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Current Opinion in Organ Transplantation

Sue V McDiarmid
PURPOSE OF REVIEW: This review will focus on the lessons learned over several decades of solid organ transplantation in children, and their relevance to the emerging field of pediatric VCA. Particular attention will be focused on the risk-benefit ratio of immunosuppression as it applies to children receiving a life-enhancing transplant as compared with a life-saving transplant. Potential indications for pediatric VCA will be considered. RECENT FINDINGS: The report in 2015 of the first child to receive a VCA, bilateral upper extremity grafts from a nonrelated deceased donor, is a seminal event...
October 2018: Current Opinion in Organ Transplantation
Mats Brännström
PURPOSE OF REVIEW: The current review gives an updated synopsis of all cases of uterus transplantation (UTx) that has been published and technical details about surgery. The live births that so far have been reported are described regarding pregnancy and outcome. In addition, the review highlights some specific areas of live donor UTx, deceased donor UTx and UTx in general that need further research for clarification/optimization. It is predicted that the clinical field of UTx will expand rapidly and recommendations for a scientific development of the UTx field are presented...
October 2018: Current Opinion in Organ Transplantation
Thomas H Tung, Susan E Mackinnon
PURPOSE OF REVIEW: The current review will discuss the current understanding of nerve regeneration in vascularized composite allotransplantation (VCA). The success of proximal arm and leg transplants has been hampered by the limitations of nerve regrowth across long distances resulting in poor regeneration and functional recovery. Relevant research in stem-cell therapies to overcome these issues will be reviewed. RECENT FINDINGS: The effect of rejection on nerve regeneration in the VCA may be unpredictable and may be quite different for the nerve allograft...
October 2018: Current Opinion in Organ Transplantation
Emmanuel Morelon, Palmina Petruzzo, Jean Kanitakis
PURPOSE OF REVIEW: Vascularized composite allografts (VCA), which restore severely damaged body parts that cannot be repaired with conventional surgical techniques, often undergo acute skin rejection episodes in the early postgraft period. Although the risk of human VCA to be affected by chronic rejection was initially unknown, such cases were recently observed. RECENT FINDINGS: Chronic rejection targets preferentially the skin (dermal sclerosis, adnexal atrophy, necrosis) and vessels (graft vasculopathy) and may cause graft dysfunction, often resulting in ischemic graft loss...
October 2018: Current Opinion in Organ Transplantation
Gerald Brandacher
No abstract text is available yet for this article.
October 2018: Current Opinion in Organ Transplantation
Angus W Thomson
No abstract text is available yet for this article.
October 2018: Current Opinion in Organ Transplantation
Laura C Burlage, Shannon N Tessier, Joanna W Etra, Korkut Uygun, Gerald Brandacher
PURPOSE OF REVIEW: In this review, we discuss novel strategies that allow for extended preservation of vascularized composite allografts and their potential future clinical implications for the field of vascularized composite allotransplantation (VCA). RECENT FINDINGS: The current gold standard in tissue preservation - static cold preservation on ice - is insufficient to preserve VCA grafts for more than a few hours. Advancements in the field of VCA regarding matching and allocation, desensitization, and potential tolerance induction are all within reasonable reach to achieve; these are, however, constrained by limited preservation time of VCA grafts...
October 2018: Current Opinion in Organ Transplantation
Miguel I Dorante, Sotirios Tasigiorgos, Bohdan Pomahac
PURPOSE OF REVIEW: Face transplantation is no longer a young field. Reported outcomes suggest that this life-enhancing transplantation is viable and ethically justified for appropriate patients. Given that pediatric hand transplantation has been performed with promising reported outcomes, it is time to consider how to properly expand the field of face transplantation into pediatric patients. RECENT FINDINGS: Appropriate collaboration between adult and pediatric colleagues can mitigate risks associated with expanding surgical innovation between respective patient demographics...
October 2018: Current Opinion in Organ Transplantation
Adriano Taddeo, Catherine Tsai, Esther Vögelin, Robert Rieben
PURPOSE OF REVIEW: The long-term adverse effects of immunosuppressive treatment, the high rate of acute rejection and the development of chronic rejection are the main factors preventing a wider clinical application of vascularized composite allotransplantation (VCA). Targeted immunosuppression using innovative drug delivery systems (DDS) may help to overcome these hurdles, increasing therapeutic efficacy while reducing systemic toxicity. This review provides a summary of the recently developed strategies for targeted delivery of immunosuppressive drugs in VCA...
