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Current Opinion in Organ Transplantation

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https://www.readbyqxmd.com/read/28306594/extending-normothermic-regional-perfusion-to-the-thorax-in-donors-after-circulatory-death
#1
Steven S L Tsui, Gabriel C Oniscu
PURPOSE OF REVIEW: Despite a significant increase in the utilization of donors after circulatory death (DCD), the number of organs recovered and their function are largely inferior to those from donors after brain death. This review summarizes recent advances in in-situ normothermic regional perfusion of DCD organs prior to procurement. RECENT FINDINGS: The combination of warm and cold ischemia in DCD donation are detrimental to organ function. As a consequence, the acceptance criteria are far more restrictive and many organs are discarded...
March 16, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28306593/current-concepts-for-sensitized-patients-before-transplantation
#2
Dael Geft, Jon Kobashigawa
PURPOSE OF REVIEW: Antibody allosensitization poses a major immunologic challenge for patients awaiting heart transplantation. It is associated with significant morbidity and mortality for both pretransplant and posttransplant patients by prolonging wait times to transplant and increasing posttransplant rejection and vasculopathy. Many questions remain regarding methods and interpretation of antibody detection, the relevance of sensitization in specific patient populations such as those with mechanical circulatory support and the ideal strategies for desensitization...
March 16, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28306592/bridging-the-gap-in-heart-transplantation
#3
Jacqueline M Smits, Undine Samuel, Guenther Laufer
PURPOSE OF REVIEW: Countries in Europe and in the USA are proclaiming their need for an objective allocation system that can cope with distribution of a scarce resource in a changing environment of an older donor and recipient population and of an increased number of patients on mechanical circulatory support, whose prospects are increasing. RECENT FINDINGS: The current heart allocation systems in Eurotransplant, France and the USA are all urgency tier systems, where within the same tier a first-come, first-served principle is applied...
March 16, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28301389/ex-vivo-lung-perfusion-the-model-for-the-organ-reconditioning-hub
#4
Jonathan C Yeung, Marcelo Cypel, Shaf Keshavjee
PURPOSE OF REVIEW: Lung evaluation and reconditioning by ex-vivo lung perfusion (EVLP) is becoming increasingly established. We review strategies for broader implementation of this technology to transplant centers worldwide. RECENT FINDINGS: The organ reconditioning hub model is a viable strategy for disseminating EVLP to small and large transplant centers given the well tolerated prolongation of preservation time afforded by EVLP. Regulatory and process issues remain hurdles to be overcome...
March 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28301388/cold-storage-or-normothermic-perfusion-for-liver-transplantation-probable-application-and-indications
#5
Carlo D L Ceresa, David Nasralla, Simon Knight, Peter J Friend
PURPOSE OF REVIEW: Preservation of the liver via normothermic machine perfusion (NMP) is rapidly becoming an area of great academic and clinical interest. This review focuses on the benefits and limitations of NMP and where the role for static cold storage may lie. RECENT FINDINGS: Clinical studies have recently been published reporting the use of NMP in liver preservation for transplantation. They have described the technology to be well tolerated and feasible with potentially improved posttransplant outcomes...
March 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28301387/antibody-mediated-rejection-in-heart-transplantation-new-developments-and-old-uncertainties
#6
Valentina Manfredini, Ornella Leone, Valentina Agostini, Luciano Potena
PURPOSE OF REVIEW: Antibody-mediated rejection (AMR) currently represents one of the main problems for clinical management of heart transplant because of its diagnostic complexity and poor evidences supporting treatments. RECENT FINDINGS: Disorder-based diagnosis is a cornerstone in defining AMR. The limitations of the current classification have been partially overcome by novel studies improving the description of the immune-pathological graft abnormalities, and by new molecular approaches allowing a better understanding of the mechanisms behind AMR and of its relationship with cellular rejection and chronic vasculopathy...
