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Clinical Transplants

Michiko Taniguchi, Lorita M Rebellato, Kimberly P Briley, Carl E Haisch, Paul Bolin, Nubia Banuelos, Judy Hopfield, Paul I Terasaki, Matthew J Everly
BACKGROUND: Human leukocyte antigen (HLA) antibodies are a major cause of graft loss in mismatched transplant recipients. However, the time to graft loss resulting from antibody induced injury is unpredictable. The unpredictable nature of antibodies may be related to the subclass of antibodies. In this study, HLA immunoglobulin G (IgG) subclasses were investigated to determine whether a unique IgG subclass composition could better identify those patients at eminent risk for graft loss...
2015: Clinical Transplants
José M Arreola-Guerra, Luis E Morales-Buenrostro, Natalia Castelán, Adrián de Santiago, Adriana Arvizu, Norma Gonzalez-Tableros, Mayra López, Mario Vilatobá, Julio Granados, Josefina Alberú
In complement dependent cytotoxicity crossmatch negative renal transplant candidates with human leukocyte antigen donor-specific antibodies (DSA), both the presence of DSA C1q+ and the dominant DSA fluorescence were significantly associated with a positive flow cytometry crossmatch (FXM+). The C1q+ assay was highly specific, but had low sensitivity when predicting FXM+, so the clinical significance of a FXM+ in the absence of DSA C1q+ remains to be clarified in future studies.
2015: Clinical Transplants
Tiffany E Kaiser, Rita R Alloway
Following solid organ transplant, complex, lifelong medication regimens are required to prevent allograft rejection. Estimates of medication nonadherence in transplant recipients vary and may be as high as 70%. Poor medication adherence post transplant has been recognized as a contributing factor to reduced outcomes, including rejection, graft loss, and survival. Despite the numerous identified approaches for adherence assessment, there remains no gold standard. Ongoing efforts to identify optimal immunosuppressant adherence monitoring and measuring tools in an attempt to identify at risk populations post transplantation continue; however, the link between this information and outcomes remains to be discovered...
2015: Clinical Transplants
Joseph Kahwaji, Jua Choi, Ashley Vo, Stanley C Jordan
Desensitization therapies evolved more than a decade ago to deal with the growing numbers of highly human leukocyte antigen sensitized patients who have an immunologic barrier to successful transplantation. Two protocols have evolved and have been adopted for primary desensitization. These include high dose intravenous immune globulin (IVIG), plasma exchange + low doses IVIG +/- rituximab. These protocols have been very successful and have extended and improved the lives of numerous sensitized patients who would otherwise languish on dialysis...
2015: Clinical Transplants
Kassem Safa, Eliot Heher, Hannah Gilligan, Winfred Williams, Nina Tolkoff-Rubin, David Wojciechowski
BK virus (BKV) is a common infection encountered after kidney transplantation. BKV is associated with a spectrum of manifestations, starting with sub-clinical viruria, followed by viremia and BKV-associated nephropathy. Standard of care includes routine post-transplant screening for BK viruria and/or viremia. Both the Kidney Disease Improving Global Outcomes and the American Society of Transplantation Infectious Diseases Community of Practice have published screening recommendations. Although they vary slightly, they both highlight the importance of early detection with serial screening...
2015: Clinical Transplants
Deirdre Sawinski, Jennifer Trofe-Clark
BK virus (BKV) viremia is a common complication of kidney transplantation. In 2008, we enacted a screening protocol to detect BKV infection at our institution. The cumulative incidence of BKV viremia at our center is 24%, with most cases being detected in the first year post-transplant. We have previously identified the development of de novo donor specific antibody as a consequence of BKV infection treated with immunosuppression reduction; in this report, we confirm our prior findings and extend them to include an association of both Class I and Class II antibodies with BKV viremia...
