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Current Opinion in Organ Transplantation

Peter Abrams, Matthew Cooper, Jon S Odorico
PURPOSE OF REVIEW: The volume of pancreas transplants performed annually in the United States (US) has steadily declined for more than a decade. In the face of this negative trend, efforts at several centers are underway to expand their pancreas transplant volumes through alterations in the structure and function of their pancreas transplant programs. We highlight these programmatic changes and emphasize the culture and characteristics of these high volume centers to serve as models for other centers to emulate...
July 3, 2018: Current Opinion in Organ Transplantation
Leigh A Cantrell, José Oberholzer
PURPOSE OF REVIEW: Robotic pancreas transplantation is a novel procedure that aims to reduce surgical invasiveness, and thereby limit complications related to the surgical access. Given that few centers are providing robotic transplantation, this review serves as a state of the science article to outline early experiences and highlight areas for future research. RECENT FINDINGS: Pancreas transplantation results in relatively high rates of wound and other surgical complications that are known to deleteriously impact outcomes...
July 3, 2018: Current Opinion in Organ Transplantation
Marcelo Perosa, Francisco Sergi, Huda Noujaim
PURPOSE OF REVIEW: Pancreas retransplantations are rarely carried out, and their outcomes are still debatable because of a lack of studies and clinical series on this issue. RECENT FINDINGS: In general, pancreas retransplantations achieve similar or even higher patient survival than primary transplantations; however, it should be noted that this finding may be biased, as only healthier patients are selected for retransplantation. Graft survival in retransplantations is usually lower than that in primary transplantation, but this comparison may also be biased, as most retransplantations are solitary pancreas transplantations (which are known to have lower graft survival), whereas primary transplantations are mostly simultaneous kidney-pancreas transplantations...
July 3, 2018: Current Opinion in Organ Transplantation
Christine Koval
PURPOSE OF REVIEW: LVAD infections remain a frequent complication of LVAD care and can markedly affect patient management before and after transplantation. This review highlights the standard-of-care approaches offered by recent guidelines as well as published data that may improve the care for patients with these challenging and often persistent infections. RECENT FINDINGS: Prevention and management of LVAD infections has become more standardized with updated consensus guidelines published in 2017...
July 3, 2018: Current Opinion in Organ Transplantation
Stanislaw Stepkowski
No abstract text is available yet for this article.
June 27, 2018: Current Opinion in Organ Transplantation
Paolo Antonio Grossi
PURPOSE OF REVIEW: Donor-derived transmission of infectious diseases is a well-recognized complication of solid organ transplantation (SOT). Most donor-derived disease transmissions are expected. Although uncommon, unexpected donor-derived infections can be associated with significant morbidity and mortality, and as the volume of patients undergoing SOT increases, the number of infections transmitted through organ donation can also be expected to rise. The growing gap between the number of patients waiting for transplantation and available organs continue in fact to be the number one issue facing the transplant community...
June 18, 2018: Current Opinion in Organ Transplantation
Talal M Al-Qaoud, Jon S Odorico, Robert R Redfield
PURPOSE OF REVIEW: Pancreas transplantation in type 2 diabetes mellitus (T2DM) candidates remains disproportionately lower than in type 1 diabetes mellitus (T1DM); however, outcomes in carefully selected patients mirrors that of T1DM. Despite the 2014 United Network for Organ Sharing (UNOS) eligibility criteria for simultaneous pancreas/kidney transplant (SPK) transplantation in T2DM patients, an expected increase in the number of transplants was not observed. RECENT FINDINGS: In an updated International Pancreas and Transplant Registry (IPTR) analysis, 1514 primary deceased donor pancreas transplants were performed in T2DM recipients [1995-2015, SPK 88%, pancreas after kidney (PAK) 9%, pancreas transplant alone (PTA) 3%]...