October 2018: Current Opinion in Organ Transplantation
Antoine Sicard, Dominic A Boardman, Megan K Levings
PURPOSE OF REVIEW: Adoptive cell therapy using CD4FOXP3 regulatory T cells (Treg) has emerged as a promising therapeutic strategy to treat autoimmunity and alloimmunity. Preclinical studies suggest that the efficacy of Treg therapy can be improved by modifying the antigen specificity, stability and function of therapeutic Tregs. We review recent innovations that considerably enhance the possibilities of controlling these parameters. RECENT FINDINGS: Antigen-specific Tregs can be generated by genetically modifying polyclonal Tregs to express designated T-cell receptors or single-chain chimeric antigen receptors...
October 2018: Current Opinion in Organ Transplantation
Paloma Riquelme, James A Hutchinson
PURPOSE OF REVIEW: Now that adoptive transfer of regulatory macrophages (Mregs) is clinically practicable, we ask whether this approach could be used to achieve self-sustaining peripheral regulation and what mechanisms may be involved. RECENT FINDINGS: Dehydrogenase/reductase 9 (DHRS9)-expressing Mregs are a specialized subset of monocyte-derived macrophages that are currently being investigated as a tolerogenic cell-based therapy. Human Mregs are defined by their capacity to convert naïve CD4 T cells to IL-10-secreting FoxP3 regulatory T cells (Tregs) through an activation-dependent process involving signals mediated by TGF-β, retinoic acid, indoleamine 2,3-dioxygenase activity, notch and progestagen associated endometrial protein (PAEP)...
October 2018: Current Opinion in Organ Transplantation
Kanishka Mohib, Aravind Cherukuri, David M Rothstein
PURPOSE OF REVIEW: Regulatory B cells (Bregs) are potent inhibitors of the immune system with the capacity to suppress autoimmune and alloimmune responses. Murine transplant models showing that Bregs can promote allograft tolerance are now supported by clinical data showing that patients who develop operational tolerance have higher frequency of Bregs. Breg function has been widely studied resulting in improved understanding of their biology and effector mechanisms. However, our overall understanding of Bregs remains poor due the lack of specific marker, limited knowledge of how and where they act in vivo, and whether different Breg subpopulations exhibit different functions...
October 2018: Current Opinion in Organ Transplantation
Angus W Thomson, Mohamed B Ezzelarab
PURPOSE OF REVIEW: There is currently increased focus on improved understanding of how dendritic cell tolerogenicity is determined and maintained, and on their therapeutic potential. We review recent progress in profiling of regulatory dendritic cells (DCreg), innovative approaches to enhancing dendritic cell tolerogenicity in situ, ex-vivo generation of DCreg and initial clinical testing of these cells in organ transplantation. RECENT FINDINGS: "Omics' studies indicate that the distinctive properties of DCreg are the result of a specific transcriptional program characterized by activation of tolerance-enhancing genes, rather than the retention of an immature state...
October 2018: Current Opinion in Organ Transplantation
Trishan Vaikunthanathan, Niloufar Safinia, Giovanna Lombardi
PURPOSE OF REVIEW: Initial clinical trials of adoptive regulatory T-cell (Treg) therapy in solid organ transplantation have proven to be both feasible and well tolerated. With Phase 2 trials underway, efforts have been focused on the optimization of the Treg product. RECENT FINDINGS: With science and our knowledge on the biology of these cells constantly advancing, we have been able to refine our search for a Treg population that would be ideally suited for therapeutic application...
October 2018: Current Opinion in Organ Transplantation
Anil Dangi, Shuangjin Yu, Xunrong Luo
PURPOSE OF REVIEW: This article is aimed to provide readers with an updated review on the applicability, efficacy, and challenges of employing donor apoptotic cell-based therapies to promote transplantation tolerance in various experimental and clinical settings. RECENT FINDINGS: Recently, donor apoptotic cell-based therapies have been employed in various models of cell (including pancreatic islets and bone marrow hematopoietic stem cells) and solid organ (heart and kidney) transplantation to promote donor-specific tolerance...
October 2018: Current Opinion in Organ Transplantation
Anita Yogendra Chhabra, Suzanne T Ildstad
PURPOSE OF REVIEW: This review discusses the role and mechanisms by which facilitating cells promote stem cell engraftment and induce tolerance in HLA-disparate kidney transplant recipients. RECENT FINDING: Facilitating cells in both mice and human are heterogeneous, consisting of several subpopulations. They have been shown to enhance stem cell engraftment in allogeneic recipients. They also increase hematopoietic stem cells (HSC) clonogenicity, enhance migration and homing of stem cells via secretion of cytokines/chemokines/growth factors, prevent apoptosis of stem cells and induce regulatory cells...
October 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
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...
August 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...
August 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...
August 2018: Current Opinion in Organ Transplantation
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