2015: Clinical Transplants
Ramsey R Hachem
Lung transplantation rapidly evolved from an experimental to a conventional therapy for patients with end-stage lung disease. In recent years, approximately 4,000 lung transplants are performed annually worldwide. A shortage of suitable donor organs remains the main obstacle to increasing transplant volume. In addition, long-term outcomes remain disappointing, and the median survival after transplantation is approximately 6 years. Chronic rejection has clearly emerged as the leading obstacle to better outcomes beyond the first year after transplantation...
2015: Clinical Transplants
Rajil Mehta, Aravind Cherukuri, Puneet Sood, Chethan Puttarajappa, William Hoffman, Christine Wu, Nirav Shah, Sundaram Hariharan
Substantial strides have been made in improving the short-term success after kidney transplantation. Although there has been some progress, there has not been a robust improvement with respect to long-term outcomes. However, there remain many potentially modifiable transplant-specific risks to long-term patient and graft survival. In this chapter, we detail the current state of five important short-term transplant-specific clinical events. The early post-transplant events that negatively impact long-term survival discussed in this chapter are: acute T cell mediated rejection, acute antibody mediated rejection, delayed graft function, post-transplant viral infections, and recurrent and de novo diseases after transplantation...
2015: Clinical Transplants
Michael E Seifert, Roslyn B Mannon
Despite dramatic improvements in acute rejection rates and short-term allograft survival, long-term allograft survival remains unchanged in the modern era, largely due to chronic allograft injury, a progressive disease that is common across all solid organ transplantation but has no proven treatment. Studies of novel diagnostic and therapeutic strategies for chronic allograft injury have been relatively sparse, in part due to the time and expense required to conduct traditional long-term clinical studies of a variably progressive disease...
2015: Clinical Transplants
Matthew J Everly
The current half-life of a transplanted organ has not improved in a very long time. Historical reports on the causes of allograft failure have pointed to a plethora of contributing issues. However, in recent years, alloantibody-mediated injury has emerged as the major cause of allograft loss. As such, one road to advance transplant is to address this problem. There is a hope that new treatments can minimize the impact of alloantibody-mediated injury just as T-cell directed therapies developed over the last few decades have minimized the impact of T-cell mediated rejection on allograft survival...
2015: Clinical Transplants
Matthew F Cusick, Anat R Tambur
The field of histocompatibility testing has seen significant changes and advancements in the past quarter of a century. The introduction of polymerase chain reaction amplification into routine human leukocyte antigen (HLA) typing has informed us on the magnitude of polymorphism among HLA alleles. Solid phase testing for antibodies has provided unparalleled insight into antibody specificity and the role of antibody mediated rejection in transplant outcomes. Herein, we provide a brief overview of advancements in the field that are currently in progress...
2015: Clinical Transplants
Caroline C Jadlowiec, Timucin Taner
Donor organ scarcity remains a major limitation in liver transplantation and accounts for a great proportion of wait list mortality. As a result, over the past decade, significant efforts have been made to increase the existing donor pool. These efforts have, in part, resulted in greater use of liver allografts following donation after cardiac death (DCD) along with suboptimal (so-called marginal) and extended criteria donors. Improved understanding of the pathophysiology underlying the inferior outcomes of the liver allografts procured after circulatory arrest has not only resulted in better selection and management of DCD donors, but has also helped in the development of mechanical perfusion strategies...
2015: Clinical Transplants
Keisha P Bonner, Yogish C Kudva, Mark D Stegall, Patrick G Dean
Pancreas transplantation can provide insulin independence, improved survival, and improved quality of life for patients with diabetes mellitus. However, there has been a steady decline in the number of pancreas transplants (either alone or with a kidney) performed in the United States over the past decade. This decline has occurred despite a steady increase in the number of diabetic patients with end stage renal disease on the kidney transplant alone waiting list. This paper will review the current status of pancreas transplantation, suggest possible explanations for the declining numbers of transplants, highlight current gaps in knowledge, and suggest possible future studies and developments aimed at increasing the application of this effective therapy...
