawthorne, Henry C Pleass, Howard Lau
Robotic-assisted kidney transplantation (RAKT) represents the most recent innovation in the evolution of kidney transplantation surgery. Vascular techniques enabling kidney transplantation have existed since the early 20 century and contributed to the first successful open kidney transplant procedure in 1954. Technical advances have since facilitated minimally invasive laparoscopic and robotic techniques in live-donor surgery, and subsequently for the recipient procedure. This review follows the development of surgical techniques for kidney transplantation, with a special focus on the advent of robotic-assisted transplantation because of its potential to facilitate transplantation of those deemed previously too obese to transplant by standard means...
June 18, 2018: Transplantation
Nailah Seale, Suvasini Ramaswamy, Yu-Ru Shih, Inder Verma, Shyni Varghese
BACKGROUND: Given the shortage of available organs for whole or partial liver transplantation, hepatocyte cell transplantation has long been considered a potential strategy to treat patients suffering from various liver diseases. Some of the earliest approaches that attempted to deliver hepatocytes via portal vein or spleen achieved little success due to poor engraftment. More recent efforts include transplantation of cell sheets or thin hepatocyte laden synthetic hydrogels. However, these implants must remain sufficiently thin to ensure that nutrients can diffuse into the implant...
June 18, 2018: Transplantation
Michael McRae, François Bouchard-Boivin, Stéphanie Béland, Réal Noël, Isabelle Côté, Isabelle Lapointe, Julie Lesage, Eva Latulippe, Julie Riopel, Dominick Santoriello, Syed A Husain, Olivier Désy, Isabelle Houde, Ibrahim Batal, Sacha A De Serres
BACKGROUND: Since the borderline changes suspicious for acute T-cell-mediated rejection (BL) category was broadened, there has been a debate regarding the right threshold for tubulitis (t) and interstitial inflammation (i) scores. METHODS: We studied a first cohort of 111 patients with BL found on an indication biopsy between 2006 and 2016 and compared those with scores of t1i0 (BLt1i0) to those with higher scores (BL≥t1i1). A second cohort of 56 patients with BL was used for external validation...
June 18, 2018: Transplantation
Daisuke Imai, Tomoharu Yoshizumi, Kazuhito Sakata, Toru Ikegami, Shinji Itoh, Noboru Harada, Takashi Motomura, Takeo Toshima, Yohei Mano, Yuji Soejima, Yoshihiko Maehara
BACKGROUND: Although risk factors for the long-term mortality of liver transplantation are well described, there is a lack of detailed study regarding these factors for adult living donor liver transplantation (LDLT). METHODS: We retrospectively analyzed 528 adult LDLT recipients in our hospital. The risk factors were analyzed for overall deaths >5 years post-LDLT. RESULTS: Over the 20-year follow-up, 137 patients died. Patient survival at 1, 3, 5, and 10 years post-LDLT was 87...
June 13, 2018: Transplantation
Mary G Bowring, Lauren M Kucirka, Allan B Massie, Tanveen Ishaque, Sunjae Bae, Ashton A Shaffer, Jacqueline Garonzik Wang, Mark Sulkowski, Niraj Desai, Dorry L Segev, Christine M Durand
BACKGROUND: The availability of direct-acting antiviral (DAA) therapy might have impacted use of HCV-infected (HCV+) deceased-donor kidneys for transplantation. METHODS: We used 2005-2018 SRTR data to identify 18 936 candidates willing to accept HCV+ kidneys and 3348 HCV+ recipients of HCV+ kidneys. We compared willingness to accept, utilization, discard, and posttransplant outcomes associated with HCV+ kidneys between 2 treatment eras (Interferon [IFN] era: 1/1/2005-12/5/2013 versus DAA era: 12/6/2013-8/2/2018)...
June 13, 2018: Transplantation
Duilio Pagano, Ester Badami, Pier Giulio Conaldi, Aurelio Seidita, Fabio Tuzzolino, Marco Barbàra, Fabrizio di Francesco, Alessandro Tropea, Rosa Liotta, Gaia Chiarello, Angelo Luca, Salvatore Gruttadauria
BACKGROUND: The ability to predict which recipients will successfully complete their posttransplant clinical course, is crucial for liver transplant (LT) programs. The assessment of natural killer (NK) cell subset determined by flow cytometry from a monocentric series of consecutive liver perfusates (LPs) could help identify risk factors portending adverse LT outcomes. METHODS: LPs were collected during the back-table surgical time after the procurement procedures for donors after brain death (DBDs)...