June 18, 2018: Current Opinion in Organ Transplantation
Juan Gea-Banacloche
PURPOSE OF REVIEW: The current review highlights the most relevant articles on lung infections following hematopoietic stem cell transplantation (HCT) published over the last year. Between 30 and 50% of HCT recipients will develop pulmonary infiltrates. These pulmonary complications may be infectious (caused by virus, bacteria, fungi, or protozoa) or noninfectious (e.g., fluid overload, heart failure, transfusion reactions like transfusion associated lung injury and transfusion-associated circulatory overload, drug reactions, engraftment syndrome, idiopathic pneumonia syndrome, diffuse alveolar hemorrhage, cryptogenic organizing pneumonia, and bronchiolitis obliterans syndrome)...
June 7, 2018: Current Opinion in Organ Transplantation
Reshika Dhakal, Kiran Gajurel, Jose G Montoya
PURPOSE OF REVIEW: Unlike in orthotopic heart transplant (OHT) setting where toxoplasma prophylaxis is a standard practice in pretransplant toxoplasma seronegative recipients who have received donor hearts from seropositive donors (D+/R-), there is no consensus regarding prophylaxis in non-OHT recipients. RECENT FINDINGS: The incidence of toxoplasma disease in non-OHT recipients is less than 1% but its true burden is underestimated. Among 31 cases of toxoplasma disease reported from 2004 through 2017, renal and liver transplant recipients comprised of 90% of cases...
June 6, 2018: Current Opinion in Organ Transplantation
Alexander C Wiseman, Erik Stites, Peter Kennealey
PURPOSE OF REVIEW: To define the natural history of kidney allograft loss related to recurrent diabetes following transplant, and to understand the potential benefit of pancreas transplantation upon kidney allograft survival. RECENT FINDINGS: A postulated benefit of simultaneous pancreas kidney transplant is that, unlike kidney transplant alone, euglycemia from the added pancreas allograft may confer a nephroprotective benefit and prevent recurrent diabetic nephropathy in the renal allograft...
June 6, 2018: Current Opinion in Organ Transplantation
Andrew R Pepper, Antonio Bruni, A M James Shapiro
PURPOSE OF REVIEW: Clinical pancreatic islet transplantation has evolved into a routine means to restore glycemic control in patients with type 1 diabetes mellitus (T1DM) suffering from life-threatening hypoglycemia and severe glucose liability. This chapter examines the current progress in islet transplantation while outlining the remaining limitations preventing this life-altering therapy's application to the broader T1DM population. RECENT FINDINGS: Islet transplantation has recently been demonstrated to provide superior glycemic control with reduced glucose lability and hypoglycemic events compared with standard insulin therapy...
May 29, 2018: Current Opinion in Organ Transplantation
Sebastiaan Heidt, Geert W Haasnoot, Frans H J Claas
PURPOSE OF REVIEW: Highly sensitized patients awaiting a renal transplant have a low chance of receiving an organ offer. Defining acceptable antigens and using this information for allocation purposes can vastly enhance transplantation of this subgroup of patients, which is the essence of the Eurotransplant Acceptable Mismatch program. Acceptable antigens can be determined by extensive laboratory testing, as well as on basis of human leukocyte antigen (HLA) epitope analyses. RECENT FINDINGS: Within the Acceptable Mismatch program, there is no effect of HLA mismatches on long-term graft survival...
May 24, 2018: Current Opinion in Organ Transplantation
Santiago M C Lopez, Marian G Michaels, Michael Green
PURPOSE OF REVIEW: Adenoviruses (AdVs) infection is a self-limited disease in the majority of immunocompetent children and adults, but can cause disseminated and life-threatening illness in immunocompromised hosts. This article will discuss therapeutic strategies for AdV infection in the pediatrics transplant recipient. RECENT FINDINGS: Currently, there is no FDA approved antiviral therapy for AdV infection. Accordingly, the primary initial therapy would be decreasing immunosuppression, whenever possible...