2015: Clinical Transplants
Stanley C Jordan, Jua Choi, Ashley Vo
Kidney transplantation has emerged as the preferred treatment for end-stage renal disease. Despite excellent short-term outcomes with standard T-cell centric immunosuppression, long-term outcomes have not improved. Indeed, approximately 5,000 renal allografts fail in the United States each year. Until recently, the focus on causes for late graft failures was on calcineurin inhibitor toxicity and the effects of primary co-morbid conditions (i.e., diabetes and hypertension) or recurrent glomerular diseases. However, several recent studies have identified donor-specific antibodies and chronic antibody-mediated rejection as the primary causes of late allograft failures...
2015: Clinical Transplants
Diane D Tran, Jon Kobashigawa
Success and advances in the management of all aspects of heart disease and heart transplantation have allowed for normalcy in life, including the question as to the possibility of pregnancy in transplantation. With the growing young adult population undergoing heart transplant, pregnancy and transplantation have become an issue of importance. Despite the fact that nearly 50 years have passed since the first heart transplant, there remains to be little evidence in regard to management of pregnant heart transplant recipients...
2015: Clinical Transplants
Randall E Morris
No abstract text is available yet for this article.
2015: Clinical Transplants
Curtis Maehara, Matthew J Everly
In recent years, there have been multiple studies published on longitudinal and retrospective analysis of anti-human leukocyte antigen (anti-HLA) antibodies. The focus of these reports was to determine specific characteristics of the impact of donor specific anti-HLA antibodies (DSA) in organ transplantation. There has been a growing concern about DSA in a multitude of organ transplants. Research efforts are attempting to gain a better understanding of DSA and possible treatment implications for patients with DSA...
2015: Clinical Transplants
Jeffrey Rogers, Alan C Farney, Giuseppe Orlando, Samy S Iskandar, William Doares, Michael D Gautreaux, Scott Kaczmorski, Amber Reeves-Daniel, Amudha Palanisamy, Hany El-Hennawy, Muhammad Khan, Jason Bodner, L Beth Moraitis, Roberta Brown, Debra Felts, Robert J Stratta
Our single center experience with pancreas transplantation (PTx) over an 11+ year period is reviewed. METHODS: We retrospectively studied outcomes in 202 consecutive PTxs in 192 patients at our center. All patients received either rabbit anti-thymocyte globulin (rATG) or alemtuzumab (Alem) induction with tacrolimus/mycophenolate mofetil and tapered steroids or early withdrawal. 179 PTxs (89%) were performed with portal-enteric and 23 with systemic-enteric drainage. RESULTS: From 11/01 to 3/13, we performed 162 simultaneous kidney-PTxs (SKPT), 35 sequential PTxs after kidney, and 5 PTx alone (40 solitary PTxs, SPT)...
2015: Clinical Transplants
Soo Y Yi, Katie Shaw, Nadiesda Costa, David B Leeser
The characteristic of our diabetic population has been ever changing. No longer are our Type 1 diabetics young and thin; they too suffer from the obesity epidemic and now present later with the complications of diabetes (renal dysfunction, hypoglycemic unawareness, vision loss, neuropathy, etc.). Even with all of our medical and technological advances to combat diabetes, there are many who are not very well controlled. We evaluated the pancreas transplant recipients in the last three years at the University of Maryland to study the outcomes of these older and higher body mass index (BMI) recipients, as well as the impact of using older and higher BMI donors...
2015: Clinical Transplants
Yvonne de Vries, Iris E M de Jong, Tim A Berendsen, Ton Lisman, Henkjan J Verkade, René Scheenstra, Koen M E M Reyntjens, Marieke T de Boer, Johannes Blokzijl, Paul M G Peeters, Aad P van den Berg, Robert J Porte
The liver transplantation program of the University Medical Center Groningen in the Netherlands was started in 1979, making it one of the first programs worldwide. During the past 36 years, a total of 1478 liver transplantations have been performed, 459 of which were in children. One of the first patients transplanted in 1979 is still alive and is one of the longest surviving patients after liver transplantation worldwide. During the last decade, an increasing number of donation after circulatory death (DCD) donor livers have been accepted for transplantation...
2015: Clinical Transplants
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