March 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28301386/kidney-perfusion-some-like-it-hot-others-prefer-to-keep-it-cool
#7
Ina Jochmans, Michael L Nicholson, Sarah A Hosgood
PURPOSE OF REVIEW: Machine perfusion technologies provide an opportunity for improved preservation, organ assessment, and resuscitation of damaged kidneys. This review summarizes the recent advances in hypothermic and normothermic kidney machine perfusion technologies. RECENT FINDINGS: Modifications to the perfusion conditions with the addition of oxygen during hypothermic machine perfusion can support a low level of metabolism, which in experimental settings improves graft function...
March 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28266942/personalized-treatment-in-heart-transplantation
#8
Kiran K Khush
PURPOSE OF REVIEW: We are entering the era of personalized medicine, in which pharmacogenomics and biomarker-based assays can be used to tailor diagnostic tests and drug therapies to individual patients. This new approach to patient-specific care offers the potential to maximize the efficacy of available medical treatments while reducing the incidence of adverse side effects. Here, we present approaches to personalize the care of heart transplant recipients. RECENT FINDINGS: Four strategies for personalized posttransplant care are described, including use of pharmacogenomic data to individualize the use of immunosuppressive drugs, immune monitoring to prevent acute rejection while reducing the long-term consequences of over immunosuppression, noninvasive surveillance for acute rejection, and targeted prophylaxis against opportunistic infections...
March 6, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28266941/subzero-organ-preservation-the-dawn-of-a-new-ice-age
#9
Bote G Bruinsma, Korkut Uygun
PURPOSE OF REVIEW: Herein, we review the field of subzero organ preservation with a focus on recent developments in hepatic supercooling. RECENT FINDINGS: Organ preservation is making a rapid shift from the decade old standard of storage on ice toward techniques that improve organ availability as well as preservation time. Long-term organ preservation would have tremendous benefits to the organ transplantation field, including better organ allocation, donor-recipient matching, as well as reduced preservation injury, and subsequent improvement of donor organ use...
March 6, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28266940/role-of-temperature-in-reconditioning-and-evaluation-of-cold-preserved-kidney-and-liver-grafts
#10
Thomas Minor, Charlotte von Horn, Andreas Paul
PURPOSE OF REVIEW: Organ shortage in transplantation medicine forces surgical research toward the development of more efficient approaches in organ preservation to enable the application of 'less than optimal' grafts. This review summarizes current techniques aiming to recondition cold-stored organ grafts prior to transplantation to reduce reperfusion-induced tissue injury and improve postimplantation graft function. RECENT FINDINGS: End-ischemic reconditioning has classically been attempted by cold oxygenated perfusion...
March 6, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28212160/current-controversies-in-organ-transplantation
#11
Douglas W Hanto
No abstract text is available yet for this article.
February 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28212159/liver-allocation-and-distribution-time-for-a-change
#12
Ranjit Deshpande, Ryutaro Hirose, David Mulligan
PURPOSE OF REVIEW: Liver allograft allocation has been a topic of hot debate for over a decade. New redistricting changes have been proposed by the Liver and Intestinal Transplant Committee to the existing United Network for Organ Sharing (UNOS) liver allocation policy. The basis of this new proposal is similar to the old one with an aim to distribute organs in a fair, efficient and equitable fashion. In this review, we plan to look in depth at the redistribution proposals thus far, their merits and how they may help patients who do not have adequate access to livers...
February 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28212158/an-integrated-understanding-of-the-immunology-of-allograft-inflammation
#13
Brenna Houlihan, Priscilla Cha, Michael Zasloff, Thomas M Fishbein, Alexander Kroemer
PURPOSE OF REVIEW: The purpose of this review is to summarize recent advances in our understanding of the complex immunology of intestinal transplantation and allograft rejection. RECENT FINDINGS: Recent findings highlight the importance of the intestinal microbiome for intestinal homeostasis and the role of newly discovered innate lymphoid cells in intestinal transplantation. In addition, the role of host antimicrobial Th17 responses in the pathogenesis of inflammatory bowel diseases and intestinal allograft rejection has been further elucidated...