May 24, 2018: Current Opinion in Organ Transplantation
Sabina Herrera, Shahid Husain
PURPOSE OF REVIEW: The diagnosis of invasive aspergillosis remains challenging in solid organ transplants in general, and in lung transplant recipients, in particular, because of colonization. Lung transplant recipients may be over treated with antifungal drugs because of the lack of appropriate diagnostic tools. RECENT FINDINGS: A review of the new developments of diagnostic tools and whether this help distinguishing colonization from invasive disease is presented...
May 21, 2018: Current Opinion in Organ Transplantation
Raymund R Razonable
PURPOSE OF REVIEW: Cytomegalovirus (CMV) infection can be refractory to antiviral treatment. Although refractoriness can be due impaired host immunity, it can also be due to viral mutations that confer antiviral drug resistance. This article provides a succinct review of mutations in CMV genes that confer drug resistance, and offer guidance on clinical management. RECENT FINDINGS: Recent advances in medical and research technology have confirmed traditional mutations and identified novel ones that confer resistance to current antiviral drugs...
May 21, 2018: Current Opinion in Organ Transplantation
Chris Wiebe, Peter Nickerson
PURPOSE OF REVIEW: Pretransplant and posttransplant alloimmune risk assessment needs to evolve towards a precision medicine model already used in other areas of medicine. Although this has not been possible with traditional risk factors available at the time of transplant, new methods of human leukocyte antigen (HLA) molecular mismatch have generated hope that alloimmune risk assessment may be precise enough for personalized treatment strategies. RECENT FINDINGS: This review describes the various HLA molecular mismatch methods and some of the recent publications for each method...
May 18, 2018: Current Opinion in Organ Transplantation
Anat R Tambur
PURPOSE OF REVIEW: A renaissance for human leukocyte antigen (HLA) testing emerged with the understanding that donor-specific HLA antibodies play a significant role in long-term allograft survival. This renewed focus on donor/recipient histocompatibility led to a recent quest to decipher antibody responses or, as introduced into the transplantation lexicon, 'HLA-epitope matching'. RECENT FINDINGS: Whether matching is at the antigen or the epitope level, in-depth understanding of how histo-incompatibility leads to activation of an immune response is required...
May 9, 2018: Current Opinion in Organ Transplantation
René J Duquesnoy
PURPOSE OF REVIEW: This study reflects my personal experience with the characterization of human leukocyte antigen (HLA) epitopes and their significance in HLA matching for transplantation. It offers a subjective assessment what further studies are needed to have this concept be applied in the clinical setting. RECENT FINDINGS: This study addresses the structural characteristics of antibody-reactive HLA epitopes determined by different methods, eplet-associated antibody analysis and acceptable mismatching for sensitized patients and eplet immunogenicity and determination of mismatch permissibility...
August 2018: Current Opinion in Organ Transplantation
Hannah C Copley, Madhivanan Elango, Vasilis Kosmoliaptsis
PURPOSE OF REVIEW: Donor-recipient human leukocyte antigen (HLA) matching improves outcomes after solid-organ transplantation, but current assessment of HLA incompatibility is inadequate as it does not consider the relative immunogenicity of individual HLA mismatches. In this article, we review existing strategies for assessing HLA immunogenicity and discuss current challenges and future opportunities in this field. RECENT FINDINGS: Current HLA immunogenicity algorithms focus primarily on the humoral component of the alloimmune response and aim to determine a measure of 'dissimilarity' between donor and recipient HLA...
August 2018: Current Opinion in Organ Transplantation
Amanda L Hulbert, Elizabeth N Pavlisko, Scott M Palmer
PURPOSE OF REVIEW: There is increasing recognition of the importance of antibody-mediated rejection (AMR) after lung transplantation. The development of donor-specific antibodies, a key feature of AMR, occurs in approximately 30% of lung transplant recipients and is associated with poor posttransplant outcomes. This review highlights recently developed AMR diagnostic criteria in lung transplantation, potential mechanisms that mediate the development of AMR, and discusses current and emerging treatment strategies for this significant, graft-limiting complication...
June 2018: Current Opinion in Organ Transplantation
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