June 13, 2018: Transplantation
Tarek Alhamad, John Manllo Dieck, Usman Younus, Dany Matar, Sami Alasfar, Vikas Vujjini, Devin Wall, Bilal Kanawati, Reiser Jochen, Daniel C Brennan, Nada Alachkar
BACKGROUND: Treatment of focal segmental glomerular sclerosis (FSGS) after kidney transplantation is challenging with unpredictable outcomes. The objective was to investigate the use of adrenocorticotropic hormone (ACTH) analogue gel in kidney transplant recipients with de novo or recurrent FSGS resistant to therapeutic plasma exchange and/or rituximab. METHODS: We performed a retrospective review of cases of de novo or recurrent resistant FSGS at 2 large U.S. transplant centers between April 2012 and December 2016...
June 12, 2018: Transplantation
M Delville, G Canaud, Ch Legendre
No abstract text is available yet for this article.
June 12, 2018: Transplantation
Hisamitsu Miyaaki, Satoshi Miuma, Naota Taura, Hidetaka Shibata, Ryu Sasaki, Akihiko Soyama, Masaaki Hidaka, Mitsuhisa Takatsuki, Susumu Eguchi, Kazuhiko Nakao
BACKGROUND: Posttransplant liver steatosis occurs frequently and can affect patient outcome. Our aim was to clarify the risk factors for steatosis or steatohepatitis after living donor liver transplantation (LT) through a retrospective examination of recent 100 living donor LT recipients and their liver donors. METHODS: Liver biopsy was performed at 1-year after LT and each year, thereafter, or as needed due to abnormal liver enzyme levels, with a median follow-up of 4 (2~10) years...
June 11, 2018: Transplantation
Lior Bibas, Eli Saleh, Samah Al-Kharji, Jessica Chetrit, Louis Mullie, Marcelo Cantarovich, Renzo Cecere, Nadia Giannetti, Jonathan Afilalo
BACKGROUND: Frailty assessment is recommended to evaluate the candidacy of adults referred for orthotopic heart transplantation (OHT). Psoas muscle area (PMA) is an easily measured biomarker for frailty. There has yet to be a study examining the prognostic impact of PMA in OHT patients. METHODS: In this retrospective study, pre and postoperative CT scans were retrieved for adults transplanted between 2000-2015 at a tertiary care hospital. PMA was measured on a single axial image...
June 6, 2018: Transplantation
Massimo Mangiola, Marilyn Marrari, Christopher Ensor, Martin O Spycher, Mel Berger, Adriana Zeevi
BACKGROUND: Human immunoglobulins (H-Ig) are widely used in solid organ transplantation for IgG replacement and for desensitization and treatment of antibody mediated rejection. They are obtained from plasma pools and may contain HLA antibodies that can be detrimental to transplant recipients. The goal of this study was to evaluate HLA antibodies in multiple lots of 2 commercial H-Ig preparations by. Luminex single antigen bead (SAB) and cell-based crossmatch assays. METHODS: Thirty lots of 2 commercial H-Ig products (CSL Behring, King of Prussia, PA...
June 6, 2018: Transplantation
Georg A Böhmig, Markus Wahrmann, Farsad Eskandary, Lionel Rostaing
The complement system may contribute in many ways to transplant injury, being a promising target for specific therapeutic interventions. There is evidence that the monoclonal anti-C5 antibody eculizumab is effective in the prevention and treatment of early antibody-mediated rejection (ABMR), but terminal complement blockade might be of limited efficiency in chronic rejection. Given the diversity of immunological events triggered by activation steps upstream to C5, in particular, opsonin and anaphylatoxin formation through C3 cleavage, one may argue that, in the specific context of ABMR, inhibition of antibody-triggered classical pathway (CP) activation might be beneficial...