February 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28151810/are-geographic-differences-in-transplantation-inherently-wrong
#14
Keren Ladin, Douglas W Hanto
PURPOSE OF REVIEW: Geographic variation in liver transplantation has been the subject of extensive scrutiny, reflecting concerns that location is unfairly determinative for people needing organ transplantation. Drawing upon a number of established ethical approaches, we examine whether geographic differences in access to livers are inherently unethical. RECENT FINDINGS: We posit that the ethical imperative for redistribution largely hinges upon the belief that access to organs systematically disadvantages certain identifiable groups of patients over others...
February 1, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28151809/liver-transplantation-around-the-world
#15
James F Trotter
PURPOSE OF REVIEW: In the past few years, there have been important changes in the development of liver transplantation around the world. In particular, several emerging countries have rapidly developed transplant programs. There have also been important changes in liver allocation, utilization of donors by cardiac death, and living donors. A review of the practices in different countries around the world will help provide the reader with a better appreciation of their own program as well as the recognition of potential areas of improvement based on the experience of their colleagues...
February 1, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28151808/techniques-for-abdominal-wall-reconstruction-in-intestinal-transplantation
#16
Gabriel E Gondolesi, Nicolás F Aguirre
PURPOSE OF REVIEW: One of the most important challenges in the intestinal (ITx) and multivisceral transplant (MVTx) is to achieve a successful abdominal wall closure. RECENT FINDINGS: A tension-free primary closure should be our aim. In most of the cases, we need to perform a component separation technique, alone or combined, to the use of a synthetic mesh. If those options are not feasible, the abdominal wall composite vascularized allograft transplant (AW-CVA) utilizing direct orthotopic vascularization can be considered...
February 1, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28151807/the-impact-of-antibodies-and-virtual-crossmatching-on-intestinal-transplant-outcomes
#17
Elaine Y Cheng, Bernard J DuBray, Douglas G Farmer
PURPOSE OF REVIEW: Sensitization to human leukocyte antigens (HLAs) limits access to potential donors and contributes to inferior graft survival after transplantation. In this article, we will review the effects of HLA-specific antibodies on intestinal transplant outcomes, and discuss considerations in the monitoring and treatment of anti-HLA antibodies. RECENT FINDINGS: Only a handful of studies has investigated the effects of donor-specific anti-HLA antibodies (DSAs) on intestinal allograft outcomes...
February 1, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28060025/antibody-mediated-rejection-what-is-the-clinical-relevance
#18
Rachel Hogen, Joseph DiNorcia, Kiran Dhanireddy
PURPOSE OF REVIEW: The review outlines the diagnosis, clinical implications, and treatment strategies for acute and chronic antibody-mediated rejection (AMR) after orthotopic liver transplantation (OLT). RECENT FINDINGS: A combination of clinical work-up, histopathology, C4d staining, and donor-specific antibody (DSA) should be used to diagnose AMR. The differential diagnosis for idiopathic fibrosis now includes chronic AMR. Characterization of pathogenic DSA continues to progress...
January 3, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28030433/the-case-against-imminent-death-donation
#19
Grace S Lee, Vishnu S Potluri, Peter P Reese
PURPOSE OF REVIEW: Imminent death donation (IDD) is a proposal to procure organs from patients prior to the withdrawal of life support, which is anticipated to lead to death. In this review, we outline substantial concerns that the transplant community should consider when deliberating the possibility of practicing IDD. RECENT FINDINGS: Although there are several compelling theoretical and intuitive reasons to support IDD, its application has been hindered because of inadequate definitions or protocols...
December 26, 2016: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28030432/outcomes-and-disparities-in-liver-transplantation-will-be-improved-by-redistricting-cons
#20
David Seth Goldberg, Seth Karp
PURPOSE OF REVIEW: Over the last 2 years, the liver transplant community has been debating a proposal to redraw the maps of organ distribution. The basis for these proposed changes is reported disparities in severity of illness at transplantation across the USA - however, this is based on the allocation model for end-stage liver disease score. In this review, we provide a critical overview of the redistribution proposal, its flaws and how it may worsen outcomes and exacerbate disparities in liver transplantation...
December 26, 2016: Current Opinion in Organ Transplantation
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