June 4, 2018: Transplantation
Oscar K Serrano, David M Vock, Srinath Chinnakotla, Ty B Dunn, Raja Kandaswamy, Timothy L Pruett, Roger Feldman, Arthur J Matas, Erik B Finger
BACKGROUND: Recent changes in policies guiding allocation of transplant kidneys are predicted to increase sharing between distant geographic regions. The potential exists for an increase in cold ischemia time (CIT) with resulting increases in delayed graft function (DGF) and transplant-related costs (TRC). We sought to explore the impact of CIT on metrics that may influence TRC. METHODS: Between 2006 and 2014, 81,945 adult solitary deceased donor kidney transplants (KT) were performed in the United States; 477 (0...
May 31, 2018: Transplantation
Rachel M Engen, Giulia E Park, Cooper S Schumacher, Idoia Gimferrer, Paul Warner, Laura S Finn, Noel S Weiss, Jodi M Smith
INTRODUCTION: The development of de novo donor-specific antibodies (dnDSA) has been associated with rejection and graft loss in kidney transplantation, and DSA screening is now recommended in all kidney transplant recipients. However, the clinical significance of dnDSA detected by screening patients with a stable creatinine remains unclear. METHODS: 103 patients <18 years old receiving a first, kidney alone transplant between 12/1/2007 and 12/31/2013 underwent DSA screening every 3 months for 2 years posttransplant, with additional testing as clinically indicated...
May 31, 2018: Transplantation
Cesar A Keller, Andras Khoor, Douglas A Arenberg, Michael A Smith, Shaheen U Islam
BACKGROUND: Acute cellular rejection (ACR) in lung transplant recipients requires demonstration of perivascular lymphocytic infiltration in alveolar tissue samples from transbronchial biopsies (TBBs). Probe-based confocal laser endomicroscopy (pCLE) allows in vivo observation of alveolar, vascular, and cellular microstructures in the lung with potential to identify ACR. The objective of our prospective, blinded, multicenter observational study was to identify pCLE findings in patients with ACR diagnosed histopathologically by TBB...
May 29, 2018: Transplantation
Jeffrey Veale, Erik L Lum, Nick G Cowan, Melissa Wong, Kelly Skovira, Mauri Armijo, Gabriel Danovitch, Tom Mone
BACKGROUND: Procurement and retransplantation of a previously transplanted kidney reclaims a functioning organ that would otherwise have been discarded. METHODS: Case series of 3 retransplantation cases within the course of 1 calendar year. RESULTS: These cases illustrate how to overcome the immunological, logistical, and technical barriers that have thus far limited the potential of this approach. Within this series we report kidney reuse weeks and years following the original transplantation, as well as the previously undescribed 'living donation of a deceased donor kidney'...
May 29, 2018: Transplantation
Andrej A Petrov, Joseph M Pilewski
No abstract text is available yet for this article.
May 29, 2018: Transplantation
François Durand, Claire Francoz, Sumeet K Asrani, Saro Khemichian, Thomas A Pham, Randall S Sung, Yuri S Genyk, Mitra K Nadim
Since the implementation of the MELD score-based allocation system, the number of transplant candidates with impaired renal function has increased. The aims of this review are to present new insights in the definitions and predisposing factors that result in acute kidney injury (AKI), and to propose guidelines for the prevention and treatment of post liver transplantation (LT) AKI. This review is based on both systematic review of relevant literature and expert opinion. Pretransplant AKI is associated with posttransplant morbidity, including prolonged post LT AKI which then predisposes to posttransplant chronic kidney disease (CKD)...
May 29, 2018: Transplantation
Tarak Srivastava, Sundaram Hariharan, Uri S Alon, Ellen T McCarthy, Ram Sharma, Ashraf El-Meanawy, Virginia J Savin, Mukut Sharma
Kidney donors face a small but definite risk of end-stage renal disease 15-30 years postdonation. The development of proteinuria, hypertension with gradual decrease in kidney function in the donor after surgical resection of 1 kidney has been attributed to hyperfiltration. Genetic variations, physiological adaptations, and co-morbidities exacerbate the hyperfiltration-induced loss of kidney function in the years following donation. A focus on glomerular hemodynamics and capillary pressure has led to the development of drugs that target the renin-angiotensin-aldosterone system (RAAS), but these agents yield mixed results in transplant recipients and donors...
May 29, 2018: Transplantation
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